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MRCP Revision > Deck 1 > Flashcards

Deck 1 Flashcards

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1
Q

Common SE of cisplatin

A

Hypomag

NB: p

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2
Q

Common SE of taxels

A

e.g. docetaxel = neutropenia

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3
Q

Common SE cyclophosphamide

A

Haemorrhagic cystitis, myelosuppression, TCC

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4
Q

Which antipsychotics can be used vs shoudl be avoided in Lewy body dementia?

A

low-dose second-generation can be sued e.g. clozapine, quetiapine, aripiprazole

avoid haloperidol and tranylcpromine

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5
Q

Clotting results in antiphospholipid syndrome

A

(paradoxically) prolonged APTT + low platelets

NB: antiphospholipid antibodies interfere with phospholipid-dependent coagulation tests, leading to a prolonged APTT. The presence of thrombocytopenia is also a common finding in APS.

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6
Q

Lambert Eaton antibodies

A

Against voltage gated Ca channels

NB: commonly found as a paraneoplastic disorder , lower limbs first, symptoms improve with use

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7
Q

Anti JO antibodies

A

Polymyositis

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8
Q

Anti-Mi-2 antibodies

A

dermatomyositis

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9
Q

Anti-MuSK antibodies

A

Also MG but less common than anti-AChR

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10
Q

t(11:14)

A

Mantle cell - cyclin D1 expression
6% of all non-Hodgkin lymphomas

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11
Q

t(15;17)

A

Acute promyelocytic leukaemia (subtype of AML) - abnormal retinoic acid receptor alpha which blocks maturation of myeloid cells

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12
Q

Burkitt’s translocations

A

t(8;14), t(2;8), t(8;22)

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13
Q

t(9;22)

A

CML - causes BCR-ABL1
Philadelphia chromosome

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14
Q

Acetazolamide MOA

A

Carbonic anhydrase inhibitor used as diuretic
Causes bicarbonaturia and metabolic acidosis

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15
Q

PAH definition

A

resting mean pulm artery pressure of >=20mmHg - endothelin plays key role

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16
Q

Clinical signs of PAH

A

RV heave (RV hypertrophy or dilatation)
loud P2
Raised JVP with ‘a’ waves
TR

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17
Q

Before starting management for PAH

A

Acute vasodilator testing (inhaled nitric oxide or intravenous epoprostenol)

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18
Q

Positive response to vasodilator testing in PAH …

A

Oral CCB e.g. nifedipine

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19
Q

Negative vasodilator response to PAH….

A

Prostacyclin analogues (treprostinil, iloprost)
Endothelin receptor antaghonists - bosentan, ambrisentan
Phosphodiesterase inhibitors - sildenafil

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20
Q

Life threatening asthma features

A

PEFR < 33% best or predicted
Oxygen sats < 92%
‘Normal’ pC02 (4.6-6.0 kPa)
Silent chest, less respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma

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21
Q

Severe asthma features

A

PEFR 33 - 50% best or predicted
Can’t complete sentences
RR > 25/min
Pulse > 110 bpm

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22
Q

Moderate asthma features

A

PEFR 50-75% best or predicted
Speech normal
RR < 25 / min
Pulse < 110 bpm

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23
Q

What would pH of 7.33 in acute asthma suggest ?

A

Carbon dioxide retention in tiring patient

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24
Q

Dermatomyositis antibodies

A

ANA

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25
Anti-Scl-70 antibodies = ?
Diffuse systemic sclerosis
26
First line in delirium tremens/alcohol withdrawal
chlordiazepoxide, loraz/diazepam
27
Film of FBC in G6PD deficiency
Heinz bodies Bite and blister cells
28
Medications to avoid in G6PD deficiency
Ciprofloxacin Antimalarials Sulph group drugs incl sulfonylureas
29
Inheritance of G6PD deficiency
X linked recessive - males only
30
Baclofen MOA
GABA agonist, acts in CNS
31
Genetic condition associated with renal angiomyolipomata
Tuberous sclerosis
32
Where is phosphate reabsorbed in the nephron
Proximal tubule
33
Anorexia features
most things low G's and C's raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia
34
Bevacizumab MOA
ANti VEGF
35
Screening for hereditary angioedema
Serum C4m- will be low (C1 always low, and C2 low)
36
Tx of hereditary angioedema
IV C1 inhibitor concentrate FFP Prophylactic: Danazol (anabolic steroid)
37
Gingival hyperplasia drug causes
phenytoin, ciclosporin, calcium channel blockers and AML
38
Gold standard tests for PNH (paroxysmal nocturnal haemoglobinuria)
Flow cytometry for CD59 and CD55
39
Causes of methaemoglobinaemia
Congenital causes haemoglobin chain variants: HbM, HbH NADH methaemoglobin reductase deficiency Acquired causes drugs: sulphonamides, nitrates (including recreational nitrates e.g. amyl nitrite 'poppers'), dapsone, sodium nitroprusside, primaquine chemicals: aniline dyes
40
ABG features of methaemoglobinaemia
Normal PO2 but decreased oxygen saturation
41
Screen for which virus before starting rituximab ?
Hep B - can reactivate if present as rituximab binds to CD20 which is expressed on B cells
42
Fish tank granuloma
Myocobacterium marinum
43
Which tablets interact with levothyroxine absorption?
Iron and calcium carbonate - should be taken at least 4hrs apart
44
Blurred peripheral vision after panretinal photocoagulation for proliferative diabetic retinopathy?
Reduced rod cell function is a complication of panretinal photocoagulation
45
Inducers of the P450 system
antiepileptics: phenytoin, carbamazepine barbiturates: phenobarbitone rifampicin St John's Wort chronic alcohol intake griseofulvin smoking (affects CYP1A2, reason why smokers require more aminophylline)
46
Inhibitors of P450
antibiotics: ciprofloxacin, erythromycin isoniazid cimetidine,omeprazole amiodarone allopurinol imidazoles: ketoconazole, fluconazole SSRIs: fluoxetine, sertraline ritonavir sodium valproate acute alcohol intake quinupristin
47
A new blood test is developed to screen for prostate cancer. Trials have shown it has a sensitivity for detecting clinically significant prostate cancer of 80% but a specificity of 60%. What is the likelihood ratio for a positive test result?
Likelihood ratio for a positive test result = sensitivity / (1 - specificity) = 0.8 / (1 - 0.6) = 2
48
Ambrisentan MOA
endothelin receptor A antagonist
49
Subunits of troponins and their action
troponin C: binds to calcium ions troponin T: binds to tropomyosin, forming a troponin-tropomyosin complex troponin I: binds to actin to hold the troponin-tropomyosin complex in place
50
Name 3 cytokines in sepsis
IL-1, IL-6, and TNF-a
51
Which electrolyte abnormality increases digoxin levels and how
hypokalaemia - Digoxin normally binds to the ATPase pump on the same site as potassium. Hypokalaemia → digoxin more easily bind to the ATPase pump → increased inhibitory effects
52
Leptospirosis spread
Mainly contact with rat urine
53
Speech fluent but repetition poor = ?
54
autosomal dominant and typically affects young adults and causes replacement of normal bone by spongy tissue in the ear and as a result hearing loss
Otosclerosis
55
'spike and dome' appearance of the basement membrane due to subepithelial deposits = ?
Membraneous glomerulonephritis
56
Idiopathic membranous GN is associated with which autoantibodies?
anti-phospholipase A2 antibodies.
57
Anti-GQ1b antibodies ?
Miller-Fisher syndrome, a variant of Guillain-Barre syndrome characterised by ataxia, ophthalmoplegia and areflexia.
58
Anti-p62 antibodies?
Primary biliary cirrhosis
59
Anti-Ri antibodies?
opsoclonus-myoclonus syndrome, often in the context of breast cancer.
60
ANti Ro in pregnancy?
SLE in pregnancy can cause foetal bradycardia
61
Which drugs can induce thrombocytopenia?
quinine abciximab NSAIDs diuretics: furosemide antibiotics: penicillins, sulphonamides, rifampicin anticonvulsants: carbamazepine, valproate heparin
62
SUlfonylurea example?
GLiclazide
63
Gliclazide side effects?
Common adverse effects hypoglycaemic episodes (more common with long-acting preparations such as chlorpropamide) weight gain Rarer adverse effects hyponatraemia secondary to syndrome of inappropriate ADH secretion bone marrow suppression hepatotoxicity (typically cholestatic) peripheral neuropathy
64
HAemophilia inheritance?
X-linked recessive disorder of coagulation
65
Haemophilia clotting results?
Blood tests prolonged APTT bleeding time, thrombin time, prothrombin time normal
66
Which are the main features of GPA?
Granulomatosis with polyangiitis (GPA) would cause sinus, pulmonary and renal symptoms. An asthma syndrome is not commonly described
67
Churg-Strauss syndrome features ?
i.e. eosinophilic granulomatosis with polyangiitis (EGPA). The American College of Rheumatology has produced criteria for the diagnosis of EGPA: asthma, eosinophilia, presence of mono-/polyneuropathy, flitting pulmonary infiltrates, paranasal sinus abnormalities histological evidence of extravascular eosinophils. The presence of four of these criteria is considered highly sensitive for a diagnosis of EGPA.
68
Pseudogout microscopic joint findings
Weakly positively birefringent rhomboid shaped crystals
69
Which tests are key to identify patients who will benefit from cardiac resynchronisation therapy in HF?
Echo ECG - LBBB, QRS duration more than 120
70
Which antibody is deposited in the dermis in dermatitis herpetiformis?
IgA
71
Features of optic neuritis
unilateral decrease in visual acuity over hours or days poor discrimination of colours, 'red desaturation' pain worse on eye movement relative afferent pupillary defect central scotoma
72
Ix for diagnosis of optic neuritis
MRI of the brain and orbits with gadolinium contrast is diagnostic in most cases NB: MRI: if > 3 white-matter lesions, 5-year risk of developing multiple sclerosis is c. 50%
73
Management of optic neuritis
high-dose steroids recovery usually takes 4-6 weeks
74
Which type of anaemia does lead poisoning cause?
Lead interferes with several steps of haem synthesis leading to inhibition of heme biosynthesis and subsequent microcytic hypochromic anaemia.
75
Features of lead poisoning
abdominal pain peripheral neuropathy (mainly motor) neuropsychiatric features fatigue constipation blue lines on gum margin (only 20% of adult patients, very rare in children)
76
Hyperparathyroidism treatment
definitive management is total parathyroidectomy conservative management may be offered if the calcium level is less than 0.25 mmol/L above the upper limit of normal AND the patient is > 50 years AND there is no evidence of end-organ damage - patients not suitable for surgery may be treated with cinacalcet, a calcimimetic a calcimimetic 'mimics' the action of calcium on tissues by allosteric activation of the calcium-sensing receptor
77
What are the phases of a clinical trial?
0 - exploratory studies I - safety assessment II - assess efficacy - 2a = optimal dosing , 2b=assess efficacy III - assess effectiveness IV - postmarketing suverillance
78
Electrolyte causes of a prolonged QT?
Hypokalaemia Hypocalcaemia Hypomag
79
What is the MOA of red man syndrome?
The proposed mechanism is non IgE mediated mast cell degranulation. NB: happens with vancomycin if given fast
80
Which nerve is affected in foot drop and what are some common causes?
Leg crossing, squatting or kneeling may cause a foot drop secondary to a common peroneal neuropathy
81
Which chromosomes are affected in ADPKD type 1 vs type 2?
Type 1 = chromosome 16 (85% of all cases) Type 2 = Chromosome 4 (15% of all cases)
82
Indications for NIV
CIA-2 C: cardiogenic pulmonary oedema refractory to CPAP I: Intubation weaning A: Acidosis (respiratory) - COPD with pH 7.25-35 or <7.25 + HDU 2: Type II resp failure caused by OSA, neuromuscular weakness, chest wall deformity
83
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MRCP Revision (1 decks)

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