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MRCP PART 1 > Past paper tit bits > Flashcards

Past paper tit bits Flashcards

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1
Q

Which vitamin deficiency linked to colorectal Ca

A

Vit D

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2
Q

5cm plaque with inflamed border
Progress from thickened ->atrophic
May become hyperpigmented / ivory white over time

A

Morphoea

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3
Q

What dictates when to use Telapravir in HepC

A

HepC genotype

Genotype 1 has poor clearance and so use new agents such as Telapravir

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4
Q

STEMI going for PCI give what? If on oral anticoag?

A

Aspirin and prasugrel

Aspirin and clopidogrel

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5
Q

Woman (asymptomatic) who’s brother has haemophilia. What is risk of her son getting it?

A

25%

1 in 2 risk she has it
1 in 2 risk she passes on her dodge one

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6
Q

How does ticagrelor work

A

Platelet ADP receptor blocker

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7
Q

Aspirin mechanism

A

Cox-1 inhibitor

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8
Q

Cerebral toxoplasmosis rx = Pyrimethamine +

A

Sulfadiazine + folic acid

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9
Q

Biggest risk factor for suicide

A

Previous attempt

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10
Q

Cerebellar pontine tumour +calcification with no hearing loss / tinitus?

A

Meningioma

(if hearing loss = acousic neuroma)

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11
Q

Rheum A
Fever, dyspnea and multifocal consolidation =

A

Organising pneumonia

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12
Q

Usual time frame for MTX pneumonitis in Rheum A

A

4 months after starting MTX

CT shows pulm infiltrates

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13
Q

Alcoholic with urinary incontinence, peripheral neuropathy + reduced knee jerk =

A

B12 deficient

[B1 is just wernikes for exam]

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14
Q

How to screen for risk of steven johnsons syndrome
Eg if starting carbamazepine

A

HLA testing

HLA-B1502

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15
Q

Gram -ve bacilli causing cavitating pneumonia in big boozer

A

Klebsiella

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16
Q

Raised white/flesh colored lumps ? usually seen in? Cause?

A

Molluscum contagiosum
immunocompromised/
Children

Poxvirus

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17
Q

48 hour lag -> bloody diarrhoea

A

Campylobacter

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18
Q

70s when is loss of high frequency sounds presbycusis? Loss of cochlear hair cells?

A

Presbycusis - age related

Loss of cochlear hair cells - due to load noises Eg Gamekeeper, factory, war…

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19
Q

Key side effect of pethedine? When does it happen and why?

A

pethidine is metabolised to norpethedine
If renal impairment -> accumulates
->Seizures

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20
Q

What accumulates in renal failure and morphine administration

A

Morphine 6 - glucaronide

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21
Q

mid 20s with hereditary peripheral neuro symptoms -> ataxia? Inheritance?
Most common presentation?

A

Friedriecks ataxia
GAA repeat in frataxin gene

Unstable gait is usual presentation

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22
Q

Rheum A, now pancytopenic. What has happened

A

Felty syndrome (hypersplenism)

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23
Q

Haemarthrosis, factor VIII lower end of NORMAL and mild elevated APTT. Prev surgery with no issues =

A

Von Wilebrand

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24
Q

Karposi’s sarcoma virus

A

HHV 8

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25
Rx of SVC obstruction
Stenting followed by consideration of radiotherapy
26
Bone and muscle pain, weakness, lethargy. Proximal myopathy Low Ca, raised ALP =?
Osteomalacia Needs calcium + vit D
27
Positively birefringent rhomboids =
Caclium pyrophosphate [pseudogout / CPPD]
28
MRSA UTI rx
Doxy (or other tetracycline) if mild IV vanc if severe
29
Why CLL get recurrent infections?
Hypogamaglobulinaemia
30
Diarrhoeal illness and acute hepatitis. Which Hep viruses in differentials?
A or E | Consider HepE if south east asia
31
Corneal reflex - explain and nerves involved
Touch cornea -> stimulates sensory branch of CN V (trigeminal) Spinal trigeminal nucleus stimulates CN 7 facial nerve to cause both eyes to blink
32
How can you exclude adrenal insufficiency with synacthen test?
Cortisol rise of >200nmol/L and 30 min level >600nmol/L
33
Who gets neuropathy with isonazid?
-NAT-2 deficient -Slow aceytlators
34
2 mechanisms of nicorandil
Nitrate Potassium channel agonist Both lead to smooth muslce relaxation
35
2 drugs which can be used for myeloma
Thalidomide Bortezomib
36
Blast cells and aeur rods on blood film and acute leukaemia (especially if young) which chromosomal thing? What if CML?
t (15:17) CML - philadelphia t (9:22)
37
Post partum, hyperthyroid. Postive TPO antibodies whats the cause
Post partum thyroiditis
38
Which 2 leukaemias does philadelphia chromosome cause
ALL CML
39
3 poor prognostic factors in ALL ?
Males WCC >50 Philadelphia chromosome
40
Active SLE with thrombocytopenia. What rx>?
DMARD Eg hydroxycloroquine
40
Active SLE with thrombocytopenia. What rx>?
DMARD Eg hydroxycloroquine
41
Which CD and which MHC class on T helper Cytotoxic T
T helper - CD4, MHC class 2 Cytotoxic - CD8, MHC class 1 ## Footnote Multiply toget to 8
42
Which IL in acute phase response. Drug to target each?
IL-1 - Anakinra IL-6 - Toculizumab ## Footnote Both used in Rheum A
43
IL-2 does what? Drugs targetting it?
Drives T cell proliferation Eg in tranplant rejection Calceneurin inhibitors Eg Ciclosporin and tacrolimus | IL-2 in transplant rejection as 2 peoples organs there
44
Which IL is ANTI-inflamatory
IL-10 ## Footnote 10/10 well done bud calming things down
45
Which IL is ANTI-inflamatory
IL-10 ## Footnote 10/10 well done bud calming things down
46
Severe allergic asthma may get what -mab therapry
Anti-IgE Omazilumab
47
Which Ig deficiency gets autoimmune disease
IgA
48
Which T helper cell in Agressive inflam response? Tollerant response eg preg? Autoimmune disease?
TH -1 TH - 2 TH - 17 (secretes IL-17)
49
Why gynaecomastia in liver disease
Decreased steroid hormon catabolism [specifically androstenedione -> increased substrate converted into oestrogens]
50
Why feminism in someone who is fat and drinks lots
increases aromatase activity
51
FVC in COPD Inspiratory loop?
FVC often slightly low (due to gas trapping) Normal inspiratory loop
52
Coeliac and then small bowel obstruction =
T cell lymphoma ## Footnote Bacterial overgrowth would not lead to obstruction
53
Coeliac and then small bowel obstruction =
T cell lymphoma ## Footnote Bacterial overgrowth would not lead to obstruction
54
Hayflick limit is?
Number of times a cell can divide
55
2 most common rescue therapies in IBD
Ciclosporin Infliximab Both have quick acting properties | Other immunosupressive Eg Azathioprine, 6-metacarporine take weeks
56
Throat infetion then couple weeks later - salmon pink patches with scales
Guttate psoriasis
57
Gastrocnemius nerve root?
S1/2 (tibial nerve)
58
Common drug which seems to reduce the risk of colon cancer
Aspirin [and maybe NSAIDs]
59
Azathioprine / ciclosporin / methotrexate in preg?
Aza / ciclo can be continued Stop methotrexate
60
Azathioprine / ciclosporin / methotrexate / sulphasalazine in preg?
Aza / ciclo can be continued Stop methotrexate / sulphasalazine
61
Key risk of suphasalzine in preg
Baby born with haemolytic anaemia
62
Pulm / renal involvement only. 2 week course and really sick?
Goodpastures | GPA usually a bit slower with some sinus / upper stuff
63
Pulm / renal involvement only. 2 week course and really sick?
Goodpastures | GPA usually a bit slower with some sinus / upper stuff
64
Fomepazil mechanism ? Why do toxic alcohol peeps go blind?
Inhibits alcohol dehydrogenase ->prevents formation of formaldehyde -> formic acid -> acidosis and ocular toxicity
65
Dilsufiram mechanism
Inhibits aldehyde dehydrogenase | not alcohol dehydrogenase
66
Can you have DI with a normal serum osmolality ?
No IT WILL BE HIGH
67
Can you have DI with a normal serum osmolality ?
No IT WILL BE HIGH
68
Trip to africa Now 6-12 weeks later Fever and massive urticaria and rasied eosinophils? What if after just a couple weeks?
Shitosomiasis -> eggs -> big reaction (Katayama fever) Ascaris ssp (if soon after return)
69
How long Rx in schitz for symptoms to resolve
About 4-6 weeks
70
How long Rx in schitz for symptoms to resolve
About 4-6 weeks
71
Monozygotic twin with SLE whats risk? Dizygotic?
25% 3%
72
Monozygotic twin with SLE whats risk? Dizygotic?
25% 3%
73
Fatty with slightly low FEV1 and FVC with progressive SOB. What test to differentiate multiple small PEs and obesity hypoventilation.
Transfer coeeficient Eg Kco 55% will be PEs ## Footnote You dont get chest pain with small PEs
74
How does ATG work
Depletes T cells [inhibits monocyte-derived dendritic cells maturation]
75
Anti La found in which 2 conditons most commonly
SLE Sjorgrens
76
Repaired Aortic aneurysm. Which class of drug most important for long term?
B blockers | Keep the BP low and minimise vessle stress
77
Speaking in sentences but it is meaningless - Damage to? Where is this located?
Wernike's Superior temporal gyrus
78
Unable to say sentences = damage to? Where is it found?
Brocas Inferior frontal gyrus
79
What is nephritic factor actually called?
Anti-C3bBb ## Footnote Causes alternative complement pathway to be constantly stimulated
80
What is most common non traumatic cause of a chylothorax
Lymphoma
81
1st line Primary pulm HTN after a CCB? Mechanism ?
Bosentan Endothelien A receptor antagonist
82
Klebsiella osteomyelitis Abx
Tazocin
83
Endocarditis with Strep Sanguinis blood culutres. What Ix for source?
Orthopantomogram ## Footnote Sanguininis is usally from a dental abscess
84
What causes the raised urate in tumour lysis
Neucleic acid breakdown -> purines ->uric acid
85
H+ pH conversion - 2 vaulues to remeber
ph 7.4 = h+ 40 ph 7 = h+ 100
86
Lutembacher's syndrome is?
a congenital atrial septal defect (ASD) complicated by acquired mitral stenosis (MS).
87
Why do people who've had a big stroke stay cold?
Damage to hypothalamus -Leads to an impaired catecholamine response
88
Left Trochlear nerve palsy. How would patient tilt head when speaking to you?
Tild head to right
89
When do you see bilateral scotomas
Methanol posioning
90
Lesion in central scotoma is where
Optic nerve
91
Antibodies in HIT
Anti PF4 | [platelet factor]
92
Visit Nepal/india and up to date with vaccines Acute symptoms. Which hepatitis do they have ? Incubation period?
HepE 2-9 weeks
93
Contact dermatitis which hypersenitivity type?
Type 4
94
Klebsiella pneumonia drug choice?
Tazocin
95
Mechanism for PTH reducing PO4 in blood
Reduces proximal tubule reabsorbtion
96
Septic arthritis gonorrhea Rx
Ceftriaxone
97
Ballistic movements - where is damaged
Sub thalamic nucleus
97
Ballistic movements - where is damaged
Sub thalamic nucleus
98
Blueish discolouration of the skin caused by?
Amiodarone
99
Blueish discolouration of the skin caused by?
Amiodarone
100
Which cardiac drug causes mouth ulceration (and GI)
Nicorandil
101
P Vivax initial Rx
Chloroquine [followed by a course Primaquine]
102
Difference between an auditory hallucination and a second-person auditory hallucination.
Auditory - 'He wants to...' -Commentary Secondary - 'You are going to...' -Second person talking to you
103
Pyoderma gangrenosum Topical/oral steroids?
Oral
103
Pyoderma gangrenosum Topical/oral steroids?
Oral
104
Worried about thyroid eye disease - what test can you do first?
Perimetry [formal visual field testing]
105
Target lesions, haemolysis and pneumonia likely?
Mycoplasma
106
PVL staph - not responding to fluclox. What next?
Clinda [Doxy, rifampicin other options]
107
Where on the ECG is the 4th heart sound ? What is it?
P wave Caused by atria contracting forcefuly to overcome a stiff ventricle
108
Heart sounds 1 2 Where on ECG?
1 closure mitral/tricuspid QRS 2 closure aortic / pulm T
109
where are ketones formed in DKA
Lypolysis
110
DVT prophylaxis post acute stroke
Pneumatic compression boots | LMWH carries risk of bleed
111
CKD why raised PTH
Low vit D -> Low Ca
112
Shallow painless ulcer on penis enlarged lymph node in groin? bug? Rx?
Lymphogranuloma venereum Chlamydia Doxy 1 week
113
Unconcious house fire. Metabolic acidosis, normal O2 sats. Ischemic ECG
CO posioning
114
Chostochondritis - Do you need an Xray?
No
115
Erythema nodosum and bilateral ankle arthritis - whats high on differential
Lofgren syndrome [sarcoidosis -> needs a CXR]
116
Pre menopausal woman with iron defiiency anaemia 1st line Ix?
TTG
117
When is ivabradine used? Class
Heart failure with pulse > 75 HCN channel blockers [Hyperpolarization and Cyclic Nucleotide ] ## Footnote It works by slowing the heart rate so the heart can pump more blood through the body each time it beats
118
Which class of drug is HIV most commonly resistant to?
Reverse transcriptase inhibitors
119
Which class of drug is HIV most commonly resistant to?
Reverse transcriptase inhibitors
120
Can you reduce O2 % in COPD if they have a PO2 < normal
No | Heading towards NIV
121
What is lactate produced from?
Anaerobic metabolism from Pyruvate via lactate dehydrogenase
122
Fly to Africa and bitten by Tetse fly? Months later now sleep/wake cycle becomes reversed + other general CNS / psych issues? Bug? Ix? Rx?
Trypanosoma Brucei species [sleeping sickness] CSF Pentamidine
122
Flu -> cavitating pneumonia. Which bug?
Staph Aureus
123
Head injury -> persistent headaches, memory loss, lethargy. Slowly improving over several weeks
Post concussion syndrome
124
Pleuretic chest pain relieved while sitting forward. Best Ix?
ECG - pericarditis [trop wont be that exiting]
125
Which part of antibody binds to a receptor on surface of phagocyte
Fc Portion
126
Which part of antibody binds to a receptor on surface of phagocyte? Which part to bugs?
Fc Portion [FagoCyte] Fab [Think Fab fragments finding to digoxin - or faBacteria]
127
Travel. Chronic fevers + weight loss + splenomegally Pancytopenia and derranged LFTs =
Visceral leishmaniasis
128
Diagnosis of PMR
Clinical -> give pred
129
Common electrolyte abnormality in thyrotoxicosis
HyperCa
130
Rapid correction of hyperNa -> ? Whats happening intracellularly?
Cerebral oedema due to gain of water
131
Atherosclerosis which cells in tunica intima?
Macrophages | lipid laden foam cells
132
DVT in preg Rx
LMWH
133
Long term rate control in AF with cardiac failure
Bisoprolol ## Footnote Digoxin worse mortality
134
Lots of lifting - Carpal tunnel symptoms but also paraesthesia over palm
Pronator syndrome | carpal tunnel symptoms do not affect the palm, pronator syndrome will ## Footnote Lesion is proximal to formation of sensory branch They will also not get worsening of symptoms atnight unlike carpal tunnel
135
Which enzyme transports free fatty acids into cell to use as energy?
carnitine acyltransferase ## Footnote Carnivors eat lots of fat
136
coarctation usually also have?
Bicuspid aortic valve - in 60%
137
Ring enhancing lesions on CT. How to confirm Dx? Rx?
CSF PCR Pyrimethamine and sulfadiazine
138
Stab wound just lateral to sternum hits?
RV | LV if a couple cm lateral
139
Wells score DVT - If 1 or less? 2 or more?
1 or less - D-dimer 2 or more - Doppler
140
If doppler negative for DVT then what?
if doppler negative -> d dimer and if this is positive repeat the doppler after 6 days
141
No freinds and not intersted in people and does not feel lonely? What if they were lonely?
Schitzoid Avoidant if they are lonely
142
Differentiate common peroneal and L5 lesion
Common peroneal has preserved foot inversion and plantar flexion
143
Which post-mi heart failure drug might cause pancreatitis
Furosemide
144
Carbamazepine mechanism
Inhibit voltage gated sodium channel | Think causes hypoNa (different mechaism but same electrolyte)
145
Diabetes, gall stones, weight loss, dia/steatorrhoea, HypoCl
Somatostatinoma From D cells
146
BP med worsening psoriasis
B blockers
147
Endocarditis - which bug has better outcomes
Strep - less resistance and better response to Abx
148
Severe lung disease in A1AT which genotype
ZZ [tired of trying to remeber these]
149
Carribean Intermittent confusion Nodular skin rash, distal sensory deficit, thoracic anuerysm
Syphilis ## Footnote syphilitic aneurysms occur in 90% of cases on the thoracic aorta
150
Bar immunpsupression what other cause for poor antibody response to vaccines
HLA type
151
Prolactinoma - drug class for Rx
Dopamine agonist Eg bromocriptine, ropinorole, carbegoline
152
Syringomyelia - where LMN signs? UMN?
LMN - upper limbs (reduced reflexes and wasting UMN - Lower limbs - spaciticty
153
Thumb to touch fingertips muscle?
Opponens pollicus ## Footnote Opposition of thumb
153
Thumb to touch fingertips muscle?
Opponens pollicus ## Footnote Opposition of thumb
154
2 Types of BP med that worsen myasthenia
BB / CCBs
155
Cat scratch disease - usual Rx?
Conservative in immunocompetent | cipro/azithro if needed
156
Cat scratch disease - usual Rx?
Conservative in immunocompetent | cipro/azithro if needed
157
What causes finger drop in rheum A
Swelling of ulnar styloid ->rupture of tendon ## Footnote Needs surgical repaire obvs
158
Dosuleptin class
Tricyclic
159
Recurrent myoglobinuria likely cause?
Cartinine palmitoyltransferase deficiency
160
Gonnorrheoa Rx
IM cef + oral azithro
161
Ph of normal pleural fluid? Ph to suspect pleural fluid is malignant
7.6 under 7.3
162
Icidental finding of pleural plaques on XR - what next
Nothing - likely asbestos but in absence of lung disease just leave them alone
163
Surgical referral in endocardititis
Prolonged PR ongoing Fevers after 5 days
164
Neck pain tongue deviates right Right sided loss of vibration and proprioception Left sided weakness Where is lesion
Vertebral artery
165
What stimulates bladder emptying? Overactive bladder drug class for Rx ?
Parasympathetic stimulation Muscarinic antagonists
166
Closure of urethral sphincter is from?
Sympathetic stimulation ## Footnote opposite of bladder - want bladder contraction and urethral relaxion at the same time
167
Malignant / asbestosis effusion 1st line Ix?
Pleural tap
168
Tertiary hyperPTH when cinacalcet, when parathyroidectomy
Cinacalcet if surgery inappropriate If young deffs surg
169
Paracetamol OD INR for poor outcome
>2 by 24hrs >3.5 by 72 ## Footnote >6.5 is referral for liver Tx
170
IVDU - now extensive palapable purpuric rash and distal motor weakness over months. What has happened ?
Cryoglobulinaemia secondary to HepC
171
Lorazepam mechanism? When might it be used in pal care not for agitation?
GABA-A agonist Nausea - enhances the effects of conventional antiemetics
172
2 things prolonging life in MND
Riluzole NIV
173
Codine to morphine calculation
divide by 12 240mg codeine = 20mg morphine

MRCP PART 1 (22 decks)

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