Last Minute MRCP Revision

BADRAWY MRCP Revision

This is a collection of commonly
tested facts for part 1
MRCP ...including the 100
commonly tested
facts & > 200 more....
1a
a must read before part 1 ...

U'll find at least 20-30
Questions in your MRCP 1
exam from these notes.

1b
Somatisation vs
hypochondria
2a
Somatisation = patient
concerned about Symptoms.
HypochonDria = patient
concerned about underlying
Disease eg Cancer.
2b
DiGeorge syndrome =
affects what type of cell?
3a
- a T-cell disorder
3b
Antithrombotic therapy in
bioprosthetic vs
mechanical heart valves
4a
- bioprosthetic: aspirin mechanical: warfarin +

aspirin
4b
Goodpasture's syndrome histology?

5a
- IgG deposits on renal

biopsy - anti-GBM
antibodies
5b
Adrenaline induced
ischaemia treatment
6a
- phentolamine
6b
Complete heart block

following a MI?
7a
- right coronary artery

lesion
7b
Wilson's disease: diagnosis
8a
- serum caeruloplasmin is
decreased
8b
Fluctuating
confusion/consciousness in
elderly plus/minus
deterioration ?
9a
chronic subdural. Can last

even longer than 6 months
9b
Acute promyelocytic
leukaemia translocation
10a
- t(15;17)
10b
Dermatophyte nail
infections Rx
11a
- use oral terbinafine
11b
Actions of BNP
12a
- vasodilator - diuretic and

natriuretic - suppresses
both sympathetic tone and
the renin-angiotensinaldosterone system
12b
Burning thigh pain - ?nerve

compression
13a
? meralgia paraesthetica lateral cutaneous nerve of

thigh compression
13b
URTI symptoms +
amoxicillin --> rash
14a
?glandular fever
14b
IgM paraproteinaemia -
15a
?Waldenstrom's
macroglobulinaemia
15b
Absolute risk reduction =
16a
= (Control event rate) (Experimental event rate)

16b
Terlipressin - MoA?
17a
= constriction of the
splanchnic vessels
17b
Localising bitemporal
hemianopia - upper
quadrant defect > lower
quadrant defect.
18a
= inferior chiasmal
compression, commonly a
pituitary tumour
18b
Tear-drop poikilocytes ?
19a
= myelofibrosis
19b
Localising bitemporal
hemianopia - upper
quadrant defect > lower
quadrant defect.
20a
= superior chiasmal
compression, commonly a
craniopharyngioma
20b
Imatinib - MoA
21a
= tyrosine kinase inhibitor

used in CML
21b
Flushing, diarrhoea,
bronchospasm, tricuspid
stenosis, pellagra diagnosis?
22a
--> carcinoid with liver

mets
22b
Flash pulmonary oedema,

U&Es worse on ACE
inhibitor, asymmetrical
kidneys: ?diagnosis
23a
--> renal artery stenosis do MR angiography

23b
Collapse + ARF =
24a
--> rhabdomyolysis - treat

with IV fluids
24b
Statistical power =
25a
1 - the probability of a type

II error
25b
Sarcoidosis CXR stages
26a
1 = BHL - 2 = BHL +
infiltrates - 3 = infiltrates 4 = fibrosis
26b
Calculating breakthrough
morphine dose?
27a
1/6th of daily morphine

dose
27b
Post-natal depression
incidence?
28a
10% of women
28b
COPD - when to start

LTOT?
29a
2 measurements of pO2 <

7.3 kPa
29b
Stroke thrombolysis time

limit?
30a
4.5 hours
30b
1mg prednisolone = ?
hydrocortisone
31a
4mg hydrocortisone
31b
Finasteride MoA
32a
5 alpha-reductase inhibitor
- inhibits conversion of
testosterone to
dihydrotestosterone
32b
Finasteride treatment of
BPH may take how long
before results are seen?
33a
6 months
33b
DVLA restriction postseizure

34a
6 months
34b
Rx for Hypertension in
diabetics 35a
ACE-inhibitors are firstline regardless of age

35b
Dysphagia affecting both

solids and liquids from the
start - think?
36a
achalasia
36b
Loss of corneal reflex - key

differential?
37a
acoustic neuroma
37b
Factor V Leiden mutation

results in?
38a
activated protein C
resistance
38b
Key treatments in migraine

- acute vs prophylactic
39a
acute: 5-HT1 agonist prophylaxis: beta-blocker

39b
Congenital heart disease acyanotic - most common

cause:
40a
acyanotic: VSD most

common cause
40b
Glitazones: MoA
41a
agonists of PPAR-gamma
receptors
41b
Atrial fibrillation cardioversion rx:

42a
amiodarone + flecainide
42b
Adult Life Support (ALS)

adrenaline doses 43a
anaphylaxis: 0.5ml 1:1,000

IM - cardiac arrest: 10ml
1:10,000 IV or 1ml of
1:1000 IV
43b
Bartter's syndrome ?
44a
AR inherited cause of
hypokalaemia associated
with normotension
44b
Miller Fisher syndrome CFs?

45a
areflexia, ataxia,
ophthalmoplegia
45b
Polycythaemia rubra vera

progression?
46a
around 5-15% progress to

myelofibrosis or AML
46b
malt workers' lung pathogen

47a
Aspergillus clavatus
47b
Urticaria - common drug

cause?
48a
Aspirin
48b
Antiphospholipid
syndrome in pregnancy
treatment
49a
aspirin + LMWH
49b
Causes of raised transfer

factor?
50a
asthma, haemorrhage, leftto-right shunts,

polycythaemia
50b
Beta-blocker overdose
management:
51a
atropine + glucagon
51b
Hereditary haemorrhagic
telangiectasia - inheritance
52a
autosomal dominant
52b
Alpha-1 antitrypsin
deficiency inheritance
53a
autosomal recessive / codominant

53b
Aortic stenosis
management:
54a
AVR if symptomatic,
otherwise cut-off is
gradient of 50 mmHg
54b
Live attenuated vaccines -
55a
BCG - MMR - oral polio yellow fever - oral typhoid

55b
Atrial fibrillation: rate

control rx 56a
beta blockers (preferable to

digoxin)
56b
Aortic stenosis - most

common cause <65 yrs:
57a
bicuspid aortic valve
57b
Most common cardiac

defect in Turner's
syndrome?
58a
Bicuspid aortic valve
58b
Porphyria cutanea tarda CP?

59a
Bullae on hands ,blistering

photosensitive rash hypertrichosis hyperpigmentation, fragile
SKIN torn by minor trauma
59b
Amiodarone MoA
60a
Blocks potassium channels
60b
Visual changes secondary

to drugs - blue vision?
Yellow-green vision?
61a
blue vision: Viagra ('the

blue pill') - yellow-green
vision: digoxin
61b
HRT: adding a progestogen

increases the risk of?
62a
breast cancer
62b
Common cause of tumour

lysis syndrome?
63a
Burkitt's lymphoma
63b
EBV: associated
malignancies?
64a
Burkitt's lymphoma Hodgkin's lymphoma nasopharyngeal carcinoma

64b
Variables used to calculate

eGFR?
65a
CAGE - Creatinine, Age,

Gender, Ethnicity
65b
Aortic stenosis - most

common cause >65 yrs:
66a
calcification
66b
What drugs are now

preferred to thiazides in the
treatment of hypertension?
67a
Calcium channel blockers
67b
DVLA advice post CVA:
68a
cannot drive for 1 month
68b
DVLA advice following

angioplasty 69a
cannot drive for 1 week
69b
DVLA advice post multiple

TIAs:
70a
cannot drive for 3 months
70b
DVLA advice post MI -
71a
cannot drive for 4 weeks
71b
Epilepsy medication: firstline - partial seizure:

72a
carbamazepine
72b
Trigeminal neuralgia first-line Rx?

73a
carbamazepine
73b
Trastuzumab (Herceptin) important SE?

74a
cardiotoxicity
74b
Schistosoma haematobium
75a
causes haematuria
75b
Horner's syndrome anhydrosis of head, arm,

trunk =
76a
central lesion: stroke,

syringomyelia
76b
Chickenpox exposure in
pregnancy - first step?
77a
check antibodies
77b
CLL - treatment?
78a
chlorambucil
78b
ADPKD type 1
chromosome
79a
chromosome 16 = 85% of
cases
79b
Chemo agent associated

with hypomagnesaemia?
80a
Cisplatin
80b
Rx Infertility in PCOS -
81a
clomifene is superior to
metformin
81b
JVP: C wave - physiological

correlate
82a
closure of the tricuspid

valve
82b
Episodic eye pain,

lacrimation, nasal
stuffiness occurring daily ?diagnosis
83a
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 dysarthria
96b
Restless leg syndrome management

97a
dopamine agonists such as

ropinirole
97b
Change to steroid dose in

people on long term tx if
intercurrent illness?
98a
Double doses
98b
Rheumatoid arthritis HLA association?

99a
DR4
99b
HRT: unopposed oestrogen

increases risk of?
100a
endometrial cancer
100b
Bosentan - MoA, uses?
101a
endothelin-1 receptor
antagonist used if negative
response to acute
vasodilator testing in
pulmonary hypertension
101b
Pemphigus vulgaris key

features?
102a
Epidermal, desmoglein 3,
involves mucosa, flaccid
non-pruritic blisters,
younger people
102b
Head injury followed by

lucid interval?
103a
Epidural haematoma
103b
Zollinger-Ellison syndrome
- CFs
104a
epigastric pain and

diarrhoea
104b
Key contraindication to
buproprion?
105a
epilepsy
105b
Ciclosporin side-effects
106a
everything is increased fluid, BP, K+, hair, gums,

glucose
106b
Activated protein C
resistance =
107a
Factor V Leiden, the most

common inherited
thrombophilia
107b
Diabetes diagnosis:
108a
fasting > 7.0, random > 11.1

- if asymptomatic need two
readings
HbA1c of 6.5% or greater is
now diagnostic (WHO 2011)
108b
investigation of choice for

upper airway compression
109a
Flow volume loop
109b
Common antibiotic causes

of cholestasis
110a
Flucloxacillin + coamoxiclav
110b
Ethylene glycol toxicity

management 111a
fomepizole. Also ethanol /

haemodialysis
111b
Benzodiazepines enhance
the effect of which
neurotransmitter?
112a
GABA, the main inhibitory

neurotransmitter
112b
Signet ring cells =
113a
Gastric adenocarcinoma
113b
Screening for
haemochromatosis 114a
general population:
transferrin saturation >
ferritin - family members:
HFE genetic testing
114b
SSRI + NSAID interaction?
115a
GI bleeding risk - give a

PPI
115b
Tricyclic overdose - rx
116a
give IV bicarbonate
116b
ITP - rx
117a
give oral prednisolone
117b
PHaeochromocytoma -
118a
give PHenoxybenzamine
before beta-blockers
118b
Exenatide MoA
119a
Glucagon-like peptide-1
(GLP-1) mimetic
119b
Philadelphia translocation
and prognosis?
120a
good prognosis in CML,

poor prognosis in AML +
ALL
120b
Absence seizures prognosis
121a
good: 90-95% become

seizure free in adolescence
121b
Bronchiectasis: most
common organism?
122a
Haemophilus influenzae
122b
Cyclophosphamide SE:
123a
haemorrhagic cystitis prevent with mesna

123b
Genital ulcers - painful:
124a
herpes >> chancroid
124b
CT head showing temporal

lobe changes - think what?
125a
herpes simplex
encephalitis,temporoparietal
attentuation subacute onset i.e. Several
days.
125b
most common cause of

sudden cardiac death in the
young
126a
HOCM
126b
U waves on ECG
127a
Hypokalaemia -
127b
Liddle's syndrome:
128a
hypokalaemia +
hypertension
128b
Hashimoto's thyroiditis key

features?
129a
hypothyroidism + goitre +
anti-TPO
129b
Asymmetrical symptoms in
PD suggest what cause?
130a
Idiopathic Parkinson's
130b
NSTEMI/unstable angina
Rx. 6 month mortality risk
>1.5% vs 6m risk >3%
131a
if > 1.5% clopidogrel for 12

months - if > 3%
angiography within 96
hours
131b
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,
propanolol
136b
Ciclosporin + tacrolimus MOA:

137a
inhibit calcineurin thus

decreasing IL-2
137b
Statins - MoA?
138a
inhibit HMG-CoA
reductase, the rate-limiting
enzyme in hepatic
cholesterol synthesis
138b
Bisphosphonates MoA
139a
inhibit osteoclasts,prevent
steroid incduced
osteoperosis
(vitamin D also).
139b
Clopidogrel MoA:
140a
inhibits ADP binding to

platelet receptors
140b
Dipyridamole - MoA
141a
inhibits phosphodiesterase
141b
Digoxin - MoA
142a
inhibits the Na+/K+

ATPase pump
142b
Isoniazid SEs:
143a
inhibits the P450 system,

causes peripheral
neuropathy
143b
Allopurinol MoA
144a
inhibits xanthine oxidase
144b
Symptom control in nonCF bronchiectasis?

145a
inspiratory muscle training

+ postural drainage
145b

following an ANterior MI ?pacing
146a
is AN indication for pacing,

unlike with an inferior MI
146b
Streptococcus pneumoniae
147a
is associated with cold

sores
147b
Streptococcus bovis
endocarditis
148a
is associated with
colorectal cancer
148b
Legionella pneumophilia
149a
is best diagnosed by the

urinary antigen test
149b

following an INferior MI - ?
pacing
150a
Is Not an indication for

pacing, unlike with an
anterior MI
150b
Most common cause of

occupational asthma?
151a
Isocyanates
151b
Lichen sclerosus:
152a
itchy white spots typically

seen on the vulva of elderly
women
152b
Polycythaemia rubra vera genetic cause?

153a
JAK2 mutation
153b
Hypertension - step 4 rx?
154a
K+ < 4.5 then

spironolactone - K+ > 4.5
then higher-dose thiazidelike diuretic
154b
Pneumonia in an alcoholic
- pathogen?
155a
Klebsiella
155b
BTS COPD: breathless

despite PRN inhalers, and
FEV1 < 50%
156a
LABA + ICS or LAMA
156b
BTS COPD: breathless

despite PRN inhalers, and
FEV1 > 50%:
157a
LABA or LAMA
157b
Polymorphic eruption of
pregnancy - CFs?
158a
Last trimester, may see

vesicles, but no blistering
158b
Cerebellar signs,
contralateral sensory loss &
ipsilateral Horner's =
159a
Lateral medullary
syndrome - PICA lesion 159b
Mucocutaneous ulceration
following travel - key
differential?
160a
Leishmania brasiliensis
160b
Most common presenting

symptom in myelofibrosis?
161a
lethargy
161b
Safest TCA in overdosage?
162a
Lofepramine
162b
Second heart sound (S2) loud, soft, fixed split,

reversed split?
163a
loud: hypertension - soft:

AS - fixed split: ASD reversed split: LBBB
163b
ESR in polycythaemia
rubra vera
164a
low
164b
Oxygen dissociation curve shifts Left?

165a
Lower oxygen delivery Lower acidity, temp, 2-3

DPG - also HbF,
carboxy/methaemoglobin 165b
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?
169a
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
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
178b
Kearns-Sayre syndrome -
179a
mitochondrial inheritance onset < 20-years-old external ophthalmoplegia retinitis pigmentosa

179b
Common topical steroids

and their potency?
180a
moderate: Clobetasone
butyrate 0.05% - potent:
Betamethasone valerate 0.1%
- very potent: Clobetasol
propionate 0.05%
180b
Magnesium sulphate monitoring

181a
monitor reflexes +
respiratory rate
181b
Cetuximab - MoA?
182a
monoclonal antibody
against the epidermal
growth factor receptor
182b
Trastuzumab (Herceptin) -
183a
monoclonal antibody that

acts on the HER2/neu
receptor
183b
Anorexia features -
184a
most things low - G's and

C's raised: growth
hormone, glucose, salivary
glands, cortisol,
cholesterol, carotinaemia
184b
Rises first following MI?
185a
Myoglobin
185b
Hypercholesterolaemia
rather than
hypertriglyceridaemia:
186a
nephrotic syndrome,
cholestasis,
hypothyroidism
186b
Signs suggesting TTP

rather than HUS?
187a
Neuro signs and purpura

point towards TTP
187b
Motor neuron disease treatment:

188a
NIV is better than riluzole
188b
AF treatment: young man,

no TIA or risk factors,
189a
no treatment is now
preferred to aspirin
189b
Hodgkin's lymphoma most common type =

190a
nodular sclerosing
190b
Renal tubular acidosis anion gap?

191a
normal anion gap
191b
Urinary incontinence + gait

abnormality + dementia.
Diagnosis?
192a
normal pressure
hydrocephalus
192b
Rx metastatic bone pain
193a
NSAIDs, bisphosphonates
or radiotherapy
193b
Acromegaly diagnosis?
194a
oral glucose tolerance with

growth hormone
measurements
194b
Cushing's syndrome - best

test to diagnose?
195a
overnight dexamethasone
suppression test
195b
Drug metabolism - phase I

components?
196a
oxidation, reduction,
hydrolysis
196b
Antiphospholipid
syndrome: APPT, PLTs
197a
Paradoxically prolonged
APTT + low platelets
197b
Progressive supranuclear
palsy CFs?
198a
Absent voluntary downward

gaze, normal dolls eye . i.e.
Occulomotor nuclei intact,
supranuclear Pathology.
parkinsonism
198b
SSRI with high incidence of

discontinuation symptoms?
199a
Paroxetine
199b
Collapsing pulse - which

congenital heart defect?
200a
Patent ductus arteriosus -
200b
Vincristine - important SE?
201a
peripheral neuropathy
201b
Drugs with zero-order

(saturation) kinetics 202a
phenytoin - alcohol
202b
Causes of gingival
hyperplasia?
203a
phenytoin, ciclosporin,
calcium channel blockers
and AML
203b
TTP first-line Rx?
204a
Plasma exchange
204b
Painful third nerve palsy key differential?

205a
posterior communicating
artery aneurysm
205b
Horner's syndrome anhydrosis absent =

206a
post-ganglionic lesion:
carotid artery
206b
Rx Minimal change
glomerulonephritis?
207a
prednisolone
207b
Horner's syndrome anhydrosis of just face =

208a
pre-ganglionic lesion:
Pancoast's, cervical rib
208b
Causes of raised prolactin?
209a
pregnancy - prolactinoma physiological - polycystic ovarian

syndrome - primary
hypothyroidism phenothiazines,
metoclopramide, domperidone
209b
Taxanes (e.g. Docetaxel)

MoA?
210a
prevent microtubule
disassembly
210b
Infective endocarditis strongest risk factor

211a
previous episode of
infective endocarditis
211b
Ptosis + dilated pupil vs

Ptosis + constricted pupil
212a
Ptosis + dilated pupil = 3rd

nerve palsy; Ptosis +
constricted pupil =
Horner's
212b
Lichen - planus:
213a
purple, pruritic, papular,

polygonal rash on flexor
surfaces. Wickham's striae
over surface. Oral
involvement common
213b
Oxygen dissociation curve shifts Right?

214a
Raised oxygen delivery Raised acidity, temp, 2-3

DPG
214b
HbA1C - when to recheck

after change in therapy?
215a
recheck after 2-3 months
215b
Inferior MI -
216a
right coronary artery lesion
216b
Farmers lung pathogen
217a
Saccharopolyspora
rectivirgula
217b
Erythema nodosum is
associated with a good
prognosis in what systemic
condition?
218a
sarcoidosis
218b
Combined B- and T-cell

disorders
219a
SCID WAS ataxic (SCID,

Wiskott-Aldrich syndrome,
ataxic telangiectasia)
219b
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: firstline - generalised seizure:

225a
sodium valproate -
225b
Syringomyelia - CFs?
226a
spinothalamic sensory loss

(pain and temperature)
226b
Asthma diagnosis - first

line investigation in
intermediate probability?
227a
Spirometry
227b
Paraneoplastic features of
lung cancer - squamous cell
vs small cell?
228a
squamous cell: PTHrp,

clubbing, HPOA - small
cell: ADH, ACTH, LambertEaton syndrome
228b
Pneumonia following
influenza - pathogen?
229a
Staphylococcus aureus
pneumonia
229b

endocarditis if < 2 months
post valve surgery
230a
Staphylococcus
epidermidis
230b
Asthma diagnosis - first

line investigation in high
probability?
231a
Start treatment
231b
Infective endocarditis good prognosis

232a
streptococcal infection
232b

endocarditis
233a
Streptococcus viridans
233b
Antipsychotics in the
elderly -> risk of?
234a
stroke and VTE
234b
Autosomal dominant
conditions tend to be ?? with what exceptions?
235a
Structural. Exceptions =
hyperlipidaemia type II,
hypokalaemic periodic
paralysis
235b
Cluster headache - acute

treatment
236a
subcutaneous sumatriptan
+ 100% O2
236b
Bullous pemphigoid key

features?
237a
Subepidermal,
hemidesmosomal BP
antigens, rarely involves
mucosa, tense pruritic
blisters, older people
237b
Diagnosing insulinoma?
238a
supervised prolonged
fasting
238b
Cryptosporidium diarrhoea
Rx
239a
Supportive therapy
239b
Contraindications to lung
cancer surgery
240a
SVC obstruction, FEV < 1.5,

MALIGNANT pleural
effusion, and vocal cord
paralysis
240b
Reason for ^sweating in

acromegaly
241a
sweat gland hypertrophy
241b
Alcohol withdrawal time to

symptoms/signs
242a
symptoms: 6-12 hours seizures: 36 hours delirium tremens: 72 hours

242b
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
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 Type 2
253a
type 1: cryoglobulinaemia,
hepatitis C - type 2: partial
lipodystrophy
253b
Aortic dissection - Type A
254a
type A - ascending aorta control BP(IV labetalol) +

surgery
254b
Aortic dissection - Type B
255a
type B - descending aorta control BP(IV labetalol), no

surgery
255b
Diagnosing systemic
mastocytosis?
256a
Urinary histamine
256b
Vigabatrin - important SE?
257a
V for Vigabatrin - V for

Visual field defects
257b
Ventricular tachycardia which antiarrhythmic is

contraindicated?
258a
verapamil
258b
macrophages containing
Periodic acid-Schiff (PAS)
granules
259a
Whipple's disease jejunal

biopsy
259b
PCI - biggest RF for stent

thrombosis?
260a
withdrawal of antiplatelets
260b
Alport's syndrome
inheritance
261a
X-linked dominant (in the

majority)
261b
Keloid scars - more

common in who and what
body part?
262a
young, black, male adults

on the sternum
262b
Ankylosing spondylitis: CFs
263a
Features - the 'A's

Apical fibrosis (CXR)
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
And cauda equina syndrome
263b
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
TNF
268b
Nitric oxide - key effects
269a
Vasodilation - mainly
venodilation
Inhibits platelet
aggregation
269b
Superiority vs equivalence
vs non-inferiority. What
sample sizes?
270a
Superiority trial --> large

sample size needed.
270b
Clotting factors affected by

warfarin?
271a
Mnemonic = 1972 (Simon)

- 10, 9, 7 and 2.
271b
Adrenal cortex - what part

releases what?
272a
Mnemonic GFR - ACD

1) Glomerulosa (outer):
Aldosterone
2) Fasciculata (middle): Cortisol
3) Reticularis (on inside): DHEA
and androgens
272b
Obese T2DM with

abnormal LFTs - think of
what disease?
273a
non-alcoholic fatty liver

disease
273b
EBV-associated
malignancies
274a
Burkitt's lymphoma
Hodgkin's lymphoma
nasopharyngeal carcinoma
HIV-associated central nervous
system lymphomas
Hairy leukoplakia (non malignant).
274b
Associations between
hypermetropia/myopia and
glaucoma?
275a
Acute angle closure glaucoma

is associated with
hypermetropia, where as
primary open-angle glaucoma
is associated with myopia
275b
Antiphospholipid
syndrome: key triad of
features
276a
arterial/venous
thrombosis, miscarriage,
livedo reticularis
276b
Types of cells seen in CLL?
277a
CLL is caused by a
monoclonal proliferation of
B-cell lymphocytes
277b
Atrial natriuretic peptide effect on vessels?

278a
Atrial natriuretic peptide powerful vasodilator

278b

primary
hyperaldosteronism
279a
Bilateral idiopathic adrenal

hyperplasia is the most
common cause of primary
hyperaldosteronism
279b
Obesity - NICE bariatric

referral cut offs
280a
NICE bariatric referral cutoffs

with risk factors (T2DM, BP
etc): > 35 kg/m^2
no risk factors: > 40 kg/m^2
280b
CT most commonly
associated with PBC
281a
Sjogren's syndrome
281b
How names of ART drugs

relate to function
282a
HIV drugs, rule of thumb:

NRTIs end in 'ine'
Pis: end in 'vir'
NNRTIs: nevirapine,
efavirenz
282b
Interpreting the ACR

results
283a
in non-diabetics an ACR greater than 30

mg/mmol is considered clinically
significant proteinuria
in diabetics microalbuminuria (ACR
greater than 2.5 mg/mmol in men and
ACR greater than 3.5 mg/mmol in women)
is considered clinically significant
283b
Which antiepileptic is safe

in breast feeding?
284a
Breast feeding is acceptable

with nearly all antiepileptic drugs
284b
ATN or prerenal uraemia?
285a
In prerenal uraemia think

of the kidneys holding on
to sodium to preserve
volume
285b
Renal stones on x-ray
286a
cystine stones: semiopaque

urate + xanthine stones:
radio-lucent
286b
Isoretinoin adverse effects?
287a
teratogenicity - females MUST be

taking contraception
low mood
dry eyes and lips
raised triglycerides
hair thinning
nose bleeds
287b
An important and common

interaction with statins?
288a
Statins +
erythromycin/clarithromycin
- an important and common
interaction
288b
Low CSF glucose but viral

aetiology in meningitis?
289a
Mumps meningitis is
associated with a low
glucose in up to a third of
patients
289b
Type of bladder cancer

association with
schistosomiasis
290a
SchistoSomiaSiS is a risk
factor for SquamouS cell
bladder cancer
290b
%tage of people with Hep C

developing cirrhosis?
291a
Liver cirrhosis will develop

in around 20-30% of
patients over 20-30 years
291b
Rash on buttocks
292a
Dermatitis herpetiformis
(coeliac dx).
292b
Obese woman,
papilledema/headache
293a
Benign Intercanial
Hypertention.
293b
Drug induced pneumonitis
294a
methotrexate or
amiodarone.
294b
foreign travel, macpap

rash/flu like illnes
295a
HIV acute.
295b
Splenectomy
296a
need pneumococcal vaccine

AT LEAST 2 weeks pre-op
and for life.
296b
Primary
hrperparathyroidism
297a
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
headache.
301b
1.5 cm difference btwn

kidneys
302a
Renal artery stenosis

Magnetic resonance
angiogram.
302b
Temporal tenderness
303a
temporal arteritis
steroids > 90% ischemic
neuropathy, 10%
retinal art occlusion.
303b
cluster headache.
304a
Severe retroorbital, daily

headache, lacrimation
304b
Diagnosis of polyuria
305a
water deprivation test, then

DDAVP
305b
Causes of villous atrophy
306a
coeliac (lymphocytic
infiltrate), Whipples , dec Ig,
lymphoma, trop sprue (Rx
tetracycline).
306b
Hepatitis B with general

deterioration
307a
hepaocellular carcinoma
307b
Albumin normal, total

protein high
308a
myeloma (hypercalcemia,
electrophoresis).
308b
HBsAg positive, HB DNA

not detectable
309a
chornic carirer
309b
Aortic Stenosis
310a
s2 paradoxical split, length

proportional to severity
310b
Loud S1
311a
MS, hyperdynamic, short

PR
311b
Soft S1
312a
immobile MS, MR.
312b
Loud S2
313a
hypertension, AS
313b
Fixed split
314a
ASD
314b
Opening snap
315a
MOBILE MS, severe near

S2
315b
HOCM/MVP
316a
inc by standing,valsalva,
dec by squating (# all
others)
316b
HOCM
317a
Sudden death athlete, FH,

Rx. Amiodarone, ICD
317b
Guillan Barre syndrome
318a
check VITAL CAPACITY.
318b
Horners
319a
sweating lost in upper face

only - lesion proximal to
common carotid artery.
319b
Internuclear
opthalmoplegia
320a
medial longitudinal
fasciculus connects CN
nucleus 3-4.
320b
Perinauds syndrome
321a
dorsal midbrain syndrome,

damaged midrain and superior
colliculus: impaired upgaze (cf
PSNP), lid retraction, convergence
preserved. Causes: pineal tumor,
stroke, hydrocephalus, MS.
321b
Acute red eye
322a
acute closed angle

glaucoma >> less common
(ant uveitis, scleritis,
episcleritis, subconjuntival
hemmorrhage).
322b
Sweats and weight gain
323a
insulinoma.
323b
Diagnostic test for asthma
324a
morning dip in PEFR

>20%.
324b
Causes of SIADH
325a
chest/cerebral/pancreas Pathology
, porphyria, malignancy, Drugs
(carbamazepine, chlorpropamide,
clofibrate, atipsychotics, NSAIDs,
rifampicin, opiates)
325b
Causes of central DI
326a
tumor, infiltration, trauma
326b
Causes of Nephrogenic DI
327a
Lithium, amphoteracin,
domeclocycline, prologed
hypercalcemia/hypornatremia,
FAMILIAL X linked type
327b
Returned from airline

flight, TIA
328a
paradoxical embolus do
TEE.
328b
Alcoholic, given glucose

develops nystagmus
329a
B1 deficiency (wernickes).
329b
Mono-artropathy with
thiazide
330a
gout (neg birefringence).

NO ALLOPURINOL for
acute.
330b
MC Cause of gout
331a
dec urinary excretion
331b
Painful 3rd nerve palsy
332a
posterior communicating
artery aneurysm till proven
otherwise
332b
Late complication of
scleroderma
333a
pulmonary hypertention
fibrosis
333b
Mouth/genital ulcers and

oligarthritis
334a
behcets (also eye /SKIN

lesions, DVT)
334b
Cavernous sinus syndrome
335a
3rd nerve palsy, proptosis,

periorbital swelling, conj
injection
335b
Asymetric parkinsons
336a
likely to be idiopathic
336b
Obese, NIDDM with

abnormal LFT's
337a
NASH
337b
Ipsilateral ataxia, Horners,

contralateral loss
pain/temp
338a
PICA stroke (lateral

medulary syndrome of
Wallenburg)
338b
Distal, asymetric
arthropathy
339a
PSORIASIS
339b
Episodic headache with

tachycardia
340a
Pheochromocytoma
340b
Very raised WCC
341a
ALWAYS think of
leukemia.
341b
Diagnosis of CLL
342a
immunophenotyping NOT
cytogenetics, NOT bone
marrow
342b
Prognostic factors for AML
343a
bm karyotype
(good/poor/standard)
343b
Pancytopenia with raised

MCV
344a
check B12/folate first

(other causes possible, but
do this FIRST). Often
associayed with phenytoin
use folate
344b
Anosmia, delayed puberty
345a
Kallmans syndrome
(hypogonadotrophic
hypogonadism)
345b
Commonest finding in
G6PD hamolysis
346a
haemoglobinuria
346b
Flank pain,
urinalysis:blood, protein
347a
renal vein thrombosis.

Causes: nephrotic
syndrome, RCC, amyloid,
acute pyelonephritis, SLE
,atiphospholipid syndrome
347b
Anemia in the elderly

assume
348a
GI malignancy
348b
Diptheria
349a
exudative pharyngitis,
lymphadenopathy, cardio
and neuro toxicity.
349b
Indurated plaques on
cheeks, scarring alopecia,
hyperkeratosis over hair
follicles
350a
Discoid LUPUS
350b
Wt loss, malabsoption, inc

ALP
351a
pancreatic cancer
351b
Wt loss, anemia
(macro/micro), no obvious
cause
352a
coeliac (diarrhea does NOT

have to be present)
352b
Hematuria, proteinuria,
best investigation
353a
if glomerulonephritis
suspected renal biopsy
353b
Venous ulcer treatment
354a
exclude arteriopathy (eg

ABPI), control edema,
prevent infection,
compression bandaging.
354b
Fever, lymphadenopathy,
lymphocytosis, pharygitis
355a
EBV heterophile
antibodies
355b
GI bleed after endovascular

AAA Surgery
356a
aortoenteric fistula
356b
Functional
hypogonadotrophic
hypogonadism
357a
amennorhea. LH and FSH

both low.
All other hormones are
usually normal. Ferritin
low.
357b
Vitiligo - commonest
assoctions
358a
pernicious anemia type 1

DM , autoimmune
addisons, autoimmune
thyoid
358b
Peripheral neuropathy
359a
a) B12 - rapid, dorsal columns (joint pos,

vibration), sensory
ataxia, pseudoathetosis of upperlimbs
b) diabetic - slow, spinothalamic (pain,
temp?)
c)alcohol - slow progressive, spinothalamic
d) Pb - motor upper limbs
359b
CNS abnormalities in HIV
360a
toxoplaasmosis (multiple ring

enhancing), lymphoma (solitary
lesion). HIV encephalopathy,
progressive multifocal
leucoencephalopathy (PML demylination in advanced HIV, low
attenuation lesions)
360b
Travellers diarrohea
361a
chronic (>2 WEEKS) giardia

(incidious onset rx.
Metronidazole),
SALMONELLA (serious systemic
illness), E.coli (rx. Ciprofloxacin)
, Shigella
361b
If you see blood on

urinalysis forget about
362a
RAS
362b
Fasciculations
363a
Motor neurone diease
363b
Silvery white scale
364a
PSORIASIS
364b
Hypopigmented
365a
vitiligo/pityriasis versicolor
365b
Pretibial myxedema
366a
Graves
366b
R. Arthritis with nephritic

syndrome
367a
looks for amyloidosis, even

by rectal biopsy.
367b
Your valuable comments

are highly appreciated.
368a
Thank You
368b

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a must read before part 1 ...

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- bioprosthetic: aspirin mechanical: warfarin +

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Goodpasture's syndrome histology?

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- IgG deposits on renal

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Complete heart block

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- right coronary artery

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Wilson's disease: diagnosis

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chronic subdural. Can last

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- use oral terbinafine

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- vasodilator - diuretic and

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Burning thigh pain - ?nerve

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? meralgia paraesthetica lateral cutaneous nerve of

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Absolute risk reduction =

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= (Control event rate) (Experimental event rate)

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= tyrosine kinase inhibitor

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--> carcinoid with liver

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Flash pulmonary oedema,