MRCP > MRCP Part 1C > Flashcards

MRCP Part 1C Flashcards

Recognize high-yield MRCP associations, clinical presentations, and management strategies across multisystem diseases, with emphasis on linking conditions to investigations, complications, and treatment pathways. (204 cards)

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1
Q

Which skin disorder is associated with ovarian and lung cancer?

A

Dermatomyositis

Lung cancer only: erythema gyratum repens

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2
Q

Which skin disorder is associated with pancreatic cancer?

A

Migratory thrombophlebitis

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3
Q

Which skin disorder is associated with glucagonoma?

A

Necrolytic migratory erythema

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4
Q

Which skin disorder is associated with myeloproliferative disorders?

A

Pyoderma gangrenosum

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5
Q

Which skin disorder is associated with haematological malignancies?

A

Sweet syndrome

Sudden onset of fever and painful rash on the arms, legs, trunk, face, or neck. It’s also known as acute febrile neutrophilic dermatosis.

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6
Q

Which skin disorder is associated with oesophageal cancer?

A

Tylosis

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7
Q

Outline the management of neuropathic pain.

A
  • First-Line: amitriptyline, duloxetine, gabapentin or pregabalin (don’t add)
  • Tramadol rescue therapy
  • Topical capsaicin for localised neuropathic pain
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8
Q

Which gene mutations are often seen in essential thrombocytosis?

A
  • JAK2
  • CALR

Treated with aspirin and hydroxycarbamide

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9
Q

List some causes of chorea.

A
  • Huntington’s disease
  • Wilson’s disease
  • Ataxia telangiectasia
  • SLE, anti-phospholipid syndrome
  • Rheumatic fever: Sydenham’s chorea
  • Drugs: oral contraceptive pill, L-dopa, antipsychotics, neuroacanthocytosis
  • Pregnancy: Chorea gravidarum
  • Thyrotoxicosis
  • Polycythaemia rubra vera
  • Carbon monoxide poisoning
  • Cerebrovascular disease
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10
Q

List the main trinucleotide repeat disorders.

A
  • Fragile X (CGG)
  • Huntington’s (CAG)
  • Myotonic dystrophy (CTG)
  • Friedreich’s ataxia (GAA)
  • Spinocerebellar ataxia
  • Spinobulbar muscular atrophy
  • Dentatorubral pallidoluysian atrophy
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11
Q

What is the mechanism of action of triptans?

A

Agonist of 5HT1B and 1D

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12
Q

Describe the typical presentation of haemochromatosis.

A
  • Lethargy
  • Arthralgia (with chondrocalcinosis)
  • Diabetes mellitus
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13
Q

What is the mechanism of action of ondansetron?

A

5HT3 Antagonist

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14
Q

List some causes of vertigo.

A
  • BPPV
  • Viral Labyrinthitis
  • Vestibular Neuronitis
  • Meniere’s Disease
  • Vertebrobasilar ischaemia
  • Acoustic neuroma
  • Posterior circulation stroke
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15
Q

What is a major adverse effect of hydroxychloroquine?

A

Bull’s Eye Retinopathy

Therefore, it requires regular eye checks

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16
Q

Which drugs should be avoided in people with HOCM?

A
  • Nitrates
  • ACE inhibitors
  • Inotropes
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17
Q

How is TEN managed?

A
  • Stop precipitating factor
  • Supportive care
  • IVIG (first line)
  • Alternatives: immunosuppressive medication
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18
Q

What is the difference between MRI FLAIR and STIR?

A
  • FLAIR: Suppresses water (does not appear bright). Used for periventricular and cortical lesions in multiple sclerosis.
  • STIR: Suppresses fat. Shows bright signal in acutely inflamed tissues. Used in flares of thyroid eye disease.
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19
Q

List some classes of drugs that prolong the QT interval.

A
  • Antiarrhythmics (amiodarone, sotalol, class 1)
  • TCA
  • Antipsychotics
  • Chloroquine
  • Erythromycin
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20
Q

How does the second-line antihypertensive medication differ for people of Afro-Caribbean origin?

A

ARB > ACEi

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21
Q

What is bile acid malabsorption and how is it investigated and treated?

A
  • Chronic diarrhoea resulting from excessive production of bile acids or reduced reabsorption. May be secondary to Crohn’s disease, coeliac disease, SIBO or cholecystectomy.
  • Investigations: SeHCAT
  • Treatment: Cholestyramine
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22
Q

What is the triad of renal cancer?

A
  • Hypertension
  • Hypercalcaemia
  • Haematuria
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23
Q

What are the features of Gerstmann syndrome?

A
  • Acalculia
  • Right-Left Disorientation
  • Finger Agnosia
  • Agraphia

Caused by lesion in the angular and supramarginal gyri between the dominant parietal and temporal lobes.

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24
Q

What are troponin I and T bound to?

A
  • Troponin I: Binds to actin to hold the troponin-tropomyosin complex in place
  • Troponin T: Binds to tropomyosin to help position it on the actin
  • Troponin C: Binds calcium ions
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25
Which antibodies are associated with **autoimmune hepatitis**?
* **Type I**: ANA, ASMA (Adults and Children) * **Type II**: Anti-LKM1 (Children Only) * **Type III**: Soluble Liver Antigen (Adults Only)
26
Which drugs, if administered together, can reduce the absorption of **levothyroxine**?
* Iron * Calcium Carbonate ## Footnote Give at least 4 hours apart.
27
If someone is allergic to **sulfasalazine**, what other important drug may they be allergic to?
Aspirin or sulphonamides
28
What clinical feature can help distinguish **dengue** from **chikungunya**?
Severe arthralgia
29
What are some indicators for poor prognosis in **acute pancreatitis**?
* Age > 55 years * Hypocalcaemia < 2 * Hyperglycaemia > 10 * Hypoxia (PaO2 < 7.9) * Neutrophilia (WCC > 15) * Elevated LDH (> 600) * Urea > 16 * Albumin < 32
30
Who should be offered **LTOT**?
Patients with a pO2 of **< 7.3 kPa** or to those with a pO2 of **7.3 - 8 kPa** and one of the following: * secondary polycythaemia * nocturnal hypoxaemia * peripheral oedema * pulmonary hypertension
31
What are the main features of **brucellosis**?
* Non-specific: fever, malaise * Hepatosplenomegaly * Sacroiliitis: spinal tenderness may be seen ## Footnote **Complications**: osteomyelitis, infective endocarditis, meningoencephalitis, orchitis leukopenia often seen **Investigations**: Brucella serology **Management**: doxycycline and streptomycin
32
List some key indications for **IVIG**.
* Primary and secondary immunodeficiency * Idiopathic thrombocytopenic purpura * Myasthenia gravis * Guillain-Barre syndrome * Kawasaki disease * Toxic epidermal necrolysis * Pneumonitis induced by CMV following transplantation * Low serum IgG levels following haematopoietic stem cell transplant for malignancy * Dermatomyositis * Chronic inflammatory demyelinating polyradiculopathy
33
What are the main features of **background diabetic retinopathy**?
* Microaneurysms (dots) * Blot haemorrhages (<=3) * Hard exudates
34
What are the three stages of **LGV infection**?
* 1: small painless pustule which later forms an ulcer * 2: painful inguinal lymphadenopathy * 3: proctocolitis
35
How do **fibrates** work?
Activating PPAR alpha receptors resulting in an increase in LPL activity reducing triglyceride levels
36
How is **actinic keratosis** managed?
* Avoid sun * Topical 5-FU * Topical diclofenac * Cryotherapy * Curettage
37
Which antibiotics are used to treat **cholera**?
* Doxycycline * Ciprofloxacin
38
What is **Heerfordt syndrome**?
* Subset of sarcoidosis * Parotid enlargement * Fever * Anterior uveitis
39
Describe the treatment escalation for mild-moderate **proctitis**.
1. Topical Aminosalicylate 2. Oral Aminosalicylate (after 4 weeks) 3. Topical or Oral Steroid
40
How is **leprosy** treated?
Rifampicin, dapsone and clofazimine for 12 months.
41
How should **antiphospholipid syndrome** be managed in pregnancy?
1. **Low-dose aspiri**n should be commenced once the pregnancy is confirmed on urine testing. 2. **LMWH** once a fetal heart is seen on ultrasound. This is usually discontinued at 34 weeks gestation.
42
Describe the presentation of **visceral leishmaniasis**.
* Massive Splenomegaly * Fever * Weight Loss * Pancytopaenia * Darkened Skin ## Footnote Spread by bites of sand flies.
43
List some causes of **hypokalaemia** with alkalosis.
* Vomiting * Thiazide and Loop Diuretics * Cushing Syndrome * Conn Syndrome
44
How long should patients continue being anticoagulated for after successful **DCCV** for AF?
4 weeks ## Footnote If a subsequent echocardiogram shows a structurally abnormal heart, they should be considered for long-term anticoagulation.
45
What is the first-line treatment option for **seborrhoeic dermatitis**?
Topical Ketoconazole
46
List some causes of **villous atrophy**.
* Coeliac disease * Tropical sprue * Hypogammaglobulinaemia * Gastrointestinal lymphoma * Whipple's disease * Cow's milk intolerance
47
List the main non-sedating **antihistamines**.
* Loratadine (LEAST sedating) * Cetirizine
48
How would you treat **limited impetigo**?
1. Hydrogen Peroxide Cream 2. Topical Fusidic Acid or Topical Mupirocin ## Footnote Oral flucloxacillin if severe.
49
What is the **anchor drug** for maintenance treatment in lupus?
Hydroxychloroquine
50
What is seen on a biopsy in a patient with **rheumatic heart disease**?
* Aschoff bodies (granuloma with giant cells) * Anitschkow cells (enlarged macrophages with wavy rod-like nucleus)
51
What eye complication can **amiodarone** cause?
Vortex keratopathy (corneal opacities)
52
What are the main features of **progressive supranuclear palsy**?
* Impaired vertical gaze * Parkinsonism * Postural instability and falls * Cognitive impairment
53
What is the most common cause of **visceral larva migrans**?
Toxocara Canis
54
What are the three types of **type I antiarrhythmic**?
They all **block sodium channels**, but in addition: * **Ia**: increases action potential (AP) duration (procainamide, disopyramine) * **Ib**: decreases AP duration (lidocaine) * **Ic**: no effect on AP duration (flecainide, propafenone)
55
Which mutations cause **nephrogenic diabetes mellitus**?
* V2 receptor mutation (most common) * Aquaporin 2 channel mutation
56
Which antibiotics can affect **skin pigmentation**?
* Minocycline: darkening of skin * Doxycycline/Tetracycline: photosensitivity
57
List some causes of **hypertrichosis**.
* Drugs: minoxidil, ciclosporin, diazoxide * Congenital hypertrichosis lanuginosa; congenital hypertrichosis terminalis * Porphyria cutanea tarda * Anorexia nervosa ## Footnote Hypertrichosis is when hair grows anywhere, whereas hirsutism is when women develop male pattern facial hair.
58
What are the features of **Meig syndrome**?
* Ovarian fibroma * Ascites * Pleural effusion
59
List some drugs that cause **impaired glucose tolerance**.
* Thiazides, furosemide (less common) * Steroids * Tacrolimus, ciclosporin * Interferon-alpha * Nicotinic acid * Antipsychotics
60
How is **Prinzmetal angina** treated?
Dihydropyridine CCB | (e.g. felodipine)
61
Which organisms are normally isolated from **human bites**?
* Streptococci spp. * Staphylococcus aureus * Eikenella * Fusobacterium * Prevotella
62
What kind of drug is **naftidrofudryl**?
5-HT2 Receptor Antagonist ## Footnote It is used in peripheral vascular disease as it increases blood flow to the peripheries.
63
Which antibody is associated with idiopathic **membranous glomerulonephritis**?
Anti-phospholipase A2
64
Describe the electron microscopy appearance of **membranous glomerulonephritis**.
**Basement membrane is thickened** with subepithelial electron **dense deposits** (creating spike and dome appearance).
65
What kind of drug is **aprepitant**?
Neurokinin 1 receptor blocker ## Footnote Used as an anti-emetic.
66
Which antibiotics are used to treat **brain abscesses**?
IV 3rd generation **cephalosporin** and **metronidazole**.
67
Which diagnostic test is useful for investigating **hereditary angioedema** in between attacks?
C4 (low) ## Footnote C1-INH is low during an attack.
68
What is the best test for **chronic pancreatitis**?
Secretin stimulation test
69
What are the main side-effects of **ciclosporin**?
* Fluid retention * Hypertension * Hyperkalaemia * Hypertrichosis * Gingival Hyperplasia * Tremor * Impaired Glucose Tolerance * Nephro-/Hepatotoxic
70
Which nerve root is damaged in **Klumpke's palsy** and how does it manifest?
* Damage to T1 * Loss of intrinsic hand muscles * Due to traction
71
Which nerve root is damaged in **Erb's palsy** and how does it manifest?
* Damage to C5,6 roots * Winged scapula * May be caused by a breech presentation
72
What is a neonatal complication of **systemic lupus erythematosus** and which antibody is it associated with?
* Congenital heart block, rash and hepatosplenomegaly * Associated with **Anti-Ro**
73
What causes the following **syndromes**? * Benedikt syndrome * Millard-Gubler syndrome * Nothnagel syndrome * Weber syndrome
* **Benedikt**: occlusion of the posterior cerebral artery is a possible cause. It causes 3rd nerve palsy, cerebellar ataxia and movement disorders (including tremor and chorea). * **Millard-Gubler**: ipsilateral 6th and 7th nerve palsies and contralateral hemiparesis. * **Nothnagel**: ipsilateral 3rd nerve palsy and limb ataxia * **Weber**: contralateral hemiparesis and a 3rd nerve palsy
74
How does **rasburicase** work?
Converts uric acid to **allantoin**.
75
Which drug that is commonly used in patients with **ischaemic heart disease** is associated with causing shortness of breath as a side-effect?
Ticagrelor ## Footnote If patients experience this side-effect, it can be switched for clopidogrel.
76
How does **congenital toxoplasmosis** manifest?
* Cerebral calcification * Chorioretinitis ## Footnote Patients may present later in life.
77
How is **pneumocystis pneumonia** managed?
* Co-trimoxazole * Steroids if pO2 < 9.3 kPa ## Footnote IV pentamidine in severe cases (risk of pneumothorax).
78
What causes **granuloma inguinale**?
Klebsiella granulomatis ## Footnote Gram-negative bacillus that causes painless ulcer. Swab reveals mononuclear cells containing Donovan bodies.
79
Which investigation should be considered for patients with suspected **aortic dissection** who are too unstable to go for a CT?
Transoesophageal echocardiogram
80
What are some common side-effects of **sodium valproate**?
* Tremor * Alopecia * Hepatotoxicity
81
How does **amoebiasis** present?
Profuse, bloody diarrhoea after a long incubation period. ## Footnote **Investigations**: hot stool sent for microscopy **Management**: Metronidazole
82
# . Which mutation normally causes **HOCM**?
Mutation affecting beta-myosin heavy chain protein.
83
Describe the course of **yellow fever**.
Flu-like illness --> brief remission --> jaundice and haematemesis
84
Describe the two different types of **amiodarone-induced thyrotoxicosis**.
* **Type 1**: Goitre + Treated with Carbimazole or Potassium Perchlorate * **Type 2**: NO Goitre + Treated with Steroids
85
Which conditions are associated with **thymomas**?
* Myasthenia gravis (30-40% of patients with thymoma) * Red cell aplasia * Dermatomyositis ## Footnote Other: SLE, SIADH
86
How does **zinc deficiency** manifest?
* Perioral dermatitis: red, crusted lesions * Acrodermatitis enteropathica * Alopecia * Short stature * Hypogonadism * Hepatosplenomegaly * Geophagia (ingesting clay/soil) * Cognitive impairment
87
How does a **vitreous haemorrhage** present?
**Dark spots** (scotomas) in the vision initially followed by painless **loss of vision**, associated with **diabetic retinopathy**.
88
How does **tularaemia** present?
Erythematous **papulo-ulcerative lesion** at site of bite with reactive and ulcerating regional **lymphadenopathy**. ## Footnote Transmitted by rabbits, hares, pikas, beavers and ticks. Treated with doxycycline (F. tularensis).
89
List some precipitants for **digoxin toxicity**.
* Hypokalaemia * Hypomagnesemia * Hypercalcaemia * Hypernatraemia * Acidosis * Renal impairment * Hypoalbuminaemia
90
List some causes of **rapidly progressive glomerulonephritis**.
* Goodpasture's syndrome * ANCA positive vasculitis (e.g. Wegener's)
91
List the indications for surgical intervention in patients with **infective endocarditis**.
* Severe valvular incompetence * Aortic abscess (often indicated by a lengthening PR interval) * Infections resistant to antibiotics/fungal infections * Cardiac failure refractory to standard medical treatment * Recurrent emboli after antibiotic therapy
92
Which types of **glomerulonephritis** have low complement levels?
* Post-streptococcal glomerulonephritis * Subacute bacterial endocarditis * Systemic lupus erythematosus * Mesangiocapillary glomerulonephritis
93
What advice should you give a patient on **warfarin** undergoing a dental extraction?
Check **INR** 72 hours before the procedure, and proceed if it is less than 4.0.
94
Which primary cancers cause calcified **lung metastases**?
Chondrosarcoma and Osteosarcoma
95
Describe the presentation of a **cholesterol embolism**.
* Livedo reticularis * Eosinophilia * Purpura * Renal failure ## Footnote It tends to occur after a precipitating event such as AAA repair.
96
Which medications may be used for anticoagulation in patients with **HIT**?
* Direct thrombin inhibitor (e.g. argatroban) * Danaparoid
97
What is the first-line imaging modality for **stable angina**?
CTCA
98
Which tumour marker is used for **primary peritoneal cancer**?
CA125
99
How is **membranous glomerulonephritis** managed?
* All patients should receive an ACEi or ARB * Immunosuppression may be considered in some
100
List some indications for **steroids** in **sarcoidosis**.
* Parenchymal lung disease * Uveitis * Hypercalcaemia * Neurological or cardiac involvement
101
Describe the different types of **cryoglobulinaemia**.
**_Type I_** * Monoclonal IgG or IgM * Associations: multiple myeloma, Waldenstrom macroglobulinaemia **_Type II_** * Mixed monoclonal and polyclonal: usually with rheumatoid factor * Associations: hepatitis C, rheumatoid arthritis, Sjogren's, lymphoma **_Type III_** * Polyclonal: usually with rheumatoid factor * Associations: rheumatoid arthritis, Sjogren's
102
What is the first-line investigation for **Budd-Chiari syndrome**?
Ultrasound with Doppler flow studies
103
What are the main causes of **biliary disease** in patients with HIV?
**Sclerosing cholangitis** due to infections such as CMV, Cryptosporidium and Microsporidia,
104
Why is **adenosine** contraindicated in **Wolff-Parkinson-White syndrome**?
**Blocking the AV node** may enhance the rate of conduction through the accessory pathway. Use **flecainide** instead.
105
What are the main clinical features of **Ebstein's anomaly**?
* Tricuspid regurgitation * Pansystolic murmur (louder on inspiration) ## Footnote ECG changes include: RBBB and WPW syndrome
106
List some causes of a false positive **VDRL/RPR**?
* SLE * TB * Malaria * HIV
107
How is **pneumocystis pneumonia** diagnosed?
Bronchial alveolar lavage with silver staining.
108
What are the X-ray findings in **ankylosing spondylitis**?
* Sacroiliitis: subchondral erosions, sclerosis * squaring of lumbar vertebrae * 'Bamboo spine' (late & uncommon) * Syndesmophytes: due to ossification of outer fibers of annulus fibrosus * Chest x-ray: apical fibrosis
109
Which **gynaecological conditions** is associated with secondary polycythaemia?
Uterine fibroids | (ectopic production of erythropoietin)
110
Which nerve supplies the **deltoid muscle**?
Axillary nerve
111
How should you manage the **glycaemic control** of a patient with diabetes who has been admitted with a myocardial infarction?
* Stop metformin and other oral agents * Start IV insulin infusion
112
What are the first-line treatments for **spasticity** in **multiple sclerosis**?
* Baclofen * Gabapentin
113
Which class of drugs will reduce the effect of **adenosine**?
Aminophyllines ## Footnote Dipyridamole increases the effect of adenosine.
114
Which cells mediate **hyperacute graft rejection**?
B cells
115
What are the features of **Pendred syndrome**?
* Mild hypothyroidism * Goitre * Bilateral sensorineural deafness ## Footnote It is autosomal recessive.
116
How does **Friedreich ataxia** manifest?
* Cerebellar signs * Mixed upper and lower motor neurone signs * Pes cavus * Optic atrophy * Normal IQ ## Footnote It is an autosomal recessive trinucleotide repeat disorder.
117
How does **central retinal vein occlusion** present?
* Sudden painless **loss of vision**. * **Fundoscopy** finding of retinal haemorrhages in the affected eye.
118
List some causes of **painful genital ulcers**.
* Herpes simplex * Chancroid
119
List some causes of **painless genital ulcers**.
* Syphilis * LGV
120
Damage to which **brain structure** results in chorea?
Caudate nucleus of the **basal ganglia**.
121
Describe the histological appearance of **discoid lupus**.
Follicular keratin plugs ## Footnote It also causes scarring alopecia, is photosensitive and usually presents between 20-40 years.
122
What is the most common cause of **endocarditis**?
* Staphylococcus aureus * Staphylococcus epidermidis (if within 2 months of valve replacement)
123
How does **amphotericin B** work?
Binds with **ergosterol**, a component of fungal cell membranes, forming pores that cause **lysis** of the cell wall and subsequent **fungal cell death**.
124
How does **caspofungin** work?
Inhibits synthesis of **beta-glucan**, a major fungal cell wall component.
125
What is the most common cardiac defect in **Marfan syndrome**?
Dilation of the **aortic sinuses** (predisposes to dissection).
126
What is the recommended empirical antibiotic therapy for **infective endocarditis**?
* **Native valve**: Amoxicillin (consider low-dose gentamicin) * Native valve but **penicillin allergic**: vancomycin + gentamicin * **Prosthetic valve**: vancomycin + rifampicin + gentamicin
127
What are the main treatment options for **hiccups** in palliative care?
* Chlorpromazine * Haloperidol
128
What causes **Farmer's lung**?
Saccharopolyspora rectivirgula
129
Which drug classes are contraindicated in someone who is going to start a **phosphodiesterase inhibitor**?
* Nitrates * Nicorandil
130
What are the main indications for a **chest drain** in pleural infection?
* Frankly purulent or turbid/cloudy pleural fluid * Identification of organisms upon staining * pH < 7.2
131
Which vitamin can improve **iron absorption** in the intestines?
Vitamin C
132
Which type of **collagen** is affected in Ehlers-Danlos syndrome?
Type V
133
What is **ocular opsoclonus-myoclonus**?
Paraneoplastic condition associated with breast cancer characterised by rapid eye movements, myoclonus and ataxia. ## Footnote Associated with anti-Ri antibody.
134
How is **anthrax** treated?
Oral ciprofloxacin
135
What is the first-line investigation for **chronic pancreatitis**?
CT Pancreas
136
How should **Plasmodium vivax** be treated?
Chloroquine or ACT ## Footnote **Primaquine** should also be given following acute treatment to destroy liver hypnozoites.
137
Which **cytogenetic findings** are associated with poor outcomes in AML?
Deletion of chromosome 5 or 7
138
How soon after starting new **diabetes medications** should the HbA1c be checked?
3-6 months until stable then 6 monthly
139
Describe the ECG findings seen in **ostium primum** and **ostium secundum** defects.
* Ostium **primum**: RBBB with LAD, long PR * Ostium **secundum**: RBBB with RAD
140
How is **otitis externa** managed?
**Topical antibiotic** (e.g. gentamicin) or **topical antibiotic with a topical steroid**. ## Footnote Oral antibiotics (e.g. flucloxacillin) may be considered if the infection appears to be spreading.
141
How does **posterior vitreous detachment** manifest?
Flashes and floaters
142
How is **Mycobacterium avium complex infection** managed?
Rifampicin + ethambutol + clarithromycin
143
Which **antiepileptic drug** is most associated with weight gain?
Sodium valproate
144
List some **Gram-positive bacilli**.
* Corynebacterium * Clostridia * Listeria * Bacillus
145
What **LVEF** bars people from driving?
< 40% LVEF
146
List some causes of predominantly **MOTOR neuropathy**.
* Guillain-Barre syndrome * Porphyria * Lead poisoning * Hereditary sensorimotor neuropathies (HSMN) Charcot-Marie-Tooth * Chronic inflammatory demyelinating polyneuropathy (CIDP) * Diphtheria
147
List some causes of predominantly **SENSORY neuropathy**.
* Diabetes * Uraemia * Leprosy * Alcoholism * Vitamin B12 deficiency * Amyloidosis
148
What is **Lemierre syndrome**?
When a peritonsillar abscess leads to **thrombophlebitis** of the internal jugular vein. It can result in **septic pulmonary emboli** and presents with neck pain.
149
List some treatment options for patients with **alopecia areata**.
* Hair will regrow in 50% of patients within 1 year * Topical or intralesional corticosteroids * Topical minoxidil * Phototherapy * Dithranol * Contact immunotherapy * Wigs
150
Describe the WHO classification of **lupus nephritis**.
* **Class I**: normal kidney * **Class II**: mesangial glomerulonephritis * **Class III**: focal (and segmental) proliferative glomerulonephritis * **Class IV**: diffuse proliferative glomerulonephritis * **Class V**: diffuse membranous glomerulonephritis * **Class VI**: sclerosing glomerulonephritis
151
What is the mechanism of action of **rifampicin**?
Inhibits bacterial DNA-dependent RNA polymerase (thereby inhibiting RNA synthesis).
152
What is the main physiological function of **interferon alpha, beta and gamma**?
* **Alpha**: produced by leukocytes, antiviral action * **Beta**: produced by fibroblasts, antiviral action * **Gamma**: produced by NK cells and T helper cells, important in macrophage activation
153
Which **monoclonal antibody** may be used in HUS?
Eculizumab | (mAb against C5 inhibitor)
154
List some causes of raised **leukocyte ALP**.
* Myelofibrosis * Leukaemoid reactions * Polycythaemia rubra vera * Infections * Cushing's syndrome: steroids * Pregnancy: oral contraceptive pill
155
List some causes of low **leukocyte ALP**.
* Chronic myeloid leukaemia * Pernicious anaemia * Paroxysmal nocturnal haemoglobinuria * Infectious mononucleosis
156
Which **electrolyte deficiency** is associated with cisplatin?
Hypomagnesemia
157
What is the cut-off for offering **bisphosphonates** in steroid-induced osteoporosis?
T score of less than -1.5 ## Footnote If T score is 0 to -1.5 then repeat DEXA in 1-3 years.
158
Describe the features of **SSRI discontinuation**.
* Increased mood change * Restlessness * Difficulty sleeping * Unsteadiness * Sweating * Gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting * Paraesthesia ## Footnote Paroxetine is associated with a higher risk of discontinuation symptoms.
159
Outline the levels of **scientific evidence**.
* Ia: meta-analysis of randomised controlled trials * Ib: at least one randomised controlled trial * IIa: at least one well designed controlled trial which is not randomised * IIb: at least one well designed experimental trial * III: case, correlation and comparative studies * IV: panel of experts
160
Describe the presentation of **American trypanosomiasis**.
* Myocarditis may lead to **dilated cardiomyopathy** (with apical atrophy) and **arrhythmias**. * Gastrointestinal features include megaoesophagus and megacolon causing **dysphagia** and **constipation**. ## Footnote Treated with benznidazole.
161
When is **plasma exchange** recommended for HUS?
Severe **HUS** that is not associated with diarrhoea.
162
List some causes of **optic atrophy**.
**Acquired causes** * Multiple sclerosis * Papilloedema (longstanding) * Raised intraocular pressure (e.g. glaucoma, tumour) * Retinal damage (e.g. choroiditis, retinitis pigmentosa) * Toxins: tobacco amblyopia, quinine, methanol, arsenic, lead * Nutritional: vitamin B1, B2, B6 and B12 deficiency **Congenital causes** * Friedreich's ataxia * Mitochondrial disorders e.g. Leber's optic atrophy * DIDMOAD - the association of cranial Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy and Deafness (also known as Wolfram's syndrome)
163
What are the consequences of **Fanconi syndrome**?
* Type 2 (proximal) renal tubular acidosis * Polyuria * Aminoaciduria * Glycosuria * Phosphaturia * Osteomalacia
164
List some causes of **Fanconi syndrome**.
* Cystinosis (most common cause in children) * Sjogren's syndrome * Multiple myeloma * Nephrotic syndrome * Wilson's disease
165
How does **complex regional pain syndrome** manifest?
* Progressive, disproportionate symptoms to the original injury/surgery * Allodynia * Temperature and skin colour changes * Oedema and sweating * Motor dysfunction
166
What are the two types of **complex regional pain syndrome**?
* Type I (most common): there is no demonstrable lesion to a major nerve * Type II: there is a lesion to a major nerve
167
List some causes of **onycholysis**.
* Idiopathic * Trauma e.g. Excessive manicuring * Infection: especially fungal * Skin disease: psoriasis, dermatitis * Impaired peripheral circulation e.g. Raynaud's * Systemic disease: hyper- and hypothyroidism
168
What additional medications should be part of the treatment plan for a patient with a **cocaine-induced MI**?
IV benzodiazepines
169
Describe the presentation of **Clostridium botulinum infection**.
* Afebrile, descending, flaccid paralysis. * Presenting features typically include difficulty speaking or slurred speech, blurred or double vision, and/or dysphagia. ## Footnote Other features include ptosis and facial muscle weakness.
170
What **LFT results** are considered the cut off for stopping statin therapy?
**LFTs** more than **3x upper limit** of normal. ## Footnote LFTs should be checked at baseline, 3 months and 12 months.
171
What are the CBG targets for pregnant women with **gestational diabetes mellitus**?
* Fasting: 5.3mmol/L * 1 hour postprandial: 7.8 mmol/L * 2 hours postprandial: 6.4 mmol/L
172
When should you check **lithium levels** for monitoring?
12 hours after last dose
173
List some mixed **alpha and beta antagonists**.
* Carvedilol * Labetalol
174
Which parameters can be used to distinguish **prerenal AKI** from **acute tubular necrosis**?
* Urine sodium: less than 20 in pre-renal, more than 40 in ATN * Fractional sodium excretion: <1% in pre-renal, >1% in ATN * Fractional Urea excretion: <35% in pre-renal, >35% in ATN
175
Describe the manifestations of **anterior, posterior and central cord syndromes**.
* **Anterior**: affects motor function, pain and temperature sensation. Proprioception is usually spared. * **Posterior**: affects proprioception. * **Central**: bilateral motor weakness.
176
List some features that can help distinguish **VT** from **SVT** with aberrant conduction.
* AV dissociation * Fusion or capture beats * Positive QRS concordance in chest leads * Marked left axis deviation * History of IHD * Lack of response to adenosine or carotid sinus massage * QRS > 160 ms
177
What is the most common cause of **occupational asthma**?
Isocyanates | (e.g. spray paints, foam moulding)
178
What is the target range for **TSH** in hypothyroidism?
0.5-2.5
179
List some causes of **type 1 renal tubular acidosis**.
* Idiopathic * Rheumatoid arthritis * SLE * Sjogren's * Amphotericin B toxicity * Analgesic nephropathy
180
List some causes of **type 2 renal tubular acidosis**.
* Idiopathic * Fanconi syndrome * Wilson's disease, cystinosis * Outdated tetracyclines * Carbonic anhydrase inhibitors (acetazolamide, topiramate)
181
List some causes of **type 4 renal tubular acidosis**.
* Hypoaldosteronism * Diabetes mellitus
182
Which type of bacterium is most commonly implicated in **neutropaenic sepsis**?
Gram-positive cocci | (usually S. epidermidis)
183
What is **nesidioblastosis**?
Beta cell hyperplasia
184
What is **palatal myoclonus** a feature of?
* Hypertrophic olivary degeneration * Part of the triangle of Mollaret: inferior olivary nucleus + red nucleus + contralateral dentate nucleus.
185
How is **Cryptosporidium diarrhoea** managed in an immunocompromised patient?
Supportive therapy
186
What is **cubital tunnel syndrome**?
Compression of the **ulnar nerve** and can present with tingling/numbness of the 4th and 5th finger.
187
Which antibody is associated with **PBC** and what is the first-line treatment option?
**Anti-Mitochondrial Antibody** (M2) Treatment: **Ursodeoxycholic acid**
188
What is **Melioidosis** caused by and how does it present?
**Burkholderia pseudomallei** (soil and fresh water) * Usually presents with acute pulmonary infection * May also be localised to skin (ulcer, nodule, abscess) * Visceral abscesses (prostate, spleen, kidney, liver) * Disseminated infection resulting in fever and septic shock ## Footnote Management: IV Ceftazidime, imipenem or meropenem
189
Describe the treatment of **invasive amoebiasis**.
* **Metronidazole** 7 days (target the invasive stage) * **Diloxanide furoate** for 10 days afterwards (eradicate the cystic stage)
190
What is the most common genetic abnormality seen in **Brugada Syndrome**?
SCN5A gene | (which encodes the myocardial sodium ion channel protein)
191
What is the best investigation for **insulinoma**?
Prolonged (72-h) fasting glucose levels +/- CT Pancreas
192
List some key differences between **wet** and **dry age related macular degeneration**.
* **Dry**: more common, drusen (yellow spots) * **Wet**: characterised by choroidal neovascularisation, worse prognosis
193
How is **age related macular degeneration** treated?
* Zinc with anti-oxidant vitamins * Anti-VEGF for wet AMD (e.g. bevacizumab) * Laser photocoagulation
194
What kind of **pulse abnormality** is noted with patent ductus arteriosus?
Large volume, bounding, collapsing pulse
195
List some contraindications for **lung cancer surgery**.
* SVC Obstruction * FEV < 1.5 L * Malignant pleural effusion * Vocal cord paralysis
196
Which **tumour markers** are associated with which testicular tumours?
* Seminomas: **hCG** * Non-Seminomas: **AFP** and/or **hCG** in 80% * Germ Cell: **LDH** elevated in 40%
197
What is **dacryocystitis**?
An infection of the lacrimal sac that causes eye watering and swelling and **erythema** at the **inner canthus of the eye**. ## Footnote Treated with antibiotics.
198
List some risk factors for **allopurinol sensitivity**.
* Diuretic use * CKD * Chinese, Korean and Thai ## Footnote Patients at high risk of allopurinol sensitivity should be tested for the HLA-B*5801 allele.
199
How is **strongyloides** treated?
Ivermectin ## Footnote Second-Line: Albendazole
200
Which parameters are used to monitor treatment in **hereditary haemochromatosis**?
* Ferritin * Transferrin saturation
201
Which medications should be avoided in **Wolff-Parkinson-White syndrome**?
Verapamil and digoxin ## Footnote It may precipitate VF or VT.
202
What are the two main causes of **eruptive xanthoma**?
* Familial hypertriglyceridaemia * Lipoprotein lipase deficiency
203
What is **relapsing polychondritis**?
Characterised by episodes of **inflammation and deterioration of cartilage**, most commonly affecting the ears. ## Footnote * **Ears**: auricular chondritis, hearing loss, vertigo * **Nasal**: nasal chondritis → saddle-nose deformity * **Respiratory tract**: e.g. hoarseness, aphonia, wheezing, inspiratory stridor * **Ocular**: episcleritis, scleritis, iritis, and keratoconjunctivitis sicca * **Joints**: arthralgia * **Less commonly**: cardiac valvular regurgitation, cranial nerve palsies, peripheral neuropathies, renal dysfunction
204
Which **spinal cord abnormality** are people with Marfan syndrome at increased risk of?
**Dural ectasia**: ballooning of the dural sac at the **lumbosacral** level. It may cause lower back pain and consequences such as bladder and bowel dysfunction.
MRCP
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