MRCP cont 3.

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vb406
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254392
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MRCP cont 3.
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2014-01-04 15:29:13
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  1. MEN 1?
    3 Ps

    • Parathyroid (95%)
    • Pituitary (70%)
    • Pancreas (50%)

    MEN1 gene - Autosomal dominant

    Most common presentation = hypercalcaemia therefore measure that.
  2. MEN 2?
    2 Ps and the medullary

    • Parathyroid
    • Phaeo

    RET 2 oncogene
  3. MEN 3?
    1 P and the medullary + marfanoid

    Phaeo

    Ret 2 oncogene
  4. Which antibodies suggest Sjogrens syndrome?
    What other investigations can point towards it?
    • RhF positive in nearly 100%
    • ANA postive in 70%
    • Anti-Ro (SSA) positive in 70%
    • Anti-La (SSB) positive in 50%

    Hypergammaglobulinaemia and low C4
  5. What are the treatment options for Grave's?
    • ATD titration
    • Block and replace
    • Radio-iodine
    • Surgery

    Propanalol early to block adrenergic side-effects.
  6. Detail of ATD titration.
    • Start at 40mg of carbimazole and reduce gradually until pt euthyroid
    • Usually lasts 12-18months
    • Generally entails less side effects.
  7. Detail Block-replace regimen.
    • start carbimazole at 40mg
    • Start thyroxine when pt euthyroid
    • Usually lasts 6-9months
    • Usually entails more side-effects.
  8. Miller-fisher presentation?
    • Opthalmoplegia
    • Ataxia
    • Areflexia

    Anti-GQ1b antibodies
  9. Pigment laden macrophages on biopsy of colon =?
    Laxative abuse!!

    Melanosis coli.
  10. General principles of managing a person with high INR on warfarin?
    • If theyre bleeding = IV VIT K
    • If INR is > 8. Need to do a check at 24hrs and if still high give another dose of vit K.
    • Only ever restart warfarin when INR below 5.
  11. What reduces the absorption of levothyroxine?
    Iron tablets. Give 2 hrs apart
  12. If you're thinking its a Paradoxical embolus in a young woman...what questions is it important to ask to rule out the differential?
    Recurrent miscarriages and DVTs.

    Cuz antiphospholipid syndrome is more common and you might be jumping the gun.
  13. Most common inherited thrombophilias?
    • Activated protein C deficiency (FactorVleiden)
    • Antithrombin III deficiency
    • Protein C deficiency
    • Protein S deficiency
  14. Most common inherited bleeding disorder?
    Von Willebran's disease.
  15. Features of syringomyelia?
    • Can start unilateral but then become bilat
    • Wasting of muscles + weakness
    • Spinothalamic sensory loss
    • Loss of reflexes and upgoing plantars.
    • Stronly assoc with Arnold-chiari
    • Progressive over years.
  16. Management of Prolactinomas?
    • ALWAYS dopamine agonists.
    • even with visual field defects and midline shift.

    Only tumors that dont respond to that get surgery.
  17. Exacerbating factors in MG apart from exertion?
    • Penicillamine
    • Quinidine, procainamide
    • B-blockers
    • Lithium
    • Phenytoin
    • Gent
  18. Safest TCA in overdose?
    Lofepramine
  19. Investigation for aspergilloma?
    • CXR
    • Aspergillus precipitins
  20. Management on Ank Spond?
    • Encourage exercise like swimming
    • NSAIDs are first line
    • DMARDS only useful if peripheral disease present
    • Anti-TNFs useful for very severe disease only
  21. Drugs that cause erythema multiforme?
    • Penicillins
    • Carbamazepine
    • Sulphonamides
    • NSAIDs
    • Allopurinol
    • OCP
    • Nevirapine
  22. Which drug is mainly used for drug-induced parkinsonism?
    Benzhixoltrihexyphenidyl
  23. Best way to assess response to treatment in Hep C?
    Viral load
  24. Where is the insulin resistance in IFG and IGT?
    Which typre of glucose abnormality is most likly to develop T2DM
    • IFG = hepatic insulin resistance
    • IGT = Impaired muscle glucose

    IGT most likely to develop T2DM
  25. Is dialysis useful in TCA overdose?
    NO!
  26. What percentage of chronic HEP C patients develop cirrhosis over a 20-30year period?
    20-30%
  27. What is Reye's syndrome? Cause + presentation + management.
    Usually caused by aspirinviral illness:

    • Encephalopathy: Confusion, seizure, cerebral oedema, coma
    • Fatty infiltration of kidneys, liver and pancreas
    • hypoglycaemia

    Management is supportive
  28. Causes of a false positive VDRL?
    • HIV
    • TB
    • SLE
    • Pregnancy
    • leprosy
    • malaria
  29. Causes of dilated cardiomyopathy?
    • Alcohol
    • Hypertension
    • Inherited
    • Infections: Coxsackie, HIV, diptheria, parsitic
    • Endocrine: hyperthyroidism
    • Deposition: Haemochromotosis, Sarcoid
    • Nutritional: Kwashikorr, pellagra, Selenium, thiamine
    • Drugs: doxorubicin
    • Neuromuscular: Duchenne's
  30. How long is treatment for dermatophyte finger or toe nail infection?
    • Finger nail = 6weeks to 3 months.
    • Toenail = 3-6 months!!
  31. Order of agents for neuropathic pain?
    • Amitriptyline or pregabalin
    • If Ami effective but adverse effects not tolerated then switch to IMI or NOR
    • If Ami not effective, add pregabalin
    • Then add tramadol or topical lidocaine
  32. What chromosomes are APKD 1 and 2 genes on?
    • APKD1 = 16
    • APKD 2 = 4
  33. Which features predict a poor prognosis in Rheumatoid Arthritis?
    • Rheum Factor
    • ANti-CCP antibody
    • HLA-DR4
    • poor functional status at presentation
    • insidious onset
    • extra articular symptoms
    • Xray feature in <2years.
  34. What do you do with babies born to Hep B +ve mothers?
    Full course of immunisation when they are born and Hep B Ig.

    Breast feeding is FINE

    C-section doesnt change anything
  35. What factors differentiate between

    Pre-renal uraemia
    and
    Acute tubular necrosis?
    • Urine sodium
    • PRU < 20 mmol/L
    • ATN > 30 mmol/L

    • Fractional sodium excretion*
    • PRU < 1%
    • ATN > 1%

    • Fractional urea excretion**
    • PRU < 35%
    • ATN >35%

    • Urine:plasma osmolality
    • PRU > 1.5
    • ATN < 1.1

    • Urine:plasma urea
    • PRU > 10:1
    • ATN < 8:1

    • Specific gravity
    • PRU = > 1020
    • ATN = < 1010

    • Urine
    • Pre-renal uraemia = 'bland' sediment
    • ATN = brown granular casts

    • Response to fluid challenge
    • PRU = Yes
    • ATN = No
  36. Indications for NIV?
    • COPD with pH 7.25-7.35
    • Type 2 resp failure secondary to Obx sleep apnoea, chest wall deformity or neuromusc conditions.
    • Weaning of intubation
    • Cardiogenic pulmonary oedema.
  37. How do you differentiate Drug-induced parkinsons from Parkinsons?
    Rest tremor and rigidity not present in drug induced.

    Drug induced tends to be bilateral and has a rapid onset of symptoms.
  38. Which class of drugs cause Osteomalacia?
    Anticonvulsants.
  39. What measure is best used to express survival over time?
    Hazard ratio.

    Similar to relative risk but when risk is not constant over time.
  40. Features of HIT?
    Heparin induced thrombocytopaenia

    Antibody mediated ACTIVATION of platelets

    Despite causing paenia its a PROTHROMBOTIC condition

    Usually develops in day 5-10 post treatment

    Greater than 50% reduction in platelets + thrombosis + skin allergy
  41. Features of waldenstroms?
    Features

    • monoclonal IgM paraproteinaemia
    • systemic upset: weight loss, lethargy
    • hyperviscosity syndrome e.g. visual disturbance
    • hepatosplenomegaly
    • lymphadenopathy
    • cryoglobulinaemia e.g. Raynaud's
  42. Risk fctors for oesophageal cancer?
    Risk factors

    • smoking
    • alcohol
    • GORD
    • Barrett's oesophagus
    • achalasia
    • Plummer-Vinson syndrome
    • rare: coeliac disease, scleroderma
  43. Hairy cell leukemia features?
    Features

    • pancytopenia
    • splenomegaly
    • skin vasculitis in 1/3 patients
    • 'dry tap' despite bone marrow hypercellularity
    • tartrate resistant acid phosphotase (TRAP) stain positive
  44. Hairy cell leukaemia management
    Management

    • chemotherapy is first-line: cladribine, pentostatin
    • immunotherapy is second-line: rituximab, interferon-alpha
  45. Alternative anticoagulants during HIT?
    lepirudin and danaparoid
  46. What is ebstein's anomaly?
    Displacement of the septal leaflet towards the apex causing a smaller ventricle and a larger atrium.

    Causes a Pansystolic murmur due to tricuasapid incompetence and WPW.

    Assoc with lithium exposure in utero.
  47. Complications of Pagets disease?
    • Deafness (due to nerve entrapment)
    • Bone sarcomas
    • fractures
    • Skull thickening
    • High-output cardiac failure.
  48. What is a hydatid liver cyst?

    How do you treat it?
    Caused by Echinococcus larvae.

    Best treated with albendazole
  49. What is cysticercosis?

    How to you Rx?
    Tapeworm disease contracted from Taenia Solium (from pigs) or saginata (from cows).

    Treat with niclosamide
  50. Causes of a high Leucocyte alkaline phosphatase score?
    • Myelofibrosis
    • Leukamoid reactions
    • PRV
    • Cushings
    • Pregnancy, OCP
  51. Causes of a low Leucocyte alkaline phosphatase score?
    • CML
    • Pernicious anaemia
    • PNH
    • Mono
  52. Antibody for Mixed connective tissue disease?
    Anti-RNP
  53. Axonal causes of peripheral neuropathy?
    • Alcohol
    • Vasculitis
    • Diabetes
    • Vit B12
    • HSMN II
  54. Demyelinating causes of peripheral neuropathy?
    • GBS
    • CIDP
    • Amiodarone
    • HSMN 1
    • Paraprotein neuropathy
  55. Brugada syndrome?
    • Autosomal dominant
    • Abnorm in the SCN5A gene.
    • Convex ST elevation in leads V1-3
    • Right bundle branch block
    • Exacerbated by flecanide
    • More common in asians
  56. Management of a single keratinised genital wart compared to multiple genital warts (non-keratinised).
    • Single keratinised = Cryo
    • Multiple non-keratin = Topical podophyllum
  57. Investigation for Lewy body
    DAT scan (type of SPECT)
  58. ANK SPOND features: the As?
    • Apical fibrosis
    • Anterior uveitis
    • Aortic regurg
    • Achilles tendonitis
    • AV node block
    • Amyloidosis
  59. Acute meds for cluster headaches?
    Prophylactic meds for cluster headaches?
    • Acute = 100% O2, subcut triptan, nasal lidocaine
    • Prophylaxis = Verapamil, prednisolone
  60. Stages of diabetic nephropathy?
    • Stage 1 = hyperfiltration
    • stage 2 = Latent phase
    • stage 3 = microalbuminuria
    • stage 4 = proteinuria + glomeruli sclerosis + hypertension
    • Stage 5 = ESRF
  61. What percentage of patients with Graves develop eye disease?
    25-50%
  62. where do 90% of VIPomas arise from?
    what are the symptoms?
    • Weightloss
    • diarrhoea
    • Dehydration 
    • Hypokalemia, hypochlorhydia
  63. when HLA matching for a renal transplant what is the relative importance of the HLA antigens?
    DR > B > A
  64. What types of graft failure can occur to a transplanted kidney?
    what causes them?
    • Hyper-acute (min to hrs)
    • Pre-existent antibodies
    • type 2 rcn
    • Avoided by Hla matching

    • acute
    • Due to cytotoxic t cells
    • Also caused by CMV
    • can be reversed with steroids and immunosuppresants

    • chronic
    • due to cell mediated and antibody mechanisms causing Fibrosis
  65. In chronic graft rejection that has not fibrosed. Which renal disease recurr and in what order of commonality?
    MCGN>IgA>FSGN
  66. Hashemites predisposes to which type of thyroid cancer?
    Lymphoma
  67. How does PCT present?
    which enzyme is deficient?
    • Hypertrichosis
    • photosensitive blistering skin rash
    • Hyperpigmentation

    deficient in uroporphyrinogen decarboxylase
  68. Management of Long QT syndrome?
    • Avoid drugs that prolong QT
    • Offer Bblockers (but NOT sotalol)
    • ICD if QT>500ms or if had previous cardiac arrest.

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