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1.

MRCP Revision NOTES


2. ? ? This is a collection of commonly tested facts for part 1 MRCP ...includin
g the 100 commonly tested facts & > 200 more.... 1a ????
3. a must read before part 1 ... U'll find at least 20-30 Questions in your MRCP
1 exam from these notes. ? ???
4. Somatisation vs hypochondria 2a
5. Somatisation = patient concerned about Symptoms. HypochonDria = patient conce
rned about underlying Disease eg Cancer. 2b
6. DiGeorge syndrome = affects what type of cell? 3a
7. - a T-cell disorder 3b
8. Antithrombotic therapy in bioprosthetic vs mechanical heart valves 4a
9. - bioprosthetic: aspirin - mechanical: warfarin + aspirin 4b
10. Goodpasture's syndrome - histology? 5a
11. - IgG deposits on renal biopsy - anti-GBM antibodies 5b
12. Adrenaline induced ischaemia treatment 6a
13. - phentolamine 6b
14. Complete heart block following a MI? 7a
15. - right coronary artery lesion 7b
16. Wilson's disease: diagnosis 8a
17. - serum caeruloplasmin is decreased 8b
18. Fluctuating confusion/consciousness in elderly plus/minus deterioration ? 9a
19. chronic subdural. Can last even longer than 6 months 9b
20. Acute promyelocytic leukaemia translocation 10a
21. - t(15;17) 10b
22. Dermatophyte nail infections Rx 11a
23. - use oral terbinafine 11b
24. Actions of BNP 12a
25. - vasodilator - diuretic and natriuretic - suppresses both sympathetic tone
and the renin-angiotensin- aldosterone system 12b
26. Burning thigh pain - ?nerve compression 13a
27. ? meralgia paraesthetica - lateral cutaneous nerve of thigh compression 13b
28. URTI symptoms + amoxicillin --> rash 14a
29. ?glandular fever 14b
30. IgM paraproteinaemia - 15a
31. ?Waldenstrom's macroglobulinaemia 15b
32. Absolute risk reduction = 16a
33. = (Control event rate) - (Experimental event rate) 16b
34. Terlipressin - MoA? 17a
35. = constriction of the splanchnic vessels 17b
36. Localising bitemporal hemianopia - upper quadrant defect > lower quadrant de
fect. 18a
37. = inferior chiasmal compression, commonly a pituitary tumour 18b
38. Tear-drop poikilocytes ? 19a
39. = myelofibrosis 19b
40. Localising bitemporal hemianopia - upper quadrant defect > lower quadrant de
fect. 20a
41. = superior chiasmal compression, commonly a craniopharyngioma 20b
42. Imatinib - MoA 21a
43. = tyrosine kinase inhibitor used in CML 21b
44. Flushing, diarrhoea, bronchospasm, tricuspid stenosis, pellagra - diagnosis?
22a
45. --> carcinoid with liver mets 22b
46. Flash pulmonary oedema, U&Es worse on ACE inhibitor, asymmetrical kidneys: ?
diagnosis 23a
47. --> renal artery stenosis - do MR angiography 23b
48. Collapse + ARF = 24a
49. --> rhabdomyolysis - treat with IV fluids 24b
50. Statistical power = 25a
51. 1 - the probability of a type II error 25b

52. Sarcoidosis CXR stages 26a


53. 1 = BHL - 2 = BHL + infiltrates - 3 = infiltrates - 4 = fibrosis 26b
54. Calculating breakthrough morphine dose? 27a
55. 1/6th of daily morphine dose 27b
56. Post-natal depression incidence? 28a
57. 10% of women 28b
58. COPD - when to start LTOT? 29a
59. 2 measurements of pO2 < 7.3 kPa 29b
60. Stroke thrombolysis time limit? 30a
61. 4.5 hours 30b
62. 1mg prednisolone = ? hydrocortisone 31a
63. 4mg hydrocortisone 31b
64. Finasteride MoA 32a
65. 5 alpha-reductase inhibitor - inhibits conversion of testosterone to dihydro
testosterone 32b
66. Finasteride treatment of BPH may take how long before results are seen? 33a
67. 6 months 33b
68. DVLA restriction post- seizure 34a
69. 6 months 34b
70. Rx for Hypertension in diabetics - 35a
71. ACE-inhibitors are first- line regardless of age 35b
72. Dysphagia affecting both solids and liquids from the start - think? 36a
73. achalasia 36b
74. Loss of corneal reflex - key differential? 37a
75. acoustic neuroma 37b
76. Factor V Leiden mutation results in? 38a
77. activated protein C resistance 38b
78. Key treatments in migraine - acute vs prophylactic 39a
79. acute: 5-HT1 agonist - prophylaxis: beta-blocker 39b
80. Congenital heart disease - acyanotic - most common cause: 40a
81. acyanotic: VSD most common cause 40b
82. Glitazones: MoA 41a
83. agonists of PPAR-gamma receptors 41b
84. Atrial fibrillation - cardioversion rx: 42a
85. amiodarone + flecainide 42b
86. Adult Life Support (ALS) adrenaline doses - 43a
87. anaphylaxis: 0.5ml 1:1,000 IM - cardiac arrest: 10ml 1:10,000 IV or 1ml of 1
:1000 IV 43b
88. Bartter's syndrome ? 44a
89. AR inherited cause of hypokalaemia associated with normotension 44b
90. Miller Fisher syndrome - CFs? 45a
91. areflexia, ataxia, ophthalmoplegia 45b
92. Polycythaemia rubra vera progression? 46a
93. around 5-15% progress to myelofibrosis or AML 46b
94. malt workers' lung - pathogen 47a
95. Aspergillus clavatus 47b
96. Urticaria - common drug cause? 48a
97. Aspirin 48b
98. Antiphospholipid syndrome in pregnancy treatment 49a
99. aspirin + LMWH 49b
100. Causes of raised transfer factor? 50a
101. asthma, haemorrhage, left- to-right shunts, polycythaemia 50b
102. Beta-blocker overdose management: 51a
103. atropine + glucagon 51b
104. Hereditary haemorrhagic telangiectasia - inheritance 52a
105. autosomal dominant 52b
106. Alpha-1 antitrypsin deficiency inheritance 53a
107. autosomal recessive / co- dominant 53b
108. Aortic stenosis management: 54a
109. AVR if symptomatic, otherwise cut-off is gradient of 50 mmHg 54b

110. Live attenuated vaccines - 55a


111. BCG - MMR - oral polio - yellow fever - oral typhoid 55b
112. Atrial fibrillation: rate control rx - 56a
113. beta blockers (preferable to digoxin) 56b
114. Aortic stenosis - most common cause <65 yrs: 57a
115. bicuspid aortic valve 57b
116. Most common cardiac defect in Turner's syndrome? 58a
117. Bicuspid aortic valve 58b
118. Porphyria cutanea tarda - CP? 59a
119. Bullae on hands ,blistering photosensitive rash - hypertrichosis - hyperpig
mentation, fragile SKIN torn by minor trauma 59b
120. Amiodarone MoA 60a
121. Blocks potassium channels 60b
122. Visual changes secondary to drugs - blue vision? Yellow-green vision? 61a
123. blue vision: Viagra ('the blue pill') - yellow-green vision: digoxin 61b
124. HRT: adding a progestogen increases the risk of? 62a
125. breast cancer 62b
126. Common cause of tumour lysis syndrome? 63a
127. Burkitt's lymphoma 63b
128. EBV: associated malignancies? 64a
129. Burkitt's lymphoma - Hodgkin's lymphoma - nasopharyngeal carcinoma 64b
130. Variables used to calculate eGFR? 65a
131. CAGE - Creatinine, Age, Gender, Ethnicity 65b
132. Aortic stenosis - most common cause >65 yrs: 66a
133. calcification 66b
134. What drugs are now preferred to thiazides in the treatment of hypertension?
67a
135. Calcium channel blockers 67b
136. DVLA advice post CVA: 68a
137. cannot drive for 1 month 68b
138. DVLA advice following angioplasty - 69a
139. cannot drive for 1 week 69b
140. DVLA advice post multiple TIAs: 70a
141. cannot drive for 3 months 70b
142. DVLA advice post MI - 71a
143. cannot drive for 4 weeks 71b
144. Epilepsy medication: first- line - partial seizure: 72a
145. carbamazepine 72b
146. Trigeminal neuralgia - first-line Rx? 73a
147. carbamazepine 73b
148. Trastuzumab (Herceptin) - important SE? 74a
149. cardiotoxicity 74b
150. Schistosoma haematobium 75a
151. causes haematuria 75b
152. Horner's syndrome - anhydrosis of head, arm, trunk = 76a
153. central lesion: stroke, syringomyelia 76b
154. Chickenpox exposure in pregnancy - first step? 77a
155. check antibodies 77b
156. CLL - treatment? 78a
157. chlorambucil 78b
158. ADPKD type 1 chromosome 79a
159. chromosome 16 = 85% of cases 79b
160. Chemo agent associated with hypomagnesaemia? 80a
161. Cisplatin 80b
162. Rx Infertility in PCOS - 81a
163. clomifene is superior to metformin 81b
164. JVP: C wave - physiological correlate 82a
165. closure of the tricuspid valve 82b
166. Episodic eye pain, lacrimation, nasal stuffiness occurring daily - ?diagnos
is 83a

167.
168.
169.
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188.
189.
190.
191.
192.
193.

cluster headache 83b


Burkitt's lymphoma - gene translocation? 84a
c-myc 84b
Animal bite treatment 85a
co-amoxiclav 85b
Drug metabolism - phase II components? 86a
conjugation 86b
Viagra contraindications 87a
contraindicated by nitrates and nicorandil 87b
Main indication for HRT? 88a
control of vasomotor symptoms 88b
First line investigation for PE according to current BTS guidelines? 89a
CTPA 89b
hypokalaemic metabolic alkalosis - endocrine condition? 90a
Cushing's syndrome 90b
Hemiballism (involuntary, sudden, jerking movements) = caused by? 91a
damage to the subthalamic nucleus 91b
Acute myeloid leukaemia - poor prognosis 92a
deletion of chromosome 5 or 7 92b
Most common psychiatric problem in Parkinson's disease? 93a
depression 93b
Investigation for Carcinoid 94a
Diagnosis: urinary 5-HIAA 94b
Adenosine interactions 95a
dipyridamole enhances effect - aminophylline reduces effect 95b
Dystrophia myotonica - DM1 CFs 96a
DM1 - distal weakness initially - autosomal dominant - diabetes - dysarthri

a 96b
194. Restless leg syndrome - management 97a
195. dopamine agonists such as ropinirole 97b
196. Change to steroid dose in people on long term tx if intercurrent illness? 9
8a
197. Double doses 98b
198. Rheumatoid arthritis - HLA association? 99a
199. DR4 99b
200. HRT: unopposed oestrogen increases risk of? 100a
201. endometrial cancer 100b
202. Bosentan - MoA, uses? 101a
203. endothelin-1 receptor antagonist used if negative response to acute vasodil
ator testing in pulmonary hypertension 101b
204. Pemphigus vulgaris key features? 102a
205. Epidermal, desmoglein 3, involves mucosa, flaccid non-pruritic blisters, yo
unger people 102b
206. Head injury followed by lucid interval? 103a
207. Epidural haematoma 103b
208. Zollinger-Ellison syndrome - CFs 104a
209. epigastric pain and diarrhoea 104b
210. Key contraindication to buproprion? 105a
211. epilepsy 105b
212. Ciclosporin side-effects 106a
213. everything is increased - fluid, BP, K+, hair, gums, glucose 106b
214. Activated protein C resistance = 107a
215. Factor V Leiden, the most common inherited thrombophilia 107b
216. Diabetes diagnosis: 108a
217. fasting > 7.0, random > 11.1 - if asymptomatic need two readings HbA1c of 6
.5% or greater is now diagnostic (WHO 2011) 108b
218. investigation of choice for upper airway compression 109a
219. Flow volume loop 109b
220. Common antibiotic causes of cholestasis 110a
221. Flucloxacillin + co- amoxiclav 110b

222. Ethylene glycol toxicity management - 111a


223. fomepizole. Also ethanol / haemodialysis 111b
224. Benzodiazepines enhance the effect of which neurotransmitter? 112a
225. GABA, the main inhibitory neurotransmitter 112b
226. Signet ring cells = 113a
227. Gastric adenocarcinoma 113b
228. Screening for haemochromatosis - 114a
229. general population: transferrin saturation > ferritin - family members: HFE
genetic testing 114b
230. SSRI + NSAID interaction? 115a
231. GI bleeding risk - give a PPI 115b
232. Tricyclic overdose - rx 116a
233. give IV bicarbonate 116b
234. ITP - rx 117a
235. give oral prednisolone 117b
236. PHaeochromocytoma - 118a
237. give PHenoxybenzamine before beta-blockers 118b
238. Exenatide MoA 119a
239. Glucagon-like peptide-1 (GLP-1) mimetic 119b
240. Philadelphia translocation and prognosis? 120a
241. good prognosis in CML, poor prognosis in AML + ALL 120b
242. Absence seizures prognosis 121a
243. good: 90-95% become seizure free in adolescence 121b
244. Bronchiectasis: most common organism? 122a
245. Haemophilus influenzae 122b
246. Cyclophosphamide SE: 123a
247. haemorrhagic cystitis - prevent with mesna 123b
248. Genital ulcers - painful: 124a
249. herpes >> chancroid 124b
250. CT head showing temporal lobe changes - think what? 125a
251. herpes simplex encephalitis,temporoparietal attentuation - subacute onset i
.e. Several days. 125b
252. most common cause of sudden cardiac death in the young 126a
253. HOCM 126b
254. U waves on ECG 127a
255. Hypokalaemia - 127b
256. Liddle's syndrome: 128a
257. hypokalaemia + hypertension 128b
258. Hashimoto's thyroiditis key features? 129a
259. hypothyroidism + goitre + anti-TPO 129b
260. Asymmetrical symptoms in PD suggest what cause? 130a
261. Idiopathic Parkinson's 130b
262. NSTEMI/unstable angina Rx. 6 month mortality risk >1.5% vs 6m risk >3% 131a
263. if > 1.5% clopidogrel for 12 months - if > 3% angiography within 96 hours 1
31b
264.
265.
266.
267.
268.
269.
270.
271.
272.
273.

Primary biliary cirrhosis - the M rule mnemonic? 132a


IgM - anti-Mitochondrial antibodies, M2 subtype - Middle aged females 132b
What is rheumatoid factor? 133a
IgM antibody against IgG 133b
CLL - investigation of choice? 134a
immunophenotyping 134b
Nicotinic acid MoA 135a
increases HDL levels 135b
Essential tremor: inheritance, aggravants / relievants 136a
Inheritance: AD Aggravants: Arms outstretched Relievants: Alcohol, propanol

ol 136b
274. Ciclosporin + tacrolimus - MOA: 137a
275. inhibit calcineurin thus decreasing IL-2 137b
276. Statins - MoA? 138a

277. inhibit HMG-CoA reductase, the rate-limiting enzyme in hepatic cholesterol


synthesis 138b
278. Bisphosphonates MoA 139a
279. inhibit osteoclasts,prevent steroid incduced osteoperosis (vitamin D also).
139b
280. Clopidogrel MoA: 140a
281. inhibits ADP binding to platelet receptors 140b
282. Dipyridamole - MoA 141a
283. inhibits phosphodiesterase 141b
284. Digoxin - MoA 142a
285. inhibits the Na+/K+ ATPase pump 142b
286. Isoniazid SEs: 143a
287. inhibits the P450 system, causes peripheral neuropathy 143b
288. Allopurinol MoA 144a
289. inhibits xanthine oxidase 144b
290. Symptom control in non- CF bronchiectasis? 145a
291. inspiratory muscle training + postural drainage 145b
292. Complete heart block following an ANterior MI - ?pacing 146a
293. is AN indication for pacing, unlike with an inferior MI 146b
294. Streptococcus pneumoniae 147a
295. is associated with cold sores 147b
296. Streptococcus bovis endocarditis 148a
297. is associated with colorectal cancer 148b
298. Legionella pneumophilia 149a
299. is best diagnosed by the urinary antigen test 149b
300. Complete heart block following an INferior MI - ? pacing 150a
301. Is Not an indication for pacing, unlike with an anterior MI 150b
302. Most common cause of occupational asthma? 151a
303. Isocyanates 151b
304. Lichen sclerosus: 152a
305. itchy white spots typically seen on the vulva of elderly women 152b
306. Polycythaemia rubra vera - genetic cause? 153a
307. JAK2 mutation 153b
308. Hypertension - step 4 rx? 154a
309. K+ < 4.5 then spironolactone - K+ > 4.5 then higher-dose thiazide- like diu
retic 154b
310. Pneumonia in an alcoholic - pathogen? 155a
311. Klebsiella 155b
312. BTS COPD: breathless despite PRN inhalers, and FEV1 < 50% 156a
313. LABA + ICS or LAMA 156b
314. BTS COPD: breathless despite PRN inhalers, and FEV1 > 50%: 157a
315. LABA or LAMA 157b
316. Polymorphic eruption of pregnancy - CFs? 158a
317. Last trimester, may see vesicles, but no blistering 158b
318. Cerebellar signs, contralateral sensory loss & ipsilateral Horner's = 159a
319. Lateral medullary syndrome - PICA lesion - 159b
320. Mucocutaneous ulceration following travel - key differential? 160a
321. Leishmania brasiliensis 160b
322. Most common presenting symptom in myelofibrosis? 161a
323. lethargy 161b
324. Safest TCA in overdosage? 162a
325. Lofepramine 162b
326. Second heart sound (S2) - loud, soft, fixed split, reversed split? 163a
327. loud: hypertension - soft: AS - fixed split: ASD - reversed split: LBBB 163
b
328. ESR in polycythaemia rubra vera 164a
329. low 164b
330. Oxygen dissociation curve - shifts Left? 165a
331. Lower oxygen delivery - Lower acidity, temp, 2-3 DPG - also HbF, carboxy/me
thaemoglobin - 165b

332.
333.
334.
335.
336.
337.
338.

Most common lung cancer type in non-smokers? 166a


Lung adenocarcinoma - peripheral lesion 166b
Gallop rhythm (S3) is an early sign of? 167a
LVF 167b
Hodgkin's lymphoma - best prognosis = 168a
lymphocyte predominant 168b
Patients with Sjogren's syndrome have an increased risk of which malignancy

339.
340.
341.
342.
343.
344.
345.
346.
347.
348.
349.
350.
351.

lymphoid malignancies 169b


Rx for Mycoplasma pneumonia 170a
Macrolides. If allergic =doxycycline 170b
Eclampsia - first-line treatment 171a
magnesium sulphate 171b
Sarcoidosis prognosis? 172a
Majority of patients get better without treatment 172b
PTH level in primary hyperparathyroidism 173a
may be normal 173b
TNF-#alpha# inhibitors 174a
may reactivate TB 174b
Choosing prosthetic heart valves 175a
mechanical valves last longer and tend to be given to younger patients 175b

352.
353.
354.
355.
356.
357.

Prolactinoma management -medical or surgical? 176a


medical therapy is almost always first-line 176b
Autosomal recessive conditions tend to be ?? with what exceptions? 177a
Metabolic. Exception = inherited ataxias 177b
Acne rosacea treatment: - 178a
mild/moderate: topical metronidazole - severe/resistant: oral tetracycline

? 169a

178b
358. Kearns-Sayre syndrome - 179a
359. mitochondrial inheritance - onset < 20-years-old - external ophthalmoplegia
- retinitis pigmentosa 179b
360. Common topical steroids and their potency? 180a
361. moderate: Clobetasone butyrate 0.05% - potent: Betamethasone valerate 0.1%
- very potent: Clobetasol propionate 0.05% 180b
362. Magnesium sulphate - monitoring 181a
363. monitor reflexes + respiratory rate 181b
364. Cetuximab - MoA? 182a
365. monoclonal antibody against the epidermal growth factor receptor 182b
366. Trastuzumab (Herceptin) - 183a
367. monoclonal antibody that acts on the HER2/neu receptor 183b
368. Anorexia features - 184a
369. most things low - G's and C's raised: growth hormone, glucose, salivary gla
nds, cortisol, cholesterol, carotinaemia 184b
370. Rises first following MI? 185a
371. Myoglobin 185b
372. Hypercholesterolaemia rather than hypertriglyceridaemia: 186a
373. nephrotic syndrome, cholestasis, hypothyroidism 186b
374. Signs suggesting TTP rather than HUS? 187a
375. Neuro signs and purpura point towards TTP 187b
376. Motor neuron disease - treatment: 188a
377. NIV is better than riluzole 188b
378. AF treatment: young man, no TIA or risk factors, 189a
379. no treatment is now preferred to aspirin 189b
380. Hodgkin's lymphoma - most common type = 190a
381. nodular sclerosing 190b
382. Renal tubular acidosis - anion gap? 191a
383. normal anion gap 191b
384. Urinary incontinence + gait abnormality + dementia. Diagnosis? 192a
385. normal pressure hydrocephalus 192b

386. Rx metastatic bone pain 193a


387. NSAIDs, bisphosphonates or radiotherapy 193b
388. Acromegaly diagnosis? 194a
389. oral glucose tolerance with growth hormone measurements 194b
390. Cushing's syndrome - best test to diagnose? 195a
391. overnight dexamethasone suppression test 195b
392. Drug metabolism - phase I components? 196a
393. oxidation, reduction, hydrolysis 196b
394. Antiphospholipid syndrome: APPT, PLTs 197a
395. Paradoxically prolonged APTT + low platelets 197b
396. Progressive supranuclear palsy CFs? 198a
397. Absent voluntary downward gaze, normal dolls eye . i.e. Occulomotor nuclei
intact, supranuclear Pathology. parkinsonism 198b
398. SSRI with high incidence of discontinuation symptoms? 199a
399. Paroxetine 199b
400. Collapsing pulse - which congenital heart defect? 200a
401. Patent ductus arteriosus - 200b
402. Vincristine - important SE? 201a
403. peripheral neuropathy 201b
404. Drugs with zero-order (saturation) kinetics - 202a
405. phenytoin - alcohol 202b
406. Causes of gingival hyperplasia? 203a
407. phenytoin, ciclosporin, calcium channel blockers and AML 203b
408. TTP first-line Rx? 204a
409. Plasma exchange 204b
410. Painful third nerve palsy - key differential? 205a
411. posterior communicating artery aneurysm 205b
412. Horner's syndrome - anhydrosis absent = 206a
413. post-ganglionic lesion: carotid artery 206b
414. Rx Minimal change glomerulonephritis? 207a
415. prednisolone 207b
416. Horner's syndrome - anhydrosis of just face = 208a
417. pre-ganglionic lesion: Pancoast's, cervical rib 208b
418. Causes of raised prolactin? 209a
419. pregnancy - prolactinoma - physiological - polycystic ovarian syndrome - pr
imary hypothyroidism - phenothiazines, metoclopramide, domperidone 209b
420. Taxanes (e.g. Docetaxel) MoA? 210a
421. prevent microtubule disassembly 210b
422. Infective endocarditis - strongest risk factor 211a
423. previous episode of infective endocarditis 211b
424. Ptosis + dilated pupil vs Ptosis + constricted pupil 212a
425. Ptosis + dilated pupil = 3rd nerve palsy; Ptosis + constricted pupil = Horn
er's 212b
426. Lichen - planus: 213a
427. purple, pruritic, papular, polygonal rash on flexor surfaces. Wickham's str
iae over surface. Oral involvement common 213b
428. Oxygen dissociation curve - shifts Right? 214a
429. Raised oxygen delivery - Raised acidity, temp, 2-3 DPG 214b
430. HbA1C - when to recheck after change in therapy? 215a
431. recheck after 2-3 months 215b
432. Inferior MI - 216a
433. right coronary artery lesion 216b
434. Farmers lung pathogen 217a
435. Saccharopolyspora rectivirgula 217b
436. Erythema nodosum is associated with a good prognosis in what systemic condi
tion? 218a
437. sarcoidosis 218b
438. Combined B- and T-cell disorders 219a
439. SCID WAS ataxic (SCID, Wiskott-Aldrich syndrome, ataxic telangiectasia) 219
b

440.
441.
442.
443.
444.
445.
446.
447.
448.
449.
450.
451.
452.
453.
454.

Pulsus alternans? 220a


seen in left ventricular failure 220b
HOCM - poor prognostic factor on echo = 221a
septal wall thickness of > 3cm 221b
Detecting occupational asthma? 222a
Serial peak flow measurements at work and at home 222b
Mycoplasma diagnosis 223a
Serology 223b
Dx Addison's disease 224a
short synacthen test 224b
Epilepsy medication: first- line - generalised seizure: 225a
sodium valproate - 225b
Syringomyelia - CFs? 226a
spinothalamic sensory loss (pain and temperature) 226b
Asthma diagnosis - first line investigation in intermediate probability? 22

7a
455. Spirometry 227b
456. Paraneoplastic features of lung cancer - squamous cell vs small cell? 228a
457. squamous cell: PTHrp, clubbing, HPOA - small cell: ADH, ACTH, Lambert- Eato
n syndrome 228b
458. Pneumonia following influenza - pathogen? 229a
459. Staphylococcus aureus pneumonia 229b
460. Most common cause of endocarditis if < 2 months post valve surgery 230a
461. Staphylococcus epidermidis 230b
462. Asthma diagnosis - first line investigation in high probability? 231a
463. Start treatment 231b
464. Infective endocarditis - good prognosis 232a
465. streptococcal infection 232b
466. Most common cause of endocarditis 233a
467. Streptococcus viridans 233b
468. Antipsychotics in the elderly -> risk of? 234a
469. stroke and VTE 234b
470. Autosomal dominant conditions tend to be ?? - with what exceptions? 235a
471. Structural. Exceptions = hyperlipidaemia type II, hypokalaemic periodic par
alysis 235b
472. Cluster headache - acute treatment 236a
473. subcutaneous sumatriptan + 100% O2 236b
474. Bullous pemphigoid key features? 237a
475. Subepidermal, hemidesmosomal BP antigens, rarely involves mucosa, tense pru
ritic blisters, older people 237b
476. Diagnosing insulinoma? 238a
477. supervised prolonged fasting 238b
478. Cryptosporidium diarrhoea Rx 239a
479. Supportive therapy 239b
480. Contraindications to lung cancer surgery 240a
481. SVC obstruction, FEV < 1.5, MALIGNANT pleural effusion, and vocal cord para
lysis 240b
482. Reason for ^sweating in acromegaly 241a
483. sweat gland hypertrophy 241b
484. Alcohol withdrawal time to symptoms/signs 242a
485. symptoms: 6-12 hours - seizures: 36 hours - delirium tremens: 72 hours 242b
486.
487.
488.
489.
490.
491.
492.
493.

Genital ulcers - painless: 243a


syphilis > lymphogranuloma venereum + granuloma inguinale 243b
Philadelphia translocation? 244a
t(9;22) 244b
Congenital heart disease - cyanotic - most common cause: 245a
TGA most common at birth, Fallot's most common overall - 245b
Melanoma: single most important prognostic factor 246a
the invasion depth of the tumour 246b

494.
495.
496.
497.
498.
499.
500.
501.
502.
503.
504.
505.
506.
e 2 253a
507.

tion
b

Diuretic cause of hypercalcaemia? 247a


Thiazides 247b
Disproportionate microcytic anaemia - think? 248a
think beta-thalassaemia trait 248b
Hashimoto's thyroiditis is associated with which malignancy? 249a
thyroid lymphoma 249b
Impetigo - rx 250a
topical fusidic acid --> oral flucloxacillin / topical retapamulin 250b
Chlamydia - treatment 251a
treat with azithromycin or doxycycline 251b
JVP: giant v waves 252a
tricuspid regurgitation 252b
Associations in mesangiocapillary / membranoproliferative GN. Type 1 vs Typ
type 1: cryoglobulinaemia, hepatitis C - type 2: partial lipodystrophy 253b

508. Aortic dissection - Type A 254a


509. type A - ascending aorta - control BP(IV labetalol) + surgery 254b
510. Aortic dissection - Type B 255a
511. type B - descending aorta - control BP(IV labetalol), no surgery 255b
512. Diagnosing systemic mastocytosis? 256a
513. Urinary histamine 256b
514. Vigabatrin - important SE? 257a
515. V for Vigabatrin - V for Visual field defects 257b
516. Ventricular tachycardia - which antiarrhythmic is contraindicated? 258a
517. verapamil 258b
518. macrophages containing Periodic acid-Schiff (PAS) granules 259a
519. Whipple's disease jejunal biopsy 259b
520. PCI - biggest RF for stent thrombosis? 260a
521. withdrawal of antiplatelets 260b
522. Alport's syndrome inheritance 261a
523. X-linked dominant (in the majority) 261b
524. Keloid scars - more common in who and what body part? 262a
525. young, black, male adults on the sternum 262b
526. Ankylosing spondylitis: CFs 263a
527. Features - the 'A's
Apical fibrosis (CXR)
Anterior uveitis
Aortic regurgit
Achilles tendonitis
AV node block
Amyloidosis
And cauda equina syndrome 263
528.
529.
530.
531.
532.
533.
534.
535.
536.

Septic arthritis - most common organism? 264a


Staphylococcus aureus 264b
Low levels of which type of complement are associated with SLE? 265a
C3, C4a and C4b 265b
What should you check before starting azathioprine? 266a
Check thiopurine methyltransferase deficiency (TPMT) before treatment 266b
When to start allopurinol in gout? 267a
>= 2 attacks in 12 month period. 267b
Which cytokine is most important in pathophysiology of rheumatoid arthritis

? 268a
537. TNF 268b
538. Nitric oxide - key effects 269a
539. Vasodilation - mainly venodilation Inhibits platelet aggregation 269b
540. Superiority vs equivalence vs non-inferiority. What sample sizes? 270a
541. Superiority trial --> large sample size needed. 270b
542. Clotting factors affected by warfarin? 271a
543. Mnemonic = 1972 (Simon) - 10, 9, 7 and 2. 271b
544. Adrenal cortex - what part releases what? 272a
545. Mnemonic GFR - ACD 1) Glomerulosa (outer): Aldosterone 2) Fasciculata (midd
le): Cortisol 3) Reticularis (on inside): DHEA and androgens 272b
546. Obese T2DM with abnormal LFTs - think of what disease? 273a
547. non-alcoholic fatty liver disease 273b

548. EBV-associated malignancies 274a


549. Burkitt's lymphoma Hodgkin's lymphoma nasopharyngeal carcinoma HIV-associat
ed central nervous system lymphomas Hairy leukoplakia (non malignant). 274b
550. Associations between hypermetropia/myopia and glaucoma? 275a
551. Acute angle closure glaucoma is associated with hypermetropia, where as pri
mary open-angle glaucoma is associated with myopia 275b
552. Antiphospholipid syndrome: key triad of features 276a
553. arterial/venous thrombosis, miscarriage, livedo reticularis 276b
554. Types of cells seen in CLL? 277a
555. CLL is caused by a monoclonal proliferation of B-cell lymphocytes 277b
556. Atrial natriuretic peptide - effect on vessels? 278a
557. Atrial natriuretic peptide - powerful vasodilator 278b
558. Most common cause of primary hyperaldosteronism 279a
559. Bilateral idiopathic adrenal hyperplasia is the most common cause of primar
y hyperaldosteronism 279b
560. Obesity - NICE bariatric referral cut offs 280a
561. NICE bariatric referral cut- offs with risk factors (T2DM, BP etc): > 35 kg
/m^2 no risk factors: > 40 kg/m^2 280b
562. CT most commonly associated with PBC 281a
563. Sjogren's syndrome 281b
564. How names of ART drugs relate to function 282a
565. HIV drugs, rule of thumb: NRTIs end in 'ine' Pis: end in 'vir' NNRTIs: nevi
rapine, efavirenz 282b
566. Interpreting the ACR results 283a
567. in non-diabetics an ACR greater than 30 mg/mmol is considered clinically si
gnificant proteinuria in diabetics microalbuminuria (ACR greater than 2.5 mg/mmo
l in men and ACR greater than 3.5 mg/mmol in women) is considered clinically sig
nificant 283b
568. Which antiepileptic is safe in breast feeding? 284a
569. Breast feeding is acceptable with nearly all anti- epileptic drugs 284b
570. ATN or prerenal uraemia? 285a
571. In prerenal uraemia think of the kidneys holding on to sodium to preserve v
olume 285b
572. Renal stones on x-ray 286a
573. cystine stones: semi- opaque urate + xanthine stones: radio-lucent 286b
574. Isoretinoin adverse effects? 287a
575. teratogenicity - females MUST be taking contraception low mood dry eyes and
lips raised triglycerides hair thinning nose bleeds 287b
576. An important and common interaction with statins? 288a
577. Statins + erythromycin/clarithromycin - an important and common interaction
288b
578. Low CSF glucose but viral aetiology in meningitis? 289a
579. Mumps meningitis is associated with a low glucose in up to a third of patie
nts 289b
580. Type of bladder cancer association with schistosomiasis 290a
581. SchistoSomiaSiS is a risk factor for SquamouS cell bladder cancer 290b
582. %tage of people with Hep C developing cirrhosis? 291a
583. Liver cirrhosis will develop in around 20-30% of patients over 20-30 years
291b
584. Rash on buttocks 292a
585. Dermatitis herpetiformis (coeliac dx). 292b
586. Obese woman, papilledema/headache 293a
587. Benign Intercanial Hypertention. 293b
588. Drug induced pneumonitis 294a
589. methotrexate or amiodarone. 294b
590. foreign travel, macpap rash/flu like illnes 295a
591. HIV acute. 295b
592. Splenectomy 296a
593. need pneumococcal vaccine AT LEAST 2 weeks pre-op and for life. 296b
594. Primary hrperparathyroidism 297a

595.
596.
597.
598.
599.
600.
601.
602.
603.

high Ca, normal/low PO4, normal/high PTH (in elderly). 297b


Middle aged man with KNEE arthritis 298a
gonococcal sepsis (older people ? Staph). 298b
Sarcoidosis, erythema nodosum, arthropathy 299a
Loffgrens syndrome benign, no Rx needed or NSAIDs 299b
TREMOR postural, slow progression,titubation, 300a
benign essential TREMOR AutDom. 300b
Contraindications lung Surgery 301a
FEV dec bp 130/90, Ace inhibitors (if proteinuria analgesic induced headach

e. 301b
604. 1.5 cm difference btwn kidneys 302a
605. Renal artery stenosis ? Magnetic resonance angiogram. 302b
606. Temporal tenderness 303a
607. temporal arteritis ? steroids > 90% ischemic neuropathy, 10% retinal art o
cclusion. 303b
608. cluster headache. 304a
609. Severe retroorbital, daily headache, lacrimation 304b
610. Diagnosis of polyuria 305a
611. water deprivation test, then DDAVP 305b
612. Causes of villous atrophy 306a
613. coeliac (lymphocytic infiltrate), Whipples , dec Ig, lymphoma, trop sprue (
Rx tetracycline). 306b
614. Hepatitis B with general deterioration 307a
615. hepaocellular carcinoma 307b
616. Albumin normal, total protein high 308a
617. myeloma (hypercalcemia, electrophoresis). 308b
618. HBsAg positive, HB DNA not detectable 309a
619. chornic carirer 309b
620. Aortic Stenosis 310a
621. s2 paradoxical split, length proportional to severity 310b
622. Loud S1 311a
623. MS, hyperdynamic, short PR 311b
624. Soft S1 312a
625. immobile MS, MR. 312b
626. Loud S2 313a
627. hypertension, AS 313b
628. Fixed split 314a
629. ASD 314b
630. Opening snap 315a
631. MOBILE MS, severe near S2 315b
632. HOCM/MVP 316a
633. inc by standing,valsalva, dec by squating (# all others) 316b
634. HOCM 317a
635. Sudden death athlete, FH, Rx. Amiodarone, ICD 317b
636. Guillan Barre syndrome 318a
637. check VITAL CAPACITY. 318b
638. Horners 319a
639. sweating lost in upper face only - lesion proximal to common carotid artery
. 319b
640. Internuclear opthalmoplegia 320a
641. medial longitudinal fasciculus connects CN nucleus 3-4. 320b
642. Perinauds syndrome 321a
643. dorsal midbrain syndrome, damaged midrain and superior colliculus: impaired
upgaze (cf PSNP), lid retraction, convergence preserved. Causes: pineal tumor,
stroke, hydrocephalus, MS. 321b
644. Acute red eye 322a
645. acute closed angle glaucoma >> less common (ant uveitis, scleritis, episcle
ritis, subconjuntival hemmorrhage). 322b
646. Sweats and weight gain 323a
647. insulinoma. 323b

648. Diagnostic test for asthma 324a


649. morning dip in PEFR >20%. 324b
650. Causes of SIADH 325a
651. chest/cerebral/pancreas Pathology , porphyria, malignancy, Drugs (carbamaze
pine, chlorpropamide, clofibrate, atipsychotics, NSAIDs, rifampicin, opiates) 32
5b
652. Causes of central DI 326a
653. tumor, infiltration, trauma 326b
654. Causes of Nephrogenic DI 327a
655. Lithium, amphoteracin, domeclocycline, prologed hypercalcemia/hypornatremia
, FAMILIAL X linked type 327b
656. Returned from airline flight, TIA 328a
657. paradoxical embolus do TEE. 328b
658. Alcoholic, given glucose develops nystagmus 329a
659. B1 deficiency (wernickes). 329b
660. Mono-artropathy with thiazide 330a
661. gout (neg birefringence). NO ALLOPURINOL for acute. 330b
662. MC Cause of gout 331a
663. dec urinary excretion 331b
664. Painful 3rd nerve palsy 332a
665. posterior communicating artery aneurysm till proven otherwise 332b
666. Late complication of scleroderma 333a
667. pulmonary hypertention fibrosis 333b
668. Mouth/genital ulcers and oligarthritis 334a
669. behcets (also eye /SKIN lesions, DVT) 334b
670. Cavernous sinus syndrome 335a
671. 3rd nerve palsy, proptosis, periorbital swelling, conj injection 335b
672. Asymetric parkinsons 336a
673. likely to be idiopathic 336b
674. Obese, NIDDM ? with abnormal LFT's 337a
675. NASH 337b
676. Ipsilateral ataxia, Horners, contralateral loss pain/temp 338a
677. PICA stroke (lateral medulary syndrome of Wallenburg) 338b
678. Distal, asymetric arthropathy 339a
679. PSORIASIS 339b
680. Episodic headache with tachycardia 340a
681. Pheochromocytoma 340b
682. Very raised WCC 341a
683. ALWAYS think of leukemia. 341b
684. Diagnosis of CLL 342a
685. immunophenotyping NOT cytogenetics, NOT bone marrow 342b
686. Prognostic factors for AML 343a
687. bm karyotype (good/poor/standard) 343b
688. Pancytopenia with raised MCV 344a
689. check B12/folate first (other causes possible, but do this FIRST). Often as
sociayed with phenytoin use ? ? folate 344b
690. Anosmia, delayed puberty 345a
691. Kallmans syndrome (hypogonadotrophic hypogonadism) 345b
692. Commonest finding in G6PD hamolysis 346a
693. haemoglobinuria 346b
694. Flank pain, urinalysis:blood, protein 347a
695. renal vein thrombosis. Causes: nephrotic syndrome, RCC, amyloid, acute pyel
onephritis, SLE ,atiphospholipid syndrome 347b
696. Anemia in the elderly assume 348a
697. GI malignancy 348b
698. Diptheria 349a
699. exudative pharyngitis, lymphadenopathy, cardio and neuro toxicity. 349b
700. Indurated plaques on cheeks, scarring alopecia, hyperkeratosis over hair fo
llicles 350a
701. Discoid LUPUS 350b

702. Wt loss, malabsoption, inc ALP 351a


703. pancreatic cancer 351b
704. Wt loss, anemia (macro/micro), no obvious cause 352a
705. coeliac (diarrhea does NOT have to be present) 352b
706. Hematuria, proteinuria, best investigation 353a
707. if glomerulonephritis suspected ? renal biopsy 353b
708. Venous ulcer treatment 354a
709. exclude arteriopathy (eg ABPI), control edema, prevent infection, compressi
on bandaging.
710. Fever, lymphadenopathy, lymphocytosis, pharygitis 355a
711. EBV ? heterophile antibodies 355b
712. GI bleed after endovascular AAA Surgery 356a
713. aortoenteric fistula
714. Functional hypogonadotrophic hypogonadism 357a
715. amennorhea. LH and FSH both low. All other hormones are usually normal. Fer
ritin low. 357b
716. Vitiligo - commonest assoctions 358a
717. pernicious anemia type 1 DM , autoimmune addisons, autoimmune thyoid 358b
718. Peripheral neuropathy 359a
719. a) B12 - rapid, dorsal columns (joint pos, vibration), sensory ataxia, pseu
doathetosis of upperlimbs b) diabetic - slow, spinothalamic (pain, temp?) c)alco
hol - slow progressive, spinothalamic d) Pb - motor upper limbs 359b
720. CNS abnormalities in HIV 360a
721. toxoplaasmosis (multiple ring enhancing), lymphoma (solitary lesion). HIV e
ncephalopathy, progressive multifocal leucoencephalopathy (PML - demylination in
advanced HIV, low attenuation lesions) 360b
722. Travellers diarrohea 361a
723. chronic (>2 WEEKS) giardia (incidious onset rx. Metronidazole), SALMONELLA
(serious systemic illness), E.coli (rx. Ciprofloxacin) , Shigella 361b
724. If you see blood on urinalysis forget about 362a
725. RAS 362b
726. Fasciculations 363a
727. Motor neurone diease 363b
728. Silvery white scale 364a
729. PSORIASIS 364b
730. Hypopigmented 365a
731. vitiligo/pityriasis versicolor 365b
732. Pretibial myxedema 366a
733. Graves 366b
734. R. Arthritis with nephritic syndrome 367a
735. looks for amyloidosis, even by rectal biopsy. 367b
736. Your valuable comments are highly appreciated. 368a