MRCP REVISION NOTES

‫اﻟرﺣﯾم‬ ‫اﻟرﺣﻣن‬ ‫ﷲ‬ ‫ﺑﺳم‬
This is a collection of commonly
tested facts for part 1
MRCP ...including the 100
commonly tested
facts & > 200 more....
1a
BADRAWY MRCP Revision

a must read before part 1 ...
U'll find at least 20-30
Questions in your MRCP 1
exam from these notes.
‫ﷲ‬ ‫ﺷﺎء‬ ‫إن‬ 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-angiotensin-
aldosterone 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 post-
seizure
34a

6 months
34b

Rx for Hypertension in
diabetics -
35a

ACE-inhibitors are first-
line 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, left-
to-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 / co-
dominant
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: first-
line - 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

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 + co-
amoxiclav
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 non-
CF 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 thiazide-
like 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: 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?
227a

Spirometry
227b

Paraneoplastic features of
lung cancer - squamous cell
vs small cell?
228a

squamous cell: PTHrp,
clubbing, HPOA - small
cell: ADH, ACTH, Lambert-
Eaton 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 cut-
offs
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 anti-
epileptic 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: semi-
opaque
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

MRCP REVISION NOTES

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MRCP REVISION NOTES