PM and PT 2nd run

Question 1

hairy cell leukaemia cell appearance

Answer 1

larger than normal lymphocytes, with broad based projections

pancytopaenia, splenomegaly and low monocyte count

Question 2

TEN drug causes

Answer 2

allopurinol
aspirin
NSAIDs
lamotrigine
lansoprazole
penicillins

Question 3

ostium primum vs secundum

Answer 3

wide fixed splitting of S2 with ESM in L 2nd ICS -> ASD

LAD = primum
RAD = secundum

Question 4

lead toxicity

Answer 4

nausea, abdo pain, constipation
neurological effects - isolated nerve lesions
chronic -> mild neurodevelopmental delays

treatment = chelation therapy with oral DMSA (dimercaptosuccinic acid) or IV EDTA (ethylenediaminetetraacetic acid) >450 or severe

Question 5

what count is elevated in cholesterol embolism

Answer 5

eosinophils

hyaline casts, non-visible haematuria

Question 6

multifocal motor neuropathy

Answer 6

multifocal demyelination with conduction block in contrast to MND (axonal degeneration)

MMN responds to immunomodulatory therapies

positive GM1 anti-ganglioside antibodies in 50%

Question 7

diazepam most appropriate intervention to control

Answer 7

muscle spasms

Question 8

HLA for Felty’s

Answer 8

HLA DRW4

Question 9

niacin

Answer 9

B3 deficiency

dementia diarrhoea dermatitis

Question 10

systolic click-murmur syndrome

Answer 10

MVP and non-coronary chest pains

4% of population

on standing or during the valsalva manoeuvre, as ventricular volume gets smaller, the click and murmur move earlier in systole

Question 11

psoriasis HLA

Answer 11

Cw6

Question 12

chair raise test

Answer 12

lateral epicondylitis

Question 13

TTP treatment

Answer 13

urgent plasma exchange

Question 14

causes of drug induced liver injury

Answer 14

paracetamol
halothane (multiple exposures)
NSAIDs
isoniazid
penicillins and cephalosporins
sulfonamide
ketoconazole
thiazolidinedione
ezetimibe
herbal medicines (Kava root, antidepressant)

Question 15

oxaliplatin

Answer 15

given with folinic acid and 5FU

Question 16

most specific test for SLE

Answer 16

anti-dsDNA antibodies

Question 17

botulism presentation

Answer 17

blurred vision
dysphagia
dysarthria
pupillary response to light impaired
tendon reflexes reduced
progressive symmetrical limb weakness
autonomic dysfunction - dry mouth, constipation, retention

Question 18

trastuzumab moa

Answer 18

erb-b2 inhibition

Question 19

illusion

Answer 19

misperception of a real external stimulus

Question 20

lung biopsy in Goodpasture’s

Answer 20

disruption of alveolar septa, haemosiderin-laden macrophages (pulmonary haemorrhage)

Question 21

ank spond xray

Answer 21

tramline
bamboo spine

Question 22

Friedreich’s ataxia

Answer 22

AR
early in life (die at 35)
ataxia
dysarthria
optic atrophy
hearing impairment
learning difficulties
sensory neuropathy
extensor plantars
diabetes
cardiomyopathy
pes cavus
kyphoscoliosis

Question 23

anterior spinal artery thrombosis

Answer 23

vibration and position sense retained
reflexes are diminished (in keeping with spinal shock)

Question 24

hepatosplenomegaly, anaemia, raised WCC, multiple white cell precursors, high platelet count, raised basophil

Answer 24

chronic myeloid leukaemia

Question 25

Darier's disease

Answer 25

AD warty papules and plaques in serborrhoeic, palmar pits and nail dystrophy crusting and malodour acitretin

Question 26

preferred intervention for multifocal atrial tachycardia in patients with pulmonary arterial hypertension

Answer 26

verapamil

Question 27

Crigler-najjar syndrome

Answer 27

AR severe unconjugated hyperbilirubinaemia from an absence of glucuronyl transferase

Question 28

what is a recognised complication in gastric MALT lymphoma

Answer 28

paraprotein formation and pseudohyponatraemia

Question 29

renal papillary necrosis

Answer 29

urinary tract infections in people with diabetes -> linear breaks at papillary base, and ureteric obstruction may result if the papillae have sloughed off

Question 30

HELLP syndrome

Answer 30

haemolysis, elevated liver enzymes, low platelets

Question 31

features on renal biopsy

Answer 31

glomerular IgA deposition inflammatory cells within the mesangium crescent formation

Question 32

theophylline drug interactions

Answer 32

clarithromycin ciprofloxacin cimetidine oral contraceptives allopurinol

Question 33

most teratogenic AED

Answer 33

sodium valproate

Question 34

Barrett's oesophagus endoscopy frequency

Answer 34

no dysplasia - 2-5 years low grade - every 6 months, repeat endoscopy with quadrantic biopsies every 1cm high grade - every 3 months, if visible lesion then endoscopic ablation with mucosal resection or radiofrequency ablation

Question 35

therapy of choice for radiation pneumonitis

Answer 35

corticosteroids high dose azathioprine

Question 36

complete heart block

Answer 36

slow regular pulse that does not vary with exercise compensatory increase in stroke volume -> large-volume pulse and systolic flow murmurs irregular cannon a waves

Question 37

which drug will slow ventricular rate over a prolonged period but is unlikely to result in cardioversion

Answer 37

adenosine will reveal underlying rhythms briefly but has no prolonged effect

Question 38

INO

Answer 38

MLF lesion on the side of the eye that fails to adduct

Question 39

increase in urinary delta ALA

Answer 39

AIP and lead poisoning

Question 40

ADR types

Answer 40

A - anticipated, dose-related B - unpredictable, rare C - prolonged use D - emerge late after treatment e.g. teratogenic or carcinogenic E - related to drug withdrawal phenomena

Question 41

cryptogenic pulmonary eosinophilia

Answer 41

malaise weight loss fever raised ESR asthma eosinophilia

Question 42

bosentan unwanted effects

Answer 42

flushing hypotension dyspepsia fatigue dose-dependent hepatotoxicity - contraindicated in patients with moderate-severe liver disease LFTs monitored in first 3-4 months