Quick Facts 7 Flashcards
1
Q
TCAs are toxic to which part of the body? [1]
A
Cardiotoxic: Blockade of fast sodium channels in myocardial cells slows the action potential and provides a membrane stabilizing effect. The characteristic QRS prolongation seen in TCA overdose occurs secondary to prolongation of phase “0” of the myocardial action potential. T
2
Q
venlafaxine is what drug class? [1]
A
SNRI
3
Q
Which drug class are first treatment for moderate-severe depression? [1]
A
SSRIs
4
Q
How do SSRIs differ in their mechanism to TCAs? [1]
A
SSRIs don’t inhibit noradrenaline reuptake
5
Q
Which SSRI increases QT intervals? [1]
A
Citalopram
6
Q
Phentoin is an anti-seizure drug that targets which channel?
GABA-A
NMDA Glutamate
AMPA Glutamate
Na+
CA2+
A
Phentoin is an anti-seizure drug that targets which channel?
GABA-A
NMDA Glutamate
AMPA Glutamate
Na+
CA2+
7
Q
What pathology is phenytoin used for? [1]
A
Seizures
8
Q
Name some key side effects of phenytoin acute [2] chronic [3] and idiosynchratic use [1]
A
9
Q
Name and explain a MSK disease prolonged phenytoin use can cause
A
enhanced vitamin D metabolism causing osteomalacia
10
Q
Name two uses of amantadine [2]
State MoA [2]
A
Treats: Parkinson’s disease & PVS
NMDA receptor antagonistic effect & block dopaminergic reuptake
11
Q
What does Agomelatine treat? [1]
A
Depression
12
Q
State the class of drugs that selegiline belongs to [1]
A
MOA inhibitor
13
Q
Management of tonic-clonic seizures is with:
First line: []
Second line: [] or []
A
Management of tonic-clonic seizures is with:
First line: sodium valproate
Second line: lamotrigine or carbamazepine
14
Q
Which drug class has the highest risk for mania if used to treat depression in bipolar patients?
TCAs
SNRIs
MAOIs
SSRIs
A
Which drug class has the highest risk for mania if used to treat depression in bipolar patients?
TCAs
SNRIs
MAOIs
SSRIs
15
Q
Which is the first line treatment for trigeminal neuraglia? [1]
A
Carbamazepine
16
Q
Name two indications for Carbamazepine [2]
A
Epiplepsy
Trigeminal neuralgia
17
Q
Name a common side effect of Carbamazepine use [1]
A
Carbamazepine hypersensitivity: get a rash
18
Q
What ion flows through the GABA receptor?
Sodium
Chloride
Bicarbonate
Potassium
Calcium
A
What ion flows through the GABA receptor?
Sodium
Chloride
Bicarbonate
Potassium
Calcium
19
Q
Zolpidem is a drug that causes patients to temporarily leave vegetative state. What is its MoA?
GABA-A antagonist
GABA-A agonist
NMDA Glutamate antagonist
NMDA Glutamate agonist
AMPA Glutamate antagonist
A
Zolpidem is a drug that causes patients to temporarily leave vegetative state. What is its MoA?
GABA-A antagonist
GABA-A agonist
NMDA Glutamate antagonist
NMDA Glutamate agonist
AMPA Glutamate antagonist
20
Q
Name two drugs used for seizure prophylaxis [2]
A
A
Phenytoin
Levetiracetam
21
Q
Which drug inhibits GABA metabolism? [1]
A
Vigabatrin
22
Q
Risperidone blocks which 5-HT subtype? [1]
A
5-HT2A
23
Q
Buspirone is an anti-anxiolytic that targets which receptor
5-HT1A
5-HT1B
5-HT2A
5-HT2B
5-HT2C
A
Buspirone is an anti-anxiolytic that targets which receptor
5-HT1A
5-HT1B
5-HT2A
5-HT2B
5-HT2C
24
Q
Which is the most selective SSRI?
citalopram
sertraline
fluoxetine
paroxetine
A
Which is the most selective SSRI?
citalopram
sertraline
fluoxetine
paroxetine
25
Phenelzine belongs to which drug class
SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)
Phenelzine belongs to which drug class
SNRI
SSRI
MOA (reversible)
TCA
**MOA (irreversible)**
26
Which of the following is the most cardiotoxic?
Amitriptyline
Nortriptyline
Citalopram
Sertraline
Fluoxetine
Which of the following is the most cardiotoxic?
**Amitriptyline**
Nortriptyline
Citalopram
Sertraline
Fluoxetine
27
Which dopamine pathway is involved in reward and addiction? [1]
Exam Q
**Mesolimbic**
28
Describe MoA of ketamine [1]
NMDA glutamate receptor antagonist
29
Which cortical region is thought to be most involved in affactive and emotional behaviour [1]
Exam Q
Cingulate gyrus
30
Propofol; Thiopental; Etomidate are examples of what drug class? [1]
Intravenous anaesthetics:
31
Enflurane and Halothane are what type of drug class? [1]
Inhaled anaesthetics
32
Which drugs can you use to start seizure prophylaxis? [2]
phenytoin/levetiracetam
33
Which drugs can you use to induce coma? [2]
Sedation/Induce coma with **propofol** or **benzodiazepines**
34
Foetal malformations represent a main unwanted effect of an antiepileptic drug. Name this drug [1]
Phenytoin
35
The patient has some concerns as he is aware that codeine is an opioid medication.
What side effect is likely to continue to affect the patient, even with long-term use?
Constipation
Dry mouth
Peptic ulceration
Respiratory depression
Sedation
The patient has some concerns as he is aware that codeine is an opioid medication.
What side effect is likely to continue to affect the patient, even with long-term use?
**Constipation**
Constipation All side effects of opioids tend to abate with long-term use, except for constipation
36
Which anti-epileptic treatment works by bind to synaptic vesicle protein SV2A causing a reduction in neurones
Sodium Valproate
Ethosuximide
Lamotrigine
Levetiracetam
Lorazepam
Which anti-epileptic treatment works by bind to synaptic vesicle protein SV2A causing a reduction in neurones
Sodium Valproate
Ethosuximide
Lamotrigine
**Levetiracetam**
Lorazepam
37
A 27-year-old female is recently started on olanzapine following a diagnosis of schizophrenia. Shortly after the initiation of the drugs she becomes restless and her mother states that she seems to be staring blankly. On examination you note an upward deviation of both eyes.
What is the cause of this?
Brain tumour
Neuroleptic malignant syndrome
Oculogyric-crisis
Cranial nerve III palsy
**Oculogyric-crisis**
Oculogyric crisis is a dystonic reaction that occurs shortly after initiation of anti-psychotics, most commonly with the older typical anti-psychotics. Treatment involves drug cessation and anti-muscarinic administration.
38
Which of the following inhibits GABA transaminase to prevent GABA breakdown
Vigabatrin
Levetiracetam
Phenobarbitone
Tiagabine
Which of the following inhibits GABA transaminase to prevent GABA breakdown
**Vigabatrin**
Levetiracetam
Phenobarbitone
Tiagabine
39
Name a drug that used for epilepsy that has recent use for insomnia [1]
A
**Pregabalin**
40
Name a tricyclic antidepressant that is used to treaet neuropathic and cancer pain [1]
Amitriptyline
41
[] is an effective pharmacotherapy to aid smoking cessation
**Bupropion** is an effective pharmacotherapy to aid smoking cessation
42
Which anti-epileptic drugs are safe in pregnancy? [2]
Lamotrigine and levetiracetam
43
What are the first three firstline drug classes recommended for neuropathic pain? [3]
**SNRIs** (duloxetine)
**tricyclic antidepressants** (amitrypyline)
**calcium channel blockers**(gabapentin, pregabalin)
44
What type of family of antidepressants are clomipramine, imipramine, desipramine, amitriptyline, nortriptyline and protriptyline? [1]
TRICYCLIC ANTIDEPRESSANTS (TCAs)
45
Explain the three phases of antidepressant treatment [3]
46
Focal Seizures Treatment:
First line: [] or []
Second line: [] or []
First line: **carbamazepine** or **lamotrigine**
Second line: sodium valproate or levetiracetam
47
A 28-year-old patient with schizophrenia presents to the general practice. On two occasions he has noticed discharge on his shirt, when inspecting he noticed a milky fluid was coming from his nipples. He remembers the psychiatrist mentioning something similar to this could occur with his medication.
Which of the following is the most likely cause of his discharge?
Clozapine
Risperidone
Fluoxetine
Olanzapine
Quetiapine
A 28-year-old patient with schizophrenia presents to the general practice. On two occasions he has noticed discharge on his shirt, when inspecting he noticed a milky fluid was coming from his nipples. He remembers the psychiatrist mentioning something similar to this could occur with his medication.
Which of the following is the most likely cause of his discharge?
Clozapine
**Risperidone**
Fluoxetine
Olanzapine
Quetiapine
48
A man with generalized anxiety disorder is started on buspirone therapy. This drug is thought to interact with which of the following neurotransmitters?
A. Acetylcholine
B. Gamma amino butyric acid
C. Norepinephrine
D. Serotonin (5-HT)
A man with generalized anxiety disorder is started on buspirone therapy. This drug is thought to interact with which of the following neurotransmitters?
A. Acetylcholine
B. Gamma amino butyric acid
C. Norepinephrine
**D. Serotonin (5-HT)** (5HT1A)
49
A 19-year-old man is brought in by his family. They tell you he has become withdrawn and not left the house for several months and has been acting strangely. They think he is hearing voices and he often refuses to eat as he claims the food it is poisoned. Given the likely diagnosis, what would be the most appropriate first-line treatment?
Clozapine
Olanzapine
Sertraline
Sodium Valproate
Pregabalin
A 19-year-old man is brought in by his family. They tell you he has become withdrawn and not left the house for several months and has been acting strangely. They think he is hearing voices and he often refuses to eat as he claims the food it is poisoned. Given the likely diagnosis, what would be the most appropriate first-line treatment?
Clozapine
**Olanzapine**
Sertraline
Sodium Valproate
Pregabalin
50
Ponsenti method treats which growth abnormality? [1]
**Club foot / Tapes equinovarus**
51
A: RA
B: OA
C: gout
52
Which angle is used to detect CDH via ultrasound
What is a normal angle? [1]
alpha-angle
beta-angle
delta-angle
gamma-angle
**alpha-angle**
The alpha angle is formed by the acetabular roof to the vertical cortex of the ilium. This is a similar measurement to that of the acetabular angle (see below). **The normal value is greater than or equal to 60º.**
53
What is 3? [1]
3. Synovial fold
54
Omalizumab is used to treat
Vitiligo
Phemphis vulgaris
Leukocytoclastic vulgaris
Urticaria
Omalizumab is used to treat
Vitiligo
Phemphis vulgaris
Leukocytoclastic vulgaris
**Urticaria**
55
Which cell makes type 1 collagen?
osteoclasts
osteoblasts
osteocyte
osteoprogenitor
Which cell makes type 1 collagen?
osteoclasts
**osteoblasts**
osteocyte
osteoprogenitor
56
State an autoimmune disease that can cause AVN block [1]
**Ankylosing spondylitis**
57
What pathology is depicted here? [1]
**Trigger finger**
Superficial and deep flexor tendons with local tenosynovitis at the metacarpal head subsequently develop localised nodal formation on the tendon, distal to the pulley (Fig. 1). The A1 pulley is the most frequently involved ligament in trigger finger.
58
Adalimumab is a treatment for OA. Which cytokine does it target?
IL-1
IL-6
TNF-a
IL-17
Adalimumab is a treatment for OA. Which cytokine does it target?
IL-1
IL-6
**TNF-a**
IL-17
59
A: **Involucrum**: A reactive shell of new bone forms around the sequestrum
B: **sequestrum**: necrotic bone fragment
60
Jefferson Fracture occurs at
C1
C2
C3
C4
C5
Jefferson Fracture occurs at
**C1**
C2
C3
C4
C5
61
Boutienne
62
Erosive OA typically has erosion of cartilage in
Thumb DIP
Index finger PIP
Middle finger DIP
4th finger PIP
Little finger DIP
Erosive OA typically has erosion of cartilage in
Thumb DIP
Index finger PIP
**Middle finger DIP**
4th finger PIP
Little finger DIP
63
Which of the following antibodies would help confirm the diagnosis?
Anti-Ro
Anti-nuclear
Anti-histone
Anti-U1 RNP
Anti-cyclic citrullinated peptide
Which of the following antibodies would help confirm the diagnosis?
A Anti-Ro
Anti-nuclear (your answer)
**Anti-histone (correct answer)**
D Anti-U1 RNP
E Anti-cyclic citrullinated peptide
**This is not SLE!**
One of the hallmarks of drug-induced lupus is the presence of anti-histone autoantibodies, which are found in >95% of cases (formation is drug-specific).
Anti-Ro - seen in Sjögren syndrome.
Anti-CCP - seen in rheumatoid arthritis.
Anti-nuclear - seen in many autoimmune diseases.
Anti-U1 RNP - seen in mixed connective tissue disease
64
What proportion of patients with systemic lupus erythematous are positive for anti-nuclear antibody?
A 95%
B 75%
C 50%
D 25%
E 1%
What proportion of patients with systemic lupus erythematous are positive for anti-nuclear antibody?
**A 95%**
B 75%
C 50%
D 25%
E 1%
65
Denosumab is a monoclonal antibody that can be used in the treatment of osteoporosis.
Which of the following best describes the mechanism of action of Denosumab?
A TNF-alpha inhibitor
B RANK ligand inhibitor
C IL-23 inhibitor
D IL-1 receptor inhibitor
E IL-12/IL-23 inhibitor
Denosumab is a monoclonal antibody that can be used in the treatment of osteoporosis.
Which of the following best describes the mechanism of action of Denosumab?
A TNF-alpha inhibitor
**B RANK ligand inhibitor**
C IL-23 inhibitor
D IL-1 receptor inhibitor
E IL-12/IL-23 inhibitor
66
This HLA type has been associated with rheumatoid arthritis and type 1 diabetes melllitus? [1]
HLA-DR4
67
This HLA type has been associated with coeliac disease [1]
HLA-DQ2
68
A culture that that has staphyloxanthin found in it indicates an infection from which pathogen? [1]
69
A culture that that has staphyloxanthin found in it indicates an infection from which pathogen? [1]
70
Which of the following drug treatment causes dose dependent type 2 atrophy
Statins
Hydroxychloroquine
Corticosteroids
Prednisilone
Which of the following drug treatment causes dose dependent type 2 atrophy
Statins
Hydroxychloroquine
**Corticosteroids**
Prednisilone
71
Farmers often have OA in the
Knee
Spine
Hip
Hands
Farmers often have OA in the
Knee
Spine
**Hip**
Hands
72
Damage occurs from twisting injuries:
Posterior cruciate ligament injury
Menisical injury
Medial collateral ligament injury
Lateral collateral ligament injury
Damage occurs from twisting injuries:
Posterior cruciate ligament injury
**Menisical injury**
Medial collateral ligament injury
Lateral collateral ligament injury
73
Which treatment for RA targets IL-6?
Etanercept
Adalimumab
Anakinra
Rituximab
Abatacept
Tolizumab
Which treatment for RA targets IL-6?
Etanercept
Adalimumab
Anakinra
Rituximab
Abatacept
**Tolizumab**
74
Belimubab inhibits BAFF (B cell activating factor). It is used to treat
Ankylosing spondylitis
Systemic lupus erythematosus
Dermatomyositis
Scleroderma
Rheumatoid arthritis
Belimubab inhibits BAFF (B cell activating factor). It is used to treat
Ankylosing spondylitis
**Systemic lupus erythematosus**
Dermatomyositis
Scleroderma
Rheumatoid arthritis
75
Granuloma formation is a which type of hypersensitivity reaction?
Type 1
Type 2
Type 3
Type 4
Type 4
76
Which layer do chondrocytes die in?
A: tangenitial layer
B: transitional layer
C: radial layer
D: calcified cartilage
E: bone
Which layer do chondrocytes die in?
A: tangenitial layer
B: transitional layer
C: radial layer
**D: calcified cartilage**
E: bone
77
As part of citrullination, which positively charged amino acid is converted into citrulline?
A Tyrosine
B Tryptophan
C Glutamic acid
D Arginine
E Lysine
D Arginine
The process of self-citrullination involves alteration of a positively charged arginine amino acid into the neutral citrulline.
78
A 41-year-old is seen by the rheumatology team following a diagnosis of ankylosing spondylitis. He has been suffering from chronic lower back pain and right ankle tenderness. He has no significant medical history. He has been using paracetamol 1g QDS but the pain is ongoing.
What is the most appropriate first-line pharmacological treatment?
A Tramadol 50 mg PO QDS
B Naproxen 500 mg PO BD
C Methotrexate 7.5 mg PO once a week
D Infliximab infusion regimen
E Rituximab infusion regimen
A 41-year-old is seen by the rheumatology team following a diagnosis of ankylosing spondylitis. He has been suffering from chronic lower back pain and right ankle tenderness. He has no significant medical history. He has been using paracetamol 1g QDS but the pain is ongoing.
What is the most appropriate first-line pharmacological treatment?
A Tramadol 50 mg PO QDS
**B Naproxen 500 mg PO BD**
C Methotrexate 7.5 mg PO once a week
D Infliximab infusion regimen
E Rituximab infusion regimen
**E: Anti-TNF biologic agents would be the first-line option in patients with ankylosing spondylitis if required**.
79
What is the most likely diagnosis?
Secondary syphilis
Atopic eczema
Hand, foot and mouth disease
Reactive arthritis
Necrotising fasciitis
What is the most likely diagnosis?
Secondary syphilis
Atopic eczema
Hand, foot and mouth disease
**Reactive arthritis**
Necrotising fasciitis
The image shows evidence of keratoderma blennorrhagica, which describes the thickening of the soles and palms that may be seen in reactive arthritis.
80
This person with a tattoo has an adverse reaction. This occurs due to
Mast cell-mediated inflammation
Antibody-mediated inflammation
Immune complex mediated inflammation
Delayed hypersensitivity
Automimmunity
**Immune complex mediated inflammation**
81
Radial layer
82
This histological slide supports a diagnosis of
Body inclusion myositis
Duchenne MD (early)
Duchenne MD (late)
Myositis
Infantile myopathy
Fibromyalgia
Myositis
83
The acromioclavicular joint is which type of joint
saddle
plane
hinge
condyloid
The acromioclavicular joint is which type of joint
saddle
**plane**
hinge
condyloid
84
Vincular arteries supply
Ligaments
Enthesis
Tendons
Perimysium
Tendons
85
Which treatment for RA leads to decreased T-cell proliferation and cytokine production?
Etanercept
Adalimumab
Anakinra
Rituximab
Abatacept
Tolizumab
Which treatment for RA leads to decreased T-cell proliferation and cytokine production?
Etanercept
Adalimumab
Anakinra
Rituximab
**Abatacept**
Tolizumab
86
This histological slide is suggestive of
Gout
Osteoarthritis (OA)
Hydroxyapatite deposition disease (HADD)
Septic arthritis
Pseudo-gout
Gout
87
Which area of articular cartilage does OA initiate in?
A: tangenitial layer / superifical layer
B: transitional layer
C: radial layer
D: calcified cartilage
E: bone
Which area of articular cartilage does OA initiate in?
**A: tangenitial layer / superifical layer**
B: transitional layer
C: radial layer
D: calcified cartilage
E: bone
88
Which cells characteristically infiltrate muscle cells in myositis? [1]
CD8+
89
Describe the characterisitcs of blounts disease
Infantile Blount's disease is progressive pathologic **genu varum** centered at the tibia in children 2 to 5 years of age.
90
Annular ligament
91
What type of NSAID is indomethacin
Acetic acid derivative
Propoinic acid derivative
Selective COX-2 inhibitros
Salicylates
What type of NSAID is indomethacin
**Acetic acid derivative**
Propoinic acid derivative
Selective COX-2 inhibitros
Salicylates
92
Gout
Pseudogout
Osteoarthritis
Rheumatoid arthritis
Patella tendinitis
Pseudogout
The knee x-ray shows evidence of cartilage calcification, previously termed chondrocalcinosis, which is typical of pseudogout.
In hyaline cartilage, cartilage calcification will appear as a **thin opaque line**. **The knee is the most common joint to see pseudogout. **Another common place cartilage calcification occurs is the triangular fibrocartilage complex (TFCC) of the wrist.
93
Which joints are most commonly affected in rheumatoid arthritis (RA)?
A Metacarpohalangeal (MCP) joints
B Metatarsophalangeal (MTP) joints
C Temporomandibular joints
D Cervical spine
E Elbows
Which joints are most commonly affected in rheumatoid arthritis (RA)?
**A Metacarpohalangeal (MCP) joints**
B Metatarsophalangeal (MTP) joints
C Temporomandibular joints
D Cervical spine
E Elbows
94
A DEXA scan most commonly assess the bone mineral density of which two bones?
**Hip and spine**
95
Seropostive (ACPA positive) RA is more likely in people with which HLA
HLA DRB1 alleles
HLA DRB2 alleles
HLA DRB3 alleles
HLA DRB4 alleles
Seropostive (ACPA positive) RA is more likely in people with which HLA
**HLA DRB1 alleles**
HLA DRB2 alleles
HLA DRB3 alleles
HLA DRB4 alleles
96
Osteomalacia
Rheumatoid arthritis
Pseudogout
Osteoporosis
Gout
**Pseudogout**
Pseudogout is a type of arthritis in which a layer of calcification can be seen between articulating surfaces.
97
Ruxolitinib is a JAK inhibitor used to treat
Vitiligo
Phemphis vulgaris
Leukocytoclastic vulgaris
Urticaria
Ruxolitinib is a JAK inhibitor used to treat
**Vitiligo**
Phemphis vulgaris
Leukocytoclastic vulgaris
Urticaria
98
Gout is a disorder in which deposits of uric acid crystals accumulate in the joints because of high blood levels of uric acid. Which of the following is the most common cause of high blood levels of uric acid?
Consumption of too much alcohol
Inadequate elimination of uric acid via the kidneys
Infection causing build-up of uric acid
Production of too much uric acid in the body
Gout is a disorder in which deposits of uric acid crystals accumulate in the joints because of high blood levels of uric acid. Which of the following is the most common cause of high blood levels of uric acid?
Consumption of too much alcohol
**Inadequate elimination of uric acid via the kidneys**
Infection causing build-up of uric acid
Production of too much uric acid in the body
99
Q
Which treatment for RA leads to decreased T-cell proliferation and cytokine production?
Etanercept
Adalimumab
Anakinra
Rituximab
Abatacept
Tolizumab
Q
Which treatment for RA leads to decreased T-cell proliferation and cytokine production?
Etanercept
Adalimumab
Anakinra
Rituximab
**Abatacept**
Tolizumab
100
Name this sign [1]
The **Galeazzi** **sign** is elicited by placing the child supine with both hips and knees flexed (Figure 3). An inequality in the height of the knees is a positive Galeazzi sign and usually is caused by hip dislocation or congenital femoral shortening.
101
Platelet rich plasma (PRP) is a novel treatment process for
Osteoporosis
Osteomalacia
Osteoarthritis
Rheumatoid arthritis
Platelet rich plasma (PRP) is a novel treatment process for
Osteoporosis
Osteomalacia
**Osteoarthritis**
Rheumatoid arthritis
102
Allergic contact dermatitis is caused by which type of response
Th1
Th2
Th17
Th5
Allergic contact dermatitis is caused by which type of response
**Th1**
Th2
Th17
Th5
103
This imaging supports a diagnosis of
Body inclusion myositis
Duchenne MD
Myositis
Sarcopenia
Fibromyalgia
This imaging supports a diagnosis of
**Body inclusion myositis**
Duchenne MD
Myositis
Sarcopenia
Fibromyalgia
104
Which of the following is a fibrous ligament
achilles ligament
deltoid ligament
spring ligament
patella ligament
Which of the following is a fibrous ligament
achilles ligament
deltoid ligament
**spring ligament**
patella ligament
105
Which of the following commonly affects the MCP and PIP joints?
Paget’s disease
Osteoathritis
Osteoporosis
Osteomalacia
Rheumatoid arthritis
Which of the following commonly affects the MCP and PIP joints?
Paget’s disease
Osteoathritis
Osteoporosis
Osteomalacia
**Rheumatoid arthritis**
106
Name this apparatus being used [1]
What pathology is it treating? [1]
What ages would this be used for? [1]
**Von Rosen splint**: CDH between newborn - 6 months
107
Omalizumab works by reducing which molecule? [1]
**IgE**
108
Which prostaglandin causes the most bronchoconstriction in asthma patients?
PGE2
PGD2
PGI2
PGF2α
TXA2
Which prostaglandin causes the most bronchoconstriction in asthma patients?
PGE2
**PGD2**
PGI2
PGF2α
TXA2
109
SUFE is which type of Salter-Harris fracture
Type 1
Type 2
Type 3
Type 4
**Type 1**
110
This histological slide supports a diagnosis of
Body inclusion myositis
Duchenne MD (early)
Duchenne MD (late)
Myositis
Infantile myopathy
Fibromyalgia
This histological slide supports a diagnosis of
**Duchenne MD (early)**
* Fibre size variability
* Endomysial fibrosis
* Degenerating muscle fibres undergoing myophagocytosis
111
**Pavlik harness**: treats CDH for newborns - 6 months
112
This imaging supports a diagnosis of
Body inclusion myositis
Duchenne MD
Myositis
Sarcopenia
Fibromyalgia
This imaging supports a diagnosis of
**Body inclusion myositis**
Duchenne MD
Myositis
Sarcopenia
Fibromyalgia
113
Oral steroids; mycophenolate mofetil or azathioprine and / or Rituximab would be used to treat which skin condition? [1]
Pemphis vulgaris
114
What is this skin pathology? [1]
**Leukocytoclastic Vasculitis**
Fibrin deposition can be identified within the vessel wall
The perivascular inflammatory infiltrate is comprised predominantly of neutrophils but eosinophils are also present.
115
Mast cell-mediated inflammation
Antibody-mediated inflammation
Immune complex mediated inflammation
Delayed hypersensitivity
Automimmunity
**Mast cell-mediated inflammation**
116
Molluscum contagiosum
Herpes Zoster
Human papillomavirus
Cellulitis
Impetigo
Folliculitis
**Molluscum contagiosum**
Herpes Zoster
Human papillomavirus
Cellulitis
Impetigo
Folliculitis
117
This symptom is a result of?
Mast cell-mediated inflammation
Antibody-mediated inflammation
Immune complex mediated inflammation
Delayed hypersensitivity
Automimmunity
This symptom is a result of?
**Antibody-mediated inflammation**: Pemphigus Vulgaris
118
What skin pathology is depicted? [1]
**HPV** (viral warts / verucca)
119
Molluscum contagiosum
Herpes Zoster
Human papillomavirus
Cellulitis
Impetigo
Folliculitis
Molluscum contagiosum
**Herpes Zoster**
Human papillomavirus
Cellulitis
Impetigo
Folliculitis
120
This flower would cause
Mast cell-mediated inflammation
Antibody-mediated inflammation
Immune complex mediated inflammation
Delayed hypersensitivity
Automimmunity
This flower would cause
Mast cell-mediated inflammation
Antibody-mediated inflammation
Immune complex mediated inflammation
Delayed hypersensitivity
**Automimmunity**
121
Scalded skin syndrome
Necrotising fasciitis
Pemphigus Vulgaris
Leukocytoclastic Vasculitis
Neisseria meningitidis
Scalded skin syndrome
**Necrotising fasciitis**
Pemphigus Vulgaris
Leukocytoclastic Vasculitis
Neisseria meningitidis
122
# Molluscum contagiosum
[] bodies that contain virus particles are typical of histological slide
**Henderson-Patterson bodies** that contain virus particles.
123
Pityriasis versicolour
124
What skin pathology is depicted? [1]
Scabies
125
What pathogen is causing this slide? [1]
Mycobacterium leprae or mycobacterium lepromatosis
126
What is the pathogen causing this disease? [1]
What is the name for this presentation? p1[
**Scrofuloderma** follows the direct invasion of the skin from tuberculosis in an underlying lymph node or bone, often in association with pulmonary TB.
127
Scrofuloderma is a skin pathology due to invasion of a lymph node to which pathogen? [1]
**TB**
128
What is this skin pathology depicted? [1]
**Cellulitis**: Infection of the **dermis** and **subcutaneous** **fat**
129
Which drug can be used to determine how mineralised bone is? [1]
**Tetracycline** can be used to see how mineralised bone is. Tetracycline gets taken up on the calcium ions, and becomes deposited here and auto-fluoresces
130
This slide of bone is dyed with tetracyline. What is A? [1]
Trabecula bone
131
Describe MoA of Abatacept
**Blocks T cell activation which thus means macrophages and B cells cannot be activated**.
**Competes with CD28 binding to CD80/86** by **upregulating CTLA-4,** which switches T cell off
**Reduces production of TH17 cells**
Thus reducing inflammation
132
Which drug competes with CD28 by binding to CD80/86 and upregulating CTLA-4?
Abatacept
Denosumab
133
Denosumab treats which disease? [1]
Osteoporosis
134
RA treatment:
The most important biologics to remember are the TNF inhibitors .... [3]
The most important biologics to remember are the TNF inhibitors **adalimumab, infliximab and etanercept**
135
Teriparatide treats which disease? [1]
Osteoporosis
136
State the role of sulfasalazine after it has been converted to the 5-asa PRODUG IN THE LAMINIA PROPRIA OF THE LARGE INSTESTINE [3]
**Supresses** generation of **superoxide radicals** and **cytokine** **production** by inflammatory cells
**IL8** **decreased** in synovial fluid and **decreased** production of **IgM** and **IgG**, and **decreased** **angiogenesis**
**Inhibits IL-1 and TNF-a**
137
Which antibiotics would you give for chronic osteomyelitis [1]
vancomycin cement beads
138
A 48-year-old male discusses his secondary prophylaxis medications after suffering from a myocardial infarction last week. Aspirin is included in the several drugs but he is hesitant due to suffering from multiple bouts of acid reflux despite gastric protection. Celecoxib another COX (cyclooxygenase) inhibitor is prescribed instead.
What best describes the mechanism of action of this drug?
Reversible COX-1 inhibitor
Reversible COX-2 inhibitor
Non-reversible COX-1 inhibitor
Non-reversible COX-2 inhibitor
Non-reversible COX-1 and 2 inhibitor
A 48-year-old male discusses his secondary prophylaxis medications after suffering from a myocardial infarction last week. Aspirin is included in the several drugs but he is hesitant due to suffering from multiple bouts of acid reflux despite gastric protection. Celecoxib another COX (cyclooxygenase) inhibitor is prescribed instead.
What best describes the mechanism of action of this drug?
Reversible COX-1 inhibitor
**Reversible COX-2 inhibitor**
Non-reversible COX-1 inhibitor
Non-reversible COX-2 inhibitor
Non-reversible COX-1 and 2 inhibitor
139
Hydroxychloroquine blocks TL9. What effect does this have? [1]
**decreases activation of dendritic cells**: less autoantobodies produced
140
State two side effects of chronic methotraxate use [2]
Pulmonary fibrosis
Hepatic cirrhosis
141
State some side effects of acute methotrexate use [3]
**GI upset** (naus/ vom)
**Mouthulcers and sores**
**Hair loss**
142
Name two roles of DOACs [2]
VTE
AF
143
State an advantage of using DOACS over heparin for VTE [1]
taken orally
144
Tocilizumab targets which IL? [1]
**IL-6**
145
Which IL1 biologicals can be used to treat acute gout? [3]
Rilonacept, canakinumab, anakinra
146
Treatment for HPV: viral warts and veruccas? [5]
Topical salicylic acid
Fluorouracil cream
Cryosurgery
Surgical curettage
Laser treatment (CO2 laser 582nm)
147
Describe two biological DMARDs for SLE? [2]
**Belimubab**: inhibits BAFF (B cell activating factor)
**Rituximab**: CD20 blocker
148
Name a bisphosphinate used to treat OA [1]
Alendronate
149
Describe treatment regime of dermatomyositis [4]
Prednisilone (type of corticosteroid):
* 1 mg / kg per day until creatine kinase normal
Azthioprine
Methotrexate
Rituximab
150
Treatment for leprosy? [3]
Rifampicin, dapsone and clofazimine
151
How long does Rituximab take before positive effect? [1]
3 months after infusions
152
Describe the MoA of Denosumab [2]
Denosumab is a an **osteoprotegrin artificial antibody & acts as a monoclonal antibody to RANK:**
Denosumab: human monoclonal antibody that inhibits RANKL and helps regulate turnover in healthy bone. Denosumab binds with high specificity and affinity to the cytokine RANKL, inhibiting its action; as a result, osteoclast recruitment, maturation and action are inhibited, and bone resorption slows
153
Retinoic acid & Vit. A alongside oral antibiotics would be used to treat? [1]
Folliculitis
154
Retinoic acid & Vit. A alongside oral antibiotics would be used to treat? [1]
Folliculitis
155
State why biologicals, despire their efficacy are not used straight away for RA treatment? [2]
Due to the develop of **anti-drug antibodies** that will develop no matter what - **decrease efficacy**
156
Methotrexate may cause an increase in which liver marker? [1]
ALT: causes hepatoxcity
157
What drug class is the first oral biological? [1]
JAAK inhibitor
158
Two potential AEs of JAK inhibitors? [2]
Thromboembolic events
Cancer related events
