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MRCP part 2 > First thousand - useful info > Flashcards

First thousand - useful info Flashcards

1
Q

For pregnancy of smoking abstinence which is better ?

A

combination nicotine therapy has an absolute abstinence rate of 32 percent compared to 25 percent of non combination

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1
Q

11;14 translocation causes what ?

A

Mantle cell lymphoma

Cyclin D1

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2
Q

8;14 -> 8 looks like B -> causes what ? )

A

Burkitt -> MYC oncogene (MYC Beth)

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3
Q

Translocation of 9;22 causes what ?

A

9 looks like flipped P

Philadelphia (CML) -> BCR-ABL gene (BeCause they are ABLe to imitate (imatinab)

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4
Q

Translocation of 15:17 ?

A

Acute promyelocytic leukemia

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5
Q

Translocation of 14:18?

A

Fourteeen
Think follicular

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6
Q

Translocation 11:22?

A

Ewing sarcoma

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7
Q

Exacerbating factors of myasthenia ?

A

penicillamine
quinidine, procainamide
beta-blockers
lithium
phenytoin
antibiotics: gentamicin, macrolides, quinolones, tetracyclines

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8
Q

Polymorphic eruption of pregnancy presentation

A

last trimester
- pruritus
- lesion in abdominal stria

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9
Q

Pemphigoid gestationis presentation ?

A

2nd or 3rd trimester

pruritic blistering lesions

develop in peri-umbilical region, later spreading to the trunk, back, buttocks and arms

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10
Q

drugs causing phototoxicity ?

A

antibiotics (tetracyclines, sulfonamides, fluoroquinolones),
NSAIDs,
diuretics,
sulfonylureas,
antipsychotics
amiodarone,
quinine and
hydroxychloroquine

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11
Q

Poor prognostic factors of CLL ?

A

male sex
age > 70 years
lymphocyte count > 50
prolymphocytes comprising more than 10% of blood lymphocytes
lymphocyte doubling time < 12 months
raised LDH
CD38 expression positive
TP53 mutation

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12
Q

CLL indiction for Tx ?

A

massive (>10 cm) or progressive lymphadenopathy
massive (>6 cm) or progressive splenomegaly

progressive lymphocytosis: > 50% increase over 2 months or lymphocyte doubling time < 6 months

weight loss > 10% in previous 6 months, fever >38ºC for > 2 weeks, extreme fatigue, night sweats

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13
Q

exacerbate psoriasis:

A
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14
Q

hereditary angioedema Tx and prophylaxis

A

acute attacks
plasma-derived C1 inhibitor - Berinert, Cinryze
○ Recombinant C1 inhibitor - Conestat alfa
○ Bradykinin B2-receptor antagonist - Icatibant

Second-line agents for acute attacks
○ Plasma solvent/detergent (PSD) - preferred over FFP if available
○ Fresh frozen plasma (FFP)

short-term and long-term prophylaxis
C1-INH concentrate
○ Lanadelumab
* Second line therapies
○ Antifibrinolytics - tranexemic acid,
Attenuated androgens - danazol

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15
Q

MS medication to use when deranged liver enzymes ?

A

First line: Natalizumab and fingolimod.
ocrelizumab - recombinant cd20

Second line: Interferons and glatiramer.

Third line: Mitoxantrone(when all other treatments fail to control a rapidly progressive disease).

Interferons, Natalizumab, ocreluzimab and fingolimod are all CI in deranged liver functions!

can use : glatiramer

===========
Fatigue - amantidine

Oscillopsia - gabapentin

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15
Q

useful drug post MI for depression?
however what is used instead of this when there is a bleeding risk ?

A

sertraline - best post MI

however sertraline - interfere with platelet aggregation and increase the risk of a GI bleed

when used with warfarin / heparin: NICE guidelines recommend avoiding SSRIs and considering mirtazapine

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16
Q

Paroxysmal cold hemoglobinuria features ?

A

dark urine associated with exposure to going outside, implying exposure to cold
associated with abdominal cramps and following a recent viral infection, most likely with Ebstein-Barr virus

blood tests show anaemia, elevated bilirubin and spherocytes

due to cold-reacting IgG causing complement fixation leading to haemolysis

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17
Q

dx of Paroxysmal cold hemoglobinuria features ?

A

direct Coomb test

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18
Q

Arrhythmogenic right ventricular cardiomyopathy ECG ?

A

ECG abnormalities in V1-3, typically T wave inversion. An epsilon wave is found

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19
Q

Arrhythmogenic right ventricular cardiomyopathy tx ?

A

sotalol is the most widely used antiarrhythmic

catheter ablation to prevent ventricular tachycardia

implantable cardioverter-defibrillator

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20
Q

TB tx ?

A

that all cases of active pulmonary or extra-pulmonary TB should be treated with the standard ‘2 months RIPE then 4 months RI’ regimen UNLESS there is CNS involvement. If there is CNS involvement, RIPE is given for 2 months and then RI is continued for 10 more months.

21
Q

ANGINA Treatment

A

BB or CCB (dont mix BB with Diltiazem or Verapamil -> risk of CHB).
3rd line: Add on CCB/BB (whatever was missed in 2nd line)
4th line (if no hypotension and not using sildenafil after 3rd line) ISMN/nicorandil
5th line (if no hypotension after 4th line) Add on ISMN or nicorandil (wtv was missed)
6th line (if hypotension after 5th line):
HR<70: RANOLAZINE (contraindicated in severe renal/liver disease)
HR>70: IVABRADINE (contraindicated in Sick sinus syndrome)

22
Q

HIV TX renal problems

A

Indinavir can crystallise in the urine and cause renal stones. Urine microscopy shows needle-shaped crystals.

Tenofovir typically causes acute tubular necrosis or Fanconi syndrome

23
Q

Reversible cerebrovascular vasoconstriction syndrome

A

Thunder clap headaches

s associated with hypertension and seizures and

diagnosed by arterial beeding on angiography.

24
Q

Posterior reversible encephalopathy syndrome association

posterior reversible leucoencephalopathy syndrome

A

Thunder clap headaches

associated with hypertension and specific changes on MRI brain secondary to vasogenic brain oedema.

25
Q

Internal carotid artery dissection

A

thunderclap headache

commonly following minor trauma
Horner’s syndrome, tinnitus or tongue palsy.

CT brain and lumbar puncture are usually normal

26
Q

Takotsubo cardiomyopathy ECG changes

A

ST elevation in the apical leads (V5, V6).

coronary angio - normal
apical ballooning - echo

take it easy no - treatment

27
Q

Hypertrophic cardiomyopathy ecg changes ?

A

T wave inversion in the anteroseptal leads. (V1-v3)

28
Q

brugada syndrome ecg changes

A

ST elevation and T wave inversion in V1-V2.
Rbbb

29
Q

WELLEN syndrome ECG changes ?

A

in alcoholic

Biphasic T-waves/ deeply inverted t waves in v2-v3

30
Q

Paroxysmal hemicrania vs hemicrania continua

A

paroxysmal hemicrania is characterised by recurrent attacks lasting 2-30 minutes, occurring more than five times a day for more than half of the time.

hemicrania continua is a continuous unilateral headache that persists for more than 3 months, punctuated with exacerbations of severe pain as seen in this patient. temporal pattern


both conditions are responsive to indomethacin

31
Q

what drugs induces tics ?

A

Methylphenidate, dextroamphetamine, and, lamotrigine

32
Q

Acute attacks of Acute Intermittent Porphyria (AIP) are often precipitated by drugs like

A

barbiturates, sulfonamides, chloroquin, griseofulvin, diphenyl hydantoin

33
Q

addison disease can also present with

A

Hypercalcaemia (6%) may also occur. This is partly due to a reduction in calcium removal by the kidney and an increase in mobilization of calcium from bone stores.

Thyroid stimulating hormone (TSH) can be elevated in primary hypoadrenalism due to a loss of feedback on the pituitary gland.

34
Q

Pacemaker syndrome is typically associated with

A

VVI pacemaker

fatigue, dizziness and hypotension.

35
Q

Cyclizine is a H1 receptor antagonist and anticholinergic, resulting in

A

systemic hypertension and inducing tachycardia. It can aggravate a fragile myocardium into acute failure and is hence not recommended by NICE in patients with ACS or severe heart failure

36
Q

When you see RBC in CSF you should suspect

A

hsv

In adults with HSV encephalitis the CSF opening pressure is typically moderately elevated; there is a moderate CSF pleocytosis (tens to hundreds of cells × 106/L), a mildly elevated CSF protein, and normal CSF:plasma glucose ratio’

37
Q

Features in favour of encephalitis:

A
  • unable to recognise him
  • not orientated to time or place
  • extremely irritable
  • extremely tearful

Diagnostic criteria for encephalitis are as follows:

  • Alteration in consciousness, cognition, personality or behaviour >24hrs
38
Q

MRI head, with siderosis typically prominent in the

A

posterior fossa - get MRI

previous neurosurgery or head trauma can similarly result in siderosis.

There is no current treatment for superficial siderosis

39
Q

distinguishing cluster headaches and SUNCT

A

cluster headaches
males below the age of 40
typically onset at night, last from 15 minutes to 3 hour
rarely more than 3 times per day
triggered by alcohol

SUNCT is more common
in older patients above the age of 40.
occur at any time of day and typically lasts for seconds to minutes
75 times per day

40
Q

Factors that can lead to elevated levels of azathioprine are:

A

Drugs that inhibit xanthine oxidase e.g. allopurinol
Drugs that can also cause myelosuppression e.g.sulphonamides, trimethoprim
Reduced activity of TPMT

41
Q

basophilic stippling

A

Thalassaemias, lead/arsenic poisoning, sideroblastic anaemia and megaloblastic anaemias (such as B12 deficiency)

42
Q

hyperhsegmented cells seen in ?

A

vit b12 deficiency

43
Q

warfarin blocks the activation of clotting factors II, VII, IX, and X, it also deactivates

A

also deactivates protein C and protein S,

two endogenous anticoagulants.

Since protein C has a short half-life (8 hours) and warfarin initially decreases protein C levels faster than the coagulation factors, it can paradoxically increase the coagulation tendency when treatment is first begun, leading to massive thrombosis with skin necrosis

44
Q

presence of back pain without neurological symptoms, MRI whole-spine should be performed within

A

MRI whole-spine should be performed within 7 days

45
Q

Solitary lung nodule surveillance ?

A

Nodule <5mm, or clear benign features, or unsuitable for treatment: can be discharged

Nodule 5-7mm, and low-risk*: then CT surveillance
CT surveillance: if 5-6mm then at 1 year,
=>6 then in three months

Nodule =>8mm and high risk*: then CT-PET, and if CT-PET shows high uptake then biopsy

46
Q

Colonoscopy surveillance

A

5 year follow up
Extensive colitis with no active endoscopic/histological inflammation
OR left sided colitis
OR Crohn’s colitis of <50% colon

3 year colonoscopy
Extensive colitis with mild active endoscopy/histological inflammation
OR post-inflammatory polyps
OR family history of colorectal cancer in a first degree relative aged 50 or over

1 year follow up colonoscopy
Extensive colitis with moderate/severe active endoscopic/histological inflammation
OR stricture in past 5 years
OR dysplasia in past 5 years declining surgery
OR primary sclerosing cholangitis / transplant for primary sclerosing cholangitis
OR family history of colorectal cancer in first degree relatives aged <50 years

47
Q

Liver biopsy contraindication?

A

Contraindications to percutaneous liver biopsy
deranged clotting (e.g. INR > 1.4)
low platelets (e.g. < 60 * 109/l)
anaemia
extrahepatic biliary obstruction
hydatid cyst
haemoangioma
uncooperative patient
ascites

48
Q

Features of APS type 1 (2 out of 3 needed)

A

chronic mucocutaneous candidiasis (typically first feature as young child)
Addison’s disease
primary hypoparathyroidism

49
Q

APS type 2 has a polygenic inheritance and is linked to HLA DR3/DR4. they have ?

A

Patients have Addison’s disease plus either:

type 1 diabetes mellitus
autoimmune thyroid disease

50
Q

iron replacement in ESRF

A

oral iron should be offered for patients who are not on ESAs or haemodialysis. If target Hb levels are not reached within 3 months then patients should be switched to IV iron

patients on ESAs or haemodialysis generally require IV iron

51
Q

how to differentiate mantle cell and follicular cell lymphoma in immunochemistry ?

A

mantle cell lymphoma CD4, CD19, CD20 , BCL1 trans location (11-14) , high grade, Ki-67 high

follicular cell lymphoma CD19, CD20 , BCL2 trans location (14-18), low grade , Ki-67 low

52
Q

colorectal cancer surveillance for adenomas ?

A

Low risk:
one or two adenomas smaller than 10 mm.

Intermediate risk:
three or four adenomas smaller than 10 mm or
one or two adenomas if one is 10 mm or larger.

High risk:
five or more adenomas smaller than 10 mm or
three or more adenomas if one is 10 mm or larger.

MRCP part 2 (6 decks)

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