1
Q
How is Raynaud’s phenomenon treated?
A
- 1st Line: CCBs (e.g. nifedipine)
- 2nd Line: IV Prostacyclin infusion (e.g. epoprostenol)
2
Q
Which drug groups could precipitate an attack in patients with a history of acute intermittent porphyria?
A
- Barbiturates
- Halothane
- Benzodiazepines
- Alcohol
- OCP
- Sulphonamides
3
Q
How should patients with suspected HIV seroconversion be investigated?
A
- p24 antigen test (positive from 1 to 3/4 weeks after infection)
- HIV antibody (most common and accurate test - most will develop antibodies by 4-6 weeks)
Antibodies may not be detectable yet.
4
Q
What are the main features of MODY?
A
- Develops < 25 yrs
- Family history of early-onset diabetes (autosomal dominant)
- Ketosis NOT present
- Sensitive to sulfonylureas (insulin often not necessary)
Bit like early-onset type 2 diabetes mellitus.
5
Q
Which class of diabetes medications is associated with causing SIADH?
A
Sulfonylureas
6
Q
Which bacterium most commonly causes peritonitis secondary to peritoneal dialysis?
A
Staphylococcus epidermidis
7
Q
What is the gold standard diagnostic test for hereditary spherocytosis?
A
EMA Binding Test
It is treated with folate supplementation and splenectomy (in severe cases).
8
Q
What is Ham’s test used for?
A
Paroxysmal nocturnal haemoglobinuria, but the gold standard test is now flow cytometry for CD59 and CD55 (these are negative).
9
Q
How does mycophenolate mofetil work?
A
Reduces lymphocyte production through inhibition of inosine-5-monophosphate-dehydrogenase (required for purine synthesis).
10
Q
What causes the majority of cases of primary hyperaldosteronism?
A
Bilateral adrenal hyperplasia (70%)
It used to be thought that most cases were due to adrenal adenomas (Conn’s).
11
Q
Which layers of the adrenal cortex secrete which hormones?
A
- Glomerulosa –> Aldosterone
- Fasciculata –> Glucocorticoids
- Reticularis –> Sex Steroids
- Medulla –> Catecholamines
12
Q
What do the x descent and y descent represent on a JVP waveform?
A
- X descent –> fall in atrial pressure during ventricular systole
- Y descent –> opening of the tricuspid valve
13
Q
What does the ulnar nerve supply?
A
- MOTOR: medial two lumbricals, adductor pollicis, interossei, hypothenar muscles, flexor carpi ulnaris.
- SENSORY: medial 1.5 fingers.
14
Q
How does damage to the ulnar nerve manifest?
A
- AT WRIST: Claw hand (hyperextension of MCP, flexion of distal and proximal IPJs of 4th/5th digits) + wasting of intrinsic hand muscles + wasting of hypothenar muscles + sensory loss to medial 1.5 fingers.
- AT ELBOW: Clawing is less severe, radial deviation of wrist.
15
Q
List the manifestations of different complement deficiencies.
A
- C1 inhibitor –> hereditary angioedema
- C1, C2, C4 –> immune complex disease (e.g. SLE)
- C3 –> recurrent bacterial infections
- C5 –> Leiner disease, watery diarrhoea, seborrhoeic dermatitis
- C5-C9 –> severe meningococcal infection
16
Q
Why does trimethoprim cause a slight rise in creatinine?
A
It competitively inhibits creatinine secretion in the tubule.
It also blocks ENaC in the distal nephron which causes a hyperkalaemic distal RTA.
17
Q
Which drugs can cause idiopathic intracranial hypertension?
A
- Steroids
- COCP
- Tetracyclines
- Lithium
18
Q
What is the first-line antibiotic recommended for the treatment of Campylobacter jejuni?
A
Clarithromycin
19
Q
What is the first-line antiepileptic drug for the treatment of myoclonic epilepsy?
A
Sodium valproate
Second line: clonazepam, lamotrigine
Carbamazepine can worsen myoclonic seizures
20
Q
What is the first-line antiepileptic used for generalised and focal seizures?
A
- Generalised: sodium valproate
- Focal: carbamazepine
21
Q
Which antiepileptics are used for absence seizures?
A
Sodium valproate or ethosuximide
22
Q
How should caustic ingestion be managed?
A
- Asymptomatic: discharge after trial of oral fluids + period of observation
- Symptomatic: high dose IV PPI, urgent endoscopy
23
Q
How is high-altitude pulmonary oedema managed?
A
- Descent
- Nifedipine
- Others (dexamethasone, acetazolamide, phosphodiesterase type V inhibitors)
24
Q
How is high-altitude cerebral oedema managed?
A
Descent and Dexamethasone
25
Name an **alkylating agent** and its potential side-effects.
* Cyclophosphamide
* **Side-effects**: haemorrhagic cystitis, myelosuppression, transitional cell carcinoma
## Footnote
Haemorrhagic cystitis can be prevented with mesna.
26
List some **cytotoxic antibiotics** and their adverse effects.
* Bleomycin --> degrades preformed DNA --> lung fibrosis
* Anthracyclines (e.g. doxorubicin) --> stabilised DNA topoisomerase II complex inhibits DNA and RNA synthesis --> Cardiomyopathy
27
Give an example of a **topoisomerase** inhibitor.
Irinotecan
## Footnote
Side-effects: myelosuppression
28
What is a notable side-effect of **vincristine**?
* Peripheral Neuropathy
* Paralytic Ileus
29
Which **diseases** are associated with the following HLA types?
* HLA-A3
* HLA-B51
* HLA-B27
* HLA-DR2
* HLA-DR3
* HLA-DR4
* **HLA-A3** - Hereditary Haemochromatosis
* **HLA-B51** - Behcet's Disease
* **HLA-B27** - Ankylosing Spondylitis, Reactive Arthritis, Anterior Uveitis
* **HLA-DR2** - Goodpasture's, Narcolepsy
* **HLA-DR3** - Dermatitis Herpetiformis, Sjogren Syndrome, PBC
* **HLA-DR4** - Rheumatoid Arthritis, T1DM (DRB1*04:01)
30
How does **homocystinuria** manifest?
* Tall stature
* Long fingers
* Downward lens dislocation
* Learning difficulties
* Unprovoked DVT at early age
* Malar flush
## Footnote
It is an autosomal recessive condition caused by a deficiency of cystathionine beta synthase that is screened for in neonatal screening. It is treated with pyridoxine supplements.
31
Describe the natural history of **autosomal recessive polycystic kidney disease**.
* Diagnosed on **prenatal ultrasound scan/early infancy**
* Newborns have features of **Potter sequence** due to oligohydramnios
* **End-stage renal failure in childhood**
32
Which vitamin deficiency causes **angular cheilitis**?
Riboflavin
| (Vitamin B2)
33
Which antibiotic should be used to treat **meningococcal meningitis** in a patient who has anaphylactic reactions to penicillins?
Chloramphenicol
34
Which antibiotics may be used as prophylaxis in contacts of people with **meningococcal meningitis**?
Ciprofloxacin or Rifampicin
35
Which conditions can cause **Charles-Bonnet Syndrome**?
* Age-related macular degeneration (most common)
* Glaucoma
* Cataracts
36
How does **ataxia telangiectasia** present?
* Cerebellar ataxia
* Telangiectasia
* Recurrent chest infections
37
Which nerves pass through the following **foramina**?
* Foramen rotundum
* Foramen ovale
* Jugular foramen
* Foramen rotundum - **Maxillary Nerve (V2)**
* Foramen ovale - **Mandibular Nerve (V3)**
* Jugular foramen - **IX, X and XI**
38
Which nerves pass through the **superior orbital fissure**?
* III
* IV
* V1 (Ophthalmic)
* VI
39
What are the main forms of **malaria prophylaxis** that are currently recommended?
* **Atovaquone and Proguanil (Malarone)**
* **Doxycycline** (risk of photosensitivity)
40
Which **biological therapy** may be used to prevent C. difficile recurrence?
Bezlotoxumab
41
What are some complications of **typhoid**?
* Osteomyelitis
* GI bleed/perforation
* Meningitis
* Cholecystitis
42
Give some examples of drugs that follow **zero-order kinetics**?
* Alcohol
* Phenytoin
* Salicylates (aspirin)
43
What pressures does **pulmonary capillary wedge pressure** using a Swan-Ganz catheter equate to?
Left atrial pressure
44
Which patients should be offered prophylactic antibiotics for **SBP**?
* Oral **ciprofloxacin** or **norfloxacin** for people with cirrhosis and ascites with an ascitic protein < 15 g/L until the ascites has resolved
* Patients who have had an episode of **SBP**
45
What are some features of **pseudoxanthoma elasticum**?
* Autosomal recessive disorder of elastic fibres
* Retinal angioid streaks
* Plucked chicken skin appearance
* Increased risk of ischaemic heart disease
* GI haemorrhage
46
What should **splenectomy patients** be vaccinated against?
* Pneumococcus
* Haemophilus type B
* Meningococcus type C
47
Describe the features of **Adult-onset Still's disease**.
* Arthralgia
* Very high ferritin
* Salmon-pink maculopapular rash
* Pyrexia
* Lymphadenopathy
## Footnote
It is a diagnosis of exclusion (ANA and RF negative).
48
How would a **posterior communicating artery aneurysm** present?
* 3rd nerve palsy with pupil dilation
* Painful + Headache
49
List some causes of **3rd nerve palsy**.
* Diabetes Mellitus
* Vasculitis (e.g. temporal arteritis)
* Posterior Communicating Artery Aneurysm
* Cavernous Sinus Thrombosis
* Weber Syndrome (ipsilateral third nerve palsy with contralateral hemiplegia caused by midbrain strokes)
50
Describe steps taken to reduce the risk of **contrast-induced nephropathy**.
* Give IV **0.9% saline** at a rate of 1 mL/kg/hour for the 12 hours before and after the CT scan
* **Metformin should be withheld** for a minimum of 48 hours until renal function has been shown to be normal
51
What are the first-line treatment options for **diabetic neuropathy**?
* Duloxetine
* Amitriptyline
* Pregabalin
* Gabapentin
52
How should pregnant women at high risk of developing **pre-eclampsia** be managed?
Aspirin 75 mg OD from 12 weeks until birth
53
What is **calciphylaxis**?
* Rare complication of **end-stage renal disease** (vasculopathy of small blood vessels)
* Presents with **painful necrotic skin lesions** containing calcium deposits
54
What is **methaemoglobinaemia**?
It is haemoglobin that has been oxidised to the **Fe3+ form** and can no longer carry oxygen, resulting in **global tissue hypoxia**
## Footnote
It may be congenital or may occur due to certain medications (e.g. sulphonamides, nitrates, sodium nitroprusside, dapsone, primaquine)
55
How does **methaemoglobinuria** present?
* Cyanosis
* Shortness of breath
* Anxiety
* Normal pO2 with low SaO2
## Footnote
It shifts the oxygen dissociation curve to the left and is treated using methylene blue.
56
What are some causes of **cannon a waves**?
* **Complete heart block** (irregular)
* **AVNRT** (regular)
* Ventricular tachycardia (with 1:1 atrial: ventricular contraction)
57
How does a **VIPoma** present?
* Large volume diarrhoea
* Weight loss
* Dehydration
* Hypokalaemia
* Hypochlorhydria
## Footnote
90% are seen in the pancreas (vasoactive intestinal peptide).
58
Outline the phases of the **cardiac action potential** and the direction of ion movement.
* **0** - Rapid Depolarisation - Rapid Na Influx
* **1** - Early Repolarisation - K Efflux
* **2** - Plateau - Slow Ca Influx
* **3** - Final Repolarisation - K Efflux
* **4** - Restoration of Ionic Concentrations - Na/K ATPase
59
What is the first-line treatment option for **hepatitis B**?
Pegylated interferon
## Footnote
Others: tenofovir, entecavir, telbivudine
60
List some drugs that are commonly overdosed and CAN be removed with **dialysis**.
* Barbiturate
* Lithium
* Alcohol (inc methanol, ethylene glycol)
* Salicylates
* Theophyllines (charcoal haemoperfusion is preferable)
61
List some drugs that are commonly overdosed and CANNOT be removed with **dialysis**.
* TCAs
* benzodiazepines
* dextropropoxyphene (Co-proxamol)
* digoxin
* beta-blockers
62
List some medications that should be avoided when **breastfeeding**.
* Antibiotics (ciprofloxacin, tetracyclines, chloramphenicol, sulphonamides)
* Lithium
* Benzodiazepines
* Aspirin
* Carbimazole
* Methotrexate
* Sulfonylureas
* Amiodarone
63
Which classes of drugs are used to treat **glaucoma** and how do they work?
* **Prostaglandin analogues** (e.g. latanoprost) - increases uveoscleral outflow
* **Beta-blockers** (e.g. timolol) - reduced aqueous generation
* **Sympathomimetics** (e.g. brimonidine - a2 agonist) - reduces aqueous production and increases outflow
* **Carbonic anhydrase inhibitors** (e.g. dorzolamide) - reduces aqueous production
* **Miotics** (e.g. pilocarpine) - increases uveoscleral outflow
64
What is the first-line investigation for **acute intermittent porphyria**?
Raised urinary porphobilinogen
65
What are the features of **polyarteritis nodosa**?
* Fever, malaise, arthralgia
* Low grade fever
* Haematuria
* Livedo reticularis
* Mononeuritis multiplex
## Footnote
Associated with hep B and ANCA.
66
What is **mononeuritis multiplex**?
* Painful, **asymmetrical, asynchronous sensory and motor peripheral neuropathy**.
* Involves isolated damage to at least **2 separate nerve areas**.
## Footnote
Associated with diabetes mellitus, sarcoidosis, rheumatoid arthritis and polyarteritis nodosa.
67
What is the equation for **standard error of the mean**?
SEM = SD/sqrt(n)
68
What change in **GFR** and **creatinine** is permissible in patients being started on ACE inhibitors?
* Up to **25% decrease in GFR**
* Up to **30% rise in creatinine**
69
Why do you do **U&E** before starting someone on amiodarone?
To rule out **hypokalaemia**.
## Footnote
All antiarrhythmics can cause arrhythmias and concomitant hypokalaemia massively increases the risk of that happening.
70
Outline how **gestational diabetes** should be managed.
* **If FBG < 7** : diet and exercise
If targets not met within 1-2 weeks, start **metformin** (glibenclamide is an alternative)
If targets still not met, start **insulin**.
* **If FBG > 7** : start **insulin**.
71
What is **hyperchylomicronaemia**?
Disease caused by **hereditary lipoprotein lipase deficiency** and **apolipoprotein C deficiency** that predisposes to recurrent attacks of acute pancreatitis.
72
Which antibiotics work by inhibiting **DNA synthesis**?
* Quinolones
* Metronidazole
* Sulphonamides
* Trimethoprim
73
Which antibiotics work by inhibiting **protein synthesis**?
* Aminoglycosides
* Chloramphenicol
* Macrolides
* Tetracyclines
* Fusidic Acid
74
What are some good prognostic factors for **ALL**?
* French-American-British (FAB) L1 type
* Common ALL
* Pre-B phenotype
* Low initial WBC
* del(9p)
* Hyperdiploidy
75
What is the mechanism of action of the following **antivirals**?
* Ribavirin
* Amantadine
* Oseltamivir
* Foscarnet
* Interferon Alpha
* Cidofovir
* **Ribavirin** - guanosine analogue, interferes with capping of viral mRNA
* **Amantadine** - M2 inhibitor prevents virus uncoating within cells
* **Oseltamivir** - neuraminidase inhibitor
* **Foscarnet** - inhibits viral DNA polymerase
* **Interferon Alpha** - inhibits mRNA synthesis
* **Cidofovir** - DNA polymerase inhibitor
76
List the ECG features of **digoxin toxicity**.
* Down-sloping ST depression (reverse tick)
* Flattened/inverted T waves
* Short QT interval
* Arrhythmias (e.g. AV block, bradycardia)
77
Which gene mutations does testing for **hereditary haemochromatosis** look for?
* C282Y
* H63D
78
What are the two types of **mesangiocapillary (membranoproliferative) glomerulonephritis** and what are their associations?
* **Type 1**: Cryoglobulinaemia, Hepatitis C
* **Type 2**: Partial Lipodystrophy (associated with low C3)
79
How is **primary open-angle glaucoma** treated?
* **1st**: Prostaglandin analogue (e.g. latanoprost)
* **2nd**: Beta-blocker (e.g. timolol), sympathomimetic (e.g. brimonidine) or carbonic anhydrase inhibitor
* **3rd**: surgery or laser
80
What should always be done before starting a patient with **COPD** on azithromycin?
ECG
Azithromycin can prolong **QT interval**
81
What is the difference between the mechanism of action of **vincristine** and **docetaxel**?
* **Vincristine** - inhibits microtubule formation
* **Docetaxel** - inhibits microtubule disassembly
82
Which manoeuvres are used in the diagnosis and treatment of **BPPV**?
* **Dix-Hallpike** - Diagnostic
* **Epley** - Therapeutic
83
What are the histological features of **diabetic nephropathy**?
* Kimmelstiel-Wilson lesions (nodular glomerulosclerosis)
* Hyaline arteriosclerosis
84
What are the features of a **Holmes-Adie pupil**?
* Unilateral (80% of cases) benign dilated pupil.
* Once constricted, the pupil remains small for a long time.
* Slow reaction to accommodation and none to light.
* Associated with absent knee/ankle reflexes.
85
What are the main features of **NF1** and **NF2**?
**_NF1_**
* Cafe au lait spots
* Axillary freckling
* Peripheral neurofibromas
* Lisch nodules
* Scoliosis
* Phaeochromocytomas
**_NF2_**
* Bilateral vestibular schwannomas
* Meningiomas and Ependyomas
86
What are the main features of **tuberous sclerosis**?
* Multiple CNS hamartomas
* Subependymal giant cell astrocytomas/Renal angiomyolipomas
* Cardiac rhabdomyomas
* Facial angiofibromas
* Shagreen patches
* Retinal astrocytic hamartomas
87
Which chromosome are **HLA antigens** encoded on?
Chromosome 6
88
List some **glycogen storage diseases** and their manifestations.
* **Von Gierke disease (type I)** - glucose-6-phosphatase - hypoglycaemia, lactic acidosis and hepatomegaly (hepatic glycogen accumulation).
* **Pompe's disease (type II)** - lysosomal alpha-1,4-glucosidase - cardiac, hepatic and muscle glycogen accumulation, leads to cardiomegaly.
* **Cori disease (type III)** - alpha-1,6-glucosidase - hepatic and cardiac glycogen accumulation, leads to muscle hypotonia.
* **McArdle Disease (type V)** - glycogen phosphorylase - skeletal muscle glycogen accumulation, leads to myalgia and myoglobinuria with exercise and second wind phenomenon.
89
List some **lysosomal storage disorders** and their manifestations.
* **Gaucher** - beta-glucocerebrosidase - most common, hepatosplenomegaly and avascular necrosis of femur.
* **Tay-Sachs** - Hexosaminidase A - accumulation of G2 ganglioside in lysosomes, leads to developmental delay, cherry red spot on macula, NORMAL liver and spleen.
* **Niemann-Pick** - sphingomyelinase - hepatosplenomegaly and cherry spot on macula.
* **Fabry** - alpha-galactosidase A - angiokeratomas, renal failure, peripheral neuropathy of extremities.
* **Krabbe** - galactocerebrosidase - peripheral neuropathy, optic atrophy and globoid cells.
* **Metachromatic leukodystrophy** - arylsulfatase A - demyelination of CNS and PNS.
90
List some **mucopolysaccharidoses** and their manifestations.
* **Hurler Syndrome (type I)** - leads to gargoylism, hepatosplenomegaly and corneal clouding.
* **Hunter Syndrome (type II)** - coarse facial features, behavioural problems, short stature, **no corneal clouding**.
## Footnote
Both are caused by accumulation of glycosaminoglycans.
91
Damage to which brain structure causes **hemibalismus**?
Subthalamic nucleus of basal ganglia
92
What are the ECG features of **arrhythmogenic right ventricular cardiomyopathy**?
* ECG abnormalities in **V1-3** (TWI)
* **Epsilon wave** (terminal notch in QRS complex)
93
What is **catecholaminergic polymorphic ventricular tachycardia**?
* Form of inherited (**AD**) cardiac disease associated with sudden death
* **Exercise or exertion** leads to VT and syncope
* Generally presents **< 20 years**
94
Which commonly used drugs can cause **photosensitivity**?
* Thiazides
* Tetracyclines
* Ciprofloxacin
* Amiodarone
* NSAIDs
* Sulphonylureas
95
What is the **King's College Hospital criteria** for liver transplantation following paracetamol overdose?
* Arterial **pH < 7.3** more than 24 hours after ingestion
* Or all of the following:
* PT > 100 seconds
* Creatinine > 300
* Grade III or IV Encephalopathy
96
List the uses of **interferon alpha, beta and gamma**.
* **Alpha** - hepatitis B/C, Kaposi sarcoma, metastatic renal cell carcinoma, hairy cell leukaemia
* **Beta** - relapsing-remitting MS
* **Gamma** - chronic granulomatous disease, osteopetrosis
97
What is **trihexyphenidyl**?
**Antimuscarinic** used to treat Parkinson's disease (particularly drug-induced Parkinsonism).
98
What channel abnormality tends to cause **long QT syndrome**?
Blockage or **loss of function of potassium channels**.
99
List some drugs that can cause **agranulocytosis**.
* Antithyroid (carbimazole, propylthiouracil)
* Antipsychotics (clozapine)
* Antiepileptics (carbamazepine)
* Antibiotics (penicillin, chloramphenicol)
* Antidepressant (mirtazapine)
100
What is the **Hering-Breuer reflex**?
Lung distention is detected by stretch receptors in the lungs which causes slowing of the respiratory rate.
## Footnote
This prevents the lungs from overexpanding during inspiration.
101
List some common causes of **cataracts**.
* Ageing
* Smoking
* Increased alcohol consumption
* Trauma
* Diabetes mellitus
* Long-term corticosteroids
* Radiation exposure
* Myotonic dystrophy
* Metabolic disorders: hypocalcaemia
102
How is **hepatitis C** treated?
Combination of protease inhibitors (e.g. **sofosbuvir + daclatasvir**) with or without ribavirin
## Footnote
Target: sustained virologic response (undetectable serum HCV RNA 6 months after ending therapy).
103
Which chromosomes are the genes responsible for the following diseases found on?
* **von Hippel Lindau**
* **Tuberous Sclerosis**
* **NF1**
* **NF2**
* von Hippel Lindau: **3**
* Tuberous Sclerosis: **16**
* NF1: **17**
* NF2: **22**
104
List some causes of **mixed upper and lower motor neurone signs**.
* Subacute combined degeneration of the cord
* Motor neuron disease
* Friedreich's ataxia
* Syringomyelia
* Taboparesis (syphilis)
* Conus medullaris lesion
105
What are the main features of **pemphigus vulgaris**?
* Mucosal ulceration is common
* Blisters are flaccid, easily ruptured bullae
* Nikolsky sign positive
* Acantholysis on biopsy
106
What are the main features of **macrophage activation syndrome**?
* **Definition**: Uncontrolled inflammatory state associated with systemic autoimmune diseases (e.g. JIA)
* **Features**: Refractory fever, hepatosplenomegaly
* **Pathophysiology**: caused by abnormal interferon-gamma activity which activates macrophages
107
Which antibody is primary **membranous glomerulonephritis** associated with?
Anti-PLA2R
## Footnote
Secondary causes include:
* Malignancy such as solid tumours (lung, colon, breast, kidney)
* Infections: hepatitis B or C, HIB, malaria, syphilis, schistosomiasis
* Autoimmune diseases: SLE, sarcoidosis, IBD
* Drugs: NSAIDs, captopril, gold, penicillamine, lithium, clopidogrel
108
Outline the **ECOG score**.
* **0** - Fully **active**, able to carry on all pre-disease performance without restriction.
* **1** - **Restricted in physically strenuous activity** but ambulatory and able to carry out work of a light or sedentary nature, e.g., light house work, office work.
* **2** - Ambulatory and capable of all self-care but **unable to carry out any work activities**; up and about more than 50% of waking hours.
* **3** - Capable of only limited self-care; **confined to bed or chair** more than 50% of waking hours.
* **4** - Completely disabled; cannot carry on any self-care; **totally confined to bed or chair**.
* **5** - Dead.
109
Which causes of **lung fibrosis** classically affect the upper zones?
* Hypersensitivity pneumonitis (also known as extrinsic allergic alveolitis)
* Coal worker's pneumoconiosis
* Silicosis
* Sarcoidosis
* Ankylosing spondylitis (rare)
* Histiocytosis
* Tuberculosis
110
Which causes of **lung fibrosis** classically affect the lower zones?
* Idiopathic pulmonary fibrosis
* Most connective tissue disorders (except ankylosing spondylitis) e.g. SLE
* Drug-induced: amiodarone, bleomycin, methotrexate
* Asbestosis
111
How does **meglitinide** work?
Stimulates **insulin release**. It is good for **post-prandial hyperglycaemia** and for erratic lifestyles and is less likely to cause hypoglycaemia than sulfonylureas.
112
How does **anhydrosis** determine the site of the lesion in Horner syndrome?
* Head, arm, trunk = **central lesion**: stroke, syringomyelia
* Just face = **pre-ganglionic lesion**: Pancoast's, cervical rib
* Absent = **post-ganglionic lesion**: carotid artery
113
What is **Miller Fisher syndrome**?
A type of **Guillain-Barré Syndrome** that primarily affects the cranial nerves.
Presents with **ataxia, ophthalmoplegia, areflexia** and descending paralysis. Associated with antiganglioside antibodies **GQ1b and GT1a**.
114
What is the difference between **Hazard Ratio and Risk Ratio**?
* It is used when **risk is not constant to time**.
* It is usually used when **assessing survival over time**.
115
Describe the CXR stages of **sarcoidosis**.
* **1** = BHL
* **2** = BHL + infiltrates
* **3** = infiltrates
* **4** = fibrosis
116
What is **Lofgren syndrome**?
Presentation of sarcoidosis characterised by the presence of the following symptoms:
* BHL
* Erythema nodosum
* Polyarthritis
* Fever
117
What are the ECG features of **hypokalaemia**?
* U waves
* Small or absent T waves (occasionally inverted)
* Prolonged PR interval
* ST depression
* Long QT
118
Describe the presentation of **African trypanosomiasis**.
* Trypanosoma chancre (painless subcutaneous nodule at site of infection)
* Intermittent fever
* Enlarged posterior cervical lymph nodes
* CNS involvement (somnolence, headache, reversal or sleep-wake cycle)
## Footnote
Treated with **IV pentamidine and suramin**. **IV melarsoprol** used for CNS involvement.
119
What are the main consequences of chronic **Chagas disease**?
* Myocarditis leading to dilated cardiomyopathy
* GI features (megaoesophagus and megacolon)
## Footnote
Treated with **benznidazole or nifurtimox**.
120
What are the ECG features of **hypothermia**?
* Bradycardia
* J wave (hump at end of QRS complex)
* First degree heart block
* Long QT
* Atrial and ventricular arrhythmias
121
What is the first line treatment option for **lichen planus**?
Potent topical steroid
| (e.g. clobetasol)
## Footnote
Description of rash: papular, polygonal, violaceous, flat-topped rash is present on the palms, in the elbow creases and on the soles of her feet.
122
Which type of anaemia can **phenytoin** cause?
Folate deficiency anaemia
123
What is the diagnostic criteria for **metabolic syndrome**?
At least 3 of the following:
* Elevated waist circumference: men > 102 cm, women > 88 cm
* Elevated triglycerides: > 1.7 mmol/L
* Reduced HDL: < 1.03 mmol/L in males and < 1.29 mmol/L in females
* Raised blood pressure: > 130/85 mmHg, or active treatment of hypertension
* Raised fasting plasma glucose > 5.6 mmol/L, or previously diagnosed type 2 diabetes
124
For how long should you monitor a patient undergoing treatment for **anaphylaxis**?
8 hours
| (risk of biphasic reaction)
125
What are the features of **Staphylococcal toxic shock syndrome**?
* Fever > 38.9
* Hypotension (SBP < 90 mm Hg)
* Diffuse erythematous rash
* Desquamation of skin on palms and soles
* Involvement of three or more organ systems (e.g. gastrointestinal, renal, hepatitis, thrombocytopaenia, CNS, mucous membrane)
126
List some associations of **retroperitoneal fibrosis**.
* Riedel's thyroiditis
* Previous radiotherapy
* Sarcoidosis
* Inflammatory abdominal aortic aneurysm
* Drugs: methysergide
127
List some drugs that cause **lung fibrosis**.
* Amiodarone
* Cytotoxic agents: busulphan, bleomycin
* Anti-rheumatoid drugs: methotrexate, sulfasalazine
* Nitrofurantoin
* Ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, pergolide)
128
What is **TLCO**?
Rate at which a gas will diffuse from alveoli into blood. **Carbon monoxide** is used to test the rate of diffusion.
## Footnote
KCO is adjusted for lung volume
129
List some causes a high and a low **TLCO**.
**_HIGH_**
* Asthma
* Pulmonary Haemorrhage
* Left-to-Right Shunts
* Polycythaemia
* Hyperkinetic States
* Exercise
**_LOW_**
* Pulmonary Fibrosis
* Pneumonia
* PE
* Pulmonary Oedema
* Emphysema
* Anaemia
* Low Cardiac Output
130
List some drugs that cause **hyponatraemia**.
* Sulfonylureas
* SSRIs, tricyclics
* Carbamazepine
* Vincristine
* Cyclophosphamide
131
List some drug classes that can cause haemolysis in **G6PD deficient** patients.
* Dapsone and other sulfones
* Fluoroquinolones (including ciprofloxacin, moxifloxacin, norfloxacin, and ofloxacin)
* Methylthioninium chloride
* Nitrofurantoin
* Primaquine
* Rasburicase
* Sulfonamides
132
Which gene mutation is associated with **MEN**?
* **MEN1**: MEN1 Gene
* **MEN2**: RET Oncogene
133
What is the most common histological pattern seen in **lupus nephritis**?
Diffuse proliferative glomerulonephritis
134
What are the classical imaging features of **silicosis**?
* Multiple, small, well-rounded nodules particularly in the upper zones
* Eggshell calcification may be seen
135
Describe the presentation of acute **schistosomiasis** infection.
AKA Katayama Fever
* Fever
* Urticaria
* Arthralgia/Myalgia
* Cough
* Diarrhoea
* Eosinophilia
136
Describe the presenting features of **leptospirosis**.
* **Early**:
* Fever
* Subconjunctival suffusion/haemorrhage
* **Later** (Weil's Disease):
* AKI (common)
* Hepatitis (jaundice, hepatomegaly)
* Aseptic meningitis
137
What is **leptospirosis** caused by and how is it treated?
* Caused by **Leptospira interrogans** (spirochete).
* Treated with **benzylpenicillin or doxycycline**.
138
What are the criteria for considering a patient for **GLP1 agonist** therapy?
If triple therapy is ineffective, consider combination therapy with metformin, a sulfonylurea and GLP-1 agonist if:
* **BMI > = 35 kg/m²** and specific psychological or other medical problems associated with obesity or
* **BMI < 35 kg/m²** and for whom insulin therapy would have significant occupational implications or weight loss would benefit other significant obesity-related comorbidities
139
What is a major risk associated with **pioglitazone**?
Bladder cancer
## Footnote
Fluid retention (can't be used in heart failure).
140
What is the first-line antibiotic for **UTI in pregnancy**?
Nitrofurantoin
## Footnote
2nd line: amoxicillin, cefalexin
141
Which specialised form of imaging is used to distinguish between **CNS lymphoma** and **toxoplasmosis**?
Thallium SPECT
**CNS Lymphoma** = positive
**Toxoplasmosis** = negative
142
Which statins are associated with a higher risk of **statin-induced myopathy**?
* **Higher Risk (Lipophilic)**: Simvastatin, Atorvastatin
* **Lower Risk (Hydrophilic)**: Rosuvastatin, Pravastatin, Fluvastatin
143
How is **Giardia** treated?
Metronidazole
## Footnote
Stool microscopy is often negative in giardia.
144
Which type of thyroid cancer is associated with **Hashimoto's thyroiditis**?
Thyroid lymphoma
| (MALT Lymphoma)
145
List some vaccines of the following types:
* Live Attenuated
* Inactivated
* Toxoid
* Subunit or Conjugate
**_Live Attenuated_**
* BCG
* MMR
* Influenza (intranasal)
* Rotavirus
* Polio
* Yellow Fever
* Typhoid
**_Inactivated_**
* Rabies
* Hepatitis A
* Influenza (intramuscular)
**_Toxoid_**
* DTP
**_Subunit or Conjugate_**
* Pneumococcus
* Meningococcus
* Haemophilus
* HPV
* Hepatitis B
146
What murmur is most commonly associated with an **atrial septal defect** and **ventricular septal defect**?
* **ASD**: Ejection systolic murmur loudest on inspiration
* **VSD**: Pansystolic
147
What is the most common cause of death in **scleroderma** patients?
**Respiratory failure** due to interstitial lung disease and pulmonary hypertension
148
What are some features of **cyanide poisoning** and how is it treated?
Drowsy, headache, confusion, SOB
* **Investigations**: **lactic acidosis**, high pO2 (incl. venous), normal SaO2
* **Management**: **IV Hydroxocobalamin** (others include amylnitrate, sodium nitrite and sodium thiosulfate)
## Footnote
Cyanide can come from insecticides, photograph development, production of certain metals and burning plastic.
149
Which drug should be avoided at all costs in suspected **ventricular tachycardias**?
Verapamil
| (can trigger drop in blood pressure, VF and cardiac arrest)
## Footnote
Though a broad complex tachycardia may be caused by SVT with aberrant conduction, verapamil should still not be used.
150
Which of the following drugs are affected by a patient's **acetylator status**?
* Isoniazid
* Procainamide
* Hydralazine
* Dapsone
* Sulfasalazine
## Footnote
50% of the UK population are deficient in hepatic N-acetyltransferase.
151
Which factors shift the oxygen dissociation curve to the **LEFT**?
* Decreased temperature
* Decreased 2,3-DPG
* Decreased [H+]
* Carboxyhaemoglobin
152
What is the criteria for reversibility on **bronchodilator reversibility testing**?
> 12% increase in FEV1 which is also at least a 200 mL increase
153
List some causes of **warm AIHA**.
Usually **IgG** and occurs at body temperature
* Autoimmune diseases (e.g. SLE)
* Malignancy (lymphoma, CLL)
* Drugs (e.g. methyldopa)
154
List some causes of **cold AIHA**.
Usually **IgM** and causes haemolysis at 4 degrees (haemolysis is mediated by complement and is more commonly intravascular)
* Infections (e.g. EBV, mycoplasma)
* Lymphoma
## Footnote
Symptoms may include Raynaud's and acrocyanosis (blue colouration of the hands).
155
Describe the presenting symptoms of **Guillain-Barre syndrome**.
* Ascending weakness
* Reduced or absent reflexes
* Mild/no sensory symptoms
156
List some key indications for a **permanent pacemaker**.
* Symptomatic/haemodynamically unstable bradycardia, not responding to atropine
* Complete heart block
* Trifascicular block prior to surgery
## Footnote
Post-inferior MI complete heart block is NOT an indication for pacing if the patient is asymptomatic and haemodynamically stable.
157
What type of bacterium is **Gardnerella vaginalis**?
Gram-positive coccobacilli
## Footnote
It can occasionally be Gram-negative lactobacillus. It is responsible for the acidic environment of the vagina.
158
What is an important metabolic consequence of using **thiazide diuretics**?
Impaired glucose tolerance
| (can lead to DM)
## Footnote
Interferon alpha can also impair glucose tolerance.
159
How is **small bowel bacterial overgrowth syndrome** diagnosed?
* Hydrogen breath test
* Small bowel aspiration and culture
160
What is the first-line treatment option for **small bowel bacterial overgrowth syndrome**?
Rifaximin
## Footnote
Alternative: co-amoxiclav, metronidazole
161
How does a **Jarisch-Herxheimer reaction** manifest?
* Fever
* Rash
* Tachycardia
## Footnote
There is no wheeze or hypotension.
162
How is **restless leg syndrome** managed?
* **First-Line**: Ropinirole
* **Alternatives**: Benzodiazepines and Gabapentin
163
What are two main types of **cestodes** (tapeworms) and how are they treated?
* Echinococcus granulosus (dog)
* Taenia solium (pig)
Treated with **benzimidazoles** (or albendazole/mebendazole)
164
List some key types of **nematodes** (roundworms) and the diseases that they cause.
* **Strongyloides stercoralis**: diarrhoea, abdominal pain, vesicular lesions where skin has been penetrated by infective larvae
* **Enterobium vermicularis (pinworm)**: perianal itching
* **Ancylostoma duodenale**: gastrointestinal upset
* **Loa Loa**: itchy swellings below the skin
* **Trichinella spiralis**: fever, periorbital oedema, myositis
* **Onchocerca volvulus**: river blindness, hyperpigmented skin
* **Wuchereria bancrofti**: elephantiasis
* **Toxocara canis**: blindness
* **Ascaris lumbricoides**: intestinal obstruction
165
List some key types of **trematodes** (flukes) and the diseases that they cause.
* **Schistosoma haematobium**: haematuria, bladder cancer
* **Paragonimus westermani**: leads to bacterial lung infection
* **Clonorchis sinensis**: biliary tract inflammation
* **Fasciola hepatica (liver fluke)**: biliary obstruction
166
What is the best prognostic marker for **multiple myeloma**?
Beta-2 Microglobulin
167
List some **CYP inducers**.
* Antiepileptics: phenytoin, carbamazepine
* Barbiturates: phenobarbitone
* Rifampicin
* St John's Wort
* Chronic alcohol intake
* Griseofulvin
* Smoking
168
List some **CYP inhibitors**.
* Antibiotics: ciprofloxacin, erythromycin
* Isoniazid
* Cimetidine, omeprazole
* Amiodarone
* Allopurinol
* Imidazoles: ketoconazole, fluconazole
* SSRIs: fluoxetine, sertraline
* Ritonavir
* Sodium valproate
* Acute alcohol intake
* Quinupristin
169
What is **CADASIL**?
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy.
Genetic condition due to mutation in **NOTCH3**.
Presentation: migraines in middle age, recurrent TIAs/strokes leading to neuro-cognitive decline, psychiatric problems and dementia.
MRI shows multiple hyperintense lesions.
170
What is **black water fever**?
* Rare complication of **malaria**.
* Results in large intravascular haemolysis leading to **haemoglobinuria, anaemia, jaundice and AKI**. Urine is dark and hepatosplenomegaly may be noted. Unknown cause.
171
How does **central retinal artery occlusion** present?
* Sudden painless unilateral visual loss.
* Afferent pupillary defect and cherry red spot on pale retina.
## Footnote
It can be caused by thromboembolism or arteritis (e.g. GCA).
172
List some indications for **plasma exchange**.
* GBS
* Myasthenia Gravis
* Goodpasture syndrome
* ANCA positive vasculitis
* TTP/HUS
* Cryoglobulinaemia
* Hyperviscosity syndrome (e.g. due to myeloma)
173
List some complications of **plasma exchange**.
* Hypocalcaemia (due to binding of calcium to sodium citrate anticoagulant during procedure)
* Metabolic alkalosis
* Removal of medications
* Coagulation factor depletion
* Ig depletion
174
What is the main vector for **Lassa fever**?
Rats
## Footnote
It is a viral haemorrhagic fever.
175
Describe the classical presentation of a **vestibular schwannoma**.
* Vertigo
* Hearing Loss
* Tinnitus
* Absent Corneal Reflex
176
List some conditions that are inherited in an **X-linked** pattern.
* Androgen insensitivity syndrome
* Becker muscular dystrophy
* Colour blindness
* Duchenne muscular dystrophy
* Fabry's disease
* G6PD deficiency
* Haemophilia A, B
* Hunter's disease
* Lesch-Nyhan syndrome
* Nephrogenic diabetes insipidus
* Ocular albinism
* Retinitis pigmentosa
* Wiskott-Aldrich syndrome
177
What are the four main types of **Hodgkin disease**?
* Nodular Sclerosing
* Mixed Cellularity
* Lymphocyte Predominant
* Lymphocyte Depleted
178
How is **chlamydia** managed?
Doxycycline 7 days
## Footnote
If pregnant: azithromycin, erythromycin or amoxicillin
179
Outline the management of **stable angina**.
* **First-Line**: Beta-Blocker or Rate-Limiting CCB
* **Second-Line**: Add whichever hasn't been used so far (e.g. non-rate limiting CCB)
* **Alternatives**: nicorandil, ivabradine, ranolazine, isosorbide mononitrate
180
How might a **parietal lobe seizure** manifest?
Paraesthesia
181
How might a **frontal lobe seizure** manifest?
* Head/leg movements
* Posturing
* Post-ictal weakness
* Jacksonian march
182
Which cancers are associated with the following familial cancer syndromes?
* Li Fraumeni
* Gorlin
* Lynch
* Von Hippel Lindau
* **Li Fraumeni**: early onset breast cancer, sarcoma, leukaemia, adrenal tumours (p53 mutation).
* **Gorlin**: multiple BCC, medulloblastoma.
* **Lynch**: colorectal cancer, endometrium, ovary, stomach, small intestine, hepatobiliary tract, brain and skin.
* **Von Hippel Lindau**: hemangioblastoma, renal cyst, renal cell carcinoma, pancreatic neuroendocrine tumours, phaeochromocytomas and endolymphatic sac tumours.
183
What are the main features of **paroxysmal nocturnal haemoglobinuria**?
* Intravascular haemolytic anaemia
* Cytopaenia
* Haemoglobinuria
* Thrombosis (e.g. Budd-Chiari)
* Aplastic anaemia (in some patients)
## Footnote
It is treated with blood products and anticoagulation.
184
Which antibodies are associated with the following autoimmune conditions?
* Dermatomyositis
* Mixed Connective Tissue Disease
* Sjogren's Syndrome
* Limited Scleroderma
* Diffuse Scleroderma
* **Dermatomyositis**: Anti-Mi2
* **Mixed Connective Tissue Disease**: Anti-RNP
* **Sjogren's Syndrome**: Anti-Ro
* **Limited Scleroderma**: Anti-Centromere
* **Diffuse Scleroderma**: Anti-Scl70 (topoisomerase II)
185
What is the difference between the **Bohr Effect** and the **Haldane Effect**?
* **Bohr**: increasing acidity means that O2 binds less well to Hb.
* **Haldane**: increased pO2 means that CO2 binds less well to haemoglobin.
186
What is **Purtscher retinopathy**?
**Ischaemic retinopathy** associated with pancreatitis, head trauma, fat embolisation and vasculitic diseases.
187
What ACR and PCR is roughly equivalent to 1 g proteinuria per 24 hours?
* ACR = 70 mg/mmol
* PCR = 100 mg/mmol
188
List some drugs that can cause **drug-induced cholestasis**.
* Combined oral contraceptive pill
* Antibiotics: flucloxacillin, co-amoxiclav, erythromycin
* Anabolic steroids, testosterones
* Phenothiazines: chlorpromazine, prochlorperazine
* Sulphonylureas
* Fibrates
* Rare reported causes: nifedipine
189
List some causes of **non-scarring alopecia**.
* Male-pattern baldness
* Drugs: cytotoxic drugs, carbimazole, heparin, oral contraceptive pill, colchicine
* Nutritional: iron and zinc deficiency
* Autoimmune: alopecia areata
* Telogen effluvium
* Hair loss following stressful period e.g. surgery
* Trichotillomania
190
Outline the management of **Guillain-Barré syndrome**.
* IVIG (better than plasma exchange)
* Consider steroids and immunosuppressants
* FVC monitoring
191
Which cancers are the **MYC oncogenes** associated with?
* **c-Myc**: Burkitt's Lymphoma (t(8;14))
* **n-Myc**: Neuroblastoma
192
What is heard upon auscultation in a patient with **complete heart block**?
Variable intensity of **S1**
## Footnote
Other features: heart failure, bradycardia, wide pulse pressure, cannon a waves
193
Which class of drugs can trigger **eosinophilic granulomatosis with polyangiitis**?
Leukotriene receptor antagonists
194
What is an important contraindication for **statin therapy**?
Pregnancy
195
Which antibiotics should be avoided in **pregnancy**?
* Tetracyclines
* Aminoglycosides
* Sulfonamides and Trimethoprim
* Quinolones
196
List some causes of **hypomagnesemia**.
* Drug (diuretics, PPI)
* Diarrhoea
* Alcohol
* Hypokalaemia
* Hypercalcaemia (Ca and Mg compete for transport in the thick ascending limb of loop of Henle)
* Gitelman/Bartter
* TPN
197
What is **brachial neuritis**?
Acute onset unilateral severe pain followed by shoulder and scapular weakness several days later. Minimal sensory changes.
Triggers include trauma, infection, surgery and vaccination.
198
Which antibiotics are most strongly associated with **C. difficile** infection?
1. Clindamycin
2. Cephalosporins
3. Ciprofloxacin
199
Which receptors does **olanzapine** block?
* 5HT2 Receptor
* D2 Receptor
200
Describe the classical presentation of **aspirin overdose**?
* Mixed respiratory alkalosis and metabolic acidosis.
* Sweaty and confused.
* Pulmonary oedema is a bad sign (requires haemodialysis).
201
List some drugs that cause **peripheral neuropathy**.
* Amiodarone
* Isoniazid
* Vincristine
* Nitrofurantoin
* Metronidazole
202
Describe how **retinal detachment** manifests.
* Sudden painless loss of vision
* Dense shadow starting peripherally and progressing centrally
203
Which skin disorder is associated with **gastric cancer**?
Acanthosis nigricans
204
Which skin disorder is associated with **lymphoma**?
* Acquired ichthyosis
* Erythroderma
205
Which skin disorder is associated with **gastrointestinal and lung cancer**?
Acquired hypertrichosis lanuginosa
MRCP
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