MRCP 2 Flashcards
1
Q
Which DMARD is most likely to cause mouth ulcers
A
Methotrexate
2
Q
Which steroid sparing agent can be used in GCA
A
Methotrexate
3
Q
Which porphyria syndromes present with skin sx
A
PCT
Congenital erythropoietic porphyria
Eryrthropoietic protoporphyria
4
Q
What are two contraindications for sildenafil use in ED?
A
Unstable angina
Recent MI or stroke (prev 6mths)
Use of Nicorandil or other nitrates
Hypotension
5
Q
What is the name of the syndrome where a close person has been replaced as an imposter
A
Capgras syndrome
6
Q
What is the treatment for methotrexate toxicity
A
Folinic acid - bypasses DHFR step, needed to activate folic acid
7
Q
Which drug should be given in thyroid storm
A
PTU - acts quicker than carbimazole
8
Q
What is the first line investigation for stable angina
A
CT coronary angiography
If equivocal -> MRI perfusion study
If positive and intervention warranted -> angiography
9
Q
Pompe disease
What is it
What are the features
What is the treatment
A
Deficiency of a-galactosidase causing glycogen deposition in organs
Risks cardiomyopathy and cardiomegaly
Treated with glucosidase
10
Q
Drugs that are CI in idiopathic intracranial htn (7)
A
Tetracyclines Lithium Contraceptives Cimetidine Isotretinoin Steroids Thyroxine
11
Q
Sjogrens classically causes which type of renal tubular acidosis
A
Type 1
12
Q
What is the first line treatment for restless legs syndrome
A
DA agonists - ropinerole
13
Q
When should FFP be given in a variceal bleed
A
Fibrinogen <1
INR >1.5
14
Q
What is the mode of action of febuxostat
A
Xanthine oxidase inhibitor, like allopurinol
15
Q
Bilateral loin pain - what diagnosis must be considered
A
Retroperitoneal fibrosis
16
Q
When is it safe to fly post pneumothorax
A
One week pos resolution on XR
17
Q
Retinitis pigmentosa, chronic progressive external ophthalmoplegia, bilateral ptosis, mild cerebellar signs and a cardiac conductive defect (first degree heart block).
What is the diagnosis
A
Kearns Sayre - mitochondrial disorder
18
Q
How are palpitations in cocaine toxicity treated
A
Verapamil
19
Q
What is the treatment for Norwegian scabes
A
Ivermectin orally
20
Q
haemangioblastomas can secrete what
A
Epo
21
Q
Does acute interstitial nephritis cause proteinuria
A
Yes
Also haematuria, eosinophilia & rash
22
Q
Which antibiotic should be avoided with aminophylline
A
Ciprofloxacin, due to inhibition of CYP 1A2 causing accumulation of aminophylline and toxicity
23
Q
Kearns Sayre - what are the features
A
Three in the eyes
Retinitis pigmentosa
Chronic ophthalmoplegia
Bilateral ptosis
Two elsewhere
Cardiac conduction defects
Mild cerebellar signs
24
Q
What are the two types of amyloidosis and what are the underlying causes
A
AL - driven by light chain dyscrasia / myeloma
AA - driven by inflammation - RA, and spond
25
Purkinje cell antibody
CF
Associated with
Peripheral neuropathy
| Breast cancer
26
ASDs usually cause what on ECG
| How does the axis help to distinguish
RBBB
LAD - more likely ostium primum (PL)
RAD - more likely ostium secondum (RS)
27
What two drugs have evidence for improvement of fibromyalgia
Duloxetine and pregabalin
28
What is the treatment for GI bleeding on apixaban
Tranexamic acid +/- prothrombin complex
29
Canakinumab
MOA
Indication
interleukin-1 beta receptor antagonist
| Tx for acute gout in those not tolerant of NSAIDs & colchicine
30
What is the treatment for lymphatic filariasis
Diethylcarbamazine
31
What is the first line treatment for pouchitis
Abx - metronidazole or cipro
32
Which drugs potentiate / inhibit adenosine
Dipyridamole - potentiates effect of adenosine by blocking its cellular uptake & increasing its circulating level;
Aminophylline reduces the effect of adenosine
33
Fludarabine
MOA
SE
What drug needs to be given with it
MOA: Purine analogue - inhibits ribonucleotide reductase and DNA polymerase
SE: lymphopaenia -> PCP
Needs prophylactic co-trimoxazole
34
Which antibiotics can worsen myasthenia
Cipro & levofloxacin, gent
35
What drugs can cause an acute interstitial nephritis
```
Abx
NSAIDs
Allopurinol
PPIs
Diuretics
```
36
Councilman bodies are diagnostic of what condition
| How does it normally present
Yellow fever
| Deranged LFTs and U&E, jaundice & death
37
What is the risk of vertical transmission of hep C?
| What co-infection increases the probability
6%
| HIV
38
Dukes A colorectal cancer is defined by what
| What is the 5YS
Mucosa and submucosa involvement only
| 95% 5YS
39
Which antipsychotics have a high risk of inducing insulin resistance
Clozapine
| Olazepine
40
a postero-infero-lateral STEMI is due to occlusion of what artery
Left circumflex
41
What 3 things can increase the risk of developing porphyria cutaena tarda
Hep C
Alcoholism
HIV
42
What is the best laxative for opiate use
Sodium docusate
43
Which anti-thyroid drugs are used when in pregnancy
PTU - early
| Carbimazole - late
44
What is the treatment for cryptosporidium
Nitazoxanide
45
What are the common side effects of cisplatin
Hypomagnesaemia
Renal impairment
Peripheral neuropathy
46
What are the two types of hepatorenal syndrome
| What are the treatments
Type 1 HRS
Rapid onset. Poor prognosis.
Treat with Human albumin solution & splanchnic vasconstriction (terlipressin)
Type 2
Slow gradual onset
Treat with TIPSS (tx underlying liver disease)
47
What factors are used in the staging of multiple myeloma
B2 microglobulin & albumin
48
What is a CI for TCAs & SSRIs
TCAs - IHD
| SSRIs - GI bleed (plt dysfunction)
49
What mutation is seen in hairy cell leukaemia
B-Raf
50
What drug is used to prevent the frequency of sickle cell crises
Hydroxyurea
51
What should be added to the treatment for neutropenic sepsis if there has been no response after 48hrs
Anti-fungal
52
What must be tested before starting pregabalin
Renal function - dose is adjusted for renal function
53
What is the treatment of lupus nephritis?
Mycophenylate
54
Anti-Ri
CF
Associated with
Breast and small cell lung carcinoma
| ocular opsoclonus-myoclonus
55
What is the treatment for Eaton-Lambert syndrome
3,4-diaminopyridine
56
Following a bisphosphonate treatment break, when should a DEXA scan be done
Within two years of the treatment break, or sooner if fragility fracture
57
What is the threshold for starting insulin in gestational DM
Fasting glucose >7, or >6 with sx
58
What is the chromosomal translocation in Burkitt's lymphoma
t(8;14)
59
Tinnitus is a SE of what antibiotic
Vancomycin
60
What is the test to distinguish between type 1 & 2 amiodarone-induced thyrotoxicosis
Colour flow doppler ultrasonography
61
What infection can cause fever and a small joint polyarthritis
Brucellosis
62
What are the causes of acute interstitial nephritis
Drugs - penicillin, cephalosporins, rifampicin, ciprofloxacin, allopurinol, frusemide, NSAIDs
Infection - CMV, legionella, strep
Sarcoidosis
Idiopathic
63
What is the treatment for latent TB
3mths rifampicin & isoniazid
OR
6mths isoniazid alone
64
What is the safest anticonvulsant in pregnancy
lamotrignine
65
What drug is contraindicated in atrial flutter
Flecainide - risk of converting 2:1 conduction into 1:1, unless a beta blocker or CCB is given first
66
What is the gold standard test for small bowel bacterial overgrowth
Jejunal aspirate
67
When is PCI indicated in stable angina
stable coronary artery disease and ischaemia in > 10 % of the left ventricle.
68
What 2 things are not reversible & reversible in haemochromatosis
Irreversible - Cirrhosis & hypogonadism
| Reversible - transaminitis & fatigue
69
What sort of autoimmune haemolytic anaemia does lymphoma cause
Warm
70
What is the treatment for chronic Hep B, eAg -ve, with no liver decompensation
IFN-a alone
| If decompensation -> entecavir / tenofovir
71
What features distinguish a common peroneal nerve palsy from an L5 radiculopathy
Inversion of the foot is spared in a common peroneal nerve palsy, but is weak in L5 radiculopathy
Sensory loss is usually around the lateral aspect of the lower leg and the dorsum of the foot while L5 appears as a thin strip down the middle of the anterior lower limb, usually not affect the lateral lower leg
72
How does Wellens syndrome present and what does it signify?
TWI in V2-3, indicating critical LAD stenosis.
| Need for urgent PCI. Tx as STEMI
73
What must be considered in a renal transplant pt presenting with diarrhoea
Cryptosporidium
74
What are the thresholds for carotid endarterectomy
TIA or stroke with significant CAS (M >50%; F >70%) corresponding to the same side as the stroke/TIA -> urgent CEA within 14 days.
NICE guideline - intervene if corresponding side has stenosis >70%
75
SE of mycophenylate
Blood (2)
Pancytopaenia
Pure red cell aplasia
Mouth (2)
Taste disturbance
Gingival hyperplasia
GI (3)
Nausea and vomiting
Constipation
Gastrointestinal ulceration and bleeding.
76
When is cyproheptadine used
Serotonin syndrome eg MDMA OD
77
What is the treatment of granulomatosis with polyangiitis
Steroids with cyclophosphamide/ritux
78
What are the criteria for AKI staging
Stage 1 - rise in creatinine >26 or increase in baseline up to x2. Less than 0.5ml/kg/hr urine output for 6-12hrs
Stage 2 - up to x3 rise in creatinine from baseline, or <0.5ml/kg/hr urine output for >12hrs
Stage 3 - >x3 increase in baseline creatinine or >350 increase in creatinine or imitation of RRT
79
What are the first and second line medical treatments for HOCM
b-blocker or CCB
Then dispyramide
Then DDR pacemaker or myectomy
80
What are the criteria for frequency of colonoscopy in UC/Crohns?
Lower risk - 5 yearly colonoscopy
Extensive colitis with no active endoscopic/histological inflammation
OR left sided colitis
OR Crohn's colitis of <50% colon
Intermediate risk - 3 yearly 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
Higher risk - 1 yearly 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
81
What is the treatment regime for stage III follicular lymphoma
R-CHOP
82
Which drug can worsen bullies pemphigoid?
Furosemide
83
What are the indications for valve replacement in mitral stenosis
Area <1cm2
84
Which drug class should be stopped when giving ciclosporin
Statins
85
How long must someone not drive after a seizure
6mths if normal EEG and no underlying cause found
| Otherwise 1yr
86
What is the treatment for necrobiosis lipoidica
Topical steroids
| Occurs in DM
87
what is the side effect of carbimazole apart from agranulocytosis
Deranged LFTs & jaundice - hepatotoxicity
88
What is the tx for IgA GN
BP control with ACEi;
Acute
If acute inflammation seen on biopsy, or persistent haematuria -> High dose prednisolone.
If rapid deterioration in renal function -> prednisolone + cyclophosphamide or azathioprine
Chronic
Immunosuppression and steroids if CKD
89
Does pregnancy increase or decrease the risk of a flare of SLE?
Increase
90
Nitazoxanide is a treatment for what
Cryptosporidium
91
What is the first line treatment for Wilsons
trientene
92
How is poyarteritis nodosa treated
Steroids
93
What is the triad of Felty's syndrome
Neutropaenia & splenomegaly in RA
94
What must be done before starting clozapine (2)?
ECG
| Baseline WCC
95
Anti-GAD antibody
CF
Associated with
Breast, colorectal and small cell lung carcinoma
| stiff person's syndrome or diffuse hypertonia
96
What are the truelove Witts criteria
What are the criteria for severity
2 bowels, 2 obs, 2 bloods
Bowels - number open per day; blood
Obs - temp (>37.8); HR (>90)
Bloods - ESR (>30); Hb (<105)
Mild
<4 stools a day; Small amount of blood
Moderate
4-6 stools a day; Varying amount of blood
No systemic upset
Severe
>6 stools a day
Systemic features - fever, tachycardia
Anaemia and raised ESR
97
Inverted p wave in lead I, RAD and poor R wave progression suggests what
dextrocardia
98
```
What is the first line drug class for OCD
Which has less of a positive impact
```
SSRIs
Not citalopram / escitalopram
Can use TCAs, but clomipramine only
99
What is the best test for prediction of severity of COPD
FEV1 % of predicted
100
What is the follow up on gestational DM?
Fasting blood sugar at 3mths post partum, with annual fasting sugars subsequently
101
What fungal blood test is positive in PCP
1,3-b-D-glucan
102
What are the features of severe malaria
Falciparum
Schizonts on blood film
Parasitaemia >2%
-> tx with IV ACT
103
Which vasculitis is most associated with testicular pain
polyarteritis nodosa
104
When are paracetamol levels taken and NAc started post OD
4hrs
105
When should a statin be started post ischaemic stroke
48hrs - 80mg atorvastatin
106
Which antiretroviral drug is avoided in pts positive for B5701 allele
Abacavir - increased risk of fatal hypersensitivity reaction
107
What is Gaucher's disease
| What are the CF
AR deficiency of glucocerbrocidase causing accumulation -> hepatosplenomegaly & pancytopaenia
108
What is the first line treatment for macroprolactinomas
Medical - Dopamine agonists
109
What antimicrobial is used to treat cryptosporidium
paromomycin
110
What is the treatment for lead poisoning
EDTA acutely
| DMSA chronically
111
When should mast cell tryptase be taken to confirm anaphylaxis
Immediately and within 1-2hrs
112
Which class of lupus nephritis carries the worst prognosis?
Diffuse proliferative - class IV
113
If numb rash, what is the diagnosis
Leprosy
114
What is the dose of statin that should be started in t1dm?
| What are the criteria for starting
```
20mg atorvastatin
>10yrs since diagnosis
>40yrs
CVD disease
Nephropathy
```
115
What is the main SE of ketamine
Raised ICP
116
Which porphyria syndromes present with neurovisceral symptoms
AIP
| Aminolaevulinic acid dehydrogenase porphyria (Lead poisoning)
117
Amiodarone induced thyrotoxicosis
What are the features of the two types
How are they treated
Type 1 - increased hormone synthesis
Goitre
Type 2 - destructive
No goitre
Steroids
If goitre -> carbimazole and/or potassium percolate
If no goitre -> steroids
118
what is the target for t2dm management
If drug not associated with hypoglycaemia - HbA1c 6.5-7.5%
| If associated with hypoglycaemia - HbA1c 7.0%
119
Renal tubular acidosis type 1
Defect
Sx
Inability to reabsorb HCO3 from the proximal tubule
Much less likely to form stone
Hypo-K & normal anion gap metabolic acidosis
120
Eosinophilia with diarrhoea and rash prompts what infection?
| What is the treatment
Strongyloides
| Ivermectin
121
Htn, hypo-K, low renin and low aldosterone point to which diagnosis
Liddle's syndrome - give amiloride, not spiro
122
What is the treatment of scalp psoriasis
Scalp psoriasis - first-line treatment is topical potent corticosteroids
123
Anti-Hu
CF
Associated with
Small cell lung carcinoma and neuroblastomas
sensory neuropathy - may be painful
cerebellar syndrome
encephalomyelitis
124
First line systemic tx in psoriasis
Methotrexate
125
Which combination of lobar emphysema and exercise tolerance is a contraindication to lung volume reduction surgery
High exercise tolerance
| Lower/middle lobe disease
126
What drug can precipitate a scleroderma renal crisis
Prednisolone
127
Which antiretroviral increases the risk of renal stones
Indinavir
128
What sort of renal stones does IBD predispose to
Oxalate
129
What is the target blood pressure in CKD
<140/90
130
Commonest causes of nephrotic syndrome
MMF
Membranous GN
Minimal change disease
FSGS
131
If eosinophils and lung sx, what is the diagnosis
Pulmonary eosinophilia - think worms & flukes
132
What are the three classic sx of Whipples disease
Seronegative arthropathy
Weight loss
Diarrhoea
133
What is a contraindication for interferon use in MS
Deranged LFTs
134
What is the treatment for latent TB
3mths of rifampicin & isoniazid OR 6mths of isoniazid
135
SE of mycophenylate
```
Pancytopaenia
Taste disturbance
Gingival hyperplasia
Nausea and vomiting
Constipation
Gastrointestinal ulceration and bleeding.
```
136
What is given as prophylaxis for hypokalaemia periodic paralysis
Acetazolamide
137
What treatment is used to prevent cysteine ureteric stones
D-penicillamine
138
Which porphyria syndromes present with neurovisceral and skin sx
Hereditary coproporphyria
| Variegate porphyria
139
Warfarin induced skin necrosis is associated with what
Protein C deficiency - same as Calciphylaxis
140
What are the key distinguishing features between Gitelman & Bartter's syndromes
Bartter's - hypokalaemia with hypercalciuria (stones); more likely to present in children and be more severe
Gitelman - hypokalaemia with hypocalciuria; more likely to present in adults; milder
141
anti-emetic which blocks acetylcholine, dopamine, and serotonin receptors
Levomepromazine is a 'dirty drug' which blocks lots of different receptors (e.g. ACh, DA, 5HT). It is therefore a broad spectrum anti-emetic. It is first line in the last days of life.
142
What is the first line anticholinergic in overactive bladder syndrome
Solifenacin
143
Pancoasts tumours tend to be of what type
Squamous
144
What is the treatment for chronic methaemoglobinaemia
```
Ascorbic acid (vit C)
IV methylene blue acutely
```
145
What must you consider with vague GI sx and low B12 / vit ADEK?
What is the test
Small bowel bacterial overgrowth
| Hydrogen breath test
146
What is a drug cause of microscopic colitis
PPIs
147
What is the treatment for methotrexate induced lung fibrosis
Steroids
148
What is the treatment for membranous GN
1st line - BP control with ACEi
| 2nd line, if refractory - steroids and cyclophosphamide
149
Which drug should be stopped when giving clopidogrel
Omeprazole - switch to lansoprazole as it doesn't inhibit metabolism of clopidogrel to its active metabolite
150
Renal tubular acidosis type 1
Defect
Sx
Inability to secrete H+ in the distal tubule
| Stones, hypo-K & normal anion gap metabolic acidosis
151
How is diabetic gastroparesis best managed
erythromycin acutely
| domperidone long term
152
What kind of stones are predisposed to post ileostomy
Urate
153
Which renal disease is hep B most associated with
Membranous GN
154
What is the target BP in diabetes
If no end organ damage, <140/80
| If end organ damage, <130/80
155
Which DMARD is best used in pregnancy for RA
Azathioprine
156
Which drug is used to precipitate ECG changes in Brugada syndrome
What are those changes
Flecainide
| Downward sloping ST segments in V1-V3
157
What are the features of VHL syndrome
Cerebellar haemangiomas - can cause SAH
Renal cysts (can be pre-malignant)
Extra renal cysts - epididymal, pancreatic, hepatic
Phaeochromocytoma
Clear cell renal carcinoma
endolymphatic sac tumours
retinal haemangiomas: vitreous haemorrhage
158
hereditary spherocytosis - intravascular or extravascular haemolysis
extravascular - gallstones, jaundice and splenomegaly
159
What is the second line agent for familial hypercholesterolaemia after high dose atorvastatin
Ezetimibe
160
What schistosomiasis causes bladder inflammation
Haematobium
161
Anti-Yo
CF
Associated with
Ovarian and breast cancer
| cerebellar syndrome
162
What is the treatment for cryptosporidiosis
Rifaximin
163
What conditions are included in polyglandular autoimmune syndromes type 1 & 2
```
Type 1 - Addisions, mucocutaneous candidiasis & hypo-PTHism
Type 2 (Schmidt's) - Addison's +/- T1DM & thyroid disease
```
164
PTHrP associated hyper-Ca is associated with which lung cancer
Squamous cell
165
What is the treatment for GBM?
Surgery followed by chemo-radiotherapy with temozolomide
166
What is the only absolute contraindication to electroconvulsive therapy
Raised intracranial pressure
167
What is the treatment of multi drug resistant TB
5 drugs; 18-24mths
