Alfred 2017 Exam

Question 1

5 Lacunar Syndromes

Answer 1

1. Pure motor hemiparesis
   - Unilateral paralysis of arm, face, leg
   - Dysarhthria, dysphagia
2. Pure sensory syndrome
   - Unilateral numbness of face, leg, arm
3. Ataxis hemiparesis
   - Unilateral weakness and limb ataxia
4. Sensorimotor syndrome
   - Hemiparesis or hemiplegia of face, arm and leg
   - Ipsilateral sensory impairment
5. Dysarthria-clumsy hand syndrome
   - Unilateral facial weakness
   - Dysarthria + dysphagia
   - Mild hand weakness and clumsiness

Question 2

What condition is CGRP antibodies associated with

Answer 2

Trigeminal neuralgia

Question 3

What type of headache is botulinum toxin type A useful for

Answer 3

Chronic migraine (16-30 headache days a month)

Question 4

Do statin-induced myopathies resolve after cessation of statin

Answer 4

Symptoms should resolve within weeks

If it doesn’t consider immune-mediated necrotising myopathy

Question 5

What antibodies mediated immune-mediated necrotising myopathy

Answer 5

HMG-CoA reductase antibodies

Question 6

What is the nature of symptoms in statin-associated myopathy

Answer 6

Bilateral
Large muscle groups
Symptom onset 4-6 weeks after statin initiation

Question 7

Where are lesions associated with hemiballism located

Answer 7

Subthalamic nucleus

Question 8

What tumours are associated with RET gain of function mutation

Answer 8

MEN 2A MEN 2B
Medullary thyroid cancer
Phaeochromocytoma
Parathyroid hyperplasia

Question 9

Ivabradine MOA

Answer 9

Blocks funny channel to prevent sodium influx - reduces action potential

Question 10

What causes the systolic murmur in ASD

Answer 10

Increased flow from RV across pulmonary valve to pulmonary arteries

Question 11

P2Y12 inhibitors onset of effect and reversibility

Answer 11

Clopidogrel
- 4 hours, irreversible

Ticagrelor
- 30 mins, reversible

Prasugrel
- 30 mins, irreversible

Question 12

What medication increases AUC of dabigatran

Answer 12

Verapamil

Question 13

Morphine to codeine conversion

Answer 13

1:10

Oral morphine 1mg = oral codeine 10mg

Question 14

Morphine to hydromorphone conversion

Answer 14

5:1

Morphine 5mg = hydromorphone 1mg

Question 15

Morphine to oxycodone conversion

Answer 15

1.5:1

Oral morphine 15mg = oral oxycodone 10mg

Question 16

Morphine to tapentadol

Answer 16

1:3

oral morphine 100mg = oral tapentadol 300mg

Question 17

Morphine to tramadol

Answer 17

1:5

Oral morphine 10mg = 50mg tramadol

Question 18

Oral morphine to subcut morphine

Answer 18

2-3:1

Oral morphine 30mg = subcut 10-15mg

Question 19

Oral hydromorphone to subcut hydromorphone

Answer 19

2-3:1

Oral hydromorphone 24mg = subcut hydromorphone 8-12mg

Question 20

In a drug with low hepatic extraction ratio what effect does doubling the ratio have on bioavailability

Answer 20

Low hepatic extraction ratio = high dose of drug gets through the liver

Doubling or halving extraction rate has little change on bioavailability

Question 21

What kind of peptides do MHC class I molecules present

Answer 21

Peptides generated in the cytosol by proteasome

Question 22

What kind of antigens do MHC class II molecules present

Answer 22

Extracellular proteins which are endocytosed, lysosomed and then presented as a peptide on MHC class II

Question 23

Hereditary angioedema type 1 - C1INH level and functional C1INH assay level

Answer 23

Type 1 is C1 inhibitor deficiency

C1INH level reduced

Functional C1INH assay abnormal

Question 24

Hereditary angioedema type 2 - C1INH level and functional C1INH assay level

Answer 24

Type 2 is C1 inhibitor dysregulation

C1INH level normal

Functional C1INH assay abnormal

Question 25

Icatibant MOA

Answer 25

Bradykinin-2 receptor antagonist

Question 26

Which Ig is lower level in plasma

Answer 26

IgE

Question 27

Cross-reacting foods in latex allergy

Answer 27

Avocado Chestnuts Banana Kiwi fruit

Question 28

Fried's frailty phenotype

Answer 28

``` Involuntary weight loss >=4.5kg in last year Self-reported exhaustion Slow gait Low physical activity Reduced handgrip strength ```

Question 29

Annual conversion rate of MCI to dementia

Answer 29

10%

Question 30

Neuroimaging for diagnosing Lewy body dementia

Answer 30

FDG PET

Question 31

Drugs a/w PML

Answer 31

``` Natalizumab Rituximab Ibrutinib Infliximab Ocrelizumab ```

Question 32

Chronic liver disease coagulation changes

Answer 32

Decreased protein C Reduced platelet Elevated vWF levels Decreased factor VII levels

Question 33

Hepcidin function

Answer 33

Acts to decrease intestinal iron absorption by causing down regulation of ferroportin on the basolateral membrane of enterocytes

Question 34

Favourable factors in AML

Answer 34

MDR 1-negative phenotype t(8:21), inv(16)/t(6:16), t(15:17) NPM1 mutation CEBPA mutation

Question 35

Unfavourable factors in AML

Answer 35

``` MDR 1-positive phenotype Monosomal karyotype Complex karyotype abnormalities t(6:9); t(9:11); inv(3) FLT3/ITD mutation ```

Question 36

Which organism does moxifloxacin not have antimicrobial activity against

Answer 36

Pseudomonas aeruginosa

Question 37

Germ cell tumour hormone profile

Answer 37

Testosterone normal LH normal HCG increased Oestradiol normal

Question 38

Findings in MLF lesion

Answer 38

- Paramedian pontine reticular formation (PPRF) receives contralateral information from higher centres (frontal eye fields, occipital and parietal lobes, superior colliculus) to send signal to ipsilateral CNVI - Causes INO

Question 39

Central cord syndrome UL vs LL weakness

Answer 39

Disproportionate upper limb to lower limb weakness

Question 40

Lower limb finding in psoas haematoma

Answer 40

Femoral nerve compression and femoral neuropathy Loss of power in hip flexion and knee extension Loss of knee jerk reflex Reduced anterior medial thigh sensation and medial lower leg sensation