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MRCP PART 1 > Past Year Paper 4 > Flashcards

Past Year Paper 4 Flashcards

1
Q

Which anti-htn needs to be used with caution in severe Aortic stenosis?

A

Bisoprolol (beta blockers).

A significant degree of left ventricular function is required to overcome the gradient across the valve and maintain cardiac output.

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1
Q

Where is the lesion in cortical blindness with preserve pupillary reflex to light?

A

Occipital lobe infarcts.

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2
Q

Electrolyte abnormality seen in refeeding syndrome? consequences of those abnormality?

A
  1. Hypophosphateaemia: Muscle weakness, cardiac failure, neurological disturbance -> Seizures!
  2. Hypokalaemia
  3. Hypomagnasemia: predisposes to Torsades des pointes
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3
Q

How does lithium cause nephrogenic DI?

A

Decreased aquaporin-2 expression.

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4
Q

JVP finding in patient with pulmonary stenosis?

A

Dominant A waves.

Occurs with increased atrial contraction pressure.

Tricuspid stenosis
Pulmonary stenosis
RVH
Right atrial myxoma

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5
Q

Management of psychotic symptoms in Parkinsons?

A
  • Quetiapine
  • Clozapine
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6
Q

Deficiency of which complement is associated with recurrent menigococcal infections?

A

C5 deficiency is associated with increased risk of gram negative bacteria infection.

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7
Q

Proto-oncogene seen in MEN2A and MEN2B?

A

Rearranged during transfection (RET) proto-oncogene.

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8
Q

Ix for contact dermatitis?

A

Patch testing.

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9
Q

Pharmacological treatment for itching in liver disease?

A

Cholestyramine.

Itching is caused due to bile acid accumulation and Cholesytramine is a bile acid sequestrant.

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10
Q

Genetic mutation in Polycythaemia?

A

JAK2 mutation.

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11
Q

MOA of Allopurinol?

A

Xanthine oxidase inhibitor.

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12
Q

Where are cardiac Myxoma most likely to occur?

A

Left Atrium.

Carney complex - increased risk of myxoma.

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13
Q

Symptoms of Giardiasis?

A

It is spread by the faeco-oral route.
Foreign travel, swimming/drinking water from a river or lake

  • Steatorrhoea
  • Bloating, abdominal pain
  • Flatulence
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14
Q

Sensitivity calculation?

A

True positive / (TP + FN)

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15
Q

How long does stent restenosis take after angioplasty?

A

Occurs 3 - 12 months from placement.

Stent thrombosis is more acute occurring in a few days.

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16
Q

Gene defect causing Marfan’s syndrome?

A

Fibrillin-1 Deficiency.

Marfan’s syndrome is an autosomal dominant connective tissue disorder. It is caused by a defect in the FBN1 gene on chromosome 15 that codes for the protein fibrillin-1

Upwards lens dislocaiton seen in Marfan’s.

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17
Q

Yellowing of vision seen in overdose of which condition?

A

Digoxin toxicity causes confusion, visual hallucinations and yellowing of vision.

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18
Q

Ulnar nerve neuropathy in arm features?

A
  • Weakness of hypothenar muscles
  • Sensory loss of fifth and half of fourth finger
  • Tender over medial epicondyle

?Golfer’s elbow
- ?cubital tunnel syndrome

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19
Q

Main receptor that nicotine binds to?

A

Acetylcholine receptor.

Nicotine binds to the nicotinic acetyl choline receptors.

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20
Q

Mode of inheritance for Haemophilia A?

A

X linked reccessive disorder.

Affected father cannot pass it on to a male child and that he produces female carriers of the Haemophilia A gene.

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21
Q

Haematuria 48 hours following an URTI?

A

Immunoglobulin A nephropathy.

22
Q

Mx for benign essential tremor?

A
  1. Propranolol
  2. Primidone sometimes used.
23
Q

MOA of ondansetron?

A

5-hydroxytryptaine 3 (5-HT3) antagonist.

May cause transient QT prolongation in some patients.

24
Q

Which artery lies closest to the recurrent laryngeal nerve?

A

Inferior thyroid artery.

Right recurrent laryngeal nerve is most susceptible to injury during thyroid surgery because it is close to the bifurcation of the right inferior thyroid artery.

25
Q

Seborrhoeic dermatitis is associated with what condition?

A

HIV
Parkinsons disease

Mx Topical Ketocanozole

26
Q

Barretts oesophagus puts patient at risk of which type of cancer?

A

Adenocarcinoma of the oesophagus.

Barrett’s refers to the metaplasia of the lower oesophageal mucosa, with the usual squamous epithelium being replaced by columnar epithelium.

27
Q

Mx for Paget’s disease of the bone?

A
  • Raised alkaline phosphatase (ALP)
  • Calcium and phosphate are typically normal.

Mx: Bisphosphonates

  • Oral Risedronate
  • IV Zoledronate
28
Q

Hx of IBD. Presented with rapidly enlarging ulcer with a raised edge and boggy necrotic base studded with small abscess?

A

Pyoderma Gangrenosum.

Exhibits Pathergy whereby a lesion occurs at the site of injury.

29
Q

Necrobiosis Lipodica is associated with which condition?

A

Shiny, painless areas of yellow/red skin typically on the shin of diabetics.

30
Q

Mx for pregnant pt who wants to quit smoking?

A

Nicotine replacement therapy is safe to be used in pregnancy.

31
Q

Mx for Phaeochromcytoma?

A
  • Hypertension, headaches, sweating, palpitations.

Surgery is the definitive management. The patient must first be fully alpha-blocked with Phenoxybenzamine given before a
beta-blocker (Propranolol).

32
Q

Gene associated with familial adenomatous polyposis?

A

FAP is a rare autosomal dominant condition which leads to the formation of hundreds of polyps by the age of 30-40 years. It is due to a mutation in a tumour suppressor gene called adenomatous polyposis coli gene (APC), located on chromosome 5.

33
Q

Nerve root affected causing weakness of ankle dorsiflexion, ankle eversion, ankle inversion?

A

L5.

34
Q

Treatment for Chalmydia Psitacci infection?

A

Psittacosis is infection caused by Chlamydia psittaci. Psittacosis should be suspected in a combination of typical fever with a history of bird contact.

Mx:
1. Doxycycline first line
2. Erythromycin second line

35
Q

Which commonly prescribed Abx causes pulmonary fibrosis?

A

Nitrofurantoin.

Leads to pulmonary fibrosis when used over the long term.

36
Q

Rash seen in lyme disease?

Abx choice in lyme disease?

A

Erythema chronicum migrans.

  • Doxycycline if early disease. - Amoxicillin is an alternative if doxycycline is contraindicated.
  • Ceftriaxone if disseminated disease
37
Q

How long to give TB medication for in CNS TB (meningeal TB)?

A

12 months.

Quadruple treatment RIPE for first two months and then Rifampicin and Isoniazid for further 10 months.

38
Q

Standard therapy for Active TB?

A

Initial phase - first 2 months (RIPE)

  • Rifampicin
  • Isoniazid
  • Pyrazinamide
  • Ethambutol

Continuation phase - next 4 months
- Rifampicin
- Isoniazid

39
Q

Treatment for latent TB?

A

The treatment for latent tuberculosis is 3 months of isoniazid (with pyridoxine) and rifampicin OR 6 months of isoniazid (with pyridoxine).

40
Q

Mx for Scabies?

A
  1. Permethrin 5% is first-line
  2. Malathion 0.5% is second-line
41
Q

Mx for patients with Barretts oesophagus who have low grade dysplasia on initial endoscopy?

A

Where low grade dysplasia is seen for the first time, repeat endoscopy is offered in 6 months time. Where this persists at the second endoscopy they are recommended to proceed to radiofrequency ablation of abnormal tissue.

42
Q

MOA of dipyridamole?

A

Adenosine uptake inhibitor.

43
Q

Mx for Lichen planus?

A

Potent topical steroids.

Benzydamine mouth wash for oral lesions.

44
Q

Short QT interval seen in which electrolyte abnormality?

A
  • Hypercalcaemia.
  • Hyperkalaemia
    Metabolic acidosis
45
Q

Mx for urinary schistosomiasis?

A

Praziquantel.

46
Q

Artery occluded in posterior MI?

A

Posterior Descending artery supplied by the right coronary artery.

47
Q

MOA of aspirin?

A

Aspirin is a COX-1 Inhibitor. It is a modifier of the enzymatic activity of COX-2. It also blocks thrmoboxane A2 on platelets reducing platelet aggregation.

48
Q

Most common organism seen in dog bites?

A

Pasteurella is seen in 50% of dog bites.

49
Q

Mx of bile acid diarrhoea following ileal resection?

A

Cholestyramine.

50
Q

Faecal elastase is measured in which condition?

A

Chronic pancreatitis.

Faecal elastase may be used to assess exocrine function if imaging inconclusive.

51
Q

Beta blocker overdose drug management?

A
  1. If bradycardic then Atropine
  2. In resistant cases Glucagon may be used
52
Q

Drugs that can be cleared by Haemodialysois?

A

BLAST

  • Barbiturate
  • Lithium
  • Alcohol (inc methanol, ethylene glycol)
  • Salicylates
  • Theophyllines (charcoal haemoperfusion is preferable)
53
Q

Mx in salicylate overdose?

A
  1. Urinary alkalinization with IV bicarbonate
  2. Haemodialysis

MRCP PART 1 (20 decks)

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