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MRCP 1 > MRCP PART 1 > Flashcards

MRCP PART 1 Flashcards

1
Q

What is best line of management for MS patient with urge incontinence, incomplete emptying but post micturition bladder scan shows <300?

A

Oxybutynin for symtoms of overactive bladder but no significant residual volume
Alternatives - solifenacin, tolterodine

Intermittent self catheterisation only used when significant residual urine in bladder

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2
Q

Treatment for cerebral toxoplasmosis?

A

Pyrimethamine and sulfadiazine and folate supplementation (pyrimethamine is a folate antagonist).

Cerebral toxo - ring enhancing lesions on MRI
Pyrimethamine - anti-parasitic medication

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3
Q

Indications for ECT for severe depression?

A

Refusing food and drink, psychotic depression, suicidal dangerously, catatonia/depressive stupor, situations where a delay in the effect of anti-depressants will result in serious health risk

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4
Q

Next step in management in cocaine overdose, generalised seizures not responding to IV lorazepam, pyrexial, high blood pressure, ECG shows ischaemic changes?

A

Intubation and ventilation as this will help the high blood pressure, agitation and pyrexia and therefore may stop seziures.

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5
Q

Which CTPA finding shows up that is most suggestive for right heart strain in a PE?

A

Retrograde flow of contrast into the inferior vena cava (normally delivered to the right ventricle by the superior vena cava)

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6
Q

Holmes Adie syndrome describes which 3 symptoms?

A

Abnormal pupil larger
Abnormal pupil does not react to light and sluggish to accommodation
Absent lower limb and upper limb reflexes

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7
Q

Which enzyme is deficient in congenital adrenal hyperlasia?

A

21 hydroxylase deficiency - 90% of cases, 1 in 1000 white people
- Enzyme involved in the synthesis of steroid hormones (Aldosterone and cortisol)
- Leads to lack of cortisol, aldosterone and excess androgens
- Clinically virilisation, hypertension, salt losing (addisonian crisis)
- Complete deficiency leads to salt losing and marked virilisation in childhood

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8
Q

What is the most common organism that results in septic arthritis?

A

Staph aureus
- Most commonly after a boil or otitis media

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9
Q

What does the standard deviation of data mean?

A

The range within which 68% of measurements/readings/values lie within ONE STANDARD DEVIATION + and - the mean (either side of the mean)

Standard deviation is about distribution of data in general - 95% of the data lies within x2 SD from the mean

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10
Q

How do you work out the range at which 95% of the values lie?

A

X2 standard deviations from either side of the mean (exactly x1.96)

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11
Q

What range does the standard error define?

A

The standard error defines the range within which we are 95% CONFIDENT the mean of the population lies (x2 the standard error + and - the mean)

Standard error is about the confidence in regards to where we think the mean lies - We are 95% confident that the mean lies within x2 standard errors from the mean

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12
Q

What is the risk of asbestos worker who smokes getting bronchial carcinoma?

A

50 x
Because risk is cumulative
Asbestos worker - x5
Smoking - x10 risk
Having both = 50

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13
Q

What symptoms do injuries of these nerves cause?
Axillary, ulnar, radial and brachial plexus?

A

Axillary - Deltoid muscle (motor), regimental badge area (Sensory)
Commonly injured after humeral fracture or using crutches (direct pressure on axilla)
Radial nerve injury - wrist drop
Ulnar nerve injury - injury usually occurs at elbow and causes weakness of wrist flexion
Brachial plexus injury - shoulder injury

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14
Q

What are the triad of symptoms of normal pressure hydrocephalus?

A

1 month progressive history of 1) Gait disturbance 2) Dementia 3) Urinary incontinence

Do MRI to look for dilated ventricles

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15
Q

What neurological symptom favours confusion to be an acute delirium rather than a chronic dementia?

A

Fluctuating consciousness

Apathy, emotional flatness, impaired registration, disorientation in time are all more likely to be chronic dementia.

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16
Q

Triad of symptoms seen in reactive arthritis?

A

conjunctivitis, arthritis (+plantar fascitis, achilles tendonitis, macules and papules on hands and feet), dysuria

VERY NON SPECIFIC TRIAD
UNPROTECTED SEX or BACTERIAL DYSENTRY

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17
Q

Earliest feature of syphillis?

A

Painless ulcer

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18
Q

What are the differentiating factor between primary pulmonary hypertension vs idiopathic pulmonary fibrosis?

A

PH - age ~ 30, raised pulmonary artery pressure with no apparent cause (no PE, no LVF). CXR shows enlarged pulmonary artery, death within 2.5 years of diagnosis
PF - age ~60, CXR would show bilateral reticular nodular shadowing + honeycombing

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19
Q

Clinical symptoms of acute parvovirus B19 infection?

A

Erythematous rash, arthritis, aplastic crisis

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20
Q

Clinical symptoms of Alport syndrome?

A
  1. CKD progressing to require haemodialysis 2. Bilateral sensorineural deafness 3. Hypertension 4. Anterior lenticonus

X linked disorder of the glomerular basement membrane due to type 4 collagen deposits

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21
Q

What is conn’s syndrome?

A

Aldosterone secreting adenoma
- Hypokalaemia, hypertension, hypernatraemia
Ix: aldosterone:renin ratio >800 - needs to be investigated
Blood pressure Mx in Conn’s = Amlodipine or Doxazosin

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22
Q

Sudden acute deterioration in speech - not fluent, effortful speech. Cause? Which area of brain affected (right handed)?

A

Stroke. Left inferior frontal gyrus. Left hemisphere as right handed so left hemi is dominant.

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23
Q

What ABG abnormality is seen in Hyperthyroidism (Graves)?

A

Decreased CO2

Ventilatory changes are linked to T3 levels.
And increased O2.
Often misdiagnosed as hyperventilation syndrome.

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24
Q

Seeing a long snake in the garden when in fact it is a hosepipe. What is this symptom called?

A

Illusion

An illusion is a false perception of an external stimulus, most common at heightened emotions (fear, anxiety)

Visual hallucination is seeing something in the absence of an external stimulus

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25
Q

What is an lillusion de sosies

A

An illusion of doubles. Thinking someone close to you has been replaced by an imposter.

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26
Q

Triad of nephrotic syndrome?

A

Oedema, proteinuria (>300 P:C ratio shows nephrotic cause), hypoalbuminaemia

Shows you glomerular disease, need to do renal biopsy to ascertain cause

Most common cause of nephrotic syndrome in children - minimal change disease.

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27
Q

How is the tapeworm infection Taenia saginata acquired?

A

Eating cysts of the tapeworm in infected beef

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28
Q

How do you definitively diagnose Taenia saginata?

A

Test the segments shed by the worm in the stool

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29
Q

Which tapeworm comes from infected pork? And which part of the body can this tapeworm most commonly effect?

A

Taenia solium
Brain infection

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30
Q

Definition of power of a statistical test?

A

The probability we will correctly reject a FALSE NULL HYPOTHESIS

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31
Q

Which lung condition do you see in rheumatoid arthritis?

A

Bronchiolitis Obliterans - OBSTRUCTIVE PICTURE. Granulation tissue develops in the small airways and causes irreversible airway obstruction.

Can see also see pulmonary rheumatoid nodules - but this is RESTRICTIVE PICTURE.

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32
Q

Lung function test differences in obstructive vs restrictive?

A

FEV1 <80% vs FEV1 <80%
FVC reduced but lesser extent vs FVC <80%
FEV:FVC ratio <0.7 vs FEV:FVC ratio normal
Transfer co-efficient normal vs transfer co-efficient low
Transfer factor low in both

KCO normal in Bronchiolitis Obliterans
KCO low in COPD, emphysema, pulmonary hypertension

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33
Q

What are the MOA of Renal Tubular Acidosis Type 1, 2, 3 and 4?

A

1 - Abnormal hydrogen secretion. Drugs like NSAIDs, AMBISOME, Primary biliary cholangitis
2 - Decreased bicarb reabsorption. Multiple myeloma, Fanconi syndrome, primary hyperparathyroidism
3 - Not recognised as a condition
4 - Low renin and aldosterone. Diabetes, Addison’s, sickle cell disease

All present with a hypokalaemic hyperchloraemic metabolic acidosis with LOW URINARY PH

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34
Q

Symptoms of Mumps infection?

A

Swelling of cheeks, swelling of testicles, viral meningitis (10% will develop spontaneously), no vaccine history, young person in university

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35
Q

Symptoms of EBV infection?

A

Fever, pharyngitis, lymphadenopathy

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36
Q

Treatment for non-sustained episodes of Torsades De Pointes on coronary care unit causing recurrent syncope?

A

IV magnesium
NOT DC cardioversion as episodes are non sustained

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37
Q

Causes of QT prolongation?

A

Drugs - amiodarone antidepressants
Electrolytes
Ischaemic Heart Disease
Mitral Valve Prolapse

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38
Q

Treatment of epididymo-orchitis?

A

Older than 35, most likely to be caused by enteric bacteria, first line Ofloxacin
Younger patients, most likely caused by STI, first line Ceftriaxone

Symptoms - Unilateral testical swelling, pain, fever, positive urine dip

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39
Q

Triad of Wernicke’s encephalopathy?

A

Ataxia, confusion, ophthalmoplegia (e.g. nystagmus)
Often accompanied by larger range of neuro symptoms - changes in cognition, seizures, visual/hearing disturbances

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40
Q

What is a significant concern to look out for in patients with TEN/SJS? (toxic epidermal necrolysis)

A

VTE due to fluid loss

TEN = Chinese patient, started carbamezapine, fever, skin rash, skin sloughing, ?dry cough, ?SOB

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41
Q

Gritty sensation in eyes, dry mouth, aches and pains in joints, shortness of breath. Diagnosis?

A

Sjogren’s syndrome

Athralgia, raynaud’s pulmonary defects, abnormal oesophageal dysmotility, dry eyes and mouth

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42
Q

Which drug is used in preventing relapse in opioid addiction?

A

Naltrexone

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43
Q

What is the earliest marker for Hep B acute infection?

A

Hep B sAg

A short while later Hep B eAg appears

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44
Q

What is a contra-indication for using activated oral charcoal to treat overdose?

A

Absence of bowel sounds

Paralytic ileus leads to aspiration or pneumonitis of the charcoal

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45
Q

Drug used to treat recurrent nephrolithiasis caused by increased calcium in urine?

A

Thiazide diuretic

Reduces calcium excretion in the urine at the renal tubule

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46
Q

What drug is used to treat cystinuria?

A

Penicillamine

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47
Q

What treatment is used to increase urate excretion alongside allopurinol to reduce episodes of gout?

A

Benzbromarone

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48
Q

Most common anti-depressant prescribed by GP that causes dry mouth and constipation?

A

Amitriptyline

(Anticholinergic effects - dry mouth, urinary retention, constipation)

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49
Q

First line abx treatment for neutropenic sepsis in a patient post chemotherapy?

A

Pip-Taz

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50
Q

Most appropriate first step of investigation in patient with suspected appendicitis causing peritonism?

A

Abdominal CT

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51
Q

Definitive management for patient with acute cholangitis?

A

ERCP to relieve obstruction of biliary system

You would only proceed with laparoscopic cholecystectomy after recurrent episodes of cholecystitis and the cholangitis had fully resolved

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52
Q

Triad of features in acute cholangitis?

A

RUQ pain, fever, jaundice

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53
Q

Urine results in a patient with pre-renal uraemia?

A

Low sodium in urine, raised urine osmolality

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54
Q

How do you treat amiodarone induced thyrotoxicosis?

A

Anti-thyroid drugs AND steroids
(type 1 - anti thyroid, type 2 - steroids, normally you’re whether it’s type 1 or type 2)

You do not discontinue the amiodarone because it has a long half life so it will not quickly treat it

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55
Q

First line biologic agent indicated to treat ankylosing spondylitis if they haven’t responded to NSAIDs and physiotherapy?

A

Adalimumab

Ankylosing spondylitis features
- Lower back pain and stiffness which improves with exercise
- Bamboo spine deformity
- HLA B27 positive in 90% of cases

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56
Q

How do the peripheral and central chemoreceptors in our body drive the increased respiratory drive (kussmaul breathing) in metabolic acidosis caused by DKA

A
  • Increased plasma pH is sensed by peripheral chemoreceptors located in the carotid arteries.
  • Central chemoreceptors also increase the resp drive by sensing the increase of Hydrogen ions in the CSF. (Increased CO2 diffuses into the CSF and dissociated into hydrogen ions)
    These mechanisms increase the resp drive to cause faster and deeper ventilation to lower CO2 levels.
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57
Q

Which cardiac abnormality is usually associated with coarctation of the aorta?

A

Bicuspid aortic valve in around 50-80% cases

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58
Q

Treatment of reactive arthritis?

A
  • Joint aspiration for microbial analysis to rule out septic arthritis
  • Steroid injection when analysis is negative
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59
Q

Which diagnosis shows smudge cells on peripheral blood smear? How is it treated?

A

CLL
Single agent therapy with Chlorambucil

FBC shows: Increased WCC count (lymphocytosis), low platelets and anaemia

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60
Q

20 weeks pregnant lady with glycosuria, fasting glucose <7 and no complications on fetal USS. What is the initial management?

A

Exercise and diet control

After 2 week review if continues to have poor control, offer Metformin.
If glucose >7, or 6-6.9 and complications on fetal USS should be offered Insulin immediately
Aspirin offered in those with high risk factor or two moderate risk factors for pre-eclampsia

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61
Q

What happens to phosphate excretion levels, PTH levels and vitamin d levels in CKD associated metabolic bone disease?

A

1) PTH increases
2) Phosphate excretion decreases
3) Vitamin D decreases

CKD does 2 THINGS - impaired vit D metabolisation (as 1 alpha hydroxylation cannot occur) + reduced phosphate excretion

low vit d, low calcium, high phosphate

THEN PTH is triggered so this stimulates osteoclast activity, cyst formation and bone marrow fibrosis

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62
Q

First line treatment for pyoderma gangrenosum? e.g. ulcer with necrotic pus filled core

A

Topical tacrolimus

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63
Q

First line treatment of gastric MALT lymphoma (caused by chronic H Pylori infection)?

A

H pylori eradication (induces remission)

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64
Q

Which organism causes toxic shock syndrome?

A

Exotoxins released from staph aureus

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65
Q

Five criteria to diagnose toxic shock syndrome?

A
  1. fever
  2. hypotension
  3. widespread erythematous MP rash
  4. desquamation of skin in extremities
  5. 3 different organ systems (neuro, hepatic, renal, GI, mucus membranes, blood)
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66
Q

Which condition can cause death in infancy due to severe progressive jaundice due to severe unconjugated bilirubinaemia?

A

Crigler-Najjar syndrome

Autosomal recessive
Caused by absence of gluconyl transferase enzyme
Tx is liver transplant

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67
Q

Which two TB drugs out of the potion of 4 is most linked to hepatotoxicity?

A

Isoniazid - normally ALT <100
Pyrazinamide

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68
Q

Which one lung condition is LTOT shown to decrease mortality for?

A

COPD
(in the setting of cor pulmonale due to chronic obstruction of airflow)

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69
Q

Which learning difficulty causes short stature, large head circ, large jaws, large ears and the characteristic eye abnormality of pale irises?

A

Fragile X Syndrome

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70
Q

What is the characteristic clinical manifestation of mucocutaneous leishmaniasis?

A
  • ulcerating papule involving the nasal septum

Extra info:
Clue of patient working in a jungle school makes leishmaniasis more likely (visceral leishmaniasis causes splenomegaly)
Bloods normal
Parasitic infection

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71
Q

What is the lipid abnormality in Asian patients with IHD/diabetes?

A

low HDL/elevated triglycerides

72
Q

Which two muscles are innervated by the ulnar nerve?

A

Adductor pollicis
Third palmar interosseus

Ulnar neuropathy causes
- Injury, osteoarthritis, MS, diabetes

73
Q

Clinical manifestations when a patient is coning? (tonsillar herniation)

A

Severe hypertension and bradycardia

Tonsillar herniation is increased pressure in the midbrain
Transcalvarial herniation is external herniation through a skull aperture from e.g. previous neurosurgery

74
Q

Which alpha adrenoreceptor antagonist is used to treat hypertension in phaemochromocytoma

A

Phenoxybenzamine

75
Q

Which antibiotic is contra-indicated in pregnancy?

A

Ciprofloxacin
- Causes tendon rupture in early animal fetal studies

76
Q

What is the key step in degranulation in basophils, eosinophils and mast cells?

A

Fusion of the lysosomal membrane intracellularly with the plasma membrane to discharge their contents

77
Q

Clinical manifestation of diptheria?

A

Pharyngitis, lymphadenopathy and oedema of neck

Specifically, grey membrane surrounding the tonsils and dysphagia

(Likely in a patient who’s moved from a developing country with no vaccination programme)

78
Q

Clinical manifestation of pulmonary hypertension?

A

Age 30, woman, R heart failure (increased JVP, oedema, SOB, loud P2, L parasternal heave)

79
Q

Which medication is strongly linked to the development of pulmonary hypertension?

A

Appetite suppressant (fenfluramine)

80
Q

Which cytokine is a key element to the acute phase response and systemic inflammation?

A

TNF alpha

(Infliximab is anti-TNF alpha agent)

81
Q

Patient has recurrent urolithiasis with no other PMH and a positive urine cyanide nitroprusside test. What is the diagnosis? What shaped crystals would be seen on urine analysis?

A

Diagnosis - Cystinuria
Crystals - Hexagon shaped
Test to confirm diagnosis - Cyanide Nitroprusside test

Uric acid crystals are seen in patients with high uric acid levels (gout, tumour lysis syndrome, lesch-nyhan learning difficulty) and crystals are rhomboid shaped

82
Q

Treatment of hyponatraemia in a 72 year old man with a new lower lobe pneumonia?

A

Fluid restriction

Hyponatraemia likely caused by SIADH due to LRTI, so should start with fluid restriction. If doesn’t work then demeclocycline.

83
Q

Clinical characteristics of MODY - maturity onset diabetes of the young?

A

Raised HDLs, normal insulin sensitivity but glycosuria

84
Q

Which hormone is the direct pre-cursor to oestradiol?

A

Testosterone

Cholesterol&raquo_space; testosterone&raquo_space; oestradiol (by aromatase)
Obesity and alcohol excess increase aromatase

85
Q

Which condition causes high calcium levels but low urinary calcium excretion?

A

Familial hypocalcinuric hypercalcaemia

Autosomal dominant inherited condition
Lifelong, rare, benign conditions

86
Q

What is the concern regarding clinically assisted hydration in end of life care?

A

It could cause fluid overload

  • It does improve signs and symptoms of dehydration
  • It does not affect rate of death or deterioration
87
Q

What is the mechanism of action by which statins cause muscle aches and pains?

A

Rhabdomyolysis (CK elevated, blood in urine)

88
Q

Which lung condition develops in people with alpha 1 anti-trypsin deficiency?

A

Emphysema

89
Q

Which renal disease is strongly linked to Hep C infection?

A

Idiopathic mesangiocapillary glomerulonephritis

Caused by immune complex deposition due to Hep C infection

90
Q

Classical features of Mesangiocapillary Glomerulonephritis (MCGN)?

A

Mixed nephritic-nephrotic picture, pan-hypocomplementemia, cyroglobulinemia

91
Q

Which muscle movements are affected in a lesion in the pyramidal tract?

A

Flexion in lower limbs
Extension in upper limbs

92
Q

Gold standard test to detect giardiasis infection?

A

Stool antigen test
Or x3 stool cultures

93
Q

Which two medications can be given pre-chemotherapy to reduce urate levels and reduce risk of urate nephropathy?

A

Allopurinol, Rasburicase

94
Q

What are the symptoms of tennis elbow?

A
  • Pain and restriction of movement of elbow (worst on outside of arm)
  • Local tenderness over lateral epicondyle
  • Pain when pushing against wrist extension
  • Pain on attempting the chair raise test
  • Inflammation of the muscles and tendons of the muscles on the lateral side of the elbow
95
Q

How is the Mantoux test done?

A

A SKIN TEST (intra-dermal)
- Injection of protein solution given intra-dermally to cause a small wheal
- Measure the diameter of the skin induration in the next 2-5 days

96
Q

What are the clinical manifestations of Multiple Endocrine Neoplasia Type 1?

A
  • Pituitary tumours - prolactinoma/ACTH secreting tumour/GH tumour
  • Parathyroid tumour
  • Pancreatic Islet cell tumour - insulinoma, glucagonoma

Autosomal dominant condition, deficiency of tumour suppressor protein called menin (Chromosome 11)

97
Q

Which infection is most strongly associated with normal bloods apart from peripheral blood eosinophilia?

A

Eosinophils = Helminth infection
Most common helminth = Strongyloides infection

Found in far east

98
Q

What is used in the treatment of Strongyloides infection?

A

Ivermectin

99
Q

Which diuretic can cause a metabolic alkalosis?

A

Furosemide
(Loop and thiazide diuretics - sodium chloride loss causes this)

100
Q

Which diuretic causes a metabolic acidosis?

A

Acetazolamide

101
Q

Which condition is associated with a widespread, itchy, bullous rash on scalp, knees, albows and buttocks with numerous small blisters, unexplained anaemia?

A

Dermatitis Herpetiformis

  • Seen in coeliac disease
102
Q

What is the first Ix in coeliac disease?

A

anti ttg antibodies

103
Q

What does renal biopsy show in mesangio-capillary glomerular nephritis?

A

Splitting of the capillary basement membrane (due to immune complex deposits)

104
Q

Typical presentation of Psoriatic Arthritis?

A
  • Similar changes to RA - PIP/DIP arthritis with ulnar deviation
    PLUS
  • Nail changes - pitting, onycholysis
105
Q

Classic triad of renal cell carcinoma?

A

Loin pain, visible haematuria, palpable mass on one side + B symptoms

106
Q

Classic triad of renal cell carcinoma?

A

Loin pain, visible haematuria, palpable mass on one side + B symptoms

107
Q

What test is the best pre-operative screen of lung function?

A

Ratio of FEV:FVC
Predicts pulmonary complications in post-operative period

108
Q

Characteristics of a scabies rash?

A

Itching in the webspaces of hands, feet and genital region.

108
Q

Characteristics of a scabies rash?

A

Itching in the webspaces of hands, feet and genital region.

109
Q

Characteristics of a scabies rash?

A

Itching in the webspaces of hands, feet and genital region.

110
Q

Characteristics of scabies rash?

A
111
Q

Characteristics of scabies rash?

A

Itching in webspaces of hands and feet

112
Q

Which enzyme is responsible for separating DNA strands in replication?

A

Helicase

113
Q

Treatment for proven Left leg DVT in pregnancy?

A

SC LMWH throughout pregnancy

114
Q

Most common drug to cause drug induced liver injury?

A

Nitrofurantoin

115
Q

Two symptoms defining PKD?

A
  • Bilaterally enlarged kidneys due to cysts&raquo_space; progressing to end stage renal disease
  • Intra-cranial aneurysm
116
Q

First line treatment for radiation pneumonitis? (occuring post radiotherapy for lung cancer)

A

Steroids

> > Develops to residual pulmonary fibrosis

117
Q

Adverse effects of IV urography to investigate for chronic upper urinary tract obstruction?

A
  • Contrast nephropathy
  • Worsening of pain from obstruction

(use low osmolality contrast to mitigate this)

118
Q

Which pharmokinetic parameter is affected by chronic kidney disease when giving drugs?

A

Altered volume of distribution

119
Q

Which clotting disorder is linked to nephrotic syndrome?

A

Protein S deficiency

120
Q

By which process does protein C deficiency cause a clotting disorder?

A

Increases factors 5 and 8
(Reduced degradation of 5a and 8a)

121
Q

By which process does protein C deficiency cause a clotting disorder?

A

Increases factors 5 and 8
(Reduced degradation of 5a and 8a)

122
Q

What is heterotopic ossification? When does it occur?

A

Formation of extraskeletal bone during tissue repair. Post op eg. surgical hip reduction and fixation.

123
Q

What sort of drug is celecoxib? What is a known action of this drug?

A

COX1/COX2 inhibitor. Reduces risk of heterotopic ossification. Causes sodium retention.

124
Q

Which 3 clinical manifestations characterise E coli causing HUS?

A

E coli causes the normal GI symptoms - bloody diarrhoea, fever

Triad - Haemolysis, Thrombocytopenia, Renal Failure

Blood film - Schistocytes

Source - visit to the petting zoo

125
Q

What does the penetrance of a gene mutation mean?

A

Proportion of the individuals with the gene who develop the phenotype.

126
Q

Absolute contraindications to lithotripsy of a renal calculi?

A

Uncorrected coagulation disorder (stop all anti-coagulants before procedure), complete obstruction distal to stone (can still do if a stricture present), pregnancy, acute urosepsis

127
Q

MOA of N-acetyle cystine in the treatment of paracetamol overdose?

A

Conjugates with NAPQI (the toxic metabolite) as an external glutathione source and therefore stops hepatocellular toxicity.

128
Q

Characteristic rash of herpes virus?

A

Painful, vesicular rash in a dermatomal distrubtion

129
Q

What does faecal occult blood test for?

A

Screening for Colorectal cancer after the age of 60

130
Q

Aetiology of HOCM?

A

Autosomal dominant mutation in the gene coding for the sarcomere protein

131
Q

Treatment of digoxin toxicity?

A
  • Fluids and correct electrolytes
  • If refractory to this, or develops bradycardia with hypotension REFRACTORY to atropine - then you use digoxin-specific antibodies.
  • If renal failure, you need haemodialysis or else ultimately digoxin will not excreted
  • Potential life threatening complication to digoxin: Serum sickness
132
Q

Which anti-epileptic medication DOES NOT interact with warfarin?

A

Lamotrigine

133
Q

Which cytokine is expressed in high levels in psoriasis?

A

IL 17

134
Q

What is kernicterus? Which clinical conditions do you see kernicterus in?

A

Neurological impairment due to bilirubin induced neurotoxicity

Condition - Crigler Najar (no activity of glucuronyl transferase enzyme)

135
Q

Which characteristic sound is heard in left bundle branch block?

A

Reversed splitting of the second heart sound

136
Q

Which characteristic sound is heard in left bundle branch block?

A

Reversed splitting of the second heart sound

137
Q

Which HIV anti-retroviral drug causes lipoatrophy?

A

Stavudine

138
Q

Which statin is the least likely to have drug interactions due to inducing cytochrome P450 enzymes?

A

Pravstatin

139
Q

Which anti-epileptic drug is most risky in pregnancy?

A

Sodium valproate

140
Q

Which investigation finding most suggests toxoplasma cerebral infection?

A

Ring enhancing lesions on MRI

141
Q

Which mutation is found in patients with maturity onset diabetes of the young?

A

HNF-1 alpha mutation

142
Q

Which cells of the pancreas does this mutation affect?

A

Beta cells of the pancreas (defective insulin release)

143
Q

Which syndrome causing kidney disease involves severe rhabdomyolysis leading to raised creatine kinase?

A

Anti-Jo-1 syndrome
- lung fibrosis
- polymyositis (weakness)
- rhabdomyolysis causing&raquo_space;
- kidney disease with myoglobinuria

144
Q

Which glucose transporter is responsible for insulin sensitivity?

A

GLUT 4

145
Q

Which condition is therapeutic plasmapheresis most effective for?

A

Haemolytic anaemia associated with Mycoplasma pneumonia

146
Q

Which two types of cancer are TKIs most useful in?

A

CML
Gastrointestinal stromal tumours

147
Q

In which disease does urine dipstick test positive for blood but microscopy shows no red cells?

A

PNH

  • This is a sign of intravascular haemolysis
148
Q

Which two factors of mechanical ventilation favour a diagnosis of ARDS?

A

Low compliance, high elastic recoil

Also low pulmonary artery wedge pressure

149
Q

Which area of the brain is affected when a patient presents with tremor and parkinsonian symptoms?

A

Basal ganglia

150
Q

HLA association with coeliac disease?

A

HLA DQ2 haplotype

151
Q

Most common abnormality in HD in CKD?

A

Protein-calorie malnutrition

152
Q

Diagnostic test for Wilson’s?

A

Urinary copper level

153
Q

Patient with sternal fracture in a car accident shows widespread t wave inversion. Diagnosis?

A

Myocardial contusion
- Observed for arrythmia
- Analgesia

154
Q

Clinical triad of Q fever?

A

1) Systemic fever sx (fevers, headaches, rhinitis) 2) Endocarditis (Systolic murmur) 3) Pneumonia (haemoptysis, blood stained)

155
Q

First line management for new adult with T1DM?

A

Basal bolus insulin regimen
- Mimics body’s insulin system
- Allows more flexibility

156
Q

Which three medications undergo high first pass metabolism? (High liver extraction)

A

Verapamil, Morphine and Propranolol

157
Q

Anti-dote to benzodiazepine overdose?

A

Flumenazil

158
Q

Drug used in treatment of Myasthenia Gravis?

A

Neostigmine

159
Q

What test is used to monitor respiratory function in GBS?

A

Forced vital capacity

160
Q

Which protein is a negative acute phase protein?

A

Albumin

161
Q

Target INR in anti-phospholipid antibody syndrome?

A

INR 2.5 for lifelong
Test: Lupus anticoagulant and anti-cardiolipin antibodies and anti B2 glycoprotein 1 antibodies

162
Q

Which blood test is most specific marker of myocardial damage 6 hours post chest pain?

A

Trop T

CK not as specific

163
Q

Which antibiotic regime is used in pregnancy for dog bites for a patient with penicillin reaction?

A

Azithromycin with metronidazole
- Gram negative and anaerobic cover
- Common sp: Staph, strep, proteus

164
Q

Common complication of post PCI/CABG procedure where one sees eosinophils, hyaline casts and microscopic haematuria in urine?

A

Cholesterol embolism

  • Toe discolouration
165
Q

Most common cause of nephrotic syndrome in adults?

A

Idiopathic membranous nephropathy

166
Q

Presence of tense blisters in pregnancy?

A

Pemphigoid of pregnancy
- Immunobullous disease

167
Q

First line treatment for osteoporosis?

A

Bisphosphonates

  • Adverse effect is GI side effects (ulceration)
168
Q

What is dermatitis hepetiformis associated with?

A

Immunobullous condition associated with coeliac disease

169
Q

Why is chlorpromazine, haloperidol and metoclopramide contra-indicated as anti-emetics in parkinson’s?

A

They block dopamine receptors

170
Q

Which antipsychotic medication is associated with a low risk of diabetes?

A

Risperidone

171
Q

Which cell is implicated in the inflammatory response of psoriatic arthritis?

A

T cells

172
Q

Lichen sclerosus clinical symptoms?

A

Genital and peri-anal skin condition - thickened scarred patches of skin

173
Q

Lichen sclerosus clinical symptoms?

A

Genital and peri-anal skin condition - thickened scarred patches of skin

174
Q

Toxic effect of MD?

A

Hyponatraemia due to inappropriate ADH secretion leading to seizures, vomiting, arrythmias

Increases serotonin and sympathetic nervous system

MRCP 1 (2 decks)

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