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2MRCP Part 2 > Wrong Answers > Flashcards

Wrong Answers Flashcards

1
Q

Porphyria Cunatea Tarda
- presentation
- investigation

A

Skin eruptions
Urine uroporphyrin

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2
Q

AF + WpW
- medication used
- what to avoid

A

Procanamide
Avoid ABCD
= adenosine, B blockers, CCB, digoxin

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3
Q

Iron overdose
- threshold
- management

A

> 40mg/kg = need levels 2-4 hours after, abdominal XR
60mg/kg = whole bowel irrigation
90umol = desferrioxamine

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4
Q

When do you use desferrioxamine in iron overdose?

A

When serum levels >90umol

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5
Q

Difference between scleritis and episcleritis

A

Scleritis = scary pain
Episcleritis = easy going

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6
Q

Caution in ascitic tap

A

INR >2.0 (aim for <1.5 but accept some abnormality e.g. coagulopathy)

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7
Q

ECG finding in ARVC

A

TWI in V1-V3

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8
Q

What is the J point

A

Transition between the QRS complex and ST segment

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9
Q

Causes of pulmonary eosinophilia (3)

A

Churg Strauss
Allergic Bronchopulmonary Aspergillosis
Loffler’s Syndrome (2y to parasite)

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10
Q

What is Loffler’s Syndrome?
Management

A

Simple pulmonary eosinophilia
Often triggered by a parasite
Mx = mebendazole

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11
Q

Guidance for management of BMs in DKAHe

A

Aiming to reduce BM by 3 mmol/hour until 14mmol
Need to avoid rapid correction

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11
Q

What is Type 2 Cryoglobulinaemia associated with?

A

Hepatitis C

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12
Q

Cavitating lesion with halo sign and hyphae =

A

Invasive aspergillosis

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13
Q

Inflammatory infiltrates and inclusions on muscle biopsy

A

= inclusion body myositis

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14
Q

Presentation of inclusion body myositis

A

= affects wrists and fingers
Specifically finger flexor weakness: may also affect quadriceps muscle
Mixed proximal and distal distribution
Normal-high CK

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15
Q

Lymphocytic infiltrates CD8 invading non-necrotic muscle fibres on muscle biopsy

A

= polymyositis

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16
Q

Crescendo TIAs
Management

A

= multiple TIAs within 7 days
Admit for investigation: need to be treated as high risk

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17
Q

Management of myxoedema coma

A

T3 (liothyronine) and T4

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18
Q

Management of anaemia in CKD
- ferritin threshold

A

Anaemia + ferritin <200
= iron infusion first
THEN
epo

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19
Q

Management of Barrett’s Oesophagus

A

Ablation

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20
Q

Give three fibrin specific agents used in STEMI

A

Alteplase
Tenecteplase
Reteplase

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21
Q

Management of pituitary adenoma

A

Dopamine agonist
= regardless of size or neurology

Only progress to surgery if medical management fails

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22
Q

Assessment of delirium

A

= confusion assessment method
Comparable to 4AT in studies

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23
Q

Management of regular narrow complex tachycardias

A

Adenosine 6/12/18mg
Then CCB e.g. verapamil
Then DCCV
Consider amiodarone if irregular ?flutter or fibrillation

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24
Threshold for starting statin based on QRISK
>10% If <10% then no indication
25
Trigger for worsening EGPA
Starting LTRA (e.g. difficult to control supposed asthma, actually EGPA)
26
Cerebellar signs Rapid progression (1-2 weeks) Myoclonic movements
Consider CJD
27
Parenchymal bands Honeycombing Traction bronchiectasis CT Thorax - diagnosis?
Asbestosis
28
Acutely painful red eye Photophobia Small pupil Reduced visual acuity
Anterior uveitis
29
Prednisolone in severe alcoholic hepatitis
Review response at 7 days If no response, discontinue and continue with supportive management (a Lille score of >0.45 = failure of prednisolone)
30
What is the anti-fibrotic used in IPF?
Perfenidone
31
Presentation of autoimmune pancreatitis Investigation findings Associations
Nausea, jaundice, new diabetes IgG4 RA, Sjogrens
32
Associations with autoimmune pancreatitis
Rheumatoid Arthritis Sjogren's Syndrome
33
Immunosuppressant + biologic Increased risk of?
Non melanoma skin cancer
34
Small Bowel Overgrowth VS Dumping
SBO = low albumin, deficient in fat soluble vitamins Macrocytic anaemia Negative faecal calprotectin Dumping Micro and macrocytic anaemia - B12/folate and iron deficient
35
Hiking + flavavirus Management
Tick born encephalitis = supportive management
36
Nerve distribution in HSMN Genetic basis
Ulnar and common peroneal nerve common PMP22 gene
37
Risk of aminophylline and theophylline (4)
Tachycardia Hyperglycaemia Hypokalaemia Increased contractility of myocardium
38
Management of VRE (3)
Linezolid Daptomycin Tigecycline
39
Cirrhosis in Hepatitis B associated biochemical marker
DNA levels of hepatitis B
40
Uraemia and pericardial pathology
Uraemia Pericarditis Repeated episodes Pericardial calcification Constrictive pericarditis
41
Management of homozygous CF
Orkambi - lumacaflor/ivacaflor Delta F508 mutation
42
What is lumacaflor/ivacaflor?
Orkambi Modifying treatment in CF
43
Intermittent dysphagia Corkscrew appearance Management?
Oesophageal spasm Management = long acting nitrates, then CCB then surgical options e.g. dilation
44
Presentation of iron overdose (3)
Liver failure Hyperglycaemia - characteristic (then hypoglycaemia) Haemolysed samples
45
CT Chest - Goodpasture's Syndrome
Bibasal parenchymal consolidation No masses or nodules
46
Visceral leishmaniasis presentation (6) Investigation
Grey tinge to skin Malaise Fever Abdominal pain Hepatomegaly Splenomegaly Ix: splenic aspirate
47
Grey tinge to skin Malaise Fever Abdominal pain Hepatomegaly Splenomegaly Foreign travel with bites Diagnosis?
Visceral leishmaniasis
48
Management of hypercalcaemia How does option #3 work?
IV fluids Bisphosphonates Calcitonin - decreases calcium resorption, inhibits calcium reabsorption in intestine, inhibits osteoblast activity
49
Management of medication overuse headache
Wean opiate Stop all other medications abruptly
50
Contra-indication for ECT
Raised ICP
51
What GN is hepatitis C associated with?
Mesangiocapillary GN
52
Epistaxis, Haemoptysis, IDA Investigation findings
Hereditary Haemorrhagic Telangiectasia CXR - lung nodules (AVMs) in lungs CT - AVMs in liver and spleen
53
Management of fully sensitive TB
2 months RIPE then 4 months rifampicin and isoniazid
54
Management of isoniazid resistant TB
2 months RIPE (usually takes that long to get sensitivities) THEN 4 months rifampicin and ethambutol
55
What is retinitis pigmentosa associated with?
Alport's Syndrome
56
Management of salmonella gastroenteritis
Conservative IF immunocompromised/valve = ciprofloxacin
57
Haematuria Abdominal pain Haemolytic anaemia Coombs negative
Paroxysmal nocturnal haemoglobinuria
58
Paroxysmal nocturnal haemoglobinuria - pathology - management
= decreasd CD59, increased complement lysis Curative management = bone marrow
59
T2DM Weight loss On SGLT2
= if significant weight loss, re-consider diagnosis Can trigger euglycemic ketoacidosis
60
Management of peritoneal dialysis
Intraperitoneal abx = vancomycin + ceftazidime
61
Management of IgA nephropathy
Depends on proteinuria NO = conservative YES = ACE-I If eGFR falling = add in steroid
62
Conduction pattern in ARVC
LBBB VT originates from right ventricle, takes abnormal pattern of conduction from right > left ventricle through slow myocardium
63
Lung collapse XR findings
White out Trachea pulled TOWARD
64
Deciding on management of subclinical hypothyroidism
Need DEXA scan if woman - if osteoporosis may mean needs medication
65
Management of amiodarone induced thyrotoxicosis
Stop amiodarone Give prednisolone
65
Chronic hepatitis B with sudden worsening
Hepatitis D infection
66
Least risk of overdose in bipolar disorder
Sodium valproate
67
Presentation of alcoholic neuropathy
Burning pains Symmetrical B12/folate normal (ish)
67
CSF = low glucose, lymphocytes, increased protein
TB meningitis
68
High BMI Psychotic Best anti-psychotic
Aripiprazole
69
TB meningitis - CSF results
Low glucose, lymphocytes, increased protein
70
Cause of parkinsonism (extra-pyramidal signs)
Heavy metal poisoning
71
What common medication interacts with HIV medications
PPI = reduces efficacy, can see rise in opportunistic infections
72
Diagnosis of TB HIV + CD4 <200
Need QF (Mantoux unreliable)
73
IgG deposits and complement on basement membrane - renal biopsy
Membranous nephropathy
74
Lung nodule management <5mm, solid
Nil further investigation needed
75
Management of Crohn's Disease
1. Prednisolone 2. Budesonide
76
Management of Thyroid Storm
1. IV BB e.g. propranolol Then PTU/methimazole Then steroids
77
Start NAC immediately if...
Overdose >24 hours ago AND Tender OR raised ALT OR jaundiced
78
Suspected PE, renal impairment
Need VQ scan
79
Monitoring for malignancy in MEN II
Calcitonin
80
Risk of TIPS procedure
Worsening hepatic encephalopathy
81
1st line management of Wilson's Disease
Trientine (Pencillamine less favoured, CI if penicillin allergic)
82
Risk factor for warfarin-induced skin necrosis
Protein C deficiency (also protein S deficiency, but protein C has shorter half life so effects visible faster)
83
Systemic sclerosis + HTN (extreme) - diagnosis - management
= sclerodermic renal crisis Need PO ACEI to manage HTN IV labetalol can cause severe ATN
84
Visual phenomena alone
Acephalgic migraine
85
What is the malignancy with the highest increased risk in Cowden's Sydnrome
Breast cancer - approx 50% lifetime risk (endometrial approx 30%)
86
Repeated UTI in poorly controlled DM - organism
Extended spectrum B lactamase producing E. coli
87
Lack of response to calcium supplementation
Need to be magnesium replete
88
Management of TB - no evidence of pulmonary disease
Rifampicin Isoniazid - both for three months
89
Non-dominant weakness Sensory inattention - lobe of brain involved - visual field defect
Parietal lobe = inferior quadrantopia
90
SOB + click synchronised with inspiration
Apical pneuomthorax - CXR may be "normal"
91
Hepatitis B treatment
Pegylated interferon is 1st line
92
Management of amoebic abscess
Metronidazole
93
Management of GPA
Prednisolone + cyclophosphamide - rituximab if cyclophosphamide contra-indicated
94
Violaceous rash in IBD - management
= pyoderma gangrenosum Can form around stoma sites Mx: PO steroids - if nil response then trial IV infliximab
95
Management of severe AR - asymptomatic
AVR if EF <55% OR LV dilation (diastolic volume >70, systolic >50)
95
Urticaria Night sweats Fibrosis Restrictive Cardiomyopathy
Hyper eosinophilic Syndrome = myleproliferative disorder Usually seen in men, 30-40s
96
Leprosy - tuberculoid vs lepromatous
Tuberculoid - sensation classically lost in rash, confined to a nerve distribution Lepromatous - widespread, may involve eyes
97
Threshold for respiratory support in GBS
FVC <20ml/kg e.g. 60kg FVC <1.2L
98
Risk of fleccanide in AF
= increases risk of AF transforming into flutter Usually go >200bpm MUST co-prescribe with a BB
99
What suggests the drainage of an effusion will not be successful?
Septation of pleural effusion
100
Management of necrotising fasciitis
Tazocin Clindamycin
101
Thrombocytopaenia MP rash Fever Facial Flushing Traveller
Dengue haemorrhagic fever
102
Can you use ceftriaxone in penicillin allergy?
No - need alternative e.g. chloramphenicol in meningitis
103
Management of acute angle closure glaucoma (definitive)
Iridotomy

2MRCP Part 2 (14 decks)

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