PP3 Flashcards
(205 cards)
1
Q
Buprenorphine mechanism
A
Partial mu agonist
2
Q
COPD on prn salbutamol. Next rx if:
If FEV 1 <50% ?
>50%?
A
<50% High dose flucatasone + salmeterol
> 50% tiotropium
3
Q
Greater curve of stomach artery
A
Gastroepiploic
4
Q
factor V Leiden previous DVT, now retinal vein thombosis rx?
A
Life long anti coag
5
Q
Lateral epicondylitis is inflammation of which tendon?
A
Extensor carpi radialis brevis
6
Q
alternative to thalidomide in myeloma
A
Bortezomib
7
Q
Ezetimibe mechanism
A
NPC1L1 inhibitor
N before P
8
Q
Evolocumab mechanism
A
PCSK9 inhibitor (prevents degradation of LDL receptor)
P after N in alphabet
9
Q
Lead poisoning renal issue
A
Type 2 RTA
(Proximal bicarb)
10
Q
Primary CNS lymphoma. Which virus
A
EBV
11
Q
Rofulimast used when mechanism?
A
COPD fail to get Sx control on triple inhaled therapy
PDE4 inhibitor
12
Q
Defib synchronised with which part of ECG
A
R wave
13
Q
Recurrent nasal and sinus infections + salmonella that needed Abx? Which Ig?
A
IgA Deficiency
14
Q
Myasthenia on pred / pyridostigmine but not responding what next?
Third line?
When thymectomy?
A
Azathioprine / ciclosporin / mycophenolate [steroid sparing]
Rituxumab / belimumab
Thymectomy if unresponsive to second line rx or obvious thymoma
15
Q
New dx of SLE affecting joints, renal 1st line?
A
Hydroxychloroquine
16
Q
SLE medical management struggling, which -mab?
A
Belimumab
17
Q
Which mab PMR
A
Toculizumab
18
Q
Gum hypertrophy cardiac med
A
CCBs eg amlodipine
19
Q
Blood finding to indicate anti-GBM disease rather than another vasculitis. [Excluding antibody screen]
A
Normal ESR in Anti-GBM
20
Q
Trimethoprim vs cipro in pregancy for UTI
A
Cipro contra indicated - tendon rupture
Trimeth - caution and prescribed with folic acid
21
Q
Where does indapamide work on kidney
A
Distal convoluted tubule
22
Q
What can you do in central retinal artery occlusion?
A
Thrombolysis - not brilliant results but positive
23
Q
Acromegaly rx? What can you do before this
A
Transsphenoidal surgery
Octreotide (or other somatostatin analogue) in run-up
24
Q
MI heart block with low BP needs
A
Pacing - trans cut or trans venous on the way to PCI
25
RTA then 6 weeks later complains of neck pain and weakness / neuropathy
Prolapsed disc
Cervical spondylosis often referred pain up to occiput and more chronic
26
Obetichloic acid mechanism
FXR agonist
27
Yersinia Rx
Quinilones Eg Ofloxacin
28
Sudden onset shoulder pain after vaccine =
Brachial neuritis
29
Thyrotoxicosis in preg with proptosis means? Rx?
Graves
Needs Rx Eg carbimazole if in final trimester
30
Antidepressants + tramadol risk
Serotonin syndrome
31
Carpal tunnel Rx?
1. Splint
2. Corticosteroid injection
3. Surgical release
32
Fastest conduction in heart found in
Purkinje fibres
33
NASH + T2DM diet controlled and obese Rx?
GLP-1 agonist
34
Paraneoplastic cerebellar degeneration antibody in breast Ca? Small cell?
Anti-Yo - breast
Anti-Hu - Small cell
[Yo look at those breasts]
35
Recent genital herpes prevention of vertical transmission
Prophylactic aciclovir from week 36
36
Bilat mild RAS and one episode pulm oedema Rx
BP control eg CCB
37
Mab for asthma with normal IgE but raised eosinophils
Mepolizumab
38
Hashimotos gets preg. Expected change to 100mg thyroxine dose
50% more Eg 150mg
39
Pregnant woman contact with HepA positive Plan?
Hep A vaccination
40
Detention of a patient for 72 hours in hospital
5 (2)
41
reverse transcriptase does
DNA from RNA template
42
Pure seminoma Ca marker
LDH
[20% have bhcg 0% AFP]
43
Rheum A HLA
DR4, DR1
44
Stills first line mab
IL-1
Anakinra / Canakinumab
45
BM 6.5 preg after diet an exercise. Rx 1st line
Metformin
46
Which lung Ca paraneoplastic cerebellar degeneration? Antibody?
Small cell
Anti yo
47
Which muscle stops you falling forward when standing
Soleus
[Gastrocnemius for walking/jumping ets]
48
Cisplatin chemo common side effects that not kidneys / ears?
AF
Peripheral neuropathy
49
Disseminated gonorrhoea rx
IV Cef
50
Pemphigus rx if not responding to steroids + steroid sparing
Rituxumab
51
Why haemoptysis in worsening Mitral Stenosis
Pulm HTN -> alveolar haemorrhage
52
Which Abx avoid in G6PD
Quinolones, fluoroquinolones
Nitrofurantoin
53
Heart failure EF <40% On ACEi and BB what can you add
Eplerenone
54
drug induced Parkinsons is more likely to be...
Symmetrical and does not have a resting tremor
55
Congugate gaze palsy when looking to left lesion which MLF?
Right medial longitudinal fasciculus
[the right eye is failing to adduct]
56
Initial Rx NPH
Therapeutic LP
[Helps predict response to shunt]
57
Mycophenolate most common side effect
tremor
58
Metastatic prostate Ca resistant to goserelin Rx?
Enzalutamide
[enz of life]
59
Possible MRSA head abscess
Linezolid
60
Aciclovir mechanism
DNA polymerase inhibitor
61
Caribean, dry cough, no clubbing restrictive lung function
Sarcoid
62
Metformin GFR when change dose
reduce when <45ml/min
Stop if <30ml/min
63
Cystinuria Rx drug
Penicillamine
64
Alcoholism -> cavitating pneumonia =
Klebsiella
65
Altepase mechanism
Tissue plasminogen Activator (TPA)
66
Fibrate mechanism
PPAR-a agonist
67
Derranged LFTs with Anti-LKM1 positivitiy
Autoimmune / drug induced hepatitis
68
Rheum A, coughs up blood-stained phlegm most days for 5 years
bronchiectasis
69
CLL with haemolytic anaemia Rx? if not responding?
Pred
Rituxumab
70
Fronto temporal dementia with lots of disinhibited behaviour pharma Rx
SSRI to help reduce disinhibited behaviour
71
Clinical DVT and right heart strain in pregnancy
Anticoagulate
[and arrange VQ scan]
72
Th-2 cells produce
IL 4
73
Wood-grain rash on the abdomen and weight loss
Bronchial Ca
[Erythema gyratum repens]
74
Takayasu arteritis HLA type
HLA B52
75
HLA B52 couple assoc
ulcerative colitis
Takayasu
76
HLA DR2 couple assoc
Goodpastures
SLE
MS
Narcolepsy
77
On lithium. Develops hypothyroid. Plan?
Thyroxine
[Can continue lithium and then make plan with psychiatry]
78
HepB with decompensated LFTs
Tenofovir or entecavir
79
Thialand
Now cough, raised eosinophils, epigastric pain and weight loss + urticarial rash =
Strongyloides
80
Membranous nephropathy with worsening renal function and proteinuria Rx
Pred + cyclophosphamide
81
Thyroid eye disease not responding to pred ?
Rituxumab /
Cyclosporin
82
Pyrexia in serotonin syndrome
Mechanical cooling
[NOT dantrolene - though it may be added in later]
83
Outcome trial looking at death, MI and stroke. How to compare conventional therapy and new intervention
Cox proportional hazards
84
Infliximab in preg
Stop at week 16
85
What causes the pupil abnormality in holmes-adie
Damage to parasympathetic ciliary ganglion
86
Risk with emollients
If you smoke you might set on fire
87
Hypertensive with renal adenoma. Low K raised bicarb Rx? What would make you want to use eplerenone?
Aldosterone agonist - Spironolactone
If gynaecomastia -> eplerenone
88
Contra indication to trans cutaneous liver biopsy but not a trans jugular
Ascites
89
Where does RNA splicing occur
Nucleus
[Stop tryna be clever]
90
Mild anaemia, wcc 30, normal platelets dx?
CLL
[would expect platelets to be high if CML]
91
45F Flank pain, HTN, progressive cognitive impairment and lived reticularis
Antiphospholipid
Cognitive impairment from thrombus
92
What is broken down into glucose and galactose in the intestine
Lactose
93
recurrent renal stones, mild raised urinary Ca. bloods all normal rx?
Potassium citrate
94
Most common thyroid malignancy
Papilliary
95
BCL-2 ca marker in
B cell lymphoma
[c-myc more specific for burkitts]
96
Bleeding in lung ca or any thing else which vessel target for embolisation
Bronchial artery
[pulm artery in 5%]
97
Delayed transfusion haemolysis what diagnostic test
Coombs
98
Venous ulcer. Ix before compression bandages
ABPI
99
L5 vs common peroneal
Weakness of ankle inversion present in L5 lesion
100
On lithium 1st line antihypertensive
Amlodipine
101
Ig in hyperacute rejection of organ
IgG
102
Restless leg syndrom Rx
Dopamine agonists eg ropinirole
103
What is the lung disease you develop in CREST
Interstitial lung disease
104
6 months progressive breathlessness in 80-year-old with goitre. Ix to determine if the goitre is the cause of breathlessness?
Flow volume loop
105
23 no cardiac history gives birth then has anterior STEMI on ECG why
Coronary artery dissection
106
Acute heavy PR bleeding in a 70s most likely
Diverticular bleed
107
AF, then stroke, then cardioverted how long warfarin
Lifelong likely
108
Erythroderma initial Rx
Topical white soft parafin
109
Erythematous scaly rash affecting nasolabial folds and eyebrows
seborrhoeic dermatitis
110
What is an anacrotic pulse
Low volume pulse seen in aortic stenosis
111
Old age or bereavement a bigger risk factor for completed suicide
Old
112
Symptoms of claudication but normal pulses
Spinal stenosis
113
24, URTI then nephrotic syndrome with 1+ blood
Minimal change
114
What do you need to check before making a diagnosis of SIADH
TFTs
115
Isosorbide mononitrate mechanism
Increase cyclic GMP
116
Persistent microscopic haematuria in what age is indication for cystoscopy
>50
117
Belief worms under the skin is which disorder
Delusional §
118
How to calculate osmolality
2Na + 2K + glucose + urea
119
Overactive bladder. No response to oxybutinin next line?
Solifenacin
[another AntiMusk]
120
Old with IDA. UGI scope demonstrates 1cm DU? What next?
Colonoscopy
10% IDA are due to Ca and need to rule out R side colon Ca
121
Which cardiac med if nasal polyps and worsening of asthma
Aspirin
122
Where does haloperidol bind to for antiemetic effects
Area postrema (medulla)
123
Worked in Italy
3-year gradually increasing erythematous scaly patch about 5x6cm on the shin with well-demarcated edge
Bowen's
124
A study evaluated the effectiveness of a new analgesic in patients with painful knee osteoarthritis. Subjects were asked to assess their pain on a 10-point scale both before and after 6 weeks of treatment. Which stat?
Wilcoxon's
[Student's t-test is a test comparing means if they are normally distributed, while Wilcoxon's (man whitney) if unknown.]
125
Painless Loss of vision in the segment of 1 eye. Fundoscopy mild disc swelling. No fundal haemorrhage.
Branch arterial thrombus
[Would get haemorrhage in vein]
126
20. Epiglottitis bug?
H influenza
127
Old person breathless - CT basal fibrosis associated with dilated bronchi, but no honeycombing or ground-glass change
recurrent aspiration -> bronchiectasis
128
Face lupus not responding to topical steroids
Hydroxycloroquine
129
Abdo pain, diarrhoea, erythema nodosum. CT cluster of lymph nodes at appendix suggestive of mesenteric adenitis
Yersinia enterocolitica
[can mimic Crohn’s disease and appendicitis (pseudoappendicitis).]
130
Pancytopenia:
Haematuira + nucleated red blood cells, myelocytes and metamyelocytes?
normal blood film?
poikilocytosis?
hypersegmented neutrophils
Bone marrow mets
[leukoerythroblastic film]
Normal - aplasic anaemia / hypothyroid
Poikilocytosis - Myelodysplasia
Hypersegmented neutrophils - B12 deficiency
131
Left face UMN. Left hemiparesis. R fixed gaze palsy =
R frontal
[eyes ‘look towards’ the side of the lesion]
132
R arm wasting of the small muscles of the right hand, loss of reflexes. pinprick and temperature sensation throughout the right arm.
Syringomyelia
133
Digoxin half-life? How long to get to therapeutic level?
36hrs
5 half lives = 1 week
134
term used to describe the presence of an abnormal number of chromosomes (either less than 46 or more
aneuploid
135
Mechanism of renal injury with aciclovir
When dehydrated, aciclovir can precipitate as crystals
136
Origin of foam cells
Monocyte
137
Which Ig in ANA lupus
IgG
138
Ankle inversion vs common peroneal?
Eversion?
Inversion L5
[move towards largest of 5]
Peroneal - just foot drop
Eversion - S1
[move towards small 1]
139
Hypo while drunk
Increased 1st phase insulin secretion
140
What causes the progressive muscle loss in becker and duchene
telomere shortening
[cant produce new muscle]
141
Turners decreased exercise tolerance and systolic murmur
Bicuspid > coarctation
142
Thenar wasting and loss of sensation over finger tips
Distal median
[Loss of sensation over thenar = proxmial]
143
How to tell if someone is infectious with TB
Sputum cultures
144
Marfan description with pitting oedema of ankles and right sternal diastolic murmur
Pulm regurg
145
Recurrent sinusitis and LRTIs = which IgG deficiency
IgG1
146
Boozer and uses NO what is the cause of optic neuritis / plantar upgoing
B12 deficiency
[NO converts B12 to inactive form]
147
Digoxin mechanism? What happens
Inhibits Na/k/ATPase pump
leads to intracellular Na accumulation
148
Panretinal photocoag leads to what visual impairment
Peripheral loss
Loss of colour vision
149
Diptheria Abx
Macrolide
150
100 get new therapy 50 drop out, 10 don't get better and 40 improve. What is the ITT?
40%
How many improve / total planned to treat
150
100 get new therapy 50 drop out, 10 don't get better and 40 improve. What is the ITT?
40%
How many improve / total planned to treat
151
Amaurosis fugax vessel?
Internal carotid -> retinal
152
stable T2DM how often hba1c?
6 monthly
153
Campylobacter rX
Macrolide Eg Azithro
154
Initial Ix for early Rheum a hands
Colour doppler US
155
Ix OSA
Polysomnography
156
Pulseless VT given amiodarone 300mg. What next
Adrenaline
CPR
Further 150mg amiodarone
157
Where is PO4 reabsorbed
Proximal tubule
P for P
158
Stress incontinence Rx 1 / 2
1 - pelvic floor
2 - surgery
- Duloxetine if not for surg
159
Main constituent of bile
bile salts
160
Peroxisome does what?
Oxidation of branch fatty acids
161
Infectious Bloody diarrhoea that gets better with metronidazole? What if it didn't improve
Entamboea
[Salmonella / campylobacter if it didnt improve]
162
Relapsing and remitting small joint polyarthritis that fully resolves between attacks Rx?
hYDROXYCLOROQUINE
163
Where in nephron is impermeable to water
Ascending loop of Henle
164
Marked hypoK whats found on ECG
U waves
165
Bronchiectasis for 40 years. Why nephrotic syndrome
Amyloid
166
Negative concordance across chest leads seen in? means?
VT
Entirely positive R or entirely negative QS with no RS complexes
167
DKA H+ is normal but still mild ketonuria what is the cause
Acetoacetate
168
Wilxocon rank test also called used when?
Man whitney
Compare means of non normally distributed data
169
Worsening of renal function in lupus on hydroxychloroquine
Add mycophenolate
[Cyclophosphamide if life-threatening]
170
Erythematous photosensitive rash with scarring hair loss
Discoid lupus
PCT would be blistering
171
A1AT deficiency with only mild symptoms genotype
MZ
172
Where is the ostium of the coronary sinus ? What covers it in 60% of people
Drains into right atrium
[like the rest of the deoxygenated blood]
Thebesian valve
173
At what age is 100% sensitivity for ADPKD with US scan
20
174
PPV if sens 80% specificity 95% and prevalence 40%
Make table
Prevalance 40% = 400 in Disease present column
sens 400x0.8 = a = 320
d = 0.95x600 = 570
b= 600-570 = 30
ppv = 320 /(320+30) = 91%
175
Differentiate factiously and malingering
Malingering they are tying to gain something
176
VHL with slowly progressing visual impairment
Hemangioblastoma
177
PR3 positivity with lung/ renal vasculitis
GPA
178
MPO positivity with lung/ renal vasculitis
MPA
179
pregnant VZV contact. Antibody negative. What next
Give IVIg
180
Spherocytosis with deranged LFTs
Cholescystitis
bile pigment gallstones
181
Juvenile myoclonic epilepsy in a girl
keppra
182
PPH and wants to stay preg what Rx
Change all to sildenafil
183
On allopurinol but ongoing gout attacks and raised urate add in?
Benzbromarone
URAT1 inhibitor
184
When is cortisol lowest
Midnight
185
MHC Class 2 found on what cells
Dendritic, macrophage, B cell
186
Chlamydia in preg
Azithro
187
Cyclophosphamide targets
T cells (mostly CD4 but also CD8)
[Via alkylation of dna]
188
What is the difference between chancroid and granuloma inguinale and lymphogranuloma vereneum? Bugs with each? rx?
Chancroid early spread to lymph nodes which get very big
H Durecyi
Single dose azithro / cef
Granuloma inguinale vascular and invasive ulcer [Donovan bodies]
Klebsiella granulomatis
Macrolides
Verenium - shallow painless ulcer with marked lymphadenopathy
Chlamydia
Doxy 3 weeks
189
Psoriasis 2 DMARDs and still Sx what next
TNFa Eg Golimumab
190
Bullous impetigo bug rx?
Staph A
Fuscid acid / mupirocin topical
191
GPA vs GBM biopsy
Both crecenteric glomerulonephritis
GMB has linear IgG
192
Osteomyelitis 1st line
Vanc + cef
193
HRT in premature ovarian failure
Which type?
If periods stopped >1yr = continuous HRT
<1yr - sequential combined HRT
194
VSD in preg
Reassure
195
Gonnorhea pen allergic
Azithro 2g
196
2 mutations in myelofibrosis
JAK 2 or MPL
197
Pubic lice Rx
Malathion lotion
198
Peritoneal dialysis infection most common bnug
Staph epidermis
199
mls/kg blood in a healthy person
75
[75kg, 75mls/kg, 7.5mg pred]
200
Thyroiditis Ix ? rx?
Thyroid isotope scan
NSAIDs [pred if needed]
201
persistent 1+ blood in urine not related to illness and family Hx
Thin basement membrane nephropathy
202
Philadelphia chromosome old person
CML
203
Renal colic
CT Nephrocalcinosis with multiple areas of pyramidal calcification? rx? 2nd line?
Medullary sponge kidney
Increase fluid intake
Citrate
204
Pagets whcih bisphos best
IV zoledronate
[IV option if there is a choice]
