Which one of the following is not a risk factor for the development of pre-eclampsia?
Correct Answer E:
No previous pregnancies is a risk factor for pre-eclampsia. Questions on maternal health during pregnancy are now common in the MRCP.
Pre-eclampsia:
Pre-eclampsia is a condition seen after 20 weeks gestation characterized by pregnancy-induced hypertension in association with proteinuria (> 0.3g / 24 hours). Oedema used to be third element of the classic triad but is now often not included in the definition as it is not specific.
Pre-eclampsia is important as it predisposes to the following problems:
Risk factors:
Features of severe pre-eclampsia:
Management:
Which of the following is true regarding endothelin?
Endothelin:
Endothelin is a potent, long-acting vasoconstrictor and bronchoconstrictor. It is secreted initially as a prohormone by the vascular endothelium and later converted to ET-1 by the action of endothelin converting enzyme. It acts via interaction with a G-protein linked to phospholipase C leading to calcium release. Endothelin is thought to be important in the pathogenesis of many diseases including primary pulmonary hypertension (endothelin antagonists are now used), cardiac failure, hepatorenal syndrome and Raynaud's.
Promotes:
Inhibits release of:
Raised levels in:
Which one of the following radiotracers is used during cardiac Positron Emission Tomography (PET) scans?
Correct Answer B:
Cardiac imaging: non-invasive techniques excluding echocardiography: The ability to image the heart using non-invasive techniques such as MRI, CT and radionuclides has evolved rapidly over recent years.
1- Nuclear imaging:
These techniques use radiotracers which are extracted by normal myocardium. Examples include:
The primary role of SPECT is to assess myocardial perfusion and myocardial viability. Two sets of images are usually acquired. First the myocardium at rest followed by images of the myocardium during stress (either exercise or following adenosine / dipyridamole). By comparing the rest with stress images any areas of ischaemia can classified as reversible or fixed (e.g. Following a myocardial infarction). Cardiac PET is predominately a research tool at the current time.
2- MUGA:
Cardiac Computed Tomography (CT): Cardiac CT is useful for assessing suspected ischaemic heart disease, using two main methods:
3- Cardiac MRI:
Cardiac MRI (commonly termed CMR) has become the gold standard for providing structural images of the heart. It is particularly useful when assessing congenital heart disease, determining right and left ventricular mass and differentiating forms of cardiomyopathy. Myocardial perfusion can also be assessed following the administration of gadolinium. Currently CMR provides limited data on the extent of coronary artery disease.
Which of the following conditions is NOT inherited in a X-linked recessive fashion:
Correct Answer A:
X-linked conditions: Duchenne/Becker, haemophilia, G6PD.
The following conditions are inherited in a X-linked recessive fashion:
The following diseases have varying patterns of inheritance, with the majority being in an X-linked recessive fashion: Chronic
Which one of the following conditions is NOT an autosomal recessive condition?
Correct Answer C: Autosomal recessive conditions are 'metabolic' - exceptions: inherited ataxias Autosomal dominant conditions are 'structural' - exceptions: hyperlipidaemia type II, hypokalaemic periodic paralysis.
Hereditary spherocytosis is inherited in an autosomal dominant fashion.
Autosomal recessive conditions:
Autosomal recessive conditions are often thought to be 'metabolic' as opposed to autosomal dominant conditions being 'structural', notable exceptions:
The following conditions are autosomal recessive:
*This is still a matter of debate and many textbooks will list Gilbert's as autosomal dominant.
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