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MRCP part 2 > fourth > Flashcards

fourth Flashcards

1
Q

Symptomatic splenomegaly. (evidence grade 1A)
2. Myelofibrosis‐related symptoms that are impinging upon quality of life. (evidence grade 1B)
3. Hepatomegaly and portal hypertension due to myelofibrosis tx ?

A

ruxolitinib

symptomatic splenomegaly and anaemia. First line treatment for this would be hydroxycarbamide

nterferon alpha is used for myelosuppression in myelofibrosis in the presence of thrombocytosis or leucocytosis

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2
Q

cut off FVC for referral to ICU

A

<2L for ICU ref and 1.5L for mech ventilation

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3
Q

liver transplant indication for non paracetamol overdose

A

inr more than 6.5

or
meeting the three , pt more than 100

age <40
inr more than 3.5 pt is more than 50
bilirubin more than 300
ethology drug induced - not through viral hepatitis
duration of jaundice to hepatic encephalopathy >7 days

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4
Q

reduced amplitude but normal conduction velocity is indicative of axonal pathology. Causes of a predominant sensory axonal peripheral neuropathy include

A

diabetes mellitus (commonest cause), B12 deficiency, uraemia, carcinoma (paraneoplastic) and HIV.

GBS,

chronic inflammatory demyelinating polyneuropathy,

amiodarone,

hereditary sensorimotor neuropathies (HSMN) type I,

paraprotein neuropathy,

multiple myeloma

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5
Q

Features of Addison disease

A

The low T4, raised TSH, high calcium, low FSH, low LH, low oestradiol (hypogonadotrophic hypogonadism) are all features of Addisons disease.

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6
Q

Type 4 renal tubular acidosis causes

A

Aldosterone deficiency (hypoaldosteronism): Primary vs. hyporeninaemic
Aldosterone resistance
→ 1.Drugs: Non-steroidal anti-inflammatories, angiotensin converting enzyme inhibitors, angiotensin 2 receptor blockers, eplerenone, spironolactone, trimethoprim, pentamidine
→ 2.Pseudohypoaldosteronism

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7
Q

Drugs causing a peripheral neuropathy

A

amiodarone
isoniazid
vincristine
nitrofurantoin
metronidazole

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8
Q

Drugs causing a peripheral neuropathy

A

amiodarone
isoniazid
vincristine
nitrofurantoin
metronidazole

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9
Q

drug induced lupus include ?

A

minocycline, isoniazid, hydralazine, procainamide

Anti-histone

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10
Q

what antibiotic cover should be avoided in myasthenia gravis?

A

gentamicin

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11
Q

what aesthetic drugs should be avoided in myasthenia gravis ?

A

extremely sensitive to small doses of non-depolarising muscle relaxants such as

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12
Q

treatment for the Lambert-Eaton myasthenic syndrome.

A

3,4-diaminopyridine

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13
Q

psoriasis patient considering conception (both men and women) and systemic therapy cannot be avoided

A

ciclosporin as the first choice

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14
Q

Alkaptonuria - triad of:

A

Dark urine/ black when exposed to air
2. Blue-black pigmented sclera
3. Intervertebral disc calcification

tx
high-dose vitamin C
dietary restriction of phenylalanine and tyrosine

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15
Q

If surgery was to occur in over 12 hours then VTE prophylaxis ?

A

mechanical VTE prophylaxis

low molecular weight heparin should be started, with the last dose given 12 hours before surgery.

If he also had renal failure, then unfractionated heparin should be used and also stopped 12 hours before surgery.

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16
Q

Difference between AIP and porphyria cutanea tarda

A

AIP
Defect in PORPHOBILINOGEN deaminase
Elevated urinary prophobilinogen - normal fecal porphyria
Managed with haematin

Variegate porphyria
autosomal dominant
defect in protoporphyrinogen oxidase
photosensitive blistering rash
abdominal and neurological symptoms
more common in South Africans
Elevated urinary prophobilinogen - high fecal porphyria

PCT
Only restricted to skin
Defect in uroporphyrinogen decarboxylase
Elevated uroporphinogen
pink fluorescence of urine under Wood’s lamp
manage with chloroquine

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17
Q

HIT RECOMMENDATION of Tx

A

Therapeutic danaparoid should be used

Therapeutic dose fondaparinux is an acceptable alternative anticoagulant (although it is unlicensed)

Therapeutic anticoagulation should be continued for 3 months (in those with thrombosis) and 4 weeks (in those without thrombosis)

When transitioning from argatroban to warfarin, the INR should be >4 for 2 days prior to discontinuing argatroban

Warfarin should not be used till platelet count is back in normal range

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18
Q

patients with heart transplant and if patient has bradycardia and shock what is contraindicated ?

A

Atropine

theophyline intravenousely is indicated.

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19
Q

Adverse effects of Tacrolimus:
(TACROLIMUS)

A

T: Tremor
A: Alopecia
C: Cardiovascular (HTN)
R: Renal insufficiency
O: Oncogenic (Skin)
L: Lipid abnormalities (Hyperlipidaemia)
I: Insulin dependent DM
M: Magnesium wasting, Potassium elevation
U: Uric acid elevation
S: Seizure

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20
Q

multifocal motor neuropathy with conduction block (MMNCB)

A

focal arm weakness in the distribution of a named nerve. It usually happens quite suddenly (e.g. over a week)

over several months additional named motor nerves become involved asymmetrically such that MMNCB may eventually look like motor neurone disease (MND) - the principle differential here (specifically the lower motor neurone progressive muscular atrophy form rather than the mixed upper/lower motor neurone ALS form)

nerve conduction studies.
MMNCB shows conduction block. MND does not.

MMNCB is a demyelinating condition, much in the same way Guillain Barre or chronic inflammatory demyelinating polyneuropathy (CIDP) are.

However, in MMNCB this demyelination is in segments of a nerve rather than affecting the whole nerve
So conduction block seen

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21
Q

Chronic inflammatory demyelinating polyneuropathy

A

segmental demyelination of peripheral nerves

features similar to Guillain-Barre syndrome (GBS), with motor features predominating
more insidious onset, over weeks to months - often thought of as the chronic version of GBS
high protein content in the CSF
treatment with steroids and immunosuppressants may have a role (unlike in GBS)

22
Q

tropical spastic paraparesis (TSP) vs syphilus

A

HTLV-1 Associated Myelopathy (HAM)

retrovirus endemic in southern Japan, equatorial Africa and South America.

Transmission occurs through sexual or other intimate contacts, intrauterine, breastfeeding, sharing of needles by drug users, or blood transfusion from infected persons

progressive upper motor neurone symptoms and signs particularly confined to the lower limbs

Vs syphilus
Not demyelinating
Feet slapping gait

lancinating pain- sudden, brief, severe stabs of pain that may affect the limbs, back, or face and that may last for minutes or days

Tabes has absent reflexes

23
Q

multiple daily dose regimens of gentamicin

A

pre-dose (€˜trough’) concentration is high, the interval between doses must be increased.

If the post-dose (€˜peak’) concentration is high, the dose must be decreased

24
Q

Loiasis presentation ?

A

pruritus
urticaria
Calabar swellings: transient, non-erythematous, hot swelling of soft-tissue around joints
‘eye worm’ - the dramatic presentation of subconjunctival migration of the adult worm.

25
Q

complication of loiasis compared to other
microfilarial infections Onchocerciasis and Lymphatic Filariasis

A

associated with encephalopathy following treatment with either Ivermectin or DEC. This occurs due to the death of vast numbers of blood microfilaria. Both of these drugs are contraindicated if loa loa microfilaraemia exceeds 2500 mf/ml

26
Q

leprosy presentation ?

A

saddle nose deformity (relapsing polychondritis, cocaine abuse, congenital syphilis, lepromatous leprosy and trauma. )

non-painful lumps esp medical epicondyle

joint, renal and conjunctival involement indicate a type 2 reaction which occur in patients with lepromatous leprosy (usually following treatment)

if treated with steroids patients neurological symptoms worsen yet the skin disease improves on starting steroids

27
Q

leprosy tx ?

A

multibacillary leprosy 6 lesions - triple therapy with rifampicin, dapsone and clofazimine (RDC) for 12 months.

For paucibacillary leprosy (5 or less lesions) you should give rifampicin and dapsone (RD) for 6 months.

28
Q

leprosy dx ?

A

Diagnosis is made by demonstrating acid fast bacilli within a cutaneous nerve on microscopy

29
Q

fentanyl and mss conversion

A

fentanyl 75 patch = 180mg daily intake of morphine salt

fentanyl 100patch = 240mg daily morphine salt intake.

FROM MST TO FENTANYL = 2.4

30
Q

Seizure inducers ?

A

include fentanyl,
mefenamic acid,
and tramadol (among others).

amitriptyline,
aminophylline, theophylline
isotretinoin and
haloperidol

alcohol, cocaine, amphetamines
ciprofloxacin, levofloxacin
bupropion
methylphenidate (used in ADHD)
mefenamic acid

31
Q

Prophylaxis for infective endocarditis ?

A

Prosthetic cardiac valve or prosthetic material used for cardiac valve repair

Previous infective endocarditis

Cardiac transplantation with the subsequent development of cardiac valvulopathy

Unrepaired cyanotic defects, including palliative shunts and conduits
Completely repaired defects with prosthetic material or devices whether placed by surgery or catheter intervention, during the first 6 months after the procedure (after which the prosthetic material is likely to have been endothelialised)
Repaired defects with residual defects at or adjacent to the site of a prosthetic patch or device (which inhibit endothelialisation)

32
Q

confirmed diagnosis of a superficial vein thrombosis tx ?

A

anti-embolism stockings and prophylactic doses of low molecular weight heparin (LMWH) for 30 days
or fondaparinux for 45 days.

In cases where LMWH is contraindicated, 8-12 days of oral non-steroidal anti-inflammatory drugs

33
Q

amyl nitrate toxicit

A

blurred vision, xanthopsia and haemoptysis

34
Q

gamma hydroxybutyric acid (GHB) toxicity

A

CNS and respiratory depression, hypersalivation, bradycardia and hypotension

35
Q

All NSCLC with stage I or II disease should undergo

A

resection surgery

stage III disease generally is focused on chemotherapy

FEV1 >2l/s for pneumonectomy and 1.5l/s for lobectomy

36
Q

Aortic stenosis mx ?

A

surgical aortic valve replacement (SAVR) then a bioprosthetic valve would be preferred over a mechanical valve, freeing the patient from the need for lifelong anticoagulation

Transcatheter aortic valve insertion (TAVI) - unfit for SAVR due to high predicted mortality.
transfemoral TAVI suitable for patients with a low or intermediate risk associated with SAVR

Transfemoral TAVI is increasingly favoured over SAVR as patient age increases

transapical TAVI are inferior to SAVR, so this intervention is only appropriate for individuals with an unacceptably high surgical risk

37
Q

extensor plantars with absent ankle reflexes

A

MND,
Friedrich’s ataxia,
subacute combined degeneration of the cord
or tertiary syphilis

38
Q

When to Offer revascularisation in angina

A

stable coronary artery disease and ischaemia in > 10 % of the left ventricle. Also, the patient’s age and lack of co-morbidities

39
Q

Lupus nephritis tx

A

INDUCE remission both cyclophosphamide and mycophenolate + along with glucocorticoids can be used with the same efficacy but with the former having more side effects ( can cause permanent infertility in both male and female). dealing with 32 year old female so we should chose mycophenolate.

  1. Maintenance of remission is recommended with either mycophenolate or azathioprine. Cyclophosphamide is not recommended for maintenance therapy
40
Q

Increasing tidal vol in mech ventilation

A

Increase the RR and cause resp alkalosis

41
Q

renal biopsy contra ?

A

polycystic kidneys,
obstruction of the urinary tract,
or hydronephrosis

42
Q

synthetic cannabinoid toxicity

A

seizure,
myoclonus,
mydriasis,
hypertension,
acute kidney injury and
hypokalaemia

43
Q

toluene toxicity

A

irritation to the eyes, nose and respiratory tract

44
Q

Amyl nitrate toxicity

A

hypotension
blurred vision,
xanthopsia
and haemoptysis

45
Q

gamma hydroxybutyric acid (GHB) toxicity

A

CNS and respiratory depression,
hypersalivation,
bradycardia
and hypotension

46
Q

NSCLC Management

A

Lobectomy (with hilar and mediastinal lymph node resection/sampling) is first-line treatment for those with stage I or II cancer

Radiotherapy:
Is first-line for those with stage I-III disease who are not suitable for surgery.
This treatment is given with curative intent.

Chemotherapy:
Is offered to those with stage III or IV disease to improve survival and quality of life.

=====

Adjuvant chemotherapy should be offered to patients who have undergone a complete resection

Adjuvant radiotherapy is offered to patients who have had a incomplete resection of their tumour

All patients with stage I-III disease who are not suitable for surgery should be considered for chemoradiotherapy

47
Q

chronic respiratory conditions including asthma requiring frequent use of oral steroids should be offered

A

23-valent unconjugated pneumococcal polysaccharide vaccine - 5 yearly

and the influenza vaccine - annual

========
Re-vaccination is not recommended for most people. However, for those who have asplenia, splenic dysfunction, or chronic kidney disease, re-vaccination is recommended every 5 years.

48
Q

Long QT syndromes

A

Long QT1: adrenergic surge due to intense physical activity such as swimming

Long QT2: adrenergic surge due to intense emotion such as excitement or fear

Long QT3: death during sleep

Long QT syndromes can result in sudden cardiac death when patients are exposed to an adrenergic surge which can put the patient into VF or VT.

49
Q

cavernous sinus

A

oculomotor nerve with parasympathetic involvement = complete ptosis
pupil is unreactive and larger in diameter

involvement of the trochlear nerve
vertical eye movements and loss of adduction in his left eye

and also the first and second branch of the trigeminal nerve, hence sparing of his left chin as supplied by the mandibular branch of the trigeminal nerve.

50
Q

paraneoplastic syndromes antibodies and site of production

A

NMDA receptor antibodies = ovarian cancer
limbic encephalitis typically presents with a subacute development of memory impairment, confusion, and alteration of consciousness, often accompanied by seizures and temporal lobe signal change on MRI.

Voltage-gated potassium channel antibodies =
Thymoma or small cell lung cancer

Anti-Hu antibodies = Small cell lung cancer

Anti-GAD = Thymoma

anti-Ma2 antibodies = Germ-cell tumours of testis, non-small cell lung cancer

51
Q

TIA follow up

A

Crescendo TIA - one more episode
Urgent review or admission

Suspected TIA within 7 days - urgent assessment within 24 hours

Suspected TIA occurred more than 7 days - assessment by specialist within 7 days

MRCP part 2 (6 decks)

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