MRCP revision

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MRCP revision
2013-11-29 10:41:09

MRCP notes
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  1. Micro-organisms responsible for:
    1. Farmers lung
    2. Malt workers lung
    3. Bird fanciers lung
    4. Mushroom workers lung
    • 1. Saccharopolyspora Rectivirgula
    • 2. Aspergillus Clavatus
    • 3. Avian Protiens found in aerosolised faeces
    • 4. Thermophillic Actinomyces
  2. Lichen planus is a...
    Purple, Pruritic, Papular, polygonal rash on flexor surfaces
  3. Lichen sclerosis is...
    Itchy white spots on the vulva of old ladies
  4. SHIN lesions, describe the following and their causes:
    1. Erythem Nodosum
    2. Pretibial Myxoedema
    3. Pyoderma Gangrenosum
    4. Necrobiosis Lipoidica Diabeticorum
    • 1. EN - Symmetrical Tender nodules which heal without scarring. Causes = Strep infection, IBD, Sarcoid, Drugs (Penicillin, Sulphonamides, OCP)
    • 2. Symmetrical, erythematous, shiny, orange-peel skin. Causes = Graves
    • 3. PG - Initially small papulepustule with red halo then deep red necrotic ulcer with violaceous border. Causes = 50%idiopathic, IBD, myeloproliferative and connective tissue disorders
    • 4. Shiny, painless area of yellow red skin. Assoc telangectasia. Causes = diabetes
  5. Relative strengths of opiates:
    • Codiene x 2 = tramadol
    • Tramadol x 5 = Oromorph
    • Oromorph x 2 = oxycodone
    • Oromorph x 3 = subcut diamorph
  6. Treatment options for bone pain?
    • Nsaids
    • Radiotherapy
  7. Cardiac reasons for driving restriction:
    2 days
    4 weeks
    What about aortic aneurysms?
    What about heart transplants?
    • 2 days: Catheter ablation for arrythmia
    • 1week: Elective angioplasty, Pacemaker insertion
    • 4 weeks: ACS, CABG, Prophylactic ICD insertion
    • 6 months: Sustained ventricular arrythmia
    • Aortic aneurysms: Inform DVLA. Not allowed to drive if aneurysm >6.5cm
    • Heart transplant - No restrictions!!!!
  8. What chromosome are HLA genes on?
    What denotes class 1 or 2?
    HLA associations please...
    • Chromosome 6
    • ABC=class 1, DPDQDR=class 2
    • HLA-A3=Haemochromotosis
    • HLA-B5=Behcet's
    • HLA-B27=Ankspond, Reiter's, Acute anterior uveitis
    • HLA-DQ2DQ8=Coeliacs
    • HLA-DR2=Narcolepsy, goodpasture's
    • HLA-DR3=Dermatitis herpetiformis, Sjogren's, PBC
    • HLA-DR4= T1DM, RA
  9. Define Hodgkins Lymphoma. How does it spread? What are the ages of peak incidence?
    Malignant proliferation of lymphocytes, characterised by the Reed-Sternberg cell. Spreads in an orderly fashion from lymph node to lymph node. Peaks between 15-35 and at 55.
  10. What are the B-symptoms associated with Hodgkin's Lymphoma? And why are they important?
    • Wt loss >10%
    • Night sweats 
    • Fever >38
    • Imply a worse prognosis.
  11. How is Hodgkin's Lymphoma subclassified? What are the classifications?
    • Classified based on Reed-Sternberg morphology and the reactive cell inflitrate.
    • Nodular Sclerosing - Most common (70%), More common in females, good prognosis.
    • Mixed Cellularity - 20% of all hodgkins lymphoma, good prognosis
    • Lymphocyte predominant - 5%, best prognosis
    • Lymphocyte deplete - Rare, worst prognosis.
  12. Define the following disorders:
    Somatisation disorder
    Hypochondrial disorder
    Conversion disorder
    Munchausen's Syndrome
    Dissociative Disorder
    • Somatisation = SYMPTOMS, persistent symptoms for >2yrs, refusal to accept reassurancenegative results
    • Hypochondria = DISEASE, persistent belief of serious underlying diagnosis. Again refusal to believe proof.
    • Conversion = Loss of motorsensory function. Patient does not consciously feign sx or seek material gain.
    • Malingering = Exaggerationsimulation of symptoms for financial or other gain.
    • Munchausen's - Intentional production of ACTUAL symptoms eg poisoningself harming
    • Dissociative disorder = Seperating of certain memories from conscious stream eg stuporfugueamnesia. In sever forms can cause multiple personality disorder.
  13. Parietal lobe lesions produce?
    • Sensory inattention
    • Apraxias
    • Asterognosis (tactile agnosia)
    • Inferior homonymous quadrantanopia
    • When in the dominant lobe, Gerstmann's Syndrome = alexia, acalculia, finger agnosia, right-left disorientation.
  14. Occipital lobe lesions produce?
    • Homonymous hemianopia with macula sparing
    • Cortical blindness
    • Visual agnosia
  15. Temporal Lobe lesions produce?
    • Wernicke's aphasia: Speech remains fluent but word substitutions + neologisms.
    • Superior homonymous quadrantanopia
    • Auditory Agnosia
    • Prosopagnosia
  16. Frontal Lobe lesions produce?
    • Broca's Aphasia: Speech not fluent, laboured, halting.
    • Disinhibition
    • Perserveration - repetitive thinking + behaviour
    • Anosmia
    • Inability to generate a list
  17. Where is the lesion in Wernickekorsakoff syndrome?
    Thalmus + mammilary bodies of hypothalamus
  18. Where is the lesion in Huntington's?
    Caudate Nucleus of the basal ganglia.
  19. Where is the lesion in Parkinson's disease?
    Substantia nigra pars compacta.
  20. What is Kluver-Bucy syndrome? and where's the lesion?
    Hypersexuality, Hyperorality, Hyperphagia, Visual agnosia. Lesion of the amygdala.
  21. What is membranous glomerulonephritis? Pathophys + causes?
    Presents with Nehrotic syndrome or proteinuria.

    • Thickening of basement membrane and deposition electron dense material causing a 'spike and dome' pattern.
    • Causes = Infective (malaria + hepB)
    • Malignant (lymphoma, lung ca, leukaemia)
    • Drugs (gold, penicillamine, NSAIDS)
    • Idiopathic
    • SLE

    Third commonest cause of ESRF

    Rule of thirds 13 recover, 13 remain proteinuric, 13 progress to ESRF.

    Immunosupression + ACEI for management
  22. A patientis hiv positive and desaturates on exercise, which antimicrobial is best? what are the pulmonary and extrapulmonary complications? what if it is severe?
    • Co-trimoxazole (also useful for prophylaxis)
    • Pneumothorax, Hepatosplenomegaly, lymphadenopathy, choroid lesions.
    • IV pentamidine.
  23. Paraneoplastic features of lung cancer:
    Which are most commonly assoc with Squamous and which with Small cell?
    • Squamous: Clubbing, HPOA, PTHrp
    • Small cell: ADH, ACTH, LEMS
  24. How would you differentiate between sulfonylurea abuse and insulin abuse if and 18yr old girl comes in with hypoglycaemia?
    C-peptide will tell you wether the insulin is exogenous or endogenous.
  25. A tall thin gentleman has long thin fingers. How would you tell whether this is Marfans or Homocystinuria?
    • Learning difficulties cuggest homocystinuria.
    • AR disease resulting in deficiency of cystathione beta synthase. Diagnosed with syanide-nitroprusside test and treated with VitB6 (pyridoxine.
  26. What two tests are available for parametric data? and what are they for?
    • Student's T-test - Paired or unpaired data.
    • Pearson product moment co-efficient - Correlation.
  27. Which Ig is in excess in:
    1. Multiple Myeloma
    2. Waldenstrom's macroglobulinaemia
    • MM = IgG or IgA
    • Waldenstroms = IgM
  28. What are saturation Pharmacokinetics?
    Same as zero order. E.g. phenytoin and alcohol.
  29. Cutaneous features of tuberous sclerosis?
    • Ash-leaf spots - depigmented spots that fluoresce under UV.
    • Shagreen patches - rough skin over lumbar spine.
    • Subungual Fibromata
    • Cafe-au-lait spots
    • Adenoma Sebaceum - butterfly distribution around nose.
  30. Alport's syndrome...?
    • Bilateral sensorineural deafness, progressive renal impairment and X-linked dominant in most cases (more severe in males).
    • Can also present with Lenticonus (lens protruding into the ant.chamber) and retinitis pigmentosa.
    • Classic exam question involves a pt with Alport's who has a renal transplant which is failing because they develop Goodpastures.
  31. What is triple therapy for H.pylori eradication?
    • Full dose PPI + clarithromycin +
    • EITHER amox or metronidazole.
  32. Other names for IgA nephropathy? What are the histological changes?
    • Berger's disease Mesangioproliferative glomerulonephritis.
    • Histopathology will show Mesangial hypercellularity because IgA is all over it and +ve immunofluorescence for IgA and C3.
  33. Differentiating factors between IgA nephropathy and Post-strep glomeruloneph?
    • Usually a lag between sore throat and onset of renal probs in Post-strep (hence the POST bit)
    • Post-strep usually has proteinuria rather than haematuria
    • Post-strep assoc with low complement levels.
  34. Typical presentation of Berger's disease?
    • Young male with recurrent episodes of macroscopic haematuria assoc with mucosal infections (eg URTI).
    • Nephrotic range proteinuria is rare
    • Can progress to renal failure.
  35. Prognosis of Mesangioproliferative Glomerulonephritis?
    • 25% develop ESRF
    • Frank haematuria = GOOD prognosis
    • males, proteinuria >2gday, hypertension, smoking, hyperlipidaemia, ACE genotype DD.
  36. Risk factors for Pre-eclampsia?
    • >40yrs old
    • Nulliparity
    • Multips
    • High BMI
    • Diabetes
    • +ve FHx, PMHx
    • Pre-existing HTN or Renal disease.
  37. Anti-HTNs used for Pre-eclampsia? At what level would you start them?
    • Labetalol, Nifedipine and Hydralazine IN THAT ORDER.
    • 160110 would be a good starting point but if they are symptomatic or showing signs of increasing severity in any way, start earlier.
  38. Which aspects of SLE would not be present in Drug-induced lupus?
    • Renal involvment
    • Nervous system involvment
  39. Causes of drug-induced lupus?
    • Most common - Procainamide, Hydralazine
    • Less common - isoniazid, minocycline, phenytoin.
  40. What treatments for Grave's can worsen thyroid eye disease?
    Radioiodine treatment
  41. What is the most immportant modifiable risk factor for thyroid eye disease in a person who has grave's?
  42. Drugs that cause a hepatocellular picture?
    • Paracetamol
    • valproate, phenytoin
    • Anti-tb drugs - isoniazid, rifampicin, pyrazinamide
    • Statins
    • amiodarone
    • methyldopa
  43. Drugs that cause a Cholestatic picture?
    • OCP
    • Antibiotics
    • Phenothiazines - chlorpromazine, prochlorperazine
    • Sulfonylureas
    • Fibrates
  44. Indications for starting treatment in CLL?
    • Progressive marrow failure
    • Massive lymphadenopathy
    • Massive splenomegaly
    • Systemic symptoms
    • Lymphocytosis of >50%in 2months or doubling time <6months
    • Autoimmune cytopenias (eg ITP)
    • Treatment is FCR (Fludarabine, cyclophos and rituximab)
  45. Causes of chorea?
    • Huntingtons, Ataxic telangectasia, Wilsons
    • SLE
    • Carbon monoxide poisoning
    • Rheumatic fever: Sydenhams chorea
    • Drugs: OCP, Ldopa, antipsychotics
    • Neuroacanthocytosis
    • Polycythemia Ruba Vera
    • Cerebrovasc disease
  46. What rule is applied to remeber primary biliary cirrhosis
    • The M rule:
    • IgM
    • Mitochondrial antibodies
    • Middle aged females
  47. What is other disease is PSC associated with?
    • UC
    • 80%of pts with PSC have UC.
  48. How do you investigate suspected PSC?
    ERCP - shows views of the liver with a 'beaded' appearence of the lobules

    ANCA- may be positive

    Liverbiopsy - my show onion skin appearence.
  49. Mnemonic for adrenal cortex?
    • GFR-ACD
    • Glomerulosa - Aldosterone
    • Fasiculata - Cortisol
    • Reticularis - DHEA and the androgens
  50. Pharmocological options for infertility in women with PCOS?
    • First line = Clomiphene
    • Second line = Metformin

    Can be used in conjunction.
  51. Name the gram positive bacilli.
    • Actinomyces
    • Bacillus anthracis
    • Clostridium
    • Diptheria: coryne bacterium diptheriae
    • Listeria monocytogenes
  52. What is going on at a cellular level in myelofibrosis?
    • Proliferation of abnormal megakaryocytes in bone marrow which give out lots of platelet derived growth factor. This stimulates fibroblasts in the marrow that the cause fibrosis.
    • Because of a lack of haematopoesis from marrow, spleen + liver take over (hence massive splenomegaly).
  53. Presenting signs and symptoms of myelofibrosis?
    • Always in old people
    • Fatigue (most common)
    • Massive splenomegaly
    • Hypermetabolic symptoms (night sweats + wt loss)
  54. What inverstigations would you do in Myelofibrosis? What would they find?
    • Bloods = Anaemia, High WBCs and platelets early in disease. High urate + LDH (high cell turnover).
    • Blood Film = Tear-drop poikilocytes.
    • Bone marrow biopsy = unobtainable'dry tap' therefore requires trephine.
  55. Causes of hirsuitism?
    • PCOS
    • Cushings
    • obesity
    • Androgen therapytumor
    • drugs eg phenytoin
  56. Causes of hypertrichosis?
    • Minoxidil, ciclosporin, diazoxide
    • Porphyria cutanea tarda
    • Anorexia Nervosa
    • Congenital causes
  57. What is Bosentan used for? What is it's mechanism of action?
    • Bosentan = endothelin receptor antagonist
    • Used for primary pulmonary hypertension
  58. Which malignany is associated with HTLV-1?
    • Adult T cell lymphoma.
    • HTLV-1 = human t-cell lymphotropic virus
  59. Which malignancy is assoc with:
    • EBV = burkitt's, nasopharyngeal carcinoma
    • HIV = high grade B-cell lymphoma
    • H.pylori = Gastric Lymphoma (MALToma)
    • Malaria = Burkitt's lymphoma.
  60. Causes of a pleural effusion and their characteristic findings on aspiration?
    • Parapneumonic: Low pH or Turbid
    • TB: Low glucose, blood staining.
    • RA: Low glucose
    • Pancreatitits: Raised amylase
    • Oesophageal perforation: Raised amylase
    • Mesothelioma: Blood staining
    • PE: Blood staining
  61. What are the 4 variables required to calculate eGFR?
    • Remember CAGE
    • Creatinine
    • Age
    • Gender
    • Ethnicity
  62. Indications for spironolactone? And side effects?
    • Heart Failure (reduces all cause mortality in latter stages)
    • Conn's (as an aldosterone agonist)
    • PCOS (as an anti androgen)
    • Nephrotic syndrome.

    SE=Hyperkalemia + Gynaecomastia
  63. Dermatological conditions assoc with internal malignancies:
    Necrolytic Migratory erythema
    Acquired icthyosis
    Acquired hypertrichosis lanuginosa
    Erythema gyratum repens
    Migratory thrombophlebitis
    Pyoderma gangrenosum
    • Necrolytic Migratory erythema - Glucagonoma
    • Acquired icthyosis - Lymphoma
    • Acquired hypertrichosis lanuginosa - GI and lung
    • Dermatomyositis - Ovarian and lung
    • Erythroderma - Lymphoma
    • Erythema gyratum repens - Lung
    • Migratory thrombophlebitis - Pancreatic
    • Pyoderma gangrenosum - Myeloproliferative
    • Sweet's - Myelodysplasia
    • Tylosis - Oesophageal
  64. Causes of erythema nodosum?
    • Infection : Streptococcal + TB
    • Systemic disease: IBD, Sarcoid, Behcet's
    • Drugs: COCP, penicillins, sulphonamides
    • Malignancylymphoma
    • Pregnancy.
  65. Side effects of the quinolones?
    • Lower seizure threshold
    • Tendon damagerupture
  66. Mortality figure for ASDs?
    50% dead at 50!!!
  67. What are the 2 types of ASD and their features?
    • Secundum
    • 70% of ASD. ECG=RBBB+RAD. Fixed splitting of S2 (ejec systolic). Can cause paradoxical embolism.
    • Primum
    • Present earlier than secundum. ECG = RBB + LAD, prolonged PR. Assoc with abnormal AV valves.
  68. What are the features of Dextrocardia?
    • Quiet heart sounds
    • Small volume complexes in lateral leads.
    • Assoc with Kartageners
  69. Ptosis + dilated pupil =...?
    Third nerve palsy
  70. Ptosis + constricted pupil =...?
  71. Mechanism of action of Rituximab...?
    Monoclonal antibody against CD20 on Bcells. Therefore destroys Bcells and is useful in autoimmune disorders, leukemias, lymphomas and transplant rejection.
  72. Mechanism of action for cetuximab?
    Anti-EGFR antibody. For metastic CRC and head and neck cancers.
  73. Causes of profuse diarrhoea in HIV patients?
    • Cryptosporidium (most common) (Acid-fast)
    • CMV
    • Mycobacterium avium
    • Giardia
  74. First-line treatment for gastric MALT lymphoma?
    H.Pylori eradication. Effective in 80% of low-grade cases.
  75. At what pH level does NIV confer most benefit? At what pH does invasive ventilation confer most benefit? 

    Invasiv vent...<7.25
  76. What is the big risk with antipsychotics in the elderly?
    Strokes and VTE.
  77. Topical steroids in order of strength?
    • Hydrocort
    • Eumovate
    • Betnovate
    • Dermovate
  78. What 4 'C's' cause post ganglionic horner's syndrome? What clinical feature delineates it as post-ganglionic?
    • Carotid dissection
    • Carotid aneurysm
    • Cavernous sinus thrombosis
    • Cluster headache

    • Post-ganglionic= no anhydrosis
    • Pre-Ganglionic = anhydrosis of the face only
    • Central lesions = Anhydrosis of face arm and trunk
  79. What T's cause horner's with anhydrosis of the face?
    • Pancoasts Tumor
    • Trauma
    • Thyroidectomy
    • +Cervical rib

    These are pre-ganglionic lesions as they cause anhydrosis
  80. What S's cause central lesions leading to anhydrosis of the face arm and trunk?
    • Stroke
    • Multiple sclerosis
    • Syringomyelia
    • Tumor
    • Encephalitis
  81. Mnemonic to remember chromosome for NF1 and NF2 genes?
    • NF1 has 17 characters ergo chromo 17
    • NF2 = ALL THE 2's. chromo 22
  82. Wiskott-aldrich syndrome...
    • Decreased IgM
    • Recurrent chest infections
    • Thrombocytopaenia
    • Eczema
  83. Polycythaemia rubra know?
    Myeloproliferative disorder, increase red cell count, can be assoc with increased WCC and platelets too. Underlying aetiology = JAK2 mutation allowing the tyrosine kinase to be hypersensitive to EPO. Epo levels are usually decreased. Symptoms = pruritis especially when limb put in warm water. Erythromelalgia = pain + discolouration of a limb. Gouty arthritis and increased risk of thrombotic events inc budd-chiari.

    • Diagnose with genetics for JAK2 mutation.
    • Red cell mass + haematocrit secondline.

    Treat with phlebotomy, low dose aspirin, hydroxyureacarbamide to decrease RBC prolif.
  84. Methaemaglobinaemia is...?
    Haemaglobin which has been oxidised from Fe2+ to Fe3+.

    NADH methaemaglobin reductase reduces Fe3+ to Fe2+. This needs to be done cuz Fe3+ doesnt bind oxygen and therefore moves the dissociation curve to the left.

    A deficiency in the enzyme causes methaemaglobinaemia. Precipitating factors are Sulphonamides, dapson, nitrates, primaquinen and aniline dyes.

    Treat with ascorbic acid.
  85. Acute promyelocytic leukaemia...the important facts?
    • 1. t(15;17) PML-Rar-alpha
    • 2. Presents in younger people with PC being DIC
    • 3. good prognossis
  86. The X-linked recessive conditions are...?
    • 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
  87. Leading cause of death following Trypanosoma Cruzi infection?
    Heart failuremyocarditis

    Chagas usually presents with a chagoma at site of infection + periorbital cellulitis.

    Iv pentamidine
  88. Features on clinical exam of a PDA?
    • Left sternal heave
    • Constant machinery murmur
    • Collapsing pulse
    • Wide pulse pressure.

    Majority close with indomethacin.
  89. Risk factors for Prostate Ca?
    • Increasing age.
    • Afro-Caribbeans.
  90. Target cells =..?
    • Hyposplenism
    • Liverdisease
    • Fe deficiency anaemia
    • Sickle cellthallasemia
  91. Howell-Jolly bodies=...?
  92. Heinz bodies = ...?
    • G6PD deficiency
    • Alpha-thallasemia
  93. Schistocytes (helmet cells) = ...?
    • Intravasc haemolysis
    • Mechanical heartvalve
    • DIC
  94. Basophillic stippling = ...?
    • Lead poisoning
    • thalaasemia.
  95. Spherocytes = ...?
    • Spherocytosis
    • Autoimmune haemolytic anaemia.
  96. What one feature is common to all the types of Renal tubular acidosis?
    They all cause Hyperchloraemic acidosis. Therefore causing a metabolic acidosis with a normal anion gap.
  97. What feature is common to RTA1 and 2?
    Both cause HYPOkalemia.

    And obviously both cause Hyperchloraemic acidosis and can be idiopathic.
  98. Gold standard Ix for Bacterial overgrowth in small bowel? Other options for Ix?
    Small bowel aspiration and culture.

    Other tests are hydrogen breath test, 14C-xylose breath test and 14C-glycocholate breath test.
  99. What 3 things improve survival in pts with stale COPD?
    • LTOT
    • Stop smoking
    • Lung volume reduction surgery.
  100. Which of the glomerulonephritidies is most commonly assoc with good pastures?
    Rapidly progressive
  101. Which of the glomerulonephritidies is most commonly assoc with HIV and heroin users?
    Focal segmental
  102. Which of the glomerulonephritidies is most commonly assoc with Post-strep and SLE.?
    Diffuse Proliferative.
  103. Which of the glomerulonephritidies is most commonly assoc with infections, rheumatioid drugs and malignancy?
    Membranous Glomerulonephritis
  104. Which of the glomerulonephritidies is most commonly assoc with Hep C, cryoglobulinaemia and Lipodystrophy?
  105. What is a leukamoid reaction and how does it differ from CML?
    Leukaemoid reaction = Presence of immature cells in blood stream as they are being 'pushed out'produced too quickly due to acute stressor (e.g, haemmorhage, sepsis, haemolysis, metastic spread to marrow) 

    • -high leucocyte alkaline phosphatase score
    • -toxic granulation (Dohle bodies) in the white cells
    • -'left shift' of neutrophils i.e. three or less segments of the nucleus

    • Chronic myeloid leukaemia
    • low leucocyte alkaline phosphatase score
  106. Features of Lewy-body dementia/
    • Gets worse with neuroleptics (possibly irreversible)
    • progressive cognitive impairment
    • parkinsonism
    • visual hallucinations (other features such as delusions and non-visual hallucinations may also be seen)
  107. Steroid conversions for :

    Hydrocort to pred to dexameth?
    hydrocort x 4 = Pred

    Pred x 7 = Dexamethasone.
  108. Drugs that cause impaired glucose tolerance?
    • Thiazides
    • Steroids
    • Tacrolimus + Ciclosporin
    • Atypical antipsychotics
    • Beta blockers
    • Nicotinic acid
    • Interferon-alpha
  109. What pathologies cause lower zone fibrosis?
    • Cryptogenic
    • Connective tissue disorders (except AnkSpond)
    • Drug induced (meth, bleo, amiodarone)
    • Asbestosis

    Mnemonic = SCAR

    • S=Systemic sclerosis
    • C=Crypto + connective tissue disord
    • A=Asbestosis
    • R=radiation
  110. What pathologies cause upper zone fibrosis?
    • B=Berylliosos
    • R=Radiation
    • E= EAE
    • A= Ankspond
    • S=Silicosis + sarcoidosis
    • T=TB
    • + Coal workers and Histiocytosis
  111. Mnemonic for blotting techniques?
    • SNOW = South, north, west
    • DROP= DNA, RNA, Protein
  112. Pharmacological and psychological therapies for IBS?
    Pharma= Antispasmodics, Laxatives or Loperamide dependent on predominance, Low dose TCAs.

    Psych= CBT or hypnotherapy.
  113. Mnemonic for Tumor suppresor genes?
    • N=NF1
    • A=APC
    • R=Retinoblastoma
    • P=p53

    NARp implying loss of function results in tumor. Both alleles must be mutated.
  114. Mechanism of action of bruproprion?
    Norad+dopa reuptake inhibitor + Nicotinic antagonist.
  115. Mechanism of action of varenicline?
    Partial agnoist of nicotinic receptor.
  116. Stop smoking options in pregnancy?
    Motivational and psychological therapies.

    Can use NRT if above fail.

    DO NOT USE brupropion or varenicline.
  117. Most common heart defect in turners?
    Bicuspid aortic valve
  118. Causes of a Normal anion gap metabolic acidosis?

    Renal tub acidosis


    • Fistula
    • Acetazolamide
    • Diarrhoea
  119. Antibiotic for prostatitis?
    quinolone or trimethoprim
  120. Antibiotic treatment for pyelonephritis?
    Broad-spec cephalosporin or quinolone.
  121. Side effects of the central Ca2+ antags?
    Heart failure, hypotension, bradycardia.
  122. Side effects of the peripheral Ca2+ antags?
    • Flushing
    • Headaches
    • Ankle swelling (justlike pioglitazone)
  123. Type1 RTA?
    • Inability to secrete h+ in distal tubule
    • Causes hypokalemia
    • Can cause nephrocalcinosis and renal stones
    • Causes = idiopathic, RA, SLE, Sjogrens.
  124. Type2 RTA?
    • Decreased HCO3- resorption in proximal tubule
    • Causes hypokalemia
    • Complications include osteomalacia
    • Causes=idiopathic, fanconi syndrome, wilson's, cystinosis
  125. Type3 RTA?
    • Causes HYPERkalemia
    • Causes=hyperaldosteronism, diabetes.
  126. What rule do you use to memorise Myotonic dystrophy?
    The D rule for Dystrophica Myotonica (DM1)...

    • Distal weakness initially
    • Autosomal Dominant
    • Diabetes
    • Dysarthria

    Bilateral ptosis + loss of red reflex due to cataracts.
  127. Pathophysiology of ITP?
    Antibodies against the Gp2b3a or 1b-5-9 complex. Its an immune mediated reduction in platelet count.
  128. How would you sub divide ITP?
    • Acute
    • More common in kids
    • Equal sex incidence
    • May follow infection or vaccination
    • Self limiting over 2 weeks

    • Chronic
    • More common in youngmiddle aged
    • Relapsing remitting

    • Evans syndrome
    • ITP in assoc with autoimmune haemolytic anaemia.
  129. Treatment options for Acne Rosacea?
    • Topical metro
    • Oral tetra
    • Daily high factor suncream
    • Camouflage creams
    • Laser therapy for the telangectasia.
  130. features of Friedrick's Ataxia?
    Trinucleotide repeat on chr 9 FRATAXIN gene.

    • Neuro features:
    • Absent lower limb reflexes
    • Cerebellar ataxia
    • Spinocerebellar tract degen
    • Optic atrophy

    • Other features:
    • HOCM
    • Diabetes Mellitus
    • High arched palate
  131. What is the mnemonic for Phaeochromocytomas?

    What do you treat them with?

    What are they assoc with?
    • Rule of 10cents.
    • 10% bilateral, 10%malignant, 10%extra-adrenal(organ of Zuckerkandl at bifurcation of aorta)

    Treat with PHenoxybenzamine before b-blockers

    Assoc with MEN2, neurofibromatosis and VHL
  132. Best neuropathic painkiller for shingles?
    Amitriptyline or pregabalin
  133. Sequence of events in alcohol withdrawal.
    • 6-12 hrs =symptoms
    • 36hrs = seizures
    • 72hrs = Delerium Tremens
  134. Exenatide...tell me watch know?
    • GLP1 mimetic
    • subcut inject 60 mins before morn+eve meal
    • good for the situation in which you want to start some one on high dose insulin and they are fatty fatty fat fat
    • Continue if they show a good response in first 6 months hba1c drops by 1% and wt loss of >3%
  135. Exenatide side effects?
    • Nausea and vom
    • inceeased risk of severe pancreatitis and renal failure.
  136. Sarcoidosis with erythema nodosum = ???
    GOOD THING!! erythema nodosum confers a good prognosis.

    Insisious onset, black people, stage 3 radiographic change and splenomegaly are all bad things.
  137. What is pituitary apoplexy?
    • Sudden haemorrhage or infarct of pituitary gland.
    • Clinically very much like an SAH=headache,nec stiffnes,vomitting
    • Classic visual defect
    • Extraocular cranial nerve nuropathies
    • Features of pit.insufficiency e.g. Hyperkalemic Hypotension due to decreased ACTH secretion leading to aldosterone deficit
  138. Once started how long should an SSRI be continued?
    How quickly do you stop it?
    Which SSRI do you not care about withdrawal with?
  139. ECG changes in Hypothermia?
    • Brady
    • First degree HB
    • Long qt
    • J waves after the QRS
  140. Incongruous incomplete hemanopias are caused by lesions of the...?
    Optic Tract
  141. CHA2DS2 VAS=?
    • CHF
    • Hypertension
    • Age >75 (2)
    • Diabetes
    • Previous strokeTIA (2)

    • Vascular symptoms
    • Age 65-74 (1)
    • Sex female = 2
  142. Percentage of abscence seizure patients who are seizure free by 18?
  143. Mnemonic for thyroid cancers and their features?
    Pleas Find My Anaplastic Lymphoma

    • Papillary = Most common great prognosis
    • Follicular = 2nd commonest.
    • Medullary = Assoc Men-2, cancer of the parafollicular calcitonin secreting cells.
    • Anaplastic = Worst one
    • Lymphoma = Assoc hashimoto's.
  144. What organisms cause visceral larva migrans?
    • Toxocara species
    • Ascaris
    • Baylisascaris
  145. Causes of Raynauds?
    • CT disorders
    • Cervical rib
    • Leukemia
    • Type 1 cryoglobulinaemia
    • Drugs: OCP, Ergot
    • Use of vibrating tools.
  146. Imaging of choice for renal stones?
    Non-contrast CT.
  147. Contraindications to liver biopsy?
    • Anaemia
    • INR >1.4
    • Platelet <60
    • Hadatid cyst
    • Extrahepatic biliary obx
    • Haemangioma
    • Ascites
    • Un-co-op pt.
  148. Antiphospholipid syndrome?
    • Venousarterial thrombosis
    • Livedo reticularis
    • Recurrent fetal loss
    • Prolonged APTT
    • Thrombocytopenia
    • Other: pre-eclampsia, pulmonary hypertension.
  149. Palmar xanthomata?
    Remnant hyperlipidaemia
  150. Eruptive xanthoma?
    Caused by triglycerides:

    • Hypertriglyceridaemia
    • lipoprotien lipase deficit
  151. Tendon xanthomata, tuberous xanthomata and xanthelasma?
    • Familial hypercholesterolaemia
    • Remnant hyperlipidaemia
  152. Treatment for xanthelasma?
    Surgery, lasers, electrodessication

    or topical tricolor acetic acid.
  153. Classification of Streptococci?
    • Alpha = partial hemolysis
    • Contains strep pneumo and viridans

    • Beta = complete hemolysis 
    • betas are divided into groups A-H
    • A, B, D only ones important in humans.
    • a = strep pyogenes, erisypelas, OM, cellulitis impetigo
    • b = strep agalactiae neonatal infection
    • d = enterococcus far alias and faecium
  154. What is Fanconi syndrome?
    • Kidneys have become rubbish And cause
    • Type 2 RtA
    • glycouria
    • aminoaciduria
    • phosphaturia
    • Osteomalacia

    caused by Wilson's, cystinosis,
  155. What are insulin stress tests used for?
    In hypopituitaryism - give insulin and measure GH and cortisol. If pituitary normal both should rise.

    in cushings to differentiate between cushions and pseudocushings.
  156. Risk factors for pseudo gout?
    • Hyperparathyroid
    • hypothyroid
    • haemochromotosis
    • low phosphate or magnesium
    • wilsons
  157. what is Kearns-Sayre syndrome?
    • Mitochondrial disorder so classic red ragged fibres on muscle biopsy
    • Onset <20 years 
    • external opthalmoplegia
    • retinitis pigmentosa
    • Bilateral ptosis
  158. Name the mitochondrial disorders.
    • Leber's optic atrophy
    • MELAS - mitochondrial encephalopathy lactic acidosis stroke like episodes
    • MERRF - myoclonus epilepsy with red ragged fibres
    • Kearns-Sayre
    • sonsorineural hearing loss
  159. What is the Ann-Arbour classification of lymphoma?
    • I-single Ln
    • II- 2 or more LNs on same side of diaphragm 
    • III- LNs on both sides of diaphragm
    • III- gone beyond LNs

    • A= no systemic symptoms except pruritis
    • B= weight loss, fevers, night sweats,
  160. What anti thrombotic Therapy do you give for mechanical or bioprosthetic valves?
    • Bioprosthetic = aspirin
    • mechanical = warfarin + aspirin
    • aortic INR = 2-3
    • mitral = 2.5-3.5
  161. Whats the minimum steroid level someone should be taking before being offered osteoporotic protection?
    7.5mg of pred for 3 months or more
  162. Causes of Galactorrhoea?
    • Prolactinoma
    • Pregnancy
    • PCOS
    • Oestrogens
    • Hypothyroidism (TRH stims lactotrophs)
    • Acromegly (1\3d)
    • Stress, exercise, sleep.
  163. Factors whick put para overdose pts at higher risk?
    Taking enzyme inducers.

    Malnutrition (Anorexia+bulimia, alcohol, CF, pancreatic insuff, hep c, HIV)

    Not having eaten for a few days