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MRCP PART 1 > PAST YEAR PAPER 2 > Flashcards

PAST YEAR PAPER 2 Flashcards

1
Q

Which drug causes blue discolouration of vision?

A

Sildenafil (phosphodiesterase 5 inhibitor)

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2
Q

Features of kallman syndrome?

A

X-linked recessive trait.

  • delayed puberty
  • hypogonadism, cryptorchidism
  • anosmia
  • sex hormone levels are low
  • LH, FSH levels are inappropriately low/normal
  • patients are typically of normal or above-average height
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3
Q

Widespread flame haemorrhages are seen in which eye condition?

A

Central retinal vein occlusion.

  • sudden painless loss of vision
  • Several retinal haemorrhages ‘stormy sunset’
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4
Q

Features of central retinal artery occlusion?

A
  • Sudden painless unilateral visual loss
    Associated with retinal pallor apart from a small area known as the cherry red spot.
    This is because this small area continues to receive blood supply from the posterior ciliary arteries.
  • Cherry red spot on pale retina.
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5
Q

Common cause of SBP?

A

E.coli
Gram negative

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6
Q

Lesions where cause superior homonymous quadrantanopia?

A

Temporal lobe lesions.
Occurs on the opposite side of lesion.

For example left temporal lobe lesion causes right superior homonymous quadrantanopia.

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7
Q

Treatment for pituitary adenoma?

A
  1. Hormonal therapy: Bromocriptine is the first-line treatment for prolactinomas.
  2. Surgery (e.g. transsphenoidal transnasal hypophysectomy)
    e.g. if progression in size
  3. Radiotherapy
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8
Q

Electrolyte abnormality in squamous cell carcinoma?

A

Hypercalcaemia.

Parathyroid hormone related peptide production which leads to hyercalcaemia and hypophosphataemia.

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9
Q

Mode of inheritance for BRCA?

A

BRCA mutations follow an autosommal dominant inheritance pattern.

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10
Q

Maternal antibody associated with neonatal heart block?

A

Anti Ro antibodies.

Associated with SLE and Sjogren’s.

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10
Q

Investigation for H.pylori post eradication?

A

Re-testing for H.Pylori is performed by a carbon 13 urea breath test.

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11
Q

Abx for chlamydia?

A

Doxycycline.

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12
Q

BRCA 2 associated with increased risk of which cancers?

A
  • Breast cancer
  • Ovarian cancer
  • Prostate cancer
  • Pancreatic cancer
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13
Q

Organism causing white fishy smelling discharge?

A

Gardnerella vaginalis.

Bacterial vaginosis.
Not sexually transmitted.
Excessive washing/douching contribute.

Mx oral or topical metronidazole.

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14
Q

Conversion factor of codeine to morphine?

A

0.1

Example 240mg codeine is 24mg morphine

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15
Q

HLA for Behcet’s?

A

HLA-B51

  • Oral and genital ulceration
  • Erythema nodosum
  • Anterior uveitis
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16
Q

Tumour marker for testicular teratoma to monitor for tumour recurrence?

A

Alpha-fetoprotein.

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17
Q

Tumour marker for seminomas and choriocarcinoma?

A

Human chorionic gonadotrophin

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18
Q

Mx for acute cerebral oedema?

A

IV Dexamethasone.

additional intervention with mannitol or hypertonic saline

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19
Q

Area of colon most likely affected in ischaemic colitis?

A

Splenic flexure.

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20
Q

Management for barrett’s oesophagus if still showing dysplasia despite PPI treatment?

A

Radiofrequency ablation.

26% of patient’s progress to high grade dysplasia or cancer without ablation.

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21
Q

Which TB drug commonly causes peripheral neuropathy?

A

Isoniazid.

Supplementation with low dose pyridoxine is recommended

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22
Q

Itchy rash affecting the flexor surface of both wrists and raised white colour streaky lesions in the mouth.
Small white topped raised violaceous lesions affecting both wrists.

A

Lichen planus.

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23
Q

Kaposi’s sarcome caused by what virus?

A

Prevalent in HIV with high viral load and depressed CD4 count.
Caused by human herpes virus 8

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24
Q

Acute severe asthma management after back to back nebulisers and steroids?

A

Intravenous Magnesium.

aminophylline has little incremental value in patients who have been given adequate beta agonist therapy. and also increases risk of arrythmia.

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25
Q

Life threatening UGIB from bleeding varices treatment?

A

IV Terlipressin.

It leads to splanchnic vasoconstriction. It can be given until haemostasis is achieved or for a maximum of 5 days.

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26
Q

Painful ulcer affecting the penis?

A

Chancroid.

Chancroid is a tropical disease caused by Haemophilus ducreyi. It causes painful genital ulcers associated with unilateral, painful inguinal lymph node enlargement.

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27
Q

What percentage of lung cancer is caused by smoking?

A

85%

Squamous, small and large bronchial cancer are related to smoking.

Adenocarcinomas are not thought to be smoking related.

28
Q

Investigation for small bowel bacterial overgrowth syndrome?

A

SBBOS is a disorder characterised by excessive amounts of bacteria in the small bowel resulting in gastrointestinal symptoms.

Risk factors:
- Neonates with congenital gastrointestinal abnormalities
- Scleroderma
- Diabetes mellitus

Symptoms:
- Chronic diarrhoea
- Bloating, flatulence
- Abdominal pain

Diagnosis:
- 14-C D-Xylose breath test
- Hydrogen breath test
- Small bowel aspiration and culture: this is used less often as invasive and results are often difficult to reproduce.

(The hydrogen breath test involves having the patient fast for a minimum of 12 hours then having them drink a substrate usually glucose or lactulose, then measuring expired hydrogen and methane concentrations typically over a period of several hours.)

Management
- Antibiotic therapy: Rifaximin is now the treatment of choice due to relatively low resistance. Co-Amoxiclav or metronidazole are also effective in the majority of patients.

29
Q

Tumour marker for suspected hepatic metastases from previous colon cancer?

A

CEA.

AFP is associated with primary liver cancer. It is not associated with liver secondaries from colon cancer, where CEA levels are likely to be raised.

30
Q

Mode of transmission of meningococcus?

A

Respiratory droplet.

Infection is transmitted by droplets or secretions from the upper respiratory tract.

31
Q

What finding on CSF analysis is suggestive of SAH?

A

Bilirubin.

Bilirubin is the by product of haem breakdown.

A high red cell count is not specific for SAH. A traumatic LP is quite common and can result in a high red cell count which usually reduces over subsequent bottles.

32
Q

Which anti-emetic can trigger oculogyric crisis? What is the antidote?

A

Meotclopramide. (D2 Dopamine receptor antagonist).

Benzatropine or Procyclidine.

33
Q

How to differentiate between scleritis (typically associated with RA) and anterior uveitis on slit lamp?

A

Scleritis - slit lamp clear views of the retina.

Anterior uveitis - Inflammatory cells in the anterior chamber.

Posterior Uveitis - Inflamamtory cells in the posterior chamber.

34
Q

Which complement levels are reduced in SLE?

A

C3, C4.

Both can be measured as a marker of lupus activity. C3 is preferred.

35
Q

AST/ALT ratio of greater than what is associated with which condition?

A

AST/ALT ratio of >2 is associated with alcoholic liver disease.

36
Q

Auto-immune hepatitis is associated with which antibody?

A

Anti-smooth muscle antibody.

37
Q

Murmur associated with pulmonary hypertension?

A

Tricuspid regurgitation.

38
Q

Congenital adrenal hyperplasia is mainly caused by deficiency in which enzyme?

A

21-hydroxylase deficiency.

39
Q

Most common sexually acquired organism for reactive arthritis?

A

Chalmydia trachomatis.

40
Q

Cushings syndrome has what biochemical abnormality?

A

Hypokalemic metabolic Alkalosis.

41
Q

JVP finding in patient with complete heart block?

A

Cannon a waves.

42
Q

Large tense blisters with sparing of the mucous membranes?

A

Bullous pemphigoid.

43
Q

Antispasmodics used in IBS?

A

Mebeverine, alverine.

Peppermint oil may be used.

44
Q

Besides colon cancer, what other cancer is associated with HNPCC mutation?

A

Endometrial cancer (60%)

Ovarian cancer (12%)

45
Q

Example of urate lowering therapy used in Gout? include second line as well.

A
  • Allopurinol is first-line
  • Second-line agent when allopurinol is not tolerated or ineffective is febuxostat.
46
Q

Investigation for polycythaemia vera?

A

JAK2 mutation testing.

JAK2 mutation is seen in approx 95% of patients.

47
Q

Criteria for liver transplant from paracetamol overdose?

A
  • Arterial pH < 7.3
  • INR >6.5
  • Creatinine >300
  • Grade III or IV hepatic encephalopathy
48
Q

Heart murmur associated with Anklyosing spondylitis?

A

Aortic Regurgitation.

Early diastolic murmur.

49
Q

Function of lateral rectus muscle?

A

Abduction of the eye

50
Q

Abx of choice for dog bites?

A

Co-Amoxiclav.

51
Q

Immunoglobulin A Nephropathy

A

Prsents with haematuria 48 hours after an upper respiratory tract infection.

52
Q

Post streptococcal glomerulonephritis

A

Associated with haematuria occuring 1 - 2 weeks after a streptococcal throat infection.

53
Q

Features seen in idiopathic intracranial hypertension?

A
  • Headache
  • Blurred vision
  • Aggravated by straining on the toilet
  • greying of vision when bending forward
  • Raised BMI
54
Q

Mode of action of Liraglutide?

A

Glucagon like Peptide 1 agonist enhance the incretin effect.

  • Subcutaneous injections
  • These drugs increase insulin secretion and inhibit glucagon secretion. One of the major advances of GLP-1 mimetics is that they typically result in weight loss.
  • Example liraglutide (OD), semaglutide (OW), dulaglutide (OW), Exanatide
55
Q

Most sensitive HIV screening test?

A

HIV-1 RNA testing.

Becomes postive as early as 1.5 - 2 weeks after HIV infection. Earliest to become positive and most sensitive.

56
Q

Gold standard investigation for Ankylosing Spondylitis?

A

MRI spine and sacroiliac joints.

  • ## optimal for detecting early sacroilitis.
57
Q

Inferior STEMI, which artery is affected?

A

Right coronary artery.

58
Q

Prophylaxis against variceal haemorrhage?

A

Beta blockers.

(Carvedilol, propranolol)

59
Q

Which anti-epileptics are safe in pregnancy?

A

Lamotrigine and Levetiracetam are among the safest for use in pregnancy.

60
Q

Skin biopsy findings for dermatitis herpetiformis?

A

Immunoglobulin A deposits within the dermal papillae.

61
Q

Mode of inheritance of A1AT deficiency?

A

Autosomal recessive/Co-Dominant.

62
Q

Investigation for phaechomocytoma?

A

24 hour urinary catecholamines and metanephrines.

63
Q

Investigation for carcinoid syndrome?

A

24 hour urinary 5-hydroxyindoleacetic acid.

Usually occurs when metastases are present in the liver and release serotonin into the systemic circulation
- Flushing, diarrhoea.

64
Q

Management for severe colitis?

A

Intravenous steroids are usually given first-line (methyprednisolone).

If after 72 hours there has been no improvement - IV Ciclosporin.

or consider surgery

65
Q

Which condition is Signet Ring sign seen on CT scan?

A

The signet ring sign is seen in Bronchiectasis when the dilated bronchus and accompanying pulmonary artery branch are seen in cross-section. The bronchus and artery should be the same size, whereas in bronchiectasis, the bronchus is markedly dilated.

66
Q

Mode of action of Carbimazole?

A

Thyroid Peroxidase inhibitor.

67
Q

Mode of action of pyridostigmine?

A

Acetycholinesterase inhibitor.

68
Q

TB testing first line?

A

Mantoux testing is the initial investigation of choice for individuals who are close contacts of patients with active TB and require screening. If Mantoux is positive and further confirmation of latent TB is required then an Interferon Gamma Release Assay should be performed.

MRCP PART 1 (20 decks)

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