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MRCP PART 1 > Past Year Paper 3 > Flashcards

Past Year Paper 3 Flashcards

1
Q

Anti smooth muscle antibody is seen in which condition?

A

Autoimmune hepatitis.

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2
Q

Features of granulomatosis with polyangiitis?

A

Involves upper, lower respiratory tract and renal.

  1. Upper respiratory tract: Epistaxis, sinusitis
  2. Lower respiratory tract: Dysponea, Haemoptysis
  3. Glomerulonephritis
  4. Saddle shape nose deformity
  5. cANCA
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3
Q

Supplies the terminal ileum?

A

Ileocolic artery supplies the terminal ileum and appendix.

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4
Q

Blood supply to the duodenal cap?

A

Gastroduodenal artery.

It mainly supplies the pylorus of the stomach, proximal duodenum and head of pancreas.

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5
Q

Left gastric artery supplies what?

A

Superior portion of the lesser curvature of the stomach and lower oesophagus.

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6
Q

Splenic artery supplies what?

A

Spleen, pancreas, greater curvature of the stomach and posterior surface of the stomach.

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7
Q

Egg allergy cannot have which vaccine?

A

Yellow fever vaccine contains significant amounts of egg protein.

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8
Q

Treatment for rosacea?

A
  • Topical brimonidine gel

Papules/pustules:
- Topical ivermectin
Alternatives: Topical metronidazole or topical azelaic acid

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9
Q

pH for correct placement of NG tube?

A

pH 1.5 - 3.5

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10
Q

Conversion disorder symptoms?

A

Conversion disorder is associated with a focal neurological deficit such as limb weakness, blindness, loss of hearing which occurs after a stressful life event.

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11
Q

Cancers associated with Li-Fraumeni syndrome?

A

Li-Fraumeni syndrome is a rare autosomal dominant disorder characterised by the early onset of a variety of cancers such as sarcoma, breast cancer and leukaemias.

It is caused by mutation in the TP53 gene. p53 is a tumour suppressor gene.

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12
Q

Mx for stress incontinence?

A
  1. Pelvic floor muscle training.
  2. Surgical procedures: e.g. retropubic mid-urethral tape procedures.
  3. Duloxetine (SNRI)
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13
Q

Mx for urge incontience?

A
  1. Bladder retraining
  2. Antimuscarinics are first-line
    - Oxybutynin (immediate release)
    - Olterodine (immediate release)
    - Darifenacin (once daily preparation)

Oxybutynin should be avoided in ‘frail older women’

  • Mirabegron (a beta-3 agonist) may be useful if there is concern about anticholinergic side-effects in frail elderly patients
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14
Q

Treatment for homocystinuria?

A

Homocystinuria is a rare autosomal recessive disease caused by a deficiency of cystathionine beta synthase. This results in severe elevations in plasma and urine homocysteine concentrations.

Treatment is with vitamin B6 Pyridoxine.

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15
Q

Streptococcus bovis endocarditis is associated with which conditions?

A

Patients with underlying colon cancer and disease of the biliary tree.
If colonoscopy fails to identify underlying cancer then imaging of biliary tree is performed (cholangiocarcinoma, ascending cholangitis).

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16
Q

First line investigation for suspected Acromegaly?

A

Insulin Growth Factor 1.

It correlates directly with growth hormone levels. Can be followed up with OGTT with growth hormone assay. Pituitary imaging is also needed if IGF1 levels are raised.

Random growth hormone has short half life and may miss Acromegaly.

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17
Q

Investigation for hereditary spherocytosis?

A

Cryohaemolysis and eosin-5’-maleimide binding tests

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18
Q

Multiple ring enhancing lesions on MRI in patient who is immunocompromised?

A

CNS Toxoplasmosis.

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19
Q

Cardiac murmur in pulmonary hypertension?

A

Tricuspid Regurgitation.

Pulmonary hypertension leads to back pressure which leads to tricuspid regurg. Leads to progressive atrial dilatation. RVH also seen.

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20
Q

Mx for Ventricular tachycardia secondary to TCA overdose?

A

Sodium bicarbonate.

Administration of sodium bicarbonate treats the acidosis and reduces the risk of VT and seizures.

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21
Q

Most common deficiency seen post roux-en-Y gastric bypass surgery?

A

Iron deficiency.

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22
Q

Weber’s syndrome is caused by occlusion of which artery?

A

Posterior Cerebral Artery.

Weber’s sydnrome is characterised by ipsilateral third nerve palsy (eye down and out) and contralateral hemiplegia.

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23
Q

Which HLA is associated with Behcet’s disease?

A

HLA B51

1) oral ulcers
2) genital ulcers
3) anterior uveitis
- Thrombophlebitis and deep vein thrombosis

24
Q

Useful test before water deprivation test for suspected diabetes insipidus?

A

Paired urine and plasma osmolality.

High plasma and low urine osmolality is suspicious for DI.

25
Q

Treatment for micr- and macro prolactinoma?

A

Dopamine agonists - Cabergoline

26
Q

Investigation for motor neurone disease?

A

Electromyography.

Weakness with mixed UMN and LMN signs.
EMG shows fibrillations and fasciculations.

27
Q

Mode of action of Rasburicase?

A

Urate Oxidation.

Drives the metabolism of uric acid into allantoin which is water soluble and secreted harmlessly in urine to prevent acute urate nephropathy.

28
Q

Avoidance of contact sports for how long post EBV infection to prevent splenic rupture?

A

4 weeks.

29
Q

Drug choice for non-falciparum malaria?

A

Arthemether and lumefantrine.

30
Q

Drug choice for falciparum malaria?

A

Artesunate.

31
Q

What does small cell lung cancer cause?

A

Associated with ectopic ADH and ACTH production.

ADH -> Hyponatramia
ACTH -> Cushing syndrome

32
Q

Which malignancy are at increased risk following renal transplantation?

A

Haematological malignancies.
Non hodgkin’s lymphoma, Kaposis sarcoma.

Squamous cell carcinoma and basal cell carcinoma as well.

33
Q

Symptoms of giardiasis?

A
  • Foreign travel
  • Chronic diarrhoea
  • Abdominal bloating
  • Flatulence

Treatment is with Metronidazole.

34
Q

Which protein acumulates in Alzheimers?

A

Tau protein for Alzheimer’s disease.

Alpha synuclein is seen in Parkinsons!

35
Q

Features seen in RTA type 1?

A
  • Low serum calcium
  • Renal stones
  • Metabolic acidosis
  • Hypokalaemia
  • Seen in patients with autoimmune conditions.
  • Unable to form acid urine in distal tubule.
36
Q

Triad seen in normal pressure hydrocephalus?

A
  1. urinary incontinence
  2. dementia and bradyphrenia
  3. gait abnormality
37
Q

Investigation for CLL?

A

Immunophenotyping.
Peripheral blood flow cytometry to perform immunophenotyping is the best test to confirm CLL.

38
Q

Muscle responsible for plantar flexion?

A

Gastrocnemius.

39
Q

Bicohemical features seen in Addisons?

A
  • Hyponatraemia
  • Hyperkalaemia
  • Hypotension
  • Hypoglycaemia
  • Hyperpigmentation
40
Q

Prophylactic medication against CMV infection in transplantation?

A

Valganciclovir.

41
Q

Enlarging ulcerating lesion, started small but will enlarge with a raised inflammatory border and boggy necrotic base, studded with small abscesses?

A

Pyoderma Gangrenosum.

Seen in autoimmune conditions, IBD, RA, PBC.

42
Q

Lateral medullary syndrome?

A

Occlusion of posterior inferior cerebellar artery/Vertebral artery.

  • ataxia
  • nystagmus

Brainstem features
- ipsilateral: dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s
- contralateral: limb sensory loss

43
Q

Investigation for ADPKD?

A

Abdominal ultrasound.

NO GENETIC TESTING.

44
Q

Mode of action for metformin?

A

Metformin is proved to reduce hepatic insulin resistance, which manifests as reduced hepatic glucose output.

45
Q

Abx choice for Gonorrhea?

A

Males: urethral discharge, dysuria
Females: cervicitis e.g. leading to vaginal discharge

First line: IM ceftriaxone

  • if ceftriaxone is refused (e.g. needle-phobic) then oral Cefixime + oral azithromycin should be used
46
Q

What artery supplies the parietal lobe?

A

Anterior cerebral artery.

(Anterior cerebral artery supplies the medial portions of the frontal and parietal lobes and corpus callosum. The middle cerebral artery supplies large portions of the lateral surfaces of frontal, parietal, and temporal lobes).

47
Q

Which artery affected in locked in syndrome?

A

Basilar artery.

48
Q

Mx for SIADH due to small cell lung cancer?

A

Correction must be done slowly to avoid precipitating central pontine myelinolysis.

  1. Fluid restriction.
  2. Demeclocycline: reduces the responsiveness of the collecting tubule cells to ADH.
49
Q

Features seen in Diphtheria?

A

Diphtheria toxin commonly causes a ‘diphtheric membrane’ on tonsils caused by necrotic mucosal cells.

Possible presentations:
1. Recent visitors to Eastern Europe/Russia/Asia.

  1. Sore throat with a ‘diphtheric membrane’ - grey, pseudomembrane on the posterior pharyngeal wall.
  2. Bulky cervical lymphadenopathy
    may result in a ‘bull neck’ appearanace
  3. Neuritis e.g. cranial nerves
    heart block
  4. FLACCID PARALYSIS

Mx: IM Penicillin

50
Q

In patients with primary pulmonary hypertension who get pregnant which medication needs to be added?

A

LMWH.

To reduce risk of PE.

51
Q

Conditions associated with HLAB27?

A

Ankylosing spondylitis
Reactive Arthritis
Juvenile Rheumatoid Arthritis
Anterior Uveitis

52
Q

Management for Torsades pointes Polymorphic VT?

A

IV Magnesium Sulphate

53
Q

Cause of cat scratch fever?

A

Bartonella Henselae

54
Q

HPV responsible for cervical cancer?

A

HPV 16 and 18.

55
Q

Abx choice for Spontaneous bacterial peritonitis?

A

IV Cefotaxime.

56
Q

Ix for suspected renal artery stenosis?

A

CT renal angiogram.

Rise in >30% in creatinine following initiation of ACE-inhibitors, need to look for underlying cause.

57
Q

Ix to monitor for progression of Multiple Sclerosis?

A

MRI brain with contrast.

  • To diagnose new lesions with or without active inflammation.

MRCP PART 1 (20 decks)

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