MRCP cont 3.
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MRCP cont 3.
More of the same
MEN1 gene - Autosomal dominant
Most common presentation = hypercalcaemia therefore measure that.
2 Ps and the medullary
RET 2 oncogene
1 P and the medullary + marfanoid
Ret 2 oncogene
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
What are the treatment options for Grave's?
Block and replace
Propanalol early to block adrenergic side-effects.
Detail of ATD titration.
Start at 40mg of carbimazole and reduce gradually until pt euthyroid
Usually lasts 12-18months
Generally entails less side effects.
Detail Block-replace regimen.
start carbimazole at 40mg
Start thyroxine when pt euthyroid
Usually lasts 6-9months
Usually entails more side-effects.
Pigment laden macrophages on biopsy of colon =?
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.
What reduces the absorption of levothyroxine?
Iron tablets. Give 2 hrs apart
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.
Most common inherited thrombophilias?
Activated protein C deficiency (FactorVleiden)
Antithrombin III deficiency
Protein C deficiency
Protein S deficiency
Most common inherited bleeding disorder?
Von Willebran's disease.
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.
Management of Prolactinomas?
ALWAYS dopamine agonists.
even with visual field defects and midline shift.
Only tumors that dont respond to that get surgery.
Exacerbating factors in MG apart from exertion?
Safest TCA in overdose?
Investigation for aspergilloma?
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
Drugs that cause erythema multiforme?
Which drug is mainly used for drug-induced parkinsonism?
Best way to assess response to treatment in Hep C?
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
Is dialysis useful in TCA overdose?
What percentage of chronic HEP C patients develop cirrhosis over a 20-30year period?
What is Reye's syndrome? Cause + presentation + management.
Usually caused by aspirinviral illness:
: Confusion, seizure, cerebral oedema, coma
Fatty infiltration of kidneys, liver and pancreas
Management is supportive
Causes of a false positive VDRL?
Causes of dilated cardiomyopathy?
: Coxsackie, HIV, diptheria, parsitic
: Haemochromotosis, Sarcoid
: Kwashikorr, pellagra, Selenium, thiamine
How long is treatment for dermatophyte finger or toe nail infection?
Finger nail = 6weeks to 3 months.
Toenail = 3-6 months!!
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
What chromosomes are APKD 1 and 2 genes on?
APKD1 = 16
APKD 2 = 4
Which features predict a poor prognosis in Rheumatoid Arthritis?
poor functional status at presentation
extra articular symptoms
Xray feature in <2years.
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
What factors differentiate between
Acute tubular necrosis?
PRU < 20 mmol/L
ATN > 30 mmol/L
Fractional sodium excretion*
PRU < 1%
ATN > 1%
Fractional urea excretion**
PRU < 35%
PRU > 1.5
ATN < 1.1
PRU > 10:1
ATN < 8:1
PRU = > 1020
ATN = < 1010
Pre-renal uraemia = 'bland' sediment
ATN = brown granular casts
Response to fluid challenge
PRU = Yes
ATN = No
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.
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.
Which class of drugs cause Osteomalacia?
What measure is best used to express survival over time?
Similar to relative risk but when risk is not constant over time.
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
Features of waldenstroms?
monoclonal IgM paraproteinaemia
: weight loss, lethargy
hyperviscosity syndrome e.g. visual disturbance
cryoglobulinaemia e.g. Raynaud's
Risk fctors for oesophageal cancer?
: coeliac disease, scleroderma
Hairy cell leukemia features?
skin vasculitis in 1/3 patients
'dry tap' despite bone marrow hypercellularity
tartrate resistant acid phosphotase (TRAP) stain positive
Hairy cell leukaemia management
chemotherapy is first-line
: cladribine, pentostatin
immunotherapy is second-line
: rituximab, interferon-alpha
Alternative anticoagulants during HIT?
lepirudin and danaparoid
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.
Complications of Pagets disease?
Deafness (due to nerve entrapment)
High-output cardiac failure.
What is a hydatid liver cyst?
How do you treat it?
Caused by Echinococcus larvae.
Best treated with albendazole
What is cysticercosis?
How to you Rx?
Tapeworm disease contracted from Taenia Solium (from pigs) or saginata (from cows).
Treat with niclosamide
Causes of a high Leucocyte alkaline phosphatase score?
Causes of a low Leucocyte alkaline phosphatase score?
Antibody for Mixed connective tissue disease?
Axonal causes of peripheral neuropathy?
Demyelinating causes of peripheral neuropathy?
Abnorm in the SCN5A gene.
Convex ST elevation in leads V1-3
Right bundle branch block
Exacerbated by flecanide
More common in asians
Management of a single keratinised genital wart compared to multiple genital warts (non-keratinised).
Single keratinised = Cryo
Multiple non-keratin = Topical podophyllum
Investigation for Lewy body
DAT scan (type of SPECT)
ANK SPOND features: the As?
AV node block
Acute meds for cluster headaches?
Prophylactic meds for cluster headaches?
Acute = 100% O2, subcut triptan, nasal lidocaine
Prophylaxis = Verapamil, prednisolone
Stages of diabetic nephropathy?
Stage 1 = hyperfiltration
stage 2 = Latent phase
stage 3 = microalbuminuria
stage 4 = proteinuria + glomeruli sclerosis + hypertension
Stage 5 = ESRF
What percentage of patients with Graves develop eye disease?
where do 90% of VIPomas arise from?
what are the symptoms?
when HLA matching for a renal transplant what is the relative importance of the HLA antigens?
DR > B > A
What types of graft failure can occur to a transplanted kidney?
what causes them?
Hyper-acute (min to hrs)
type 2 rcn
Avoided by Hla matching
Due to cytotoxic t cells
Also caused by CMV
can be reversed with steroids and immunosuppresants
due to cell mediated and antibody mechanisms causing Fibrosis
In chronic graft rejection that has not fibrosed. Which renal disease recurr and in what order of commonality?
Hashemites predisposes to which type of thyroid cancer?
How does PCT present?
which enzyme is deficient?
photosensitive blistering skin rash
deficient in uroporphyrinogen decarboxylase
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.