MRCP Part 1 > MRCP 2 > Flashcards

MRCP 2 Flashcards

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1
Q

Features of digoxin toxicity

A

Generally unwell, lethargy, N+V, anorexia, confusion, yellow-green vision
Arrhythmias
Gynaecomastia

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2
Q

Risk factors for aortic dissection

A

1) HTN
2) Trauma
3) Bicuspid aortic valve
4) Collagens: Marfans, Ehlers-Danlos syndrome
5) Turners and Noonan’s
6) pregnancy
7) syphilis

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3
Q

ECG changes in brugada syndrome
What makes ECG more apparent?

A

ST elevation in V1-V3 followed by negative t waves.
Give flecanide to make ECG changes more apparent

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4
Q

Which gene mutation causes Brugada syndrome, what does it code for

A

SCN5A
Codes for the myocardial sodium ion channel protein

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5
Q

What medication is used for rate control in asthmatics with AF

A

Verapamil
Digoxin in HF

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6
Q

What are the indications for valve replacement for AS?

A

1) symptomatic pt
2) severity - aortic valve gradient >40mmHg

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7
Q

What is MART inhaler? When is it used in asthma treatment?

A

Maintenance and reliever therapy - ICS + formoterol
Used PRN first line and regular + PRN second line

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8
Q

What are the two potentially fatal conditions caused by high altitude?

A

HAPE - high altitude pulmonary oedema
HACE - high altitude cerebral oedema

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9
Q

How do you treat high altitude cerebral oedema?

A

Descent
Dexamethasone

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10
Q

What skin conditions are associated with sarcoidosis?

A

Erythema nodosum
Lupus pernio - butterfly rash
Subcutaneous nodules

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11
Q

Treatment of pneumonia secondary to clamydia psittaci (Psittacosis)

A

1st-line: tetracyclines e.g. doxycycline
2nd-line: macrolides e.g. erythromycin

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12
Q

What therapies are used in asthma that is not controlled using standard therapy

A

Monoclonal antibody therapy

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13
Q

Where does the monoclonal antibody drug Dupilumab target?

A

IL-4 receptor alpha

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14
Q

What are flow volume loops used for?

A

Rate of airflow (y axis) vs total volume breathed (x axis)
Used for differentiating between fixed and variable upper airway obstruction

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15
Q

Triad of eosinophilic granulomatosis + polyangitis (churg strauss)

A

Asthma, eosinophilia, systemic vasculitis

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16
Q

Which medications can mask eosinophilic granulomatosis + polyangitis

A

Asthma treatment - corticosteroids + montelukast act as anti-inflammatories, suppressing the vasculitis componenet

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17
Q

Chronic sinusitis + nephritic syndrome =

A

Granulomatosis with polyangitis (wegners)

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18
Q

Indications for starting steroids in sarcoidosis

A

PUNCH
Parenchymal lung disease: CXR stage 2/3 or symptomatic
Uveitis
Neurological involvement
Cardiac involvement
Hypercalcaemia

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19
Q

COPD patients using inhaled corticosteroids have an increased risk of?

A

Pneumonia

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20
Q

What is Kartageners syndrome? features?

A

Primary ciliary dyskinesia
Dextrocardia
Bronchiectasis
Recurrent sinusitis
Subfertility

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21
Q

Which conditions cause a raised TLCO ( total gas tansfer) ?

A

Asthma
Pulmonary Haemorrhage (e.g granulomatosis with polyangitis, goodpastures)
Left-right shunts
Polycythemia

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22
Q

Which gene is associated with bronchiectasis?

A

HLA-DR1

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23
Q

What is bronchiolitis obliterans syndrome?

A

Main long term cause of graft failure in lung transplant patients. (there are other causes e.g rheumatoid)
Airway obstruction caused by immune-mediated inflammation and fibrosis of small airways

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24
Q

Complications of plasma exchange

A

1) Hypocalcaemia
2) metabolic alkalosis
3) removal of systemic medications
4) coagulation factor and immunoglobulin depletion

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25
What is the commonest and most severe form of lupus nephritis?
Class IV (WHO classification) Diffuse membranous glomerulonephritis
26
Inheritance of alports syndrome
X-linked dominant
27
In renal transplant HLA matching, which is the most important HLA to match
HLA-DR
28
What is Papillary necrosis?
necrosis of the renal papillae and medulla,
29
What conditions cause Papillary necrosis?
Acute pyelonephritis Overuse of analgesia - NSAIDs TB Sickle cell disease Diabetes
30
Which renal stones have a semi-opaque appearance on XR?
Cystine
31
Which stones are radiolucent on XR?
Urate and Xanthine - require US or CTKUB
32
Painful necrotic skin lesions in ESRF = What causes it?
Calciphylaxis Deposition of calcium deposits in small vessels -> occlusion -> necrosis
33
Tumour markers in testicular cancer Germ cell (seminoma vs non-seminoma)
Seminoma - hCG may be elevated in around 20% Non-seminoma -AFP and/or beta-hCG are elevated in 80-85% LDH elevated in 40% germ cell tumours
34
MOA of spironolactone, where does it act
Aldosterone antagonist - inhibition of the mineralocorticoid receptor Acts in cortical collecting duct (after distal convoluted tubule).
35
MOA of finasteride How long can it take to be effective
5 a-reductase inhibitor 6 months to have effect
36
What congenital syndrome is Wilm's tumour associated with?
Beckwith-Wiedemann syndrome - overgrowth syndrome (large tongue) - ass with several childhood tumours
37
A positive cyanide-nitroprusside test is suggestive of
Cystinuria - autosomal recessive disorder (leads to cystine renal stones)
38
Causes of anaemia in CKD
1) Reduced EPO 2) Reduced absoprtion of iron 3) blood loss due to capillary fragility and stress ulceration
39
MOA of reduced iron absoprtion in CKD
1) elevated hepcidin levels (reduced renal clearance) leads to decreased iron absorption from the gut and impaired release of stored iron from macrophages and hepatocytes, reducing the iron available for erythropoiesis 2) metabolic acidosis inhibits the absoprtion of ferric iron (Fe3) to its absorbale form (Fe2)
40
Genes involved in autosomal dominant PKD + which is most commonly involved + which chromosome
PKD1 - chromosome 16 (85%) PKD2 - chromosome 4
41
MOA of Bicalutamide
Androgen receptor blocker
42
Genetic cause of nephrogenic diabetes insipidus, which gene on which chromosome
1) Genetic mutation affecting vasopressin (ADH) receptor AVPR2 gene mutation on X chromosome (X-linked) 2) mutation in the gene that encodes the aquaporin 2 channel (less common)
43
IgG deposits on renal biopsy =
Goodpastures syndrome/ anti-GBM
44
What antibodies are associated with idiopathic membranous glomerulonephritis?
anti-phospholipase A2 antibodies
45
Thickened basement membrane with subepithelial electron dense deposits =
Membranous glomerulonephritis
46
proteus mirabilis infection pre-disposes to which type of renal stone?
Struvite
47
What is fibromuscular displasia? Features
Cause of renal artery stenosis Young female, CKD/renal failure, HTN, asymmetric kidneys on US, flash pulmonary oedema
48
Symptomatic treatment for Sjogrens
Pilocarpine - stimulates production of saliva and tears
49
First line abx for septic arthritis
IV flucloxacillin
50
Test for De Quervain's tenosynovitis
Finkelstein test
51
What ophthalmology complication is associated with GCA? What is seen on fundoscopy?
Anterior ischaemic optic neuropathy (AION) Swollen pale disc and blurred margins on fundoscopy
52
What is familial mediterranean fever? How does it present?
Autosomal recessive disorder presents in 20s. Attacks lasting 1-3 days or pyrexia, abdominal pain (peritonitis), pleurisy, arthritis and pericarditis
53
Anti RNP (ribonuclear protein) antibodies =
Mixed connective tissue disease
54
Which HLA is associated with Behcet's syndrome
HLA B51
55
Initial treatment of rheumatoid arthritis
Methotrexate/DMARD and short course of prednisolone
56
Which conditions increase your risk of pseudogout?
1) Hyperparathyroidism 2) Haemochromatosis 3) Low PO4, Low Mg 4) Acromegaly 5) Wilsons disease`
57
What is osteogenesis imperfecta? (genetics and pathophysiology)
Brittle bone disease Autosomal Dominant Disorder in type 1 collagen due to decreased synthesis of pro-alpha 1 or pro-alpha 2 collagen peptides
58
Features of osteogenesis imperfecta
1) fractures following mild trauma 2) blue sclera 3) deafness secondary to otosclerosis 4) dental imperfections
59
Eye sign in Marfan's syndrome
1) upwards lens dislocation (superotemporal ectopia lentis) 2) blue sclera 3) myopia
60
What is the main target for pANCA antibody?
Myeloperoxidase (MPO)
61
What complement levels are associated with SLE?
C3 and C4 - used to monitor flares
62
Which XR feature allows you to distinguish gout from pseudogout
Pseudogout: chondrocalcinosis on XR -linear calcifications of the meniscus and articular cartilage. NAD acutely in gout
63
What is Von Hippel-Lindau (VHL) syndrome
Autosomal dominant disease that is characterised by the abnormal growth of benign and malignant tumours and cysts in various organs in the body.
64
What is Klumpke's paralysis
Damage to T1 due to traction injury of brachial plexus. Loss of intrinsic hand muscle strength
65
Prognosis in absence seizures
90-95% of children have grown out of absence seizures by adolescence
66
Which condition is associated with bilateral vestibular schwannomas?
Neurofibromatosis type 2
67
What causes downbeat nystagmus?
Foramen magnum lesions - Arnold-Chiari malformation (herniation of cerebellar tissue into foramen magnum)
68
What is miller fisher syndrome? How does it present?
Variant of Guillian Barre Ophthalmoplegia, ataxia and areflexia Typically ascending weakness rather than descending
69
Bitemporal hemianopia - worse upper vs lower quadrant defect = which type of tumour
upper quadrant defect > lower quadrant defect = inferior chiasmal compression, commonly a pituitary tumour lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a craniopharyngioma
70
Where is the median longitudinal fasciculous located
Paramedian area of midbrain and pons
71
Features of median longitudinal fasciculous lesion
Ipsilateral eye cannot adduct past midline Can get nystagmus and diplopia in contralateral eye
72
How quickly do you stop simple analgesia, tripans and opioid analgesia with medication overuse headache?
Simple analgesia and triptans = stop immediately Opioid medication -> gradually
73
What is Foster Kennedy Syndrome?
A frontal lobe tumour - most commonly olfactory groove meningioma
74
Key features of Foster Kennedy Syndrome?
Ipsilateral optic atrophy – due to direct compression of the optic nerve by the tumor. Contralateral papilledema – due to raised intracranial pressure. Anosmia (loss of smell) – from involvement of the olfactory nerve/tract (often seen).
75
Which chromosomes have mutations in NF1 and NF2
NF1 = chromosome 17 NF2 = chromosome 22
76
Treating neuropathic pain - if one drug is not working at maximum dose what is the next step
Neuropathic pain killers should be used as monotherapy Stop current drug and commence another
77
What is transverse myelitis
Acute inflammation of the spinal cord at a specific level - leaving motor, sensory and autonomic dysfunction below that level.
78
Adverse effect of lamotrigine
Rarely causes Steven's Johnsons Syndrome
79
Which IV Abx are used for brain abscesses
IV 3rd-generation cephalosporin + metronidazole
80
Which MRI form is used to diagnose MS? What is seen?
MRI FLAIR sequence Dawson fingers are seen -> hyperdense lesions perpendicular to the corpus callosum
81
Thrombolysis + thrombectomy window for stroke
4.5 hrs from symptom onset for thrombolysis 6 hrs for thrombectomy
82
What is acute disseminating encephalomyelitis
autoimmune demyelinating disease of the central nervous system, follows infection.
83
What is seen on CT in Herpes Simplex encephalitis
Temporal lobe changes (petechial haemorrhages)
84
What are the drug causes of hypertrichosis
minoxidil, ciclosporin, diazoxide
85
Management of erythema nodosum
Will heal spontaneously without scarring in 1-2 months
86
Features of Pellagra What is it caused by?
3 D's - dermatitis, diarrhoea, dementia Caused by Niacin deficiency
87
Vesicular lesions on knees, elbows, buttocks =
dermatitis herpetiformis
88
How is dermatitis herpetiformis diagnosed?
Skin biopsy
89
What type of surgical excision is used for SCC in cosmetically important sites
Mohs micrographic surgery
90
Investigations in patient presenting with erythema nodosum
CXR ?sarcoidosis, TB, pulmonary infections and lymphoma Throat swab for Group A strep FBC,CRP
91
Antibodies against what in pemphigus vulgaris?
Desmoglein
92
What is Dermatitis artefacta
Rare psycho-dermatological condition - self-inflicted skin lesions
93
Management of fungal nail infections
Limited involvement: topical amorolfine - 6 months for fingernails, 9-12 months for toetails Extensive involvement: oral terbinafine - 6 weeks - 3 months for fingernail infections and toenails 3-6 months
94
Features of Zinc deficiency
1) Acrodermatitis: red, crusted lesions 2) Alopecia 3) Short stature 4) Hypogonadism 5) Hepatosplenomegaly 6) Cognitive Impairment
95
Skin conditions related to pregnancy - how to tell them apart
Polymorphic eruption of pregnancy - lesions appear in abdominal striae. Pemohigoid gestationis - blistering lesions
96
Causes of Oncholysis
DIRT PIT Dermatitis Idiopathic Raynaud's Trauma - XS manicuring Psoriasis Infections - fungal Thyroid disease (hyper/hypo)
97
Purplish non-blanching net-like rash = What is it associated with?
Livedo reticularis Associated with SLE, polyarteritis nodosa, Ehlers-Danlos, Antiphospholipid syndrome
98
Shin lesions with orange peel texture =
Pretibial Myxoedema
99
Uncontrolled psoriasis - management
Biologics - Etanercept
100
Treatment of pemphigoid gestationis
oral steroids
101
What is seborrhoeic dermatitis caused by?
Malassezia furfur
102
Common complications of seborrhoeic dermatitis
Otitis externa and blepharitis
103
Shiny painless areas of yellow/red skin typically on the shins of diabetics, associated with telangiectasia
Necrobiosis Lipoidica Diabeticorum
104
Severe acne treatment in pregnamcy
Topical benzoyl peroxide + oral erythromycin
105
Ciclosporin side effects
Everything is increased! HTN Hyperkalaemia gingival hypertrophy fluid retention nephrotoxicity hepatotoxicity
MRCP Part 1
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