MRCP Flashcards
.
1
Q
Wilcoxon signed-rank test
Parametric or non-parametric data
A
Non-parametric
compares two sets of observations on a single sample
2
Q
Which drugs can cause cirrhosis (3)
A
methotrexate
methyldopa
amiodarone
3
Q
Inheritance of Ocular albinism
A
X-linked recessive
4
Q
What is the antibiotic regime of choice for pseudomonas in CF
A
Ceftazidime and tobramycin
5
Q
What drug decreases concentration of Li
A
Acetazolamide & osmotic diuretics
6
Q
Which GN typically present with nephritic syndrome (2)
A
Typically presents with nephritic syndrome (haematuria, hypertension)
Rapidly progressive glomerulonephritis - aka crescentic glomerulonephritis
Rapid onset, often presenting as acute kidney injury
causes include Goodpasture’s, ANCA positive vasculitis and SLE
IgA nephropathy - aka Berger’s disease, mesangioproliferative GN
typically young adult with haematuria following an URTI
7
Q
When are steroids not indicated first line, for GN?
A
Membranous - tx with BP control and ACEi
Membranoproliferative - steroids are ineffective; can use eculizumab
Diffuse proliferative (post-strep) - self limiting
8
Q
What are the driving restrictions for syncope (4)
A
Simple faint: no restriction
single episode, explained and treated: 4 weeks off
single episode, unexplained: 6 months off
two or more episodes: 12 months off
9
Q
ANP is mainly secreted by the L or R atrium
A
Right atrium
10
Q
Docetaxel
MOA
SE
A
MOA: antimicrotubule agent; Prevents microtubule depolymerisation and disassembly, decreasing free tubulin
SE: Neutropaenia
11
Q
Glossopharyngeal nerve (IX) Vagus nerve (X) Accessory nerve (XI)
Posterior meningeal artery Ascending pharyngeal artery Inferior petrosal sinus Sigmoid sinus Internal jugular vein
Which skull foramen
A
Jugular foramen
12
Q
Bronchial malignancy is associated with which skin disorder
A
Erythema gyratum repens
Erythematous scaling rash over the abdomen
Wood grain appearance
13
Q
Iron-deficiency anaemia - cells seen on microscopy (2)
A
target cells
‘pencil’ poikilocytes
14
Q
Which anti TB drug is most likely to cause drug-induced lupus
A
procainamide
hydralazine
Isoniazid
15
Q
Vincristine, vinblastine
MOA
SE
A
MOA: antimicrotubule agents; Inhibits formation of microtubules - act in mitosis phase of cell cycle
SE: Vincristine: Peripheral neuropathy (reversible) , paralytic ileus
Vinblastine: myelosuppression
16
Q
Paraneoplastic syndromes - Anti-Hu
Associated with (2)
CF (3)
A
Associations: small cell lung carcinoma and neuroblastomas
CF
sensory neuropathy - may be painful
cerebellar syndrome
encephalomyelitis
17
Q
Histiocytosis X is a cause of cranial or nephrogenic DI
A
Cranial
18
Q
6-mercaptopurine
MOA
SE
A
MOA: antimetabolite; Purine analogue that is activated by HGPRTase, decreasing purine synthesis
SE: Myelosuppression
19
Q
IFN-gamma
Function
Indications (2)
A
Produced by T lymphocytes and NK cells
Weaker antiviral action, more of a role in immunomodulation particularly macrophage activation
Chronic granulomatous disease and osteopetrosis
20
Q
Secretin
Released by which cells
Stimulus
Effect
A
S cells
Acidic chyme and fatty acids
Increases pancreatic secretions and hepatic duct cells.
Decreases gastric acid secretion
Trophic effect on pancreatic acinar cells
21
Q
Inheritance of Lesch-Nyhan syndrome
A
X-linked recessive
22
Q
Mann-Whitney U test
What does it test
Parametric or non-parametric data
A
Non-parametric
Unpaired data
23
Q
Inheritance of Von Willebrand’s disease (types 1 and 2) type 3
A
1 and 2 -> AD; 3 -> AR
24
Q
What is the bug in cat scratch fever
What is the tx
A
Bartonela hensalae
Immunocompetent - supportive tx
Systemic disease - cipro
25
What is increased in lead poisoning
Urinary coproporphyrin
26
What are the features of cubital tunnel syndrome
| Which nerve is involved
Ulnar nerve
Tingling in ulnar nerve distribution; weakness is late
Worse when elbow is resting on a surface or the arm is flexed
27
When are steroids indicated first line, for GN?
Minimal change disease
FSGS
IgA / mesangioproliferative
Rapidly progressive
28
Causes of a false positive VDRL test (4)
'SomeTimes Mistakes Happen' (SLE, TB, malaria, HIV)
29
commonest SE of nicorandil
ulceration
30
complication of pcp
pneumothorax
31
```
Wilson's disease
Gene defect, chromosome and inheritance
Effects
Serum caeruloplasmin is high/low
Serum copper is high/low
Urinary Cu excretion is high/low
```
AR inheritance of ATP7B gene on chr13
Cu deposition in basal ganglia, eyes and liver
Reduced serum caeruloplasmin
Reduced serum copper (counter-intuitive, but 95% of plasma copper is carried by ceruloplasmin)
Urinary copper excretion - Increased
32
When should anticoagulation be started for an ischaemic stroke with AF
2 weeks
33
What tumour markers is elevated in teratoma / non-seminiferous testicular cancer
AFP & HCG
34
Indications for IFN-b
Relapsing remitting MS
35
IL-3
Source:
Effect:
Source: Activated T helper cells
Effect: Stimulates differentiation and proliferation of myeloid progenitor cells
36
Schizophrenics typically do or do not have insight into their condition
Not
37
when does the risk of neutropenic sepsis peak
10 days
38
What is the side effect of zanamivir
Bronchospasm
39
Tx of HSV (3)
Gingivostomatitis: oral aciclovir, chlorhexidine mouthwash
Cold sores: topical aciclovir although the evidence base for this is modest
Genital herpes: oral aciclovir. Some patients with frequent exacerbations may benefit from longer term aciclovir
40
IFN-alpha
Function
Indications (5)
SE
Produced by leucocytes
Antiviral action
Hepatitis B and C, Kaposi's sarcoma, metastatic renal cell cancer, hairy cell leukaemia
Flu-like symptoms and depression
41
```
Homocystinuria
Inheritance
Enzyme defect
CF
Tx
```
AR
Deficiency of cystathionine beta synthase -> accumulation of homocysteine
```
CF:
Fine, fair hair
Marfanoid
Learning difficulties, seizures
Downwards (inferonasal) dislocation of lens
```
Pyridoxine (50% respond)
42
t(11;14) disease and mechanism
```
Mantle cell lymphoma
Cyclin D1 (BCL-1) deregulation
```
43
When is omalizumab indicated
Pts with severe allergic asthma who have required >4 courses of steroids in the past month
44
Drugs which can precipitate myasthenia crisis
Beta-blockers
Penicillamine, Quinidine, procainamide, Li, Phenytoin
Abx: gentamicin, macrolides, quinolones, tetracyclines
45
Histology of IgA nephropathy
LM - Mesangial cell proliferation
| IF - Granular IgA and C3 deposition in the mesangium
46
How is gestational DM treated
If fasting glucose <7 -> trial diet & exercise; add metformin if not controlled after 1-2wks; add insulin if still not controlled
If glucose >7 at dx or >6 with sx -> insulin
Glibenclamide can be used if metformin is insufficient but insulin refused
47
Loss of which protein in nephrotic syndrome increases the risk of thrombosis
Antithrombin III
48
CREST is associated with which antibody
Anti-centromere
49
Tx for Mycobacteria avium
rifampicin, ethambutol & azithromycin
50
GFR increases or decreases during pregnancy
Increases
51
What are the two kinds of serological test in syphilis
```
cardiolipin tests (not treponeme specific)
treponemal specific antibody tests
```
52
What antibiotics risk worsening G6PDD
quinolone (cipro) and nitrofurantoin
53
What is the tx of tapeworm infection (Taenia)
praziquantel or niclosamide
54
Which gene mutation is likely to exist in essential thrombocythaemia once JAK2 is excluded
Calreticulin
| ET in around 20% of JAK-2 negative patients.
55
Bladder cancer is associated with what industry and what within it
Dyes industry. Rubber and leather industry
| Aromatic amines
56
What does the SeHcat test, test for
Bile acid malabsorption
57
CCK
Released by which cells
Stimulus
Effect
L cells of upper small intestine
Partially digested proteins and TGs
Increases pancreatic secretions, GB contraction & relaxation of the sphincter of Oddi
Decreases gastric emptying
Trophic effect on pancreatic acinar cells
Induces satiety
58
What proportion of values lie within 1SD, 2SD and 3SD of the mean
68. 3% of values lie within 1 SD of the mean (14)
95. 4% of values lie within 2 SD of the mean (14)
99. 7% of values lie within 3 SD of the mean (18)
59
Valproate
| MOA and SE
GABA agonist
Weight gain
Nausea
60
SE of ciclosporin
Everything is increased - fluid, BP, K+, hair, gums, glucose
61
What is the mode of renal toxicity of gentamicin
Proximal tubule dysfunction
62
Ix for stable angina: 1, 2 and 3
CT coronary angiography - lumenal flow
Non-functional imaging - MRI, stress echo
Invasive coronary angiography
63
Which group of antibiotics are associated with exacerbations of myasthenia
Aminoglycosides
64
When should ciclosporin levels be taken
Trough dose - immediately before the next dose
65
Amyloidosis
What is the classification
What causes each
AL - primary (AL is alone - 1°)
Myeloma, Waldenstrom's, MGUS
features include: cardiac and neurological involvement, macroglossia, periorbital eccymoses
AA - secondary - acute phase reactant
seen in chronic infection/inflammation
e.g. TB, bronchiectasis, rheumatoid arthritis
features: renal involvement most common feature
66
Driving restrictions
| AAA
>6cm -> notify DVLA; will have annual r/v
| >6.5cm -> disqualifies patients from driving
67
Poor prognostic features in AML
> 60 years
> 20% blasts after first course of chemo
cytogenetics: deletions of chromosome 5 or 7
68
What is the treatment for schistosomiasis
Praziquantel
69
What monitoring is required for those on hydroxychloroquine
Annual eye assessment
| Hydroxychloroquine can cause a retinopathy
70
Raltegravir
| MOA
Integrase inhibitor
71
What are the 5 stages of lung changes in sarcoid
Stage 0 - normal CXR
Stage 1 - BHL only
Stage 2 - BHL & pulmonary infiltrates
Stage 3 - Diffuse pulmonary infiltrates only
Stage 4 - widespread fibrosis
72
Which drug post MI has the best effect on survival / lowers NNT
ACEi
73
Does a high or low phosphate predispose to pseudogout
Low
74
```
Churg Strauss
What is it
What antibody is positive
CF
What drug can precipitate an attack
```
Small/medium vessel vasculitis
pANCA
Asthma, mononeuritis multiplex and eosinophilia
Leukotriene receptor antagonists can worsen the disease (montelukast)
75
What drug is added 2nd line in those still sx with gout despite maximal allopurinol tx
Benzbromarone
76
What are the associations of thymoma (5)
```
Madras:
Myasthenia
Dermatomyositis
Red cell aplasia
SLE
SIADH
```
77
IL-6
Source:
Effect:
Source: Macrophages, Th2 cells
Effect:
Stimulates differentiation of B cells
Induces fever
78
Polyglandular autoimmune syndrome type 1
Gene defect
Conditions within
Also known as
AR mut AIRE1 gene, chr 21
Addison’s disease; chronic mucocutaenous candidiasis; HypoPTHism
MEDAC - Multiple Endocrine Deficiency Autoimmune Candidiasis
79
Broca's area
Where is it
What does it do
What effect does a stroke in this area have
Inferior frontal gyrus - left frontal lobe
Causes expressive dysphasia
Difficulty with fluency - poor repetition
80
When are steroids not indicated first line, for GN?
Membranous - tx with BP control & ACEi
Membranoproliferative - steroids are ineffective; can use eculizumab
Diffuse proliferative (post-strep) - self limiting
81
anti dsDNA antibodies are associated with which disease
SLE - specificity 99%; sensitivity 70%
82
Hyposplenism - cells seen on microscopy (3)
Target cells
Howell-Jolly bodies
Pappenheimer bodies
83
Histology of minimal change disease
Light microscopy - no change
EM - effacement of podocyte foot processes; thickening of GBM
IF - no immune deposits
84
Where are antibodies directed against in bullies pemphigoid
Hemidesmosomes BP180 and 230
85
Which clotting factor in paradoxically increased in liver failure?
FVIII
86
IL-2
Source:
Effect:
Source: Th1 cells
Effect: Stimulates growth and differentiation of T cell response
87
Inheritance of Wiskott-Aldrich syndrome
X-linked recessive
88
Secondary causes of hyper-TGaemia
Hypertriglyceridaemia:
Diabetes mellitus (types 1 and 2) - Disproportionately high VLDL and low HDL
Obesity
Alcohol
Chronic renal failure
Drugs: thiazides, non-selective beta-blockers, unopposed oestrogen, immunosuppressants
Liver disease
Asian diabetics - tend to have low HDL and raised TGs
89
IFN-beta
Function
Indications
Produced by fibroblasts
Antiviral action
MS - reduces the frequency of exacerbations
90
Variceal bleed - is banding or sclerotherapy first line
Banding
91
What is the commonest associated symptom with Waldenstroms macroglobulinaemia
generliased weakness
Other facts:
Raised IgM
Hepatosplenomegaly
Sx of hyperviscosity
92
Which body part is acne rosecea also associated with
Eyes - blepharitis, keratitis, conjunctivitis
93
What is the mx of a myasthenic crisis
plasmapheresis or IV Ig
94
Which drugs can cause hepatocellular damage / hepatitis (10)
```
Paracetamol
Anti-convulsants - sodium valproate, phenytoin
anti-tuberculosis: isoniazid, rifampicin, pyrazinamide
statins
alcohol
nitrofurantoin
MAOIs
halothane
amiodarone
methyldopa
```
95
Driving restrictions
| CABG
CABG - 4 weeks off driving
96
Association of HLA-A3
haemochromatosis
97
For how long after a prosthetic valve replacement does staph epidermidis remain the most likely bug in IE, before staph aureus becomes more likely
2 months
98
Which vaccine should absolutely be avoided in HIV
BCG
99
What antibodies are present in paraneoplastic pemphigus
Anti-(...)plakins eg envoplakin
100
Erythema nodosum is a good or bad prognostic feature of sarcoid
Good
101
Inheritance of Kallman's syndrome
| Presents with undescended testes or not
X-linked recessive
| Undescended testes -> much more likely Kallman's than Klinefelters
102
What is the treatment for narcolepsy & cataplexy
Modafinil
103
Which drugs can precipitate acute glaucoma
Amitriptyline and anticholinergics
104
Which cytokines to Th2 cells secrete (4)
involved in mediating humoral (antibody) immunity
e.g. stimulating production of IgE in asthma
secrete IL-4, IL-5, IL-6, IL-10, IL-13
105
Second line choice of antibiotic in suspected meningitis when penicillin / cephalosporin contraindicated
Chloramphenicol
106
BP targets
Age
DM
CKD
<140/90 if <80yrs (clinic) or <135/85 (home);
<150/95 if >80yrs
DM
<130/80 if end organ damage;
Otherwise <140/80
Chronic renal disease
<125/75
107
IL-4
Source:
Effect:
Source: Th2 cells
Effect: Stimulates proliferation and differentiation of B cells
108
where are antibodies found in pemphigus vs pemphigoid
pemphigus - within the epidermis
| pemphigoid - at the dermo-epidermal junction
109
Paroxysmal nocturnal haemoglobinuria is associated with what cell markers
what is the classic triad
CD and CD59 negative cells
| Haemoglobinuria, pancytopenia, venous thrombosis
110
Inheritance of Hereditary haemorrhagic telangiectasia
AD
111
Indications for haemodialysis in methanol poisoning
Low GCS
Visual impairment
Severe poisoning - Level >0.5g/L
Renal impairment
112
What is the treatment for TTP
Plasma exchange with protein replacement
113
Which cell surface receptor allows entry of P. vivax, and is absent in West African populations, causing resistance
Duffy
114
Abciximab
| MOA
Glp IIb / IIIA inhibitor
115
Which GN typically present with nephritic syndrome (2)
Typically presents with nephritic syndrome (haematuria, hypertension)
Rapidly progressive glomerulonephritis - aka crescentic glomerulonephritis
Rapid onset, often presenting as acute kidney injury
causes include Goodpasture's, ANCA positive vasculitis and SLE
IgA nephropathy - aka Berger's disease, mesangioproliferative GN
typically young adult with haematuria following an URTI
116
What factors predispose to pseudogout?
3 electrolytes
4 conditions
```
Hyper-Ca (hyper-PTHism)
Low Mg
Low phosphate
Hypothyroidism
Haemochromatosis, acromegaly, Wilson's disease
```
117
Visceral leishmaniasis
species
Tx
L. donovani
| Amphotericin B
118
VHL predisposes to what tumours / sites - 8
What is the commonest cause of death
Which chromosome
```
Cerebellar, brainstem and spinal haemangioblastomas
Retinal angiomas
Phaeochromocytomas
Paragangliomas
Renal cysts and clear cell carcinoma
Pancreatic cysts and islet cell tumours
Epidydimal tumours
Endolymphatic tumours
```
Renal carcinoma is commonest cause of death
Chr 3
119
Inheritance of Von Willebrand's disease (types 1 and 2) and type 3
1 and 2 -> AD; 3 -> AR
120
Inheritance of Fabry's disease
X-linked recessive
121
Test for phaeochromocytoma
urinary vanillylmendelic acid and plasma metanephrines
122
Which antibody is positive in mixed connective tissue disease
anti RNP
| Features of SLE, systemic sclerosis and polymyositis
123
Which drugs can cause cholestasis (6)
oral contraceptive pill
antibiotics: flucloxacillin, co-amoxiclav, erythromycin*
anabolic steroids, testosterones
phenothiazines: chlorpromazine, prochlorperazine
sulphonylureas
fibrates
124
Which kinds of diuretics are associated with hypo-Mg
Thiazide
Loop
K-sparing
Thiazide - yes
Loop - yes
K-sparing - no
125
What are the transplant criteria for paracetamol OD
pH <7.3
Or all 3 of:
Creatinine >300
PT >100
Grade 3/4 encephalopathy
126
Doxorubicin
MOA
SE
MOA: Cytotoxic; Stabilizes DNA-topoisomerase II complex inhibits DNA and RNA synthesis
SE: Cardiomyopathy
127
Lofgren’s syndrome
| What is it
```
Acute sarcoid with:
Erythema nodosum
Arthralgia
Acute anterior uveitis
Fever
```
128
How are DOACs measured
PT
129
Inheritance of Hereditary spherocytosis
AD
130
MODY5
HNF-1b gene mutation
Pancreatic atrophy & renal cysts
x
131
Features of yellow nail syndrome (5)
```
Yellow nails
Bronchiectasis
Congenital lymphedema
Pleural effusions
Chronic sinusitis
```
132
What condition is associated with quadriceps muscle weakness and weakness of finger flexors
Inclusion body myositis
133
LRTI with what can cause reactivation of HCV cold sores
Strep pneumo
134
When should Li levels be taken
12hrs post dose
135
Which cyclins and CDKs are active in G2 phase of cell cycle
Cyclin B and CDK1
136
Bupropoion
MOA
SE
a norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist
Reduces seizure threshold - CI in epilepsy & bipolar
137
What are the commonest primary malignancies for those presenting with bone mets
Breast & lung - 80%
| Remaining 20% - incl kidney, thyroid
138
Below which LVEF are HGV licences (Group 2) not allowed
40%
139
IFN-alpha
Function
Indications (5)
SE
Produced by leucocytes
Antiviral action
Hepatitis B & C, Kaposi's sarcoma, metastatic renal cell cancer, hairy cell leukaemia
Flu-like symptoms and depression
140
Doxorubicin
Class of drug
MOA
SE
Anthracycline
MOA: Cytotoxic; Stabilizes DNA-topoisomerase II complex inhibits DNA and RNA synthesis
SE: Cardiomyopathy
141
MODY5
What is the mutation
CF
tx
HNF-1b gene mutation
Pancreatic atrophy & renal cysts
Usually responsive to sulfonylureas - insulin not usually necessary.
142
Causes of occupational asthma (7)
| I pretend some girls fancy early penetration
```
isocyanates - commonest cause. Example occupations include spray painting and foam moulding using adhesives
platinum salts
soldering flux resin
glutaraldehyde
flour
epoxy resins
proteolytic enzymes
```
143
Neuropathic pain - 1st, 2nd and 3rd line mx
1st - pregabalin, gabapentin, duloxetine, amitriptyline
2 - add one of the other first line agents
3 - tramadol
144
What tx can be added to a PD pt suffering dyskinesia with L-Dopa & DA agonists
MOA
Amantadine
| Antimuscarinic & NMDA-R antagonist
145
What is the specific effect of metformin
Reduces hepatic glucose output
146
How does phenytoin cause a macrocytosis
Altered folate metabolism
147
What is the minimum steroid intake a patient should be taking before they are offered osteoporosis prophylaxis?
7.5mg / day for 3mths
148
Inheritance of G6PD deficiency
X-linked recessive
149
Inheritance of Malignant hyperthermia
AD
150
Inheritance of Di George syndrome
AD - microdeletion of TBX1 on chr 22
151
Drugs associated with thrombocytopenia (7)
quinine
abciximab
NSAIDS
diuretics: furosemide
antibiotics: penicillins, sulphonamides, rifampicin
anticonvulsants: carbamazepine, valproate
heparin
152
```
Churg Strauss
What is it
What antibody is positive
CF
What drug can precipitate an attack
```
Small/medium vessel vasculitis
pANCA
Asthma, mononeuritis multiplex and eosinophilia
Leukotriene receptor antagonists can worsen the disease (montelukast)
153
What proportion of values lie within 1SD, 2SD & 3SD of the mean
68. 3% of values lie within 1 SD of the mean (14)
95. 4% of values lie within 2 SD of the mean (14)
99. 7% of values lie within 3 SD of the mean (18)
154
Tx regimes for malaria
Falciparum - complicated
ACT - Riamet & Malarone
Falciparum - uncomplicated
Quinine and doxycycline
Non-falciparum
Chloroquine and primaquine
155
Arcuate fasciculus
What does it do
What effect does a stroke in this area have
Connects Brocas and Wernickes areas
| Stroke causes a fluent dysphasia, mimicking Broca's
156
Inheritance of Hunter's disease
X-linked recessive
157
How is gestational DM treated
If fasting glucose <7 -> trial diet and exercise; add metformin if not controlled after 1-2wks; add insulin if still not controlled
If glucose >7 at dx or >6 with sx -> insulin
Glibenclamide can be used if metformin is insufficient but insulin refused
158
Tenofovir
Nucleotide RTI
159
What are the predominant features of visceral leishmaniasis
fever, widespread lymphadenopathy, hepatosplenomegaly, organ dysfunction
Pancytopaenia
Abnormal LFTs
160
Inheritance of PKU
AR
161
Alpha haemolytic strep infective endocarditis tx
Benpen & gent
162
What effect does bradykinin have on the airways
Bronchoconstriction
163
von Willebrands disease - bleeding time prolonged or normal
prolonged
164
Ix of choice for avascular necrosis
MRI
165
Inheritance of Cystinuria
AR
166
Myelofibrosis - cells seen on microscopy (1)
'tear-drop' poikilocytes
167
What are the causes of FSGS (6)
```
1° - idiopathic
2° to other renal pathology e.g. IgA nephropathy, reflux nephropathy
HIV
heroin
Alport's syndrome
sickle-cell
```
168
Inheritance of ataxia telangiectasia
Autosomal recessive
169
Which anticonvulsants do not interact with P450
Lamotrignine, Levetiracetam (the Ls are Level)
170
Which antibody test has the best negative predictive value for SLE
ANA
171
What are the commonest electrolyte imbalances in reseeding syndrome
hypophosphataemia -> heart failure and skeletal muscle weakness
hypokalaemia
hypomagnesaemia
172
primarily malabsorptive bariatric procedure
Biliopancreatic diversion with duodenal switch
173
What are first and second line for the treatment of bipolar disorder
1 - Valproate
| 2 - Li
174
what is the first line tx for threadworm
mebendazole
175
Contraindication to pneumonectomy
FEV1 <2L
176
Wire looping of capillaries in the glomeruli is seen in which glomerulonephrtis
Diffuse proliferative glomerulonephritis (often due to SLE).
177
Raltegravir, elvitegravir, dolutegravir
| MOA
Integrase inhibitors
178
Inheritance of Lipid storage disease: Tay-Sach's, Gaucher, Niemann-Pick
AR
179
Malignancies cause what kind of GN
Membranous - malignancy
180
IL-10 (human cytokine synthesis inhibitory factor):
Source:
Effect:
Source: Th2 cells
Effect: Inhibits Th1 cytokine production - anti-inflammatory
181
What antibiotic can reduce the renal clearance of Li (2)
| What other drugs
```
metronidazole & tetracyclines
NSAIDs
steroids
thiazide & loop diuretics
ACEi / ARB
```
182
Combining pioglitazone with what, increases the risk of peripheral oedema (CI in HF)
Insulin
183
What drug is used to treat gastroparesis in T1DM
Domperidone
184
BPPV
Dix-Hallpike manoeuvre and Epley manoeuvre
Which is therapeutic and which diagnostic
Dix-Hallpike manoeuvre - dx
| Epley manoeuvre - therapeutic
185
Associations of coarctation of the aorta (4)
Turner's syndrome
bicuspid aortic valve
berry aneurysms
neurofibromatosis
186
Absorption of which drug is impaired by calcium carbonate
Levothyroxine
187
What are the acute SE of phenytoin (3-4)
Cerebellar sx - ataxia, slurred speech, dizziness
Diplopia
Nystagmus
+/- confusion and seizures
188
95% of samples lie within how many SD of the mean
1.96 SD of the mean lie 95% of the sample values
189
Superior orbital fissure
| What leaves via this foramen (6)
Superior ophthalmic vein
Inferior ophthalmic vein
```
Oculomotor nerve (III)
Trochlear nerve (IV)
lacrimal, frontal and nasociliary branches of ophthalmic nerve (V1)
Abducent nerve (VI)
```
190
two main modes of paracetamol metabolism
glucoronic acid conjugation & sulphation
191
What is the driving restriction post first unprovoked/isolated seizure (2)
6 months - if no structural abnormalities on brain imaging and no definite epileptiform activity on EEG
Otherwise 12 months
192
IHD and AF - what is the anticoagulation guideline
If stable IHD -> oral anticoagulation only
If recent PCI / ACS -> 6mths of dual anti-plt tx with oral anticoagulation, then single antiplt oral anticoagulation until 12mths
193
Above what cd4 count in HIV should live vaccines of MMR, yellow fever and chickenpox be given
200
194
t(15;17) disease and mechanism
Acute promyelocytic leukaemia (M3)
| PML and RAR fusion
195
What are the indications for surgery in primary hyper-PTHism (5)
```
Age <50 years.
Ca > 2.85
gfr <60
Complications of hyper-Ca - stones, nephrocalcinosis, osteoporosis or osteoporotic fracture.
Symptomatic disease
```
196
Indications for orlistat
BMI >30
BMI >28 if associated complications
>5% weight loss in 3mths
197
What is first line tx for CMV
ganciclovir
198
commonest GI problem in SLE
Mouth ulcers
199
What drugs can be cleared by haemodialysis (5)
What drugs cannot (5)
Drugs that can be cleared with haemodialysis - mnemonic: BLAST
Barbiturate
Lithium
Alcohol (inc methanol, ethylene glycol)
Salicylates
Theophyllines (charcoal haemoperfusion is preferable)
```
Drugs which cannot be cleared with haemodialysis include
tricyclics
benzodiazepines
dextropropoxyphene (Co-proxamol)
digoxin
beta-blockers
```
200
t(15;17) - disease and mechanism
Acute promyelocytic leukaemia (M3)
| PML and RAR fusion
201
When should an LP be done post headache onset in SAH to exclude a bleed
12hrs
202
First line tx for SVC obstruction
Stenting esp if solid tumour
| Steroids more useful for haematological malignancy
203
Which factors contribute to the MDRD calculation of gfr
CAGE - serum creatinine, age, gender, ethnicity
204
What kind of gallstones are most likely to be found in states of raised haemolytic eg HS
Black pigment stones - radiolucent
205
IL-2
Source:
Effect:
Source: Th1 cells
Effect: Stimulates growth and differentiation of T cell response
206
What is the prevalence of RA?
1%
207
What is the conversion ratio between oral MST / morphine sulphate and parenteral (sc, iv, im)
Halve the dose
208
Associated with breast, colorectal and small cell lung carcinoma
stiff person's syndrome or diffuse hypertonia
Anti-GAD antibody
209
Which type of glomerulonephritis is most characteristically associated with partial lipodystrophy?
Mesangiocapillary GN type 2
```
Mesangiocapillary glomerulonephritis (membranoproliferative)
type 1: cryoglobulinaemia, hepatitis C
type 2: partial lipodystrophy
```
210
Which anti TB drugs should be avoided / reduced in renal impairment (2)
Ethambutol and streptomycin
211
Bupropoion
x
212
What is the effect of C5 deficiency
Predisposes to Leiner disease
| recurrent diarrhoea, wasting and seborrhoeic dermatitis
213
IL-10 (human cytokine synthesis inhibitory factor):
Source:
Effect:
Source: Th2 cells
Effect: Inhibits Th1 cytokine production - anti-inflammatory
214
What drugs increase the risk of idiopathic intracranial htn
Vit A, OCP, steroids, tetracycline, Li
215
Felty's syndrome
What is it
Blood
Triad of RA, neutropaenia and splenomegaly
Reticuloendothelial stimulation causes hypersplenism
Normochromic or hypo chromic anaemia
216
Gardner's syndrome
| CF - 4
Variant of FAP
| Osteomas of the skull and mandible, retinal pigmentation, thyroid carcinoma and epidermoid cysts on the skin
217
Which GN are associated with low complement levels?
```
Post strep GN
Mesangiocapillary GN
Subacute bacterial endocarditis GN
Cryoglobulinaemia
SLE
```
218
A1AT - inheritance and gene
AR or co-dominant inheritance
| Chr 14
219
How often should Li levels be checked
3mthly
| 6mthly for U&E & TFT
220
Optic canal
| What leaves via this foramen (2)
Optic nerve
| Ophthalmic artery
221
VIP
Released by which cells
Stimulus
Effect
Released by small intestine & pancreas
Stimulus: neural
Stimulates secretion of water & intestinal smooth muscle relaxation
Inhibits acid secretion
222
What hormone triggers epiphyseal fusion
Oestrogen
223
Direct contact with left kidney
Left suprarenal gland
Pancreas
Colon
224
IL-8
Source:
Effect:
Source: Macrophages
Effect: Neutrophil chemotaxis
225
What are the irreversible features of haemochromatosis
Arthropathy
Diabetes
Liver cirrhosis
Hypergonadotrophic hypogonadism
226
Histology of FSGS
LM - focal and segmental sclerosis
EM - Thickening of GBM
IF - IgG and C3 deposition
227
Amphotericin B
MOA
SE
MOA: Binds ergosterol
SE: Nephrotoxicity, flu-like symptoms, electrolytes (hypokalaemia, hypomagnaseamia)
228
Management (1st and; 2nd line) tx of migraine in pregnancy
Migraine during pregnancy
paracetamol 1g is first-line
aspirin 300mg or ibuprofen 400mg can be used second-line in the first and second trimester
229
Which viral meningitis is associated with a low CSF glucose
Mumps
230
Direct contact with right kidney
Right suprarenal gland
Duodenum
Colon
231
Pearson's product-moment coefficient
Parametric or non-parametric data
What does it test
Parametric
| Tests correlation
232
Foramen ovale
```
Mandibular nerve (V3)
Accessory meningeal artery
```
233
Draw and label the JVP
```
A - Atria contract
C - TV closes (c for close)
X - RV contracts
V - Atria contact against closed TV
Y - TV opens
```
234
What are the causes of a decreased TLCO
R->L shunting
Pneumonia
Pulmonary emboli
Problems with the alveolar wall
Fibrosis
pulmonary oedema
Loss of lung tissue
emphysema
No blood
anaemia
low cardiac output
235
When should digoxin levels be taken
6hrs post dose
236
MODY2
What is the mutation
CF
tx
Mutation in glucokinase (glucose sensor in pancreatic beta cells)
Controlled with diet alone.
237
Gold for RA
| SE
Peripheral neuropathy
Nephrotic syndrome
Aplastic anaemia
Pulmonary fibrosis
238
Ehlers Danlos syndrome
Inheritance
Which collagen is most often defective
AD
| Collagen 3
239
Causes of extravascular haemolysis
Haemoglobinopathies: sickle cell, thalassaemia
Hereditary spherocytosis
Haemolytic disease of newborn
Warm autoimmune haemolytic anaemia
240
Histology of FSGS
LM - focal and segmental sclerosis
EM - Thickening of GBM
IF - IgG and C3 deposition
Second commonest GN cause of nephrotic syndrome in adults after membranous GN
241
Hep B PEP
What are the 3 classes of responder
Unknown source
Unknown source:
Known responder to the vaccine, non-responder, currently being vaccinated
Known responders - booster dose of HBV vaccine.
Non-responders - HBIG + vaccine
Those in the process of being vaccinated - accelerated course of HBV vaccine
242
MOA of antipsychotics eg olanzapine (2)
D2 antagonist
| 5HT-2 antagonist
243
Dipyradimole
| MOA
PDE inhibitor - non-specific
244
Which drugs may exacerbate HF (5)
thiazolidinediones - pioglitazone - fluid retention
verapamil: negative inotropic effect
NSAIDs & glucocorticoids - fluid retention
class I antiarrhythmics - flecainide (negative inotropic and proarrhythmic effect)
245
SLE is associated with deficiencies of which complement factors
C3 and 4
246
A central scotoma points to a defect in which part of the optic pathway
Optic nerve
247
Inheritance of Hyperlipidaemia type II
AD
248
Ritonavir
P450 inhibitor or inducer
MOA
Inhibitor
| Protease inhibitor
249
Causes of a raised prolactin (the Ps)
```
Pregnancy / physiological
Prolactinoma
polycystic ovarian syndrome
primary hypothyroidism
Drugs - phenothiazines, metoclopramide, domperidone
```
250
MOA of ticagrelor
Plt ADP-R (P2Y12) inhibitor
Does not undergo hepatic activation - not vulnerable to p450 interaction, which clopidogrel is
Reversible allosteric block
251
Indications for IV Ig (10)
* primary and secondary immunodeficiency
* low serum IgG levels following haematopoietic stem cell transplant for malignancy
* pneumonitis induced by CMV following transplantation
•toxic epidermal necrolysis
idiopathic thrombocytopenic purpura
•Kawasaki disease
•dermatomyositis
* myasthenia gravis
* Guillain-Barre syndrome
* chronic inflammatory demyelinating polyradiculopathy
252
Which drugs can cause cholestasis (6)
SOAP SF
Steroids
oral contraceptive pill
antibiotics: flucloxacillin, co-amoxiclav, erythromycin*
phenothiazines: chlorpromazine, prochlorperazine
sulphonylureas
fibrates
253
Resistance to ARV drugs tends to be against what class
RTIs
254
What is the test for hypopituitarism
```
Combined pituitary function test
Including hypoglycaemia (<2.2) to stimulate ACTH and GH
```
255
Spearman, Kendall rank
| Parametric or non-parametric data
Non-parametric
| Tests correlation
256
SLE is associated with which antibody
anti dsDNA - specificity 99%; sensitivity 70%
257
Which antibiotic can cause a peripheral neuropathy & optic neuritis
Nitrofurantoin
258
What is the effect of C1 inhibitor (C1-INH) protein deficiency
Hereditary angioedema
259
Renal failure in Alports post transplant is typically caused by
Anti GBM antibodies causing a goodpastures like picture
260
Diffuse systemic sclerosis is associated with which antibody
Scl-70 antibodies
261
Secretin
Released by which cells
Stimulus
Effect
S cells
Acidic chyme and fatty acids
Increases pancreatic secretions of bicarb from centriacinar cells and hepatic duct cells.
Decreases gastric acid secretion
262
Indications for IFN-g
Chronic granulomatous disease
| Osteopetrosis
263
Inheritance of Myotonic dystrophy
AD
264
Associated with small cell lung carcinoma and neuroblastomas
sensory neuropathy - may be painful
cerebellar syndrome
encephalomyelitis
Anti-Hu
265
Ipilimumab
| MOA
CTLA-4 inhibitor
266
antibiotic of choice for legionnaire's disease
quinolone
267
```
Leukocyte adhesion deficiency
Which cell type is affected
Defect
Effect
Test
```
Neutrophil disorder
Defect of LFA-1 integrin (CD18) protein on neutrophils
Recurrent bacterial infections, Delay in umbilical cord sloughing
Absence of neutrophils/pus at sites of infection
268
Saquinavir
P450 inhibitor or inducer
MOA
Inhibitor
| Protease inhibitor
269
IFN-gamma
Function
Indications (2)
Produced by T lymphocytes and NK cells
Weaker antiviral action, more of a role in immunomodulation particularly macrophage activation
Chronic granulomatous disease and osteopetrosis
270
t(8;14) - disease and mechanism
Burkitt’s lymphoma
| Myc - Ig
271
Histology of FSGS
LM - focal and segmental sclerosis
EM - Thickening of GBM
IF - IgG and C3 deposition
272
Which GN typically present with nephrotic syndrome
Typically presents with nephrotic syndrome (proteinuria, oedema)
Minimal change disease
typically a child with nephrotic syndrome (accounts for 80%)
causes: Hodgkin's, NSAIDs
good response to steroids
Membranous glomerulonephritis
presentation: proteinuria / nephrotic syndrome / chronic kidney disease
cause: infections, rheumatoid drugs, malignancy
1/3 resolve, 1/3 respond to cytotoxics, 1/3 develop chronic kidney disease
Focal segmental glomerulosclerosis
may be idiopathic or secondary to HIV, heroin
presentation: proteinuria / nephrotic syndrome / chronic kidney disease
273
What is Weber's syndrome
| What causes it
Ipsilateral third nerve palsy with contralateral hemiplegia -
Midbrain strokes
274
Drugs causing retinopathy
Hydroxychloroquine
| Vigabatrin
275
What cytokine activates macrophages
| What cell release it
```
IFNg
Th1 cells (induced by IL12)
```
276
Inheritance of Becker muscular dystrophy
X-linked recessive
277
What is the inheritance of hypophosphataemic rickets
X-linked dominant
278
Regimes in multiple myeloma
x
279
Lamivudine, emtricitabine, epzicom, combivir, trizivir
Zidovudine (AZT)
zalcitabine, stavudine
Abacavir
MOA
SE
Nucleoside RTI
| SE - peripheral neuropathy
280
MODY2
What is the mutation
CF
tx
Mutation in glucokinase (glucose sensor in pancreatic beta cells)
Controlled with diet alone
281
Association of HLA-DR2 (3)
narcolepsy
Goodpasture's
SLE
MS
282
Gastrin
Released by which cells
Stimulus
Effect
G cells in the duodenum & pyloric antrum
Gastric distension, luminal peptides, vagus nerve
Increases acid secretion from parietal cells, pepsinogen and intrinsic factor secretion
Stimulates maturation of parietal cells
283
Contraindications to lung cancer surgery
SVC obstruction
FEV < 1.5
MALIGNANT pleural effusion
Vocal cord paralysis
284
Premack principle
Less desired behaviours can be encouraged by use of a more desired reward
Often used in eating disorders
285
Paroxysmal nocturnal haemoglobinuria is associated with what cell markers
and what is the classic triad
CD and CD59 negative cells
| Haemoglobinuria, pancytopenia, venous thrombosis
286
What are the features of an axonal polyneuropathy
| What are the causes (5)
Axonal pathology - conduction speed not lost, but action potential is smaller
Alcohol
Diabetes mellitus (may also cause a demyelinating picture)
Vasculitis
Vitamin B12 deficiency (may also cause a demyelinating picture)
Hereditary sensorimotor neuropathies (HSMN) type II
287
What is the 1st line DMARD for PsA
Methotrexate
288
acute intermittent porphyria is due to a defect in which enzyme
Porphobilinogen synthase
289
CLL causes what kind of autoimmune haemolytic anaemia
Warm AHA
290
Cutaneous leishmaniasis
Species
Tx
L major/ mexicana / tropicana
| Topical sodium stibogluconate
291
MS - good prognostic factors (5)
```
Female
Young onset
Sensory symptoms
Long gap between attacks
Relapsing remitting disease
```
292
Student's t-test
| Parametric or non-parametric data
Parametric
293
Complications of hepatitis B (6)
```
Chronic hepatitis
Liver failure
HCC
Glomerulnephritis
Polyarteritis nodosa
Cryoglobulinaemia
```
294
Histology of membranous GN
LM - thickening of GBM and capillaries
EM - Subepithelial deposits
IF - Granular IgG and C3 on outside of GBM
295
Inheritance of Marfan's syndromes
AD
296
Which drugs can cause hepatocellular damage / hepatitis (10)
```
Paracetamol
Anti-convulsants - sodium valproate, phenytoin
MAOIs
halothane
anti-tuberculosis: isoniazid, rifampicin, pyrazinamide
statins
alcohol
amiodarone
methyldopa
nitrofurantoin
```
297
Thresholds for dx of DM
Fasting
>7 -> DM
6-7 -> IFG
<6 -> normal
OGTT
>11.1 -> DM
7.8-11.0 -> IFG
<7.8 -> normal
Random >11.1
298
Which has more effect, R- or S-warfarin
Which p450 metabolises it
Which drug interacts
S-warfarin
2c9
Metronidazole - decreases metabolism of the more efficacious S-warfarin
299
Goodpasture's vs Wegener's - which is more associated with a raised ESR
Goodpastures
300
```
Maxillary nerve (V2)
Which skull foramen
```
Foramen rotundum
301
What are the risk factors for cataracts?
| How are they classified (2)
Most are age related
```
Systemic
DM
Steroids
Infection - congenital rubella
Metabolic - hypo-Ca, galactosaemia
Conditions - myotonic dystrophy, Down's
```
```
Ocular
•trauma
•uveitis
•high myopia
•topical steroids
```
302
Which cyclins and CDKs are active in G1 phase of cell cycle
Cyclin D and E; CDK 2,4,6
303
What is the Haldane effect
Increase in pO2 means CO2 binds less well to Hb
304
How are the causes of cataracts classified (2)
(i) 5
(ii) 4
Most are age related
```
Systemic
DM
Steroids
Infection - congenital rubella
Metabolic - hypo-Ca, galactosaemia
Conditions - myotonic dystrophy, Down's
```
```
Ocular
•trauma
•uveitis
•high myopia
•topical steroids
```
305
Association of HLA-B27
ankylosing spondylitis
Reiter's syndrome
acute anterior uveitis
306
What are Gram positive rods
| ABCD L
```
Actinomyces
Bacillus
Clostridium
Corynebacterium diphtheria
Listeria
```
307
Varenicline
| MOA
Nicotinic receptor partial agonist
308
Drugs known to precipitate TEN/SJS (6)
Phenytoin, carbamazepine, penicillin, sulphonamides, NSAIDs, allopurinol
Tx with IVIg +/- immunosuppression (cyclophosphamide, ciclosporin) +/- plasmapheresis
309
How is hep c confirmed
HCV RNA
310
Inheritance of Alports disease
X linked dominant
| 10-15% are autosomal recessive
311
What are used as prophylaxis in migraine
Topiramate
| Propranolol
312
naftidrofuryl
| MOA
5HT2 antagonist
| Used for intermittent claudication -> vasodilation
313
How do you calculate OR
| What sort of study generates an OR
Odds of intervention / odds of control
Odds = number with thing / number without thing
Case control - retrospective
314
Association of HLA-DR3
```
dermatitis herpetiformis
Sjogren's syndrome
primary biliary cirrhosis
Primary sclerosing cholangitis
T1DM
```
315
What is the mutation that leads to carbapenem resistance
New Delhi metallo-beta-lactamase 1
316
IL-8
Source:
Effect:
Source: Macrophages
Effect: Neutrophil chemotaxis
317
Leprosy
What is the classification
How are they treated
Tuberculoid leprosy (immunocompetent) vs Lepromatous leprosy (immunosuppressed)
```
Tuberculoid leprosy (immunocompetent)
Monthly rifampicin & daily dapsone for 6mths
```
```
Lepromatous leprosy (immunosuppressed)
Monthly rifampicin; daily dapsone & clofazamine for 24mths
```
318
what is the initial step in metabolism of isoniazid
acetylation
319
Normal range for TSH
0.5 - 2.5
320
Amiodarone induced thyrotoxicosis I
Pathology
Goitre present or not
Tx
Excess iodine induced thyroxine synthesis -> thyrotoxicosis
Goitre present
Tx: K percolate or carbimazole
321
TNFa is released from what cell
| What is its effect
Macrophages
| Fever and neutrophil chemotaxis
322
Bleomycin
Class
SE
Cytotoxic - Degrades preformed DNA - single DNA strand scission causing inhibition of cell division
(Blows over preformed DNA)
Lung fibrosis
323
Association of HLA-DR2 (3)
narcolepsy
Goodpasture's
SLE
324
Methotrexate
MOA
SE
MOA: Antimetabolite; Inhibits dihydrofolate reductase and thymidylate synthesis
SE: Myelosuppression, mucositis, liver fibrosis, lung fibrosis
325
Which cyclins and CDKs are active in S phase of cell cycle
Cyclin A and CDK 2
326
Sleep terrors occur in which stage of sleep
Early stage 4
327
After 3mths of statin use, what is the target for cholesterol
>40% reduction in non-HDL cholesterol
328
What drugs are levels informative in toxicity (8)
```
Paraquat
Paracetamol
Salicylate
Li
Iron
Methanol
Ethylene glycol
Theophylline
```
329
SE of isoniazid
Peripheral neuropathy - taken with pyridoxine (B6)
| Drug induced lupus
330
What is Charles Bonnet syndrome
Visual hallucinations, known not to be real, in isolated elderly people, often with impaired vision.
331
Ribavirin
MOA
SE
MOA:
Guanosine analog which inhibits inosine monophosphate (IMP) dehydrogenase -> interferes with the capping of viral mRNA
SE: haemolytic anaemia
332
What is the tx for plaque psoriasis
| 1st, 2nd, 3rd
1 - Potent topical steroid with calcipotroil
Both applied daily for 4wks, one in the morning and one the evening
2 - BD topical vitamin D analogue if no improvement after 8wks
3 - a potent corticosteroid applied twice daily for up to 4 weeks or a coal tar preparation applied once or twice daily
short-acting dithranol can also be used
333
What is the mode of action of terlipressin in hepatorenal syndrome
Smooth muscle relaxation -> decreased renin secretion
334
Nivolumab
| MOA
PD-1 inhibitor
335
Cardiolipin tests for syphilis
Examples (2)
Stay positive or negative after tx'd infection
examples VDRL & RPR
| becomes negative after treatment
336
Cushings / Conns causes what kind of metabolic disturbance
Hypochloraemic metabolic alkalosis - low K, high Na
337
Paraneoplastic syndromes - Anti-GAD antibody
Associations
CF
Associated with breast, colorectal and small cell lung carcinoma
CF: stiff person's syndrome or diffuse hypertonia
338
Porphyria cutanea Garda is due to a defect in which enzyme
What accumulates
Uroporphyrilinogen decarboxylase
339
Inheritance of Retinoblastoma
AD
340
What is the commonest form / source of partial seizure
Temporal lobe epilepsy
341
Which spirometry measure is used to monitor the severity & progression of COPD
FEV1
| FEV1/FVC <0.7 is for diagnosis only
342
Inheritance of Fanconi anaemia
AR
343
Drugs causing erythema nodosum
Hep B vaccine
Omeprazole
Isoretinoin
344
t(8;21) is associated with which condition
| What is likely to be present
AML
| Auer rods
345
Inheritance of AT-III deficiency
AD
346
IL-5
Source:
Effect:
Source: Th2 cells
Effect: Stimulate production of eosinophils
347
What is the side effect of GLP1 analogues
| When are they CI
Delayed gastric empyting
| CI if gastroparesis
348
Inheritance of Nephrogenic diabetes insipidus
X-linked recessive
349
Inheritance of Neurofibromatosis and chromosomes
AD
NF1 - chr 17 (neurofibromatosis has 1 letters)
NF2 - chr 22 (all the 2s)
350
Raltegravir, elvitegravir, dolutegravir
| MOA
Integrase inhibitors
351
Confirmatory test for coeliac disease
Eat gluten for 6wks
| Jejunal biopsy
352
What are the acute SE of phenytoin (3-4)
Cerebellar sx - ataxia, slurred speech, dizziness
Diplopia
Nystagmus
+/- confusion & seizures
353
What additional SE is present with sulfasalazine over mesalazine
Oligospermia
354
What is the commonest cause of erythema multiforme
Herpes simplex
355
How should AF with WPW be managed
Flecainide or DC cardioversion
356
Didanosine
MOA
SE
Nucleoside RTI
| SE: pancreatitis - didanosine makes you die of pancreatitis
357
enfuvirtide
| MOA
Attachment inhibitor - CCR5 antagonist
358
What are the congenital causes of optic neuropathy
Friedrich's
Mitochondrial disorders - Leber's
Retinitis pigmentosa
Wolfram syndrome
359
Features of a Holmes-Adie pupil
Dilated pupil
Slowly contracts to light and accommodation
Once constricted is very slow to dilate
Associated with decreased ankle reflexes
360
HSMN type 2 gives what type of peripheral neuropathy
axonal
361
Othello syndrome
Pt falsely holds wife / partner to be cheating on them, despite no evidence to support it
362
What are the 5 patterns of psoriatic arthritis
Rheumatoid-like polyarthritis (commonest)
Oligoarthritis - hands and feet; asymmetrical
DIP joint disease
Sacroiliitis
Arthritis mutilans
363
Causes of macroglossia (5)
```
Duchenne muscular dystrophy
hypothyroidism
Acromegaly
Amyloidosis
Mucopolysaccharidosis (e.g. Hurler syndrome)
```
364
Paraneoplastic syndromes - Anti-Yo
Associated with (2)
CF
Associated with ovarian and breast cancer
| Cerebellar syndrome
365
What proportion of primary syphilis cases progress to tertiary
30%
366
Causes of a false positive syphilis cardiolipin test (5)
```
pregnancy
SLE, anti-phospholipid syndrome
TB & leprosy
malaria
HIV
```
367
What does troponin C bind
Calcium
368
What is the PPV of the faecal occult blood test for detecting colorectal cancer
5-15%
369
TNFa is mainly secreted by
Macrophages
370
What is the effect of C3 deficiency
Recurrent bacterial infections
371
Cadasil
What is it
What are the features
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy
Inherited stroke disorder due to notch 3 mutation on chr19
Presents with migraines, mood disorder & TIA/strokes
372
Polyglandular autoimmune syndrome type 2
Also known as
Conditions within
HLA relation
Schmidt’s syndrome
HLA-DR3/4
Addison’s disease +/- T1DM or autoimmune thyroid disease
373
What signs are associated with a cholesterol embolism
Eosinophilia
Livedo reticularis
Purpura
Renal failure
374
Benserazide
MOA
Indication
Peripheral dopa-decarboxylase inhibitor
| PD - reduces peripheral conversion of l-dopa to DA, reducing SE of postural hypotension and N&V
375
What is seen on histology of rheumatic fever
Achaff bodies (granuloma with giant cells)
376
How does alcohol cause a diuresis
Cranial DI - decreased release of ADH from the posterior pituitary
377
Secondary causes of hyper-TGaemia (6)
DM (1 and 2) - high VLDL and low HDL
(Asian diabetics tend to have high TGs and low HDL)
Obesity
Alcohol
Chronic renal failure
Liver disease
Drugs: thiazides, beta-blockers, unopposed oestrogen, immunosuppressants
378
What is the tx of VTE in cancer
LMWH for 6mths
379
```
Leukocyte alkaline phosphatase is:
High in (6)
Low in (4)
```
```
Raised in
myelofibrosis
leukaemoid reactions
polycythaemia rubra vera
infections
steroids, Cushing's syndrome
pregnancy, oral contraceptive pill
```
```
Low in
chronic myeloid leukaemia
pernicious anaemia
paroxysmal nocturnal haemoglobinuria
infectious mononucleosis
```
380
Which antibiotic class can lower the seizure threshold of epilepsy
Example
What is the mode of action
Quinolones
Ciprofloxacin
Inhibit DNA synthesis by interfering with DNA gyrase (topoisomerase II) and topoisomerase IV
381
Inheritance of leech nyhan syndrome
x-linked recessive
382
Which immunodeficiencies have defects in B & T cells
SCID Was Ataxic
SCID
Wiskott-Aldrich syndrome
Ataxia Telangiectasia
383
IL-12
Source:
Effect:
Source: APCs - Dendritic cells, macrophages, B cells
Effect: Activates NK cells and stimulates differentiation of naive T cells (Th0) into Th1 cells
384
Which SSRI is preferred for breast feeding
sertraline
385
How can the SE of phenytoin be classified (4)
Acute
Chronic
Idiosyncratic
Teratogenic
386
A prominent y descent in the JVP is seen in which condition
Constrictive pericarditis
387
capecitabine is a pro-drug to which chemotherapeutic
5FU
388
Gitelman vs Bartter syndrome
Which occurs as a child and which as an adult
Which causes stones
Bartter - child
Gitelman - adult
Both hypokalaemia met alkalosis
Bartters causes stones. Gitelman doesn't
389
How long should anticoagulation be continued after DC cardioversion of AF
4wks
390
Association of HLA-DR3
dermatitis herpetiformis
Sjogren's syndrome
primary biliary cirrhosis
Addisons
391
Levothyroxine absorption is decreased by taking it with which drugs
Ca or Fe
392
Inheritance of facioscapulohumeral muscular dystrophy
AD
393
Superior ophthalmic vein and Inferior ophthalmic vein
```
Oculomotor nerve (III), Trochlear nerve (IV)
lacrimal, frontal and nasociliary branches of ophthalmic nerve (V1)
Abducent nerve (VI)
```
All leave via which foramen
Superior orbital fissure
394
associated with ovarian and breast cancer
| cerebellar syndrome
Anti-Yo
395
Inheritance of Haemophilia A,B
X-linked recessive
396
Commonest presentaiton of PsA
Asymmetrical seronegative oligoarthritis
397
How do you calculate relative risk
| What sort of study generates an RR
experimental event rate / control event rate
ER = number with thing happening / TOTAL number in that arm
Cohort - prospective
398
Hashimotos thyroiditis increases the risk of what thyroid malignancy
Thyroid lymphoma
399
What is the first line treatment for MRSA UTI
Doxycycline / tetracyclines
400
Which immunodeficiencies have defects in B and T cells
SCID Was Ataxic
SCID
Wiskott-Aldrich syndrome
Ataxia Telangiectasia
401
Gaucher's disease
Defect
CF - 4
Glucocerebrosidase deficiency
```
Bruising & thrombocytopaenia
Fatigue & anaemia
Bone lesions / fractures
Immunocompromise
Hepatosplenomegaly
```
402
```
Chronic granulomatous disease
Which cell type is affected
Defect
Effect
Tests
```
Neutrophil disorder
Lack of NADPH oxidase
Reduced ability of phagocytes to produce reactive oxygen species
Recurrent pneumonias and abscesses, particularly due to catalase-positive bacteria (e.g. Staphylococcus aureus and fungi (e.g. Aspergillus)
Negative nitroblue-tetrazolium test
Abnormal dihydrorhodamine flow cytometry test
403
What drugs demonstrate zero-order kinetics (3)
Alcohol, phenytoin, salicylates
404
What are the causes of a decreased TLCO
```
Fibrosis
Pneumonia
Right to left shunting - pulmonary emboli
pulmonary oedema
emphysema
anaemia
low cardiac output
```
405
Chlorambucil
MOA
Indication
Cold autoimmune haemolytic anaemia
| Alkylating agent
406
Erythema gyratum repens is associated with which malignancy
Bronchial
407
what drugs are metabolised by acetylation
```
Drugs affected by acetylator status - “I Prefer Dynamic Hip Screws”
Isoniazid
Procainamide
Dapsone
Hydralazine
Sulfasalazine
```
408
Inferior ophthalmic veins
Infraorbital artery
Infraorbital vein
Zygomatic nerve and infraorbital nerve of maxillary nerve (V2)
Orbital branches of pterygopalatine ganglion
Which skull foramen
Inferior orbital fissure
409
Inheritance of Albinism
AR
410
Which cytokines to Th1 cells secrete (3)
Involved in the cell mediated response and delayed (type IV) hypersensitivity
IL2, 3
IFNg
411
Which cytokine triggers differentiation of Th0 cells to TH2 cells
IL5
412
Cadasil
What is it
What are the features
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy
Inherited stroke disorder due to notch 3 mutation on chr19
Presents with migraines, mood disorder and TIA/strokes
413
IL-12
Source:
Effect:
Source: Dendritic cells, macrophages, B cells
Effect: Activates NK cells and stimulates differentiation of naive T cells into Th1 cells
414
Cinacalcet
MOA
Indication
MOA: agonsit at the calcium sensing receptor of the parathyroid.
Indication:
Used with tertiary hyper-PTHism to reduced PTH secretion, where surgical parathyroidectomy may not be appropriate
415
What is the driving restriction post first unprovoked/isolated seizure:
6 months - if no structural abnormalities on brain imaging & no definite epileptiform activity on EEG
Otherwise 12 months
416
What is fourth line for c. diff infection after oral metro, oral vac, IV metro
Fidaxomycin
417
What are the features of MEN2A
2Ps
Medullary thyroid cancer
Phaeochromocytoma
Parathyroid
418
HSMN type 1 gives what type of peripheral neuropathy
demyelinating
419
What electrophoresis pattern is seen in nephrotic syndrome
Low albumin
| Raised a1 and a1 globulins
420
IHD and AF - what is the anticoagulation guideline
If stable IHD -> oral anticoagulation only
If recent PCI / ACS -> 6mths of dual anti-plt tx with oral anticoagulation, then single antiplt oral anticoagulation until 12mths
421
What are the SE of quinolone abx
Lower seizure threshold in patients with epilepsy
Tendon damage (including rupture) - the risk is increased in patients also taking steroids
Cartilage damage
Lengthens QT interval
422
What abx can precipitate theophylline toxicity
Macrolides & quinolone
423
Atazanavir
P450 inhibitor or inducer
MOA
Inhibitor
| Protease inhibitor
424
Association of HLA-B5
Behcet's disease
425
Association of HLA-B5
Behcet's disease
| Can cause both arterial and venous occlusion & venous vasculitis
426
If all stages of plasmodium are visible in the blood, what is the likely species
O vale
427
Which gastric diseases cause a lymphoma
| Which cells are predominant
H. pylori - B-cell lymphoma
| Coeliac - T-cell lymphoma
428
SE of oxaliplatin
Sensory polyneuropathy
429
Indications for IFN-a
Hep B&C
Metastatic renal malignancy
Kaposi sarcoma
430
Inheritance of Androgen insensitivity syndrome
X-linked recessive
431
What antibiotic causes creatinine to rise
| Why
Trimethoprim
Competitively inhibits the tubular secretion of creatinine.
Rise reverses upon stopping the drug
Rise in creatinine does not represent a decrease in grr
432
patients with suspected idiopathic intracranial htn - should a dx LP take place or OCP stopped first
LP
433
For how long after a prosthetic valve replacement does staph epidermidis remain the most likely bug in IE, before staph aureus becomes more likely
2 months
| Strep viridans becomes more likely long term
434
What is the standard error of the mean
= sd / root (number of patients)
435
Management (1st and 2nd line) tx of migraine in pregnancy
Migraine during pregnancy
paracetamol 1g is first-line
aspirin 300mg or ibuprofen 400mg can be used second-line in the first and second trimester
436
Commonest cause of HCC in the Uk
hep C (hep B worldwide)
437
Inheritance of Hereditary non-polyposis colorectal carcinoma (+genes -2)
Peutz-Jeghers syndrome
Inheritance of Familial adenomatous polyposis (+chr)
AD
HNPCC - MSH2 / MLH1
FAP - APC on chr 5
438
What needs to be monitored with leflunomide therapy
BP - can cause hypertension
439
Absorption of which drug is impaired by calcium carbonate or iron
Levothyroxine
440
IL-12
Source:
Effect:
Source: APCs - Dendritic cells, macrophages, B cells
Effect: Activates NK cells and stimulates differentiation of naive T cells (Th0) into Th1 cells
441
IL-5
Source:
Effect:
Source: Th2 cells
Effect: Stimulate production of eosinophils
442
Causes of a LBBB (7)
```
ischaemic heart disease
hypertension
aortic stenosis
cardiomyopathy
rare: idiopathic fibrosis, digoxin toxicity, hyperkalaemia
```
443
Fluorouracil (5-FU)
MOA
SE
MOA: Antimetabolite; Pyrimidine analogue inducing cell cycle arrest and apoptosis by blocking thymidylate synthase (works during S phase)
SE: Myelosuppression, mucositis, dermatitis
444
What is common variable immunodeficiency (CVID)
Commonest clinically significant immunodeficiency
Defined as:
The presence of hypogammaglobulinaemia of two or more immunoglobulin isotypes (low IgG, IgA, or IgM)
Recurrent sinopulmonary infections
Impaired functional antibody responses
IgG is more likely to be deficient than IgM
445
What are the features of a demyelinating polyneuropathy
| What are the causes (5)
Demyelinating pathology - slowed conduction due to loss of myelin
Guillain-Barre syndrome
Chronic inflammatory demyelinating polyneuropathy (CIDP)
Amiodarone
Hereditary sensorimotor neuropathies (HSMN) type I
Paraprotein neuropathy
446
Inheritance of Hypokalaemic periodic paralysis
AD
447
On which chromosome are the alpha chains of Hb found (a-thal)
Chr 16
448
Which spirometry measure is used to monitor the severity and progression of COPD
FEV1
| FEV1/FVC <0.7 is for diagnosis only
449
Inheritance of Von Hippel-Lindau syndrome
AD
450
HLA Cw6 is associated with
psoriasis
451
Associated with breast and small cell lung carcinoma
| CF: ocular opsoclonus-myoclonus
Anti Ri
452
What drug is used in myeloma when thalidomide is not tolerated
bortezomib
453
What does troponin I bind
Actin
454
Inheritance of Noonan syndrome
AD
455
Steroids boost levels of which white cell
Neutrophils
456
What is familial dis-b-lipoproteinaemia
| How is it treated
ApeE2/2 genotype causing raised TGs
| Tx'd with omega 3 acids or fibrates
457
What are the thresholds for diagnosing DM in pregnancy
Fasting glucose >5.6
| OGTT >7.8
458
What are the SE of topiramate (3)
Weight loss, renal stones, cognitive and behavioural changes
459
What is the tx of lichen planus
Topical steroids +/- oral steroids or immunosuppression if
| extensive
460
```
Wilson's disease
Gene defect, chromosome & inheritance
Effects
Serum caeruloplasmin is high/low
Serum copper is high/low
Urinary Cu excretion is high/low
```
AR inheritance of ATP7B gene on chr13
Cu deposition in basal ganglia, eyes and liver
Reduced serum caeruloplasmin
Reduced serum copper (counter-intuitive, but 95% of plasma copper is carried by ceruloplasmin)
Urinary copper excretion - Increased
461
What is the preferred access for dialysis
AV fistula
462
What are the idiosyncratic SE of phenytoin (7)
2 blood - Megaloblastic anaemia, aplastic anaemia
2 skin / systemic - fever, rash (TEN)
2 liver - Dupytren's contracture, hepatitis
SLE
463
Which cytokines to Th2 cells secrete (4)
involved in mediating humoral (antibody) immunity
e.g. stimulating production of IgE in asthma
secrete IL-4, IL-5, IL-6, IL-10, IL-13
464
Which drugs can precipitate acute glaucoma
Amitriptyline and anticholinergics
465
CCK
Released by which cells
Stimulus
Effect
I cells of upper small intestine
Partially digested proteins and TGs
Increases pancreatic secretions, GB contraction & relaxation of the sphincter of Oddi
Decreases gastric emptying
Trophic effect on pancreatic acinar cells
Induces satiety
466
Which cytokine triggers differentiation of Th0 cells to TH1 cells
IL12
467
Antibody associations of drug induced lupus
dsDNA -ve; anti ANA in 100%
Anti histone in 80-90%
anti-Ro, anti-Smith positive in around 5%
468
Maraviroc
| MOA
Attachment inhibitor - CCR5 antagonist
469
t(11;14) - disease and mechanism
```
Mantle cell lymphoma
Cyclin D1 (BCL-1) deregulation
```
470
Management of a secondary pneumothorax
If >50yrs & >2cm -> chest drain
1-2cm -> aspirate and if fails, chest drain
If <1cm -> oxygen only
471
What are the treatments for pseudo gout
NSAIDs
| Colchicine if NSAIDs contraindicated
472
Optic nerve and Ophthalmic artery leave via which foramen
Optic canal
473
ECG changes associated with hypokalaemia
```
P wave flattening
PR interval lengthening
ST depression
T wave flattening or inversion
U waves
Long QT interval
```
474
t(9;22) - disease and mechanism
Philadelphia chromosome - CML
475
Ondansetron
MOA
SE
5HT3 antagonist
Acts at the chemoreceptorvtrigger zone of the medulla oblongata
Constipation is main side effect
476
What are the chronic SE of phenytoin (7)
Peripheral neuropathy, gingival hyperplasia, coarsening of facial features, lymphadenopathy, hirsutism, osteomalacia, dyskinesia
477
Inheritance of Romano-Ward syndrome
AD
478
What does troponin T bind
Tropomyosin
479
SLE is associated with deficiencies of which complement factors
C3 and 4
480
What are the reversible complications of haemochromatosis
Cardiomyopathy
| Skin pigmentation
481
Benzbromarone
MOA
Indication
Benzbromarone
MOA: URAT-1 inhibitor - increases excretion of uric acid
Indications:
For those who fail to achieve sufficient uric acid target or who are still sx despite maximal allopurinol therapy
482
What hormones are potentially secreted from a rental cell carcinoma
ACTH
Pth
Epo
Renin
483
Tuberous sclerosis
What is it
What is the gene defect
What are the features
AD inherited neurocutanoues syndrome
TSC1 on chr9 - hamartin
TSC2 on chr16 - tuberin
Features:
Cutaneous - ash leaf macules; shagreen patch; adenoma sebaceum; subungual fibromas;
Neurological - epilepsy, developmental delay
Abdo - polycystic kidneys, angiomyolipomas
Retinal - hamartomas
Cardiac rhabdomyomas
484
Churg Strauss is associated with which kind of GN
FSGS
485
A 30-year-old female is diagnosed with having Grave's disease. What is her chance of developing thyroid eye disease?
25-50%
486
VIP
Released by which cells
Stimulus
Effect
Released by small intestine & pancreas
Stimulus: neural
Stimulates secretion by pancreas and intestines
Inhibits acid secretion
487
Inheritance of FAP
| Gene
AD defect in APC gene - chr 5
488
Which drugs cause haemolysis in G6PDD (4)
Ciprofloxacin
Primaquire
Sulph-drugs - sulphonamides, sulphasalazine, sulfonylureas
489
What are the causes of a raised TLCO
```
Pulmonary haemorrhage
Left to right shunts
Hyperkinetic states
Asthma
Polycythaemia
male gender, exercise
```
490
Which cytokines to Th1 cells secrete (3)
Involved in the cell mediated response and delayed (type IV) hypersensitivity
IL2, 3
IFNg
491
What are the tx options for hiccoughs in palliative care
Chlorpromazine or haloperidol
492
Associations of mesangiocapillary GN
```
Mesangiocapillary glomerulonephritis (membranoproliferative)
type 1: cryoglobulinaemia, hepatitis C
type 2: partial lipodystrophy
```
493
Terbinafine
| MOA
Inhibits squalene oxidase
494
Prognostic markers in ALL - good or bad?
Hypodiploidy
Hyperdiploidy
Trisomy 4, 10 and 17
t(12;21) translocation
t(1:19) translocation
t(9:22) translocation
Precursor B-ALL
Hypodiploidy - bad
Hyperdiploidy - good
Trisomy 4, 10 and 17 - good
t(12;21) translocation - good
t(1:19) translocation - good
t(9:22) translocation - bad
Precursor B-ALL - good; more responsive to chemotherapy
495
Secondary causes of hypercholesterolaemia (3 - organs)
Hypercholesterolaemia:
Kidneys - Nephrotic syndrome, Chronic renal failure, dialysis or post-transplant
Liver - Cholestasis
Thyroid - Hypothyroidism
496
Which drugs can worsen gout
Ciclosporin, alcohol, nicotinic acid, thiazides, loops, ethambutol, aspirin, pyrazinimade
497
What are the 5 stages of lung changes in sarcoid
```
Stage 0 - normal CXR
Stage 1 - BHL only
Stage 2 - BHL and pulmonary infiltrates
Stage 3 - Diffuse pulmonary infiltrates only
Stage 4 - widespread fibrosis
```
498
Febuxostat
MOA
Indication
CI
Xanthine oxidase inhibitor
Gout
CI with azathioprine - causes toxic accumulation
499
What is added to standard RIPE therapy for tx of TB meningitis
Steroids
500
t(9;22) - disease and mechanism
Philadelphia chromosome - CML
501
Histology of IgA nephropathy
LM - Mesangial cell proliferation
| IF - Granular IgA and C3 deposition in the mesangium
502
Nevirapine
Delavirdine
Efavirenz
Non-nucleotide RTI
503
Which TCAs are best and worst in OD
Best (least bad) - lofeprimine
| Worst - amitryptiline or dosulepin
504
What is the treatment for mall and syndrome
bHCG
505
Hydroxyurea
MOA
SE
MOA: cytotoxic; Inhibits ribonucleotide reductase, decreasing DNA synthesis
SE: Myelosuppression
506
Contraindication to lobectomy
FEV1 <1.5L
507
Inheritance of Duchenne muscular dystrophy
X-linked recessive
508
What are pts with Di George syndrome most at risk of
T-cell defect - viral and fungus infections
| Eg cryptococcus
509
What does the galactomannan test test for
ELISA - Invasive aspergillosis
510
What are parameters of the CURB65 score
```
Confusion
Urea >8
RR >30
BP <90 syst or <60 dias
Age >65
```
511
What is the tx for bacillus anthracis infection
Ciprofloxacin or doxycycline
512
Test of choice for giardia
Stool culture / antigen testing
513
Causes of membranous GN
| Classification (5)
idiopathic
infections: hepatitis B, malaria, syphilis
malignancy: lung cancer, lymphoma, leukaemia
drugs: gold, penicillamine, NSAIDs
autoimmune diseases: systemic lupus erythematosus (class V disease), thyroiditis, rheumatoid
514
Association of HLA-DR4
```
T1DM (associated with DR4>DR3)
rheumatoid arthritis
Pemphigus
Drug induced SLE
PMR
IgA nephropathy
```
515
What is the role of IL-1
| What is it secreted by
It is secreted mainly by macrophages and monocytes and acts as a costimulator of T cell and B cell proliferation.
Increases the expression of adhesion molecules on the endothelium.
Stimulates the release by the endothelium of vasoactive factors such as PAF, nitric oxide and prostacyclin
Causes vasodilation and increases vascular permeability.
516
Which is painful, scleritis or episcleritis
Scleritis because it stings
517
What tx is used for Tourette's syndrome
Atypical antipyschotic eg risperidone
518
TNFa is released from what cell
| What is its effect
Macrophages
| Fever and neutrophil chemotaxis
519
MODY3 - 60%
What is the mutation
CF
tx
HNF-1a gene mutation
Higher glucose levels to be required to elicit insulin secretion.
Usually responsive to sulfonylureas - insulin not usually necessary
520
Inheritance of Colour blindness
X-linked recessive
521
Which antibody is most likely to be positive in dermatomyositis
ANA - commonest (positive in 60%)
| 25% are anti-Mi-2 positive - most specific
522
Driving restrictions
| Angioplasty (elective)
Angioplasty (elective) - 1 week off driving
523
What is the driving restriction for someone experiencing multiple TIAs over a short time period
3mths
524
c3 nephritic factor is what
Anti-C3bBb
525
```
Chediak-Higashi syndrome
Which cell type is affected
Defect
Effect
CF
```
Neutrophil disorder
Microtubule polymerization defect
Decrease in phagocytosis
Partial albinism, peripheral neuropathy, recurrent bacterial infections
526
Which kind of melanoma is normally seen on the palms and soles
Acral lentiginous
527
IL-4
Source:
Effect:
Source: Th2 cells
Effect: Stimulates proliferation and differentiation of B cells
528
Driving restrictions
| Successful catheter ablation for an arrhythmia
successful catheter ablation for an arrhythmia- 2 days off driving
529
Paroxysmal nocturnal haemoglobinuria is associated with what cell markers
& what is the classic triad
CD55 & CD59 negative cells
| Haemoglobinuria, pancytopenia & venous thrombosis
530
Mucocutaneous leishmaniasis
Species
Tx
L. braziliensis
| amphotericin B
531
HLA DR1 is associated with what
Bronchiectasis
532
Wernicke's area
Where is it
What does it do
What effect does a stroke in this area have
Superior temporal gyrus - left temporal lobe
Responsible for recognising and analysing spoken language.
Causes a receptive dysphasia - poor repetition, poor comprehension
533
Amiodarone induced thyrotoxicosis II
Pathology
Goitre present or not
Tx
Amiodarone related destruction of the thyroid
No goitre
Steroids
534
What cytokine activates macrophages
| What cell release it
```
IFNg
Th1 cells (induced by IL12)
```
535
pH 7.4 corresponds to what H+ conc
pH 7.0 corresponds to what H+ conc
7. 4 = H+ of 40
| 7. 0 = H+ of 100
536
Irradiated blood is given to prevent what
Graft vs host disease
537
Mandibular nerve (V3)
Accessory meningeal artery
Which skull foramen
Foramen ovale
538
Features of lateral medullary syndrome
Cerebellar features
ataxia
nystagmus
Brainstem features
ipsilateral: dysphagia, facial numbness, cranial nerve palsy e.g. Horner's
contralateral: limb sensory loss
539
5 stages of diabetic glomerular nephropathy
Stage 1 - hyperfiltration: increase in GFR
Stage 2 (silent or latent phase) - pre-microalbuminuria
Stage 3 (incipient nephropathy) - microalbuminuria
Stage 4 (overt nephropathy) - persistent proteinuria
Stage 5 - end-stage renal disease
540
Commonest SE of ticagrelor
Dyspnoea
541
What is the best prognostic marker in multiple myeloma
B2 microglobulin
542
Features of Alports syndrome
microscopic haematuria
progressive renal failure
bilateral sensorineural deafness
lenticonus: protrusion of the lens surface into the anterior chamber
retinitis pigmentosa
renal biopsy: splitting of lamina densa seen on electron microscopy
543
Causes of a raised anion gap
```
Raised anion gap
lactate: shock, hypoxia
ketones: diabetic ketoacidosis, alcohol
urate: renal failure
acid poisoning: salicylates, methanol
```
544
chi-squared test
| Parametric or non-parametric data
Non-parametric
| Used to compare proportions or percentages
545
Causes of a normal anion gap metabolic acidosis
```
Normal anion gap ( = hyperchloraemic metabolic acidosis)
GRAD
GI bicarbonate loss: diarrhoea, fistula
Renal - renal tubular acidosis
Drugs: e.g. acetazolamide
Addison's disease
```
546
At what level of falciparum parasitaemia should exchange transfusion be considered
10% parasitaemia on blood film
547
What is the commonest malignancy associated with dermatomyositis
Lung
548
What is the treatment for leptospirosis (Weil's disease)
Penicillin or doxycycline
549
What ophthalmic condition is most commonly associated with Charles Bonnet syndrome
AMD
550
Which drug class is used first line to tx glaucoma in those with asthma
Prostaglandin analogue - latanoprost
551
What are Gram negative cocci (2)
Neisseria & moroxella
552
What is the MOA of mycophenylate
Inhibits inosine monophosphate dehydrogenase
553
IL-6
Source:
Effect:
Source: Macrophages, Th2 cells
Effect:
Stimulates differentiation of B cells
Induces fever
554
Foramen rotundum
Maxillary nerve (V2)
555
What are the features of MEN2B
```
1P
Phaeo
Medullary thyroid
Marfanoid
Neurofibromatosis / neuromas
```
556
4 features of tetralogy of fallot
Overriding aorta
Pulmonary atresia
Right ventricular hypertrophy
VSD
557
What is the screening test for hereditary angiooedema
C4
558
What is the most common ocular manifestation of RA
Keratoconjunctivitis sick - dryness of the eyes
559
What factor is the strongest predictor of the risk of progression to cirrhosis in hep B
Viral load
560
Drugs causing a raised ICP (7)
```
Steroids
Tetracyclines
OCP
Isoretinoin
Levothyroxine
Lithium
Antihistamine - cimetidine
```
561
Treponemal specific tests for syphilis
Examples (2)
Stay positive or negative after tx'd infection
THPA
| Stay positive
562
IL-3
Source:
Effect:
Source: Activated T helper cells
Effect: Stimulates differentiation and proliferation of myeloid progenitor cells
563
What is the urinary test for phaeochromocytoma
24hr metnephrins
564
Inheritance of Neurofibromatosis and chromosomes
AD
NF1 - chr 17 (neurofibromatosis has 1 letters)
NF2 - chr 22 (all the 2s)
565
Drugs which can precipitate myasthenia crisis
Beta-blockers
Penicillamine, Quinidine, procainamide, Li, Phenytoin
Abx: aminoglycosides (gentamicin), macrolides, quinolones, tetracyclines
566
What is the role of IL-1
| What is it secreted by
It is secreted mainly by macrophages and monocytes and acts as a costimulator of T cell and B cell proliferation.
Increases the expression of adhesion molecules on the endothelium.
Stimulates the release by the endothelium of vasoactive factors such as PAF, nitric oxide and prostacyclin
Causes vasodilation and increases vascular permeability.
567
MODY5
What is the mutation
CF
tx
HNF-1b gene mutation
Pancreatic atrophy & renal cysts
Usually responsive to sulfonylureas - insulin not usually necessary
568
Which is more common - ostium primum or ostium secundrum ASD
Ostium secundum
569
Commonest complication of ERCP
Acute pancreatitis
