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MRCP PART 1 > PP3 > Flashcards

PP3 Flashcards

1
Q

Buprenorphine mechanism

A

Partial mu agonist

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2
Q

COPD on prn salbutamol. Next rx if:
If FEV 1 <50% ?
>50%?

A

<50% High dose flucatasone + salmeterol

> 50% tiotropium

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3
Q

Greater curve of stomach artery

A

Gastroepiploic

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4
Q

factor V Leiden previous DVT, now retinal vein thombosis rx?

A

Life long anti coag

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5
Q

Lateral epicondylitis is inflammation of which tendon?

A

Extensor carpi radialis brevis

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6
Q

alternative to thalidomide in myeloma

A

Bortezomib

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7
Q

Ezetimibe mechanism

A

NPC1L1 inhibitor
N before P

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8
Q

Evolocumab mechanism

A

PCSK9 inhibitor (prevents degradation of LDL receptor)

P after N in alphabet

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9
Q

Lead poisoning renal issue

A

Type 2 RTA
(Proximal bicarb)

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10
Q

Primary CNS lymphoma. Which virus

A

EBV

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11
Q

Rofulimast used when mechanism?

A

COPD fail to get Sx control on triple inhaled therapy
PDE4 inhibitor

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12
Q

Defib synchronised with which part of ECG

A

R wave

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13
Q

Recurrent nasal and sinus infections + salmonella that needed Abx? Which Ig?

A

IgA Deficiency

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14
Q

Myasthenia on pred / pyridostigmine but not responding what next?
Third line?
When thymectomy?

A

Azathioprine / ciclosporin / mycophenolate [steroid sparing]

Rituxumab / belimumab

Thymectomy if unresponsive to second line rx or obvious thymoma

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15
Q

New dx of SLE affecting joints, renal 1st line?

A

Hydroxychloroquine

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16
Q

SLE medical management struggling, which -mab?

A

Belimumab

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17
Q

Which mab PMR

A

Toculizumab

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18
Q

Gum hypertrophy cardiac med

A

CCBs eg amlodipine

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19
Q

Blood finding to indicate anti-GBM disease rather than another vasculitis. [Excluding antibody screen]

A

Normal ESR in Anti-GBM

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20
Q

Trimethoprim vs cipro in pregancy for UTI

A

Cipro contra indicated - tendon rupture
Trimeth - caution and prescribed with folic acid

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21
Q

Where does indapamide work on kidney

A

Distal convoluted tubule

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22
Q

What can you do in central retinal artery occlusion?

A

Thrombolysis - not brilliant results but positive

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23
Q

Acromegaly rx? What can you do before this

A

Transsphenoidal surgery

Octreotide (or other somatostatin analogue) in run-up

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24
Q

MI heart block with low BP needs

A

Pacing - trans cut or trans venous on the way to PCI

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25
Q

RTA then 6 weeks later complains of neck pain and weakness / neuropathy

A

Prolapsed disc

Cervical spondylosis often referred pain up to occiput and more chronic

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26
Q

Obetichloic acid mechanism

A

FXR agonist

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27
Q

Yersinia Rx

A

Quinilones Eg Ofloxacin

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28
Q

Sudden onset shoulder pain after vaccine =

A

Brachial neuritis

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29
Q

Thyrotoxicosis in preg with proptosis means? Rx?

A

Graves
Needs Rx Eg carbimazole if in final trimester

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30
Q

Antidepressants + tramadol risk

A

Serotonin syndrome

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31
Q

Carpal tunnel Rx?

A
  1. Splint
  2. Corticosteroid injection
  3. Surgical release
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32
Q

Fastest conduction in heart found in

A

Purkinje fibres

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33
Q

NASH + T2DM diet controlled and obese Rx?

A

GLP-1 agonist

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34
Q

Paraneoplastic cerebellar degeneration antibody in breast Ca? Small cell?

A

Anti-Yo - breast

Anti-Hu - Small cell

[Yo look at those breasts]

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35
Q

Recent genital herpes prevention of vertical transmission

A

Prophylactic aciclovir from week 36

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36
Q

Bilat mild RAS and one episode pulm oedema Rx

A

BP control eg CCB

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37
Q

Mab for asthma with normal IgE but raised eosinophils

A

Mepolizumab

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38
Q

Hashimotos gets preg. Expected change to 100mg thyroxine dose

A

50% more Eg 150mg

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39
Q

Pregnant woman contact with HepA positive Plan?

A

Hep A vaccination

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40
Q

Detention of a patient for 72 hours in hospital

A

5 (2)

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41
Q

reverse transcriptase does

A

DNA from RNA template

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42
Q

Pure seminoma Ca marker

A

LDH

[20% have bhcg 0% AFP]

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43
Q

Rheum A HLA

A

DR4, DR1

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44
Q

Stills first line mab

A

IL-1
Anakinra / Canakinumab

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45
Q

BM 6.5 preg after diet an exercise. Rx 1st line

A

Metformin

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46
Q

Which lung Ca paraneoplastic cerebellar degeneration? Antibody?

A

Small cell
Anti yo

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47
Q

Which muscle stops you falling forward when standing

A

Soleus
[Gastrocnemius for walking/jumping ets]

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48
Q

Cisplatin chemo common side effects that not kidneys / ears?

A

AF
Peripheral neuropathy

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49
Q

Disseminated gonorrhoea rx

A

IV Cef

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50
Q

Pemphigus rx if not responding to steroids + steroid sparing

A

Rituxumab

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51
Q

Why haemoptysis in worsening Mitral Stenosis

A

Pulm HTN -> alveolar haemorrhage

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52
Q

Which Abx avoid in G6PD

A

Quinolones, fluoroquinolones
Nitrofurantoin

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53
Q

Heart failure EF <40% On ACEi and BB what can you add

A

Eplerenone

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54
Q

drug induced Parkinsons is more likely to be…

A

Symmetrical and does not have a resting tremor

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55
Q

Congugate gaze palsy when looking to left lesion which MLF?

A

Right medial longitudinal fasciculus
[the right eye is failing to adduct]

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56
Q

Initial Rx NPH

A

Therapeutic LP
[Helps predict response to shunt]

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57
Q

Mycophenolate most common side effect

A

tremor

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58
Q

Metastatic prostate Ca resistant to goserelin Rx?

A

Enzalutamide

[enz of life]

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59
Q

Possible MRSA head abscess

A

Linezolid

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60
Q

Aciclovir mechanism

A

DNA polymerase inhibitor

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61
Q

Caribean, dry cough, no clubbing restrictive lung function

A

Sarcoid

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62
Q

Metformin GFR when change dose

A

reduce when <45ml/min
Stop if <30ml/min

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63
Q

Cystinuria Rx drug

A

Penicillamine

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64
Q

Alcoholism -> cavitating pneumonia =

A

Klebsiella

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65
Q

Altepase mechanism

A

Tissue plasminogen Activator (TPA)

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66
Q

Fibrate mechanism

A

PPAR-a agonist

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67
Q

Derranged LFTs with Anti-LKM1 positivitiy

A

Autoimmune / drug induced hepatitis

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68
Q

Rheum A, coughs up blood-stained phlegm most days for 5 years

A

bronchiectasis

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69
Q

CLL with haemolytic anaemia Rx? if not responding?

A

Pred

Rituxumab

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70
Q

Fronto temporal dementia with lots of disinhibited behaviour pharma Rx

A

SSRI to help reduce disinhibited behaviour

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71
Q

Clinical DVT and right heart strain in pregnancy

A

Anticoagulate

[and arrange VQ scan]

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72
Q

Th-2 cells produce

A

IL 4

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73
Q

Wood-grain rash on the abdomen and weight loss

A

Bronchial Ca
[Erythema gyratum repens]

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74
Q

Takayasu arteritis HLA type

A

HLA B52

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75
Q

HLA B52 couple assoc

A

ulcerative colitis
Takayasu

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76
Q

HLA DR2 couple assoc

A

Goodpastures
SLE
MS
Narcolepsy

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77
Q

On lithium. Develops hypothyroid. Plan?

A

Thyroxine
[Can continue lithium and then make plan with psychiatry]

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78
Q

HepB with decompensated LFTs

A

Tenofovir or entecavir

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79
Q

Thialand
Now cough, raised eosinophils, epigastric pain and weight loss + urticarial rash =

A

Strongyloides

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80
Q

Membranous nephropathy with worsening renal function and proteinuria Rx

A

Pred + cyclophosphamide

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81
Q

Thyroid eye disease not responding to pred ?

A

Rituxumab /
Cyclosporin

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82
Q

Pyrexia in serotonin syndrome

A

Mechanical cooling

[NOT dantrolene - though it may be added in later]

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83
Q

Outcome trial looking at death, MI and stroke. How to compare conventional therapy and new intervention

A

Cox proportional hazards

84
Q

Infliximab in preg

A

Stop at week 16

85
Q

What causes the pupil abnormality in holmes-adie

A

Damage to parasympathetic ciliary ganglion

86
Q

Risk with emollients

A

If you smoke you might set on fire

87
Q

Hypertensive with renal adenoma. Low K raised bicarb Rx? What would make you want to use eplerenone?

A

Aldosterone agonist - Spironolactone
If gynaecomastia -> eplerenone

88
Q

Contra indication to trans cutaneous liver biopsy but not a trans jugular

89
Q

Where does RNA splicing occur

A

Nucleus
[Stop tryna be clever]

90
Q

Mild anaemia, wcc 30, normal platelets dx?

A

CLL

[would expect platelets to be high if CML]

91
Q

45F Flank pain, HTN, progressive cognitive impairment and lived reticularis

A

Antiphospholipid

Cognitive impairment from thrombus

92
Q

What is broken down into glucose and galactose in the intestine

93
Q

recurrent renal stones, mild raised urinary Ca. bloods all normal rx?

A

Potassium citrate

94
Q

Most common thyroid malignancy

A

Papilliary

95
Q

BCL-2 ca marker in

A

B cell lymphoma

[c-myc more specific for burkitts]

96
Q

Bleeding in lung ca or any thing else which vessel target for embolisation

A

Bronchial artery
[pulm artery in 5%]

97
Q

Delayed transfusion haemolysis what diagnostic test

98
Q

Venous ulcer. Ix before compression bandages

99
Q

L5 vs common peroneal

A

Weakness of ankle inversion present in L5 lesion

100
Q

On lithium 1st line antihypertensive

A

Amlodipine

101
Q

Ig in hyperacute rejection of organ

102
Q

Restless leg syndrom Rx

A

Dopamine agonists eg ropinirole

103
Q

What is the lung disease you develop in CREST

A

Interstitial lung disease

104
Q

6 months progressive breathlessness in 80-year-old with goitre. Ix to determine if the goitre is the cause of breathlessness?

A

Flow volume loop

105
Q

23 no cardiac history gives birth then has anterior STEMI on ECG why

A

Coronary artery dissection

106
Q

Acute heavy PR bleeding in a 70s most likely

A

Diverticular bleed

107
Q

AF, then stroke, then cardioverted how long warfarin

A

Lifelong likely

108
Q

Erythroderma initial Rx

A

Topical white soft parafin

109
Q

Erythematous scaly rash affecting nasolabial folds and eyebrows

A

seborrhoeic dermatitis

110
Q

What is an anacrotic pulse

A

Low volume pulse seen in aortic stenosis

111
Q

Old age or bereavement a bigger risk factor for completed suicide

112
Q

Symptoms of claudication but normal pulses

A

Spinal stenosis

113
Q

24, URTI then nephrotic syndrome with 1+ blood

A

Minimal change

114
Q

What do you need to check before making a diagnosis of SIADH

115
Q

Isosorbide mononitrate mechanism

A

Increase cyclic GMP

116
Q

Persistent microscopic haematuria in what age is indication for cystoscopy

117
Q

Belief worms under the skin is which disorder

A

Delusional §

118
Q

How to calculate osmolality

A

2Na + 2K + glucose + urea

119
Q

Overactive bladder. No response to oxybutinin next line?

A

Solifenacin
[another AntiMusk]

120
Q

Old with IDA. UGI scope demonstrates 1cm DU? What next?

A

Colonoscopy

10% IDA are due to Ca and need to rule out R side colon Ca

121
Q

Which cardiac med if nasal polyps and worsening of asthma

122
Q

Where does haloperidol bind to for antiemetic effects

A

Area postrema (medulla)

123
Q

Worked in Italy
3-year gradually increasing erythematous scaly patch about 5x6cm on the shin with well-demarcated edge

124
Q

A study evaluated the effectiveness of a new analgesic in patients with painful knee osteoarthritis. Subjects were asked to assess their pain on a 10-point scale both before and after 6 weeks of treatment. Which stat?

A

Wilcoxon’s

[Student’s t-test is a test comparing means if they are normally distributed, while Wilcoxon’s (man whitney) if unknown.]

125
Q

Painless Loss of vision in the segment of 1 eye. Fundoscopy mild disc swelling. No fundal haemorrhage.

A

Branch arterial thrombus

[Would get haemorrhage in vein]

126
Q
  1. Epiglottitis bug?
A

H influenza

127
Q

Old person breathless - CT basal fibrosis associated with dilated bronchi, but no honeycombing or ground-glass change

A

recurrent aspiration -> bronchiectasis

128
Q

Face lupus not responding to topical steroids

A

Hydroxycloroquine

129
Q

Abdo pain, diarrhoea, erythema nodosum. CT cluster of lymph nodes at appendix suggestive of mesenteric adenitis

A

Yersinia enterocolitica

[can mimic Crohn’s disease and appendicitis (pseudoappendicitis).]

130
Q

Pancytopenia:

Haematuira + nucleated red blood cells, myelocytes and metamyelocytes?

normal blood film?

poikilocytosis?

hypersegmented neutrophils

A

Bone marrow mets
[leukoerythroblastic film]

Normal - aplasic anaemia / hypothyroid

Poikilocytosis - Myelodysplasia

Hypersegmented neutrophils - B12 deficiency

131
Q

Left face UMN. Left hemiparesis. R fixed gaze palsy =

A

R frontal
[eyes ‘look towards’ the side of the lesion]

132
Q

R arm wasting of the small muscles of the right hand, loss of reflexes. pinprick and temperature sensation throughout the right arm.

A

Syringomyelia

133
Q

Digoxin half-life? How long to get to therapeutic level?

A

36hrs
5 half lives = 1 week

134
Q

term used to describe the presence of an abnormal number of chromosomes (either less than 46 or more

135
Q

Mechanism of renal injury with aciclovir

A

When dehydrated, aciclovir can precipitate as crystals

136
Q

Origin of foam cells

137
Q

Which Ig in ANA lupus

138
Q

Ankle inversion vs common peroneal?
Eversion?

A

Inversion L5
[move towards largest of 5]

Peroneal - just foot drop

Eversion - S1
[move towards small 1]

139
Q

Hypo while drunk

A

Increased 1st phase insulin secretion

140
Q

What causes the progressive muscle loss in becker and duchene

A

telomere shortening
[cant produce new muscle]

141
Q

Turners decreased exercise tolerance and systolic murmur

A

Bicuspid > coarctation

142
Q

Thenar wasting and loss of sensation over finger tips

A

Distal median

[Loss of sensation over thenar = proxmial]

143
Q

How to tell if someone is infectious with TB

A

Sputum cultures

144
Q

Marfan description with pitting oedema of ankles and right sternal diastolic murmur

A

Pulm regurg

145
Q

Recurrent sinusitis and LRTIs = which IgG deficiency

146
Q

Boozer and uses NO what is the cause of optic neuritis / plantar upgoing

A

B12 deficiency
[NO converts B12 to inactive form]

147
Q

Digoxin mechanism? What happens

A

Inhibits Na/k/ATPase pump

leads to intracellular Na accumulation

148
Q

Panretinal photocoag leads to what visual impairment

A

Peripheral loss
Loss of colour vision

149
Q

Diptheria Abx

150
Q

100 get new therapy 50 drop out, 10 don’t get better and 40 improve. What is the ITT?

A

40%
How many improve / total planned to treat

150
Q

100 get new therapy 50 drop out, 10 don’t get better and 40 improve. What is the ITT?

A

40%
How many improve / total planned to treat

151
Q

Amaurosis fugax vessel?

A

Internal carotid -> retinal

152
Q

stable T2DM how often hba1c?

153
Q

Campylobacter rX

A

Macrolide Eg Azithro

154
Q

Initial Ix for early Rheum a hands

A

Colour doppler US

155
Q

Ix OSA

A

Polysomnography

156
Q

Pulseless VT given amiodarone 300mg. What next

A

Adrenaline
CPR
Further 150mg amiodarone

157
Q

Where is PO4 reabsorbed

A

Proximal tubule
P for P

158
Q

Stress incontinence Rx 1 / 2

A

1 - pelvic floor
2 - surgery
- Duloxetine if not for surg

159
Q

Main constituent of bile

A

bile salts

160
Q

Peroxisome does what?

A

Oxidation of branch fatty acids

161
Q

Infectious Bloody diarrhoea that gets better with metronidazole? What if it didn’t improve

A

Entamboea

[Salmonella / campylobacter if it didnt improve]

162
Q

Relapsing and remitting small joint polyarthritis that fully resolves between attacks Rx?

A

hYDROXYCLOROQUINE

163
Q

Where in nephron is impermeable to water

A

Ascending loop of Henle

164
Q

Marked hypoK whats found on ECG

165
Q

Bronchiectasis for 40 years. Why nephrotic syndrome

166
Q

Negative concordance across chest leads seen in? means?

A

VT

Entirely positive R or entirely negative QS with no RS complexes

167
Q

DKA H+ is normal but still mild ketonuria what is the cause

A

Acetoacetate

168
Q

Wilxocon rank test also called used when?

A

Man whitney

Compare means of non normally distributed data

169
Q

Worsening of renal function in lupus on hydroxychloroquine

A

Add mycophenolate

[Cyclophosphamide if life-threatening]

170
Q

Erythematous photosensitive rash with scarring hair loss

A

Discoid lupus

PCT would be blistering

171
Q

A1AT deficiency with only mild symptoms genotype

172
Q

Where is the ostium of the coronary sinus ? What covers it in 60% of people

A

Drains into right atrium
[like the rest of the deoxygenated blood]

Thebesian valve

173
Q

At what age is 100% sensitivity for ADPKD with US scan

174
Q

PPV if sens 80% specificity 95% and prevalence 40%

A

Make table
Prevalance 40% = 400 in Disease present column
sens 400x0.8 = a = 320

d = 0.95x600 = 570
b= 600-570 = 30

ppv = 320 /(320+30) = 91%

175
Q

Differentiate factiously and malingering

A

Malingering they are tying to gain something

176
Q

VHL with slowly progressing visual impairment

A

Hemangioblastoma

177
Q

PR3 positivity with lung/ renal vasculitis

178
Q

MPO positivity with lung/ renal vasculitis

179
Q

pregnant VZV contact. Antibody negative. What next

180
Q

Spherocytosis with deranged LFTs

A

Cholescystitis
bile pigment gallstones

181
Q

Juvenile myoclonic epilepsy in a girl

182
Q

PPH and wants to stay preg what Rx

A

Change all to sildenafil

183
Q

On allopurinol but ongoing gout attacks and raised urate add in?

A

Benzbromarone
URAT1 inhibitor

184
Q

When is cortisol lowest

185
Q

MHC Class 2 found on what cells

A

Dendritic, macrophage, B cell

186
Q

Chlamydia in preg

187
Q

Cyclophosphamide targets

A

T cells (mostly CD4 but also CD8)

[Via alkylation of dna]

188
Q

What is the difference between chancroid and granuloma inguinale and lymphogranuloma vereneum? Bugs with each? rx?

A

Chancroid early spread to lymph nodes which get very big
H Durecyi
Single dose azithro / cef

Granuloma inguinale vascular and invasive ulcer [Donovan bodies]
Klebsiella granulomatis
Macrolides

Verenium - shallow painless ulcer with marked lymphadenopathy
Chlamydia
Doxy 3 weeks

189
Q

Psoriasis 2 DMARDs and still Sx what next

A

TNFa Eg Golimumab

190
Q

Bullous impetigo bug rx?

A

Staph A
Fuscid acid / mupirocin topical

191
Q

GPA vs GBM biopsy

A

Both crecenteric glomerulonephritis
GMB has linear IgG

192
Q

Osteomyelitis 1st line

A

Vanc + cef

193
Q

HRT in premature ovarian failure
Which type?

A

If periods stopped >1yr = continuous HRT

<1yr - sequential combined HRT

194
Q

VSD in preg

195
Q

Gonnorhea pen allergic

A

Azithro 2g

196
Q

2 mutations in myelofibrosis

A

JAK 2 or MPL

197
Q

Pubic lice Rx

A

Malathion lotion

198
Q

Peritoneal dialysis infection most common bnug

A

Staph epidermis

199
Q

mls/kg blood in a healthy person

A

75

[75kg, 75mls/kg, 7.5mg pred]

200
Q

Thyroiditis Ix ? rx?

A

Thyroid isotope scan
NSAIDs [pred if needed]

201
Q

persistent 1+ blood in urine not related to illness and family Hx

A

Thin basement membrane nephropathy

202
Q

Philadelphia chromosome old person

203
Q

Renal colic
CT Nephrocalcinosis with multiple areas of pyramidal calcification? rx? 2nd line?

A

Medullary sponge kidney

Increase fluid intake
Citrate

204
Q

Pagets whcih bisphos best

A

IV zoledronate
[IV option if there is a choice]

MRCP PART 1 (22 decks)

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