MRCP Part 1 Flashcards
(168 cards)
1
Q
Ethylene Glycol Poisoning - Biochemical Features
A
HAGMA with high osmolar gap i.e. >10
2
Q
Addisonian Crisis - Biochemical Features
A
NAGMA, hyperchloremic
3
Q
Renal Tubular Acidosis - Biochemical Features
A
NAGMA, Type 1 and 2 - hypokalaemic, type 4 - hyperkalaemic (K+ non diagnostic). Creatinine can be normal.
4
Q
High anion gap metabolic acidosis Mnemonic
A
Methanol, Uremia, Diabetic ketoacidosis, Propylene glycol, Isoniazid, Iron, Lactic acidosis, Ethylene glycol, Salicylates
5
Q
Stages of ethylene glycol poisoning
A
Stage 1: Confusion, slurred speech, dizziness.
Stage 2: HAGMA with high osmolar gap, tachycardia, hypertension.
Stage 3: AKI
6
Q
Gonnorrhoea Sx Mx
A
Sx - Asymptomatic or pelvic pain +/- mucupurolent cervical discharge.
Mx - IM Ceftriaxone first line
7
Q
Chlamydia Sx Mx
A
Sx - Asymptomatic or abdo pain/cervicitis/IMB/dysuria, dysuria/urethral discharge in men
Mx - Oral doxycycline
8
Q
Trichomonas Vaginalis discharge + microscopy
A
Frothy yellow green, Wet motile trophozites
9
Q
Bacterial vaginosis discharge + microscopy
A
Thin grey malodorous, Clue cells
10
Q
Doxazosin mechanism of action
A
Alpha 1 antagonist
11
Q
Alpha - 2 antagonist
A
Yohimbine MOA
12
Q
Alpha - non selective antagonist
A
Phenoxybenzamine MOA
13
Q
Beta-1 antagonist
A
Atenolol MOA
14
Q
Non-selective beta antagonist
A
Propanolol MOA
15
Q
Mixed alpha and beta antagonists
A
Carvedilol and labetalol MOA
16
Q
When to measure digoxin levels in suspected toxicity
A
8-12 hours after last dose
17
Q
Features of digoxin toxicity
A
N+V, lethargy, confusion, yellow-green vision, bradycardia, gynaecomastia.
18
Q
States precipitating digoxin toxicity
A
Hypokalaemia, hypomagnaesaemia, hypercalcaemia, hypernatraemia, acidosis, hypoalbuminaemia, hypothermia, hypothyroidism
19
Q
Drugs that increase likelihood of digoxin toxicity
A
Amiodarone, quinidine, verapamil, diltiazem, spironolactone, ciclosporin, thiazides, loop diuretics
20
Q
Strongyloides stercobacteria characteristic features
A
Non-bloody diarrhoea, bloating, characteristic pruritic papulovesicular lesions on buttocks and soles.
21
Q
Giardia duodenalis characteristic features
A
Chronic greasy, foul-smelling diarrhea which can occur for weeks or months if untreated
22
Q
Loeffler’s syndrome features, causes
A
Pulmonary eosinophilia. Migratory pulmonary infiltrates, peripheral eosinophilia. Transient allergic reaction linked to parasitic infections
23
Q
Management of Strongyloides stercobacteria
A
Ivermectin, albendazole
24
Q
Friedrich’s ataxia neurological examination
A
Spinocerebellar signs, corticospinal tract signs and dorsal column loss
25
Friedrich's ataxia inheritance pattern
Autosomal recessive
26
Angioid retinal streaks - description + causes
Irregular dark red streaks radiating from the optic nerve head. Causes - Paget's disease, pseudoxanthoma elasticum, Ehlers-Danlos Syndrome, sickle cell anaemia, acromegaly.
27
What are the causes of a loud S2?
- hypertension: systemic (loud A2) or pulmonary (loud P2)
- hyperdynamic states
- atrial septal defect without pulmonary hypertension
28
Drugs increasing risk of idiopathic intracranial hypertension
combined oral contraceptive pill
steroids
tetracyclines
retinoids (isotretinoin, tretinoin) / vitamin A
lithium
29
IIH eye signs
Papilloedema, enlarging blindspot, 6th nerve palsy
30
Cardiac manifestations of Turner's disease
Bicuspid aortic valve, coarctation of aorta, aortic dilatation (most serious due to risk of dissection)
31
Causes of upper zone pulmonary fibrosis
Coal workers pneumoconiosis
Hypersensitivity pneumonitis, histiocytosis
Ankylosing spondylitis
Radiation
Tuberculosis
Silicosis, sarcoidosis
32
Causes of lower zone pulmonary fibrosis
Most connective tissue diseases (e.g. rheumatoid arthritis)
Asbestosis
Idiopathic pulmonary fibrosis
Drugs (e.g. methotrexate)
33
Pathogen responsible for Farmer's Lung
Saccharopolyspora rectivirgula
34
Pathogen responsible for malt workers' lung
Aspergillus clavatus
35
Pathogen responsible for mushroom workers' lung
thermophilic actinomycetes
36
Which specific investigation findings would you expect to see in hypersensitivity pneumonitis/External Allergic Alveolitis
imaging: upper/mid-zone fibrosis
bronchoalveolar lavage: lymphocytosis
serologic assays for specific IgG antibodies
blood: NO eosinophilia
37
Potential complication of panretinal photocoagulation
Decrease in night vision
38
Classification of Non-Proliferative Diabetic Retinopathy
Mild - 1 or more microaneurysm, Moderate - microaneurysms, blot haemorrhages, hard exudates, cotton wool spots (soft exudates), venous beading + looping, IRMA (non-severe), Severe - blot haemorrhages and microaneurysms in 4 quadrants, venous bleeding in 2 quadrants, IRMA in 1 quadrant.
39
Insulinoma features
Rapid weight gain, hypoglycaemia (sweating, double vision) in the early morning. Whipple's Triad - symptomatic hypoglycaemia when glucose is expected to be low, resolved by eating.
40
Biochemical features of insulinoma
High insulin, raised proinsulin:insulin ratio, high C-peptide
41
Insulinoma diagnosis
Supervised prolonged fasting, CT pancreas
42
Insulinoma Mx
Surgery, if not suitable - diazoxide, somatostatin
43
Pathogen responsible for Chagas' disease
Trypanosoma Cruzi
44
Symptoms in acute phase of Chagas' disease
Asymptomatic (95%), chagoma, periorbital oedema
45
Complications of Chronic Chagas disease
GI: Megaoesophagus (malnutrition, oesophagitis, oesophageal cancer), megacolon (faecaloma, sigmoid volvulus)
Cardiac: Dilated cardiomyopathy (most common and severe) - CHF, apical aneurysms, arrhythmia, death.
46
Treatment of Chagas' Disease
Azole or nitroderivatives such as benznidazole or nifurtimox (most effective in acute phase)
Chronic management of complications.
47
Sleeping sickness causative pathogen
Trypanosoma gambiense, Trypanosoma rhodesiense (spread by the tsetse fly)
48
Sleeping sickness - clinical course
Trypanosoma chancre, intermittent fever, enlargement of posterior cervical lymph nodes, CNS involvement (somnolence, headaches, mood changes, meningoencephalitis)
49
What are the adverse cardiovascular effects of cocaine?
Coronary artery spasm, tachy/bradycardia, hypertension, QRS widening, QT prolongation, aortic dissection.
50
What are the adverse neurological effects of cocaine?
Seizures, mydriasis, hypertonia, hyperreflexia.
51
What are some of the other adverse effects of cocaine?
Ischaemic colitis, hyperthermia, metabolic acidosis, rhabdomyolisis.
52
What are the risk factors for SBBOS
Neonates with congenital gastrointestinal malformations, scleroderma, DM
53
What is the first line diagnostic test for SBBOS?
Hydrogen breath test
Small bowel aspiration also feasible (although not first line as invasive)
54
What is the management of SBBOS?
Manage underlying conditions, Abx (rifamixin usually treatment of choice, co-amoxiclav and metronidazole also used)
55
What are some of the common drug causes of lung fibrosis?
Amiodarone, cytotoxics (busulphan, bleomycin), anti-rheumatoid drugs (methotrexate, sulfasalazine), nitrofurantoin, ergot derived dopamine receptor agonists (bromocriptine, cabergoline, pergolide).
56
What is erythema nodosum described as?
symmetrical, erythematous, tender, nodules which heal without scarring
57
What are the common causes of erythema nodosum?
Streptococcal infections, sarcoidosis, inflammatory bowel disease and drugs (penicillins, sulphonamides, oral contraceptive pill)
58
What is pretibial myxoedema described as?
symmetrical, erythematous lesions
shiny, orange peel skin
59
What is Pyoderma gangrenosum described as?
initially small red papule, later deep, red, necrotic ulcers with a violaceous border
60
What are the causes of pyoderma gangrenosum?
Idiopathic in 50%, may also be seen in inflammatory bowel disease, connective tissue disorders and myeloproliferative disorders
61
What is necrobiosis lipoidica described as?
Shiny, painless areas of yellow/red skin typically on the shin of diabetics
Often associated with telangiectasia
62
What are the two different types of tests for syphilis?
Treponemal and non-treponemal
Treponemal: TP-EIA, TPHA. +ve after successful treatment
Non-treponemal: RPR, VDRL. Can be false positives (if treponemal test negative)
63
What are the causes for a false positive non-treponemal test for syphilis?
Pregnancy, SLE/APS, TB, leprosy, malaria, HIV
64
How do aminoglycosides cause renal toxicity?
Acute tubular necrosis (brown muddy casts in urine)
65
How does vancomycin cause renal toxicity?
Acute interstitial nephritis
66
Which HLA subtype is most commonly associated with dermatitis herpetiformis?
HLA-DR3
67
Which HLA subtypes are most commonly associated with Coeliac disease?
HLA-DQ2 and DQ8
68
Which HLA subtype is most commonly associated with Behcet's disease?
HLA-B51
69
Which HLA subtype is most commonly associated with T1DM?
HLA-DR4 (also associated with HLA-DR3)
70
Which HLA subtype is most commonly associated with Haemochromatosis
HLA-A3
71
Which conditions are associated with HLA-B27?
Anklylosing spondylitis
Reactive Arthritis
Acute anterior unveitis
Psoriatic arthritis
72
Which HLA subtype is most commonly associated with narcolepsy?
HLA-DR2
73
Which HLA subtype is most commonly associated with Goodpasture's?
HLA-DR2
74
Which HLA subtype is most commonly associated with Sjogren's syndrome?
HLA-DR3
75
Which HLA subtype is most commonly associated with PBC?
HLA-DR3
76
Which HLA subtype is most commonly associated with rheumatoid arthritis?
HLA-DR4 (in particular the DRB1 gene)
77
What conditions are risk factors for osteoporosis?
Endo: hyperthyroidism, hypogonadism (Turner's, testosterone deficiency), GH deficiency, hyperparathyroidism, DM.
Malignancy: Multiple myeloma, lymphoma
GI: IBD, coeliac's, gastrectomy, liver disease.
CKD
Inherited: osteogenesis imperfecta, homocystinuria
78
What medications may worsen osteoporosis (apart from glucocorticoids)?
SSRIs
Antiepileptics
PPIs
Glitazones
Long term heparin therapy
Aromatase inhibitors (e.g. anastrozole)
79
What antibodies are associated with limited cutaneous systemic sclerosis?
Anti-centromere antibodies
80
What is a common GI complication of CREST syndrome?
Malabsorption secondary to bacterial overgrowth of the sclerosed small intestine
81
What antibodies are associated with diffuse cutaneous systemic sclerosis?
Anti scl-70
82
What is the most common cause of death in diffuse cutaneous systemic sclerosis?
Respiratory complications - ILD and PAH
83
What are the complications of diffuse cutaneous systemic sclerosis?
Respiratory involvement (ILD, PAH), renal disease and hypertension (patients should be started on ACE-I, typically captopril)
84
What complication are anti-scl-70 antibodies associated with in diffuse cutaneous systemic sclerosis?
Severe ILD
85
What is the most likely complication of thyroid eye disease?
Exposure keratopathy (proptosis and eyelid retraction can lead to difficulty in completely closing the eyes).
Foreign body sensation, pain, photophobia.
86
What is the most important modifiable risk factor for the development of thyroid eye disease?
Smoking
87
What treatment of thyroid disease can worsen eye disease?
Radioiodine treatment. Prednisolone may help reduce the risk.
88
What is the management of thyroid eye disease?
Smoking cessation
Topical lubricants
Steroids
Orbital radiotherapy
Surgery
89
What is one of the most serious complications of thyroid eye disease?
Optic neuropathy - reduction in acuity, colour vision defects, visual field defects.
Requires urgent medical intervention to prevent permanent vision loss.
90
What are the complications of thyroid eye disease?
Exposure keratopathy
Optic neuropathy
Strabismus and diplopia
91
What features of thyroid eye disease indicate the need for urgent opthalmology review?
Unexplained deterioration of vision
Change in intensity or quality of colour vision.
Globe subluxation (eye suddenly popping out)
Corneal opacity
Cornea still visible when eyelids are closed.
Optic disc swelling
92
What is the dose of IM adrenaline required in anaphylaxis in a baby <6 months?
100 - 150 micrograms (0.1 - 0.15 ml 1 in 1,000)
93
What is the dose of IM adrenaline required in anaphylaxis in a child 6 months - 6 years?
150 micrograms (0.15 ml 1 in 1,000)
94
What is the dose of IM adrenaline required in anaphylaxis in a child 6 - 12 years?
300 micrograms (0.3ml 1 in 1,000)
95
What are the causes of an oculogyric crisis?
Antipsychotics
Metoclopramide
Postencephalitic PD
96
What is the management of an oculogyric crisis?
Cessation of causative medication
IV antimuscarinic (benztropine, procyclidine)
97
Which condition is most associated with a bisferiens pulse?
Mixed aortic valve disease
HOCM may occasionally be associated with a bisferiens pulse
98
What condition is associated with a slow-rising pulse?
Aortic stenosis
99
What murmur is associated with PDA?
Continuous machinery like murmur
100
What conditions are associated with pulsus paradoxus?
Severe asthma
Cardiac tamponade
101
What conditions are associated with a collapsing pulse?
Aortic regurgitation
PDA
Hyperkinetic states
102
What condition is associated with pulsus alternans?
Severe LVF
103
What condition is most associated with a 'jerky' pulse?
HOCM
104
What is the most significant prognostic factor in melanoma?
Invasion depth of tumour (Breslow thickness)
105
In melanomas thicker than 1mm, what is most significant for determining overall prognosis?
Depth (breslow thickness), sentinal lymph node biopsy status (SLNB) becomes equally significant.
106
What are the contraindications to statin therapy?
Macrolides (erythromycin, clarithromycin)
Pregnancy
107
What are the indications for spironolactone?
Ascites
Hypertension (NICE step 4)
Heart failure NYHA III + IV, already taking an ACE-I
Nephrotic syndrome
Conn's syndrome
108
What is the causative organism for a pneumonia with peripheral blood smear showing red blood cell agglutination?
Mycoplasma pneumoniae
109
What are the characteristic complications of mycoplasma pneumonia?
Erythema multiforme
Cold autoimmune haemolytic anaemia
Meningoencephalitis, GBS
Bullous myringitis
Pericarditis/myocarditis
Hepatitis, pancreatitis
Acute glomerulonephritis
Erythema nodosum
110
What is the treatment for immune related adverse events in a patient on checkpoint inhibitors (e.g. nivolumab, pembrolizumab)?
Corticosteroids - either topical (if dermatological SEs) or systemic.
111
What are some of the immune-mediated adverse effects of checkpoint inhibitors (e.g. nivolumab, pembrolizumab)?
Diarrhoea
Pneumonitis
Nephritis
Rash
Pruritis
112
What is the treatment for immune related adverse events in a patient on checkpoint inhibitors refractory to corticosteroid therapy?
Immunosuppressants - azathioprine, infliximab, MMF
113
What are the side effects of donepazil?
Sleep disorders
Bradycardia (relative CI in existing bradycardia)
114
What is the first and second line pharmacological management of Alzheimer's disease?
First line - acetylcholinesterase inhibitors (donepazil, galantamine, rivastigmine).
Second line - memantine (NMDA receptor antagonist)
115
What are the indications for memantine in Alzheimer's disease?
Moderate AD if CI acetylcholinesterase inhibitors.
Moderate/severe AD - Add on to acetylcholinesterase inhibitors.
Severe AD - monotherapy
116
What drug is used for the prevention of tumour lysis syndrome in high risk patients?
Rasburicase
117
What drug is used for the prevention of tumour lysis syndrome in lower risk patients?
Allopurinol
118
How is laboratory tumour lysis syndrome characterised?
Abnormality in two or more of the following, occurring within three days before or seven days after chemotherapy.
- uric acid > 475umol/l or 25% increase
- potassium > 6 mmol/l or 25% increase
- phosphate > 1.125mmol/l or 25% increase
- calcium < 1.75mmol/l or 25% decrease
119
How is clinical tumour lysis syndrome characterised?
Laboratory tumour lysis syndrome plus one or more of the following:
- increased serum creatinine (1.5 times upper limit of normal)
- cardiac arrhythmia or sudden death
- seizure
120
Which atypical antipsychotic has a relatively higher risk of dyslipidemia and obesity compared to others?
Olanzapine
121
What side effect is associated with aripiprazole
Generally good side-effect profile particularly for prolactin elevation.
Associated with akathisia.
122
What side effects are specifically associated associated with quietiapine?
Orthostatic hypotension
Transient sedation
123
What is Leiner's disease?
Erythroderma desquamativum (severe form of sebborheic dermatitis that typically begins in infancy, associated with recurrent infections and diarrhoea)
124
A deficiency of what protein predisposes to Leiner's disease?
Complement protein C5
125
What protein deficiency leads to hereditary angioedema?
Complement protein C1
126
What protein deficiencies are strongly associated with SLE?
Complement protein C2, C4
127
A deficiency of what protein can lead to serious recurrent bacterial infections including pneumonia and meningitis?
Complement C3
128
What complement proteins form the classical pathway, and what does deficiency predispose to?
C1q, C1rs, C2, C4
Immune complex disease e.g. SLE, Henoch-Shonlein
129
What does complement C5-9 deficiency predispose to?
Neisseria Meningitidis infection
130
What is the clinical manifestation of a 6th nerve palsy?
Ipsilateral difficulty abducting the eye, medial deviation at rest.
131
What is the clinical manifestation of a 4th nerve palsy?
Affects the superior oblique muscle.
Problems with downward gaze and torsional diplopia
132
What is the clinical manifestation of a 3rd nerve palsy?
Ipsilateral ptosis, mydriasis and multiple extraocular muscle weakness.
133
ADPKD type 1 is associated with a gene defect in which chromosome?
Chromosome 16
134
What genetic disorders are associated with mutations of chromosome 4?
ADPKD type 2
Huntington's disease
Ellis van Creveld syndrome
135
What genetic disorders are associated with mutations of chromosome 8?
Burkitt lymphoma
Charcot Marie Tooth disease type 1a
136
What genetic disorders are associated with mutations of chromosome 12?
Hypochondrogenesis
Achondrogenesis type II
137
What genetic disorders are associated with mutations of chromosome 20?
Aligille syndrome type II
Adenosine deaminase deficiency
138
What is the diagnostic criteria on abdominal ultrasound for ADPKD?
Ultrasound diagnostic criteria (in patients with positive family history)
- two cysts, unilateral or bilateral, if aged < 30 years
- two cysts in both kidneys if aged 30-59 years
- four cysts in both kidneys if aged > 60 years
139
What is the pharmacological management of ADPKD and what is its mechanism of action?
Tolvaptan (vasopressin receptor 2 antagonist)
140
What is the INR target following mechanical aortic valve replacement?
3.0
141
What is the INR target following mechanical mitral valve replacement?
3.5
142
What are the key features of facet joint syndrome?
LBP pain over the facets
Pain worse on extension of the back
143
What are the key features of spinal stenosis?
Unilateral or bilateral leg pain, numbness and weakness +/- back pain
Worse on walking
Resolves wen sitting down, leaning forwards, crouching down
144
What are the key features of spinal stenosis?
Pain on walking, relieved by rest
Absent/weak foot pulses and other signs of limb ischaemia.
145
What cardiac complication does methadone cause?
Prolonged QT interval.
146
What is the length of a normal QTc in males and females?
430ms in males
450ms in females
147
What are the congenital causes of a prolonged QT interval?
Jervell-Lange-Nielson syndrome (includes deafness)
Romano-Ward syndrome
148
What drugs can cause a prolonged QT?
Amiodarone, sotalol, Class 1a antiarrhythmic drugs
TCAs, SSRIs (especially citalopram)
Methadone
Chloroquine
Terfenadine
Erythromycin
Haloperidol
Ondansetron
149
What are non-drug, non-congenital causes of long QT syndrome?
Hypocalcaemia, hypokalaemia, hypomagnesaemia, hypothermia
Acute MI
Myocarditis
SAH
150
What is the typical clinical manifestation of long QT1?
Exertional syncope, often swimming
151
What are other therapies for recurrent C.diff?
Bezlotoxumab (monoclonal antibody). Currently not NICE supported.
Faecal microbiota transplant for patients who've had 2 or more previous episodes.
152
What is the medical therapy for a prolactinoma?
Dopamine agonist (cabergoline or bromocriptine)
153
What is the medical therapy for a GH secreting adenoma?
Somatostatin analogues (ocreotide, lanreotide), GH receptor antagonists (pegvisomant)
154
What is the medical therapy for ACTH secreting adenomas?
Cortisol synthesis inhibitors (e.g. ketoconazole, metyrapone), and neuromodulators (pasireotide)
155
What histological type of lung cancer causes hypercalcaemia?
Squamous cell lung cancer due to PTHrP secretion from the tumour
156
What drugs can cause hypercalcaemia?
Thiazides, calcium containing steroids.
157
What murmur would you expect to find with an atrial septal defect?
Ejection systolic murmur louder on inspiration
158
What murmur would you expect to find with HOCM?
Ejection systolic louder on expiration
159
What murmur would you expect to find with tetralogy of fallot?
Ejection systolic
160
What murmur would you expect to find with mitral and tricuspid regurgitation?
Pansystolic. TR louder on expiration.
High pitched, blowing in character.
161
What murmur would you expect to find in a VSD?
Harsh pansystolic murmur
162
What murmur would you expect to find in mitral valve prolapse?
Late systolic
163
What murmur would you expect to find in coarctation of the aorta?
Late systolic?
164
What murmur would you expect to find in pulmonary regurgitation?
Graham steel murmur
High pitched, blowing, early diastolic
165
What murmur would you expect to find in severe aortic regurgitation?
Austin flint murmur, rumbling mid-late diastolic.
166
What is the characteristic presentation of legionella pneumonia?
Severe pneumonia, hyponatraemia, deranged LFTs, recent travel history/air conditioning systems.
Dry cough.
Relative bradycardia
Lymphopenia
Mid to lower zone patchy consolidation.
Diagnosed with urinary antigen.
167
What are the features of an essential tremor?
Postural - worse if arms outstretched
Improved by alcohol and rest
Most common cause of titubation
168
What is the first line management of an essential tremor?
Propanolol
Primidone is sometimes used
