Past Papers Flashcards
(210 cards)
1
Q
What is associated with poor prognosis in RA?
A
Anti CCP antibody
2
Q
Pure sensory neuropathy - diagnosis?
A
Uraemic neuropathy
Not GBS as no motor involvement
3
Q
What is the mechanism of action of irinotecan?
A
Topoisomerase inhibitor
4
Q
Multiple cranial nerve palsies - where is the lesion?
A
Cavernous sinus
5
Q
What exhibits zero order kinetics?
A
Aspirin - salicylates
6
Q
Congruous vs incongruous quadrantopias
A
CRIT
Congruous - radiations
Incongruous - tract
7
Q
Urine findings in acute tubular necrosis (2)
A
High urine osmolality
High urine sodium - tubules unable to reabsorb
8
Q
Where are parietal cells found?
A
Fundus of stomach
9
Q
What is the precursor to endogenous NO?
A
L-arginine
NO then causes an increase in cGMP
10
Q
What drug is associated with IUGR
A
Bisoprolol (B blockers)
11
Q
Jaundice
Ascites
Weight gain
Sudden onset
Differential?
A
Veno-occlusive event in liver e.g. Budd Chiari
12
Q
Management of nephrogenic DI secondary to lithium
A
Use thiazide diuretic, reduces the urine output
13
Q
Precursor to cortisol
A
11 deoxycortisol
13
Q
Basal meningeal enhancement + bacterial CSF
A
TB meningitis
13
Q
Concern with TEN
A
VTE - fluid loss, resulting hyperviscosity
13
Q
Horner’s syndrome
- course of neurones
A
1st order - hypothalamus to cervical spine
2nd order - runs along sympathetic chain to superior cervical ganglion
3rd order - superior cervical ganglion to cavernous sinus (via internal carotid artery)
14
Q
Genotype in severe A1-antitrypsin deficiency
A
PiZZ
14
Q
Management of botulism
A
Anti-toxin
14
Q
Management of cyanide poisoning
A
Amyl nitrate
15
Q
What is tobramycin an example of?
A
Aminoglycoside (30s subunit inhibition)
15
Q
Management of active lupus disease + renal involvement
A
MMF better than HCQ
15
Q
Management of hip osteonecrosis + young patient
A
Decompression and grafting
THR as a last resort
15
Q
A
16
Q
What is fear of germs?
A
Mysophobia
16
Management of nausea in bowel obstruction
Haloperidol
17
Grapefruit juice is a...
CYP3A4 inhibitor
Reduces metabolism - greater toxicity effect of medication
17
What is the pathogenesis of serotonin syndrome?
Impaired serotonin reuptake
17
Diagnosis of MND
Electromyography is helpful
17
Management of persistent air leak in PTX
Video guided thorascopic pleurodesis
Talc pleurodesis most helpful in malignancy
17
Fixed S2 - ostium secundum vs ostium primum
Ostium secundum is more common
Both cause fixed S2
17
Number needed to treat?
1/
control event rate - experimental event rate
17
How do B cells switch which immunoglobulins they produce?
Switch the constant heavy chain region
17
What is the risk of celecoxib?
Less risk of GI haemorrhage than other NSAIDs
Risk of worsening cardiac failure
17
1st line management in ADPKD
ACEI
17
Rapid reversal of warfarin e.g. urgent surgery
PCC - offers more rapid reversal than vitamin K
17
Gene association with
- breast/pancreatic/prostate cancer
BRAC2
(BRAC1 not pancreatic cancer as much)
18
What is the pathophysiology of haemoptysis in
- bronchiectasis
- PE
Bronchiectasis = capillary engorgement
PE = pulmonary parenchyma necrosis
18
Assessment of function post stroke
Barthel Index
Does Bart need hel(p) following his stroke?
18
What measure of lung function is reduced in obesity?
ERV
18
Feature in CKD that contributes to iron deficiency anaemia
Increased hepcidin
= hepcidin reduces oral iron absorption
18
Anti-hypertensive to avoid in lithium use
ACEI/ARB - can increase lithium toxicity
18
1st line anti-HTN in pregnancy
Labetalol
(nifedipine is second line)
18
Vomiting - determining between bulimia and anorexia
Bulimia - if BMI >17.5
If below that = anorexia
18
Type of receptor
- insulin
Tyrosine kinase
18
What has the greatest influence on O2 inspiration?
Flow rate of O2 (think HFNC - doesn't matter about the mask, all about the flow)
18
Management of pericarditis
Colchicine
Anakinra
Pericardectomy
18
Non reactive pupil
Occular muscles intact
What is painful?
= microvascular cause
If painful consider posterior communicating aneurysm
18
Investigation for confirmation of renal artery stenosis
MR angiography
18
Idiopathic pulmonary hypertension classification
Group 1
18
What in management of pulmonary hypertension can reduce sperm count?
Endothelin receptor antagonist
19
What gallbladder stones are people with sickle cell prone to?
e.g. sickle cell or hereditary spherocytosis
= chronic haemolysis
= bile pigment stones due to increased bilirubin
19
Management of erythroderma in psoriasis
Ciclosporin
19
Bronchiolitis obliterans
- lung function pattern
- symptom
Obstructive
Breathlessness
19
Determining bone involvement in myeloma
Whole body MRI
19
Management of lewy body dementia
Donezepil
- poor response to levodopa
19
How do fibrates reduce cholesterol?
They reduce intestinal cholesterol absorption
19
What is needed for the diagnosis of amoebiasis?
Hot poo - sample taken within 15 mins to the lap
19
Statistical test for crossover trial
Paired T test
19
Colon cancer + no polyps at young age =
= HNPCC
MSH2 gene
19
Which anti-epileptic is associated with visual field defects?
Vigabatrin
19
What testicular tumour is associated with hCG?
Teratoma
19
Viral CSF sample + low glucose =
= mumps meningitis
19
Mechanism of action of Orlistat
= inhibits pancreatic lipase to prevent absorption of fat
20
Investigating ARMD
Fluorescein angiography
20
What supplies the first web space?
Radial nerve (superficial branch)
20
Reversed split S2
Loud S1
Palpitations
= WPW Type B
- RV accessory pathway results in early RV excitation and depolarisation = early P2
= widely split reversed S2
20
What do you need to monitor in GBS?
Vital capacity
= ask the patient to count to 10 in one breath
20
What is the first line medication for acute schizophrenia?
Risperidone
20
What is the trinucleotide repeat in Huntington's disease?
CAG repeat
20
Unilateral optic neuropathy
Proximal myopathy
Telengiectasia
- inheritance
Leber's Hereditary Optic Neuropathy
- mitochondrial inheritance
20
Management of retinopathy near the macula
Focal retinal photocoagulation
- want to prioritise and save the macula
21
Management of aortic root dilation in Marfan's syndrome
ARB
21
What is the metabolite of morphine which results in respiratory depression and nausea?
Morphine-6-glucoronide
21
What are those with IgG2 deficiency susceptible to?
Haemophilus influenzae
21
When in the cell cycle does vincristine act?
Metaphase
- interrupts tubule formation
21
Raynaud's
Vibration
Sensory loss
Hand arm vibration syndrome
- sensory loss is the key, not seen in RP
21
How does alcohol cause hypoglycaemia?
= increased blood flow to pancreas, increased endocrine pancreatic function
= increased insulin production
22
Psychosis/paranoia
+ depression
= schizoaffective disorder
23
What is heard in ASD?
Wide split S2
- also increased blood flow over tricuspid valve
24
Biphasic fever from abroad
Dengue
25
Long QT syndrome mutation
K+ alpha subunit - K+ channels
26
Management of Barrett's oesophagus
Radiofrequency ablation
27
Management of UC flare
- no response to steroids despite 72 hours
Ciclosporin
27
Scleritis vs Episcleritis
Scleritis = SCREAMing in PAIN
28
Positive predictive value =
= how well test can identify true positives vs false positives
29
Abnormal sensation > motor activity > seizure
- where is the problem?
Right parietal lobe
30
Valve abnormality seen in pulmonary hypertension
Tricuspid regurgitation
(similar to MR in severe LV failure)
31
What controls plantarflexion?
Gastrocnemius
31
Management of listeria
Amoxicillin + gentamicin
32
Consideration/avoid with febuxostat
Avoid in cardiac disease
- use colchicine if unable/no response to allopurinol
33
What cardiac abnormality is associated with ankylosing spondylitis?
Aortic regurgitation
34
What VHL has the greatest risk of phaeochromocytoma and renal cell carcinoma?
VHL Type 2B
35
Anti-topoisomerase 1 antibodies =
= anti-Scl 70 antibodies
36
Two biochemical features of Child Pugh score
Bilirubin >52
INR >2.3
37
Which anti-epileptics are safe in pregnancy?
L-L
lamotrigine + levetiracetam
38
What is the genetic inheritance of alpha anti-1 trypsin deficiency?
Autosomal co-dominant
39
Component of staghorn calculus
Struvite (magnesium ammonium phosphate calculus)
40
Schistomiasis with lung/liver involvement
- which type involved?
S. japonicum
41
Management of membranous nephropathy
Prednisolone + cyclophosphamide
OR
Rituximab
42
What is the approximate rates of pancreatic tumours in MEN1?
Gastrinoma - 60%
Insulinoma - 30%
43
Management of urge incontinence
1. Bladder retraining
2. Oxybutynin OR tolteradine
3. Mirabegron - frail, want to avoid anti-cholinergics
44
Management of stress incontinence
1. Pelvic floor training
2. Duloxetine
45
Relative risk =
intervention rate group - control rate group /control rate group
46
Bifascicular block + EF <30%
Consider CRT
47
Ipsilateral 3rd nerve palsy + contralateral hemiplegia =
= Weber's syndrome
47
Amyloid in chronic inflammatory disorders e.g. RA
AA amyloid
48
Gitelman's
- gene affected
- channel affected
- biochemical results (3)
SLC12A3
Na/Cl transporter channel
= hypokalaemia, high bicarbonate, hypocalciuria
49
Exclamation hairs are seen in...
Alopecia areata
50
How can you differentiate between acute and chronic renal failure on blood tests?
= PTH
- high in chronic renal failure (to compensate for hypocalcaemia)
51
Mechanism of action of rasburicase?
Urate oxidation
52
EBV - how long to avoid contact sports?
4 weeks
53
What must you use with caution in severe aortic stenosis?
B blockers - may worsen syncope (remember LV is trying to overcome the gradient)
54
Statistical test to compare 2 means?
ANOVA
54
Which anti-tuberculous drug is associated with increased steroid requirement?
Rifampicin - inducer = more rapid metabolism, need more steroid
55
Recent subarachnoid
Headache + confusion
Diagnosis?
Hydrocephalus
56
What anti-psychotic should you avoid in movement disorders
e.g. Parkinson's disorder
Risperidone
57
Reticulocytes VS erythrocytes
= reticular staining
Reticulocytes do NOT have a nucleus
58
What can you use to treat itching in liver failure?
Cholestyramine
59
What type of receptor is the nicotinic receptor?
Acetylcholine receptor
60
1st line management of HOCM and LVOT obstruction
Bisoprolol
2nd = verapamil or disopyramide
61
What is the recurrent laryngeal nerve closely related?
Inferior thyroid artery
62
Subtypes of lupus nephritis
- which is the most common?
Membranous = nephritic syndrome, usually normotensive, normalish renal function
Diffuse = associated with poor renal function
Advanced sclerotic = ESRF
63
What can you use for carcinoid syndrome not responding to octreotide?
Teloristat (blocks serotonin production from tryptophan)
64
First management of acute hepatitis B infection
Usually observe and repeat PCR - likely to resolve
65
Poor prognostic factor in paracetamol OD
Low BMI
66
Poorly controlled HIV
Oesophageal ulcers
- diagnosis
- management
- what can be used as prophylaxis?
= CMV
Valganiclovir - also used as prophylaxis
67
Rule for mixed overdose
Never just treat one isolated item
Try and obtain an ECG
68
Mechanism of cisplatin
Causes DNA crosslinking
69
Mechanism of action of central pontine myelinosis
Rapid water efflux out of neurones
= loss of myelin
70
Actions of Vitamin D (4)
Increased absorption of calcium and phosphate from gut
Decreased PTH release
Osteoclast activation
Decreased TH1 response
71
Inferior ST elevation - which artery and region affected?
Distal RCA
- proximal RCA would result in spread to the anterior leads
72
1st line management in rosacea
Topical invermectin OR metronidazole (pregnant)
73
Brugada Syndrome
- genetic problem
- presentation
Mutations in sodium channels
VF usually at night (rather than exercise association)
74
Tall female
Nil axillary or pubic hair
Primary amenorrhoea
Androgen insensitivity syndrome
- XY genotype, female phenotype
75
Raised triglycerides and LDL =
Familial combined hypercholesterolaemia
76
Drugs associated with acute pancreatitis (6)
Sodium valproate
Loop diuretics
Tetracyclines
Oestrogens
Steroids
Octreotide
77
Management of serotonin syndrome
Cyproheptadine
78
Avascular necrosis in the foot - which bone usually affected?
2nd metatarsal head - tortuous blood supply
79
Management of impetigo
Mupirocin
OR fucidin
80
Pancreatic Insufficiency
- vitamin supplement
Vitamin A, D, E and K
81
Deficiency of alpha-galactoside
- condition
- inheritance
= Fabry's disorder
X-linked recessive
82
Measure for survival time
Hazards ratio
83
Management of magnesium sulphate toxicity
Calcium gluconate
84
Polymyositis
Lung fibrosis
Rhabdomyolysis
- diagnosis
- pathophysiology of renal failure
Anti-Jo 1 syndrome
ATN due to rhabdomyolysis
85
Management of Behcet's
Prednisolone where there is eye involvement
86
What is the effect of carbon monoxide on ventilation and inspiration?
Has no effect
87
ECG signs of left ventricular aneurysm
ST elevation in V1-V3
88
ECG signs of ischaemic cardiomyopathy
Poor R wave progression
LBBB
89
Conversion of PO to SC morphine
1/2 the oral dose
90
Management of pulmonary hypertension in pregnancy
Stop dual endothelin receptor antagonist e.g. bosentan
Start LMWH as prophylaxis
91
What cells are responsible for immune memory?
T cells
92
What is responsible for draining the oesophagus?
Azygous vein - upper 2/3rds
93
Management of dermatomyositis
Prednisolone
If not responsive trial azathioprine
94
Biochemical picture in Addison's disease
Hyperkalaemic metabolic acidosis
95
Mechanism of action of baclofen
inhibits glutamate release
96
What is at risk of injury when close to the right recurrent laryngeal nerve?
Right thyroid artery
97
Management of hypocalcaemia/hyperphosphataemia in CKD
1st line - calcium acetate
98
Which is associated with pulmonary haemorrhage - EGPA or GPA?
GPA - so raised transfer factor
99
MND - two tests for prognosis
FVC
Sniff nasal inspiratory pressure
100
1st management of spontaneous bacterial peritonitis
IV antibiotics
Wouldn't do ascitic drain
101
Rapid virilisation
Rapid onset puberty
Weight gain
Adrenal tumour
102
What mineral often needs supplementing following gastric bypass surgery?
Zinc
103
Sequence of events leading to T2DM
Ectopic fat deposition
Insulin resistance
B-cell failure
104
Management of coronary artery vasospasm
Calcium channel blocker e.g. amlodipine
105
Liddle VS Barter VS Gitelman
Liddle - hypertension, hypokalaemia, epithelial sodium channels
Barter's - hypokalaemia, Na/K+/Cl- cotransporter
Gitelman - hypokalaemia, hypocalciuria
Na/Cl- thiazide sensitive channel
106
Syndrome associated with breast, endometrial, thyroid and colon cancer
- genetic mutation
Cowden's syndrome
PTEN
107
CV defect in Noonan's Syndrome
Pulmonary Stenosis
108
Management of Tourette's Syndrome
Psychoeducation
Clonidine
Risperidone
109
Screening for haemochromatosis
General - transferrin saturation
Family - HFE genetic testing
110
What is associated with TB management and drug induced lupus?
Isoniazid
111
What activates macrophages?
INF-gamma
112
What stage of mitosis does vincristine act on?
Metaphase
113
Disinhibition
Gambling
Increased sweet tooth
Frontotemporal Dementia
114
Grave's Disease VS TMN on scintigraphy
Graves = uniform uptake
TMN = patchy uptake
115
Where are SGLT2 channels?
EARLY proximal convoluted tubule
116
Basophilic stippling is seen in....
Lead poisoning
Sideroblastic anaemia
B thalassaemia trait
117
Isolated lymphocytosis
Smudge cells
- What is the diagnosis?
- What is the management?
CLL
FCR chemotherapy
= fludarabine, cyclophosphamide, rituximab
118
Management of severe alcoholic hepatitis
Steroids
119
What is the pattern in Brown-Sequard syndrome?
Contralateral temperature loss
(spinothalamic tract decusates at each level)
Ipsilateral loss of proprioception, vibration sense, spastic paresis
120
Management of high altitude cerebral oedema
Descent + dexamethasone
121
What does troponin I bind to?
actIn
(troponin C = calcium ions, troponin T = tropomyosin)
122
What causes chancroid?
What is the presentation?
Haemophilus ducreyi
= do CRY about pain (painful lesion), usually travel history
123
Investigation of choice for reflux nephropathy
Micturating cystogram
124
What is the toxic product in paracetamol overdose?
NAPQI
= n acetyl p benzoquinonemine
125
Young male
Arthralgia
Abdominal pain
Fever
Pericardial Effusion
Familial Mediterranean Fever
126
Odds Ratio - how to calculate?
Did: Didn't
VS
Did: Didn't
127
Specificity =
specifically negative
(negative + false positive)
128
Sensitivity =
they are sensitive so it's important to be positive
129
Think celebrity is in love with them
De Clerambault's syndrome
130
What is associated with T1 cyroglobulinaemia?
Raynaud's phenomenon
Membranoproliferative GN - common to all cryoglobulinaemias
131
Side effect associated with sulphonylureas?
Example
Weight gain
Tolbutamide
132
Management of OCD
Exposure response therapy
133
Management options for vasodilator NEGATIVE pulmonary hypertension
PDE5 inhibitor e.g. sildenafil
Dual endothelin receptor antagonist e.g. bosentan
Prostacyclin analogues
134
Biochemical abnormality seen in Cushing's Syndrome
Hypokalaemic metabolic alkalosis
- think there is XS aldosterone = K+ loss, alkalosis
135
Features associated with pancreatic cancer (2)
Double duct sign
Migratory thrombophlebitis
136
What movement is reduced in adhesive capsulitis?
External rotation
137
Which renal tubular acidosis is associated with renal stones?
T1 RTA
= too little acid in urine, alkaline urine, means that calcium and phosphate clump together = stones
138
Phosphate abnormality in 1y hyperparathyroidism
- why?
Low phosphate
Reduced absorption/increased excretion of phosphate in proximal tubule
139
Mechanism of action of pilocarpine
Muscarinic agonist
140
Management of pulseless VT or VF - initial
Unsynchronised DC shock (nothing to synchronise to)
141
What does the Golgi do?
Adds mannose 6-phosphate
142
What is the first choice anti-depressant in ischaemic heart disease?
Sertraline
143
How do you monitor haemochromatosis?
Ferritin
144
COPD
- where will they see benefit in NIV?
If pH is 7.25-7.35
145
Syringomyelia
- which tracts affected and where?
Spinothalamic tract - because they decussate at the anterior white commissure
146
What immunodeficiency predisposes to SLE?
C1q, C1rs, C2 and C4
147
Sudden painless loss of vision
Multiple retinal haemorrhages
Diagnosis?
Central retinal vein occlusion
148
Which cells in stomach secrete stomach acid (and so gastrin acts on)?
Parietal cells
149
HLA loci associated with RA
HLA DRB1
150
What technique is used for oncogene detection?
PCR
