MRCP Part 1 Flashcards

Question

Which bits of the brain are particularly affected by alcohol excess?

Answer 1

Cerebellum Frontal lobe Limbic System

Answer 2

Repeated heart beat pattern (one long then one short) that is most often due to ectopic beats occurring so frequently that it happens after each sinus beat. It does not require treatment unless it is symptomatic (then use beta-blockers)

Answer 3

Ventricular ectopic occurs every third beat

Answer 4

Heartbeat is initiated by the Purkinje fibres in the ventricles by the sinoatrial node

Answer 5

RBBB + left or right axis deviation

Answer 6

RBBB + left or right axis deviation + PR prolongation

Answer 7

``` Class 1 (Sodium Channel Blocker) - 1a: Quinidine, Procainamide, Disopyramide, Ajmaline - 1b: Lidocaine, Mexiletine, Phenytoin - 1c: Flecainide, Propafenone Class 2 (Beta-Blocker): bisoprolol Class 3 (Potassium Channel Blocker): amiodarone Class 4 (Calcium Channel Blockers): verapamil ```

Answer 8

``` Acidosis Electrolyte Abnormalities (hyperkalaemia) Ingestion of Toxins Overload (Fluid) Uraemic Symptoms ```

Answer 9

It leads to an anticoagulant effect (as the packed red cell samples contain anticoagulant (calcium citrate)) This means that patients should also receive FFP if they have any more than 4 units of packed red cells

Answer 10

``` Similar to lymphoma Enlarged lymph nodes Fever Night sweats Weight loss ```

Answer 11

RIG does not require sedation and hence is better in patients with respiratory compromise (e.g. MND).

Answer 12

Thrombosis The binding of heparin to platelet factor 4 stimulates the generation of antibodies. These antibodies then bind to the heparin-platelet factor 4 complex and causes platelet activation resulting in thrombosis formation and depletion of platelets.

Answer 13

ST depression and T wave inversion in V1-3, I, II and aVF

Answer 14

10 mg codeine = 1 mg morphine NOTE: breakthrough pain should be 1/6 of the total daily dose of morphine

Answer 15

Streptococcus bovis

Answer 16

NSAIDs and colchicine

Answer 17

Hypoxia Bilateral pulmonary infiltrates Fever Hypotension NOTE: it is caused by the activation of host neutrophils by substances in the blood products. This triggers an inflammatory reaction within the lungs.

Answer 18

``` Alcohol Diuretics Cytotoxics Ciclosporin Pyrazinamide ```

Answer 19

Beta-blockers Antimalarials Stress Streptococcal infection (guttate)

Answer 20

It labels white cell and watches where they accumulate (a bit like a PET scan for infection) It is good for identifying occult abscesses

Answer 21

pH < 7.2 Glucose < 3.3 mmol/L LDH > 1000

Answer 22

Non-selective phosphodiesterase inhibitor (raises cAMP --> activate PKA --> inhibits TNF-alpha and leukotriene synthesis) Non-selective adenosine receptor antagonist NOTE: end result is bronchodilator

Answer 23

Headache Papilloedema Tonic Clonic Seizures NOTE: MR or CT angiography/venography is required for diagnosis, and it is treated with anticoagulation

Answer 24

Diarrhoea and arthropathy Can also cause lymphadenopathy, skin hyperpigmentation, pleurisy and pericarditis Duodenal biopsy shows subtotal villous atrophy which is PAS stain positive (caused by Tropheryma whipplei) It is treated with oral co-trimoxazole

Answer 25

NSAIDs Colchicine 500 mg QDS can be used if NSAIDs are contraindicated (NOTE: reduced dose of 500 mg BD can be used in patients with renal impairment)

Answer 26

Condition characterised by generalised tonic clonic seizures usually provoked by sleep deprivation and excessive alcohol intake

Answer 27

Diuretics (in particular, thiazide diuretics)

Answer 28

A haemodynamic parameter measured in intensive care which divides cardiac output from the left ventricle in one minute by the total body surface area Low cardiac index is suggestive of cardiogenic shock

Answer 29

Weakness of quadriceps and long muscles of fingers | CK may be normal

Answer 30

A lymphoproliferative disorder characterised by IgM paraproteinaemia It can result in hyperviscosity and splenomegaly

Answer 31

C56 Therefore, damage to this root will result in Erb's palsy (loss of abduction and loss of biceps-mediated supination)

Answer 32

A secondary cause of hypertension resulting from a mutated epithelial sodium channel Results in hypertension, alkalosis and hypokalaemia with suppressed renin and aldosterone.

Answer 33

Fever, muscle aches, headache, rash Lymphopaenia, Thrombocytopaenia and deranged LFTs

Answer 34

Hepatic Nuclear Factor 1A (HNF1A) NOTE: MODY presents in early adulthood with insulin-dependent diabetes mellitus (autosomal dominant) - they are very sensitive to sulphonylureas

Answer 35

In roughly 2 weeks as phenytoin has a long half-life and therefore takes time to reach steady state concentrations Aim 10-20 mg/L

Answer 36

Reabsorb sodium, amino acids and glucose | Exchange H+ ions for bicarbonate (reabsorb bicarbonate)

Answer 37

Headaches Nose bleeds Hepatosplenomegaly Papilloedema NOTE: resulting from hypercoagulable state (Ix: protein electrophoresis)

Answer 38

Cisplatin and Etoposide NOTE: carboplatin is used for those who cannot tolerate cisplatin

Answer 39

Weakness in hands then arms (anterior horn cells) Loss of pain and temperature in upper limbs (cape-like) Followed by loss of fine touch, vibration and proprioception later on

Answer 40

A receptor that can stimulate the sympathetic nervous system Clonidine and Moxonidine block this receptor to achieve a reduction in blood pressure

Answer 41

``` Haemolytic anaemia Seizures Confusion Cardiomyopathy Skeletal Muscle Weakness ```

Answer 42

Increased Renal Excretion - Hyperparathyroidism - X-Linked Hyperphosphataemia - Fanconi Syndrome - Diuretics Decreased GI Absorption - Reduced intake - Phosphate binders (sevelamer) - Alcohlism Transcellular Shifts - Refeeding syndrome - Insulin

Answer 43

Plasma exchange (steroids may be used as an adjunct)

Answer 44

Dorsal Midbrain It may also be associated with convergence nystagmus and impaired pupillary reflexes NOTE: known as Parinaud syndrome

Answer 45

Sulfadiazine + Pyrimethamine + Folinic Acid for 6 Weeks

Answer 46

Warty brown papules on the chest and back | Autosomal dominant inheritance pattern

Answer 47

Rapidly Progressive Dementia Ataxia Myoclonus MRI --> Pulvinar Sign (High intensity in pulvinar region of thalamus) - described as 'hockey stick sign'

Answer 48

Haloperidol This is the most potent D2 antagonist and the mechanism of hypercalcaemia induced nausea is via the D2 receptor

Answer 49

Jugular Foramen

Answer 50

``` 1 L 0.9% NaCl over 1 Hour 1 L 0.9% NaCl + KCl over 2 Hours 1 L 0.9% NaCl + KCl over 2 Hours 1 L 0.9% NaCl + KCl over 4 Hours 1 L 0.9% NaCl + KCl over 6 Hours ``` ADD 10% Dextrose at 125 mL/hour once BM < 14 mmol/L BOLUS: 500 mL NaCl if SBP < 90 mm Hg

Answer 51

HOURLY capillary ketones and glucose | VBG at 1 hour, 2 hours then every 2 hours thereafter

Answer 52

Complication of diabetes mellitus that results from damage to the lumbosacral plexus (supplying thighs and buttocks) Manifests with lower leg pain, weakness, wasting and paraesthesia

Answer 53

``` Ciprofloxacin Clarithromycin Erythromycin Omeprazole Metronidazole Chloramphenicol Cranberry Juice ```

Answer 54

``` Fever Myalgia Weight loss Headache Abdominal pain ``` Bloods may show deranged LFTs but everything else may be normal Blood cultures will be positive after 5 days (slow growing) Caused by exposure to unpasteurised dairy products

Answer 55

``` Benign early repolarisation (looks like pericarditis) - common feature in < 50 yrs ST elevation in precordials leads Prominent T waves ST segment/T wave ratio < 0.25 Fishhook appearance in V4 ECG changes are stable over time ```

Answer 56

QT prolongation NOTE: you get QT shortening in hypercalcaemia

Answer 57

Mitochondrial toxicity + impaired gluconeogenesis (impairs pyruvate carboxylase which normally converts pyruvate into oxaloacetate)

Answer 58

IV glucagon

Answer 59

Abdominal pain Motor neuropathy Basophilic stippling

Answer 60

It is highly protein bound and require protein binding in order to be secreted into the filtrate at the proximal convoluted tubule. Other causes of reduced protein binding of furosemide include the presence of competing highly protein-bound drugs like phenytoin and warfarin.

Answer 61

Ipsilateral facial sensory loss Contralateral body sensory loss Cerebellar features (dysphagia, dysarthria, vertigo, nystagmus) NOTE: due to PICA aneurysm/stroke

Answer 62

Haemolytic anaemia

Answer 63

Ciprofloxacin

Answer 64

Haemodialysis (especially if level is > 4 mmol/L)

Answer 65

Naltrexone

Answer 66

``` Metronidazole NSAIDs ACE inhibitors and ARBs Thiazide diuretics Steroids ```

Answer 67

SKIN: yellow papules over neck, puckered skin VASCULAR: PVD, mitral valve prolapse, GI bleed, visual loss (retinal angioid streaks) NOTE: it is a hereditary disorder of elastic tissue

Answer 68

HLA DQ2 and DQ8

Answer 69

Discoid lupus

Answer 70

``` Acute intermittent porphyria (no photosensitivity) Variegate porphyria (photosensitivity) ``` NOTE: both present with abdominal pain and hypertension

Answer 71

``` Severe vomiting Seizures Hyperthermia Hypokalaemia Hyperglycaemia Tachyarrhythmia ```

Answer 72

Oral Prednisolone --> IVIG Splenectomy and immunosuppressive drugs (e.g. cyclophosphamide) may also be used

Answer 73

AIHA + ITP NOTE: it is treated with steroids

Answer 74

It can worsen hyperthyroidism caused by toxic multinodular goitre It can improve hyperthryoidism in Graves' disease NOTE: a thyroid uptake scan would be recommended

Answer 75

``` Decreased consciousness Neuromuscular excitability (tremor) Confusion Abdominal pain Vomiting AKI ECG Changes (TWI, QT prolongation) ```

Answer 76

Niclosamide 2 g STAT NOTE: tapeworm is caused by Taenia solium (pork) or Taenia saginata (beef)

Answer 77

Ciprofloxacin

Answer 78

``` Ascending epigastric aura Olfactory/gustatory hallucinations Ictal fear Lip smacking/swallowing Limb automatisms (fiddling, tapping) ``` NOTE: caused by hippocampal sclerosis

Answer 79

Myocarditis

Answer 80

Vincristine Cisplatin (platinum containing compounds) Docetaxel (taxanes)

Answer 81

20 mg IV/PO Hydrocortisone = 5 mg PO Prednisolone

Answer 82

15;17 NOTE: it is associated with DIC

Answer 83

IL-6 (tocilizumab)

Answer 84

Dissociative disorder characterised by approximate answers, pseudohallucinations, somatic conversion, amnesia and reduced consciousness

Answer 85

Botulinum toxin injections

Answer 86

Regional osteopaenia Periosteal reaction Focal bone lysis or cortical loss

Answer 87

Monthly hepatitis C PCR | If it becomes positive, patients should be offered ribavirin and interferon (or daclatasivir)

Answer 88

A rare condition associated with enlarged gastric folds in the fundus and body of the stomach It causes epigastric pain, protein loss (hypoalbuminaemia) and hypochlorhydria

Answer 89

Long QT | Bilateral sensorineural hearing loss

Answer 90

Vasopressin increases the activity of urea transporter 1 (UT-A1) in the collecting ducts NOTE: the thin ascending limb of the loop of Henle and the inner medullary collecting ducts are permeable to urea. Urea adds to the osmolality of the medullary interstitium, thereby allowing the nephron to concentrate urine.

Answer 91

The iliopsoas muscle has a very rich blood supply meaning that it is predisposed to haematogenous spread of infection.

Answer 92

Drug Reaction with Eosinophilia and Systemic Symptoms TRIAD: extensive skin rash + high fever + organ involvement (e.g. liver impairment) NOTE: Occurs most commonly with use of anticonvulsants (e.g. carbamazepine), allopurinol and sulphonamide antibiotics.

Answer 93

Treat the ESBLs NOTE: they will be resistant against co-amoxiclav

Answer 94

Gittelman: dysfunction of Na-Cl cotransporter in distal convoluted tubule (effects similar to thiazide diuretic use), leads to low calcium and low magnesium Bartter: dysfunction of Na-K-Cl triple transporter in ascending limb of loop of Henle (effects similar to loop diuretic use) Liddle: prevention of degradation of ENaC in collecting duct (effects similar to hyperaldosteronism)

Answer 95

Anti-myeloperoxidase antibody NOTE: cANCA target proteinase 3

Answer 96

Ceftazidime and tobramycin

Answer 97

Developmental delay Abdominal pain Blue line on gums Constipation

Answer 98

Unilateral sensorineural hearing loss Ipsilateral ataxia Facial weakness Trigeminal sensory loss

Answer 99

Unilateral sensorineural hearing loss Ipsilateral ataxia Facial weakness Trigeminal sensory loss

Answer 100

1 mg dexamethasone at midnight | Measure serum cortisol at 9 am

Answer 101

Wells: Determine whether CTPA or D-Dimer would be required PERC: Determine whether a PE is even a feasible possibility/requires further investigation PESI: Determines mortality in people with a diagnosed PE

Answer 102

Beta-D Glucan

Answer 103

If a chest drain has failed to resolve the pneumothorax and there is a persistent air leak after 48 hours

Answer 104

Presence of anti-HLA antibodies in the donated blood product

Answer 105

``` Bloody stools > 6 per day HR > 90 Temp > 37.8 Hb < 10.5 ESR > 30 CRP > 30 ```

Answer 106

Alitretinoin

Answer 107

Fringolimod NOTE: it is a sphingosine-1-phosphate receptor modulator which affects the activity of lymphocytes

Answer 108

Staphylococcus aureus

Answer 109

Ataxia Nystagmus Agitation Drowsiness (Cerebellar signs)

Answer 110

Patients who cannot undergo two stages of the Bruce protocol (< 6 mins) are at higher risk of adverse cardiovascular events and should be considered for coronary angiography.

Answer 111

300 mg over 30-60 mins followed by 900 mg over 24 hours Needs to be infused through a large cannula into a large peripheral vein or into a central vein as it can cause thrombophlebitis

Answer 112

Metformin should be held for 48 hours before and after any procedure involving IV contrast (e.g. CT scan, angiogram) This is because it could increase the risk of lactic acidosis.

Answer 113

Oral Methylprednisolone 0.5 g OD for 5 days

Answer 114

Verapamil Alternatives: lithium, sodium valproate, gabapentin

Answer 115

Second or third degree heart block complicating an acute anterior MI

Answer 116

Beta-blockers ICD Sympathectomy

Answer 117

Urticaria pigementosa (with Darier sign) Abdominal Pain Flushing Monocytosis on blood film

Answer 118

Raised serum tryptase levels | Urinary histamine

Answer 119

Postural tremor that is worse when arms are outstretched Improves with alcohol Propranolol is the first-line treatment (primidone is used sometimes)

Answer 120

Pasteurella multocida Treated with co-amoxiclav (same with human bites)

Answer 121

Antiepileptics (phenytoin, carbemazepine) Rifampicin St. John's Wort Alcohol intake

Answer 122

Bisoprolol Nebivolol Carvedilol

Answer 123

A technique for producing monoclonal antibodies which combines mouse spleen cells with human myeloma cells. The antibodies generated have a mouse variable region and a human constant region.

Answer 124

After 2 DMARDs have been trialled and disease activity remains high (DAS28-CRP or DAS28-ESR > 5.1)

Answer 125

Oral aciclovir and oral steroids

Answer 126

Dorsal columns (resulting in loss of vibration and proprioception) Lateral corticospinal tract (upper motor neurone findings in the legs) Damage to peripheral nerves results in loss of knee and ankle jerks

Answer 127

Night blindness Tunnel vision NOTE: it is genetic and associated with Refsum disease, Usher syndrome, abetalipoproteinemia, Laurence-Moon-Biedl syndrome, Kearns-Sayre syndrome and Alport syndrome

Answer 128

Clopidogrel 75 mg OD | If not tolerated --> Aspirin 75 mg OD + Dipyridamole 200 mg BD

Answer 129

Radiofrequency ablation to the tricuspid valve isthmus

Answer 130

1st line: topical metronidazole (mild) 2nd line: systemic antibiotics (e.g. oxytetracycline) for severe disease NOTE: topical brimonidine gel may be used in patients predominantly complaining of flushing

Answer 131

Phase I: Oxidation, Reduction and Hydrolysis (products are usually more active and may be toxic) Phase II: Conjugation (products are inactive and excreted in the urine or bile)

Answer 132

Modified Ziehl-Neelsen staining of stool to reveal red cysts

Answer 133

Student's t-test - paired or unpaired* | Pearson's product-moment coefficient - correlation

Answer 134

Mann-Whitney U test compares ordinal, interval, or ratio scales of unpaired data Wilcoxon signed-rank test compares two sets of observations on a single sample, e.g. a 'before' and 'after' test on the same population following an intervention Chi-squared test used to compare proportions or percentages e.g. compares the percentage of patients who improved following two different interventions Spearman, Kendall rank - correlation

Answer 135

Sensory loss of posterolateral aspect of leg and lateral aspect of foot Weakness in plantar flexion of foot Reduced ankle reflex Positive sciatic nerve stretch test

Answer 136

Anticoagulated for at least 3 weeks After DCCV, the patient should be anticoagulated for at least 4 weeks before decisions about anticoagulation should be made NOTE: patients can have a TOE and, if negative, be heparinised and receive DCCV then and there. If there is high risk of cardioversion failure (e.g. previous failure or AF recurrence) then patients should also have at least 4 weeks of amiodarone or sotalol before DCCV.

Answer 137

``` PiMM = normal PiSS = A1AT 50% of normal PiZZ = A1AT 10% or normal - this is the type that gets lung/liver manifestations ```

Answer 138

``` Sensory inattention Apraxia Astereognosis Inferior homonymous quadrantanopia Gerstmann syndrome (lesion of dominant parietal lobe): alexia, acalculia, finger agnosia and right-left disorientation ```

Answer 139

Acute angle closure glaucoma Presents with acute myopia, headache and unreactive pupils

Answer 140

C6 - thumb and index finger C7 - middle finger + palm of hand C8 - ring + little finger

Answer 141

``` Prostacyclin analogues (treprostinil) Endothelin receptor antagonists (bosentan) Phosophodiesterase inhibitors (sildenafil) ``` NOTE: if good response to acute vasodilator testing - CCBs may be used (minority of patients)

Answer 142

NRTI: zidovudine, abacavir, emtricitabine, lamivudine, tenofovir NNRTI: nevirapine, efavirenz

Answer 143

Photosensitive rash with blistering in sun exposed areas (usually hands) Hypertrichosis Hyperpigmentation NOTE: treated with chloroquine and venesection

Answer 144

Inability to adduct the affected eye resulting in nystagmus and diplopia It is caused by damage to the median longitudinal fasciculus which is found in the paramedian area of the midbrain and pons

Answer 145

Fomepizole (inhibitor of alcohol dehydrogenase) NOTE: ethanol used to be used to treat this k

Answer 146

``` External ophthalmoplegia Retinitis pigmentosa (night blindness) Ptosis Usually < 20 yrs Diabetes mellitus (insulin-dependent) Complete heart block Cardiomyopathy Recurrent stroke ``` Maternal inheritance

Answer 147

Percutaneous mitral commisurotomy (balloon valvulotomy) NOTE: transcatheter mitral valve repair is a second choice

Answer 148

``` Beta-blockers Antibiotics (gentamicin, macrolides, quinolones, tetracyclines) Phenytoin Lithium Penicillamine Procainamide ```

Answer 149

Pemphigus Vulgaris: Desmoglein 3 | Bullous Pemphigoid: Hemidesmosome

Answer 150

Mannose-6-phosphate

Answer 151

Nicorandil (potassium channel activator) NOTE: it is associated with causing gastrointestinal ulceration (ranging from oral ulcers to anal ulcers)

Answer 152

Hydrocortisone (most mineralocorticoid activity) Prednisolone Dexamethasone/Betamethasone

Answer 153

Sudden-onset flank pain Deterioration in renal function Haematuria

Answer 154

Neutrophil disorder resulting from a lack of NADPH oxidase, which reduces the ability of the neutrophil to produce ROS Presents with recurrent pneumonia/abscesses (particularly S. aureus and funguses like Aspergillus)

Answer 155

Negative nitroblue-tetrazolium test | Abnormal dihydrorhodamine flow cytometry

Answer 156

Neutrophil disorder resulting from a defect in microtubule polymerisation leading to reduced phagocytosis Affected children have partial albinism and peripheral neuropathy, recurrent bacterial infections

Answer 157

Neutrophil disorder caused by defect in LFA-1 integrin on neutrophils Leads to recurrent bacterial infections, delay in umbilical cord sloughing and absence of neutrophils at site of infection

Answer 158

It is a B cell disorder that results in hypogammaglobulinaemia It may predispose to lymphoma and autoimmune disorders

Answer 159

B cell disorder characterised by a defect in Bruton's tyrosine kinase resulting in a severe block in B cell development Patients develop recurrent bacterial infections, there is an absence of B cells and reduced immunoglobulins of all classes

Answer 160

Recurrent sinus and respiratory tract infections Associated with coeliac disease May develop severe reactions to blood transfusions (due to anti-IgA antibodies)

Answer 161

T cell disorder caused by 22q11.2 deletion resulting in failure to develop the 3rd and 4th pharyngeal pouches Manifestations include congenital heart disease (e.g. tetralogy of Fallot), learning difficulties, hypocalcaemia, recurrent viral/fungal diseases, cleft palate

Answer 162

SCID (multiple causes) Ataxia Telangiectasia (defect in DNA repair, leads to cerebellar ataxia, telangiectasia, recurrent chest infections and increased risk of malignancy) Wiskott Aldrich Syndrome (defect in WASP gene, recurrent bacterial infection, eczema, thrombocytopaenia, autoimmune diseases) Hyper IgM Syndrome (mutation in CD40 gene, hepatitis, diarrhoea, PCP infection)

Answer 163

1st line: alendronate 2nd line: risedronate or etidronate 3rd line: strontium ranelate or raloxifene

Answer 164

Inherited myopathy that presents at around 20-30 years Autosomal dominant trinucleotide repeat disorder (DM1 caused by CTG repeat, DM2 is caused by repeat expansion of ZNF9 gene) Main features are myotonic facies, frontal balding, bilateral ptosis, cataract and dysarthria Also associated with dysphagia, diabetes mellitus, mild mental impairment, testicular atrophy, heart block and cardiomyopathy

Answer 165

Uncomplicated (no visual involvement or tongue/jaw claudication) --> PO prednisolone 40-60 mg OD Complicated (visual involvement and/or tongue/jaw claudication) --> IV methylprednisolone 500-1000 mg for 3 days before starting oral prednisolone

Answer 166

``` Schizonts on a blood film Parasitaemia > 2% Hypoglycaemia Acidosis Temperature > 39 °C Severe anaemia Cerebral malaria (seizures, coma) Acute renal failure ARDS DIC ```

Answer 167

Previous history of urinary retention NOTE: it should also be avoided in the elderly as it can worsen confusion

Answer 168

Mantoux IGRA is used if Mantoux is positive

Answer 169

High humidity and heat

Answer 170

``` Follicular Lymphoma - t(14,18) Burkitt Lymphoma - t(8,14) CML - t(9,22) Mantle Cell Lymphoma - t(11, 14) Ewing Sarcoma - t(11, 22) APML - t(15, 17) ```

Answer 171

Full course of tetanus vaccines (5) with last dose < 10 years --> no vaccine or immunoglobulin Full course of tetanus vaccines with last dose > 10 years --> if tetanus prone then reinforcing dose of vaccine, if very high-risk give reinforcing dose and tetanus immunoglobulin If vaccination history unclear --> give reinforcing dose, give tetanus immunoglobulin if tetanus-prone or high-risk wound

Answer 172

autosomal dominant defect in porphobilinogen deaminase female and 20-40 year olds more likely to be affected typically present with abdominal symptoms, neuropsychiatric symptoms hypertension and tachycardia common urine turns deep red on standing

Answer 173

most common hepatic porphyria defect in uroporphyrinogen decarboxylase may be caused by hepatocyte damage e.g. alcohol, oestrogens classically photosensitive rash with bullae, skin fragility on face and dorsal aspect of hands urine: elevated uroporphyrinogen and pink fluorescence of urine under Wood's lamp manage with chloroquine

Answer 174

``` autosomal dominant defect in protoporphyrinogen oxidase photosensitive blistering rash abdominal and neurological symptoms more common in South Africans ```

Answer 175

If person is known to be a responder to HBV vaccine --> give booster dose If non-responder or not fully vaccinated --> Give HBIG + Vaccine Booster NOTE: if unclear whether exposed to HBV, consider giving booster dose and if known non-responder, give booster dose and HBIG

Answer 176

PKD1 --> Chromosome 16 | PKD2 --> Chromosome 4

Answer 177

Arrhythmias (long QRS - risk of ventricular arrhythmia) Seizures Metabolic Acidosis Coma

Answer 178

IV Sodium Bicarbonate (first-line for hypotension and arrhythmias)

Answer 179

1st Line: CCBs (e.g. nifedipine) | 2nd Line: IV Prostacyclin infusion (e.g. epoprostenol)

Answer 180

``` Barbiturates Halothane Benzodiazepines Alcohol OCP Sulphonamides ```

Answer 181

``` p24 antigen test (positive from 1 to 3/4 weeks after infection) HIV antibody (most common and accurate test - most will develop antibodies by 4-6 weeks) ``` NOTE: antibodies may not be detectable yet

Answer 182

Develops < 25 yrs Family history of early-onset diabetes (autosomal dominant) Ketosis NOT present Sensitive to sulfonylureas (insulin often not necessary) NOTE: bit like early-onset type 2 diabetes mellitus

Answer 183

Sulfonylureas

Answer 184

Staphylococcus epidermidis

Answer 185

EMA Binding Test NOTE: it is treated with folate supplementation and splenectomy (in severe cases)

Answer 186

Paroxysmal nocturnal haemoglobinuria BUT, the gold standard test is now flow cytometry for CD59 and CD55 (these are negative)

Answer 187

Reduces lymphocyte production through inhibition of inosine-5-monophosphate-dehydrogenase (required for purine synthesis)

Answer 188

Bilateral adrenal hyperplasia (70%) NOTE: it used to be thought that most cases were due to adrenal adenomas (Conn's)

Answer 189

Glomerulosa --> Aldosterone Fasciculata --> Glucocorticoids Reticularis --> Sex Steroids Medulla --> Catecholamines

Answer 190

X descent --> fall in atrial pressure during ventricular systole Y descent --> opening of the tricuspid valve

Answer 191

MOTOR: medial two lumbricals, adductor policis, interossei, hypothenar muscles, flexor carpi ulnaris SENSORY: medial 1.5 fingers

Answer 192

AT WRIST: Claw hand (hyperextension of MCP, flexion of distal and proximal IPJs of 4th/5th digits) + wasting of intrinsic hand muscles + wasting of hypothenar muscles + sensory loss to medial 1.5 fingers AT ELBOW: Clawing is less severe , radial deviation of wrist

Answer 193

C1 inhibitor --> hereditary angioedema C1, C2, C4 --> immune complex disease (e.g. SLE) C3 --> recurrent bacterial infections C5 --> Leiner disease, watery diarrhoea, seborrhoeic dermatitis C5-C9 --> severe meningococcal infection

Answer 194

It competitively inhibits creatinine secretion in the tubule NOTE: It also blocks ENaC in the distal nephron which causes a hyperkalaemic distal RTA

Answer 195

Steroids COCP Tetracyclines Lithium

Answer 196

Clarithromycin

Answer 197

Sodium valproate Second line: clonazepam, lamotrigine NOTE: carbamazepine can worsen myoclonic seizures

Answer 198

Generalised: sodium valproate Focal: carbamazepine

Answer 199

Sodium valproate or ethosuximide

Answer 200

Asymptomatic - discharge after trial of oral fluids + period of observation Symptomatic - high dose IV PPI, urgent endoscopy

Answer 201

Descent Nifedipine Others (dexamethasone, acetazolamide, phosphodiesterase type V inhibitors)

Answer 202

Descent | Dexamethasone

Answer 203

Cyclophosphamide SE: haemorrhagic cystitis, myelosuppression, transitional cell carcinoma NOTE: haemorrhagic cystitis can be prevented with mesna

Answer 204

Bleomycin --> degrades preformed DNA --> lung fibrosis Anthracyclines (e.g. doxorubicin) --> stabilised DNA topoisomerase II complex inhibits DNA and RNA synthesis --> Cardiomyopathy

Answer 205

Iriontecan SE: myelosuppression

Answer 206

Peripheral Neuropathy | Paralytic Ileus

Answer 207

HLA-A3 - Hereditary Haemochromatosis HLA-B51 - Behcet's Disease HLA-B27 - Ankylosing Spondylitis, Reactive Arthritis, Anterior Uveitis HLA-DR2 - Goodpasture's, Narcolepsy HLA-DR3 - Dermatitis Herpetiformis, Sjogren Syndrome, PBC HLA-DR4 - Rheumatoid Arthritis, T1DM (DRB1*04:01)

Answer 208

``` Tall stature Long fingers Downward lens dislocation Learning difficulties Unprovoked DVT at early age Malar flush ``` NOTE: it is an autosomal recessive condition caused by a deficiency of cystathione beta synthase that is screened for in neonatal screening. It is treated with pyridoxine supplements.

Answer 209

Diagnosed on prenatal ultrasound scan/early infancy Newborns have features of Potter sequence due to oligohydramnios End-stage renal failure in childhood

Answer 210

Riboflavin (Vitamin B2)

Answer 211

Chloramphenicol

Answer 212

Ciprofloxacin or Rifampicin

Answer 213

Age-related macular degeneration (most common) Glaucoma Cataracts

Answer 214

Cerebellar ataxia Telangiectasia Recurrent chest infections

Answer 215

Foramen rotundum - Maxillary Nerve (V2) Foramen ovale - Mandibular Nerve (V3) Jugular foramen - IX, X and XI

Answer 216

III IV V1 (Ophthalmic) VI

Answer 217

Atovaquone and Proguanil (Malarone) | Doxycycline (risk of photosensitivity)

Answer 218

Bezlotoxumab

Answer 219

Osteomyelitis GI bleed/perforation Meningitis Cholecystitis

Answer 220

Alcohol Phenytoin Salicylates (aspirin)

Answer 221

Left atrial pressure

Answer 222

Oral ciprofloxacin or norfloxacin for people with cirrhosis and ascites with an ascitic protein < 15 g/L until the ascites has resolved And patients who have had an episode of SBP

Answer 223

Autosomal recessive disorder of elastic fibres Retinal angioid streaks Plucked chicken skin appearance Increased risk of ischaemic heart disease GI haemorrhage

Answer 224

Pneumococcus Haemophilus type B Meningococcus type C

Answer 225

NOTE: it is a diagnosis of exclusion (ANA and RF negative) ``` Arthralgia Very high ferritin Salmon-pink maculopapular rash Pyrexia Lymphadenopathy ```

Answer 226

3rd Nerve Palsy with Pupil Dilation | Painful + Headache

Answer 227

``` Diabetes Mellitus Vasculitis (e.g. temporal arteritis) Posterior Communicating Artery Aneurysm Cavernous Sinus Thrombosis Weber Syndrome (ipsilateral third nerve palsy with contralateral hemiplegia - caused by midbrain strokes) ```

Answer 228

Give IV 0.9% saline at a rate of 1 mL/kg/hour for the 12 hours before and after the CT scan Metformin should be withheld for a minimum of 48 hours until renal function has been shown to be normal

Answer 229

Duloxetine Amitriptyline Pregabalin Gabapentin

Answer 230

Aspirin 75 mg OD from 12 weeks until birth

Answer 231

Rare complication of end-stage renal disease (vasculopathy of small blood vessels) Presents with painful necrotic skin lesions containing calcium deposits

Answer 232

It is haemoglobin that has been oxidised to the Fe3+ form and can no longer carry oxygen, resulting in global tissue hypoxia It may be congenital or may occur due to certain medications (e.g. sulphonamides, nitrates, sodium nitroprusside, dapsone, primaquine)

Answer 233

Cyanosis Shortness of breath Anxiety Normal pO2 with low SaO2 NOTE: it shifts the oxygen dissociation curve to the left and is treated using methylene blue

Answer 234

Complete heart block (irregular) AVNRT (regular) Ventricular tachycardia (with 1:1 atrial: ventricular contraction)

Answer 235

``` Large volume diarrhoea Weight loss Dehydration Hypokalaemia Hypochlorhydria ``` NOTE: 90% are seen in the pancreas (vasoactive intestinal peptide)

Answer 236

0 - Rapid Depolarisation - Rapid Na Influx 1 - Early Repolarisation - K Efflux 2 - Plateau - Slow Ca Influx 3 - Final Repolarisation - K Efflux 4 - Restoration of Ionic Concentrations - Na/K ATPase

Answer 237

Pegylated interferon | Others: tenofovir, entecavir, telbivudine

Answer 238

``` Barbiturate Lithium Alcohol (inc methanol, ethylene glycol) Salicylates Theophyllines (charcoal haemoperfusion is preferable) ```

Answer 239

``` TCAs benzodiazepines dextropropoxyphene (Co-proxamol) digoxin beta-blockers ```

Answer 240

``` Antibiotics (ciprofloxacin, tetracyclines, chloramphenicol, sulphonamides) Lithium Benzodiazepines Aspirin Carbimazole Methotrexate Sulfonylureas Amiodarone ```

Answer 241

Prostaglandin analogues (e.g. latanoprost) - increases uveoscleral outflow Beta-blockers (e.g. timolol) - reduced aqueous generation Sympathomimetics (e.g. brimonidine - a2 agonist) - reduces aqueous production and increases outflow Carbonic anhydrase inhibitors (e.g. dorzolamide) - reduces aqueous production Miotics (e.g. pilocarpine) - increases uveoscleral outflow

Answer 242

Raised urinary porphobilinogen

Answer 243

``` Fever, malaise, arthralgia Low grade fever Haematuria Livedo reticularis Mononeuritis multiplex ``` NOTE: associated with hep B and ANCA

Answer 244

Painful, asymmetrical, asynchronous sensory and motor peripheral neuropathy Involves isolated damage to at least 2 separate nerve areas Associated with diabetes mellitus, sarcoidosis, rheumatoid arthritis and polyarteritis nodosa

Answer 245

SEM = SD/sqrt(n)

Answer 246

Up to 25% decrease in GFR | Up to 30% rise in creatinine

Answer 247

To rule out hypokalaemia | All antiarrhythmics can cause arrhythmias and concomitant hypokalaemia massively increases the risk of that happening

Answer 248

If FBG < 7 - diet and exercise - If targets not met within 1-2 weeks, start metformin (glibenclamide is an alternative) - If targets still not met, start insulin If FBG > 7 - start insulin

Answer 249

Disease caused by hereditary lipoprotein lipase deficiency and apolipoprotein C deficiency that predisposes to recurrent attacks of acute pancreatitis.

Answer 250

Quinolones Metronidazole Sulphonamides Trimethoprim

Answer 251

``` Aminoglycosides Chloramphenicol Macrolides Tetracyclines Fusidic Acid ```

Answer 252

``` French-American-British (FAB) L1 type Common ALL Pre-B phenotype Low initial WBC del(9p) Hyperdiploidy ```

Answer 253

Ribavirin - guanosine analogue, interferes with capping of viral mRNA Amantadine - M2 inhibitor prevents virus uncoating within cells Oseltamivir - neuraminidase inhibitor Foscarnet - inhibits viral DNA polymerase Interferon Alpha - inhibits mRNA synthesis Cidofovir - DNA polymerase inhibitor

Answer 254

Down-sloping ST depression (reverse tick) Flattened/inverted T waves Short QT interval Arrhythmias (e.g. AV block, bradycardia)

Answer 255

C282Y | H63D

Answer 256

Type 1: Cryoglobulinaemia, Hepatitis C | Type 2: Partial Lipodystrophy (associated with low C3)

Answer 257

1st: Prostaglandin analogue (e.g. latanoprost) 2nd: Beta-blocker (e.g. timolol), sympathomimetic (e.g. brimonidine) or carbonic anhydrase inhibitor 3rd: surgery or laser

Answer 258

ECG Azithromycin can prolong QT interval

Answer 259

Vincristine - inhibits microtubule formation | Docetaxel - inhibits microtubule disassembly

Answer 260

Dix-Hallpike - Diagnostic | Epley - Therapeutic

Answer 261

Kimmelstiel-Wilson lesions (nodular glomerulosclerosis) | Hyaline arteriosclerosis

Answer 262

Unilateral (80% of cases) benign dilated pupil Once constricted, the pupil remains small for a long time Slow reaction to accommodation and none to light Associated with absent knee/ankle reflexes

Answer 263

``` NF1 - Cafe au lait spots - Axillary freckling - Peripheral neurofibromas - Lisch nodules - Scoliosis - Phaeochromocytomas NF2 - Bilateral vestibular schwannomas - Meningiomas and Ependyomas ```

Answer 264

``` Multiple CNS hamartomas Subependymal giant cell astrocytomas Renal angiomyolipomas Cardiac rhabdomyomas Facial angiofibromas Shagreen patches Retinal astrocytic hamartomas ```

Answer 265

Chromosome 6

Answer 266

Von Gierke disease (type I) - glucose-6-phosphatase - hypoglycaemia, lactic acidosis and hepatomegaly (hepatic glycogen accumulation) Pompe's disease (type II) - lysosomal alpha-1,4-glucosidase - cardiac, hepatic and muscle glycogen accumulation, leads to cardiomegaly Cori disease (type III) - alpha-1,6-glucosidase - hepatic and cardiac glycogen accumulation, leads to muscle hypotonia McArdle Disease (type V) - glycogen phosphorylase - skeletal muscle glycogen accumulation, leads to myalgia and myoglobinuria with exercise and second wind phenomenon

Answer 267

Gaucher - beta-glucocerebrosidase - most common, hepatosplenomegaly and avascular necrosis of femur Tay-Sachs - Hexosaminidase A - accumulation of G2 ganglioside in lysosomes, leads to developmental delay, cherry red spot on macula, NORMAL liver and spleen Nieman-Pick - sphingomyelinase - hepatosplenomegaly and cherry spot on macula Fabry - alpha-galactosidase A - angiokeratomas, renal failure, peripheral neuropathy of extremities Krabbe - galactocerebrosidase - peripheral neuropathy, optic atrophy and globoid cells Metachromatic leukodystrophy - arylsulfatase A - demyelination of CNS and PNS

Answer 268

Hurler Syndrome (type I) - leads to gargoylism, hepatosplenomegaly and corneal clouding Hunter Syndrome (type II) - coarse facial features, behavioural problems, short stature, no corneal clouding NOTE: both are caused by accumulation of glycosaminoglycans

Answer 269

Subthalamic nucleus of basal ganglia

Answer 270

``` ECG abnormalities in V1-3 (TWI) Epsilon wave (terminal notch in QRS complex) ```

Answer 271

Form of inherited (AD) cardiac disease associated with sudden death Exercise or exertion leads to VT and syncope Generally presents < 20 years

Answer 272

``` Thiazides Tetracyclines Ciprofloxacin Amiodarone NSAIDs Sulphonylureas ```

Answer 273

``` Arterial pH < 7.3 more 24 hours after ingestion Or all of the following - PT > 100 seconds - Creatinine > 300 - Grade III or IV Encephalopathy ```

Answer 274

Alpha - hepatitis B/C, Kaposi sarcoma, metastatic renal cell carcinoma, hairy cell leukaemia Beta - relapsing-remitting MS Gamma - chronic granulomatous disease, osteopetrosis

Answer 275

Antimuscarinic used to treat Parkinson's disease (particularly drug-induced Parkinsonism)

Answer 276

Blockage or loss of function of potassium channels

Answer 277

Antithyroid (carbimazole, propylthiouracil) Antipsychotics (clozapine) Antiepileptics (clozapine) Antibiotics (penicillin, choramphenicol) Antidepressant (mirtazapine)

Answer 278

Lung distention is detected by stretch receptors in the lungs which causes slowing of the respiratory rate NOTE: this prevent the lungs from overexpanding during inspiration

Answer 279

``` Ageing Smoking Increased alcohol consumption Trauma Diabetes mellitus Long-term corticosteroids Radiation exposure Myotonic dystrophy Metabolic disorders: hypocalcaemia ```

Answer 280

Combination of protease inhibitors (e.g. sofosbuvir + daclatasvir) with or without ribavirin TARGET: sustained virologic response (undetectable serum HCV RNA 6 months after ending therapy)

Answer 281

von Hippel Lindau - 3 Tuberous Sclerosis - 16 NF1 - 17 NF2 - 22

Answer 282

``` subacute combined degeneration of the cord motor neuron disease Friedreich's ataxia syringomyelia taboparesis (syphilis) conus medullaris lesion ```

Answer 283

Mucosal ulceration is common Blisters are flaccid, easily ruptured bullae Nikolsky sign positive Acantholysis on biopsy

Answer 284

Definition; uncontrolled inflammatory state associated with systemic autoimmune diseases (e.g. JIA) Features: Refractory fever, hepatosplenomegaly Pathophysiology: caused by abnormal interferon-gamma activity which activates macrophages

Answer 285

Anti-PLA2R Secondary causes include: Malignancy such as solid tumours (lung, colon, breast, kidney) Infections: hepatitis B or C, HIB, malaria, syphilis, schistosomiasis Autoimmune diseases: SLE, sarcoidosis, IBD Drugs: NSAID's, captopril, gold, penicillamine, lithium, clopidogrel

Answer 286

0 Fully active, able to carry on all pre-disease performance without restriction 1 Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light house work, office work 2 Ambulatory and capable of all selfcare but unable to carry out any work activities; up and about more than 50% of waking hours 3 Capable of only limited selfcare; confined to bed or chair more than 50% of waking hours 4 Completely disabled; cannot carry on any selfcare; totally confined to bed or chair 5 Dead

Answer 287

hypersensitivity pneumonitis (also known as extrinsic allergic alveolitis) coal worker's pneumoconiosis/progressive massive fibrosis silicosis sarcoidosis ankylosing spondylitis (rare) histiocytosis tuberculosis

Answer 288

idiopathic pulmonary fibrosis most connective tissue disorders (except ankylosing spondylitis) e.g. SLE drug-induced: amiodarone, bleomycin, methotrexate asbestosis

Answer 289

Stimulates insulin release It is good for post-prandial hyperglycaemia and for erratic lifestyles and is less likely to cause hypoglycaemia than sulfonylureas

Answer 290

Head, arm, trunk = central lesion: stroke, syringomyelia Just face = pre-ganglionic lesion: Pancoast's, cervical rib Absent = post-ganglionic lesion: carotid artery

Answer 291

Type of Guillain Barre Syndrome that primarily affects the cranial nerves Presents with ataxia, ophthalmoplegia, areflexia and descending paralysis. Associated with antiganglioside antibodies GQ1b and GT1a

Answer 292

It is used when risk is not constant to time | It is usually used when assessing survival over time

Answer 293

``` 1 = BHL 2 = BHL + infiltrates 3 = infiltrates 4 = fibrosis ```

Answer 294

Presentation of sarcoidosis characterised by the presence of the following symptoms: - BHL - Erythema nodosum - Polyarthritis - Fever

Answer 295

``` U waves Small or absent T waves (occasionally inverted) Prolonged PR interval ST depression Long QT ```

Answer 296

Trypanosoma chancre (painless subcutaneous nodule at site of infection) Intermittent fever Enlarged posterior cervical lymph nodes CNS involvement (somnolence, headache, reversal or sleep-wake cycle) Treated with IV pentamidine and suramin. IV melarsoprol used for CNS involvement.

Answer 297

``` Myocarditis leading to dilated cardiomyopathy GI features (megaoesophagus and megacolon) ``` Treated with benznidazole or nifurtimox

Answer 298

``` Bradycardia J wave (hump at end of QRS complex) First degree heart block Long QT Atrial and ventricular arrhythmias ```

Answer 299

Potent topical steroid (e.g. clobetasol) Description of rash: papular, polygonal, violaceous, flat-topped rash is present on the palms, in her elbow creases and on the soles of her feet

Answer 300

Folate deficiency anaemia

Answer 301

At least 3 of the following: elevated waist circumference: men > 102 cm, women > 88 cm elevated triglycerides: > 1.7 mmol/L reduced HDL: < 1.03 mmol/L in males and < 1.29 mmol/L in females raised blood pressure: > 130/85 mmHg, or active treatment of hypertension raised fasting plasma glucose > 5.6 mmol/L, or previously diagnosed type 2 diabetes

Answer 302

8 hours (risk of biphasic reaction)

Answer 303

``` Fever > 38.9 Hypotension (SBP < 90 mm Hg) Diffuse erythematous rash Desquamation of skin on palms and soles Involvement of three or more organ systems (e.g. gastrointestinal, renal, hepatitis, thrombocytopaenia, CNS, mucous membrane) ```

Answer 304

``` Riedel's thyroiditis Previous radiotherapy Sarcoidosis Inflammatory abdominal aortic aneurysm Drugs: methysergide ```

Answer 305

Amiodarone Cytotoxic agents: busulphan, bleomycin Anti-rheumatoid drugs: methotrexate, sulfasalazine Nitrofurantoin Ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, pergolide)

Answer 306

Rate at which a gas will diffuse from alveoli into blood. Carbon monoxide is used to test the rate of diffusion. KCO is adjusted for lung volume

Answer 307

HIGH - Asthma - Pulmonary Haemorrhage - Left-to-Right Shunts - Polycythaemia - Hyperkinetic States - Exercise LOW - Pulmonary Fibrosis - Pneumonia - PE - Pulmonary Oedema - Emphysema - Anaemia - Low Cardiac Output

Answer 308

``` sulfonylureas* SSRIs, tricyclics carbamazepine vincristine cyclophosphamide ```

Answer 309

Dapsone and other sulfones (higher doses for dermatitis herpetiformis more likely to cause problems) Fluoroquinolones (including ciprofloxacin, moxifloxacin, norfloxacin, and ofloxacin) Methylthioninium chloride Niridazole [not on UK market] Nitrofurantoin Pamaquin [not on UK market] Primaquine (30 mg weekly for 8 weeks has been found to be without undue harmful effects in African and Asian people) Quinolones (such as nalidixic acid [not on UK market]) Rasburicase Sulfonamides (including co-trimoxazole; some sulfonamides, e.g. sulfadiazine, have been tested and found not to be haemolytic in many G6PD-deficient individuals)

Answer 310

MEN1 - MEN1 Gene | MEN2 - RET Oncogene

Answer 311

Diffuse proliferative glomerulonephritis

Answer 312

Multiple, small, well-rounded nodules particularly in the upper zones Eggshell calcification may be seen

Answer 313

AKA Katayama Fever - Fever - Urticaria - Arthralgia/Myalgia - Cough - Diarrhoea - Eosinophilia

Answer 314

EARLY: fever, subconjunctival suffusion/haemorrhage LATER (Weil's Disease) - AKI (common) - Hepatitis (jaundice, hepatomegaly) - Aseptic meningitis

Answer 315

Caused by Leptospira interrogans (spirochete) Treated with benzylpenicillin or doxycycline

Answer 316

If triple therapy is ineffective, consider combination therapy with metformin, a sulfonylurea and GLP-1 agonist if: - BMI >= 35 kg/m² and specific psychological or other medical problems associated with obesity or - BMI < 35 kg/m² and for whom insulin therapy would have significant occupational implications or weight loss would benefit other significant obesity-related comorbidities

Answer 317

``` Bladder cancer Fluid retention (can't be used in heart failure) ```

Answer 318

Nitrofurantoin 2nd line: amoxicillin, cefalexin

Answer 319

Thallium SPECT CNS Lymphoma = positive Toxoplasmosis = negative

Answer 320

``` Higher Risk (Lipophilic): Simvastatin, Atorvastatin Lower Risk (Hydrophilic): Rosuvastatin, Pravastatin, Fluvastatin ```

Answer 321

Metronidazole NOTE: stool microscopy is often negative in giardia

Answer 322

Thyroid lymphoma (MALT Lymphoma)

Answer 323

Live Attenuated - BCG - MMR - Influenza (intranasal) - Rotavirus - Polio - Yellow Fever - Typhoid Inactivated - Rabies - Hepatitis A - Influenza (intramuscular) Toxoid - DTP Subunit or Conjugate - Pneumococcus - Meningococcus - Haemophilus - HPV - Hepatitis B

Answer 324

ASD: Ejection systolic murmur loudest on inspiration VSD: Pansystolic

Answer 325

Respiratory failure due to interstitial lung disease and pulmonary hypertension

Answer 326

Drowsy, headache, confusion, SOB Ix: lactic acidosis, high pO2 (incl. venous), normal SaO2 Rx: IV Hydroxocobalamin (others include amylnitrate, sodium nitrite and sodium thiosulfate) NOTE: cyanide an come from insecticides, photograph development, production of certain metals and burning plastic

Answer 327

Verapamil (can trigger drop in blood pressure, VF and cardiac arrest) NOTE: thought a broad complex tachycardia may be caused by SVT with aberrant conduction, verapamil should still not be used

Answer 328

``` isoniazid procainamide hydralazine dapsone sulfasalazine ``` NOTE: 50% of the UK population are deficient in hepatic N-acetyltransferase

Answer 329

Decreased temperature Decreased 2,3-DPG Decreased [H+] Carboxyhaemoglobin

Answer 330

> 12% increase in FEV1 which is also at leas a 200 mL increase

Answer 331

Usually IgG and occurs at body temperature - Autoimmune diseases (e.g. SLE) - Malignancy (lymphoma, CLL) - Drugs (e.g. methyldopa)

Answer 332

Usually IgM and causes haemolysis at 4 degrees (haemolysis is mediated by complement and is more commonly intravascular) - Infections (e.g. EBV, mycoplasma) - Lymphoma NOTE: symptoms may include Raynaud's and acrocyanosis (blue colouration of the hands)

Answer 333

Ascending weakness Reduced or absent reflexes Mild/no sensory symptoms

Answer 334

Symptomatic/haemodynamically unstable bradycardia, not responding to atropine Post-ANTERIOR MI: type 2 or complete heart block* Trifascicular block prior to surgery NOTE: post-inferior MI complete heart block is NOT an indication for pacing if the patient is asymptomatic and haemodynamically stable

Answer 335

Gram-positive coccobacilli NOTE: can occasionally be Gram-negative NOTE: lactobacillus is responsible for the acidic environment of the vagina

Answer 336

Impaired glucose tolerance (can lead to DM) NOTE: interferon alpha can also impair glucose tolerance

Answer 337

Hydrogen breath test | Small bowel aspiration and culture

Answer 338

Rifaximin Alternative: co-amoxiclav, metronidazole

Answer 339

Fever Rash Tachycardia NOTE: there is NO wheeze or hypotension

Answer 340

First-Line: Ropinirole | Alternatives: Benzodiazepines and Gabapentin

Answer 341

``` Echinococcus granulosus (dog) Taenia solium (pig) ``` Treated with bendazoles

Answer 342

Strongyloides stercoralis - diarrhoea, abdominal pain, vesicular lesions where skin has been penetrated by infective larvae Enterobium vermicularis (pinworm) - perianal itching Ancylostoma duodenale - gastrointestinal upset Loa Loa - itchy swellings below the skin Trichinella spiralis - fever, periorbital oedema, myositis Onchocerca volvulus - river blindness, hyperpigmented skin Wucheria bancrofti - elephantiasis Toxocara canis - blindness Ascaris lumbricoides - intestinal obstruction

Answer 343

Schistosoma haematobium - haematuria, bladder cancer Paragonimus westermani - leads to bacterial lung infection Clonorchis sinensis - biliary tract inflammation Fasciola hepatica (liver fluke) - biliary obstruction

Answer 344

Beta-2 Microglobulin

Answer 345

antiepileptics: phenytoin, carbamazepine barbiturates: phenobarbitone rifampicin St John's Wort chronic alcohol intake griseofulvin smoking (affects CYP1A2, reason why smokers require more aminophylline)

Answer 346

``` antibiotics: ciprofloxacin, erythromycin isoniazid cimetidine,omeprazole amiodarone allopurinol imidazoles: ketoconazole, fluconazole SSRIs: fluoxetine, sertraline ritonavir sodium valproate acute alcohol intake quinupristin ```

Answer 347

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy Genetic condition due to mutation in NOTCH3 Presentation: migraines in middle age, recurrent TIAs/strokes leading to neuro-cognitive decline, psychaitric problems and dementia MRI shows multiple hyperintense lesions

Answer 348

Rare complication of malaria Results in large intravascular haemolysis leading to haemoglobinuria, anaemia, jaundice and AKI. Urine is dark and hepatosplenomegaly may be noted. Unknown cause.

Answer 349

Sudden painless unilateral visual loss Afferent pupillary defect and cherry red spot on pale retina NOTE: can be caused by thromboembolism or arteritis (e.g. GCA)

Answer 350

``` GBS Myasthenia Gravis Goodpasture syndrome ANCA positive vasculitis TTP/HUS Cryoglobulinaemia Hyperviscosity syndrome (e.g. due to myeloma) ```

Answer 351

``` Hypocalcaemia (due to binding of calcium to sodium citrate anticoagulant during procedure) Metabolic alkalosis Removal of medications Coagulation factor depletion Ig depletion ```

Answer 352

Rats NOTE: it is a viral haemorrhagic fever

Answer 353

Vertigo Hearing Loss Tinnitus Absent Corneal Reflex

Answer 354

``` Androgen insensitivity syndrome Becker muscular dystrophy Colour blindness Duchenne muscular dystrophy Fabry's disease G6PD deficiency Haemophilia A,B Hunter's disease Lesch-Nyhan syndrome Nephrogenic diabetes insipidus Ocular albinism Retinitis pigmentosa Wiskott-Aldrich syndrome ```

Answer 355

Nodular Sclerosing Mixed Cellularity Lymphocyte Predominant Lymphocyte Depleted

Answer 356

Doxycycline 7 days If pregnant: azithromycin, erythromycin or amoxicillin

Answer 357

First-Line: Beta-Blocker or Rate-Limiting CCB Second-Line: Add whichever hasn't been used so far (e.g. non-rate limiting CCB) Alternatives: nicorandil, ivabradine, ranolazine, isosorbide mononitrate

Answer 358

Paraesthesia

Answer 359

Head/leg movements Posturing Post-ictal weakness Jacksonian march

Answer 360

Li Fraumeni - early onset breast cancer, sarcoma, leukaemia, adrenal tumours (p53 mutation) Gorlin - multiple BCC, medulloblastoma Lynch - colorectal cancer, endometrium, ovary, stomach, small intestine, hepatobiliary tract, brain and skin Von Hippel Lindau - hemangioblastoma, renal cyst, renal cell carcinoma, pancreatic neuroendocrine tumours, phaeochromocytomas and endolymphatic sac tumours

Answer 361

``` Intravascular haemolytic anaemia Cytopaenia Haemoglobinuria Thrombosis (e.g. Budd-Chiari) Aplastic anaemia (in some patients) ``` NOTE: treated with blood products and anticoagulation

Answer 362

Dermatomyositis - Anti-Mi2 Mixed Connective Tissue Disease - Anti-RNP Sjogren Syndrome - Anti-Ro Limited Scleroderma - Anti-Centromere Diffuse Scleroderma - Anti-Scl70 (topoisomerase II)

Answer 363

Bohr - increasing acidity means that O2 binds less well to Hb Haldane - increased pO2 means that CO2 binds less well to haemoglobin

Answer 364

Ischaemic retinopathy associated with pancreatitis, head trauma, fat embolisation and vasculitic diseases

Answer 365

``` ACR = 70 mg/mmol PCR = 100 mg/mmol ```

Answer 366

combined oral contraceptive pill antibiotics: flucloxacillin, co-amoxiclav, erythromycin* anabolic steroids, testosterones phenothiazines: chlorpromazine, prochlorperazine sulphonylureas fibrates rare reported causes: nifedipine

Answer 367

male-pattern baldness drugs: cytotoxic drugs, carbimazole, heparin, oral contraceptive pill, colchicine nutritional: iron and zinc deficiency autoimmune: alopecia areata telogen effluvium hair loss following stressful period e.g. surgery trichotillomania

Answer 368

IVIG (better than plasma exchange) Consider steroids and immunosuppressants FVC monitoring

Answer 369

c-Myc - Burkitt's Lymphoma t(8;14) | n-Myc - Neuroblastoma

Answer 370

Variable intensity of S1 Other features: heart failure, bradycardia, wide pulse pressure, cannon a waves

Answer 371

Leukotriene receptor antagonists

Answer 372

Tetracyclines Aminoglycosides Sulphamides and Trimethoprim Quinolones

Answer 373

``` Drug (diuretics, PPI) Diarrhoea Alcohol Hypokalaemia Hypercalcaemia (Ca and Mg compete for transport in the thick ascending limb of loop of Henle) Gitelman/Bartter TPN ```

Answer 374

Acute onset unilateral severe pain followed by shoulder and scapular weakness several days later. Minimal sensory changes. Triggers include trauma, infection, surgery and vaccination.

Answer 375

1. Clindamycin 2. Cephalosporins 3. Ciprofloxacin

Answer 376

5HT2 Receptor | D2 Receptor

Answer 377

Mixed respiratory alkalosis and metabolic acidosis Sweaty and confused Pulmonary oedema is a bad sign (require haemodialysis)

Answer 378

``` amiodarone isoniazid vincristine nitrofurantoin metronidazole ```

Answer 379

Sudden painless loss of vision | Dense shadow starting peripherally and progressing centrally

Answer 380

Acanthosis nigricans

Answer 381

Acquired icthyosis | Erythroderma

Answer 382

Acquired hypertrichosis lanuginosa

Answer 383

Dermatomyositis Lung cancer only: erythema gyratum repens

Answer 384

Migratory thrombophlebitis

Answer 385

Necrolytic migratory erythema

Answer 386

Pyoderma gangrenosum

Answer 387

Sweet syndrome - sudden onset of fever and painful rash on the arms, legs, trunk, face, or neck. It's also known as acute febrile neutrophilic dermatosis

Answer 388

First-Line: amitriptyline, duloxetine, gabapentin or pregabalin (don't add) Tramadol rescue therapy Topical capsaicin for localised neuropathic pain

Answer 389

JAK2 CALR Treated with aspirin and hydroxycarbamide

Answer 390

``` Huntington's disease, Wilson's disease, ataxic telangiectasia SLE, anti-phospholipid syndrome rheumatic fever: Sydenham's chorea drugs: oral contraceptive pill, L-dopa, antipsychotics neuroacanthocytosis pregnancy: chorea gravidarum thyrotoxicosis polycythaemia rubra vera carbon monoxide poisoning cerebrovascular disease ```

Answer 391

``` Fragile X (CGG) Huntington's (CAG) myotonic dystrophy (CTG) Friedreich's ataxia* (GAA) spinocerebellar ataxia spinobulbar muscular atrophy dentatorubral pallidoluysian atrophy ```

Answer 392

Agonist of 5HT1B and 1D

Answer 393

Lethargy Arthralgia (with chondrocalcinosis) Diabetes mellitus

Answer 394

5HT3 Antagonist

Answer 395

``` BPPV Viral Labyrinthitis Vestibular Neuronitis Meniere's Disease Vertebrobasilar ischaemia Acoustic neuroma Posterior circulation stroke ```

Answer 396

Bull's Eye Retinopathy Therefore, it requires regular eye checks

Answer 397

Nitrates ACE inhibitors Inotropes

Answer 398

Stop precipitating factor Supportive care IVIG (first line) Alternatives: immunosuppressive medication

Answer 399

FLAIR: Suppresses water (does not appear bright). Used for periventricular and cortical lesions in multiple sclerosis. STIR: Suppresses fat. Shows bright signal in acutely inflamed tissues. Used in flares of thyroid eye disease.

Answer 400

``` Antiarrhythmics (amiodarone, sotalol, class 1) TCA Antipsychotics Chloroquine Erythromycin ```

Answer 401

ARB > ACEi

Answer 402

Chronic diarrhoea resulting from excessive production of bile acids or reduced reabsorption. May be secondary to Crohn's disease, coeliac disease, SIBO or cholecystectomy Ix: SeHCAT Rx: Cholestyramine

Answer 403

Hypertension Hypercalcaemia Haematuria

Answer 404

Acalculia Right-Left Disorientation Finger Agnosia Agraphia Caused by lesion in the angular and supramarginal gyri between the dominant parietal and temporal lobes

Answer 405

Troponin I: Binds to actin to hold the troponin-tropomyosin complex in place Troponin T: Binds to tropomyosin to help position it on the actin Troponin C: Binds calcium ions

Answer 406

Type I: ANA, ASMA (Adults and Children) Type II: Anti-LKM1 (Children Only) Type III: Soluble Liver Antigen (Adults Only)

Answer 407

Iron Calcium Carbonate NOTE: give at least 4 hours apart

Answer 408

Aspirin or sulphonamides

Answer 409

Severe arthralgia

Answer 410

``` age > 55 years hypocalcaemia < 2 hyperglycaemia > 10 hypoxia (PaO2 < 7.9) neutrophilia (WCC > 15) elevated LDH (> 600) urea > 16 albumin < 32 ```

Answer 411

Patients with a pO2 of < 7.3 kPa or to those with a pO2 of 7.3 - 8 kPa and one of the following: - secondary polycythaemia - nocturnal hypoxaemia - peripheral oedema - pulmonary hypertension

Answer 412

non-specific: fever, malaise hepatosplenomegaly sacroiliitis: spinal tenderness may be seen complications: osteomyelitis, infective endocarditis, meningoencephalitis, orchitis leukopenia often seen Ix: Brucella serology Rx: doxycycline and streptomycin

Answer 413

primary and secondary immunodeficiency idiopathic thrombocytopenic purpura myasthenia gravis Guillain-Barre syndrome Kawasaki disease toxic epidermal necrolysis pneumonitis induced by CMV following transplantation low serum IgG levels following haematopoietic stem cell transplant for malignancy dermatomyositis chronic inflammatory demyelinating polyradiculopathy

Answer 414

``` microaneurysms (dots) blot haemorrhages (<=3) hard exudates ```

Answer 415

1 - small painless pustule which later forms an ulcer 2 - painful inguinal lymphadenopathy 3 - proctocolitis

Answer 416

Activating PPAR alpha receptors resulting in an increase in LPL activity reducing triglyceride levels

Answer 417

``` Avoid sun Topical 5-FU Topical diclofenac Cryotherapy Curettage ```

Answer 418

Doxycycline | Ciprofloxacin

Answer 419

Subset of sarcoidosis Parotid enlargement Fever Anterior uveitis

Answer 420

1. Topical Aminosalicylate 2. Oral Aminosalicylate (after 4 weeks) 3. Topical or Oral Steroid

Answer 421

Rifampicin, dapsone and clofazimine for 12 months

Answer 422

1. Low-dose aspirin should be commenced once the pregnancy is confirmed on urine testing 2. LMWH once a fetal heart is seen on ultrasound. This is usually discontinued at 34 weeks gestation

Answer 423

``` Massive Splenomegaly Fever Weight Loss Pancytopaenia Darkened Skin ``` NOTE: spread by bites of sand flies

Answer 424

Vomiting Thiazide and Loop Diuretics Cushing Syndrome Conn Syndrome

Answer 425

4 weeks If a subsequent echocardiogram shows a structurally abnormal heart, they should be considered for long-term anticoagulation

Answer 426

Topical Ketoconazole

Answer 427

``` coeliac disease tropical sprue hypogammaglobulinaemia gastrointestinal lymphoma Whipple's disease cow's milk intolerance ```

Answer 428

Loratadine (LEAST sedating) | Cetirizine

Answer 429

1. Hydrogen Peroxide Cream 2. Topical Fusidic Acid or Topical Mupirocin Oral flucloxacillin if severe

Answer 430

Hydroxychloroquine

Answer 431

``` Aschoff bodies (granuloma with giant cells) Anitschkow cells (enlarged macrophages with wavy rod-like nucleus) ```

Answer 432

Vortex keratopathy (corneal opacities)

Answer 433

Impaired vertical gaze Parkinsonism Postural instability and falls Cognitive impairment

Answer 434

Toxocara Canis

Answer 435

They all block sodium channels, but in addition: Ia - increases action potential (AP) duration (procainamide, disopyramine Ib - decreases AP duration (lidocaine) Ic - no effect on AP duration (flecainide, propafenone)

Answer 436

V2 receptor mutation (most common) | Aquaporin 2 channel mutation

Answer 437

Minocycline - darkening of skin | Doxycycline/Tetracycline - photosensitivity

Answer 438

drugs: minoxidil, ciclosporin, diazoxide congenital hypertrichosis lanuginosa, congenital hypertrichosis terminalis porphyria cutanea tarda anorexia nervos NOTE: hypertrichosis is when hair grows anywhere, whereas hirsutism is when women develop male pattern facial hair

Answer 439

Ovarian fibroma Ascites Pleural effusion

Answer 440

``` thiazides, furosemide (less common) steroids tacrolimus, ciclosporin interferon-alpha nicotinic acid antipsychotics ```

Answer 441

Dihydropyridine CCB (e.g. felodipine)

Answer 442

``` Streptococci spp. Staphylococcus aureus Eikenella Fusobacterium Prevotella ```

Answer 443

5-HT2 Receptor Antagonist It is used in peripheral vascular disease as it increases blood flow to the peripheries

Answer 444

Anti-phospholipase A2

Answer 445

Basement membrane is thickened with subepithelial electron dense deposits (creating spike and dome appearance)

Answer 446

Neurokinin 1 receptor blocker Used as an anti-emetic

Answer 447

IV 3rd generation cephalosporin and metronidazole

Answer 448

C4 (low) NOTE: C1-INH is low during an attack

Answer 449

Secretin stimulation test

Answer 450

``` Fluid retention Hypertension Hyperkalaemia Hypertrichosis Gingival Hyperplasia Tremor Impaired Glucose Tolerance Nephro/Hepatotoxic ```

Answer 451

damage to T1 loss of intrinsic hand muscles due to traction

Answer 452

damage to C5,6 roots winged scapula may be caused by a breech presentation

Answer 453

Congenital heart block, rash and hepatosplenomegaly | Associated with Anti-Ro

Answer 454

Benedikt: occlusion of the posterior cerebral artery is a possible cause. It causes 3rd nerve palsy, cerebellar ataxia and movement disorders (including tremor and chorea). Millard-Gubler: ipsilateral 6th and 7th nerve palsies and contralateral hemiparesis. Nothnagel: ipsilateral 3rd nerve palsy and limb ataxia Weber: contralateral hemiparesis and a 3rd nerve palsy

Answer 455

Converts uric acid to allantoin

Answer 456

Ticagrelor NOTE: if patients experience this side-effect, it can be switched for clopidogrel

Answer 457

Cerebral calcification Chorioretinitis NOTE: patients may present later in life

Answer 458

Co-trimoxazole Steroids if pO2 < 9.3 kPa NOTE: IV pentamidine in severe cases (risk of pneumothorax)

Answer 459

Klebsiella granulomatis Gram-negative bacillus that causes painless ulcer. Swab reveals mononuclar cells containing Donovan bodies

Answer 460

Transoesophageal echocardiogram

Answer 461

Tremor Alopecia Hepatotoxicity

Answer 462

Profuse, bloody diarrhoea after a long incubation period Ix: hot stool sent for microscopy Rx: Metronidazole

Answer 463

Mutation affecting beta-myosin heavy chain protein

Answer 464

Flu-like illness --> brief remission --> jaundice and haematemesis

Answer 465

Type 1: Goitre + Treated with Carbimazole or Potassium Perchlorate Type 2: NO Goitre + Treated with Steroids

Answer 466

myasthenia gravis (30-40% of patients with thymoma) red cell aplasia dermatomyositis also : SLE, SIADH

Answer 467

``` perioral dermatitis: red, crusted lesions acrodermatitis enteropathica alopecia short stature hypogonadism hepatosplenomegaly geophagia (ingesting clay/soil) cognitive impairment ```

Answer 468

Dark spots (scotomas) in the vision initially followed by painless loss of vision Associated with diabetic retinopathy

Answer 469

Erythematous papulo-ulcerative lesion at site of bite with reactive and ulcerating regional lymphadenopathy Transmitted by rabbits, hares, pikas, beavers and ticks Treated with doxycycline (F. tularensis)

Answer 470

``` Hypokalaemia Hypomagnesemia Hypercalcaemia Hypernatraemia Acidosis Renal impairment Hypoalbuminaemia ```

Answer 471

Goodpasture's syndrome | ANCA positive vasculitis (e.g. Wegener's)

Answer 472

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

Answer 473

post-streptococcal glomerulonephritis subacute bacterial endocarditis systemic lupus erythematosus mesangiocapillary glomerulonephritis

Answer 474

Check INR 72 hours before the procedure, and proceed if it is less than 4.0

Answer 475

Chondrosarcoma and Osteosarcoma

Answer 476

Livedo reticularis Eosinophilia Purpura Renal failure NOTE: it tends to occur after a precipitating event such as AAA repair

Answer 477

Direct thrombin inhibitor (e.g. argatroban) | Danaparoid

Answer 478

All patients should receive an ACEi or ARB | Immunosuppression may be considered in some

Answer 479

parenchymal lung disease uveitis hypercalcaemia neurological or cardiac involvement

Answer 480

Type I monoclonal - IgG or IgM associations: multiple myeloma, Waldenstrom macroglobulinaemia Type II mixed monoclonal and polyclonal: usually with rheumatoid factor associations: hepatitis C, rheumatoid arthritis, Sjogren's, lymphoma Type III polyclonal: usually with rheumatoid factor associations: rheumatoid arthritis, Sjogren's

Answer 481

Ultrasound with Doppler flow studies

Answer 482

Sclerosing cholangitis due to infections such as CMV, Cryptosporidium and Microsporidia

Answer 483

Blocking the AV node may enhance the rate of conduction through the accessory pathway Use flecainide instead

Answer 484

``` Tricuspid regurgitation Pansystolic murmur (louder on inspiration) ``` ECG changed include RBBB and WPW syndrome

Answer 485

SLE TB Malaria HIV

Answer 486

Bronchial alveolar lavage with silver staining

Answer 487

sacroiliitis: subchondral erosions, sclerosis squaring of lumbar vertebrae 'bamboo spine' (late & uncommon) syndesmophytes: due to ossification of outer fibers of annulus fibrosus chest x-ray: apical fibrosis

Answer 488

Uterine fibroids (ectopic production of erythropoietin)

Answer 489

Axillary nerve

Answer 490

Stop metformin and other oral agents | Start IV insulin infusion

Answer 491

Balcofen | Gabapentin

Answer 492

Aminophyllines NOTE: dipyridamole increases the effect of adenosine

Answer 493

Mild hypothyroidism Goitre Bilateral sensorineural deafness NOTE: it is autosomal recessive

Answer 494

``` Cerebellar signs Mixed upper and lower motor neurone signs Pes cavus Optic atrophy Normal IQ ``` NOTE: it is an autosomal recessive trinucleotide repeat disorder

Answer 495

Sudden painless loss of vision | Fundoscopy finding of retinal haemorrhages in the affected eye

Answer 496

Herpes simplex | Chancroid

Answer 497

Syphilis | LGV

Answer 498

Caudate nucleus of the basal ganglia

Answer 499

Follicular keratin plugs NOTE: it also causes scarring alopecia, is photosensitive and usually presents between 20-40 years

Answer 500

``` Staphylococcus aureus Staphylococcus epidermidis (if within 2 months of valve replacement) ```

Answer 501

Binds with ergosterol, a component of fungal cell membranes, forming pores that cause lysis of the cell wall and subsequent fungal cell death

Answer 502

inhibits synthesis of beta-glucan, a major fungal cell wall component.

Answer 503

Dilation of the aortic sinuses (predisposes to dissection)

Answer 504

Native valve: Amoxicillin (consider low-dose gentamicin) Native valve but penicillin allergic: vancomycin + gentamicin Prosthetic valve: vancomycin + rifampicin + gentamicin

Answer 505

Chlorpromazine | Haloperidol

Answer 506

Saccharopolyspora rectivirgula

Answer 507

Nitrates | Nicorandil

Answer 508

Frankly purulent or turbid/cloudy pleural fluid Identification of organisms upon staining pH < 7.2

Answer 509

Paraneoplastic condition associated with breast cancer characterised by rapid eye movements, myoclonus and ataxia NOTE: associated with anti-Ri antibody

Answer 510

Oral ciprofloxacin

Answer 511

CT Pancreas

Answer 512

Chloroquine or ACT Primaquine should also be given following acute treatment to destroy liver hypnozoites

Answer 513

Deletion of chromosome 5 or 7

Answer 514

3-6 months until stable then 6 monthly

Answer 515

Ostium primum: RBBB with LAD, long PR | Ostium secundum: RBBB with RAD

Answer 516

Topical antibiotic (e.g. gentamicin) or topical antibiotic with a topical steroid NOTE: oral antibiotics (e.g. flucloxacillin) may be considered if the infection appears to be spreading

Answer 517

Flashes and floaters

Answer 518

Rifampicin + ethambutol + clarithromycin

Answer 519

Sodium valproate

Answer 520

Corynebacterium Clostridia Listeria Bacillus

Answer 521

< 40% LVEF

Answer 522

Guillain-Barre syndrome porphyria lead poisoning hereditary sensorimotor neuropathies (HSMN) - Charcot-Marie-Tooth chronic inflammatory demyelinating polyneuropathy (CIDP) diphtheria

Answer 523

``` diabetes uraemia leprosy alcoholism vitamin B12 deficiency amyloidosis ```

Answer 524

When a peritonsillar abscess leads to thrombophlebitis of the internal jugular vein It can result in septic pulmonary emboli Presents with neck pain

Answer 525

``` Hair will regrow in 50% of patients within 1 year topical or intralesional corticosteroids topical minoxidil phototherapy dithranol contact immunotherapy wigs ```

Answer 526

``` class I: normal kidney class II: mesangial glomerulonephritis class III: focal (and segmental) proliferative glomerulonephritis class IV: diffuse proliferative glomerulonephritis class V: diffuse membranous glomerulonephritis class VI: sclerosing glomerulonephritis ```

Answer 527

Inhibits bacterial DNA-dependent RNA polymerase (thereby inhibiting RNA synthesis)

Answer 528

Alpha - produced by leukocytes, antiviral action Beta - produced by fibroblasts, antiviral action Gamma - produced by NK cells and T helper cells, important in macrophage activation

Answer 529

Eculizumab (mAb against C5 inhibitor)

Answer 530

``` myelofibrosis leukaemoid reactions polycythaemia rubra vera infections steroids, Cushing's syndrome pregnancy, oral contraceptive pill ```

Answer 531

chronic myeloid leukaemia pernicious anaemia paroxysmal nocturnal haemoglobinuria infectious mononucleosis

Answer 532

Hypomagnesemia

Answer 533

T score of less than -1.5 NOTE: if T score is 0 to -1.5 then repeat DEXA in 1-3 years

Answer 534

``` increased mood change restlessness difficulty sleeping unsteadiness sweating gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting paraesthesia ``` NOTE: paroxetine is associated with a higher risk of discontinuation symptoms

Answer 535

Ia - meta-analysis of randomised controlled trials Ib - at least one randomised controlled trial IIa - at least one well designed controlled trial which is not randomised IIb - at least one well designed experimental trial III - case, correlation and comparative studies IV - panel of experts

Answer 536

Myocarditis may lead to dilated cardiomyopathy (with apical atophy) and arrhythmias Gastrointestinal features includes megaoesophagus and megacolon causing dysphagia and constipation NOTE: treated with benznidazole

Answer 537

Severe HUS that is NOT associated with diarrhoea

Answer 538

Acquired causes multiple sclerosis papilloedema (longstanding) raised intraocular pressure (e.g. glaucoma, tumour) retinal damage (e.g. choroiditis, retinitis pigmentosa) ischaemia toxins: tobacco amblyopia, quinine, methanol, arsenic, lead nutritional: vitamin B1, B2, B6 and B12 deficiency Congenital causes Friedreich's ataxia mitochondrial disorders e.g. Leber's optic atrophy DIDMOAD - the association of cranial Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy and Deafness (also known as Wolfram's syndrome)

Answer 539

``` type 2 (proximal) renal tubular acidosis polyuria aminoaciduria glycosuria phosphaturia osteomalacia ```

Answer 540

``` cystinosis (most common cause in children) Sjogren's syndrome multiple myeloma nephrotic syndrome Wilson's disease ```

Answer 541

``` progressive, disproportionate symptoms to the original injury/surgery allodynia temperature and skin colour changes oedema and sweating motor dysfunction ```

Answer 542

``` type I (most common): there is no demonstrable lesion to a major nerve type II: there is a lesion to a major nerve ```

Answer 543

idiopathic trauma e.g. Excessive manicuring infection: especially fungal skin disease: psoriasis, dermatitis impaired peripheral circulation e.g. Raynaud's systemic disease: hyper- and hypothyroidism

Answer 544

IV benzodiazepines

Answer 545

Afebrile, descending, flaccid paralysis. Presenting features typically include difficulty speaking or slurred speech, blurred or double vision, and/or dysphagia. Other features include ptosis and facial muscle weakness.

Answer 546

LFTs more than 3 x upper limit or normal NOTE: LFTs should be checked at baseline, 3 months and 12 months

Answer 547

Fasting: 5.3mmol/L 1 hour postprandial: 7.8 mmol/L 2 hours postprandial: 6.4 mmol/L

Answer 548

12 hours after last dose

Answer 549

Carvedilol | Labetalol

Answer 550

Urine sodium: less than 20 in pre-renal, more than 40 in ATN Fractional sodium excretion: <1% in pre-renal, >1% in ATN Fractional Urea excretion: <35% in pre-renal, >35% in ATN

Answer 551

Anterior: affects motor function, pain and temperature sensation. Proprioception is usually spared. Posterior: affects proprioception. Central: bilateral motor weakness.

Answer 552

``` 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 ```

Answer 553

Isocyanates (e.g. spray paints, foam moulding)

Answer 554

``` idiopathic, rheumatoid arthritis SLE Sjogren's amphotericin B toxicity analgesic nephropathy ```

Answer 555

``` idiopathic as part of Fanconi syndrome Wilson's disease, cystinosis outdated tetracyclines carbonic anhydrase inhibitors (acetazolamide, topiramate) ```

Answer 556

Hypoaldosteronism | Diabetes mellitus

Answer 557

Gram-positive cocci (usually S. epidermidis)

Answer 558

Beta cell hyperplasia

Answer 559

Hypertrophic olivary degeneration Part of the triangle of Mollaret: inferior olivary nucleus + red nucleus + contralateral dentate nucleus

Answer 560

Supportive therapy

Answer 561

Compression of the ulnar nerve and can present with tingling/numbness of the 4th and 5th finger

Answer 562

Anti-Mitochondrial Antibody (M2) | Rx: Ursodeoxycholic acid

Answer 563

Cause: Burkholderia pseudomallei (soil and fresh water) Usually presents with acute pulmonary infection May also be localised to skin (ulcer, nodule, abscess) Visceral abscesses (prostate, spleen, kidney, liver) Disseminated infection resulting in fever and septic shock Rx: IV Ceftazidime, imipenem or meropenem

Answer 564

Metronidazole 7 days (target the invasive stage) | Diloxanide furoate for 10 days afterwards (eradicate the cystic stage)

Answer 565

SCN5A gene (which encode the myocardial sodium ion channel protein)

Answer 566

Prolonged (72-h) fasting glucose levels +/- CT Pancreas

Answer 567

Dry - more common, drusen (yellow spots) | Wet - characterised by choroidal neovascularisation, worse prognosis

Answer 568

Zinc with anti-oxidant vitamins Anti-VEGF for wet AMD (e.g. bevacizuimab) Laser photocoagulation

Answer 569

Large volume, bounding, collapsing pulse

Answer 570

SVC Obstruction FEV < 1.5 L Malignant pleural effusion Vocal cord paralysis

Answer 571

Seminomas - hCG Non-Seminomas - AFP and/or hCG in 80% Germ Cell - LDH elevated in 40%

Answer 572

Infection of the lacrimal sac Causes eye watering and swelling and erythema at the inner canthus of the eye Treated with antibiotics

Answer 573

Diuretic use CKD Chinese, Korean and Thai NOTE: patients at high risk of allopurinol sensitivity should be tested for the HLA-B*5801 allele

Answer 574

Ivermectin Second-Line: Albendazole

Answer 575

Ferritin | Transferrin saturation

Answer 576

Verapamil and digoxin | It may precipitate VF or VT

Answer 577

Familial hypertriglyceridaemia | Lipoprotein lipase deficiency

Answer 578

Characterised by episodes of inflammation and deterioration of cartilage, most commonly affecting the ears Ears: auricular chondritis, hearing loss, vertigo Nasal: nasal chondritis → saddle-nose deformity Respiratory tract: e.g. hoarseness, aphonia, wheezing, inspiratory stridor Ocular: episcleritis, scleritis, iritis, and keratoconjunctivitis sicca Joints: arthralgia Less commonly: cardiac valcular regurgitation, cranial nerve palsies, peripheral neuropathies, renal dysfunction

Answer 579

Dural ectasia - ballooning of the dural sac at the lumbosacral level. It may cause lower back pain and consequences such as bladder and bowel dysfunction.

Answer 580

Sensory loss anterior aspect of knee Weak quadriceps Reduced knee reflex Positive femoral stretch test

Answer 581

Sensory loss over anterior thigh Weak quadriceps Reduced knee reflex Positive femoral stretch test

Answer 582

Sensory loss dorsum of foot Weakness in foot and big toe dorsiflexion Reflexes intact Positive sciatic nerve stretch

Answer 583

Sensory loss posterolateral aspect of leg and lateral aspect of foot Weakness in plantar flexion of foot Reduced ankle reflex Positive sciatic nerve stretch test

Answer 584

Urinary hydroxyproline (raised)

Answer 585

Mild - Hydrocortisone 0.5-2.5% Moderate - Betamethasone valerate 0.025%, Clobetasone butyrate 0.05% Potent - Fluticasone propionate 0.05%, Betamethasone valerate 0.1% Very potent - Clobetasol propionate 0.05%

Answer 586

``` paracetamol sodium valproate, phenytoin MAOIs halothane anti-tuberculosis: isoniazid, rifampicin, pyrazinamide statins alcohol amiodarone methyldopa nitrofurantoin ```

Answer 587

``` Escherichia coli Haemophilus influenzae Pseudomonas aeruginosa Salmonella sp. Shigella sp. Campylobacter jejuni ```

Answer 588

with risk factors (T2DM, BP etc): > 35 kg/m^2 | no risk factors: > 40 kg/m^2

Answer 589

``` There may be a history of frequently sprained ankles Foot drop High-arched feet (pes cavus) Hammer toes Distal muscle weakness Distal muscle atrophy Hyporeflexia Stork leg deformity ```

Answer 590

first unprovoked/isolated seizure: 6 months off if there are no relevant structural abnormalities on brain imaging and no definite epileptiform activity on EEG. If these conditions are not met then this is increased to 12 months for patients with established epilepsy or those with multiple unprovoked seizures: may qualify for a driving licence if they have been free from any seizure for 12 months if there have been no seizures for 5 years (with medication if necessary) a ’til 70 licence is usually restored withdrawawl of epilepsy medication: should not drive whilst anti-epilepsy medication is being withdrawn and for 6 months after the last dose

Answer 591

simple faint: no restriction single episode, explained and treated: 4 weeks off single episode, unexplained: 6 months off two or more episodes: 12 months off

Answer 592

stroke or TIA: 1 month off driving, may not need to inform DVLA if no residual neurological deficit multiple TIAs over short period of times: 3 months off driving and inform DVLA craniotomy e.g. For meningioma: 1 year off driving* pituitary tumour: craniotomy: 6 months; trans-sphenoidal surgery 'can drive when there is no debarring residual impairment likely to affect safe driving' narcolepsy/cataplexy: cease driving on diagnosis, can restart once 'satisfactory control of symptoms' chronic neurological disorders e.g. multiple sclerosis, motor neuron disease: DVLA should be informed, complete PK1 form (application for driving licence holders state of health)

Answer 593

acute attacks: buccal or intramuscular prochlorperazine. Admission is sometimes required prevention: betahistine and vestibular rehabilitation exercises may be of benefit

Answer 594

intravenous antimuscarinic: benztropine or procyclidine

Answer 595

other causes of cavernous sinus syndrome: local infection (e.g. sinusitis), neoplasia, trauma periorbital oedema ophthalmoplegia: 6th nerve damage typically occurs before 3rd & 4th trigeminal nerve involvement may lead to hyperaesthesia of upper face and eye pain central retinal vein thrombosis

Answer 596

compares ordinal, interval, or ratio scales of unpaired data

Answer 597

MUGA (Multi Gated Acquisition Scan, also known as radionuclide angiography)

Answer 598

if bradycardic then atropine | in resistant cases glucagon may be use

Answer 599

Ferritin to exclude iron deficiency anaemia

Answer 600

angioplasty (elective) - 1 week off driving CABG - 4 weeks off driving acute coronary syndrome- 4 weeks off driving 1 week if successfully treated by angioplasty angina - driving must cease if symptoms occur at rest/at the wheel pacemaker insertion - 1 week off driving implantable cardioverter-defibrillator (ICD) if implanted for sustained ventricular arrhythmia: cease driving for 6 months if implanted prophylactically then cease driving for 1 month. Having an ICD results in a permanent bar for Group 2 drivers successful catheter ablation for an arrhythmia- 2 days off driving aortic aneurysm of 6cm or more - notify DVLA. Licensing will be permitted subject to annual review. an aortic diameter of 6.5 cm or more disqualifies patients from driving heart transplant: do not drive for 6 weeks, no need to notify DVLA

Answer 601

Likelihood ratio for a positive test result = sensitivity / (1 - specificity)

Answer 602

Visual field defects, hearing loss and paraesthesia

Answer 603

Trichophyton tonsurans

Answer 604

Lymphoproliferative disorder associated in a subset of cases with HIV and HHV-8. Patient's with unicentric Castleman's disease tend to be asymptomatic and lymphadenopathy is constrained to one lymph node group.

Answer 605

CAG: Huntington's disease GAA: Friedrich Ataxia CTG: Myotonic dystrophy CGG: Fragile X syndrome

Answer 606

``` target cell insensitivity to PTH short fourth and fifth metacarpals short stature cognitive impairment obesity round face ```

Answer 607

Phenytoin induces vitamin K metabolism, which can cause a relative vitamin K deficiency, creating the potential for heamorrhagic disease of the newborn

Answer 608

After a lag time of between a few days to 2 months, there is an acute onset of multifocal neurological symptoms with rapid deterioration. Non-specific signs such as headache, fever, nausea and vomiting may also accompany the onset of illness. Motor and sensory deficits are frequent and there may also be brainstem involvement including oculomotor defects.

Answer 609

IgA nephropathy

Answer 610

gradual onset leg and back pain, weakness and numbness which is brought on by walking (with a normal clinical examination)

Answer 611

Recurrent renal stones | Diagnosed using the cyanide-nitroprusside test

Answer 612

Wet - heart failure | Dry - peripheral neuropathy

Answer 613

Baclofen | Gabapentin

Answer 614

loud: hypertension soft: AS fixed split: ASD reversed split: LBBB

Answer 615

autosomal recessive disorder that is a result of a deficiency of homogentisic acid dioxygenase leading to elevated levels of homogentisic acid (HGA). Clinically features include brown/bluish pigment of the ear cartilage or sclera, arthropathy, renal stones, cardiac valve involvement and coronary calcification. Urine turns dark on standing.

Answer 616

Oral Steroids

Answer 617

Ovarian teratoma

Answer 618

Tumour marker for small cell lung cancer

Answer 619

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 NOTE: caused by X-linked dominant mutation in type IV collagen

Answer 620

tricuspid insufficiency and pulmonary stenosis

Answer 621

hyoscine > cyclizine > promethazine

Answer 622

hydroxychloroquine | sulfasalazine

Answer 623

``` I Arteriolar narrowing and tortuosity Increased light reflex - silver wiring II Arteriovenous nipping III Cotton-wool exudates Flame and blot haemorrhages IV Papilloedema ```

Answer 624

Otitis externa | Blepharitis

Answer 625

Pulsus alternans

Answer 626

Mixed aortic valve disease

Answer 627

HHV6 and HHV7

Answer 628

Acquired protein C deficiency

Answer 629

Red cells fail to completely form haem. This leads to deposits of iron in the mitochondria that form a ring around the nucleus called a ring sideroblast. CONGENITAL: delta-aminolevulinate synthase-2 deficiency ACQUIRED: myelodysplasia, alcohol, lead, anti-TB medications Treated with pyridoxine

Answer 630

Praziquantel

Answer 631

``` gastrointestinal bicarbonate loss: diarrhoea, ureterosigmoidostomy, fistula renal tubular acidosis drugs: e.g. acetazolamide ammonium chloride injection Addison's disease ```

Answer 632

lactate: shock, sepsis, hypoxia ketones: diabetic ketoacidosis, alcohol urate: renal failure acid poisoning: salicylates, methanol

Answer 633

1: Hyperfiltration 2: Silent or Latent (GFR remains elevated) 3: Incipient nephropathy (microalbuminuria) 4: Over nephropathy (persistent proteinuria, hypertension, diffuse glomerulosclerosis with focal glomerulosclerosis (Kimmelstiel-Wilson nodules) 5: ESRF

Answer 634

Pyridoxine | Cholestyramine

Answer 635

``` expressive (Broca's) aphasia: located on the posterior aspect of the frontal lobe, in the inferior frontal gyrus. Speech is non-fluent, laboured, and halting disinhibition perseveration anosmia inability to generate a list ```

Answer 636

Acute Attack: Prochlorperazine | Prevention: Betahistine and vestibular rehabilitation exercises

Answer 637

Parvovirus B19 | HHV6

Answer 638

mixed hyperlipidaemia (raised cholesterol and triglyceride levels) Treated with fibrates

Answer 639

Upbeat - Cerebellar Vermis Lesion | Downbeat - Arnold Chiari Malformation

Answer 640

haemochromatosis hyperparathyroidism low magnesium, low phosphate acromegaly, Wilson's disease

Answer 641

Alpha - 16 | Beta - 11

Answer 642

Age under 50 years. Adjusted serum calcium concentration that is 0.25 mmol/L or more above the upper end of the reference range. Estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2 although this threshold depends on other factors, such as age. Renal stones or presence of nephrocalcinosis on ultrasound or CT. Presence of osteoporosis or osteoporotic fracture. Symptomatic disease

Answer 643

visual effects, particular luminous phenomena, are common headache bradycardia, heart block NOTE: it acts on the funny channel and reduces the cardiac pacemaker activity

Answer 644

FIRST LINE : potent corticosteroid applied once daily plus vitamin D analogue applied once daily should be applied separately, one in the morning and the other in the evening) for up to 4 weeks as initial treatment SECOND LINE: if no improvement after 8 weeks then offer a vitamin D analogue twice daily THIRD LINE: if no improvement after 8-12 weeks then offer either: a potent corticosteroid applied twice daily for up to 4 weeks, or a coal tar preparation applied once or twice daily short-acting dithranol can also be used

Answer 645

Anti-Hu: small cell lung cancer and neuroblastomas, sensory neuropathy (may be painful), cerebellar syndrome, encephalomyelitis Anti-Yo: ovarian and breast cancer, cerebellar syndrome Anti-GAD: breast, colorectal and small cell lung cancer, stiff person's syndrome or diffuse hypertonia Anti-Ri: breast and small cell lung cancer, ocular opsoclonus-myoclonus Purkinje Cell Antibody: peripheral neuropathy in breast cancer

Answer 646

Ceftriaxone + amoxicillin + gentamicin

Answer 647

Diagnosis is requires bilateral optic neuritis, myelitis and 2 of the follow 3 criteria: 1. Spinal cord lesion involving 3 or more spinal levels 2. Initially normal MRI brain 3. Aquaporin 4 positive serum antibody

Answer 648

Causes both the effects associated with alcohol (intoxication, nausea etc) and also specific visual problems, including blindness. NOTE: treated with fomepizole or ethanol, haemodialysis and cofactor therapy with folinic acid to reduce ophthalmoplegic complications

Answer 649

Oxygen therapy to maintain saturations > 95% Intravenous fluids to ensure euvolaemia Adequate pain relief Incentive spirometry in all patients presenting with rib or chest pain Antibiotics with cover for atypical organisms Early consultation with the critical care team and haematology

Answer 650

Macrophages --> acute inflammation, induced fever

Answer 651

Th1 cells --> stimultes growth and differentiation of T cell response

Answer 652

Activated T helper cells --> stimulates differentiation and proliferation of myeloid progenitor cells

Answer 653

Th2 cells --> stimulates differentiation and proliferation of B cells

Answer 654

Th2 cells --> stimulates production of eosinophils

Answer 655

Macrophages, Th2 cells --> stimulates differentiation of B cells, induced fever

Answer 656

Macrophages --> neutrophil chemotaxis

Answer 657

Th2 --> inhibits Th1 cytokine production (anti-inflammatory cytokine)

Answer 658

Dendritic cells, macrophages, B cells --> activates NK cells and stimulates production of Th1 cells

Answer 659

Features small, irregular pupils no response to light but there is a response to accommodate Causes diabetes mellitus syphilis

Answer 660

exhaustion / patient request 'severe', 'limiting' chest pain > 3mm ST depression > 2mm ST elevation.Stop if rapid ST elevation and pain systolic blood pressure > 230 mmHg systolic blood pressure falling > 20 mmHg attainment of maximum predicted heart rate heart rate falling > 20% of starting rate arrhythmia develops

Answer 661

IV fluids Benzodiazepines Cyproheptadine (in severe cases - blocks H1 receptors and serotonin receptors)

Answer 662

Irregular cardiac rhythm caused by at least three different sites in the atria, which may be demonstrated by morphologically distinctive P waves. It is more common in elderly patients with chronic lung disease, for example COPD Management - correction of hypoxia and electrolyte disturbances - rate-limiting calcium channel blockers are often used first-line - cardioversion and digoxin are not useful in the management of MAT

Answer 663

Nephrotic syndrome Cholestasis Hypothyroidism

Answer 664

IM Tetanus Immunoglobulin | IV Metronidazole

Answer 665

Bradycardia and AV node block

Answer 666

ECG changes, hypotension, metabolic acidosis, hypoglycaemia and classically tinnitus, flushing and visual disturbances. Flash pulmonary oedema may occur

Answer 667

IV Ceftriaxone

Answer 668

Bone pain (usually skull or proximal femur) Cutaneous nodules Recurrent otitis media/mastoiditis Tennis racket-shaped Birbeck granules on electron microscopy

Answer 669

Prolonged PR interval

Answer 670

NSAIDs (first-line for fever, joint pain and serositis) Steroids Methotrexate, IL-1 (anakinra) or anti-TNF

Answer 671

When a frontal lobe tumour leads to ipsilateral optic atrophy and contralateral papilloedema

Answer 672

One-third of normal dose before sunrise | Two-thirds of normal dose after sunset

Answer 673

NMDA Receptor Antagonist

Answer 674

Raised serum lead concentration Microcytic anaemia with basophilic stippling Raised serum and urine delta aminolaevulinic acid Raised urinary coproporphyrin

Answer 675

immunofluorescence shows IgG and C3 at the dermoepidermal junction

Answer 676

Congenital lymphoedema Bronchiectasis Chronic sinusitis Pleural effusions

Answer 677

left anterior hemiblock left bundle branch block inferior myocardial infarction Wolff-Parkinson-White syndrome* - right-sided accessory pathway hyperkalaemia congenital: ostium primum ASD, tricuspid atresia minor LAD in obese people

Answer 678

``` right ventricular hypertrophy left posterior hemiblock lateral myocardial infarction chronic lung disease → cor pulmonale pulmonary embolism ostium secundum ASD Wolff-Parkinson-White syndrome* - left-sided accessory pathway normal in infant < 1 years old minor RAD in tall people ```

Answer 679

parametric (normally distributed): Pearson's coefficient | non-parametric: Spearman's coefficient

Answer 680

Inherited condition associated with organomegaly, macroglossia, abdominal wall defects, Wilm's tumour and neonatal hypoglycaemia

Answer 681

symptomatic treatment e.g. paracetamol treatment of underlying precipitating event beta-blockers: typically IV propranolol anti-thyroid drugs: e.g. methimazole or propylthiouracil Lugol's iodine dexamethasone - e.g. 4mg IV qds - blocks the conversion of T4 to T3

Answer 682

equivalent of prednisolone 7.5mg a day for 3 or more months

Answer 683

older than 40 years, or have had diabetes for more than 10 years or have established nephropathy or have other CVD risk factors

Answer 684

repeat a full lipid profile if the non-HDL cholesterol has not fallen by at least 40% concordance and lifestyle changes should be discussed with the patient NICE recommend we consider increasing the dose of atorvastatin up to 80mg

Answer 685

An ECG should be performed 90 minutes following thrombolysis to assess whether there has been a greater than 50% resolution in the ST elevation - if there has not been adequate resolution then rescue PCI is superior to repeat thrombolysis - for patients successfully treated with thrombolysis PCI has been shown to be beneficial. The optimal timing of this is still under investigation

Answer 686

Combination of proximal myopathy and mechanic's hands

Answer 687

Inhibits squalene epoxidase thereby inhibiting the production of ergosterol

Answer 688

Inhibits 14a-demethylase which produces ergosterol

Answer 689

Interacts with microtubules to disrupt the mitotic spindle

Answer 690

Converted by cytosine deaminase to 5-fluorouracil, which inhibits thymidylate synthase and disrupts fungal protein synthesis

Answer 691

Inhibits synthesis of beta-glucan, a major fungal cell wall component

Answer 692

Binds with ergosterol forming a transmembrane channel that leads to monovalent ion (K+, Na+, H+ and Cl) leakage

Answer 693

Anti-CD52 | Used in CLL

Answer 694

Anti-CD3 | Used to prevent organ rejection

Answer 695

presence of immature cells such as myeloblasts, promyelocytes and nucleated red cells in the peripheral blood. This may be due to infiltration of the bone marrow causing the immature cells to be 'pushed out' or sudden demand for new cells Causes include severe infection, severe haemolysis, massive haemorrhage and metastatic cancer with bone marrow infiltration

Answer 696

High leucocyte alkaline phosphatase score Toxic granulation (Dohle bodies) in the white cells 'Left shift' of neutrophils i.e. three or fewer segments of the nucleus

Answer 697

Phentolamine

Answer 698

Corpus callosum

Answer 699

``` Dietary modification (e.g. elemental diet) Topical steroids (e.g. fluticasone) Oesophageal dilatation ```

Answer 700

Pyrimidine analogue inducing cell cycle arrest and apoptosis by blocking thymidylate synthase (works during S phase)

Answer 701

Purine analogue that is activated by HGPRTase, decreasing purine synthesis

Answer 702

Pyrimidine antagonist. Interferes with DNA synthesis specifically at the S-phase of the cell cycle and inhibits DNA polymerase

Answer 703

Causes cross-linking in DNA

Answer 704

Inhibits ribonucleotide reductase, decreasing DNA synthesis

Answer 705

transient CXR shadowing and blood eosinophilia thought to be due to parasites such as Ascaris lumbricoides causing an alveolar reaction presents with a fever, cough and night sweats which often last for less than 2 weeks. generally a self-limiting disease

Answer 706

First-Line: Slit lamp microscopy Fluorescein angiography if neovascular ARMD is suspected Ocular coherence tomography

Answer 707

Offer thrombectomy, together with thrombolysis, for patients who have a confirmed occlusion of the proximal anterior circulation on imaging. NICE have also made recommendations to use a modified Rankin score of less than 3 and a National Institutes of Health Stroke Scale (NIHSS) score of more than 5 when considering the selection of patients for mechanical thrombectomy.

Answer 708

Eye drops (e.g. pilocarpine, timolol or apraclonidine) and IV acetazolamide

Answer 709

Rare and serious syndrome of infantile erythroderma of severe and progressive generalized seborrheic-like dermatitis, recalcitrant diarrhea, malabsorption and wasting, and recurrent local and systemic infections. Associated with C5 deficiency

Answer 710

IFN-gamma IL-2 IL-3 NOTE: involved in cell-mediated immunity and delayed (type IV) hypersensitivity

Answer 711

``` IL-4 IL-5 IL-6 IL-10 IL-13 ``` NOTE: involved in humoral immunity

Answer 712

the patient has a neurological deficit brain imaging shows a structural abnormality the EEG shows unequivocal epileptic activity the patient or their family or carers consider the risk of having a further seizure unacceptable

Answer 713

Loss of function or blockade of potassium channels This leads to the myocardial cells being overloaded with positively charged ions

Answer 714

1: SABA 2A (+ Asthmatic Features): LABA + ICS 3A: LAMA + LABA + ICS 2B (- Asthmatic Features): LABA + LAMA

Answer 715

``` Fluid - 25-30 mL/kg Sodium - 1mmol/kg Potassium - 1 mmol/kg Water - 30ml/Kg Glucose - 50-100g ```

Answer 716

Combination antiretrovirals (tenofovir, emtricitabine, lopinavir/ritonavir) + repeat HIV test in 12 weeks

Answer 717

azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate

Answer 718

Collapsing

Answer 719

Causes acid secretion, mucosal growth and smooth muscle contraction

Answer 720

Inhibits pancreatic enzyme secretion

Answer 721

Disease that causes progressive asymmetrical, distal upper limb weakness Associated with anti-GM1 antibodies

Answer 722

Clindamycin

Answer 723

Granulomatous inflammatory process involving the cavernous sinus/superior orbital fissure Leads to III, IV, VI and V(I) palsy

Answer 724

Vertebral artery

Answer 725

Type III Hyperlipidaemia (Broad Beta Disease)

Answer 726

Type of cutaneous T cell lymphoma (like mycosis fungoides) Presents with erythroderma

Answer 727

Contralateral limb weakness with bulbar involvement | Ipsilateral 6th and 7th nerve palsies

Answer 728

Coeliac plexus block

Answer 729

Unilateral emphysema following childhood bronchiolitis

Answer 730

Pancytopenia and acute tubulointerstitial nephritis

Answer 731

The bone loses its capacity to buffer calcium and can be associated with over treatment with alfacalcidol It leads to reduced active mineralisation and increased risk of fractures (especially NOF) It is more common in diabetic patients and those on peritoneal dialysis

Answer 732

Bedside echocardiogram to confirm right heart strain

Answer 733

To identify rare adverse events

Answer 734

Recurrent miscarriage Thrombocytopaenia VTE Livedo reticularis Other: renal vein thrombosis, progressive cognitive impairment

Answer 735

Glucose and Galactose

Answer 736

2 x glucose

Answer 737

Glucose and Fructose

Answer 738

Potassium citrate It reduces urinary supersaturation of calcium salts by forming soluble complexes with calcium ions, and by inhibiting crystal growth and aggregation

Answer 739

Papillary (80%) - associated with spread to lymph nodes Others: follicular, medullary, anaplastic

Answer 740

2-4 weeks before surgery

Answer 741

Neck and mediastinal lymphadenopathy in adolescents

Answer 742

Bronchial (95%)

Answer 743

Acute tubulointerstitial nephritis

Answer 744

ATN has bland urinalysis | AIN will feature blood/protein/leucocytes

Answer 745

``` Haemoglobinuria = acute haemolysis Haemosiderinuria = chronic haemolysis ```

Answer 746

Blood cultures Then antibiotics and joint fluid aspiration

Answer 747

Four-wavelength spectrophotometer

Answer 748

Topical white soft paraffin all over the body

Answer 749

Pulsus paradoxus

Answer 750

In V1-V3 - horizontal ST depression - tall, broad R waves - upright T waves - dominant R wave (R/S ratio > 1 in V2)

Answer 751

Area postrema

Answer 752

Hydroxychloroquine

Answer 753

In the presence of dehydration, aciclovir can precipitate as crystals in the kidney tubules

Answer 754

Sensory innervation to larynx inferior to the vocal cords

Answer 755

Chromosome 7 Abnormalities

Answer 756

Unilateral paralysis of the diaphragm During force inspiratory movement (sniff) the unaffected hemidiaphragm moves down forcefully and increases the intra-abdominal pressure, thereby pushing the affected hemidiaphragm up (paradoxical movement) This can be confirmed using X-ray and fluoroscopy

Answer 757

Metoclopramide Ondansetron Prochlorperazine

Answer 758

INR at 48 hours NOTE: a doubling of the INR in 24 hours warrants referral to a specialist liver unit

Answer 759

GLUT1: erythrocytes and endothelial barrier cells GLUT2: from intestinal cells into portal circulation GLUT3: neurones GLUT4: striated muscle and adipose tissue

Answer 760

Antiarrhythmics (sotalol, procainamide, flecainide) Antibiotics (erythromycin, levofloxacin) Antifungals (ketoconazole) Antipsychotics (risperidone, haloperidol) TCA Lithium

Answer 761

Reduces intestinal cholesterol absorption

Answer 762

Gitelman causes low urinary calcium excretion whereas Bartter does not

Answer 763

Position I - Paced Chamber (Atrium, Ventricle or Dual) Position II - Sensed Chamber (Atrium, Ventricle or Dual) Position III - How It Will Respond to Sensed Chamber (Inhibit, Trigger output pulse, Dual modes of response, nO response to sensed input) Position IV - Rate Modulation (Rate modulation active, rate modulation nOt active) Position V - location or absence of multisite pacing (rarely used)

Answer 764

IV Haem Arginate

Answer 765

Chromogranin A Neuron-specific enolase is less sensitive

Answer 766

Glycogen phosphorylase BB

Answer 767

Immature white and red cells on peripheral blood film - this is caused by bone marrow infiltration

Answer 768

Serum Galactomannan

Answer 769

Verapamil NOTE: multifocal atrial tachycardia is a rapid, irregular atrial rhythm arising from multiple ectopic foci within the atria. Most commonly seen in patients with severe COPD or congestive heart failure.

Answer 770

Anti-LGI1 | NMDA

Answer 771

Positive urine cyanide nitroprusside test

Answer 772

Spinal bulbar muscular atrophy Proximal weakness and cramps, wasting, fasciculations, weakness and hyporeflexia Associated with androgen insensitivity

Answer 773

Corticosteroids

MRCP Part 1 Flashcards

(817 cards)