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Sophie MRCP Part 1 > Quick facts > Flashcards

Quick facts Flashcards

1
Q

Which area of the bowel is most commonly affected by ischaemic colitis

A

Splenic flexure (watershed area)

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2
Q

XR signs of ischaemic colitis

A

Thumbprinting

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3
Q

Which malignancy are patients with Sjogren’s syndrome at greater risk of?

A

Lymphoma / lymphoid malignancies

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4
Q

Aetiology of pemphigus vulgaris

A

Antibodies against desmoglein 3

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5
Q

Clotting screen abnormality in Von Willebrands disease

A

Mildy elevated APTT

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6
Q

Most aggressive type of melanoma

A

nodular

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7
Q

Cells responsible for hyperacute organ rejection

A

B cells

induce a reaction normally within minutes or hours of the transplant

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8
Q

How long before a patient with a resolved pneumothorax should fly?

A

2 weeks

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9
Q

Which marker raises first after a myocardial infarction

A

myoglobin

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10
Q

Which type of pneumonia causes red blood cell agglutination

A

Mycoplasma pneumoniae
Promotes production of IgM antibodies (cold agglutinins)

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11
Q

Translocation associated with Burkitt’s lymphoma

A

c-myc gene translocation, usually t(8:14).

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12
Q

Disease with ‘starry sky’ appearance on microscopy

A

Burkitt’s lymphoma

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13
Q

Translocation and disease associated with Philadelphia chromosome

A

t(9:22)
chronic myeloid leukaemia

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14
Q

What is the ABG picture in hypoventilation

A

Respiratory acidosis

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15
Q

What kind of skin cancer has keratin pearls on histopathology

A

SCC

SCCs arising in a chronic scar are typically more aggressive and carry an increased risk of metastasis

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16
Q

Most common non-iatrogenic cause of Cushing’s syndrome?

A

Pituitary tumour = Cushing’s disease (80%)

Adrenal adenoma (10%)

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17
Q

What conditions are pyoderma gangrenosum linked to?

A

IBD (UC, Crohn’s)
RA, SLE
PBC

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18
Q

Other features of ulcerative colitis

A

Large joint arthritis
Sacroilitis
Pyoderma gangrenosum

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19
Q

Which TCA is most dangerous in overdose

A

Dosulepin

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20
Q

What might cause a false negative Coeliac’s serology test?

A

IgA deficiency as TTG is an IgA antibody

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21
Q

Endoscopic biopsy findings in Coeliac’s

A

Gold standard Ix
Villous atrophy
Crypt hyperplasia
Increased intraepithelial lymphocytes
Lamina propria infiltration with lymphocytes

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22
Q

Which antibiotics might have a crossover with a Penicillin allergy

A

Cephalosporins e.g. cefalexin, Ceftriaxone
Carbapenems

All beta-lactam antibiotics

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23
Q

Which infections are patients with a splenectomy particularly at risk of?

A

Pneumococcus
Haemophilus
Meningococcus

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24
Q

Prophylaxis and vaccines for patients undergoing splenectomy

A

Hib, meningitis A&C
Annual influenza
Pneumococcal every 5 years

Pen V

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25
Q

H. Pylori associations

A

Duodenal and Gastric Ulcers
Gastric cancer
B cell lymphoma of MALT tissue
Atrophic gastritis

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26
Q

Management of H. Pylori

A

PPI
Amox
Clari or Metro (or both if pen allergic)

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27
Q

Tx of scabies

A

5% Permethrin
All skin including scalp
Leave on for 12 hours
Repeat in 7 days

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28
Q

Signs of Wilson Disease

A

Neuropsychiatric Sx
Kayser-Fleischer rings
Liver disease - hepatitis, cirrhosis

Ix - reduced serum caeruloplasmin, reduced serum copper, increased urinary excretion

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29
Q

Inheritance pattern of Wilson’s disease

A

Autosomal recessive
Increased copper absorption
Reduced hepatic copper excretion
ATP7B, chromosome 13

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30
Q

Mx of Wilson’s disease

A

Penicillamine / Trientine hydrochloride +/- tetrathiomolybdate
Chelates copper

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31
Q

Causes of foot drop

A

Most commonly - common peroneal nerve lesion

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32
Q

Tx of cerebral oedema in patients with brain tumours

A

Dex

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33
Q

Presentation of mercury poisoning

A

Visual field defects
Hearing loss
Paraesthesia
High chloride
Metabolic acidosis

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34
Q

Presentation of lead poisoning

A

Abdo pain
Constipation
Neuropsych Sx
Blue gum margin

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35
Q

How does St John’s Wort affect P450 system?

A

Inducer (decreasing levels of drugs such as warfarin, COCP etc.)

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36
Q

Onset of Sx in alcohol withdrawal

A

Sx from 6-12 hours
Seizures from 36 hours
Delirium tremens from 48-72 hours

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37
Q

Conversion of PO to SC/IV morphine

A

2:1 (half PO dose)

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38
Q

Treatment of ITP

A

Oral pred
IV Ig is 2nd line / given in severe bleeding

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39
Q

Drug causes of liver cirrhosis

A

Methotrexate
Methyldopa
Amiodarone

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40
Q

Management of genital warts

A

Multiple, non-keratinised –> topical podophyllum
Single, keratinised –> cryotherapy

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41
Q

Mx of Myaethenic crisis

A

Plasmapheresis or IV Ig

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42
Q

Presentation of myaethenia gravis

A

Muscle fatiguability
Insufficient functioning acetylcholine receptors

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43
Q

Mx of Myasthenia Gravis

A

Long acting acetylcholinesterase inhibitors e.g. pyridostigmine
+/- pred

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44
Q

Cause of CLL

A

Monoclonal proliferation of B-cell lymphocytes

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45
Q

Ix for CLL

A

Lymphocytosis, anaemia, thrombocytopenia
Smudge cells on blood film
Immunophenotyping is key

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46
Q

Tx of essential tremor

A

Propanolol
Primidone if asthmatic

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47
Q

Presentation of acoustic neuroma / vestibular schwannomas

A

Vertigo
Hearing loss
Tinnitus
Absent corneal reflex

–> MRI of cerebellopontine angle

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48
Q

Mx of Meniere’s disease

A

Acute - prochlorperazine
Prevention - betahistine

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49
Q

Ix findings in dermatomyositis

A

Elevated CK
ANA +ive 60%
Anti-Mi-2 (highly specific, 20%)

Tx - pred

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50
Q

Test prior to starting Azithromycin

A

ECG - to rule out prolonged QT
LFTs

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51
Q

Secondary prevention of MI

A

Dual anti-platelet
ACE-I
BB
Statin

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52
Q

What causes amiodarone to have a long half life

A

Extensive lipid binding resulting in extensive tissue distribution

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53
Q

Endocarditis pathogen associated with poor dental hygiene

A

Strep mitis (subtype of strep viridans)

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54
Q

Mx of stable angina

A

Bisoprolol (BB) or Amlodipine (CCB) for prevention
(Aspirin and statin)
GTN

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55
Q

ECG changes in hypokalaemia

A

In hypokalaemia, U have no Pot and no T, but a long PR and a long QT

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56
Q

Measure of QT interval

A

Start of Q to end of T

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57
Q

MOA of loop diuretics

A

Inhibits Na-K-CL co-transporter in the thick ascending limb of the loop of Henle

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58
Q

What does troponin T bind to?

A

Tropomyosin

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59
Q

main constituent of Pulmonary surfactant

A

main constituent is dipalmitoyl phosphatidylcholine (DPPC)

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60
Q

What condition is adenomatous polyposis coli gene (APC) associated with?

A

FAP
Autosomal dominant
Hundreds of polyps in the large intestine
Increased risk of CRC

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61
Q

Which condition is DNA mismatch repair protein linked to?

A

Lynch syndrome
Autosomal dominant
Increased risk of CRC in proximal colon

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62
Q

Genotype of sickle cell disease

A

HbAS - trait. asymptomatic
HbSC - moderate
HbSS - severe disease

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63
Q

Presentation of methanol poisoning

A

Metabolic acidosis
Reduced vision
Poorly reactive pupils

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64
Q

Features of otosclerosis

A

Autosomal dominant
Young adults
Conductive deafness

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65
Q

Complications of polycythaemia rubra vera

A

Myelofibrosis, AML
Tx with aspirin, venesection and hydroxyurea

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66
Q

Cause of slow-rising pulse

A

Aortic stenosis

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67
Q

Cause of collapsing pulse

A

aortic regurg
PDA

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68
Q

Cause of pulsus alternans

A

Severe LVF

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69
Q

Causes of jerky pulses

A

HOCM

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70
Q

Which CCBs should not be used with betablockers

A

Verapamil or Diltiazam
(Non-dihydropyridine CCBs)

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71
Q

Treatment of Patent ductus arteriosus in newborns

A

Ibuprofen
Indomethacin

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72
Q

ECG changes seen in hypercalcaemia

A

Shortening of QT interval
Prolonged PR
Widened QRS
ST elevation

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73
Q

Define cardiac syndrome X

A

Microvascular angina
Normal ECG, normal coronary angiogram
ST depression on exercise stress testing

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74
Q

How to determine 4th line management of HTN

A

K <4.5 –> spiro
K >4.5 –> beta-blocker / alpha-blocker

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75
Q

Other cause of ejection systolic murmur

A

Atrial septal defects (louder on inspiration, fixed split S2)

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76
Q

Initial blind therapy in infective endocarditis

A

Amox +/- Gent

Pen allergic –> Vanc + Gent

Prosthetic valve –> Vanc, Rifampicin + Gent

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77
Q

Abx in IE due to staph (native vs prosthetic valve)

A

Native - Fluclox
(Vanc + Rifampicin if pen allergic)

Prosthetic - Fluclox + Rifampicin + Gent
(Vanc + Rifampicin + Gent if pen allergic)

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78
Q

Abx Tx in fully sensitive strep

A

Benpen - add Gent if partially sensitive
(Vanc + Gent if pen allergic)

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79
Q

Cause of bisferiens pulse

A

Mixed aortic valve disease

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80
Q

Recent MI + Persistent ST elevation + No CP

A

Left ventricular aneurysm

  • High risk of thrombus formation
  • Should receive anti-coag
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81
Q

Triad of cardiac tamponade

A

Falling BP
Rising JVP
Muffled heart sounds

Beck’s triad

recognised complication of PCI

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82
Q

Causes of ‘a’ wave on JVP

A

Large due to raised atrial pressure e.g. tricuspid stenosis, pulmonary stenosis, pulmonary HTN

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83
Q

Causes of cannon ‘a’ waves on JVP

A

Atrial contractions against a closed tricuspid

Complete heart block, ventricular tachycardias/ectopics, nodal rhythm, single chamber ventricular pacing

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84
Q

Features of severe aortic stenosis

A

Narrow pulse pressure
Slow rising pulse
Soft S2
Present S4

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85
Q

Cause of U waves

A

Hypokalaemia
Due to delayed ventricular repolarisation

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86
Q

Cause of delta waves

A

WPW

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87
Q

ECG changes in pericarditis

A

PR depression - most specific for percarditis
Saddle-shaped ST elevation

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88
Q

Which meds should be avoided in HOCM

A

ACE-inhibitors
Nitrates
Nifedipine/ Dihydropyridine CCB

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89
Q

Which blistering skin condition involves the mucosa

A

Pemphigus vulgaris

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90
Q

Tx of fungal nail infection

A

Mild - topical treatment (6 months fingernails, 9-12 months for toenails)
Extensive - oral terbinafine (3-6 months)

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91
Q

What can exacerbate plaque psoriasis

A

Alcohol
Ace-inhibitors, Beta-blockers and NSAIDs
Lithium
Anti-malarials

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92
Q

What is urticaria pigmentosa and what disease is it caused by

A

affected skin undergoes whealing upon rubbing
due to systemic mastocystosis

Diagnosis made by urinary histamine

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93
Q

Causes of eczema herpeticum

A

HSV 1 or 2
Coxsackie virus

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94
Q

Tx of lichen planus

A

Potent topical steroids

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95
Q

Which cancer and conditions are associated with Acanthosis nigricans

A

Gastric cancer

T2DM, PCOS, Acromegaly, Cushing’s, Hypothyroidism

COCP

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96
Q

Tx of rosacea

A

Topical ivermectin
Oral Doxy

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97
Q

Presentation of hereditary haemorrhagic telangiectasia

A

Autosomal dominant

Epistaxis, Telangiectasia, AV malformations

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98
Q

Why does severe hyponatraemia cause confusion

A

Cerebral oedema

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99
Q

What happens if hyponatraemia is correctly too rapidly

A

Central pontine myelinolysis

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100
Q

Differentiating MODY vs LADA

A

Maturity onset diabetes of the young - autosomal dominant, slim individuals, polyuria, polydispia, recurrent balanitis –> Mx Sulphonylrureas

Latent autoimmune diabetes of adults - overweight individuals

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101
Q

MOA mirabegron

A

Beta-3 agonist
Used in urge incontinence

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102
Q

Tx of stress incontinence

A

Pelvic floor exercises
Duloxetine
+/- surgery

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103
Q

Tx of urge incontinence

A

Bladder retraining
Oxybutynin 1st line
Mirabegron
Tolerodine

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104
Q

Liddle’s syndrome

A

Rare autosomal dominant condition
HTN + hypokalaemic alkalosis
Tx - amiloride or triamterene

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105
Q

Which conditions cause hypercholesterolaemia (as opposed to hypertriglyceridaemia)

A

Nephrotic syndrome
Cholestasis
Hypothyroidism

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106
Q

Tx of infertility in PCOS

A

Clomifenere (or Metformin)

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107
Q

Sick euthyroid syndrome

A

Reversible state
Abnormal thyroid function tests due to non-thyroidal illness
No pre-existing thyroid issues
TSH - normal, T4 and T3 - low

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108
Q

Most common cause of primary hyperaldosteronism (Con’s)

A

Bilateral idiopathic adrenal hyperplasia (60-70% of cases)
Adrenal adenoma (20-30% of cases)

HTN + Hypokalaemia

Mx - surgery or aldosterone antagonist e.g. spironolactone

109
Q

Signs of congenital adrenal hyperplasia

A

Irregular menses, acne, hirsutism, early breast and pubic hair development, clitoromegaly and male-pattern baldness

Due to 21-hydroxylase deficiency

110
Q

Tx of gestational diabetes

A

Dx with FG >5.6 and 2hr >7.8

Fasting Glucose:
< 7 - diet and exercise trial
>7 - insulin
6-6.9 + foetal complication - insulin

If after a couple of weeks of trial, FG remains >5.3 –> add metformin –> add insulin

111
Q

Indications for hyperparathyroidism surgery

A

<50yrs old
adj Calcium >0.25 above upper range
eGFR <60
Renal stones
Osteoporosis or #
Symptomatic disease

112
Q

Safe thyroid medications in pregnancy

A

1st trimester - propylthiouracil
2nd trimester - switch to carbimazole

113
Q

Cancer assocaited with Hashimoto’s thyroiditis

A

MALT (mucosa-assocaited lymphoid tissue) lymphoma

Malignancy arises due to chronic inflammation of thyroid

Presents as thyroid lump - USS and FNA

114
Q

Presentation of anaplastic thyroid carcinoma

A

Rapidly enlarging neck mass + compression associated symptoms

115
Q

Riedel’s thyroiditis

A

Normal thyroid tissue is replaced with dense fibrotic tissue that extends beyond the thyroid capsule
results in a hard woody thyroid gland and compression sx

116
Q

Tx of diabetic neuropathy

A

Amitriptyline (avoid in BPH –> retention)
Duloxetine
Gabapentin
Pregabalin

117
Q

Which cardiac medication can cause gynaecomastia

A

Digoxin

118
Q

Signs of pseudohypoparathyroidism

A

target cells insensitive to PTH

Ass. w/ low IQ, short stature, shortened 4th and 5th metacarpals

Low calcium, high phosphate, high PTH

119
Q

Addison’s disease

A

Primary hypoadrenalism
Reduced cortisol and aldosterone

120
Q

Side effects of radioiodine treatment

A

Worsening of thyroid eye disease

121
Q

Bartter’s syndrome

A

Polyuria and polydipsia
Hypokalaemia
Normotension
Weakness

Autosomal recessive - defect in Na-K-SCL co-transporter

122
Q

Primary Ix for Con’s

A

Plasma renin:aldosterone ratio
(Results can be interfered with by any meds that involved RAAS e.g. ACE-i, ARBs, spiro)

Causes include adrenal adenoma or bilateral adrenal hyperplasia

123
Q

Mx of hypercalcaemia

A

IVF first to correct any dehydration
Can use bisphosphonates once adequately hydrated
Furosemide can sometimes play a role

124
Q

Causes of Pseudohyperkalaemia

A

Haemolysis
Myeloproliferative disorders e.g. thrombocytosis

125
Q

Inheritance of familial hypercholesterolaemia

A

Heterozygous
Autosomal dominant

126
Q

Which type of thyroid cancer is associated with RET Oncogene

A

Medullary - associated with MEN2
Encodes a tyrosine kinase receptor

127
Q

Define Impaired fasting glucose

A

Due to hepatic insulin resistance
Fasting glucose 6-7

128
Q

Define impaired glucose tolerance

A

Due to muscle insulin resistance
Fasting glucose <7 + OGTT 2hr >7.8

129
Q

Presentation of subacute thyroiditis

A

tender goitre
hyperthyroidism
raised ESR

Technetium thyroid scan - globally reduced uptake (due to inflammation/destruction of thyroid tissue)

130
Q

Kallman’s syndrome

A

Pubertal delay and poor secondary sexual development
Anosmia, cleft palate

Low FSH, LH and testosterone –> hypogonadotropic hypogonadism

X-linked inheritance

131
Q

Klinefelter syndrome

A

Delayed pubertal development and small testes

Raised FSH and LH but low testosterone –> Hypergonadotropic hypogonadism

132
Q

Nuclear scintigraphy scan for toxic multinodular goitre

A

Patchy uptake

133
Q

Causes of HTN + Hypokalaemia

A

Conn’s syndrome (high aldosterone, low renin)
Cushing’s syndrome (high aldosterone, low renin)
Liddle’s syndrome (low aldosterone, low renin)
11-beta hydroxylase deficiency

134
Q

Commonest types of inherited colon cancer

A

Hereditary non-polyposis CRC (5%)
Familial adenomatous polyposis (<1%)

135
Q

RF for eosinophilic oesophagitis

A

Dysphagia
Young males
Hx of allergies/eczema/asthma

Initial Mx - dietary changes and steroids, if Sx not improving then dilatation

136
Q

What deficiency causes haemochromotosis

A

HFE (the protein that regulates iron absorption) - autosomal recessive, chromosome 6

Presents with multi-system dysfunction e.g. DM, ED, HF, liver disease, arthritis, hypogonadism + TAN

137
Q

Which deficiency causes Wilson’s disease

A

ATP7B, autosomal recessive, chromosome 13

Usually presents with neurological disease, liver disease, Kayser-Fleischer rings, blue nails

Tx - Penicillamine

138
Q

Which deficiency causes Gilbert’s disease

A

Glucuronyl transferase deficiency

139
Q

Presentation of re-feeding syndrome

A

Symptoms mainly due to low phosphate (although low magnesium and potassium are often also present)

Feeding causes reactive hyperinsulinaemia
Results in low phosphate
Leads to heart failure and skeletal muscle weakness

140
Q

Associated conditions with PBC

A

Sjogrens (80%)
RA
Systemic sclerosis
Thyroid disease

141
Q

Treatment of recurrent C. Diff infections

A

Bezlotoxumab

142
Q

Mx of SBP

A

IV Cefotaximine

143
Q

Presentation of Peutz-Jegher’s syndrome

A

Autosomal dominant

Numerous hamartomatous polyps in the GI tract
Pigmented freckles on the lips, face, palms and soles

High risk of CRC

144
Q

Vitamin supplementation required in gastric bypass patients

A

Iron
Calcium

(Absorbed in the duodenum)

145
Q

Which vaccination should Coeliac disease patients receive?

A

Pneumococoal every 5 years
Influenza every year
Repeat Hep B vaccine once on a gluten free diet

Coeliacs –> hyposplenism

146
Q

Prophylaxis of variceal haemorrhage

A

Propanolol
Endoscopic variceal band ligation
Transjugular Intrahepatic Portosystemic Shunt

147
Q

Indicators of severe pancreatitis

A

Age > 55
WCC >15
Calcium <2
Urea >16
LDH >600
Albumin <32
Glucose >10

148
Q

Budd-Chiari syndrome

A

Hepatic vein thrombosis

Causes: pregnancy, COCP, malignancy, polycythaemia

Sx - sudden onset abdo pain, ascites and tender hepatomegaly

Bloods - sig. raised ALT

Dx - doppler US liver

149
Q

Most common complication of ERCP

A

Acute pancreatitis

150
Q

Presentation of Primary Biliary Cholangitis

A

Fatigue amd pruritus
Cholestatic LFTs (ALP, GGT)
Anti-mitochondrial antibody positive (M2)
IgM
Middle aged females

Tx - ursodeoxycholic acid

151
Q

Test/Signs of chronic pancreatitis

A

CT pancreas
Shows calcification

152
Q

How does C. Diff spread

A

Faecal-oral route
Ingestion of spores

153
Q

Signs of Whipples Disease

A

Chronic curable systemic bacterial infection

Chronic diarrhoea +/- steatorrhoea
Weight loss
Arthralgia
Lymphadenopathy
Ophthalmoplegia - supranuclear gaze palsy

154
Q

Sx of Still’s disease

A

Fever
Joint pain
Salmon-coloured bumpy rash

155
Q

Zollinger-Ellison Syndrome

A

Excessive gastrin secretion from tumour in duodenum or pancreas (increased hydrogen secretion from gastric parietal cells)

Sx - multiple gastro/duodenal ulcers, diarrhoea and malabsorption

Dx - fasting gastrin levels

30% of cases occur as part of MEN1

156
Q

Carcinoid syndrome

A

Flushing
Diarrhoea
Bronchospasm
Hypotension
Right heart valvular stenosis
Pellagra

Ix - urinary 5-HIAA

Mx - somatostatin analogue e.g. octreotide

157
Q

Commonest bacteria in SBP

A

E. Coli

158
Q

How is haemochromatosis monitored

A

Transferrin saturation and serum ferritin

159
Q

Grading severity of UC

A

mild: < 4 stools/day, only a small amount of blood
moderate: 4-6 stools/day, varying amounts of blood, no systemic upset
severe: >6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)

160
Q

Abx for liver abscess

A

Amox + Cipro + Metro
(Cipro and Clinda if pen allergic)

161
Q

BMI cut off for referral for bariatric surgery

A

BMI 35 + as well as RF (T2DM, HTN)
BMI 40 + (if no RF)

162
Q

Mx of ascites 2ndary to liver cirrhosis

A

Aldosterone antagonist e.g. spironolactone

163
Q

Presentation of Cholangiocarcinoma

A

Palpable gallbladder + painless jaundice
Raised CA 19-9
Anorexia and weight loss

PSC is the main RF

164
Q

Microscopic colitis

A

Chronic diarrhoea, mildly elevated faecal calprotectin and ESR

Causes: PPIs

Ix - colonoscopy and biopsy

165
Q

Osteoarthritic and skin changes in haemochromatosis

A

Hook like osteophytes at the 2nd and 3rd digits of MCP joints

Slate-grey appearance

Monitor with transferrin saturation (and can test ferritin)

166
Q

What need to be check with TTG levels

A

IgA

167
Q

Presentation of schistosomiasis/ Katayama fever

A

fever
myalgia
cough
diarrhoea
urticarial rash
hepatosplenomegaly

Bloods - eosinophilia

CXR - B/L pulmonary infiltrates

Tx - Praziquantel

168
Q

Presentation of leptospirosis

A

Transmitted through rat urine
Sewage workers at risk

Lower back pain, fever, myalgia, fatigue, jaundice and subconjunctival haemorrhage

169
Q

Causes of bloody diarrhoea

A

Shigella
Amoebic dysentery
Enterohaemorrhagic E. Coli
Possibly Campylobacter

170
Q

Which HPV causes genital warts

A

HPV 6 and 11

171
Q

Tx of Amoebiasis

A

7 days oral metronidazole or tinidazole (for invasive stage)
Followed by 10 days Diloxanide (for cystic stage)

172
Q

HIV

A

RNA retrovirus
HIV 1 is more severe than HIV 2
Leads to depletion of T Cells
Enters the cell via CD4 receptor

173
Q

Tx for animal or human bites

A

Co-Amox

174
Q

Jarisch-Herxheimer reaction

A

Seen following treatment of syphilis
Thought to occur due to release of endotoxins

Fever, rash, tachycardia

Can give paracetamol if needed

175
Q

Tuberculoid leprosy

A

Limited number of skin lesions
Hyperaesthesia
Hair loss

176
Q

Most common organism found in central line infections

A

Staph epidermidis

177
Q

Chest infection common in HIV patients

A

Pneumocystis jiroveci

Pneumothorax is a common complications

178
Q

Common causes of UTI in young SA women

A

E. Coli (gram-negative)

Staphylococcus saprophyticus (gram positive, coagulase-negative)

179
Q

Most common organism in animal bites

A

Generally polymicrobial
Pasteurella mutocida

180
Q

Tx of trichomonas vaginalis

A

Oral Metronidazole

181
Q

Tx of gonorrhoea

A

IV Ceftriaxone

182
Q

Presentation of yellow fever

A

Flu-like illness
Brief remission
Development of jaundice and haematemesis

183
Q

Live attenuated vaccines

A

MMR
BCG
Yellow fever

Oral - typhoid, polio, rotavirus

184
Q

Mx of viral meningitis

A

Self-limiting
Supportive care

185
Q

Cause of rocky mountain spotted fever

A

Rickettsia ricketsii

186
Q

Cause of endemic vs epidemic typhus

A

Endemic - Rickettsia typhi
Epidemic - Rickettsia prowazekii

187
Q

Hookworm presentation

A

Iron deficient anaemia
Eosinophilia
Rash

Ix - stool sample for ova, cysts and parasites

188
Q

Tx of severe campylobacter

A

Clarithromycin or azithromycin

189
Q

Tx of toxoplasmosis

A

Only indicated in severe infections or immunocompromised patients

6 weeks of pyrimethamine and sulphadiazide

190
Q

Common organism in human bites

A

Eikenella corrodens
Strep spp.
Staph aureus
Fusobacterium
Prevotella

191
Q

Types of schistosomiasis infections

A

Schistosoma haematobium - bladder ca, calcification

Schistosoma mansoni and japonicum - inhabit protal system –> hepatosplenomegaly, liver cirrhosis, cor pulmonale

192
Q

Tx of gonorrhoea

A

IM Ceftriaxone

193
Q

SE of tetracyclines

A

Photosensitivity

194
Q

UTI in pregnancy

A

Oral Nitro (Trimethoprim CI)

195
Q

Most severe complication of Chagas disease

A

Cardiomyopathy

196
Q

Tx of aspergilloma

A

Surgical resection

197
Q

What are the 4 variable use to calculate eGFR

A

Creatinine
Age
Gender
Ethnicity

198
Q

Nephropathy associated with malignancy

A

Membranous nephropathy

199
Q

Indications for renal replacement therapy

A

Hyperkalaemia
Metabolic acidosis
Complications of uraemia e.g. pericarditis, encephalopathy
Severe pulmonary oedema

AND refractory to medical management of these conditions

200
Q

Cause of nephrotic syndrome in HIV

A

Focal segmental glomerulosclerosis (FSGS)

201
Q

Defect in Alport’s syndrome

A

Type IV collagen

202
Q

Causes of nephrogenic DI

A

Hypercalcaemia
Hypokalaemia
Lithium
Demeclocycline
Tubulo-interstitial disease - obstruction, sickle-cell, pyelonephritis

203
Q

Sx of Haemolytic uraemic syndrome

A

Microangiopathic haemolytic anaemia
Thrombocytopenia
Renal impairment

Typically 2ndary to GI infection

Tx - eculizumab

204
Q

Most common bacteria in peritonitis secondary to peritoneal dialysis

A

Coagulase negative staph

Tx - Ceftazidime + Vanc added to dialysis fluid

205
Q

Valve disease associated with ADPKD

A

Mitral valve prolapse

206
Q

Extra-renal manifestations of ADPKD

A

Liver cysts
Berry aneurysms
Mitral valve prolapse/incompetence
Aortic root dilation
Aortic dissection

207
Q

Anti-GBM disease

A

Small vessel vasculitis

Pulmonary haemorrhage
Rapidly progressive glomerulonephritis

Anti-GBM antibodies against type IV collagen
IgG deposit along basement membrane
Raised transfer factor

Mx - plasma exchange, steroids, cyclophosphamide

208
Q

Differentiating Conn’s from renal artery stenosis

A

Both low potassium and high aldosterone

Conn’s - low renin
RAS - high renin

(Bartter’s is the same as RAS but pt is normotensive)

209
Q

Most common cause of nephrotic syndrome in children

A

Minimal change disease

210
Q

Tumour markers in testicular cancer

A

Seminomas - hCG

Non-seminomas - AFP +/- hCG

LDH is raised in approx. 40%

211
Q

Features of fibromuscular dysplasia

A

Young female
HTN
Asymmetrical kidneys

212
Q

Which glomerulonephritis is associated with SLE?

A

Diffuse proliferative GN

213
Q

Why are patients will nephrotic syndrome predisposed to clots

A

Loss of anti-thrombin-III, protein C and S
Rise in fibrinogen levels

214
Q

Chromosome affected in ADPKD Type 1 vs 2

A

Type 1 - chromosome 16 (85% of cases)
Type 2 - chromosome 4 (15% of cases)

215
Q

Most common causes of nephrotic syndrome in adults

A

focal segmental glomerulosclerosis
Membranous glomerulopathy

216
Q

How to calculate anion-gap

A

(sodium + potassium) - (chloride + bicarb)

Normal is 10-18

217
Q

Causes of normal anion gap

A

prolonged diarrhoea
uterosigmoidostomy
fistula
renal tubular acidosis
acetazolamide
addison’s

218
Q

causes of raised anion gap

A

lactate e.g. shock, sepsis and hypoxia
ketones e.g. DKA, alcohol
urate e.g. renal failure
acid poisoning e.g. salicylates, methanol

219
Q

Conditions associated with IgA nephropathy

A

Alcoholic cirrhosis
Coeliac disease
HSP

220
Q

Presentation of IgA nephropathy

A

Macroscopic haematuria
Young person
Usually after an URTI

221
Q

Antibodies present in idiopathic membranous GN

A

Anti-phospholipase A2

222
Q

How does lithium cause Diabetes Insipidus

A

Desensitises the kidneys ability to respond to ADH

223
Q

Which glomerulonephritis is associated with heroin use

A

FSGN

224
Q

Prevention of stones (calcium, uric acid, oxalate)

A

Calcium stones - thiazide diuretics

Uric acid stones - allopurinol, oral bicarb

Oxalate - cholestyramine, pyridoxine

225
Q

Factors that may affect eGFR

A

Pregnancy
Muscle mass
Eating red meat prior to sample

226
Q

What is a staghorn calculus made of?

A

Struvite - magnesium ammonium phosphate

227
Q

Calciphylaxis

A

Complication of end-stage renal disease

Necrotic, progressive skin ulcer, reticular pattern
Painful

228
Q

Treatment of minimal change disease

A

Steroids

229
Q

Henoch-Schonlein purpura

A

IgA mediated

Purpuric rash, abdo pain, polyarthritis
Features of IgA nephropathy - haematuria, renal failure

Biopsy - mesangial hypercellularity

230
Q

Signs of CMV infection

A

Often in immunocompromised patients

Fever, deranged LFTs, leukopenia, thrombocytopenia

Tx - ganciclovir

231
Q

Nephritic syndrome + URT signs

A

Granulomatous with polyangiitis
Crescents on renal biopsy
Ass. w/ cANCA

(Anti-GBM presents with pulmonary haemorrhage)

232
Q

Which med is CI in absence seizures

A

Carbamazepine

Ethosuximide is gold standard

233
Q

Which area of the brain causes expressive aphasia

A

Broca’s area - inferior frontal gyrus, posterior/lateral frontal lobe

234
Q

Positive Rinnes test

A

air cond. > bone cond.

normal or indicates SNHL

235
Q

Negative Rinnes test

A

air cond. < bone cond.

Conductive HL

236
Q

Tx of Ramsay-Hunt

A

Oral aciclovir and corticosteroids

237
Q

Myotonic dystrophy

A

Ptosis, cataracts
Dysarthria
Distal weakness
DM
Heart block or caridomyopathy
Dysphagia

Autosomal dominant - presents around 20-30 years old

238
Q

Neurofibromatosis Type 1

A

Neurofibromas of the skin
Cafe au lait spots
Lisch nodules
Optic gliomas

239
Q

Neurofibromatosis Tpye 2

A

Schwannomas
Meningioma
Acoustic neuromas - SNHL

240
Q

Sturge-Weber Syndrome

A

Developmental delay
Port-wine stains
Glaucoma
Seizures

241
Q

Tuberous sclerosis

A

Angiofibromas and moles
Development delay
Epilepsy

242
Q

Von Hippel Lindau Syndrome

A

Patients develop multiple cysts and tumours

Subarachnoid haemorrahge (2ndary to haemangiomas)
Vitreous haemorrhage
Phaeochromocytoma
RCC
Cysts in pancreas, liver and epididymis

243
Q

Which migraine med can cause acute angle closure glaucoma

A

Topiramate

244
Q

Stroke prophylaxis

A

Clopi +/- statin if appropriate

245
Q

Conjugate gaze palsy

A

Ipsilateral loss of adduction
Contralateral abduction nystagmus

Medial longitudinal fasciculus affected
In paramedian area of midbrain and pons

246
Q

First line Tx of myoclonic seizures

A

Sodium valproate

247
Q

Miller-Fisher variant

A

Type of GBS
Starts by affecting cranial nerves –> eye signs
Usually preceded by an infection

248
Q

Normal pressure hydrocephalus

A

Urinary incontinence + Gait abnormality + Dementia

‘Magnetic gait’

249
Q

Most common subtype of Motor Neuron Disease

A

Amyotrophic lateral sclerosis (50% of patients)

250
Q

Tx. of restless leg syndrome

A

Ropinorole - dopamine agonist

251
Q

Causes of raised lymphocytes in CFS

A

Viral/TB/Bacterial meningitis/encephalitis
Lyme disease
Behcet’s disease
SLE
Lymphoma or leukaemia

252
Q

Lambert-Eaton Syndrome

A

Muscle weakness
Improves with repetition
Hyporeflexia
Dry mouth, impotence and difficulty PU

Antibodies against voltage gated calcium channels

253
Q

Ix for suspected SAH

A

CTH
If NAD <6hrs - consider other Dx
If NAD >6 - perform LP 12hrs after onset of Sx

254
Q

Von Hippel-Lindau Syndrome

A

Episodic HTN
Sweating
++HTN
Phaeochromocytoma
RCC

255
Q

Myasthenia Gravis

A

Autoimmune - antibodies to Acetylcholine receptors
Progressive weakening of muscles
Diplopia
Ptosis
Dysphagia

Mx - pyridostigmine

256
Q

Causes of gingival hyperplasia

A

Phenytoin
Ciclosporin
Calcium channel blockers
AML

257
Q

Vessel damaged in extra-dural haemorrhage

A

Middle meningeal artery

258
Q

cluster headaches tx

A

Acute - SC sumatriptan + O2

Prevention - verapamil

259
Q

Eye sign in raised ICP

A

Down and out eye - CNIII palsy
Occurs due to herniation

260
Q

Abx Mx of brain abscess

A

Cephalosporin
Metronidazole

261
Q

Sx of GBS

A

Flaccid paralysis
Hyporeflexia
Tachycardia
Urinary retention

Nerve conduction studies - reduced velocity

262
Q

Cause of chorea

A

Damage to basal ganglia inc. caudate nucleus

263
Q

Sx of Creutzfeldt-Jakob disease

A

Rapid onset dementia
Myoclonus

264
Q

Sign of HSV encephalitis

A

Temporal lobe changes on CTH

265
Q

Columns affected in subacute combined degeneration of the cord

A

Dorsal and lateral

Dorsal - impaired proprioception and vibration sense
Lateral - motor impairment
(Anterior - pain, temp, coarse touch and pressure)

266
Q

Syringomyelia

A

collection of CSF within the spinal cord
- cape-like loss of sensation to temp

267
Q

Weakness of intrinsic muscles of the hands

A

T1 lesion

268
Q

MRI signs of Wernicke’s

A

Enhancement of the mamillary bodies

Sophie MRCP Part 1 (7 decks)

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