RACP 2020

Question 1

PARP inhibitors MOA and example

Answer 1

Inhibits PA-CRP1. PARP1 usually repairs single stranded breaks in DNA. By not repairing these single stranded breaks, they turn into double stranded breaks and inhibits cancerous growth

E.g olaparib

Question 2

What receptor does frusemide act at

Answer 2

Na-K-Cl co-transporter at ascending loop of henle

Question 3

Most common mutation in HFE gene causing hereditary haemochromatosis

Answer 3

C282Y. H63D less common than C282Y

Question 4

Most common CF mutation

Answer 4

F508del

Question 5

BK nephropathy Mx

Answer 5

Mainstay is to reduce immunosuppression
- If pt is on tac (calcineurin inhibitor), MMF (anti-metabolite) + pred, would reduce MMF first by half, then cease if no decrease in viral load
- Could also reduce calcineurin inhibitor followed by anti-metabolite
No antiviral agents avail for treatment

Question 6

Accumulation of which substance in ACEi induced angioedema

Answer 6

Bradykinin

Question 7

What is agnosia

Answer 7

Inability to recognise objects, people, smells, sounds

Question 8

What is apraxia

Answer 8

Inability to perform learned movements

Question 9

What is abulia

Answer 9

Lack of initiative, will, drive for action, speech, thought

Question 10

Which cranial nerves carry parasympathetic outflow fibers through outside the cranium

Answer 10

CN III, VII, IX, X

Question 11

Tranexamic acid MOA

Answer 11

Binds lysine binding site on plasminogen

Question 12

In a box plot what does the line in the middle of the box represent

Answer 12

Median of the IQR

Question 13

Mechanism of emphysema in alpha-1-antitrypsin

Answer 13

Imbalance between neutrophil elastase and elastase inhibitor AAT

Question 14

Denosumab MOA

Answer 14

Monoclonal antibody that binds to RANKL

Blocks osteoclast maturation, function and survival

Question 15

Which co-receptor binds with CD4 in early HIV infection

Answer 15

CCR5 in early

CXCR5 in later HIV infection

Question 16

What antidepressant has the most anti-cholinergic effect

Answer 16

TCA

Question 17

Which immunological structure is beta-2-microglobulin a part of

Answer 17

MHC class I

Question 18

How to prevent dialysis related amyloidosis

Answer 18

High flux membranes
Beta-2 globulin absorber
Preservation of residual kidney function
Early kidney transplant

Question 19

What vitamin deficiency do you get with metformin

Answer 19

Vitamin B12 deficiency

Question 20

What happens to B cells in germinal centres?

Answer 20

Antigen-activated B cells diversify their immunoglobulins by somatic hypermutation to generate high-affinity immunoglobulins

Question 21

Toxic metabolite of paracetamol

Answer 21

NAPQI

Question 22

How does NAC work in paracetamol poisoning

Answer 22

Acts as a glutathione donor to prevent NAPQI accumulation

Question 23

Amyloidosis cardiac and renal involvement

Answer 23

AA - kidneys
AL - kidneys and restrictive cardiomyopathy
ATTR - cardiac

Question 24

What type of breast cancer derives most benefit from CDK inhibitors

Answer 24

Hormone positive, HER negative

Question 25

Fulvestrant MOA

Answer 25

Selective oestrogen down regulator

Use in metastatic hormone positive postmenopausal pts in combo with AI or CDK inhibitor

Question 26

Population attributable fraction

Answer 26

PAF = { F(RR-1) / [1 + F(RR-1)] } x 100

F is the prevalence or exposure in the population

Question 27

Type B nerve fibres function

Answer 27

Visceral afferent fibres
Preganglionic nerve fibres of autonomic nervous system

Moderately myelinated - less myelinated than type A nerve fibres

Question 28

Type A motor nerve fibres function

Answer 28

Alpha - skeletal muscle fibre innervation

Gamma - intrafusal muscle fibre innervation

Question 29

Type A sensory nerve fibres function

Answer 29

Ia - proprioception
Ib - golgi tendon organ
II - secondary receptors of muscle spindle, cutanoues mechanoreceptors
III - touch and pressure, nociceptors of neospinothalamic tract, cold thermoreceptors
IV - nociceptors of paleospinothalamic tract, warm receptors

Question 30

Type C nerve fibres

Answer 30

Unmyelinated, small diameter, low conduction velocity

Responsible for burning pain, warmth, itch

Question 31

Metaraminol MOA

Answer 31

Stimulates alpha-1 receptors to cause peripheral vasoconstriction and increase BP

Question 32

Terlipressin MOA

Answer 32

Splanchnic and extrarenal vasoconstriction by stimulating V1 receptors (found in smooth muscle of splanchnic arteries)

Question 33

Sulfasalazine in which type of SpA

Answer 33

Good for peripheral SpA, not for axial

Applies for MTX as welll

Question 34

Carbapenamase MOA

Answer 34

Hydrolysis beta-lactam ring

Question 35

By what mechanism does clozapine cause myocarditis

Answer 35

Myocytes shows eosinophilic infiltration suggesting IgE mediated acute hypersensitivity reaction

Question 36

Cytokines that drive Familial Mediterranean Fever

Answer 36

IL-1 and IL-18

Question 37

What non-malignant cause increases CEA

Answer 37

Smoking
Infections
IBD
Pancreatitis
Liver cirrhosis