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MRCP > Top 100 Passmedicine Concepts pt 1 > Flashcards

Top 100 Passmedicine Concepts pt 1 Flashcards

1
Q

When should adrenaline be given in non-shockable rhythm?

A

ASAP

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2
Q

What artery blockage can lead to complete heart block post MI?

A

Right coronary artery

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3
Q

What are the most common causes of infective endocarditis? For native and prosthetic valves

A

Staph aureus

Staph epidermidis if valve replacement <2months ago

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4
Q

What channel problem causes long QT syndrome?

A

Loss of function/blockage of K+ channels

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5
Q

Which electrolyte abnormality can lead to long QT syndrome?

A

Hypokalaemia

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6
Q

What drug is a common cause of QT prolongation?

A

Methadone

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7
Q

Describe the murmur heard in atrial septal defects.

A

Ejection systolic murmur louder on inspitation

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8
Q

How is symptomatic bradycardia treated?

A

Atropine

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9
Q

What are the antithrombotic therapies used for bioprosthetic and mechanical prosthetic valves?

A

Biosynthetic - aspirin

Mechanical - warfarin + aspirin

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10
Q

What is pulsus alternans seen in?

A

Left ventricular failure

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11
Q

What lung disease should pregnancy be avoided with?

A

Pulmonary hypertension as very high mortality levels

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12
Q

What are the rules for discharge post anaphylaxis?

A

Fast track 2hours after symptom resolution if good response to one dose of adrenaline, complete resolution, know how to use epipen
6+ hours post symptom resolution if 2 doses IM adrenaline needed or previous biphasic reaction
12+ hours if requiring more than 2 doses adrenaline, severe asthma, ongoing reaction, late night presentation, difficulty in reaching ED

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13
Q

How is CLL investigated for diagnosis?

A

Immunophenotyping

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14
Q

What is CLL caused by?

A

Monoclonal proliferation of B-cell lymphocytes

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15
Q

How is hereditary spherocytosis managed in acute haemolytic crisis and longer term?

A

Acute - supportive, transfusion if needed

Longer term - folate replacement, splenectomy

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16
Q

What is the pathogenesis of thrombotic thrombocytopenic purpura?

A

Abnormally large and sticky multimers of von Willebrand’s factor -> platelet clumps within vessels. Deficiency of ADAMTS13 which breaks down these large multimers.

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17
Q

What can help distinguish TTP from HUS?

A

Neuro signs seen in TTP

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18
Q

What happens to the oxygen dissociative curve in carbon monoxide poisoning?

A

Oxygen saturation of Hb decreases so early plateau in curve

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19
Q

Patient with cocaine use presenting with abdo pain or rectal bleeding =?

A

Ischaemic colitis

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20
Q

How does hypokalaemia cause digoxin toxicity?

A

Digoxin normally binds to ATPase pump at same site as potassium, if hypokalaemia then digoxin can bind more easily and has more inhibitory effects

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21
Q

What is the tried of symptoms in DRESS syndrome?

A

Drug rash with eosinophilia and systemic symptoms = skin rash + high fever + organ involvement

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22
Q

What are some common drug causes of urticardia?

A

Aspirin, penicillins, NSAIDs, opiates

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23
Q

Which drugs exhibit zero-order kinetics?

A

Phenytoin, salicylates, heparin, ethanol

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24
Q

What’s the general rule for autosomal recessive and dominant conditions?

A

Recessive are metabolic e.g. CF, sickle cell anaemia

Dominant are structural e.g. achondroplasia, APCKD, EDS

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25
Q

Give an example of an autosomal recessive and dominant condition

A

AR - CF, sickle cell anaemia, cystinuria, familial mediterranean fever, Fanconi anaemia, Friedreich’s ataxia, haemochromatosis, homocystinuria, thalassaemia
AD - achondroplasia, APCKD, EDS, hereditary spherocytosis, Huntington’s disease, Marfan’s syndrome, Noonan syndrome, Peutz-Jeghers syndrome

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26
Q

What cell surface protein is found on Reed-Sternberg cells?

A

CD15

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27
Q

What receptor does insulin bind to?

A

Tyrosine kinase

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28
Q

What is a p53 mutation associated with?

A

Li-Fraumeni syndrome - early-onset breast cancer, sarcoma, leukaemia

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29
Q

How do you calculate relative risk reduction?

A

(experimental event rate - control event rate)/control event rate

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30
Q

What is the response of pulmonary arteries to hypoxia?

A

Vasoconstriction

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31
Q

What does riboflavin/vitamin B2 deficiency cause?

A

Angular cheilitis

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32
Q

What is eczema herpeticum caused by?

A

Herpes simplex virus 1 or 2

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33
Q

Describe the rash associated with eczema herpeticum

A

Monomorphic punched-out erosion, circular, depressed, ulcerated lesions 1-3mm diameter

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34
Q

How can fungal nail infections be treated?

A

Oral terbinafine

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35
Q

Which patient population do Keloid scars most commonly occur in?

A

Young, black, male adults

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36
Q

Describe the usual presentation of lentigo maligna melanoma

A

Suspicious freckle on face or scalp of chronically sun-exposed patients

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37
Q

Describe the nature of nodular melanomas

A

Invade aggressively and metastasise early

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38
Q

What can deficiency of niacin /vitamin B3 cause?

A

Pellagra - dermatitis, diarrhoea, dementia

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39
Q

How does pemphigus vulgaris present?

A

Mucosal blistering, painful but non itchy blisters

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40
Q

What type of cancer can arise from chronic scars?

A

SCC - more aggressive and increased metastatic risk

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41
Q

What is Stevens-Johnson syndrome?

A

Severe systemic reaction affecting skin and mucosa

42
Q

How is Cushing’s syndrome investigated?

A

Low-dose overnight dex suppression test

43
Q

What HbA1c level is diagnostic of DM?

A

48mmol/mol (6.5%) or greater

44
Q

When should metformin be considered in T1DM patients?

A

If BMI >25

45
Q

What is the initial management of DKA?

A

Isotonic saline, then start IV insulin 0.1 units/kg/hour

46
Q

What are the typical features of MEN type 1?

A

Peptic ulceration, galactorrhoea, hypercalcaemia

Parathyroid cancer, pituitary cancer, pancreatic cancer, adrenal and thyroid cancers

47
Q

What’s the first line investigation in suspected primary hyperaldosteronism?

A

Plasma aldosterone/renin ratio - shows high aldosterone levels with low renin levels

48
Q

What’s the best way to test exocrine function in chronic pancreatitis?

A

Faecal elastase

49
Q

What is the pattern of inheritance for haemochromatosis?

A

Autosomal recessive

50
Q

What are the reversible and irreversible complications of haemoachromatosis?

A

Reversible - cardiomyopathy, skin pigmentation

Irreversible - liver cirrhosis, DM, hypogonadotrophic hypogonadism, arthropathy

51
Q

How should non-alcoholic fatty liver disease be investigated?

A

Enhanced liver fibrosis blood test

52
Q

What complication could PPIs cause that results in chronic diarrhoea?

A

Microscopic colitis - needs colonoscopy + biopsy

53
Q

How should small bowel bacterial overgrowth syndrome by investigated?

A

Hydrogen breath test

54
Q

How should spontaneous bacterial peritonitis be treated?

A

IV cefotaxime

55
Q

What is BCG vaccine unreliable in protecting against?

A

Pulmonary TB

56
Q

When should someone receive VZIG post exposure to chickenpox?

A

If they are immunosuppressed secondary to long-term steroids or methotrexate and have no antibodies, pregnant women without antibodies

57
Q

How should recurrent genital herpes be treated in pregnancy?

A

With suppressive therapy, low risk of transmission is low, aciclovir is safe in pregnancy

58
Q

How should genital warts be treated if multiple and non-keratinised vs solitary keratinised?

A

Multiple non-keratinised - topical podophyllum

Solitary keratinised - cryotherapy

59
Q

How is gonorrhoea treated?

A

IM ceftriaxone

60
Q

How is HIV investigated 4 weeks post exposure?

A

p24 (with HIV antibody)

61
Q

When should exchange transfusion be considered in malaria falciparum?

A

If parasite count >10%

62
Q

What is the typical CSF picture with mumps meningitis?

A

Viral but low bacteria, clear/cloudy appearance, normal/raised protein, 15-1000 cells lymphocytes

63
Q

How is mycoplasma pneumonia treated?

A

Doxycyline or macrolide

64
Q

How is latent syphilis treated?

A

Benpen IM single dose

65
Q

What can give a false positive to syphilis testing?

A

SomeTimes Mistakes Happen - SLE, TB, malaria, HIV

66
Q

What would the urine tests show in acute interstital nephritis?

A

Sterile pyruia, white cell casts

67
Q

What can help differentiate acute tubular necrosis from prerenal uraemia?

A

Prerenal uraemia holds onto sodium to preserve volume - low urine sodium, high urine osmolality, good response to fluid challenge, raised urea:creatinine ratio
ATN is the opposite

68
Q

How long does it take for an AV fistula to develop?

A

6-8 weeks

69
Q

What would recent URTI + haematuria make you think about?

A

Rapidly progressive GN - granulomatosis with polyangiitis

70
Q

How does thiazide diuretics impact renal stone risk?

A

Calcium excretion and stone formation decreased by their use

71
Q

What are some of the adverse effects of tacrolimus?

A

Impaired glucose tolerance, diabetes, tremor

72
Q

What is the most common form of renal disease in SLE?

A

Diffuse proliferative glomerulonephritis

73
Q

How does Klumpke’s palsy present?

A

T1 nerve root damage -> loss of intrinisc hand muslces

74
Q

What can trigger cluster headaches?

A

Alcohol

75
Q

What anti-epileptic is linked with Stevens-Johnson syndrome?

A

Lamotrigine

76
Q

How should bladder dysfunction be managed in MS?

A

Ultrasound to assess bladder emptying.
If significant residual volume -> intermittent self-catheterisation
If not -> anticholinergic to improve frequency

77
Q

What is the presentation of progressive supranuclear palsy?

A

Postural instability and falls, impairment of vertical gaze (down gaze worse than up), parkinsonism, cognitive impairment

78
Q

How can raised ICP cause 3rd nerve palsy?

A

Through uncal herniation through tentorium

79
Q

What are the antiplatelets used in TIA/stroke?

A

Clopidogrel

Aspirin + dipyridamole if can’t tolerate clopi

80
Q

How do you differentiate between upper and lower quadrant bitemporal hemianopias?

A

Upper - inferior chiasmal compression due to pituitary tumour
Lower - superior chiasmal compression due to craniopharyngioma

81
Q

What’s the classic presentation of central retinal vein occlusion + fundoscopy findings?

A

Sudden painless loss of vision

Several retinal haemorrhages on fundoscopy

82
Q

How should morphine dose be adjusted in palliative care if still in pain?

A

Increase by 30-50%

83
Q

How do benzodiazepines work?

A

Enhance effect of GABA - inhibitor neurotransmitter

84
Q

What’s first line treatment in GAD/panic disorder?

A

SSRIs

85
Q

What drugs should be avoided when a patient is on an SSRI?

A

NSAIDs - give with PPI
Warfarin/heparin - consider mirtazapine
Aspirin - consider mirtazapine
Triptans - increased risk of serotonin syndrome
MAOIs - increased risk of serotonin syndrome

86
Q

Which TCA is most dangerous in overdose?

A

Dosulepin

87
Q

How should a patient with suspected asthma be investigated?

A

With FeNO test + spirometry with reversibility

88
Q

What bacteria causes aspiration pneumonia?

A

Klebsiella

89
Q

What is the prognosis of sarcoidosis?

A

Remits in 2/3 without treatment

90
Q

What are the vasculites associated with the two ANCA types?

A 
c = granulomatosis with polyangiitis
p = eosinophilic granulomatosis with polyangiitis
91
Q

What are the causes of avascular necrosis of the hip?

A

Long-term steroid use, chemotherapy, alcohol excess, trauma

92
Q

What advice should be given to a pregnant patient taking azathioprine?

A

Safe to use

93
Q

What is the typical presentation of Behcet’s syndrome?

A

Oral ulcers + genital ulcers + anterior uveitis

94
Q

What can cause drug-induced lupus?

A

Proceinamide, hydralazine, isoniazid, minocycline, phenytoin

95
Q

What is the pathophysiology of gout?

A

Microcrystal synovitis caused by deposition of monosodium urate monohydrate in the synovium due to chronic hyperuricaemia

96
Q

What are the cardiac associations with Marfan’s disease?

A

Dilation of aortic sinuses -> aortic aneurysm, aortic dissection, aortic regurgitation, mitral valve prolapse

97
Q

What disease can cause positive anti-U1 ribonucleoprotein? (anti-RNP)

A

Mixed connective tissue disease, SSc, SLE

98
Q

What are the characteristic pattern of joint involvement in osteoarthritis of the hand?

A

Carpometacarpal joints, distal interphalangeal joints affected more than proximal interphalangeal joints

99
Q

What are the early XR features of RA?

A

Juxta-articular osteoporosis/osteopenia

100
Q

What antibodies are associated with SLE in pregnancy causing congenital heart block?

A

Anti-Ro

MRCP (3 decks)

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