Past P 2 Flashcards
1
Q
What does ADH do
A
Increase Aquaporin-2 channels in collecting duct
2
Q
Post chemo most at risk of neutropenic sepsis which day
A
Day 10
3
Q
Vinblastine mechanism
A
Binds to microtubular proteins
[causes metaphase arrest]
4
Q
Adrenic receptors
a1
b1
b2
A
a1 - Smooth muscle contraction
-G protein-coupled actives phospholipase C
b1- Heart Kidneys
-G protein-coupled actives adenyl cyclase
b2 - Bronchioles, Visceral smooth muscle, skeletal muscle
-G protein-coupled actives adenyl cyclase
5
Q
Muscles supplied by median nerve
A
Abductor pollis brevis
Flexor pollis longus (in forarm)
6
Q
New stable mild angina for 1 year- What do you do?
A
Don’t need ETT as stable
Bisop (or other cardioselective bb)
/ cardioselective CCB [verapamil and diltiazem]
7
Q
Latex allergy which foods
A
Banana, chesnut, kiwi, avocado
8
Q
Suspected osteomyelitis of diabetic foot. MRI or C&S more important
A
MRI
9
Q
MODY - most common?
What if renal cysts?
What if no symptoms and incidental finding?
A
HNF-alpha most common
HNF-beta if you have cysts
Glucokinase - mild form
10
Q
1st line antihypertensive in preg
A
Labetalol
[then methyldopa / CCB]
11
Q
Sildenafil which type of PDE
A
PDE-5 inhibitor
12
Q
Threadworm Rx
A
Mebendazole, then second dose after 2-3 weeks
13
Q
Macular oedema. Not for laser rx?
A
VGEF inhibitors
14
Q
What is the main ketoacid in DKA
A
Beta-hydroxybutyrate
15
Q
Rtixumab is anti-
A
Anti-CD20
16
Q
Sickle painful crisis. Rx for pain
A
Opiates required
17
Q
Inferior stemi -> complete HB. Rate 30 and hypotensive. Rx ?
A
Transcutaneous pacing on the way to PCI
18
Q
Left coronary artery anatomy. Arises? Becomes?
A
Just above the left aortic cusp
-Then divides into Left Anterior descending and circumflex
19
Q
Karnovsky score?
A
Marker of function pre chemo.
under 60% = poor outcomes
20
Q
Travel then come back with IBS-type illness? Rx?
A
Giardia
Metronidazole course
[Or single dose Tinidazole]
[Campylobacter more acute gastroenteritis]
20
Q
Travel then come back with IBS-type illness? Rx?
A
Giardia
Metronidazole course
[Or single dose Tinidazole]
[Campylobacter more acute gastroenteritis]
21
Q
Cluster headache Sx but in woman and shorter duration and higher frequency of headaches? Rx?
A
Paroxysmal hemicrania
Indomethacin
22
Q
Radio-iodine and preg ? Mother and father advice
A
Teratogenic
Should not get preg for 6 months after
Men shouldn’t father children for 4 months
23
Q
Reactive arthritis 1st line
A
NSAIDS Eg Naproxen
24
IIH on COCP order of CT / LP / Cesation of COCP
CT
LP
Cessation
25
Learning difficulty, high arched palate, mitral valve prolapse, joint laxicity, big ears, obese
Fragile X
[Homocystinuria - unlikely to be obese or have big ears.]
26
When Abx in cat scratch disease
Immunocompromised / severe Sx
[Ciprofloxaxin]
27
Isoniazid mechanism
Inhibits fatty acid synthesis
[fatty acids in liver - bit tenuous good luck]
28
What inhibits DD transpeptidase
Penicillins
29
what inhibits DNA Gyrase
quinolones - eg cipro
30
what inhibits RNA synthesis
Macrolides
31
Tired, hypotensive, Raised bicarb, HypoK = defect where?
Gentleman's
Distal convoluted tubule
[Adrenal failure would have high K, conns would be hypertensive,
Barters usually presents in childhood]
32
Which hormone is usually under continuous inhibition
Prolactin
33
Molluscum contagiosum - Ix/rx
Doesn't need any usually
[Q should indicate need for hiv test etc.]
34
Pie chart needs how many groups
At least 3 for MRCP
35
Heart where do you find Actin, troponin, Myosin?
What structure is actin, and in who is it deficient?
Thin filaments - Actin + trop
Thick filaments - myosin
Actin is double a-helix. HOCM deficient
36
Acanthosis nigrans = what when malignant
Gastric tumours in 90% of cases
[adenocarcinoma usually]
37
Erythema nodosum, macrocytic anaemia and normal sigmoidoscopy... What other aspects of question to differentiate coeliac vs crohns
Chrons - nail ridging
Coeliac - steathorrea sometimes
38
Hypocalcuric hypercalcaemia usual Rx
Reassure - HyperCa levels usually very stable
39
Severe diarrhoea symptoms post transplant on - which drug is cause
Mycophenolate
40
Pseudogout acute Rx
Colchicine - same as gout
41
Influenza -> Acute cavitating pneumonia Rx? If pen allergic?
IV fluclox
Macrolide
42
ACEi when can you get first episode of angiodema
straight away or not for many years.
Ie occurring after 5 years of Rx it is still the likely cause
43
Where is the posterior cerebellar artery found
Next to the posterior communicating artery
44
COCP may cause which rash
Erythema nodosum
45
Polycythemia -> Stroke
Rx?
Aspirin - just like normal
46
Rheum - now nodule compressing radial nerve Rx?
Surgical excision
47
Difference between asbestos plaques and asbestosis as the answer to a question
Plaques are incidental and do not cause symptoms.
If breathlessness / cough = asbestosis
48
Why HyperCa in thyrotoxicosis
Thyroxine stimulates osteoclasts
49
P vivax / ovale have which stage of life cycle not found in falciparum
Hypnozoites
50
2 main DMARDs for UC
Azathioprine / 6-metacaptopurine
[Infliximab]
51
Liver referral in paracetamol OD before 48hrs
INR?
Cr?
BP?
2 things on blood gas?
INR >2
Cr >200
SBP <80 despite fluids
BM <4
Acidosis
52
How many single nucleotide polymorphisms have been mapped as part of the genome project
3.7 million
53
Spironolactone acts on
Distal convoluted tubule
54
What are the 2 types of Hb that carry sickle trait
HbS
HbC
55
Cryoglobulinaemia and lymphadenopathy
NHL
56
Thermoregulation and circadian rhythms are controlled where
Anterior hypothalamic nucleus
57
Who gets Levothyroxine titrated very slowly
Old people
[high risk arrythmias]
58
MI + stents. What factor is most associated with future cardiac events
CAD - especially if >1 vessel stent required
More important than obesity, LDL levels ...
59
Haemochromatosis often get what joint issue
Pseudogout (often bilat)
60
Where is landmark for subclavian line
1cm inferior to the junction of the middle and medial section of clavicle
61
Monitor rivaroxaban compliance
PT time
62
Pathology of lithium -> DI
Reduces cAMP-mediated aquaporin-2 expression
[Less aquaporins -> less water reabsorbed]
63
Joint erosions of Anti-CCP worse prognosis in Rhem A
Anti CCP
[Joint erosions likely just delayed presentation]
64
Erythema multiform most commonly what? When would you think of the other cause?
Herpes simplex - most common
[May just have vague Sx]
Symptoms of pneumonia -> mycoplasma
65
Which receptor is target in therapy for B-cell NHL?
CD20
[Rituxumab]
66
What are the mitochondrial inherited disorders
Conveniently can remember most of them using DIDMOAD - both this syndrome and all the parts of it
-Just add an EN to make DIDMOADEN
Diabetes insipidus
Diabetes Mellitus
Optic Atrophy
Deafness
Epilepsy
Neuropathy
67
Parietal Left vs Right side most common issue
Right - Visual spacial navigation
Left - Not understanding or being able to speak language
68
Visual memory defect if stroke affects where?
Right temporal lobe
69
What does evolocumab do?mechanism?
PCSK9 inhibitor
-> Prevents LDL receptor degradation
70
How does Ezetimbine work?
Inhibits NCP1L1
-> Reduces cholesterol absorption from GI
71
Rx in severe hereditary spherocytosis
Splenectomy
72
Neutropenic spesis 1st line? If pen allergic?
Taz + gent
Vanc, cipro + single dose gent
73
CN 3 palsy if Posterior communicating / vertebral isn't an option
Internal carotid
74
Who classically get de Quervain's tendosynovitis
Rx?
Mums of babies 6-12 months
->due to repeated picking them up
Splint / steroid injection
75
calcium carbonate reduces the absorption of what?
Levothyroxine
Levofloxacin (+ quinilones)
[Iron, zinc, strontium]
76
Aspirin in preg with antiphospholipid. When would you add in prophylactic LMWH ?
>2 miscarriages
Or any fetal loss after 10 weeks gestation
77
Why hypoNa in thiazide diuretics
Distal tubule Na loss
78
Suspected pneumococcal meningitis what might be added to Ceftriaxone
Vanc + cef
79
Kleinfelters genetics
XXY
[Not XYY. Remember they have normal XY with some feminism Eg breast development so must have an extra X]
80
Heyde with normal OGD / colonoscopy what next?
Capsule endoscopy
81
Parkinsonism and urinary incontinence Ix?
MRI / CT first
Then LP
82
Lupus membranous nephropathy Rx?
Mycophenolate
Cyclophosphamide second line
83
Benzbromarone used in? How does it work? Commonly used in combination with?
Gout - prevents uric acid resorption in the kidney
-URAT-1 inhibitor
Often used with allopurinol (xanthine oxidase inhibitor
-Inhibits uric acid formation
84
What inflammatory cytokine key in gout? Drug targeting it?
IL-1
Canakinumab
85
Gastroparesis Sx in long-term diabetic. Rx?
Domperidone
86
Chinese patient is given carbamazepine. what happens next and why?
SJS
Probably HLA-B1502
87
Severe COPD and is already on salbutamol. What inhaler to add?
Inhaled steroid (high dose Eg 500mcgBD) and LAMA
Eg
Fluticasone/Salmeterol 500/50mcg BD
88
Varenicline used for? mechanism?
Smoking cessation
Partial nicotinic agonist
89
MgSO4 mechanism in acute asthma
Decreased histamine
Inhibits smooth muscle contraction
Inhibit Ach
90
Which pneumonia if have cold sore?
Strep pneumo
[Reactivates herpes simplex-1 for some reason]
91
1st line rescue therapy UC
Ciclosporin
Then Infliximab
92
Death of parter is massive risk for suicide
IDK cba thinking to to make that a flash card
93
Metformin mechanism
Indirect AMP kinase activator
94
Gliclazide mechanism
ATP sensitive potassium channel activator
95
Nintedanib used for? Mechanism
Pulm fibrosis
Tyrosine kinase inhibitor
96
Long QT due to which ion channel
Potassium
97
The senescence of cells is what
Cessation of mitosis - due to telomere shortening to critical point
98
Eosin-5-maleimide binding test used for
Hereditary spherocytosis
[Basically looks at the fragility]
99
First line long QT? When ICD?
What is option if people don't respond to b blockers and don't want an ICD
Beta blockers
ICD if collapse secondary to VT or unsuccessful b blockers
Stellate ganglionectomy
100
ACEi, BB and frusemide in heart failure, but worsening - what's next step?
Change ACEi to sacubitril valsartan
[Entresto]
101
When ivabradine in HF
Pulse >75 and reduced EF
102
Young person with recurrent bacterial sinusitis and pneumonias with normal Ig's in question has which Ig deficiency?
IgG subclass deficiency
103
How long after significant blood transfusions can you re-check HbA1c?
12 weeks
104
Primary PTX 3cm rx?
Aspirate 1st line
[Drain if unsucsessful]
105
Haemochromatosis in Q with raised transferrin sats. What is the next step for Dx?
Genetic testing
[Liver biopsy later]
106
Medical epicondylitis usually affects which nerve?
Ulnar
107
72 slow visual loss
Blind spot in the middle of vision of one eye.
Pigment deposition in retina with sub-retinal haemorrhage + pigment deposition in other eye =?
Rx?
Wet macular degeneration
VGEF inhibitors
Eg Bevacizumab
[Bev and her old eyes]
108
Why delayed hypos with alcohol consumption
Reduced glucogenesis
[Often delayed slighly]
109
Bitemporal inferior quadranopia - where is lesion?
Rathke's pouch
[Suprasellar lesion and probably a craniopharyngioma]
110
FEV values for contraindication for lung ca?
<2L for pneumonectomy
<1.5L for lobectomy
111
Cut off karnofsky score for good / poor prognosis in AML
60% more = good
112
Strep Gallolyticus endocarditis is from?
Colon Ca
[Its the new name for Strep Bovis LOL]
113
Recurrent infections especially N meningitis has what deficiency?
C5-9
[1,2,4 is SLE
IgG subclass would be recurrent respiratory infections]
114
19. Peripheral neuropathy.
Osteoperosis. Abdo pain. Heritability
Purple purpuric rash = ? deficiency of?
Fabry disease
Alpha-galactosidase
115
What is esomeprazole
S isomer of omeprazole
116
Quinilone resistant bacteria
2 Common reasons why?
DNA gyrase mutation
Decreased membrane Protein F
117
Ribosomal mutation gives bacteria resistance to
Macrolides
118
N acetyl transferase mutation gives bacteria resistance to
Aminoglycosides
119
Disseminated gonorrhoea Abx
Cef + azithro
120
Ulcerative colitis - develops anterior uveitis Rx?
Topical [not oral] steroids
121
Mycobacterium avium Rx?
If cavitating disease?
Rifampicin, ethambutol and azithromycin
Add streptomycin
122
Common gene FAP
APC
123
C-myc seen commonly in which Ca
Ovarian Ca
124
Back pain
Predominant distal weakness. Increased tone + hyperreflexia
Early urinary incontinence
Conus meddularis
125
Imatinib resistance, second line?
Dasatinib
126
Pazopanib and sunatinib used for
Renal Ca
127
Lesser curve of the stomach supplied by
Left / right gastric arteries
128
Blood supply for pylorus and proximal duodenum
Gastroduodenal
129
Fundus of stomach supplied by?
Short gastric arteries
[Branch of splenic]
130
Greater curve of stomach supplied by?
Left gastro omental
131
Prognosis in COPD
BODE [but it spells BODD....]
BMI
Obstruction - FEV1
Distance walked in 6 mins
Dyspnea
132
COPD with persistent AF and IHD with atrial enlargement. 1st line Rx?
Bisoprolol
Would be amiodarone if the plan was to get them back to SR but this very unlikely given atrial enlargement
133
Pemphigoid biopsy
IgG and C3
[IgG mostly in the roof of the blisters]
134
COPD on high dose corticosteroid/LABA inhaler whats next
Long-Acting Muscarinic Antagonist
Eg Tiotropium
135
Which alcohol makes them go blind
Methanol
[Formic acid crystals in optic nerve]
136
-setron antiemetics work where in brain
Nucleus tractus solitarius
137
Young, cessation of menses with autoimmune disease and raised FSH
Primary ovarian failure
138
Pancreatitis and vomiting - how to feed
NG
139
Microscopic or macroscopic haematuria worse prognosis in IgA nephropathy
Microscopic
140
Hx sounds like ulcer.. differentiate GU vs DU?
DU more commonly assoc with obstruction
-history of fullness and bloating associated with nausea + Vomiting after food
141
Denosumab action
RANK ligand inhibitor
142
Vit D main action
Increase GI absobtion of Ca
143
What is the functional residual capacity
Volume of air present after passive expiration
[Residual volume is air left after forced expiration]
144
Thromboembolic stroke BP 190/100 plan?
Observe
[No need to treat unless >220 without cv issues]
145
Rheum A on MTX with multiple round nodules on CXR =
Rheumatoid nodules
146
Stop ETT if...? Which ecg changes
Dizziness / pre syncope
ST depression by 2mm or more
147
Which vein drains blood from the atrium into the coronary sinus? Which from apex of ventricles
Small cardiac vein
Great cardiac vein drains from Apex of ventricles
148
Rash on the scrotum and inner thighs in keen cyclist
Tinea cruis
149
Hashimotos -> thyroid Ca WHICH TYPE
Lymphoma
150
Most common genetic defect in HOCM
Myosin-binding protein C [heavy chain]
151
Worry about which bias in meta analysis
Publication bias
[negative trials may not have been published]
152
MHC Class II major presenting cells ?
Dendritic
153
SLE membranous nephropathy Rx
Mycophenolate
154
GPA, not responding to steroids and cyclophosphamide What next?
Rituximab
155
MHA which section for doctors to detain for 72hrs? For 28 days assessment and Rx?
5 (2) doctors
2 for 28 days
[3for 6months]
156
Botulism but pen allergic?
Metronidazole
157
Mum had PKD how to screen 20 year old
US
158
HNPCC which gene mutation?
MLH1 - DNA missmatch repair
159
Most common moody type?
Which one with renal cysts
Which one with Glucokinase
HNF-alpha - MODY 3
HNF beta - MODY 5
Glucokinase - MODY 2
160
Scleroderma renal crisis after prescription with what in systemic sclerosis
Prednisolone
[It is unknown why]
161
Carbimazole mechanism
Converted to methimazole
which Inhibits thyroid peroxidase
162
MS 1st line?
2nd line?
When straight to mabs?
Interferon or glatiramer acetate
Dimethyl fumarate
[Then the mabs eg natalizumab]
Mabs if 2 disabling relapses in 1 year
163
When NF type 2
Bilat CN 8 tumors
164
Lidle syndrome affects
Distal convoluted tuble
165
Most common percarditis bug
Coxsackie
166
Simvastatin and cyclosporin in which hepatic transporter
CYP3A4
167
What does eplerenone do
Prevents binding of aldosterone to mineral corticoid receptors
168
Liquorish inhibits?
11-b-hydroxysteroid dehydrogenase
169
Brugada Rx
ICDefib
170
pyridostigmine class
cholinesterase inhibitor
171
Nec fasc 1st line
Clinda + metronidazole
172
Left posterior artery stroke leads to
Right sensory/motor loss
Right homonymous hemianopia
173
Phase 0-4 action potential
[N0 People CAn CLOSE]
0 - Na influx
1 - Potassium efflux (lasts until phase 3)
2 - Ca influx
3 - Ca channels close
4 - Resting action potential
174
What does microRNA do?
Silences messengerRNA
175
Rheum vs OA knee xray
Rheum - Joint erosion lateral aspect (non-weight bare part)
OA - Medial joint space narrowing and subchondral sclerosis
176
Omeprazole electrolyte abnormalities
HypoMg
HypoNa
177
Most common antibody in systemic sclerosis
ANA
178
HOCM on echo. No symptoms ever. Next line
Ambulatory ECG monitoring
179
Why combination chemo
Prevents drug resistance and kills more cells per cycle
180
Acute on chronic renal failure. When bicarb?
If Ph <7.2
181
Latent Tb rx
3 months Rifampicin and Isoniazid
182
Worst prognosis CLL
17p(del)
p53
183
Thyroid nodule palpated with thyrotoxicosis initial Ix
Thyroid isotope uptake scan
184
Waldenstroms - what does the Rx contain if they can hack it
Rituxumab
[+bendamustine]
185
What detects hypoxia Eg in high altitude
Glomus cells in the carotid body
186
Deadly disease eg meningitis what screening bit is most important
High sensitivity
187
early detection of HIV
HIV RNA
188
How does aspirin inhibit platelets
Reduced production of thomboxine A2
189
GH deficiency 1st line ix? if this is low?
IGF-1
Then Arginine GHRH test
190
How many lung Ca deaths due to smoking
>90%
191
What type of Ig is Rheum Factor?
IgM
192
Long term prevention of hepatic encephalopathy
Rifaxamin
193
When would you hear 4th heart sound on ECG
Just after p wave
[s3 is just before p wave]
194
Lateral medullary most commonly occlusion where
Vertebral
[then PICA aneuryism]
195
Pacing wire insertion patient suddenty develops VT where has the pacing wire ended up
Coronary sinus
196
Lithium-induced DI. Stopped lithium several months ago and followed low salt low protein diet. Still DI. Rx?
Thiazide
197
Baclofen mechanism
BABA Agonist
198
How do neutrophils kill bacteria
Phagocytosis
199
What causes hypotension in anaphylaxis
Histamine release
200
What is the chance of a sibling being a HLA match
25%
201
Assessment of ability to perform ADLs which score system?
Barthel
202
Where are SLG-2 transporters found
Proximal convoluted tubule
203
Acute optic neuritis Ix
MRI orbits
[VER testing rarely done]
204
Hashimotos -> nephrotic syndrome ?Initial Rx ?
Membranous nephropathy
Furosemide initially to get ocntrol of oedema
Then steroids
205
Primary progressive MS Rx?
Secondary progressive?
Ocrelizumab
Siponomod
206
What does a reticulocyte have that an erythrocyte doesn't
Ribosomal RNA
207
Most common cause of u waves
HypoK/Ca/Mg
208
Cause of hypoxia in early single lobe consolidation
intrapulmonary shunting
[blood directed to the area (consolidation) with poor oxygen diffusion capacity]
209
Ebstein anomaly? ECG?
Tricuspid regurg
[displacement of the septal and posterior tricuspid valve leaflets]
RBBB
210
Aqueous humour drains into
The canal of schlem
211
Most common bug in human bite
Strep anginosus
212
Fit healthy septic arthritis 1st Abx
IV fluclox
213
Clyclospora diarrhoea rx
Septrin
214
Peritoneal dialysis infection rx
Oral cipro and peritoneal vanc
215
Turners rx to prevent osteoperosis
HRT
[need oestrogen replaced]
216
MODY 3 HNFa. BM control worsening on max gliclazide. Second line?
Insulin
217
Cyclophosphamide mechanism
DNA alkylation
-depletes CD4>CD8 T cells
218
Cyclophosphamide - what causes haemorrhagic cystitis
Acrolein
219
Pregnant fasting bm >7
Insulin metformin and lifestyle
220
TIA - what are 2 parts on ABCD2 score worth 2 points
Unilateral weakness
duration > 60 mins
221
When lobeectomy in epilepsy
Partial complex siezures (temporal) on 2 antiepileptics with ongoing disabling seizures
222
how does timolol help raised IOP
Reduced aqueous humour production
223
Bony met pain on high dose opiates
Bisphosphonates or denosumab
224
Common classes of drugs causing microscopic colitis
PPI
NSAID
225
Global aphasia means damage to
Left parisylvian region and thalamus
226
Graves 1st line mab
Toculizumab
227
Complex partial epilepsy 1st line?
If Han Chinese ?
Oxycarbazine
Keppra (HLA B1502* in 10%-> risk of SJS)
228
Most common antibody T1DM
Anti GAD
229
HNPCC drug
Aspirin 600mg
230
Pancreatitis - when would you think new palapble mass is necrotic pancreatitis and when pseudocyst
Acute clinical deterioration = necrotic
Grumbling long term abdo pain = pseudo
231
Which soda bic in tricyclic OD
50-100mls of 8.4%
232
Essential thrombocytosis rx
Hydroxyurea
233
Bechets rx
Pred
234
Ectopic ACTH in which lung Ca
Small cell
235
Thyroid hormone receptor found
In the nucleus
236
C1 esterase inheritance
Hereditary angioedema .... DOMINANT
237
CO poisoning effect on ventilation
None
238
ASx bacteruria in old person
Dont treat
239
Recent MI now episode of VT (resolved) and some ST elevation in a couple leads
Ventricular aneurysm
240
When straight to evolocumab rather than ezetimibe in someone already on statins ?
LDL >4 with issues eg reccurent MI
241
Epley or brand daroff
Epley
242
Which lymphocytes in immune memory
T cells
243
Kallman's inheritance
X linked recessive
244
Restless leg with no dopamine agonist as option rx?
Gabapentin / pregabalin
245
Dermatomyositis not responding to pred
Azathioprine
246
CKD with raised phosphate 1st line
Calcium acetate
247
>65. T score -3.5 or worse and prev fractures who cant tolerate bisphosphonates
Teriparatide
248
Antiepileptic with highest risk osteoperosis
Phenytoin
249
CKD what is best blood test for iron deficiency anaemia
% hypochromic blood cells
