MRCP all Flashcards
1
Q
What drug should be avoided in IBS?
A
Lactulose
2
Q
What blood markers suggest Alcoholic liver disease OR non alcoholic liver disease?
A
ALD - AST: ALT >2
non alcoholic liver disease
ALT>AST
3
Q
how is severe alcoholic hepatitis managed? what criteria is used for this ?
A
Corticosteroids
Maddreys discriminant function - uses PT and billirubin. if >32 then use steroids
4
Q
what are the scoring systems for upper GI bleed?
A
Glasgow blatchford
Rockall - after endoscopy
5
Q
what is the prophylaxis for reducing risk of variceal upper GI bleed?
A
Propanolol
6
Q
What Ix is needed in Budd Chiari syndrome?
A
USS dopler of liver - very sensitive
7
Q
What Abx prophylaxis is given in spontaneous bacterial peritonitis and when?
A
Ciprofloxacin/ norfloxacin if ascites + - previous SBP - protein fluid <15g/l - child pugh of 9 - hepatorenal syndrome
8
Q
how is spontaneous bacterial peritonitis diagnosed? what is the most common organism found?
A
neutrophils >250
Ecoli
9
Q
what drugs cause cholestasis?
A
COCP steroids fluclox erythromycin fibrates sulphonylureas
10
Q
what change is seen in barrets oesophagus?
A
sqaumous –> columnar
11
Q
when is barrets oesophagus treated?
A
metaplasia - endoscopic surviellence 3-5yrs
dysplasia - endoscopic mucosal resection/ radiofreq ablation
12
Q
what is the target of clopidogrel?
A
P2Y ADP receptor
13
Q
what drug makes clopidogrel less effective?
A
PPI
14
Q
what does hypercalcaemia do to an ECG?
A
Short QT
also causes HTN
15
Q
what are the causes of long QT?
A
hypo K, Mg, Ca, hypothermia
antidepressants (SSRI (citalopram), tricyclics),
antiarrhythmics (amiodarone, sotolol) ,
antibiotics - ciprofloxacin, erythromycin
other - SAH, myocarditis
Romeo ward
Jervall lange nielson
16
Q
what are the ecg changes in hypo K
A
no T/ flat long PR long QT ST depression U waves
17
Q
what is the treatment for mitral stenosis?
A
percutaneous mitral commissuratomy
18
Q
What is the equation for sensitivity?
A
Out of the positive people how many of them test positive
19
Q
What is the equation for positive predictive value?
A
OF all the positive tests, how many actually have the disease?
20
Q
How are DNA, RNA and proteins investigated?
A
DNA - southern blot
RNA - northern blot
protein - western blot
21
Q
Which Ab is most abdunant in the serum?
A
IgG
22
Q
which Ab is most abdundant in breast milk and muscosal lining?
A
IgA
23
Q
which Ab is first to respond to infection?
A
IgM
24
Q
which antibody activates B cells?
A
IgD
25
which HLA is coeliacs, haemochromatosis and behcets? (each a separate one)
HLA DQ2 - coeliacs
HLA A3 - haemachromatosis
HLA b51 - behcets
26
which medication is first line for trigeminal neuralgia?
Carbemazepine
27
which Abx should be used for septic arthritis and how long?
IV fluclox
4-6 weeks
after 2 weeks can be made oral
28
which organism most commonly causes septic arthritis?
S.aureus
| N.gonorrhoea - most common in young sexually active
29
how is septic arthritis most commonly acquired?
haematogenous spread
30
which is the most common site for septic arthritis?
knee
31
How are cluster headaches managed?
S/C sumatriptan + 100% O2
32
what are the triggers/ associateion of cluster headaches?
males
smokers
alcohol is a trigger
33
how can cluster headaches be prevented?
verapamil
34
how does radial tunnel syndrome present?
signs and symptoms like lateral epiconylitis however pain is about 4-5cm disatal to lateral epicondyl
35
what ECG change is seen in a subarachnoid haemorrhage?
ST elevation
36
what are the predictive factors for the outcome of SAH?
level of consciousness
age
amount of blood on CT
37
How does drug induced parkinsonism present differently to parkinsons?
motor symptoms rapid onset and bilateral
less rigidity and tremor in comparison
mask like face, flexed posture and restlessness - seen in both
38
what is the most common psych issue in parkinsons?
depression
39
Marfans is complicated by dural ectasia, how does this present?
ballooning or dural sac in lumbar level.
headaches, lower back pain, leg weakness, bladder/bowel changes
40
which Antibody is associated with dermatomyositis?
anti Mi2 - most specific
| ANA - more common
41
Which malignancy is sjorgrens more at risk of?
lymphoid malignancy
42
which Ab are seen in sjogren, which is most common?
Ro> La
| low C4
43
How is bells palsy managed?
oral pred within 72 hours of onset
44
which malignancy and antibody is stiff persons syndrome associated with?
anti GAD
| colorectal, breast, small cell
45
how long does Driving need to be banned for after stroke/ TIA?
one TIA - one month
multiple TIA / stroke - 3 months + tell DVLA
46
what treatment best prolongs life expectancy in MND?
NIV > riluzole
47
what screening is needed on patients using hydroxychloroquine and why? what advice would you give pregnant women?
fundoscopy and visual tests before and annually.
Due to risk of bulls eye retinopathy
can be used in pregnancy
48
For bitemporal hemianopias how can we identify where a lesion is depending on the quadrant affected?
upper quadrants - pituitary
| lower quadrants - craniopharygioma
49
which disease is HLA DR4 associated with?
diabetes
| RA (DRB1 gene particularly)
50
Which Ab are associated with HLA DR2 ?
Nacrolepsy
| goodpastures
51
What statistical test is used in cohort and case control studies?
cohort - relative risk
| case control - odd ratio
52
For parametric data which tests can be used and when?
T test
| pearson - correlation
53
for non parametric data which test can be used and when ?
man whitney - compares intervals/ ratios
wilcox - before and after
chi squared - compares % proportion
spearmans rank - correlation
54
list the translocations seen in haematological malignancy...
t(9:22) - CML , ALL (poor prog) - BCR ABL
t (14:18) - follicular lymphoma - BCL2
t(11:14 ) - mantle - cyclin D
T(8:14) - burkitts - myc
t(15:17) - promyelocytic - RAR-PML
55
what is the function of vWF?
stabilises factor VIII
56
what changes are there to clotting factors in von willebrand disease?
low factor 8
57
what is the treatment for von willebrand disease?
Desmopressin - stimulates release of vWF
58
what is the dose adrenaline for anaphylaxis by age?
<6 months: 100-150
6m-6yr 150microG
6-12yr: 300 microG
>12: 500microG
all 1 in 1000
59
what are the different cryoglobulinaemia immunoglobulins and what diseases are they associated with?
type 1 - monoclonal IgG or IgM. associated with muliple myeloma/ waldenstorm. only one with raynauds
type 2 - mixed mono/ polyclonal. hep C, RA, sjorgrens , lymphoma
type 3 - polyclonal. RA and sjogrens
60
what is the treatment for ITP?
oral prednisolone
61
what is evans syndrome?
ITP + autoimmune haemolytic anaemia
62
```
state the mechanism and side effect of:
cyclophosmide
bleomycin
doxorubicin
vincistrine
```
cyclophosmadie - cross link DNA, haemorrhagic cystitis, transitional cell carcinoma, myelosupression
bleomycin - degrades DNA, lung fibrosis
doxorubicin - stabilises topoisomerase - cardiomyopathy
vincistrine - microtubule inhibition. peripheral neuropathy,, paralytic ileus
63
```
state the mechanism and side effect of:
docetazxel
irinotecan
cisplatin
hydroxyurea?
```
docetaxel - microtubule inhibitrion. neutropenia
irinotecan - topoisomerase inhibitor - myelosupression
cisplatin - cross links DNA. HypoMg, periperal neuropathy, ototoxic
hydroxyurea - inhibits ribonucleotide reductase
64
what is the best marker for diagnosis of hereditary angioedema between attacks?
low C4
65
what immunoglobulins are seen in cold and warm haemolytic anaemias?
cold - IgM
| Warm - IgG
66
what infection gives burkitts?
MAlaria
67
which haematological malignancy is HIV linked to?
high grade B cell lymphoma
68
what is seen in methamoglobinaemia in terms of oxygenation?
low sats
| normal pO2
69
what is the test for hereditary spherocytosis ?
EMA binding test
70
which drugs have 0 order kinetics?
salicyclates
ethanol
phenytoin
heparin
71
how does methanol poisoning present and how is it treated?
Like alcohol intox + visual changes
managed with fomepizole
72
what is the dose of adrenaline in adults in anaphylaxis vs cardiac arrest?
500micrograms - anaphylaxis (0.5 ml) (1 in 1000)
1mg in cardiac arrest (0.1ml) (1 in 10,000)
(or for cardiac arrest can use 1 in 1000, 1ml)
73
when can gastric levage and charcoal be used?
both within 1 hour of ingestion
74
what can be given for tricyclic OD And when?
IV bicarb if..
| pH<7.1 , QRS >160 or arrhythmia
75
what are the side effects of sulphonylureas?
Hypoglycaemic episodes
Increased appetite and weight gain
```
Syndrome of inappropriate ADH secretion
Liver dysfunction (cholestatic)
```
76
what are the side effects of glitazones?
Weight gain
Fluid retention
Liver dysfunction
Fractures
77
What is the kings college criteria for liver transplant?
pH <7.3 ORRR...
Creatinine > 300
PT > 100 s
Hepatic encephalopathy 3 or 4
78
What is the mechanism of rifampicin , isoniazid and pyrazinamide?
Rifampicin - inhibits DNA dep RNA pol
Isoniazid - reduces mycolic synthesis
Pyrazinamide - inhibits fatty acids
79
What are the ADRs of rifampicin
Orange secretions
Hepatitis
Flu like symptoms
Liver enzyme inducer
80
What are the side effects of isoniazid ?
Peripheral neuropathy - give pyroxidine
Hepatitis
Agranulocytosis
81
What are the side effects of pyrazinamide?
Gout
Arhralgia, myalgia
Hepatitis
82
What is side effects of ethambutol
Optic neuritis
83
What drugs should not be taken with statins ?
Macrolides - erythromycin / clarithromycin
| These inhibit p450 so statin levels rise to toxic
84
Which electrolyte can promote digoxin toxicity
HypoK
| Because digoxin competes for pottasium binding site on Na/ K ATPase
85
What are the complications of transtuzumab?
Transtuzumab = herceptin
Cardiomyopathy
Do ECHO before starting
Don’t take with antracyclines e.g doxorubicin as these also cause cardiomyopathy
86
What are the side effects of dopamine agonists
```
Fibrosis - pulmonary , retrroperitoneal
Sleepiness
Hallucination
Nausea
Postural hypotension
```
87
what organism is most commonly seen in animal bites and what is the management?
Pasteurella multicida
Mx:
co-amox
or doxy + metronidazole
88
what blood test suggests poor compliance to levothyroxine?
high TSH - has been trying to compensate for a while
normal T3/4 - has taken drug recently - short term fix before blood test
89
what are the ADRs of sulphonylureas?
weight gain
hypoglycaemia
SiADH
bone marrow sup
hepatotoxic
peripheral neuropathy
dont use in preg/ breast feeding
90
what inheritance is kallmans? what are the features?
X linked recessive
small testis, tall, anosmia
low / normal LH and FSH
91
what are the causes of euvolaemic hyponatraemia?
siADH
hypothyroid
urinary sodium high >20
92
which electrolyte is associated with low K?
low Mg
93
what inheritance does familial hyperlipidaemia have?
auto dominant
94
what are the complications of acromegaly?
HTN, CRC, diabetes, cardiomyopathy
95
what are the causes of gynaecomastia?
testicular failure - mumps
klinefelters , kallmans
seminoma - HCG secreting
haemodialysis
hyperthyroid
drugs = spironolactone, goreselin , digoxin, cimetidine, cannabis, finasteride, steroids
96
what is HbA1c 6% equivalent too?
42
| 1% = 11 increase
97
who are fibroids more common in?
afrocaribeans
98
what blood abnormality is seen with fibroids?
high Hb
| fibroids produce EPO
99
What are the ADRs of SGLT2 inhibitors? what are thes drugs called?
Gliflozins
forniers gangrene
UTI
normoglycaemic ketoacidosis
limb amputation
100
what is the most common cause of primary hyperaldosteronism?
bilateral adrenal hyperplasia
101
what is the mechanism of action of thiazolinediones (TZDs) and the ADRs
```
PPARg receptor (intracellular receptor) - increases insulin sensitivity
e.g. pioglitazone
```
ADRs - fluid retention - shouldnt be used in HF
- weight gain
- increased risk of fractures
- increased risk of bladder Ca with pioglitazone
- liver impairment - monitor LFTs
(fluid retention worse if also taking insulin)
102
How is SIADH initially managed?
fluid restriction
103
what is the management for diabetic nephropathy?
duloxetine, gabapentin, amitriptyline
| tramadol for rescue therapy
104
how can you distinguish klinefelters and kallmans?
klinefelters - high LH/ FSH
| Kallmans - normal/ low FSH / LH
105
Which genes are mutated in MODY
Type 3 - HNF1a - most common
Type 2 - glucokinase
Type 5- HNF1b - associated with cyst
106
Which type of malignancy does hashimotos predispose to ?
MALT lymphoma
107
What is the most common cause of Cushing’s syndrome
What is the most common cause of Cushing’s syndrome
108
How is gestational diabetes managed
If bm less than 7 can try diet and metformin but if targets are still not met with this then start insulin
If more than 7 - start insulin straight away
If any effects of diabetes e.g. macrosomia - start insulin
109
What is the first line for fertility in PCOS
Clomifene
110
Which antibodies are associated with Graves’ disease
Anti TSH r - stimulating -90%
| Anti thyroid peroxidase - 70%
111
what is temporal arteritis assocaited with?
polymyalgia rheumatica
| visual changes - anterior ischaemic optic neuropathy
112
what are the CK and EMG results in temporal arteritis? how is this condition managed?
normal results
| high dose steroids
113
how is neuropathic pain managed?
| what is max dose of amitriptyline
monotherapy
switch if not working
max dose amitriptyline = 75mg
try for 6-8 weeks or 2 weeks at max dose
114
what is miller fisher and what antibody is associated with this?
variant of guillian barre
Anti GQ1b
ataxia, areflexia and ophthalmoplegia
descending paralysis (reverse than normal)
115
who does polyarteritis nodosa affect? any other associations?
middle age men
Hep B
(not always ANCA positive)
116
what is the first line medication for stroke/ TIA?
clopidogrel
117
when is a carotid endartectomy performed?
when >70% stenosis
118
which part of lungs does ank spondylosis affect?
apical fibrosis
119
what is the prognosis of absence seizures?
excellent, 95% gone by adolescence.
120
which drugs make myasthenia gravis wose?
```
B blockers
lithium
gentamicin, tetracyclines, macrolides
phenytoin
penicilliamine
quinidine , procainamide
```
121
what are the classical signs of normal pressure hydrocephalus?
gait disturbances - magnetic/ parkinsonism
dementia
urinary incontinence
122
what is the management of general and focal seizures?
general inc myoclonic- sodium val
| focal - carbemazepine
123
which seizures does carbemazepine make worse?
absence and myoclonic
124
how is an acute ischaemic stroke treated when within 4.5 hours?
thrombectomy - within 6
thrombolysis - within 4.5
if within 4.5hours can offer both of the above
125
how does CJD disease present?
rapid onset
dementia
rigidity
myoclonus
126
what improves prognosis for motor neuron disease?
riluzole - 2 to 3 years improvement
| NIV - best outcome overall
127
which bacteria is most strongly associated with guillian barre?
campylobacter
128
what are the DVLA rules regarding seizures?
first seizure, unprovoked, normal EEG and imaging --> no driving 6 months and inform DVLA
otherwise 12 months seizure free
129
how is catheterised patients with positive urine dip treated?
not treated
130
what is the prophylaxis for meningitis in close contacts?
ciprofloxacin or rifampicin
131
what is webers syndrome?
stroke of branches of posterior cerebral artery that supplies the midbrain
ipsilateral CNIII
contralateral weakness of upper and lower limbs (internal capsule)
132
what is wallenberg syndrome? (aka lateral medullary)
posterior inferior cerebral artery
ipsilateral spinothalamic of the face
contralateral spinothalamic of the limbs
ataxia and nystagmus too
133
how is parkinsons managed depending on motor symtpoms?
motor symptoms affecting daily living - L dopa
| not affecting daily living but having motor symptoms - ropinerole (dopamine agonist)
134
how is spasticity managed in MS?
gabapentin
| baclofen
135
how are bladder issues in MS manaaged?
USS - if there is residual volume then intermitent self catheterisation.
if there is no residual vol then use an anti-cholinergic
136
How does tuberculoid leprosy differ from lepromatous leprosy?
Tuberculoid:
- hair loss
- assymetric nerve involvement
- limited skin
- high cell mediated immunity
lepromatous:
- symmetrical nerve involvemnt
- extensive skin involvment
- low level cell immediated immunity
137
what skin and neuro changes are seen in leprosy?
hypopigmentation
| sensory loss
138
what is the incubation period for amoebiasis like?
long period
139
what is the most common cause of viral meningitis?
enterovirus - coxsackie and echovirus
140
how does anthrax present cutaneously?
black painless eschar
141
how is anthrax treat?
ciprofloxacin or doxy
142
what is the most common complication of measles?
otitis media
| pneumonia is most common cause of death
143
how does measles present?
rash starts behind ears
kolpik spots in mouth
conjunctivitis
144
what are the diagnostic features of bacterial vaginosis?
high pH (less lactobacilli)
clue cells
white thin fishy discharge
positive whiff test
145
how is bacterial vaginosis managed? and in pregnancy?
metronidazole
| also in preg
146
what blood test finding is associated with glandular fever?
atypical lymphocytes
147
how is glandular fever diagnosed?
FBC and monospot test in 2nd week of illness
Monospot = heterophil Ab
148
how is pneumocytis jiroveci managed?
co-trimoxazole
steroids if hypoxic
IV pentamidine if severe
149
what is the most common organism of central line infections?
s. epidermidis
150
what do the following Abx target?
- macrolides and cloramphenicol
- aminoglycosides and tetracyclines?
- macrolides and cloramphenicol - 50S ribosomes
| - aminoglycosides and tetracyclines - 30S ribo
151
what time frame does tetanus vaccine need to be complete by for no further mx ?
if complete within 10 yrs no further doses or immunoglobulins regardless of wound type
152
what are the side effects of phenytoin?
gingival hyperplasia
lymphodenopathy
peripheral neuropathy
megaloblastic anaemia - secondary to folate deficiency
haemorrhagic disease of new born - bleeding mucus membrane, bleeding umbilicus and GI tract
teratogen
153
which spinal cord sections are affected in subacute degeneration of the cord?
dorsal columns
| lateral corticospinal tracts - limb movement
154
what is the lateral and anterior corticospinal tracts responsible for?
lateral - limb movement
| anterior - trunk movement
155
what is facioscapulohumeral muscular dystrophy?
auto dominant
face weakness, shoulder weakness,
presents by 20 yrs
156
what is multiple systems atrophy?
parkinsonism plus
autonomic issues - impotence, postural hypotension
cerebellar signs
157
how is serotonin syndrome and neuroleptic malignant syndrome differentiated?
```
Only in serotonin:
myoclonus
faster onset
increased reflexes
dilated pupils
```
in NMS:
- rigidity
- reduced reflexes
158
what drugs cause gingival hyperplasia?
phenytoin
ciclosporin
calcium channel blockers
Acute myeloid leukaemia
159
for BPPV which manoevers are used to diagnose and treat?
dix halpike - diagnosis - vertigo and rotational nystagmus
epley - treatment
brandt- doroff exercises - at home exercises
160
which drug is used for SVT in asthmatics?
adenosine is contraindicated
| use verapamil
161
how is future SVT prevented?
B blocker
| radioablation
162
what heart sounds are heard in pulmonary HTN?
loud S2
163
which drugs are contraindicated in WPW?
adenosine and verapamil
164
what happens to the murmur in eisenmenger syndrome?
original murmur may disappear when shunt reverses
165
what are the features of takaysa arteritis?
asians
females
aorta and causes occlusion
typical Q refers to absent limb pulses
166
what is syndrome X? how is it managed?
presents like angina
but normal coronary arteries on angio
ST dep on exercise stress
nitrates to manage
167
what are the poor prognostic factors for HOCM?
```
septal wall thickness >3cm
non sustained VT
young age at presentation
BP chnages with exercise
FHx of sudden death
syncope
```
168
which drugs are preferred for BP control in afrocaribeans?
ARBs > ACEi
169
Which drugs during pregnancy are linked to ebstein anomoly?
lithium and benzos
170
how is severe eclampsia managed?
restrict fluids - risk of pulmonary/ cerebral oedema
| IV MgSO4
171
how is aortic dissection managed?
type A - surgery + IV labetolol
| type B - IV labetolol/ conservative
172
how is COPD managed (chronic)?
1st line - SABA/ SAMA
2nd line - check if asthma symptoms/ Hx of atopy/ eosinophilia/ variation in FEV1
- if yes - LABA + ICS (can later add LAMA if still no control)
- if no - LAMA + LABA
173
how does lichen planus present?
itchy rash, polygonal rash with white lines
on soles of feet/ palms, flexor surface, genitalia
white lace on oral mucosa
174
how is lichen planus managed?
potent topical steroids
175
how does DRESS syndrome present?
```
multi organ - e.g. high LFTs
high eosinophils
morbilliform skin rash
fever
following 2-8 weeks after offensive drug
```
176
what is TLCO and KCO?
TLCO - rate of diffusion across alveolar membrane
| KCO - as above but corrected for lung volume
177
what are the causes of increased TLCO?
```
pulmonary haemorrhage
polycythaemia
left to right shunt
asthma
hyperkinetic state
exercise
```
178
how are bullous pemphigoid and phemigoid vulgaris differentiated?
bullous - no mucosal involvement
| pemphigoid - mucosal invovlment
179
what antibody is found in pemiphoid vulgaris? who is it most common in?
anti desmoglein 3
| Jews
180
which opioids are used in palliative patients with renal impairment?
oxycodone - mild renal failure
| alfentanil - severe (or fentanyl / buprenorphine patch)
181
how are TRALI and TACO differentiated?
TRALI - hypotension, fever, increased leucopenia
| TACO - hypertension, more common
182
which Ab are involved in acute haemolytic reaction after ABO mismatch?
IgM
183
what are the features of african sleeping sickness? which organism and vector
typanosoma gambiese
tstes fly
chancre, fever, posterior cervical nodes, sleepiness, headaches, mood change
184
what are the features of american trypanosomiasis/ chagas disease? which organism
typanosoma cruzi
acute - chagoma and periorbital oedema
cardiomyopathy - dilated cardiomegaly
megacolon/ oesophagus - constipation etc
185
how is american trypanosomiasis treated?
Benznidazole
186
how is african sleeping sickness treated?
IV pentamidine - early
| IV metasoprol - later
187
what are the causes of aortic stenosis by age?
<65 - bicuspid valve
| >65 - calcification
188
how is mural invasion best assessed with oesophageal/ gastric cancer?
endoscopic USS
189
what is the function of docetaxel?
microtubule inhibitor
190
what is the best predictor of COPD severity?
FEV1
191
most common symptom of P.E
tachypnoea
192
if an ECG still shows changes 90 mins after thrombolysis, what is the next stage?
if <50% resolution then PCI
193
where is BNP secreted from ?
left ventricle
194
what heart sounds are found in complete heart block?
variable S1
195
what is first line treatment for HF?
B B and ACEi in all patients - shown to improve mortality (only for those with reduced ejection fraction)
only bisoprolol or carvedilol have shown to improve mortality. no change for other BB
196
how is major bleed + a high INR managed?
5mg IV vit K
| prothrombin complex concentrate
197
what are the features of hyperosmotic hyperglycaemic state?
osmolarity >320
glucose high
dehydration, low Na/low K
hypovolaemia
198
how do DKA and HHS compare?
HHS higher mortality
DKA - ketones
DKA - more acute
HHS - slow and insidious, worse electrolyte changes, more dehydrated
199
How is HHS managed?
fluid replacement
| dont give insulin unless ketones are high
200
what are the different types of renal tubular acidosis?
T1 - inability to secrete H+, leads to hypokalaemia. associated with RA/SLE/ Sjogrens
T2 - inability to reab HCO3 at PCT , leads to hypoK
associated with fanconi and wilsons
T3 - rare carbonic anhydrase II deficiency.
T4 - hyperkalaemia, not enough aldosterone
201
how does a strongyloides infection present?
pruiritic rash on bum and soles of feet
abdo pain, bloating , diarrhoea
(worm penetrates skin)
202
how does progressive nuclear palsy present?
parkinsonism
vertical gaze impairment
postural instability and falls
cognitive impairment
203
how does progressive supranuclear palsy respond to levo dopa?
poor response
204
name the different diabetic drugs and give example.
```
sulphonylurea - gliclazide
DDP4 inhibitors - gliptins
SGLT2 inhibitors - gliflozin
metformin
GLP 1 - exanatide
TZDs - pioglitazone
```
205
what are the causes of nephrogenic diabetes insipidus?
```
low K
high Ca
lithium, demeclocycline
sickle cell
pyelonephritis/ obstruction
```
206
what are the immune test findings in primary biliary cirrhosis? who is it most common in?
anti mitochondrial Ab
high IgM
middle aged women, sjogrens
also RA/ Systemic sclerosis, thyroid disease
207
how is primary biliary cirrhosis managed?
ursodeoxycholic acid
208
what is the mode of marfans inheritence and which gene is affected?
fibrillin 1
| auto dom
209
how does altitude sicknes present?
tired, headache, sickness
| can lead to pulmonary or cerebral oedema.
210
how is altitude sickness prevented? and treated?
prevented - acetazolamide (carbonic anhydrase inhibitor)
treated - descent.
cerebral oedema = dexamethasone
211
which anti depressant is most at risk of giving discontinuation syndrome?
paroxetine
212
what is peutz jeghers syndrome?
auto dominant
intestinal hamartomas polyps in GIT
frackles on lips, face, palms and soles
risk of intussusception, GI bleeding, cancer
213
how does wilsons disease present?
liver - hepatitis/ cirrhosis
neuro - basal ganglia - chorea, dementia, parkinsons
kayser fleischer rings
blue nails
214
what are the blood test findings in wilsons?
reduced serum caeroplasmin
reduced serum copper
increased 24 hour urinary copper
215
what is the management for wilsons?
penicillamine
216
which life style choice increases risk of thyroid eye disease?
smoking
217
which clotting factors are affected by warfarin?
1972 --> 10, 9, 7, 2
218
what happens in fanconi syndrome?
inadequate absorption in PCT
| leads to renal tubular acidosis type 2
219
which is the most important HLA to match when giving a transplant?
HLA DR
220
how is QT measured?
start of Q
| end of T
221
list the P450 inducers
phenytoin, carbemazepine
chronic alcohol
smoking
rifampicin
222
list the P450 inhibitors
cipro, erythromycin
acute alcohol
sodium valproate
isoniazid
223
how is complete heart block after an MI managed?
inferior MI - conservative management
| anterior - temporary pacing
224
which drugs cause photosensitivity?
```
thiazides
tetracyclines (doxy)
amiodarone
NSAIDs
sulphonylureas
```
225
how is prinzmental angina managed?
Calcium channel blockers
226
what is bicalutamide?
androgen receptor antagonist
| used in prostate Ca
227
which Chromosome is HLA found on?
6
228
how does Behcets present?
middle east
| oral and genital ulcers, painful
229
how long should antidepressants be trialed before stopping?
6 months
230
how does plummer vinson syndrome present?
dysphagia, glossitis, iron def anaemia
231
what are the ADRs of ondansetron?
constipation
| long QT
232
which drug reverses dabigatron?
idarucizumab
233
what are the poor prognostic features of RA?
```
RF positive
CCP posistive
HLA DR4
early erosions on Xray
nodules
insideous onset
poor functionality at the start
```
234
which vit D is used in CKD?
alfacalcidol and calcitriol
235
how is angina managed?
```
aspirin, statin, GTN
B blocker e.g. atenolol
+ CaB - nifedipine
increase to max dose
long acting nitrates (nicorandil, ivabradine, ranolazine)
```
236
how is orbital cellulitis managed (before anything)?why?
IV abx
| risk of venous sinus thrombosis and intracranial spread
237
which type of blood transfusion carries highest risk of bacterial infection?
platelets
238
what is the chronic management of asthma?
```
SABA
+ ICS
+ LRTA (montelukast)
+ LABA
switch to medium dose ICA
switch to high dose/ extra drug
```
239
which is the most common renal stone?
calcium oxaloate
240
which are the radiolucent stones?
xanthine and uric acid
241
what is the most diagnostic Ix for CLL?
immunophenotyping
242
what is the most common cause of peritoneal dialysis infection?
s. epididermis
243
how is peritoneal dialysis infection managed?
vanc + ceftazidine - added to dialysis
244
how does NAC help in paracetamol OD?
precursor for glutathione
245
what is the kings college criteria for liver transplant post paracetamol OD?
pH <7.3
PT >100 s
Creat >300
hepatic enceph grade 3 or 4
246
what is the function of bisphosphonates?
inhibit osteoclasts
247
what is the mechanism of action of baclofen?
GABA agonist
248
how are pubic lice managed?
Permethrim or malathion cream
| reapply 3-7 days later
249
what is a common side effect of oral Mg?
diarrhoea
250
what are the causes of erythema nodosum?
```
pregnancy
strept infection
sarcoid
IBD
Behcet
malignancy
COCP/ penniclins
```
251
what drugs should be avoided in HOCM?
ACEi
nitrates
Ionotropes
252
which type of hepatitis is very severe in pregnancy?
E
253
what are the stages of diabetic nephropathy?
1. hyperfiltration (high eGFR)
2. latent
3. incipient nephropathy - microalbuminaemia
4. overt nephropathy - increase BP, increase protein, glomerulosclerosis
5. End stage
254
what are the causes of nephrotic vs nephritic?
nephrotic - minimal change, focal segmental glomerulosclerosis, membranous and amyloidosis
nephritic - mesangial glomerulonephritis, rapidly progessive, IgA and alports
255
what are the symptoms of vit B3 deficiency?
niacin deficinecy
| pellegra - dermatitis (rash on neck usually dark), dementia, diarrhoea
256
what is the most common complication of chagas disease?
dilated cardiomyopathy
257
how is urge incontinence managed?
bladder training- 6weeks
anticholinergics (oxybutynin, tolderidone)
- avoid in old women - risk of dementia
- instead mirabegron
258
how is stress incontinence managed?
pelvic floor training - 3 months
duloxetine
mid uretral tape
259
what does alcohol binging do to urination freq?
increased due to inhibition of ADH
260
what is cotard syndrome?
psych syndrome where person thinks they are dead
261
what is dermatitis artefacta?
self inflicted skin lesions
262
what are the causes of increased ferritin?
increased: CKD, Liver disease, alcohol excess, inflammation, malignancy
with iron overload - haemochromatsis or repeated transfusion
263
how is hospital acquired pneumonia managed?
Within 5 days of admission: co-amoxiclav or cefuroxime
| More than 5 days after admission: tazocin
264
what is the treatment for actinic keratoses?
5 flurouracil cream - goes red and inflamed so can use steroid cream on top
265
what is the management and prophylaxis of a migraine? what is the mechnism of action of triptans.
acute: triptan + NSAID or triptan + paracetamol
prophylaxis: topiramate or propranolol
triptans are 5HT2 agonists
266
what is the action of mycophenolate mofetil
• inhibits inosine monophosphate dehydrogenase, which is needed for purine synthesis
267
which treatments reduce mortality in HF with a reduced ejection fraction?
ACEi
B blockers
spironolactone
nitrates and hydralazine
(not furosemide)
268
what are the stages of sarcoidosis on CXR? what other Ix findings are there?
```
Sarcoidosis CXR
1 = BHL
2 = BHL + infiltrates
3 = infiltrates
4 = fibrosis
```
high ACE
high Ca
high ESR
non caseating granulomatosis
269
what are the examples of ADP receptor inhibitors?
* Clopidogrel
* Prasugrel
* Ticagrelor
* Ticlopidine
270
what is the main side effect of ticagrelor?
dyspnoea due to poor clearance of adenosine
| should be used with caution in asthmatics
271
what is the treatment for methaglobinaemia?
NADH - methaemoglobinaemia reductase deficiency: ascorbic acid
IV methylthioninium chloride (methylene blue) if acquired
272
which thyroid cancer occurs in older woman, grows aggeessively and can cause pressure symptoms?
Anaplastic
273
which thyroid is most common in younger females?
papillary - good prognosis
274
what would give a false negative result in coeliacs?
IgA deficiency
275
what HbA1c value is diagnostic of diabetes?
6.5% (48mM)
| prediabetes (6-6.5)
276
what factors can affect eGFR?
eating red meat 12 hrs before
exercise
pregnancy
277
what is akathsia?
severe restlessness
| seen in patients taking antipsychotics
278
which are the poor prognostic factors of infective endocarditis ?
staphylococcus aureus - organism with highest mortality
culture negative
prosthetic valve
low complement levels
279
what is the management of infective endocarditis?
```
Initial therapy if…
- Native valve:
Amoxicillin
- Penicillin allergy/ MRSA
Vancomycin + low dose gentamicin
- Prosthetic valve
Vancomycin + low dose gent + rifampicin
Staphylococcal infection, if…
- Native valve
§ Flucloxacillin
- Pen allergy / MRSA:
§ Vanco + rifampicin
- Prosthetic valve:
§ Fluclox + rifampicin + low dose gent
Streptococci:
- Native valve
§ Benzylpenicillin
- MRSA/ pen allergy:
§ Vancomycin + low dose gent
```
280
what are the indications for surgery in infective endocarditis?
severe valvular incompetence
aortic abscess (often indicated by a lengthening PR interval)
infections resistant to antibiotics/fungal infections
cardiac failure refractory to standard medical treatment
recurrent emboli after antibiotic therapy
281
what is the treatment for pityriasis versicolor
ketonazole shampoo
282
what is pityriasis versicolor?
fungal - Malassezia furfur
| affects trunks/arms following sun tan
283
what drug reduces PSA? (and can cause a false negative result)?
Finasteride
284
what factors increase PSA?
```
vigorous exercise
ejaculation
prostatitis/ UTI
instrumentation e.g. catheterisation
urinary retension
BPH
```
285
what investigations are used in acromegaly?
IGF1 levels
if raised - OGTT + serial GH levels
MRI pituitary
286
what type of hypersensitivity does scabies cause?
type 4
287
what are the features of horners syndrome?
miosis
anhydrosis
ptosis
enopthalmos
heterochromia (difference in eye colour) - seen in congential horners
288
what is relapsing polychondritis?
inflammatory disease of cartilage.
signs and symptoms - auricular chondritis, nasal chondtritis, respiratory issues (wheeze, horseness etc), joint arthralgia.
manage with steroids/ DMARDs
289
what is the discharge criteria for anaphylaxis?
Fast tract if..
- Good response to one adrenaline dose
- Complete resolution of symptoms
- Has been given autoinjector and trained how to use it
Minimum 6 hours after symptoms resolution
○ 2 doses of IM adrenaline
○ Previous biphasic reaction
Minimum 12 hours after symptoms resolved
○ Severe reaction >2 injections needed
○ Has severe asthma
○ Late at night presentation
○ Difficult access to ED
○ Possibility of ongoing reaction - e.g. slow release allergen medication
290
what are the two types of polycystic kidney disease and how do they differ?
PKD1 - earlier renal failure, more common. PKD1 on chrom 16
PKD2 on chrom 4
291
what is the management of polycystic kidney disease?
ADH receptor ANTAGONIST
- Tolvaptan
slows progression of cyst
292
what is the diagnosis for li fraumeni syndrome? what is the genetics behind this syndrome?
sarcoma under age or 45yrs
OR
relative with sarcoma <45yrs AND 1st degree with any cancer <45yrs
li fraumeni = auto dom and p53 mutation
293
what is the main indication for cryoprecipitate use?
low fibrinogen
294
what part of lung does amiodarone affect?
lower zone fibrosis
295
what causes lung fibrosis in upper zones?
```
CHARTS
C - Coal worker's pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidosis
```
296
what causes lung fibrosis in lower zones?
idiopathic pulmonary fibrosis
most connective tissue disorders (except ankylosing spondylitis)
drug-induced: amiodarone, bleomycin, methotrexate
asbestosis
297
what triad is seen in haemolytic uraemic syndrome?
AKI
micro-angiopathic haemolytic anaemia
thrombocytopenia
298
what is the cause of haemolytic uraemic syndrome?
Shiga toxin producing Ecoli
pneumococcal
HIV
drugs
cancer
299
who is sarcoidosis more common in?
Africans
300
what are the poor prognostic features of sarcoidosis?
insidious onset >6 m
absence of erythema nodosum
extrapulmonary manifestations - lupus/ splenomegaly
CXR III or IV
black people
301
how is retinitis pigmentosa characterised?
Retinitis pigmentosa - night blindness + tunnel vision
302
what symptoms are common in posterior vitreous detachment?
flashes and floaters
303
what is conversion disorder?
Conversion disorder - typically involves loss of motor or sensory function. May be caused by stress
304
what antibodies are seen in bullous pemphigoid
antibodies against hemidesmosomal proteins BP180 and BP230.
305
how does retinal detachment present?
painless visual loss
sudden
dense dark shadow from peripheral to centre
306
how does optic neuritis present?
loss of vision - often transient
| painful eye movmeents
307
what are the features of asperigilloma?
rounded opacification with a cresent sign air cavity
| more common in people with TB
308
what is the most common cause of hyperparathyroidism?
parathyroid adenoma - 80%
hyperplasia
mutliple adenoma
carcinoma
PTH doesnt have to be high in parathyroid adenoma but can be inappropriately normal (i.e. should be low if Ca is high)
309
what happens to INR target if patient has has a thrombosis on warfarin ?
increase INR target e.g. 2-3 to 3-4 and make warfarin life long
310
if pain not controlled in palliative patients, how much should morphine be increased by?
30-50%
311
How are Dermatophyte nail infections treated? e.g. Trichophyton rubrum
- use oral terbinafine 12 weeks
312
what prophylaxis is given to meningococcal contacts?
ciprofloxacin within 7 days
| only for meningococcal disease. no need for pneumococcal
313
what are the risk factors for statin induced myopathy?
advanced age
female sex
low body mass index
presence of multisystem disease such as diabetes mellitus.
Myopathy is more common in lipophilic statins (simvastatin, atorvastatin) than relatively hydrophilic statins (rosuvastatin, pravastatin, fluvastatin)
314
what is seen on JVP in tricuspid regurg?
prominant V waves
315
```
when are the following seen?...
cannon A waves
absent A waves
prominent X descent
absent X descent
```
irregular Cannon A waves = complete heart block
Absent A waves = atrial fibrillation
Prominent x descent is = acute cardiac tamponade and constrictive pericarditis
Absent x descent = atrial fibrillation
316
which drug are patients with MODY nromally given?
dont usualy require insulin
| normally given sulphonylureas
317
which drugs enhance/ reduce the effects of adenosine?
Adenosine
dipyridamole enhances effect
aminophylline reduces effect
318
what drugs are used in alcohol withdrawel?
chlordiazepoxide or diazepam.
| Lorazepam may be preferable in patients with hepatic failure.
319
what are the features of severe aortic stenosis?
narrow pulse pressure
slow rising pulse
delayed ESM
soft/absent S2
S4
thrill
duration of murmur
left ventricular hypertrophy or failure
320
what are the topical steroids strengths order?
Topical steroids
mild - hydrocortisone
moderate: Clobetasone butyrate 0.05% (Eumovate)
potent: Betamethasone valerate 0.1% (betnovate)
very potent: Clobetasol propionate 0.05% (Dermovate)
321
What are the different medications that can be used in smoking cessation and their mechnaism?
nicotine replacemnt
varenicline - nicotine partial agonist
Bupropion - NA and dopamine reuptake inhibitor and nicotinic antagonist
322
what is sick euthyroid?
during illness T3/4 go low, TSH is normal or low
| reversible
323
how is IgA nephropathy and post streptococcal syndrome differentiated ?
post-streptococcal glomerulonephritis
- associated with low complement levels
- occurs 2 weeks after infection
- mainly proteinuria (although haematuria can occur)
IgA nephropathy
- haematuria
- 2 days post infection
324
which cancers are seen in MEN type 1, 2a and 2b?
1a = 3 Ps
- parathyroid (95%)
- pituitary
- pancreas
IIa = 2ps
- parathyroid (60%)
- pheochromocytoma
- mainly medullary thyroid (70%)
IIb = 1p
- pheochromocytoma
- mainly medullary thyroid cancer
- marfanoid
- neuromas
325
which genes are mutated in MEN 1/2a/b?
men type 1 = MEN 1
Men 2a - RET oncogene
Men 2b - RET oncogene
326
what are the features of polycystic kidney disease?
HTN, haematuria, UTI , renal stones, abdo pain, CKD
extra renal:
liver cysts
berry aneurysm
cardiac - mitral valve prolapse, aortic root dilation, aoritc dissection, mitral/tricuspid incompetence
327
how is non-falciparium malaria managed?
artemisinin-based combination therapy (ACT) or chloroquine
in areas which are known to be chloroquine-resistant an ACT should be used
ACTs should be avoided in pregnant women
patients with ovale or vivax malaria should be given primaquine following acute treatment with chloroquine to destroy liver hypnozoites and prevent relapse
328
how does non-falciparium malaria present?
headache
hepatosplenomegaly
cyclical fever - vivax and ovale every 48hrs, malarie every 72 hours.
malarie also associated with nephrotic syndrome
329
what is the commonest form of malaria
falciparium - and most severe
330
what are the features of severe falciparium infection?
```
Feature of severe malaria
• schizonts on a blood film
• parasitaemia > 2%
• hypoglycaemia
• acidosis
• temperature > 39 °C
• severe anaemia
• complications
```
331
how is falciparium managed?
Artemisinin-based combination therapies (ACTs) as first-line therapy
examples include artemether plus lumefantrine
if severe - IV artusunate
if parasite count 10% or more - exchange transfusion
332
how is minimal change glomerulonephritis managed?
oral prednisolone
333
where are iron and calcium absorbed?
duodenum
334
what are the features of ataxia telangiectasia? which mode of inheritance
cerebellar ataxia
telangiectasia (spider angiomas)
IgA deficiency resulting in recurrent chest infections
10% risk of developing malignancy, lymphoma or leukaemia, but also non-lymphoid tumours
auto recessive - mutation in ATM repair gene
335
what are the features of dengue?
Fever, headache (often retro-orbital), myalgia, bone pain and arthralgia ('break-bone fever')
pleuritic pain
facial flushing (dengue)
maculopapular rash
haemorrhagic manifestations e.g. positive tourniquet test, petechiae, purpura/ecchymosis, epistaxis
336
which cell type is associated with hodgkins lymphoma and which marker does it have?
reed sternberg
| CD15 and CD30
337
what is the first line treatment for lymes disease?
First line treatment for early Lyme disease is a 14-21 day course of oral doxycycline
338
what are the symptoms of lymes disease?
erythema migrans - bulls eye rash at site of tick bite.
develops 1-4 weeks post bite. usually painless
fever, headache, arhralgia
later - heart block, myocarditis, facial nerve palsy, meningitis
339
what is the mechanism of action of donepezil? memantine?
anti-cholinergic - donepazil
memantine - NMDA receptor antagonist
340
what is the contraindication of taking donepezil ? what are the ADRs of donepezil?
contraindicated in patients with bradycardia
ADR - insomnia
341
what feature suggests that haematuria is glomerular in origin?
dysmorphic RBC on microscopy
342
when are fatty urinary casts seen?
nephrotic syndrome
343
how is oral morphine converted to subcut?
divide by 2
344
how does TTP present?
pentand: fever, neuro signs, thrombocytopenia, haemolytic anaemia and renal failure
345
what protein is involved in TTP?
reduced von Willebrand factor-cleaving proteases (ADAMTS13).
| thrombi form from platelets
346
which type of macular degeneration carries worst prognosis?
wet macular degeneration
347
what blood electrolyte finding is found in cushings syndrome?
hypokalaemic metabolic alkalosis
348
what is the management of gout?
NSAIDs or colchicine 1st line
NSAIDs avoided in elderly
urate lowering agents can be offered after 1st attack e.g. allopurinol - start at 100mg and titrate to aim for urate <300
349
what is the most common side effect of colchicine?
diarrhoea
350
In SLE, which Ab is associated with congenital heart block?
SLE - antibodies associated with congenital heart block = anti-Ro
351
which Ab is associated with drug induced lupus?
anti-histone
352
what are the symptoms of discontinuation syndrome for antidepressants?
```
icreased mood change
restlessness
difficulty sleeping
unsteadiness
sweating
gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting
paraesthesia
```
353
what is Uhthoff ’s phenomenon?
Uhthoff ’s phenomenon where neurological symptoms are exacerbated by increases in body temperature is typically associated with multiple sclerosis
354
what is the most common presenting symptom of MS?
tiredness
355
which drugs precipitate G6PD deficiency?
primaquine
ciprofloxacin
sulphate containing drugs - sulphonamides etc
e.g. sulphonylureas - gliclazide, glimepiride
356
which viral meningitis has a low CSF glucose?
MUMPS
357
which antibody is dermatitis herpetiformis associated with?
HLA DR3
358
what are the features of sleep paralysis?
Paralysis - this occurs after waking up or shortly before falling asleep
hallucinations - images or speaking that appear during the paralysis
359
what antibody is seen in goodpastures?
anti- glomerular basement membrane
| IgG
360
which electrolyte disturbance can lead to cataracts?
hypocalcaemia
361
what is the most common cause of congenital adrenal hyperplasia?
21 hydroxylase deficiency
362
what pattern of inheritance is liddles? what are the features?
auto dominant - disorder of sodium channels in DCT
hypertension
hypokalaemic alkalosis
363
which Abx causes Clostridium difficile?
Clindamycin
364
what receptor does tamsulosin act on?
Alpha 1a
365
what is charles bonnet syndrome?
hallucinations - visual or auditory
| occur in normal consciousness/ cognition
366
what is the equation for power of a study?
1 - type 2 error probability
367
when in varienicline contraindicated? what is the mechnism of action?
self harm/ depression
pregnancy
breast feeding
nicotinic receptor partial agonist
368
how does mercury poisoning present?
```
paraeshtesia
visual changes
sensorineural hearing loss
irritable
renal tubular acidosis
```
369
what is fabry disease?
X-linked recessive
deficiency of alpha-galactosidase A
```
Features
burning pain/paraesthesia in childhood
angiokeratomas
lens opacities
proteinuria
early cardiovascular disease
```
370
which other drug should be avoided in aspirin allergy?
sulphasaalazine
371
which recreational drug can lead to ischaemic colitis? How does this present?
cocaine (vasoconstrictor and can reduce blood flow to the gut)
abdo pain, bloody diarhoea
tachycardic , mydriasis (dilated pupil) - due to cocaine
372
how is cocaine toxicity managed?
1. benzos
add
- GTN for chest pain
- sodium nitroprusside for HTN
373
what are the features of hereitary haemorrhagic telangiectasia?
nose bleeds
telangiectasia around nose and lips
GI/pulmonary telangiectasia - can lead to bleeds
FHx
(autosomal dominant)
374
what are the drug causes of retinopathy?
ethambutol, vigabatrin and amiodarone and hydroxychloroquine
375
what is DC cardiovarsion synchronised with?
R wave
376
what are the features of mastocytosis? How is this investigated?
* urticaria pigmentosa - produces a wheal on rubbing (Darier's sign)
* flushing
* abdominal pain
* monocytosis on the blood film
raised urinary histamine
raised serum tryptase
377
what is the first line Ix for lymes disease?
(ELISA) antibodies to Borrelia burgdorferi
repeat after 4-6 weeks if negative but high suspicion of lymes
immunoblot test for lymes can be done later to confirm
if erythema migrans is present - no need
378
what is calciphylaxis? what drug exacerbates this?
linked to dialysis and high Ca/PO4/PTH
necrosis of skin secondary to arterial occlusion by calcium deposits.
painful skin lesions that are necrotic
exacerbated by warfarin
379
what is sweets syndrome?
Sweet's syndrome is also known as acute febrile neutrophilic dermatosis has a strong association with acute myeloid leukaemia
Small red bumps on The arms, neck, head and trunk
Sudden onset of fever
Bumps grow rapidly
Painful rashes
380
which skin conditions are associated with diabetes?
Necrobiosis lipoidica - shiny, painless areas of yellow/red/brown skin typically on the shin. often associated with surrounding telangiectasia
```
Infection- candidiasis, staphylococcal
Neuropathic ulcers
Vitiligo
Lipoatrophy
Granuloma annulare= papular lesions that are often slightly hyperpigmented and depressed centrally
```
381
how does bullous pemphigoid present?
itchy rash
then develop into tense blisters
no mucosal invovlement
usually older patients
382
when are platelet transfusions contraindicated?
TTP
heparin induced thromocytopenia
ITP
chronic bone marrow failure
383
when are platelet transfusions adviced?
levels <10
levels <30 with bleeding / planned proceedure
levels <100 if severe bleeding/ intracranial bleed
384
how are baby blues, post natal depression and puerpural psychosis differentiated?
baby blues 3-7days post birth - reassure
post natal depression - peaks at 3 months - reassure, CBT
peurpural psychosis- 2-3 weeks, mood swings, hallucinations/ dellusions - admit to hospital , mum and baby unit
385
what are the causes of pulmonary eosinophilia?
* Churg-Strauss syndrome
* allergic bronchopulmonary aspergillosis (ABPA)
* Loffler's syndrome - parasitic infection and accumulation of eosinophils in lungs
* eosinophilic pneumonia
* hypereosinophilic syndrome
* tropical pulmonary eosinophilia
* drugs: nitrofurantoin, sulphonamides
* less common: Wegener's granulomatosis
NOT EXTRINSIC ALLERGIC ALVEOLITS
386
what is the most common type of glomerulonephritis in adults and how does it present?
membranous
| nephrotic usually
387
which Ab is the idiopathic cause of membranous glomerulonephritis associated with?
anit-phospholipase A2
388
how is membranous glomerulonephriits managed?
ACEi
steroids
+ cyclophosphamide if severe
389
what is the mechanism of aciclovir?
inhibits DNA polymerase
| activated by virally infected cells
390
what are the predisposing factors for pagets disease?
age, male, northern lattitude, FHx
391
what are the Ix findings in pagets?
high ALP
normal Ca/PO4
urinary hydroxyproline
Xray - osteolysis early , later thickening and osteoporosis. (pagets is due to excess osteoclasts followed by osteoblasts)
392
what are the complications of pagets?
fractures
deafness
bone sarcoma
high output cardiac failure
393
how does subacute thyroiditis present?
tender goitre
hyperthyroid clinical and bloods
reduced uptake via scan
high ESR
then euthyroid
then hypothryroid
all post infection
394
what is ARVC (Arrhythmogenic right ventricular cardiomyopathy)? how does it present?
auto dominant - desmosome protien
right ventricle replaced by fibrofatty tissue
second most common cause of sudden cardiac death in young (after HOCM)
palpitations, syncope, sudden death
395
what is Naxos disease?
autosomal recessive variant of ARCV .
| triad of ARCV, palmoplantar ketatosis and woolly hair
396
which zones does extrinsic allergic alvolitis affect? (e..g bird fanciers lung/ farmers lung)
upper / mid zone fibrosis
397
what is the most common subtype of renal cell cancer?
clear cell
398
what is the management for torsades de pointes?
IV MGSO4
399
drugs to avoid in renal failure?
antibiotics: tetracycline, nitrofurantoin
NSAIDs
lithium
metformin
```
Drugs likely to accumulate in chronic kidney disease - need dose adjustment
most antibiotics
digoxin, atenolol
methotrexate
sulphonylureas
furosemide
opioids
```
400
How do we test for Non fatty alcoholic liver disease?
ELF - enhanced liver fibrosis blood test - looks at a collection of markers to assess risk
401
how is leprosy managed?
rifampicin, dapsone and clofazimine 12 months - for 6 or more lesions - multibacilary leprosy
For paucibacillary leprosy (5 or less lesions) you should give rifampicin and dapsone for 6 months.
402
when does neuroleptic malignant syndrome happen?
usually from starting anti-psychotic
| suddenly stopping dopaminergic drugs
403
how is neuroleptic malignant syndrome managed?
stop antipsychotic
IV fluids
sometimes dantrolene
dopaminergic drugs- bromocriptine
404
which HPV types are at risk of developing cervical cancer?
16,18,33
other risks:
smoking, human immunodeficiency virus, early first intercourse, many sexual partners, high parity, lower socioeconomic status and the use of the combined oral contraceptive pill.
405
what is post concussion syndrome?
Post-concussion syndrome is seen after even minor head trauma
```
Typical features include
headache
fatigue
anxiety/depression
dizziness
```
406
what is bumetanide?
loop diuretic
407
what are the ECG changes in constrictive cardiomyopathy?
low voltage QRS
408
how does wernickes and korsakoff present?
wernickes - opthalmoplegia (lateral rectus palsy and/or nystagmus), confusion and ataxia
korsakoff - anterograde amnesia and confabulation as well as above
409
what is the management of acute angle glaucoma?
Alongside eye drops, IV acetazolamide is used in the initial emergency medical management of acute angle-closure glaucoma
410
how is metastatic bone pain managed?
opioids, dexamethasone, radiation
411
which proteins are affected in HOCM?
B myosin heavy chain or myosin binding protein C
412
what are the features of HOCM?
```
Features:
Exertional syncope
Angina
Sudden death
Jerky pulse
Ejection systolic murmur - increases with valsalva
```
413
when should pneumococcal vaccine be given for splenectomys? which other vaccines are needed and which Abx prophylaxis?
2 weeks before op
- Hib, Men A &C
- Annual influenza
- Pneumococcal every 5 years
life long penicillin V
414
what is the most common type of cyanotic CHD and when does it present?
tetralogy of fallot
presents around 1-2 months
415
which organism is most common cause of osteomyeliits?
S.aureus
| in sickle cell patients - salmonella species
416
what is potts disease?
spinal TB - history of TB, back pain, fevers, weight loss
| more common in thoracic and upper lumbar vertebrae
417
how is epidiymo-orchitis managed?
• if the organism is unknown BASHH recommend:
ceftriaxone 500mg intramuscularly single dose, plus doxycycline 100mg by mouth twice daily for 10-14 days
418
how does toxoplasmosis present?
lymphadenopathy , fever and malaise in immunocompetent host - self limiting
in immunocompromised - chorioretinitis, cerebral lesion
419
how is cerebral toxoplasmosis managed?
pyrimethamine plus sulphadiazine for at least 6 weeks
420
how does congential toxoplasmosis present?
```
• neurological damage
○ cerebral calcification
○ hydrocephalus
○ chorioretinitis
• ophthalmic damage
○ retinopathy
○ cataracts
```
421
how does optic neuritis present?
unilateral decrease in visual acuity over hours or days
poor discrimination of colours, 'red desaturation'
pain worse on eye movement
relative afferent pupillary defect
central scotoma
associated with MS, diabetes and sphyllis
422
how is optic neuritis managed?
high dose steroids
423
what is the first line Ix for stable angina?
CT coronary angiography
424
what are the ADRs of lithium?
nausea/vomiting, diarrhoea
fine tremor
nephrotoxicity: polyuria, secondary to nephrogenic diabetes insipidus
thyroid enlargement, may lead to hypothyroidism
```
ECG: T wave flattening/inversion
weight gain
idiopathic intracranial hypertension
leucocytosis
hyperparathyroidism and resultant hypercalcaemia
```
425
what is the management of PTSD?
watchful waiting - for mild symptoms lasting less than 4 weeks
trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR) therapy may be used in more severe cases
venlafaxine or a selective serotonin reuptake inhibitor (SSRI), such as sertraline should be tried.
severe - risperidone
426
what are the features of whipples disease?
HLA B27 , men
caused by infection
```
malabsorption, diarrhoea,
large joint arthralgia
hypopigmentation
neurology
opthalmoplegia
```
427
what are the Ix findings in whipples and what is the management?
jejunal biospy --> macrophages containing periodic acid schiff (PAS) granules
Mx:
- Co-trimoxazole - 1 year
428
which antihistamines are non sedating/sedating?
sedating - chlorampheniramine
| non - certirizine and loratidine
certirizine is more sedating than loratidine
429
How does pompholyx eczema present?
type of eczema which causes tiny blisters to arise across the fingers, palms of the hands and in some cases the soles of the feet.
It commonly affects adults under 40 years old.
factors such as stress, sensitivity to metal compounds, sweating can aggravate it.
430
what are the risks of chicken pox in pregnnacy?
fetal vericella syndrome
mother - pneumonitis
neonatal varicella - if mum gets chicken pox 5days before birth- 2 days after
431
when is risk of fetal varicella syndrome highest and what are the symptoms?
- Highest risk when exposure is before 20 weeks
Skin scarring, micropthalmia, limb hypoplasia, microcephaly and learning disability
432
how is maternal chicken pox exposure managed?
check ab
<20 weeks - give VZIG asap
>20 weeks - give VZIG 7-14 days after
433
what are the different types of amyloidosis?
AL - most common. associated with MGUS/ myeloma.
AA - associated with inflammation- TB/ RA
B2 microglobulin - associated with dialysis
434
how is amyloidosis diagnosis?
congo red staining - apple green birefringence
435
what is the treatment for facial hirsuitism?
topical eflornithine
436
what is the management of spontaneous bacterial peritonitis?
IV cefotaxime
437
what is the ECG changes in pericarditis?
PR depression - most specific
| ST elevation saddle shaped, wide spread
438
what are the aDRs of clozapine?
agranulocytosis
neutropaenia
reduced seizure threshold -
constipation
myocarditis: a baseline ECG should be taken before starting treatment
hypersalivation
439
what are the main ADRs of ati-typical antipsychtocis?
increased stroke risk
VTE risk
weight gain
high prolactin
clozapine - agranulocytosis
olanzapine - higher risk of dyslipidaemia and obesity
440
what colour is gram negative?
pink
441
which Ab is seen in Wegners (granulomatosis with polyangiitis)?
cANCA
442
how is mycoplasma pneumonia diagnosed?
serology
443
what are the causes of papilloedema?
```
space occuping lesion
malignant hypertension
idiopathic intracranial HTN
hydrocephalus
hypercapnia
```
rare - vit A toxicity, hypo PTH/ hypoCa
444
What are the ADRs of SSRIs?
GI symptoms
GI bleed - take with PPI if also on NSAIDs. avoid if on warfarin
hyponatraemia
citalopram - increase QT
445
which SSRI has greatest risk in pregnancy?
risk of pulmonary HTN if used in T3.
paroexetine has most risk of congenital malformations
446
what type of bacteria in klebsiella? Who is it most common in? and what distinguishing feature is present in patients?
gram neg rod
common in alcoholic/diabetic/ aspiriation
red current jelly sputum. Affects upper lobes
447
what type of pneumothorax is seen in menstruating women?
catamenial pneumothorax
448
what are the side effects of phosphodiesterase inhibitors?
visual disturbances - blue discolouration
non-arteritic anterior ischaemic neuropathy
```
nasal congestion
flushing
gastrointestinal side-effects
headache
priapism
```
449
what are the features of leptospirosis?
fever, flu like , subconjunctival haemorhage/
AKI
hepatitis / hepatomegaly
aseptic meningitis
Bilateral conjunctivitis, bilateral calf pains and high fevers
450
how is leptospirosis managed?
high dose benzylpenicillin doxy
451
how does japenese encephalitis present?
The majority of infection is asymptomatic.
Clinical features are headache, fever, seizures and confusion.
Parkinsonian features indicate basal ganglia involvement.
It can also present with acute flaccid paralysis.
452
which medication for paliative patients can treat bowel colic?
respiratory secretions & bowel colic may be treated by hyoscine hydrobromide, hyoscine butylbromide, or glycopyrronium bromide.
can be put in syringe driver
453
which drug is incompatiable with many other drugs in a syringe driver?
cyclizine
454
what is the genetics behind osteogenesis imperfecta?
auto dom
| type 1 collagen
455
what are the features of osteogenesis imperfecta?
blue sclera
fractures
deafness - otosclerosis
dental imperfections
456
what are the different occular problems associated with RA?
keratoconjunctivitis sicca - most common
episcleritis - erythema, no pain
scleritis - erythema and pain
corneal ulcers
keratitis
457
what is pathogenesis of PKU?
auto recessive
phenylalanine hydroxyalase mutation
(normally converts phenylalanine to tyrosine)
458
what are the features of PKU?
```
developmental delay
fair hair and blue eyes
seizures - infantile spasms
musty odour to urine and sweat
eczema
```
459
how is dermatitis herpetiformis. manaaged?
dapsone
460
what is most common cause of pneumonia in COPD?
Haemophilus influenza
461
what causes papilloedema of one optic disc and atrophy of the other?
frontal lobe lesion - ipsilateral atrophy of optic disc and contralateral papilloedema = Foster-Kennedy syndrome
usually caused by meningioma
462
what is the normal QTc in men and women?
men <450
| women <470
463
what are the features of chinchonism?
quinine toxicity
- long QT/ QRS --> VT VF
- pulmonary oedema
- tinnitus
- blurring of vision
- dry skin, abdo pain
- hypglycaemia
- metabolic acidosis
- hypotension
464
what is the functions of terbinifene, azoles, nystatin?
azoles - Inhibits 14α-demethylase which produces ergosterol
terbinifene - Inhibits squalene epoxidase
nystatin - Binds with ergosterol forming a transmembrane channel that leads to monovalent ion leakage
465
what is the secondary prevention after MI?
dual antiplatelet:
- ticagrelor and aspirin (stop ticagrelor after 12 months)
- if PCI then prasugrel or ticagrelor + aspirin.
ACEi, B blocker, statin.
if HG - left ventricular dysfunction then add in aldosterone antagonist (epleronone)
466
What are the features of frontotemporal lobar dementia ?
onset <65
insidious
preserved memory and visuospatial skills
personality change and social conduct problems
often family Hx.
467
what is picks disease?
most common type of frontotemporal dementia
characterised by imparied social impairment, personality change, disinhibition, increased appetite
Atrophy of frontal and temporal lobes
468
what is the condition called where there is compression of the lateral cutaneous nerve of the thigh?
meralgia paraesthesia
469
list different haemorrgahic fever causes
dengue, yellow fever
Lassa fever
Ebola virus, Marburg virus
Hantaviruses, Crimean-Congo haemorrhagic fever, Rift Valley fever
470
what organism carries lassa fever?
rats
in africa
(also spreafd person to person)
471
what organism carries marburg virus?
in caves
| bats and primates
472
which animal carries leishmaniasis?
sandflies
473
beta carotine is an anti-oxidant. who shouldnt take this and why?
smokers - increases risk of lung cancer
474
what is the best blood marker of severity of acute pancreatitis?
CRP now recomended
| correlates with necrosis
475
what are the ECHO findings of HOCM?
mitral regurgitation (MR)
systolic anterior motion (SAM) of the anterior mitral valve leaflet
asymmetric hypertrophy (ASH)
476
which diabetic meds are linked to severe pancreatitis and renal impairment?
Exanatide
477
how is lewy body dementia and parkinsons diagnosed?
SPECT scan
478
which blood test is important for restless leg syndrome?
serum ferritin
479
how does an iliopsoas abscess present?
fever and pain on hip extension
480
which organism is most common in iliopsoas abscesses?
S.aureus
481
which is the most common type of glomerulonephritis in wegners/ granulomatosis with polyangiitis? how does it present? what is seen on biopsy?
rapidly progressive glomerulonephritis, with its severe and rapid loss of kidney function, haematuria and proteinuria. A renal biopsy demonstrates glomerular crescents.
482
what are the ADRs of bisphosphonates?
* oesophageal reactions: oesophagitis, oesophageal ulcers (especially alendronate)
* osteonecrosis of the jaw
* increased risk of atypical stress fractures of the proximal femoral shaft in patients taking alendronate
* acute phase response: fever, myalgia and arthralgia may occur following administration
* hypocalcaemia: due to reduced calcium efflux from bone. Usually clinically unimportant
483
which antibody is found in mixed connective tissue disease?
anti-RNP
484
how can the cause of horners determine the location of compression (central, pre ganglionic, post ganglionic)
Anhidrosis of the face, arm and trunk = central lesion = stroke, syrignomyelia, MS, tumour, encephalitis
Anhidrosis of the face = preganglionic lesion - pancoast tumour, thyroidectomy, trauma, cervical rib
No anhidrosis = post ganglionic - Carotid artery dissection, Carotid aneurysm, Cavernous sinus thrombosis, Cluster headache
485
what is the first line for guillian barre?
IV IG
486
what are the contraindications to breast feeding?
galactosaemia
certain viral infections
```
The following drugs should be avoided:
antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone
```
487
how does otosclerosis present?
```
Onset is usually at 20-40 years - features include:
conductive deafness
tinnitus
normal tympanic membrane*
positive family history
```
488
which drugs cause steven johnson syndrome?
```
penicillin
sulphonamides - any sulphur containing stuff
lamotrigine, carbamazepine, phenytoin
allopurinol
NSAIDs
oral contraceptive pill
```
489
what is the pathogenesis behind porphyria cutanea tarda?
uroporphyrinogen decarboxylase defect - inherited
OR acquired from hepatocyte damage
defect in haem production
490
what are the symptoms of porphyria cutanea tarda?
photosensitive blistering rash
hypertrichosis (hair growth)
hyperpigmentation
491
how long is serum tryptase elevated after anaphylaxis?
12 hours
492
which drugs lead to glucose intolerance?
```
Steroids
tacrolimus / ciclosporin
nicotinic acid
thiazides
IFNa
antipsychotics
(B blockers)
```
493
what are the complications of plasma exchange:
* hypocalcaemia
* metabolic alkalosis
* removal of systemic medications
* coagulation factor depletion
* immunoglobulin depletion
494
what are the features of goodpastures? what is found on biopsy?
pulmonary haemorrhage
rapidly progressive glomerulonephritis- this typically results in a rapid onset acute kidney injury
○ nephritis → proteinuria + haematuria
IgG deposits on BM
495
what murmur is found in an ASD?
ejection systolic , louder on inspiration
496
what is the management of organophosphate poisoning?
atropine
497
what are the symptoms of organophosphate poisoning?
headache, disorientation, weakness, vomiting, and muscarinic effects such as miosis, bradycardia and increased urination, lacrimation
498
what Abx is used in tetanus?
metronidazole
499
what medication can be used in acute delirium?
haloperdol (not benzos - can worsen)
500
what are the associations to WPW?
Associations with WPW:
- Thyrotoxicosis
- Mitral valve prolapse
- Ebstein anomaly
- HOCM
- Secundum ASD
501
what are the features of von hippau lindau?
cerebellar haemangiomas: these can cause subarachnoid haemorrhages
retinal haemangiomas: vitreous haemorrhage
renal cysts (premalignant)
phaeochromocytoma
extra-renal cysts
clear-cell renal cell carcinoma
502
how much should non-HDL be reduced by after starting statins?
>40%
503
what are the symptoms of visceral leishmaniasis?
```
fever, sweats, rigors
massive splenomegaly. hepatomegaly
poor appetite*, weight loss
grey skin - 'kala-azar' means black sickness
pancytopaenia secondary to hypersplenism
```
504
What are the ADRs of azothioprine?
bone marrow depression
consider a full blood count if infection/bleeding occurs
nausea/vomiting
pancreatitis
increased risk of non-melanoma skin cancer
505
can azothioprine be used in pregnancy?
yes, as well as mesalazine and sulfasalazine
506
what are the features of alports syndrome? what is the genetic defect?
- Microscopic haematuria
- Bilateral sensorineural hearing loss
- Renal failure
- Lenticonus - protrusion of lens
- Retinitis pigmentosa
Renal biopsy - splitting of lamina densa seen on electron microscope
X linked dominant - collagen IV
507
what are the ADRs of ciclosporin?
nephrotoxicity
hepatotoxicity
```
everything increased:
fluid retention
hypertension
hyperkalaemia
hypertrichosis
gingival hyperplasia
tremor
impaired glucose tolerance
hyperlipidaemia
increased susceptibility to severe infection
```
508
which lens dislocation is seen in marfans/ homocysteinuria?
marfans - upward
| homocysteinuria - downward
509
which antibodies are present in dermatomyositis?
the majority of patients (around 80%) are ANA positive
around 30% of patients have antibodies to aminoacyl-tRNA synthetases (anti-synthetase antibodies), including: anti jo, Anti SRP, anti-Mi-2 antibodies
510
how does acne roseca present and how is it treated?
```
typically affects nose, cheeks and forehead
flushing is often first symptom
telangiectasia are common
rhinophyma
ocular involvement: blepharitis
sunlight may exacerbate symptoms/
```
Management
topical metronidazole may be used for mild symptoms more severe disease is treated with systemic antibiotics e.g. Oxytetracycline
511
what are the side effects of EPO?
```
HTN
bone aches
flu like symptoms
red cell aplasia
skin rash/urticaria
```
iron deficiency secondary to erythropoeisis
512
what is seen on renal biopsy in alports?
ongitudinal splitting of the lamina densa of the glomerular basement membrane, resulting in a 'basket-weave' appearance
513
how often is lithium checked? what else should be checked?
weekly until stable and then every 3 months
| thyroid and renal function every 6 months
514
what is blocked in cyanide poisoning and what are the features?
cytochrome c oxidase
brick red skin
bitter smell
hypoxia. hypotension, headache
515
how is relative risk calculated?
| How is relative risk reduction calculated?
% of new drug effect/ % of placebo
RRR = % of new drug - % placebo / % placebo
516
what blood result is found in chronic Hep B infection?
The negative IgM anti-HBc points to a chronic rather than acute infection.
Positive anti-HBc IgG, negative anti-HBc IgM
postive HBs antigen
anti HBs = immunity. This is negative in chronic disease
517
which scoring system is used for liver cirrhosis and what paramets does it include?
Child pugh - for severity.
billiruubin, albumin, PT, encephalopathy, ascites
Model for end stage liver disease (MELD) scoring = predicts survival (INR, bilirubin,creatinine)
518
what is the classic symptoms of pre-eclampsia?
new-onset blood pressure ≥ 140/90 mmHg after 20 weeks of pregnancy
AND 1 or more of the following:
proteinuria (oedema)
other organ involvement e.g. renal insufficiency (creatinine ≥ 90 umol/L), liver, neurological, haematological, uteroplacental dysfunction
519
How is initial RA diagnosis managed? how is the response to treatment monitored?
DMARD monotherapy + steroids
monitored via CRP and DAS28
520
howis absolute risk reduction calculated and numbers needed to treat?
absolute RR = % test - %control
NNT = 1/ ARR
521
how is MS managed?
high dose steroids (IV / oral methylpred) - 5 days (this shortens relapse)
Reducing relapse - B IFN
fatigue - amantidine
spacsticity - baclofen/ gabapentin.
Oscillopsia - gabapentin.
522
how does polyarteritis nodosa present?
```
Fever, malaise, arthralgia
weight loss
hypertension
mononeuritis multiplex, sensorimotor polyneuropathy
testicular pain
livedo reticularis
haematuria, renal failure
pANCA
hepatitis B serology positive in 30% of patients
```
523
what is lithium toxicity precipitated by?
dehydration
renal failure
drugs: diuretics (especially thiazides), ACE inhibitors/angiotensin II receptor blockers, NSAIDs and metronidazole.
524
what drug should be used if patients cant tolerate alendronate?
switching to risedronate or etidronate in patients unable to tolerate alendronate
525
what should be checked before starting azothioprine?
thiopurine methyltransferase deficiency (TPMT) before treatment
deficiency leads to toxicity
526
which tumour is associated with anti NMDA (autoimmune encephalitis). what are the features of this?
ovarian teratoma
| psychiatric features including agitation, hallucinations, delusions
527
how does eosinophilic oesophagitis present?
young men with symptoms of dysphagia and in patients with a history of food allergy, eczema and asthma
528
what are the hormonal changes in annorexia?
Low FSH, LH, oestrogens and testosterone
raised cortisol and growth hormone
529
what features suggest it will be an VT rather than SVT?
* AV dissociation
* fusion or capture beats
* positive QRS concordance in chest leads
* marked left axis deviation
* history of IHD
* lack of response to adenosine or carotid sinus massage
* QRS > 160 ms
530
how can eye drops be used to distinguish between the lesion of horners?
Apraclonidine eye drops are initially used to confirm a Horner's pupil. Apraclonidine stimulates both alpha-1 and alpha-2 receptors. When added to the affected eye, it causes pupil dilation by >2mm because of the relative supersensitivity of this pupil to alpha-1 receptor activity. In a normal pupil, however, it causes constriction due to the more potent activity at the alpha-2 receptor which triggers reuptake of noradrenaline in the synaptic cleft.
Hydroxyamphetamine is then used to distinguish between first/second or third order neurones. In a normal pupil or a first/second order Horner's, the pupil will dilate. In a third order neurone lesion, this will not occur.
531
what are the contraindications to TB vaccine?
• previous BCG vaccination
• a past history of tuberculosis
• HIV
• pregnancy
• positive tuberculin test (Heaf or Mantoux)
The BCG vaccine is not given to anyone over the age of 35, as there is no evidence that it works for people of this age group.
532
wahat is malingering?
faking illnes for gain - e.g. financial gain (whiplash) or pain releif meds
533
causes of raised anion gap?
lactate: shock, hypoxia
ketones: diabetic ketoacidosis, alcohol
urate: renal failure
acid poisoning: salicylates, methanol
5-oxoproline: chronic paracetamol use
534
causes of normal anion gap?
```
gastrointestinal bicarbonate loss: diarrhoea, ureterosigmoidostomy, fistula
renal tubular acidosis
drugs: e.g. acetazolamide
ammonium chloride injection
Addison's disease
```
535
what are the poor prognostic factors of schizophenia?
```
low IQ
family Hx
insideious onset
prodromal phase of social withdrawl
lack of obvious precipitant
```
536
what leads to coagulation in nephrotic syndrome?
loss of ATIII
537
strongest risk factor for dry age related macular degeneration?
smoking
538
what are the ADRs of aromatase inhibitors?
osteoporosis- NICE recommends a DEXA scan when initiating
hot flushes
arthralgia, myalgia
insomnia
539
what is mechanism and side effect of tamoxifen?
Tamoxifen is a SERM which acts as an oestrogen receptor antagonist and partial agonist.
```
Adverse effects
menstrual disturbance:
hot flushes -
venous thromboembolism
endometrial cancer
```
540
what is an example of an aromatase inhibitor?
Anastrazole
541
what causes cannon a waves?
- Caused by right atrium contracting against a closed tricuspid valve
- Regular:
○ VT
○ AVNRT
- Irregular
○ Complete heart block
542
how do B blockers (timolol) in acute angle glaucoma work?
by reducing aqueous production
543
what is seen in Seborrhoeic dermatitis?
otitis externa and blethritis
| eczematous lesions on the sebum-rich areas: scalp (may cause dandruff), periorbital, auricular and nasolabial folds
544
what is the mechanism of action of acarbose?
Acarbose is an inhibitor of intestinal alpha glucosidases, which results in decreased absorption of starch and sucrose.
common side effect = flatulence
545
what type of cancer is schistosomiasis infection linked to ?
squamous cell bladder
546
How does schistosomiasis infection present acutely?
swimmers' itch
acute schistosomiasis syndrome (Katayama fever)
fever, urticaria/angioedem, arthralgia/myalgia, cough, diarrhoea, eosinophilia
547
what are the chronic issues of schistosomiasis?
Schistosoma mansoni and Schistosoma japonicum - liver/ colon infestation, hepatomegaly, splenomegaly. cirrhosis, variceals, cor-pulmonale.
Schistosoma haematobium - bladder cancer
548
who is benign ethnic neutropenia seen in?
Benign ethnic neutropaenia is common in people of black African and Afro-Caribbean ethnicity
isolated neutropenia - no issues
549
which infection is associated with struvite stones?
Proteus mirabilis
550
what is the genetics behind freidrich ataxia?
autorecessive
trinucleotide repeat
doesnt have anticipation
551
what are the features of friedrich ataxia?
absent ankle jerks/extensor plantars
cerebellar ataxia
spinocerebellar tract degeneration
optic atrophy
high arched palate
HOCM
diabetes
10-15yrs
552
what is the difference in impaired fasting glucose and impaired glucose intolerance pathophysiology?
Impaired fasting glucose (IFG) - due to hepatic insulin resistance
impaired glucose tolerance (IGT) - due to muscle insulin resistance
patients with IGT are more likely to develop T2DM and cardiovascular disease than patients with IFG
553
which occular pathology is associated with charles bonnet syndrome?
Age-related macular degeneration is associated with Charles-Bonnet syndrome (visual hallucinations, patient aware and no psych problems)
554
what is the conversion of oral morphine to s/c diamorphine?
divide by 3
555
what is the most common sign on USS in gout?
double-contour sign
= a hyperechoic, irregular band over the superficial margin of the joint cartilage, produced by deposition of monosodium urate crystals on the surface of the hyaline cartilage,
556
what is the power of a study?
probability of detecting a significant difference.
| i.e. rejecting the null correctly
557
what is the investigation for pheochromocytoma?
Phaeochromocytoma: do 24 hr urinary metanephrines, not catecholamines
558
what is mcardles disease?
autosomal recessive type V glycogen storage disease
this causes decreased muscle glycogenolysis
```
Features
muscle pain and stiffness following exercise
muscle cramps
myoglobinuria
low lactate levels during exercise
```
559
what is the treatment for cryptosporidiosis for immunocompromised patients?
Nitazoxanide
560
what happens to clotting factors in liver disease?
most low
| factor 8 is normal/ raised
561
what conditions are associated with IgA nephropathy?
alcoholic cirrhosis
coeliac disease/dermatitis herpetiformis
Henoch-Schonlein purpura
562
what does the A wave on JVP present and what abnormalities are associated with it?
atrial contraction (first wave on JVP)
large if there is high atrial presssure e.g. tricuspid/pulmonary stenosis, pulomnonary HTN.
cannon a waves - contracts against closed tricuspid e.g. complete heart block
Absent in AF.
563
what does the C wave on JVP present?
2nd wave on JVP
| closure of tricuspid. not always visible
564
what does the V wave on JVP present and what abnormalities are associated with it?
Third increase wave on JVP .
due to passive filling of atria .
giant v waves in tricuspid regurg.
565
what does the x and y descent represent on JVP?
X decent - after c wave.
fall in pressure due to ventricular systole
y decent after v wave - opening of tricuspid valve
566
what is rieldel thyroiditis?
rare cause of hypothyroidism
dense fibrois tissue replaces normal thyroid
appears hard and painless goitre
middle aged women
either euthyroid (most cases) or hypothyroid.
567
what is reidels thyroiditis associated with?
retroperitoneal fibrosis
568
after starvation, how is food reintroduced to avoid refeeding syndrome?
NICE recommend that if a patient hasn't eaten for > 5 days, aim to re-feed at no more than 50% of requirements for the first 2 days.
569
when is calcification of lung mets seen?
only if there is chondrocarcinoma or osteosarcoma
570
when are eruptive xanthomas most common?
high triglycerides - familial hypertriglyceridaemia
| also lipoprotein lipase deficiency
571
what organism causes syphilis?
Treponema pallidum
572
how is syphilis tested for?
non-treponemal tests
(cardiolipin test) - e.g. RPR and VDRL - these become negative after treatment.
Treponemal specific tests - TPHA and TP-EIA - stay positive after treatment.
573
how can the syphilis tests be interupted?
Positive non-treponemal test + positive treponemal test
• consistent with active syphilis infection
Positive non-treponemal test + negative treponemal test
• consistent with a false-positive syphilis result e.g. due to pregnancy or SLE
Negative non-treponemal test + positive treponemal test :
• consistent with successfully treated syphilis
574
what are the causes of false positive non-treponemal tests?
```
SLE
pregnnacy
HIV
TB
Malaria
leprosy
```
575
what is the mechanism of pilocarpine?
Pilocarpine is a muscarinic receptor agonist
used in gaulcoma
increases uveoscleral outflow by constricting the pupil.
576
how is metformin initiated?
start at 500mg and titrate slowly. minimum interval for titration = 1 week
577
what are the risk factors for adenocarcinoma of oesophagus and squamous cell carcinoma?
squamous: smoking, alcohol, achalasia and plummer vinson
adeno - smoking, alcohol, barrets
578
how do angioid retinal steaks appear?
what conditions is this associated with?
irregular dark red streaks from optic nerve
associated with ehlers danlos, acromegaly, pagets, sickle cell, pseudoxanthoma elasticuum
579
what is hungry bone syndrome?
after srugery to treat hyperparathyoidism there is a sudden drop in PTH
this results in bones absorbing a lot of calcium
hypoCa
580
which antiepileptics are safe in breast feeding?
Most are safe
| except barbiturates
581
how does primary infection with herpes present?
gingivostomastitis - ulcers and oral inflammation. swelling of submandibular gland.
plus fever/ unwell
582
how are SSRIs stopped?
withdraw slowly over 4 weeks
| not necessary with fluoexetine due to longer half life
583
what is the genetics behind gilberts?
autorecessive.
defective bilirubin conjungation
deficiency in UDP glucuronosyltransferase
584
how is gilberts tested for?
rise in bilirubin following prolonged fasting or IV nicotinic acid
585
how are babies who's mum has chronic hep B managed?
| can mum breast feed?
vaccine and IVIG given to baby
little evidence for need for c section
cant be transmitted via breast milk
586
What organism causes rocky mountain fever ? how does it present?
Rocky mountain fever = Rickettsia ricketsii
headache, fever, rash (starts on peripheries and spreads centrally)
587
What organism causes Q fever ? how does it present?
Q fever= Coxiella burnetti
No rash but causes pneumonia
588
What organism causes endemic typhus ? how does it present?
ndemic typhus Rickettsia typhi
| Rash starts centrally then spreads to the peripheries
589
What organism causes epidemic typhus ? how does it present?
Epidemic typhus
| Rickettsia prowazekii
590
what are the poor prognostic factors following ACS?
```
age
development (or history) of heart failure
peripheral vascular disease
reduced systolic blood pressure
Killip class*
initial serum creatinine concentration
elevated initial cardiac markers
cardiac arrest on admission
ST segment deviation
```
591
what is the killip class?
```
risk straification post MI
1 - no HF signs
2- lung crackles, S3
3 - frank pulmonary oedema
4 - cardiogenic shock
```
592
what is the management of acne?
```
topical retiniod
topical antibiotic
oral therapy
- tetracyclines - use for max 3 mont
COCP
oral isotretinoin
```
593
which antibiotics for ACNE are safe in pregnancy?>
erythromycin
594
which acne medication causes irreversible pigmentation?
minocycline
595
what are the indications for steroids in sarcoidosis?
CXR 2 or 3 disease and symptomatic
hypercalcaemia
eye, heart, or neuro involvement
596
how is haemochromatosis diagnosed?
transferrin saturation
ferritin levels
(low total iron binding content)
family members - HFE gene mutation
597
which cancer are the following skin conditions associated with?
```
Erythema gyratum repens
acanthosis nigricans
dermatomyosis
migratory thrombophlebitis
necrolytic migratory erythema
```
erythema gyratum repens - lung cancer
acanthosis nigricans - gastric cancer
dermatomyositis - ovarian and lung cancer
Migratory thrombophlebitis - Pancreatic cancer
Necrolytic migratory erythema Glucagonoma
598
what is the mechanism of warfarin?
```
inhibits epoxide reductase - stops vit K reduction
inhibits factors (1972)
```
599
can warfarin be used in pregnancy and breastfeeding?
yes breastfeeding
600
what factors can increase warfarin?
liver disease
P450 enzyme inhibitors, e.g.: amiodarone, ciprofloxacin
cranberry juice
drugs which displace warfarin from plasma albumin, e.g. NSAIDs
inhibit platelet function: NSAIDs
601
what is the target for statin therapy in primary prevention?
In the primary prevention of CVD using statins aim for a reduction in non-HDL cholesterol of > 40%
602
which type of testicular tumour is associated with rise in hCG?
seminoma - just hCG raised
choriocarcinoma - but much rarer than above
yolk sac tumours - hCG and alpha fetoprotein both rasised
603
how is phenytoin toxicity/ levels measured?
just before next dose
604
which scoring system is used for appendaidictis?
The Alvarado score can be used to suggest the likelihood that a patient has acute appendicitis
605
which Ab are found in SLE
ANA - 95% - sensitive, not specific
| Anti DsDNA/ anti smith - specific not sensitive
606
what are the ECG changes in arryhthmogenic RV cardiomyopathy?
ECG abnormalities in V1-3, typically T wave inversion. An epsilon wave is found in about 50% of those with ARV - this is best described as a terminal notch in the QRS complex
607
what are the features of ebstein anomoly?
cyanosis
prominent 'a' wave in the distended JVP,
hepatomegaly
tricuspid regurgitation - giant V wave in JVP
pansystolic murmur, worse on inspiration
right bundle branch block → widely split S1 and S2
608
how are wounds treated in regards to tetanus if they completed vaccine >10yrs ago?
tetanus prone wound - reinforcing vaccine dose
| high risk wound - reinforcing vaccine dose + Ig
609
what are the causes of avascular necrosis of the hip?
steroids
chemo
alcohol
trauma
610
which anti-epileptic can cause agranulocytoiss?
carbemazepine
611
how does a left venticular aneurysm post MI present?
persistent ST elevation
no chest pain
signs of HF
612
how long is needed for a fistula to develop?
6-8 weeks
613
How is cryptosporidium diagnosed
Cryptosporidium can be diagnosed by modified Ziehl-Neelsen staining of stool to reveal red cysts
614
what mode of inheritance is alports?
auto dominant
| collagen type 4
615
what are the features of alports?
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 - basket weave appearance
616
whats the difference between docetaxel and vincistrine?
docetaxel - prevents microtubule dissasembly
| vincistrine - prevents microtubule formation
617
In patients with low K and HTN, how can we differentiate the causes?
renin:aldosterone
- both high = renal artery stenosis
- aldosterone high, renin low = primary hyperaldosteronism
- neither high = liddles.
618
what are the characteristics of Argyll robertson pupils? what are the cuases?
small, irregular pupils
no light response
but there is accomodation response
causes - diabetes and syphillis
619
when is vitamin D deficiency treated?
<30
620
which movement is most classically impaired in adhesive capsulitis?
external rotation
621
how long after initial infection of C.diff is oral vanc used again?
1st line = oral vanc
reinfection after 12 weeks - oral vanc
within 12 weeks - oral fidaxomicin
622
what is the diagnosis for obstructive sleep apnoea?
Polysomnography
623
what are the secondary causes of hypercholesterolaemia over hypertriglyceridaemia?
nephrotic syndrome, cholestasis, hypothyroidism
624
what is the action of dipyrimadol?
inhibits phosphodiesterase, elevating platelet cAMP levels which in turn reduce intracellular calcium levels
other actions include reducing cellular uptake of adenosine and inhibition of thromboxane synthase
625
what abnormal observation should not be treated following acute stroke?
HTN
626
when are angiod retinal streaks seen?
```
pseudoxanthoma elasticum
Ehler-Danlos syndrome
Paget's disease
sickle-cell anaemia
acromegaly
```
627
what is Bevacizumab
monoclonal against VEGF
628
what is the management of eosinophilic oesophagiits?
Dietary modification and topical steroids are used in the management of eosinophilic oesophagitis
629
what are the side effects of ECT?
```
Short-term side-effects
headache
nausea
short term memory impairment
memory loss of events prior to ECT
cardiac arrhythmia
```
Long-term side-effects
some patients report impaired memory
630
Which Abx promotes MRSA?
ciprofloxacin
631
what is pseudohypoparathyroidism ?
Pseudohypoparathyroidism is caused by target cell insensitivity to parathyroid hormone (PTH) due to a mutation in a G-protein.
autosomal dominant fashion*
632
what are the features of pseudohypoparathyroisim?
Bloods
PTH: high
calcium: low
phosphate: high
```
Features
short fourth and fifth metacarpals
short stature
cognitive impairment
obesity
round face
```
633
how is raynauds managed?
CAB - nifedipine
| Epoprostenol (amongst other prostaglandins)
634
what is the cause of endocarditis in prosthetic valves?
<2 month hx of surgery - epidermidis
| >2 month - S.aureus
635
what defines pulmonary artery HTN?
Pulmonary arterial hypertension is defined as an elevated pulmonary arterial pressure of greater than 25mmHg at rest or 30mmHg after exercise
636
what medication should all SLE patients take?
hydroxychloroquine
637
which operations are available for weight loss and when?
Primarily restrictive operations
laparoscopic-adjustable gastric banding (LAGB)
it is normally the first-line intervention in patients with a BMI of 30-39kg/m^2
produces less weight loss than malabsorptive or mixed procedures but as it has fewer complications
Primarily malabsorptive operations
biliopancreatic diversion with duodenal switch
usually reserved for very obese patients (e.g. BMI > 60 kg/m^2)
Mixed operations
Roux-en-Y gastric bypass surgery
is both restrictive and malabsorptive in action
638
which zones of the lung does asbestosis causing fibrosis affect?
lower zone
639
how is occulogyric crisis managed?
intravenous antimuscarinic: benztropine or procyclidine
640
at what pottasium level is ramipril stopped?
stop ramipril at K+ >6
641
how is a cerebral abscess managed?
IV antibiotics: IV 3rd-generation cephalosporin + metronidazole
intracranial pressure management: e.g. dexamethasone
642
what are the contraindications to lung cancer surgery?
SVC obstruction, FEV < 1.5, MALIGNANT pleural effusion, and vocal cord paralysis
643
what type of glomerulonephritis is heroin associated with?
focal segmental glomerulosclerpsois
644
what are the genetics behind bruguda syndrome?
mutation in the SCN5A gene which encodes the myocardial sodium ion channel protein
autosomal dominant
645
what are the features and management of bruguda?
convex ST segment elevation V1-V3 followed by a negative T wave
partial right bundle branch block
the ECG changes may be more apparent following the administration of flecainide
ICD= management
646
what is the inheritance of myotonic dystrophy?
auto dominant
Trinucleotide repeat
DM1 and DM2
647
what are the features of myotonic dytrophy?
distal weakness - DM1
proxinal weakness - DM2
myotonic facies, diabetes, bilateral ptosis , cataracts, dysarthria, heart block
648
which drugs precipitate acute intermittent porphyria?
```
barbiturates
halothane
benzodiazepines
alcohol
oral contraceptive pill
sulphonamides
```
649
what blood test abnormalities are associated with antiphospholipid syn?
thrombocytopenia
| prolonged APTT
650
what are the ADRs of PPIs?
hypo Mg/ Na
microscopic colitis
Cdif
osteoporosis
651
what are the features of cholesterol emboli?
eosinophilia
purpura
renal failure
livedo reticularis
652
what should be checked if a man has osteoporosis?
testosterone
653
what anti-psychotic is contraindicated in parkinsons?
Haloperidol
654
what viruses could cause eczema herpeticum?
HSV and less commonly coxsackie
655
which is the most common and severe form of renal diseae in SLE?
diffuse proliferative glomerulonephritis
656
how long can you not drive for after angioplasty?
1 week
657
what are the genetics behind familial mediterranean fever?
auto recesive
| in turkey/ arabic decent
658
what are the features of familial mediterraean fever?
pyrexia, abdo pain, pleurisy, pericarditis, artritis, rash
colchicine helps
659
what is the most common type of hodgkins lymphoma?
nodular sclerosing
660
what type of hodgekin lymphoma has worst prognosis?
lymphocyte deplete
661
what arises first in MI?
myoglobin
662
what conditions are associated with sebhorreic dermatitis and how is it treated?
HIV
parkinsons
topical ketonazole
663
what is the treatment for campylobacter?
clarithromycin if severe
664
how does acute cerebellar haemorrahage present?
sudden-onset gait unsteadiness, vomiting and headache, followed by increasing drowsiness.
i.e. raised ICP symptoms
665
A post-marketing observational study of a new drug was conducted on 5000 patients following clinical trials.
What best describes the data generated from this type of study?
profile of adverse effects
| / post authorisation safety study
666
what is seen on renal biopsy in henoch schloin purpura?
mesangial deposition of IgA
667
which form of gastroenteritis can often have a negative stool culture?
giardiasis
668
what are the genetics of alpha 1 antitrypsin deficiency?
normal: PiMM
heterozygous: PiMZ - low risk of emphysema in non smokers
homozygous PiSS: 50% normal A1AT levels
homozygous PiZZ: 10% normal A1AT levels
669
what is the first line Ix for insulinoma?
Measuring prolonged (72-h) fasting glucose levels is the gold standard initial test for insulinoma.
670
how can you differentiate between common peroneal and L5 lesion?
Weakness of inversion is not seen in common peroneal nerve lesion but may be present with L5 lesion
671
which antihypertensive should be used in people taking lithium?
CaB
ACE inhibitors, angiotensin II receptor antagonists and thiazide diuretics can all cause lithium toxicity by reducing renal lithium clearance.
672
hyperacute rejection reactions are mediated by which Ab?
IgG
673
The combination of headache, increasing drowsiness (suggesting increasing intracranial pressure), focal neurological signs and seizures in a woman shortly post partum is highly suggestive of ...
venous sinus thrombosis.
674
what are the sympotms of acute closed angle glaucoma?
Symptoms include headaches, eye pain, nausea, halos and reduction of visual acuity. Ciliary vessel hyperaemia is an early sign.
675
which Abx cause tendon damage?
Tendon damage including rupture can occur rarely after use of quinolones. Quinolones are contraindicated in patients with a history of tendon disorders related to quinolone use. e.g. ciprofloxacin
676
what is the PEP for needle stick of HIV patient
Post-exposure prophylaxis (PEP) of HIV requires a three-drug antiretroviral for 1 month
677
what is Intention-to-treat method?
include anyone who drops out
678
when is oxygen saturation by four-wavelength spectrophotometry low compared to sats/PO2?
CO poisoning
679
what is a common cause of MI related to pregnancy?
coronary artery dissection
680
what are the parameters of the waterlow score?
t uses the following parameters to risk-stratify the patient: body weight, nutritional status, continence, skin type, mobility, age and sex.
681
how can we assess cvs risk with patients with renal disease/ HTN?
Proteinuria is an independent predictor of cardiovascular risk in patients with diabetes mellitus and/or hypertension.
682
what complication is most strongly associated with H.pylori?
duodenal ulcer
683
which Abx cause long QTc?
Antimicrobials that cause QT prolongation are: erythromycin, clarithromycin, moxifloxacin, fluconazole and ketoconazole.
684
at what age can polymyalgia rheumatica be diagnosed?
>55
685
which Ab is raised in autoimmune hepatitis?
IgG
686
what ECG change indicates posterior MI and which artery is invovled?
3-mm ST-segment depression in leads V1 to V3, with upright T waves and tall R waves
Circumflex
687
how is cellulitis with penicillin allergy treated?
clindamycin
688
what is Yersinia enterocolitica infection indicated in?
mesenteric adenitis
689
what does aciclovir do to the kidneys?
crystaluria
690
Ferritin is very high in a rare condition that causes fever, joint pain/inflammation and evanescent macular rash
Still's disease
691
what increases and decreases pulmonary vascular resistance?
It is increased by hypoxia, noradrenaline (norepinephrine) and endothelin.
decreased by epoprostenol (prostacyclin).
692
what oncogene is in neuroblastoma?
n-myc
693
which form of hodgkins carries best prognosis?
Hodgkin's lymphoma - best prognosis = lymphocyte predominant
694
what is the vital capacity?
Vital capacity - maximum volume of air that can be expired after a maximal inspiration
695
how is TTP managed?
steroids, immunosupressants
Plasma exchange
NOT IVIG
696
what is the typical presentation of methaglobinaemia?
SoB, headache, cyanosis
low sats, normal pO2
can be triggered by meds - co-trimoxazole, sulphonamides, dapsone
697
which part of hypothalamus is invaded by craniopharygiomas?
ventromedial area of the hypothalamus
698
which features of haemachromatosis are reversible upon treatment?
cardiomyopathy
skin pigmentation
other irreversible features: diabetes, liver cirrhosis, arthropathy, hypogonadism
699
what are the features of neurofibromatosis type 1 and 2
```
type 1
Café-au-lait spots (>= 6, 15 mm in diameter)
Axillary/groin freckles
Peripheral neurofibromas
Iris hamatomas (Lisch nodules) in > 90%
Scoliosis
Pheochromocytomas
```
type 2
Bilateral vestibular schwannomas
Multiple intracranial schwannomas, mengiomas and ependymomas
700
whatis the differece in amiodarone induced thyrotoxicosis type 1 and 2?
type 1 - iodine excess, goitre present, treat with carbimazole or pottasium perchlorate
type 2 - amiodarone induced destruction, no goitre, treat with steroids./
701
what is the treatement for restless legs and cramping legs?
restless legs - ropinerole
cramping - quinine
702
what is the mechanism behind heparin induced thrombocytopenia?
antibodies form against complexes of platelet factor 4 (PF4) and heparin
703
how are early keloid scars treated?
early keloids may be treated with intra-lesional steroids e.g. triamcinolone
704
which cause of pneumonia is associated with cold sores?
strept pneumonia
705
how is bacterial vaginosis managed?
oral metronidazole
706
which type of acute myeloid leukaemia carries best prognosis?
promyelocytic - t(15;17)
707
what are the features of tuberous sclerosis?
depigmented 'ash-leaf' spots which fluoresce under UV light
roughened patches of skin over lumbar spine (Shagreen patches)
adenoma sebaceum (angiofibromas): butterfly distribution over nose
fibromata beneath nails (subungual fibromata)
café-au-lait spots
retinal hamartomas: dense white areas on retina
rhabdomyomas of the heart
