1) Painful third nerve palsy = posterior communicating artery aneurysm

2) Multiple sclerosis diagnosis that requires demyelinating lesions that are

separated in space and time

3) 99
4) Desmopressiin - induces release of von Willebrand's factor from
endothelial cells

5) 98
6) Insoluble sources of fibre such as bran and wholemeal should be
avoided in IBS

7) 98
8) MR Venogram is the gold standard test for diagnosing venous sinus
thrombosis

9) 98
10) Local anesthetic toxicity can be treated with IV 20% lipid
emulsion

11) 98
12) In Cushing's disease, cortisol is not suppressed by low-dose
dexamethasone but is suppressed by high-dose dexamethasone

13) 98
14) Benznidazole is used in the acute phase of Chagas' disease to
manage the illness

15) 97
16) Activated charcoal can be used within an hour of an aspirin
overdose

17) 97
18) Amoebiasis should be considered in the presentation of
dysentery after a long incubation period

19) 96
20) DRESS syndrome presents with a triad of extensive skin rash,
high fever, and organ involvement

21) 96
22) Patients with MI secondary to cocaine use should be given IV
benzodiazepines as part of acute (ACS) treatment
23) 95
24) The universal donor of fresh frozen plasma is AB RhD negative
blood

25) 95
26) If a sexually active patient presents with genital chlamydia and
bowel symptoms, LGV proctocolitis should be considered

27) 95
28) Elevated hepcidin levels in patients with CKD are a contributory
factor to the development of iron-deficiency anaemia

29) 95
30) TSH antibodies are found in 90% of patients with Graves' disease
and can help distinguish from other forms of hyperthyroidism

31) 94
32) Ergot-derived dopamine receptor agonists may cause pulmonary
fibrosis

33) 94
34) Sensorineural hearing loss is the most common complication
following meningitis

35) 93
36) Large artery acute ischaemic stroke? Consider mechanical clot
retrieval

37) 93
38) The BCG vaccine is unreliable in protecting against pulmonary
tuberculosis

39) 93
40) If neoplastic spinal cord compression is suspected, high-dose oral
dexamethasone should be given whilst awaiting investigations

41) 93
42) Tachycardia with a rate of 150/min ?atrial flutter

43) 92
44) Staphylococcus aureus is associated with cavitating lesions when
it causes pneumonia

45) 92
46) Transverse myelitis can be caused by viral infection - such as
varicella, herpes simplex, EBV and HIV
47) 92
48) Juxta-articular osteoporosis/osteopenia is an early x-ray feature
of rheumatoid arthritis

49) 91
50) While amylase is an important investigation in the diagnosis of
pancreatitis, it does not offer prognostic value

51) 91
52) Patients with an uncertain tetanus vaccination history should be
given a booster vaccine + immunoglobulin, unless the wound is very
minor and < 6 hours old

53) 91
54) Sepsis triggers the release of IL-1 causing vasodilation →
hypotension

55) 91
56) Leptin is secreted by adipose tissue

57) 90
58) Miller Fisher syndrome - areflexia, ataxia, ophthalmoplegia

59) 90
60) Hashimoto's thyroiditis is associated with thyroid lymphoma

61) 90
62) In a very athletic woman, hypothalamic hypogonadism is a
common cause of secondary amenorrhoea

63) 90
64) Whilst dysphagia of solids and liquids is a classic history for
achalasia, certain features such as significant weight loss are not
consistent and suggest cancer - 'pseudoachalasia'

65) 90
66) Antiretroviral therapy is the treatment of choice for HIV-
associated nephropathy

67) 90
68) Lip smacking + post-ictal dysphasia are localising features of a
temporal lobe seizure

69) 89
70) Ciclosporin side-effects: everything is increased - fluid, BP, K +,
hair, gums, glucose

71) 88
72) Patients with peritonsillar abscesses can develop Lemierre's
syndrome (thrombophlebitis of the IJV)- this can present with neck
pain, and can result in septic pulmonary embolism

73) 88
74) Oral ciprofloxacin or rifampicin is used as prophylaxis for
contacts of patients with meningococcal meningitis

75) 88
76) Homocystinuria - give vitamin B6 (pyridoxine)

77) 87
78) P. knowlesi has the shortest erythrocytic replication cycle,
leading to high parasite counts in short periods of time

79) 87
80) Carpometacarpal and distal interphalangeal joint involvement is
characteristic of hand osteoarthritis

81) 87
82) Mumps meningitis is associated with a low CSF glucose

83) 86
84) Generally supportive treatment is given in the management of a
patient in haemolytic crisis secondary to hereditary spherocytosis. I.e.
folic acid, transfusion if symptomatic from anaemia. Steroids are not
indicated

85) 86
86) Multiple sclerosis patient with bladder dysfunction - get an
ultrasound first to assess bladder emptying

87) 86
88) Pulmonary fibrosis results in decreased lung compliance

89) 86
90) Focal seizures not responding to first-line drug - try lamotrigine
or levetiracetam (i.e. the first-line drug not already tried) and if neither
help then carbamazepine

91) 86
92) Combined HIV antibody/antigen tests are now the first-line test
for HIV screening of asymptomatic individuals or patients with signs
and symptoms of chronic infection

93) 86
94) Patients with type I diabetes and a BMI > 25 should be
considered for metformin in addition to insulin

95) 85
96) If a mild-moderate flare of ulcerative colitis does not respond to
topical or oral aminosalicylates then oral corticosteroids are added

97) 85
98) If a patient with ulcerative colitis has had a severe relapse or
>=2 exacerbations in the past year they should be given either oral
azathioprine or oral mercaptopurine to maintain remission

99) 85
100) Ovarian teratoma is associated with Anti-NMDA receptor
encephalitis

101) 85
102) Patients who are immunosuppressed secondary to long-term
steroids or methotrexate should receive VZIG if they are exposed to
chickenpox and have no antibodies to varicella

103) 85
104) Imaging is required before making a diagnosis of PBC to exclude
extrahepatic biliary obstruction

105) 85
106) Flushing, diarrhoea, bronchospasm, tricuspid stenosis, pellagra →
carcinoid with liver mets - diagnosis: urinary 5-HIAA

107) 84
108) Bilateral idiopathic adrenal hyperplasia is the most common
cause of primary hyperaldosteronism

109) 84
110) Raised ICP can cause a third nerve palsy due to herniation

111) 84
112) Eikenella is notable as a cause of infections following human
bites

113) 84
114) Ciprofloxacin promotes acquisition of MRSA

115) 84
116) The sulfamethoxazole in co-trimoxazole causes haemolysis in
G6PD, not the trimethoprim

117) 83
118) Syringomyelia classically presents with cape-like loss of pain and
temperature sensation due to compression of the spinothalamic tract
fibres decussating in the anterior white commissure of the spine

119) 83
120) When prescribing fluids, the potassium requirement per day is 1
mmol/kg/day

121) 82
122) Carbamazepine can cause agranulocytosis

123) 82
124) Azithromycin, erythromycin or amoxicillin may be used to
treat Chlamydia in pregnancy

125) 82
126) Pseudoxanthoma elasticum is associated with mitral valve
prolapse and increased risk of ischaemic heart disease

127) 82
128) Hepatorenal syndrome is primarily caused by splanchnic
vasodilation

129) 81
130) In chronic myeloid leukaemia there is an increase in granulocytes
at different stages of maturation +/- thrombocytosis

131) 81
132) Skeletal muscle contraction is dependent on acetylcholine which
activates nicotinic acetylcholine receptors

133) 81
134) Insulinoma is diagnosed with supervised prolonged fasting

135) 80
136) Hepatitis C - 55-85% become chronically infected

137) 80
138) Patients with stable CVD who have AF are generally managed on
an anticoagulant and the antiplatelets stopped

139) 80
140) Corticosteroids are used in the management of severe alcoholic
hepatitis

141) 80
142) In haemochromatosis, cardiomyopathy and skin pigmentation
are reversible with treatment

143) 80
144) A decrease in night vision is a potential complication of
panretinal photocoagulation

145) 80
146) Hereditary haemorrhagic telangiectasia - autosomal dominant

147) 78
148) SVC obstruction - dyspnoea is the most common symptom

149) 78
150) Surgery is the mainstay of treatment for hydatid cysts

151) 78
152) Recommend Adult Life Support (ALS) adrenaline doses
153) anaphylaxis: 0.5mg - 0.5ml 1:1,000 IM
154) cardiac arrest: 1mg - 10ml 1:10,000 IV or 1ml of 1:1000 IV

155) 77
156) Excessive flatulence is an extremely common side effect of
acarbose which is often poorly tolerated

157) 77
158) PEG insertion is not normally recommended in advanced
dementia patients

159) 77
160) DVLA advice post multiple TIAs: cannot drive for 3 months

161) 76
162) Corticosteroids can induce neutrophilia

163) 76
164) Hb SC is a milder form of sickle disease
165) 76
166) ERCP/MRCP are the investigations of choice in primary sclerosing
cholangitis

167) 75
168) Severe manifestations of enteric fever include bowel perforation
and neurological complication. If these occur it is typically in the third
week of illness

169) 75
170) Li-Fraumeni syndrome is caused by germline mutations to p53
tumour suppressor gene

171) 75
172) HLA antigens are encoded for by genes on chromosome 6

173) 75
174) Chorea is caused by damage to the basal ganglia, in particular
the Caudate nucleus

175) 74
176) Hypertonic saline (typically 3% NaCl) is usually indicated in
patients with acute, severe, symptomatic hyponatraemia (< 120
mmol/L)

177) 74
178) Lung adenocarcinoma
179) most common type in non-smokers
180) peripheral lesion

181) 73
182) Renal cell carcinoma can cause liver dysfunction in particular
cholestasis and hepatosplenomegaly

183) 73
184) Complete heart block following an inferior MI is NOT an indication
for pacing, unlike with an anterior MI

185) 72
186) Filgrastim is a granulocyte-colony stimulating factor used to treat
neutropenia

187) 72
188) Diabetes is the strongest risk factor for the development of
melioidosis

189) 71
190) Anthrax presents with a black eschar that is typically painless; it
is treated with ciprofloxacin

191) 71
192) Flash pulmonary oedema, U&Es worse on ACE inhibitor,
asymmetrical kidneys → renal artery stenosis - do MR angiography

193) 70
194) Progressive supranuclear palsy: postural instability, impairment
of vertical gaze, parkinsonism, frontal lobe dysfunction

195) 70
196) Dietary modification and topical steroids are used in the
management of eosinophilic oesophagitis

197) 70
198) Eczema herpeticum is a primary infection of the skin caused by
herpes simplex virus (HSV) and uncommonly coxsackievirus

199) 70
200) Hepatocellular carcinoma
201) hepatitis B most common cause worldwide
202) hepatitis C most common cause in Europe

203) 69
204) There is a repeat expansion of CAG trinucleotide in Huntington's
disease

205) 69
206) Stepwise deterioration in cognitive function? - think vascular
dementia

207) 69
208) Hypercholesterolaemia rather than hypertriglyceridaemia:
nephrotic syndrome, cholestasis, hypothyroidism

209) 68
210) Disproportionate microcytic anaemia - think beta-thalassaemia
trait

211) 68
212) Percutaneous mitral commissurotomy is the intervention of
choice for severe mitral stenosis

213) 68
214) A 'hot stool' (a stool examined within 15 minutes of passage, or
kept warm) is required to make a microscopic diagnosis of intestinal
amoebiasis as once cooled Entamoeba histolytic returns to its cystic
state and becomes indistinguishable from the non-
pathogen Entamoeba dispar

215) 68
216) Budd-Chiari syndrome - ultrasound with Doppler flow studies is
very sensitive and should be the initial radiological investigation

217) 68
218) Alcohol bingeing can lead to ADH suppression in the posterior
pituitary gland subsequently leading to polyuria

219) 68
220) Patients with a secondary spontaneous pneumothorax that is
managed conservatively should be monitored as an inpatient

221) 68
222) Factor V Leiden mutation results in activated protein C resistance

223) 67
224) G6PD deficiency: sulph- drugs: sulphonamides, sulphasalazine
and sulfonylureas can trigger haemolysis

225) 67
226) Acute schistosomal infection can present with a syndrome known
as Katayama Fever

227) 67
228) Obesity with abnormal LFTs - ? non-alcoholic fatty liver disease

229) 67
230) Chi-squared test - used to compare proportions or percentages
e.g. compares the percentage of patients who improved following two
different interventions

231) 67
232) Ivermectin is the drug of choice for treatment of strongyloidiasis

233) 66
234) TRALI is differentiated from TACO by the presence of
hypotension in TRALI vs hypertension in TACO

235) 66
236) The majority of gastrinomas are found in the first part of the
duodenum

237) 64
238) C8 is the ONLY cervical nerve root that comes out BELOW the
vertebra

239) 63
240) del 17p is associated with a poor prognosis in CLL

241) 63
242) Retinal detachment is a cause of sudden painless loss of vision. It
is characterised by a dense shadow starting peripherally and
progressing centrally

243) 62
244) Recurrent herpes outbreaks in pregnancy should be treated with
suppressive therapy; risk of transmission to the baby is low and
aciclovir is safe to use in pregnant women

245) 62
246) Haemochromatosis is more common than cystic fibrosis

247) 61
248) Patent ductus arteriosus: ibuprofen/indomethacin is given to the
neonate in the postnatal period, not to the mother in the antenatal
period

249) 61
250) High urea levels can indicate an upper GI bleed versus lower GI
bleed

251) 60
252) Aplastic crises in sickle cell disease are associated with a sudden
drop in haemoglobin

253) 60
254) DVLA advice post stroke or TIA: cannot drive for 1 month

255) 59
256) Glitazones are agonists of PPAR-gamma receptors, reducing
peripheral insulin resistance
257) 59
258) Urea breath test - no antibiotics in past 4 weeks, no antisecretory
drugs (e.g. PPI) in past 2 weeks

259) 59
260) Epidermis - 5 layers - bottom layer = stratum germinativum
which gives rise to keratinocytes and contains melanocytes

261) 58
262) Naftidrofuryl is a 5-HT2 receptor antagonist which can be used
for peripheral vascular disease

263) 58
264) Chondrocalcinosis helps to distinguish pseudogout from gout

265) 57
266) Hereditary angioedema (HAE) is pathophysiologically separate
from anaphylaxis and is treated differently. Therapeutic options are:
intravenous infusion of human C1-esterase inhibitor or subcutaneous
injection of the bradykinin receptor inhibitor icatibant

267) 56
268) Anaphylaxis - serum tryptase levels rise following an acute
episode

269) 56
270) Uterine fibroids may rarely be associated with secondary
polycythaemia due to autonomous production of erythropoietin

271) 56
272) Ascites: a high SAAG gradient (> 11g/L) indicates portal
hypertension

273) 55
274) Sodium valproate may cause tremor

275) 55
276) Obesity - NICE bariatric referral cut-offs
277) with risk factors (T2DM, BP etc): > 35 kg/m^2
278) no risk factors: > 40 kg/m^2

279) 54
280) Dystrophia myotonica - DM1
281) distal weakness initially
282) autosomal dominant
283) diabetes
284) dysarthria

285) 54
286) For a man with mitochondrial disease, none of his children will
inherit the condition

287) 54
288) Ebstein's anomaly → tricuspid regurgitation → pansystolic
murmur, worse on inspiration

289) 54
290) Cat scratch disease - caused by Bartonella henselae

291) 53
292) People with cardiac syndrome X have normal coronary
angiograms despite ECG changes on exercise stress testing

293) 53
294) HIV: anti-retrovirals - P450 interaction
295) nevirapine (a NNRTI): induces P450
296) protease inhibitors: inhibits P450

297) 52
298) Fabry disease: X-linked recessive

299) 52
300) Glycaemic control in diabetes may be worsened by nicotinic acid

301) 51
302) PPIs are a cause of microscopic colitis, which can present with
chronic diarrhoea, colonoscopy and biopsy should be considered when
patients present in this way and are taking a PPI

303) 51
304) Reticulocytes have a mesh-like (reticular) network of ribosomal
RNA that is visible when stained. This is not present in mature
erythrocytes

305) 50
306) Bacterial vaginosis - overgrowth of predominately Gardnerella
vaginalis
307) 49
308) Sulfonylureas - bind to an ATP-dependent K +(KATP) channel on the
cell membrane of pancreatic beta cells

309) 49
310) Witnessed cardiac arrest while on a monitor - up to three
successive shocks before CPR

311) 49
312) If C. difficile does not respond to first-line vancomycin , oral
fidaxomicin should be used next, except in life-threatening infections

313) 48
314) In gestational diabetes, if blood glucose targets are not met with
diet/metformin then insulin should be added

315) 48
316) Hereditary angioedema - C4 is the best screening test inbetween
attacks

317) 47
318) Normal pO2 but decreased oxygen saturation is characteristic of
methaemoglobinaemia

319) 47
320) Colorectal cancer screening - PPV of FOB = 5 - 15%

321) 47
322) SIADH - drug causes: carbamazepine, sulfonylureas, SSRIs,
tricyclics

323) 46
324) SeHCAT is the investigation of choice for bile acid malabsorption

325) 44
326) Power - the probability of (correctly) rejecting the null hypothesis
when it is false

327) 43
328) Moraxella catarrhalis - Gram-negative cocci

329) 41
330) Amphotericin B binds with ergosterol, a component of fungal cell
membranes, forming pores that cause lysis of the cell wall and
subsequent fungal cell death
331) 40
332) Secretin increases secretion of bicarbonate-rich fluid from
pancreas and hepatic duct cells

333) 38
334) Wilcoxon signed-rank test - compares two sets of observations
on a single sample, e.g. a 'before' and 'after' test on the same
population following an intervention

335) 36
336) Aciclovir - guanosine analog, phosphorylated by thymidine
kinase which in turn inhibits the viral DNA polymerase

337) 35
338) Amantadine - inhibits uncoating (M2 protein) of virus in cell. Also
releases dopamine from nerve endings

339) 32
340) Ribavirin - guanosine analog which inhibits inosine
monophosphate (IMP) dehydrogenase, interferes with the capping of
viral mRNA

341) 22
342) The thin ascending limb of the loop of Henle is impermeable to
water

343) Intravenous phenytoin can cause hypotension

344) Phenytoin use is a cause of the cerebellar syndrome

345) Sulphonylureas may cause syndrome of inappropriate ADH

346) Nicotinic acetylcholine - ligand-gated ion channel receptor

347) IV ceftriaxone should be used as first-line treatment of Lyme

disease with disseminated or central nervous system involvement

348) Schizonts and late stages of trophozoites are typically sequested

in Plasmodium falciparum infection and their presence on the
peripheral smear indicates severe disease
349) Human papillomavirus 16/18 is a risk factor for oropharyngeal
cancer

350) Carbon monoxide poisoning: 100% high-flow oxygen is the first-

line treatment

351) Bupropion is a norepinephrine-dopamine reuptake inhibitor and

nicotinic antagonist

352) Lithium toxicity: IV saline is the first-line treatment

353) The first line investigation for adults with suspected asthma is to
measure the eosinophil count OR fractional nitric oxide

354) FVC is used to monitor respiratory function in Guillain-Barre

syndrome

355) Brown-Sequard syndrome is a result of lateral hemisection of the

spinal cord

356) In patients with a new diagnosis of dermatomyositis, urgent

malignancy screen is needed

357) Adult-onset Still's disease is a diagnosis of exclusion and can only

be diagnosed if rheumatoid factor and anti-nuclear antibody are
negative

358) Tertiary hyperparathyroidism is an important differential in

hypercalcaemia post renal replacement therapy

359) New onset AF is considered for electrical cardioversion if it

presents within 48 hours of presentation
360) If high-risk of failure of cardioversion (previous failure), offer
electrical cardioversion after at least 4 weeks treatment with
amiodarone

361) In genetics, expressivity describes the extent to which a

genotype shows its phenotypic expression in an individual

362) Vitamin C (ascorbic acid) supplementation can aid iron

absorption from the gut by conversion of Fe3+ to Fe2+

363) The hazard ratio is typically used when analysing survival over
time

364) Loss of corneal reflex - think acoustic neuroma

365) Pulmonary arteries vasoconstrict in the presence of hypoxia

366) Immune cells bind to the crystallising region (Fc) of

immunoglobulins

367) Confusion in an asthma attack is a life-threatening feature

368) An obsession is an intrusive, unpleasant and unwanted thought.

A compulsion is a senseless action taken to reduce the anxiety caused
by the obsession

369) Severe depression can mimic dementia but gives a pattern of

global memory loss rather than short-term memory loss - this is called
pseudodementia

370) Deficiency in C1q, C1rs, C2 and C4 predisposes to immune

complex disease such as SLE

371) Intravenous calcium gluconate is used for the acute

management of hypocalcaemia
372) Acute toxoplasmosis in the immunocompetent patient can mimic
acute EBV infection (low-grade fever, generalised lymphadenopathy
with prominent cervical lymph nodes and malaise) and should be
suspected with negative EBV serology. Pregnancy testing and
counselling is paramount due to the risk of congenital toxoplasmosis

373) Laughter → fall/collapse ?cataplexy

374) Contrast-induced nephropathy occurs 2 -5 days after

administration

375) In a mild-moderate flare of distal ulcerative colitis, the first-line

treatment is topical (rectal) aminosalicylates

376) Polycythaemia rubra vera is associated with a low ESR

377) Leptospirosis - give IV benzylpencillin for severe disease

378) CLL - immunophenotyping is investigation of choice

379) Minimal change disease - prednisolone

380) Alcohol withdrawal

381) symptoms: 6-12 hours
382) seizures: 36 hours
383) delirium tremens: 72 hours

384) CKD on haemodialysis - most likely cause of death is IHD

385) Acne vulgaris in pregnancy - use oral erythromycin if treatment

needed
386) Staphylococci is the leading organism contributing to mortality in
infective endocarditis

387) The Cushing reflex is a physiological nervous system response to

increased intracranial pressure (ICP) that results in hypertension and
bradycardia

388) Tricuspid valve endocarditis can cause tricuspid regurgitation,

which may manifest with a new pan-systolic murmur, large V waves
and features of pulmonary emboli

389) Coxiella presents may present with culture-negative endocarditis

390) Topiramate can precipitate acute angle closure glaucoma

391) Obesity can caused decreased BNP levels, leading to a false

negative for heart failure screening

392) Hydroxychloroquine is the treatment of choice for SLE

393) Statins inhibit HMG-CoA reductase, the rate-limiting enzyme in

hepatic cholesterol synthesis

394) Keloid scars are most common on the sternum

395) Fluctuating confusion/consciousness? - subdural haematoma

396) Nitric oxide - vasodilation + inhibits platelet aggregation

397) Rapidly progressive glomerulonephritis, causes:

398) Goodpasture's
399) ANCA positive vasculitis
400) V for Vigabatrin - V for Visual field defects

401) The most common malignancy associated with acanthosis

nigricans
is gastrointestinal adenocarcinoma

402) A rare but recognised adverse effect of lamotrigine therapy is

Stevens-Johnson syndrome

403) In patients with non-alcoholic fatty liver disease, enhanced liver

fibrosis (ELF) testing is recommended to aid diagnosis of liver fibrosis

404) Antivirals are of no benefit in the treatment of confirmed viral

meningitis

405) Vincristine acts during the metaphase

406) M. tuberculosis can cause hypoadrenalism

407) Yellow fever typically presents with flu like illness → brief
remission→ followed by jaundice and haematemesis

408) A common complication of plasma exchange is hypocalcaemia

409) Buprenorphine or fentanyl are the opioids of choice for pain relief
in palliative care patients with severe renal impairment, as they are
not renally excreted and therefore are less likely to cause toxicity than
morphine

410) Osmotic demyelination syndrome develops secondary to

astrocyte apoptosis

411) Addison's disease is associated with a metabolic acidosis

412) Spontaneous bacterial peritonitis - treatment: intravenous
cefotaxime

413) Paroxetine - higher incidence of discontinuation symptoms

414) HOCM - poor prognostic factor on echo = septal wall thickness of

> 3cm

415) Alcohol is a common trigger for cluster headaches

416) Sotalol is known to cause long QT syndrome

417) Troponin T binds to tropomyosin, forming a troponin-tropomyosin

complex

418) NSAIDs are a cause of acute interstitial nephritis

419) Amiodarone can cause corneal opacities

420) In the investigation of acromegaly, if a patient is shown to have

raised IGF-1 levels, an oral glucose tolerance test (OGTT) with serial
GH measurements is suggested to confirm the diagnosis

421) ACE inhibitors can cause first dose hypotension

422) The most common malignancy in the lower lip is a squamous cell
carcinoma

423) Lethargy is a very common early symptom of multiple sclerosis

424) T2DM on metformin, if HbA1c has risen to 58 mmol/mol then one

of the following should be offered depending on the individual clinical
scenario:
425) DPP-4 inhibitor
426) pioglitazone
427) sulfonylurea
428) SGLT-2 inhibitor (if NICE criteria met)

429) Dyspnoea, obstructive pattern on spirometry in patient with

rheumatoid → ? bronchiolitis obliterans

430) Aspirin is a common cause of urticaria

431) Osteoporosis in a man - check testosterone

432) Keloid scars - more common in young, black, male adults

433) Syringe drivers: respiratory secretions & bowel colic may be

treated by hyoscine hydrobromide, hyoscine butylbromide, or
glycopyrronium bromide

434) Burning thigh pain - ? meralgia paraesthetica - lateral cutaneous

nerve of thigh compression

435) Post-exposure prophylaxis for HIV: oral antiretroviral therapy for

4 weeks

436) CT pancreas is the preferred diagnostic test for chronic

pancreatitis - looking for pancreatic calcification

437) Lithium toxicity can be precipitated by thiazides

438) In the UK all HIV positive women should be advised not to

breastfeed

439) The fastest conduction velocities in the heart are in the Purkinje
fibres
440) IL-8 - main functions include: neutrophil chemotaxis

441) Bisphosphonates are associated with an increased risk of

atypical stress fractures

442) One of the sequelae of diphtheria is cardiovascular disease;

notably heart block

443) DEXA scans: the T score is based on bone mass of young

reference population

444) A potassium above 6mmol/L should prompt cessation of ACE

inhibitors in a patient with CKD (once other agents that promote
hyperkalemia have been stopped)

445) SCCs arising in a chronic scar are typically more aggressive and
carry an increased risk of metastasis

446) Mucosal involvement is prominent and severe in Stevens-Johnson

syndrome

447) Clinical audit seeks to improve patient care and outcomes

through systematic review of care against explicit criteria and
the implementation of change

448) Tetanus toxin (tetanospasmin) blocks the release of the

inhibitory neurotransmitters GABA and glycine resulting in continuous
motor neuron activity

449) Red eye - glaucoma or uveitis?

450) glaucoma: severe pain, haloes, 'semi-dilated' pupil
451) uveitis: small, fixed oval pupil, ciliary flush

452) Congenital toxoplasmosis

453) cerebral calcification
454) chorioretinitis

455) Raynaud's disease (i.e. primary) presents in young women with

bilateral symptoms

456) Dermatophyte nail infections - use oral terbinafine

457) Renal transplant + infection ?CMV

458) COPD - reason for using inhaled corticosteroids - reduced

exacerbations

459) Diabetic nephropathy histological findings- Kimmelstiel-Wilson

lesions, nodular glomerulosclerosis

460) Staphylococcus saprophyticus can commonly cause UTI in

sexually active young women

461) Dapsone + dyspnoea → methaemoglobinaemia

462) Campylobacter infection is characterised by a prodrome,

abdominal pain and bloody diarrhoea

463) NSAIDs are a cause of thrombocytopenia

464) Beta-blockers can cause sleep disturbance

465) Lithium levels should be checked every 3 months once a stable

dose has been achieved

466) Aspirin decreases the formation of thromboxane A2 resulting in

decreased platelet aggregation
467) Baclofen and gabapentin are first-line for spasticity in multiple
sclerosis

468) A skin biopsy is used to diagnose dermatitis herpetiformis

469) Adrenaline induced ischaemia - phentolamine

470) Antiplatelets
471) TIA: clopidogrel
472) ischaemic stroke: clopidogrel

473) Essential tremor is an AD condition that is made worse when

arms are outstretched

474) Macular degeneration - smoking is risk factor

475) X-linked recessive conditions - there is no male-to-male

transmission. Affected males can only have unaffected sons and carrier
daughters.

476) Wilson's disease - serum caeruloplasmin is decreased

477) Nimodipine is used to prevent vasospasm in aneurysmal

subarachnoid haemorrhages

478) 'CRAB' features of multiple myeloma = hyperCalcaemia, Renal

failure, Anaemia (and thrombocytopenia) and Bone fractures/lytic
lesions

479) Drugs which exhibit zero-order kinetics include phenytoin,

alcohol and salicylates
480) Typical antipsychotics should be avoided in delirious patients
with a background of Parkinson's disease

481) Cysticercosis can be treated with bendazoles

482) Ciprofloxacin is a P450 enzyme inhibitor

483) Use MRI FLAIR sequence in diagnosis of multiple sclerosis vs. MRI
STIR in flares of thyroid eye disease

484) Erythema nodosum may be caused by pregnancy

485) Transient elastography may be useful for diagnosing and

monitoring the severity of liver cirrhosis

486) Faecal incontinence is a risk factor for pressure ulcers

487) Hypertension should not be treated in the initial period following

an ischaemic stroke (unless prior to thrombolysis)

488) Lateral medullary syndrome - PICA lesion - cerebellar signs,

contralateral sensory loss & ipsilateral Horner's

489) Obesity hormones

490) Leptin Lowers appetite
491) Ghrelin Gains appetite

492) JVP: y descent = opening of tricuspid valve

493) Polymorphic eruption of pregnancy is not associated with

blistering
494) Indications for corticosteroid treatment for sarcoidosis are:
parenchymal lung disease, uveitis, hypercalcaemia and neurological or
cardiac involvement

495) The main source of IL-1 is macrophages

496) Urine output of < 0.5 ml/kg/hr over 6 consecutive hours

constitutes an acute kidney injury

497) Donepezil can cause insomnia

498) Non-REM stage 1 (N1) sleep is the lightest sleep which is

associated with hypnagogic jerks

499) When treating angina, if there is a poor response to the first-line

drug (e.g. a beta-blocker), the dose should be titrated up before adding
another drug

500) An aspergilloma may arise in a lung cavity that developed

secondary to previous tuberculosis

501) Leishmaniasis is caused by the intracellular protozoa Leishmania,

which are spread by the bites of sandflies

502) Lichen sclerosus: itchy white spots typically seen on the vulva of
elderly women

503) Hodgkin's lymphoma - best prognosis = lymphocyte predominant

504) Congenital rubella

505) sensorineural deafness
506) congenital cataracts

507) Diarrhoea + hypokalaemia → villous adenoma

508) Man returns from trip abroad with maculopapular rash and flu-
like illness - think HIV seroconversion

509) Management of venous ulceration - compression bandaging

510) Atypical antipsychotics commonly cause weight gain

511) Mycoplasma? - serology is diagnostic

512) SLE: complement levels (C3, C4) are usually low during active
disease - may be used to monitor flares

513) Radial tunnel syndrome presents similarly to lateral epicondylitis

however pain is typically distal to the epicondyle and worse on elbow
extension/forearm pronation

514) SSRIs + MDMA = higher risk of serotonin syndrome

515) Cutaneous leishmaniasis acquired in South or Central America

merits treatment due to the risk of mucocutaneous leishmaniasis
whereas disease acquired in Africa or India can be managed more
conservatively

516) Phosphate is reabsorbed in the proximal tubule

517) Pompholyx eczema is a subtype of eczema characterised by an

intensely pruritic rash on the palms and soles

518) Li-Fraumeni syndrome (p53 mutation) is associated with early-

onset breast cancer, sarcoma and leukaemia

519) Acute onset of tear-drop scaly papules on trunk and limbs → ?

guttate psoriasis
520) In patients with T2DM, SGLT-2 should be introduced at any point
they develop CVD, a high risk of CVD or chronic heart failure

521) TTP - plasma exchange is first-line

522) SSRI + NSAID = GI bleeding risk - give a PPI

523) Retinitis pigmentosa - night blindness + tunnel vision

524) Goodpasture's syndrome is caused by autoantibodies against

collagen type IV

525) B cells mediate hyperacute organ rejection

526) Thinning of pubic and axillary hair is seen in females with

Addison's disease due to reduced production of testosterones from the
adrenal gland

527) SSRIs are the first-line pharmacological therapy for generalised

anxiety disorder

528) Teicoplanin is similar to vancomycin (e.g. a glycopeptide

antibiotic), but has a significantly longer duration of action, allowing
once daily administration after the loading dose

529) On CT imaging, a chronic subdural haematoma will appear as a

hypodense (dark), crescentic collection around the convexity of the
brain

530) Latent syphilis (i.e asymptomatic syphilis) can occur at an early

and a late stage and requires the same antibiotic treatment
531) Familial hypercholesterolaemia is an autosomal dominant
condition

532) A beta-blocker or a calcium channel blocker is used first-line to

prevent angina attacks

533) Sulphonylureas may cause cholestasis

534) Congenital adrenal hyperplasia is most commonly due to 21-

hydroxylase deficiency

535) Japanese encephalitis can present with Parkinsonism- this is a

sign of basal ganglia involvement

536) T2DM initial therapy: if metformin is contraindicated + patient

has a risk of CVD, established CVD or chronic heart failure → SGLT-2
monotherapy

537) Arterial/venous thrombosis, miscarriage, livedo reticularis →

anticardiolipin antibody +ve

538) Intention to treat analysis - include patients who dropped out of

trial

539) Trimethoprim may cause pantcytopaenia

540) Supportive therapy is the mainstay of treatment in

Cryptosporidium diarrhoea

541) T2DM with abnormal LFTs - ? non-alcoholic fatty liver disease

542) Infective endocarditis - streptococcal infection carries a good

prognosis
543) An MRI whole spine should be performed in a patient suspected
of spinal metastases

544) Coeliac disease has a strong association with HLA-DQ2 (present

in 95% of patients)

545) A normal short synacthen test does not exclude adrenocortical

insufficiency due to pituitary failure

546) Hypoglycaemia in patients with alcoholic liver disease does not

respond to glucagon

547) Antipsychotics are associated with a significant increase in

mortality in dementia patients

548) Triptans should be avoided in patients taking a SSRI

549) High-resolution CT scanning is the diagnostic investigation of

choice for pancreatic cancer

550) Anti-A, B blood antibodies - IgM

551) Lithium toxicity can be precipitated by ACE inhibitors

552) Distal renal tubular acidosis can cause calcium phosphate renal
stones and is linked to Sjogrens syndrome

553) Mercury poisoning can cause visual field defects, hearing loss
and paraesthesia

554) Same-day referral to a dermatologist is recommended if eczema

herpeticum is suspected
555) Microtubules help guide movement during intracellular transport
and also help bind internal organelles

556) If starting an SGLT-2 as initial therapy for T2DM then ensure

metformin is titrated up first

557) Common variable immunodeficiency - low antibody levels,

specifically in immunoglobulin types IgG, IgM and IgA. → recurrent
chest and other infections

558) NICE recommend co-prescribing a PPI with NSAIDs in all patients

with osteoarthritis

559) Medication overuse headache

560) simple analgesia + triptans: stop abruptly
561) opioid analgesia: withdraw gradually

562) Gingival hyperplasia: phenytoin, ciclosporin, calcium channel

blockers and AML

563) Holmes ADIe = DIlated pupil, females, absent leg reflexes

564) PCI - patients with drug-eluting stents require a longer duration

of clopidogrel therapy

565) Prolactin release is persistently inhibited by dopamine

566) Leucocyte alkaline phosphatase is low in CML but raised in

myelofibrosis

567) Raised total T3 and T4 but normal fT3 and fT4 suggest high
concentrations of thyroid binding globulin, which can be seen during
pregnancy
568) Renal transplant patients - skin cancer (particularly squamous
cell) is the most common malignancy secondary to
immunosuppression

569) Thyrotoxic storm is treated with beta blockers, propylthiouracil

and hydrocortisone

570) Offer allopurinol to all patients after their first attack of gout

571) Left parasternal heave is a feature of tricuspid regurgitation

572) Campylobacter infection is often self-limiting but if severe then

treatment with clarithromycin may be indicated

573) TTP presents with a pentad of fever, neuro signs,

thrombocytopenia, haemolytic anaemia and renal failure

574) ADPKD is associated with mitral valve prolaspe

575) Disseminated gonococcal infection triad = tenosynovitis,

migratory polyarthritis, dermatitis

576) Leber's Hereditary Optic Neuropathy: mitochondrial inheritance

pattern

577) Nicorandil may cause ulceration anywhere in the gastrointestinal

tract

578) Melanoma: the invasion depth of the tumour is the single most
important prognostic factor

579) Breast feeding is acceptable with nearly all anti-epileptic drugs

580) Erythema nodosum is associated with a good prognosis in
sarcoidosis

581) Atrial natriuretic peptide - powerful vasodilator

582) Asymmetrical symptoms suggests idiopathic Parkinson's

583) Troponin C binds to calcium ions

584) Dry beriberi is caused by thiamine deficiency and causes

peripheral neuropathy

585) Otitis externa and blepharitis are common complications of

seborrhoeic dermatitis

586) A central scotoma is a feature of optic neuritis

587) When analyzing data on a scatter plot, linear regression may be

used to predict how much one variable changes when a second
variable is changed

588) Vitamin D increases serum calcium primarily through raising its

absorption via the small intestine

589) Erythema nodosum can be caused by streptococcal infection

590) In sickle-cell, acute painful vaso-occlusive crises should be

diagnosed clinically

591) Severe pre-eclampsia - restrict fluids

592) Motion sickness - hyoscine > cyclizine > promethazine

593) Dermatitis herpetiformis - caused by IgA deposition in the dermis

594) Flashes and floaters - vitreous/retinal detachment

595) JVP: x descent = fall in atrial pressure during ventricular systole

596) Dry skin is the most common side-effect of isotretinoin

597) NICE recommend avoiding lactulose in the management of IBS

598) Phenytoin induces vitamin K metabolism, which can cause a

relative vitamin K deficiency, creating the potential for heamorrhagic
disease of the newborn

599) Klumpke's paralysis: T1 nerve root damage

600) Early endoscopy and risk stratification is important in patients

with symptomatic caustic ingestion

601) Thiazides may cause photosensitivity

602) Cryptosporidium can be diagnosed by modified Ziehl-Neelsen

staining of stool to reveal red cysts

603) The definitive management of primary hyperparathyroidism is

total parathyroidectomy

604) Patients who are high-risk for contrast-induced nephropathy

should have metformin withheld for a minimum of 48 hours and until
the renal function has been shown to be normal

605) Coagulase-negative, Gram-positive bacteria such

as Staphylococcus epidermidis are the most common cause of
neutropenic sepsis
606) Oral steroids are the first-line treatment for pyoderma
gangrenosum

607) Metastatic bone pain may respond to analgesia, bisphosphonates

or radiotherapy

608) Benzodiazepines enhance the effect of GABA, the main inhibitory

neurotransmitter

609) Fluctuating consciousness = subdural haemorrhage

610) Diffuse proliferative glomerulonephritis, causes:

611) post-streptococcal
612) SLE

613) Unmasking of Churg-Strauss syndrome: Montelukast

614) Narcolepsy is associated with low orexin (hypocretin) levels

615) Carcinoid syndrome can affect the right side of the heart. The
valvular effects are tricuspid insufficiency and pulmonary stenosis

616) Benign ethnic neutropaenia is common in people of black African

and Afro-Caribbean ethnicity

617) Oxycodone is a safer opioid to use in patients with moderate to

end-stage renal failure

618) Reactive arthritis: develops after an infection where the

organism cannot be recovered from the joint
619) Familial Mediterranean fever (FMF) is an autosomal recessive,
hereditary inflammatory disorder characterised by reoccurring
episodes of abdominal pain, fever, arthralgia, and chest pain

620) Amiodarone in breastfeeding must be avoided

621) Recall bias is a particular problem in case-control studies

622) Vomiting / aspiration - metabolic alkalosis

623) Least abundant isotype in blood serum - IgE

624) Screen for HLA-B *5801 allele in a patient at high risk for
allopurinol induced severe cutaneous adverse reaction

625) Suxamethonium is a depolarising muscle relaxant

626) MDMA (Ecstasy) poisoning is associated with hyponatraemia

627) The renoprotective effects of ACE inhibitors are mediated

through dilation of the glomerular efferent arteriole

628) Cushing's syndrome - hypokalaemic metabolic alkalosis

629) Horner's syndrome - anhydrosis determines site of lesion:

630) head, arm, trunk = central lesion: stroke, syringomyelia
631) just face = pre-ganglionic lesion: Pancoast's, cervical rib
632) absent = post-ganglionic lesion: carotid artery

633) Hypocalcaemia: Trousseau's sign is more sensitive and specific

than Chvostek's sign

634) Gastric MALT lymphoma - eradicate H. pylori

635) Gentamicin causes an intrinsic AKI

636) Hashimoto's thyroiditis is associated with the development of

MALT lymphoma

637) Tuberous sclerosis patients develop renal angiomyolipomata

which are prone to haemorrhage

638) Haemochromatosis is a risk factor for pseudogout

639) REM sleep is associated with dreaming and loss of muscle tone

640) Myelofibrosis is associated with 'tear drop' poikilocytes on blood

film

641) Ataxic telangiectasia is characterised by cerebellar ataxia and

telangiectasia, onset is in childhood

642) Meningiomas are typically benign tumours that arise from the
arachnoid cap cells of the meninges but are typically located next to
the dura

643) NICE guidelines do not support the use of memantine in mild

dementia

644) Smoking is a P450 enzyme inductor

645) Chancroid causes painful genital ulcers

646) Herpes hominis virus 7 (HHV-7) is thought to play a role in the

aetiology of pityriasis rosea
647) Mycophenolate mofetil inhibits of inosine-5'-monophosphate
dehydrogenase which is needed for purine synthesis

648) Systemic glucocorticoids can cause drug-induced acne. This is

characterised as monomorphic papular rash without comedones or
cysts. This does not respond to acne treatment but improves on drug
discontinuation

649) The 'double duct' sign may be seen in pancreatic cancer

650) In toxic multinodular goitre, nuclear scintigraphy reveals patchy

uptake

651) Brain abscess: IV 3rd-generation cephalosporin + metronidazole

652) If subarachnoid haemorrhage is suspected but a CT head done

within 6 hours of symptom onset is normal, do not do an LP, consider
an alternative diagnosis instead

653) Combined oral contraceptive pill

654) increased risk of breast and cervical cancer
655) protective against ovarian and endometrial cancer

656) CKD: only diagnose stages 1 & 2 if supporting evidence to

accompany eGFR

657) Antiphospholipid syndrome in pregnancy: aspirin + LMWH

658) Paraneoplastic features of lung cancer

659) squamous cell: PTHrp, clubbing, HPOA
660) small cell: ADH, ACTH, Lambert-Eaton syndrome

661) Cubital tunnel syndrome is caused by compression of the ulnar

nerve and can present with tingling/numbness of the 4th and 5th finger
662) Bleeding on dabigatran? Can use idarucizumab to reverse

663) Sarin gas is a highly toxic synthetic organophosphorus

compound which causes inhibition of the enzyme acetylcholinesterase

664) Headache caused by raised intracranial pressure due to brain

cancer (or metastases) can be palliated with dexamethasone

665) Beta-blocker - atropine, glucagon in resistant cases

666) SLE is a risk factor for warm autoimmune haemolytic anaemia

667) Dexamethasone improves outcomes (by reducing neurological

sequelae) in the treatment of bacterial meningitis

668) Haloperidol is contraindicated in patients with Parkinson's

disease

669) Extensor plantars + absent ankle jerk → mixed UMN + LMN

signs- motor neuron disease, subacute combined degeneration of cord,
syringomyelia

670) A non-healing painless ulcer associated with a chronic scar is

indicative of squamous cell carcinoma (SCC)

671) Cessation of smoking may trigger an ulcerative colitis flare

672) OCD with mild impairment: low-intensity psychological

treatments: cognitive behavioural therapy (CBT) including exposure
and response prevention (ERP) is first-line

673) Migraine, stroke → ?patent foramen ovale

674) Returning traveller with fever/flu-like symptoms,
anaemia/jaundice/renal impairment → ?falciparum malaria

675) Alongside eye drops, IV acetazolamide is used in the initial

emergency medical management of acute angle-closure glaucoma

676) Shoulder abduction - deltoid muscle - axillary nerve (C5,C6)

677) Rasburicase - a recombinant version of urate oxidase, an enzyme

that metabolizes uric acid to allantoin

678) JVP: giant v waves in tricuspid regurgitation

679) IgD is involved in the activation of B-cells

680) Confusion, gait ataxia, nystagmus + ophthalmoplegia are

features of Wernicke's encephalopathy

681) Negative non-treponemal test + positive treponemal test is

consistent with successfully treated syphilis

682) Ketamine is an NMDA receptor antagonist

683) 1st line of treatment for blepharitis is hot compresses

684) Klinefelter's syndrome - elevated gonadotrophin levels

685) Nitric oxide , second messenger = cGMP

686) Contrast MRI scan is the gold standard investigation for cerebral
metastases - provided no contraindications
687) Eczema herperticum rash can be described as monomorphic
punched-out erosions (circular, depressed, ulcerated lesions) usually 1-
3 mm in diameter

688) Irradiated blood products are used to avoid transfusion-

associated graft versus host disease

689) The short synacthen test is the best test to diagnose Addison's
disease

690) Flow volume loop is the investigation of choice for upper airway
compression

691) HRT: adding a progestogen increases the risk of breast cancer

692) Dentistry in warfarinised patients - check INR 72 hours before

procedure, proceed if INR < 4.0

693) Tight control of vascular risk factors, rather than antidementia

medication, is recommended by NICE in vascular dementia

694) Paget's disease of the bone is treated with bisphosphonates

695) Troponin I binds to actin to hold the troponin-tropomyosin

complex in place

696) Acral lentiginous melanoma: Pigmentation of nail bed affecting

proximal nail fold suggests melanoma (Hutchinson's sign)

697) Insulin binds to a receptor tyrosine kinase in the cell membrane

698) Peptic ulceration, galactorrhoea, hypercalcaemia - multiple

endocrine neoplasia type I
699) Patients with obsessive-compulsive personality can be rigid with
respect to morals, ethics and values and often are reluctant to
surrender work to others

700) Measles complication - pneumonia

701) Latanoprost is a prostaglandin analog used in glaucoma. It works

by increasing uveoscleral outflow

702) A relative afferent pupillary defect is when the affected and

normal eye appears to dilate when light is shone on the affected eye

703) In a mild-moderate flare of ulcerative colitis extending past the

left-sided colon, oral aminosalicylates should be added to rectal
aminosalicylates, as enemas only reach so far

704) Nondisjunction is the commonest cause of Down's syndrome

705) The EMA binding test should be used to diagnose hereditary

spherocytosis - the osmotic fragility test is no longer widely used

706) p53 - plays a crucial role in the cell cycle, preventing entry into
the S phase until DNA has been checked and repaired

707) Ongoing diarrhoea in Crohn's patient post-resection with normal

CRP → cholestyramine

708) Rosacea: a combination of topical ivermectin + oral doxycycline

is first-line for patients with severe papules and/or pustules

709) Blisters/bullae
710) no mucosal involvement: bullous pemphigoid
711) mucosal involvement: pemphigus vulgaris
712) Hypertension - NICE now recommend ambulatory blood pressure
monitoring to aid diagnosis

713) Ivabradine use may be associated with visual disturbances

including phosphenes and green luminescence

714) Severe hepatitis in a pregnant woman - think hepatitis E

715) Diabetes meliitus diagnosis: fasting > 7.0, random > 11.1 - if
asymptomatic need two readings

716) Flexural psoriasis - topical steroid

717) Mesangiocapillary glomerulonephritis (membranoproliferative)

718) type 1: cryoglobulinaemia, hepatitis C
719) type 2: partial lipodystrophy

720) Fundoscopy reveals end organ damage in hypertension

721) Aminophylline reduces the effect of adenosine

722) Over rapid aspiration/drainage of pneumothorax can result in re-

expansion pulmonary oedema

723) Takayasu's arteritis is an obliterative arteritis affecting the aorta

724) Lentigo maligna melanoma: Suspicious freckle on face or scalp of

chronically sun-exposed patients

725) Type II hypersensitivity reaction - ITP

726) Asthmatic features/features suggesting steroid responsiveness in

COPD:
727) previous diagnosis of asthma or atopy
728) a higher blood eosinophil count
729) substantial variation in FEV1 over time (at least 400 ml)
730) substantial diurnal variation in peak expiratory flow (at least
20%)

731) Orlistat works by inhibiting gastric and pancreatic lipase to

reduce the digestion of fat

732) Common features of PTSD

733) re-experiencing e.g. flashbacks, nightmares
734) avoidance e.g. avoiding people or situations
735) hyperarousal e.g.hypervigilance, sleep problems

736) Adrenaline acts via G protein-coupled receptors

737) Swelling at the DIP joints (Heberden's nodes) is a feature of

osteoarthritis in the hand

738) Gitelman's syndrome: normotension, hypokalaemia +

hypocalciuria

739) Symptom control in non-CF bronchiectasis - inspiratory muscle

training + postural drainage

740) Ventricular tachycardia - verapamil is contraindicated

741) Limited (central) systemic sclerosis = anti-centromere

antibodies

742) Genital ulcers

743) painful: herpes much more common than chancroid
744) painless: syphilis more common than lymphogranuloma
venereum
745) Mucocutaneous ulceration following travel? - Leishmania
brasiliensis

746) The presence of upper respiratory tract signs points towards

granulomatosis with polyangiitis in a patient with rapidly progressive
glomerulonephritis

747) Surgery is indicated in patients with ongoing acute bleeding

despite repeated endoscopic therapy

748) Amyotrophic lateral sclerosis is associated with mixed UMN and

LMN signs (usually no sensory deficits)

749) Duloxetine mechanism of action = serotonin and noradrenaline

reuptake inhibitor

750) CN6 palsy manifesting as diplopia could be the first sign of brain
metastasis

751) Carbamazepine is known to exhibit autoinduction. hence when

patients start carbamazepine they may see a return of seizures after 3-
4 weeks of treatment

752) Trypanosomiasis: African-form causes sleeping sickness and

American-form causes Chagas' disease

753) HIV is associated with seborrhoeic dermatitis

754) Acute dystonia - sustained muscle contraction such as torticollis

or oculogyric crisis

755) Amiloride selectively blocks the epithelial sodium transport

channels
756) Vitamin K acts as a cofactor in the carboxylation of clotting
factors (II, VII, IX, X)

757) Arrhythmogenic right ventricular cardiomyopathy - T wave

inversion in V1-3

758) If a patient has had 5 doses of tetanus vaccine, with the last
dose < 10 years ago, they don't require a booster vaccine nor
immunoglobulins, regardless of how severe the wound is

759) Bone pain, tenderness and proximal myopathy (→ waddling gait)

→ ?osteomalacia

760) Genital wart treatment

761) multiple, non-keratinised warts: topical podophyllum
762) solitary, keratinised warts: cryotherapy

763) Patients with established cardiovascular disease (e.g. IHD,

stroke, PVD) should take high-intensity statin therapy (e.g. atorvastatin
80mg) regardless of baseline lipid profile

764) Diffuse proliferative glomerulonephritis is the most common and

severe form of renal disease in SLE patients

765) Trastuzumab (Herceptin) - cardiac toxicity is common

766) Metformin should be titrated slowly, leave at least 1 week before

increasing dose

767) Oesophageal adenocarcinoma is associated with GORD or

Barrett's

768) In patients with factor V Leiden, activated factor V is inactivated

10 times more slowly by activated protein C than normal
769) Burkitt's lymphoma is commonly associated with c-MYC

770) Cocaine can induce preterm labour

771) A facial palsy caused by an upper motor neuron lesion 'spares'

the upper face i.e. forehead

772) Contralateral hemiparesis and sensory loss with the upper

extremity being more affected than the lower, contralateral
homonymous hemianopia and aphasia - middle cerebral artery

773) Paget's disease - increased serum and urine levels of

hydroxyproline

774) Grave's disease, orange peel shin lesions - pretibial myxoedema

775) Multiple sclerosis is a cause of spastic paraparesis

776) Variance = square of standard deviation

777) 'B' symptoms in Hodgkin's lymphoma are associated with a poor

prognosis
778) weight loss > 10% in last 6 months
779) fever > 38ºC
780) night sweats

781) Causes of raised prolactin - the p's

782) pregnancy
783) prolactinoma
784) physiological
785) polycystic ovarian syndrome
786) primary hypothyroidism
787) phenothiazines, metoclopramide, domperidone
788) Bartter's syndrome is associated with normotension

789) There is no evidence that antibiotics other than enzyme inducing

antibiotics such as rifampicin reduce the efficacy of the combined oral
contraceptive pill

790) Management of high altitude cerebral edema (HACE) is with

descent + dexamethasone

791) Ehlers-Danlos syndrome is most commonly associated with a

defect in type III collagen

792) Interferon-γ is responsible for activating macrophages

793) Nodular melanoma: Invade aggressively and metastasise early

794) Common peroneal nerve lesion can cause weakness of foot

dorsiflexion and foot eversion

795) Micturating cystography is the investigation of choice for reflux

nephropathy

796) Paranoid personality disorder may be diagnosed in patients who

are overly sensitive and can be unforgiving if insulted, question loyalty
of those around them and are reluctant to confide in others

797) Riboflavin deficiency causes angular cheilitis

798) Non specific (non gonococcal) urethritis is a common

presentation where inflammatory cells but no gonococcal bacteria are
seen on swab; it requires treatment with doxycycline or azithromycin
799) An itchy rash affecting the face and scalp distribution is
commonly caused by seborrhoeic dermatitis

800) Oral lichen planus typically presents with buccal white-lace

pattern lesions and ulcers

801) Interferon-gamma is produced primarily by natural killer cells

and T helper cells

802) Diarrhoea, weight, arthralgia, lymphadenopathy,

ophthalmoplegia ?Whipple's disease

803) Hypoglycaemia treatment - if the patient is conscious and able to

swallow the first-line treatment is a fast-acting carbohydrate by mouth
i.e.. glucose liquids, tablets or gels

804) Isotretinoin adverse effects

805) teratogenicity - females MUST be taking contraception
806) low mood
807) dry eyes and lips
808) raised triglycerides
809) hair thinning
810) nose bleeds

811) Co-danthramer is genotoxic and should only be prescribed to

palliative patients due to its carcinogenic potential

812) Otosclerosis is characterised by conductive hearing loss, tinnitus

and positive family history

813) Contrast-enhanced CT coronary angiogram is the first line

investigation for stable chest pain of suspected coronary artery disease
aetiology
814) Fluorescence in situ hybridization uses fluorescent DNA or RNA
probe to bind to specific gene site of interest for direct visualisation of
chromosomal anomalies

815) Vitamin A toxicity is a rare cause of papilloedema

816) Gastrointestinal side-effects such as diarrhoea are seen in SSRI

discontinuation syndrome

817) Immune reconstitution inflammatory syndrome can occur in HIV

positive patients when starting anti-retrovirals; this is an immune
phenomenon that results in the clinical worsening of a pre-exisiting
opportunistic infection

818) The triangle of safety for chest drain insertion involves the base
of the axilla, lateral edge pectoralis major, 5th intercostal space and
the anterior border of latissimus dorsi

819) Polymerase chain reactions are used to detect mutated

oncogenes

820) IgE is synthesised by plasma cells

821) Dermatomyositis antibodies: ANA most common, anti-Mi-2 most

specific

822) Antidiuretic hormone (ADH) - site of action = collecting ducts

823) Drusen = Dry macular degeneration

824) Autosomal recessive conditions are 'metabolic' - exceptions:

inherited ataxias

Autosomal dominant conditions are 'structural' - exceptions:

hyperlipidaemia type II, hypokalaemic periodic paralysis
825) Polycythaemia rubra vera - around 5-15% progress to
myelofibrosis or AML

826) CLL - treatment: Fludarabine, Cyclophosphamide and Rituximab

(FCR)

827) Women with hypothyroidism may need to increase their thyroid

hormone replacement dose by up to 50% as early as 4-6 weeks of
pregnancy

828) Measles is characterised by prodromal symptoms, Koplik spots.

maculopapular rash starting behind the ears and conjunctivitis

829) Rickettsia ricketsii is the causative organism for rocky mountain

spotted fever

830) Patients with orbital cellulitis require admission to hospital for IV

antibiotics due to the risk of cavernous sinus thrombosis and
intracranial spread

831) Tolvaptan is a vasopressin receptor 2 antagonist

832) Flashes + floaters are most commonly caused by a posterior

vitreous detachment

833) Pain on the radial side of the wrist/tenderness over the radial
styloid process ? De Quervain's tenosynovitis

834) Syndesmophytes (ossification of outer fibres of annulus fibrosus)

are a feature of ankylosing spondylitis

835) Nitazoxanide may be used to treat immunocompromised

patients with cryptosporidiosis
836) Topical steroids
837) moderate: Clobetasone butyrate 0.05%
838) potent: Betamethasone valerate 0.1%
839) very potent: Clobetasol propionate 0.05%

840) Eczema herpeticum is a serious condition that requires IV

antivirals

841) Prosthetic heart valves - mechanical valves last longer and tend
to be given to younger patients

842) Waterlow score - used to identify patients at risk of pressure

sores

843) The PTH level in primary hyperparathyroidism may be normal

844) Activated protein C resistance (Factor V Leiden) is the most

common inherited thrombophilia

845) Ankylosing spondylitis features - the 'A's

846) Apical fibrosis
847) Anterior uveitis
848) Aortic regurgitation
849) Achilles tendonitis
850) AV node block
851) Amyloidosis

852) Ankylosing spondylitis - x-ray findings: subchondral erosions,

sclerosis
and squaring of lumbar vertebrae

853) Aspergillus clavatus causes malt workers' lung, a type of EAA

854) Riedel's thyroiditis is associated with retroperitoneal fibrosis

855) Cyanide inhibits the enzyme cytochrome c oxidase, resulting in
cessation of the mitochondrial electron transfer chain

856) Patients with Waldenstrom's macroglobulinaemia often present

with issues secondary to hyperviscosity

857) Beta-blockers are known to exacerbate plaque psoriasis

858) Stroke and TIA are associated with sudden-onset 'negative'

symptoms, migraine is more commonly associated with 'positive'
symptoms

859) Myoclonic seizures: sodium valproate is first-line for males

860) Monocular transient painless loss of vision (amaurosis fugax)

should be treated as a TIA

861) A stable patient presenting in AF with an obvious precipitating

cause may revert to sinus rhythm without specific antiarrhythmic
treatment

862) Endothelin causes pulmonary vasoconstriction (hence why

antagonists are used in primary pulmonary hypertension)

863) Psoriatic arthritis is associated with HLA B27

864) Porphyria cutanea tarda - photosensitive rash with blistering and

skin fragility on the face and dorsal aspect of hands

865) Prosthetic heart valves - antithrombotic therapy:

866) bioprosthetic: aspirin
867) mechanical: warfarin + aspirin
868) Prolactin - under continuous inhibition

869) Motor neuron disease - treatment: NIV is better than riluzole

870) Trochanteric bursitis presents with isolated lateral hip/thigh pain

with tenderness over the greater trochanter

871) The main ECG abnormality seen with hypercalcaemia is

shortening of the QT interval

872) Graves' disease may present first or become worse during the
post-natal period

873) Urea breath test is the only test recommended for H. pylori post-
eradication therapy

874) C5-9 deficiency predisposes to Neisseria meningitidis infections

875) Faecal elastase is a useful test of exocrine function in chronic

pancreatits

876) Rate-limiting CCBs should be avoided in patients with AF with

heart failure with reduced EF (HFrEF) due to their negative inotropic
effects

877) Stereotypical features of Legionella include flu-like symptoms

and a dry cough, relative bradycardia and confusion. Blood tests may
show hyponatraemia

878) Calcification in lung metastases is uncommon except in the case

of chondrosarcoma or osteosarcoma

879) Bleeding gums and receding, think scurvy

880) For thrombectomy in acute ischaemic stroke, an extended target
time of 6-24 hours may be considered if there is the potential to
salvage brain tissue, as shown by imaging such as CT perfusion or
diffusion-weighted MRI sequences showing limited infarct core volume

881) Aminoglycoside nephrotoxicity is secondary to tubular necrosis

882) Patients with suspected neoplastic spinal cord compression

should have an urgent MRI of the whole spine

883) Drugs for neuropathic pain are typically used as monotherapy,

i.e. if not working then drugs should be switched, not added

884) Bevacizumab is a monoclonal antibody directed against vascular

endothelial growth factor (VEGF)

885) Phaeochromocytoma, renal cell cancer → ?Von Hippel-Lindau

syndrome

886) Brugada syndrome is due to a mutation of the myocardial

sodium ion channel protein

887) Bronchiectasis: most common organism = Haemophilus

influenzae

888) Aortic stenosis management: AVR if symptomatic, otherwise cut-

off is gradient of 40 mmHg

889) Primary biliary cholangitis - the M rule

890) IgM
891) anti-Mitochondrial antibodies, M2 subtype
892) Middle aged females

893) Congenital heart disease

894) cyanotic: TGA most common at birth, Fallot's most common
overall
895) acyanotic: VSD most common cause

896) Blisters/bullae
897) no mucosal involvement (in exams at least*): bullous pemphigoid
898) mucosal involvement: pemphigus vulgaris

899) The C6 dermatome is located on the index finger and thumb

900) Raynaud's - Type I cryoglobulinaemia

901) A normal temporal artery biopsy in a patient with suspected

giant cell arteritis does not exclude the disease because of the
potential for skip lesions

902) Ciprofloxacin lowers the seizure threshold

903) Harsh inspiratory breath sounds in the last hours of life are
caused by respiratory secretions, and can be treated with hyoscine
hydrobromide

904) Repeated cramping, rhabdomyolysis and myoglobinuria after

short bouts of exercise can point towards McArdle's disease

905) Familial adenomatous polyposis is due to a mutation in a tumour

suppressor gene called adenomatous polyposis coli gene (APC)

906) Sickle cell patients should be started on long term

hydroxycarbamide to reduce the incidence of complications and acute
crises

907) Dorzolamide - carbonic anhydrase inhibitor

908) Benzydamine hydrochloride mouthwash or spray may be useful
in reducing the discomfort associated with a painful mouth that may
occur at the end of life

909) The most common causes of viral meningitis in adults are

enteroviruses

910) Typical BPPV history:

911) vertigo triggered by change in head position (e.g. rolling over in
bed or gazing upwards)
912) may be associated with nausea
913) each episode typically lasts 10-20 seconds

914) Heparin-induced thrombocytopaenia - antibodies form against

complexes of platelet factor 4 (PF4) and heparin

915) Urinary incontinence - first-line treatment:

916) urge incontinence: bladder retraining
917) stress incontinence: pelvic floor muscle training

918) Relative risk = EER / CER

919) Acute angle closure glaucoma is associated with hypermetropia,

where as primary open-angle glaucoma is associated with myopia

920) Mitochondrial diseases follow a maternal inheritance pattern

921) Autosomal recessive conditions are 'metabolic' - exceptions:

inherited ataxias

Autosomal dominant conditions are 'structural' - exceptions: Gilbert's,

hyperlipidaemia type II

922) Adenosine
923) dipyridamole enhances effect
924) aminophylline reduces effect

925) PDE 5 inhibitors (e.g. sildenafil) - contraindicated by nitrates and

nicorandil

926) Venous thromoboembolism - length of anticoagulation

927) provoked (e.g. recent surgery): 3 months
928) unprovoked: 6 months

929) Non-functioning pituitary tumours present with hypopituitarism

and pressure effects

930) Leg crossing, squatting or kneeling may cause a foot drop

secondary to a common peroneal neuropathy

931) Delirium involves an impairment of conscious level and often

involves psychotic symptoms

932) Patients on warfarin undergoing emergency surgery - give four-

factor prothrombin complex concentrate

933) Verapamil and beta-blockers should never be taken concurrently

- possibility of heart block and fatal arrest

934) Rupture of the papillary muscle due to a myocardial infarction →

acute mitral regurgitation → widespread systolic murmur, hypotension,
pulmonary oedema

935) Atrioventricular dissociation suggests VT rather than SVT with

aberrant conduction

936) Immunocompetent patients with toxoplasmosis don't usually

require treatment
937) You cannot interpret TTG level in coeliac disease without looking
at the IgA level

938) Patients with osteopetrosis have normal calcium, phosphate, ALP

and PTH levels

939) A chest drain should be inserted if needle aspiration of a

pneumothorax is unsuccessful

940) EBV: associated malignancies:

941) Burkitt's lymphoma
942) Hodgkin's lymphoma
943) nasopharyngeal carcinoma

944) Odds - remember a ratio of the number of people who incur a

particular outcome to the number of people who do not incur the
outcome

NOT a ratio of the number of people who incur a particular outcome to

the total number of people

945) Rheumatoid arthritis - TNF is key in pathophysiology

946) Gastric adenocarcinoma - signet ring cells

947) During mitosis, sister chromatids move to opposite ends of the

cell during anaphase

948) A normal pCO2 in a patient with acute severe asthma is an

indicator that the attack may classified be life-threatening

949) Pelvic inflammatory disease: oral ofloxacin + oral metronidazole

can be used second-line
950) Frontotemporal dementia presents with social disinhibition and
often has a family history

951) AV block can occur following an inferior MI

952) Uraemic polyneuropathy is predominantly sensory

953) GnRH agonists (e.g. goserelin) used in the management of

prostate cancer may result in gynaecomastia

954) Hyperprolactinaemia is uncommon with certain atypical

antipsychotics - consider other causes such as prolactinoma if prolactin
raised

955) TD2M: if a triple combination of drugs has failed to reduce HbA1c

then switching one of the drugs for a GLP-1 mimetic is recommended,
particularly if the BMI > 35

956) Familial adenomatous polyposis - once diagnosed patients

typically have a total proctocolectomy with ileal pouch anal
anastomosis due to the extremely high risk of developing colorectal
cancer

957) Pneumothorax management: the high-risk characteristics that

determine the need for a chest drain are:
958) Haemodynamic compromise (suggesting a tension
pneumothorax)
959) Significant hypoxia
960) Bilateral pneumothorax
961) Underlying lung disease
962) ≥ 50 years of age with significant smoking history
963) Haemothorax

964) Absolute risk reduction = (Control event rate) - (Experimental

event rate)
965) Renal stones on x-ray
966) cystine stones: semi-opaque
967) urate + xanthine stones: radio-lucent

968) Anorexia features

969) most things low
970) G's and C's raised: growth hormone, glucose,
salivary glands, cortisol, cholesterol, carotinaemia

971) Sarcoidosis CXR

972) 1 = BHL
973) 2 = BHL + infiltrates
974) 3 = infiltrates
975) 4 = fibrosis

976) Amylase: breaks starch down to sugars

977) CD21 is the receptor for the Ebstein-Barr virus

978) Potent topical steroids are the first-line treatment for lichen
planus

979) HPV infection is the strongest risk factor for anal cancer

980) If subarachnoid haemorrhage is suspected but a CT head done >

6 hours after symptom onset is normal, a lumbar puncture should be
done to confirm or exclude the diagnosis

981) Trimethoprim in breastfeeding is considered safe to use

982) Ischaemic changes in leads V1-V4 - left anterior descending

983) Golimumab is a TNF inhibitor

984) Dosulepin - avoid as dangerous in overdose

985) Rheumatoid factor is an IgM antibody against IgG

986) Scabies - permethrin treatment: all skin including scalp + leave

for 12 hours + retreat in 7 days

987) Skewed distributions

988) alphabetical order: mean - median - mode
989) '>' for positive, '<' for negative

990) Exposure to asbestos is a risk factor for bronchial carcinoma as

well as mesothelioma

991) Deficiency of niacin (B3) causes pellagra

992) Pilocarpine is a muscarinic receptor agonist

993) ADPKD is associated with hepatomegaly (due to hepatic cysts)

994) Immune related adverse events in a patient on checkpoint

inhibitors (e.g. nivolumab)? Need to treat with corticosteroids

995) Angioid retinal streaks are a feature of pseudoxanthoma

elasticum

996) Sjogren's syndrome- HLA- DR3

997) The presence of an elevated prolactin level along with secondary

hypothyroidism and hypogonadism is indicative of stalk compression is
consistent with a non-functioning pituitary adenoma
998) Amlodipine may cause gingival hyperplasia

999) Relative afferent pupillary defect indicates an optic nerve lesion

or severe retinal disease

1000) The majority of glucose reabsorption in the nephron occurs

within the proximal convoluted tubule

1001) The Barthel index is a scale that measures disability or

dependence in activities of daily living in stroke patients

1002) Hiccups in palliative care - chlorpromazine or haloperidol

1003) Digoxin - inhibits the Na+/K+ ATPase pump

1004) The majority of patients with sarcoidosis get better without

treatment

1005) Restrictive cardiomyopathy: amyloid (most common),

haemochromatosis, Loffler's syndrome, sarcoidosis, scleroderma

1006) Inflammatory arthritis involving DIP swelling and dactylitis points

to a diagnosis of psoriatic arthritis

1007) Tetracyclines can cause photosensitivity

1008) Metabolic ketoacidosis with normal or low glucose: think alcohol

1009) HPV vaccination should be offered to men who have sex with
men under the age of 45 to protect against anal, throat and penile
cancers
1010) Hydrogen breath testing is an appropriate first line test for
diagnosis of small bowel overgrowth syndrome

1011) Hungry bone syndrome is the result of a sudden drop in

previously high parathyroid hormone levels

1012) HIV, neuro symptoms, single brain lesions with homogenous

enhancement - CNS lymphoma

1013) Basal atelectasis should be suspected in the presentation of

dyspnoea and hypoxaemia 72 hours post operatively

1014) Livedo reticularis can be caused by SLE

1015) The treatment of botulism - supportive care and botulism

antitoxin

1016) Patient with a fixed, false belief (delusion) that they are infested
by 'bugs' → delusional parasitosis

1017) RNA splicing takes place within the nucleus

1018) DVLA advice post MI - cannot drive for 4 weeks

1019) Exenatide causes vomiting

1020) Neuroimaging is required to diagnose dementia

1021) Acute myeloid leukaemia - poor prognosis: deletion of

chromosome 5 or 7

1022) Kallman's syndrome - LH & FSH low-normal and testosterone is

low
1023) Scleritis is painful, episcleritis is not painful

1024) CD15 is found on Reed-Sternberg cells

1025) Rapid sodium influx causes rapid depolarisation (phase 0)

1026) Topical eflornithine is the treatment of choice for facial hirsutism

1027) Type IV hypersensitivity reaction - scabies

1028) Membranous nephropathy is frequently associated with

malignancy

1029) Beta blockers such as timolol work in primary open-angle

glaucoma by reducing aqueous production

1030) The oral contraceptive pill is associated with drug-induced

cholestasis

1031) Telbivudine is a synthetic thymidine nucleoside analogue

1032) Pompholyx eczema may be precipitated by humidity (e.g.

sweating) and high temperatures

1033) Internuclear ophthalmoplegia is due to a lesion in the medial

longitudinal fasciculus

1034) Chronic infection with Burkholderia cepacia is an important CF-

specific contraindication to lung transplantation

1035) Doxazosin - alpha-1 antagonist

1036) Anion gap = (sodium + potassium) - (bicarbonate + chloride)

1037) Rosacea: topical ivermectin is first-line for patients mild papules

and/or pustules

1038) Meta-analysis increases power and improves estimates of the

size of the effect by combining individual studies that may be low-
powered

1039) Anterior mediastinal mass + symptoms of myasthenia =

thymoma

1040) Autosomal recessive conditions are 'metabolic' - exceptions:

inherited ataxias

Autosomal dominant conditions are 'structural' - exceptions: Gilbert's,

hyperlipidaemia type II

1041) Adrenal cortex mnemonic: GFR - ACD

1042) JVP: C wave - closure of the tricuspid valve

1043) In around 10% of patients subsequently diagnosed with lung

cancer the chest x-ray was reported as normal

1044) Membranoproliferative glomerulonephritis (mesangiocapillary)

1045) type 1: cryoglobulinaemia, hepatitis C
1046) type 2: partial lipodystrophy

1047) Leflunomide may cause hypertension

1048) Anticoagulation should be considered for the following:

1049) Men: CHA2DS2-VASC >= 1
1050) Women CHA2DS2-VASC >= 2
1051) Urine dip can be used to differentiate acute tubular necrosis from
acute interstitial nephritis in AKI

1052) Colour vision ('red desaturation') is affected in optic neuritis

1053) Hypokalaemia can lead to long QT syndrome

1054) Visual hallucinations with dementia = Lewy body dementia

1055) Persistent ST elevation following recent MI, no chest pain - left

ventricular aneurysm

1056) Anticholinergics for urge incontinence are associated with

confusion in elderly people - mirabegron is a preferable alternative

1057) Carbimazole blocks thyroid peroxidase from coupling and

iodinating the tyrosine residues on thyroglobulin → reducing thyroid
hormone production

1058) Smooth muscle proliferation and migration from the tunica

media into the intima is the last step in the formation of an atheroma

1059) Duloxetine may be used in patients with stress incontinence who

don't respond to pelvic floor muscle exercises and decline surgical
intervention

1060) Anterior ischemic optic neuropathy - fundoscopy typically shows

a swollen pale disc and blurred margins

1061) Dermatitis in acral, peri-orificial and perianal distribution → ?zinc

deficiency
1062) Symptomatic pneumothorax patients with no high-risk features
should be offered the following choice:
1063) conservative management
1064) needle aspiration
1065) ambulatory device (where available)

1066) Animal bite - co-amoxiclav

1067) Rosacea treatment:

1068) mild/moderate: topical ivermectin
1069) severe/resistant: combination of topical ivermectin + oral
doxycycline

1070) HRT: unopposed oestrogen increases risk of endometrial cancer

1071) Methaemoglobinaemia = oxidation of Fe2+ in haemoglobin to

Fe3+

1072) Lofepramine - the safest TCA in overdosage

1073) Urinary incontinence + gait abnormality + dementia = normal

pressure hydrocephalus

1074) Goodpasture's syndrome

1075) IgG deposits on renal biopsy
1076) anti-GBM antibodies

1077) ACE-inhibitors should be avoided in patients with HOCM

1078) The spinothalamic tract decussates at the same level the nerve
root enters the spinal cord. The corticospinal tract, dorsal column
medial lemniscus, and spinocerebellar tracts decussate at the medulla
1079) Dermatitis herpetiformis is associated with HLA-DR3

1080) Donepezil is generally avoided (relative contraindication) in

patients with bradycardia and is used with caution in other cardiac
abnormalities

1081) The most specific ECG finding in acute pericarditis is PR

depression

1082) The Jarisch-Herxheimer reaction, unlike an anaphylactic reaction,

will not present with hypotension and wheeze

1083) Serum IGF-1 levels are now the first-line test for acromegaly

1084) The major target for pANCA is myeloperoxidase (MPO)

1085) Gitelman's syndrome is due to a reabsorptive defect of the NaCl

symporter in the DCT

1086) In genetics, penetrance describes the proportion of a population

of individuals who carry a disease-causing allele who express the
related disease phenotype

1087) In subacute combined degeneration of the spinal cord, the dorsal

columns and lateral corticospinal tracts are affected

1088) Paracetamol overdose: acute alcohol intake is not associated

with an increased risk of developing hepatotoxicity and may actually
be protective

1089) Facioscapulohumeral muscular dystrophy: facial weakness (e.g.

difficulty closing eyes, smiling, blowing), winged scapula and weakness
of the shoulderm upper arm and hip girdle muscles

1090) Psoriasis: lithium may trigger an exacerbation

1091) Quinine toxicity (cinchonism) presents with myriad ECG
changes, hypotension, metabolic acidosis, hypoglycaemia and
classically tinnitus, flushing and visual disturbances. Flash pulmonary
oedema may occur

1092) Contraindications to lung cancer surgery include SVC

obstruction, FEV < 1.5, MALIGNANT pleural effusion, and vocal cord
paralysis

1093) Bartter's syndrome is associated with normotension

1094) Thyrotoxicosis with tender goitre = subacute (De Quervain's)

thyroiditis

1095) Antidepressants should be continued for at least 6 months after

remission of symptoms to decrease risk of relapse

1096) Korsakoff's syndrome is a complication of Wernicke's

encephalopathy. It's features include: anterograde amnesia, retrograde
amnesia, and confabulation

1097) Bupropion should not be used in a patient with epilepsy as it

reduces seizure threshold

1098) Antibodies against desmoglein 3 are seen in pemphigus vulgaris

1099) Hypocalcemia is associated with QT interval prolongation;

Hypercalcemia is associated with QT interval shortening

1100) Ulcerative colitis - depletion of goblet cells

1101) In acute intermittent porphyria, urinary porphobilinogen is

typically raised
1102) Ketoconazole shampoo is used to treat pityriasis versicolor

1103) Aspirin is a non reversible COX 1 and 2 inhibitor

1104) Differentiating chronic myeloid leukaemia from leukaemoid

reactions: leukocyte alkaline phosphatase score is low in CML, high in
leukaemoid reaction

1105) Angiotensin II receptor blockers block the effects of angiotensin 2

at the AT1 receptor

1106) Prinzmetal angina - treatment = dihydropyridine calcium channel

blocker

1107) Aortic stenosis - most common cause:

1108) younger patients < 65 years: bicuspid aortic valve
1109) older patients > 65 years: calcification

1110) Antipsychotics in the elderly - increased risk of stroke and VTE

1111) X-linked conditions: Duchenne/Becker, haemophilia, G6PD

1112) Tetracyclines inhibit the 30S subunit of ribosomes

1113) S1 lesion features = Sensory loss of posterolateral aspect of leg

and lateral aspect of foot, weakness in plantar flexion of foot, reduced
ankle reflex, positive sciatic nerve stretch test

1114) Prominent V waves on JVP → tricuspid regurgitation

1115) Ubiquitin tagging destines proteins to proteasome for

degradation
1116) Bombesin is a tumour marker in small cell lung carcinomas

1117) Is affected by acetylator status - hydralazine

1118) Marfan's syndrome is associated with dilation of the aortic

sinuses which may predispose to aortic dissection

1119) Bilateral spastic paresis and loss of pain and temperature

sensation - anterior spinal artery occlusion

1120) Third heart sound - constrictive pericarditis

1121) Diabetes, waxy yellow shin lesions - necrobiosis lipoidica

diabeticorum

1122) Aortic regurgitation typically causes an early diastolic murmur

1123) Rickets can present as widening of the wrist joints due to an

excess of non-mineralized osteoid at the growth plate

1124) Extrinsic allergic alveolitis is associated with upper/mid zone lung

fibrosis

1125) Following panretinal laser photocoagulation up to 50% of

patients have a noticeable reduction in their visual field

1126) High insulin, Low C-peptide = Exogenous insulin administration →

Exogenous insulin overdose

1127) Complete heart block causes a variable intensity of S1

1128) Gliptins (DPP-4 inhibitors) reduce the peripheral breakdown of

incretins such as GLP-1
1129) Anti-ribonuclear protein (anti-RNP) = mixed connective tissue
disease

1130) n-MYC is an oncogene for neuroblastoma

1131) Ulnar nerve supplies sensory innervation to the palmar and

dorsal aspects of 1 and 1/2 fingers medially

1132) Parietal lobe lesions may cause astereognosis

1133) Atrial septal defect - ejection systolic murmur louder on

inspiration

1134) Amiodarone has a long half-life - it is highly lipophilic and widely

absorbed by tissue, which reduces its bioavailability in serum.
Therefore, a prolonged loading regime is required to achieve stable
therapeutic levels

1135) Hypokalaemia, nephrocalcinosis - type 1 renal tubular acidosis

1136) Specificity - proportion of patients without the condition who

have a negative test result

1137) The t(14;18) translocation causes increased BCL-2 transcription

and causes follicular lymphoma

1138) Medullary thyroid cancer, phaeochromocytoma, marfanoid body

habitus - multiple endocrine neoplasia type IIb

1139) Metabolic acidosis with a high anion gap and high osmolar gap is
seen in ethylene glycol poisoning

1140) Pityriasis versicolor is caused by Malassezia furfur

1141) INR > 8.0 (no bleeding) - stop warfarin, give oral vitamin K 1-
5mg, repeat dose of vitamin K if INR high after 24 hours, restart when
INR < 5.0

1142) Anastrozole and letrozole are aromatase inhibitors that reduces

peripheral oestrogen synthesis

1143) Smoking cessation is very important in patients with asbestos-

related lung disease as the risk of lung cancer in smokers is very high

1144) Mechanism of hypokalaemia due to thiazides: increased delivery

of sodium to the distal part of the distal convoluted tubule

1145) Hodgkin's lymphoma - most common type = nodular sclerosing

1146) Nephrotic syndrome in children / young adults - minimal change

disease

1147) Oxycodone is preferred to morphine in palliative patients with

mild-moderate renal impairment

1148) Avoidance of using hypotonic (0.45%) in paediatric patients - risk

of hyponatraemic encephalopathy

1149) Type IV hypersensitivity reaction - allergic contact dermatitis

1150) Poorly controlled hypertension, already taking an ACE inhibitor,

calcium channel blocker and a standard-dose thiazide diuretic. K+ >
4.5mmol/l - add an alpha- or beta-blocker

1151) A prolonged PR interval - hypokalaemia

1152) A prolonged PR interval - aortic root abscess

1153) HIV-associated nephropathy (HIVAN) causes collapsing FSGS and
usually presents as nephrotic syndrome

1154) Organophosphate insecticide poisoning - bradycardia

1155) As well as ear problems, relapsing polychondritis may present

with nasal chondritis, respiratory tract involvement and arthralgia

1156) Hyoscine hydrobromide or hyoscine butylbromide is generally

used first-line to manage secretions in a palliative care setting

1157) Asymmetric dosing regimes should be used for standard-release

ISMN to prevent nitrate tolerance

1158) Acute confusional state: if treating the underlying cause and

environmental modification not working then haloperidol sometimes
used

1159) A family history of breast and ovarian cancer suggests a

mutation in the BRCA genes

1160) Causes of villous atrophy (other than coeliacs): tropical sprue,

Whipple's, lymphoma, hypogammaglobulinaemia

1161) Chlamydia - treat with doxycycline

1162) Seborrhoeic dermatitis - first-line treatment is topical

ketoconazole

1163) Lichen
1164) planus: purple, pruritic, papular, polygonal rash on flexor
surfaces. Wickham's striae over surface. Oral involvement common
1165) sclerosus: itchy white spots typically seen on the vulva of elderly
women
1166) Infective endocarditis - indications for surgery:
1167) severe valvular incompetence
1168) aortic abscess (often indicated by a lengthening PR interval)
1169) infections resistant to antibiotics/fungal infections
1170) cardiac failure refractory to standard medical treatment
1171) recurrent emboli after antibiotic therapy

1172) Digoxin can cause drug-induced gynaecomastia

1173) Arrhythmogenic right ventricular cardiomyopathy is

characterised by right ventricular myocardium replaced by fatty and
fibrofatty tissue

1174) Transposition of great vessels is due to the failure of the

aorticopulmonary septum to spiral

1175) BRCA2 mutation is associated with prostate cancer in men

1176) Short stature + primary amenorrhoea ?Turner's syndrome

1177) Azathioprine is metabolised to the active compound

mercaptopurine, a purine analogue that inhibits purine synthesis

1178) Major bleeding - stop warfarin, give intravenous vitamin K 5mg,

prothrombin complex concentrate

1179) The HLA-DRB1 gene is the major genetic susceptibility locus for
rheumatoid arthritis (DRB1*04:01 and DRB1*04:04 hence the
association with DR4)

1180) Transjugular Intrahepatic Portosystemic Shunt commonly causes

an exacerbation of hepatic encephalopathy
1181) In hypercalcaemia secondary to malignancy, PTH is low, although
PTHrP may be raised

1182) Inflammatory back pain (e.g. ankylosing spondylitis) typically

improves with exercise

1183) Buprenorphine is a partial agonist of the mu-opioid receptor and

an antagonist of the kappa-opioid receptor

1184) Turner's syndrome - most common cardiac defect is bicuspid

aortic valve (more common than coarctation of the aorta)

1185) Urinary histamine is used to diagnose systemic mastocytosis

1186) ICD means loss of HGV licence, regardless of the circumstances

1187) Patients on insulin may now hold a HGV licence if they meet
strict DVLA criteria

1188) Molecular biology techniques

1189) SNOW (South - NOrth - West)
1190) DROP (DNA - RNA - Protein)

1191) Paraneoplastic features of lung cancer

1192) squamous cell: PTHrp, clubbing, HPOA
1193) small cell: ADH, ACTH, Lambert-Eaton syndrome

1194) ATN or prerenal uraemia? In prerenal uraemia think of the

kidneys holding on to sodium to preserve volume

1195) Second heart sound (S2)

1196) loud: hypertension
1197) soft: AS
1198) fixed split: ASD
1199) reversed split: LBBB

1200) Myoglobin rises first following a myocardial infarction

1201) Power = 1 - the probability of a type II error

1202) Combined B- and T-cell disorders: SCID WAS ataxic (SCID,

Wiskott-Aldrich syndrome, ataxic telangiectasia)

1203) With MAHA, once TTP and HUS are excluded, atypical HUS needs
to be considered and treated

1204) Enterococci - Gram-positive cocci

1205) Ciclosporin may cause hepatotoxicity

1206) If angina is not controlled with a beta-blocker, a longer-acting

dihydropyridine calcium channel blocker should be added

1207) Erythema gyratum repens is a paraneoplastic eruption with a

'wood-grain' pattern and figurate erythema commonly seen in patients
with lung cancer

1208) STEMI management: fibrinolysis should be offered within 12

hours of onset of symptoms if primary PCI cannot be delivered within
120 minutes

1209) Minimally symptomatic pneumothorax, regardless of size, can be

treated with conservative treatment / regular follow-up

1210) X-linked recessive conditions - no male-to-male transmission

1211) Angiodysplasia is associated with aortic stenosis

1212) Down's syndrome risk - 1/1,000 at 30 years then divide by 3 for
every 5 years

1213) Most common cause of endocarditis:

1214) Staphylococcus aureus
1215) Staphylococcus epidermidis if < 2 months post valve surgery

1216) Brush border enzymes:

1217) maltase: glucose + glucose
1218) sucrase: glucose + fructose
1219) lactase: glucose + galactose

1220) Peroxisomes are responsible for the catabolism of long chain

fatty acids

1221) Ventricular septal defect - holosystolic murmur, 'harsh' in

character

1222) Reactive arthritis - HLA-B27

1223) Goodpasture's - HLA-DR2

1224) Contralateral hemiparesis and sensory loss with the lower

extremity being more affected than the upper - anterior cerebral artery

1225) Bisferiens pulse - mixed aortic valve disease

1226) Positive anti-HBc IgG, negative anti-HBc IgM and negative anti-
HBc in the presence of HBsAg implies chronic HBV infection

1227) Nicorandil is a potassium channel activator

1228) Cardiovascular disease is a contraindication to triptan use

1229) Pellagra is caused by vitamin B3 (niacin) deficiency

1230) Vancomycin is a useful antibiotic to treat MRSA infections

1231) Desmopressin is used in the management of Von Willebrand's

disease

1232) Whipple's disease: jejunal biopsy shows deposition of

macrophages containing Periodic acid-Schiff (PAS) granules

1233) Superior homonymous quadrantanopias are caused by lesions of

the inferior optic radiations in the temporal lobe

1234) Gallop rhythm (S3) is an early sign of LVF

1235) Atrial myxoma - commonest site = left atrium

1236) Conduction dysphasia: speech fluent, but repetition poor.

Comprehension is relatively intact

1237) A risk-stratified approach should be taken when discharging

patients who have presented with anaphylaxis

1238) Vitreous haemorrhage is a cause of sudden painless loss of vision

in the context of diabetic retinopathy

1239) Selegiline - MAO-B inhibitor

1240) Ovarian cancer - CA 125

1241) Clostridium tetani - blocks the release of GABA and glycine

1242) 11-beta hydroxylase deficiency associated with hypertension

1243) Kyphoscoliosis (e.g. ankylosing spondylitis) can cause a

restrictive lung defect on spirometry

1244) SGLT-2 inhibitors reversibly inhibit sodium-glucose co-transporter

2 (SGLT-2) in the renal proximal convoluted tubule

1245) Tuberculoid leprosy is suggested by a limited number of skin

lesions, hypaesthesia and hair loss

1246) The Malnutrition Universal Screening Tool (MUST) is used to

screen patients for malnutrition

1247) Pleural effusion: malignancy is associated with an exudate

1248) In a hospital setting, suspected bacterial meningitis should be

treated with IV cefotaxime (or ceftriaxone) for adults < 50 years

1249) Deletion of chromosome 15

1250) Prader-Willi - paternal
1251) Angelman syndrome - maternal

1252) Absence seizures - good prognosis: 90-95% become seizure free

in adolescence

1253) AIP - porphobilinogen deAminase; PCT - uroporphyrinogen

deCarboxylase

1254) Dabigatran is a direct thrombin inhibitor

1255) Amoxicillin is an alternative to treat early Lyme disease if
doxycycline is contraindicated such as in pregnancy

1256) A Z-score is helpful in diagnosing secondary osteoporosis and

should always be used for children, young adults, pre-menopausal
women and men under the age of 50

1257) Aortic regurgitation - early diastolic murmur, high-pitched and

'blowing' in character

1258) Atrial natriuretic factor - guanylate cyclase receptor

1259) Glycaemic control in diabetes may be worsened by interferon-

alpha

1260) Right axis deviation - left posterior hemiblock

1261) Langerhans cell histiocytosis is characterized by Birbeck granules

on electron microscopy

1262) Intravascular haemolysis - paroxysmal nocturnal

haemoglobinuria

1263) Follicular lymphoma is characterised by a t(14:18) translocation

1264) Niacin (B3) deficiency is characterised by dermatitis, diarrhoea

and dementia, a condition known as pellagra

1265) Type II error - the null hypothesis is accepted when it is false

1266) S4 coincides with the P wave on ECG

1267) Linear, well-demarcated skin lesions that appear suddenly, with

'la belle indifference' → ?dermatitis artefacta
1268) Bilateral, mid-to-lower zone patchy consolidation in an older
patient → ?Legionella

1269) In palliative patients increase morphine doses by 30-50% if pain

not controlled

1270) Relative risk reduction = (EER - CER) / CER

1271) Kearns-Sayre syndrome

1272) mitochondrial inheritance
1273) onset < 20-years-old
1274) external ophthalmoplegia
1275) retinitis pigmentosa

1276) Macrolides inhibit the 50S subunit of ribosomes

1277) Nephrotic syndrome is associated with a hypercoagulable state

due to loss of antithrombin III via the kidneys

1278) Golgi adds mannose-6-phosphate to proteins for trafficking to

lysosomes

1279) Blood pressure target (< 80 years, clinic reading) - 140/90 mmHg

1280) Furosemide - inhibits the Na-K-Cl cotransporter in the thick

ascending limb of the loop of Henle

1281) Collapsing pulse - patent ductus arteriosus

1282) Triptans are serotonin 5-HT1B and 5-HT1D receptor agonists

1283) G1 phase determines cell cycle length

1284) HBsAg negative, anti-HBs positive, IgG anti-HBc positive -
previous infection, not a carrier

1285) Haemochromatosis is autosomal recessive

1286) NNT = 1 / Absolute Risk Reduction

1287) Fomepizole - used in ethylene glycol and methanol poisoning -

competitive inhibitor of alcohol dehydrogenase

1288) Funnel plots - show publication bias in meta-analyses

1289) Oral ulcers + genital ulcers + anterior uveitis = Behcet's

1290) Widened QRS or arrhythmia in tricyclic overdose - give IV

bicarbonate

1291) Aortic stenosis - S4 is a marker of severity

1292) DiGeorge syndrome - a T-cell disorder

1293) Wernicke's dysphasia: speech fluent, comprehension abnormal,

repetition impaired

1294) Broca's dysphasia: speech non-fluent, comprehension normal,

repetition impaired

1295) Antipsychotics may cause akathisia (severe restlessness)

1296) A 60-year-old man has recurrent episodes of atrial fibrillation

which don't self terminate. He uses flecanide to cardiovert himself into
sinus rhythm - persistent atrial fibrillation
1297) Functional neurological disorder (conversion disorder) - typically
involves loss of motor or sensory function

1298) Primaquine is used in non-falciparum malaria to destroy liver

hypnozoites and prevent relapse

1299) Mann-Whitney U test - compares ordinal, interval, or ratio scales

of unpaired data

1300) Haloperidol - dopamine D2 receptor antagonist, blocking

dopaminergic transmission in the mesolimbic pathways

1301) APML is treated with all-trans retinoic acid (ATRA) to force

immature granulocytes into maturation to resolve a blast crisis prior to
more definitive chemotherapy

1302) Patients cannot drive for 6 months following a first unprovoked

or isolated seizure if brain imaging and EEG normal

1303) BNP - actions:

1304) vasodilator: can decrease cardiac afterload
1305) diuretic and natriuretic
1306) suppresses both sympathetic tone and the renin-angiotensin-
aldosterone system

1307) Pulmonary surfactant - main constituent is dipalmitoyl

phosphatidylcholine (DPPC)

1308) Migraine
1309) acute: triptan + NSAID or triptan + paracetamol
1310) prophylaxis: topiramate or propranolol
1311) Patent ductus arteriosus - large volume, bounding, collapsing
pulse

1312) Constipation can cause delirium in the elderly

1313) Erotomania (De Clerambault's syndrome) is the presence of a

delusion that a famous is in love with them, with the absence of other
psychotic symptoms

1314) Ureterosigmoidostomy - normal anion gap metabolic acidosis

1315) Sodium valproate may cause weight gain

1316) Lesch-Nyhan syndrome causing hyperuricemia is genetically

inherited in an X-linked recessive pattern

1317) Third heart sound - mitral regurgitation

1318) Power - the probability of detecting a statistically significant

difference

1319) Flecainide blocks the Nav1.5 sodium channels in the heart

1320) Cardiac catheterisation results - jump in oxygen saturation from

right atrium to right ventricle → ?VSD

1321) Osteonecrosis of the jaw: IV bisphosphonates for the treatment

of cancer are significantly greater risk than oral bisphosphonates for
osteoporosis or Paget's disease

1322) Bitemporal hemianopia

1323) lesion of optic chiasm
1324) upper quadrant defect > lower quadrant defect = inferior
chiasmal compression, commonly a pituitary tumour
1325) lower quadrant defect > upper quadrant defect = superior
chiasmal compression, commonly a craniopharyngioma

1326) Transfer factor

1327) raised: asthma, haemorrhage, left-to-right shunts, polycythaemia
1328) low: everything else

1329) Intramuscular ceftriaxone is the treatment of choice

for Gonorrhoea

1330) Central retinal vein occlusion - sudden painless loss of vision,

severe retinal haemorrhages on fundoscopy

1331) Correlation
1332) parametric (normally distributed): Pearson's coefficient
1333) non-parametric: Spearman's coefficient

1334) Sleep apnoea causes include obesity and macroglossia

1335) Saccharopolyspora rectivirgula causes farmer's lung, a type of

EAA

1336) Palpitations should first be investigated with a Holter monitor

after initial bloods/ECG

1337) For patients of black African or African-Caribbean origin taking a

calcium channel blocker for hypertension, if they require a second
agent consider an angiotensin receptor blocker in preference to an ACE
inhibitor

1338) Denosumab - RANKL inhibitor

1339) Fluctuation of symptoms helps to differentiate delirium and
dementia

1340) Low serum calcium, low serum phosphate, raised ALP and raised
PTH - osteomalacia

1341) A long QT interval - hypothermia

1342) Rosacea features:

1343) nose, cheeks and forehead
1344) flushing, erythema, telangiectasia → papules and pustules

1345) Pulmonary stenosis is louder on inspiration

1346) Bicalutamide is an androgen recept blocker

1347) A recurrent episode of C. difficile within 12 weeks of symptom

resolution should be treated with oral fidaxomicin

1348) Breakthrough dose = 1/6th of daily morphine dose

1349) Trastuzumab (Herceptin) - monoclonal antibody that acts on the

HER2/neu receptor

1350) Homocystinuria is caused by a deficiency of cystathionine beta

synthase

1351) Pulsus alternans - seen in left ventricular failure

1352) Rifampicin is a P450 enzyme inductor

1353) Clostridium - Gram-positive rod

1354) Pulmonary arterial hypertension patients with negative response
to vasodilator testing should be treated with prostacyclin analogues,
endothelin receptor antagonists or phosphodiesterase inhibitors. Often
combination therapy is required

1355) Fourth heart sound - aortic stenosis

1356) Mutations in the SCN5A gene (which encode the myocardial

sodium ion channel protein are the most common gene abnormality
seen in Brugada syndrome

1357) The medial longitudinal fasciculus is located in the paramedian

area of the midbrain and pons

1358) Illness anxiety disorder (hypochondriasis) is the persistent belief

in the presence of an underlying serious disease, e.g. cancer

1359) Ticagrelor has a similar mechanism of action to clopidogrel -

inhibits ADP binding to platelet receptors

1360) Cisplatin is associated with hypomagnesaemia

1361) Malaria prophylaxis (e.g. primaquine) can trigger haemolytic

anaemia in those with G6PD deficiency

1362) Chlordiazepoxide, lorazepam or diazepam are used in the

treatment of delirium tremens/alcohol withdrawal

1363) Vision worse going down stairs? Think 4th nerve palsy

1364) Cisplatin may cause ototoxicity

1365) Poorly controlled hypertension, already taking an ACE inhibitor

and a calcium channel blocker - add a thiazide-like diuretic
1366) Marfan's syndrome - dural ectasia

1367) Type I error - the null hypothesis is rejected when it is true

1368) Cohort study - the usual outcome measure is the relative risk

1369) Case-control study - the usual outcome measure is the odds ratio

1370) Meglitinides - bind to an ATP-dependent K +(KATP) channel on the

cell membrane of pancreatic beta cells

1371) Hypertrophic obstructive cardiomyopathy - is characterized by

decreased compliance, secondary to ventricular hypertrophy

1372) Porphyria cutanea tarda is caused by an inherited defect in

uroporphyrinogen decarboxylase

1373) Tearfulness, anxiety 3-7 days postpartum → ?baby blues

1374) DVLA advice following angioplasty - cannot drive for 1 week

1375) LH surge causes ovulation

1376) Dipyridamole is a non-specific phosphodiesterase inhibitor and

decreases cellular uptake of adenosine

1377) Visual field defects:

1378) left homonymous hemianopia means visual field defect to the
left, i.e. lesion of right optic tract
1379) homonymous quadrantanopias: PITS (Parietal-Inferior, Temporal-
Superior)
1380) incongruous defects = optic tract lesion; congruous defects=
optic radiation lesion or occipital cortex
1381) Narcolepsy - HLA-DR2

1382) Gastrin increases H+ secretion by gastric parietal cells

1383) Methotrexate works by inhibiting dihydrofolate reductase

1384) ALS - give adrenaline in non-shockable rhythm as soon as

possible

1385) P value - is the probability of obtaining a result by chance at

least as extreme as the one that was actually observed, assuming that
the null hypothesis is true

1386) DPP-4 inhibitors increase levels of incretins such as GLP-1 and

GIP

1387) Hypercalcaemia + bilateral hilar lymphadenopathy → ?

sarcoidosis

1388) Rheumatoid arthritis - HLA DR4

1389) Azathioprine - check thiopurine methyltransferase deficiency

(TPMT) before treatment

1390) Lying or exaggerating for financial gain is malingering, for

example someone who fakes whiplash after a road traffic accident for
an insurance payment

1391) Poorly controlled hypertension, already taking an ACE inhibitor -

add a calcium channel blocker or a thiazide-like diuretic

1392) Neurofibromatosis type 1 - chromosome 17

1393) Cushing's syndrome causes hypokalaemia with alkalosis

1394) Memantine - NMDA receptor antagonist

1395) Water deprivation test: nephrogenic DI

1396) urine osmolality after fluid deprivation: low
1397) urine osmolality after desmopressin: low

1398) Water deprivation test: primary polydipsia

1399) urine osmolality after fluid deprivation: high
1400) urine osmolality after desmopressin: high

1401) Taxanes such as docetaxel - prevents microtubule

depolymerisation & disassembly, decreasing free tubulin

1402) Divide by two for oral to subcutaneous morphine conversion

1403) Sulphasalazine can cause oligospermia and infertility in men

1404) Cisplatin - causes cross-linking in DNA

1405) Apomorphine - dopamine receptor agonist

1406) Granuloma inguinale - Klebsiella granulomatis

1407) Acetazolamide causes hypokalaemia

1408) Likelihood ratio for a negative test result - how much the odds of
the disease decrease when a test is negative

1409) Extravascular haemolysis - hereditary spherocytosis

1410) Tall, long fingered, downward lens dislocation, learning
difficulties, DVT - homocystinuria

1411) Impetigo - topical fusidic acid if hydrogen peroxide not suitable

1412) Sulfonylureas often cause weight gain

1413) Consider granulomatosis with polyangiitis when a patient

presents with ENT, respiratory and kidney involvement

1414) Non-parametric tests are more appropriate when the data sets
are not normally distributed

1415) Lymphogranuloma venereum - Chlamydia trachomatis

1416) Lead-time bias - occurs when two tests for a disease are
compared, the new test diagnoses the disease earlier, but there is no
effect on the outcome of the disease

1417) Hydralazine - increases cGMP leading to smooth muscle

relaxation

1418) Oral allergy syndrome is strongly linked with pollen allergies and
presents with seasonal variation

1419) Alpha-1 antitrypsin: PiMZ = carrier and unlikely to develop

emphysema if a non-smoker

1420) Amiodarone is a cause of photosensitivity

1421) Bartter's syndrome results from a defective NKCC2 channel in

the ascending loop of Henle
1422) VF/pulseless VT should be treated with 1 shock as soon as
identified

1423) Case-control study - compares a group with a disease to a group

without, looking at past exposure to a possible causal agent for the
condition

1424) Prosthetic valve endocarditis caused by staphylococci →

Flucloxacillin + rifampicin + low-dose gentamicin

1425) Nonsense - a mutation that results in a stop codon

1426) Patients starting rituximab should be screened for hepatitis B

before starting treatment

1427) Cetuximab - monoclonal antibody against the epidermal growth

factor receptor

1428) Standard error of the mean = standard deviation / square root

(number of patients)

1429) APOE polymorphic alleles are the main genetic determinants of

sporadic Alzheimer disease risk. Individuals carrying the γ4 allele have
the highest risk

1430) Type II hypersensitivity reaction - pernicious anemia

1431) Hypertrophic obstructive cardiomyopathy - ejection systolic

murmur

1432) Vital capacity - maximum volume of air that can be expired after
a maximal inspiration

1433) Positive predictive value = TP / (TP + FP)

1434) Positive predictive value - the chance that the patient has the
condition if the diagnostic test is positive

1435) Oral glucocorticoids are the treatment of choice for allergic

bronchopulmonary aspergillosis

1436) Somatostatin is produced by D cells in the pancreas & stomach

1437) Cyclophosphamide - causes cross-linking in DNA

1438) Lassa fever is contracted by contact with the excreta of infected

African rats (Mastomys rodent) or by person-to-person spread

1439) Patients with very poor dental hygiene may develop endocarditis
secondary to Viridans streptococci e.g. Streptococcus sanguinis

1440) Irinotecan inhibits topoisomerase I which prevents relaxation of

supercoiled DNA

1441) Burkitt's lymphoma - t(8:14)

1442) Ambrisentan - endothelin receptor A antagonist

1443) HBsAg negative, anti-HBs positive, IgG anti-HBc negative -

previous immunisation

1444) COPD - still breathless despite using SABA/SAMA

and asthma/steroid responsive features → add a LABA + ICS

1445) Hypocalcemia is a side effect of loop diuretics

1446) CD8 - co-receptor for MHC class I

1447) Sensitivity - proportion of patients with the condition who have a
positive test result

1448) Nephrogenic diabetes insipidus may be caused genetic

mutations:
1449) the more common form affects the vasopression (ADH) receptor
1450) the less common form results from a mutation in the gene that
encodes the aquaporin 2 channel

1451) Women who smoke are at a two-fold increased risk of developing

cervical cancer than women who do not

1452) Terbinafine inhibits the fungal enzyme squalene epoxidase,

causing cellular death

1453) CCK - I cells in upper small intestine

1454) Shifts the oxygen dissociation curve to the left - low pCO2

1455) Donepezil - acetylcholinesterase inhibitor

1456) Codeine to morphine - divide by 10

1457) Friedreich's ataxia is autosomal recessive

1458) Glycaemic control in diabetes may be worsened by ciclosporin

1459) Integrase inhibitors ('gravirs') - blocks the enzyme that inserts

the viral genome into the DNA of the host cell

1460) Levothyroxine acts via nuclear receptors

1461) Likelihood ratio for a positive test result = sensitivity / (1 -
specificity)

1462) Widely split S2 - RBBB

1463) Gastrin - increases gastric motility

1464) Tay-Sachs disease typically presents with developmental delay

and cherry red spot on the macula, without hepatomegaly or
splenomegaly

1465) Non-functioning adenomas are generally diagnosed due to their

compressive symptoms (e.g. visual problems) or hormone deficiencies
- transsphenoidal surgery is therefore the first-line treatment

1466) Thiazides/thiazide-like drugs (e.g. indapamide) - inhibits sodium

reabsorption by blocking the Na +-Clˆ’ symporter at the beginning of the
distal convoluted tubule

1467) Mitral stenosis - opening snap

1468) Vital capacity - 4,500ml in males, 3,500 mls in females

1469) Specificity = TN / (TN + FP)

1470) A 70-year-old man is treated with a beta-blocker to control his

atrial fibrillation. A previous attempt to cardiovert him failed -
permanent atrial fibrillation

1471) Shifts the oxygen dissociation curve to the right - hypercapnia

1472) Poorly controlled hypertension, already taking a calcium channel

blocker - add an ACE inhibitor or an angiotensin receptor blocker or a
thiazide-like diuretic
1473) Negative predictive value = TN / (TN + FN)

1474) Hypertrophic obstructive cardiomyopathy - characterized by

myofibrillar hypertrophy with chaotic and disorganized fashion
myocytes ('disarray') and fibrosis on biopsy

1475) A patient who is known to have HIV presents gradually worsening

speech and behavioural problems associated with coordination
difficulties. A MRI shows multifocal non-enhancing lesions - JC virus

1476) Fabry disease is caused by a deficiency of alpha-galactosidase A