1
Q
Vitamin D modes of action?
A
- Improves calcium and phosphate reabsorption from the gut
- Decreases T-helper 1 T-cells response
2
Q
What is Filgrastim and what is it used for?
A
- It’s a recombinant granulocyte-stimulating factor
- Used for primary prophylaxis of neutropaenia and neutrosepsis, as well as secondary prophylaxis of neutropaenia associated with cytotoxic chemotherapy
3
Q
What does the ileocolic artery supply?
A
Terminal ileum
4
Q
Anticoagulation after atrial fibrillation?
A
DOAC - Apixaban
5
Q
Patient presenting with early stage rhumatoid arthritis, what investigation?
A
Colour doppler ultrasound
6
Q
L5 lesion gives what?
A
Weakness of extension of big toe + sensory loss over great toe
7
Q
pH of gastric juice?
A
1.5 to 3.5
8
Q
HF + heart block, how to treat?
A
Cardiac resynchronisation therapy
9
Q
Albendazole, Mebendazole and colchicine MOA?
A
Inhibition of tubulin polymerisation
10
Q
Blood supply of recurrent laryngeal nerve come from?
A
Inferior thyroid artery
11
Q
Carcinoid syndrome treatment, other than octreotide?
A
Telotristat
12
Q
In alcoholic cirrhosis, what is the underlying pathophysiology?
A
Raised Endothelin-1 levels
13
Q
Signs of severe pulmonary stenosis correspond to on jugular venous pulse?
A
Dominant A wave
14
Q
What type of cells are Interleukin-12?
A
Natural killer cells
15
Q
Dihydropiridine calcium channel blockers (nimodipine, nifedipine, amlodipine) and alpha channel blockers (Doxazosin) can cause…?
A
Peripheral vasodilation => ankle edema
(CCB also cause brain vasculature vasodilation causing headaches and facial flushing)
16
Q
Where are insulin receptors located?
A
Cell membrane
17
Q
Winging scapula = lesion in ?
A
Long thoracic nerve
18
Q
Sjögren’s syndrome and SLE are associated with what renal condition?
A
RTA type 1 (distal type of RTA)
19
Q
Muscles involved in ankle clonus?
A
Gastrocnemius, soleus, plantaris
20
Q
Histology of diabetic nephropathy?
A
Thickening of glomerular basement membrane
21
Q
Urinary sodium in SIADH ?
A
> 20 mmol/L
22
Q
Urinary sodium in ATN?
A
> 40 mmol/L
23
Q
If egg allergy, what vaccine to avoid?
A
Yellow fever vaccine and live influenza vaccine
24
Q
MEN type 1 associations?
A
3Ps :
- HyperParathyroidism
- Prolactinoma
- Pancreatic tumours: Gastrinoma - Zolliger-Ellison syndrome
25
Management of delirium/acute confusion? and in patients with Parkinson's disease?
- In general population: Haloperidol (dopamine receptor antagonist)
- In Parkinson's : Low-dose short-acting benzodiazepine MIDAZOLAM or Lorazepam IM if hospital setting (Haloperidol CI as it worsens motor symptoms of PD)
26
In cystic fibrosis, what is the predominant inflammatory cell?
Neutrophils
27
Radiolodical apperance of bronchiectasis on CT scan?
- Broncho-arterial ratio >1.5
- Lack of bronchial tapering
- Bronchi visualised next to pleural surface (within 1 cm)
Tree-in-bud appearance
28
Regular cannon A wave=?
VT/AtrioVentricular Nodal-Reentry Tachycardia
29
Irregular cannon A waves =
Complete Heart Block
30
Eye abduction, which nerve?
Abducens nerve VI by innervating the Lateral rectus muscle
31
Eye adduction, which nerve?
Medial rectus - Oculomotor nerve
32
Eye elevation, which nerve?
Superior rectus - oculomotor nerve
33
Eye depression, which nerve?
Inferior rectus - oculomotor nerve
34
What is the soleus muscle responsible for?
- Prevents from falling forward while standing
- Plantar flexion of foot
35
What is gastrocnemius muscle responsible for?
Plantar flexion of foot
36
What abnormality in blood tests is seen in beta-thalassemia trait?
Isolated Raise in Hb A2 [>3.5%]
37
What abnormality in Hb is seen in Beta-thalassemia major?
- Microcytic anaemia
- Raised Hb A2 and foetal haemoglobin
- Absent Hb A
38
Features of Beta-thalassemia major?
- Presents in first year of life with failure to thrive and hepatosplenomegaly
- Microcytic anaemia
39
Dorsiflexion of foot is done by which muscle?
Tibialis anterior
40
Eversion of foot is done by which muscle?
Peroneus longus
41
What does Clindamycin and Macrolides work on?
50S subunit
42
Managment of nephrogenic DI?
Step-wise:
Low-solute diet => Thiazide diuretics (bendroflumethiazide) => NSAIDs (Indomethacin +++, naproxen)
43
Hydroxycarbamide MOA ?
Ribonucleotide reductase inhibitor
44
Indication of parathyroidectomy (primary and tertiary hyperparathyroidism)?
- Symptomatic hypercalciuria (thirst, frequent urination,constipation)
- End-organ damage (renal stones, fragility fracture, osteoporosis)
- Albumin-adjusted serum calcium level >=2.85mmol/L
45
Which drugs cause Clostridium difficile diarrhoea/pseudo-membranous colitis?
3 Cs:
- Clindamycin
- Ciprofloxacin
- 3rd gen cephalosporins
46
Causes of sterile pyuria?
Nsaids - Steroids - PPI
47
AST:ALT ratio >2 = ?
Alcoholic Liver Disease/Alcoholic SteatoHepatitis
48
AST:ALT <1 =?
Non-Alcoholic Fatty Liver Disease / Non-Alcoholic SteatoHepatitis
49
Polymyositis confirmation test?
Muscle biopsy or EMG
50
RTA type 1 (distal-hypokalaemic metabolic acidosis) is associated with which conditions?
Osteomalacia - nephrocalcinosis - Sjögren - SLE - Primary biliary cholangitis - Rheumatoid arthritis
51
RTA type 2 (proximal - hypokalaemic metabolic acidosis) is assocatied with what conditions?
Osteomalacia - Lead poisoning (house repairs) - Fanconi - Cisplatine
52
Physiopathology of urge incontinence?
Detrusor overactivity
53
Physiopathology of stress incontinence?
Increased abdominal pressure - uterine prolapse
54
Features of Pituitary apoplexy?
- Acute onset of sever bilateral headache
- Hypotension, hyponatraemia, low cortisol
- History of late term pregnancy
- Bitemporal hemianopia
- +/- tiredness, lethargy, pre-syncope
- Loss of libido
55
Most common cause of pituitary apoplexy?
Haemorrhage into a pituitary adenoma
56
Investigation in case of suspected pituitary apoplexy?
MRI +/- pituitary function tests
57
Management of pituitary apoplexy?
Urgent cortisol replacement
58
How does trimethoprim cause raise in creatinine?
Reversibly inhibit renal tubular secretion of creatinine
59
Frontal lobe lesion cause?
Disinhibition/behavioural changes
60
Parietal lobe lesions cause?
Visual-spatial awareness
61
Occipital lobe lesions cause?
Cortical blindness
62
Temporal lobe lesions cause?
Visual memory impairment
63
Arrythmogenic Right Ventricular Cardiomyopathy findings on MRI or Echo?
Fibro-fatty tissue deposition in right ventricle
64
Side-effect of mefloquine? (anti-malarial)
Drug-induced psychosis
65
An important raise in ALT is seen in what conditions?
Hepatocyte necrosis : - Paracetamol toxicity
- Hepatitis A and E
- Ischaemic colitis
66
A patient with systemic amyloidosis can present with what conditions?
Glomerulonephritis or bronchiectasis (cough, clubbing, coarse crackles)
67
Parametric + paired = ?
Student T test (paired)
68
Parametric + unpaired = ?
Student T test (unpaired)
69
Non-parametric + paired = ?
Wilcoxon signed-rank test
70
Non-parametric + unpaired = ?
Mann-Whitney U test/Wilcoxon rank-sum test
OR
CHI-squared test
71
SLE + rise in creatinine = ?
Lupus nephritis
72
What does the hilum of the left kidney overlie?
Pancreatic tail
73
How does alcohol cause hypoglycaemia?
Acute phase: increase first phase insulin response
Chronic phase: reduces neoglucogenesis
74
Rheumatic fever + mid systolic radiating towards left lateral position=
MS - Mitral stenosis
75
Rheumatic fever + pansystolic murmur radiating towards apex =
MR - Mitral regurgitation
76
Post-partum blues occurs when?
5-10 days post-delivery, no signs of self-harm or baby harm
77
Post-partum depression occurs when?
starts within a month and peaks at 3 months
78
Puerperal psychosis occurs when?
First 2-3 weeks post-delivery
79
Management of baby blues, post-partum depression and puerperal psychosis?
BB: Reassurance and support
PPD: Reassure and support + CBT +/- paroxetine or sertraline
PP: admit to a mother and baby unit ideally
80
Duchenne/Becker muscular dystrophy features?
Gradual worsening of muscle weakness + history of atrial fibrillation or heart failure
81
Duchenne/Becker muscular dystrophy muscle defect?
Telomere shortening (no muscle regeneration)
82
How to differentiate between Becker and Duchenne muscular dystrophy?
Becker presents in patients from 10 to 30 yo
Duchenne is deadly, with death intrapartum or shortly after partum
83
Anti-Ro/anti-la (aka anti-SSA and anti SSB- they're IgG) associated with what disease?
- SLE => neonatal heart block
- Sjögren's
84
Initial management of Behçet?
- Steroids (prednisolone) first line
- Azathioprine second line
85
Genetic defects of HOCM?
- Mutation in Beta myosin heavy chain protein (+++)
- Myosin binding protein C mutation (+)
86
Turner's syndrome + heart failure =
Coarctation of aorta
87
Turner's syndrome + aortic stenosis (gradual limitation in activity + Ejection Systolic Murmur) =
Bicuspid aorta
88
Hyperthermia + hyperreflexia + clonus + increased muscle tone + confusion = ?
Serotonin syndrome (use of Tramadol and SSRIs)
(Neuroleptic malignant syndrome has hyporeflexia)
89
Carpal tunnel syndrome, lesion where?
Distal medial nerve
90
Carpal tunnel syndrome features?
Loss of sensation in fingertips of thumb, second and third fingers
91
Lesions of distal radial nerve?
- Loss of sensation in dorsal and radial portion of the hand, dorsum of thumb + index
- Weakness in thumb and index, lateral+outer hand
92
Features of median nerve damage at elbow?
- Thenar eminence wasting
- Numbness/sensory loss of thumb+index+middle finger
- Numbness/sensory loss of thenar eminence
93
Features of median nerve damage at the wrist?
- Thenar eminence wasting
- Numbness/sensory loss of thumb+index+middle finger
- NO SENSORY DEFICIT OVER THENAR (that happens if the lesion is at the elbow)
94
Ulnar nerve damage?
- Wasting of HYPOTHENAR eminence
- Sensory loss over little finger and half of the ring finger
95
Most common organism in platelet contamination?
Staph epidermidis
96
In-stent thrombosis (post stenting) features?
First 30 days post-stent - related to antiplatelet stoppage - Features of angina
97
When does Stent restenosis occur? What are its features?
6 months post stenting - not related to antiplatelet - Features of MI
98
Causative organism of eczema herpeticum? and management?
- Herpex simplex virus 1
- IV Aciclovir
99
Eczema herpeticum features?
Existing atopic eczema + worsening rash + vesicles and blisters + hypotension + tachy cardia
100
MOA of aciclovir?
DNA polymerase inhibitor
101
side effects of Aciclovir?
AIN - crystalluria
102
Hypogammagobulinaemia common features?
- Recurrent sinusitis + pulmonary infections/bronchiectasis
- GIT infections are seen in IgA deficiency
- No GIT infections = IgG deficiency
103
Features of hydrocephalus?
History of SAH + severe headache + STABLE neurologic deficit + apyrexia + bilateral PAPILLOEDEMA + bilateral 6TH NERVE PALSY
104
HLA of Rheumatoid arthritis?
HLA-DRB1* 04:01/ DR4
105
Most specific test to diagnose latent TB?
Quantiferon gamma test
106
Conus medullaris syndrome features?
- HYPERREFLEXIA
- Bilateral symmetrical lower limb weakness with increased tonus
- Lower back pain
- Perianal numbness + urinary incontinence
107
Cauda equina features?
- Asymmetrical lower limb weakness with decreased tone
- Hyporeflexia
- Saddle area numbness
108
Difference between cauda equina syndrome and conus medullaris syndrome?
- Cauda equina is asymmetrical lower limb weakness with loss of tone and hyporeflexia
- Conus medullaris syndrome has bilateral symmetrical lower limb weakness with increased tone and hyperreflexia
109
Digoxin MOA and effect on cell?
- NA+K+ATPase pump inhibitor
- Leads to increased sodium in the cell
110
Schizophrenia first-line choice of TTT?
Risperidone
Olanzapine
111
Vincristine works at what cycle of the cell division?
Metaphase
112
Side effects of full-scatter panretinal photocoagulation?
Impaired night vision / tunnel vision
113
Single painless genital ulcer + delayed lymph node involvment = ?
Syphilis (Treponema pallidum)
114
Single painless genital ulcer + early lymph node involvment = ?
Lymphogranuloma venereum (caused by Chlamydia trachomatis)
115
Painless genital ulcers + NO lymphadenopathy =
Granuloma inguinale
116
Single painful ulcer + painful adenopathy =
Chancroid (haemophylus ducreyii)
117
Multiple painful ulcers + painful lymphadenopathy =?
Herpes simplex infection (HSV-2)
118
In case of active bleeding, when to give cryoprecipitate and when to give fresh frozen plasma?
Fibrinogen <1.5 = Cryo-PPT
Fibrinogen >1.5 = FFP
119
Weak flexion of terminal phalanx of thumb, which nerve is affected?
Median nerve damage
120
Assymetrical kidneys?
Unilateral renal artery stenosis
121
Initial investigation in renal artery stenosis?
Colour doppler ultrasound
122
Campylobacter jejuni diarrhea features?
- Incubation period 36-72h
- Renal impairment is a cardinal feature
123
Wedding meal (meat or dairy) + hypotension and tachycardia + renal impairment =
Campylobacter jejuni
124
Management of Campylobacter jejuni infection?
- Macrolides (Azithromycin or erythromycin or clarithromycin)
- Ciprofloxacin possible
125
Poor prognosis markers in Primary Pulmonary Hypertension?
- High pro-BNP levels
- Atrial fibrillation
126
OCP raises the risk of which cancers?
oCB => C and B => Cervical and Breast cancers
127
Investigation of choice in Primary Sclerosing Cholangitis?
MRCP
128
Where does reabsorption of phosphate take place in the nephron? And what inhibits it?
- Proximal convoluted tubule
- Inihibited by PTH (PTH works on PCT)
129
What respiratory abnormality is seen in Ankylosing spondylitis?
Diminished KCO
130
What effect does Carbamazepine have on mucosal membranes?
Carbamazepine causes Stevens Johnson Syndrome
131
Role of Peroxisomes?
Oxidation of Branched Chains Fatty Acids (BCFAs)
132
What is osmosis?
Movement of solute from Low concentration to High concentration
133
What effect does standing have on cardiovascular system?
Increases: Systemic vascular resistance, heart rate
Decreases: Central venous pressure, stroke volume, venous compliance
134
How to treat AIHA associated with Fludarabine?
First-line : Prednisolone
Second-line: Rituximab
135
Warfarin-induced haemorrhage, how to treat?
if INR>8, stop Warfarin and give Prothrombin Complex Concentrate (contains factors 2,7,9,10 at 25-50U/KG)+ IV vitamin K
136
T1 nerve root lesion causes?
- Wasting + weakness of intrinsic muscles of the hand
- Weakness of medial aspect of upper arm
137
C8/T1 dermatome ?
Dorsal interossei
Hypothenar eminence
138
C5 dermatome?
Deltoid and biceps
139
C6 dermatome?
Thumb + index/biceps
140
C7 dermatome?
Triceps
141
Features of amphetamine psychosis? And treatment?
Acute manic episode + marked sympathetic activation with hypertension + tachycardia
TTT = antipsychotics +/- benzodiazepine if confusion or agitation
142
Features of frontotemporal dementia?
Behavioural changes including sexual disinhibition + repetitive checking + binge eating +/- history of being a footballer (header)
MRI shows: frontal and temporal atrophy
PET scan: frontal hypoperfusion
143
Treatment of frontotemporal dementia?
SSRIs => Fluoxetine or Paroxetine
144
Features of Alzheimer's dementia?
Memory loss (dementia) + Cerebral atrophy on CT + Apraxia
145
Features of Lewy body dementia?
Parkinsonism + visual hallucinations
146
Features of multi-infarct dementia?
Vascular events/CVS risk factors + cognitive impairment
147
DVT/PE + pregnancy, which imagery to use?
Compression duplex USG
148
S/E of Cisplatin/carboplatin/oxaliplatin?
Peripheral neuropathy (platins cause peripheral neuropathy) + Atrial Fibrillation
149
S/E of Bleomycin?
Bleomycin-induced pneumonitis
150
S/E of Cyclophosphamides?
Haemorrhagic cystitis
151
S/E of Prembolizumab?
Increased risk immune disease (Prembolizumab is a checkpoint inhibitor)
152
S/E Trastuzumab?
Dilated cardiomyopathy/heart failure
153
Sudden painless loss of vision + flame-shaped haemorrhage + H/O of DVT/DM/Dyslipidaemia =
Central retinal vein occlusion
154
Sudden painless loss of vision + Pale retina + cherry-red spot =
Central retinal artery occlusion
TTT = intra-arterial thrombolysis
155
Pizza retina/flame haemorrhage + H/O HIV/immunodepression =
CMV retinitis
156
What antibody is associated with limited cutaneous systemic sclerosis?
Anti-centromere antibody
157
Mode of transmission of Peutz-Jeghers?
Autosomal dominant
158
Action of IL-4?
Promotes differenciation of T-helper cells into T-helper 2 cells
159
Breast cancer screening, which CA?
CA 15-3 and CA 27.29
160
Management of Torsades VT?
IV magnesium
161
Obstructive lung features with low transfer factor (emphysema) + deranged LFT (hepatic fibrosis) =
Alpha-1-antitrypsin deficiency
162
Anti-1-antitrypsin deficiency mode of inheritance?
Autosomal co-dominant inheritance
163
Management of Tourette's syndrome?
- Risperidone
- Olanzapine
164
Management of psoriatic arthritis/extensive plaque psoriasis?
Methotrexate
165
TCA overdose + QRS>100 ms, management?
Sodium bicarbonate infusion (100ml 8.4% sodium bicarbonate)
166
Elderly with progressive confusion/pregnant lady/history of eating french cheese + meningism + raised CRP + lymphocytosis in CSF + non-responsiveness to cerftriaxone =
Listeria meningitis
167
Management of Listeria meningitis? (Gram positive rod)
IV Amoxicillin/ampicillin for 21 days + Gentamycin
168
Management of bacterial overgrowth syndrome?
RMC
- Rifaximin
- Metronidazole
- Co-Amoxiclav
169
Management of Bile acid diarrhoea due to short bowel syndrome?
Cholestyramine
170
Management of Pancreatic Exocrine insufficiency?
Creon/pancreatin
171
Management of bile acide diarrhoea due to metformin?
Modified-release metformin
172
Gradual weight loss + rash in buttocks and waist + respiratory symptoms + eosinophilia + raised CRP =
Strongyloides infection
173
Management of Strongyloides?
Mebendazole or albendazole
Ivermectin
174
Difference between idiopathic and typical membranous nephropathy?
Idiopathic = positive anti-phospholipase A2
Typical variant = underlying malignancy
175
Management of idiopathic membranous nephropathy?
4C :
1st line: Anti-CD20 Rituximab
2nd line: Calcineurin inhibitors
3rd line: Corticosteroids + cyclophosphamide
176
Mangement of typical variant of membranous nephropathy?
Corticosteroids + cyclophosphamide
177
What auto-immune disease is associated with membranous nephropathy?
Hashimoto's thyroiditis (and Hashimoto's thyroiditis itself is associated with thyroid lymphoma, x60 times risk)
178
In CVD risk calculation, how to know whether to do interventional therapy or conventional therapy?
COX regression analysis
179
Features of tuberous sclerosis?
CUTANEOUS FEATURES
- Ash leaf macule
- Adenoma sebaceum: red spot/papule on nose, chin, cheek, nasolabial fold
- Ungual fibroma: smooth fleshy growth adjacent to nail
- Shagreen patch: roughened skin over lumbar spine
ORGAN FEATURES
- Renal angiomyolipomata, renal cysts, lung cysts
- Rhabdomyomas of the heart
- Retinal hamartoma: translucent rounded lesion in retinal periphery
NEUROLOGICAL FEATURES
Epilepsy, intellectual impairment, developmental delays
180
Brown-Sequard syndrome association?
Bronchial carcinoma metastasis
181
Features of Brown-Séquard syndrome?
Ipsilateral muscle weakness + loss of vibration and proprioception (abd+leg)
Contralateral loss of pain and temperature (upper limb/hand)
182
Multiple myeloma (Light Chain Deposition Disease) features?
CRAB
- Hypercalcaemia, hyperkalaemia
- Renal impairment
- Anaemia: normochromic normocytic, or pancytopaenia
- Bone and back pain
183
Biological findings of Multiple Myeloma?
- Pancytopaenia
- Increased total protein level with a normal albumin => the raise is in immunoglobulins
- Urinary dipstick positive for Bence-Jones proteins
- Hyperkalaemia + hypercalcaemia
184
Infliximab + pregnancy, when to stop?
16 weeks and replaced by azathioprine
(safe DMARDs in pregnancy are azathioprine, mesalazine, sulfasalazine)
185
Improperly stored fish + diarrhoea, abdominal cramp, facial flushing, blurred vision =
Scombroid toxin found in improperlystored tuna, mackerel, skipjack, salmon, sardines
NOT an allergic reaction, but an intoxication with histamines
186
Features of Holmes Adie pupil, and what lesion causes it?
- Slight mydriasis in one pupil + slow reaction to light
- Lesion in Parasympathetic Ciliary Ganglion
- Normal in young females
187
If a patient is using paraffin-based emollient, what advice to give?
Stop smoking and avoid open flames
188
Alcohol withdrawal first-line treatment?
Chlordiazepoxide
Alternatively benzodiazepines can be used but Chlordiazepoxide is preferred
189
Genetic mutation in Bartter's syndrome?
SCL12A1
190
Genetic mutation in Gitelman syndrome?
SCL12A3
191
Genetic mutation in Liddle's syndrome?
SCNN1B
192
Pneumonia post-influenza + abcess + cavity = which causative organism?
Staph aureus
193
Pneumonia + cavitation + empyema + neutrophilia + alcoholism = which causative organism?
Kelbsiella pneumoniae
194
Pneumonia + erythema multiforme + target lesion = which causative organism?
Mycoplasma pneumoniae
195
Pneumonia + low CD4<200mm = which causative organism?
Pneumocystis jirovecii
196
Pneumonia + hyponatraemia + hypotension + diarrhoea + confusion + air-conditioning use = which organism?
Legionella
197
Treatment of Legionella pneumonia?
- 1st line: Levofloxacin
- 2nd line: Azithromycin
198
Management of fulminant/severe ulcerative colitis?
1st line is Calcineurin inhibitor: CICLOSPORIN
199
CI to transcutaneous liver biopsy?
Ascites
200
Patients with primary polycythaemia has a higher chance of developing which condition?
Acute gout
201
Small cell bronchial carcinoma/breast cancer
+ ataxia + anti-YO antibodies =
Paraneoplastic cerebellar degeneration
202
Ivabradine MOA?
If channel inhibitor (IVa= If = INhibitor)
203
Conditions to use ivabradine in Heart Failure?
- Heart rate >75 bpm
- EF <35%
-History of CI or intolerance to Beta-Blockers or increased ventricular rate despite BB treatment
- If heart rate condition is not met and EF condition is met, start SACUBITRIL-VALSARTAN
204
In a patient heart failure, taking ACEi+BBlocker and Spironolactone, when to switch Spironolactone to Sacubitril-Valsartan?
When EF equal or less than 55% and there's not response to Spironolactone
205
Which conditions involve distal interphalangeal joints?
- Osteoarthritis
- Psoriatic arthritis
- Adult-onset Still's Disease
206
Features of Adult-Onset Still's Disease?
Oligoarthritis of DIP + Elevated ferritin + Intermitten fever => High spiking fever + Erythematous rash => Maculopapular, salmon-pink rash + Hepatomegaly + negative Rheumatoid Factor and ANA (it's a degenerative disease, not inflammatory)
207
Specific treatment of Adult-Onset Still's disease?
IL-1 inhibitor => Anakinra
Most specific treatment, but last line after NSAIDS, Prednisolone and DMARD
208
Management of Adult-Onset Still's disease?
NSAIDS => Prednisolone => DMARD (methotrexate or sulfasalazine) => IL-1 inhibitor ANAKINRA
209
Indications of IL-1 inihibitor? (ANAKINRA)
- 1st line in Non-arteriopathic ischaemin optic neuropathy
- 4th line in Adult-Onset Still's disease
210
Management of Ankylosing Spondylitis?
2 NSAIDS, if no response =>
Anti-TNF drugs (Etanercept, Adalimumab)
211
Indications of Infliximab?
RA/IBD/PSORIASIS
212
Indication of Belimumab? (B-lymphocyte specific inhibitor)
SLE non-responsive to hydroxychloroquine and methotrexate
213
Indications of Golimumab? (Anti-TNF alpha)
Psoriasis/Psoriatic Arthritis/Ankylosing Spondylitis
214
Indications of Tocilizubam? (ToSIXlizumab-To6lizumab- IL-6 monoclonal antibody)
RA/GCA/TED
215
Indication of anti-CD20? (Rituximab)
- 1st line in Idiopathic membranous nephropathy
- RA/Granulomatosis with PolyAngiitis/Haematological malignancies
216
Indications of Apremilast? (PDE4i - phosphodiesterase 4 inhibitor)
Psoriasis
217
Azathioprine indication?
Crohn's disease (safe in pregnancy, but add folic acid)
218
Goserelin MOA?
LHRH Analogue - Luteineising Hormone Releasing Hormone Analogue
219
Tamoxifen/Raloxifen, which class of medication?
SERM - Selective Estrogen Receptor Modulator
220
Enzalutamide/Bicalutamide are what class of medication?
NON-Steroidal Androgen Receptor ANTAgonists (NSARA=ENZALA)
221
Cyproterone is what class of medication?
Steroidal Androgen Receptor ANTAgonist
222
Management of metastatic prostate cancer?
1st line: Goserelin (LHRH analogue)
2nd line: NSARA = Enzalutamide/Bicalutamide
(all these drugs are specific to metastatic prostate cancer)
223
Management of bone pain secondary to metastatic prostate cancer?
1st line: NSAIDS +/- opiods
2nd line: Bisphosphonates - Radiotherapy
3rd line: Denosumab
224
How to differenciate between Arterial Ischaemic Optic Neuropathy (AION), Non-AION and Acute Demyelinating Optic Neuritis (ADON) ?
- AION has features of GCA/Temporal arteritis and history of TIA or amaurosis fugax
- ADON had gradual onset, NAION has sudden onset
- ADON has marked optic disk swelling, NAION has superior optic disk swelling
- NAION has vascular risk factor
225
Rapid-onset visual deterioration + vascular risk factors (DM/HTN/dyslipidaemia) + partial oedema of optic disc (superior) = ?
Non-arteritic ischaemic optic neuropathy
226
Gradual onset visual loss with marked optic disc swelling + loss of colour first + diminished visual acuity + light flashes across visual field + RAPD (relative afferent pupillary defect)
Acute Demyelinating Optic Neuritis
227
Management of Acute Demyelinating Optic Neuritis?
IV Methylprednisolone
228
Management of Pemphigus Vulgaris?
P-A-R
Prednisolone => Azathioprine => IV Rituximab (anti-CD 20)
229
Patient with Mitral Stenosis + Haemoptysis =
Haemoptysis is a sign of worsening MS
230
Mode of inheritance of Hereditary Hypophoasphataemic Rickets?
X-linked dominant
231
Why do patients with CKD develop hyperphosphataemia?
Reduced functional renal tissue
232
Risperidone is first-line in which psychiatric conditions?
- Cannabis psychosis
- Schizophraenia
- Delusional parasitosis (if not alcohol-induced)
- Tourette's syndrome
233
Quinolones and Nitrofurantoin are CI in what condition?
- G6PD because they lead to haemolysis
- Nitrofurantoin is also CI in CKD stage 3+
234
IV drug abuser + purpuric skin rash =
Hepatitis C infection
235
Which antibody is associated with Mixed Connective Tissue Disorders?
Anti U1-RNP antibodies
236
Which drugs are associated with drug-induced Parkinsonism?
- Dopamine antagonists (Prochlorperazine + metoclopramide)
- Anti-psychotics
237
Features of drug-induced parkinsonism?
Always bilateral - No resting tremor or less likely
238
Drug causes of tremor?
- Mycophenolate mofetil
- Ciclosporin/Tacrolimus
(Most common cause of tremor in renal patients = tacrolimus)
239
What is Ropinirole?
D2/D3 dopamine receptor agonist
240
Head injury + brain abcess
Linezolid (covers MRSA and has good CNS penetrance)
241
Management of brain abcess?
Ceftriaxone + metronidazole
242
Management of dog bite?
- 1st line: Co-Amoxiclav
- If penicillin allergy => Metronidazole + Doxycycline
- If penicillin allergy and pregnant => Metronidazole + Azithromycin
- If life-threatening/resistant => Clinda+Cipro
243
Indications of surgery in infective endocarditis?
Complete heart block or any degree of heart block
244
MOA of Buprenorphine?
Partial Mu + Kappa opioid receptor AGOnist
245
Bilobed nuclei of white cells + skeletal abnormalities (short limb) = ?
Congenital Pelger-Hüet anomaly, a type of Laminopathies
246
Low mood+ early morning wakening + poor appetite + social withdrawing + H/O of spousal death =
Reactive depression
247
Greater curvature of stomach is supplied by which artery? And the lesser curvature?
- Greater curvature: Left gastro-epiploic (gastro-omental) artery, which is the largest branch of the splenic artery
- Lesser curvature: left gastric artery
248
Factor V Leiden + DVT = which treatment?
Long-term warfarin
249
Denosumab MOA?
RANK Inhibitor (Receptor Activator of Nuclear factor Kappa-B ligand inhibitor)
250
MOA of Sildenafil?
PhosphoDiEsterase 5 inhibitor
251
Roflumilast and Apremilast MOA?
PDE-4 inhibitor
252
Bortezomid and Thalidomid are what?
Proteasome inhibitors
253
Cause of Primary CNS lymphoma?
Epstein-Barr virus
254
Autosomal dominant T2DM isassociated with what genetic mutation?
Glucokinase mutation
255
DM + Anti-GAD (+) = which TTT?
DM + Anti-GAD (-) = which TTT?
Anti-Gad + = Metformin
Anti-Gad - = Sulfonylureas
256
MOA of Ezetinibe?
NPC1L1 Inhibitor (Niemann-Pick C-1 Like 1 protein)
257
MOA of Evolocumab/Inclisiran?
PCSK9 inhibitor (Proprotein convertase subtilisin Kexin D Type 9)
258
MOA of statins?
HMG-CoA reductase inhibitor (HydroxyMethylGlutaryl Coenzyme A reductase)
259
MOA of Evinacumab?
ANGPTL3 inhibitor (Angioprotein-like protein 3)
260
MOA of Fibrates?
PPAR-alpha agonist (Peroxisome-proliferator-activated receptor)
261
MOA of Thiazolidinediones?
PPAR-Gamma agonist (Peroxisome-proliferator-activated receptor)
262
Gradual deterioration (weakness+confusion) + Low WBC + H/O HIV/immunosuppression/J C virus + MRI: multiple white matter lesions in the parieto-occipital regions = ?
Progressive Multifocal LeukoEncephalopathy
263
Management of Myasthenia gravis? And myasthenic crisis?
P-P...MAC...R
- 1st line: Pyridostigmine +/- prednisolone
- 2nd line: steroid sparing therapy: Mycophenolate/Azathiprine/Ciclosporin
- 3rd line: Rituximab (anti CD-20)
- Thymectomy
Myasthenic crisis : plasmapheresis - IV immunoglobulins
264
Cerebral venous thrombosis features?
Acute onset of severe unremitting headache + worse when lies flat/strains + young obese female + bilateral 6th nerve palsy + papilloedema + hypertension
265
Small cell lung cancer paraneoplastic associations?
SIADH/Lambert-Eaton myastenic syndrome/Cushing syndrome
Paraneoplastic cerebellar degeneration
266
Squamous cell carcinoma of the lung is associated with which conditions?
Hypercalcaemia by increase in PTHrP
267
Adenocarcinoma of the lungis associated with?
Asbestosis/Non-smokers
268
Bronchial carcinoid is associated with ?
young patients + haemoptysis + bronchial obstruction
269
Mode of action of Obeticholic acid?
FXR agonist (farnesoid-x-receptor)
270
Management of bronchial asthma when PEFR<50%?
IV magnesium
271
NASH + Obesity (BMI of 35 or +), which drug?
GLP-1 analogue: Liraglutide
272
What is the management of a pregnant woman with genital herpes?
Aciclovir at 36 weeks (300mg TDS)
273
Parkinsonism + fall + agitation, which medication is appropriate?
Midazolam
274
Severe asthma + elevated eosinophil levels = which medication?
Mepolizumab (IL-5 monoclonal inhibitor)
275
Severe asthma + elevated IgE =
Omalizumab (anti-IgE antibody)
276
Elevated creatinine + eosinophilia + WBC/RBC/Blood in urine dipstick + recent use of NSAID, PPI, penicillin, cephalosporin, aciclovir + T lymphocytes and monocytes infiltration =
Acute Interstitial Nephritis
277
Elevated creatinine with raised urinary sodium >40mmol/L + diminished urine output + H/O of MI (hypoperfusion, hypotension) +/- gram negative sepsis (treatment with gentamycin or aminoglycosides) =
Acute Tubular Necrosis
278
Management of ATN?
Rehydration
279
Multiple symptoms across different systems with normal physical examination + history of depression/sertraline use =
Somatic symptom disorder
280
What is anaphylactic reaction mediated by?
Mast cell tryptase (massive mast cell degranulation)
281
Indication to stop Exercise Tolerance Test?
- Drop in systolic BP >10 mmHg
- Dizziness
282
Stroke >4.5 hours = TTT?
Stroke <4.5 hours = TTT?
>4.5h: Aspirin + thrombectomy (if within 6h)
<4.5h: Thrombolysis + thrombectomy
283
Patient on high dose steroids + confusion/neuropsychiatric symptoms = ?
Steroid-induced psychosis
284
Long-standing coeliac disease is associated with which GI malignancy?
SCC of the oesophagus => Urgent upper endoscopy
285
MOA of Warfarin?
Inhibits vitamin KO reductase
286
Sodium, potassium and chloride daily requirements?
1mmol/kg/day
287
What are dendritic cells?
Antigen presenting cell as part of MHC Class II antigen
288
What causes congestive heart failure + neuropathy ?
Restrictive cardiomyopathy due to amyloidosis
289
Graves ophthalmopathy underlying physiopathology?
Glycosaminoglycans deposition
290
Bitemporal hemianopia + mildly raised prolactin?
Non-functioning pituitary adenoma
291
Cystic fibrosis + diabete, how to manage?
Basal bolus insulin regimen + high calorie diet + high fat diet
292
Coeliac disease relationship with calcium?
Causes hypocalcaemia
293
Rapid neuro deterioration + rapidly worsening short term memory loss with progressive movement disorder + progressive myoclonus with dystonia + EEG: periodic triphasic sharp wave + MRI: increased signal intensity in Putamen and Caudate + 14-3-3 protein in CSF +++ =
Sporadic Creutzfeld Jakob Disease
294
Difference between sporadic CJD and new variant CJD?
- sCJD = rapidly progressive + increased signal in PUTAMEN + CAUDATE + 14-3-3 PROTEIN IN CSF
- nv CVD = progressive worsening + increased signal in THALAMUS
295
What is MLH1 gene?
DNA mismatch repair gene
296
Mutation of MLH1 causes what cancers?
Colon - Stomach - Non-small cell lung cancer
297
What antibody is seen in Hashimoto's thyroiditis?
Anti-TPO antibodies
298
Late prosthetic valve + dental work or poor dental hygiene = which organism?
Streptococcus viridans (Very late = Viridans)
299
Early prosthetic valve (within 2 months of surgery) + endocarditis = which organism?
Streptococcus epidermidis (Early = Epidermidis)
300
Most common cause of infective endocarditis overall, if no timeline of surgery or dental hygiene is mentioned?
Staphylococcus aureus
301
DM + multiple renal cysts =
Mody 5
302
Fenofibrates increase the chance of what condition?
Higher risk of gallstones
303
MOA of Carbimazole?
Thyroid peroxidase inhibitor
304
Management of relapsing-remitting MS?
Dimethylfumarate
305
Management of progressive MS?
Ocrelizumab
306
Most common cause of viral pericarditis?
Coxsackie B virus
307
Management of Scleroderma renal crisis?
ACEi + stopping steroids
308
Scleroderma on steroids + new hypertension and renal failure = ?
Scleroderma renal crisis (precipitated by steroids)
309
Café-au-lait spots (6 or more) + inguinal/axillary freckles + Lisch nodules (seen in iris by slit lamp microscope) = ?
Neurofibromatosis type 1 (peripheral)
310
Renal stone + bowel resection = which type of stone?
Calcium oxalate
311
Clarithromycin and eryhromcin inhibit which CYP?
CYP3A4 (34)
312
Ciprofloxacin inhibits which CYP?
CYP1A2
313
Fluoxetine/paroxetine inhibit which CYP?
CYP2A6
314
Lesinurad (gout management) inhibits what cytochrome?
OAT1
315
Confirmatory test for hereditary spherocytosis?
EMA test (Eosin 5-Maleimide binding test)
316
Which scale to use for pressure sores?
Waterlow score
317
Contraindication to pneumonectomy and lobectomy?
Pneumonectomy: FEV1 < 2L
Lobectomy: FEV1 < 1.5L
318
Cause of HEYDES syndrome?
Von-Willebrand factor multimer deficiency
319
In Methaemoglobulinaemia, what happens to Fe?
Oxidation of Fe2+ (ferrous) => Fe3+ (ferric)
- Treated by methylene blue which reduces ferric Fe3+ back into ferrous Fe2+
320
History of fluoxetine + overinflated opinion/clang association =
Manic episode
321
In Guillain-Barré, how to assess outcome?
FVC
322
Anaemia + splenomegaly + poikilocytes and leukoerythroblasts on blood film = ?
Myelofibrosis
323
The aortic arch gives birth to what arteries?
- Left sub-clavian artery
- Left common carotid artery
- Brachio-cephalic trunk
324
Features of Heyde's syndrome?
Iron deficiency anaemia due to GI bleeding from angiodysplasia + aortic stenosis + acquired coagulopathy (vWF deficiency)
325
What Karnofsky score is of good prognosis in AML?
>60%
326
What complement deficiency is associated with Neisseira meningitidis?
C5-C9
327
What is the molecular structure of Omeprazole and Esomeprazole?
Esomeprazole = S-isomer
Omeprazole = R-isomer and S-isomer
328
Mycobaterium avium infection + bronchiectasis = what's the management?
REA
Rifampicin + Ethambutol + Azithromycin for 15-18 months
329
Skin rash + osteoporosis + abdominal pain with intermittent diarrhoea + corneal haziness + neurological dysfunction + loss of fine touch/proprioception + pins and needles sensation =
Fabry's disease
330
Mode of inheritance of Fabry's disease? and what molecule is defective?
- X-linked recessive
- Alpha-galactosidase deficiency
331
Biventricular failure with proteinuria + Mitral regurgitation (pansystolic murmur) + Burning pain in lower limbs + Maltese cross appearance on urine microscopy (suggestive of sphingolipid in urine) = what is the diagnosis?
Atypical Anderson-Fabry's disease due to alpha-galactosidase deficiency
332
Management of Atypical Anderson-Fabry's disease?
Enzyme replacement with Agalsidase beta
333
Duration of warfarin therapy after successful cardioversion?
4 weeks
334
In the management of CML, if there is resistance to imatinib (tyrosine kinase inhibitor), which drug to choose?
Dasatinib (also a tyrosine kinase inhibitor)
335
Best initial investigation in case of IBD suspicion?
Faecal calprotectin
- <100 : No IBD
- 100-250: intermediate suspicion
- >250: IBD
336
Best test to diagnose pancreatic insufficiency?
Faecal elastase
- >200 = normal
- 100-200: mild to moderate insufficiency
- <100: severe insufficiency
337
Which artery supplies the head of pancreas, duodenal bulb, pylorus and proximal duodenum?
Gastroduodenal artery
338
Staghorn/struvite renal stone following Proteus mirabilis infection = what is its composition?
Ammonium magnesium phosphate
339
Renal stone + hyperthyroidism/RTA = composition?
Calcium phosphate
340
Renal stone + congenital cystinuria = composition?
Cystine stone
341
Renal stone + chronic tophaceous gout = composition?
Uric acid stone
342
Investigation of choice in avascular necrosis of femoral head?
MRI
343
Prognosis assessment of COPD?
FEV1
344
COPD + pH 7.26-7.34 = next best step in management?
NIPPV: Non-Invasive Positive Pressure Ventilation
345
COPD + pH of 7.25 or less, next step?
- If NIPPV not tried yet, go for it
- If tried and unsuccessful => Invasive ventilation
346
Asthma + pH<7.35 = what management?
Invasive ventilation
347
Features of Methanol overdose?
Irreversible loss of vision due to formation of formic acid crystals in the optic nerve => Optic atrophy + bilateral pale optic disc
348
Antibody in Pemphigus Vulgaris?
Anti-DGS1/G3 antibody (IgG in epidermis)
349
Antibody in Steven-Johnson syndrome?
Anti-desmoplakin antibody
350
Antibody in coeliac disease/dermatitis herpetiformis?
Anti-TTG antibody
351
Pathophysiological process of bullous pemphigoid?
Precipitated by NSAIDs
Deposition of IgG and C3 in the dermo-epidermal junction
352
Psoriasis biopsy finding?
Basal keratinocyte proliferation + neutrophil/lymphocyte infiltration
353
Dermatitis herpetiformis biopsy finding?
Granular IgA deposition within dermal papillae
354
Pathophysiology underlying Acne?
Follicular epidermal proliferation (most common)
355
Contraindication to Non-Invasive ventilation?
Copious secretions
356
Drugs associated with bullous pemphigoid?
NSAID + Furosemide
357
Site of action of Ondansetron, Granisetron (and other serotonin 5 HT-3 receptor inhibitors)?
Nucleus tractus solitaris in the brainstem, more precisely in the area postrema
358
Elderly patient + history of alcoholism + falls + hemiplaegia or neglect of half body + sixth nerve palsy = ?
Subdural haemorrhage - CT scan shows crescent hyperdensity not limited by sutures (or hypodensity if chronic)
359
Amenorrhoea with negative pregnancy test + background of autimmune disease + markedly high FSH +/- low libido
Primary ovarian failure
360
Management of primary ovarian failure?
Hormone replacement therapy
361
Difference between Prolactinoma and Primary Ovarian Failure in regards to FSH?
- POF = HIGH FSH
- Prolactinoma = LOW FSH
362
Where are Howel-Jolly bodies seen?
In hereditary spherocytosis, hyposplenism and splenectomy
363
Where are Heinz-bodies seen?
G6PD deficiency
364
What is ECG's U wave associated with ?
Hypothermia
Hypocalcaemia
Hypokalaemia
Hypomagnesaemia
365
U wave + history of collapse = underlying diagnosis?
Hypokalaemia
366
ECG sign of hypothermia?
J wave
U wave
367
When is J wave seen on ECG?
Hypothermia
Hypercalcaemia
Subarachnoid haemorrhage
Intracranial haemorrhage
368
Antibody in Grave's disease?
TSH receptor antibody (long-acting thyroid stimulating hormone antibody
369
Pathophysiology underlying hypoxia in pneumonia?
Early: intrapulmonary shunting
Late: VQ mismatch
370
Cardinal ECG finding in Ebstein's anomaly?
RBBB due to atrialisation of right ventricle
371
Risk factors for Ebstein's anomaly?
Lithium therapy and pregnancy
372
What's the common and less common pathophysiology of Congenital long QT syndrome?
Most common = Potassium channel defect
Less common = Voltage gated L-type calcium channel mutation
373
Management of congenital LQTS with and without cardiac arrest?
LQTS without cardiac arrest = Beta-blockers
LQTS + cardiac arrest = Implantable cardioverter defibrillator
374
Management of Alport syndrome?
1st line:Acei/ARB
2nd line: Aldosterone antagonist: Spironolactone
375
Obesity + hypoventilation + raised CO2 + raised HCO3 =
Obesity hypoventilation syndrome; causes carbon dioxide retention and acidosis leading to compensation by increasing bicarbonates
376
What is the Rheumatoid factor?
An IgM directed against the Fc portion of IgG
377
Recurrent sino-pulmonary infections = diagnosis?
Selective IgG1 deficiency
378
Recurrent sino-pulmonary infections + GIT infections = diagnosis?
Selective IgA deficiency
379
In patients comitting suicide, what is the sign of a successful suicide?
Suicide note
380
Management of primary progressive multiple sclerosis?
Ocrelizumab (CD-20 monoclonal antibody, like Rituximab, except it's fully human, unlike Rituximab which is part mouse part human)
381
How do PPI cause pseudo-gout?
By causing hypomagnesaemia
382
Which drugs cause microscopic colitis (watery diarrhoea)?
NSAID/PPI/SSRI
383
Adverse effect of IV quinine?
Hypoglycaemia
384
Definitive management of Wolff-Parkinson-White syndrome?
- Radiofrequency ablationof the abnormal pathway
- Beta-blocker for symptom control
385
Anti-Jo1 antibodies associations?
Polymyositis + dermatomyositis + pulmonary fibrosis
386
Anti-Mi2 antibody association?
Dermatomyositis
387
Anti-VGCC antibody?
Lambert-Eaton Myasthenic syndrome in Small cell lung cancer
388
Anti-VGKC antibody?
Limbic encephalitis
389
Anti-Ri antibody associations?
Breast cancer/Small cell lung cancer/Non-small cell lung cancer
390
Anti-NMDA receptor?
- Limbic encephalitis secondary to Ovarian Teratoma
- Stiff person syndrome
391
Anti-Scl 70 association?
Diffuse cutaneous systemic sclerosis
392
Anti-centromere association?
Limited cutaneous systemic sclerosis
393
Anti-smooth muscle antibody association?
Autoimmune hepatitis (along with anti-ANA, defines type 1 AIH that affects both adults and children)
394
Anti-LKM 1 antibodies (Anti-liver kidney microsomal type 1 antibody) associations?
Type 2 Autoimmune hepatitis (affects children)
395
Anti-mitochondrial antibody association?
Primary biliary cholangitis
396
Trip to Austrian alps is indicative of what disease in exam questions?
Lyme disease - features of Facial nerve VII palsy+relative bradycardia or heart block+small joint polyarthritis - treat with doxycycline
397
Management of Lyme disease in pregnance and in case of disseminated disease?
DAC
Normal Lyme= Doxycycline
Pregnancy = Amoxicillin
Disseminated = Ceftriaxone
398
How to reduce incidence of renal stones in cystinuria?
D-penicillamine
399
Management of Yersinia (Left iliac fossa pain +/- diarrhoea) =
Cipro/Ofloxacin
400
In management of hypertension, if CCB is contraindicated or not tolerated and patient is already on ACEi or ARB, what medication to go next?
Thiazide-like diuretics (Indapamide +++ or Chlorthalidone)
401
Management of Carpal Tunnel syndrome?
1st line: steroid injection
2nd line: surgical carpal tunnel release
402
Asthma + high eosinophils = DDx
- ABPA - Allergic Bronchopulmonary Aspergillosis
- CSS - Churg-Strauss syndrome aka eosinophilic granulomatosis with polyangiitis (p-ANCA positive)
403
Prognosis markers in respiratory diseases?
FFVC = Myasthenia gravis + Guillain-Barré
FEV1 = COPD
PEFR = Asthma
TLCO = Idiopathic Pulmonary Fibrosis
404
FEV1 <50% + COPD = management?
FEV1 >50% + COPD = management?
- LABA + ICS
- LABA + LAMA
405
Management of Mycoplasma infections?
MFT
Macrolides (Azithromycin)/ Fluoroquinolones / Tetracyclines (Doxyxycline)
406
In the context of Rapidly progressive glomerulonephritis + reno-pulmonary syndrome
Could be Granulomatosis with polyangiitis (saddle-nose/sinusitis + c-ANCA + Anti-PR3) - Microscopic polyangiitis (pANCA + anti-MPO) - Anti-GBM disease (Goodpasture syndrome - normal ESR)
407
Sub-arachnoid haemorrhage + fluctuations in body temperature + H/O hypertension= where is the lesion
Anterior hypothalamic nucleus (in the inferior border of paraventricular nucleus): regulates temperature and circadian rythm
408
Lewy-Body dementia is associated with what cytoplasmic inclusions?
And in Alzheimer's disease?
- Lewy-body: AS - Alpha-sinuclein
- Alzheimer's: TAU protein
409
What is Nintedanib?
Tyrosine Kinase inhibitor (like Imitanib and Dasatanib used to treat CML)
- Nintedanib is used to treat Idiopathic Pulmonary Fibrosis
410
Rapid deterioration of vision following injection of intra-ocular anti-VEGF = diagnosis?
Bacterial endophthalmitis - treated by IV antibiotics
411
Skin sensations with no external stimuli (insect crawling) = diagnosis and management?
Haptic hallucination, associated with many psychiatric conditions like schizophrenia, acute mania/cocaine overdose (antipsychotics; risperidone) /alcohol withdrawal (benzodiazepine or chlordiazepoxide)
412
What does chronic lithium therapy cause in respect to kidneys?
Reduced Aquaporin II gene expression, leading to Nephrogenic Diabetes Insipidus (as well as fine tremor)
- Acute toxicity will lead to coarse tremor
413
Most common cause of erythema multiforme?
Herpes simplex virus
414
Where is the problem in Follicular B-cell Non-Hodgkin lymphoma?
In CD20, that's why it is treated with anti-CD20 Rituximab
415
What isthe mode of inheritance of Optic atrophy?
Mitochondrial
- Part of DIDMOAD aka Wolfram syndrome (Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy and Deafness)
- Another mitochondrial disease affecting eyes is Leber's optic atrophy and Kearns-Sayre syndrome
416
What is Evolocumab and how does it work?
PCSK9 inhibitor - prevents LDL receptor degradation
417
Chest X-ray finding of "eggshell calcification", what is the underlying diagnosis?
Silicosis - occupation: stone miner/exposure to stone dust - Reduced PEFR - Spirometry shows a mixed obstructive/restrictive pattern
418
How to assess prognosis in paracetamol overdose?
PT - prothrombin time
419
Alzheimer's disease treatment according to severity?
Cholinesterase inhibitors: Rivastigmine/Donepezil/Galantamine
Severe disease => Memantine
If Heart block, bradycardia, sick sinus syndrome or AV nodal block => Memantine no matter the severity
420
Vincristine side-effect?
Peripheral neuropathy
421
How do thiazides cause hyponatraemia?
Increased delivery of sodium to distal convoluted tubule
422
Posterior territory neurological symptoms following head turning + loss of consciousness + Dizziness, nausea, vomiting + HTN + Ejection systolic murmur or carotid bruit = diagnosis?
Vertebrobasilar insufficiency
423
Superior vena cava obstruction + bronchial cancer, definitive management?
Stenting
424
Post-partum thyroiditis features and management?
Thyrotoxicosis followed by hypothyroidism followed by stabilisation - manage thryotoxicosis with beta blockers and hypothyroidism with thyroxin replacement
425
Diabetic retinopathy can cause what sort of visual symptoms?
Visual hallucinations (can be part ofCharles-Bonnet syndrome)
426
Parathyroid hormone action on phosphate?
Increases phosphate secretion by decreasing its reabsorption in the proximal tubules
427
H/O of RA or immunosuppressant medication or contact lens + acute painful eye + greenish coloured branched uptake on fluorescein staining = diagnosis and management?
- Reactivation of herpes simplex virus causing Herpes simplex corneal ulcer also known as dendritic corneal ulcer
- Treat with topical aciclovir ointment
428
Young patient with meningism + cough with purulent sputum and consolidation + Gram positive diplococci =
Streptococcal meningitis
429
Management of streptococcal meningitis?
Ceftriaxone + Vancomycin
430
Elderly patient with meningism + papilloedema =
Pneumococcal meningitis
431
Management of pneumococcal meningitis?
- Ceftriaxone + Vancomycin
- No prophylaxis in needed
432
Purpuric rash + meningism =
Meningococcal meningitis
433
Management of meningococcal meningitis?
- Ceftriaxone
- Prophylaxis with ciprofloxacin to contacts
434
What is Elbasvir?
NS5A Inhibitor - used in management of Hepatitis C
435
MOA of Benzbromarone?
Inhibits uric acid reabsorption in the kidney
436
What molecule causes inflammation in acute gout?
IL-1
- That's why it is treated with IL-1 inhibitors like Canakinumab when conventional therapy fails
437
What is Varenicline?
Nicotinic receptor partial agonist - used in smoking cessation protocols
438
Family history of thyroid cancer + hypercalcaemia + hypertension =
MEN 2
- Medullary thyroid cancer + pheochromocytoma + Marfanoid body habitus = MEN IIb
439
Raised TLCO + haematuria + proteinuria + elevated creatinine + patchy shadowing on CXR = diagnosis?
Pulmonary vasculitis/haemorrhage
440
Visual hallucinations in elderly + worsening in the evening + normal MMSE = diagnosis and treatment?
Charles-Bonnet syndrome, most commonly due to macular degeneration
Physiological phenomenon => Reassure
441
How does IV Magnesium work in Asthma with PEFR<50%?
Blocks histamine release from mast cells and reduces acetylcholine release => Smooth muscle relaxation
442
Management of severe hypocalcaemia?
- IV Calcium Gluconate (10ml over 10 mins)
- Hypocalcaemia can be seen after thyroidectomy, and carpopedal spasm is a sign of severe hypocalcaemia
- Cardiac arrythmias with LQTS can also occur
443
What is Hungry Bone Syndrome?
Sudden withdrawal of PTH after thyroidectomy causing severe hypocalcaemia
444
MOA of Metformin?
- Reduces hepatic gluconeogenesis through indirect activation of AMP kinase
- Metformin also reduces gut glucose absorption and enhances insulin sensitivity
445
In DKA, what are ketones due to?
- Beta-hydroxybutyrate: mediates a large amount of ketones but only works up to 90 minutes of onset
- Acetoacetate: mediates less ketones but does so for hours
446
In the context of AML, MDR1 positivity is a sign of what?
Poor prognosis
447
Lithium toxicity levels?
1mmol/L = therapeutic level
>2mmol/L = Toxicity
>3 mmol/L = IV normal saline or IV NAHCO3+Alkaline diuresis
>4 mmol/ = haemodialysis
448
Features of Fragile X syndrome?
Intellectual disability with poor concentration + learning disability + high-arched palate + Mitral valve prolapse + strabismus + large ears + joint laxity and obesity
449
Diagnostic test for Fragile X syndrome?
Chromosomal analysis/Karyotyping
450
MOA of Isoniazid? (INH=isonicotinyl hydrazine)
Inhibition of fatty acid synthase
451
Huntington's chorea exhibits what sort of genetic trait?
Genetic anticipation
452
IBS + iron deficiency anaemia + hypocalcaemia =
Coeliac disease
Do Anti-TTG antibodies
453
What is RivaroXaban and how to monitor it?
- Direct Xa inhibitor
- Monitored by Prothrombin time PT
454
Common Variable ImmunoDeficiency (CIVD) share the same clinical picture as what other disease?
Giardiasis
- Abdominal pain - diarrhoea - flatulence - malabsorption + HIV or AIDS = CIVD
- Abdominal pain - diarrhoea - flatulence - malabsorption + long incubation period = giardiasis
455
Acute watery diarrhoea + abdominal cramps + HIV =
Cryptosporidiosis
456
Severe abdominal pain + pink salmon rash + bloody diarrhoea + fever =
Salmonella
457
Long incubation period + acute onset diarrhoe + blood + mucus =
Amoebiasis
458
Giardiasis shares the sames clinical picture as what other diseases?
IBS and CVID common variable immunodeficiency
459
Diagnosis and management of giardiasis?
- Stool antigen or direct stool microscopy to look for trophozoites
TTT: Metronidazole or Tinidazole
460
Which species of Plasmodium have the hypnozoite stage?
P. vivax and ovale
461
How to eradicate Pseudomonas in patients with Cystic Fibrosis?
Inhaled tobramycin
462
Post-chemotherapy neutropaenia peaks at which point?
Highest risk around 10 days
463
In Parkinson's disease, which anti-emetics can be prescribed?
Central acting anti-emetics like Ondansetron
464
How is INH (isoniazid) metabolised?
Slow acetylation
465
MOA of Vinblastine?
Binding to microtubular proteins
466
MOA of Dobutamine? and what is it used in?
Predomintly Beta-1 receptor Agonist, used in cardiogenic shock
- Also has a weak Beta-2 activity and Alpha-1 selective activity
467
How to manage Inferior MI presenting with bradycardia and hypotension?
Trancutaneous pacing (immediate step)
If longer pacing is needed => Transvenous pacing
468
LADA supplies which part of the heart?
Left Ventricle
469
Post-renal transplant diarrhoea is cause by what?
Mycophenolate mofetil +++
Tacrolimus
Ciclosporin
470
Classical facial weakness + weakness of shoulder muscles and pain + winging scapula + pectoral wasting + high-pitch deafness + retinal changes + cardiac arrythmia =
Facioscapulohumeral muscular dystrophy
(AD inheritance)
471
Management of Acne rosacea?
Topical metronidazole => Topical azelaic acid (most specific TTT) => other topical antibiotics => oral antibiotics => oral retinoids
472
Facial flushing + palpitations + weight loss + diarrhoea + abnormal LFTs + old age = diagnosis and test?
- Carcinoid syndrome
- Diagnosed by 24-h urinary HIAA
473
Weight gain + hypertension + hyperglycaemia = diagnosis and test?
- Cushing syndrome
- Diagnosed by24h urinary free cortisol
474
Which test to know aetiology of Cushing's syndrome?
Plasma ACTH (adrenocorticotropic)
475
Side-effects of Nitrofurantoin?
Interstitial pneumonitis + basal pulmonary fibrosis
476
Flaccid bullae that leak straw-coloured liquid + heal with erythematous base = diagnosis + management?
- Bullous impetigo caused by Staph aureus
-1st line = topical fusidic acid
if MRSA = Mupirocin
477
In Hereditary Haemochromatosis with heart failure, what is the best test?
Cardiac MRI to detect cardiac iron content
478
Genetic testing to diagnose haemochromatosis?
In family members: HFE gene
In general population: C282Y / H63D
479
Class of medication and MOA of Flecainide?
-Class 1C antiarrythmic drug
- MOA: Fast sodium channel inhibitor
480
Tendon involved in tennis elbow (lateral epicondylitis) ?
Extensor carpi radialis brevis
481
Psychotic symptoms + Parkinson's disease = management?
Olanzapine or Clozapine
482
Thamine deficiency (Wernicke's encephalopathy) features?
-Con Ata Oph:
Confusion + Ataxia + Ophthalmoplegia and nystagmus)
- (In Miller Fischer variant of GBS => Arre Ata Oph = Arreflexia+ataxia+ophthalmoplegia)
483
Massive splenomegaly + marked elevation of granulocytes (Basophils, Eosinophils, Neutrophils) + raised LDH = Diagnosis?
CML
- Treated with tyrosine kinase inhibitors : Imatinib first-line, if resistance or failure, then Dasatinib.
Another tyrosine kinase = nintedanib but is used in primary pulmonary fibrosis
484
Lymph nodes + mild splenomegaly + marked elevation in lymphocytes =?
CLL
- Treated with FCR regimen: Fludarabine + cyclophosphamide + rituximab
485
What is arcuate scotoma?
Manifestation of glaucoma
486
Painful red eye+ constricted +/- deformed pupil + hazy anterior chamber (hypopion) + intense photophobia + blurred vision + gradual impairment of vision = diagnosis and management?
- Acute anterior uveitis (iritis)
- Urgent referral to ophthalmologist
- Treated with cycloplegics: atropine, cyclopenolate + topical steroids
487
Management of spontaneous bacterial peritonitis?
1st line: IV cefotaxime
2nd lin: Piperacillin + tazobactam
If penicillin allergy
ORAL CIPRO+ IV VANCO
488
Management of neutropaenic sepsis?
- Penicillin sensitive or blind TTT : Piperacillin-Tazobactam
- Penicillin allergy: Cipro+vanco
489
Side-effects of Phenytoin?
- Peripheral neuropathy
- Hirsutims
- Hypotension
- Osteoporosis
490
History of trekking?
Orientia tsutsugamushi
491
Investigation in early rheumatoid arthritis?
Colour doppler ultrasound
492
Lesion in medial longitudinal fasciculus causes what?
Contralateral nystagmus
i.e Right-sided MLF, if the patient looks left => nystagmus
493
What is the bone density of 95% of males?
-2.0 to +2.0
494
What is Naltrexone?
Opiod antagonist
495
What is the mechanism by which there is hypercalcaemia in thyrotoxicosis?
Stimulation of osteoclast activity by thyroxine
- Same mechanism in overtreatment of hypothyroidism by thryoxine replacement
496
In atherosclerosis, which WBC are present in tunica intima?
Fat-laden macrophages/monocytes
497
Diagnosis of insulinoma?
72h supervised overnight fasting
498
What GIT condition is caused by Furosemide therapy?
Acute pancreatitis
499
MOA of Carbamazepine?
Voltage-dependent sodium channel inhibition
500
Most common ocular manifestations of RA?
Keratoconjunctivitis sicca - episcleritis - scleritis
501
Painless red eye + watering + photophobia + gritty sensation/foreign body + H/O of RA = diagnosis?
Episcleritis
502
Severely painful red eye + watering + photophobia + H/O of RA =
Scleritis
503
Myasthenia gravis + hypertension, which drugs to avoid?
Beta-blockers and Calcium channel blocker
- In contrast, these 2 drugs are the only ones used in lithium-induced hypertension
503
What is Ciclosporin and Tacrolimus?
Calcineurin inhibitor which in turn inhibits IL-2 which then supresses T-cell response
504
Recurrent myoglobinuria (red urine), what is the deficit?
Carnityl Palmitoyl Transferase deficiency (inherited metabolic myopathy)
505
In paracetamol overdose, what is the marker of poor prognosis related to INR?
INR 2> at or before 48h
INR 3.5> at or before 72h
INR >6.5 at any point = liver transplantation
506
Shipyard worker/demolition worker + chest pain + pleural effusion + pleural plaques + systemic symptoms =
Mesothelioma
- Diagnosis is made with pleural tap/biopsy
- Crocidolite (blue asbestos) is the most dangerous form
507
What is the difference between mesothelioma and asbestosis?
- Mesothelioma can occur with minimal exposure and carries a sombre prognosis (patients usually offered palliative chemo)
- Asbestosis severity correlates with lenght of exposure
508
Management of DVT + pregnancy?
LMWH: Enoxaparin
509
Management of CKD + DVT?
- LMWH - evidence of DOAC safety too
- CKD stage V eGFR<15ml => LMWH
510
What molecule is reponsible for fatty acid transport?
Carnitin Acetyl Tranferase I
511
Complication of chronic/recurrent gonorrheoa?
Infertility/PID
512
Management of extensive psoriatic arthritis?
Golimumab (anti-TNF alpha)
513
C3 nephritic factor role?
Binds to C3bBb and stabilises it, protecting it from the body's regulation mechanism, prolongs its activity leading to increased consumption of C3 and its deposition in tissues, ultimately leading to membranoproliferative glomerulonephritis
514
Hyperacute graft rejection is mediated by what?
Preformed circulating cytotoxic IgG antibody against the HLA antigen
515
Which diseases does klebsiella cause? and how is it treated?
- Osteomyelitis in patients with sickle cell anaemia, treated with Tazocin (Piperacillin-Tazobactam)
- Pneumonia in alcoholic patients
516
Most common organism in acute osteomyelitis? and in chronic osteomyelitis?
Acute - Staph Aureus
Chronic - Mycobacterium tuberculosis
517
Amiodarone side effect on skin?
Blue skin or light-blue grey discolouration
518
Management of Plasmodium vivax?
Chloroquine
519
Management of Plasmodium falciparum if parasitaemia <2%? and in 2>%? and in >10%?
<2% => Arthemeter-lumefantrin
>2% => IV Artesunate
>10% => Exchange-transfusion
520
What electrolyte abnormality does Ciclosporin cause?
Hyperkalaemia
521
Central scotoma is a sign of what lesion?
Optic nerve lesion
522
Why is there hyperuricaemia in haematological malignancies?
Increased nucleic acid breakdown
523
What vaccines are contraindicated in immunosuppressed patients?
Live vaccines: Yellow fever - Varicella - Influenza
524
Childhood Right heart failure/Right ventricular hypertrophy with Atrial fibrillation + H/O of rheumatoid disease + mid-diastolic murmur + left parasternal heave = Diagnosis?
Lutembacher syndrome = congenital ASD complicated by acquired Mitral Stenosis
- Lutembacher involved right heart - HOCM involved left heart - Noonan's disease is congenital (male version of Turner's syndrome)
525
What antobody is present in heparin-induced thrombocytopaenia?
Anti-PF4 antibody
526
Contact dermatitis is an example of what type of hypersensitivity?
Type IV hypersensitivity
527
Where is the lesion in hemiballism?
Subthalamic nucleus
528
H/O of HIV + tubular dilatation + interstitial nephritis + FSGS on renal biopsy + high viral load and low CD4 count = ?
HIVAN
Management is HAART
529
HAART predisposes to what infection?
Parvovirus B19 infection
530
What drugs lead to a decrease in Colon cancer risk?
- Aspirin
- Vitamin D
- Combined OCP
531
Isolated tibial tubercle pain = diagnosis?
Osgood Schlatter disease
532
Definition of "intention to treat"?
All patients allocated to each treatment group
533
Before going for PCI in ST-elevation, which drugs to give?
Aspirin + Clopidogrel + Bivalirudin (direct thrombin inhibitor)
534
Sertraline causes what endocrine symptom?
Galactorrhea
535
Ataxia telangiectasia is associated with what cancer?
Breast cancer
536
What cells bind with Class I MHC ? and Class II?
Class I MHC = CD8
Class II MHC = CD4
537
What is the cause of gynaecomastia in Chronic Liver Disease?
Diminished androstenedione metabolism
538
COPD respiratory function tests characteristics ?
Reduced FEV1 and FEF 25-75 + slightly reduced FVC + normal inspiratory loop + significant decrease in expiratory loop
539
What is Hayflick limit? and what does it correlate with?
Maximum number of times a human cell can divide - Correlates with telomere length region at the end of the chromosomes
540
MOA of Fomepizole?
Competitive inhibitor of alcohol dehydrogenase
541
Cerebral toxoplasmosis management?
Empirical therapy = Pyrimethamine + sulfadiazine + folinic acid
542
Hypogammaglobulinaemia (recurrent URTI) is a factor of poor prognosis in what disease?
CLL
543
Increased levels of Beta-2-microglobulin is a sign of poor prognosis in what disease?
CLL
544
H/O of falls with progressive unsteadiness + Hypertension + Postural drop/instability + Bradykinesia + Micrographia + VERTICAL GAZE PALSY
Progressive supranuclear palsy
545
Orthostatic hypotension + urinary incontinence + erectile dysfunction + cerebellar syndrome with NO GAZE PALSY =
Multiple system atrophy (Autonomic + cerebellar symptoms)
546
Difference between Multiple System Atrophy and Normal Pressure Hydrocephalus?
In MSA, there is autonomic involvement
547
Side-effect of inhaled steroids?
Skin bruising / skin fragility / mobile joint
548
What is the mechanism of Isoniazid-induced peripheral neuropathy?
N-Acetyltransferase type II gene defect
549
H/O coeliac disease with small bowel obstruction + abdominal pain + distension + night sweats = diagnosis and investigation?
Enteropathy associated T-cell lymphoma
- Colonoscopy + biopsy
- MRI abdomen
550
Extensive scaly erythematous rash + salmon pink colour/rain drop shape + following respiratory tract infection =
Guttate psoriasis
551
What vaccines are contraindicated in egg allergy?
Yellow fever vaccine and influenza
552
What is the primary stimulator of respiratory chemoreceptors?
Increased [H+] ions
553
Non-cardiogenic pulmonary oedema +H/O of multiple transfusions + dyspnoea + HYPOTENSION + BILATERAL DIFFUSE PULMONARY INFILTRATES = diagnosis and management?
Transfusion-related lung injury
- Managed by oxygen and supportive care
554
Back pain + shock + DIC + collapse after transfusion = ?
ABO incompatibility
- Managed by fluids
555
Pulmonary oedema + hypertension while getting a transfusion?
Transfusion-Associated Circulatory Overload
- Mangement by stopping or slowing the transfusion +/- loop diutretics and oxygen
556
Fever + chills following transfusion without signs of shock = ?
Non-haemolytic febrile reaction (due to antibodies reacting with white cell fragments in the blood product and cytokines that have leaked from the blood cell during storage)
- Management and paracetamol
557
Diabetes mellitus + weakness and wasting of proximal quadriceps = Diagnosis and management?
Diabetic femoral neuropathy
- Treated with Pregabalin or Gabapentin, amitryptilline or duloxetine
558
Treatment of supraventricular tachycardia in a patient with asthma?
Verapamil, since adenosine is contraindicated by the asthma
559
Where does gentamycin cause the dysfunction in the nephron?
proximal tubular dysfunction
560
What suppresses gene expression in Human genome?
Methylation supresses gene expression
561
What is dysthymia?
Low-grade depression lasting for more than 2 years
562
MRCP 1 PASSMED
flashcards
Decks in class (25)
# Cards
-
MADBOX563
-
CARDIOLOGY87
-
PNEUMOLOGY94
-
Pneumothorax management9
-
NEPHROLOGY86
-
GASTROLOGY59
-
Gastroenterology50
-
PSYCHIATRY56
-
OPHTHALMOLOGY29
-
NEUROLOGY113
-
INFECTIOUS DISEASES137
-
RHEUMATOLOGY128
-
CLINICAL SCIENCES38
-
PHARMA + TOXICO71
-
ENDOCRINO74
-
DERMA87
-
HAEMATO/ONCO95
-
Cardiac murmurs and JVP wave10
-
PAST PAPERS289
-
GERIATRICS8
-
BIOCHEMISTRY29
-
PATHOLOGY8
-
Metabolism25
-
CELL BIOLOGY5
-
CLINICAL SCIENCES11
