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MRCP part 1 x SZ > MRCP > Flashcards

MRCP Flashcards

(108 cards)

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1
Q

What is the antidote for anti-freeze?

A

Fomepizole

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2
Q

What is the mechanism of action of fomepizole?

A

Competitive inhibitor of alcohol dehydrogenase

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3
Q

How does flecainide reduce the occurrence of tachyarrhythmias?

A

It slows the upstroke of the cardiac action potential by blocking Nav1.5 sodium channels

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4
Q

What electrolyte disturbance is ecstasy toxicity associated with?

A

Hyponatraemia

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5
Q

In heparin induced thrombocytopenia, what antibodies form?

A

Antibodies form against complexes of platelet factor 4 (PF4) and heparin

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6
Q

What drugs can cause urinary retention?

A

Tricyclic antidepressants - eg amitriptyline
Anticholinergics - antipsychotics, antihistamines
Opioids
NSAIDs
Disopyramide

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7
Q

How does pilocarpine reduce intra-ocular pressures?

A

Stimulation of the muscarinic cholinergic receptors to increase aqueous humour outflow

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8
Q

What is the mechanism of action of fleicanide?

A

Sodium channel blocker

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9
Q

How does levothyroxine work?

A

It is a lipid soluble hormone replacement medication that interacts with nuclear receptors found intracellularly, exerting its effect by the control of DNA transcription and protein synthesis

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10
Q

What does cyanide do to the body?

A

Cyanide inhibits cytochrome c oxidase in the mitochondrial electron transport chain, halting aerobic respiration

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11
Q

What is the mechanism of action of tacrolimus?

A

It decreases IL-2 release by inhibiting calcineurin

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12
Q

What is the mechanism of action of digoxin?

A

Decreases conduction through the AVNode which slows the ventricular rate in AF
Increases the force of cardiac muscle contraction due to inhibition of the Na/K/ATPase pump
Stimulates the vagus nerve

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13
Q

What can be a cause of gingival hyperplasia (drug)?

A

Amlodipine

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14
Q

How does paracetamol overdose work?

A

The conjugation system becomes saturated, leading to oxidation by P450 mixed function oxidases producing a toxic metabolite (N acetyl B benzoquinone amine). If glutathione stores run out, the toxin forms bonds with cell proteins and denatures them. N - acetyl cysteine is a precursor of glutathione so increases the production of this

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15
Q

What are the features of a beta blocker overdose?

A

Bradycardia, Hypotension, Heart failure, Syncope

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16
Q

What is the management of a beta blocker overdose?

A

If bradycardia - atropine
If resistent - glucagon

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17
Q

What are the features of lithium toxicity?

A

Coarse tremor, hyperreflexia, acute confusion, polyuria, seizure, coma

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18
Q

What is the management of lithium toxicity?

A

Normal saline
Haemodialysis in severe toxicity

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19
Q

What is the management of thrombotic thrombocytopenia purpura?

A

Steroids, immunosuppressants, plasma exchange

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20
Q

When are IV immunoglobulins indicated?

A

Primary and secondary immunodeficiency
ITP
Myasthenia gravis
Guillain-Barre syndrome
Kawasaki disease
Toxic epidermal necrolysis
Pneumonitis induced by CMV after transplantation
Low serum igG levels after haematopoietic stem cell transplant for malignancy
Dermatomyositis
Chronic inflammatory demyelinating polyradiculopathy

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21
Q

What is the management of accidental injection of adrenaline eg resulting in digital ischaemia?

A

Local infiltration of phentolamine

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22
Q

What is first pass metabolism?

A

A phenomenon where the concentration of a drug is greatly reduced before it reaches the systemic circulation due to hepatic metabolism. As a consequence, much larger doses are needed orally than if given in other routes

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23
Q

Which drugs have first pass metabolism?

A

aspirin, isosorbide dinitrate, glyceryl trinitrate, lignocaine, propanolol, verapamil, isoprenaline, testosterone, hydrocortisone

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24
Q

What is zero order kinetics?

A

Metabolism which is independent of the concentration of the reactant. This is due to metabolic pathways becoming saturated, resulting in a constant amount of drug being eliminated per unit time.

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25
Name some drugs which exhibit zero order kinetics?
phenytoin, salicylates, heparin, ethanol
26
Name drugs affected by acetylator status?
isoniazid, procainamide, hydralazine, dapsone, sulfasalazine
27
List some common drugs that cause agranulocytosis
Carbimazole, propylthiouracil, clozapine, carbamazepine, penicillin, chloramphenicol, cotrimoxazole, mirtazapine, methotrexate
28
What are side effects of metformin?
GI side effects Lactic acidosis
29
What are side effects of sulfonylureas?
hypoglycaemic episodes increase appetite and weight gain SIADH liver dysfunction
30
What are side effects of glitazones?
weight gain, fluid retention, liver dysfunction, fractures
31
What are side effects of gliptins?
pancreatitis
32
How do macrolides e.g. erythromycin work?
They inhibit bacterial protein synthesis by blocking translocation.
33
What is the mechanism of action of metformin?
It is a biguanide. It activates AMP-activated protein kinase, increases insulin sensitivity, decreases hepatic gluconeogenesis, reduces GI absorption of carbohydrates
34
Name the licensed indications for BOTOX?
Blepharospasm Hemifacial spasm Focal spascitiy Spasmodic torticollis Severe hyperhidrosis of the axillae Achalasia
35
What are the adverse effects of beta blockers?
Cold peripheries, sleep disturbances, bronchospasm
36
What are the adverse effects of calcium channel blockers?
ankle oedema, constipation, dyspepsia
37
What are the adverse effects of clindamycin
c diff, joint pain, heart burn
38
What are the adverse effects of warfarin?
severe bleeding, red or brown urine, black/bloody stools, stomach pain
39
What are the adverse effects of omeprazole?
diarrhoea, fever, cold symptoms, headache
40
Management of a tricyclic overdose?
IV bicarbonate
41
Name medications which will exacerbate heart failure?
Piogiltazone Verapamil NSAIDs/glucocorticoids Flecainide
42
What is the mechanism of action of buprenorphine?
Partial agonist of the mu-opioid receptor and an antagonist of the kappa-opioid receptor
43
What is the moA of doxazosin?
Alpha 1 antagonist
44
45
What is the mechanism of action of LMWH?
Activates antithrombin III. Forms a complex that inhibits Factor Xa
46
What is the mechanism of action of heparin?
Activates antithrombin III. Forms a complex that inhibits thrombin, factors Xa, IXa, XIa, XIIa
47
How does levothyroxine work?
It acts via nuclear receptors.
48
What drugs can cause corneal opacities?
Amiodarone, Indomethacin
49
What drugs can cause optic neuritis?
Ethambutol, amiodarone, metronidazole
50
What are the clinical features of ecstasy poisoning?
neuro: agitation, anxiety, confusion, ataxia CVS: tachycardia, hypertension hyponatraemia hyperthermia rhabdomyolysis
51
What class of antibiotic is cephalosporins?
B Lactam antibiotic
52
What infection is likely to cause mucocutaneous ulceration following travel?
Leishmania brasiliensis
53
Chagas disease - what is the parasite, and what is the treatment?
Protozoan paraside - Trypanosoma cruzi Benznidazole
54
Presentation of dysentery after a long incubation period is due to?
Amoebiasis
55
What medication prevents the relapse of Plasmodium vivax?
Primaquine - it destroys liver hypnozoites and prevents relapse
56
What can treat chlamydia in pregnancy?
Azithromycin, erythromycin or amoxicillin
57
How is Lassa fever transmitted?
Rodents or person to person
58
What are the features of leptospirosis?
Fever, subconjunctival haemorrhage
59
What is the criteria for severe falciparum malaria?
High parasitaemia (>2%) Hypoglycaemia Severe anaemia Renal failure Pulmonary oedema Metabolic acidosis abnormal bleeding convulsions shock
60
Management of malaria?
severe falciparum? IV artesunate non severe? ACT non falciparum malaria? oral ACT or chloroquine if not resistent
61
What are some live attenuated vaccines?
BCG MMR oral polio yellow fever oral typhoid
62
How do you diagnose acute epiglottis?
Direct visualisation from a senior airway trained staff
63
What are the features and management of Anthrax?
painless black eschar, painless and non tender ciprofloxacin
64
How does tubercoid leprosy present?
Limited number of skin lesions, hyperaesthesia and hair loss
65
What is monads sign?
Air crescent sign - radiographic feature of air around a ball of fungus - specific for aspergilloma
66
What are the features and management of strongyloides stercoralis?
Diarrhoea, abdominal pain/bloating, pepulovesicular lesions on soles of feet/bum Larva currents If larvae migrate to lungs, Loefflers syndrome Treat - ivermectin and albendazole
67
What are the features and management of Legionella?
Flu like sx, cough, relative bradycardia, confusion, lymphopaemia, deranged LFTs CXR mid to lower zone patchy consolidation Pleural effusions in 30% Treat w erythromycin/clarithromycin
68
How does Lemierres syndrome present?
Young adult, sore throat, rigours, neck stiffness, ARDS, tender sternocleidomastoid
69
How is leishmaniasis spread?
Bites of sandflies
70
Antibiotic treatment for listeria meningitis?
IV amoxicillin/ampicillin and gentamicin
71
How does leprosy present?
Patches of hypo pigmented skin affecting the buttocks, face, extensor surfaces Sensory loss
72
What is the mechanism of action of amphotericin B?
Binds with ergosterol, a component of fungal cell membranes, forming pores that cause lysis of the cell wall and subsequent fungal cell death
73
Common complications of measles?
otitis media pneumonia encephalitis
74
Most common organism after an animal bite?
Pasteurella multocida
75
What is the mechanism of action of macrolides?
Binding to the 50S subunit of bacterial ribosomes, specifically interfering with protein synthesis
76
Which antibiotic promotes the acquisition of MRSA?
Ciprofloxacin
77
What is the most common cause of viral meningitis in adults?
Enterovirus eg coxsackie
78
Treatment options for genital warts?
Multiple, non keratinised ? topical podophyllum Solitary, keratinised? cryotherapy
79
What is the treatment of Leishmania?
Sodium stibogluconate
80
What is immune reconstitution inflammatory syndrome?
associated with HIV, the immune system begins to recover, but then responds to a previously acquired opportunistic infection with an overwhelming inflammatory response that paradoxically makes the symptoms of infection worse
81
What are the hallmark features of Chikungunya?
Acute debilitating joint pain
82
What is the Jarisch-Herxheimer reaction?
a phenomenon afer syphyllis treatment - no need for treatment of investigations other than antipyretics
83
What causes a high TLCO?
asthma pulmonary haemorrhage left to right cardiac shunts polycythaemia hyperkinetic state male gender, exercise
84
How does yellow fever present?
Flu like symptoms, then a brief remission, then jaundice and haematemasis
85
What antibiotics should be avoided on methotrexate?
Trimethoprim and cotrimoxazole
86
What malignancies are associated with EBV?
Burkitt's lymphoma Hodgkin's lymphoma nasopharyngeal carcinoma
87
88
What causes a low TLCO?
pulmonary fibrosis pneumonia anaemia pulmonary emboli pulmonary oedema emphysema low cardiac output
89
What lung fibrosis affects the upper zones?
hypersensitivity pneumonitis (also known as extrinsic allergic alveolitis) coal worker's pneumoconiosis/progressive massive fibrosis silicosis sarcoidosis ankylosing spondylitis (rare) histiocytosis tuberculosis radiation-induced pulmonary fibrosis
90
What lung fibrosis affects the lower zones?
idiopathic pulmonary fibrosis most connective tissue disorders (except ankylosing spondylitis) e.g. SLE drug-induced: amiodarone, bleomycin, methotrexate asbestosis
91
What are the factors associated with sarcoidosis that mean a poorer prognosis?
insidious onset, symptoms > 6 months absence of erythema nodosum extrapulmonary manifestations: e.g. lupus pernio, splenomegaly CXR: stage III-IV features black African or African-Caribbean ethnicity
92
What are some contraindications for lung cancer surgery?
SVC obstruction FEV < 1.5 MALIGNANT pleural effusion and vocal cord paralysis
93
What is Lofgrens syndrome?
an acute form of the disease characterised by bilateral hilar lymphadenopathy (BHL), erythema nodosum, fever and polyarthralgia. It usually carries an excellent prognosis
94
What is Heerfordt's syndrome (uveoparotid fever) ?
parotid enlargement, fever and uveitis secondary to sarcoidosis
95
What are the landmarks for a chest drain?
base of the axilla, lateral edge pectoralis major, 5th intercostal space and the anterior border of latissimus dorsi
96
What are the indications for corticosteroids in sarcoidosis?
parenchymal lung disease, uveitis, hypercalcaemia and neurological or cardiac involvement
97
What features suggest steroid responsiveness in COPD?
previous diagnosis of asthma or atopy a higher blood eosinophil count substantial variation in FEV1 over time (at least 400 ml) substantial diurnal variation in peak expiratory flow (at least 20%)
98
What is Bartter's syndrome?
Inherited (AR) cause of severe hypokalaemia due to the defective chloride absorption at the Na K Cl cotransporter in the ascending loop of Henle. It is associated with normotension.
99
What causes lower than expected Hba1c?
Sickle cell anaemia G66D deficiency Hereditary spherocytosis Haemodialysis
100
What causes a higher than expected level of Hba1c?
Vitamin B12/folic acid deficiency IDA Splenectomy
101
How do sulfonylureas work?
Increase pancreatic insulin secretion (so are only effective if functional B cells are present). On a molecular level they bind to an ATP-dependent K+ channel on the cell membrane of pancreatic beta cells
102
What is Graves disease?
An autoimmune condition caused by igG antibodies to the TSH receptor
103
Multiple endocrine neoplasia (MEN) types...
MEN 1 = 3 Ps - parathyroid, pituitary, pancreas MEN 2a = 2 Ps - parathyroid, phaeochromocytoma (RET oncogene) MEN2b = 1 P - phaeochromocytoma (RET oncogene)
104
Treatment of thyroid storm?
Paracetamol Treat the underlying precipitating event Beta blocker - IV Propanolol Antithyroid drugs - methimazole or propylthiouracil Lugols iodine Dexamethasone
105
What gene is responsible for inheriting MODY?
HNF1-Alpha
106
What is the first line treatment for acromegaly?
Trans-sphenoidal surgery
107
What is the mechanism of action of terlipressin?
synthetic analogue of vasopressin, and it works primarily by causing vasoconstriction of the splanchnic vessels. This reduces portal venous inflow, which in turn decreases portal pressure. It's used in the management of variceal bleeding, a serious complication of portal hypertension in patients with liver cirrhosis.
108

MRCP part 1 x SZ (1 decks)

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