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MRCP Combined > Pastest 3 > Flashcards

Pastest 3 Flashcards

1
Q

Which envelope proteins on the surface of HIV virus enable it to get into cells?

A

GP120 binds to primary receptor (CD4 molecule)

GP41 mediates movement through the cell membrane

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2
Q

How long does it take for HIV to become AIDs?

A

5-10 years

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3
Q

How does mefloquine toxicity present?

A

Acute psychosis

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4
Q

What does bartonella henselae cause?

A

Cat scratch disease

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5
Q

Which serological marker most strongly confirms recent acute hepatitis B infection?

A

Anti-HBC IgM

HbsAg often disappears by the time patients are jaundiced, and is present in acute and chronic

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6
Q

What is Jo1 syndrome?

A

Polymyositis + interstitial lung disease

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7
Q

When is methotrexate used in SLE?

A

If arthritis is present

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8
Q

What are the causes of death in PAN?

A

Renal failure
Bowel obstruction or perforation
Cardiovascular causes

(does not affect the pulmonary arteries)

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9
Q

What are the features of thoracic outlet syndrome?

A

Disappearance of arm pulse when raised above head

Pain, numbness and tingling

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10
Q

What are the characteristics of scleroderma renal crisis?

A

Malignant hypertension
Rapid renal impairment
Onion skin intrarenal vasculature
More common in diffuse systemic sclerosis

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11
Q

How is bronchiolitis obliterans diagnosed?

A

Irreversible obstructive picture

CT: bronchial wall thickening and air trapping

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12
Q

What is the cause of hypoxia in primary pulmonary hypertension?

A

Intra-pulmonary shunting

Reduced diffusion capacity secondary to arterial fibromuscular dysplasia

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13
Q

How does sleep apnoea lead to cor pulmonale?

A

Chronic nocturnal hypoxia –> pulmonary artery vasoconstriction –> secondary pulmonary hypertension

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14
Q

What are the causes of primary pulmonary hypertension?

A

Plexogenic pulmonary arteriopathy

Chromosome 2

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15
Q

What type of arthritis can worsen in the post-operative period?

A

Crico-arytenoid arthritis

Causes stridor

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16
Q

What are the causes of type 2 membranoproliferative glomerulonephritis?

A

Partial lipodystrophy
Factor H deficiency
Measles

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17
Q

What can acute kidney rejection be confused for?

A

Post-transplant lymphoproliferative disorder

Polyomavirus BK virus

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18
Q

What are the two types of acute kidney transplant rejection?

A

Cell mediated

Antibody mediated

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19
Q

What are the criteria for diagnosis of antibody mediated acute kidney transplant rejection?

A

Graft dysfunction
Histological evidence of tissue injury
Positive staining for C4d
Presence of donor specific antibody

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20
Q

What medications are given during kidney transplant surgery?

A

1g methylprednisolone

Anti-CD25 monoclonal antibody e.g. basiliximab

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21
Q

Which antibodies are involved in acute kidney transplant rejection?

A

IgG

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22
Q

What is the WAGR triad?

A

Wilms’ tumour
Aniridia
Genitourinary problems
LD

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23
Q

What are the causes of normal anion gap metabolic acidosis?

A

CAT MUDPILES

Cyanide poisoning
Aminoglycosides
Toluene
Methanol
Uraemia
DKA
Paracetamol
Isoniazid
Lactic acid
Ethanol
Salicylates
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24
Q

Which type of nephropathy is caused by underlying malignancy in 10%?

A

Membranous

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25
Q

What are Bartter and Gitelman syndromes?

A

Bartter - kidneys cannot reabsorb chloride in the thick ascending limb of the Loop of Henle
Gitelman - kidneys cannot reabsorb chloride in the distal convoluted tubule

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26
Q

When are Bartter and Gitelman syndromes diagnosed?

A

Bartter - childhood

Gitelman - later

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27
Q

What is disequilibrium syndrome?

A

Cerebral oedema caused by rapid shifts of uraemic toxins, associated with too-rapid haemodialysis

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28
Q

What type of antibody deficiency is associated with infection with polysaccharide coated organisms?

A

IgG2

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29
Q

What investigation confirms hyperaldosteronism?

A

Saline suppression test

But often hypertension, hypokalaemia, and raised aldosterone are adequate for diagnosis.

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30
Q

When is oral aciclovir given in chickenpox?

A

Adults presenting within 72h onset

Pregnancy/immunocompromised

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31
Q

What are the features of Sweet’s syndrome?

A

Associated with myelodysplastic disorders
Plum coloured lesions, mucosal involvement
Neutrophilia and fever

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32
Q

How does lorazepam enhance the effects of anti-emetics?

A

GABA-A modulator

Increases the opening frequency of GABA activated chloride channels

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33
Q

What are the characteristics of disseminated mycobacterium avium complex?

A

Occurs in pts with CD4 <50
Fever + night sweats
Diarrhoea and weight loss
Hepatomegaly and lymphadenopathy

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34
Q

How effective is the BCG vaccine at preventing severe TB?

A

70-80%

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35
Q

What is the treatment of syphilis?

A

IM Procaine penicillin/benzathine penicillin

Pen allergic - azithromycin

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36
Q

When should you suspect alpha thalassaemia?

A

Microcytic anaemia

Normal/raised ferritin

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37
Q

How is methanol metabolised?

A

By alcohol dehydrogenase to formaldehyde

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38
Q

What are indications of haemodialysis in methanol poisoning?

A 
Methanol concentration >50mg/dL
Visual disturbance/CNS toxicity
Severe metabolic acidosis
Severe electrolyte imbalance
Renal failure
Deterioration despite initial treatment with fomepizole/ethanol
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39
Q

How does heparin cause hyperkalaemia?

A

Inhibits aldosterone secretion
leads to impaired renal potassium secretion
Particularly in patients who are diabetic or acidotic

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40
Q

What receptor increases response to chemotherapy if expressed on cancer cells?

A

P-glycoprotein

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41
Q

How does HCOM compare to aortic stenosis?

A

Similar symptoms and signs
Jerky pulse in HCOM
Valsalva increases intensity of murmur in HCOM and decreases murmur in aortic stenosis

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42
Q

Which cytotoxic agent is used in colorectal carcinoma?

A

5-fluoruracil

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43
Q

What is seen on fundoscopy in CMV retinitis?

A

Necrotising retinitis with haemorrhages

Brush fires

44
Q

What is the treatment of hyphaema?

A

Acetazolamide to lower IOP (blood clots and blocks trabecular network)
Anterior chamber paracentesis 2nd line

45
Q

What does asymmetrical diabetic retinopathy suggest?

A

Ocular ischaemic syndrome (on the side affected worse)

46
Q

Why are nerve conduction studies normal in MS?

A

Peripheral nerves are unaffected

47
Q

What are the ocular features of rosacea?

A

Blepharitis

Keratitis

48
Q

Why are IV nitrates used in acute pulmonary oedema?

A

Activation of RAAS and high catecholamine levels lead to peripheral vasoconstriction which increases myocardial oxygen demand

49
Q

What pressures are seen in right ventricular infarct?

A

High right atrial pressure

Low left atrial pressure

50
Q

What is reversed splitting of the 2nd heart sound?

A

The pulmonary valve closes before the aortic valve

LBBB, HCOM, AS

51
Q

What is a fixed splitting of the 2nd heart sound represent?

A

ASD or VSD

52
Q

What is the choice of rhythm control in AF?

A

Structurally normal heart - flecainide
LVSD - amiodarone
IHD - sotalol

53
Q

Which drugs can cause primary pulmonary hypertension?

A

Appetite suppressants - fenfluramine

Methamphetamine

54
Q

Why is the posteromedial papillary muscle more likely to rupture than the anterolateral papillary muscle?

A

Supplied by right coronary artery only

Anterolateral is supplied by LAD and left circumflex

55
Q

Where is the focus of radiofrequency ablation in AF?

A

Where the pulmonary veins join with the atrium

56
Q

What is pro-insulin cleaved to?

A

Insulin and C peptide

57
Q

What anaesthetic agents are patients most likely to be allergic to?

A

Neuromuscular blocking agents e.g. vecuronium

58
Q

What is the cause of hyperglycaemia in trauma?

A

Noradrenaline and glucagon –> glycogenolysis

Cortisol acts more slowly –> gluconeogenesis

59
Q

What is the cause of hoarse voice in recurrent laryngeal nerve injury?

A

Paralysis of the posterior cricoarythenoid muscle, which opens the vocal cords

60
Q

What is the cause of Kartagener’s syndrome?

A

Absence of dynein - which converts chemical energy from ATP into ciliary movement

61
Q

Why is renal disease not seen in Waldenstrom’s macroglobulinaemia?

A

Absence of light chains

62
Q

In which population is Gaucher disease most prevalent in?

A

Ashkenazi Jews

63
Q

Which complement changes are associated with acquired lipodystrophy?

A

Low C3

High C3b nephritic factor

64
Q

Which cells produce CSF?

A

Ependymal cells

65
Q

What are the two most common types of autoimmune encephalitis?

A

1) NMDA receptor abs –> presents with psychiatric sx

2) LGI1 receptor abs –> faciobrachio dystonic seizures

66
Q

What are the features of progressive supranuclear palsy?

A 
Symmetrical rigidity, proximal worse than distal
Dysphagia
Loss of verbal fluency
Minimal autonomic dysfunction
Vertical gaze palsy
Early falls
Poor response to levodopa
67
Q

What is T wave discordance with LBBB?

A

The T wave deflection must be opposite the terminal deflection of the QRS complex

Concordant deflections suggest IHD/MI

68
Q

Why are people with liver disease susceptible to hypoglycaemia?

A

Liver’s inability to produce glycogen

69
Q

How are myeloproliferative disorders classified?

A

According to the proliferating type of cell

RBC: polycythaemia vera
WBC: CML
Platelets: essential thrombocytosis
Fibroblasts: myelofibrosis

70
Q

What is melanosis coli pathognomic of?

A

Senna abuse

71
Q

What are the signs of cardiac amyloid?

A

Dilated atria (restrictive filling pattern)
Thickened LV walls
Granular sparkling appearance of LV
Heart block

72
Q

What is seen on MRI in variant and sporadic CJD?

A

Variant: increased signal in the pulvinar of the thalamus
Sporadic: increased signal in the caudate nucleus with cortical ribbon hyperdensity

73
Q

What are the differences in presentations of variant and sporadic CJD?

A

Variant: 26 years, neuropsychiatric, painful sensory disturbance
Sporadic: 40-60 years, myoclonus, dementia, ataxia

74
Q

What are the characteristics of inclusion body myositis?

A

Muscle weakness - esp quadriceps and finger flexors
CK can be normal
Aged over 50

75
Q

What is the CSF biomarker for sporadic CJD?

A

14-3-3 protein

76
Q

What is the cause of cavernous sinus thrombosis?

A

Suppurative process in the orbit, nasal sinuses, or upper half of face –> s.aureus

77
Q

What are the features of cavernous sinus thrombosis?

A

Obstruction of ophthalmic vein: chemosis, oedema, cyanosis of upper face
Damage to 3rd, 4th, 6th CN: ophthalmoplegia
Damage to V1th CN: eye pain and hyperaesthesia of the forehead

78
Q

What is myocardial bridging?

A

Coronary artery (commonly proximal portion of LAD) takes an intramuscular course - predisposes to IHD as compressed during systole

79
Q

What are single nucleotide polymorphisms?

A

Point mutations (substitution of a single nucleotide) that result in changes in alleles

80
Q

How does oestrogen form?

A

Cholesterol –> testosterone –> oestradiol (catalysed by aromatase)

81
Q

Why can obese/alcoholic patients become feminised?

A

Alcohol and obesity increase aromatase activity

82
Q

What is seen on bone biopsy in Paget’s disease?

A

Multinucleated osteoclasts

83
Q

What does the RET protooncogene code for?

A

A receptor tyrosine kinase

84
Q

How is an extra-adrenal phaeochromocytoma diagnosed?

A

Noradrenaline is particularly raised

MIBG scan - specific uptake in sites of sympathetic activity

85
Q

What is the cause of nephrotic syndrome in SLE?

A

Class V nephritis - membranous nephropathy

86
Q

Untreated UTI in diabetic patients can result in?

A

Renal papillary necrosis

87
Q

Why can RV infarction cause hypovolaemic shock?

A

Blood pools in RV

Consequential decreased preload in LV

88
Q

Why does proximal R coronary artery occlusion have a higher rate of complete heart block than distal?

A

Includes AV nodal artery and right superior descending artery

89
Q

What type of axis deviation is seen in ASDs?

A

LAD: ostium primum
RAD: ostium secundum

90
Q

What is the mode of action of adenosine?

A

G-protein coupled receptor agonist of the adenosine A1 receptor in AV node

91
Q

What are the differences between cauda equina syndrome and conus medullaris syndrome?

A

C.E: gradual and unilateral, unilateral weakness, ankle and knee jerks affected, urinary retention
C.M: sudden and bilateral, symmetrical weakness distal>proximal, knee jerks preserved, urinary and faecal incontinence, fasciculations

92
Q

Where does pre-mRNA splicing occur?

A

Nucleus

93
Q

Why does quinine lead to hypoglycaemia?

A

Stimulates insulin release

94
Q

What type of laxative is recommended to prevent/treat opioid induced constipation?

A

Stimulant e.g. senna

95
Q

Why might a patient with allergies and coeliac disease have negative anti-endomyseal antibody?

A

IgA deficiency - they may have used IgA assay instead of IgG

96
Q

Which cytokine drives the production of CRP?

A

IL-6

97
Q

Which interleukin is seen in transplant rejection?

A

IL-2, as it causes T cell proliferation

Therefore use of calcineurin inhibitors such as tacrolimus and ciclosporin

98
Q

Which antibody confirms recent infection?

A

IgM

As it is the first to be secreted in response to infection

99
Q

What type of T helper cell drives autoimmune disease?

A

Th-17 - secretes IL-17

100
Q

Which part of the antibody forms the antigen binding site?

A

The variable domains of each light and heavy chain of the antibody

101
Q

How do you calculate ejection fraction?

A

(EDV - ESV) / EDV

102
Q

Which antibody is negative in discoid lupus?

A

ANA

103
Q

What is the treatment of cataracts?

A

Extracapsular lens extraction with a posterior chamber lens implant

104
Q

What are the features of sarcoid granulomas?

A

Non caseating
Centre contains macrophages and Langerhans giant cells (which contain >10 nuclei)
Schumann body containing calcium phosphate crystals
Surrounded by ring of CD4 helper and then CD 8 suppressor cells

105
Q

What is a crossover study?

A

The patient will receive all the drugs in the study

106
Q

How does lambert Eaton syndrome differ from myasthenia graves?

A
  • loss of reflexes
  • autonomic symptoms
  • ptosis, no oculoparesis
107
Q

How does Terlipressin treat hepatorenal syndrome?

A

Decreased renin activity

MRCP Combined (58 decks)

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