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MRCP Part 1 QUESTIONS AND ANSWERS 2024
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MRCP Part 1 QUESTIONS AND ANSWERS 2024
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MRCP Part 1 QUESTIONS AND ANSWERS2024
Pregnancy and Thyroid Hormone - Pregnancy increases the amount of TBG
(thyroid binding globulin) so increases the total thyroxin levels but not free
thyroxine
Hyperthyroid in pregnancy - Untreated - fetal loss, premature labour, maternal
heart failure
Graves disease most common
HCG can activate TSH receptors - transient gestational hyperthyroid - these fall in
trimester 2 & 3
treatment - propylthiouracil in first trimester
this can cause hepatic injury
carbimazole in 2nd trimester once lower risk of congenital abnormalities
Monitoring - free thyroxine levels should be kept upper third normal so to avoid
fetal hypothyroid
- thyrotrophin receptor stimulating antibodies should be checked weeks 30-36
DO NOT - block and replace or use radioiodine.
Hypothyroid in pregnancy - Thyroxine replacement is safe in pregnancy and
breastfeeding
TSH measured each trimester and 6-8 weeks post partum
,MRCP Part 1 QUESTIONS AND ANSWERS
2024
Women often require an increased dose - up to 50% by weeks 4-6
untreated - developmental abnormalities, miscarriage, still birth, low birth weight,
pre-eclampsia, anaemia
Gentamicin - Aminoglycoside antibioitic
Given IV or topically
Ototoxic - irreversible due to auditory or vestibular nerve damage
Nephrotoxic - causes tubular necrosis, accumulates in renal failure requiring
increased monitoring, furosemide increases this risk
CI - Myasthenia Gravis
Dosed via height and weight and renal function. Peak and trough levels monitored
with dose adjustments based on trough levels
CSF: Protein levels - normal = 0.2-0.4 g/L
Causes of raised CSF protein
GBS
Froin's syndrome - a spinal canal blockage characterised by xanthochromia, raised
protein and CSF hypercoagulability
TB, bacterial or fungal meningitis
,MRCP Part 1 QUESTIONS AND ANSWERS
2024
viral encephalitis
Vigabatrin - Irreversibly inhibits GABA transaminase-->increased GABA levels in
synapse
Uses = tx infantile spasms (Viga"Baby"trin)
Or used as adjunct therapy for adults with refractory complex partial seizures
SE = visual field constriction and even visual loss in 40% of patients- visual fields
must be checked every 6 months as visual loss can be irreversible
Tricuspid regurgitation - Signs: pansystolic murmer, parasternal heave, giant V
waves, pulsatile hepatomegaly
causes: IVDU endocarditis, rheumatic heart disease, right ventricle infarction,
pulmonary hypertension, carcinoid syndrome, epsteins anamoly (rare heart defect
that causes tricuspid regurg)
Corticosteroid side effects - COME IN PIGG
, MRCP Part 1 QUESTIONS AND ANSWERS
2024
Cushings
opthalmic - glaucoma, catterachts
M - musculoskeletal - OP, proximal myopathy, avascular necrosis
Endocrine- hyperglycaemia, weight gain, hirsuitism, high lipids
Immunosupression
Neutrophilia
Psychiatric - mania, psychosis, insomnia, depression
Intracranial hypertension
Gastric - pancreatitis, ulcers,
Growth suppression in kids
Acne - 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
Therapeutic Steroids - Fludocortisone - mostly mineralocorticoid
hydrocortisone - some glucocorticoid, some mineralocoticoid
Dexamethsone - high glucocorticoid
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