Académique Documents
Professionnel Documents
Culture Documents
1.
(repeated Question)Patient with past history of guttate psoriasis , having joint paints, RA fctor
is negative, there is assymetrical small joint involvement. What is the diagnosis?
Answer is psoriatic arthritis
Psoriatic arthritis is most commonly a seronegative oligoarthritis found in patients with psoriasis, with
less common, but characteristic, differentiating features of distal joint involvement and arthritis
mutilans. Psoriatic arthritis (see the image below) develops in at least 5% of patients with psoriasis.
Swelling and deformity of the metacarpophalangeal and distal interphalangeal joints in a patient with
psoriatic arthritis.
See Psoriasis: Manifestations, Management Options, and Mimics, a Critical Images slideshow, to help
recognize the major psoriasis subtypes and distinguish them from other skin lesions.
Signs and symptoms
Onset of psoriasis and arthritis are as follows:
Psoriasis appears to precede the onset of psoriatic arthritis in 60-80% of patients (occasionally
by as many as 20 years, but usually by less than 10 years)
In as many as 15-20% of patients, arthritis appears before the psoriasis
Occasionally, arthritis and psoriasis appear simultaneously
In some cases, patients may experience only stiffness and pain, with few objective findings. In most
patients, the musculoskeletal symptoms are insidious in onset, but an acute onset has been reported in
one third of all patients.
Findings on physical examination are as follows:
Psoriasis may occur in hidden sites, such as the scalp (where psoriasis frequently is mistaken
for dandruff), perineum, intergluteal cleft, and umbilicus
Psoriatic nail changes, which may be a solitary finding in patients with psoriatic arthritis, may include
the following:
Beau lines
Leukonychia
Onycholysis
Oil spots
Subungual hyperkeratosis
Splinter hemorrhages
Spotted lunulae
Transverse ridging
Cracking of the free edge of the nail
Uniform nail pitting
Extra-articular features are observed less frequently in patients with psoriatic arthritis than in those
with rheumatoid arthritis (RA) but may include the following:
Synovitis affecting flexor tendon sheaths, with sparing of the extensor tendon sheath
Subcutaneous nodules are rare
Ocular involvement may occur in 30% of patients, including conjunctivitis in 20% and acute
anterior uveitis in 7%; in patients with uveitis, 43% havesacroiliitis
Patterns of arthritic involvement
The patterns of psoriatic arthritis involvement are as follows:
No specific diagnostic tests are available for psoriatic arthritis.[2] The most characteristic laboratory
abnormalities in patients with the condition are as follows:
Elevations of the erythrocyte sedimentation rate (ESR) and C-reactive protein level
Negative rheumatoid factor in 91-95% of patients
In 10-20% of patients with generalized skin disease, the serum uric acid concentration may be
increased
Low levels of circulating immune complexes have been detected in 56% of patients
Serum immunoglobulin A levels are increased in two thirds of patients
Synovial fluid is inflammatory, with cell counts ranging from 5000-15,000/L and with more
than 50% of cells being polymorphonuclear leukocytes; complement levels are either within
reference ranges or increased, and glucose levels are within reference ranges
Radiographic studies
Radiologic features have helped to distinguish psoriatic arthritis from other causes of polyarthritis. In
general, the common subtypes of psoriatic arthritis, such as asymmetrical oligoarthritis and
symmetrical polyarthritis, tend to result in only mild erosive disease. Early bony erosions occur at the
cartilaginous edge, and cartilage is initially preserved, with maintenance of a normal joint space.
The following radiographic abnormalities are suggestive of psoriatic arthritis:
Particularly sensitive for detecting sacroiliitic synovitis, enthesitis, and erosions; can also be
used with gadolinium to increase sensitivity
May show inflammation in the small joints of the hands, involving the collateral ligaments
and soft tissues around the joint capsule, a finding not seen in persons with RA
See Workup for more detail.
Management
Medical treatment regimens include the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and
disease-modifying antirheumatic drugs (DMARDs). DMARDs include the following[3] :
Methotrexate
Sulfasalazine
Cyclosporine
Leflunomide
Biologic agents, such as the antiTNF-alpha medications
In patients with severe skin inflammation, medications such as methotrexate, retinoic-acid derivatives,
and psoralen plus ultraviolet (UV) light should be considered. These agents have been shown to work
on skin and joint manifestations. Intra-articular injection of entheses or single inflamed joints with
corticosteroids may be particularly effective in some patients. Use DMARDs in individuals whose
arthritis is persistent.
Surgical care
2.
(Repeated Question changed a bit) Patient that relieved by lactose free diet, blood result
showed iron and folate deficiency.
Answer is bacterial overgrowth syndrome
BOS:
History
No specific symptoms are pathognomonic for bacterial overgrowth syndrome (BOS). Nonetheless,
various nonspecific GI symptoms are common in affected individuals. Clinicians should have a
heightened clinical suspicion for bacterial overgrowth syndrome in patients who present with the
following:
Bloating
Flatulence
Abdominal pain
Diarrhea
Dyspepsia
Weight loss
Advanced cases of bacterial overgrowth syndrome may manifest as malabsorption findings, as follows:
Gastrocolic fistulae
Jejunal-colic fistulae
Partial obstruction caused by the following may result in bacterial overgrowth syndrome:
Strictures
Adhesions
Abdominal masses
Leiomyosarcoma
Reduced gastric acid secretion from the following may result in bacterial overgrowth syndrome:
Achlorhydria
Vagotomy
Long-term administration of proton pump inhibitors[9]
Prevalence of BOS rises with age.[4, 10]
Previous
Laboratory Studies
Bacterial overgrowth syndrome (BOS) diagnostic testing should include a workup for diarrhea, anemia,
and malabsorption. In the past, retrieval of aspirates from the small intestine itself during endoscopy
was the diagnostic tool of choice; however, its use was limited due to low specificity.
Standard anemia workup and nutritional evaluation are indicated.
Stool analysis can help detect abnormal stool components. The pH may be acidic, and reducing
substance may be present in the stool.
D-lactic acidosis syndrome can result from carbohydrate fermentation. Lactic acid levels may need to
be measured and, if elevated, monitored. D-lactic acid levels, measured in the blood or urine, can help
differentiate bacterial overgrowth syndrome from other metabolic causes.
Short-chain fatty acid levels may be elevated in the duodenal fluid but not the stool.[11] Abnormal
duodenal short-chain fatty acid levels average approximately 1 mol/mL, with acetic acid, propionic
acid, and n -butyric acid representing 61%, 16%, and 8% of the total, respectively. The average shortchain fatty acid level in a healthy patient is 0.27 mol/mL, with acetic acid representing 84% of the
total.
Keto-bile acid concentration in duodenal fluid is increased and correlates with the type of bacterial
overgrowth.[12] The molar percent of keto-bile acids in normal duodenal fluid is very close to 0, while
gram-negative aerobic and anaerobic overgrowth is associated with levels of 32 mol/mL and 11
mol/mL, respectively.
Urine 4-hydroxyphenylacetic acid levels may be elevated.[13] Enteric bacteria that possess L-amino acid
decarboxylase produce 4-hydroxyphenylacetic acid from dietary tyrosine. Increased excretion has been
demonstrated in adults with bacterial overgrowth syndrome. Creatinine levels that exceed 120 mg/g are
typical in children with small-bowel disease or bacterial overgrowth syndrome, including children with
chronic Giardia lamblia gastroenteritis. Children with severe pancreatic dysfunction secondary to cystic
fibrosis also have significantly high levels of this metabolite. A 2% false-positive rate and no falsenegative results are found when this test is used to screen healthy control subjects and hospitalized
children.
Imaging Studies
Evaluation for malabsorptive processes should include small-bowel follow-through, which is used to
evaluate structure and mobility. Strictures, malrotation, diverticulosis, fistulae, and pseudo-obstruction
can be found with this technique.
Imaging and examination of the lower GI tract should be considered if upper GI evaluation is
nondiagnostic.
Procedures
Breath tests are used to measure byproducts of bacterial metabolism to identify malabsorbed
substances.[14] Several studies suggest that 3 breath tests are of adequate specificity, but these studies are
not in full agreement regarding the exact sensitivity. Studies that compare these tests with duodenal
bacterial counts suggest that the xylose breath test yields the highest specificity.[15]
Hydrogen breath test
Hydrogen breath tests are based on the fact that in humans hydrogen is exclusively produced by
intestinal bacteria, most notably by anaerobic bacteria in the colon of healthy people and also in the
small intestine in the case of bacterial overgrowth syndrome. Preoral glucose or lactulose challenge is
given before performing hydrogen breath tests. Bacteria ferment malabsorbed carbohydrates.
Fermentation releases hydrogen gas that is absorbed and excreted by the lungs.
Under normal conditions, fermenting bacteria reside in the colon. In bacterial overgrowth syndrome,
the exhaled hydrogen concentration rises early, corresponding to small intestinal bacteria fermentation
of carbohydrates. Under such conditions, a later rise in exhaled hydrogen may also be detected during
large bowel fermentation. Antibiotic administration invalidates this test.
For diagnosis, use 1-2 g/kg of glucose, not to exceed 25-50 g. A rise in exhaled hydrogen to 20 parts
per million is diagnostic. For diagnosis, use 10 g lactulose. A rise in 20 parts per million above baseline
is diagnostic. The specificity and sensitivity of this test are 62.5 and 82% after glucose and 56% and
86% after lactulose administration.[16]
Bile acid breath test
Give glycocholate tagged with carbon 14 with a light meal, and collect breath samples at 2, 4, and 6
hours. An abnormal rise in radioactive carbon dioxide levels indicates bacterial deconjugation of
glycocholate.
The specificity and sensitivity of this test are 60%-76% and 33%-70%, respectively
False positive results may come from disease or resection of terminal ileum, the site of bile absorption.
Carbon 14 carries a risk of radiation, which can be problematic in children and pregnant women. [4]
Xylose breath test
Gram-negative bacteria metabolize xylose, resulting in the release of radioactive carbon dioxide.
Administer 1 g of D-xylose tagged with carbon 14, as a liquid, after an overnight fast. Measure
radioactive breath carbon dioxide at 30, 60, 90, and 120 minutes. An abnormally high carbon dioxide
concentration is usually detected within 30-60 minutes. The specificity and sensitivity of this test are
14.3-95% and 40-94%, respectively.[4]
Combination of hydrogen breath test with simultaneous D-xylose breath test results in increase in
sensitivity of noninvasive diagnostics of bacterial overgrowth syndrome.[17, 18]
Histologic Findings
Descending duodenal biopsies performed in a group of elderly individuals with bacterial overgrowth
syndrome demonstrated that mean villus height, mean crypt depth, and total mucosal thickness may be
reduced. These indices are not significantly different from controls after 6 months of treatment of
bacterial overgrowth syndrome. A significant drop in the number of intraepithelial lymphocytes is also
seen over this observation period. Mucosal atrophy can result in an 80% reduction of intestinal surface
area in infants. Once the offending agent is removed, repair of the small bowel progresses slowly. After
2 months, the villi surface area is 63% normal but the microvillous surface area is only 38% normal.
Medical Care
Treatment in bacterial overgrowth syndrome (BOS) should include correction of primary underlying
disease if any, including antibiotic therapy and nutritional support. The primary approach should be the
treatment of any disease or anatomic defect that potentiated bacterial overgrowth. Many of the clinical
conditions associated with bacterial overgrowth syndrome are not readily reversible, and management
is based on antibiotic therapy aimed at rebalancing enteric flora. Careful consideration must be taken to
prevent total eradication of protective microorganisms. The goal should be directed at reducing
symptoms. Initial antibiotic therapy is usually empiric and should be broad and cover both aerobic and
anaerobic microorganisms. Community resistance patterns should also be considered.
Tetracycline was the mainstay of therapy, but its use as single agent has fallen out of favor in adult
patients given community increases in bacterial resistance.
Bacterial sensitivities from duodenal intubations with nonidiopathic bacterial overgrowth syndrome
support the use of amoxicillin-clavulanate. Amoxicillin-clavulanate appears to be 75% effective in
patients with diabetes.
Studies show that rifaximin eradicates bowel overgrowth syndrome in as many as 80% of patients.[19,
20]
Higher doses (1200 or 1600 mg/d) are more effective then standard doses (600 or 800 mg/d).
[21]
Long-term favorable clinical results have been achieved with rifaximin in patients with irritable
bowel and BOS.[22]
Clindamycin and metronidazole are useful in elderly patients with idiopathic bacterial overgrowth
syndrome.
As outlined below, gentamicin, but not metronidazole, significantly improves intractable diarrhea in
children younger than 1 year.[23]
Cholestyramine reduces diarrhea in infants and neonates with intractable diarrhea.[24] Infants with 10-25
days of severe persistent diarrhea for which a cause could not be found despite an extensive infectious
and immunologic workup were treated with cholestyramine and gentamicin or metronidazole.
Cholestyramine and gentamicin significantly reduced stool weight within 4-5 days of therapy but had
mild detrimental effects on fat and nitrogen absorption.
Ciprofloxacin and metronidazole result in normalization of hydrogen breath tests in most patients with
Crohn disease.[25]
Norfloxacin, cephalexin, trimethoprim-sulfamethoxazole, and levofloxacin have been recommended
for the treatment of bacterial overgrowth syndrome.[4, 26]
The exact length of therapy is not clearly defined; length of therapy should be tailored to symptom
improvement. A single 7-10 day course of antibiotic may improve symptoms in 46-90% of patients
with bacterial overgrowth syndrome.[27] . Recurrence following therapy is not uncommon and is more
likely in elder patients, especially those with history of appendectomy and chronic proton pump
inhibitor use. Patients with recurrent symptoms may need repeated (eg, the first 5-10 d of every month)
or continuous use of cyclical antibiotic therapy.[4]
Probiotic therapy results in bacterial overgrowth syndrome have been inconclusive and not generally
recommended for general clinic use.[2, 28]
Therapeutic use of prokinetics in bacterial overgrowth syndrome due to motility disorders have been
tried in many studies. Metoclopramide, cisapride, domperidone, erythromycin, tegaserod, and
octreotide have been used; however, data suggest long-term effectiveness is limited. [26]
Nutritional support with dietary modifications such as lactose-free diet, vitamin replacement, and
correction of deficiencies in nutrients like calcium and magnesium should be an important part of
bacterial overgrowth syndrome treatment, if applicable.
Certain potential underlying abnormalities are amenable to treatment, as follows:
Infectious diarrhea
Malnutrition
Malabsorption
Hypothyroidism
Inflammatory bowel disease
Immunodeficiency
The following potential underlying diseases are not amenable to treatment, but prevention of their
progression may be therapeutic:
3.
(repeated question) A 67-year-old woman presents with severe stabbing pain in the left cheek
lasting a few seconds, occurring several times a day, and precipitated by washing her face.
There are no abnormalities on physical examination.
What is the most appropriate initial treatment?
Carbamazepine
Baclofen
Gabapentin
Diazepam
Prednisolone
Many patients try to hold their face still while talking, to avoid precipitating an attack
In contrast to migrainous pain, attacks of TN rarely occur during sleep
See Clinical Presentation for more detail.
Diagnosis
No laboratory, electrophysiologic, or radiologic testing is routinely indicated for the diagnosis of TN,
as patients with a characteristic history and normal neurologic examination may be treated without
further workup.
Strict criteria for TN as defined by the International Headache Society (IHS) are as follows[1] :
A Paroxysmal attacks of pain lasting from a fraction of a second to 2 minutes, affecting 1 or more
divisions of the trigeminal nerve and fulfilling criteria B and C
B Pain has at least 1 of the following characteristics: (1) intense, sharp, superficial or stabbing; or (2)
precipitated from trigger areas or by trigger factors
C Attacks stereotyped in the individual patient
D No clinically evident neurologic deficit
E Not attributed to another disorder
IHS criteria for symptomatic TN vary slightly from the strict criteria and include the following[1] :
A Paroxysmal attacks of pain lasting from a fraction of a second to 2 minutes, with or without
persistence of aching between paroxysms, affecting 1 or more divisions of the trigeminal nerve and
fulfilling criteria B and C
B Pain has at least 1 of the following characteristics: (1) intense, sharp, superficial or stabbing; or (2)
precipitated from trigger areas or by trigger factors
C Attacks stereotyped in the individual patient
D A causative lesion, other than vascular compression, demonstrated by special investigations and/or
posterior fossa exploration
A blood count and liver function tests are required if therapy with carbamazepine is contemplated.
Oxcarbazepine can cause hyponatremia, so the serum sodium level should be measured after institution
of therapy.
See Workup for more detail.
Management
Treatment of TN comprises the following:
Pharmacologic therapy
Percutaneous procedures (eg, percutaneous retrogasserian glycerol rhizotomy)
Surgery (eg, microvascular decompression)
Radiation therapy (ie, gamma knife surgery)
Features of pharmacologic therapy are as follows:
Pharmacologic trials should always precede the contemplation of a more invasive approach, as medical
therapy alone is adequate treatment for 75% of patients
Single-drug therapy may provide immediate and satisfying relief
Carbamazepine is the best studied drug for TN and the only one with US Food and Drug
Administration (FDA) approval for this indication
Because TN may remit spontaneously after 6-12 months, patients may elect to discontinue their
medication in the first year following the diagnosis; most must restart medication in the future
Over the years, patients may require a second or third drug to control breakthrough episodes and finally
may need surgical intervention
Lamotrigine and baclofen are second-line therapies
Controlled data for adding a second drug when the first fails exist only for the addition of lamotrigine
to carbamazepine
Gabapentin has demonstrated effectiveness in TN, especially in patients with multiple sclerosis
Features of surgical treatment include the following:
Three operative strategies now prevail: percutaneous procedures, gamma knife surgery (GSK), and
microvascular decompression (MVD)
Ninety percent of patients are pain-free immediately or soon after any of the operations, [2] but the
relief is much more long-lasting with microvascular decompression
Percutaneous surgeries make sense for older patients with medically unresponsive trigeminal neuralgia
Younger patients and those expected to do well under general anesthesia should first consider
microvascular decompression
Practice Essentials
The most common cause of portal hypertension is cirrhosis. Vascular resistance and blood flow
are 2 important factors in its development. The images below depict esophageal varices, which are
responsible for the main complication of portal hypertension, massive upper gastrointestinal (GI)
hemorrhage.
Anterior abdominal wall dilated veins: May indicate umbilical epigastric vein shunts
Venous pattern on the flanks: May indicate portal-parietal peritoneal shunting
Caput medusae (tortuous paraumbilical collateral veins)
Rectal hemorrhoids
Ascites [1]
Paraumbilical hernia
Signs of a hyperdynamic circulatory state include the following:
Bounding pulses
Warm, well-perfused extremities
Arterial hypotension
Flow murmur over the pericardium
Other signs of portal hypertension and esophageal varices include the following:
Diagnosis
Laboratory testing
Management
Treatment is directed at the cause of portal hypertension. Gastroesophageal variceal hemorrhage
is the most dramatic and lethal complication of portal hypertension; therefore, the focus is on the
treatment of variceal hemorrhage. Management of patients with liver cirrhosis and ascites but
without hemorrhage includes a low-sodium diet and diuretics.
Emergent treatment
Surveillance
Nonselective beta-blockers (eg, propranolol, nadolol, carvedilol)
Vasodilators (eg, isosorbide mononitrate [ISMN])
Combination pharmacotherapy when a single agent fails
Secondary prophylaxis
Nonselective beta-blockers
Endoscopic therapy (EVL, treatment of choice; endoscopic sclerotherapy)
Combination EVL and pharmacotherapy
Surgery has no role in primary prophylaxis. Consider procedures, such as the following, for the
prevention of rebleeding when pharmacologic and/or endoscopic therapy have failed:
Portosystemic shunts
Devascularization procedures
Orthotopic liver transplantation: Treatment of choice for advanced liver disease
5.
(repeated question) Female patient wth history of multiple suicidal attempts and harsh
physical relationship, low mood and hearing voices off n on ,history of self harm ......
Diagnosis...Borderline personality disorder(other options were , bipolar disorder, .paranoid
schizophrenia, )
Medscape BPD:
Practice Essentials
Borderline personality disorder (BPD) is characterized by marked instability in functioning, affect,
mood, interpersonal relationships, and, at times, reality testing. BPD is associated with significant
morbidity due to common comorbid conditions, including dysthymia, major depression,
psychoactive substance abuse, and psychotic disorders. Approximately 70-75% of patients with
BPD have a history of at least one deliberate act of self-harm, and the mean estimated rate of
completed suicides is 9%.[1, 2]
Disturbances in experiencing oneself as unique, poor boundaries between self and others,
and poor emotion regulation.
An inability to soothe themselves adequately, resulting in excess emotional reactions to
stresses and frustrations; maladaptive attempts at self-soothing, suicide threats, self-harm, and
angry behavior
An unstable sense of self with poor ability for self-direction and impaired ability to pursue
meaningful short-term goals with satisfaction
Marked instability in functioning, affect, mood, interpersonal relationships, and, at times,
reality testing
Disturbances in empathy and intimacy
A pattern of impulsivity, risk taking, and poor self-image
See Presentation for more detail.
Diagnosis
In the American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders,
Fifth Edition (DSM-5),[4] BPD is diagnosed on the basis of (1) a pervasive pattern of instability of
interpersonal relationships, self-image, and affects, and (2) marked impulsivity beginning by early
adulthood and present in a variety of contexts, as indicated by at least five of the following:
Frantic efforts to avoid real or imagined abandonment; this does not include suicidal or
self-mutilating behavior covered in criterion 5
A pattern of unstable and intense interpersonal relationships characterized by alternating
between extremes of idealization and devaluation
Markedly and persistently unstable self-image or sense of self
Impulsivity in at least two areas that are potentially self-damaging (eg, spending, sex,
substance abuse, reckless driving, binge eating) [5] ; this does not include suicidal or selfmutilating behavior covered in criterion 5
Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
Affective instability due to a marked reactivity of mood (eg, intense episodic dysphoria,
irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
Chronic feelings of emptiness
Inappropriate, intense anger or difficulty controlling anger (eg, frequent displays of temper,
constant anger, or recurrent physical fights)
Transient, stress-related paranoid ideation or severe dissociative symptoms
An alternative model described in DSM-5 for personality disorders includes essential features for
personality disorders, with specific features added to denote the specific personality disorder.
Essential features of personality disorders using this model include: impairment in self-concept and
interpersonal relationships, inflexible traits causing impairment in personal and social situations,
and pathological personality traits. Pathological personality traits included in this model are
Negative Affectivity, Detachment, Antagonism, Disinhibition, and Psychoticism.
No laboratory tests are useful in identifying BPD. Some patients have abnormal results on
dexamethasone suppression testing and with abnormal thyrotropin-releasing hormone testing;
however, these findings are also present in many patients with depression. As with any thorough
workup of a patient with a mood disorder, fasting glucose and thyroid function studies are usually
indicated. Screening for substance abuse is often useful. Other laboratory tests are indicated,
depending on the clinical presentation.
See Workup for more detail.
Management
Historically, treatment of patients with BPD has been difficult. Therapy for BPD is as follows:
Selective serotonin reuptake inhibitors (SSRIs) are greatly preferred to the other classes
of antidepressants; they can reduce impulsivity and aggression; they are less dangerous in
overdose than many other psychoactive drugs; care must be taken that they do not lead to
suicidality, however
Low-dose neuroleptics (eg, risperidone) are effective in the short term for control of
transient psychotic symptoms and can decrease general agitation
Treatment with the opiate receptor antagonist naltrexone may reduce the duration and
intensity of dissociative symptoms in a small number of patients with BPD [8]
Patients with BPD tend to have strong placebo responses to medication; thus, impressive
short-term improvement might occur and unexpectedly fade
Patients with BPD commonly take overdoses of their prescribed medication; thus, tricyclic
antidepressants, lithium, and other mood stabilizers must be prescribed with great caution and
as part of an ongoing therapeutic relationship
Benzodiazepines, although helpful with anxiety, create risks of increased impulsivity and
dependency
O Western blot
O RT-PCR
Blotting methods
the proteins are then transferred to a membrane at which point they can
be probed with antibodies to a specific
protein
7.
SLE want to ask about developing neonatal Lupus which antibody present ? Anti Double Ds ?
Answer is Anti Ro ?
may appear on the trunk or extremities. They may be urticarialike and desquamative, occasionally
with ulceration.[19, 20] They are sometimes crusted; this finding is observed more often in male babies
than in female babies.
Atrophic lesions may develop[21] ; however, over time, even these lesions leave little residual
change. Telangiectasia is often prominent and is the sole cutaneous manifestation reported in
some patients. The atrophic telangiectatic changes are most evident near the temples and scalp.
When the scalp is involved, there may be associated permanent alopecia. Dyspigmentation is
frequent, but, with time, this change spontaneously resolves.
Two thirds of patients with skin findings have them at birth, [22] and the remainder develop cutaneous
findings within the first 2-5 months of life. In some infants, solar exposure seems to precipitate the
eruption, although exposure to ultraviolet (UV) light may not be necessary for the development of
cutaneous lesions.[23] The eruptions usually disappear when maternal antibodies are no longer
present in the neonatal circulation at approximately the sixth month of life.
At times, small angiomalike papulonodules may be seen. Follicular plugging is usually not evident.
Targetoid plaques may rarely be seen.[24]
In one study, cutaneous involvement was characterized as erythematous patches (91.7%), SCLElike lesions (50%), petechiae (41.7%), persistent cutis marmorata (16.7%), and discoidlike lesions
(8.3%).[13]
In children selected because of cutaneous involvement, thrombocytopenia and hepatic disease
may be as common as cardiac disease, and these diseases occur more often in male babies with
crusted plaques than in female babies. Thus, children with cutaneous NLE should be evaluated for
hematologic, hepatic, and cardiac involvement.
Cardiac disease
Cardiac involvement in NLE is common, occurring in roughly 65% of patients. [13]Cardiac rhythm
abnormalities and conduction defects may be observed in various forms, but the occurrence of
congenital complete heart block is most closely related to NLE, with an incidence of 15-30%.
Cardiac blocks usually develop in utero between the 18th and 20th weeks of gestation. Mothers
with primary Sjgren syndrome or undifferentiated autoimmune syndrome have a greater risk of
delivering an infant with congenital complete heart block than those with systemic LE (SLE). [25]
NLE that affects the heart is often noted upon physical examination at birth, but it may be
recognized with ultrasonography in utero. Complete congenital heart block is the usual finding, but
incomplete heart block is possible. This finding may be noted as a bradycardia in utero or during
physical examination at birth.
Heart failure is a well-recognized complication during the neonatal period. Other disturbances may
also be present. These disturbances lead to blocks in the atrioventricular or Purkinje systems,
potentially resulting in sinus bradycardia or prolongation of the QT interval. Incomplete heart block
and an irregular heartbeat may also be present. In some cases, myocarditis and pericarditis can
develop and lead to bradycardia. Congenital heart block may be associated with endocardial
fibroelastosis, which can be severe, and dilated cardiomyopathy.[26]
Circulating fetal blood antibodies, which have been passively acquired, can lead to permanent
heart disease and transient cutaneous manifestations. Hematologic and hepatic abnormalities may
also occur.
Hepatobiliary findings
Hepatobiliary involvement occurs in approximately 53% of patients with NLE. [13]The clinical
spectrum of associated hepatobiliary disease may vary from mild elevations of aminotransferase
levels to conjugated hyperbilirubinemia with normal or slightly elevated aminotransferase levels.
Hepatosplenomegaly is an occasional transient finding.
Hematologic findings
Hematologic disturbances in NLE (eg, hemolytic anemia, profound thrombocytopenia,
neutropenia) may occur in the first 2 weeks of life. [13]Autoantibodies, mainly anti-Ro, can bind
directly to the neutrophil and cause neutropenia. Thrombocytopenia may manifest as petechiae
(see the image below). Hematologic symptoms may vary from benign to severe and usually
appear at around the second week of life and disappear by the end of the second month; these
findings may improve or disappear as maternal antibodies are metabolized.
Other manifestations
Neurologic involvement may also be seen in NLE and may manifest as hydrocephalus and/or
macrocephaly.[27] A recent systematic literature review determined that most cases of neurologic
NLE are asymptomatic and identified by neuroimaging. White matter abnormalities, calcification of
the basal ganglia, intracranial hemorrhage, and subependymal pseudocysts were amongst the
abnormalities identified on neuroimaging. Symptomatic patients manifested with seizures, spastic
paraparesis, myelopathy, disturbance of consciousness, and hydrocephalus. [28] Infants born to
mothers with anti-Ro antibodies should probably be monitored for hydrocephalus and other
neurologic manifestations with cerebral sonography as part of their routine physical examination.
Pneumonitis may also be seen, manifesting as tachypnea or tachycardia.
In addition, rare reports describe chondrodysplasia punctata occurring in association with NLE. [29]
Laboratory Testing
Neonatal lupus erythematosus (NLE) is related to the anti-Ro (SSA) antibody in more than 90% of
patients. Occasionally, patients only have anti-La (SSB) or anti-U1RNP antibodies. These maternal
autoantibodies cross the placenta and can react with various fetal tissues, causing an increased
risk of acquiring NLE.
Infants with NLE should have cutaneous, cardiac, hepatobiliary, hematologic, and neurologic
assessments, along with thorough physical examinations and close attention to cardiopulmonary
status. Children with cutaneous NLE should be evaluated for hematologic, hepatic, and cardiac
involvement.
The blood panel may reveal pancytopenia, thrombocytopenia, or leukopenia with a hemolytic
anemia. Liver function tests may reveal transaminitis. Hepatomegaly may be observed.
In addition, screen the maternal serum for antinuclear, antidouble-stranded DNA, anti-SSA/Ro,
anti-SSB/La, and antiU1-RNP antibodies. Despite being positive for Ro and/or La antibodies,
many mothers may be healthy and without clinical symptoms during pregnancy. Mothers with
positive SSA/Ro and/or SSA/La antibodies should be counseled regarding the risk of NLE, and
mothers who have given birth to an infant with NLE should be counseled regarding the elevated
risk of NLE with subsequent pregnancies. Fetal cardiac monitoring is imperative for at-risk
mothers. In addition, closely monitor mothers in whom systemic lupus erythematosus (SLE) is
diagnosed by clinical symptoms and laboratory test results.
In a neonate with congenital heart block or thrombocytopenia, serum autoantibodies should be
investigated to rule out NLE, even if a suggestive maternal history is lacking. [14] Neonatal lupus in
triplets from a mother with undifferentiated connective-tissue disease evolving to SLE has been
described.[30]The 3 newborns had only SSA/Ro positivity associated with asymptomatic transient
neutropenia.
Children in whom SLE is suspected should undergo a serologic evaluation, including antinuclear
antibody (ANA), anti-dsDNA, anti-Sm, anti-RNP, anti-Ro (SSA), and anti-La (SSB), as well as
measurement of complement levels. Also test for other organ involvement, including a complete
blood cell (CBC) count and tests of renal function, including a urinalysis.
Approach Considerations
Neonatal lupus erythematosus (NLE) that affects the skin (see the image below), blood, spleen, or
liver is usually self-limited and resolves without intervention within 2-6 months.
8.
(Previous question) Rheumatoid Arthritis: related to HLA? a- DR4 b- DR3 c- DR2 d- B27
A
Fusion of bilateral sacroiliac joints Sacroililtis may present as sclerosis of joint margins
which can be asymmetrical at early stage of disease, but is bilateral andsymmetrical
in
late disease
Syndesmophytes and sguaring of vertebral bodies Squaring of anterior vertebral
margins
encourage regular
physiotherapy
exercise such
as
swimming
see
(such as suiphasaiaane)
are onty really useful if there is penpheral joint involvement
10. INFERIOR MI with complete heart block :PCI? What to do? Asked severally not sure f the
answer
mmol/l
Urea 8.1mmol/l
K+
4.6
Creatinine 99 |jmol/l
Bicarbonate 18 mmol/l
What is the most appropriate management?
Arrange haemodialysis
Intravenous magnesium
Intravenous bicarbonate
Intravenous hypertonic saline
The high lithium level and reduced GCS are an indication tor haemodialysis in
this patient.
Lithium toxicity
Lithium is mood stabilising drug used most commonly prophylatically in
bipolar disorder but also as an
adjunct in refractory depression. It has a very narrow therapeutic range (0.41 0 mmol/L) and a long
plasma half-life being excreted primarily by the kidneys. Lithium toxicity
generally occurs following
concentrations >1.5 mmol/L.
Toxicity may be precipitated by dehydration renal failure, diuretics (especially
bendroflumethiazide} or
ACE inhibitors
Features of toxicity
* coarse tremor (a fine tremor is seen in therapeutic levels)
* acute confusion
* seizure
* coma
Management
* mild-moderate toxicity may respond to volume resuscitation with normal
saline
* haemodialysis may be needed in severe toxicity
* sodium bicarbonate is sometimes used but there is limited evidence to
support this. By increasing
the alkalinity of the urine it promotes lithium excretion
Alopecia areata
Alopecia areata is a presumed autoimmune condition causing localised well
demarcated patches of hair loss. At the edge of the hair loss . there may be
small broken 'exclamation mark' hairs Hair will regrow in 50% of patients by
1year, and in 80-90% eventually. Careful explanation is therefore
sufficient in many patients. Other treatment options include
* topical or intralesional corticosteroids
* topical minoxidil
* phototherapy
* dithranol
* contact immunotherapy
* wigs
Most likely this patient has autoimmune thyroid disease
17. Lady with amenorrhoea and raised LH and FSH. The likely possibility.
a. Primary ovarian failure
b. PCOD
c. Investigate for pituitary cause.
Ans: primary ovarian failure.
18. A new blood test which can show signs of myocardial damage within
one hour of the onset of chest pain
Sildenafil
Sildenafil is a phosphodiesterase type V inhibitor used in the treatment of
impotence
Contraindications
* patients taking nitrates and related drugs such as nicorandil
* hypotension
* recent stroke or myocardial infarction
* non-arteritic anterior ischaemic optic neuropathy
Side-effects
* visual disturbances e.g blue discolouration, non-arteritic anterior ischaemic
neuropathy
* nasal congestion
* flushing
* gastrointestinal side-effects
* headache
20. A 1-year-old girl is noted to have a continuous murmur, loudest at the left
sternal edge She is not
cyanosed A diagnosis of patent ductus arteriosus is suspected What pulse
abnormality is most
associated with this condition?
Collapsing pulse
Bisferiens pulse
Pulsus parodoxus
'Jerky' pulse
Pulsus altemans
Features
19. AORTIC STENOSIS low hb upper endo normal? Further investigation capsule enteroscopy
21. Reverse split S2? LBBB
Physical Examination
Show All
Multimedia Library
References
History
Attacks of cluster headache (CH) are typically short and occur with a clear periodicity, particularly
during sleep or early morning hours, usually corresponding with onset of rapid eye movement
(REM) sleep.[5, 9] Unlike migraine, CH is not preceded by aura and is not usually accompanied by
symptoms such as nausea, vomiting, photophobia, or osmophobia. Typically, a patient experiences
1-2 cluster periods per year, each lasting 2 weeks to 3 months.
The International Headache Society (IHS) classifies CH as episodic or chronic on the basis of
duration as follows[3] :
Episodic CH occurs in periods lasting from 7 days to 1 year; cluster attacks are separated
by pain-free intervals at least 1 month long
Chronic CH persists for more than 1 year either without remission or with remissions
shorter than 1 month; it is further divided into 2 subcategories, chronic CH from onset and
chronic CH evolving from episodic CH
The pain of CH is manifested as follows:
Character - Excruciating, stabbing, sharp, and lancinating (as if the eye is being pushed
out), rather than throbbing
Location Unilateral, in the periorbital, retro-orbital, or temporal regions, though pain
sometimes radiates to the cheek, jaw, occipital, and nuchal regions; the pain tends to remain on
the same side during the cluster period but in rare cases may switch sides
Distribution - First and second divisions of the trigeminal nerve; approximately 18-20% of
patients complain of pain in the extratrigeminal areas (eg, the back of the neck, along the carotid
artery)
Onset Sudden, peaking in 10-15 minutes
Duration - 5 minutes to 3 hours per episode
Frequency - May occur 1-8 times a day for as long as 4 months (often nocturnal)
Periodicity - Circadian regularity in 47%
Remission - Long symptom-free intervals occur in some patients; the length of these
remissions averages 2 years but may range from 2 months to 20 years
Pain is accompanied by various cranial parasympathetic symptoms, including the following [5] :
Physical Examination
Physical examination findings should be normal, except for certain findings that serve as hallmarks
of CH. These accompanying findings are consistent with ipsilateral autonomic features
characterized by cranial parasympathetic activation and sympathetic hypofunction. The presence
of other abnormalities suggests another etiology for the headache.
Characteristic findings include the following:
Distinctive facial appearance - Leonine facies, multifurrowed and thickened skin with
prominent folds, a broad chin, vertical forehead creases, and nasal telangiectasias
Approach Considerations
Pharmacologic management of cluster headache (CH) may be classified into 2 general
approaches as follows:
Pharmacologic Therapy
Abortive agents are given to stop or reduce the severity of an acute CH attack, whereas
prophylactic agents are used to reduce the frequency and intensity of individual headache
exacerbations. In view of the fleeting, short-lived nature of the attacks, effective prophylaxis should
be considered the cornerstone of management. The prophylactic regimen should start at the onset
of a CH cycle and continue until the patient is headache-free for at least 2 weeks. The agent then
may be tapered slowly to prevent recurrences.
Abortive agents
Oxygen (8 L/min for 10 minutes or 100% by mask) may abort the headache if used early.[18, 19] The
mechanism of action is unknown.
5-Hydroxytryptamine-1 (5-HT1) receptor agonists, such as triptans or ergot alkaloids with
metoclopramide, are often the first line of treatment. Stimulation of 5-HT 1receptors produces a
direct vasoconstrictive effect and may abort the attack.
The triptan that has received the most study in the setting of CH is sumatriptan. [14, 18,
19]
Subcutaneous injections can be effective, in large part because of the rapidity of onset. Studies
have indicated that intranasal administration is more effective than placebo but not as effective as
injections; there is no evidence that oral administration is effective. A typical dose is 6 mg
subcutaneously, which may be repeated in 24 hours. Nasal spray (20 mg) may also be used.
Other triptans that may be considered for abortive treatment of CH are zolmitriptan, naratriptan,
rizatriptan, almotriptan, frovatriptan, and eletriptan. In addition, researchers have begun to explore
the possibility of using triptans for prophylaxis of CH.[20]
Dihydroergotamine can be an effective abortive agent. It is commonly given intravenously (IV) or
intramuscularly (IM) and may be self-administered; it can also be given intranasally (0.5 mg
bilaterally).[19] Dihydroergotamine tends to cause less arterial vasoconstriction than ergotamine
tartrate and is more effective when given early in a cluster attack.
Parenteral opiates may be used if relief is inadequate. The short-lived and unpredictable character
of CH precludes effective use of oral narcotics or analgesics, though oral regimens may
sometimes be helpful for residual soreness. Abuse potential does exist. Narcotics are not generally
recommended for aborting CH.
Intranasal civamide and capsaicin have yielded good results in clinical trials. Application of
capsaicin to the nasal mucosa led to a clinically significant decrease in the number and severity of
cluster headaches; nasal burning was the most common adverse effect.
Intranasal administration of lidocaine drops (1 mL of a 10% solution placed on a swab in each
nostril for 5 minutes) is possibly helpful; however, it requires a specific and, for many patients,
difficult technique.
Prophylactic agents
Calcium channel blockers may be the most effective agents for CH prophylaxis. [19]They can be
combined with ergotamine or lithium. Of the calcium channel blockers, verapamil may be the most
useful, though others, including nimodipine and diltiazem, have also been reported to be effective.
Lithium has been suggested as an option because of the cyclical nature of CH, which is similar to
that of bipolar disorders. It effectively prevents CH (particularly in its more chronic forms) [21] and
treats bipolar mood disorder, another cyclic illness. Responses vary (with chronic CH patients
generally being more responsive), but lithium is still a recommended first-line agent for CH. There
is a tendency for the effect to wane after dramatic relief is seen in the first week.
Methysergide, though no longer available in the United States, is very effective for episodic and
chronic CH prophylaxis. It can often reduce pain frequency, particularly in younger patients with
episodic CH. If it yields no improvement after 3 weeks, it is unlikely to be beneficial. It should not
be given continuously for longer than 6 months; a drug-free interval of 3-4 weeks must follow each
6-month course.
A few relatively small controlled studies have found anticonvulsants (eg, topiramate and
divalproex) to be effective in the prophylaxis of CH, though the mechanism of action remains
unclear.
Corticosteroids are extremely effective in terminating a CH cycle and in preventing immediate
headache recurrence. High-dose prednisone is prescribed for the first few days, followed by a
gradual taper. Simultaneous use of standard prophylactic agents (eg, verapamil) is recommended.
The mechanism of action in CH is still subject to speculation.
Tricyclic antidepressants are more helpful as prophylaxis of other headache syndromes. Beta
blockers may worsen bradycardia occurring during the cluster attack.
of complications, including intracranial hemorrhage.[29] Other serious side effects are subcutaneous
infection, micturition syncope, and transient loss of consciousness. [30]
Stimulation of the sphenopalatine ganglion, which is located in the pterygopalatine fossa, may also
be considered.[31] This approach has shown effectiveness in select patients with chronic CH. [32]
Prevention
The patient should avoid known headache triggers to the extent possible. For example,
disturbances in the sleep cycle can induce attacks. Strong emotions and excessive physical
activity may also induce attacks.
Tobacco may slow responsiveness to medications. Narcotics may expedite transformation of
episodic CH to chronic CH.
to an hour. During
the episodes his wife has seen him performing lip-smacking, chewing and
Presentation
[1]
Aura occurs in the majority of temporal lobe seizures. Most auras and
automatisms last a very short period - seconds or 1 to 2 minutes. Auras may cause
sensory, autonomic or psychic symptoms:
Psychic phenomena:
Fear or anxiety.
Following the aura, a temporal lobe focal dyscognitive seizure begins with a wideeyed, motionless stare, dilated pupils and behavioural arrest.
[2]
Hamartomas.
Gliomas.
Idiopathic (rare).
PatientPlus
Lennox-Gastaut Syndrome
Differential diagnosis
Absence seizures: have an abrupt onset with no aura, usually last for less than
30 seconds, have no postictal confusion and are not associated with complex
automatisms. Focal dyscognitive seizures are usually preceded by a distinct aura,
last longer than a minute, and have a period of postictal confusion.
Frontal lobe focal dyscognitive seizures appear in clusters of brief seizures with
abrupt onset and ending. There is minimal postictal state. May cause behavioural
changes with vocalisations and complex motor and sexual automatisms. In
differentiating from TLE, may need electroencephalograph (EEG) localisation.
Tardive dyskinesia.
Panic attacks.
Occipital lobe epilepsy: may spread to the temporal lobe and be clinically
indistinguishable from a temporal lobe seizure.
Investigations
[3]
Interictal EEG: one third of patients with TLE have bilateral, independent,
temporal interictal epileptiform abnormalities.
Management
[4][3]
Decision aids
Doctors and patients can use Decision Aids together to help choose the best
course of action to take.
Retigabine is recommended as an option for the adjunctive treatment of focalonset seizures with or without secondary generalisation in adults aged 18 years and
older with epilepsy, only when previous treatment with carbamazepine, clobazam,
gabapentin, lamotrigine, levetiracetam, oxcarbazepine, sodium valproate and
topiramate has not provided an adequate response, or has not been tolerated. [5]
Other anti-epileptic drugs (AEDs) that may be considered by the tertiary epilepsy
specialist are eslicarbazepine acetate, lacosamide, phenobarbital, phenytoin,
pregabalin, tiagabine, vigabatrin and zonisamide.
Prognosis
[3]
After three first-line AEDs have failed, the chance for seizure freedom is greatly
reduced.
Those patients with dominant TLE often have impaired language function.
25. Young boy 18 with renal impairment and recurrent uti as child + small kidneys on US? 1Reflux
nephritis
26. Rituximab. CD20
27. RA Patient used mtx and one more disease modifying med... What's next step?
28. Patient post real transplant on microfenolate, tacrulimus, ranitidine and has abdo pain? Cause
29 CT thorax finding aspergillosis
30 Patient unable to tip toe? Which tendon affected
63) disease presenting earlier - anticipation
64) oral thrush - fluconazole
65) protein sized and antibodies - western blot
75)
76)
77)
78)
There was a question about some occupational lung disease in which they
asked what will be the findings on spirometry....like matched reduction in
lung volume and TLCO.....anyone remembers the details of that question?
Pie chart- sex
Ques with pericardial effusion, systolic murmur, valves normal, investign to
b done? Mammography.
What about the person who came with a right sided tremor had shuffling
gate , cog wheel rigidity and bradykinesis a what treatment ?
Was it CRVO occlusion - because in CRAO the macula is pale
Also could any one list the neuro questions there were a few
irradiated RBC....benefit?....to inactivate leukocytes?
-
HTN pt on thiazide started on anti TB regimen then developed gout after 4 months of TB med,
what is the most likely cause ?
Inh,rifamp,ethamp,thiazide,strepto
mycophenolate side effect- abdominal pain?,
tip toe- achilles tendon
There was question about ESRD pt for dialysis with hyperkalemia >7 and 3rd degree heart block
how to manage?
Ca gluconate ,insulin, pacing, dialysis
I think for pace maker since there is complete heart block
1 gutter psoriasis , fingers welling? 2- palpitation and vt- which drugs to avoid, strep milleri and
abscess , pda pulse, lambert eaten syndrome receptor, Parkinson's and agitation, slidenafil Moa, basilar
artery anatomy. Chadvascscore 6, essential htn and pregnancy, , asthma and cough, asthma with low
vqmismatch, lack of sleep, subdural heamatoma and upgoing eyes, Cn 6 palsy, banana, ? Wucheleria
and eosinophilia , insect bite rash 10 cm and ? Treatment doxy Lyme!
oA- previous ulcer now arthritis pain-? Treatment , complement ,
70 female feeling unwell, attending for haemodialysis. K 7.9, Ur 22, Creat 500. Complete heart block.
HR 40. 1) haemodialysis 2) calcium gluconate 3) insulin dextrose 4) 5) temporary pacing
1.Tamponade sign :
2. Rivaroxaban Mia
3. Young girl mennoragia . VWD
4. Young male, haemophilia screen negative but prolonged bleeding at venepuncture
5. Syphills treatment
6. Painful genital ulcers
7. SLE treatment when wanting to conceive
8. Treatment for nausea in old male with Lewy body dementia
9. Elderly lady with diarrhoea treatment IVF vs rehydration salt
10. DKA still acidotic but no ketones and glucose normalised ?
11. Blood gas analysis for salicylate poisoning
12. Treatment for inducing remission in UC
13.preventing thyroid eye disease
14. Unable to stand on tiptoe , tendon involved post to med malleolus
15. Claudication better on sitting cause ?
16. Parotid swelling, dry eyes, antibody ?
17. SLE ab and pregnancy
18. Papular itchy rash on shins with long ridges in nails ?
19. Elderly woman with dry skin no rash TX . Emollient vs Anti histamine
20. Cause of creatinine rise in patient with simvastatiin , trimethoprim, dozasozin
21. Stones with hypercalcemia : treatment
23. Lady with diarrhoea RIF pain granule a formation, thickening and inflammation ileum cause ?
24. Cystic fibrosis inheritance in offspring
25. Son with glycosuria, father uncle and grandfather DM1 what deletion/mutation
26. Number needed to treat calculation
27. Statement true for syringomyelia ?
28. Acanthosis Nigrans cause ?
29. Man with dysphagia to solids and GORD - oesophageal cancer
30. Man with k 7.9 in complete heart block management ?
31. Kid went to Eastern Europe in rural areas with relatives and cats , lymphadenopathy in axilla and
splenomegaly ?
32. long QT due to which ion channel block ?
33. Hyper polarisation due to which ion ?
34. Prognosis in liver cirrhosis which factor ?
35. Paracetamol OD most severe prognosis PH 7.2
36 most common symptom of lung cancer ?
37. Stridor and swelling in thyroid cancer, what cancer of thyroid ?
38. Girl vomiting for one year with lanugo hair discoloured palms , what feature needs further
investigations ?
84. hyperpolarization..sodium..
85. capsule endoscopy..
86. alcohal withdrawl..chlordiazepoxide.
87. hemophillia transmission from father to son...0%
88. irradiated blood given to...to irradicate donor lymphocyte..
89. MODY..glucokinase mutation.
90. mebendazole.
91. addinosian crises..hydrocortisone.
92. leshmeniasis.
93. coelic disease..
94. levothyroxine action...dont know..
95. alzhimer...family history..
96 syringomyelia...pinprick hand
97. l5/s1
98. actin is the component of which orgenlle...cytoskeleton.
99. cataplasy.
100. sleep deprivation..
101. osteoporosis of vertebrae with osteopenia of hip.
102. facioscapulohumeral
103. young boy with renal failure...past history of recurrent UTi..reflex nephropathy.
104. axillary nerve.
105. supraspinatus tendnitis.
106. vitamin b12...dna synthesis.
107. excessive iodine intake.
108. ventricula tachycardia..verampail
109. lambert eaton myasthenic syndrome.
110. PDA..collapsing pulse.
111. acanthis nigrans..gastric cancer.
112. essential hypertension in pregnacy.
113. diastolic pressure increases during standing.
114.ct thorax..aspergillosis.
115. bullous pempigous
116 joint pain previous history of gastric ulceration...diclofenac and omeprazole or celecoxib
117. risk of lower limb ulceration...previous ulceration,
118. peripheral eosinophillia...strongloides
119. heart block..hyperkalamia..transerve pacing or ca gluconate.
120. radiation entritis..cholystramine.
121. ralovaxoban MOA...factor 10 A inhibitor.
122. negative cocci..right iliac pain..yersinia.
123. elective cholycystectomy..systolic murmur..normal chest xray..in echo small effusion..proceed
with surgery.
124. isoniazed metabolism...n acetyl transfrence status.
125. patient with RA and wants to pregnant..azothiapurine.
126. folate deficiancy
127. erectile dysfunction...patient has slightly increase prolactin..diabitis melitis..treatment..metformin
or bromocriptine.
128. MRSA...protein binding.
129. lupus sneraio..compliment deficiancy...C2
130. patient known alcohal..bottle of phenytoin empty..presented with confusion..nystgmus...ggt
increase..werncis
131. diazipam...rapid distribution to muscles.
132. medullary sponge kidney..nephrocalcinosis.
133. disartheria hinder in the process of stroke
134. egfr..phosphate increase.
135.marker of sickle cell crises...hematocrit.
136, parietal lobe.
137. DKA...hydroxybutyrate.
138. elderly with loose stool..ORS.
139. lyme disease..doxy
140. dexa scan..95%
141. loose stool..greater than 2 weeks...giardiasis.
From facebook
21. . Thyroid eye problem? Highlight risk due to smoking or high iodine uptake?
Rania Mahadi L5 /S1
Like Reply 1 16 hrs
Rania Mahadi Loss of ankle reflex
Like Reply 16 hrs
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No
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Rania Mahadi PCI ttt for ST elevation anferior MI and heart block
Like Reply 3 16 hrs
Nadia Irfan I did venous pacemaker but i think pci was right
Like Reply 9 hrs
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Write a reply...
Write a reply...
Pneumothorax.smoking
Like Reply 2 15 hrs
Pardeep Kumar nop its swimming..
Like Reply 15 hrs
Ahmed Moneim Badra No flying
Statistic ppv890/900
Like Reply 4 15 hrs
Nadia Irfan Yes
Like Reply 8 hrs
Farah Elaila option E righy
Like Reply 15 mins
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sensitivity??
Ahmed Fathalla Mesenteric angiography?
Like Reply 2 15 hrs
Ahmed Moneim Badra Mesentric angio
Like Reply 1 15 hrs
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Rania Mahadi First line ttt for parkinson disease in young male
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Rania Mahadi Dopamin
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Ahmed Fathalla Levodopa?
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Herpes!!
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Yes domperidonSee translation
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Rania Mahadi Please anwear by replies inside the Q for easy fallow
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Write a reply...
Write a reply...
Or ropinirol
Like Reply 2 15 hrs
Pardeep Kumar sjogrens...anti laSee translation
Like Reply 8 15 hrs
Ahmed Fathalla Congenital. Anti ro?
Like Reply 3 15 hrs
Rania Mahadi Arthritis and skin lesion on joint
Dermatomyositis
Rania Mahadi Pt with red eye
Like Reply 15 hrs
Ahmed Moneim Badra ConjuctivitisSee translation
Like Reply 15 hrs
Ahmed Fathalla Conjunctivitis?
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CoSee translation
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Ventricular tachycardia verapamil
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Episcleritis
Like Reply 3 15 hrs
DysthymiaSee translation
Like Reply 3 15 hrs
Depression not affecting work dysthmia
Like Reply 6 hrs
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Rania Mahadi Pt with headach an eye pain five time per day
Like Reply 15 hrs
Rania Mahadi No responce to opoid
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Rania Mahadi Stabbing headach
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Respiratory!!
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Rania Mahadi Respiratory was very defiult to remmber
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Rania Mahadi Ifeel chest pain
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Is thr
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Rania Mahadi Respiratory alkalosis
Like Reply 3 15 hrs
Asprin?See translation
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Ahmed Moneim Badra HyperventilationSee translation
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Haematology is so diffic
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also oncology
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Rania Mahadi Respiratory and dermatology
Like Reply 15 hrs
what about psychatry?
Like Reply 15 hrs
Rania Mahadi Pt with low mode
Like Reply 1 15 hrs
DysthymiaSee translation
Like Reply 15 hrs
Rania Mahadi Idont remember my answer in this Q
Like Reply 15 hrs
Write a reply...
Mahmoud Elhoriny Pain in the lt eye when moving in all directions, can't remember
Like Reply 9 hrs
Musaab Karrar Ishihara chart 1/17
Like Reply 1 8 hrs
Muzaffar Khan Also had afferent defect. It's optic neuritis
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Mahmoud Elhoriny That study which have 450 person have complications from plavix . So how many
pt needed ? What's the answer
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Musaab Karrar Statistics such a crab
Like Reply 7 hrs
Mahmoud Elhoriny hahaha its shit man grin emoticon
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Musaab Karrar Pt for elective cholecystectomy with systolic murmur and normal cxr echo small
effusion poterior what to do
Like Reply 8 hrs
Proceed
Like Reply 5 hrs
Nadia Irfan Yes
Like Reply 4 hrs
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Musaab Karrar Pt for elective cholecystectomy with systolic murmur and normal cxr echo small
effusion poterior what to do
Like Reply 8 hrs
Farah Elaila i put go for surgery
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Musaab Karrar Me too
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Musaab Karrar Parkinson pt had urosepsis and got confused and agitated ttt?
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Musaab Karrar Drug of choice lochen planus with kobner phenomena
Like Reply 8 hrs
1 Reply
Musaab Karrar Pt with transient UL weakness cbc low PLT and high LDH and blood film shistocytes
Like Reply 1 8 hrs
4 Replies 4 hrs
Musaab Karrar Man with extwnsive seborrheic eczema and HX of previous eczema what to do for him
Like Reply 2 7 hrs
1 Reply
Mahmoud Elhoriny pt was vision loss in examination there is hge with white spots
Like Reply 1 7 hrs
7 Replies 4 hrs
6 Replies 4 hrs
Musaab Karrar Pt with hypothyroidism and presented with adrenal crises treament
Like Reply 7 hrs
4 Replies 6 hrs
Mahmoud Elhoriny Pt with mandibular swelling and tender with history of cancer
Like Reply 4 hrs
1 Reply
Farah Elaila pt with bone pain hx of peptic ulcer treated whats the management
Like Reply 4 hrs
5 Replies 4 hrs
Nadia Irfan Systemic sclerosis with rash arhtladia and centromere antibodies
Like Reply 1 4 hrs
Mahmoud Elhoriny Female pt with multi fits attack define where is the problem
Like Reply 4 hrs
Mahmoud Elhoriny Female pt have attack of non speaking but doing homework according to her
husband
Like Reply 1 4 hrs
6 Replies 4 hrs
Mahmoud Elhoriny Pt with lt 4th finger swelling and 4th toe swelling and rt ring finger unsure
emoticon
Like Reply 4 hrs
4 Replies 4 hrs
Mahmoud Ahmed There was alot of Antibiotics mcqs .. u should study it well
Like Reply 1 3 hrs
Mahmoud Ahmed Cll anemia was iron or hypo function in BM ?
Like Reply 3 hrs
Mahmoud Ahmed Hemophilia % ?
Like Reply 3 hrs
1 Reply
See translation
Like Reply 3 hrs
Mahmoud Ahmed Most indication of pulmonary htn ?
Like Reply 3 hrs
1 Reply
Mahmoud Ahmed Patient with lupus and antiphospho ... pulmonary embolism ??
Like Reply 1 3 hrs
1 Reply
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Hanna Hanna Pt known hypothyroid , on thyroxine what is the pathophysiology of this treatment( sorry
I can't remember the points)
Like Reply 8 hrs
Hanna Hanna Pt attended latex anaphylaxis what type of food related ( answer was bannana)
Hanna Hanna Pregnant woman with boy baby, her father known haemophilia A
What is the risk the her son will have HA
25%, 50%, 100%, 0%
Like Reply 8 hrs
Hanna Hanna Woman had CF what is the chance her son will be affected
Like Reply 8 hrs
Hanna Hanna Addison crisis- treatment
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Muzaffar Khan Hydrocort
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Hanna Hanna 18 year old male with puffniss of the face and peripheral oedema
Unite positive +3 protein (minimal GN)
Like Reply 8 hrs
Hanna Hanna Chest pain 2 hour, ECG st elevation in inferior leads and CHB what is the treatment
Hanna Hanna Patient unprotected sex presented with multiple ulcers in penis and painful inguinal
lymph node - HSV
Like Reply 8 hrs
Muzaffar Khan Y not lymphogranuloma
Like Reply 6 hrs
Hanna Hanna Lymphogranuloma not multiple ulcers
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Hanna Hanna Elderly lady after treatment of pneumonia 3 days noted agitated, hallucination and
believes nurse wants to kill her- delirium
Like Reply 8 hrs
Hanna Hanna Dobutamin mechanics of action
Like Reply 8 hrs
Nafia Muqeet b1 agonist
Like Reply 8 hrs
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Hanna Hanna Patient with recurrent meningococcal meningitis where is the defect- I think answer was
complement pathway
Like Reply 1 8 hrs
Nafia Muqeet Anyone remember just paper 2 Qs plz so that we can search answers
Like Reply 1 7 hrs
Younis Osman Abdishakur Leishmaniasis....
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Hanna Hanna Pt with Huntington disease at young age, this father diagnosed at 36, his grandfather
daignosed at 68- ( anticipated
Like Reply 7 hrs
Hanna Hanna Patient known alcohol excess, noted a bottle of phenytoin empty presented with
confusion , nystagmus , defect in lateral lectus palsy, GGt above 400
1- phenytoin toxicity or 2- wernick
Like Reply 7 hrs
Amani Khalifa For me and my personal experience ithink onexam is better
Like Reply 7 hrs
Musaab Karrar I think so also its meant to be hard and with so damn tricky questions
Like Reply 1 hr
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Hanna Hanna Thee was a question about reactive arthritis, pt unprotected sex, dyuria and arthritis
Like Reply 7 hrs
Hanna Hanna Pt with history of chest pain on exertion presented with chest pain while walking uphill,
ecg normal and trop normal
What is the best intervention
Like Reply 7 hrs
Hanna Hanna Patient recently diagnosed sle, planning to be pregnant, she is on prednisone what
additional treatment:
1- cyclophosphamide
2- methotrexate ...See more
Like Reply 7 hrs
1 Reply
Hanna Hanna What I remember on this question was all the options are immunosuppressant
And the question clearly said she is planning pregnancy
Like Reply 6 hrs
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24. A 59-year-old female pub landlady presents with acute, severe lumbar back pain. There is no
history of orthopaedic problems and until this event she had been in perfect health. The patient
complains of paraesthesia in the lower limbs and on further questioning has not voided urine
since the onset of the pain. Neurological examination reveals weakness (3/5 of both lower
limbs, loss of sensation in L4, L5 and S1). Vibration sensation and joint position sensation is
preserved. Reflexes in the ankles and knees are absent and the plantar response is equivocal.
The blood pressure is 158/68 mmHg, heart rate 95 bpm, temperature 36.9C and ECG shows
normal sinus rhythm with no ischaemic changes. The remainder of the examination is normal.
Which of the following should be undertaken next for this patient?
1- CT head2- Duplex scan of aorta 3- MRI spinal cord4- Rectal examination 5- USS abdomen
anaesthesia.
MRI is the investigation of choice to confirm the diagnosis and determine the level of compression and
underlying cause. Delayed diagnosis and intervention can lead to permanent neurological damage, and
therefore MRI should be undertaken in a timely fashion.
Determining the presence of bowel dysfunction (with reduced anal tone and sensation) can be helpful
prognostically, but does not assist with the differential diagnosis. The pattern of weakness is not
consistent with an intracranial cause, and USS abdomen or duplex scan of the aorta are unlikely to help
here.
25. A 24-year-old man suddenly develops severe back pain while lifting some luggage. He is
unable to straighten up and subsequently develops numbness and weakness in his left leg,
followed by retention of urine. He is admitted to the Emergency Department where he is
unable to move off the bed due to pain. Urinary retention is confirmed, as is motor and
sensory loss affecting his left lower limb, and evidence of perianal sensory loss. Given the
likely clinical diagnosis, which plan of management is likely to be required?
Lumbar traction
NSAIDs
Extension exercises
Bedrest
Laminectomy and fusion
26. A 62-year-old man presents with lower back pain radiating into the posterior part of the tops
of both legs. He also reports trouble with starting and stopping his stream of urine and
difficulty making it to the toilet when he wants to pass stool. His symptoms have gradually
increased over the past 2 weeks. On examination he has local tenderness to palpation over the
lower back. There is diminished light touch in the perianal region and decreased anal tone. He
has bilateral lower limb weakness with diminished reflexes.
Where is the most likely cause of his symptoms?
Conus medullaris lesion
L1 disc lesion
Cauda equina syndrome
T10 disc lesion
Spinal meningioma
Cauda equina syndrome
The clinical picture seen here is typical of cauda equina syndrome with lower back pain and saddle
anaesthesia with bowel and bladder disturbance, caused by compression of nerve roots below the end
of the spinal cord
MRI or CT scanning of the lower spine is the investigation of choice
Initial pain relief is the cornerstone of management
Where a cause of compression is identified, such as intervertebral disc herniation, neurosurgical
intervention is of value
27. A 39-year-old woman with a history of rheumatoid arthritis presents with a two day history of
a red right eye. There is no itch or pain. Pupils are 3mm, equal and reactive to light. Visual
acuity is 6/5 in both eyes.
What is the most likely diagnosis?
A - Keratoconjunctivitis sicca B - ScleritisC - GlaucomaD - Episcleritis
E - Anterior uveitis
Answer: D. Episcleritis
Answer & Comments
episcleritis (erythema)
corneal ulceration
keratitis
Iatrogenic
steroid-induced cataracts
chloroquine retinopathy
Theme: ..cholesterol embolism about 5 times. Some are just plain questions, another showed a picture
and another asked for association of cholesterol embolism (eosionpilia)
28. A 72-year-old man was admitted with an acute anterior myocardial infarction. He has chronic
renal impairment, with a recent creatinine recorded at 148 pmol/litre. Medication included
ramipril, atorvastatin and indapamide for the treatment of hypertension. He was taken straight
to the angiography suite where he received stenting of a left main-stem stenosis. You are asked
to see him after about 30 hours as the nurses feel he is deteriorating. On examination his BP is
149/84 mmHg, his pulse is 75 bpm and regular. His legs look dusky in colour, particularly his
right big toe which looks blue in colour. He has splinter haemorrhages affecting toenails on
both feet. There isa loud left femoral bruit. The table below contains the investigation results
Cholesterol embolism
Risk factors for cholesterol embolism after coronary artery instrumentation include increased age (>
60 years), hypertension, cerebral vascular disease and aorto-iliac arterial disease
cholesterol emboli may break off causing renal disease seen more commonly in arteriopaths ,
abdominal aortic aneurysms and after Coronary artery surgery.
eosinophilia
purpura
renal failure
livedo reticularis
Management
Further vascular procedures, anti-coagulant and thrombolytic therapies are not of value in the
management of the condition
Patients should be dialysed during the acute period as they may recover a limited amount of renal
function
Prognosis
Unfortunately the prognosis of cholesterol embolism is very poor: where multiple organs are involved
mortality may approach 90% at 3 months
WBCS/mm3), this may still be signifi cant; treat if symptomatic. Cultured organisms are tested for
sensitivity to a range of antibiotics; check local sensitivity patterns
Sulfonylureas
Sulfonylureas are oral hypoglycaemic drugs used in the management of type 2
diabetes mellitus. They work by increasing pancreatic insulin secretion and hence
are only effective if functional Bcells are present. On a molecular level they bind to
an ATPdependent K (K ) channel on the cell membrane of pancreatic beta
cells.
Common adverse effects
hypoglycaemic episodes (more common with long acting preparations such
as chlorpropamide)
weight gain
Rarer adverse effects
syndrome of inappropriate ADH secretion
bone marrow suppression
liver damage (cholestatic)
photosensitivity
peripheral neuropathy
Sulfonylureas should be avoided in breast feeding and pregnancy
32. .ADH...action on the kidney. What part? cortical collecting duct 8 times
Antidiuretic hormone
Antidiuretic hormone (ADH) is secreted from the posterior pituitary gland. It promotes water
reabsorption in the collecting ducts of the kidneys by the insertion of aquaporin2 channels
theme: Antipsychotics
33. You review a 72-year-old man with a history of dementia. He is becoming increasingly hard to
manage at home, is agitated and difficult and is suffering from delusions that the members of
his family who care for him are trying to poison him. You decide to add risperidone to his
regime.
For which one of the following receptors does risperidone have the highest affinity?
5HT-3 receptors
5HT-2 receptors
alpha-Adrenergic receptorsvvg
D1 receptors
H2 receptors
insomnia
agitation
anxiety
headache
Risperidone may also lead to impaired glucose tolerance, although the incidence of abnormalities in
glucose metabolism is less than that seen with other antipsychotics
34. A 72-year-old man comes to the Elderly Care clinic with his wife for the results of tests to
determine the underlying cause of dementia, diagnosed some 2 months earlier because of
progressively increasing confusion and memory loss over the past year. Whilst he is still able
to wash and dress himself, his wife is finding it increasingly difficult to cope with him
wandering and trying to get out of the house at night. He takes no regular medication. On
examination his BP is 132/72 mmHg; pulse is 79/min and regular. He looks slightly unkempt.
His
BMI is 22 kg/m2. MMSE is 12/30.
They are given a diagnosis of Alzheimer's disease.
Which of the following is the most appropriate initial therapy?
Amitriptyline
Donepezil
Lorazepam
Memantine
Risperidone
The answer is Donepezil Acetylcholinesterase inhibitor treatment (Donepezil, Galantamine or Rivastigmine) should be
considered in patients with mild or moderate Alzheimer's disease although should ideally be initiated
by a specialist. In patients where these first line therapies are not tolerated, or are contra-indicated,
NICE recommends use of
Memantine. Tricyclic antidepressants such as Amitriptyline are not recommended because they may
worsen underlying confusion. Anti-psychotics should be avoided if possible, although if needed for
significant delusions and aggressive or confused behaviour, Risperidone would be considered first line.
Lorazepam is a
potential option, particularly for IM use in acute confusion and aggression.
Acetylcholinesterase inhibitors
Donepezil, which is licensed for the treatment of mild to moderate dementia, is a selective inhibitor of
acetylcholinesterase
Just four acetylcholinesterase inhibitors are currently licensed in the UK for the treatment of
Alzheimer's disease:
Tacrine
Donepezil
Rivastigmine
Galantamine
Memantine is also used for the treatment of Alzheimer's, it is a glutamate receptor
Theme....adrenaline...IM
36. patient with angioedema who used the adrenaline first time - I gave the adrenalin again as the
question repeated the fact that it was her first time using it maybe it was not correct - not sure .
another said FFP
Question isnt really clear however:
beats per minute and regular and severe pain on palpation of the epigastrium. Blood tests
reveal hypocalcaemia, metabolic acidosis and a markedly elevated serum amylase. He cannot
remember
what he takes for his epilepsy.
Which of the following antiepileptic agents is most likely to have caused his acute pancreatitis?
Lamotrigine
Phenytoin
Valproate
Carbamazepine
Topiramate
Drug-inducedacute pancreatitis
A number of agents may be associated with acute pancreatitis:
thiazide diuretics
furosemide
corticosteroids
tetracyclines
oestrogens
valproate
metronidazole
azathioprine
methyldopa
pentamidine
procainamide
nitrofurantoin
angiotensin converting enzyme (ACE) inhibitors
danazol
cimetidine
ranitidine
erythromycin, among many other agents
More than 90% of cases of acute pancreatitis however are associated with either biliary tract disease
or excess
alcohol consumption
Other causes include abdominal trauma, surgery, endoscopic retrograde cholangiopancreatography
and some viral
-
Infections
Theme : .angioedema
39. A 21-year-old woman is admitted to the hospital with a 1-hour history of sudden onset
breathlessness. This was accompanied by abdominal pain. She also has an erythematous rash,
which developed 24 hours earlier. In the Emergency Department she is mildly distressed and
has
an audible wheeze. There is no past medical history of significance. Her family history is unavailable
as she was adopted when she was 2 years old. As she has deteriorated, the intensivists decide to
intubate and ventilate her. Which one of the following investigations is most likely to help reach a
diagnosis?
CT thorax
Cold agglutinins
Arterial blood gases
Mycoplasma serology
C1 esterase inhibitor level
Theme: Dysphagia
40. A 55-year-old man complains of dysphagia for both solids and liquids. He says this began first
with liquids around
6 months ago, and has progressively worsened, although he has only lost 2kg in weight. On
examination his BP
is 147/87 mmHg, pulse is 75.min and regular, and his BMI is 32.
What is the most likely diagnosis?
Achalasia
Barretts oesophagus
Carcinoma of the oesophagus
Schatzki's rings
Benign oesophageal stricture
Dysphagia
Oesophageal motor disorders, such as achalasia, as in this scenario, are characterised by dysphagia for
both solids and liquids, although unlike dysphagia due to strictures or an underlying carcinoma, this
doesn't begin with solids andprogress. Obstructive oesophageal conditions such as carcinoma, stricture
and Schatzki's rings always cause
dysphagia for solids initially. The dysphagia associated with Schatzki's rings is intermittent.
43. A 50-year-old company director was admitted to hospital because of a myocardial infarction.
He wasthrombolysed and received a coronary artery bypass graft. The lesion leading to the
myocardial infarction startedmany years previously with foam cells.
What is the most likely cell contributing to this formation?
Endothelial cells
Fibroblasts
Lymphocytes
Macrophages
Erythrocytes
Answer is macrophages
Cardiac lesions
The earliest lesions of atherosclerosis are fatty streaks:
These consist of an accumulation of lipid-engorged macrophages (foam cells)
The fatty streaks progress to intermediate lesions (or transitional plaque), composed mainly of
macrophage foam cells and smooth muscle cells which migrate into the intima from the media
With time, these develop into raised fibrous (advanced) plaques, characterised by a dense fibrous cap
of connective tissue and smooth muscle cells overlying a core containing necrotic material and lipid,
mainlycholesterol esters, which may form cholesterol crystals on histological section
The necrotic core is a result of apoptosis and necrosis, increased proteolytic activity and lipid
accumulation
Fibrous plaques also contain a large number of macrophage foam cells, T cells and smooth muscle
cells:
This collection of cells, surrounding the necrotic core, promotes plaque growth
The plaque undergoes vascularisation and microvessels develop in connection with the artery's
vasavasorum
The new vessels provide a channel for the access of inflammatory cells and may also lead to
intraplaque
haemorrhage and thus weaken the plaque
Advanced atherosclerotic plaques frequently accumulate calcium, owing to the presence of proteins
specialised in binding calcium (osteocalcin, osteopontin, bone morphogenic proteins)
The advanced plaque is the substrate from which the complicated plaque develops, leading almost
inevitably
to clinical symptoms:
The complicated plaque has a thin cap, especially at the shoulders or margins of the lesion, and may
contain ulcerations, fissures, erosions or cracks
These provide sites of platelet adherence, aggregation and thrombosis
The thin fibrous cap may break or tear leading to haemorrhage into the necrotic core and thrombosis
Theme: encephalopathy Wernicke findings new Q
44. 58-year-old publican attends the clinic with confusion; you suspect alcohol-related problems.
Which one of the following pathological changes is a characteristic feature of the Wernicke-Korsakoff
syndrome?
Cerebellar atrophy
Dilatation of the III ventricle
Neuronal loss in the mammillary bodies
Demyelination in the pons medulla
Microvascular lesions in the cortex
Anser is C
Wernicke-Korsakoff syndrome
Background
Wernicke's encephalopathy represents the acute neuropsychiatric reaction to severe thiamine
deficiency
It is a disorder of acute onset, characterised by nystagmus, abducens and conjugate gaze palsies
systemic sclerosis
Wegener's granulomatosis
Theme: atrial fibrillation medication
46. Your next patient in the care of the elderly clinic is a 79-year-old lady who you initially saw
two months ago with
a history of palpitations. She has a history of stable coronary artery disease (CAD) and controlled
hypertension
on bendroflumethiazide. She remains active and lives alone independently.
When you saw her last you sent her for an echo. This demonstrates good LV function, mild
concentric LVH and
a dilated LA (AP diameter 5.7 cm). A 24 hour ECG has shown AF throughout, maximal rate 135.
On questioning
during this consultation she has noted a few episodes of palpitations lasting a few hours. Today her
ECG
confirms AF.
What is the most appropriate initial management of her arrhythmia?
Arrange DC cardioversion
Start amiodarone
Start bisoprolol
Start digoxin
Start sotalol
This question tests knowledge of the recommended initial strategy for patients with AF (that is.
rhythm or rate
control). The decision to start either strategy is based on symptoms and other clinical features.
This patient should be offered rate control in the first instance because she is older (>65). has a
history of CAD
and has a large left atrium (>5.5 cm) which makes cardioversion less likely to be successful.
Initial treatment for a rate control strategy is either a standard beta-blocker (that is. bisoprolol) or
calcium
channel blocker. Digoxin should only be used first line for patients who are predominantly sedentary
or
hypotensive.
Therefore the correct choice is start bisoprolol. The patient should also be considered for anticoagulation
based on her CHADS2 score.
Theme: Bupropion contraindication
47. What has NICE recommended the use of bupropion for?
Alcohol withdrawal
Opioid withdrawal
Cannabis cessation
Cocaine cessation
Smoking cessation (cigarettes)
Bupropion
Bupropion (Zyban) is used as a treatment adjunct, in combination with motivational support, for
smoking cessation
NICE recommended that nicotine replacement therapy or bupropion should be prescribed only for a
smoker who
commits to a target stop date
The smoker should also be offered advice and encouragement to stop smoking
Therapy to aid smoking cessation is chosen according to the smoker's likely compliance, availability
of counselling
48. and support, previous experience of smoking cessation aids, contraindications and the
smoker's preference
49. What disorder is bupropion contraindicated in?
Bupropion is contraindicated in patients with a history of seizures, eating disorders, CNS tumour or
those experiencing the acute symptoms of alcohol or benzodiazepine withdrawal
Theme: Metformin side effect new question
50. So, why would taking metformin possibly put you at risk for a B12 deficiency? According to
some studies, between 10% and 30% of people who take metformin on a regular basis have
some evidence of decreased B12 absorption.
Theme: Neutropenic Sepsis asked about 6 times
51.
This patient meets the diagnostic criteria for neutropenic sepsis. After failing to respond to standard
empirical treatment the questions is what to do next.
There are no guidelines that can fit every patient & scenario The decision to use antifungals is now
often taken after risk stratifying patients and ordering investigations such as HRCT. Aspergillus PCR
etc to determine the likelihood of systemic fungal infection. For the purposes of the exam however
the answer is often to give antifungals empirically. G-CSF is not used routinely in neutropenic sepsis.
Neutropenic sepsis
Neutropenic sepsis is a relatively common complication of cancer therapy, usually as a consequence of
chemotherapy. It may be defined as a neutrophil count of < 0.5 * 10s in a patient who is having
anticancer treatment and has one of the following:
a temperature higher than 38C or
other signs or symptoms consistent with clinically significant sepsis
if it is anticipated that patients are likely to have a neutrophil count of < 0.5 * 103 as a
consequence of their treatment they should be offered a fluoroquinolone
Management
antibiotics must be started immediately, do not wait for the WBC
NICE recommend starting empirical antibiotic therapy with piperacillin with tazobactam (Tazocin)
immediately
many units add vancomycin if the patient has central venous access but NICE do not support this
approach
following this initial treatment patients are usually assessed by a specialist and risk-stratified to
see if they may be able to have outpatient treatment
if patients are still febrile and unwell after 48 hours an alternative antibiotic such as meropenem is
often prescribed +/- vancomycin
if patients are not responding after 4-6 days the Christie guidelines suggest ordering
investigations for fungal infections (e.g. HRCT). rather than just starting therapy antifungal
therapy blindly
there may be a role for G-CSF in selected patients
52. What Antibiotic is advised for neutropenic sepsis ?
One that should should cover Pseudomonas Aeruginosa by giving IV Piperacillin /
Tazobactam.
53. What prophylaxis do you give to patient expected to have neuropenic sepsis? prophylactic
cipro
Theme: ITP asked over 10 times
54. A 42-year-old patient presents with increasing purpura affecting his arms and legs, particularly
when he bangs them, and problems with nose bleeds. He has no significant past medical
history. On examination he has
extensive purpura, bruising on his arms and legs and areas of petechiae, more on his lower limbs and
buttocks.
Abdominal examination is normal with no hepatosplenomegaly.
Investigations:
Hb 12.1 g/dl
White cell count 6.4 x 109/1
Platelets 8 x 109/1
Na+ 141 mmol/l
K+ 4.8 mmol/l
Creatinine 115 pmol/l
Which one of the following is the most appropriate initial therapy?
Cyclophosphamide
Immunoglobulins
Splenectomy
Prednisolone
Anti CD52 antibody
The likely diagnosis in this patient is idiopathic thrombocytopenic purpura The first line treatment in
such patients is high-dose prednisolone. Bone marrow examination would demonstrate increased
megakaryocytes
ITP: Investigation and management
Idiopathic thrombocytopenic purpura (ITP) is an immune mediated reduction in the platelet count.
Antibodies are directed against the glycoprotein llb-llla or lb complex
Investigations antiplatelet autoantibodies (usually IgG) bone marrow aspiration shows
megakaryocytes in the marrow. This should be carried out prior to the commencement of steroids in
order to rule out leukaemia
Management oral prednisolone (80% of patients respond) splenectomy if platelets < 30 after 3
months of steroid therapy IV immunoglobulins immunosuppressive drugs e.g. cyclophosphamide
55. Patient with ITP on steroids, not getting better after 3 months. What next to give?
Answer is IV immunoglobulins
Theme: Vitamin D in Chronic Kidney disease
56. Chronic kidney disease: bone disease
Basic problems in chronic kidney disease
* low vitamin D (1-alpha hydroxylation normally occurs in the Kidneys)
high phosphate
* low calcium due to lack of vitamin D.
* secondary hyperparathyroidism: due to low calcium high phosphate and low vitamin D
Several clinical manifestations may result:
Osteitis fibrosa cystica
aka hyperparathyroid bone disease
Adynamic
* reduction in cellular activity (both osteoblasts and osteoclasts) in bone
* may be due to over treatment with vitamin D
Osteomalacia
due to low vitamin D
Osteosclerosis
Osteoporosis
Theme: Bullous Pemphigoid asked over 10 times
Question 34 of 153
A 70-year-old woman complained of a rash that had developed over a month. She had otherwise been
fit and well. She has been on aspirin for 7 years.
On examination, there were numerous tense, fluid-filled blisters over the trunk and limbs, but no
mucosal
involvement was evident.
What is the most likely diagnosis?
Dermatitis herpetiformis
Erythema multiforme
Herpes simplex
Pemphigoid
Pemphigus vulgaris
The patient presents with tense blisters on her arms, trunk and legs. She is otherwise well and there is
nomucosal involvement. This is typical of bullous pemphigoid.
Dermatitis herpetiformis presents with itchy excoriated areas in the elbows knees and buttocks.
Erythema multiforme presents with characteristic target lesions.
Herpes simplex is vesicular and in generalised cases the patient is likely to be unwell.
Pemphigus presents with superficial erosions and usually there is mucosal involvement
Bullous pemphigoid
Bullous pemphigoid is an autoimmune condition causing sub-epidermal blistering of the skin This is
secondary to the development of antibodies against hemidesmcsomal proteins BP1 BO and BP230
Bullous pemphigoid is more common in elderly patients. Features include
itchy tense blisters typically around flexures
the blisters usually heal without scarring
mouth is usually spared*
Skin biopsy
* immunofluorescence shows IgG and C3 at the dermoepidermal junction
Management
referral to dermatologist for biopsy and confirmation of diagnosis
oraI c orticosteroids are the mainstay of treatment
* topical corticosteroids, immunosuppressants and antibiotics are also used
In reality around 1 0-50% of patients have a degree of mucosal involvement. It would however be
unusual for an exam question to mention mucosal involvement as it is seen as a classic differentiating
feature between pemphigoid and pemphigus.
Examination shows purplish, polygonal, flat-topped papules on her wrists and ankles. She also
has fine, white, lacy papules in her mouth. What is the diagnosis?
Pityriasis rosea
O Scabies
O Lichen planus
Drug reaction
O Candidiasis
Lichen
* planus: purple pruritic papular polygonal rash on flexor surfaces. Wickham's striae over
surface Oral involvement common
* sclerosus' itchy while spots typically seen on the vulva or elderly women
Mucous membrane involvement is common in lichen planus
Lichen planus
Lichen planus is a skin disorder of unknown aetiology, most probably being immune mediated
Features
itchy, papular rash most common on the palms, soles, genitalia and flexor surfaces of arms
rash often polygonal in shape 'white-lace1 pattern on the surface (Wickham's striae)
Kcebner phenomenon may be seen (new skin lesions appearing at the site of trauma}
oral involvement in around 50% of patients
nails' thinning of nail plate, longitudinal ridging
Lichenoid drug eruptions - causes
* gold
quinine
* thiazides
Management topical steroids are the mainstay of treatment - extensive lichen planus may require oral
steroids or immunosuppression
by an increase in environmental temperature, thus many patients notice that the condition begins after a
summer vacation.
It is a disorder of the healthy, but the immunocompromised are at risk.
The condition is asymptomatic and appears pale in comparison to the normal skin. The fungus affects
the
melanocytes hence the hypo-pigmentation.
The treatment options include topical imidazole creams, selenium sulphide shampoo and. if not
responding to
topical treatment, oral itraconazole 200mgonce a day for seven days.
In this patient the topical treatment should be tried first.
Theme: Melanomas
59. A 78-year-old woman asks you for cream to treat a lesion on her left cheek. It has been present
for the
past nine months and is asymptomatic. On examination you find a 2 * 3 cm area of flat brown
pigmentation with a jagged irregular edge The pigmentation on the anterior aspect of the lesion is a
darker brown. What is the most likely diagnosis?
Solar lentigo
Dermatofibroma
Lentigo maligna
0 Bowen's disease
Seborrhoeic keratosis
This patient presents with a lentigo maligna melanoma. These lesions commonly arise from a lentigo
maligna
which is a very slowly progressing over years. It is most commonly found on the head and neck regions
of older
adults. Features of progressing malignancy include the ABCDE rule of pigmented lesions:
increase in Asymmetry
irregular Borders
Colour variation
increase in Diameter, and
Evolution.
Lentigo maligna is the carcinoma in situ of melanoma
Theme: Anaphylaxis
60. You review a 24-year-old woman with a hi&tory pf a&thma in the Emergency Department.
She ha& been
admitted with acute shortness of breath associated with tongue tingling and an urticarial rash after
eating a meal containing shellfish. Her symptoms settle with nebulised salbutamol and intravenous
hydrocortisone. What is the most useful test to establish whether this episode was due to anaphylaxis?
Serum tryptase
Serum IgE
Plasma histamine
Eosinophil count
C-reactive protein
Anaphylaxis - serum tryptase levels rise following an acute episode
Serum tryptase levels may remain elevated for up to 12 hours following an acute episode of
anaphylaxis.
Anaphylaxis
Anaphylaxis may be defined as a severe life-threatening, generalised or systemic
hypersensitivity reaction
Anaphylaxis is one of the few times when you would not have time to look up the dose of a
medication.
The Resuscitation Council guidelines on anaphylaxis have recently been updated Adrenaline is by
far
the most important drug in anaphylaxis and should be given as soon as possible
Adrenaline can be repeated every 5 minutes if necessary. The best site for IM injection is the
anterolateral aspect of the middle third of the thigh.
Common identified causes of anaphylaxis
* food (e.g. Nuts) - the most common cause in children
* drugs
* venom (e.g. Wasp sting)
Tryptase
Chimase
Heparin
Chondroitin sulphate
IL4
IL13.
IL4 and IL13 are thought to be important in driving the onward
65. A 17-year-old woman presents with an erythematous rash affecting her wrists, ears and just
below her belly button. She admits to wearing some bangles, earrings and a belly-button ring
in the areas which appear to beaffected. She is otherwise well and has no significant past
medical history, only medication of note is the oral contraceptive pill. On examination, you
can see patches of an eczematous-type rash in the distribution that shedescribes. The table
below contains the investigation results.
Hb 13.1 g/dl
WCC 5.9 >= 109/litre
PLT 200 x 109/litre
Na+ 139 mmol/litre
K+ 4.5 mmol/litre
Creatinine 90 pmol/litre
Which one of the following is the most appropriate investigation?
RAST testing
Skin biopsy
Serum immunoglobulins
Patch testing
Fungal culture
Answer is Patch testing
Contact dermatitis
The distribution of the rash in this woman suggests contact dermatitis to nickel, which is often
prevalent in belt buckles and cheaper costume jewellery, such as earrings or bangles
Patch testing is the investigation of choice, where small amounts of the suspected chemical
responsible for the allergy are applied to the skin and left occluded for a period of 2 days
RAST testing has fallen out of favour in recent years due to the availability of more specific immune
testing
Occupation or planned occupation will dictate testing to a number of other allergens
It is not uncommon for patients allergic to nickel to also show cross reactivity to latex, which may be
a consideration if considering work where gloves are required to prevent exposure to hazardous
materials
66. IgE-mediated allergic reactions can be formally tested by skin prick testing.
Adverse reactions to which one of the following substances can be tested in this manner?
Morphine
Radiocontrast media
Scombrotoxin
Colloid plasma expanders
Latex
mahi
67. Nurse with Latex allergy 10 years back and now got the same problem wearing rubber (latex)
gloves- What is the mode of this reaction - TYPE IV HYPERSENSITIVITY
68. Which one of the following adverse food reactions is mediated by IgE-dependent mechanisms
and hence can be ascertained by skin prick testing?
Monosodium glutamate in Chinese food
Scombroid fish poisoning
Sulphites on prepacked salads
Salicylate-induced urticaria
Kiwi fruit
Answer is Kiwi fruit
Adverse food reactions
Kiwi fruit is a member of the latex-associated foods and adverse reactions to this fruit are
mediated by IgE
All the others (ie monosodium glutamate in Chinese food, scombroid fish poisoning, sulphites on
prepacked salads
and salicylate-induced urticaria) are examples of intolerance, indicating that detailed history-taking
is essential to
making the correct diagnosis
Scombroid fish poisoning causes immediate diffuse redness, diarrhoea and vomiting following
the consumption of
fish such as tuna, mackerel and mahi-mahi
Monosodium glutamate can cause abdominal bloating and vomiting - the so-called 'Chinese
restaurant syndrome'
Sulphites on prepacked salads causing asthma is called the 'salad-bar syndrome'
69. Which one of the following investigations will be most useful in subsequently establishing the
trigger for
an IgE-mediated process (anaphylactic mechanism)?
Elevated serum tryptase at approximately 1 hour after collapse
Total serum IgE level
Skin prick tests to anaesthetic agents CORRECT ANSWER
Serum/plasma C3 and C4 levels
Specific IgE to latex
The Answer Comment on this Question
YOUR ANSWER WAS INCORRECT
Anaphylaxis
Although tryptase measurements indicate mast-cell degranulation, they do not point to the triggering
mechanism
Total serum IgE is a test with little clinical value except in the interpretation of specific IgE
measurements
Skin prick tests performed at neat and 1:10 dilutions are the recognised investigations in anaphylaxis
Plasma complement levels are rarely helpful
Specific IgE to latex for investigating latex allergy may be helpful but is unlikely to be the cause of a
reaction at
induction, ie before the surgeon has a gloved hand inside the patient
70. A 42-year-old, atopic, health-care worker presents with red wheals and itchy hands within 20
min of wearing latex
gloves.
Which one of the following mechanisms is most likely to be relevant?
Contact dermatitis
Complement-mediated hypersensitivity reaction
Immune complex-mediated hypersensitivity reaction
Delayed-type hypersensitivity
IgE-mediated sensitivity CORRECT ANSWER
Treatment andprognosis
Excision surgery is the treatment of choice for larger lesions, cryosurgery being another option;
radiotherapy may be considered for difficult lesions, those who cannot tolerate surgery, or in surgical
failures
Cure is possible in more than 90% of patients
Morpheaform lesions have the highest recurrence rate, with positive tumour margins in up to 30% of
excisions
72. An elderly man presented with a lump on his temple that is shiny and is gradually increasing
in size. What is the most likely diagnosis?
Basal-cell carcinoma
Squamous-cell carcinoma
Seborrhoeic wart
Lentigo maligna
Amelanotic melanoma
Basal-cell carcinoma
Basal-cell carcinomas are the most common malignant skin tumour and are related to excessive sun
exposure
They are common later in life and may present as a slow-growing nodule or papule
Basal-cell carcinomas grow slowly and may cause local erosion, but they almost never metastasise
Management
Treatment is with surgical excision, although radiotherapy may be used for large superficial lesions
Very superficial small basal-cell carcinomas may be managed with cryotherapy, although regular
follow-up to examine for recurrence is recommended
Other notes
Squamous-cell carcinomas tend to have a keratinised or ulcerated surface, and seborrhoeic warts have
a papillomatous, pigmented surface appearance
Lentigo maligna arises in a pre-existing freckle
Amelanotic melanomas have a lack of pigment vs melanotic melanomas, but still have the
characteristic irregular border and a faint line of pigmentation around their edge
73. PT WITH SKIN LESION IN HIS FACE WAS TRESTED BY CRYOTHERAPY FOR
RECURENT SOLAR KERATITIS>>>BASAL CELL CARCINOMA?
74. Picture of BCC See below:
Theme: eczema
52.
Theme Sarcoidosis
New question
77. A 43-year-old man presented with a nodular tattoo lesion on his right upperarm. Its an old
tattoo. Further evaluation revealed asymmetrical hilar lymphadenopathy with no interstitial
lung disease.
Answer is Sarcoidosis Skin lesions in scars or tattoos may be the first symptom of systemic
sarcoidosis. Skin biopsy for histological confirmation of the diagnosis is recommended, as is
further investigation to evaluate other organ systems which may be affected
Theme: Leishmaniasis
78. A 37-year-old traveller to Latin America presents with an ulcer in his nose and says that he has
suffered problems
with nasal congestion for some time. He had been working for around 9 months or so on an Operation
Raleigh project at a jungle school. On examination there is a firm red ulcerated papule in the left
nostril, which involves the
nasal septum.. Investigations;
Hb 12.1 g/dl
WCC 9.1 x109/l
PLT 202 x109/l
Na+ 142 mmol/l
K+ 4.6 mmol/l
Creatinine 105 mol/l
Which of the following is the most likely diagnosis?
A Visceral leishmaniasis
B Basal cell carcinoma
C Squamous cell carcinoma
D Mucocutaneous leishmaniasis
E Blastomycosis
This presentation with an ulcerating papule involving the nasal septum is very typical of
mucocutaneous leishmaniasis. In this condition laboratory investigations are usually normal, and
culturing the parasite from a lesion is the simplest way to confirm the diagnosis, PCR does exist in
some centres however. Sodium stibogluconate is the usual therapy of choice. Leishmania viannia
braziliensis is one South American species known to result in mucocutaneous infection
Leishmaniasis
Leishmaniasis is caused by the intracellular protozoa Leishmania. usually being spread by sand flies.
Cutaneous, mucocutaneous leishmaniasis and visceral forms are seen
Cutaneous leishmaniasis
* caused by Leishmania tropica or Leishmania mexicana
crusted lesion at site of bite
* may be underlying ulcer
Mucocutaneous leishmaniasis
* caused by Leishmania braziiiensis
* skin lesions may spread to involve mucosae of nose, pharynx etc
Visceral leishmaniasis (kala-azar}
* mostly caused by Leishmania donovani
occurs in the Mediterranean, Asia. South America. Africa
* fever, sweats, rigors
massive splenomegaly, hepatomegaly
* poor appetite*, weight loss
grey skin - 'kala-azar' means black sickness
* pancytopaenia secondary to hypersplenism
Occasionally patients may report increased appetite with paradoxical weight loss
79. A 45-year-old man of Sudanese origin is admitted with a history of low-grade fever for over 7
days.He migrated to the UK 1year ago and has a past history of well-controlled asthma. His
temperature
chart shows that on some days there is a doubled rise in his temperature during 24 h.
Examinationshows a massively enlarged spleen and mild hepatomegaly. His full blood count shows a
mild
microcytic and hypochromic anaemia along with granulocytopenia and thrombocytopenia. Whichone
of the following investigations will establish a diagnosis?
Lymph node aspirate
Widal test
Xenodiagnosis
Examination of a wet blood film taken at night
Blood culture
Answer is lymph node aspirate
Visceral leishmaniasis
The diagnosis in the present case is visceral leishmaniasis
Causative organism
It is caused by infection with Leishmania donovani
L. donovani is found in the Mediterranean and Red Sea area, Sudan, India, China and South America
The organism multiplies in the monocytes and macrophages in various organs, especially in the liver
and spleen (which become enlarged), the bone marrow, lymphoid tissue and the small intestinal mucosa
Incubation period
The incubation period may be up to 10 years with an insidious onset and low-grade fever
Clinical features and prognosis
The temperature typically rises twice in 24 h
The spleen and liver are enlarged and if not treated the patient becomes wasted
Diagnosis
Diagnosis is by bone marrow, spleen, lymph node or liver aspiration
80. A 26-year-old traveller has just returned from South America. He notices several erythematous
nodules all over his body. Some have a golden crust. Which one of the following options is the
most likely diagnosis?
Leishmaniasis
Tuberculosis
Malaria
Loiasis
Infectious mononucleosis
Ans: Leishmaniasis
Causative organism
Leishmaniasis is caused by parasites of the genus Leishmania, which are transmitted by phlebotomine
sandflies
Clinical course
After an incubation period of a few days to several months an erythematous nodule develops at the
site of the infected sandfly bite
A golden crust forms
The sore reaches its final size, usually 1-5 cm in diameter, over weeks or months
The crust may fall away leaving an ulcer with a raised edge
Satellite papules are common
After months or years the lesion starts to heal, leaving a depressed, mottled scar
A forest plot, also known as a blobbogram, is a graphical display of estimated results from a number of
scientific studies addressing the same question, along with the overall results. [1] It was developed for
use in medical research as a means of graphically representing a meta-analysis of the results
of randomized controlled trials.
Although forest plots can take several forms, they are commonly presented with two columns. The lefthand column lists the names of the studies (frequently randomized controlled trials orepidemiological
studies), commonly in chronological order from the top downwards. The right-hand column is a plot of
the measure of effect (e.g. an odds ratio) for each of these studies (often represented by a square)
incorporating confidence intervals represented by horizontal lines. The graph may be plotted on
a natural logarithmic scale when using odds ratios or other ratio-based effect measures, so that the
confidence intervals are symmetrical about the means from each study and to ensure undue emphasis is
not given to odds ratios greater than 1 when compared to those less than 1. The area of each square is
proportional to the study's weight in the meta-analysis. The overall meta-analysed measure of effect is
often represented on the plot as a dashed vertical line. This meta-analysed measure of effect is
commonly plotted as a diamond, the lateral points of which indicate confidence intervals for this
estimate.
A vertical line representing no effect is also plotted. If the confidence intervals for individual studies
overlap with this line, it demonstrates that at the given level of confidence their effect sizes do not
differ from no effect for the individual study. The same applies for the meta-analysed measure of effect:
if the points of the diamond overlap the line of no effect the overall meta-analysed result cannot be said
to differ from no effect at the given level of confidence.
Theme: Psoriasis
82. You review a 24-year-old man who has recently presented with large psoriatic plaques on his
elbows
and Knees. He has no history of skin problems although his mother has psoriasis. You recommend
that
he uses an emollient to help control the scaling. What is the most appropriate further prescription
to use as a first-line treatment on his plaques?
Topical steroid
Topical steroid + topical calcipotriol
Topical coal tar
Topical calcipotriol
Topical dithranol
NICE recommend a potent corticosteroid applied once daily plus vitamin D analogue applied once
daily (applied separately, one in the morning and the other in the evening) for up to 4 weeks as initial
treatment.
Psoriasis: management
NICE released guidelines in 2012 on the management of psoriasis and psoriatic arthropathy. Please
see the link for more details.
Chronic plaque psoriasis
* regular emollients may help to reduce scale loss and reduce pruritus
* first-line: NICE recommend a potent corticosteroid applied once daily plus vitamin D analogue
applied once daily (applied separately, one in the morning and the other in the evening) for up to 4
weeks as initial treatment
* second-line if no improvement after 8 weeks then offer a vitamin D analogue (calciprotriol) twice
daily
* third-line: if no improvement after 3-12 weeks then offer either a potent corticosteroid applied
twice daily for up to 4 weeks or a coal tar preparation applied once or twice daily
short-acting dithranol can also be used
Steroids in psoriasis
* topical steroids are commonly used in flexural psoriasis and there is also a role for mild steroids
in facial psoriasis. If steroids are ineffective for these conditions vitamin D analogues or
tacrolimus ointment should be used second line
* patients should have 4 week breaks between course of topical steroids
* very potent steroids should not be used for longer than 4 weeks at a time. Potent steroids can
beused for up to 3 weeks at a time
* the scalp, face and flexures are particularly prone to steroid atrophy so topical steroids should
not be used for more than 1-2 weeks/month
Scalp psoriasis
* NICE recommend the use of potent topical corticosteroids used once daily for 4 weeks
* if no improvement after 4 weeks then either use a different formulation of the potent
corticosteroid (for example a shampoo or mousse) and/or a topical agents to remove adherent
scale (for example, agents containing salicylic acid emollients and oils) before application of the
potent corticosteroid
Face flexutal and genital psoriasis
* NICE recommend offering a mild or moderate potency corticosteroid applied once or twice daily
for a maximum of 2 weeks
Secondary care management
Phototherapy
* narrow band ultraviolet B light is now the treatment of choice. If possible this should be given 3
times a week
* photochemotherapy is also used - psoralen + ultraviolet A light (PUVA)
* adverse effects' skin ageing squamous cell cancer (not melanoma)
Systemic therapy
* oral methotrexate is used first-line. It is particularly useful inhere is associated joint disease
* ciclosporin
* systemic retinoids
* biological agents: infliximab, etanercept and adalimumab
* ustekinumab (IL-f 2 and IL-23 blocker) is showing promise in early trials
Mechanism of action of commonly used drugs
* coal tar probably inhibit DNA synthesis
* calcipotricl vitamin D analogue which reduces epidermal proliferation and restores a normal
horny layer
dithranol inhibits DNA synthesis, wash off after 30 mins SE burning, staining
Note that in some questions methotrexate or vit d isnt there, then choose cyclosporine.
83. You review a 50-year-old man who has psoriasis. Which one of the following medications
is most likely
exacerbate his condition?
Nicorandil
Simvastatin
Verapamil
Atenolol
Isosorbide mononitrate
Myasthenia gravis
Myasthenia gravis is an autoimmune disorder resulting in insufficient functioning acetylcholine
receptors Antibodies to acetylcholine receptors are seen in 90% of cases* Myasthenia is more
common in women (2:1)
The key feature is muscle fatigability - muscles become progressively weaker during periods of activity
and slowly improve after periods of rest:
* extraocular muscle weakness: diplopia
proximal muscle weakness: face. neck, limb girdle
* ptosis
* dysphagia
Associations
* thymomas in 15%
* autoimmune disorders: pernicious anaemia, autoimmune thyroid disorders rheumatoid 5LE
* thymic hyperplasia in 50-70%
Investigations
* Tensilon test: IV edrophonium reduces muscle weakness temporarily
* CT thorax to exclude thymoma
* CK normal
Management
* cholisnesterase inhibitor e.g. pyridostigmine
* immunosuppression: prednisolone initially
* thymectomy
Management of myasthenic crisis
* plasmapheresis
* intravenous immunoglobulins
are less commonly seen in disease limited to the ocular muscles
85. Which one of the following antibiotics is most likely to exacerbate myasthenia gravis?
Metronidazole
Ceftriaxone
Trimethoprim
Doxycycline
Gentamicin
Myasthenia gravis: exacerbating factors
The most common exacerbating factor is exertion resulting in fatigability, which is the hallmark feature
of
myasthenia gravis . Symptoms become more marked during the day
The following drugs may exacerbate myasthenia:
* penicillamine
* quinidine, procainamide
* beta-blockers
* lithium
* phenytoin
Awaiting the results of antibody testing does not alter the management, which is thymectomy.
Thymomas containedwithin the thymic capsule tend to be benign, but those that have extended beyond
it are generally malignant. Biopsy or fine-needle aspiration can breech the capsule and so increase the
risk of thymoma tumour seeding and should be avoided. Postoperative radiotherapy is indicated for
malignant or incompletely excised thymomas.
89. There was a case of Myasthenia gravis treatment? a- cholinesterase inhibitors
Physostigmine
Neostigmine
Pyridostigmine
Ambenonium
Demecarium
Rivastigmine
Donezepil,
Edrophonium
Theme : Benign intracranial hypertension
90. An obese 24-year-old female presents with headaches and blurred vision. Examination
reveals bilateral
blurring of the optic discs but is otherwise unremarkable with no other neurological signs. Blood
pressure is 130/74 and she is apyrexial What is the most likely underlying diagnosis'?
Multiple sclerosis
Meningococcal meningitis
Brain abscess
Normal pressure hydrocephalus
idiopathic intracranial hypertension
Obese. young female with headaches / blurred vision think idiopathic intracranial hypertension
The combination of a young, obese female with papilloedema but otherwise normal neurology
makes idiopathic intracranial hypertension the most likely diagnosis
Idiopathic intracranial hypertension
Idiopathic intracranial hypertension (also known as pseudotumour cerebri and formerly benign
intracranial hypertension} is a condition classically seen in young overweight females.
Features
* headache
blurred vision
* papilloedema (usually present}
* enlarged blind spot
* sixth nerve palsy may be present
Risk factors
* obesity
* female sex
* pregnancy
* drugs* oral contraceptive pill, steroids, tetracycline, vitamin A
Management
* weight loss
* diuretics eg. acetazolamide
* repeated lumbar puncture
* surgery optic nerve sheath decompression and fenestration may be needed to prevent damage
to the optic nerve. A lumboperitoneal or ventriculoperitoneal shunt may also be performed to
reduce intracranial pressure
*if intracranial hypertension is thought to occur secondary to a known causes (e.g. Medication} then it
is of course not idiopathic
Note that some of the Qs asked what to do to relieve symptoms (then you can choose LP)
91. A 24-year-old lady with a BMI of 36 and on the combined oral contraceptive pill presented
with a one month
history of increasing vertex headaches, worse in the mornings and worse on coughing and sneezing.
She also complained of blurry vision in both eyes.
Fundoscopy revealed bilateral extensive papilloedema with a lot of flame shaped haemorrhages around
and on
the optic discs.
Which one of the following is the best long term management of this patient?
(Please select 1 option)
Changing the combined oral contraceptive pill to an oestrogen based one
Perform lumbar puncture
Reduce weight
Start oral acetazolamide
This patient has idiopathic intracranial hypertension. The best longterm management is weight
reduction,which can improve her symptoms. Short term u can to LP
The first step in symptom control is drainage of cerebrospinal fluid by lumbar puncture. If necessary,
this may be performed at the same time as a diagnostic LP (such as done in search of a CSF infection).
In some cases, this is sufficient to control the symptoms, and no further treatment is needed. [3][5]
The procedure can be repeated if necessary, but this is generally taken as a clue that additional
treatments may be required to control the symptoms and preserve vision. Repeated lumbar punctures
are regarded as unpleasant by patients, and they present a danger of introducing spinal infections if
done too often.[1][3]Repeated lumbar punctures are sometimes needed to control the ICP urgently if the
patient's vision deteriorates rapidly
Changing the combined oral contraceptive pill to a more oestrogen based one can worsen the
symptoms.
Lumbar puncture and acetazolamide can help improve the symptoms, but should not be considered as
longterm management.
Theme: Reiters disease
92. A 25-year-old man gives a 2-week history of painful joints affecting his lower limbs. He
returned
from a holiday in south-east Asia 3 weeks ago. During this holiday he had developed loose bowel
motions followed by eye irritation, for which he had consulted a local doctor. He has a
psoriasiform rash on his lower limbs and soles. What is the most likely diagnosis?
Lichen planus
Guttate psoriasis
Reactive arthritis
Mastocytosis
Porphyria
Reactive arthritis
Reactive arthritis is characterised by non-suppurative polyarthritis following a lower urogenital or
enteric infection
It usually affects young men carrying the HLA-B27 antigen
Inflammatory eye disease and mucocutaneous manifestations are common
Chlamydia trachomatis, Ureaplasma spp, Shigella spp and other organisms may be responsible
Conjunctivitis occurs early and may be followed by iritis
The skin lesions are psoriasiform (keratoderma blennorrhagicum), but erosive lesions may affect the
penis
(circinate balanitis) or mouth
Rare complications include heart block, aortic incompetence and pericarditis
Other
93. A 30-year-old man presents with malaise, fever, backache and joint pains of 1week's duration.
On examination,
arthritis is present asymmetrically in the lower limbs, involving the knees, one ankle, and some
metatarsophalangeal and toe joints. An eye examination reveals conjunctival congestion and there is a
vesicular crusting lesion on his left sole. Investigations reveal: erythrocyte sedimentation rate (ESR) 60
mm in 1st hour, Creactive
protein (CRP) 50 mg/l; rheumatoid factor is negative and HLA B27 is positive.
Which one of the following is the most likely diagnosis?
Rheumatoid arthritis
Gout
Reactive arthritis
Psoriatic arthritis
Ankylosing spondylitis
Reactive arthritis
The spondyloarthropathies share common clinical features and HLA B27 positivity. Rheumatoid factor
is usually
negative. This group of diseases includes:
Ankylosing spondylitis
Reactive arthritis (formerly known as Reiter syndrome)
Psoriatic arthritis
Enteropathic arthritis
Undifferentiated arthritis
Clinical features of reactive arthritis
Patients with reactive arthritis may have had a prodromal infection 1-4 weeks before its onset, usually
with Shigella,
Salmonella, Yersinia, Campylobacter or Chlamydia spp. Constitutional symptoms and asymmetric
lower limb arthritis
are characteristic. Skin lesions include vesicular keratoderma blennorrhagica (usually on the palms and
soles) and
circinate balanitis on the glans penis.
Differential diagnosis
Psoriatic arthritis is a close differential, but the arthritis is usually in the upper limb and more gradual
in onset. The
skin lesions in psoriasis are flat-topped plaques with silvery scales, usually found on the elbows, knees
and scalp.
Rheumatoid arthritis usually presents with gradual-onset symmetrical arthritis.
Gout is usually acute and monoarticular.
94. A 28-year-old man presents to the clinic with painful knees and ankles. He is noted to have a
rash on the glans
penis. He has a history of urethritis due to Chlamydia trachomatis. He has also recently attended the
Ophthalmology Department for an episode of uveitis.
What is the most likely diagnosis?
Reactive arthritis
SLE
Gouty arthritis
Septic arthritis
Rheumatoid arthritis
Reactive arthritis
The classic triad of arthritis, urethritis and conjunctivitis was previously known as Reiter syndrome, but
is now referred
to as reactive arthritis. It often occurs with mucocutaneous lesions. Uveitis or episcleritis may also
occur as ocular
findings. A similar spectrum of clinical manifestations can be triggered by enteric infection with any of
several Shigella,
Salmonella, Yersinia and Campylobacter species and by genital infection with Chlamydia trachomatis
(an organism
particularly associated with reactive arthritis). Reactive arthritis has a strong HLA-B27 association and
is a
seronegative spondyloarthropathy. The arthritis is usually asymmetrical and additive. There is no sepsis
and joint
aspirates are sterile.
The history and findings here are not suggestive of rheumatoid arthritis.
95. A 22-year-old man who suffers from inflammatory bowel disease has developed pain and
stiffness in his lower back over the past 6 months. Examination reveals tenderness over both
sacroiliac joints. He tests positive for
HLA-B27.
What is the most probable diagnosis?
Prolapsed intervertebral disc
Rheumatoid arthritis
Ankylosing spondylitis
Osteoarthritis
Enteropathic arthritis
Ankylosing spondylitis
Ankylosing spondylitis most commonly involves the sacroiliac joints causing pain and stiffness. Up to
half the patients
have inflammation of the colon or ileum. Although this may be asymptomatic, frank inflammatory
bowel disease may
develop in 5-10% of cases. The HLA-B27 gene is present in nearly 90% of patients with ankylosing
spondylitis. It is
the distribution, with particularly the sacroiliac joints being affected and the absence of a peripheral
small joint arthropathy, which fits better with ankylosing spondylitis rather than enteropathic arthritis.
Theme: AAT Deficiency
96. A 56-year-old man with severe exertional dyspnoea is admitted with jaundice and ascites. He
has recently been diagnosed with COPD by his GP although he insists that he only smokes
occasional cigars. His father died of respiratory illness at 54 years of age. Bilirubin, aspartate
transaminase (AST) and alkaline phosphatase levels are elevated and liver biopsy reveals the
presence of periodic acid-Schiff- (PAS-) positive, diastase-resistant globules in periportal
hepatocytes.
What is the most likely diagnosis?
Alcoholic liver disease
Alpha-1-antitrypsin deficiency
Cor pulmonale
Budd-Chiari syndrome
Haemochromatosis
antitrypsin deficiency
The liver biopsy appearance is also supportive of the diagnosis, with a-i-antitrypsin deficiency predisposing to cirrhosis
Absolute avoidance of alcohol and cigarettes is crucial, and recombinant a-j-antitrypsin may be
considered for some patients.
97. A 45-year-old man has severe pulmonary emphysema. A diagnosis of -antitrypsin deficiency
is being
considered.
What is the genotype most typically associated with this condition?
PiMM
PiMZ
PiSS
PiSZ
PiZZ
Answer is Pizz
Alpha i-Antitrypsin deficiency
The function of a-j-antitrypsin is to inhibit neutrophil elastase and other proteases
The wild type is Pi (protease inhibitor) MM
The gene displays considerable polymorphism, with co-dominant inheritance
Most of the variant proteins function normally but the PiZZ phenotype (approximately 1:2000 live
births in Northern
Europe) is associated with deficiency of the protein and a risk of liver disease in infants and
emphysema in adults (especially smokers)
SS homozygotes and MS heterozygotes are not at increased risk
MZ heterozygotes have a slightly increased susceptibility to emphysema
Alpha 1 antitrypsin- Neutrophil elastase inhibitor
Which form of lung disease develops typically in people with ai-antitrypsin deficiency?
Atelectasis
Pneumonitis
Emphysema
Interstitial fibrosis
Bronchiectasis
Answer is ephysema
98. Alpha one anti trysin inheritance pattern: Autosomal recesive, co deominat. Look this up
99. Repeated severally but not found in any of the notes.. Mechanism of action of cyclosporine?
Cyclosporine cyclosporin A, CsA , a neutral lipophilic cyclic undecapeptide isolated from the fungus
Hypocladium inflatum gams, has been widely used for the treatment of allograft rejection and graft-vs.host disease since re ported its immunosuppressive activity. Early biological studies revealed that CsA
inhibits T cell activation by blocking the transcription of cytokine genes, including those of IL-2 and
IL-4.
Theme: CREST/raynauds
100.A 56-year-old lady is referred to rheumatology clinic due to severe Raynaud's phenomenon
associated
with arthralgia of the fingers. On examination you note shiny and tight sKin of the fingers with a
number
of telangiectasia on the upper torso and face She is also currently awaiting a gastroscopy to
investigate heartburn. Which one of the following antibodies is most specific for the underlying
condition?
0 Anti-Jo fantiobodies
Rheumatoid factor
Anti-Scl-70 antibodies
Anti-centromere antibodies
Anti-nuclear factor
systemic sclerosis anti-centromere antibodies are the most specific test for limited cutaneous systemic
sclerosis
Systemtc sclerosis
Systemic sclerosis is a condition of unknown aetiology characterised by hardened sclerotic skin and
other connective tissues It is four times more common in females
There are three patterns of disease:
Limited cutaneous systemic sclerosis
Raynaud's may be first sign
* scleroderma affects face and distal limbs predominately
associated with anti-centromere antibodies
* a subtype of iimited systemic sclerosis is CREST syndrome Calcinosis. Raynaud's phenomenon
Esophageal dysmotility. Sclerodactyly. Telangiectasia
Diffuse cutaneous systemic sclerosis
* scleroderma affects trunk and proximal limbs predominately
* associated with scl-70 antibodies
* hypertension lung fibrosis and renal involvement seen
* poor prognosis
Scleroderma (without internal organ involvement)
tightening and fibrosis of skin
* may be manifest as plaques (morphoea) or linear
Antibodies
ANA positive in 90%
* RF positive in 30%
* anti-scl-70 antibodies associated with diffuse cutaneous systemic sclerosis
anti-centromere antibodies associated with limited cutaneous systemic sclerosis
* testicular pain
* livedo reticularis
* haematuria. renal failure
* perinuclear-antineutrophil cytoplasmic antibodies (ANCA) are found in around 20% of patients
with 'classic' PAN
* hepatitis B serology positive in 30% of patients
Theme: Cocaine
102.A 22-year-old cocaine addict presents with central crushing chest pain after apparently
snorting 3 lines of the
drug. He is pale and sweaty. His blood pressure is 180/110 mmHg. ECG shows anterior ST elevation
consistent with myocardial infarction.
Which one of the following is the most appropriate treatment?
Thrombolysis
Heparin
Percutaneous coronary intervention
Naloxone
Glycoprotein 2b/3a inhibitors
Cocaine use has recently been implicated as a cause of unstable angina
Three possible mechanisms by which cocaine induces myocardial ischaemia are:
increased myocardial oxygen demand
decreased myocardial oxygen supply secondary to vasospasm or coronary thrombosis
direct myocardial toxicity
Documented cocaine use should not be considered to rule out underlying significant coronary artery
disease (CAD), as the drug may precipitate coronary vasospasm or acute myocardial infarction in the
patient with atherosclerotic CAD
Where urgent angioplasty is available, this is preferable to thrombolysis as outcome studies show it to
be superior
103.You review a 28-year-old man who has been admitted in a state of collapse from a night club.
His friends admitthat because of pressure at work he has been using increasing amounts of
cocaine recently.
Which of the following stems is commonly associated with cocaine overdose?
Bradycardia
Hypotension
Metabolic alkalosis
Hypothermia
Metabolic acidosis
Cocaine overdose
Cocaine blocks the re-uptake of biogenic amines, and inhibition of dopamine re-uptake is the cause of
the
psychomotor agitation that commonly accompanies cocaine use
Blockage of noradrenaline (norepinephrine) re-uptake leads to tachycardias, and serotonin re-uptake
blockade leads to hallucinations
In overdose, cocaine leads to agitation, tachycardia, hypertension, sweating, hallucinations and finally
convulsions
Metabolic acidosis, hyperthermia, rhabdomyolysis and ventricular arrhythmias also occur
Chronic use may be associated with premature coronary artery disease, dilated cardiomyopathy and
increased risk of cerebral haemorrhage
104.cocaine abuser having chest pain and htn what complication he will develops hyponatremia /
hyperkalemia / hyperthermia / hypothermia etc >>>HYPERTHERMIA??
Theme: NASH
106.A 52-year-old woman is diagnosed with non-alcoholic steatohepatitis following a liver biopsy.
What is
the single most important step to help prevent the progression of her disease?
Stop smoking
Start statin therapy
Eat more omega -3 fatty acids
Start sulfonylurea therapy
Weight loss
108.A 56-year-old female is noted to have hepatomegaly. Six years ago she was diagnosed with
diabetes mellitus
and takes metformin 500mgtds and gliclazide 80mgbd. She drinks approximately 15 units of alcohol
weekly and stopped smoking10 years ago.
On examination she has a BMI of 36.2 kg/m2, no stigmata of liver disease are evident but she has 6 cm
hepatomegaly.
Investigations reveal:
Total bilirubin 11 pmol/L (1-22)
Alkaline phosphatase 145U/L (45-105)
AST 100U/L (1-31)
ALT 150U/L (5-35)
Albumin 40 g/L (37-49)
Ferritin 434 pg/L (15-300)
Ultrasound of the abdomen reveals an echobright appearance of the liver and gallstones in the
gallbladder.
What is the most likely cause of her liver disease?
Alcoholic liver disease
Druginduced hepatitis
Gallstone disease
Haemochromatosis
Non-alcoholic steatohepatitis (NASH)
The patient has a hepatitic picture in contrast to cholestasis.
Ferritin level is not too high to be considered for haemochromatosis and is an acute phase reactant
being
typically increased in any inflammatory process. It is often raised, sometimes quite dramatically, in the
setting
of NASH.
NASH is commonand is typically encountered in obese patients presenting with a hepatitic picture with
or
without jaundice. Echo bright liver suggests fatty change in the liver seen in NASH.
It was previously termed idiopathic decompensated hepatitis
109.A 4-year-old boy is being investigated for failure to thrive and generalised weakness. His
blood
pressure is normal The following blood results are obtained
Na+ 137 mmol/l
K+ 3,0 mmol/i
Urea 4,5 mmol/l
Creatinine 65 Mmo [/I
Bicarbonate 33 mmol/l
What is the most likely diagnosis?
Conn's syndrome
Barker's syndrome
Cushing's syndrome
21-hydroxylase deficiency
Liddle's syndrome
Barker's syndrome is associated with nonnotension
Barker's syndrome is the most likely diagnosis. Congenital adrenal hyperplasia due to 21-hydroxylase
deficiency is associated with precocious puberty rather than failure to thrive in boys. Both Conn's and
Cushing's are associated with hypertension and are not common in this age group
Liddle's syndrome is a rare autosomal dominant condition that causes hypertension and hypokalaemic
alkalosis It is thought to be caused by disordered sodium channels in the distal tubules leading to
increased reabsorption of sodium.
Bartters syndrome
Bartter's syndrome is an inherited cause (usually autosomal recessive) of severe hypokalaemia due to
defective chloride absorption at the Na+ K+ 2 Cl- cotransporter in the ascending loop of Henle. It
should
be noted that it is associated with normotension (unlike other endocrine causes of hypokalaemia such
as Conn's. Cushing's and Liddle's syndrome which are associated with hypertension)
Features
* usually presents in childhood, e.g. Failure to thrive
* polyuria, polydipsia
* hypokalaemia
* normotension
* weakness
110.A 41-year-old woman presents with palpitations and heat intolerance On examination her
pulse is
90/min and a small diffuse goitre is noted which is tender to touch. Thyroid function tests show the
following:
Free T4 24 pmol/l
TSH < 0,05 mu/l
What is the most likely diagnosis?
Grave's disease
Sick thyroid syndrome
0 De Quervain's thyroiditis
Hashimoto's thyroiditis
Toxic multinodular goitre
113.A 15-year-old girl from India who recently immigrated to England has been referred by her
GP because she looks
anaemic. On examination you notice frontal bossing of the skull and chronic leg ulcers. Her Hb is 70
g/l (120-160
The patient has hyposplenism as suggested by the blood film and a mixed anaemia.
Coeliac disease could therefore fit the above picture with anti-TTG antibodies being the most
appropriate
selection from the above list.
Anti-mitochonrial antibodies are seen in PBC.
Anti-gastric and anti-intrinsic Abs are seen in pernicious anaemia.
Anti-GAD abs are found in auto-immune DM.
Screening for coeliac disease should include high risk groups such as anaemia (iron or folate
deficiency).
hyposplenism, reduced bone density and infertility.
HowellJolly bodies are seen with markedly decreased splenic function. Common causes
include asplenia (post-splenectomy), trauma to the spleen, and autosplenectomy caused by
sickle cell anemia. Other causes areradiation therapy involving the spleen, such as that used to
treat Hodgkin lymphoma. HowellJolly bodies are also seen in: amyloidosis, severe hemolytic
anemia, megaloblastic anemia, hereditary spherocytosis, heterotaxywith asplenia and
myelodysplastic syndrome (MDS). Also can be seen in premature infants.
115.HUS-- cells seen are howell jolly bodies (Howell-Jolly bodies are histopathological findings
of basophilic nuclear remnants (clusters of DNA) in young erythrocytes during the response to
severe hemolytic anemia, megaloblastic anemia, splenectomy, or due to a damaged spleen.
They can be present in conditions such as hyposplenism, hereditary
spherocytosis, sickle cell anemia and myelodysplastic syndrome(MDS). -wikipedia)
mnemonic for HUS-FANTM- FEVER ARF NEURO MANIFESTATION,
116.A question on image of Howel jolly bodies..patient had accident and laparotomy was
done..what to offer. .. Pneumococcal vaccine
red urine with howell jolly body-pnh or pch
117.A 32-year-old woman presents with a three-month history of tiredness, shortness of breath and
rash. She admits to passing dark urine but denies any other urinary symptoms. There is no
previous medical history of note other
than a six-month course of oral anticoagulants for a spontaneous deep vein thrombosis (DVT) two
years
previously. On examination she has a petechial rash around her ankles and some bruises on her
forearms. The
full blood count demonstrates haemoglobin 6.1 g/dl, white blood cell count 1.2 x 109 per litre, platelets
10 x 109
per litre, mean cell volume 105 femtolitre (fl), and reticulocytes 4%. Dipstick analysis of the urine was
positive for
'blood', but the microscopy showed no red cells.
Which one of the following is the most likely diagnosis?
O Acute myeloid leukaemia
O Aplastic anaemia
O Megaloblastic anaemia
O Paroxysmal nocturnal haemoglobinuria
O Systemic lupus erythematosus
Paroxysmal nocturnal haemoglobinuria
Paroxysmal nocturnal haemoglobinuria (PNH) is an acquired disorder leading to haemolysis (mainly
intravascular) of haematological cells. It is thought to be caused by increased sensitivity of cell
membranes to complement (see below) due to a lack of glycoprotein glycosyl-phosphatidylinositol
(GPI). Patients are more prone to venous thrombosis
Pathophysiology
GPI can be thought of as an anchor which attaches surface proteins to the cell membrane
complement-regulating surface proteins, e.g. decay-accelerating factor (DAF). are not properly
bound to the cell membrane due a lack of GPI
thrombosis is thought to be caused by a lack of CD59 on platelet membranes predisposing to
platelet aggregation
Features
haemolytic anaemia
red blood cells, white blood cells, platelets or stem cells may be affected therefore pancytopaenia
may be present
haemoglobinuria. classically dark-coloured urine in the morning (although has been shown to
occur throughout the day)
thrombosis e.g. Budd-Chiari syndrome
aplastic anaemia may develop in some patients
flow cytometry of blood to detect low levels of CD59 and CD55 has now replaced Ham's test as
the gold standard investigation in PNH
Ham's test: acid-induced haemolysis (normal red cells would not)
Management
blood product replacement
anticoagulation
eculizumab. a monoclonal antibody directed against terminal protein C5. is currently being trialled
and is showing promise in reducing intravascular haemolysis
stem cell transplantation
.
118.A 70-year-old male is admitted with haematemesis. He is currently being treated with warfarin
for atrial
fibrillation and his INR returns as 10.
Which of the following is the most appropriate immediate treatment of his INR?
(Please select 1 option)
Cryoprecipitate
Fresh frozen plasma
Intravenous vitamin K
Oral vitamin K
Prothrombin complex concentrate
This gentleman is having a potentially life threatening bleed in the setting of a grossly elevated INR.
Due to his warfarin therapy he will have reduced levels of factors II. VII, IX and X and requires
replacement to
correct his INR rapidly. This is most effectively achieved by the administration of prothrombin
complex
concentrate (Beriplex or Octaplex, 25-50 units/kg IV).
These result in complete reversal of the warfarin-induced anticoagulation within 10 minutes but the
clotting factors have a finite half life and therefore 5 mgIV vitamin K should be given at the same time.
Fresh frozen plasma (FFP) contains more dilute clotting factors and therefore produces inferior
correction and
should not be used in the management of life threatening bleeding (unless prothrombin complex
concentrate
is not available).
Cryoprecipitate and oral vitamin K are not recommended for the management of life threatening
bleeding.
119.A 78-year-old female who is on warfarin for atrial fibrillation presents with melaena.
Her blood pressure is 90/60mmHgand heart rate is 100 bpm.
Investigations show:
Haemoglobin 90g/L (120-160)
MCV 87 fL (83-95)
INR 7.2 (<1.4)
A PR examination confirms melaena.
Which is the best option for correcting the coagulopathy?
(Please select 1 option)
FFP
IV vitamin K
Stop warfarin
Whilst many doctors may use oral lorazepam in this situation the Royal College of Physicians
recommend haloperidol as the first-line sedative NICE also advocate the use of olanzapine.
Acute confusional state
Acute confusional state is also known as delirium or acute organic brain syndrome It affects up to 30%
of elderly patients admitted to hospital
Features - wide variety of presentations
* memory disturbances {loss of short term > long term)
* may be very agitated or withdrawn
disorientation
* mood change
* visual hallucinations
* disturbed sleep cycle
* poor attention
Management
* treatment of underlying cause
modification of environment
* the 2006 Royal College of Physicians publication 'The prevention diagnosis and management of
delirium in older people concise guidelines' recommended haloperidol 0.5 mg as the first-line
sedative
the 20 f0 NICE delirium guidelines advocate the use of haloperidol or olanzapine
121.What is the most common cause of paranoid psychosis with visual hallucination?
Alcohol withdrawal
Opiate withdrawal
Amphetamine withdrawal
Selective serotonin re-uptake inhibitor withdrawal
Benzodiazepine withdrawal
Alcohol withdrawal
Presentation
Delirium tremens (the 'DTs') occurs in less than 5% of individuals withdrawing from alcohol and
happens around 34 days after cessation of consumption
Untreated it carries a high mortality of around 15%
Features include coarse tremor, agitation, confusion, delusion and visual hallucinations
Fever, sweating and tachycardia may also occur, rarely there is associated ketoacidosis
Co-existent hypoglycaemia and Wernicke-Korsakoff psychosis are considerations
Management
Patients should be nursed in a well-lit room with adequate support
sedation with chlordiazepoxide is often necessary
Vitamin B supplements given intravenously (Pabrinex) should be considered
Withdrawal seizures are usually self-limiting, but intravenous diazepam may be used
Oral chlordiazepoxide is the best prophylactic measure against withdrawal seizures
medical student who has been dumped by his girlfriend is Mania? - he exhibited loosening of
assocaitions, grandiose behaviour but no hallucinations or other features of psychosis?
11. Guy with mania and hasn't slept for 5 days ? Bipolar - lithium
129-Agitation with mania --i think stiil Haloperidol as lithium takes 2 weeks to work. LITHIUM
122.A 29-year-old woman presents with insomnia, aggressiveness and increased libido. Her
husband says that prior
to this, she was markedly withdrawn and blamed herself for her daughter's death due to cancer. She
now also
has suicidal thoughts although hasn't yet planned how she would kill herself.
In the context of appropriate medical supervision, which drug would be most suitable in this case?
Diazepam
Fluoxetine
Lithium
Carbamazepine
Phenytoin
Bipolar affective disorder
The features, ie insomnia, aggressiveness, increased libido and suicidal thoughts, with previous
marked
withdrawal, are suggestive of a bipolar affective disorder
Prophylactic use of lithium carbonate prevents both mania and depression
Diazepam would be only useful in the manic phase, while fluoxetine may be effective in the
depressive phase
Carbamazepine has been considered to be a reasonable alternative to lithium when the latter is less
than optimally
efficacious
Valproate has been demonstrated to have antimanic effects and is now being widely used for this
indication and
is a reasonable alternative to lithium
Phenytoin may also have value as a mood stabiliser but other agents such as lithium and sodium
valproate are
used ahead of it
Lithium toxicity
Lithium is a potentially very toxic drug but is the first-line alternative to valproate
It is associated with a risk of nephrogenic diabetes insipidus and/or encephalopathic syndrome in
overdose
Toxicity is closely related to serum levels and can occur at doses close to therapeutic levels
Therapeutic monitoring is therefore required and patients should be warned of the possible effects of
toxicity
(polyuria, polydipsia, diarrhoea, vomiting, tremor, confusion, ataxia, dizziness)
It should not be used in the presence of significant renal or cardiac disease, and concomitant diuretic
therapy
should be avoided
For these reasons of toxicity, particular caution must be used in treating patients with suicidal ideation
(such as in
this case) because of the increased risk of overdose
Very close medical supervision would be mandatory in this instance
123.A 32-year-old woman comes to the clinic for review. She has severe hand dermatitis and
admits to washing her
hands with antiseptic soap at least 10-15 times/day. She has no significant past medical history of note
and her
only medication from the doctor is the combined oral contraceptive pill. Clinical examination reveals
significant,
severe hand eczema with contact bleeding.
Which of the following would drive you towards a diagnosis of obsessive compulsive disorder in
this case?
Checking door locks 10 times before going to bed
Early morning waking
Loss of appetite
Previous history of depression
Previous overdose 15 years ago
Obsessive compulsive disorder (OCD) is associated with both unwanted intrusive thoughts, images or
urges
that repeatedly enter the person's mind and repetitive behaviours or mental acts that the person feels
driven
to perform. In this situation it is likely there are both compulsive hand washing, and repetitive
behaviours
and thoughts that the house is not secure going to bed. The other options listed are features of
depression,
which may be associated with OCD, but are not indicative of OCD as the underlying diagnosis.
Individual
cognitive behavioural therapy (CBT) plus exposure and response prevention (ERP) are the gold
standard
interventions with respect to changing behaviours.
125.A 35-year-old patient who is usually physically fit, has no past medical history of note, and
works as a fitness instructor presents to the clinic with polyuria and polydypsia, tiredness and
lethargy. He is not on any regular prescription drugs but he does take ibuprofen and diclofenac
on most days because of sports injuries. On examination he looks dehydrated, his BP is
105/55 mmHg. Investigations;
Hb 13.8 g/dl
WCC 6.7 x109/l
PLT 210 x109/l
Na+ 150 mmol/l
K+3.0 mmol/l
Creatinine 156 mol/l
Random glucose 9.0 mmol/l
Urine osmolality 450 mosmol/kg (350 1000)
126.A 60-year-cld woman with a history of hypothyroidism and inflammatory arthritis is admitted
after
slipping on ice and falling over. Some routine blood tests are performed
Na+ 141mmol/l
K+ 2.9 mmol/l
Chloride 114 mmol/l
Bicarbonate 16 mmol/l
Urea 5.2 mmol/l
Creatinine 75 jjmol/l
Which one of the following is most likely to explain these results?
Renal tubular acidosis (type 1}
Diabetic ketoacidosis
Renal tubular acidosis (type 4)
Aspirin overdose
Conn's syndrome
Renal tubular acidosis causes a normal anion gap
The low bicarbonate suggests an acidosis The anion gap is however normal. (141 + 2.9} - (114 + 16} =
13.9 mmol/i The different diagnosis is therefore causes of a metabolic acidosis with a normal anion gap
(usually between 8 and 16)
Aspirin and diabetic ketoacidosis causes a metabolic acidosis associated with a raised anion gap.
Conn's syndrome would explain the hypokalaemia but it does not cause a metabolic acidosis.
Renal tubular acidosis type 4 is associated with hyperkalaemia. The correct answer is therefore renal
tubular acidosis type 1 which is likely to be secondary to this patient's inflammatory arthritis.
Metabolic acidosis
Metabolic acidosis is commonly classified according to the anion gap This can be calculated by: (Na+
+K+) - (Cl- + HCO-3} If a question supplies the chloride level then this is often a clue that the anion
gap
should be calculated The normal range = 10-18 mmol/L
Normal anion gap ( * hyperchloraemic metabolic acidosis)
* gastrointestinal bicarbonate loss: diarrhoea, ureterosigmoidostomy fistula
* renal tubular acidosis
54-year-old diabetic man presents for review. His annual review bloods reveal a raised creatinine
of 165 pmol/l, potassium of 5.9 mmol/l and bicarbonate of 19 mmol/l. Urinary protein excretion is
normal. Which one of the following diagnoses fits best with this clinical picture?
Renal tubular acidosis (RTA)-type IV
O Diabetic nephropathy
O RTA-type II
RTA-type I
O Diabetic ketoacidosis
Renal tubular acidosis (type IV)
Epidemiology
Renal tubular acidosis (RTA)-type IV, 'hyporeninaemic hypoaldosteronism', is seen in diseases such
as diabetes
mellitus or chronic reflux nephropathy
Clinical features
These include hyperkalaemia and metabolic acidosis
Plasma renin and aldosterone levels are low if measured
Management
Dietary potassium restriction is usually ineffective
Treatment with fludrocortisone may be required
Differentialdiagnosis (other RTA types)
Type 2 RTA is very rare in adult practice, and is caused by the failure of sodium bicarbonate
reabsorption in the
proximal tubule
# Type 1 RTA is due to failure of H+ ion secretion in the distal tubule, and may be associated with
nephrocalcinosis,
hypergammaglobulinaemic states, drugs such as amphotericin B or autoimmune disease such as
primary biliary
cirrhosis or thyroiditis
A 56-year-old woman with a 15-year history of rheumatoid arthritis has been regularly taking
diclofenac for pain relief. She presents with mild chronic renal failure, hyperkalaemia and acidosis.
Blood tests show decreased plasma renin and aldosterone. Which one of the following is the most
probable diagnosis?
O Type-I renal tubular acidosis
Type-ll renal tubular acidosis
O Type-IV renal tubular acidosis
Uraemic acidosis
O Acute tubulointerstitial nephritis
Answer above
A 35-year-old patient who is usually physically fit, has no past medical history of note, and works as a
fitness
instructor presents to the clinic with polyuria and polydipsia, tiredness and lethargy. He is not on any
regular
prescription drugs but he does take ibuprofen and diclofenac on most days because of sports injuries.
On
exam examination he looks dehydrated and his blood pressure (BP) is 105/55 mmHg.
Investigations:
Hb 13.8 g/dl, WCC, 6.7 x 109/l, PLT 210 * 109/l, Na+ 148 mmol/l, K+ 3.0 mmol/l, bicarbonate 12
mmol/l, creatinine 156
(jmol/l, random glucose 9.0 mmol/l, urine osmolality 450 mosmol/kg (350 - 1000). Urinary protein and
blood are negative.
Which one of the following is the most likely diagnosis?
Diabetes insipidus
Psychogenic polydipsia
Hyperosmolar diabetic crisis
Interstitial nephritis
Distal renal tubular acidosis CORRECT ANSWER
The Answer Comment on this Question
YOUR ANSWER WAS INCORRECT
Renal tubular acidosis
Diagnostic considerations
This patient's sodium is elevated as is his creatinine, hence psychogenic polydipsia is unlikely
Equally, urine osmolality of 450 mosmol/kg argues against diabetes insipidus
Hyperosmolar non-ketotic coma is associated with markedly elevated glucose levels
This leaves us with a choice of either interstitial nephritis or distal renal tubular acidosis as possible
causes
Distal renal tubular acidosis is associated with hypokalaemia, and possible causes include long-term
use/abuse of
non-steroidal anti-inflammatory agents. Hence that is the most likely diagnosis here
Interstitial nephritis is associated with eosinophilia and mild to moderate proteinuria, neither
of which is seen here
127.A 39-year-old woman with Hashimoto's thyroiditis presents to the clinic for review. Her
Hashimoto's is managed
with replacement thyroxine 125 micrograms/day. She presents to the Endocrine Clinic complaining of
bilateral
loin pain. Investigations reveal: haemoglobin 12.1 g/dl, white cell count 5.4 x 109/l, platelets 294 x
109/l, sodium
139 mmol/l, potassium 3.3 mmol/l, creatinine 140 pmol/l, bicarbonate 15 mmol/. A KUB (kidney,
ureter, bladder) Xray
study shows evidence of nephrocalcinosis.
Which of the following is the most likely diagnosis?
Renal tubular acidosis type 4
Medullary sponge kidney
Renal tubular acidosis type 2
Renal tubular acidosis type 1 CORRECT ANSWER
Chronic interstitial nephritis
The Answer Comment on this Question
YOUR ANSWER WAS INCORRECT
Type 1 renal tubular acidosis
Renal tubular acidosis type 1 (hypokalaemic distal renal tubular acidosis) can occur in association with
a number of
autoimmune conditions, including systemic lupus erythematosus (SLE), vasculitis and autoimmune
hypothyroidism.
Other causes include drugs such as amphotericin B and lithium, chromosomal abnormalities such as
Marfan
syndrome, and conditions such as chronic pyelonephritis and obstructive uropathy. Treatment includes
oral
supplementation with potassium and bicarbonate. In exam was sjorgen they used.
128.A 29 year old woman with renal disease secondary to systemic lupus erythematosis is seen in
the rheumatology clinic. She has had three urinary tract infections in the past year and was
recently admitted to the emergency department with acute severe unilateral abdominal pain
which settled spontaneously after several hours. On her last outpatient visit a number of
investigations were requested, the results of which are now available:
Na-141 mmol/l
K-3.3 mmol/l
Urea-9.0 mmol/l
Creatinine-188umol/l
HCO3-8 mmol/l
Urine-pH 7.4
What is the most likely underlying cause of these results and possibly for some of her recent
presentations?
A- Type 1 renal tubular acidosis
B- Type 2 renal tubular acidosis
C- Type 4 renal tubular acidosis
D- Staghorn calculus leading to recurrent urinary sepsis
E- Bartter's syndrome
Ans A
130.A 40 year old man presented because he is concerned about his family history of hypertrophic
obstructive cardiomyopathy. His brother has recently deceased from due to the condition.
What investigation should be offered?
1- Transthoracic echocardiogram
2- Transoesophageal echocardiogram
3- Electrophysiological study
4- Coronary angiogram
5- Cardiac thallium scan
131.A 16-year-old young man had a cardiac arrest while playing football and was resuscitated.
(some say ECG showns VT) He
recovered fully and was later found to have HOCM (hypertrophic obstructive cardiomyopathy).
Which one of the following is the best treatment option?
Implantable cardioverter defibrillator
Amiodarone
(3-Blockers
Verapamil
Rate-responsive, dual-chamber pacemaker
Hypertrophic obstructive cardiomyopathy
For the secondary prevention of sudden cardiac death (SCD) in patients with HOCM, there is
evidence and
general agreement that implantable cardioverter defibrillator is the most useful option
Even for the primary prevention of SCD in HOCM, the weight of evidence is currently in favour of
its efficacy,
although in selected patients amiodarone has a role
Options C, D and E are not considered effective in preventing SCD in HOCM
132.A 17-year-old female presents with recurrent attacks of collapse These episodes typically
occur without
warning and have occurred whilst she was running tor a bus. There is no significant past medical
history and the only family history of note is that her father died suddenly when he was 38-years-old
What is the likely cause?
Vaso-vagal attacks
Anxiety
Epilepsy
Cardiogenic syncope
Malingering
HOCM: features
Hypertrophic obstructive cardiomyopathy (HOCM) is an autosomal dominant disorder of muscle tissue
caused by defects in the genes encoding contractile proteins. The most common defects involve a
mutation in the gene encoding Beta-myosin heavy chain protein or myosin binding protein C. The
estimated prevalence is1in 500
Features
* often asymptomatic
* dyspnoea angina, syncope
* sudden death (most commonly due to ventricular arrhythmias), arrhythmias, heart failure
* jerky pulse, large 'a' waves, double apex beat
* ejection systolic murmur: increases with Valsalva manoeuvre and decreases on squatting
Associations
* Friedreich's ataxia
* Wolff-Parkinson White
Echo - mnemonic - MR SAM ASH
* mitral regurgitation (MR)
* systolic anterior motion (SAM) of the anterior mitral valve leaflet
* asymmetric hypertrophy (ASH)
ECG
* Ieft ventricuIar hypertrophy
* progressive T wave inversion
* deep Q waves
* atrial fibrillation may occasionally be seen
133.A 23-year-old man with a family history of sudden cardiac death is diagnosed as having
hypertrophic
obstructive cardiomyopathy. Which one of the following is the strongest marker of poor prognosis?
Mitral regurgitation
0 Apical hypertrophy
Systolic anterior motion of the anterior mitral valve leaflet
0 Septal wall thickness of* 3cm
HOCM: prognostic factors
Hypertrophic obstructive cardiomyopathy (HOCM) is an autosomal dominant disorder of muscle tissue
caused by defects in the genes encoding contractile proteins. Mutations to various proteins including
beta-myosin, alpha-tropomyosin and troponin T have been identified Septal hypertrophy causes left
ventricular outflow obstruction. It is an important cause of sudden death in apparently healthy
individuals.
Poor prognostic factors
* syncope
* family history of sudden death
* young age at presentation
* non-sustained ventricular tachycardia on 24 or 4B-hour Holter monitoring
* abnormal blood pressure changes on exercise
An increased septal wall thickness is also associated with a poor prognosis
inter
134.What kind of inheritance ins hocm? Answer Autosomal dominant
135.A 17-year-old boy whose brother had hypertrophic cardiomyopathy was referred for a
cardiological
assessment. His echocardiogram confirmed the condition.
Which one of the following echocardiographic features is the most important risk factor for sudden
cardiac
death?
(Please select1 option)
A gradient of 10mmHgacross the left ventricular outflow tract X Incorrect answer selected
An enlarged left atrium
Significant thickening of the interventricular septum This is the correct answer
Systolic anterior motion of the mitral valve
The presence of mitral regurgitation
In hypertrophic obstructive cardiomyopathy the cause of death is usually ventricular tachycardia or
ventricular
fibrillation. Therefore, the thicker the muscle the more abnormal the cardiac architecture and the higher
the
risk of arrhythmia and sudden death.
136.question on Jerky double impulse pulse-- one of the answer was HOCM
137. Pt died and case of HOCM. Post-mortem . (Myosin pathology)
138.a scnerio of hocm (ask about which Beta myosin/alspha subunit of sodium)...........answer is
Beta
139. HOCM family history is most imp risk factor
140.Treatmetnt for HoCM? B blocker for HOCM
HOCM: management
Hypertrophic obstructive cardiomyopathy (HOCM) is an autosomal dominant disorder of muscle tissue
caused by detects in the genes encoding contractile proteins. The estimated prevalence is t in 500
Management
* Amiodarone
* Beta-blockers or verapamil for symptoms
* Cardioverter defibrillator
* Dual chamber pacemaker
* Endocarditis prophylaxis*
Drugs to avoid
nitrates
* ACE-inhibitors
inotropes
141..patient with HOCM, nodding off while driving - alcohol ablation of septum
142.A 55-year-old male patient presents arthralgia affecting his hands, wrists, elbows and knees.
He has been living and working in Portugal where he runs a hotel and bar. Past medical
history of note includes erectile dysfunction which is managed with sildenafil. He has no
children and no partner at the current time. On examination he looks tanned, his BP is 139/72
mmHg, his BMI is 27. Investigations;
Hb 11.0 g/dl
WCC 8.7 x109/l
PLT 181 x109 /l
Na+ 139 mmol/l
K+ 4.4 mmol/l
Creatinine 110 mol/l
ALT 132 U/l
Alk P 160 U/l
Bilirubin 76 mol/l
Fasting glucose 9.1 mmol/l
Which of the following is the most likely diagnosis?
A Type 2 diabetes
B Wilsons disease
C Pseudogout
D SLE
E Haemochromatosis
This patient has evidence of hepatic dysfunction, diabetes, joint pains and increased skin pigmentation;
this picture is entirely in keeping with haemochromatosis. Excess iron deposition in the pancreas leads
to beta cell failure and diabetes mellitus, iron deposition in the liver leads to cirrhosis, and pituitary iron
deposition leads to hypogonadism. The gene responsible for the development of the disease is named
HFE and is found on chromosome 6. Regular
phlebotomy to reduce total body iron stores is the treatment of choice.
143.A 42-year-old man presents with chronic right knee pain. He lives and works in Italy and only
returns to the UK intermittently to see his family. He has a history of Type 2 diabetes mellitus
diagnosed last time he was in the UK, which is currently managed with diet. On examination
his BP is 142/82 mmHg, his pulse is 76/min and regular. He
looks particularly tanned. You count a number of spider naevi on examination of his upper chest and
you notice that his pubic hair seems a little sparse. His BMI is 31. Investigations;
Hb 10.9 g/dl
WCC 8.1 x109 /l
PLT 190 x109 /l
Na+ 139 mmol/l
K+ 4.5 mmol/l
Creatinine 134 mol/l
ALT 182 U/l
Bili 65 mol/l
Glucose 11.1 mmol/l
Right knee x-ray chondrocalcinosis
Which of the following tests would you carry out next?
A Serum calcium
B Serum ferritin
C Serum copper
D Urinary copper
E Hepatitis serology
The suspicion is that he has so-called bronze diabetes, or haemochromatosis, associated with chronic
liver disease, diabetes mellitus and chondrocalcinosis. The condition occurs because of an inherited
mutation on chromosome 6, which affects the way that the transferrin receptor binds to transferrin, and
leads to iron accumulation. It is this which results in organ damage and consequent chronic liver
disease and diabetes mellitus. The C282Y mutation is found in
the majority of patients with haemochromatosis, and this can be screened for using a widely available
genetic test. Ferritin is usually elevated in association with haemochromatosis, and is a useful initial
screening test. It is not specific for haemochromatosis however, as ferritin may be elevated in chronic
liver disease per se.
144.A 45-year-old woman presents to the Emergency Department with monoarthritis affecting her
right knee. She has
a past history of mild asthma, which is managed with a Salbutamol inhaler, but nil else of note. Over
the past few
months she has been gaining a little weight. Uric acid is normal and x-rays of the knee reveal
calcification
consistent with pseudogout.
Which of the following investigations is most likely to reveal the underlying cause?
Thyroid function tests
Fasting glucose
Serum copper
Serum ferritin
Serum PTH
The answer is Thyroid function testing
Hypothyroidism, Wilson's disease, haemochromatosis and hyperparathyroidism are all diseases with a
recognised association to pseudogout. The clue here is the gradual weight gain, which is a pointer to
hypothyroidism as the underlying cause, and the fact that the other options such as Wilson's and
haemochromatosis are substantially rarer than thyroid disease.
Whilst serum ferritin is elevated in haemochromatosis, it is transferrin saturation that is the gold
standard
investigation for diagnosing the condition. Wilson's usually presents at a younger age, either with an
asymptomatic elevation in transaminases, psychiatric disturbance, ataxia or signs of chronic liver
disease.
145.A 44-year-old male patient has returned from running his bar in Spain to the UK to seek
medical advice. He is
worried as he has been suffering from joint pains, is up 2 or 3 times in the night to pass urine and
thirsty all the
time, and is unable to maintain his erection. He has a history of hypertension for which he takes
ramipril 10mg
daily. On examination he looks well and is very suntanned, has a BP of 145/88 mmHg and is obese
with a BMI of
32. There is seems to be a slight reduction in secondary body hair. You also notice some spider naevi
on close
examination of the skin.
Investigations
Hb 14.1 g/dl
WCC 4.5 x109/l
PLT 245 x109/l
Na+ 139 mmol/l
K+ 5.0 mmol/l
Creatinine 145 [jmol/l
ALT 90 U/l
Alk P 185 U/l
Which of the following would be the investigation of choice?
Blood glucose
Serum ferritin
Transferrin saturation
Caeruloplasmin
Urinary copper excretion
Haemochromatosis used to be known as "bronze diabetes", where iron overload leads to cirrhosis,
chondrocalcinosis, and
diabetes mellitus. Hypogonadism also occurs, primarily due to pituitary iron deposition. Transferrin
saturation is the
diagnostic blood test of choice, as serum ferritin may be raised in alcoholic cirrhosis, and a number of
inflammatory
conditions. Mutation screening for the two commonest mutations which cause haemochromatosis
exists, and is available at a
number of UK centres. Management of haemochromatosis centres on venesection.
Hereditary haemochromatosis
Epidemiology andaetiology
Hereditary haemochromatosis is an autosomal-recessive disorder of iron metabolism, resulting in
excess intestinal
absorption and the cellular deposition of iron
It is relatively common in people of northern European origin
The disease was found to be associated with the HLA-A3 allele
The HFEgene (located on chromosome 6) has now been discovered to be mutated in over 83% of
patients
Presentation
The disorder presents with non-specific complaints such as malaise, fatigue, arthralgia, sexual
dysfunction and
abdominal pain
The classical 'bronze diabetes' with hepatic fibrosis and cirrhosis, cardiomyopathy, endocrine
dysfunction and liver
cancer presents after prolonged iron loading when the diagnosis is made late
Investigations
Transferrin saturation (serum iron/total iron-binding capacity) is the most sensitive biochemical
marker of iron
overload
A transferrin saturation of > 55% in men or > 50% in women merits investigation for
haemochromatosis
Treatment
Treatment is with venesection
It is recommended that weekly phlebotomy is carried out until the serum ferritin level is between 10
and 20 pg/l,
followed by maintenance phlebotomy three or four times a year to maintain the serum ferritin level at
50 pg/l
Liver biopsy should be considered in patients with a serum ferritin level greater than 400 pg/l in men
and 200 pg/l in women to determine the amount of stainable iron and to assess for liver injury
146.A 56-year-old man during a screening test for abnormal skin pigmentation was found to have
an elevated serum
ferritin of 3246 pg/l. He drank modestly and had no history of jaundice. He was found to be
homozygous for the
C282Y mutation and was confirmed to have hereditary haemochromatosis. Regular weekly venesection
was
started.
Which one of these measures of iron is best used for monitoring his therapy?
Serum ferritin
Zinc erythrocyte protoporphyrin
Serum iron and total iron-binding capacity
Bone marrow haemosiderin quantification
Serum transferrin saturation
Hereditary haemochromatosis
Epidemiology/aetiology
Hereditary haemochromatosis is an autosomal recessive inherited disorder
It is more common in males than in females
It is caused by excessive iron absorption from the gut
Iron is deposited in the skin, liver, pancreas, heart, kidneys, and other vital organs
Clinical findings
Serum iron levels exceed 180 mg/dl
Total iron-binding capacity (TIBC) is normal or low
Serum ferritin, which is a measure of storage iron, is greater than 400 pg/l
it can be used to monitor the effectiveness of venesections more so than can estimates of transferrin
saturation
Estimates of the marrow iron have little or no diagnostic value
Management
Weekly venesections to serum ferritin less than 50 pg/l and periodic maintenance sessions can confer
a normal
lifespan and protect against hepatocellular carcinoma
Note that: A liver biopsy for iron accumulation and genotype testing are necessary for absolute
confirmation of the diagnosis.
147.Each of the following diseases has an autosomal dominant inheritance EXCEPT?
Allo-immunisation against platelets
Adult polycystic kidney disease
Marfan syndrome
Haemochromatosis Type I
Neurofibromatosis
Answer is hemochromatosis
In an adult patient with cirrhosis, which of the following findings is the most reliable diagnostic
indicator that hereditary haemochromatosis is the cause of the cirrhosis?
Liver biopsy CORRECT ANSWER
Serum ferritin concentration
Serum iron concentration
Serum total iron-binding capacity
Transferrin saturation
The Answer Comment on this Question
YOUR ANSWER WAS INCORRECT
Hereditary haemochromatosis
In hereditary haemochromatosis (HH), the excess iron is primarily found in parenchymal cells, whereas
with
secondary iron overload, accumulation tends to be in Kupffer cells
Liver biopsy can demonstrate this, allows assessment of liver damage and is of prognostic value
Serum ferritin concentrations are almost always markedly elevated, but elevations can occur in any
inflammatory
condition (including other liver diseases)
Serum iron concentration is normal in approximately 25% of patients with HH and can be elevated in
healthy
individuals or people with secondary iron overload
Total iron-binding capacity (TIBC) reflects the transferrin concentration, which is usually normal in
haemochromatosis,
although TIBC can also be reduced
Moreover, although transferrin saturation is typically high in HH, it can also be increased in other iron
overload
conditions and in liver disease
Molecular genetic analysis and demonstration of homozygosity for the C282Y mutation, or of
compound
heterozygosity for C282Y and H63D, can detect asymptomatic individuals at risk of developing
clinical
haemochromatosis
148.A 45-year-old man who is Known to have haemochromatosis presents with a swollen and
painful right
knee. An x-ray shows no fracture but extensive chondrocalcinosis. Given the likely diagnosis, which
one
of the following is most likely to present in the joint fluid?
Raised hyaluronic acid levels
Monosodium urate crystals
Bipyramidal oxalate crystals
Negatively birefringent calcium carbonate crystals
Positively birefringent rhomboid-shaped crystals
Pseudogout - positively birefringent rhomboid shaped crystals
Pseudogout
Pseudogout is a form of microcrystal synovitis caused by the deposition of calcium pyrophosphate
dihydrate in the synovium
Risk factors
* hyperparathyroidism
* hypothyroidism
* haemochromatosis
* acromegaly
* low magnesium, low phosphate
* Wilson's disease
Features
* knee, wrist and shoulders most commonly affected
joint aspiration: weakly-positively birefringent rhomboid shaped crystals
* x-ray: chondrocalcinosis
Management
* aspiration of joint fluid, to exclude septic arthritis
* N5AIDs or intra-articular, intra-muscuIar or oral steroids as for gout
149.A 30-year-old man enquires about screening for haemochromatosis as his
brother was diagnosed with the condition 2 years ago. The patient is currently
well with no features suggestive of haemochromatosis. What is the most
appropriate investigation ?
o Serum total iron-binding capacity
o HFE gene analysis
o Serum transferrin saturation
o Serum ferritin
o Serum iron
Serum transferrin saturation is currently the preferred investigation for population screening. However,
the patient has a sibling with haemochromatosis and therefore HFE gene analysis is the most suitable
investigation In clinical practice this would be combined with iron studies as well
A 35-year-old man is investigated for lethargy, arthralgia and deranged liver function tests He is
eventually diagnosed as having hereditary hemochromatosis His wife has a genetic test which shows
she is not a carrier of the disease. What is the change his child will develop haemochromatosis?
0%
25%
50% if female. 0% if male
50% if male 0% if female
50%
Haemochromatosis is an autosomal recessive condition. If one of the parents has haemochromatosis
(i.e is homozygous) and the other is not a carrier/affected then all the children will inherit one copy of
the gene from the affected parent and hence will be carriers.
Haemochromatosis: features
Haemochromatosis is an autosomal recessive disorder of iron absorption and metabolism resulting in
iron accumulation. It is caused by inheritance of mutations in the HFE gene on both copies of
chromosome 6*. It is often asymptomatic in early disease and initial symptoms often non-specific e.g.
lethargy and arthralgia
Epidemiology
* 1 in 10 people of European descent carry a mutation genes affecting iron metabolism, mainly
HFE
* prevalence in people of European descent =1in 200
Presenting features
* early symptoms include fatigue erectile dysfunction and arthralgia (often of the hands)
'bronze' skin pigmentation
* diabetes mellitus
liver: stigmata of chronic liver disease hepatomegaly, cirrhosis, hepatocellular deposition)
* cardiac failure (2nd to dilated cardiomyopathy)
hypogonadism (2nd to cirrhosis and pituitary dysfunction - hypogonadotrophic hypogonadism)
* arthritis (especially of the hands)
Questions have previously been asked regarding which features are reversible with treatment
Irreversible complications
* Liver cirrhosis**
Reversible complications Diabetes mellitus
Cardiomyopathy * Hypogonadotrophic hypogonadism
Skin pigmentation * Arthropathy
*there are rare cases of families with classic features of genetic haemochromatosis but no mutation in
the HFE gene
Whilst elevated liver function tests and hepatomegaly may be reversible, cirrhosis is not
150.mother hemochromatosis carrier ...asking for chance of affected baby given that husband is
unrelated given frequency of carrier in general population is 1 in 100 ....... 1/400
151.
152.A 29-year-old IV heroin abuser is admitted to the Emergency department with a severe cough,
fever and rigors. He says that he has suffered progressively increasing shortness of breath on
exertion over the past few days. On examination he has a pyrexia of 37.9o C, he has a BP of
122/75 mmHg and a BMI of 17. There are mild crackles andwheeze on auscultation of the
chest.Investigations;
Hb 10.9 g/dl
WCC 11.1 x109 /l
PLT 245 x109/l
Na+ 141 mmol/l
K+ 4.0 mmol/l
153.A 44-year-olei man who is Known to be HIV positive presents with shortness-of-breath.
Which one of the
following features is most characteristic of Pneumocyss carinit pneumonia?
Usually occurs when the CD4 count is 200-300/mm*
Absence of fever
Productive cough
Oxygen saturations usually improve after short period of exertion
Normal chest auscultation
Answser is E. HIV: Pneumocystis jiroveci pneumonia
Whilst the organism Pneumocystis c&rinii is now referred to as Pneumocystis jiroveci, the term
Pneurfititiysfis canmi pneumonia (PGP) is still in common use
* Pneumocystis jirovec; is an unicellular eukaryote generally classified as a fungus but some
authorities consider it a protozoa
* PcP is the most common opportunistic infection in AIDS
* all patients with aCD4count< 200/mms should receive PGP prophylaxis
Features
* dyspnoea
* dry cough
* fever
* very few chest signs
Pneumothorax is a common complication of PcP
Extrapulmonary manifestations are rare (1-2% of cases), may cause
* hepatosplenomegaly
* lymphadenopathy
* choroid lesions
Investigation
* CXR typically shows bilateral interstitial pulmonary infiltrates but can present with other x-ray
findings e g. lobar consolidation. May be normal
* exercise-induced desaturation
* sputum often fails to show PGP bronchoalveolar lavage (BAL) often needed to demonstrate PcP
(silver stain shows characteristic cysts)
Management
* co-trimoxazole
IV pentamidine in severe cases
* steroids if hypoxic (if p02 < 9 3kPa then steroids reduce risk of respiratory faiiure by 50% and
death by a third)
154.A 2S-year-cld man who is immunosuppressed secondary to HIV infection is admitted to
hospital with
dyspnoea and a dry cough. His chest x-ray shows bilateral interstitial pulmonary infiltrates and he is
started on co-trimoxazole empirically. The following morning he complains of a sudden worsening of
his
dyspnoea associated with left-sided chest pain. Which complication is most likely to have developed?
Empyema
Pulmonary embolism
Acute respiratory distress syndrome
Pericarditis
Pneumothorax
155.A 31-year-cld man who is known to be HIV positive presents with dyspnoea and a dry cough.
He is
currently homeless and has not been attending his outpatient appointments or taking antiretroviral
medication.
Clinical examination reveals a respiratory rate of 24 / min Chest auscultation is unremarkable with only
scattered crackles. His oxygen saturation is 96% on room air but this falls rapidly after walking the
length ot the ward Given the likely diagnosis, what is the most appropriate first-line treatment?
Fluconazole
Co-trimoxazole
Erythromycin
Ganciclovir
Sulfadiazine and pyrimethamine
Answered above
156.A 39-year-old man with HIV is admitted due to shortness of breath. Chest x-ray shows
bilateral
pulmonary infiltrates and Pneumocystis cannii pneumonia is suspected What type of staining should be
applied to the bronchoalveolar lavage to demonstrate the organism?
Rubeanic acid
Silver stain
Pearl's stain
Rose Bengal
Congo red
Investigation
* CXR: typically shows bilateral interstitial pulmonary infiltrates but can present with other x-ray
findings e.g. lobar consolidation May be normal
* exercise-induced desaturation
* sputum often fails to show PCP. bronchoalveolar lavage (BAL) often needed to demonstrate PCP
(silver stain shows characteristic cysts)
159.A 28-year-old man is referred to you by the practice nurse for hypertension management. She
has seen him
three times over the past four months and his BP is persistently elevated at around155/92 mmHg.
Your partner has seen him previously for some non-specific right upper quadrant abdominal pain.
On examination of the abdomen you can feel bilateral enlarged kidneys, and a liver edge.
Investigations show
Haemoglobin 125 g/L (135-180)
White cell count 6.4 *109/L (4-10)
Platelets 182 109/L (150-400)
Sodium 139mmol/L (134-143)
Potassium 4.8 mmol/L (3.5-5)
Creatinine 182 pmol/L (60-120)
Glucose 4.5 mmol/L (<6.0)
Urine Blood ++
Protein Which one of the following is most closely associated with his underlying condition?
(Please select1 option)
Aortic stenosis
Coarctation of the aorta
Diabetes mellitus
Mitral valve prolapse
Tricuspid stenosis
Answer is MVP. A young man presenting with renal failure, haematuria and liver and renal masses
raises the suspicion of polycystic Kidney disease.
Associated liver cysts are found in around 80% of individuals with polycystic kidney disease.
Pancreatic cysts
are rarer, and may in some cases be associated with recurrent pancreatitis.
Patients are at increased risk of renal stones, but the predominant increase is seen in urate stones, rather
than other types.
Up to 25% of patients may have some degree of mitral valve prolapse.
MODY 5 is associated with hepatic and renal cysts and diabetes mellitus, but that is less likely to be the
diagnosis here in the presence of a normal glucose.
Polycystic kidney disease carries an autosomal dominant pattern of inheritance, but may occur as a de
novo mutation in 5%.
You review a 6S-year-old man who has chronic obstructive pulmonary disease (CORD). Each year he
typically has around 7-8 courses of oral prednisolone to treat infective exacerbations of his CORD.
Which one of the following adverse effects is linked to long-term steroid use?
0 Osteomalacia
Enophthalmos
Leucopaenia
0 Avascular necrosis
Constipation
Answer is avascular necrosis
Long-term corticosteroid use is linked to osteopaenia and osteoporosis, rather than osteomalacia.
Corticosteroids
Cortic osteroids are amongst the most commonly prescribed therapies in clinical practice They are used
both systemically (oral or intravenous) or locally (skin creams, inhalers, eye drops, intra-articular).
They
augment and in some cases replace the natural glucocorticoid and mineralocorticoid activity ot
endogenous steroids.
The relative glucocorticoid and mineralocorticoid activity of commonly used steroids is shown below:
Minimal Predominant Very high
glucocorticoid Glucocorticoid glucocorticoid glucocorticoid
Disseminated gonococcal infection (DGI) and gonococcal arthritis may also occur, with gonococcal
infection being the most common cause of septic arthritis in young adults The pathophysiology of DGI
is not fully understood but is thought to be due to haematogenous spread from mucosal infection (e.g
Asymptomatic genital infection) Initially there may be a classic triad of symptoms' tenosynovitis.
migratory polyarthritis and dermatitis. Later complications include septic arthritis endocarditis and
perihepatitis (Fitz-Hugh-Curtis syndrome)
Key features of disseminated gonococcal infection
* tenosynovitis
* migratory polyarthritis
* dermatitis (lesions can be maculopapular or vesicular)
161.New q. Which of the following congenital heart defects is associated with a bicuspid aortic
valve
Tetralogy of Fallot
Ventricular septal defect
Atrial septal defect
Coarctation of the aorta
Transposition of the great arteries
Bicuspid aortic valve
Overview
* occurs in 1-2% of the population
* usually asymptomatic in childhood
* the majority eventually develop aortic stenosis or regurgitation
* associated with a left dominant coronary circulation (the posterior descending artery arises from
the circumflex instead ot the right coronary artery) and Turner's syndrome
* around 5% of patients also have coarctation ot the aorta
Complications
* aortic stenosis/regurgitation as above
higher risk for aortic dissection and aneurysm formation of the ascending aorta
162.A 63-year-old man presents to his GP complaining of pain in his right eye On examination the
sclera is red and the pupil is dilated with a hazy cornea What is the most likely diagnosis'?
Scleritis
Conjunctivitis
Acute angle closure glaucoma
Anterior uveitis
Subconjunctival haemorrhage
Red eye - glaucoma or uveitis?
glaucoma severe pain, haloes, 'semi-dilated' pupil
* uveitis: small fixed oval pupil ciliary flush
Red eye
There are many possible causes of a red eye It is important to be able to recognise the causes which
require urgent referral to an ophthalmologist. Below is a brief summary of the key distinguishing
features
Acute angle closure glaucoma
* severe pain (may be ocular or headache)
* decreased visual acuity, patient sees haloes
* semi-dilated pupil
* hazy cornea
Anterior uveitis
* acute onset
* pain
* blurred vision and photophobia
* small fixed oval pupil, ciliary flush
Scleritis
* severe pain (may be worse on movement) and tenderness
* may be underlying autoimmune disease e.g. rheumatoid arthritis
Conjunctivitis
* purulent discharge if bacteria! clear discharge if viral
Subconjunctival haemorrhage
* history of trauma or coughing bouts
163.A 67-year-old woman presents tor review. She has recently been diagnosed with dry agerelated
macular degeneration. Which one of the following is the strongest risk factor for developing this
condition?
Hypertension
Poor diet
Smoking
Diabetes mellitus
Alcohol excess
Macular degeneration - smoking is risk factor
Having a balanced diet with plenty of fresh fruits and vegetables may also slow the progression of
macular degeneration. There is still ongoing research looking at the role of supplementary antioxidants
Age refated macular degeneration
Age related macular degeneration is the most common cause of blindness in the UK. Degeneration of
the central retina (macula) is the key feature with changes usually bilateral.
Traditionally two forms of macular degeneration are seen:
* dry (geographic atrophy) macular degeneration characterised by drusen - yellow round spots in
Bruch's membrane
* wet (exudative neovascular) macular degeneration: characterised by choroidal
neovascularisation. Leakage of serous fluid and blood can subsequently result in a rapid loss of
vision. Carries worst prognosis
Recently there has been a move to a more updated classification
early age related macular degeneration (non-exudative age related maculopathy): drusen and
alterations to the retinal pigment epithelium (RPE)
late age related macular degeneration (neovascularisation. exudative)
Risk factors
age most patients are over 60 years of age
* smoking
family history
* more common in Caucasians
high cumulative sunlight exposure
* female sex
Features
reduced visual acuity: 'blurred' 'distorted' vision, central vision is affected first
* central scotomas
fundoscopy: drusen. pigmentary changes
Investigation and diagnosis
optical coherence tomography: provide cross sectional views of the macula
* if neovascularisation is present fluorescein angiography is performed
General management
stop smoking
* high dose of beta-carotene vitamins C and E and zinc may help to slow down visual loss for
patients with established macular degeneration. Supplements should be avoided in smokers due
to an increased risk of lung cancer
164.New q A 37-year-old homosexual male presented to the medical take with an acute onset of
reduced vision in his left eye. Fundoscopy of the left eye revealed an extensive 'brushfire-like'
lesion in the major superior temporal arcade
with a large patch of white fluffy lesion mixed with extensive retinal haemorrhages.
What is the most likely diagnosis?
(Please select1 option)
CMV retinitis
Ocular histoplasmosis
Syphilitic choroiditis
Syphilitic neuroretinitis
Tuberculous periphlebitis
This is a classic example of Cytomegalovirus(CMV) retinitis secondary to human immunodeficiency
virus (HIV).
as is suggestive of the information given in this scenario.
Ocular histoplasmosis and syphilitic choroiditis would give a fundus picture of multiple whitish
lesions.
Syphilitic neuroretinitis would normally give a picture of a macular star exudation.
Tuberculous periphlebitis is the next closest answer, but does not fit the description of 'brushfire-like'
lesion in
that it gives a picture of perivenous sheathing and minimal retinal haemorrhages
A 62-year-old woman presents with severe nausea and lethargy a few days after beginning diclofenac
and
amoxicillin from her GP for pain and a urinary tract infection. She has no past history of note apart
from
hypertension for which she takes ramipril, and she believes she injured her back lifting a wardrobe.
On examination her BP is 159/92 mmHg. she has bilateral crackles on auscultation of the chest, her
pulse is 89
and regular. Abdominal examination is unremarkable. She has a widespread erythematous rash.
Investigations show
Hb 119 g/L (135-180)
WCC 8.9 *109/l (4-11)
Eosinophilia
PLT 203 x 109/l (150-400)
Na 139mmol/l (135-146)
K 6.1mmol/l (3.5-5)
Cr 382mmol/l (79-118)
Urine Protein++
BloodWhite cellsWhich of the following is the most likely diagnosis?
Acute tubular necrosis
Churg-Strauss syndrome X Incorrect answer selected
Interstitial nephritis
Membranous nephropathy
Pyelonephritis
The rapid onset of renal failure, coupled with a rash and eosinophilia is highly suspicious of a diagnosis
of
interstitial nephritis as a result of exposure to non-steroidal or amoxicillin.
40-60% of cases of interstitial nephritis are due to drug hypersensitivity. Those most commonly
involved
include penicillins, cephalosporins, vancomycin. NSAIDs, thiazides and furosemide. Interstitial
nephritis usually
develops within 2-60 days of treatment with a beta-lactam, and presents with haematuria, acute kidney
injury
and fever. A maculopapular rash and hepatic involvement can also occur. Interstitial nephritis
associated with
NSAIDs is most commonly seen in elderly patients who have taken non-steroidals intermittently for
months to
years. Proteinuria is dominant, and the nephrotic syndrome can develop.
Ultrasound scanningis generally recommended in all cases of acute kidney injury, to exclude renal tract
obstruction. In interstitial nephritis, renal size is usually normal and there may be some increased
cortical
echogenicity. A definite diagnosis can only be made with renal biopsy, which usually shows
mononuclear cell
infiltrate throughout the interstitium with associated oedema.
The mainstay of treatment is to withdraw any drug which may be causative. High-dose prednisolone is
indicated in some cases to hasten recovery. Dialysis may be required in severe cases.
165.A 33-year-old woman presents with back pain which radiates down her right leg. This came
on suddenly
when she was bending down to pick up her child On examination straight leg raising is limited to 30
degrees on the right hand side due to shooting pains down her leg. Sensation is reduced on the
dorsum of the right foot, particularly around the big toe and big toe dorsiflexion is also weak. The ankle
and knee reflexes appear intact. A diagnosis of disc prolapse is suspected. Which nerve root is most
likely to be affected?
L2
L3
L4
L5
S1
Lower back pain: prolapsed disc
A prolapsed lumbar disc usually produces clear dermatomal leg pain associated with neurological
deficits
Features
* leg pain usually worse than back
* pain often worse when sitting
The table below demonstrates the expected features according to the level of compression.
Site of compression Features
L3 nerve root compression Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test
L4 nerve root compression Sensory loss anterior aspect of knee
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test
L5 nerve root compression Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test
S1 nerve root compression Sensory loss posterolateral aspect of leg and lateral aspect offoot
Weakness in plantar flexion of foot
New Q:
168.Which one of the following medications is least associated with the development of
methaemoglobinaemia? Sometimes they ask most and put only one of the options.
Phenytoin
Sulphonamides
Dapsone
Sodium nitroprusside
Primaquine
Methaemoglobinaemia
Methaemoglobinaemia describes haemoglobin which has been oxidised from Fe2+ to Fe3+ This is
normally regulated by NADH methaemoglobin reductase, which transfers electrons from NADH to
methaemoglobin resulting in the reduction of methaemoglobin to haemoglO'bin There is tissue hypoxia
as Fe3+ cannot bind oxygen, and hence the oxidation dissociation curve is moved to the left
Congenital causes
* haemoglobin chain variants HbM, HbH
* NADH methaemoglobin reductase deficiency
Acquired causes
* drugs' sulphonamides nitrates dapsone, sodium nitroprusside, primaquine
* chemicals: aniline dyes
Features
* 'chocolate1 cyanosis
* dyspnoea anxiety, headache
* severe: acidosis arrhythmias, seizures, coma
* normal p02 but decreased oxygen saturation
Management
* NADH - methaemoglobinaemia reductase deficiency: ascorbic acid
* IV methylene blue if acquired
169.Of the following, which one is the most useful prognostic marker in paracetamol overdose'5
ALT
Prothrombin time
Paracetamol levels at presentation
Paracetamol levels at 12 hours
Paracetamol levels at 24 hours
An elevated prothrombin time signifies liver failure in paracetamol overdose and is a marker of poor
prognosis. However, arterial pH creatinine and encephalopathy are also markers of a need for liver
transplantation
Paracetamol overdose: management
Management
The following is based on 2012 Commission on Human Medicines (CHM) review of paracetamol
overdose management The big change in these guidelines was the removal of the 'high-risk' treatment
line on the normogram. All patients are therefore treated the same regardless of risk factors for
hepatotoxicirt. The National Poisons Information Service/TOXBASE should always be consulted for
situations outside of the normal parameters.
Acetylcysteine should be given if:
* there is a staggered overdose* or there is doubt over the time of paracetamol ingestion
regardless of the plasma paracetamol concentration: or
* the plasma paracetamol concentration is on or above a single treatment line joining points of 100
mg/L at 4 hours and 15 mg/L at 15 hours, regardless of risk factors of hepatotoxicity
Acetylcysteine is now infused over 1hour (rather than the previous 15 minutes) to reduce the number
of adverse effects.
King's College Hospital criteria for liver transplantation (paracetamol liver failure)
Arterial pH < 7.3, 24 hours after ingestion
or all of the following:
prothrombin time > 100 seconds
creatinine > 300 pmol/l
grade III or IV encephalopathy
170.A new blood test to screen patients for heart failure is trialled on 500 patients. The test was
positive in
40 of the 50 patients shown to have heart failure by echocardiography. It was also positive in 20
patients who were shown not to have heart failure What is the positive predictive value of the test?
08
0.66
0.33
0.1
Cannot be calculated
A contingency table can be constructed from the above data as shown below.
Heart failureNo heart failure Test positive4020 Test negativel 0430
Positive predictive value = TP / (TP + FP} = 40i (40 + 20} = 0.66
Screening test statistics
It would be unusual for a medical exam not to feature a question based around screening test statistics.
The available data should be used to construct a contingency table as below
TP = true positive FP = false positive TN = true negative; FN = false negative
Disease present Disease absent
Test positive TP FP
Test negative FN TN
The table below lists the main statistical terms used in relation to screening tests;
Measure Formula Plain english
Sensitivity TP / (TP + FN ) Proportion of patients with the condition who
have a positive test result
Specificity TNl (TN + FP) Proportion of patients without the condition who
have a negative test result
Positive predictive value TPi (TP + FP} The chance that the patient has the condition if
the diagnostic test is positive
Negative predictive
value
TNl (TN + FN} The chance that the patient does not have the
condition if the diagnostic test is negative
Likelihood ratio for a
positive test result
sensitivity!(1 specificity}
How much the odds of the disease increase
when a test is positive
Likelihood ratio for a
negative test result
(1 - sensitivity} /
specificity
How much the odds of the disease decrease
when a test is negative
Positive and negative predictive values are prevalence dependent. Likelihood ratios are not prevalence
dependent
171.A 70-year-old man who is known to have atrial fibrillation presents with abdominal pain and
rectal
bleeding. A diagnosis of ischaemic colitis is suspected Which part of the colon is most likely to be
affected?
Hepatic flexure
Descending colon
Splenic flexure
Ascending colon
Rectum
Mesenteric ischaemia
Mesenteric i&chaemia is primarily caused by arterial embolism resulting in infarction of the colon. It is
more likely to occur in areas such as the splenic flexure that are located at the borders of the territory
supplied by the superior and inferior mesenteric arteries.
Predisposing factors
increasing age
* atrial fibrillation
* other causes of emboli, endocarditis
* cardiovascular disease risk factors: smoking hypertension diabetes
Features
abdominal pain
rectal bleeding
* diarrhoea
fever
* bloods typically show an elevated WBC associated with acidosis
Management
* supportive care
* laparotomy and bowel resection
172.A 46-year-old woman has, over the past 14 hours, developed weakness and numbness in her
legs. She has no
previous medical history of note, apart from treated hypertension. She smokes cigarettes 'occasionally'.
Her
mother died of a 'heart problem' in her early forties. On examination, the cranial nerves and upper
limbs are
normal to examination. Power is reduced to 3/5 in all modalities below the hips and reflexes are absent.
Pain and
temperature sensation are lost to the waist. Vibration and joint-position sense are normal.
What is the most likely diagnosis?
Friedreich's ataxia
O Motor neurone disease
O Subacute combined degeneration of the spinal cord
A lesion at the cornus medullaris
O Anterior spinal artery thrombosis
The patient with weakness andnumbness in her legs
Anterior spinal artery thrombosis affects the corticospinal tracts and spinothalamic tracts (motor
neurones and
pain/temperature sensation)
These are found at the front of the spine
Posterior columns carry vibration and joint-position sense
In the acute stage reflexes are diminished, in keeping with "spinal shock", this may last for several
days
The other stems (ie Friedreich's ataxia, motor neurone disease, subacute combined degeneration of the
spinal
cord and a lesion at the cornus medullaris) will produce a combination of upgoing plantars with absent
knee jerks
This is because upper and lower motor neurones are affected at the same time in these conditions
Complete heart block
Features
syncope
* heart failure
* regular bradycardia (30-50 bpm)
wide pulse pressure
JVP: cannon waves in neck
variable intensity of 51
types of heart block
First degree heart block
* PR interval > 0.2 seconds
Second degree heart block
* type 1 (Mobitzl.Wenckebach): progressive prolongation of the PR interval until a dropped beat
occurs
type 2 (Mobitz II): PR interval is constant but the P wave is often not followed by a QRS complex
Third degree (complete) heart block
* there is no association between the P waves and QRS complexes
173.A 65-year-old man with a history ot primary open-angle glaucoma presents with sudden
painless loss ot
vision in his right eye On examination of the right eye the optic disc is swollen with multiple
flameshapedand blot haemorrhages. What is the most likely diagnosis?
Diabetic retinopathy
Vitreous haemorrhage
ischaemic optic neuropathy
Occlusion of central retinal vein
Occlusion of central retinal artery
Central retinal vein occlusion - sudden painless loss ot vision severe retinal haemorrhages on
fundoscopv
Sudden painless loss of vision
The most common causes of a sudden painless loss of vision are as follows'
* ischaemic optic neuropathy (e.g. temporal arteritis or atherosclerosis)
* occlusion of central retinal vein
* occlusion of central retinal artery
* vitreous haemorrhage
* retinal detachment
Ischaemic optic neuropathy
* may be due to arteritis (e.g. temporal arteritis) or atherosclerosis (e g. hypertensive, diabetic
older patient)
* due to occlusion of the short posterior ciliary arteries, causing damage to the optic nerve
* altitudinal field defects are seen
Central retinal vein occlusion
* incidence increases with age. more common than arterial occlusion
* causes' glaucoma polycythaemia. hypertension
* severe retinal haemorrhages are usually seen on fundoscopy
Central retinal artery occlusion
* due to thromboembolism (from atherosclerosis) or arteritis (e.g. temporal arteritis)
* features include afferent pupillary defect, 'cherry red1 spot on a pale retina
Vitreous haemorrhage
* causes: diabetes, bleeding disorders
* features may include sudden visual loss, dark spots
Retinal detachment
* features of vitreous detachment, which may precede retinal detachment, include flashes of light
or floaters (see below)
174.In patients with suspected insulinoma, which one of the following is considered the best
investigation?
Oral glucose tolerance test
Insulin tolerance test
Early morning C-peptide levels
Glucagon stimulation test
Supervised fasting
Insulinoma is diagnosed with supervised prolonged fasting
CT of the pancreas is also useful in demonstrating a lesion
InsLttinoma
An insulinoma is a neuroendocrine tumour deriving mainly from pancreatic Islets of Langerhans cells
Basics
* most common pancreatic endocrine tumour
* 10% malignant. 10% multiple
* of patients with multiple tumours. 50% have MEN-1
Features
* of hypoglycaemia: typically early in morning or just before meal, e.g diplopia, weakness etc
Hyperventilation due to panic, what will be immediate blood abnormality -- answer was either low
HCO3 or low H+ ion....?? I marked H+ because HCO3 takes time.
chronic inflammatory demyelination in alcoholic woman who had neuropathy? other answers urate
nephropathy/alcoholic nephropathy
27.DEMYELINATION-decreased motor conduction velocity
A 22-year-cld female presents with an offensive vaginal discharge History and examination findings
show clue cells. What is the most appropriate initial management?
Oral azithromycin
Topical hydrocortisone
Oral metronidazole
Clotrimazole pessary
Advice regarding hygiene and cotton underwear
Bacterial vaginosis oral metronidazole
Bacteria! vaginosis
Bacterial vaginosis (BV) describes an overgrowth of predominately anaerobic organisms such as
Gardnere"a vaginalis. This leads to a consequent fall in lactic acid producing aerobic lactobaciili
resulting in a raised vaginal pH
Whilst BV is not a sexually transmitted infection it is seen almost exclusively in sexually active
women.
Features
* vaginal discharge 'fishy1, offensive
* asymptomatic in 50%
Amsel's criteria for diagnosis of BV - 3 of the following 4 points should be present
* thin white homogenous discharge
clue cells on microscopy
* vaginal pH >4.5
positive whiff test (addition of potassium hydroxide results in fishy odour)
Management
* oral metronidazole for 5-7 days
* 70-80% initial cure rate
* relapse rate > 50% within 3 months
* the BPJF suggests topical metronidazole or topical clindamycin as alternatives
177.
178.
A 24-year-old woman is diagnosed as having nephrotic syndrome after being investigated for
proteinuria. A diagnosis of minimal change glomerulonephritis is made. What is the most appropriate
initial treatment to reduce proteinuria?
Protein restriction in diet
No treatment shown to effective
Angiotensin-converting-enzyme inhibitor
Diuretic
Prednisolone
Minimal change glomerulonephritis - prednisolone
Angiotensin-converting-enzyme inhibitors may be used to reduce proteinuria in patients with heavy
proteinuria or who have a slow response to prednisolone
Minimal change disease
Minimal change disease nearly always presents as nephrotic syndrome, accounting for 75% of cases in
children and 25% in adults.
The majority of cases are idiopathic, but in around 10-20% a cause Is found:
drugs: NSAIDsr rifampicin
* Hodgkin's lymphoma, thymoma
infectious mononucleosis
Pathophysiology
* T-cell and cytokine mediated damage to the glomerular basement membrane -> polyanion loss
the resultant reduction of electrostatic charge increased glomerular permeability to serum
albumin
Features
* nephrotic syndrome
normotension - hypertension Is rare
* highly selective proteinuria*
* renal biopsy: electron microscopy shows fusion of podocytes
Management
* majority of cases (80%) are steroid responsive
cyclophosphamide is the next step for steroid resistant cases
Prognosis is overall good, although relapse is common. Roughly:
* 1/3 have just one episode
* 1/3 have infrequent relapses
1/3 have frequent relapses which stop before adulthood
only intermediate-sized proteins such as albumin and transferrin leak through the glomerulus
179.A 20-year-old man presents with facial and ankle swelling This has slowly been developing
over the
past week. During the review of systems he describes passing 'frothy' urine. A urine dipstick shows
protein +++ What is the most likely cause of this presentation?
Minimal change disease
IgA nephropathy
Membranoproliferative g1omeru1onephritis
Polycystic kidney disease
Membranous glomerulonephritis
Nephrotic syndrome in children / young adults - minimal change glomerulonephritis
Minimal change glomerulonephritis nearly always presents as nephrotic syndrome, accounting for 75%
of cases in children and 25% in adults. The majority of cases are idiopathic and respond well to
steroids.
Membranous glomerulonephritis would be unusual in a 20-year-old.
Minimal change disease
Minimal change disease nearly always presents as nephrotic syndrome, accounting for 75% of cases in
children and 25% in adults.
The majority of cases are idiopathic, but in around 10-20% a cause is found:
drugs: NSAIDs, rifampicin
Hodgkin's lymphoma, thymoma
infectious mononucleosis
Pathophysiology
* T-cell and cytokine mediated damage to the glomerular basement membrane poiyanion loss
* the resultant reduction of electrostatic charge - increased glomerular permeability to serum
albumin
Features
nephrotic syndrome
normotension - hypertension is rare
highly selective proteinuria*
renal biopsy: electron microscopy shows fusion of podocytes
Management
majority of cases (80%) are steroid responsive
cyclophosphamide is the next step for steroid resistant cases
Prognosis is overall good, although relapse is common. Roughly:
1/3 have just one episode
1/3 have infrequent relapses
* 1/3 have frequent relapses which stop before adulthood
*only intermediate-sized proteins such as albumin and transferrin leak through the glomerulus
young boy who had an infn one month back, not taken antibiotic, now has edema both legs upto thigh,
hypoalbumemia, proteinuria with uncle who had renal transplant- very confusing-??Minimal change
disease
180.A 16 yr old boy with proteinuria and had similar episode at the age of 7 years= minimal
change disease
Answered above!
Chilhood minimal change disease,same symptoms in the adult,same person - ?Membranous
nephropathy
181.A 76-year-old man is reviewed in the Elderly Medicine clinic. He is concerned about his
increasing
forgetfulness over the past six months. His daughter notes he has generally 'slowed down1 and
struggles to follow conversations. Over the past month he has noted increasingly frequent episodes of
urinary incontinence. He has also had one episode of faecal incontinence in the past week. On
examination he is noted to have brisk reflexes and a short, shuffling gait. No cerebellar signs are noted
What is the most likely diagnosis?
Multiple system atrophy
Parkinson's disease
Normal pressure hydrocephalus
Urinary tract infection
Pick's disease
Urinary incontinence + gait abnormality + dementia = normal pressure hydrocephalus
The presence of dementia and absence ot cerebellar signs point away from a diagnosis of multiple
system atrophy
Normal pressure hydrocephalus
Normal pressure hydrocephalus is a reversible cause of dementia seen in elderly patients. It is thought
to be secondary to reduced CSF absorption at the arachnoid villi These changes may be secondary to
head injury, subarachnoid haemorrhage or meningitis
A classical triad of features is seen
urinary incontinence
dementia and bradyphrenia
* gait abnormality (may be similar to Parkinson's disease)
Imaging
* hydrocephalus with an enlarged fourth ventricle
Management
Treatment and prognosis
Surgical treatment with shunting is the management of choice; response can be predicted
volume lumbar puncture
Response to shunting is variable, with patients presenting with more advanced symptoms
generally poorer response
94...HIV antibody
182.
A 39-year-old man is admitted to hospital with decompensated liver disease of unknown
aetiology. As
part of a liver screen the following results are obtained
Anti-HBs Positive
Anti-HBc Negative
HBs antigen Negative
Anti-HBs = Hepatitis B Surface Antibody: Anti-HBc = Hepatitis B Core Antibody: HBs antigen =
Hepatitis B
Surface Antigen
What is this man's hepatitis B status?
Chronic hepatitis B - highly infectious
Previous immunisation to hepatitis B
Probable hepatitis D infection
Acute hepatitis B infection
Chronic hepatitis B - not infectious
Hepatitis B serology
Interpreting hepatitis B serology is a dying art form which still occurs at regular intervals in medical
exams. It is important to remember a few key facts:
* surface antigen (HBsAg) is the first marker to appear and causes the production of anti-HBs
* HBsAg normally implies acute disease (present for 1-G months}
* if HBsAg is present for > 6 months then this implies chronic disease (i.e. Infective)
* Anti-HBs implies immunity (either exposure or immunisation}. It is negative in chronic disease
* Anti-HBe implies previous (or current) infection. IgM anti-HBc appears during acute or recent
hepatitis B infection and is present for about 6 months. IgG anti-HBc persists
* HbeAg results from breakdown of core antigen from infected liver cells as is therefore a marker of
infectivity
Example results
previous immunisation: anti-HBs positive, all others negative
* previous hepatitis B (> 6 months ago), not a carrier: anti-HBc positive. HBsAg negative
* previous hepatitis B. now a carrier: anti-HBc positive HBsAg positive
183.
A 30-year-old sales executive is admitted for an operative procedure requiring general
anaesthesia. He drinks
over 60 units of alcohol per week. It is necessary that he does not suffer from withdrawal symptoms
postoperatively.
Which drug would be most appropriate in alleviating this problem?
Chlordiazepoxide
Temazepam
Lorazepam
Clomethiazole
Chlorpromazine
Alcohol withdrawalprevention
Diazepam and chlordiazepoxide are used to prevent withdrawal symptoms in alcoholics
Clomethiazole readily causes addiction and respiratory depression and is therefore no longer used
period and delivery were unremarkable She is exclusively breastfeeding her child at the current time.
Abdominal examination is unremarkable and she is apyrexial. A urine dipstick shows blood +. protein
+.
leucocytes +++ and nitrates positive What is the most appropriate management?
Ciprofloxacin
Co-amoxiclav
Trimethoprim
Amoxicillin
Co-amoxiclav + metronidazole
Trimethoprim is considered safe to use in breastfeeding women.
Breast feeding: contraindications
The major breastfeeding contraindications tested in exams relate to drugs (see below). Other
contraindications of note include:
galactosaemia
* viral infections - this is controversial with respect to HIV in the developing world. This is because
there is such an increased infant mortality and morbidity associated with bottle feeding that some
doctors think the benefits outweigh the risk of HIV transmission
Drug contraindications
The following drugs can be given to mothers who are breast feeding:
antibiotics: penici11ins, cephalosporin s, trimethoprim
* endocrine: glucocorticoids (avoid high doses), levothyroxine*
epilepsy: sodium valproate, carbamazepine
* asthma: salbutamol, theophyllines
* psychiatric drugs: tricyclic antidepressants, antipsychotics**
* hypertension: beta-blockers, hydralazine, methyldopa
anticoagulants: warfarin, heparin
* digoxin
The foilowing drugs should be avoided:
* antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines
* aspirin
* carbimazole
* sulphonylureas
cytotoxic drugs
* amiodarone
*the BNF advises that the amount is too small to affect neonatal hypothyroidism screening
clozapine should be avoided
187.A 34-year-old man with a history of depression is admitted to the Emergency Department. He
states he
has taken an overdose of both diazepam and dosulepin. On examination blood pressure is 116/78 and
the pulse is 140 bpm His respiratory rate is S per minute and the oxygen saturations are 97% on room
air. What is the most appropriate next course of action?
Give flumazenil
insert a haemodialysis line
0 Obtain an EGG
Give naloxone
Start N-acetylcysteine infusion
As this patient has a marked tachycardia the first step would be to obtain an EGG it changes such
as
QRS widening are seen then intravenous bicarbonate should be given
Some users have argued that an 'ABC' approach should be taken, with Tlumazenil given to reverse
the
respiratory depression The potential risk of doing this would be inducing a seizure given the
coexistent
tricyclic overdose
Tricyclic overdose
Overdose of tricyclic antidepressants is a common presentation to emergency departments.
188.
A 60-year-old man is admitted with a productive cough with flecks of blood in his sputum.
Chest x ray reveals a mass lesion in the right mid zone.
Investigations reveal:
Sodium 110mmol/L (137-144)
Potassium 4.0mmol/L (3.5-4.9)
Bicarbonate 24 mmol/L (20-28)
Urea 3.0mmol/L (2.5-7.5)
Creatinine 80 pmol/L (60-110)
Which of the following findings suggest a diagnosis of the syndrome of inappropriate ADH (SIADH)
secretion?
(Please select 1 option)
Plasma osmolality 236 mosmol/kg(278-305) X Incorrect answer selected
Presence of ascites
Urine flow rate 20 mL/hour
Urine osmolality 250 mosmol/kg (350-1000)
Urine sodium 110 mmol/L This is the correct answer
The serum osmolality associated with hyponatraemia is generally low and so would not in itself
suggest SIADH.
However, in the context of the low plasma osmolality a high urine osmolality (twice that of the plasma
osmolality) with an elevated urine sodium (above 20 mmol/L) is suggestive of this diagnosis.
189.You are reviewing a 40-year-old man who is known to have bronchiectasis. What organism is
most likely
to be isolated from his sputum?
Streptococcus pneumoniae
Klebsiella spp.
Haemophilusinfluenzae
Pneumocystis jiroveci
Pseudomonas aeruginosa
Bronchiectasis: management
Bronchiectasis describes a permanent dilatation of the airways secondary to chronic infection or
inflammation.. After assessing for treatable causes (e g. immune deficiency) management is as follows.
* physical training (e.g. inspiratory muscle training) - has a good evidence base for patients with
non-cystic fibrosis bronchiectasis
* postural drainage
* antibiotics for exacerbations + long-term rotating antibiotics in severe cases
* bronchodilators in selected cases
* immunisations
* surgery in selected cases (e.g. Localised disease)
Most common organisms isolated from patients with bronchiectasis
* Haemophilusinfluenzae (most common)
* Pseudomonas aeruginosa
* Klebsiella spp
* Streptococcus pneumoniae
190.A patient is due to start chemotherapy for metastatic colorectal cancer What is the main
advantage of
using capecitabine instead of fiuorouracil?
0 Current data shows increased survival
Less cardiotoxic
0 Oral administration
Less nausea
Not renally excreted therefore can be used in patients with chronic kidney disease
Capecitabine is an orally administered prodrug which is enzymatically converted to 5-fluorouracil in
the
tumour
Cytotoxic agents
The tables below summarises the mechanism of action and major adverse effects of commonly used
cytotoxic agents.
Alkylating agents
Cytotoxic Mechanism of action Adverse effects
Cyclophosphamide Alkylating agent - causes Haemorrhagic cystitis, myelosuppression.
cross-linking in DNA transitional cell carcinoma
Cytotoxic antibiotics
Cytotoxic Mechanism of action
Adverse
effects
Bleomycin Degrades preformed DNA Lung fibrosis
Doxorubicin Stabilizes DNA-topoisomerase II complex inhibits DNA & RNA Cardiomyopathy
synthesis
Antimetabolites
Cytotoxic Mechanism of action Adverse effects
Methotrexate Inhibits dihydrofolate reductase and
thymidylate synthesis
Myelosuppression. mucositis.
liver fibrosis, lung fibrosis
Fluorouracil
(5-FU)
Pyrimidine analogue inducing cell cycle arrest Myelosuppression. mucositis.
and apoptosis by blocking thymidylate dermatitis
synthase (works during S phase)
6-mercaptopurine Purine analogue that is activated by
HGPRTase. decreasing purine synthesis
Myelosuppression
Cytarabine Pyrimidine antagonist. Interferes with DNA Myelosuppression, ataxia
synthesis specifically at the S-phase of the cell
cycle and inhibits DNA polymerase
Acts on microtubules
Cytotoxic Mechanism of action Adverse effects
Vincristine.
vinblastine
Inhibits formation of microtubules Vincristine: Peripheral neuropathy
(reversible) paralytic ileus
Vinblastine: myelosuppression
Docetaxel Prevents microtubule depolymerisation &
disassembly, decreasing free tubulin
Neutropaenia
Other cytotoxic drugs
Cytotoxic Mechanism of action Adverse effects
Cisplatin Causes cross-linking in DNA Ototoxicity, peripheral neuropathy.
hypomagnesaemia
Hydroxyurea Inhibits ribonucleotide reductase.
(hydroxycarbamide) decreasing DNA synthesis
Myelosuppression
191.A 40-year-old man is investigated for abnormal liver function tests. It is decided to perform a
liver
biopsy. Which one of the following is a contraindication to liver biopsy?
ALT Of 2,212 iu/l
Aspirin therapy
0 Platelet count of 100 * 10&/l
Body mass index of 33 kg/m*?
Extrahepatic biliary obstruction
192.With modem techniques such as ERCP and MRI cholangiography the risks of liver biopsy
when there is
extra-hepatic biliary obstruction are rarely justified.
Liver biopsy
Contraindications to percutaneous liver biopsy
deranged clotting (e.g. INR > 1.4)
* low platelets (e.g. < 60 * 109/l)
anaemia
* extrahepatic biliary obstruction
hydatid cyst
* haemoangioma
uncooperative patient
* ascites
Contraindications Uncooperative patient; *Prolonged prothrombin time (> 4 seconds) (BSG guidelines
2004); *Platelets < 60 x 109/litre (Grant et al, 2004); *Ascites; Extrahepatic cholestasis. (Kumar &
Clark, 2009)
193.Where is the most common site tor primary cardiac tumours to occur in adults?
Left atrium
Right ventricle
Right atrium
Lett atrial appendage
Left ventricle
inwardly. Lesions of
this nerve cause outward rotation and a torsional element to the diplopia. Diplopia is also worse for
near vision
because the eyes look down when reading. Diplopia that is episodic or worse at night are not
anatomically localising
features but might of course be important in terms of aetiology.
195.After a traumatic injury to her left upper limb, a 36-year-old woman presents with acute
weakness and numbness
of her left arm. On examination she has a wrist drop with marked weakness of the extensor digitorum
longus,
brachioradialis and subtle triceps muscles. There is sensory loss over the posterior forearm and a small
area of
numbness over the dorsum of her hand. The triceps reflex is diminished but other reflexes are intact.
Where is the likely anatomical location of the nerve injury?
Lateral cord of the brachial plexus
Medial cord of the brachial plexus
Proximal median nerve in the axilla
Radial nerve in the spiral groove of the humerus CORRECT ANSWER
Ulnar nerve in the ulnar groove
The Answer Comment on this Question
YOUR ANSWER WAS INCORRECT
Sequelae of radialnerve injury
The radial nerve is composed of fibres from C6 to C8 cervical spinal roots, but mainly from C7; it is
the
continuation of the posterior cord of the brachial plexus
It is particularly susceptible to compression or traumatic damage as it winds around the humerus
(including
'Saturday night palsy', a pressure palsy sustained while sleeping in an awkward position under the
influence of
alcohol), and may also be compressed in the axilla (eg from using a crutch)
It supplies the muscles controlling elbow, wrist and finger extension as well as sensation over the
posterior forearm
and a small patch at the dorsal base of the thumb
The long and medial heads of triceps are supplied proximal to the spiral groove, but a branch to the
lateral head
emerges within the spiral groove, so some degree of triceps weakness could be expected
It is worth remembering that the radial nerve supplies no muscles in the hand itself, which is supplied
partly by the
median nerve (lateral two lumbricals, opponens pollicis, abductor pollicis brevis, flexor pollicis brevis:
mnemonic
LOAF) and the ulnar nerve (all other intrinsic hand muscles)
196.In a patient with diplopia which one of the following findings is most suggestive of
myasthenia
gravis?
Loss of pin prick sensation around the chin area
Preserved pupillary light reflex with absent accommodation reflex
Thymoma on computed tomography scan (CT scan) of the chest CORRECT ANSWER
Elevated creatinine phosphokinase (CPK)
Proptosis
The patient with diplopia
Myasthenia gravis
Myasthenia gravis is an acquired autoimmune disorder associated with acetylcholine receptor
deficiency at the
motor endplate
The ocular muscle involvement is usually bilateral, asymmetrical and typically associated with ptosis
and diplopia
Epilepsy
The family history of epilepsy and the provocation of a generalised seizure by sleep deprivation (with
or without
alcohol) in a young patient are strongly suggestive of a primary generalised epilepsy syndrome
Juvenile myoclonic epilepsy is the most common primary generalised epilepsy, but is underdiagnosed
partly owing
to the lack of awareness of the condition by doctors
Presentation of juvenile myoclonic epilepsy
Absence seizures in childhood (which may be subtle and remain undiagnosed)
Myoclonic jerks, especially of the upper limbs, which predominantly occur in the mornings shortly
after waking (and
may be so subtle as to be interpreted as 'clumsiness' when eating breakfast)
Generalised tonic-clonic seizures (GTCS), which often present for the first time between the ages of
13 and 18
years
There may be a positive family history
Investigations in juvenile myoclonic epilepsy
In a young person presenting with a first GTCS, these features should be carefully sought, bearing in
mind they
may not have been recognised as being pathological by the patient or their family
Interictal EEG is diagnostic or strongly supportive of the diagnosis in a high percentage of cases,
showing
generalised spike- and polyspike-wave activity; a photosensitive response may also be present
Management of juvenile myoclonic epilepsy
It is important to be aware of the syndrome as it responds extremely well to sodium valproate, but
may be
exacerbated by some other antiepileptic drugs including carbamazepine
Input from a specialist epilepsy service is recommended for all such first seizures (SIGN guidelines;
NICE
guidelines (in preparation))
199.pt wth status epilepticus was treated with loading dose of phenytoin
Then d/c on oral phenytoin 100mg bd, but he had seizures in the 4 months a/f d/c , what would
u do?
A) loading dose phenytoin
B) add lamotrigine
C) switch to sodium valproate
D) increase phenytoin to 200mg bd
200.elderly post stroke in house care..has a problem using cooker and microwave. .who can help
him.
occupational therapist
neurophysicist
neurophysiotherapist
psychiatrist
201.A 27-year-old man presents with a history of fits consistent with tonic-clonic seizures.What is
the most
suitable first-line treatment?
0 Gabapentin
Lamotrigine
Sodium valproate
Carbamazepine
Phenytoin
202.A 12-year-old boy is brought to the Emergency Department. He was hit on the side the head
by a
cricket ball during a match. His teacher describes him initially collapsing to the ground and
complaining
of a sore head. After two minutes he got up said he felt OK and continued playing After 30 minutes he
suddenly collapsed to the ground and lost consciousness. What type of injury is he most likely to have
sustained?
0 Cerebral contusion
Subarachnoid haemorrhage
Intraventricular haemorrhage
Extradural haematoma
Subdural haematoma
203.
new q (note that they swtch the sides in the exams) During a routine cranial nerve
examination the following findings are observed
Rinne's test: Air conduction > bone conduction in both ears
Weber's test: Localises to the right side
What do these tests imply?
Left conductive deafness
Normal hearing
Right conductive deafness
Right sensorineural deafness
Left sensorineural deafness
In Weber's test it there is a sensorineural problem the sound is localised to the unaffected side (right)
indicating a problem on the left side
Rinne's and Weber's test
Performing both Rinne's and Weber's test allows differentiation of conductive and sensorineural
deafness.
Rinne's test
tuning fork is placed over the mastoid process until the sound is no longer heard followed by
repositioning just over external acoustic meatus
* air conduction (AC) is normally better than bone conduction (BC)
* if BC > AC then conductive deafness
Weber's test
* tuning fork is placed in the middle of the forehead equidistant from the patient's ears
* the patient is then asked which side is loudest
* in unilateral sensorineural deafness, sound is localised to the unaffected side
* in unilateral conductive deafness, sound is localised to the affected side
Olfactory meningiomas are rare benign tumours and represent about 12% of all basal meningiomas.
Anosmia is thought to be among the first symptoms, even though patients often present with headaches
or visual problems
205.
pt with small m/s wasting in hand , weak extension of elbow , loss of triceps reflex in UL
LL - UMNL
Sensory - loss of vibration in ankles
What dx?
A) cervical radiculomyelopathy
B) MND
C) syringomyelia
D) transverse myelitis
E) intramedullary spinal cord tumour
206.A 44-year-old woman presents with pain in her right hand and forearm which has been getting
worse Tor
the past few weeks. There is no history ot trauma. The pain is concentrated around the thumb and
index finger and is often worse at night Shaking her hand seems to provide some relief. On
examination there is weakness of the abductor pcllicis brevis and reduced sensation to fine touch at the
index finger What is the most likely diagnosis?
C6 entrapment neuropathy
Thoracic outlet syndrome
0 Carpal tunnel syndrome
Cervical rib
Pancoast's tumour
More proximal symptoms would be expected with a CS entrapment neuropathy e g weakness of the
biceps muscle or reduced biceps reflex.
Patients with carpal tunnel syndrome often get relief from shaking their hands and this may be an
important clue in exam questions.
Carpal tunnel syndrome
Carpal tunnel syndrome is caused by compression of median nerve in the carpal tunnel.
History
* pain/pins and needles in thumb, index, middle finger
* unusually the symptoms may 'ascend' proximally
* patient shakes his hand to obtain relief, classically at night
Examination
* weakness of thumb abduction {abductor pollicis brevis)
* wasting of thenar eminence (NOT hypothenar)
* Tinel's sign: tapping causes paraesthesia
* Phalen's sign, flexion of wrist causes symptoms
Causes
* idiopathic
* pregnancy
* oedema e.g. heart failure
* lunate fracture
* rheumatoid arthritis
Electrophysiclogy
* motor + sensory: prolongation of the action potential
Treatment
* corticosteroid injection
* wrist splints at night
* surgical decompression (flexor retinaculum division)
207.55-year-old man who has received haemodialysis for many years presents with deteriorating
discomfort in
both shoulders. Past medical history included bilateral carpal tunnel decompression.
His investigations reveal:
Haemoglobin 100 g/L (130-180)
ESR 30mm/1st hr (1-10)
C reactive protein 12mg/L (<10)
Urate 0.58mmol/L (<0.45)
What is the most likely diagnosis?
(Please select 1 option)
62 microglobulin amyloidosis Correct
Gout
Osteoarthritis
Polymyalgia rheumatica
Pseudogout
The features of shoulder pain associated with a past history of carpal tunnel syndrome in a patient
receiving
haemodialysis suggests a diagnosis of 62 microglobulin amyloidosis.
Amyloid deposits composed of 62 microglobulin as the major constituent protein are mainly localised
in joints
and periarticular bone and lead to destructive arthropathy which tends to develop five to ten years after
the
initiation of dialysis.
Death from amyloidosis of gut and heart may occur after 20 years of dialysis
208.A 30-year-old pregnant woman presents with a weak grip and tingling of her right hand. She
complains of a dull
aching pain in her forearm, which is made worse by carrying a shopping bag. On examination you find
weakness
of the right abductor pollicis brevis and mild weakness of thumb flexion. Finger abduction and
adduction appear
to be within normal limits. There is sensory loss to pinprick mainly affecting the right thumb and index
finger.
Phalen's sign is positive. The left-hand sensorimotor examination is normal. The deep tendon reflexes
are
symmetrical.
What is the most likely cause of her symptoms?
Compression of the right ulnar nerve at the elbow
Right C8 nerve root irritation
Right brachial plexopathy
Compression of the right median nerve in the forearm
Compression of the right median nerve in the carpal tunnel CORRECT ANSWER
YOUR ANSWER WAS INCORRECT
The Answer Comment on this Question
The patient with suspected carpal tunnelsyndrome
Pregnancy is a risk factor for carpal tunnel syndrome, as are other conditions that promote fluid
retention or
thickening of the subcutaneous tissues (eg hypothyroidism), factors that alter the configuration of the
wrist
structures (eg osteoarthritis or rheumatoid arthritis) and conditions that predispose to neuropathy (eg
diabetes,
hereditary tendency to pressure palsy)
Although the median nerve supplies the lateral two lumbricals, opponens pollicis, abductor pollicis
brevis and flexor
pollicis brevis (mnemonic LOAF), the pattern of weakness may be incomplete; this also applies to the
pattern of
sensory loss
Phalen's sign involves placing pressure over the carpal tunnel with the wrist flexed - it is considered
positive if this
reproduces the patient's symptoms (although, of course, it is neither 100% specific nor 100% sensitive)
Nerve conduction studies would confirm the diagnosis
Carpal Tunnel Syndrome features seen in Rheumatoid Arthiritis
And hypogamm
aglobulinaemia
Which test to confirm underlying dx?
A) blood glucose
B) RF
C) TFT
D) a test for SLE ??
blood tests (full blood count, serum calcium and liver function tests) and urinalysis.
Consider further investigations for cancer with an abdomino-pelvic CT scan (and a mammogram for
women) in all patients aged over 40 years with a first unprovoked DVT or PE
Thrombophilia screening
not offered if patients will be on lifelong warfarin (i.e won't alter management)
consider testing for antiphospholipid antibodies if unprovoked DVT or PE
consider testing for hereditary thrombophilia in patients who have had unprovoked DVT or PE
and who have a first-degree relative who has had DVT or PE
210.An autoantibody screen reveals that a patient is positive tor anti-Jo 1 antibodies. What is the
most likely
underlying diagnosis?
Limited cutaneous systemic sclerosis
0 Mixed connective tissue disease
Dermatomyositis
Polymyositis
Diffuse cutaneous systemic sclerosis
* prednisolone
EMG is normal
212.A 61-year-oId man is noted to have thickened patches of skin over his knuckles and extensor
surfaces
consistent with Gottron's papules. His creatinine kinase levels are also elevated. A diagnosis of
dermatomyositis is suspected Which one of the following types ot autoantibody is most specific for this
condition?
Anti-scl-70 antibodies
0 Anti-Jo-1 antibodies
Anti-nuclear antibodies
Anti-Mi-2 antibodies
Anti-centromere bodies
Dermatomyositis antibodies: ANA most common. anti-Mi-2 most specific
Dermatomyositis: investigations and management
Investigations
elevated creatine kinase
* EMG
muscle biopsy
ANA positive in 60%
anti-Mi-2 antibodies are highly specific for dermatomyositis, but are only seen in around 25% of
patients
* antkJo-1 antibodies are not commonly seen in dermatomyositis - they are more common in
polymyositis where they are seen in a pattern of disease associated with lung involvement,
Raynaud's and fever
Management
prednisolone
213.Dermatomyositis, initial mgt - prednisolone
Dermatomyositis
The typical rash of dermatomyositis is a macular erythema with a blue-violet (heliotrope)
coloration around the
eyes
There is also linear erythema over the dorsum of the hands and feet, and nailfold haemorrhages in
some patients.
In adults there is an association with occult malignancy
Clinicalinvestigations
Skin biopsy usually reveals liquefaction degeneration of the basal layer, and thin and atrophic
overlying epidermis
The dermis may contain large numbers of free melanin granules
Muscle biopsy may show fibre degeneration and internalisation of the sarcolemmal nuclei
Proximal myopathy affecting all four limbs is the commonest pattern of muscle weakness, and
may be manifest in
problems with performing simple tasks around the home, eg climbing the stairs or getting up out of
a chair
Diagnosis and treatment
Diagnosis is made on the basis of the typical rash, proximal myopathy and raised circulating
muscle enzymes
Oral prednisolone, with or without the addition of azathioprine for steroid-sparing, is standard
therapy
214.A 28-year-old female undergoes a renal transplant for focal segmental glomerulosclerosis.
Within hours
of the operation the patient becomes unwell with features consistent with severe systemic inflammatory
response syndrome. The patient is immediately taken back to theatre and the transplanted kidney is
removed. What type of immunoglobulins are responsible for the graft rejection?
igE
igM
ige
IgD
IgA
Hyperacute graft rejection is due to pre-existent antibodies to HLA antigens and is therefore IgG
mediated
Renal transplant: HLA typing and graft failure
The human leucocyte antigen (HLA) system is the name given to the major histocompatibility complex
(MHC) in humans. It is coded for on chromosome 6.
Some basic points on the HLA system
class1 antigens include A, 6 and C. Class 2 antigens include DRDQ and DR
* when HLA matching for a renal transplant the relative importance of the HLA antigens are as
follows DR > B > A
Graft survival
* 1year = 90%, 10 years = 60% for cadaveric transplants
1 year= 95%, 10 years = 70% for living-donor transplants
Post-op problems
ATN of graft
* vascular thrombosis
urine leakage
* UTI
Hyperacute acute rejection (minutes to hours)
* due to pre-existent antibodies against donor HLA type 1 antigens (a type II hypersensitivity
reaction)
rarely seen due to HLA matching
Acute graft failure ('< 6 months)
usually due to mismatched HLA. Cell-mediated (cytotoxic T cells)
* other causes include cytomegalovirus infection
may be reversible with steroids and immunosuppressants
Causes of chronic graft failure (> 6 months)
* both antibody and cell mediated mechanisms cause fibrosis to the transplanted kidney (chronic
allograft nephropathy)
* recurrence of original renal disease (MCGN > IgA > FSGS)
215.A 49-year-old woman has been admitted with haemoptysis and epistaxis. Her chest X-ray
shows multiple rounded
lesions with alveolar shadowing. Her serum is positive for cytoplasmic anti-neutrophil cytoplasmic
antibody (cANCA).
What is the most likely diagnosis?
Tuberculosis
Carcinoma of the lung
Echinococcosis
Wegener's granulomatosis CORRECT ANSWER
Systemic lupus erythematosus
Wegener's granulomatosis
Almost all patients will have evidence of granulomatous lung disease at presentation, which is often
accompanied by
alveolar capillaritis. The bronchi can also be affected and bronchial stenoses occur as late
manifestations.
Clinical features
Symptoms include:
Cough
Dyspnoea
Haemoptysis
Chest pain (which can be pleuritic)
Signs on chest examination depend on the nature of the pulmonary lesions and include:
Fine crepitations
Bronchial breathing
Pleural rubs and signs of pleural effusion (less common)
Investigation
Radiology - pulmonary granulomas are usually diagnosed on the basis of chest X-ray and computed
tomography,
which show single or multiple rounded lesions, which can cavitate.
Bronchoscopy - often reveals granulomatous inflammation and the diagnosis can sometimes be made
from
bronchial biopsies.
There are two main types of anti-neutrophil cytoplasmic antibodies (ANCA) - cytoplasmic (cANCA)
and
perinuclear (pANCA)
For the exam, remember:
* cANCA -Wegener's granulomatosis
* pANCA - Churg-Strauss syndrome + others (see below)
cANCA
most common target serine proteinase 3 (PR3)
* some correlation between cANCA levels and disease activity
* Wegeners granulomatosis, positive in > 90%
microscopic polyangiitis, positive in 40%
216.24-year-old student presents with bloody diarrhoea. She says that she has been passing up to
12 motions per
day for the past 2-3 weeks. She now presents to the Emergency Department complaining of abdominal
pain and
distension. On examination she is dehydrated with a clearly distended, tender abdomen. There is
anaemia with
raised plasma viscosity, the potassium is mildly decreased at 3.2 mmol/l and the urea is raised in
keeping with
the dehydration. Liver function testing reveals a decreased albumin level. Autoantibody screen is
positive for
perinuclear antineutrophil cytoplasmic antibody (pANCA). Sigmoidoscopy shows a friable mucosa
with a uniform
pattern of inflammation and loss of normal mucosa. Stool culture is negative.
Which diagnosis fits best with this clinical picture?
Crohn's disease
Coeliac disease
Ischaemic colitis
Ulcerative colitis CORRECT ANSWER
Diverticulitis
The Answer Comment on this Question
YOUR ANSWER WAS INCORRECT
Ulcerative colitis
This is the typical presentation of ulcerative colitis. Extraintestinal manifestations such as arthropathy,
uveitis and
pyoderma gangrenosum can also occur. The annual incidence of ulcerative colitis is said to be 50150 cases/100,000 of the population, with the commonest age at presentation being between 14 and 38
years.
Perinuclear antineutrophil cytoplasmic antibody (pANCA) is positive in 45% of cases.
Management
Management includes correction of dehydration and subcutaneous heparin for patients who are
inactive. The acute
management of inflammation involves a combination of intravenous hydrocortisone and 5aminosalicylic acid
compounds such as mesalazine. Between 15% and 20% of patients eventually require colectomy for
disease that is
resistant to medical therapy.
217.Unkown question about complements: C1q, C2, C4, -associated with Classical Pathway
Compfement deficiencies
Complement is a series of proteins that circulate in plasma and are involved in the inflammatory and
immune reaction of the body. Complement proteins are involved in chemotaxis. cell lysis and
opsonisation
Cf inhibitor (C1-INH) protein deficiency
causes hereditary angioedema
Cf-INH is a multifunctional serine protease inhibitor
* probable mechanism is uncontrolled release of bradykinin resulting in oedema of tissues
C1q 61rs. C2. C4 deficiency (classical pathway components)
* predisposes to immune complex disease
* e.g. 3LE Henoch-Schonlein Purpura
C3 deficiency
* causes recurrent bacterial infections
C5 deficiency
* predisposes to Leiner disease
* recurrent diarrhoea, wasting and seborrhoeic dermatitis
C5-9 deficiency
* encodes the membrane attack complex (MAC)
particularly prone to Neisseria meningitidis infection
218.
alcoholic with ataxia and opthalmoplegia comes with hypoglycemia -first drug to guve? IV
thiamine
If there is coexisting hypoglycaemia (often the case in
this group of patients), make sure thiamine is given before glucose, as Wernickes can
be precipitated by glucose administration to a thiamine-defi cient patient. Prognosis:
Untreated, death occurs in 20%, and Korsakoff s psychosis occurs in 85%a quarter
of whom will require long-term institutional care. Give thiamine (PabrinexR) 2 pairs of
high-potency ampoules IV/IM/8h over 30min for 2d, then 1 pair OD for a further 5d. Oral
supplementation (100mg OD) should continue until no longer at risk
219.A 24-year-old male with no past medical history presents to the Emergency Department with
pleuritic
chest pain. There is no history of a productive cough and he is not short of breath. Chest x-ray shows a
right-sided pneumothorax with a 1cm rim of air and no mediastinal shift. What is the most appropriate
management
Immediate 1:4G cannula into 2nd intercostal space, mid-clavicular line
Discharge with outpatient chest x-ray
Aspiration
Intercostal drain insertion
Admit for 48 hours observation
It would of course be prudent to give advice about what he should do if his symptoms worsen and also
suggest routine follow-up with his GP
Pneumothorax
The British Thoracic Society (BTS) published updated guidelines for the management of spontaneous
pneumothorax in 20 fO A pneumothorax is termed primary if there is no underlying lung disease and
secondary it there is
Primary pneumothorax
Recommendations include:
* if the rim of air is < 2cm and the patient is not short of breath then discharge should be
considered
* otherwise aspiration should be attempted
if this fails (defined as > 2 cm or still short of breath} then a chest drain should be inserted
Secondary pneumothorax
Recommendations include
* if the patient is > 50 years old and the rim of air is > 2cm and/or the patient is short of breath then
a chest drain should be inserted
otherwise aspiration should be attempted if the rim of air is between 1-2cm. If aspiration fails (i.e.
pneumothorax is still greater then 1cm) a chest drain should be inserted All patients should be
admitted for at least 24 hours
* if the pneumothorax is less the f cm then the BTS guidelines suggest giving oxygen and admitting
for 24 hours
regarding scuba diving, the BTS guidelines state 'Diving should be permanently avoided unless
tnepatient nas undergone bilateral surgicalpleurectomy and has normal lung function and chest
CT scan postoperatively. '
Iatrogenic pneumothorax
Recommendations include:
* less likelihood of recurrence than spontaneous pneumothorax
majority will resolve with observation, if treatment is required then aspiration should be used
* ventilated patients need chest drains, as may some patients with CORD
220.You review a 60-year-old man who had a drug-eluding stent inserted 6 months ago for
ischaemic heart
disease His current medication includes aspirin, clopidogrel. atorvastatin. ramipril and bisoprolol. He
has developed an inguinal hernia and is keen for surgical repair. The cardiologists plan was to continue
clopidogrel for 12 months following stent insertion. What is the most appropriate course of action?
Stop clopidogrel the day before the operation
Stop clopidogrel 7 days before the operation
Continue clopidogrel as normal
Delay operation for 6 months
Stop clopidogrel the day before the operation and start low-molecular weight heparin
(prophylaxis dose)
221.A 70 year old lady presents with hip pain on the right side. She has a history of hypertension.
On examination, she is able to mobilise and has normal flexion and extension of movement of
her hip. She is However, tender to the palpation in the right lateral hip. What is the likely
diagnosis?
1- Osteoarthritis
2- Ankylosing spondylitis
3- Rheumatoid arthritis
4- Trochanteric bursitis
5- Fracture of neck of femur
Trochanteric bursitis Trochanteric bursitis is characterized by painful inflammation of the bursa located
just superficial to the greater trochanter of the femur. Patients typically complain of lateral hip pain,
although the hip joint itself is not involved. The pain may radiate down the lateral aspect of the thigh. It
may occur with trauma. Rest and physiotherapy are best management options, although steroid
injection is an option.
222.A 60-year-cld man is investigated tor progressive shortness of breath On examination a loud
P2 is
noted associated with a left parasternal heave. An EGG shows evidence of right ventricular strain and a
diagnosis of pulmonary hypertension is suspected. Which one of the following is the single most
important test to confirm the diagnosis?
Echocardiography
High resolution CT thorax
Cardiac catheterisation
Pulmonary angiography
Ventilation perfusion scanning
Whilst echocardiography may strongly point towards a diagnosis of pulmonary hypertension all
patients
need to have right heart pressures measured Cardiac catheterisation is therefore the single most
important investigation. Please see the British Thoracic Society guidelines for more details.
Pulmonary arterial hypertension: features and management
Pulmonary arterial hypertension (PAH) may be defined as a sustained elevation in mean pulmonary
arterial pressure of greater than 25 mmHg at rest or 30 mmHg after exercise.
Features
* exertional dyspnoea is the most frequent symptom
* chest pain and syncope may also occur
* loud P2
* left parasternal heave (due to right ventricular hypertrophy)
Management should first involve treating any underlying conditions, for example with anticoagulants
or
oxygen. Following this, it has now been shown that acute vasodilator testing is central to deciding on
the appropriate management strategy. Acute vasodilator testing aims to decide which patients show a
significant fall in pulmonary arterial pressure following the administration of vasodilators such as
intravenous epoprostencl or inhaled nitric oxide
223.You are reviewing a patient's urea and electrolyte results. There appears to be a
discrepancy between the serum creatinine and the calculated eGFR.
Which one of the following factors is most likely to explain this discrepancy?
1- Diuretic use
2- Pregnancy
3- Type 1 diabetes mellitus
4- Significant hypertension
5- Female gender
Answer & Comments
Answer: 2- Pregnancy
When a person's creatinine is stable, an estimated Glomerular filtration rate can be
obtained with inputs of creatinine, age, gender and racial origin.
The eGFR estimate may be inaccurate in people over 70 years of age, people less than
18 years old, pregnancy, amputees, malnourishment and dehydration states.
224.A 35 year old man is admitted with fevers, cough and night sweats.
Which one of the following test results suggests that he needs isolation into a side
room in the hospital?
1- Positive sputum culture for TB
2- Positive sputum direct smear for TB
3- Positive CSF culture for TB
4- Positive urine culture for TB
5- Positive urine direct smear for TB
Answer & Comments
Answer: 2- Positive sputum direct smear for TB
Stained smears of sputum specimens to detect the presence of acid fast bacilli (AFB) are
useful diagnostic tools in the management of tuberculosis. Patients with tuberculosis who have
negative sputum smears for AFB are less contagious than patients with positive smears. Patients with
positive direct sputum smears should be
isolated in negative pressure rooms.
225.A 62 year old woman has recently had lethargy and arthralgia. She was
diagnosed as having influenza infection, as there was an outbreak in the area recently.
She presents 1 week later with a cough and breathlessness. On examination, she had
226.A 50-year-old hypertensive man presents with difficulty in using his right arm, slow walking
and occasional loss of balance.
He has a broad-based gait with cogwheel rigidity and intention tremor of his right arm.
His blood pressure is 140/80 mmHg sitting and 100/60 mmHg standing.
What is the most likely diagnosis?
1- Idiopathic Parkinson's disease
2- Multiple system atrophy
3- Progressive supranuclear palsy
4- Corticobasal degeneration
5- Drug-induced parkinsonism
Answer & Comments
Answer: 2- Multiple system atrophy
This man presents with a combination of akinetic rigid syndrome, cerebellar signs and
the suggestion of autonomic features. This is most suggestive of a diagnosis of multiple
system atrophy. This disorder typically presents in middle age and consists of a
mixture of an akinetic-rigid syndrome unresponsive to l-dopa, cerebellar ataxia and
autonomic features. The mixture of individual features can vary from patient to patient.
A 61 year old man presents with
bradykinesia and mask like facies. He was
found to have cogw heeling and bradykinesia.
His gait is shuffling in nature.
Which one of the following drugs is most likely
to help the bradykinesia?
1- Amantadine
2- Benzhexol
3- Bromocriptine
4- Levodopa
Levodopa
The primary pathology in Parkinson's disease is
loss of dopaminergic action in the substantia
nigra, leading to rigidity, bradykinesia and
tremors.
Bradykinesia results from a failure of basal
Renal ultrasound revealed a right kidney of 7 cm and a left kidney of 10 cm (normal dimensions 10-14
cm).
Which investigation should be requested to establish a diagnosis?
(Please select 1 option)
Cystoscopy
Intravenous urography X Incorrect answer selected
Isotope renography
Renal arteriography This is the correct answer
Renal biopsy
This patient has renovascular disease with a right renal artery stenosis.
The gold standard for establishing a diagnosis of renal artery stenosis is renal arteriography and this is
commonly performed with magnetic resonance angiography.
In one third of cases the disease is bilateral: 40% may have peripheral vascular disease and there may
be
proteinuria.
228.A 60-year-old man presents to the Emergency medical take as a GP referral. He has had a nonproductive
niggling cough over the past few weeks, and most recently severe headaches and swelling of his face
and arms.
He smokes 20 cigarettes per day and has done so for 40 years. Examination reveals a blood pressure of
155/85
mmHg,you notice dilated veins over his arms and upper chest, his face looks plethoric, and there is
evidence of
oedema. Auscultation of the chest reveals poor air entry and wheeze consistent with COPD.
Investigations;
Hb 13.8 g/dl
WCC 9.9x109/1
PLT 188 x 109/1
Na+ 137 mmol/l
K+ 4.5 mmol/l
Creatinine 112 micromol/l
CXR Large right hilar mass
CT scan right hilar mass suspicious of bronchial carcinoma, leading to SVC compression
Which of the following is the most appropriate intervention?
Chemotherapy
Corticosteroids
Radiotherapy
Surgical bypass
Stenting CORRECT ANSWER
The Answer Comment on this Question
YOUR ANSWER WAS INCORRECT
The answer is Stenting
This patient has SVC obstruction as a result of extrinsic compression from an underlying bronchial
carcinoma. A NICE review has concluded that stenting offers a greater degree of success in terms of
relief of
symptoms than radiotherapy, and is therefore the intervention of choice here. Radiotherapy may be an
option later, if radiotherapy is used initially then stenting becomes significantly more difficult due to
local
fibrosis. Surgical bypass is only really an option for benign tumours, and there is little evidence to say
that it
confers any better benefit than stenting. Corticosteroids are most useful where the cause of
compression is
an underlying haematological malignancy.
229.A 50-year-old chronic alcoholic presents with a persistent skin rash on his hands, arms, neck
and face.
The rash is red-brown in colour, symmetrical and scaly. He also complains of a poor appetite, nausea
and diarrhoea. Which vitamin deficiency is most likely to have caused his symptoms?
Niacin
Folic acid
Thiamine
Vitamin B6
Zinc
Pellagra
Pellagra is a caused by nicotinic acid {niacin} deficiency The classical features are the 3 D's
-dermatitis, diarrhoea and dementia
Pellagra may occur as a consequence of isoniazid therapy (isoniazid inhibits the conversion of
tryptophan to niacin} and it is more common in alcoholics.
Features
* dermatitis (brown scaly rash on sun-exposed sites - termed Casal's necklace if around neck}
* diarrhoea
* dementia depression
* death if not treated
230.A 24-year-old female with a history of anorexia nervosa presents with red crusted lesions
around the
corner of her mouth and below her lower lip. What is she most likely to be deficient in?
Zinc
Tocopherol
0 Pantothenic acid
Thiamine
Magnesium
Zinc deficiency
Features
* perioral dermatitis: red. crusted lesions
* acrodermatitis
* alopecia
* short stature
* hypogonadism
* hepatosplenomegaly
* geophagia (ingesting clay/soil)
* cognitive impairment
Vitamin B2 (riboflavin) deficiency may also cause angular cheilosis
10. PANCREATIC INSUFFICIENCY
Bicarbonate 31 mmol/l
Urea 3,4 mmol/l
Creatinine 77 urnol/l
Which one of the following investigations is most likely to be diagnostic'?
Renal ultrasound
Overnight dexamethasone suppression test
Renin:aldosterone ratio
MR angiography
21-hydroxylase estimation
Conn's syndrome is the likely diagnosis - a renin:aldosterone ratio would be an appropriate first-line
investigation. A normal clinical examination makes a diagnosis of Cushing's syndrome less likely
Primary hyperaldosteronism
Primary hyperaldosteronism was previously thought to be most commonly caused by an adrenal
adenoma termed Conn's syndrome However, recent studies have shown that bilateral idiopathic
adrenal hyperplasia is the cause in up to 70% of cases. Differentiating between the two is important as
this determines treatment. Adrenal carcinoma is an extremely rare cause of primary hyperaldosteronism
Features
* hypertension
* hypokalaemia (e.g. muscle weakness}
alkalosis
Investigations
high serum aldosterone
* low serum renin
high-resolution CT abdomen
* adrenal vein sampling
Management
adrenal adenoma: surgery
* bilateral adrenocortical hyperplasia: aldosterone antagonist e.g. spironolactone
note that some of these notes have been copied to Wikipedia, and not vice-versa
232.A 42-year-old woman is referred to the clinic with very difficult to manage hypertension. She
is currently taking indapamide, ramipril, amlodipine and doxasosin, yet her blood pressure is
still 155/95 mmHg. On examination she has a BMI of 25. Ophthalmoscopy reveals evidence
of chronic changes consistent with hypertension.
Bloods reveal; Hb14.0g/dl
WCC 5.8 x 109/L
PLT 190 x 109/L
Na+ 139mmol/l
K+ 3.3mmol/l
Creatinine 100 mol/l
You suspect Conns syndrome.
Which of the following is the investigation of choice to confirm the diagnosis?
1- CT Abdomen
2- Iodine (I131) iodocholesterol scanning
3- Aldosterone:renin ratio
4- MRI abdomen
5- Morning cortisol
Answer & Comments
Answer: 3- Aldosterone:renin ratio
Whilst CT/ MRI abdomen is useful in differentiating the underlying cause of primary
hyperaldosteronism (bilateral adrenal hyperplasia vs adenoma, aldosterone:renin ratio is still needed to
make the primary diagnosis. Anti-hypertensives can affect interpretation of the result and ideally the
test should be done following a period off medication. Iodocholesterol scanning is very expensive and
not a first line investigation. There is no indication of Cushings, so a morning cortisol is not likely to
be useful in this case.
233.Features of conns syn given. Qn is where is the Pathology? a- aff arteriole b- glomerulus cDCT
234.
A 41-year-old man with a past history ot asthma presents with pain and weakness in his left
hand
Examination findings are consistent with a left ulnar nerve palsy Blood tests reveal an eosinophilia.
Which one of the following antibodies is most likely to be present?
ANA
Anti-Scl70
pANCA
Antiphospholipid antibodies
cANCA
This patient has Churg-Strauss syndrome as evidenced by the asthma, mononeuritis and eosinophilia
Churg-Strauss syndrome
Churg-Strauss syndrome is an ANCA associated small-medium vessel vasculitis.
Features
* asthma
* blood eosinophilia (e.g. > 10%)
* paranasal sinusitis
* mononeuritis multiplex
* pANCA positive in 60%
Leukotriene receptor antagonists may precipitate the disease
235.
A 64-year-old female with a history of CORD and hypertension presents with pain on
swallowing
Current medication includes a salbutamol and becotide inhaler bendrofluazide and amlcdipine What is
the most likely cause of the presentation?
Myasthenia gravis precipitated by bendrofluazide
Oesophageal web
Achalasia secondary to amlodipine
Oesophageal candidiasis
Oesophageal cancer
Pain on swallowing (odynophagia) is atypical of oesophageal candidiasis, a well documented
complication of inhaled steroid therapy
Dysphagia
The table below gives characteristic exam question features for conditions causing dysphagia:
Oesophageal
cancer
Dysphagia may be associated with weight loss, anorexia or vomiting
during eating
Past history may include Barrett's oesophagus, GORD, excessive
smoking or alcohol use
Oesophagitis May be history of heartburn
Odynophagia but no weight loss and systemically well
Oesophageal
candidiasis
There may be a history of HIV or other risk factors such as steroid inhaler use
Achalasia Dysphagia of both liquids and solids from the start
Heartburn
Regurgitation of food - may lead to cough, aspiration pneumonia etc
Pharyngeal pouch More common in older men
Represents a posteromedial herniation between thyropharyngeus and
cricopharyngeus muscles
Usually not seen but if large then a midline lump in the neck that gurgles on
palpation
Typical symptoms are dysphagia, regurgitation, aspiration and chronic cough.
Halitosis may occasionally be seen
Systemic
sclerosis
Other features of CREST syndrome may be present, namely Calcinosis,
Raynaud's phenomenon, oEsophageal dysmotility. Sclerodactyly,
Telangiectasia
As well as oesophageal dysmotility the lower oesophageal sphincter (LES)
pressure is decreased. This contrasts to achalasia where the LES pressure is
increased
Myasthenia
gravis
Other symptoms may include extraocular muscle weakness or ptosis
Dysphagia with liquids as well as solids
Globus hystericus May be history of anxiety
Symptoms are often intermittent
236.
A 65-year-old woman is reviewed. She is on the waiting list for a varicose vein operation but
during the
preoperative assessment was noted to have a raised lymphocyte count. She reports feeling well
currently and clinical examination is normal. Her bloods were as follows:
Hb 11.8 g/dl
Pit 184 * 109/I
WBC 21.2 x 109/l
There are no previous bloods to compare these results with. Following referral to haematology a
diagnosis of chronic lymphocytic leukaemia was made. What is the most appropriate management?
No treatment + cancel operation
O No treatment + go ahead with operation and observe
Chlorambucil + cancel operation
Fludarabine + go ahead with operation but with quinolone prophylaxis
Alemtuzumab + cancel operation
There is no indication for treating this patient at the current time or not going ahead with surgery
Chronic lymphocytic leukaemia: management
Indications for treatment
progressive marrow failure: the development or worsening of anaemia and/or thrombocytopenia
massive (>10 cm) or progressive lymphadenopathy
massive (>6 cm) or progressive splenomegaly
progressive lymphocytosis: > 50% increase over 2 months or lymphocyte doubling time < 6
months
systemic symptoms: weight loss > 10% in previous 6 months, fever >38C for > 2 weeks, extreme
fatigue, night sweats
autoimmune cytopaenias e.g. ITP
Management
patients who have no indications for treatment are monitored with regular blood counts
fludarabine. cyclophosphamide and rituximab (FCR) has now emerged as the initial treatment of
choice for the majority of patients
19. INO-> LESION IS IN MLF
Intranuclear opthalmoplegia
brainstem is the place effected if internuclear opthalmoplegia occurs ..as the man with poor right gaze
and loss of right eye addaction ...???
patient presents with double vision on left lateral gaze ,all other eye movements are normal what is
most likely cause?
temperature does not occur in 20% of cases. Arthralgia is almost universal and can intensify during the
febrile
episodes. Distal interphalangeal joint involvement, seen in one in five patients, is useful to distinguish
it from other
inflammatory arthropathies. The classic Still's rash is a maculopapular, salmon-pink rash on the trunk,
thighs and arms
or axillae, which appears during the temperature spike. The rash can also appear on the face, palms and
soles and at
sites of skin trauma (the Koebner phenomenon) in a third of adults. A severe sore throat (culturenegative) is relatively
common in adults.
Other common manifestations are hepatosplenomegaly, with or without generalised lymphadenopathy,
and
polyserositis, of which pericarditis (in a third of cases) and pleuritis are the most common. Rare
features include sicca
symptoms (dry eyes, mouth), myocarditis, restrictive lung disease, liver or renal failure,
panophthalmitis or
inflammatory orbital pseudotumour, epilepsy, intravascular coagulopathy or haemophagocytic
syndrome, and
amyloidosis.
239.A 27-year-old woman presents to the Rheumatology Clinic. She complains of arthritis
affecting her knees, elbows,
wrists, ankles and the small joints of her fingers. She has also had fever and weight loss of 4 kg over
the past 5
months. On examination, she has hepatomegaly and arthritis over a joint distribution that is consistent
with
rheumatoid arthritis.
s
Which one of the following investigations would be most indicative of a diagnosis of adult-onset Still's disease?
<
Positive rheumatoid factor 1
I
Positive anti-nuclear antibody
Raised ESR
F
Raised ferritin CORRECT ANSWER
(
Positive anti-CCP antibodies
The Answer Comment on this Question
YOUR ANSWER WAS INCORRECT
Diagnosis of adult Still's disease
Raised antinuclear antibody, rheumatoid factor and raised erythrocyte sedimentation rate are all wellknown findings in
patients with established rheumatoid arthritis. Markedly raised ferritin is, however, more specifically
associated with
Still's disease. Anti-cyclic citrullinated peptide (anti-CCP) antibodies are found more commonly in
patients with rheumatoid arthritis than those with adult-onset Still's disease
erythematous macular rash over his trunk and limbs associated with cervical and inguinal
lymphadenopathy. What is the most likely diagnosis?
Typhoid fever
Tuberculosis
Dengue fever
Schistosomiasis
Acute HIV infection
Man returns from trip abroad with maculopapular rash and flu-like illness - think HIV
seroconversion
Stereotypes are alive and well in the MRCP exam. For questions involving businessmen always
consider sexually transmitted infections. The HIV prevalence rate in Kenya is currently around 8%.
HIV: seroconversion
HIV seroconversion is symptomatic in 60-30% of patients and typically presents as a glandular fever
type illness Increased symptomatic severity is associated with poorer long term prognosis It typically
occurs 3-12 weeks after infection
Features
sore throat
* lymphadenopathy
* malaise, myalgia arthralgia
* diarrhoea
* maculopapular rash
* mouth ulcers
rarely meningoencephalitis
Diagnosis
* antibodies to HIV may not be present
* HIV PGR and p24 antigen tests can confirm diagnosis
HIV seroconversion in African boy--- glandular fever atypical lymphocytes
sore throat then after 2 weeks rash: erythema mutiform-HIV seroconversion
241.A 78-year-old woman is admitted with a productive cough and pyrexia to hospital. Chest x-ray
shows a
pneumonia and she is commenced on intravenous ceftriaxone Four days following admission a
stool
sample is sent because ot diarrhoea This confirms the suspected diagnosis of Clostridium difficile
diarrhoea and a 10-day course of oral metronidazole is started After 10 days her diarrhoea is
ongoing
but she remains clinically stable What is the most appropriate treatment?
Oral vancomycin for 14 days
IV vancomycin for 3 days
Oral rifampicin for 7 days
Oral clindamycin for 7 days
Oral metronidazole for a further 7 days
The Health Protection Agency suggests switching to oral vancomycin in this scenario.
Clostridium difficile
Clostridium diffic&e is a Gram positive rod often encountered in hospital practice It produces an
exotoxin which causes intestinal damage leading to a syndrome called pseudomembranous colitis.
Clostridium difficile develops when the normal gut flora are suppressed by broad-spectrum antibiotics
Clindamycin is historically associated with causing Clostridium difficile, but the aetiology has evolved
significantly over the past 10 years. Second and third generation cephalosporins are now the leading
cause of Clostridium difficile
Features
* diarrhoea
* abdominal pain
* a raised white blood ceil count is characteristic
* hypothyroidism
* drugs: amiodarone quinidine verapamil diltiazem. spironolactone (competes for secretion in
distal convoluted tubule therefore reduce excretion}, ciclosporin Also drugs which cause
hypokalaemia e.g. thiazides and loop diuretics
Management
Digibind
* correct arrhythmias
* monitor potassium
Tiyperkalaemia may also worsen digoxin toxicity, although this is very small print
247.The nurse bleeped you because an obese patient is feeling nauseated and is vomiting. He is
also complaining
of seeing green and yellow halos.
He has recently been treated with a standard intravenous bolus of digoxin for fast atrial fibrillation. His
creatinine clearance is normal. Digoxin toxicity is suspected.
What do you think is the cause of his symptoms?
(Please select 1 option)
Decreased hepatic excretion
Decreased protein binding
Decreased renal clearance
Decreased volume of distribution This is the correct answer
Increased half life
Digoxin is concentrated in tissues and therefore has a large apparent volume of distribution. Serum
digoxin
concentrations are not significantly altered by large changes in fat tissue weight so that its distribution
space
correlates best with lean (that is, ideal) body weight, not total body weight.
In this case a higher dose than necessary was given due to calculation on the patient total body weight
resulting in digoxin toxicity. In other words his distribution space had been overestimated. Ideal body
weight
should be used, rather than total body weight, when calculating doses.
Approximately 25% of digoxin in the plasma is bound to protein.
248.A 43-year-old man from South Africa is reviewed in clinic. He has recently started treatment
for
tuberculosis but is complaining of a deterioration in his vision. Which one of the following drugs is
most
likely to cause decreased visual acuity?
Rifampicin
Streptomycin
Isoniazid
Ethambutol
Pyrazinamide
Optic neuritis is common in patients taking ethambutol
Isoniazid may also cause optic neuritis but it is not as common a cause as ethambutol
Tuberculosis: drug side-effects and mechanism of action
Rifampicin
* mechanism ot action inhibits bacterial DMA dependent RNA polymerase preventing transcription
of DNA into mRNA
* potent liver enzyme inducer
* hepatitis, orange secretions
* flu-like symptoms
Isoniazid
* mechanism of action: inhibits mycolic acid synthesis
* peripheral neuropathy: prevent with pyridoxine (Vitamin 06)
* hepatitis, agranulocytosis
* liver enzyme inhibitor
Pyrazinamide
* mechanism of action: converted by pyrazinamidase into pyrazinoic acid which in turn inhibits fatty
acid synthase (FAS) I
* hyperuricaemia causing gout
* hepatitis
Ethambutol
* mechanism of action: inhibits the enzyme arabinosyl transferase which polymerizes arabinose
into arabinan
* optic neuritis: check visual acuity before and during treatment
* dose needs adjusting in patients with renal impairment
Side effects of ethambutol: Blurred vision, eye pain, red-green color blindness, or any loss of vision
(more common with high doses)
fever.
joint pain.
numbness, tingling, burning pain, or weakness in hands or feet.
249.A 35-year-old man returns from a two week holiday in Italy. He has a 10 day history of
rectal bleeding
associated with lower back pain. On examination there is a painful swelling of his right knee. What is
the
most likely diagnosis?
Gonococcal septicaemia
Amoebiasis
Crohn's disease
Tuberculosis
Ulcerative colitis
Gonococcus contracted via anal sex may cause proctitis The knee swelling seen in this patient is
septic
arthritis, which is characteristic otthe second stage of disseminated gonococcal infection. Proctitis
may
present with either lower back or rectal pain
Gonorrhoea
Gonorrhoea is caused by the Gram negative diplococcus Neisseria gonorrhoea. Acute infection can
occur on any mucous membrane surface typically genitourinary but also rectum and pharynx. The
incubation period of gonorrhoea is 2-5 days
Features
males': urethral discharge dysuria
* females: cervicitis e.g. leading to vaginal discharge
250.A 50-year-old female with a history of knee injury with a suspected septic Knee joint. A
diagnostic aspiration is performed and sent to microbiology. Which of the following
organisms is most likely to be responsible?
Staphylococcus aureus
Staphylococcus epidermidis
Escherichia coll
Neisseria gonorrhoeas
Streptococcus pneumoniae
Septic arthritis
Overview
* most common organism overall is Staphylococcus aureus
in young adults who are sexually active Neisseria gonorrhoeae should also be considered
Management
* synovial fluid should be obtained before starting treatment
* intravenous antibiotics which cover Gram-positive cocci are indicated The BNF currently
recommends flucloxacillin or clindamycin if penicillin allergic
* antibiotic treatment is normally be given for several weeks (BNF states 6-12 weeks)
* needle aspiration should be used to decompress the joint
* surgical drainage may be needed if frequent needle aspiration is required
251.An 18-year-old man presented to his GP having noticed a bloody discoloration of his urine
over the past couple of days; he has also recently suffered a respiratory tract infection. Urine
testing confirms haematuria and proteinuria. Ontwo previous occasions after respiratory tract
infection he was noted to have microscopic haematuria. He was referred for renal opinion.
Biopsy reveals a focal proliferative glomerulonephritis.What underlying diagnosis fits best
with this clinical picture?
A HenochSchnlein syndrome
B Goodpastures syndrome
C Minimal-change disease
D IgA nephropathy Correct answer
E Membranous glomerulonephritis
IgA nephropathy is said to be the commonest form of glomerulonephritis seen worldwide. The disease
consists of
focal proliferative glomerulonephritis, with mesangial IgA deposits. In some cases IgG, IgM and C3
deposits are also
seen. It appears to be caused by an exaggerated and abnormal IgA1 immune response to viral or other
antigens.
Abnormal IgA1 molecules may bind to other abnormal IgA1 molecules or to fibronectin, producing
macromolecular
aggregates which only clear slowly from the circulation and are trapped in the glomerular mesangium.
IgA
nephropathy tends to occur in children and young adults, proteinuria occurs in 5%, and may be in the
nephrotic
range.
The prognosis is usually good, especially when blood pressure is normal. Some commentators claim
benefit of fish
oils or corticosteroids, but proper randomised controlled studies of therapy are difficult to find. Longterm studies
suggest that renal failure rates are around 20%, 20 years after diagnosis.
252.A 35-year-old man is referred with macroscopic haematuria on two occasions, he says that
prior to the onset of the
haematuria each time he suffered from a cold/ respiratory tract infection. He also has hypertension
which is currently
being monitored by the practice nurse. On the past 2 visits to the surgery his BP has been 155/92
mmHg, and 149/94
mmHg. On examination in the clinic his BP is 155/95 mmHg, cardiovascular, respiratory and
abdominal examination
is otherwise normal.Investigations;
Hb 12.5 g/dl
WCC 8.7 x109/l
PLT 276 x109
/l
Na+
140 mmol/l
K+
4.7 mmol/l
Creatinine 110 mol/l
Urine blood +++, protein +
Urine ultrasound normal sized kidneys, no sign of obstruction
Which of the following is the most appropriate next investigation?
A Cystoscopy
B Abdominal CT
C Urine culture
D Renal biopsy Correct answer
E IVU
The presentation here is very suspicious of IgA nephropathy with episodes of gross haematuria
occurring in temporal proximity to respiratory tract infections. During the intervening period there is
usually microscopic haematuria, but of
course this goes undetected by the patient. If haematuria was found without proteinuria then
malignancy would be
suspected and hence cystoscopy/ abdominal CT would be the investigations of choice. Renal biopsy is
the
investigation of choice to confirm the diagnosis. Light microscopy displays extracellular matrix
proliferation and
IgA nephropathy
Basics
* also called Berger's disease or mesangioproliferative glomerulonephritis
commonest cause of glomerulonephritis worldwide
* thought to be caused by mesangial deposition of IgA immune complexes
there is considerable pathological overlap with Henoch-Schonlein purpura (HSP)
* histology: mesangial hypercellularity positive immunofluorescence for IgA & C3
%
Proliferation and hypercellularity of the mesangium is seen in the glomerulus
Differentiating between IgA nephropathy and post-streptococcal glomerulonephritis
* post-streptococcal glomerulonephritis is associated with low complement levels
* main symptom in post-streptococcal glomerulonephritis is proteinuria (although haematuria can
occur}
* there is typically an interval between URTi and the onset of renal problems in post-streptococcal
glomerulonephritis
Presentations
* young male recurrent episodes of macroscopic haematuria
* typically associated with mucosal infections e g._ URTI
* nephrotic range proteinuria is rare
* renal failure
Associated conditions
alcoholic cirrhosis
* coeliac disease/dermatitis herpetiformis
Henoch-Schonlein purpura
Management
steroidsdinmunosuppressants not be shown to be useful
Prognosis
* 25% of patients develop ESRF
markers of good prognosis frank haematuria
* markers of poor prognosis: male gender, proteinuria (especially > 2 g/day). hypertension.
254.A 36-year-old man presents with a history of red urine. This has occurred intermittently over
the
previous 3 years but he is otherwise well, and tends to occur in association with a respiratory tract
infection. His blood pressure is 140/85 mmHg and urinalysis shows +3 blood and +3 protein, with
red-cell casts evident on microscopy. He excretes 1.6 g of protein/24 h in his urine. What would a
renal biopsy most probably show?
Focal segmental glomerulosclerosis with IgA deposition
Mesangioproliferative glomerulonephritis with IgA deposition CORRECT ANSWER
Mesangioproliferative glomerulonephritis with IgM deposition
Proliferative glomerulonephritis with deposition of C3, IgG and IgM
Normal light microscopy with thin basement membranes on EM
The Answer Comment on this Question
YOUR ANSWER WAS INCORRECT
IgA nephropathy
The patient's history is typical of IgA nephropathy, the commonest form of glomerulonephritis
Although clinical features may be very variable, the typical picture is of recurrent episodes of microor
macrohaematuria
Aetiopathogenesis
IgA nephropathy may be familial and a linkage to a gene on chromosome 6 has been described in an
American
kindred
The pathogenesis is unknown, although various abnormalities in IgA homeostasis have been
identified - these
include elevated IgA levels in 50% of cases, circulating IgA-containing immune complexes and
abnormal IgA
glycosylation
Laboratory findings
In one study of 269 asymptomatic first-degree relatives of patients with IgA nephropathy, 46% had
persistent
microscopic haematuria
The renal lesion is indistinguishable from that seen in Henoch-Schonlein purpura
IgA deposition may also occur in cirrhosis and gluten enteropathy, although this is usually clinically
silent
Differentialdiagnosis
The principal differential diagnosis is the group of disorders characterised by thin basement
membranes (thin
basement membrane disease and Alport syndrome)
In terms of distinguishing different forms of glomerular disease, the clinical features and the patient's
age as well as
results of urinalysis usually point to a probable diagnosis prior to biopsy diagnosis
Three main patterns of glomerular disease occur:
focal nephritic
diffuse nephritic
nephrotic
some aetiologies are associated with more than one pattern, eg post-infectious GMN may have a focal
or a
diffuse clinico-pathological pattern
Focal nephritic: urinalysis shows red cells (often dysmorphic); red cell casts; mild proteinuria (<1.5
g/day). Usually
clinically milder disease (no hypertension/oedema)
examples: Henoch-Schonlein purpura, IgA nephropathy; lupus; thin basement membrane disease
Diffuse nephritic: similar urinalysis picture although proteinuria may be heavier, even into the
nephrotic range;
may be associated with hypertension/oedema
examples: lupus; fibrillary GMN; rapidly progressive GMN; amyloidosis
255.A 16-year-old boy presents with a purpuric rash affecting his legs and buttocks. He also
complains of joint pains, especially affecting his knees and ankles, abdominal pain and
vomiting. You understand that he suffered an upper respiratory tract infection a few days
before presenting to the GP.
9
9
Investigations; Hb 12.1 g.dl WCC 5.6 x 10 /LPLT 234 x 10 /LESR 35 mm/hr
Na+ 140 mmol/lK+ 5.0 mmol/l Creatinine 120 mol/l Urine blood+, protein+
Given the suspected diagnosis which of the following is the most likely finding on renal biopsy?
256.A 16 year old boy presents with discoloured urine. He describes having had a sore throat 5
days ago but has recovered from the symptoms. The urine dipstick shows blood +++, protein
+. Renal function was normal on the blood tests. A renal biopsy is likely to show which of the
following on light microscopy?
1- Crescents2- Collapsed glomeruli3- Normal tissue4- Segmental glomerulosclerosis 5- Mesangial
hypercellularity
258.A 32-year-old man is referred to the renal clinic by his GP after a second episode of gross
haematuria. Past
history of note includes coeliac disease. On both occasions the haematuria appears to have been closely
associated with an upper respiratory tract infection. Blood pressure is 125/80 mmHg. Light microscopy
of a renal
biopsy specimen reveals diffuse mesangial proliferation and extracellular matrix expansion. IgA
deposits are
seen on immunofluorescence.
Which one of the following diagnoses fits best with this clinical picture?
Alport syndrome
Lupus nephritis
IgA nephropathy CORRECT ANSWER
Goodpasture syndrome
Wegener's granulomatosis
YOUR ANSWER WAS INCORRECT
The Answer Comment on this Question
IgA nephropathy
Clinicalmanifestations
Episodic haematuria associated with respiratory tract infection is the typical feature of IgA
nephropathy,
sometimes known as Berger's disease, and the light microscopy result is also in keeping with the
diagnosis
As well as presenting with episodic gross haematuria, other presentations include nephrotic syndrome
with
proteinuria and acute renal failure
Associated conditions
IgA nephropathy is seen in up to one-third of patients with gluten enteropathy
It is also associated with cirrhosis, HIV infection and has a familial form
Complications
Chronic renal failure occurs in up to 2% of patients per year who have IgA nephropathy
Treatment
Medical treatment of IgA nephropathy includes angiotensin-converting enzyme (ACE)-inhibition
which as been
shown to delay progression to renal failure
Use of prednisolone in patients with severe disease may also be of benefit
259.A 23-year-old man is referred to the renal physicians with microscopic haematuria. He has
also had two episodes
of frank haematuria in the past year that occurred after upper respiratory tract infections. On
examination his BP
is 144/92 mmHg, cardiovascular and respiratory examination is unremarkable. His abdomen is soft and
nontender.
Investigations reveal;
Hb 13.1 g/dl
WCC 6.1 x 109/1
PLT 210 x 109/1
Na+ 140 mmol/l
K+ 4.5 mmol/l
Creatinine 110 pmol/l
Urine blood +, protein +
Renal biopsy suggestive of IgA nephropathy
Which of the following is most closely associated with prognosis?
Number of episodes of haematuria
Blood pressure CORRECT ANSWER
Presence of albuminuria
Plasma IgA
Age at diagnosis
The Answer Comment on this Question
YOUR ANSWER WAS INCORRECT
Hypertension is most strongly associated with deteriorating renal function in patients with IgA
Man with IgA nephropathy, doubled Cr for a year, outcome - CRF without ESRD.
unilateral exopthalmos...(investigation).........,
261.A 30-year-old female presents to the eye clinic with an acute history of pain and blurring in
the right eye.
Examination reveals a visual acuity of 6/36 in the right eye but 6/6 in the left eye, a central scotoma in
the
right eye, with a right swollen optic disc.
What is the most likely diagnosis?
Patient with decreased vision in one eye with swollen disc on retinoscopy central scotoma ...
where is the lesion....OPTIC nerve
Central scotoma is an area of depressed vision that corresponds with the point of fixation and interferes
with central vision. It suggests a lesion between the optic nerve head and the chiasm. Possible causes
include: multiple sclerosis - which may cause unilateral or asymmetrical bilateral scotoma.
262.A patient is referred due to the development of a third nerve palsy associated with a headache
On
examination meningism is present. Which one of the following diagnoses needs to be urgently
excluded?
Weber's syndrome
Internal carotid artery aneurysm
Multiple sclerosis
Posterior communicating artery aneurysm
Anterior communicating artery aneurysm
a scnerio of chronic alcohol drinker with epigastric pain .(stool report shows).............
263.A 42 year old man presents with frequent diarrhoea and upper abdominal pains.
He had a partial gastrectomy 6 months ago for upper GI bleeding. He is now on high dose omeprazole
twice a day and has been compliant. A repeat endoscopy now shows two oesophageal ulcers.
What is the appropriate investigation?
1- Barium enema
2- insulin tolerance test
3- H. pylori serology
4- Colonoscopy
5- Gastrin levels Answer & Comments
Answer: 5- Gastrin levels
Diarrhea and recurrent gastric ulceration is common with Zollinger Ellison syndrome (gastrinoma).
There would be demonstrable high fasting plasma gastrin levels
..a scnerio of a pt has loose stool 4-5 episode in day since 6 month.................cronhs disease
non bloody diarrhea..abdominal pain ...and raised CRP crohns /celia( raised CRP is a pointer
towards crohns)
2- Arterial blood gases (the question was about to choose which one is mostly showing an error during
analysis rather an imbalance in acid base)
264.
A 23-year-old man is referred to the ophthalmologists with visual problems which are found to
be
caused by a downward dislocation of the len in his right eye. The ophthalmologist notices his
marfamoid habitus and history of learning disabilities. A diagnosis of homocystinuria is suspected.
What
is the pathophysiology of this condition?
Deficiency of S-adenosyl-methionine
Deficiency of homocysteine transsulfurase
0 Excess of cystathionine beta synthase
Deficiency of cystathionine beta synthase
Excess of homocysteine transsulfurase
interestingly, patients with Down's syndrome have an excess of cystathionine beta synthase
Homocystinuria
Hcmocystinuria is a rare autosomal recessive disease caused by deficiency of cystathionine beta
synthase. This results in an accumulation of homocysteine which is then oxidized to homocystine
Features
* often patients have fine fair hair
* musculoskeletal may be similar to Marfan's - arachnodactyly etc
* neurological patients may have learning difficulties seizures
* ocular' downwards (inferonasal) dislocation of lens
* increased risk of arterial and venous thromboembolism
* also malar flush, livedo reticularis
Diagnosis is made by the cyanide-nitroprusside test, which is also positive in cystinuria
Treatment is vitamin B6 (pyridoxine) supplements
265.A 19-year-cld man with a history of learning disabilities and ectopia lentis is diagnosed as
having
homocystinuria Supplementation of which one of the following may help improve his condition?
Folic acid
Niacin
Pyridoxine
Vitamin B7
Thiamine
266.A 19-year-cld man with a history of learning disabilities and ectopia lentis is diagnosed as
having
homocystinuria Supplementation of which one of the following may help improve his condition?
Folic acid
Niacin
Pyridoxine
Vitamin B7
Thiamine
267.A 65-year-old man with a history of paroxysmal atrial fibrillation presents with palpitations
He has no
other history of note and a recent echocardiogram was normal An ECG confirms fast atrial fibrillation.
Which one of the following agents is most likely to cardiovert him into sinus rhythm?
Atenolol
Procainamide
Flecainide
Disopyramide
Digoxin
* digoxin
* disopyramide
* procainamide
268. A 64-year-old female is brought to A&E by her family, who are concerned about her
increasing confusion over the past 2 days. On examination she is found to be pyrexial at 38C.
Blood tests reveal Hb 9.6 g/dl Platelets 65 * 109/l WCC 11.1 * 109/l Urea 23.1 mmol/l
Creatinine 366 mol/l What is the most likely diagnosis? A. Wegener's granulomatosis B.
Thrombotic thrombocytopenic purpura C. Haemolytic uraemic syndrome D. Idiopathic
thrombocytopenic purpura E. Rapidly progressive glomerulonephritis Answer B
269.A 33-year-old woman presents with back pain which radiates down her right leg. This came
on suddenly when she was bending down to pick up her child On examination straight leg
raising is limited to 30 degrees on the right hand side due to shooting pains down her leg.
Sensation is reduced on the dorsum of the right foot, particularly around the big toe and big
toe dorsiflexion is also weak. The ankle and knee reflexes appear intact. A diagnosis of disc
prolapse is suspected. Which nerve root is most
likely to be affected?
L2
L3
L4
L5
S1
Symptom definitions
Derealisation is the subjective sense that the external world is unreal
Depersonalisation describes a situation where the patient feels unreal
A hallucination is a false sensory perception in the absence of a real external stimulus
An illusion is a false perception of a real external stimulus
272.A 76-year-old patient is attending the day unit for blood transfusion. She has a history of
chronic lymphocytic
leukaemia (CLL). She is very short of breath and feels permanently lethargic. She is currently receiving
a
fludarabine-based treatment regime. A recent Hb has been measured at 7.4g/dl. Her low Hb is thought
to be a
result of both bone marrow failure and a degree of autoimmune haemolytic anaemia.
Investigations:
Hb 7.4 g/dl
WCC 67 * 109/1
PLT 132 x 109/1
Na+ 141 mmol/l
K+ 5.2 mmol/l
Creatinine 142 mmol/l
Which one of the following is true with respect to the best way to replace her red cells?
She can receive whole blood
She should receive irradiated red cells CORRECT ANSWER
She may receive whole blood through a white cell filter
She can receive whole blood with prednisolone cover
She should receive whole blood with chlorpheniramine cover
The Answer Comment on this Question
YOUR ANSWER WAS INCORRECT
Blood transfusion in chronic lymphocytic leukaemia
While transfusion-related graft-versus-host disease is ordinarily rare in patients who have chronic
lymphocytic
leukaemia (CLL), it is increasingly recognised in patients who are receiving a fludarabine-based
chemotherapy
regime; this may be due to depletion of T-lymphocytes
Monoclonal antibodies that are T-lymphocyte modulating may help to reduce the incidence of graftversus-host
disease
All of the other options include potential further exposure to white cells, which run the risk of
exacerbating her
haemolytic anaemia
273.A 36 year old female has recently underwent a bone marrow transplant for acute myeloid
leukaemia. She requires a blood transfusion. The blood is crossmatched.
Which of the following must you also ensure?
1- Hepatitis B negative
2- CMV negative, no requirement for irradiation
3- Irradiated blood
4- HIV
5- CMV negative and blood irradiated Answer & Comments
Answer: 5- CMV negative and blood irradiated
275.Irradiated PRBC : ? Patient given irradiated blood .. what is the benefit ... - TO PREVENT
VIRAL INFECTION CMV
276. irradiated blood--- TO AVOID TRANSFUSION RELATED GVH REACTION
277.Why would you give irradiated platelet to that lady - because awaiting stem cell transplant
279.A 36 year old lady has recently presented with weight loss and anaemia. Investigations
confirmed that she had colon carcinoma. Upon review , she said she that both her parents had
colon carcinoma. She enquires about risks of other cancers.
Which one of the following is she most at risk of developing?
1- Pancreatic carcinoma
2- Endometrial carcinoma
3- Small cell carcinoma of the lung
4- Squamous cell carcinoma of the lung
5- Breast carcinoma Answer & Comments
Answer: 2- Endometrial carcinoma
The case scenario refers to the patient having Hereditary nonpolyposis colorectal cancer (HNPCC ) is
an autosomal dominang condition.
Associated conditions apart from which has colon cancer are cancers of the endometrium, ovary,
stomach, hepatobiliary tract and urinary tract. Women with HNPCC have a 80% lifetime risk of
endometrial cancer. The average age of diagnosis of endometrial cancer is about 46 years.
280.How To know NPcC :Compare Geniume map? Amsterdam critea to screen then do GENETIC
testing
281.-**morphine Toxcicity : Dcrease lean body Mass ..i guess.. Decreased Renal Clearance
282.A 10-year-old boy presents to his GP with a 3 day history of malaise, fever, headache, myalgia
and nausea. The
symptoms resolve with conservative treatment but within a week the boy presents again, this time
to the
Emergency department with pallor, fatigue and breathlessness.
His blood investigations show a haemoglobin of 30 g/L. a platelet count of 15 * 109/L and a white
cell count of
2 x 109/L. Parvovirus B19 (erythrovirus) specific IgM by ELISA and viral DNA by PCR were
both detected in high
titre.
What is the underlyingmechanism of this complication?
(Please select 1 option)
Aplastic anaemia due to direct cytotoxic effect on erythropoiesis Correct
Cytopenias due to consumption
Molecular mimicry by virus antigen
Nutritional deficiency
Raised cytokine
It is known that parvovirus B19 plays a distinctive role in aplastic crises due to its direct cytotoxic
effect on
haemopoietic progenitors. The cellular receptor responsive for the virus' entry is an antigen of the
group blood
P. which is present not only on erythrocytes and erythroblasts. but also on megakaryocytes and
granulocytes,
resulting in the progenitors being killed by the cytotoxic effect of the virus load and the
reticulocytes being
cleared by the reticulo-endothelial system.
The patients most at risk are those already having a bone marrow disorder resulting in decreased or
functionally abnormal haemoglobin production, such as haemoglobinopathies.
12-**HIV pt with Red cell Aplasia : CMV or EBV ??
283.You review a B5-year-old man with stage 5 chronic kidney disease in the renal outpatient
clinic He has
recently been started on erythropoietin injections. Which one of the following is the main benefit this
treatment?
Reduced proteinuria
improved exercise tolerance
Reduced blood pressure
Improved renal function
Reduced long-term all-cause mortality
Erythropoietin treats CKD associated anaemia which in turn would improve exercise tolerance It does
not improve renal function.
Erythropoietin
Erythropoietin is a haematopoietic growth factor that stimulates the production of erythrocytes The
main uses of erythropoietin are to treat the anaemia associated with chronic Kidney disease and that
associated with cytotoxic therapy
Side-effects of erythropoietin
* accelerated hypertension potentially leading to encephalopathy and seizures (blood pressure
increases in 25% of patients)
* bone aches
* flu-like symptoms
* skin rashes, urticaria
* pure red cell aplasia* (due to antibodies against erythropoietin)
* raised PCV increases risk of thrombosis (e.g. Fistula)
* iron deficiency 2nd to increased erythropoiesis
There are a number of reasons why patients may fail to respond to erythropoietin therapy:
* iron deficiency
* inadequate dose
* concurrent infection/inflammation
* hyperparathyroid bone disease
* aluminium toxicity
*the risk is greatly reduced with darbepoetin
284.A 63-year-old man who smokes heavily presents with dyspepsia. He is tested and found to be
positive for Helicobacter pylori infection. Despite eradication therapy and a course of lansoprazole his
symptoms persist. He therefore has a gastroscopy which shows an ulcer on
the duodenal cap.
The following evening he has an episode of haematemesis and collapses. What is the most
likely vessel to be responsible?
Portal vein
Short gastric arteries
Superior mesenteric artery
Gastroduodenal artery
Left gastro-omental artery
He is most likely to have a posteriorly sited duodenal ulcer. These can invade the
gastroduodenal artery and present with major bleeding. Although gastric ulcers may invade
vessels they do not tend to produce major bleeding of this nature.
Acute upper gastrointestinal bleeding
NICE published guidelines in 2012 on the management of acute upper gastrointestinal
bleeding which is most commonly due to either peptic ulcer disease or oesophageal varices.
Some of the key points are detailed below.
Risk assessment:
use the Blatchford score at first assessment, and
the full Rockall score after endoscopy
Blatchford score:
Admission risk marker Score
Urea (mmol/l) 6. 5 8 = 2
8 10 = 3
10 - 25 = 4
> 25 = 6
Haemoglobin (g/l) Men
12 - 13 = 1
10 - 12 = 3
< 10 = 6
Women
10 - 12 = 1
< 10 = 6
Systolic blood pressure (mmHg) 100 - 109 = 1
90 - 99 = 2
< 90 = 3
Other markers Pulse >=100/min = 1
285.-**Time of Elimnation of a drug to 1/8 , half life 2 h , Elimination rate 0.4/h : 6 .. right 6
hours
286. 17- **Poor Prognosis after stroke : visual spatial neglect ?? Dysphagia I guess , as neglect
from70-99%)
287.Patient who is neutropenic on the floor .. with dec wbc and dec neutrophil count .
Antibiotics against which organism would be your first priority MRSA, Pseudomonas
Aurogenosa,PCP etc ??
179 . 75yr male htn hypercholestremia , two times transient loss of vision .... amurosis fugax
A pt to neurology vd incresing headache and hx of 3 epidodes of amaurosis fugax fr last 1wk...rest
exam normal.options...acute cerebral infarction...subdural haematoma...cerebral haemorrhage..av
mslformation....anyone knw da ans
12-Occipitalsiezure presenting as marching vision proble lastin for 30 min
Patient with 6 episodes of Gradual loss of vision in the left proceeding over lominutes and
resolving.. It's not occipital seizures becauseoccipital seizures will affect thetwo sides not just
left. So it's a carotid-TIA... Amourosis Fugax
92)patient who developed TIA ( amourosis fugax) what should you do
- start warfarin
23- **Bitemporal Heminopia : Cabergoline or Surgery as it is non secretory , and causing pressure sx
surgery is the best option ..
24- Rhbdomylysis : Myoglobin in urine
72-** HUS IN adults- female visited a farm and after that had diarrhea with inc creating so ecoli0157
73- pregnant with Asthma steroid+laba then : high dose inhaled steroids ( beclomethasone)
74-**Patient with cholestatic LFT : amoxaclin I guess Augmentin is the one causes cholestasis with
Hepatits while Flucloxacillin causes cholestatsis with bile duct injury
73- well controlled Crohn's disease - PSC
74- Korsakoff syndrome - Short term memory loss
75- Patient with ataxia and nystagmus - Posterior inferior cerebellar artery
76- Pneumococcal meningitis prophylaxis- Not required
7779- **Monday morning SOB FEV!/FVC 71% = Occupational asthma 0r Hypersensitiity
pneumonitits ? well I guess this is the question with Metal Fume Fever , person with zinc related..
having coryza and sob which is related to welding but gets well off duty so answer is metal fume
fever
80-**Young female with menorrhagia (family history present) - Von willibrand disease
81-**Man with Dactylitis- of hand and toe- Psoriatic arthiritis
82- **old woman with Left wrist swelling- Pseudogout OR Ostomylitits ? people voted for
OsteoNecrosis mostly ..
83-** Herbenden and bouchards node + dip pain - Osteoarthritis
84- 45 years old with large joint involvement- RA ?
xxxxxxx85- Fever, myalgia, headache,- Metal fume fever ?(Repeated Question see ..79)
86- COPD patient with reduced Sats 86% - Venturi mask ?
87- RA on methotrexate- Bronchiolitis obliterans Or Methotraxate Toxicitiy Or Pulmonary
vasculitits ?
88-**Man with hypopigmented/desensitise lesion- Tuberculoid epilepsy
89- **Severe aortic stenosis - Quiet second heart sound OR S4 ? both are mentioned in the lists .. dont
know which one is more sensitive ..
91-.**Pearly umblicated papule in the suprapubic area scattered >>> mollascum contagusom
92- **Down syndrome 47 XY +21 - aneuploidy
93-**Intraepidermal IgG- phemphigus as its IgG deposition , if it was igA then we should think
Herpitiformis
94- **liver capsule pain in metastatic malignancy- steroid dexamethasone
95.** Nutrition for Patient with acute abdominal pain (severe pancreatitis due to gall stone) - NPO
96- NG feed nutrition - half of the energy
97- **The genetic of DM and sensorineural hearing loss, mother had mild symptoms, sister had mild
symptoms, but the brother had severe symptoms - Mitochondrial disorder Or X-linked
Dominatant well the sx were more severe in the Male which goes with X-link dominant , if it was
mitochondrial presentation would have been same in both male /female..??
98- **Long standing coeliac disease - Lymphoma , .. the malignant stricture .. Lymphoma
99-** levels do not increase in heart failure - endothelin ? Natriuretic Peptide .. I think ..
100-** Beer and polyuria - decreased aquaporin channels yeah..
101- **Origin point of AF - pulmonary veins.well its pul vein catheter ablation mostly with
85%success rates.
102- Gential warts definitive investigations - HPV PCR ? ??? dont remember this question??
xxxxxxxxx103- Paitent with well demarcated reduced sensation lesion - Tuberculoid Leprosy (the
question is repeated see Question #88)
104-**Patient with board complex regular tachycardia after PCI - no treatment required as it is
idioventricular rhythm
105- **mALE NO sti HX- BUT 2-3 weeks of gastroenteritis- Shigella
106- **Childhood pneumonia, productive cough and recurrent infection- Bronchiectasis
107- **Obese man BMI 40 and eps 9/10- ?CPAP or Loss weight ? ..well the sleep scale is 18 but the
apnea score is in normal range (<5) .. so I opted for weight reduction.
108-**Man from spain and 2 new sexual partner and red cell agglutination : Mycoplasma
109-**Neissaria Meningitis- Pophylaxis- Ciprofloxacin
110-** Cat bite Bartonella henslae
111- Lithium and metronidazole-decreased Renal clearanceor excretion
143-**Strongyloids stercoralis- wearing foot wear and avoid bare foot as it enters the skin
144- Polycythemia rubra vera - JAK2 mutation
146- Epilepsy and malaria prophylaxis- mefloquine ??
147-** splenomegally and bleeds- with gum hypertrophy, .AML
148-**carcinod syndrome intial symptome: facial flushing
149-** gonorrhea ttt UTI : ceftriaxone .. as treatment for chalymydia was already given n culture
showed gm negative diplococci
152- **RA eye manifestation-episcleritis ((Answered Above))
154- **Female with fatigue and splenomegaly - Myelofibrosis I guess this is the question in which
there myeloid series cells on peripheral film n myeloblasts..aswellhmm I went for CML ..
155- tonsils weren't coated but had exudates ??? :: diptheria
156- **pneumothorax risk : smoking ?? there are two things which a patient shouldnt do.. after
pneumothorax correction as per bts guidelines one is Scuba diving and other is Contact sports so I
opted for contact sports..
158- **the commenst factor for chrons = smoking 60%
159- **PE e DVT : CTPA CT pul Angiography
160-** CPR who decide to stop - Resuscitation team leader
161-history of lumpectomy, now backache ?? next investigation
162- **a study has alot of confounding factors....??? analysis of confouctor ---as much as I could get
from internet search it comes to .. Spearman Rank correlation ..
163-** decrease prostate size: Finastride
164- abbreviated mental test score (AMTS) 7/10- Prognostic sign- Confusion
165- ** study shows that with age there is increase in the pulse pressure- what do u think is the cause
of this relation.reduce aortic compliance
166- pt. e HTN ,raynad , SOB and cough >>> systemic sclrosi s
168-** Lipaemic serum pancreatitis - Chylomicrons
169- pt. on ch. hemodyalsis ,,invest ??
170-** Embryonic stem cell for DM management : protect itself from destruction ?? well I guess I read
somewhere that embryonic cells implanted in Type 1 dm (islet cell ) are put in a membrane to avoid
carcinogenic changes in these cells and not to avoid destruction or apotosisor senescence.so I went
for other option .. to avoid carcinogenic change.. I dont remember the exact wording now .
ring and little fingers flexed ? ..Dupuytrens contracture.. (de quervian synovitis,etc)
173-Pharma:patient with chronic alcohol use presents to the ER with tachycardia agitation , abnormal
behavior and Dilated Pupils. What overdose has he taken . Ecstacy ( marijuana, alcohol,etc)
174-Gastro: Patient with diarrhea blood stained , having itching labs showing inc bilirubin and
alkaline phosphatase while alt is within normal range and usg abdomen is normal as well .. what is the
most probable cause. Sclerosing cholangitis.. ( primary biliary cirrhosis,hepatitis,etc)
175-a female with parkinson's disease having upgaze palsyy.recurrent fall -------- p.supranuclear palsy
177-patient for long haul flight had a lot of alcohol before flight then had nausea vomitting Blackout in
Plane gained consiousness immediately was being handled by air crew reason - VASOVAGAL
SYNCOPE
179-Patient with Lyme Disease with multiple eschar/erythema sites 2nd day of treatment with
anaphylaxsis and body reaction - EXPOSURE and INTERACTION WITH DEAD PATHOGENS ?
(Jerish Herxheimer reaction)
180-Patient with lid lag, thyroid nodule .. treatedment with which modality will worsen the thyroid eye
disease - RADIOIODINE
181-A patient with ant spinal cord syndrome with all limbs paresis, loss of temp/, while fine touch
AND Vibrations are preserved what is the diagnosisAnterior Spinal cord lesion/
Syndrome
182- A Patient taking medication for Ischemic Heart Disease including Clopidogrel, ACEI, Bet Blocker
is presented with HUS/ TTP; Which test would be abnormal---------------- Raised aPTT
184-patient with tuberculosis for diagnosis , what is the most sensitive Pleural test for
Tuberculosis Pleural Fluid LDH, Pleural Biopsy and culture, Sputum Culture, Pleural aspirate
culture, Bronchial lavage culture ..??? I dont know the answer ??
185-a question for Drug trial in which two groups were studies one placebo , and the value was
nominal .. and we had to choose the test to compare before and after the treatment I rembere
answer was UNPAIRED T test ..
186-old aged woman in garden goes and gets heat exhaustion what age related change has made her
more prone to this conditiondec.Sweatingdec body water, etc
187-Pain and abdominal extension, with Ulcerative colitis, patient doesnt improve what should u do
next ..xray abdomen ( to rule out toxic megacolon)
189- cadiovascular risk ass e----which are related to the increased cardiovascular risk ..
LDL and chlesterol>> HDL and TG>> etc..
190- Patient with type T1DM recived blood transfusion.. the optimal time for measure of
HA1c?
6 months
191- pt. e typical hx of tuberous sclerosis
192- pt.parkinson on ropirinole for 3 years and dterurating ,,O/E mild tremor and sever
dyskinesa and regdity what is best RX? benzexol or carpidoa or....
e. echocardiogram
2. Q. main changes in fulminating hepatitis?
a. apoptosis
b. de differentiation
c. ischaemia
d. necrosis
e. senecense
3. Q. Hepatitis C how to assess treatment progress when tx with interferron alpha?
a. fenotype of hep C
b.
c.
d. viral load
e.
4. Q. statistics relative risk reduction?
a.10%
b. 15%
c. 25%
d. 50%
5. Q. 5000 in each group and 380 in experimental gruop and 600 in control group. what is the
likely that test will be positive? is thiis a question from sensitivity or PPV??
a. 380/400
b. 380/772
c. 380/100,000
d. 380/1000
e.
6. Q. statisttics which statistical test suitable?
a. chieldsquare
b. F test
c.
d. pearsons
e. wilcoxon
7. Q. cross over study somrthing ...
8. Q. contraversy between experts, now want to study between two tx. what is suitable study?
a. audit
b. Meta-analysis
c.
d.
e. qualitative
9. Q. cardiac catheterization in a primary pulmonary hypertension pt. increase oxygen
differentiation between superior vena cava and right ventricle?
a. ASD
b. PFO
c. PDA
d. VSD?
e. Tricuspid stenosis
10. Q. crdiac catheterization and following findings: LV 200/10, AO 200/70, right femoral
artery 120/65, left arm blood pressure 190/70?
a.
b. coarctation of aorta
c.
d.
a. midbrain
b.
c. pons
d. medulla
30. LMNL in lower limb and UMNL in upper limb
a.
b.
c.
d.
d. MND
31. gait issue, fall, some parkinsonian features. urinary incontinence,
a.
b.
c.
d. normal pressure hydrocephalus
e. parkinsons disease
32. Q. diabetic pt with right shoulder and arm pain, biceps absent. small area sensory loss over
right thumb.
a.
b. diabetic amyotrophy
c. c5 radiculopathy
d. mononeuritis multiplex
e.
33. feature of commn peroneal nerve and tibial nerve lesion togather. like loss ankle eversion
and inversion, dorsiflexion, planterfexion.
a. common peroneal nerve
b. tibial nerve
c. sciatic nerve
35. 16 year old boy with noctunal aneurosis.
a. IgA nephropathy
b. Reflux nephropathy
36. man lives alone, drinking problem. depression. wife died 6 months ago. suicidal
attempts. what is risk for next time suicide?
a. lives alone
b. wife died
c. alcohol
d. male sex
e.
37. man with depression and knowm IHD prev MI. tx
a. amitryptyllline
b. fluxetine
c. phenelzine???
d. setraline
e. venalafaxin
38. tender thyroid. tsh low, t4 high,
a.
b.
c. de quervans
d. toxic adenoma
e. toxic multinodulr goitre
39. goitre, tsh low, t4 high, t3 high??? no eye sx
a. graves
b. toxic multinodular goite
c. hasimotos
d. autoimmune
40. Q. calcium high, pth inappropriately normal,
a. primary hyperparathyroidism
b.
c.
d.
e.
41. elderly man. clcium normal, phosphate nomal. ALP high.
a. osteomalacia
b. osteoporosis
c.
d. Pagets
e.
42. left hip pain, muslim asian??/
a. Osteomalacia
b. EBV
c. fixed druug rxn
51. Q. Diabetic , left eye ......
a.
b.
c.
d.Retinal artery thrombosis
e. retinal vein occlusion
52. Q. STEMI, tx with thrombolytics. ECg St 30-40% resolution. Next step?
a. PCI
b. repeat thrombolytics
53. A black man Blood pressure high ? 167/90. Tx of choice
a. Amlodipine
b. Ramipril
c. Candesartan
d. Bisoprolol
54. Q : Hereditary Haemochromatosis
55. Q . a man dx with mitochondrial disease, who will inherit
a. sister
b. daughter
c. son
d. brother
56. Q. Th2 works through?
a. IL2
b. IL3
c. IL4
d. TNF alpha
e. Interferon gamma
57. Q. How will you assess severity of aortic stenosis?
a. third heart sound
b. ejection systolic murmur
c. absent A2
58. pregnant lady 14 weeks, blood pressure high at 14 weeks. Average 160/90. Urine: protein
1+.
a. white coat htn
b. gestational htn
c. essential htn
d. pre eclampsia
59. Q. Man not on ny tx for UC. He came with ??/
a. bone marrow examination
b.
c. rectal biopsy
60. a girl with ANA positive. ?mixed connective tissue
a.anti RO
b.anti jo1
c. antiRNP
61. Q. Actin works on
a. cytoskeleton
62. vaginal discharge, clue cells ...bacterial vaginosis
a. Gardnella
63. infective endocarditis with streptococcus viridans
a. ceftriaxone
b. ampicillin
c. gentamycin
64. Q. PCWP
a. left atrium
b. Right atrium
c. pulmonary artery
d. pulmonary vein
65. Q. Lewy body dementia
a. extra pyramidal effects
b.
c. adversely reacet with neuroleptics
d.
e.
66. Q. Syphilis, got penicillin injection. 12 hour later rash.
a.
b.
c. jervichs ... reaction
67. Q. Holiday. As a child had abdominal pain.
a. acute intermittent porphyria
b.
c.
d.
e.
68. Q. A man left lung nodule, periphery. Some mediastinal LN less than 1 cm. What next
investigation?
a. CT chest
b.
c.
d.
e. PET scan
69. Q. An 65 year old man came with Cervical lymphadenopathy .
a. ct head and neck
b. biopsy
c. excision biopsy
d. cytogenetics
70. Q. A young boy was taken to dentist as soon drill started, he had left sided jerky
movement, urinary incontinence, brief unconsciousness, on regaining he was alert and
vomited once.
a. tonic clonic
b. complex partial seizure
71. Q. Docetaxel works on
a. DNA
b. microtubules
c. RNA
d.
72. Q. Extrinsic allergic alveoliis
a. Eosinophilia
b. neutrophilia
c.
d.
e. upper lobe fibrosis
Rheumatoid arthritis 20 years now present with heavy proteinuria and low albumin,,,,,,OPTIONS
2.
Membranous GN
3.
Amyloidosis
4.
minimal change GN
5- long Qt syndrome
6- Pentrance in inheritience
7- phases of drug testing
8- Types of studies (3 questions)
9- Pneumothrax in a trumpet player (What is contraindicated for him "scuba diving idefinitly, playing
trumpet or flying)
10- cushing, hypopituitrism, paget's, hyperparathyroidism in renal failure, a case of hypertension with a
history of medullary thyroid cancer surgery "choose pheochromocytoma"), toxic thyroid nodule,
diabetic nephropathy
11- amiodarone in thyroid case
12- cardiomyopathy in pregnancy
13- radial nerve injury, macular degenration, lateral epicondilitis, transverse myelitis, temporal lobe
seizures (surgery).
14- dysentry after comin from india
15- leptospirosis after coming from indonesia
16- fulminant hepatitis after coming from india
21 yrs African male found unconscious with sats s 98%, ABg normal - cause? Probe issue, Co
poisoning, methyl haemoglobin
Young girl who returned from somewhere and taking some antimalarial medication acting psychotic
/hallucinations as she sees spiders crawling in her room? Cause
some multiple myeloma questions with renal failure hyper calcaemaia and back pain : serum
electrophoresis
Exantide is GLP
investigation for hyperprolatenemia MRI pititary
Reminant hyperlipidemia apo e2
preclamsia treatement methyl dopa
type 1 aeortic dissection-surgery followed by?
(my answer was beta blocker)
somatisation disorder-lady with multiple symptoms
diarrhea followed by arthritis- reactive arthritis
on phenytoin develops seizures with low serum phenytoin levels-? double the dose of?enteropathic
arthritis
recurrent abcesses-?membranous gr
tick bite-?
GI bleed patient on warpharin IV K given what next- FFP???
LMWH- check antifactor 10A
patient was asthamatic adenosine contraindicated give varapamil
Lady with primary amenorrhea : testicular feminization
Resistamt extention of hand and supination :lateral epicondilits
Hay flick DNA
Nicorandil causes severe tongue ulcer
Tumor lysis syndrome pathophysiology
Eradication of pylori how to confirm
Mechanism behind PET scan
Bilateral Iguinal nodes with multiple painful genital ulcer
question on STD unsafe sex heterosexual. Answers were Syphillis, Gonorrhoea, LGv
another q was ; answer Tumor lysis syndrome - may be question was about lymphoma treatment
Dumping syndrome
images one from osephageal crcimnoa
haematoma nail bed
toxic nodular giotre
ECG /? hypokalemia/hypocalcemia
alk phosphatase raised - Hyperparathyrodism/
Polymyositis
Cf brain was showing calcification...so it was av malformation
A question about chlamydia infec. Dysuria with no discharges...not gonorrhea
Also a question on blood loss >2000 for blood pressure low to 80 n pulse 142
N raised alkaline phosphatase quest was vit d levels check for osteomalacia..
Participate please..lets recall all 100 question or close enough
Pulmonary embolism after operation
Myocarditis
VSD
Severe bronchial asthma
Severe TR causing liver congestion
pheochromocytoma / familial hyperlipidemia
one more stem was Carotid artery insufficiency
a question on IBS treatment - Tricyclic Anti Dep
treated incarcerated hernia
upeerGIT borgaymi with multiple fluid levels - gall bladder ileus
breast cancer metastasis- Rx tamoxifen/laminectomy/radiation
perianal abscess - organisms are Bacteriodes fragilis/Steptococcus aureus
food poisoning one hour after eating egg cheese with vomiting and abdominal cramps-/salmonella/steptococcal/
stion on IBS treatment - Tricyclic Anti Dep
treated incarcerated hernia
upeerGIT borgaymi with multiple fluid levels - gall bladder ileus
breast cancer metastasis- Rx tamoxifen/laminectomy/radiation
perianal abscess - organisms are Bacteriodes fragilis/Steptococcus aureus
food poisoning one hour after eating egg cheese with vomiting and abdominal cramps-/salmonella/steptococcal/
C1
started
slow
inh
deficiency
on
down
-lip
ACE
swelling
reported
of
hereditary
hereditary
Diabetic
angioedema
angioedema
nephropathy--rampril
weakly positive birefregrent molecules (gout) treatment -- start allupurinol/ steriods/allopurinoal with
colchicine
STEMI
MI
-treatment
is
Aspirin
with
clopidigrel/thrombolysis/heparin
Incarcinated hernia
C1 def
Venous ulcer
Feltys syndrome
How about question of young male with strong hx of diabetes in familty n hadbpolyuria n polydipsia
with fasting blood sugar was high.... Wasbit sulphonyl urea as answer due to MODY as diagnosis
Case of MS
PE in 2 questions
Diphtheria question
papillary
necrosis--
analgesic
nephropathy/
Diabetic
Np
image of blood picture showing stellate cells --ask the pt to avoid sulpha drugs
@haroon6. A quest about naproxen to stop...
qestion on a lady with history of constipation and some more findings, mother of this lady had colon
malignancy - what is the best investigation . answers were Colonscopy/ TSH/
another question asking about rx by showing signs of GORD- answers were H2 antagonists/ other bits
dont remember
another question asking about rx by showing signs of GORD- answers were H2 antagonists/ other bits
dont remember
avascular necrosis of femur--- steriod use -- increased pain
Thromboangitis obilitrans (bergers Diseas) treatment-- Symphytectomy
Question of thrombophelebitis i dont remeber..what were other options n do u remember details of
qiestion...
Dm question was pt having polyuria n polydipsia n he had to wake up in night at least twice for
urination.. blood sugar was more or like 6.9 i guess. Im not sure about blood sugar but it was high..n he
had strong family hx..
72. Q on sputum with nifght sweats, x ray showing patchy infiltrates bilaterallyi .... Sputum analysis, ct
chest, bronchoscopy
Whats ans?? Sputum or ct?? Tb? Or pul frib? Hx wasnt too long
Q70) protein more than 30 was CSF , the findings were in favour of Herpetic meningitis -- i put
Aciclovir IV
a question on epilepsy pt became unconscious then investigations show raised ldh, ck, answers were
---Rhabdomylysis/ DIC
another q on epilepsy , tonic clonic what is the next thing u do-- airway maintenance/ IV diazepam/
which of the following is a greater risk factor for MI/CAD---- Smoking/weight/ HTN/Cholesterol
there was aquestion on Coorctation of Aorta-- answers i dont remember
question on protein more than or equal to 30 was in pleural fluid..
However. This q is also new to our recalls
72. High protein in csf..but i remember it were neutrophils in csf not lymphocytes.. options were iv
ampicillin.iv acyclovoir.steroids
2015 sept
Today MRCP 1 paper questions,Lung cancer with stridor , vaccine contraindiacted in
immunocompromised , multiple qs about arthritis (gonococal/reactive/rheumatoid/psoriatic) , lyme
diease allergic to penicillin , il affected by cyclosporin , endocrine ( cushings/ hypopituitarism,thyroid
illness 2ndry to amiodarone), pnemothorax in trumpet player contraindications later in life ,dysentry
from india with hepatomegaly, kinda PFTs in asbestosis , Staph pneumonia with cavity
..ABx, myoclonic seizures, phenytoin subtherapeutiv in seizure patient,to give loading dose again or
not, kinda defect in long Qt syndrome , Qs on penterance , , de novo mutation of PKD now further
inheritance pattern, H.pylori erdication test, prednisolone enema vs oral inUC, CAH, Rx for
hyperthyroisism with grave's ophthalmopathy, lady with headaches and anosmia, surgery in patient
with focus in temporal lobe(wht kinda lesion), , lateral epicondylitis, radial nerve injury, genital ulcers,
phase of drug trial reflecting efficacy, erythema nodosum with B/L ankle swelling, young dude with
B/L ll edmea plus pleural effusion , , Amylodosis renal part, Paroxysmal cold hemoglobinuria, paget's,
function of high PTH in renal disease, multiple myeloma, detrusor muscle excitability, lateral
medullary syndrome,blood supply of ileum..
MRCP recalls
138.cause of confusion...digoxin/atenolol.
139.history of breathlessness and stridor with lump in nck...flow vol loop
140.recurrent gout...allopurinol
141.adominnal pain with purpuric rash on legs...henoch schenolin purpura
142.pain knee worse on movment with a 2cm swelling on patella...pre patellar bursitis
143.4th,5th and 6th nerve involvment...cavernous sinus
* Anticipation
* Renal Transplant (60 y.o. wife wanted to be a kidney donor for her husband)
Another set
1.patient from india....hepatitis A
2.bacterial vaginosis....metronidazole
3.infective endocardtis...benzylpenicillin + gentamycin
4.IgG Hbc chronic hepatitis B
5.scenario of ceiliac....antiendomysial
6.Gilberts
7.diagnosis of UC
8.Chronic disease....colonoscopy
9.travel to thialand...dengue
10. sleep apnea....CPAP
11.COPD acute exacerbation....NIV....PH 7.38, PCO 7
12. alzhemer trt...donepazil
13.parkinson trt for bradykinesia....co-carbidopa
14. typical scenario of NPH
15. dermatitis herpetiformis...igA deposition
16.essentioal tremor trt....propranolol
17. SVT, nt responding valsalva manuer, asthmatic..next line manag...verapamil
pressure score :waterlow score
post transplant : gvd
female ,protienuria :losarten
p53 :cell cycle regulator
1.Sensorineural deafness+paternal uncle...Mitochondrial Diabetes
2.Visual hallucinations+macular degenration...Charles Bonte syndrome
3. Acute monocular blindness....optic neuritis
4.hypercalcemia drug.... thiazide
5.prolactin Increase....metaclopromide
6.acute cerebral hemmorahge+htn....av malformation
7.colorectal ca.....Apc mutation
8.cushing sceniario....metabolic alkalosis
9.lower quadrotnopia.....Parietal lobe
10.anorexia nervosa scenrio....fine hair on face
11.H/o influenza, lower and upper limb wekness....GB synd
14. Xray findings pleural plaques....Mesothelioma
15. Tricuspid Regurgitation. ..Prominent V wave
16. Methadone....Long QT
2) Lady on Bisoprolol came in with bradycardia refractory to atropine(3mg), what's the next thing to
do?
-I thought Glucagon is the next best treatment given the possibility of beta blocker overdose.
Transvenous pacing was given as one of the option should be done after TRANSCUTANEOUS pacing
1.risk for future suicide
2.hallucination
3.acute mono ocular visual loss
4. Clean wound vaccination
5.woman with RA on sulphasalisine planning for family
6. Angioneurotic oedema - c1 east erase
7. Splenectomy individual had vaccine but no booster prone to which infection
27. ANTI RO
28. ANTI JO
30. xray of ankylosing spondolitis????
31. scenario of postganglionic horner... carotid doppler
32. pseudopolyps, crypt abcesses, lose of goblet cells.... ulcerative colitis
33. middle aged lady with AMA+..... LFTS
34. inferior quadranopia... parietal lobe
35. meningitis with temporal lobe involvement ... herpes encephalitis
36. right handed patient with right sided pariteal infarct.... ????
37. CD8 cells... MHC1
39. HHV 8... Kaposi sarcoma
40. scenario of osteomyelitis... MRI
41. csenario of trochentaric bursitis
42. paget's disease... bisphosphonates
43.acromegaly... GTT
44. COPD exacerbation, CO2 retention on optimal medical treatment... NIV
45. spontaneous pneumothorax of 3cm at hilum... chest drain
46. young patient with hemoptysis, CXR showing collapse... bronchiectasis????
47. hepatitis A scenario
48. chronic hepatitis B
10--quetion on thrombocythemia.
11-myelofibrosis.
12- mode of action of desmopressin
13-Hashiimoto thyroiditis - firm goiter.
14-treatment of liddle syndrome.
15-gastric cancer - signet ring cell
16-pt with periumblical pain and tender abdomen.
18-SLE and glomerulonephritis.
19-cryoglobinemia - which complement is low.
20-hypertensive drug in diabetics
21-renal vascular disease
22-tendon involved in lateral epicondylitis
23-extensor of fingers - posterior introsseus n.
24-anti CCP - RA
25-smoking history , breathlessness, which improved on cessation of smoking-26-treatment of discoid lupus.
27-psoriasis treatment or psoriatic arthropathy treatment.
28-Implantable cardioverter-defibrillator -DLVA rule
29-Flow volume loop
30-question about pul. embolism.
31- female pt stating she has acquired MRSA ??
32-disseminated mycobactarium aviam infection prophylaxis for the contacts
33- ACE inhibitor and creatinine raises fro 102 to 120 , what to do.
34-edema and calcium channel blocker.
35-conversion disorder
Seems mmy all answers were wrong even most of above mention questions I don't know ,
I remember about
1.Man with hyper para thyroid ,Hyoercalcemia
Hyper phasphotemia
2. MelanoMa prognostic feature
2). SLE senario with renal failure and protein in urine, no blood - options were Membranous
nephropathy, minimal change, etc
3). DM I patient with raised ACR an. HbA1C of 50 what do you do next - options were Increase
insulin, add lisinopril etc
When do you need to stop exercise treadmill test? Hr >150
Patient with lupus and increased creat which kidney abnormalities? Membranous glomerulonephritis
Patient with slighly worsening creat once started on ramipril what actions? No changes
Angiodydplasia AS
APC gene
Farmer kitten 2 weeks hx bartonella han
Big intracereb bleed ? Av malform
Chronic hep b
Central scotom unilateral blurring red desat optic neuritis
Crypts abscess UC
CMV splenomeg high wcc plat low Hb
Immunophenotyping
Haemocystinuria
Marfan mri head
?trochhan bursitis
Accp positive RA
PEG post stroke
Co careldopa
Donpezil
Hiv nephropathy in 30 yrs old female
Dengue fever
Ptyriasis vers hydroxyqu
Adenoma sebaceoum
Horner cxr
Abd pain ct abdomen
Simvastatin myositis
?giant cell arthritis
Memberan nephropathy
Chad2vasc5/6
Old man not eating much ?olfactory recep
Parietal inferior quadranto
Carbamazepine wt gain alopecia
?occipital epilepsy
Anorexia fine hair
Hashimoto thyroiditi
L5 rediculopayhy
Claw hand ulnar
Extensor brachioradialis
Carpal tunnel median nerve
Denovo apkd <1%
Dermati herp IgA
Yellow fever live attenuated
Tetanus Ig
Acromegaly ogtt gh
Bendroflumeth hyperkalaemia
Somatization
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chuan
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I was left out with propantheline and Trospium
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chuan
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Aim UK Exams
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Hi. Was the second paper harder than the first or was I just
tired? Thanks for the answers.
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please rate this post
Ihibabe
Addicted Member
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hi there i dunno its the first paper was deep and lateral , you
come accross the stem but then surprise surprise they are asking
abouth something totally out of the blues , irratianell questions
very brief and open for your speculations rather than analysis
because there isn t enough info in q to analyse and know exactly
Mangoman906
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ulhadijawed
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Stroke/TIA: score : 2
V: Peripheral vascular: score: 0
A: age 65: score: 1
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Posts: 101
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Aim MRCP Part 1
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Thanks
I was hesitating between a score of 4 or 5
chuan
Senior Member
Posts: 28
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Aim UK Exams
a patient who was having auditory hallunations and talking
about him on radio... he was alcoholic... alcoholic
hallucinosis---within 12 to 24hrs.. deliruim tremens after 48 to
72 hrs most likely... but paranoid schizophrenia can have typical
auditory hallucination with radio broadcasting... what u think?
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15-LONG QT SYNDROME>>>SERTRALINE
16-QT PROLONGATION IN HYPOCALCEMIA
2*NEPHROLOGY
1-YOUNG PATIENT WITH RECURENT UTI AND NOT IMPROVED>>>REFLUX UROPATHY
2-DM PATIENT WITH PTURIA AND RENAL IMPAIRMENT>>>DM NEPHROPATHY OR
RENOVASCULAR DISEASE?
3-IV DRUG ABUSER WHICH TYPE OF GN>>>FOCAL SEGMENTAL G.SCLEROSIS?
(ONE COLLEGEUE SUGGESTED AMYLOIDOSIS?)
4-PATIENT WITH PERSISTENT NEPHROTIC WHT TO PRESERVE RENAL
FUNCTIONS>>>RAMIPRIL
6-PATIENT WITH HEMOLYTIC UREMIC SYNDROME WT THE CAUSE>>>E COLI
7-PATIENT WITH MI AND RENAL IMPAIRMENT WT TO PRESERVE RENAL FUNCTION
BEFORE AND AFTER CORONARY ANDIO>>>NACL IV
8-GOODPASTURE SYNDROME DEPOSITION OF ANTI GMB
9-YOUNG PT WITH HEMATURIA>>>IG A NEPHROPATHY
12-ANTIMYELOPEROXIDASE IN P ANCA
3*ENDOCRINOLOGY
1-PT WITH DIARHEA AND HYPERKALEMIA AND HYPOTENTION>>>ADRENAL
INSUFFECIENCY
2-PT WITH HYPOGLYCEMIA DIAGNOSED AS INSOLINOMA WHICH TEST>>>72 HOURS
FASTIN
3-PT E CRONS WITH LOW TSH AND FT4 BUT NORMAL FT3 >>>SICK THYROID
(EUTHYROID) OR LOW IODINE INTAKE?
4- PT E PERSISTENT HIG BP(PHEOCROMOCYTOMA) AND THYROID NODULE NORMAL
TFT>>>MEDULLARY CARCINOMA(MEN1)
5-PREGNANT DM MOTHER WITH RECURENT ATTACKS OF
HYPOGLYCEMIA,WHY>>>FETAL INSULIN,TIGHT INSULIN CONTROL?(DEBATABLE)
6-MECHANISM OF ACTION OF CARBIMAZOLE>>INHIBIT IODIZATION OF THYROXIN
7-WT TO DECREASE LIBIDO>>>DHEA DEFECIENCY
8- WHICH HORMONE UNDER CONTINOUS INHIBITION>>>PROLACTINE
9- TTT OF PHEOCROMOCYTOMA>>>PHENOXYLAMIN
10-AQUAPURINE 2 PRESENT IN>>>NEPHROGENIC DIABETES INSIPIDUS
5* INFECTIOUS DISEASES
1-PT WITH PAINFUL INGUINAL L.N ,PENILE LESION AND HISTORY OF TRAVELING
ABROAD AND CLAMYDIA SEROLOGY +VE>>> LYMPHO GRANULOMA VENEREUM OR
CHANCROID
2-DDROG USED IN TTT OF DOG BITE>>> CO AMOXICLAVE
3-TTT OF GENITAL WARTS>>> PODOPHYYLINE
4-POST SPLENECTOMY WHICH ORGANISM THE PT IS SUSSEPTIBLE FOR>>>STREPT
PNEOMONAE
5-PT CAME FROM AFRICA 6 MONTHS BEFORE WITH FEVER AND CHILLS
>>>PLASMODIUM OVALE
6-PT WITH GENERALIZED RASH ,JOINT PAIN AND POST CERVICAL
LYMPHADENOPATHY>>>MEASLES,RUBELLA OR HEPATITIS A (DEBETABLE)
7-HERPES LABIALIS ASSOCIATED WITH>>> STREPT PNEUMONAE
8-TTT OF CLAMIDIA >>>DOXYCYCLINE
9-PT WITH DIARHEA 2 WEEKS POST OPERATIVE >>>PSEUDOMEMBRANOUS COLITIS
10- PT OH HEMODIALYSIS THROUGH CENTAL LINE BECAME FEVERISH WHICH
ANTIBIOTIC TO USE BEFORE BLOOD C/S>>> PRACTICALY WE R USING VANCOMYCINE
BUT I THINK FLUCLOXACILIIN IS THE CORRECT ANSWER??
11-PT WITH JOINT PAINS AND H/O TRAVELLING ABROAD >>>>GONNOCOCCAL
ARTHRITIS OR REACTIVE ARTHRITIS
12- PT E BACK PAIN AND FEVER POST PACEMAKER INSERTION DUE TO>>>STAPH
DISCITIS
13-MOST CONTAGIOUS ORGANISM>>> SVARICELLA ZOSTER
14 TTT OF PSEUDOMONAS IN BRONCHIECTASIS>>>CIPROFLOXACIN OR
CLARITHROMYCINE
15 IMMUNOCOMPROMISED PT WITH INFECTION(VIRAL OR FUNGAL)WT TO USE>>>
AMPHOTERICIN B OR ACYCLOVIR?
16- PT RETURNED FROM ENDONESIA WITH SEVERE MUSCLE PAINS,
HYPOTENSION(DENGUE)HOW TO TREAT>>>IV FLUIDS
6*GIT
8*NEUROLOGY
1*PT WITH MOTH DEVIATION AND DIFFICULTY OF SWALLOWING AND ATAXIA WHERE
IS THE LESION>>>JAGULAR FORAMEN OR CEREBELLO PONTINE ANGLE?
2-PT WITH UPPER QUADRATIC QUADRANTOPIA>>>LESION IN TEMPORAL LOBE
3-4-PT WITH PIN POINT PUPIL >>>PONTINE HE
5-WHT IS DIAGNOSTIC IN PARKINSONS DISEASE >>>ASSYMITRICAL MOVEMENTS
6-PT WITH SUB ARACHNOID HE WHT THE COMPLICATION>>>HYDROCEPHALUS
9*CHEST
10*RHEUMATOLOGY
3-PT WITH KNEE PAIN, NORMAL XRAY , BACK PAIN AND OSTEPROSIS OF LT HIP HOW TO
DIAGNOSE LT KNEE PATHOLOGY>>>MRI KNEE ,PELVIC XRAY, DEXA SCAN ,OR
ARTHROSCOPY?
6-PATIENT WITH SWOLLEN KNEE ,RED AND PAINFULL >>>SEPTIC ARTHRITIS (ONE
COLLEGUE SUGGESTED GOUT?)
7-PT WITH SEVERE LOW BACK PAIN AND WHEN EXAMINED FOUND NOT ABLE TO FLEX
HIP WHICH IS PRIRITIZED TO WORK UP>>>BACK PAIN OR INABILITY TO FLEX HIP(VERY
STRANGE AND I COULDNT RECALL IT PROPERLY
12*PSYCHIATRY
13*OPHTHALMOLOGY
14*CLINICAL SCIENCE
-ANATOMY
1- PT WITH LOSS OF REFLEXES IN OUTER THIRD OF DORSUM OF FOOT WHER S THE
LESION>>>L5
-GENETICS
3-PEUTS JECHER>>>AUTOSOMAL DOMMINAT
5-AKAPTUNURIA DEFECIENCY IN>>>AMINO ACIDS
6-CYSTIC FIBROSIS INHERITANCE>>>50%
7- PARKONISM DEFECT IN>>>TAU PTN
8- TRANSMITTED BY POLYGENIC INHERITANCE>>>ANKYLOSIN SPONDYLITIS
-PHYSIOLOGY
12- BNP ACTION>>>RENIN ANGIOTENSIN SYSTEM INHIBIRION
-BIOCHEMISTRY
14- REVERSE TRANSCRIPTASE>>>DNA FROM RNA
15-WT IS ALLELE>>>PART OF CHROMOSOME,DIFFERENT TYPE OF CHROMOSOME??
16-CODONE>>>CODES FOR AMINO ACIDS,MSNGER RNA?
-STATISTICS
18-METANALYSIS>>>HISTOGRAM??
19-COMPARISON BETWEEN 2 DATA >>>UNPAIRED T TEST
20-NNT>>50?
21-WHICH BIAS TO USE>>>PUBLICATION OR SUBJECTIVE?
DR-MUSLIM, Feb 5, 2011
#1
1.
geust 211Guest
EXCELLENT........
geust 211, Feb 8, 2011
#2
2.
GuestGuest
hi,
yellow waxy lesion was bilateral and most appropriate answer is TSH,,, pretibial myxoedema????
dr;jehanzeb pak
Guest, Feb 9, 2011
#3
3.
GuestGuest
hi,
yellow waxy lesion was bilateral and most appropriate answer is TSH,,, pretibial myxoedema????
dr;jehanzeb pak
Guest, Feb 9, 2011
#4
4.
GuestGuest
hi,
yellow waxy lesion was bilateral and most appropriate answer is TSH,,, pretibial myxoedema????
dr;jehanzeb pak
Guest, Feb 9, 2011
#5
5.
DR-MUSLIMGuest
THANK YOU DR GUEST
ACUALY I ANSWERED THIS QUESTION AS U SAID (PRETIBIAL MYXOEDEMA)AND I
SHOSE TFT
BUT A SAW ALL ANSWERS IN THE FORUM SUGEESTING NECROBIOSIS LIPOIDICA THEN I
CHOSE FBS ACCORDING TO MAJORITY
THANK YOU
DR-MUSLIM, Feb 12, 2011
#6
6.
GuestGuest
dear these are qoute from emed so answer again is DM/FASTING GLUCOSESkin lesions of classic
necrobiosis lipoidica begin as 1- to 3-mm well-circumscribed papules or nodules that expand with an
active border to become waxy, atrophic, round plaques centrally. Initially, these plaques are red-brown
in color but progressively become more yellow and atrophic in appearance. Note the images below.
Pertinent physical findings of PTM are limited to the skin. However, physical findings consistent with
Graves thyrotoxicosis are significant because they are indicative of PTM as the etiology of the skin
lesions. This observation is especially true regarding the finding of proptosis because nearly all patients
who develop PTM have thyroid ophthalmopathy. Ophthalmopathy usually occurs prior to
dermopathy.3 Thyroid acropachy occurs in 1% of patients with Graves disease. It is clinically
characterized by clubbing of the fingers and the toes, periosteal proliferation of the shafts of the
phalanges and other distal long bones, and swelling of the soft tissues overlying affected bony
structures. When present, acropachy usually follows dermopathy. Graves dermopathy and acropachy
appear to be markers of severe ophthalmopathy.
Primary lesion
Early lesions are bilateral, firm, nonpitting, asymmetrical plaques or nodules.
Hair follicles are sometimes prominent, giving a peau d'orange texture.
Areas of nonpitting edema may develop.
In the elephantiasic form of PTM, lesions may coalesce to give the entire extremity an enlarged,
verruciform appearance.
Overlying hyperhidrosis or hypertrichosis may be present in these cases.
Distribution
Lesions characteristically appear on the lateral or anterior aspect of the legs, but they may occur on the
thighs,4 the shoulders, the hands, the forehead, or any other skin surface.
Lesions often occur in areas of recent or prior trauma or skin graft donor sites.
Color: Lesions are characteristically shiny pink to purple-brown.
Guest, Feb 12, 2011
#7
7.
1. Histological finding of crypt abcess >> Ulcerative collitis
STATISTICS:
1. What is the most appropriate test to use (the scenario sounds like a cohort prspective study)?
Relative risk
CARDIOLOGY:
1. A 47 year old referred to you by his GP w 3months hx of intermittent palpitation. ECG: paroxysmal
AF. What medication? >> This is debatable as the age 47 is borderline, in some population, it can be
considered as old. Hence, the paroxysmal AF should ideally be controlled initially with a Beta blocker,
and then to be investigated the cause of it. However, in some population, 47 is a relatively young age,
and hence pill-in-the-pocket strategy with Flecainide is appropriate. ( I answered Metoprolol, but i have
the feeling that the correct answer is Flecainide as normally, Bisoprolol is the preferred choice, not
Metoprolol)
12. SEVERE CHEST PAIN WITH tall R waves and ST depression V1 and V2, WHICH C ARTERY
AFFECTED? Left circumflex as True post MI
ENDOCRINOLOGY:
1.Old lady WITH DIARrHoEA AND HYPERKALEMIA AND HYPOTENTION. She was a diabetic
too >>> Addison's
GASTROENTEROLOGY:
6- PT WITH RECTAL BLEADIN AND SKIN LESIONS AROUND HIS LIP>> Colon Ca (likely
Peutz-Jagher's)
CHEST
2. PT WITH MESOTHELOMA AND left sided pleural fluid and thickening. How to appropriately
investigate??>>> Debatable depending on clinical setting. The best answer is VATS biopsy, however
this might not be the case for if your in a small district general hospital.
PSYCHIATRY:
3-PT WITH 3/12 hx of DEPRESSION and hallucination AFTER HIS WIFE DIED IN CAR
ACCiDENT>>> Pyschotic depression, normal grief is only upto 5/52.
GENETICS:
11. Pt with limbs muscle weakness and +ve family history >> likely Baker's dystrophy as the patient
was very young at time of presentation
STATISTICS:
8.
skin2Guest
[PT HAS FAST ACETYLATORS AND RECEIVING ANTI T.B DRUG WHT IS THE PT PRONE
TO>>> Peripheral neuropathy (Isoniazid)]
This was a controversial question. There is no doubt in the fact that it is the slow acetylators who are
more prone to neuropathy. Earlier it was thought that fast acetylators are more prone to hepatitis, but
the latest journals and Katzung says that this is not true. Even the hepatitis is also more common in
slow acetylators. In fast acetylators drug efficacy may be affected but that too only in weekly doses
format not in daily dosing or thrice weekly dosing. So drug resistance is also a less likely answer. Kalra
however very clearly says that fast acetylators are more prone to hepatitis. Certainly this is not true but
RCP may be looking for this answer.
skin2, Feb 15, 2011
96.male with pain in buttocks one after other relive with brufen
97.Dysplasia
98..
Posterior inferior cerebral artrey
99.Cause of demylination in correction of sodium fast??- loss of water
100.HIV man with resistant Heb B vaccination- because of HIV
1o1.variable intensity of S1
1o2,Lentigi maligna Basal cell carcinoma ulcer with rolled border
1o3.diclofenac with rash ; Intersitial Nephritis, ATN
1o4.Nalaxone
1o5.Multiple sclerosis
1o6.Liver Abcess with bovis ; colonoscopy
1o7.Cauda Equina
108.Risk of Suicide : Dont discharge
109.Clue cells ; Metronidazole
110.osteoarthritis
JAN 13TH, 2:14PM
111.Centromere in one plane in which part of cell cycle
112.Function of codon
113.Clopidogrel.. M/A
114.Donepezil.. M/A
115. Basophilic stippling, microcytic anaemia, asian, cause..
116.Anaphylaxis imediate rx im adrenaline
117.migraine prophylaxis.....propranolol
118.drug should avoid in myesthenia gravis? Betablocker
119.Satellite lesions(pustules)...candidiasis
120.conus medullary syndrome. Scenario
150.-deperdonalization disorder
151.UTI....first line managment ? !!! trimethoprim
152.increase ptt ...which factor deficient ? X1
153.which contain more energy ?? Trigelycerides
154.Tecagrelor...mode of action ? ADP
155.variable intensity S1...ponits to ? Complete heart block
156.level of prednisolone match the body kevel ? 7.5 mg
157.-pain left buttock then pain right buttok , no spinal movment disorder ..diagnosis ? Trochantre
brusitis !!
158.loss of sensation index...nerve injury ? C8
#11
9.
OKOGuest
Speculation that fast acetylators of isoniazid could be at increased risk of hepatotoxicity due to
production of a hepatotoxic hydrazine metabolite has not been supported; in fact, slow acetylators have
generally been found to have a higher risk than fast acetylators. This could reflect a reduced rate of
subsequent metabolism to non-toxic compounds. In addition, concentrations of hydrazine in the blood
have not been found to correlate with acetylator status.
OKO, Feb 16, 2011
#12
10.
skin2Guest
Why RCP puts in these kind of controversial questions....If they expect the candidates to be updated,
then they should also be.....i guess this question has been previously asked too....it has been discussed
in this forum last year also....
skin2, Feb 16, 2011
#13
11.
GuestGuest
result is out check it
Guest, Feb 18, 2011
#14
12.
iman kotbGuest
mrcp 2 course
Hi all
Just giving you a flavour I got the questions still working on it 195 lot
Good luck
Re: Young girrl, high bp, AV nipping- Pheochromocytoma.
Her hypertensive changes were typically upper body. Grade IV hypertensive retinopathy but normal
renal function. I thought that pointed more towards coarctation than anything else. Pheochromo or
essential hypertension would leading to such significant retinal changes would also affect kidneys.
anti ccp-RA
NHL-anti cd-20
pemphigus vulgaris
bullous pemhigoid
von willebrand disease
marfan-fibrillin
gentamicin-acute tubular necrosis
CRF- secondary hyperparathyroidism
addisonian crisis- iv hydrocort
pituitary apoplexy
hypochondriasis
somatoform disorder
OSA- polysomnography
CHADSVASc >2- warfarin
carotid artery stenosis right 100%- carotid endarterectomy
inherited kidney disease n mother died of ICB- ADPKD
drug-drug interaction cause fits- aminophylline n clarythromycin
melanoma- depth of lesion
Kyphoscoliosos- fvc/spirometery
Klinefelters- infertility
Hyper acute rejection - abo
Psiriasis- beta blockers
Ruq pain, ct scan bile stone, hypokalaemia, hypertension- cushings
Silica- egg shell calcification
Bleeding pr with ulcers in anal mucosal-lymphogranuloma venrum
Severe headache neck stiffness vomiting - subarrachanoid heam
BNP_ VENTRICLES.
PERNICIOUS ANEMIA(ANTIPARITAL CELL ANTIBDY)- VITILGO
ANDROGENINSENSIVITY-KARYOTYPING
naproxen - arthritis(prevous peptic ulce)
opposite side of sternocledomastoid
discitis- post op
g protein coupled receptors
mast cell - release
daily potassium req-60
scenrio of catatonia
lithium toxicity-hemodylisis
post op- early mobilisation
mafloqune side effect-( hallucination, night mares etc
arteriovenous dysplasia
tender hepatomegaly cause- falciparum??
vent: tech- carotid message
MEN-1 pheo+meddul ca(inc: calcium)
psychogenic polydipsia scenario.
vit B21 def: -hyperseg neutrophil+megaloblast
tumerlysis syndrome- chemotherapy related
TICAGRELOR- ADP receptor inhibitor
L5/S1 - scenerio
83.Pheochromocytoma - MEN 2
84.Q on VIPOMA
85.Bipolar disorder RX -Lithium
86.Flat effect,auditory hallucination - schizophrenia
87.Hyperkalemia fastest treatment - ?Calcium gluconate,? IV Insulin
88.Alcoholism - Nystagmus
89.Q on Lung function testing in kyphoscoliosis
90.contraindication to surgery of lung ca - ?superior vena caval obstruction,?pleural effusion
91.Acromegaly - OGTT
92. invasion of sorounding strucures - Anaplastic thyroid ca
94.Exudative pharyngitis, sore throat,eastern europe - Glandular fever
95.young female,Family h/o colon ca,now c/o fatigue and weakness - ?Colonoscopy
96.Location of Vagus nerve lesion - ?Geniculate ganglion,?Jugular foramen
97.Pleural effusion on the left,containing amylase,Left upper quadrant pain - ?acute pancreatitis,?
splenic infarction,?ruptured renal cyst
98.Q on diabetic retinopathy,for referral to opthalmologist
99.Penile ulcers,inguinal lymphedenopathy - ?Granuloma inguinale,?Herpes?syphilis
100.SVT - Carotid sinus massage
A MAN WITH OSTEOPORSIS - TESTOSTERONE LEVEL
A GYMNISTS HORMONE LEVEL DECREASED-LH/PRLACTIN/GH/CORTISOL
a man with long arms and legs. his height is 160/180cm...?/..
his karyotype is xyy..what is the most common complication?
an old mantaking many drugs detorioration of renal condition with increase in creatinine and
dehydraton due to vomiting- ramipril
i am not sure of all answers but this is what i ve marked in paper
1.monoclonal antibodies used for non-hodgkin's lymphoma --CD20
2. gram positive bacilli-- LISTERIA
3.ulcer on dueodenal cap-- GASTRODUDONEAL ARTERY
4. hepatic vein drain into --- AZYGOUS VEIN???
one patient with OA take full dose of paracetamol ,what to add next ?codeine
MIODARONE IS POTASSIUM CHANEL BLOCKER
Intensely pruritic lesions ..... deratitis herpetiformis
hba2 raised slightly alpha chain concentration 93% diagnosis- alpha thallasemia
Thu Sep 11, 2014 3:49 am (10 months ago) #44
viral meningitis
rt sternomastoid
no carotid intervention
jugular foramen
oral diclofenac
unipaternal isodisomy
achalasia
subdural hematoma
de quverian tenodosynovitis
Optic neuratis
adesive capsulitis
sec hyperparathroidism
Cetrizine
oral 5 fluro
dermatitis herptiformis
BB
steven jonnson
somatization
adjustment
mancausen
paranoid shizophrenia
salmonella
TB and HIV
strongyloid and HIV
apoplexy
herniation
bladder Ca
A pt with alchol excess sensory motor neuropathy,raised JVP,hepatomegaly,features of renal inv,normal
heart size-Alcoholic/Amyloid neuropathy
A pt cud not remember da c/F but there was FEV1 & FVC given before and after salbutamolemphysema/ch bronchitis/ashma.
Question dont remember but there was options with brucella/lyme what is the ans?
34.v.t...synchronizd shock
35.central cynosis n clubbing....Pulmonry stenosis
36.wilson...auto recesve
37.17 yrs old type 1 dm nw abgs low hco3 low k .hyprventilatng....Dka
38.paired t test
39.scater graph for data scenario
40.unpaird t test
41.false negative rate 495/500
43.scenioro of acromgly test OGTT WITH GRWTH MESURE
44.barter most specific hypokalemia
45.50.50 mixing stdy i mrkd hemoph A
47.recurent T.i.a....warfarin
48.pas +ve...whipple
49.coeliac scenrio test anti ttg
50.antipareital atibx for pernicious
51.cystic fibrosis chnce of nxt child scenrio.. to effect 1 in 4
52n 53.also two othr on this topic for wilson n hemophilia tranmision to child
54.Cjd ...jrks
55.gbs
56.cervical cored compression nt sure
57.dermatitis herpit.
58.posiriasis worsng..bisoprolol
59.anticipation
60.whn to refer to opthalmolgy .... blot hemorhages seen
61.painfull eye mov n dec visual acuity....optic neuritis
62.d quravian tenosynovitis
63.recurent pericarditis...prednisolone
64.primry pneumothorax aspiratd n dischrge wt to do nxt ...nothng
65.anaphlatic shck...i.m adrenaline
141. .Previously treated for Plasmodium falciparum and now c/o right upper qudrant pain - ?recurrence
of malaria,?HBV
142. Extrinsic allergic alveolitis which will sugest .presence of igE to allergen
143. Emphysema Pathophysiology - ?Dynamic airflow obstruction
144. Q on Mechanism of MODY GLUCOKINASE
146. DVT,Thrombus in arteries if leg - LMWH
147. Vaccine contraindicated in HIV pt - ?BCG
148. Fever,sore throat after using amoxycillin - ?EB virus
INFECTIONS
28.erythema nodosum IN TYPE 1 DM TAKING OCP
29.somatization
30.male sex with male nw ulcer in anal area ..gonococal proctitis
31.ticagrel m..o.a....ADP inhibtors
58.posiriasis worsng..bisoprolol
59.anticipation
60.whn to refer IN DIABETIC NEUROPATHY .... CHANGES IN THE MACULA
61.painfull eye mov n dec visual acuity....optic neuritis
62.d quravian tenosynovitis
63.recurent pericarditis...COLCHICINE
64. RECURRENT primAry pneumothorax aspiratd n dischrge AND xraY AFTER 2WEEKS AS ITS
RECURRENT
110.man with fever his son had fever n facial rasherythrovirus b19
111.chromatids started to move opposite endsanaphase
112. Confirmatory for cardiac tamponade = Pulsus paradoxus
115. Person not getting relief after 200 mg of beclomethasone, next step = add Salmeterol
116. . Part of kidney impermeable to water ascending loop
117. Question on anti Cd 20= Lymphoma
118. s3( gallop rhythm)- poor prognosis in LVH
119. .ST elevation in V1-V4,ST depression in inferior leads -Occlusion LAD
120. lung ca and GN- membranous GN
141. Previously treated for Plasmodium falciparum and now c/o right upper qudrant pain - HBV
142. Extrinsic allergic alveolitis which will suGgest .upper lobe fibrosis
143. Emphysema Pathophysiology - ?Dynamic airflow obstruction
144. Q on Mechanism of MODY GLUCOKINASE (HNF1APHA WAS NOT GIVEN)
146. DVT,Thrombus in arteries if leg - LMWH
147. Vaccine contraindicated in HIV pt - BCG
148. Fever,sore throat after using amoxycillin - EB virus
149. unable to abduct arm(painful and limited) adhesive capsulitis
150. Alcoholic ,ultrasound of liver hyper echogenecity - Fatty filtration
151. Bloody diarrhea in a child who been to a farm 3 times.ECOLI 0157
152. Obese female with b/l papilledema - BIH
153. Cells responsible for producing IgE - Plasma cells
154. Ig M ,Waldenstrom's - Hyperviscosity
155. Egg shell calcification hilar nodes - Silicosis
156. G proteins located at - Plasma membrane
157. 80 year old, why to reduce digoxin loading dose reduced creatine clearance
158.female with hirsute n obese family hx of mother death due to intracranial bleedAPKD
159.pt of r.a controlled on paracetamol now week hx of exb of asthma stoped paracetamol wt to
do.restart at same dose
160.pt treated for malignancy with chemo 4 days fever neutrophils 0.5 wt to dost antibiotic
prophylaxis
162. sleep apnea diagnostic test .polysmnography
163. prognositic factor for melanoma--DEPTH OF MELANOMA
164. source of BNP secretion-- CARDIAC VENTRICLES
165. blood test prior to renal transplant that can cause rejection ..MHC CLASS 2
166. patient presented with unknown substance posioning with confusion and eye symptoms-METHANOL
167. scenario of NEPHROGENIC DIABETES INSIPIDUS result of lithium pt taking 10 yrs
168. ecstasy--HYPONATREMIA
169. peripheral neuropathy--NITROFURANTOIN
170. depression-- EARLY MORNING WAKENING
171. .highest calorie value foodCHEESE
172. vit B21 def: -hyperseg neutrophil+megaloblast
173. post op pacemaker insertion severe backache it was PANCREATITIS
1-Corticobasa; syndrome
2-Which part of nephron remains impermeable to water in dehydration.
3-Patient taking multiple drugs(aspirin, amlodipine, ramipril) , having dehydration, dry oral mucosa .
Serum creatinine raised to 180 mg and pre renal picture. Which drug caused increase in creatinine ?
ANS _RAMIPRIL.
4-H/O -LITHIUM intake and different osmolarities given , not mentioned DDVP trial. Scenario was of
PSYCHOGENIC POLYDIPSIA , because serum osmolarity was 269 mmol/l.
FEV1 2.1 (2.6) FVC 4.5 (4.6) Rco normal Post bronchodilator FEV1 2.6 CXR and echo normal a
Emphysema B chronic bronchitis c heart failure d obstructive sleep apnoea e astham
01 - Factor causing increase in hunger - GHRELIN
02 - Patient with dysphagia (CA) haven't eaten since last 6 days, what should be the feed in first 24
hours - 50% OF THE PROTEINS AND ENERGY REQUIRED
10 - A Theme with patient presenting with HTN already taking ACEi, Aspirin, Statin, what should be
added to improve status - BISOPROLOL (Beta Blocker)
11 - What factor contributes to decrease pulse pressure in patients with old age - REDUCED AORTIC
VALVE COMPLIANCE
12 - A Theme about Red Cell Agglutination and Cold with dry cough - MYCOPLASMA
PNEUMONIA
14 - A SLE Patient status about compliments - Low C3 & IgG but raised C4
15 - A female with UTI who is allergic to Penicillin what second option about drug CIPROFLOXACIN
18 - Raised IGF level, HTN, Colon CA and sweating at night alongwith nerve compression bilaterally
in both wrists - ACROMEGALY
19 - A person with surity og having cancer but tests normal - HYPOCHONDRIAL DISORDER
20 - One female says that she is Queen of London - DELUSIONAL THOUGHTS (Schizophrenia)
23 - 5ml Testis on each side with norml FSH, LH and Testosterone, height little taller KLIENFELTER's SYNDROME
26 - Patient on Cytotoxics given Fluconazole for some skin infection presents with Toxicity CICLOSPORIN INDUCED FLUCONAZOLE TOXICITY
28 - A young male with small round umbilicated lesion in supra pubic region - MOLUSCUM
CONTAGIOSUM
29 - Major artery affected in duodenal ulcer and causing upper GIT bleed - GASTRODUODENAL
ARTERY
31 - A person taking Aspirin, Calcium Channel blocker, Statin feels neck tightness. Which drug is
responsible - ASPIRIN
32 - Acid-base status in a person with projectile vomiting for 4 days and Pyloric Stenosis HYPOKALEMIC ALKALOSIS
33 - Pain in area of medial epicondyle after elbow flexon against resistance - MEDIAL
EPICONDYLITIS
37 - Mother has disease, Elder daughter has, son younger he also have what is the mode of inheritance
sequence - AUTOSOMAL DOMINANT PATTERN
39 - Young man had gynecomastia unilateral and previously had been surgically treated for same
problem in other breast - KLIENFELTER's SYNDROME
40 - An old man with constant microscopic hematuria, prostate size normal but PSA little raised,
Blood+2, Protein+1 in urine. Which investigation - RENAL BIOPSY
41 - Giardia infection not isolated in stools next best investigation - DUODENAL and JUOJEONAL
ASPIRATE Examination
43 - Surgical intervention required in Infective Endocarditis due to which problem - AORTIC ROOT
ABCESS
46 - Post PCI skin echymosis and discoloration on limbs due to - CHOLESTEROL EMBOLISM Pt
presenting with ARF and Rash after Coronary angio - Cholesterol embolism answerd above
47 - In cardiac action potential Repolarization phase controlled by which ion - POTASSIUM
CHANNELS
48 - A Patient with Liver CA on maximum pain relief drug (Morphine) but not relieved, what to add
more - DEXAMETHASONE
50 - Type of Gall Stones formed in a patient with Sickle Cell Disease - BILE PIGMENT STONES
52 - CPR done for long, ER doctors, family members, wife all watching, which authority should be
asked to stop CPR - TEAM LEADER of CPR TIME
53 - Prophylaxsis for people contracted with Meningitis patient caused by Streptococcus Pneumoniae NOT REQUIRED
54 - A patient with painful shin lesions which investigation option to confirm diagnosis - CHEST
XRAY (For Sarcoidosis)
56 - Patient with tension pneumothorax, what to avoid - If Scuba diving had been the option I would
have gone with it but second to it is - ANY STRENTIOUS EXERCISES
57 - Fever, Lethargy, Posterior pharngeal wall and tonsils coated with membrane - DIPHTERIA
60 - Intraepidermal skin blisters andoral involvement - PEMPHIGUS VULGARIS
62 - Strongyoids Stercoralis, what to avoid - AVOIDE WALKING BARE FOOTED
63 - A patient with patch on hand with odema and redness, came back from nothern america - TICK
BITE (ricketsia)
64 - A small black patch of skin present since many years now have suddenly started to grow LANTINGO MALIGNA
66 - Peritoneal Lavage Fluid, how to diagnose - HIGH NEUTROPHIL COUNT
67 - Raised IgM Hep A, HBsAb +ve, IgG for HepC +ve, IgM for HepC -ve, what is the diagnosis ACTIVE HEPATITIS A
68 - Psychological distress in old man, treatment to give - HALOPERIDOL ORALLY
72 - Blackout in Plane gained consiousness was being handled by air crew reason - VASOVAGAL
SYNCOPE
73 - A patient drank 5 litres of beer and now excessive urination, mechanism ? DECREASE
PRESENTATION OF AQUAPORINS
75 - A patient with RA for last 6 years and taking methotrexate presents with shortness of breath,
crackles on lung bases - METHOTREXATE PNEUMONITIS
78 - Patient with Lyme Disease 2nd day of treatment with anaphylaxsis and body reaction EXPOSURE and INTERACTION WITH DEAD PATHOGENS
82 - A girl with menorrhagia, her sister had same problem - VON WILLEBRAND DISEASE
170 Questions Collected here and ONLY 30 LEFT
i dont remember this question at all .. any body else does ???
i hope if we get the right answers to above queries.. we can get the
TOTAL Recall
regards
Eplerenone in HF mortality? 2 questions i think.
DOC in cataplexy?
16 yr old depression fluoxetine?...webmd says prozac which is fluoxtine (fluke for me)
epelerone
osteomalacia
bollus pemiphigoid
annular lesion ttt antifungal
alopecia and nail pitting psoriasis
empyema at gall blader
miliary tb pict
Ursodeoxycholic acid for pbc .. Heamochromatisis ....viruc c pcr ?? In cryopricipatat .. .. Rerctile
dyfunction cause ?? Alciholexcess?? .... Pacemakerplus atenelol??.... Copd add cortison ... Feacal
elastase ... Vsd ... Cha2 ds2 ,history of strok .. Cpap in sleep apnea .. Gall stone liac...remove
sulphonylurea and keep exenatide.....membranous gn dto malignancy ..agitation give haloperidol
..intubate and ventilate ...pulmonary embolism catheter or echo ...ad fluxetine ??? ...giant cell arteritis
what to add to cortisine and alendronate ... Osteonecrosis ... Clozapine ... Fluxetin ...na valproat
...remove ramipril in the pregnant woman
Fomepizol... Dialysis....deluxetin ....infliximab ...ulcerative colitis...ards... Hus .... Ttp.... Nephrogenic
diabetes insipitus...propranolo in af .... Flexainide in another af ...craniopharyngioma ???? ... Non
functional pituitary tumer ???....picture of pleural effusion ...pimphegiod... Relapsing chondritis ...
Spondyloarthropathy
Mr spine ... Lumber punture in benign intracranila htn ... Lewy body dementai ... Alzehiemer?? ...
Hypothyriod myopathy ... Familial tall stature ??? ....adrenal insuffiency...celiac ..., silicosis ??? ....
Obesity .... Lyme disease ....amyliodosis ...aortic valve replacement .... Takayasu disease ???....
Dissecting aortic aneurysm ??
bone scan-pagets,osteomalacia,spondyloathritis,aortic dissection,pacemaker plus atenolol, ,relapsing
polychondritis,alteplase,amyloidosis
obstructive sleep apnoe-cpap,secondary hyperparathyroidism-cinacalcet??siadh-demiclocycline??
,silicosis,elevated hemidiaphrgm xray,giardiasis
7. thyrotoxicosis with AF
rx:
propanolol
flecainide (stupidly chosen by myself!!!)
8. question re diabetes insipid us, pt with polydipsia, polyuria. no increase in urine osmolality after
water deprivation and DVAPP: nephrogenic DI
9. pt with proteinuria Rx:
ACE?
10. pt after MI with heart failure and LV ejection 35%, which RX additional to B blockers and
furosemide improve outcome:
digoxin (correct?)
warfarin
no options for spironolactone or ACE)))
11. pregnant with deranged liver tests:
Seborrheic keratosis
Prolonged PR
SVT WITH ABBERANCY
LIMB LEADS MISPLACED
CT: Hydronephrosis
Skull x ray: fracture
intradermal naevus
supraspinatus tendinitis
CT: PE
CT: left upper lobe collapse
22. increased Ca
increased PTH
normal vit D
Rx
cinacalcet
alfacalcidol
calcitonin
Hey some themes from paper 1 I couldn't be bothered after that:
Mrcp
30- patient after admission with MI deteriotes, saturation increases from right atrium to right
ventricular - vsd
31- patient with inferior mi had PCI, has heart block on ECG - continue monitoring
32- in copd which would decrease the recurrence of attacks - inhaled steroids
33- small cell carcinoma patient coming with positive Romberg test - lambert eaten
34- budd chiari - Doppler ultrasound abdomen
35- amytripline overdose - bicarbonate
36- patient on lithium, urine and osmolality results were given after water deprivation and
desmopressin test, no improvement seen - nephrogenic diabetes ins
39- a lady with positive IgM and alp but asymptomatic - ursedeoxycolic acid
40- patient who has long term catheter, grown 10 over 5 coliform and pseudomonas but patient
asymptomatic - no treatment required
42- lady with loose teeth and jaw pain - necrosis of jaw
43- pregnant patient which tablets to stop - ramipril
44- patient on amiodorone developed hyperthyroidism treated with carbimaxole but still hyperthyroid
low intake of iodine - treat with prednisolone
45- Charcot joint on xr - resting the foot
46- patient with urethral discharge, conjunctivitis and arthritis, gram stain negative - treat for chlamydia
> doxycycline
47- patient developed breast cancer previous history of radiotherapy - most likely cause is radiotherapy
48- pheochromacytoma on ct scan - treat with Alpha blocker
49- subacute combined degeneration symptoms - check b12
50- patient on methotrexate develops sore throat, initial investigation - check FBC
51- patient with AF previous stroke asking which one weighs more when you decide warfarin previous stroke
52- ITT analysis - add all the patients
53- CKD patient with low calcium high phosphate and pth - treat with calcidol
54- primary hyperparathyroidism
55- bilateral leg swelling, old lady has erythematous lesions in both legs asking initial management s/c lmwh
56- suspicious melanoma lesion - excision biopsy
57- elderly confused, agitated and has hallucinations what to give - haloperidol
58- lymphocystosis with smear cells - phenotyping
59- patient with cancer has bleeding problem - acquired heamophilia
61- patient with chrons and previous bowel resection - renal stones
62- patient with peripheral neuropathy initial treatment - duloxetine
63- gentamicin, through level is 2, 1hour post dose level is 4 on 60mg TDS dose - don't change the
dose repeat the test again
64- patient on warfarin comes with uppergi bleed - give pcc
65- patient had syncope when having a shave - carotid hypersensitivity
67- another CXR with huge pneumothorax on the right side - chest drain
68- patient comes with syncope on standing, tilt table test produces dizziness and bp drop of 40 postural hypotension
69- Turner syndrome
70- patient has long history of anaemia had ogd colonoscopy and repeat colonoscopy which were
normal, asking for next step - capsule endoscopy
71- patient comes with abdo pain background of several abdo surgeries, colonoscopy was normal pseudo obstruction
89- patient on dialysis comes wth temps very high ferritin and rash - adults still disease
90- lead poisoning - sodium edta
91- fascioscapulahumeral muscle atrophy - this is the patient who cannot whistle
92- patient with quadriceps and hand flexor weakness - inclusion myosytosis
93- patient with chest tenderness, high total protein, low albumin, had anaemia and renal failure myeloma
94- skull xr - I thought it was myeloma
95- eplerone to increase mortality - I gave this answer twice 2x
96- returning traveler, lady comes with myalgia a month later after returning back - HIV SEROLOGY
97- inclusion body on histology - ganciclovir
99- elderly patient who looks like palliative patient has seizure and becomes unresponsive with
twitches - sc midazolam
100- benign positional vertigo
101- IV drug user with muscle weakness - botulism
102- Lewy body dementia
103- depressive disorder - old lady who was playing piano before she had a stroke
104 - ear infection - pseudomonas
105- 18 year old guy with purulent sputum previous infections grown pseudomonas in sputum - CF
106- lady post mastectomy with lung infiltrates - radiation pneumonitis
107- patient with previous pulmonary haemorrhage with microscopic polyangitis now has temps high
crp and right sided consolidation - pneumococcal pneumonia
108- farmer diagnosis is leptospirosis - treat with benpen
109- eosinophilic pneumonitis
110- pregnant lady with jaundice deranged lfts - acute fatty liver of pregnancy
111- Tb patient - negative pressure room and masks
112- retinal detachment
113- CT - hydronephrosis
115- disseminated gonorrhoea
116- what to do with warfarin before surgery - stop and swap to lmwh before surgery
117
118- Asian lady previously had blood transfusion - hepatitis c serology
119- hypothyroid myopathy
120- duedonal biopsy for coeliac
121- lady with diarrhoea negative coeliac screen, started gluten diet and stopped lansoprozole lansoprozole induced diarrhoea
122- patient on ciclosporin started on diltiazem - diltiazem&ciclosporin interaction
123- diabetic patient wth very high triglyceride - fibrate treatment
124- bed bound patient with pressure sores, also diabetic - bed arrangement
125- severe diarrhoea and dehydration in returning traveler asking the cause of renal failure - ATN
126- lady with painful lesion on her legs, previously given antibiotics for shortness of breath and cough
- I thought this is sarcoidosis and question was asking the investigation cxr
127- young gentleman comes with bloody diarrhoea, normal bowel sounds asking for the investigation
- flexisig
128- patient on dopamine agonist becomes very psychotic - dopamine side effect
129- HIV positive lady who is psychotic as well, very restless and talks quickly - amphetamine use
130- narcolepsy - modafanil
131- and I chose craniopharngioma, non functional pituitary macroadenoma but I cannot remember the
stories.
There were two EKGs one for a pt. Who came with chest pain48 hours duration another was for a pt
who came with chest pain his first EKG was normal and another after 2 hours showed RAD and right
ventricular strain.
I think the first was not dextrocardia but misplced limb leads because there was negative p in both lead
I and avl.
The second was EKG signs of PE and hence to proceed for CTPE.
Questions as i remember ..
2)
45) myocardial scan..?
46) cardiac cath .. Ventricular septal rupture
There were 3 lp reports. The one with 400 cells was neutrophil predominant and was meningococcal
meningitis. There 2nd was tb meningitis which had low sugar with very high protein and the 3 one with
temporal changes was lymphocytic predominant. I put in HSV but wome people were saying that it
waw hemorrhagic necrosis in the scan so it could be leptospirosis or lyme.
question 1 in paper 3-Vasculitic Pneumonia
Oncology Questions
CXR-Lymphangitic carcinomatosis
M.S
Rotator cuff tear
osteonecrosis to jaw
2 questions with answer-eprelinone
aspirin overdose with in 1 hour,mild acidotic,vitals-stable,no organs failure went for oral charcol
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Sat Jul 12, 2014 9:04 pm (1 year ago) #108
Posts: 17
Credits: 187
Aim AIPGE 2011
effect of dopamine
8) 2 patients with MMSE .. Around 25 ?
Age related cognitive impairment ? Dementia ? Frontal lobe
tumor
9) lambort eton mysthenia .. Ca related abs
10)patient with weakness and low fev..GB syndrome
11) another question paper 1... GB Synndrome
12) i/v drug user .. Botulism
13) patient eith toxoplasmosis ?? HIV.. Check if medical decision ,
patient intesrest
14) pateint with tb .. -ve pressure room ... Mask only in MDR TB
15) picture with mole ..nodular melanoma ??
38) diabetic with foot xray red hot tender .. Charcoat >>
immobilisation
39) primary progressive multiple sclerosis ?
40) PKD .. Common .. Hepatic cyst
41) PKD .. Pain.. Stone?
42) chest infection treated .. Had catheter MSU..
Pseudomonas .. Patient well.. Do nothing ?
43) reactive arthrtis scenario .. Doxy
48) patient with low 20% ihd risk .?? Investigation.. Exersise
tredmill? Myoscan?
49) APACHE score .. Icu patient .. VBG? Urine output?
50) skull scan ... Pagets diseaee
51) girl with angiodema ...?
52) patient with a gradiant 80... AVR
53) ischimic cardiomyopathy .. Dilated atria
Here is a comprehensive recall with as much more questions as I can remember. Please, correct for the
wrong answers.
155- Patient with frequent ashma attacks >> increase the dose of inhaled steroid.
156- ARDS case.
157- Paget's disease of breast.
158- ECG>> Transposition of limb leads.
159- Paranoid schizophrenia.
160- Patient with scarring alopecia and joint pains , which autoantibody to do >> Antinuclear antibody.
161- Another case of hypoadrenalism in the conext of autoimmune polyendocrine syndrome ( patient
with hypercalcaemia and thyroid problems).
Qs no 5. The indian lady was taking Ayurvedic medicine and her zinc protoporphyrin level was high
which is characteristic of lead poisoning ,also some Ayurvedic meds got Black level by FDA back in
early 2000 due to high level of Lead ,so it's more like Lead poisoning not porphyria .
5.
6.
7.
8.
9.
drug induced
10. PBC Long term treatment treatment ?Ursodeoxycholic acid
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.
54.
Syringomyelia
Patient lip smacking for 2 days -Non conculsive Status
CXR of ??Right middle lobe collapse
CXR of ??Right middle lobe consolidation
Isolated BHCG elevation - Testocular Choriocarcinoma
Patient with macroprolactinoma carbegoline
Patient with pulsating eyes - Carotico Carvenous Fistula
Patient with Prolactinoma extending into the carvenous sinus Carbegoline
Patient with Femoral fbruit Femoral Fistula
Patient with continuous murmur - Rupture of sinus of valsalva
Prosthetic valve patient with PUO Start IV vancomycin/ Rifampicin
Patient with Osteomyelitis whose Bone culture revealed sensitivity to Vancomycin but wound
swab revealed two diff orgs with two diff sensitivities To continue with sensitivity of bone
55.
56.
57.
58.
culture
Patient with Red Mans syndrome - Reduce rate of infusion
Patient with very high trough level of Vancomycin - Change Vacomycin to teicolplanin
Pulmonary fibrosis CT scan
Sickle cell patient with Progressive breathlessness and Loud P2 and left parasternal heave
61.
62.
63.
64.
65.
66.
67.
68.
69.
70.
71.
72.
73.
74.
75.
76.
77.
78.
79.
changes
80. Elderly woman with a scaly lesion on the lower limbs Bowens disease
81. Oral phenoxibenzamine in a patient with Phaeochromocytoma
82. IV ceftriaxone Pregnant lady with Pyelonephritis with associated nausea and vommiting
83. Treat UTI in elderly woman who is restless and Urinalysis in keeping with UTI
84. IHH in Lady who took Minoxydine
85. SJS Pix or Bechets
86. Intubation or IVIG for GBS Patient with FVC <30%
87. NIV for Cystic fibrosis patient
88. Polysomnography for OSAS (or Overnight Oximetry)
89. Pemphigus Vulgaris
90. Dobutamine echo for AS with poor left ventricular function
91. Charles Bonnet woman seeing people come into her room
92. Cholecalceferol - Osteomalacia
93. FHH
94. Charcots joint Cast/rest
95. Gonococcal arthritis 96. Patient with staphylococcal sepsis who now develops features of ARDS
97. Necrotising Fascitis or surgical emphysema Xray
98. Risperidone increases risk of stroke
99. Pancreatitis or rupture of viscus on CT scan
100.Feeding in pancreatitis with either PEG or Jejunostomy or parenteral Nutrition
101.Normal saline or ionotropes for patient with inferior MI and raised JVP and hypotension
102.Motor neuron disease Assistive device or PEG
103.Stroke for physiotherapy
104.Tilt table test for female patient with syncope
105.Elderly man falls and regains full consciousness within 2 minutes
106.Patient complains of tingling sensation moving from right thumb to involve whole of the right
upper limb them the right side of face. Lasts about 45 minutes with suboccipital headaches Migraine
107.Ischaemic CN 3 lesion
108.Patient with unilateral headache that responds to indomethacin Chronic paroxysmal
Hemicrania
109.Friedrcihs ataxia scenerio
110.Patient with Wegeners - cyclophophamide
111. Molluscum contagiosum in a know HIV patient
112.Larva migrans treatment - Albendazole
113.Homosexual man knows his partner is HIV positive after he had a receptive sex Next line of
action. -HAARTS
114.Sweet sickly smell culture - Pseudomonas
115.Patient with isolated high TG -Penofibrate
116.Patient with platelet count of 45,000 and going for Central line inserton - Platelet transfusion
or do nothing
117.Warfarin toxicity - IV concentrate and IV vit K
118.History and karyotype of a patient with - Androgen Insensitivity
119.MRI of hyperintense lesion on lumbar vertebra sparing the IV disc. How to make a diagnosisBone Biopsy
120.History of Meralgia parasthesia
121.Patient on intraperitoneal dialysis with pleural fluid which has a higher sugar than plasma
glucose Peritoneal fluid leak
122.Patient on metformin and having poor glycaemic control with a very high HbA1c- Insulin
123.Patient not having adequate glycaemic control on diet and life style..Metformin
124.Patient with BVF and poor glycaemic control - Insulin
125.D/V within 6 hours - Staph Food poisoning
126.Patient with Isolated B12 deficiency Crohns (fecal calprotectin)
127.Patient comes in from India with mild villous atrophy and mononuclear infiltrate - Tropical
Sprue (give tetracycline)
128.Patient with pleural effusion and pleural thickening - Video Assited Pleural Biopsy
129.Patient on anthypertensve and OHAs and having haematuria and being worked up for
cystoscopy by the urology team. Which drug to stop. - Pioglitazone
130.History and examination in keeping with Delirum Tremens
131.History and examination in keeping with Miller Fisher
132.History and examination in keeping with LEMS
133.Patient with oculogyric crisis and on Metoclopramide
134.Patient Nsaids and paracetamol develops rashes on the face and shoulders sparing the back of
the face. Nsaid induced phototoxicity
135.Patient found wondering on the street with AD and low MMSE score - Memantine
136.Dialysis to control recalcitrant HTN despite using all the maximal doses of antihypertensices
137.Biochemistry of a patient with Ileostomy . Normal Anion gap metabolic acidosis
138.ABG of a particular elderly woman forgot her medication at home.
139.A forestry woman with pneumonia treatment - IV amoxicillin and Clindamycin
140.Preganant lady with shrunked kidney and cortical scarring - Reflux nephropathy
141.Man with features in keeping with Kaposis (HHV 8)
142.Patient with headaches only releieved bby lying down - CSF leak
143.Laboratory features of AML and elevated Monocytes AmL (Monocytic)
144.Features of promyelocytic AML, urgent investigation.- Clotting profile
145.HIV patient with plenty drugs and couldnt remember but is cyanosed, which drug is likely Dapsone
146.Patient with BET Propranolol or Primidone
147.Pregnant lady with features of -Non rem sleep disorder
148.Woman with features of autoimmune haemolytic anaemia Give prednisolone
149.Patient develops bigeminy all through the rhythm strip and has had palpitation all day.
Reassure/ Bisoprolol or EPS study
150.Features in keeping Botulism
151.Patient with features in keeping with Syringomyelia in the lumbar region
152.Patient with features in keeping with sub acute combined generation of the cord.
153.Woman with valvular haemolysis and MCV of 102fl Serum haptoglobin
154.Likely orgasim related to GBS campylobacter
199.Patient with features in keep TB and pleural effusion Bronchial washing gives the highest
yield
200.Lady with good glycaemic control and BP control but smokes Counsel patient to stop
smoling.
1- temporal arthritis additional treatment - aspirin
3- pregnant lady with reflux - alginate
4- takayasu arthritis
reassurance
30- patient after admission with MI deteriotes, saturation increases from right atrium to right
ventricular - vsd
32- in copd which would decrease the recurrence of attacks - inhaled steroids ?LTOT
33- small cell carcinoma patient coming with positive Romberg test - lambert eaten
34- budd chiari - Doppler ultrasound abdomen
35- amytripline overdose - bicarbonate
36- patient on lithium, urine and osmolality results were given after water deprivation and
desmopressin test, no improvement seen - nephrogenic diabetes ins
39- a lady with positive IgM and alp but asymptomatic - ursedeoxycolic acid
40- patient who has long term catheter, grown 10 over 5 coliform and pseudomonas but
patient asymptomatic - no treatment required
42- lady with loose teeth and jaw pain - necrosis of jaw
43- pregnant patient which tablets to stop - ramipril
44- patient on amiodorone developed hyperthyroidism treated with carbimaxole but still
hyperthyroid low intake of iodine - treat with prednisolone
45- Charcot joint on xr - resting the foot
46- patient with urethral discharge, conjunctivitis and arthritis, gram stain negative - treat for
chlamydia > doxycycline
47- patient developed breast cancer previous history of radiotherapy - most likely cause is
radiotherapy
48- pheochromacytoma on ct scan - treat with Alpha blocker
49- subacute combined degeneration symptoms - check b12
50- patient on methotrexate develops sore throat, initial investigation - check FBC
51- patient with AF previous stroke asking which one weighs more when you decide warfarin
- previous stroke
52- ITT analysis - add all the patients
53- CKD patient with low calcium high phosphate and pth - treat with calcidol
54- primary hyperparathyroidism
55- bilateral leg swelling, old lady has erythematous lesions in both legs asking initial
78-eplerenone
79- patient with history of childhood scarlet fever had biatrial enlargement raised jvp normal
heart size - constrictive pericarditis
80- coal worker has nodular changes on cxr - ?pneumoconiosis
81- locked in syndrome
82- dextrocardia - ECG
83- ECG - wpw
84- ECG - pr prolonged
85- ECG - avnrt
86- HSP - patient with diarrhoea now has purpuric rash
89- patient on dialysis comes wth temps very high ferritin and rash - adults still disease
90- lead poisoning - sodium edta
91- fascioscapulahumeral muscle atrophy - this is the patient who cannot whistle
92- patient with quadriceps and hand flexor weakness - inclusion myosytosis
93- patient with chest tenderness, high total protein, low albumin, had anaemia and renal
failure - myeloma
94- skull xr - pagets
95- eplerone to increase mortality 96- returning traveler, lady comes with myalgia a month later after returning back - HIV
SEROLOGY
97- inclusion body on histology - ganciclovir
99- elderly patient who looks like palliative patient has seizure and becomes unresponsive
with twitches - sc midazolam
100- benign positional vertigo
101- IV drug user on methadone, healing scar with muscle weakness - GBS
102- Lewy body dementia
103- depressive disorder - old lady who was playing piano before she had a stroke
104 - ear infection - pseudomonas
105- 18 year old guy with purulent sputum previous infections grown pseudomonas in sputum
- CF
106- lady post mastectomy with lung infiltrates - radiation pneumonitis
107- patient with previous pulmonary haemorrhage with microscopic polyangitis now has
temps high crp and right sided consolidation - pneumococcal pneumonia
108- farmer diagnosis is leptospirosis - treat with benpen
109- eosinophilic pneumonitis
110- pregnant lady with jaundice deranged lfts - acute fatty liver of pregnancy
111- Tb patient - negative pressure room and masks
112- retinal detachment
113- CT - hydronephrosis
115- disseminated gonorrhoea
116- what to do with warfarin before surgery - stop and swap to lmwh before surgery
117- patient with angioedema who used the adrenaline first time - FFP
118- Asian lady previously had blood transfusion - hepatitis c serology
119- hypothyroid myopathy
120- duedonal biopsy for coeliac
121- lady with diarrhoea negative coeliac screen, started gluten diet and stopped lansoprozole
- ?IBS
122- patient on ciclosporin started on diltiazem - diltiazem&ciclosporin interaction
123- diabetic patient wth very high triglyceride - ?fibrate treatment
124- bed bound patient with pressure sores, also diabetic - bed arrangement
125- severe diarrhoea and dehydration in returning traveler asking the cause of renal failure ATN
126- lady with painful lesion on her legs, previously given antibiotics for shortness of breath
and cough - I thought this is sarcoidosis and question was asking the investigation cxr
127- young gentleman comes with bloody diarrhoea, normal bowel sounds asking for urgent
investigation AXR to rule out toxic megacolon
128- patient on dopamine agonist becomes very psychotic - dopamine side effect
129- HIV positive lady who is psychotic as well, very restless and talks quickly - ?
amphetamine ? cannabis
187. scenario with high K 7.5 and creat 1000 with atrophic kidneys , what to do first calcium
gluconate
188. abnormal blood results Na low, K high hypoadrenalism
189. drug abuser with CXR changes , likely lung abscess Cef + Metronidazole
190. Old man found at home with high CK Rhabdo
191. Suspected Lung cancer sputum cytology
192.Girl with back pain and diarrhoea IBD
193. ICU patient first cxr pic showed collapse, 2nd one showed resolution, what happened
(chest) physio
194.Woman with longstanding backpain and ibuprofen use Interstitial nephritis
194. Man with fall, high BP CT showed adrenal tumour alpha blockers
195. CT head pic of old man ? bleed ? mass - ? Dexamethasone
196.Asian man with skin changes, woods light showed bluelight (leprosy) dapsone
197. Woman with cancer treated by chemo and radiotherapy, now developed another cancer,
why Radiotherapy
198.HIV man CD4 90 with rigors - ? Non hodgkins ? visceral Kaposi
199.CXR of an ITU px - ?ARDS
200.Man with chronic chest, fine end inspiration crackles, restrictive on lung fxn
Hypersensitivity Pneumonitis
201.Lady with high calcium, high PTH, scan shoed adenoma parathyroidectomy
202.Man with diarrhoea, CRP 4 loperamide
203. Girl with bloody diahroea, AXR showed empty colon - ? UC
204. Gallstone ileus
205. Young girl under inv for proteinuria and leg swelling, renal biopsy showed Focal
segmental , management - ?Prednisolone
206. CXR of African farmer - ? miliary TB
207. Cause of retinitis in HIV pt >>> cytomegalo virus.
209- A case of PKD with loin pain >>> diagnosis is acute rupture to cyst.
Quick recall.
177- Patient with recurrent unexplained proteinuria >> investigation >> renal biopsy.
178- Long term O2 therapy.
179- Young pt with ataxia and deranged liver function >>> serum caeruloplasmin. This question is
different from the tatoo pt ques which I don't remember my answer to it.
183- Elderly with recent travel and hepatomegaly with supraclavicular lymph node >>> leukaemia.
184- COPD with type 2 respiratory failure but pt conscious >> NIV.
185- Pt with SOB and chest pain , blood gas shows respiratory alkalosis >> PE.
187- Scenario of dermatitis herpetiformis.
188- Cor pulmonale.
189- Pt with low K , low HCO3 >>> diuretic abuse.
191- Alcoholic with heart failure >> most probably dilated cardiomyopathy due to alcoholism.
192- Cholestramine for diarrhoea post ileal resection.
194- Cause of hypokalaemia >> distal tubular acidosis.
Relapsing polychondritis
Disseminated gonorrhoea
Meningococcal meningitus
Svt with aberrant conduction
Avnrt
Dextrocardia
The guy with the lesion on chin , bleeds on touch , increased in size .... nodular melanoma ?
Intradermal naevus?
Ct chest .. thymoma ? Lymphadenopathy?
Mps... irreversible inferior defect .
202- Pt with suspected septic arthritis >> investigation >> synovial fluid analysis.
203- Pt with CAP >> treatment >> co-amoxiclav+azithromycin.
204- ECG>> AVNRT.
206- Menopausal woman , investigations showed no evidence of osteoporosis >> treatment >>
oestrogen replacement.
207- Major depression >> treatment >> paroxetine.
IgA----------Dermatitis herpitiform
anorexia nervosa---------fine hair in face
marfan-------fibrilin
acne rosare------------ tetracycline
scar of rosea----- isotriton
klinfilter------karyotype
ACTH tumer----smal cell ca
50% stenosis-------Asprin
c: 9:15------pancreatic ca
osteoarthritis--------paracetamol
rhynoid case----------malabsorption
recurrent abortion------anticardiolpin
poly cyctic ovarian--------increase insuline resistanse
CMV------IV GANCLOVIR
CIPROFLAXACINE---------CONTRA INDICATED IN PREGNENT
less than 2 pnemothorax-------- discharge
plasmodium vivax---chloroquen
insitu hybridization-----prob for DNA
methemoglobine-------fe2---to----fe3
neuroleptic malgnant hyperthermia---muscle regidity
pancytopenia+vittiligo+ hymolysis--------------- pernicios anemia
cd20-------non-hodgkin lymphoma
anisa, May 30, 2011
#1
1.
anisaGuest
May 2011
Neurology
1.NPH
2.CJD
3.Na Valproate and OCP-Lamotrigine
4.Syrinx
5.L5S1 disc prolapse
6.Motor neuron disease-long standing DM with both UMN and LMN
7.Hemisection of the cord
NEPHROLOGY
17.APKD- USG screening for all 1st degree relatives
119.Thiazides- DCT
20.Ca Colon post OP- Membranous nephropathy
21.ARF with hypotension- ATN
22.Rhabdomyolysis with ARF
23.CRF with hyperkalaemia with uraemia- Haemodialysis
25.PVD with proteinuria with difff in lidney size- Ischaemic nephropathy
26.Poat renal transplant with acute rejection- Methyl prednisolone
27.RA with 4+ proteinuria- amyloidosis
28.IGA - Mesangial hypercellularity
29.HTN with HYPOKALAEMIA with increased renin- Renal artery stenosis.
GENETICS
33.CF parents with carrier chance-0%
34.Hemophilia A- 25% chance
35.Hereditary Hgic telengectasia- AD
36.Marfans-fibrillin
37.only males affected- Xlinked recessive
38.chromatids into chromosomes- prophase,mine wrong- telophase
39.Klienfelters- chromosomal analysis
40.PCR-CSF viral meningitis
41.probe for DNA- in situ hybridization
DERMATOLOGY
42.Porphyria cutanea tarda
44.Scabies-Rx.topical insecticide,mine wrong- topical antibiotic
45.Scaly rash with hair involvement- DLE
46.Rx for Acne rosacea-tetracycline
47.Resistant rosacea- ?????
49.diplopia with cranila nerve- 6th cranial nerve palpsy
50.Dermatits Herpitiformis- IGA
51.smooth lesion over temple- sebaceous cyst.
ENDOCRINOLOGY
52.Gprotein- menbranes
53.acromegaly- Inx- GTT with serial GH measurements
54.reduced FSH,LH,cortisol- Hypopitutuarism
55.Anorexia Nervosa-lanugo hair
56.Hypothyroid on RX- Increased TSH with NT4- First complaince then t3
GASTROENTEROLOGY
71.Elderly with reflux esophagitis with ?Barrets- Adeno Ca eosophagus
72.Chronic Pancreatitis- confirming Dx- ERCP/CT.
73.UC- Reducing long term relapse- Azathioprine
74.IBS- no relief after defecation /wake up in the middle of night
75.pseudomembranous colitis- cephalosporins
76.Diarrhea after cholecystectomy- Rx.Cholestramine
77.Diarrhea-HUS--- E.cole 0157
78.IV drug abuser with HCV Ab- Chronic HCV
PSYCHIATRY
80.Hypochondriac
RESPIRATORY
86.COPD on inhalers, mildly confused-- nebulization with brochodilators/NIV
87.COPD with high pco2- stop O2
89.Profound vomiting- Metabolic alkalosis with hypokalaemia
90.occupational asthma- serial PEFR
91.EAA-Barley/Isocyanite....MINE WRONG
92.Ca lung, contraindication for surgery-- Brachial plexus invasion
93.Legionares pneumonia- Urinary Ag
95.Low PH and low glucose pleural fluid- TB
96.Pulmonary infarction.. reduced TCO
97.Pneumothorax ,1.5cm.. discharge
130.High calorie-cheese
131FactorV mutation- activated protein C.MINE WRONG.
132.IV-IG
OPHTHALMOLOGY
134.RA-scleritis
135.macular degeneration-smoking, i put glaucoma
136.acute angle closure glaucoma
137.bone pigment for the tubular filed ??? -?? RP
138.asprin-rash,
139.fluocoacillin for that abscess question
140.Anxiety with ambulatory ECG free during the attack--> observe
PHARMACOLOGY
145.NHL-antiCD20
146.confusion and tremor-lithium toxicity
147.Allopurinol-xanthine oxidase inhibitor
148.methhemoglobinemia-Ferrous to ferric
149.Prolactin-metaclopramide
150.teratogenic-Ciprofloxacin i think
151.Imatinib-tyrosie kinase inhibitor
INFECTIONS
153.E-coli..??First-Ciplox OR loperamide
152.Diarrhea in Nile cruise-shigella
153.MAC--???GLOVES /??? pulmonary isolation
154.P.Vivax-First Rx-choloroquine
155.Tic typus
156.diptheria
157.Pneumonia with SIADH
158.Recuurnet gononnhea-arthropathy
159.Rx.Gancyclovir
160.Osteomyelitis
HAEMATOLOGY
161.symptom of Myelofibrosis-fatigue
162.ALL prognostic factor--BCR ABL mutation/Hypertension
163- one more controversial Q-??pernicious anameia/cealiac disease/autoimmune hemolytic anemia
164.PV-jak 2 mutation
165.Patent foramen ovale
STATISTICS
166.I have put Chi square test
167.Sensitivity
168.Standard deviation
169.drug was removed from market, now for adverse effect chasing what to do systemic
review/metanalysis adverse effect mointoiring
170.10% /2%
185.brainstem herniation
186.Ramipril only- LV dysfunction with no cardiac failure
187.Post mastectomy - ???reconstruction/?? Dumping syndrome. NOT SURE..
188.Pancreatic ca--CA-19-9
Hi Guys
What will be the cut off around.????
++May 2011 last update
Neurology
1.NPH
2.CJD
3.Na Valproate and OCP-Lamotrigine
4.Syrinx
5.L5S1 disc prolapse
6.Motor neuron disease-long standing DM with both UMN and LMN
7.Hemisection of the cord
NEPHROLOGY
17.APKD- USG screening for all 1st degree relatives
19.Thiazides- DCT
20.Ca Colon post OP- Membranous nephropathy
GENETICS
33.CF parents with carrier chance-0%
34.Hemophilia A- 25% chance
35.Hereditary Hgic telengectasia- AD
36.Marfans-fibrillin
37.only males affected- Xlinked recessive
38.chromatids into chromosomes- prophase,mine wrong- telophase
39.Klienfelters- chromosomal analysis
40.PCR-CSF viral meningitis
41.probe for DNA- in situ hybridization
DERMATOLOGY
42.Porphyria cutanea tarda
49.diplopia with cranila nerve- 6th cranial nerve palpsy -----correct is IOP
50.Dermatits Herpitiformis- IGA
ENDOCRINOLOGY
52.Gprotein- menbranes
53.acromegaly- Inx- GTT with serial GH measurements
54.reduced FSH,LH,cortisol- Hypopitutuarism
55.Anorexia Nervosa-lanugo hair
56.Hypothyroid on RX- Increased TSH with NT4- First complaince then t3
57.Ramipril- for HTN with DM with proteinuria
58..Elderly female-Primary Hyperparathyroidism correct answer -----TSHpituirary tumer
59.low ca,low phos- Osteomalacia
60.Hypercalcaemia-cause- Thiazides
61.young onset DM- Insulin
62.Hypothyroid with wt loss with borderline BP- IV Hydrocortisone
64.HTN with >70u alcohol,Na-138,K-3.8,obese,Urinary cortisol-300- Alcohol induced i think
-------correct is cushing diseease
65.Sick Eu thyroid-normal free T4
66.Post partum thyroiditis -----correct is hashimoto
67.MEN1- Parathyroid with prolactinoma
68.ACTH-Small cell CA
69.carcinoid-------------flushing or hymoptysis
70.PCOS-insulin resistance
GASTROENTEROLOGY
71.Elderly with reflux esophagitis with ?Barrets- Adeno Ca eosophagus
72.Chronic Pancreatitis- confirming Dx- CT.
73.UC- Reducing long term relapse- Azathioprine
74.IBS- no relief after defecation /wake up in the middle of night
75.pseudomembranous colitis- cephalosporins
PSYCHIATRY
80.Hypochondriac
RESPIRATORY
86.COPD on inhalers, mildly confused-- nebulization with brochodilators/NIV
87.COPD with high pco2- stop O2
89.Profound vomiting- Metabolic alkalosis with hypokalaemia
90.occupational asthma- serial PEFR
91.EAA-Barley/Isocyanite
92.Ca lung, contraindication for surgery-- Brachial plexus invasion
93.Legionares pneumonia- Urinary Ag
94.Alpha 1 antitrypsin- Neutrophil elastase inhibitor
95.Low PH and low glucose pleural fluid- TB
96.Pulmonary infarction.. reduced TCO
97.Pneumothorax ,1.5cm.. discharge
98.Reduced intensity of AS murmur- heart failure
99.Cardiac tamponade-pulsus paradoxus
100.75yrs man Paroxysmal AF- Rx-Flecainide/sotalol
101.Hemiparesis with AF-Warfarin/aspirin
102.50% Carotid stenosis with 3 TIAs in 2/52 Asprin/endarterectomy
103.Pt with edema,ascites,raised JVP- Constrictive pericarditis.
IMMUNOLOGY
125.Live attenuated vaccine-yellow fever
126.Recurrent infections- CHEDAK HIGASHI syndrome- Neutrophil.
127.CLL-hypogamaglobulinemia
128.probe for DNA- in situ hybridization
130.High calorie-cheese
131FactorV mutation- activated protein C.MINE WRONG.
132.IV-IG
OPHTHALMOLOGY
134.RA-scleritis
135.macular degeneration-smoking, i put glaucoma
137.bone pigment for the tubular filed ??? -?? RP
138.asprin-rash,
139.fluocoacillin for that abscess question
140.Anxiety with ambulatory ECG free during the attack--> observe
141.VSD - v/q more at the apex in upright lung
142.vital capacity for GB
143.Short term memory- Korsakoffs Psychosis
144.Neuroleptic malignant syndrome-muscle rigidity
PHARMACOLOGY
145.NHL-antiCD20
146.confusion and tremor-lithium toxicity
147.Allopurinol-xanthine oxidase inhibitor
148.methhemoglobinemia-Ferrous to ferric
149.Prolactin-metaclopramide
150.teratogenic-Ciprofloxacin i think
151.Imatinib-tyrosie kinase inhibitor
INFECTIONS
153.E-coli..??First-Ciplox OR loperamide
152.Diarrhea in Nile cruise-shigella
HAEMATOLOGY
161.symptom of Myelofibrosis-fatigue
162.ALL prognostic factor--BCR ABL mutation/Hypertension
163- one more controversial Q-??pernicious anameia/cealiac disease/autoimmune hemolytic anemia
164.PV-jak 2 mutation
165.Patent foramen ovale
STATISTICS
166.I have put Chi square test
167.Sensitivity
168.Standard deviation
169.drug was removed from market, now for adverse effect chasing what to do systemic
review/metanalysis adverse effect mointoiring
170.10% /2%
185.brainstem herniation
186.Ramipril only- LV dysfunction with no cardiac failure
187.Post mastectomy - ???reconstruction/?? Dumping syndrome. NOT SURE..
188.Pancreatic ca--CA-19-9
189.Tooth extraction in vwf DDAVP
190.coccain--------------heart block
191.osteoarthritis..Rx-paracetamol
192. pregnant woman with TTP--------------PLASMA EXCHANGE
193.Eczematous skin lesions- gloves
194-radiological pnemonitis
196.NAC-- toxic metasbolites reduction by replenishing glutathione
1.
Pictures:
1) Mobitz Type 1 degree heart block
4) Hydropneumothroax
6) Granuloma annulare/ tinea manuum
7) Solar Keratosis
8) Pyogenic Granuloma
9) Refsums
10) Hydropneumothorax
11) Wheezy patient with HIV but normal CD4 count. 2 previous episodes of SOB but resolved
spontaenously. B/L expiratory wheeze on clinical examination otherwise unremarkable: Asthma/?PE
12) Patient with collapse followiing standing up but takes 1 hour to recover: Tilt Table test
13) Old lady with halos on vision towards end of the day: Closed angle Glaucoma
15) 46 year Old lady with high oestroden and Prolaction: - Pregnancy
17) The classic verm rash on the abdomen wheezy high eisonophil count: Strongyloides
18) Diabetic patient uncontrolled with Metformin and Glic: Start Insulin
20) Bilateral swelling of hands and painful wakes up at nigh: Carpal Tunnel
Respiratortry
1 sarcoidosis
2 immidiate intubation for man with copd and exacerbation +respiratory failure type 2
3 chest tube for 2ndary pneumothorax
4 refer to surgeon for brochopleural fistula
5 asperegilosis for asthmatic with central bronchiactisis
6 left lung consolidation in cxr
7 Pregnant pneumonia Clarithromycin
8 carboxy heamoglobin more tha 15 %
Neurology
1 tuberculoma
2 herpis simplex encephalitis do pcr
3 picture of herpis simplex encephalitis
4 mri show epidural abcess
5 osteoporotic vertebral collapse on mri
6 ct show subarcinoid heamorheage
7 add lamotrigine for patient with epilepsy
8 Pt with vertigo with fatigable nystagmus on hellpike test- benign positional vertigo
9 pt with syncope multiple episodes ,every time preceded by standing- next investigation: do EEG
10 pt with bilateral SNHL and LMN facial palsy: cerebello pontine angle tumor
11 Anorexia nervosa in young female with wt loss
Cardiology
1 ECG 2nd degree type 1 heart block
2 ECG rapid AF +history of biventricular block give digoxine
3 ECG acute inferior MI do PTCA
4 ECG acyte anterior mi then arteial thrombosis
5 thin septum +thick apex tacupso cardiomyopathy in japanies man
6 do DC for rapid VT picture
7 stop amilodipine for leg eadema
1 young famle upset about change of hospital consultant and self harm diagnosis depressive disorder
Infectuous
1 acute septicimia streptococal pyogen
2 Dog bite augmentin
3 cmv after transplantation
4 hepatitis a patient came from eyjept
Heamatology
2.
Partha SarkarGuest
96.pt obese,bp around 190,lft deranged, cholestrol and triglycerides increased- reduce wt/add
simvastatin
97. For episodes of break through pian ,dose of immediate release morphine- 5mg
98. CT SCAN- SAH
99.pleural fluid ,ldh >0.6, glucose 1.5- rheumatoid arthritis
100.pleural fluid ldh > 0.6- .? Bronchial ca
Partha Sarkar, Dec 17, 2012
#4
3.
Partha SarkarGuest
113.Pt with vertigo with fatigable nystagmus on hellpike test- benign positional vertigo
114.
relativs of a newly diagnosd 80yr male wd alzeimr ask abt treatment response ....... ans . treatment may
or may not work
116.pt with syncope multiple episodes ,every time preceded by standing- next investigation: tilt table
test/eeg
117.pt on long term urinary catheterisation: most likely organism for uti ?pseudomonas
118.pt with crohn's with distal ilitis and two strictures: rx of underlying disease:
prednisolone/azathioprine/ mesalazine/surgery
119.lond term history of ulcerative colitis presents with itching and fatigue- primary sclerosing
cholangitis
4.
Partha SarkarGuest
151.omeprazole,lithium interaction
152. adult onset still disease
153.Lady with the dead father who wasnt speaking as she ws worried she will meet her dead father in
grave----bereavement ??
154.
155. The lady with carpal tunnel picture had neck pain and restriction to movements...cervical
spondilosis???
156. one was cryoglobunemia---hep c
157.palpitations side effects---diltiazem
5.
Partha SarkarGuest
169. started ARB ,, creatinine went up slightly.. but BP still high.. increase the doe of ARB
170. One q answer was Nesendoscopy
180 . one ca pt having spine metss suffering from pain , goin to start on bisphosphonates . what to do
before that? local irradiation? this qs ws diffrnt to that in which ansr ws dental assessment bf4 starting
bisphosphonates
181. pt sufferd hypovolemia , ressucitated , nw RFTS derrangd . this ws ATN/ARF they askd abt
prognosis . will it recovr completly/will go slowly into ckd/ will soon require dialysis???
182 . upper gi bleed pt , ressucitated nw wt to do? band ligation
In patients with hypercalcemia receiving saline hydration, we suggest not routinely using a loop
diuretic (Grade 2C). However, in individuals with renal insufficiency or heart failure, careful
monitoring and judicious use of loop diuretics may be required to prevent fluid overload. (See 'Saline
hydration' above.)
For immediate short-term management of hypercalcemia, we suggest administration of calcitonin (in
addition to saline hydration) only in patients with calcium >14 mg/dL (3.5 mmol/L) who are also
symptomatic (Grade 2B). (See 'Calcitonin' above.)
For longer-term control of hypercalcemia in patients with more severe (calcium >14 mg/dL) or
symptomatic hypercalcemia due to excessive bone resorption, we suggest the addition of a
bisphosphonate rather than gallium nitrate (Grade 2B). (See 'Bisphosphonates' above and 'Gallium
nitrate' above.)
the lady with protein + and blood + rash on the lower limbs and joint pain is microscopic polyangitis.
the lady with the flushing and sweating and unable to moves her limbs in 2 occasions and had a
diarrhoea gullian barre or carcinoid.
there was a young lady with high urea and creatinine i choose ct scan head as next investigation.
there was an answer transesophageal echo.
in the blood cuulture i choose continue fusidic acid and vancomycin.
brochoscopy for sarcoidosis.
simvastatin myopathy polymositis is wrong age of onset shes 77.
Delusions
Hallucinations
Disorganized speech
Disorganized or catatonic behavior
Negative symptoms
Only 1 symptom is required under the following circumstances:
See behaviour of idealizing someone,, and suicidal tendency are not part of schizophrenia..
Partha SarkarGuest
175. Strongyloides
177. Cyanosis on hands but palpable pulses. Thoracic Outlet Syndrome. anyone agree with this>
178. Lady on OCP dull ache occiptal represented after 5 days. MRI Venogram
179. TB pericarditis
188. Pic with bitemporal visual deficits mainly in upper outer segments of visual fields. pituiatry
tumour or craniopharyngioma?
195. Normal Saline for low BP in Right heart failure next step
196. Membranous GN
Woman with history of Hodgkin lymphoma had radiotherapy now presented with breast carcinoma
with her mother having breast ca at age of 78
What was the cause of her breast ca
1. Family history
2. Radiation
Other options I Dunn remember
There is another question above in the list in which ionised calcium low and almost every one having
response no treatment required
Partha Sarkar, Dec 18, 2012
#12
Dermatology
1 granuloma anulare
2 seborric keratitis
3 molluscom cotagiosum
4 allopurinol cause of erythema multiform
Infectuous
1 acute septicimia after tonsilitis streptococal pyogen
2 Dog bite augmentin
3 cmv after transplantation
4 hepatitis a patient came from eyjept
5 What is the Underlying cause of low GCS HYPOXIA acyclovir toxicity
6 continue fusidic acid and vancomycin after the cuulture results
Cardiology
1 ECG 2nd degree type 1 heart block
2 ECG rapid AF +history of biventricular failure give digoxin
3 ECG acute inferior MI do PTCA
4 arteial thrombosis ECG acute anterior mi not stent thrombosis
5 Start ACE inhibitor for DM plus albuminurea
6 sodium nitropruside for bp control in aortic dissection
7 stop amilodipine for leg eadema not tenormin
8 ACEI induced angio edema
10 pressure profile of inferior mi with reight sided heart failure
Respiratortry
1 sarcoidosis
2 immidiate intubation for man with copd and exacerbation +respiratory failure type 2
3 chest tube for 2ndary pneumothorax
4 refer to surgeon for brochopleural fistula
5 allegic broncopulmonary asperegilosis for asthmatic with central bronchiactisis
6 left lung consolidation in cxr
7 Clarithromycin for Pregnant have pneumonia
8 carboxy heamoglobin more tha 15 % indicate severe poisining
9 Pleural effusion secondary to TB: Pleural biopsy & Aspiration
10 Pregnancy with acute exacerbation of asthma after beta agonist and oxygen - Iv hydrocortisone
11 rheumatoid arthritis cause of pleural fluid ,ldh >0.6, glucose 1 mml
12 Mesothelioma CT guided biopsy other options were thoracoscopy, pleural fluid
13 Increases TCO and KCO Churg strauss
14 Invasive aspergilosis Dyspnea, wheeze, eosinophil elevated, IgE 700
GIT
1 candidaiasis of patient with odynifagia
2 lond term history of ulcerative colitis presents with itching and fatigue- primary sclerosing
cholangitis
3 asthmatic pt with long term nausea and abd pain. small early esophageal varices on endoscopy.
observe and repeat endoscopy after 1 year
5 occult git bleading negetive upper and lower endoscopy do capsule endoscopy
6 alcoholic hepatitis
7 omeprazole,lithium interaction
8 Esophageal rupture
9 Radiation enteritis Bloody diarrohea after radiotherapy
10 band ligation for upper gi bleed pt , ressucitated nw wt to do
11 Refeeding syndrom hypomagnicimia
Renal
1 hyperparathyroidisim cause of risistance to erythropoitin in renal failure
2 memberanus glomerulonephritis in patient wit nephrotic syndrom and sle
3 post streptococal glomerulonephritis for patient with acute glomerulonephritis and low c3
4 lupus nephritis for patient with SLE and acute renal failure
5 Oliguria after hypotension Renal function reappear without specific treatment, other option was renal
function appear with prednisolone, renal function never normal, stable CKD
6 uti in inpatient give furadantin
7 Tubulointerstital nephritis inpatient treated with AB for pneumonia
8 Pregnancy safe antibiotic : cephalaxine
9 Nephrogenic DI on water deprivation test
Rheumatology
1 paget disease of bone in pelvic x ray
2 Polymyositis in High CK and painful
4 ANCA in patient with vasculitis and Pulmonary renal presentation what investigation
Heamatology
2 heparin induced thrombocytopeania inpatient with low platletes and thrombosis after prophylactic
heparin in surgury
3 heparin induced thrombocytopeania in young man with cva and systolic murmur
4 give radiotherapy before biphosphonates for patient with dorsal spine fracture and pain due to
myaloma
5 Check haptoglobin for aneamia + prosthetic valve
6 Long term management of DVT underlying malignancy after IMWH - warfarin
Neurology
1 tuberculoma all enhansing lesion in ct brain photo
2 herpis simplex encephalitis do pcr
3 picture of herpis simplex encephalitis
4 vertebral artery dissection
5 osteoporotic vertebral collapse on mri
6 ct show subarcinoid heamorheage
7 add lamotrigine for patient with epilepsy on sodium valproate
8 benign positional vertigo Pt with vertigo with fatigable nystagmus on hellpike test9 do EEG for pt with syncope multiple episodes ,every time preceded by standing- next investigation 1
hour returnt to normal with post ictal headache
10 MRI Venogram for Lady on OCP dull ache occiptal presented after 5 days.
11 Anorexia nervosa in young female with wt loss
12 Cluster headache - Sumitriptan for relieve
13 dignosis of headache type cluster headache
14 hearing loss and gidiness garamycin toxicity
15 viral meningitis in patient with short history + csf lymphocytosis and normal glucose
16 Locked In Syndrome for patient that can not move only vertically his eyes
17 Amyotrphic neuralgia option for patient with pain and weakness
18 Alzheimer tell patient to start treatment and if no response discontinue treatment
19 one qs abt Botuilisim
20 dendritic ucler of herpez in cornia
21 Non epilepsy attack disorder
23 GB syndrome
Psychatry
1 young famle upset about change of hospital consultant and self harm diagnosis depressive disorder
Partha Sarkar, Dec 24, 2012
#14
6.
Young lady which father died recently, her voice/speech was slowing down/decreasing and when she
was angry she was not able to speak out , she ws worried she will meet her dead father in grave----?
bereavement, akinetic mutism, Depression, Conversion disorder: which one is the correct answer
Patient who underwent colectomy for Colitis, later admitted to ICU, still with signs and symptoms of
sepsis---- fumigans infection??Since H/O colectomy I went for GIT normal flora like bactericides,
streptococcus bovis (cant remember which one was in choice), any idea?
Anyone can remember a question from Charcot joint: Diabetic pt with swollen joint , was asking best
investigation: x-ray, Indium labeled WBC scan.
Well, for systemic mastocytosis: pt is usually young, abdo pain, diarrhea, flashing, urticaria &
mastocytosis in bl film. For carcinoid: most common in elderly, average 61, flashing, diarrhea, abdo
pain, urinay HIAA but NO URTICARIA. Guys which one was the answer?
7.
Neurology 1 tuberculoma 2 herpis simplex encephalitis do pcr 3 picture of herpis simplex encephalitis
4 mri show epidural abcess 5 osteoporotic vertebral collapse on mri 6 ct show subarcinoid
heamorheage 7 add lamotrigine for patient with epilepsy 8 Pt with vertigo with fatigable nystagmus on
hellpike test- benign positional vertigo 9 pt with syncope multiple episodes ,every time preceded by
standing- next investigation: do EEG 10 pt with bilateral SNHL and LMN facial palsy: cerebello
pontine angle tumor 11 Anorexia nervosa in young female with wt loss Cardiology 1 ECG 2nd degree
type 1 heart block 2 ECG rapid AF +history of biventricular block give digoxine 3 4 ECG acyte
anterior mi then arteial thrombosis 5 thin septum +thick apex tacupso cardiomyopathy in japanies man
6 do DC for rapid VT picture 7 stop amilodipine for leg eadema 8 Right bundle branch block 9 family
history most important prognostic factor for hocum 10 pressure profile of inferior mi with reight sided
heart failure 11 normal saline for patient with rheight sided heart failure 12 pregnant with hypertention
use ca channle blocker amilodipine 13 cyanide poisining in patient receiving angisid drip
Rheumatology 1 paget disease of bone in pelvic x ray GIT 1 candidaiasis of patient with odynifagia 2
lond term history of ulcerative colitis presents with itching and fatigue- primary sclerosing cholangitis
3 asthmatic pt with long term nausea and abd pain. small early esophageal varices on endoscopy.
observe and repeat endoscopy after 1 year 4 NASHbest managment wt reduction
Endocrinology and metabolisim 1 rasburicase to prevent tumer lysis syndrom 2 acute thyroiditis for
patient with acute thyrotoxicosis and tender thyroid 3 cabeguline for hyperprolactinoma 4 disturbed
hormonesin pregnancy in 46 year old lady 5 microadenoma in a man with himianopia and mri with
pituitry mass 6 case with insulin miss use with reletive with diabetes Renal 1 hyperparathyroidisim
cause of risistance to erythropoitin in renal failure 2 memberanus glomerulonephritis in patient wit
nephrotic syndrom and sle 3 post streptococal glomerulonephritis for patient with acute
glomerulonephritis and low c3 4 lupus nephritis for patient with SLE and acute renal failure 5 cyst
infection in patient with autosomal dominant pkd treatment cefotaxime 6 uti in in patient give
furadantin Psychatry 1 young famle upset about change of hospital consultant and self harm diagnosis
depressive disorder Infectuous 1 acute septicimia streptococal pyogen 2 Dog bite augmentin 3 cmv
after transplantation 4 hepatitis a patient came from eyjept Heamatology 1 INR 10 no bleeding,warf
What is the answer of rash around umbilicus?
rash umbilicus-psoriasis
face-seb.dermatitis
eczema herpeticum
According to FDA clarithromycin is class C drug, and in on study "The rate of spontaneous abortion in
the clarithromycin group was statistically higher than in the control group (14% versus 7%), although
the authors suggest that the difference could be due to confounding factors not controlled by their
study".
The manufacturer recommends that clarithromycin not be used in pregnant women except in clinical
circumstances where no alternative therapy is appropriate and the benefit justifies the potential risk to
the fetus. If pregnancy occurs during therapy with clarithromycin, the patient should be apprised of the
potential hazard to the fetus.
On the other hand :Amoxicillin has been assigned to pregnancy category B by the FDA. Animal studies
using 10 times the human dose have failed to reveal any evidence of teratogenicity. Although no
controlled data in human pregnancy are available, literature reports of adverse fetal effects are lacking.
15/01/13 Exams:
9. woman with heamophilia B asked if she has a son what chances of him having dx - 50% ?
11.What immunoglobulin gives false positive in any gastic parietal antibody - ? Igm ? IgA
13. 20 week old pregnant with new shiny lesion - Acanthosis nigricans ?
14. question about cause of hypokalemia and patient is hypertensive - ? Liddles syndrome
17.Which cell cycle stage do the nuclei cover the 2 daughter cells - telophase ( i think)
20. question about new drug to different side of the face. measurement taken before and after treatment.
what significance test to use ? - ??Wilcoson rank test
22. man with HIV develops discoloured lesion ( kaposi sarcoma i think). what virus - HHV-8
23. Question about a man with a couple of symptoms, and he had hypercalcemia - Sarcoidosis
24. 20 week pregnant lady with previously well controlled diabetes who presented with a couple of
collapse , what do you think is contributing - folate def?
25. man who is a diabetic, a smoker and regular user of illicit drugs presents with ago pain, vomiting
and diarrhoea, what drug is he withdrawing from - ? cocaine ? heroin ? alcohol ??
27. man presents with recurrent bacterial chest infections, what is deficient - C4 complement
30. drug treatment for idipathic parkinsons only ( no dopamine agonists in option) - ithink options were
entacapone, amantadine, benxhexol, sellegilline, levodopa
32. Another patient, known HIV CT- non enhanced mass - PML
33. Patient with cerebella signs, sensory loss and horners where is the lesion - PICA
34. Woman with dizzines and vertigo especially when she turns in bed - BPPV ??
36.Diabetic neuropathy, not responsive to amitriptyline ( i think ) what else do you give ( no duloxetine
in option) - pregabalin ( i think)
37. what cause of community acquired pneumonia causes heerpes labials - s. pneumonia
39. Young man with purpuric rash and abdo pain , what to see on renal - Messangial hyper cellularity
( patient has henoch scholen )
41. patient known cops with acidosis on abg, but on 60% o2 - reduce to 24% ( and repeat ABG I guess
43. Man who makes repeated uncontrolled neck movements and unintentional sounds - Gilles de
tourettes
45. Scenerio in which a patient had hyocalcemia and low PO4, question is what caused the
hypocalcemia - hypomagnesemia
51. Girl comes in with graves disease but has eye complications - carbimazole. radioiodine contraind
54. Doctor prescribes digoxin for patient and says it will take some time before effect seen, why - half
life
59. man with 3 weeks history of symptoms suggestive of endocarditis. had prosthetic valve 2 months
ago. - s viridans ( no s epidermis in option thankfully)
62.when to give glcoproeitn iib/iiia - high risk awaiting angio within 96 hrs
63. Parmanent pacemaker indications on ECG - ????Trifasicular block, ???? intermittent 3rd degree av
block ( with no other symptoms)
65. Patient with stable angina, what improves prognosis - Aspirin ???
66. Patient with symptoms of headache, hypertension and other symptoms I first thought of coarctation
of aorta, but then it says there were no radial or femoral pulses present - Takayasus' disease
67. man with fever and cough, took amoxicillin last week, cultures ; gram positive cocci, then it said
staph aureus somewhere. treatment? - ? coamoxiclav ???
68. young woman with SOB and chest pain. bilateral fine crackles - ? myocarditis
69.Patient who has had PCI following MI, develops badycardia cardiogenic shock
71. Man after angioplasty with purpura and funny toe - cholesterol emboli
72. Man with mediastinal cough and weight loss. cxr showed signs suggestive of cancer. he had cxr
four months ago which was normal. what cancer ( tricky... all the lung cancers were there - I chose
small cell
73.patient with mettalic heart valve with ? bruising and falls. warfarin stopped. what to do - start on
heparin
75. Chronic smoker with purulent sputum , SOB, ABG showed type2 RF - COPD
76. COPD man acute presentation, ABG -ph 7.30, pco2 9.2, po2 8., what's the appropriate next step NIV
77. Lady who presented with pneumothorax , reinflation successful, what should she not do - scuba
diving ( i chose this), the other option was not flying for 2 months
78. Patient being investigated for dysphagia, has signs of raynauds , what is the cause of his dysphagia
- Oesophagial dysmotility ( CREST syndrome)
79. Man with cxr showing pleural effusion, what is the next inv - ?USS lung, ?CT chest ( patient
presented with weight loss and is a known IVDU)
81. 82. man with rectal pain and rectal bleeding - Ischaemic colitis
83. Girl with abnormal LFT, elevated IgG and has developed amnorrhoea - Autoimmune Hepatitis
84. Middle aged lady with diarrhoea alternating withconstipation and pain - IBS
85. Man complains of gingival hyperplasia, is hypertensive, what drug to give - losartan
86. Man whose wife died 3 months ago in a car accident, presents with social withdrawals and vivid
dreams - ? PTSD, ?Grief reaction
87. Man who assaults his wife, showed no remorse,hasnt slept for 2 days, says he cant be prosecuted
because he has friends in high places - manic attack
89. Young man with leukaemia, and renal disease... what type of gromerulonephritis - Membranous
(right?)
91. Man with G6PD def wants to travel to Africa. What medication to avoid - Primaquine
93. Patient with gout, frequent flares, last one 3 weeks ago, controlled with ibuprofen. what next? - add
allopurinol
94. Pregnant lady with blood result suggesting subclinical hyperthyroid, not symptomatic. what next - ?
repeat TFT in 1 month???
95. Man with p falciparum malaria and platelet 46, started on quinine. what to do about
thrombocytopenia - I say do nothing for now. treating malaria will bring up platelet count ( i think you
transfuse when platelet below 35 or so???)
98. Woman presenting with severe expression of both comprehension and expression of language global aphasia
2) 50 years old man , good past health, admitted for fever , CXR showed consolidation and ABG
showed decrease pO2
what antibiotic :
1) amoxil + erythromycin
2) Co amoxiclav
3) diabetic elderly with isolated systolic HT b.p 188/88. what is the antiHT of first choice.
1) calcium channel blocker
2) B bloker
3) valsartan
4) thiazide diuretic
4) a 78 yrs oldfemale presnets with back pain.examination shows dorsal kyphosis otherwise she looks
well
urea 9 crea 135 esr 12 ca 2.7
1- mmyelma
2-hyperparathyrodism
3-bone metastases
5) patient with mutiple muscle tenderness , diagnosis is fibromyalgia , what is the 1 st choice of
treatment :
1) Naprosyn
2) amitriptyline
3) cognitive behaviour therapy
4) steroid
6) known history of depression under treatment with anti depressant , come to school with snaked and
claimed he can saved the child from suffering, what is the likely diagnosis:
1) hypomania
2) schizophrenia
3) over treatment with antidepressant
4) paedophilia
farmer with paronychia and lymphagitis , present with shock and fever,what is the diagnosis
1) toxic shock syndrome
2) Orf
....
9) HIV + VE CD4 < 50 P/C WITH 3 M HX OF CONFUSION + LT ATAXIA + LT HEMINAMOUS
HEMANOPIA.
CT SCAN LOW ATTENUATION DIFFUSELY BUT NO MASS EFFECTS OR ENHANCEMENT
1- PML
2- TOXOPLAMOSIS
3- CERBERAL LYMPHOMA
4- HIV REALTE DEMENTAIA
--
11) a 65 yrs old male with hx of pyschiatric disorder is being abusive to the nuses what is the best
choice of drug:
1-im chlorpromazine
2-recal diazepam
3-iv medazolom
4-oral halperidol
5-wait psyachatrist
14) boy with known allergy to bee sting, admitted after bee sting of the cheek , what is the most likely
reaction:
1) anaphylactic shock
2) uticaria rash
3) stridor
4) local redness
16) 38 YRS OLD FEMALE PRESNET WITH RT SIDED BLURRING OF VISION RT 6/18 + LT 6/6
V FIELDS RT DEFECT IN THE TEMPROAL AREA WITH SOME EXTENSION INTO THE
NASLA FIELDS + LT EYE PERIPERAL LOSS OF VISUAL FIELDS-SITE OF LESION
1- OPTIC NERVE
2- OPTIC RADIATION
3- OCCIPTAL
4- OPTIC CHIASMA
17) A 42 year old female presents following an episode of confusion associated with vomiting and
abdominal pain. She had a one month history of weight loss and receives thyroxine for hypothyroidism
which was diagnosed five years ago. On examination she appeared unwell, with a temperature of 37.5C
and her blood pressure was 100/50 mmHg. Investigations revealed:
sodium 130 mmol/L (137-144)
potassium 4.8 mmol/L (3.5-4.9)
urea 7.6 mmol/L (2.5-7.5)
glucose 2.7 mmol/L (3.0-6.0)
free T4 9 pmol/l (10-22)
TSH 1 mu/l (0.5-5)
Which one of the following given intravenously would be the most appropriate initial management?
Available marks are shown in brackets 1 ) Cefuroxime [0] 2 ) 10% Dextrose infusion [0] 3 ) Glucagon
[0] 4 ) Hydrocortisone [100] 5 ) Tri-iodothyronine [0]
1 A 70 year old woman with established aortic stenosis attends for annual review. Which one of the
following factors is the most important in deciding the timing of surgery? Available marks are shown in
brackets 1 ) Aortic valve gradient of 50 mmHg [0] 2 ) Left ventricular hypertrophy [0] 3 ) Valvular
calcification 4 ) The Patient's symptomatology 5 ) The intensity of the murmur
19) A 70 year old male with a 5 year history of type II diabetes mellitus presents for annual review with
a blood pressure of 188/88 mmHg.
Clinical examination was normal. An ECG reveals evidence of left ventricular hypertrophy.
Which one of the following drugs is the most appropriate treatment for this patients hypertension?
Available marks are shown in brackets
1 ) Atenolol
2 ) Amlodipine
3 ) Bendrofluazide
4 ) Doxazosin
5 ) Valsartan
19) A 32 year old woman presented with a six week history of 7kg weight loss and heat intolerance.
Investigations revealed:
free T4 45 pmol/L (10-22)
TSH <0.05 mU/L (0.5-5)
Which of the following features would support a diagnosis of Graves disease? Available marks are
shown in brackets 1 ) Family history of Radio-iodine treatment [0] 2 ) Lid lag [0] 3 ) Multinodular
goitre [0] 4 ) Pretibial myxoedema [0] 5 ) Unilateral exophthalmos [100]
20) A 29 year old female presents with acute right sided weakness. She has one child aged 4 years and
had two spontaneous abortions in the past. After the birth of her child she developed a DVT and
required three months anticoagulation with warfarin. Examination revealed a right hemiparesis. A CT
head scan showed a left middle cerebral artery territory infarct. What is the most likely finding on
echocardiography? Available marks are shown in brackets 1 ) Arterial septal defect [0] 2 ) Bicuspid
aortic valve [0] 3 ) Left atrial myxoma [0] 4 ) Normal appearances [100] 5 ) Ventricular septal defect
[0]
21)
A clinical investigation examined the effectiveness of a new test for diagnosing Panceatic carcinoma.
The sensitivity was reported as 70%. Which one of the following statements is correct?
23) 29 YRS OLD FEMALE PRESENTS WITH PURELNT COUGH ON WAKENING . BMI IS 32
MOST LIKEY CAUSE OF COUGH. NO HX OF ATOPY
1- OSA
2- SINSITIS
3- ASTHMA
4-reflux oesphagitis
24) MOST LIKELY OUTCOME OF WALDENSTORM MACRO IS
1- HYPERVISCOSITY
2- HYPER CA
3- CRF
25) 35 YRS OLD MALE PRESNTS WITH FLUSHING + PALPIATIONS + ABDOMINAL PAIN
AND DIARRHAOE FOR 1 M. HIS PAST MEDICAL HX IS UNREMARAKABLE APART FROM
RECENT ONSET OF ITCHY PAPULAR LESIONS ON THE TRUNKAND PAST PUD. THE MOST
LIKELY TEST THAT WILL REVEAL THE DIAGNOSIS WILL BE:
1-24 URINARY VMA
2-URINARY HIAA
3- URINARY METHLYHISTAMINE
I THINK IT IS 3 SINCE THE MOST LIKELY DIAGNOSIS IS SYTEMIC MASTOCYTOSIS SINE
THE DERMATOLOGICAL CONDTION PRESCRIBED IS MOST LEIKEY TO URTICARI
PIGMENTOSA
27) 58 yrs old male presnets with odema. 24 h urine proteinuria 12g/l. he fails to responds to
steroids.renal biopsy : LM+ IF NORMAL
MOST LIKELY DIAGNOSIS:
1-MINIMAL CHANGE DISEASE
2-MEN\MBRANOUS GN
3- FSGN
4-MYELOMA
5-PROLIFERTATIVE GN
I THINK TEH NASWER ID MYELOMA [ MYELOMA CAUSES AMYLOIDOSIS WIICH CAUSES
SECONADRY GD PRESNTING WITH NEPHROTIC SYNNDROME MCH IS NOT COMMMON
AT THIS AGE AND 90% WILL RESPOND TO STEROIDS>
2 patient with history of AMI and heart failure , which medication are contraindicated ?
1) bisoprolol
2) labetalol
3) metaprolol
4) sotalol
5) propranolol
29) a child present with sezisure while drilling of his teeth by a dentist, regain consciousness after
admission , also incontinence.
Dermis
S.corneum
S.basalis
Dermis
31) 76 yrs old man presents with supraclavicular lymphadenopathy
with cold agglutinin and DAT positive........
answers..
NHL
MYCOPLASMA
34) 18 years old girl with delayed puberty and altered bowel habit.....with Hb-8.0 and mcv -65 and low
albumin,low calcium ,raised alk.phosph
a)anorexia nervosa
b)crohn disease
c)gluten enteropathy
d)thal intermedia
e)turner's syndrome
35) aman who goes on holidays along with his fam.,returns one month ago and
presents with hepatitis(symptoms are 3 days only.what could be the awnser
hep. A,B.OR C.,d,e
39) .Urticaria with daily developing new lesions what pathological changes may beA.-No pathological changes(I think-Any comment?)
40) .Pt with bullous lesion on forehead & exposed parts DxA-porphyria cutanea tarda.
A-Wilsons Disease.
51) .Respiratory Pt. With FEV1/FVC ratio was less than.80%(After calculating) Dx?
A-C.O.P.D.
c. hypercalcimia
d.enlarged mediastinal L.Ns
61) contraindication to pertonial dialysis:
a. previous extensive adominal surgery
b. CHF
c.
d
e
62) a patient with dysphagia, talangectasia, anticentomere ab positive, which is a recognized late
complication:
a. thickeneing of skin
b. erosive arthopathy
63) pt with multiforme lesions on hands and mouth, which drug is responsible:
a. sulphasalazine
b
64) A 24 year old woman had ulcerative colitis for seven years. smokes 20 cigarettes per day comes 10
weeks pregnant and complains of worsening symptoms :
a. Azathioprine is contraindicated.
b. Initiation of an elemental diet risks fetal malnutrition.
c. Oral corticosteroids are contraindicated.
d. Oral mesalazine therapy should be withdrawn.
e. Termination of the pregnancy is advisable.
1. A pt. Coming back from Pak with offensive stool & marked weight loss .what is the Dx ?
Ans- Giardiasis
2.. A Pt of HIV / AIDS/Immunosuppression (exactly I could not remember) having loose stool not
responding to Ciprofloxacin or others ----treatment What is the Dx ?
Ans.- Cryptosporidium parvum.
3. A Pt. Of heart disease having a medication developing Thyroid disease./ Thyroiditis.What is the
investigation of choice ?
Ans-Technitium scanning( To see the Amiodarone induced Thyroiditis. I am in doubt about the answer.
ANY BODY CAN HELP ME ? )
4. A pt with GIT problem & other systemic problems ( I could not remember ).On radiology exam there
are presence of 3 strictures in the ileocaecal region.What is the Dx ?
Ans-Crohns Disease.
6. A Pt of GIT problem with growth abnormality / retardation.What will be the +ve investigation
finding ?
Ans- Antigliadin antibody. ( coeliac disease )
9.An old Pt having B.P. of 160/ 88( ?) ( isolated systolic HTN ). Typical description consistent with this
is
Ans-B-blocker will be less effective in this Pt(old) than the younger Pt.
10. A PT of D.M., Br. Asthma and IHD (?) started a new Rx and then developed marked dyspnoea.
Drug responsible for this
Ans- Aspirin.
12. A Pt with recurrent attack of tinnitus , vertigo with vomiting & also there is deafness.What is the
13.A Pt with cough, haemoptysis, bloody rhinorrhoea & other descriptions ( which I could not
remember ) what investigation will help the Dx ?
Ans- ANCA.
14. A Pt with the descriptions consistent with Polycythaemia having reduced Pao2 what is the Dx ?
Ans- C.O.P.D.
17. Queston characteristics of/ consistent with Brucellosis with H / O travel to a particular
country( which I could not remember ).
18.A Pt with H / O taking paracetamol,Alcohol( ? ) morphine with other descriptions having pin point
pupil. What is the Rx ? N-acetylcysteine / Methanol / Naloxone
Ans- Naloxone.
19. Worst prognosis in which type of Thyroid Carcinoma ? Papillary / Medullary as part of MEN-2/
anaplastic ca superimposed on longstanding goiter
Ans- anaplastic ca superimposed on longstanding goiter.
20.An old Pt with the description( which I could not remember ).consistent with obstructive uropathy .
Investigation of choice ? IVU /USG/ others---USG
A 68 year-old man with type II diabetes mellitus (insulin controlled) and end stage renal failure
(haemodialysis dependent for 4 years) was admitted to the coronary care unit 72 hours ago, with an
acute inferior myocardial infarction. Despite appropriate therapy, including thrombolysis, he continues
to have ischaemic symptoms, and is in pulmonary oedema. His last haemodialysis session was three
hours prior to admission. His blood pressure is 86/52 mmHg. Investigations show: Sodium 139 mmol/l
Potassium 6.7 mmol/l Urea 49 mmol/l
Creatinine 950 umol/l
Haemoglobin 10.8g/dl
Troponin T >25 (NR <0.04)
A transthoracic echocardiogram has shown a left ventricular ejection fraction of 20% (today) Select the
most appropriate management strategy?
1. A pt. Coming back from Nepal with offensive stool & marked weight loss .what is the Dx ?
Ans- Giardiasis
2.. A Pt of HIV / AIDS/Immunosuppression (exactly I could not remember) having loose stool not
responding to Ciprofloxacin or others ----treatment What is the Dx ?
3. A Pt. Of heart disease having a medication developing Thyroid disease./ Thyroiditis.What is the
investigation of choice ?
Ans-Technitium scanning( To see the Amiodarone induced Thyroiditis. I am in doubt about the answer.
ANY BODY CAN HELP ME ? )
4. A pt with GIT problem & other systemic problems ( I could not remember ).On radiology exam there
are presence of 3 strictures in the ileocaecal region.What is the Dx ?
Ans-Crohns Disease.
Ans-folic acid deficiency.(probably due to celiac disease. Other stems present in the question e.g.-Vit-
6. A Pt of GIT problem with growth abnormality / retardation.What will be the +ve investigation
finding ?
8.A Pt with D.M. with H / O regular alcohol intake ad other manifestation( which I could not remember
) having touch, vibration, loss of position sense what is the Dx ?
ANS.-Diabetic polyneuropathy.
9.An old Pt having B.P. of 160/ 88( ?) ( isolated systolic HTN ). Typical description consistent with this
is
Ans-B-blocker will be less effective in this Pt(old) than the younger Pt.
10. A PT of D.M., Br. Asthma and IHD (?) started a new Rx and then developed marked dyspnoea.
Drug responsible for this
Ans- Aspirin.
Ans-Kallmans Syndrome.
12. A Pt with recurrent attack of tinnitus , vertigo with vomiting & also there is deafness.What is the
Dx ? Vestibular neuronitis/ BPPV / Menieres Disase----
13.A Pt with cough, haemoptysis, bloody rhinorrhoea & other descriptions ( which I could not
remember ) what investigation will help the Dx ?
Ans- ANCA.
14. A Pt with the descriptions consistent with Polycythaemia having reduced Pao2 what is the Dx ?
Ans- C.O.P.D.
17. Queston characteristics of/ consistent with Brucellosis with H / O travel to a particular
country( which I could not remember ).
18.A Pt with H / O taking paracetamol,Alcohol( ? ) morphine with other descriptions having pin point
pupil. What is the Rx ? N-acetylcysteine / Methanol / Naloxone
Ans- Naloxone.
19. Worst prognosis in which type of Thyroid Carcinoma ? Papillary / Medullary as part of MEN-2/
anaplastic ca superimposed on longstanding goiter
20.An old Pt with the description consistent with obstructive uropathy . Investigation of choice ?
IVU /USG/ others----
Ans-USG ( To see the Prostatic growth / enlargement / calculi--. .IVU is risky in old patient.)anis, May
31, 2004#1
8- alcoholics have combined deff. of vit-B12+folic acid so posterior column involment is due to
this.posterir column inv is not common in DM
19-MEDULARY ca of thyroid with MEN-2 HAS BED prognosis,if some one is having a gene than it
is recommended to do thyroidectomy.
THANKS,
DR.S.IRFAN
A.HIGH OF PNEUMONITIS.
A.IV ACICLOVIR
B.IV ANTIBIOTICS
C.LOCAL ACICLOVIR
D.TOPICAL STEROIDS
TRICYCLICS
OTHER CHOICES
HYPOTENSION
NEPHROTOXICITY
HYPERGLYCEMIA
C.BAMBOO SPINE
A.MICROPROLACTINAEMIA
B.STRESS
C.DRUGS
AUTOSOMAL DOMINANT
E.LOW BIOAVAILABILITY
A.HALF LIFE
C.RENAL EXCRETION
A.ASPIRIN
B.BISOPROLOL
C.NITRATES
D.ACE INHIBITORS
A.HRT
B.SERM
D.ALENDRONATE
E.DIET
A.ASPIRIN
B.SULPHASALAZINE
C.PENICILLAMINE
D.GOLD
E.METHOTREXATE
A.ADDISON'S
B.PERNICIOUS ANAEMIA
C.APLASTIC ANAEMIA
D.MALIGNANCY
19.A PATIENT PRESENTING WITH SYNCOPAL ATTACKS AND PALPITATIONS WAS TAPED
FOR 24 HOURS. WHICH WOULD BE CLINICALLY HELPFUL.
A.ATRIAL ECTOPICS
B.VENTRICULAR ECTOPICS
C.PSVT
dr s irfanGuest1- ZIG,IF CHILD BORN WITH IN 5 DAYS SHOULD ALSO GET ZIG
8-pancrease i guess????
10-ASearly sign will be retention of lumber lordosis during spinal flexion.radiological evidence of AS
will be late feature.
15- survival depends on so many facters B blockers per se alone is not responsible. bisiprolol???
16-Aledronate should be prescribed for pt,s requiring long term steroid therapy
25-CYSTINOSIS-2 TYPES
thanks,
bhattiGuest15 - bisoprolol
Answers given here are what I feel is correct, could be otherwise. The questions here may not be 100%
accurate, but will give you some rough idea what sort of qs came . Feedback and other questions
recalled welcome.
Q2: 45 year old man with gram ve cocci meningitis. Which Abx?
A: Cefotaxime
Q4rug that most likely to keep pt in sinus rhythm post cardiversion for AF
A: Amiodarone
Q7: I think there was 2 questions on non-gonococcal urethritis. Whats the treatment ?
A: Doxyclicline
Q8: 75 year old man, post elective inginal hernia repair, developed swollen ankle. T 37.5C. Takes
diuretics for ?hypertension . What is the diagnosis?
Septic arthritis, gout, pseudogout, reactive synovitis
Q10: 40 yr old chap with total cholesterol of 20. Fasting Triglyceride of 7. High LDL & Low HDL.
ApoE positive, homozygous. Take alcohol.
A: ?
Likely to get dementia,
abstaining alcohol will reduce trig level,
to treat with fibrates,
to treat with statin.(this one is my answer)
Q11: Girl came in with overdose .Has tachycardia and long QT. What did she take?
A. ?
Amytritillin, Ecstacy etc
Q12: 20 yr old chap. Found unconscious at 3am. High BP, small pupils. What did he take?
A: ?
Q13euthz Jagger
A:Autosomal dominant
Q15: Statistics questions. Over period of 5 years- 1000 took placebo , 100 of them had MI. 1000 took
the drugs,80 from this group had MI . What is the yearly risk of MI in placebo.
A: 100/1000 = 10% . 10%/5years = 2% per year
Q17 Stats question on comparing number of days spent in hospital for man and women post MI
compared to other reasons for admission. The average number of days .
A: Mean.
Other answers given were Median, Mode, SD, SE
Q18: 75 year old man, post elective inginal hernia repair, developed swollen ankle. T 37.5C. Takes
diuretics for ?hypertension . What is the diagnosis?
Septic arthritis, gout, pseudogout, reactive synovitis
Q20: Parents with son with CF. Whats the likelihood the next child is a carrier?
A:50%
2003
1- IMPORTANCE OF TROPONIN
2-MEMBERANOUS NEPHROPATHY-SLE
3-G6PD-PRIMAQUINE
4-HENOCH SCHONLEN PURURA
5-B2 AMYLOIDOSIS-DIALYSIS
6-AMIODARONE-PULMONARY INFILTRATES
7-LIMITED SCLERODERMA-ANICENTROMERE POSITIVE WITH DYSPHAGIA
8-RHEUMATOID ARTHRITIS DIFFERENCE FROM SLE-PLEURAL EFFUSION
9-COSTOCHODROSIS-IN HAEMACHROMATOSIS
10-SCABIES TRATMENT-WASHING OF ALL BEDLINEN
11-WERNICKES KORSAKOFF-WITH EYE SIGNS
12-RED CELL MASS-IN POLYCYTHEMIA RUBRA VERA
13-C5 C6- NERVE ROOT LONG THORACIC NERVE
14- C8 T1- FINGER FLEXORS EXTENSORS
15-1-25- CYSTIC FIBROSIS CARRIER
16-GASTRIC RESECTION IN MALT LYMPHOMA WITH H PYLORI
17-CHRONIC HEP D INFECTION
18-RESTICTIVE CARDIOMYOPATHY IN AMYLOIDOSIS
19-FSGS TREATMENT- PROTEIN DIETARY RESTRICTION
20-LITHIUM >5.4- TREATMENT HAEMODIALYSIS
21- PENECILLIN INDUCED MYASTHENIA GRAVIS
22- PT MONITORING IN PARACETAMOL TOXICITY
23-SALBUTAMOL INDUCED TREMOR
24-ADDISON CRISIS
25- METOCLOPRAMIDE INCREASE PROLACTIN LEVEL
26- DIGOXIN IN ATRIAL FIBRILLATION
27- HYPOMAGNESEMIA INCREASE DIGOXIN LEVEL
29-NEUROFIBROMATOSIS- CLINICAL FEATURE, AXILLARY FRICKLING
30-INR>5- GIVE IV VIT K
31- PLASMODIUM FALCIPARUM- WEST AFRICAN, FEVER WITH RIGORS
32- EBV VIRUS
ALL THESE TOPICS ARE RANDOMLY MEMORISED FROM BOTH PAPERS, MOSTLY ARE
THE ANSWERS FROM BOF QUESTIONS
-skin lesion on elbow, hands ext. surfaces raised non itchy edges, diagnosis
-fungal infection on the trunk-treatment of choice
-85y f altered bowel habits, culture positive endocrditis-which organism?
-latex allergy
-loss of dorsiflexion of the ankle where would u expect sensory loss in the same nerve damage?
-many questions on symmetric arthritis of shoulder and wrist diff diagnosis
-septic arthritis invst. of choice
paroxysmal af treatment of c
- A case of ?diphteria
- Some confusing sotry about a drug being 10 times more potent but twice as expensive as other drug.
Is it more cost effective, less, etc.
- Lady referred from diabetic clinic with Hb 7, no alteration in bowel habit, BMI normal, no
menorragia. Options were B thalassemia, coeliac, crohns, dietary deficiency
- 15-17 translocation in APML
- One question described a jejunal biopsy and expected you to identify fron it the cause of malnutrition.
Options the usual coeliac, whipples, giardia, etc
- Minimal change glomeruloneprhitis
- Goodpastures
- Lupus Neprhitis
- Carbamazepine interactions
- Valproate, cyclosporine, azathioprine SE
- How to identify a noncalcfied mitral valve clinically in mitral stenosis
- Inferior MI - which artery
- 25 yrs old, st 1mm depression and chest pain
- ANCA
- Indications for LTOT
- SIADH
- Calculate anion gap from U + E s
MRCP part 1 23rd september paper Dublin
Discussion in 'MRCP Forum' started by sids, Oct 15, 2003.
1 week before surgery,1 month before surgery,just before surgery ,more than 1 week before surgery
4)40yrold male presents with left foot drop,tingling and numbness in right foot ,urine-blood +
+,protein+++,ESR+++
polyarterirtis nodosa,SLE.
Syringomyelia
carbimazole,radioiodine,prednisolone.
hypothyroidism,thyroid cancer .
low dose dexamethasone suppression test,high dose ,CRH test,serum ACTh levels
atenolol ,phenoxybenzamine,hydralazine.
10)features of systemic sclerosis ESR^^^ ,A dsDNA- neg ,RF-neg most common finding
erythema nodosum,malabsorption,uveitis
carbamazepine,valproate,phenytoin.
16)Itchy rash ,vesicles and excoriations on extensor surface of forearm and elbow investigation
17)itchy violaceous papules over flexor aspect of wrist ,most common finding of this condition
20)H/o of increasing chest pain at rest ,H/o of previous MI ,patient on regular haemodialysis for
ESRFpre dialysis HB-11.6g/dl,after 6 weeks ,Hb -7.9g/dlinvestigations-serum ferritin -low apprpriate
treatment
22)16 yr boy with father tested sputum + for TB,boy -tuberculin test -negative ,chest xray-normal next
step
HYDRALAZINE
24)LV systolic dysfunction on ramipril and frusemide which other drug can be added to improve
prognosis
atenolol,amlodipine,digoxin,isosorbide
isosorbide dinitrate
<10%,10-20%,etc
27)leftsided musle weakness of leg ,right sided loss of pin prick sensation of foot
28)acute onset of severe headache ,progressive drowsiness BP 170/110 mm Hg most likely cause.
30)return from east africa ,profuse watery diarhhoea,blood mucus ,patient on rehydration oral next step.
loperamide,cipro,metronidazole,vancomycin
31) Iv drug abuser ,fever ,cough ,headache and ECHo-vegetations on tricuspid valve.
32)H/o of diarrhoea and back ache ,patient on pacemaker most likely cause
40)difficulty in elevation of eye ,diplopia on lateral gaze to left side ,pain in eye cause
41)tension type headache not relieved by full dose paracetamol,next drug to be added
43)neck stiffness ,headache in cervical and occipital region Cervical Xray-widespread degenerative
change,ESR-^^^
cervical spondolysis.
44)long standing rheumatoid arthritis ,choking sensation on having food ,spastic paraparesis,cause
45)12 yr old girl-mild sore throat ,throat swab -N.Menigitidis +,immediate step
46)fever cough friends had similar complaits ,blood-macrocytic features,chest xray- bilateral hazy
shadow ,cause
S.pneumoniae,S aureus,Adenovirus
TB,mesothelioma,asbestosis.
alopecia,hepatotoxicity,nephrotoxicity
55)40 yr old woman asymptomatic gall stones-normal serum biochemisty appropriate next step.
56)H/o of sweating ,hunger episodes recurrent and weight gain since 6 months plasma glucose -6.8
mmol/L next appropriate investigation
acarbose,sc insulin,glicazide,metformin,pioglitazone.
atenolol,digoxin,adenosine
59)brusing ,blood -wbc-left side shift with promyelocytic cells ,most likely finding
t(9,22),t(15,17),t(8,22)
60)SLE antibody-
antiGBM,anca,pnca etc
63)Bone changes in RA
66)muscle weakness,progressive ,multiple tender points on bach muscle ,blood tests normal ESR^^^
fibromyalgia,polymyositis,myasthenia gravis
ACTH,TRH,INsulin etc
68)mild sore throat ,frank hematuria ,most likely finding on renal biopsy
mesangial deposition of Ig A.
69)3 episodes of vommiting after taking alcohol,4th time -cupful of blood,likely cause
coamoxiclav,Ibuprofen,hepatiits B.
74)patient low mood ,which of following statement favour schizo in place of depression
listening to her dead father 's voice saying she is prostitute,other options were delusions of reference
and illusions.
76)BMI-normal,no H/o of change in menstruation and bowel habit blood findings suggestive of iron
deficiency ,diagnosis
77)H/o of chest pain ,in woman who has H/o of multiple previous symptoms after her father who died
of MI
79)asthmatic on beclomethsone -200mg and salbutamol inhaled ,but condition not yet improved next
step
80)paracetamol overdose-1/2 hr
82)48 hrs after first MI attack ,patient has second attack, serum marker which is of value
83)patient has aortic valve disese, signs of blood loss,previous scar on abdomen
aortoenteric fistula
84)signs of blood loss ,upper GI endoscopy -normal,Faecal Occult blood test -negative,next appropriate
investigation
Mesentric angiography.
86)patient on renal transplant for six months develops ARf likely cause
87)patient asthmatic on salmeterol ,presents with titubation and postural tremor ,cause
89)patient presents with intermittent tetanic spasms ,serum corrected calcium-1.8 mmol/l next
appropriate investigation to find cause
90)patient presents with solitary cervical lymph node ,on biopsy -papillary Ca thyroid ,thyroid glandnormal.treatment.
91)patient presents with malaabsorption ,small bowel biopsy-PAS laden macrophages in lamina
propria,diagnosis
92)A 16 yr female brought with thyrotoxic features(blood),mother on long term thyroxine replacement
therapy diagnosis
93)patient presents with generalised erythema and pustules,past h/o of psoriasis and patient put on
corticosteroids for past 2 weeks.appropriate management
secondary amyloidosis
99)Patient presents with 5 day H/o of generalised rash anterior and posterior cervical lymphadenopathy
and 1 day h/o of fleeting polyarthritis of large joints.diagnosis
100)patient develops generalised rash after taking antibiotic for mild sore throat -most likely
infectious mononucleosis.
101)patient presents with exudate over pharynx ,and cervical lymphadenopathy and weakness of leg
muscles ,H/o of sore throat.
Diptheria,streptococcus,Infectious mononucleosis.
102)patient changed from naproxen to rofecoxib due to GI side effects ,which statement is true ?
103)patient is put on Carbamazepine 200mg and asked to stop taking alcohol,after 4 days ,his
requirement goes to 400mg .cause
Rhabdomyolysis.
106)patient presents with headche ,dizziness ,O/E plethoric ,hb-18.9,pcv-0.56 platelet count-500+,next
appropriate investigation
107)patient presents with decreased vibration sense in foot and muscle weaknes of leg,H/o of
pernicious anemia,likely due to
109)patient with sickle cell disease presents with Blood- reticulocytes-decreased,Hb-decreased ,which
is likely
parvovirus infection
110)patient presents with changing mole ,on skin biopsy it is malignant melanoma with Breslow
thickness <0.75mm,approprate management
111)patient presents with acidosis Na ,K,Cl,HCo3 and ph values ,calculate anion gap
25 mmol,10,15,20,5 .
113)114)patient complains of difficulty in flexing ring and little fingers ,o/e hypothenar wasting ,which
other movement is affected
115)patient undergoes brachial artery catherisation ,deveops weakness of long flexors except ring and
little finger,with difficulty in abduction of thumb ,cause
116)patient complains of tingling and numbeness of lateral aspect of right thigh O/e loss of sensation
over anterolateral thigh .cause
117)patient presents with pain over the arm ,loss of abduction of thumb etc etc ,cause
118)patient presents with palpitations and ECG-short pr interval and widened qrs complex.what is long
term treatment
radifrequency ablation,digoxin,adenosine,atenolol.
119)patient working in coal mine for 15 yrs presents with progressive deteriorating dyspnea chest xraydense shadow in both upper zoneTLCO-decreased cause
120)patient presents with excessive facial hair and menstraul disturbances which of following test is
diagnostic of PCOS
45XO,47,XXY,etc
125)patient with RA presents with pain and reddneing of right eye ,visual acuity and retinal fundoscopy
normal,which is likely
126)patient presents with cough and brethlessnes chest Xray-dense shadow in right upper lobe.likely
cause
127)patient after extensive burns with breatlessness no fever ,neutrophil count normal cause for
deteriorationg Pao2
ARDS,pneumonia etc.
128)patient presents with infection and brisuing blood counts low which drug results in this picture
azathiprine,cyclophosphamide,prednisolone
prednisone,cyclophosphamide,azathioprine,methotrexate.
133)patient presents with ankle swelling bilateral ,elevated JVP ,clear lung fields ,
134)patient omplains of intermittent chest pain which increases on breathing and ECg-diffuse St
segement elevation.
Myopericarditis
135)patient on long term NSAID presents with renal failure -which is likely
interstial nephritis,nephrocalcinosis.
Doxycycline,erythromycin.
wash hands thorughly under running water,antiretoviral treatment,test for hb a ,hb c ,hiv ,etc...
metronidazole,ciprofloxacin,nitrofurantoin.
139)patient presents with multiple lustreless nails and no other skin lesions.investigation
143)patient develops extensive facial and tongue oedema after taking food ,also develops rash to
contact with cosmetics serum C3 C4 levels are normal.
144)patient with unilateral knee swelling is tapped ,the joint fluid is sterile .One week later he develops
paiful knee swelling ,next appropriate step
IBuprofen
Bradykinin
149)During drug trial ,injection causes elevation of BP .which of following is the likely drug?
angitensin1,angiotensin2,
153) change from hydrocrtisone to predisone ,calculate dose based on hydrocortisone value.
metformin,acarbose,glibenclamide,weight reduction.
amantidine,selegiline
Next >
sheikooGuestvery tough nausating exam allah mawgoood
is ca carbonate or alpha
7/ photo orf
8/ photo molloscum
13/ radio iodine therapy in pt with graves make eye signd deteriorated
18/ pt with severe depression on flouxtine stop ttt since one weak what do
19/ pt with severe depression with suicidal attempt ttt is it ECT or drugs
20/ pt withsevere depression father has hungtinton came with symptoms of hung + vf
23/ pt with syphilis has sensitivity to penicillin star with doxycyclin what more to
do ????..........................
27/ pt with ulcerative colitis what is the cause of elevated alkaline phosphatase
psc
plenty of fluids
TRANSTHORACIC ECHO
STILL DISEASE
48/ PT WITH PAINLESS LYMPH NODE FINE NEEDLE NOT DIAGNOSTIC WHAT TO DO
EXCESION BIOPSY ???
50/ PT HAS RENAL FAILURE START DIALYSIS DEVELOP CONVULSION WHAT IS THE
I'm planning to sit the next diet 2/2008 please advice me sooooon
7 - Photo orf - ??? . ulcerative leision near ear lobe looks like basal cell carcinoma.
8 - Photo molasscum ??? - picture of tattoo with skin rash,(not elevated,macular leision ), with choice
chicken pox, allergy , molascum, milia - milia was the very close answer.
12 - Case of DI cos Plasma osm was high and given urine osml was low with concentrated blood pic
( high normal na and k)
23. syphilis , after trtment with penicillin vdrl reduced and tpa remained positive assure and
discharge
24. orlistat ( pt reduced wt previous 1 month from BMI 29.5 to 28.5 ) can b given with bmi <30 ??
dont know ,I also answered as orlistat
29. drugs caused jaundice in this pt flucloxacin (drugs causing cholestasis pic are co amoxiclav,
flucloxacillin, erythromycin, nitrofurantoin)
32. cat scratch disease?? - I think I didnt see this question itself did u remember the scenario?
46 there is a pt with hep c antibody positive with HAV antigen positive??? With dearranged Lfts
(hepatitis), - ???? supect hepatitis A virus - management no treatment
49. Only 1 case of amidarone induced hyperthyroid (rest r not)- management start carbimazole
( dont stop amidrone cos this pt v.tac was under control by amidarone)
50. post dialysis convultion first time - ? cerebral odema.raf, Apr 13, 2008#3
rafGuestadvice for part - 2 mrcp
- Onexamination part - 2
- Ecgs , x- rays .
Dont forget to review once what u have studied for part 1 (exp basic science and stats)
3/ pt with ca oesaphegus stent apply develop sudden dysphagia to fluids and solid completely
18/very elder i think 90 year with sone ttt endoscopy / surgical / lithotripsy
20/ elder with urinary incontinance + hypertension which drug used for
1. x-ray of shoulder joint -( left )- with erotion in head of humerous (pat with >10 yrs of RA)- ?
Avascular necrosis, calcular tendonitis, secondary OA
4.Picture of CT chest ( compleately forget the scenario)-came in 1st paper treatment choice asprin,
dexamethazone, etc
6. ECG of 2 nd degree av block - (2:1 av block exactly) 2 p wave and 1 qrs complex
7. ECG of V Tac and delta wave and irregular beats treatment - permanent ablation
10.Chest x-ray with b/l infiltration I think scenario of haemoptysis - ??? cause ???malignancy
18.Ecg of dextrocardia
19. Picture of tattoo with rash on one side of tattoo (non elevated rash) milia ?
20.Ecg of wpw syndrome with voltage criteria for LVH-(patient of HOCM with WPW syndrome)
what is the ecg diagnosis wpw syndrome.
21.Picture of face with rash elevated erythromatous and bulla intact - ? cellulites
24.X-ray of both hands showing erotion in right ring distal phalanx with soft tissue swelling pat
was on thiazide - ? trophaceous gout , ? psudo gout ,? RA .? hyperparathyroidism
26.X-ray of Thoracic spine with fracture (male) with sensory signs _- ? malignant infiltration, ?
osteoporotic #, ? osteophytes
34.ECg showing > 3mm st depression in lateral leads (NSTEMI) management angio
35.Skin biopsy (pat with h/o celiac disease and rash) Dermatomyositis
This much pictures only came I think. if anything more please mention,
Thank for the comments, I think I left the question of orf( I completely forget)
I now remember the umbilicated lesion in tattoo there was 2 small pearls kept separately above the
leision I thought this single leision occurred due to the pearl which has fallen. thanks for the
comments
3- I think it is due to radiation mucitis cos patient cant able to swallow even saliva.
11- case of men 2 - the scenario was made to think that the patient has men 2 , cos pat was not
affected by thyroid problem(operated) may b sister doesnt have ca medulary thyroid and other1
has another problem, but our patient has only only hyperparathyroid I think I can able to recollect
that senario faintly only I doubt it is men 2.
14 patient with low cd count around 8 / 18 and cacecxic , weak avium option was there? I
18 90 yrs old with frcture hand with cast, cbd dilated - I think ERCP
3/ pt with hodgkin complete 5 cycles therapy in need of blood transfusion what to give CMV
MRI - spine i went for metastasis instead of osteoporotic # cos of male patient.
for hodkins- transfution- irradiated blood -(i think its wrong cos irradiation is done for post bone
marrow transplant transfutions ), i am not sure of answer in it.raf, Apr 13, 2008#10
sheikooGuestmrcp april 2008
3/ 2 cases of pt with sleep dist and snoring and abnormal movement at night ttt and diagnosis
8/ loss of coscious started by parasthesia in rt arm then coma +1 hour post confusion and tired whais
diagnosis
9/ pt with renal failure has warts then develop skin lesion localized what is that non melanotic
hi every one what is going on where the questions why not share with questions comment so get
benefit all so plzzzzzzzzzzzzzzzzzzzzz[
The Exam was so bad, u cant say it was diffecult because u dont have time to read to qs .
the funest thing in it , the was q say ( apical murmer at left sternal border)
how is that?????!!!!!!!!!
:lol: :lol:
about some q
I chose epilepsy 3 times , 1st man with atack of unpleasent sensation start in the face and then to arm
and durring attack he cant find the words
the 2nd old femal go to urinate at midnight and then loss of consiousness and her husband see her
tiwitchinglimda and urination in her self after that she had headach and confusion for SEVERAL mins
the 3rd old male come with 3 episod pf loss conciousness and after each he had headach and confusion
antibiotics
3 one about old femal with fever and dysuria and she gaved amoxicillin but no responce for 3
days .....>>>>>> I chose Trimexa I guss rt one was cipro
5 imipenem after 3 days using it the pt have hypotension after 5 min of IV >>>> i chose pridinsilon I
dont know the idea of the qs
2 small int. crohns and have steatorrhra >>> I chose give her shor chain fatty acid becuse I thinjk its d2
bile acid malabsorption so give here fst dont need bile acid
3 UC and PSC
4 UC with above knee DVT and platlet 840 but pt come 2 days befor with exacerbation and her intstine
loss ALOT of blood>>>> whts ttt 4 DVT asprin or Heparin or stocking
5 pt with colon cancer and 2 cm livver metastasi in small livver lobe>>>tttt i chose surgury for bothj
6 colon cancer have surgery and after 6 mon come with 6 cm rt liver lobe >>>> ttt i chose palliative
7 NASH
9 ERCP
10 eradication therapy
11 DU and filed endoscopy to stop bleeding, the pt take 4 blood pack>>> i chose angio and
embolization othe option was give him AB or metonidazol there was no surgury option
12 old pt with Fe def. anemaian eith normal endoscopy and barium>>> i chose rbcs scan other option
re endoscoy of the colon
13 pt with fe and folat and Ca deficincy with normal b12 anf she was vegeterian>>> i chose cealiac dis
14 pt with rt uper abd pain( peridic) and very hisgh 1500 ast or ALT i dont remmeber and normal
albumin and bil for 5 days ,the pt is ht dis and take statini>> I chose statin
15 tb pt with deranged liver enzyme i chose stop rifampicin and rechck liver enzyme in 2 ws
16 osph cance with stent complain of SUDDEN dyspagia and cant swallow hie salaiva there was no
pain>>>> stent malfunction ( ity may slipt away )dregypt, Apr 14, 2008#15
dregyptGuestphoto
pict was
5 ct thoracic spin and fever >>> the was one vertebra and in its middle there is necrosis with sclerotic
margin so I chose osteomalitis
7 Echo of mitral myxoma but in the qs ther was apical systolic murmure
8 VT
10 ECG ( i coulnt know it) and the pt complian of pain and he gave nito and morphin whats the next
drugs>>> heparin or streptokinase or Alteplas or abcixmab or terofiban I chose heparin just because
other option of the same gps
11 mollasicum
12 BCC
13 cellulitis
14 rosacia
16 EN i chose behcet ( pt with pharyngral ulcer, young femal, and EN and night fever malias, abd pain
normal Abd US have all vaccin normal CXR)
17 brain abcess
18 SAH classic
19 pitutary I think it was normal but i chose crainopahryngiomadregypt, Apr 14, 2008#16
dregyptGuestcns
1 essential tremor
5 faciscapulo myopathy
7 AD
9 PD with dyskinesi , GP increas l dopa dos pt the pt have hallucination what u will do>> decreas l
dopa dos or dopaminergic drug
10 restless leg syndrom twice one diagnosis the othe ttt I chose ropinerol
11 pt loss her job las year and try suices befor come with sever depression and heavy alcohol>>>
antideprresent or chlordiazopoxid
13 neck LN and undetermind FNA next I chose ct neck and thoracs>> i think it mnay be papillary
thyroid or lymphoma
15 alchoholoic with AF and dilated cardiomyopathy with rt flant pain and heamaturia >> ischemic
nephritis and alchoholic cardiomyopathy
16 median nerve lesion with high CRP and ESR i chose atrial myxoma
19 acut polymyostid>> pt with pro ms weakness very high ms enzyme and ESR and monnuclear
inflitration of the ms
20 scleroderma
22 gout one DIP with soft tissue swlling in pt with long hx of HTN
23 depressed pt take anti HTN for long time come with renal failure>>> i chose thiazid i think it
incraese lithume cons and lithume cause CIN
25 GABA toxicity
2 bat colony caves with pnumonia I chose coccidomyucosis bu i think its histoplasmosis
4 amebiasis
5 schistosomiasis classic
6 liptospirosis
8 AIDS pt with CD4 <20 with high signal sulci and suden onset heampligia but no MASS effect what
to give next>>> i chose steriod i dont know
8 aids with atrophy of brain i chose PMLE threr wasnt AIDS dementia
9 syphilis with ttt by tetracyclin 6 mon after that VDRL decrease 4x >> reasurance
10 microprolactinoma for 5 ys ttt by dopaminrgic drugs and pt get pregnant with prolactin 1500 but no
other complain anf normal feild by conforantation>>> reasurance
12 essential HTN
14 men2
17 pt withfamily his of oseteoperosis come for check up with high Ca I chose vit D toxicity
18 pt with osteomalicia biochemistry but with pigmentaion on one side of neck and chsex i chose
osteomalicia i dont know whats pigmentation is
19 CRF with loe Ca 1.9 and high Po4 i chose Ca carbonate becuse vit d will increas both and sevelamer
with decrease both I think
dregyptGuestff
PLZ comment on my answer with explenation why u chose that vor another option
THANKS < I CALL ALLAH TO PASS FOR ALLdregypt, Apr 14, 2008#19
sheikooGuestmrcp april 2008
/1/ there is case of diaphragmatic weakness des lung fuct with position
2/ pt with cipro sensitive organism receive ttt but still febril and +ve
11-pt with family Hx of autoimmune disease present with autoimmune hepatitis...do anti smooth
muscle Ab.
18-pt with chron's disease and dietry advice..low unsaturatted fatty acid or high protiene diet.
41-pt with anterior descending artery stent develop posteroinferior MI .atheromatous plaque.
51-pt develop acute dypsnea after 24 hours post MI.do transthorathex or transoesophagous echo or
swan ganz catheter.
71-alzhimer dementia.
76-pt with sudden visual loss.retinal detachment or vitrous he or central vien occlusion.
81-CML.imitinab.
85-anticardiolipin.
86-pt with lymphoma need transfusion what blood you give.gama radiated.
89-AL Amyloidosis.
90-p53
96-pt with bilateral emphaseama what make him contraindicated for surgery.
104-diaphramatic weakness.
111- membranoproliferative gn
118-perinephric abscess?
119-obstructive nephropathy.
123-MEN 2.
125-Acromegaly.GTT.
131-pregnant use predinsolone come with cushing syndrome not suppressed by overnight
dexamethasone.
136-pt with high rennin and high aldestrone with low k renal artery stenosis.
148-methaemogloblinaemia..methyline blue.
152-vancomycine anaphylaxis.
163-haemochromatosis.ferritin test.
168-muscle biopsy..dermatomyositis.
169-PMR.
170-polymyositis.
172-leptospirosis case.
176-schestosomiasis.
178-HIV with MRI brain widen sulcci and cortical atrophy..PML, Lymphoma.
181-psittacosis case.
182-cholecystitis causeE.coli
184-CXR aspergiloma.
185-syphilis pt .reassurance.
186-tetanus antibodies.
187-botulisim?
188-ct spine.osteomylitis.
193-chancroid.
194-legionella.
198-Diabetes inspidus.
202-cholestasis cause..flucloxacillin.
205-indication for descent in high altitude cerebral oedma.chin stock breathing or unsteadiness or
headache.
210-pt with haemodialysis develop fit what is the causecerebral oedma, hypocaceamia.
216-pt with bleeding DU fail to control by OGD adrenaline infusionangio and embolization.
hiiiiiiiiiii DR ANH
hi dr anh
the young pt with paroxysm of palpitations they were occuring at rest so mostly its paroxysmal svt &
not rvot -vt which occur only after exerciseDr ANH, Apr 15, 2008#25
GuestGuestdear dr.ANH
which favours rvot-vt of course i'm not sure of the answer it is just discussionGuest, Apr 15, 2008#26
GuestGuesta pt diagnosed of having renal failure what was the acid base defect?
3/ pt on metformin has sepsis and acidosis what is cause lactic acidosis/ ketoacidosis
6/ tt of pt with heart failure and gou think colchcinesheikoo, Apr 15, 2008#29
elnzrGuesthi everybpdy
best of luck
Assalaamu alaikkum,
Regarding contraceptive when a male patient is on thalidomide , the answer is a single barrier method.
dose [1 capsule (regardless of strength)] taken by a pregnant woman can cause birth defects. If
pregnancy does occur during treatment, the drug should be immediately discontinued. Under these
conditions, the patient should be referred to an obstetrician/gynecologist experienced in reproductive
toxicity for further evaluation and counseling. Any suspected fetal exposure to THALOMID
(thalidomide) must be reported to the FDA via the MedWatch program at 1-800-FDA-1088 and also to
Celgene Corporation at 1-888-423-5436.
Because thalidomide is present in the semen of patients receiving the drug, males receiving thalidomide
must always use a latex condom during any sexual contact with women of childbearing potential. The
risk to the fetus from the semen of male patients taking thalidomide is unknown.raf, Apr 16, 2008#32
Dr.EGuestAssalam o alikum to you all.
A lot of thanks to raf for the valuable information about thalidomide.Dr.E, Apr 16, 2008#33
sheikooGuestmrcp april 2008
hiiiiiiiiiii everyone
where is the questions where is the comment plzzzzzzzzzzz share and write what u feel to exchange our
exper
i wander if any body hav 123 doc to share it withe me i have cd for clinical examination and history for
paces
1.Homosexualman..inv:??Rectal swab.
2.Tr of Restless leg syn. Is there any option for..Pramipexole or Ropinirole...??Maaaaybe I put
Pramipexol.
4.Af..Tr..Propafenone(normal heart)
results will be dispatched tonight, good luckinfinity guest, Apr 28, 2008#37
BRJGuestHi..Infinity Guest...How u know that..? But RCP website written 5th May onwards..!!!Can u
guess pass marks....plz?? BRJ, Apr 28, 2008#38
infinity guestGuestResults are dispatched now on the net site.infinity guest, May 1, 2008#39
GuestGuestpass
I used it but at the same time I kept revising K & C,OHCM & looked up the difficult topics from
Harrison's.The other books that I found helpful are-Revision for MRCP part 2 by Debra King,MRCP
part 2 BOF illustrated Q & A by Huw Beynon,Diseases for MRCP part 2 by Timothy Gray(this one has
a few mistakes-find them out-it helps for prep too!).Best of luck for the future candidates.Dr.E, May 3,
2008#43
GuestGuesti do pass
it shows
No results found for the selected exam type and RCP Code
GuestGuestnew
u may enter in ur online acount in mrcp site and u will find ur result in by click MY EXAM
HISTORY .but be sure 1st u choise ur result to appeare in web site while u made the applicationGuest,
May 5, 2008#47
GuestGuestsalam DR.E ....congatulation for ur success....with more success in ur future life
inshalla....and thanks for the prompt reply.....but will u please clarify us the abbreviations u posted
about the name of the websites and books u used...k&c for eg is it kummar or karla...ochm....and whats
about sharmma u didn't mention it...u didn't read from...
Onexam=onexamination.com
I haven't read Sharma,but some of my seniors have found it useful.Dr.E, May 6, 2008#49
GuestGuestadvice
2) every disease in sharma read its INVESTIGATION of it from LARGE TEXTBOOK (cbc, liver,renal
and radiology) and make nots the differance between similar diseas .becuse there was investigation not
in Kumar so I have guess the answers.
3)U MUST practice to read fastest as u can and training highlight the most important points in each
question to save ur time. THE time is the big chalenge in true exam.
4) In the eame most of the large list of investigation is only made to wast ur time so take care and just
read it rapidly and circle the important one
5)never take more 2 min in each qs. becuase u will miss another one and most of qs u will sure about ur
answer.
I hope that help the future candidate to pass,agin TIME TIME TIME DONT FORGET.
SEE U. :wink:
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any one who sat for MRCP MAY 2007 NEED TO DISCUSS?
Discussion in 'MRCP Forum' started by ana, May 16, 2007.
Page 1 of 3
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1.
anaGuestHELLO.
2.
ANYONE SAT FOR mrcp PART ONE NEED TO DISCUSSana, May 16, 2007#1
3.
4.
guest88Guesti did appeard in mrcp 1, and unfortunetly this was my fifth time, but i found the paper 1,
ths most difficult paper i had so far and the paper2 was a bit easier. i will post a lot questions which i do
rememberguest88, May 17, 2007#3
5.
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Lyme disease
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a pt presented with moter complication after his father deat.... conversion disorder
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pontine stroke
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a pt with pigmenation on palms and sole and genital ulcer... syphills invistagaion
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the site of portion of nephoron where thiazide diurtic acts.. proximal convulted tubule
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vikesGuestmay 07
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I hope some other people will come up and try to discuss them and fill in the gaps as i cant remember
lot of things clearly
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igg
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igm
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iga
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ige
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igd
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ans: ?igm
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2.a patient with blood gp O POSITIVE polycystic ovaries undergoing inves for transplant. His brother
is 45 year old with normal ultrasound and blood gp A positive is declared unfit for donating kidney .
why?
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due to ????
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3. A walker has been walking somewhere and after four weeks comes with fatigue after an insect bite
and exam shows a bite with a clear margin around it
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lyme disease
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leptospirosis
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malaria
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trapanosoma
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ans lyme
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4.a man comes back from india and after some time develops fatigue and lethagry with hepatomegaly
butno splenomegaly
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malaria
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leptospirosis
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glandular fever
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??
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???
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diahrea
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facial flushing
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7.a lady get dvt after surgery and started on warfarin and now a bruise on the back and her inr checked
and found to be 1.2 why?
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def of factor1
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10
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von willebrand
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8. a olish lady with fatigue , prximal mucle weakness, lethary and bone pain and being treated for
thyrorxicosis for one year with carbimazole and now bloods shw
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cacium normal
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PTH high
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t3 and t4 high
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primary hyperparathroidism
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PMR
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thyrotoxicosis
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???
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competitive antagonism
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receptor something??
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??
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??
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vikesGueststatistics questions
121.
122.
10. a study is being done on geral poulations looking at their BMI, HEART RATE AND SOMETHING
ELSE
123.
which test will be done to describe the relation ship between BMI and Heart rate?
124.
125.
paired t test
126.
corelation
127.
chi sq
128.
???
129.
130.
11. a new test for ca colon is being compared to colonoscopy , a 2by 2 table was given
131.
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sensitiviy
134.
specificity
135.
+pred vaue
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5-pregnant wityh cardiac disese which will make here as a very sever risk ? p htn
143.
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145.
1/ A 30 year old female, obese, has valvaty lines in the axilla and groin diagnosed to be Acanthosis
nigricans...... Association..Answer is Hypothyroidism
146.
2/Another pt having discrete hair loss in the scalp also having hypopigmentation of the skin... Answer
is Alopacia Areta
147.
3/Another pt came into contact with his son who got rash 8 days ago, now having the rash and
pancytpania........Answer is Paro virus infection
148.
4/Another patient having the shin lesion with surrouing talengictasia... answer is Dipetic libedicorum
149.
5/Another patient with proximal myopathy and dysphagia and red erythem and papules on the extenser
6/Pt with charactheristic lesion on the thigh with erythma.... lyme disease
151.
7/Pt with fluid filled blister over the whole body, invistagion... skin biopsy with immunofluorsence
152.
8/A pt with pruritic rashes on the extensor surface of hands and also on the trunk wit erythem and
scaling... i answerd... Atopic eczema
153.
i will post unit by unit later on thanksguest uk, May 18, 2007#10
154.
155.
156.
157.
what to give in a man with liver cirrhosis ascites and high creatini propranolo,terlipressin.
158.
there was a question about a woman with facial hair but no excessive hair else were what's the answer.
159.
160.
there was a question in haematology which i can't recall please help in which there was an option
bruises.
161.
162.
163.
what's the first response to blood loss vasocontriction,raised pulse pressure or stroke volume.
164.
what the main respiratory stimulus for chemoreceptors hypoxia ,raised hydrogen ions or lactic acid.
165.
i think the answer for the low HDL is dietery control only.
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i think in haematology it was factor 2 defieciency because pt and aptt were normal.
171.
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how to follow up mitral stenosis was it meauring the pulmonary artery pressure.
174.
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in non invasive ressucitation of a pt with COPD what's the benefit was reduced need for tracheal
intubatin.
177.
178.
what the ansewer for that pt who was told not to throw stones if your house is made of glass.
179.
180.
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which test to use i answered mann whitney test i think it's wrong though.
182.
183.
in intermeittent haemturia i answered cystoscopy because there was an answer like that in a previous
exam.
184.
the man lost in the deseret was it aquapores.drsj, May 18, 2007#11
185.
GuestGuestAuthor Message
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aedos
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AIPPG Fresher
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Posts: 3
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191 Credits
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[ Donate ]
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Posted: Wed May 16, 2007 7:44 am Post subject: MRCP 1 UK may 15 exam how was it??
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There was a question on some drug used in prostatic carcinoma ,never heard of that what was that
202.
elderly person vacinated against influenza develops symptoms of influenza in some out break ---what
should be done
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however the paper was generally much easier than january exam
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Back to top
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guest88
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aedos
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AIPPG Fresher
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Posts: 3
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191 Credits
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[ Donate ]
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and another one in which they asked about lab method of checking ant ds DNA antibodies options were
immunocytochemistry and ELISA
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Guest
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helloo gust 88
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those ppls why they are doing this ? exam should be balanced ? any way i wolud like to forget all of
this
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i dlike to ask u how did u find the exam as regard ur previous entry?
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Dr.Hada.
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Guest
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Posted: Fri May 18, 2007 8:00 am Post subject: MRCP 1 RECALLS
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310.
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Moa of clopidogrel
313.
314.
Pt with hepatic pain, ca, high dose opioids given, what to give next
315.
316.
317.
Case of ITP?
318.
Pt with Hb 18, plat 600, tlc 138, presents with hemiparesis------primary polycythemia, essential
thrombocythemia
319.
What is the good prognostic factoring determining AML----phila chromo, acute monocytic leukemia, ?
320.
321.
Girl with Hb 9, grnad father with colonic Ca, what to do with her? Gastrocscopy+duodenal apspira?
322.
323.
324.
Female with partner diagnosed as Chlamydia, she taken samples for neisseria, Chlamydia, what to give
her.acyclovir + Chlamydia
325.
326.
327.
Man 82 yrs oldwith complains of bleeding pr, 3 samples of feacle blood in stool _ve, what to do, repat
in 6 months, colonoscopy
328.
Pt had headache 12 days back , intense, occipital, sick since 1 week, CT normal, what to do: LP, mri
brain?
329.
Male came with topahceoius gout, alcohol abuse hHx, treated with allupurinol. Came after 1 week,
gout----allupurinol induced, alcohol bimge?
330.
Pt transplanted kidney 1 week back, donor was CMV +ve, acute rejection, what to do?----ganciclovir,
steroids?
331.
332.
333.
Female with Hx of 2nd DVT, 2 Hx of abortions, what to do---6 months warfarin, life long warfarin
334.
Pt with tremor, ???? was that proparnolo, what is the complete qs?
335.
Male 50 yrs old, with 24 hr urinary protein 4.8? what is the cause? Membranous nephropathy, minimal
change disease?
336.
Female from malami, with urine d/r showing rbcs, what to do? .schistosoma serology????
337.
What was the qs about the pt with migraine wanting to take OCP? Contraindications? Migraine
with focal aura? Family Hx of cervical Ca, breast Ca
338.
339.
340.
Female pregnant taking short acting Beta agonistcomes with sob on > 4 days /week, what to add? Was
It beclomethasone?????
341.
Pt with neck rigidity, c/s shows gram +ve bacilli, which one? Listeria
342.
343.
Laxative abuse pt colonoscopy done, shows melanosis coli, what laxative abuse??
344.
What was the qs about diagnosing ? case was with dilated intra and extra hepatic ducts/????
345.
Pt with 2 week Hx of leg weakness, loss of ankle and knee reflex, what immediate investigation to
do?...i answered MRI spine
346.
What was the case of person admitted in icu, shifted to ward, developed fever in gen ward, was it
empyema?
347.
Ptt with MI, low HDL, others normal, what to giv, I answered niacin
348.
Pt with left pupil small, what test to do to diagnose?...mri angio, ct headwhat was the qs?
349.
350.
351.
352.
Pt tall, with sob, what change in eye will u seecase was of marfan syndrome////// ectopic lenis?/
353.
354.
355.
356.
used in prostatic carcinoma ,never heard of that what was that .i know the ans: it was receptor
blockage
357.
elderly person k/c of copd, comes with mylagia and low grade fever, during influenzxa outbreak
vacinated against influenza develops symptoms of influenza in some out break ---what should be done
---was it osteomalvir?????
358.
359.
vsd lady planning to get pregnantwhat is the most important factor for her pregnancy becoming high
risk??? Pul HTN or increased gradient b/w left and right ventricle????
360.
361.
362.
363.
364.
365.
366.
367.
368.
369.
Lyme disease
370.
371.
372.
a pt presented with moter complication after his father deat.... conversion disorder ???
373.
374.
375.
376.
377.
pontine stroke
378.
379.
a pt with pigmenation on palms and sole and genital ulcer... syphills invistagaion
380.
381.
382.
383.
384.
385.
386.
the site of portion of nephoron where thiazide diurtic acts.. proximal convulted tubule
387.
388.
389.
390.
391.
392.
393.
394.
2.which lab inv wil u find in a women returning from spain and developing a rash on bridge of nose
and cheeck
395.
crp,anca,.......
396.
397.
3.nurse's child has the chickenpox and she has a history of herpes shingles
398.
399.
400.
401.
402.
403.
404.
405.
-pt can speak well, but u cannot undertsand him comprehension...??? temporal lobe lesion?
406.
407.
- pt with left sided hemiplegia, right sided facial weakness, ---- where's the lesion....pons?
408.
-similar q's with pt havving ataxia, contralateral loss of temp and sensation, with facial weakness....post
inf cerebellar artery
409.
410.
411.
412.
413.
414.
- pt comes with Hx of premature cataratcs in family...how to trace ---linkage analysis???????? not sure!
415.
- ot with IE, given ampicillin for prophylaxis, develkops rash, what to give next timel..is it
clindamycin?
416.
417.
418.
419.
420.
- in patient with complete heart block, what will u find----varying first heart sound???
421.
-pt with oral blisters, skin involved?...what to do: skin biopsy for immunofluorescence???? or
something like that?
422.
- pt with 20 yr Hx of dust exposure, comes with sob, x ray shows bibasal fibrosis??? what is
responsible?...asbestos ( i think so b/c it involves basal zone), other choices were silicosis, coalworker
etc
423.
- what was the q's about pt with morning stiffness, shoulder and pelvic girdle weakness, esr raised, crp
or cpk ( normal ), was that polymyalgia rheumatica???
424.
-which is indicative of pituitart tumor??? prolactin raised level one was the right option
425.
- q's about live vaccine in pt.....the answer was yellow fever vaccine..what was teh q's?
426.
-pt with watery dirrhea for long time, fasting stool osmolality given, ---vipoma
427.
-stats q's... answer was chi square?\...can anyone recall the q's?
428.
- drugs which cannot be removed by hemodialysis is due to ? i m not sure...was that due to increased
protein binding or low volume of distribution?????
429.
-what was the q's about the one with recurrent infections, immunoglobulin levels low, was the ans:
common variable immunoglobulin def??? tough q's
430.
-q's about female having lethargy, mother hypothyroid, pt's TSH raised, mild lid lag, choices were toxic
multinodular goiter, graves etc~ whats the answer,....anyone?
431.
432.
-Which is the antibody responsible for acute hyper rejection of graft?igg, igm, iga,ige,igd...i htink it
was IgM
433.
-a patient with blood gp O POSITIVE polycystic ovaries undergoing inves for transplant. His brother is
45 year old with normal ultrasound and blood gp A positive is declared unfit for donating kidney .
why?
434.
due to abo incompatilbilty, due to risk of polycstic in brother.....i think ans is due to abo incomp
435.
-A walker has been walking somewhere and after four weeks comes with fatigue after an insect bite
and exam shows a bite with a clear margin around it..yes lyme disease
436.
a man comes back from india and after some time develops fatigue and lethagry with hepatomegaly but
no splenomegaly...also was jaundiced? i think so with raised ALT levels....was it hepatitis A?
437.
-which is the most early sign in carcinoid syndrome....diahrea or facial flushing???.the case was a pt
being haven diagnosed as a lung tumor showing carcinoid features...
438.
-a lady get dvt after surgery and started on warfarin and now a bruise on the back and her inr checked
and found to be 1.2 why? i think def of factor 7....not sure
439.
-10. a study is being done on geral poulations looking at their BMI, HEART RATE AND
SOMETHING ELSE
440.
which test will be done to describe the relation ship between BMI and Heart rate?....paired t test,
corelation or chi sq...i
441.
442.
443.
444.
445.
Back to top
446.
447.
guest uk
448.
Guest
449.
450.
451.
452.
453.
454.
455.
456.
457.
--------------------------------------------------------------------------------
458.
459.
460.
1/ A 30 year old female, obese, has valvaty lines in the axilla and groin diagnosed to be Acanthosis
nigricans...... Association..Answer is Hypothyroidism
461.
2/Another pt having discrete hair loss in the scalp also having hypopigmentation of the skin... Answer
is Alopacia Areta
462.
3/Another pt came into contact with his son who got rash 8 days ago, now having the rash and
pancytpania........Answer is Paro virus infection
463.
4/Another patient having the shin lesion with surrouing talengictasia... answer is Dipetic libedicorum
464.
5/Another patient with proximal myopathy and dysphagia and red erythem and papules on the extenser
surface of the fingers... answer was dermatomyositis
465.
6/Pt with charactheristic lesion on the thigh with erythma.... lyme disease
466.
7/Pt with fluid filled blister over the whole body, invistagion... skin biopsy with immunofluorsence
467.
8/A pt with pruritic rashes on the extensor surface of hands and also on the trunk wit erythem and
scaling... i answerd... Atopic eczema
468.
469.
GuestGuestguest88
470.
Guest
471.
472.
473.
474.
475.
476.
477.
478.
479.
--------------------------------------------------------------------------------
480.
481.
m of action of bisphosphonate
482.
483.
484.
485.
486.
487.
488.
489.
490.
Lyme disease
491.
492.
493.
a pt presented with moter complication after his father deat.... conversion disorder
494.
495.
496.
497.
498.
pontine stroke
499.
500.
a pt with pigmenation on palms and sole and genital ulcer... syphills invistagaion
501.
502.
503.
504.
505.
506.
507.
the site of portion of nephoron where thiazide diurtic acts.. proximal convulted tubule
508.
509.
510.
511.
canca
512.
crp
513.
lymphopenia
514.
neutrophilia
515.
516.
517.
518.
519.
520.
521.
522.
523.
524.
after 40 yrs in a non smoker non exposure occupation wat will decrease?? i answered vital capacity
525.
526.
a question on accuracy
527.
528.
529.
530.
531.
532.
533.
Jane.Guestold woman who had htn and b/l pedal oedema wat diuretic 2 give
534.
ace,amlodipine,bisoprolol,diltizem........ace as she has oedema and cablocker no no and beta also not in
old???
535.
536.
537.
538.
539.
540.
541.
- yes...milk alkali...it cannot be Vit D intoxication b/c the Phosphate level was normal...i m 100% sure
of this
542.
-the q's was about when to give amciximab to pt with mi...choices were pt having recived thrombolysis
and still having pain, pt with trop I +ve and awaiting thrombolysis..etc etc
543.
- i think the q's about old woman who had htn and b/l pedal oedema wat diuretic 2 give ...she was
already taking a diuretic..and was asked what to add next....btw...Beta blockers are not absoultely
contraindicated in old people..its just that they r less effective..
544.
-after 40 yrs in a non smoker non exposure occupation wat will decrease?? i answered vital
capacity..yes i too answered it VC~
545.
-a pt having tremors after salbutamol and theophilline????....the pt was also taking digoxin...along side
the other medications...then he started suffering from palpitations, tremor and nausea....there was an
option of digoxin toxicity as well...cant that be the answer?Jane., May 19, 2007#16
546.
547.
548.
2-how to manage warfarin over dose, a case of adult presenting with hematemesis and INR 10.
549.
550.
551.
552.
4-lady with exertional SOB, old Hx of uvitits, presentig with extensor skin lesion, ans sarcoidosis.
553.
554.
555.
556.
557.
558.
559.
560.
561.
562.
9-case o chronic pancreatitis given pancreatic supplement what to give to enhance the efect,ans.....
563.
564.
10-youg girl with hx of diarrohea even wakes her from her sleep which investagation
565.
566.
567.
568.
569.
570.
571.
572.
573.
574.
-how to manage warfarin over dose, a case of adult presenting with hematemesis and INR 10...ans is
FFP
575.
-case o chronic pancreatitis given pancreatic supplement what to give to enhance the efect,ans..... what
were the choices...does anyone know about them?
576.
-youg girl with hx of diarrohea even wakes her from her sleep which investagation??? not sure wether
we had this q's
577.
578.
12-case discribing pyoderma gang, what treatment, ans prednisolone. i m not sure wether we had this
queston...can anyone give the complete case?
579.
580.
581.
582.
2-antiphospholipid case lady with recurrent DVT and miscariage how to manage? ans life long
warfarin.
583.
584.
3-case of Ank.spond what to expect, global loss of movement or increase lordosis,loss of straight leg
test, femoral strech test or telenderbug test.
585.
586.
587.
588.
589.
590.
591.
592.
593.
594.
8- elderly with blood pict of leukemia, ans CLL ( I cant remeber the case properly)
595.
596.
597.
598.
10-case of low FEV &FVC slightly improved after nebuliser, dx? ans COPD
599.
600.
601.
602.
603.
12- a man with COPD presenting with PE how to confirm it ans Pulm Angipraphy
604.
605.
606.
607.
608.
609.
15-a chap foud in desert sahar dehydrated, how doses the kidney conserve body fluid, ans decrease
GFR,
610.
611.
16-eldery with urinary incont, falls,loss of reflexes and weak hip flexion which invx?ant remember the
options.
612.
613.
17-case of Brown sequard syndrome what to expect below the lesion, ans contralaetral loss of
properioception
614.
615.
18-pt had Hx of resected lubg tumour presenting with nephrotic syndrom Dx, ans membranous
Nephropathy.
616.
617.
19- young pt with buccal bleeding FBC showed myelocytes, DX, AML
618.
619.
620.
GuestGuestans for the case of supplement for chronic panceatitis is gavisconGuest, May 19, 2007#18
621.
GuestGuest1. Polycystis kidney disease is Autosomal dominat,all family members got risk of develop
ADPKD.
622.
623.
2. The patient who back from India with High ALT ,ALP is a case of leptospirosis.
624.
625.
626.
627.
628.
629.
5. Multifocal atrial tachy in COPD pt , the best ans could be verapamil as others are contraindicared
and some has no benefit.
630.
631.
6. The pt with 2/12 post MI needs a statin as the T.Chol/LDL ratio is > 4.5 and the is study regarding
the benefit of statin in IHD pt.
632.
633.
7. The accurary of CT -colonoscopy test is sum of both +ve and -ve predictive value(tricky q)
634.
635.
8. The man lost in desert got RAA system activated, release aldosterone and increase water resorption
through aquapore.
636.
637.
9. The elderly pat with PR bleed with negative stool result might have piles, so he needs proctoscopy.
638.
639.
10. Senna cause melanosis coli. And PEG act by irritation of bowel wall.
640.
641.
11.PD pt ,sx not controlled needs to add selegine( ans from Kaira)
642.
643.
12. T-cell def expose to viral and fungal ifx, so the ans is cryptococcus.
644.
645.
646.
647.
14. 2 opthal q with ans is diabetic maculopathy and ant optic neuropathy.
648.
649.
15. The ans that suggest pituitary tumour is decreased ACTH, as prolactin not markedly raised.
Prolactin can be raised by many other drugs and disease .The most common cause for high cortisol
with low ACTH is pituitary tumour!
650.
651.
652.
653.
654.
655.
18. The pt with tremor after salbutamol , lithium, diuretic and digoxin could most probably has digoxin
toxicity( nausea,anorexia and tremor) 2nd to hypoK as tremor is part of sx of lithium therapy.
656.
657.
658.
659.
20. R/O UC with barium studies?. UC can also cause terminal ileitis.Guest, May 19, 2007#19
660.
661.
662.
As Hmg co a reductase activity is maximal at midnight,all statins are given at bedtime after food....to
obtain maximal effectiveness....(reference tripathi..pharmac 5th edition..page 578)mazhar, May 20,
2007#20
663.
664.
665.
after 12 hrs of warfarin tretament...clotting factor which is reduced is factor 7.......as it has shortest
plasma half ife.....mazhar, May 20, 2007#21
666.
667.
-azathioprine/dapsone/prednisolone
668.
The treatment depends on severity ,start with dapsone,if not improving start steroid or
immunosuppresants..so what is the best answer/
669.
670.
2.The lady with sx of hyperthyroidism,mother is hypothyroid, son has IDDM, her thyroid gland has
low radio I intake and the gland is tender,asymmetrical.
671.
672.
The answer is either viral thyroiditis or post partum thyroiditis. All the clue suggest post partum
thyroiditis but is the gland tender in post partum thyroiditis?Guest, May 20, 2007#22
673.
GuestGuestThe question regarding hyperacute rejection of organ transplant for kidney is not logic at
all. It says the the surgeon found out the hyperacute rejection immediately after he release the clamps
on blood vessels. The common cause for hyperacute rejection is ABO rhesus incompatibility due to
pre-formed antibody in the pt's blood against other type of blood group. Does everyone forgot this?.
How can a surgeon do any organ transplant on a pt without even knowing whether there is ABO
incompatibility or not. Organ transplant is a highly specialized procedure ,done only in organ transplant
centres. One of the routine/compulsory blood test is for ABO compatibility. The surgeon in this case
did a major procedure without this knowledge and the kidney is a waste!. Is this q logic?.A q on
reactions after blood transfusion makes more sense.Guest, May 20, 2007#23
674.
GuestGuest1. An old lady with RA had a fall at home, presented 3 days later with hot and swollen
wrist. Ans ? Septic arthritis.
675.
676.
677.
678.
679.
680.
4. U/S HBS shows dilated intra and extrahepatic duct. What to do next?> Ans ERCP.
681.
682.
5. 80+ old pt has OA with knee effusion and no hx of gastric problem.Which Rx to start. Ans ..
Paracetamol.
683.
684.
6. Non smoker 's lung function test as he becomes old shows?. Book says the test is similar to
emphysematous changes d/t to air polutions. Ans ? Reduced VC/FEV1 and increase in TLC
685.
686.
7. Test for effectiveness of venesection in pt w haemochromatosis. Ans ? serum ferritinGuest, May 20,
2007#24
687.
GuestGuestA lady with abd distension has raised level of tumour marker CA 125,CA 19.9 ,CEA and
AFP .What is the cause? Ans ? Ca ovary
688.
689.
1. Polycystis kidney disease is Autosomal dominat,all family members got risk of develop ADPKD.
690.
691.
2. The patient who back from India with High ALT ,ALP is a case of leptospirosis.
692.
693.
694.
695.
696.
697.
5. Multifocal atrial tachy in COPD pt , the best ans could be verapamil as others are contraindicared
and some has no benefit.
698.
699.
6. The pt with 2/12 post MI needs a statin as the T.Chol/LDL ratio is > 4.5 and the is study regarding
the benefit of statin in IHD pt.
700.
701.
7. The accurary of CT -colonoscopy test is sum of both +ve and -ve predictive value(tricky q)
702.
703.
8. The man lost in desert got RAA system activated, release aldosterone and increase water resorption
through aquapore.
704.
705.
9. The elderly pat with PR bleed with negative stool result might have piles, so he needs proctoscopy.
706.
707.
708.
10. Senna cause melanosis coli. And PEG act by irritation of bowel wall.
709.
11.PD pt ,sx not controlled needs to add selegine( ans from Kaira)
710.
711.
12. T-cell def expose to viral and fungal ifx, so the ans is cryptococcus.
712.
713.
714.
715.
14. 2 opthal q with ans is diabetic maculopathy and ant optic neuropathy.
716.
717.
15. The ans that suggest pituitary tumour is decreased ACTH, as prolactin not markedly raised.
Prolactin can be raised by many other drugs and disease .The most common cause for high cortisol
with low ACTH is pituitary tumour!
718.
719.
720.
721.
722.
723.
18. The pt with tremor after salbutamol , lithium, diuretic and digoxin could most probably has digoxin
toxicity( nausea,anorexia and tremor) 2nd to hypoK as tremor is part of sx of lithium therapy.
724.
725.
726.
727.
20. R/O UC with barium studies?. UC can also cause terminal ileitis.
728.
729.
1. An old lady with RA had a fall at home, presented 3 days later with hot and swollen wrist. Ans ?
Septic arthritis.
730.
731.
732.
733.
734.
735.
4. U/S HBS shows dilated intra and extrahepatic duct. What to do next?> Ans ERCP.
736.
737.
5. 80+ old pt has OA with knee effusion and no hx of gastric problem.Which Rx to start. Ans ..
Paracetamol.
738.
739.
6. Non smoker 's lung function test as he becomes old shows?. Book says the test is similar to
emphysematous changes d/t to air polutions. Ans ? Reduced VC/FEV1 and increase in TLC
740.
741.
742.
743.
A lady with abd distension has raised level of tumour marker CA 125,CA 19.9 ,CEA and AFP .What is
the cause? Ans ? Ca ovary
744.
745.
A man with ? left eye ptosis and miosis. What to do ?. Ans carotid angiogram?
746.
747.
Worseing renal function in a pt after kidney transplant from a CMV+VE donor.What to do ?. Ans
ganciclovir
748.
749.
750.
751.
752.
tricuspid valve endocarditis fits the picture well than staph pneumonia-becos iv drug abuse.Guest, May
20, 2007#25
753.
GuestGuestA man with ? left eye ptosis and miosis. What to do ?. Ans carotid angiogram?
754.
755.
Worseing renal function in a pt after kidney transplant from a CMV+VE donor.What to do ?. Ans
ganciclovirGuest, May 20, 2007#26
756.
GuestGuestAsian woman in UK with lack of vit D. The cause ? lack of sun lightGuest, May 20, 2007
#27
757.
GuestGuestAre all the MRCP Part 1 Qs the same in all the centres?.I did not remember any Q
regarding the side effect of bisphosphonate / atopic eczema or the Q on VIPomaGuest, May 20, 2007
#28
758.
759.
pinch nerve-ulnar
760.
761.
762.
763.
the tricuspid endo one....what was the Xray findings suggestive of? why not staph pneumonia...can't the
iv drug abuser be a distractor?
764.
765.
766.
Dr.plaboGuestcannot remember wether we had questions like these: Diabetic pt with dyspepsia . Side
effect of ?.Ans.. Metformin OR A lady with abd distension has raised level of tumour marker CA
125,CA 19.9 ,CEA and AFP .What is the cause? Ans ? Ca ovary. There are a few other q's which after
so much thinking, I have been unable to recall. Yes, indeed, the ones who were giving the exam on
their 2nd or more attempt had a few different questions...like my friend got the q's of the tumor marker
for pancreatic carcinoma which was not in my paper..his was the 2nd attempt~ also, on another forum, i
have read comments about even the paper being different at exam centres....does this all really happen?
what is it all about?Dr.plabo, May 20, 2007#30
767.
768.
769.
770.
771.
772.
773.
774.
775.
after 40 yrs in a non smoker non exposure occupation wat will decrease?? i answered vital capacity
776.
777.
a question on accuracy
778.
779.
780.
781.
782.
783.
784.
Dr.kashGuestold woman who had htn and b/l pedal oedema wat diuretic 2 give
785.
ace,amlodipine,bisoprolol,diltizem........ace as she has oedema and cablocker no no and beta also not in
old???
786.
787.
788.
789.
790.
791.
792.
793.
sorry having a headache due to fear of failing will post more latterDr.kash, May 20, 2007#32
794.
795.
796.
2-how to manage warfarin over dose, a case of adult presenting with hematemesis and INR 10.
797.
798.
799.
800.
4-lady with exertional SOB, old Hx of uvitits, presentig with extensor skin lesion, ans sarcoidosis.
801.
802.
803.
804.
805.
806.
807.
808.
809.
810.
9-case o chronic pancreatitis given pancreatic supplement what to give to enhance the efect,ans.....
811.
812.
10-youg girl with hx of diarrohea even wakes her from her sleep which investagation
813.
814.
815.
816.
817.
818.
819.
820.
821.
15-how to manage warfarin over dose, a case of adult presenting with hematemesis and INR 10...ans is
FFP
822.
16-case o chronic pancreatitis given pancreatic supplement what to give to enhance the efect,ans.....
what were the choices...does anyone know about them?
823.
17.-youg girl with hx of diarrohea even wakes her from her sleep which investagation??? not sure
wether we had this q's
824.
825.
19-case discribing pyoderma gang, what treatment, ans prednisolone. i m not sure wether we had this
queston...can anyone give the complete case?DLC, May 20, 2007#33
826.
GuestGuestPart I May 2007 is now over. Hope the best for all ur set for it.Guest, May 21, 2007#34
827.
GuestGuestnot a hope
828.
829.
this papaer was really tuff. i haven't come across a worse one .think out of the three diets, may is the
most diffuicultGuest, May 22, 2007#35
830.
831.
832.
post transplant patient with donor cmv ... gangciclovir or pred???Guest, May 22, 2007#36
833.
834.
835.
836.
one was log regression analysis ,other chi square(definitely right as there was a 2*2 contigency table)
however i am not sure about the log regression analysis.
837.
838.
839.
840.
841.
842.
843.
844.
6)Oral contraceptive contraindicated in Migraine with focal aura...i think many wrote obesity.
845.
846.
847.
848.
849.
850.
9)Psychiatry questions: one was about conversion disorder(loss of sensory function) and one was about
hypocondriasis( acne ,wasnt going out)
851.
852.
853.
854.
855.
856.
857.
858.
Referred hematology guidelines but got no clear answer..the ans is btw transferrin or ferritin
859.
860.
861.
862.
863.
864.
865.
866.
867.
868.
Woman with sym of polymyalgia rhematica with visual problem. Ans..Ant Optic neuropathy
869.
Dr AhmedGuestFor the psychiatry question about acne, the answer is somatoform disorder, acne is a
symptom. and for the migraine question in which u r saying the answer is zumatriptan, i wrote
ergotamine as the question seemed to ask about prophylaxis(4 headaches in 7 months), but I'm
confused. hope we all pass Inshallah.Dr Ahmed, May 23, 2007#39
870.
871.
872.
GuestGuesta)Well i still fill the answer for acne case in psy was hypochindriasis as somatisation
disorders generally result in multiple somatic symptoms requiring multiple admissions....he was afraid
of acne....as it was a big disease....thats why i still think it should be hypochondriasis......
873.
874.
b)For migraine case... am sure it was zumatriptan..when i had read the question during the
exam.....ergotamine is not given for prophylaxis(more than 2 attacks per month)....
875.
876.
877.
878.
879.
880.
WEll medsri,the answer for diabetic patient;change in the vision...was due to osmotic changes in the
lens.....this is a repeat question from onexamination ,i am 100%sure about this one....Guest, May 23,
2007#43
881.
GuestGuestsome more!!!!
882.
883.
884.
885.
886.
887.
3)Bisphosphonates:MOA:Apoptosis of osteoclasts
888.
889.
4)A case of dermato myositis with charecteristic gottron patch(erythema of knuckles) and heliotrope
rash(blue purple discolouration of the upper eye lids)
890.
891.
5)One CNS Case had answer of right pons affection(a repeat from on examination)Guest, May 24,
2007#44
892.
893.
894.
Common everyone we would rquire to post more....it will be better for others appearing new......i will
pray for all inshallah we all will pass....Guest, May 24, 2007#45
895.
yusari84Guest1) Kidney hemangioblastomas The question about the kidney hemangioblastomas, the
answer was Von Hippel Lindau syndrome.......
896.
897.
Ref: Emedicine
898.
899.
900.
901.
902.
903.
904.
905.
906.
907.
908.
909.
910.
911.
912.
913.
914.
915.
916.
917.
918.
919.
920.
921.
922.
15) PML T 15:17 GOOD prognosis Med sriGuestGoserelin is an GnRH analogue. It is chemically
similar to the body's natural GnRH though it has a greatly extended half-life. After administration, peak
serum concentrations are reached in about two hours. It rapidly binds to the GnRH receptor cells in the
pituitary gland thus leading to an initial increase in production of luteinizing hormone and thus leading
to an initial increase in the production of corresponding sex hormones. Eventually, after a period of
about 14-21 days, production of LH is greatly reduced due to receptor downregulation, and sex
hormones are generally reduced to castrate levels.[3]Med sri, May 24, 2007#51
1.
2.
3.
4.
5.
b)presence of S4
6.
7.
8.
9.
10.
11.
12.
13.
3) i am sure there was a question regarding kdney angiomyolipoma...the answer was tuberous sclerosis.
14.
15.
16.
17.
18.
19.
20.
21.
3)Hyperacute graft rejection..i wrote IgM....but i thnk the right answer is IgG..as there are preformed
antibodies....i checked on the internet also...and found it to be IgG in most articles..
22.
23.
4)Pt with features of giant cell arteritis...prednisolone to be started befor even temporal biopsy
24.
25.
26.
GuestGuestHey all of yull..another important thing which i noticed there were two versions of the
paper...with differnt questons....especialy paper 1 ...i had made one freind during the exam..wen we
discussed in the break...a few questions were different in papaer 1 .Guest, May 25, 2007#54
27.
28.
GuestGuesti personally found January exam difficult,but as people generally are not agreeing with me,i
can be wrong and my assessment may be based on misjudgment,i had 57.95 that time,how did i got a
fraction of mark .95 ,i don't know,may be my friend is true that different questions have different marks
29.
lets pray for a better situation this timeGuest, May 26, 2007#56
30.
GuestGuestoh i remember ,i think the reason is that all questions are not counted towards result,now i
remember the total questions counted for result were i think not 200 but 196 or 198 thats why marks
come in fractionsGuest, May 26, 2007#57
31.
GuestGuestto guest uk
32.
33.
the obese female can also imply a diabetic, i worked in dermat before the number of patients with
acnthosis in dm and pcos is definitely outnumbered hypothyroidismGuest, May 27, 2007#58
34.
35.
36.
2)HIV....watery diarrhoea:cryptosporidium
37.
Bloody diarrhoea:cytomegalovirus
38.
39.
40.
41.
4)patient with past history of angioplasty done,Patient gets breathlessness on lying down: LVFailure
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
Niacin useful for increasing the HDL Levels.Guest, May 28, 2007#60
59.
GuestGuestAnti Lipid
60.
61.
The best rx for post MI pt with what ever reading of the lipid value is Statin. Refer Kalra,statin reduces
mortality as shown by studies.Guest, May 29, 2007#61
62.
guest ukGuesthi, The result is going to be announce on the monday may the 11th.. Be readyguest uk,
Jun 3, 2007#62
63.
64.
eafreenGuestbest of luck
65.
66.
i wish all of u who have attempted mrcp 1 MAY best of luck , praying for all sincere efforts ..........
67.
68.
69.
70.
71.
72.
GuestGuestfriends
73.
74.
75.
76.
GuestGuestresult 58.89.. and i pass thanks to Almighty AllahGuest, Jun 11, 2007#67
77.
SMAGuestFrom where did u find out ur result. I cannot find it at the mrcpuk site.SMA, Jun 11, 2007
#68
78.
GuestGuestr u sure u mean may 2007 exam? how did u get the result?Guest, Jun 11, 2007#69
79.
guest123GuestExuse me where is the result? it is not on the mrcp site... i think that it will be announced
5 p m u k time today, as usually... May Allaha pass all ..Ameenguest123, Jun 11, 2007#70
80.
GuestGuesthellow every body i wish all the best, r u sure that the results will be ready today? because
they said it will be dispatched on the week commencing 11/6/2007? :wink:Guest, Jun 11, 2007#71
81.
82.
guest123Guestu right, i was going through the web site and i come across the same, the week
commencing.. so now it is not clear waither today or tomarrow, but if it will releas today then it will be
round about 5 to 6 p m.guest123, Jun 11, 2007#73
83.
his22333Guestif the website before the result becomes official lets you reapply for part one does that
mean you have not cleared it this time..his22333, Jun 11, 2007#74
84.
GuestGuestI got my results.I failed. Pass mark 62.05, I got 57.44 onlyGuest, Jun 11, 2007#75
85.
drzerocoolGuestwhere did u get the detailed marks from? i also failed....aaaaaaaahdrzerocool, Jun 11,
2007#76
86.
GuestGuesti was also searching about my mark because i failed the exam too...............if u have any
infromation plz i am waitingGuest, Jun 11, 2007#77
87.
GuestGuestRegister for MRCP online account and u can see your detail marksGuest, Jun 11, 2007#78
88.
89.
vikesGuestcan any overseas people see there results cause i cant!!!vikes, Jun 11, 2007#80
90.
GuestGuestthanks for the information, i registered and i got 57.44. this is my first attempt, how can i
pass MRCP? is this is a bad result for first time?Guest, Jun 11, 2007#81
91.
GuestGuestI also failed,got 57.44 at first atempt at MRCP. But ,I feel ok with the result. I realized my
mistakes. Most of it can be avoided if I studied Oxford handbook of medicine and Kalra MRCP
Revision Notes.Guest, Jun 11, 2007#82
92.
GuestGuesti think not bad for first time,i also got 57.95 percent last time(pass 60 percent) now got
through with 69.23 percent thanks GodGuest, Jun 11, 2007#83
93.
guest ukGuestThanks God, i got through, can any one tell what is the passing cut off this timeguest uk,
Jun 11, 2007#84
94.
guest ukGuest57.7 is a lot of marks on first time, i got 54.87 last time and passed this time... u people
can do it.. do not disappointe... good luckguest uk, Jun 11, 2007#85
95.
96.
i got 60.95
97.
98.
guest ukGuestit hurt me a bit guest that u failed by just one percent, all that u can do now to apply for
the another exame and i m sure that u will get through next time... May allaha give u the courge..
because i have been went through the same situation...guest uk, Jun 11, 2007#87
99.
GuestGuestI PASS TOO! Wow, the passing mark is so high! I login to my online My MRCP , but
where do i check the exact marks?Guest, Jun 11, 2007#88
100.
GuestGuestI got 69.74%. Not bad for a first attempt. For my secrets, pm me.Guest, Jun 11, 2007#89
101.
eafreenGuestcongrats all who have passed ... and 69.7 is a big score wow .... kindly upload ur questions
with answers for helping all those who r planning to attempt september one ....eafreen, Jun 11, 2007#90
102.
vikesGuestfinally i am through!!!
103.
104.
I just wanna thank everyone on the forum , i think each contribution makes a difference.
105.
106.
My experience says as many mcqs you can do will help with kalra as your basix text book to refer to.
107.
108.
Emrcp, mrcpass- free qs, onexamination all are excellent and essential.
109.
110.
111.
GuestGuestI agree this is an EXTRA tough exam compared to last diets. So it surprises me to see the
passing mark of more than 60%.
112.
113.
Any how, for those who fail. Dun give up. The key is to keep trying harder and smarter.
114.
115.
116.
117.
118.
119.
120.
121.
at my previous attempt I got 53% so don't fret if it's your first time
122.
123.
bad luck to those who failed. I myself found out today that I failed the MRCP Ireland Part 1 by 0.45%
(I got 66.75% and the pass mark was 67.2%) but at last some good news Guest, Jun 12, 2007#93
124.
GuestGuest
125.
126.
127.
128.
129.
130.
131.
guest ukGuestAlhamdulliha, i have passed my exame with 68.25 which i can,t believe.. i was expecting
round about 60 to 62, i was thinking of cardiology the worst one but i got 14 out of 15 in cardiology...
amazing... i was thinking the haematology one of the best one and i got 6 out of 12... do not
understatnd... Any how i m tooooooooooo happy... may Allaha pass all. thanksguest uk, Jun 13, 2007
#95
132.
GuestGuestHi
133.
134.
if we passed the May part 1 can we sit the July part 2 written? Online it says we can apply but at the
same time it is allowing me to apply for part 1 also. Or do we have to wait until the next diet ie
November..?Guest, Jun 13, 2007#96
135.
136.
137.
but would you guys like to discuss what books to start from for part 2 and what would be the best
method for preparing for the next diet?vikes, Jun 13, 2007#97
138.
GuestGuest can anybody tell me how is the book "Essential Lists for MRCP by Staurt McPherson? can
i rely largely on this? or do i need to do Kalra & OHCM as well?Guest, Jun 29, 2007#98
139.
eafreenGuestkindly help
140.
141.
all those who have passed kindly extend your hands for help ... is kalra and onexamination and emrcp
enough for preprations or we need to study OHCM as well ??
142.
143.
144.
also let me know where shud we read clinical medicine and psycology from ??eafreen, Jul 1, 2007#99
145.
khan 23Guesti think, kalra, emrcp and onexamination is more than enough and i m sure that u will
through the exame if u will do it twice, as i did the same and got 68.25 percent.khan 23, Jul 2, 2007
#100
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january 2009 mrcp part 1 questions
Discussion in 'MRCP Forum' started by dr A, Jan 20, 2009.
Page 2 of 11
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1.
GuestGuestIg E for latex allergy?in patient who gt facial oedema when at dentist and works in nursing
home
2.
3.
4.
5.
since hes already nt controlled with short acting b agonist and steroid both
6.
7.
man whitney u test? for one statistics question( cant remeber exact que)
8.
9.
cant use student t test if data is non parametric?Guest, Jan 21, 2009#52
10.
11.
12.
13.
I am an egyptian cardiologist, who sat for previous jan 2009, paper 1 was good, but paper 2 was really
tough, i hope all of our forum pass this In shaa Allah.
14.
Now, i will post cardiology q i have rememmbered, plz feel free to comment.
15.
Cardiology:-
16.
1- Indication for glycoprotein 11B- 111A inhibitors --> Chest pain with positive Troponin and awaiting
CA.
17.
18.
3- Pt on warfarin with INR 3-4 wants dental extraction to be undertaken; stop warfrin, start subcut
LMWH for 2 days.
19.
4- Chest pain with ST elevation from V1-V4 --> Total occluded LAD.
20.
5- sever curshing chest pain, what sign is most suggestive of aortic dissection --> neurological signs in
LL, Back pain, HTN..?
21.
6- Male patient with Acute MI, after Coronary angiography by 24h., he developed dusky blue toe, O/E
loud bruit over femoral artery. CBC: Normal, Creatinine: 650. What is the cause: cholesterol
embolisation/Acute tubular necrosis.
22.
23.
24.
25.
26.
12- During preoperative assessment for cholecystectomy, there was a precordial systolic murmur, echo:
Normal valves, post. Pericardial effusion. What to do next --> proceed to operation, mammography.
27.
13- patient with acute MI, received thrombolytic, after 2 days she deteriorate. O/E apical systolic
murmur. What is the cause --> Rupture of papillary muscle.
28.
14- During assessment for PHTN, Right heart cath revealed increase of SO2 from SVC to RV. What is
the cause --> ASD.
29.
15- Predictor of Good prognosis in IE --> Isolation of Sterpt. Viridans from Blood culture.
30.
31.
32.
why is that we stop warfarin and give lmwh ...it was just a tooth extraction unler local anesthesia
...wats the reason ?dr A, Jan 22, 2009#54
33.
34.
complete blck ? morbits 11 block ?or wat ?dr A, Jan 22, 2009#55
35.
GuestGuestwhat was the one with the right flank pain, hypertension and confusion? I thought
scleroderma renal crisis so anticentromere antibodies would be postive?
36.
37.
38.
39.
also were there 2 qs with normal pressure hydrocephalus as the answer?Guest, Jan 22, 2009#56
40.
GuestGuesthi Dr A
41.
i m sorry, but after searching in the net, it seems that the correct answer is to continue warfarin :? .
42.
"In patients who are undergoing minor dental procedures and are receiving Vitamin K Antagonists, we
recommend continuing VKAs around the time of the procedure and coadministering an oral
prohemostatic agent (Grade 1B). The Perioperative Management of Antithrombotic Therapy*
American College of Chest Physicians Evidence-Based Clinical Practice Guidelines 2008.Guest, Jan
22, 2009#57
43.
44.
mrcp0235GuestA patient is recieving 2 litre of oxygen via nasal cannuale. What percentage of oxygen
is this equivalent to?
45.
46.
a) 16%
47.
b) 28%
48.
c) 35%
49.
D) 60%
50.
e) 80%
51.
52.
53.
dr AGuestthanx dr osler ...i wrote ..continue warfarin ...coz i thought it was a minor procedure why
disturb patient INR and put it him on risk ..appreciate ur search
54.
...yea anti myeloperoxidase is the answer for the one u mentioneddr A, Jan 22, 2009#60
55.
burningiceGuesthi dr osler
56.
can u pls confirm about that question where pt accidently injected adrenalin__i ans phentalmine
57.
58.
burningiceGuestdr osler
59.
60.
61.
62.
63.
64.
65.
Dr M EGuestMRCP1 Jan 09
66.
67.
Hi all
68.
69.
70.
71.
72.
73.
74.
75.
-FEV1 improved....empysema
76.
77.
- phaechromocytoma...phenoxybenzamine
78.
79.
80.
- alternative antiepileptic...lamotrigine
81.
82.
83.
84.
lets be more active and share more questions...Dr M E, Jan 22, 2009#64
85.
86.
87.
88.
4.HOCM: TOE
89.
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95.
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99.
100.
101.
102.
103.
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105.
106.
107.
108.
109.
26.Base of thumb and 1st carpomatacarpal jnt tenderness: OA/scaphoid Avas Nec.
110.
111.
112.
113.
114.
115.
116.
117.
118.
119.
120.
121.
122.
40.SLE: Membranous
123.
41.Huntington: Anticipation
124.
42.Peutz Jehger: AD
125.
126.
127.
128.
129.
130.
131.
132.
133.
134.
135.
53.Pain in knee, loss of ankle reflex, sensory loss lat margin: Disc Prolapse L4/5?
136.
137.
138.
139.
140.
141.
142.
60.Man with left arm pain, no biceps, triceps reflex: Myelitis/C5/6 disc herniation
143.
144.
145.
146.
147.
148.
149.
150.
151.
152.
153.
154.
155.
156.
74.pt with asthma awaking him from sleep: double the steroid
157.
158.
76.pt with low FEV1/FVC, after nebs FVC improves but not FEV1: Emphysema
159.
160.
161.
162.
163.
164.
82.pt with overdose of diazepam and alc., LFTs high, cause: paracetamol ingestion
165.
166.
167.
168.
169.
170.
171.
172.
91.ST elevation and inversion in V1-6 and inf. leads: 100% rt artery occlusion?
173.
174.
175.
176.
177.
178.
179.
180.
181.
182.
183.
184.
185.
186.
187.
188.
189.
190.
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192.
193.
113. man with rt lobar consolidation 3 wks after d/c from hospital: Gm +ve (CAP)
194.
195.
115. pt refusing intubation, cant tolerate ventilation, now confused, next: proceed with ventilation(
hasnt refused this, has he? )
196.
197.
118. pt with bone pain sec. to mets, on morphine and drowsy, next: reduce morphine, add steroids/ or
amytryptiline?
198.
199.
200.
121. Girl agitated, some psychosis-???? : was amphetamine poisoning, only stimulant out of choices,
rest were alcohol, barbiturates, diazepam.
201.
122. Pt with pustules, crops, pyrexial, Rx? : Acyclovir? Flucloxacillin? (secondary staph infection)
202.
203.
204.
125. in Hypoxia vasoconstriction which organ : skeletal? (diverts blood to more important organs)
205.
126. Indication for 2a/3b inhibitors : +ve trops and awt angio
206.
127. Pt with recurrent facial oedema, wheeze, rash : C1 esterarse inh. Def. (angiodema)
207.
208.
209.
210.
131. post MI, pain and murmur radiating to axilla : pap. Muscle rupture
211.
212.
213.
214.
215.
216.
217.
lets compelete and discuss it guys. please add and no. it aswell. thanksGuest, Jan 22, 2009#65
218.
GuestGuestResults &Equating
219.
220.
221.
222.
What is equating ?
223.
224.
225.
226.
139)IgA raised with IgA n IgM normal ...Monoclonal gammopathy of udertermined significance
227.
140)AF ...flecainide
228.
229.
230.
231.
232.
233.
146)old man with confusion for many weaks with some neurological signs ..chornic subdural
heamtoma ?
234.
235.
236.
237.
238.
239.
240.
153)concrete thinking
241.
242.
155)paralysis .. GB syndrome
243.
156)multiple sclerosis
244.
245.
246.
247.
248.
161)recurrent stputum wat will help ...pateint has bronchiectasis... postural drainage
249.
162)pt with long history of RA,low heamoglobin,low mCV but Normal MCHC....aneamia of chronic
disease
250.
163)hepatorenal syndrome
251.
164)hep c...cryoglobineamia
252.
253.
166)human derived immunoglobins for use in ITP ???dr A, Jan 22, 2009#67
254.
255.
256.
257.
258.
259.
asbestos...mesothelioma
260.
VT contra...verapamil
261.
pericardial rub....observe
262.
263.
264.
GuestGuestbenzodiazepines old age-increase in body fat..something like that .. i cant remeber the exact
questionGuest, Jan 22, 2009#69
265.
GuestGuestthe RA patient also had low platelts and lowish white count therefore it is myelosuppresion
secondary to methotrexate not anaemia of chronic diseaseGuest, Jan 22, 2009#70
266.
GuestGuestasbestos is not mesothelioma as he is not symptomatic at all, also there was similar question
on pastest it is pleural plaquesGuest, Jan 22, 2009#71
267.
268.
(cant remeber whether the person was a smoker or not)Guest, Jan 22, 2009#72
269.
GuestGuestbefore doubling the steroid amount in the sthmatic, u hav to goto a long acting beta 2
agonist..
270.
271.
272.
273.
274.
according to that it represnets a case where a guy presented with global reduction mevements of the
spine.
275.
276.
so cant that be the answer for the mrcp question too?Guest, Jan 22, 2009#75
277.
GuestGuestsearched the whole internet for dracunoculosis and glutela rach but there is no mention
anywhere linking the two?
278.
279.
i answered dracunuculosis for that guy who went to africa, not having gulteal rash..
280.
281.
282.
283.
284.
285.
then u can add antagonist montelukast at then end long acting beta agonist......I dont know whether
their expalnation is wrong or right...
286.
287.
288.
burningiceGuesthe smoked 5 cigaretes in a day;;;so i think the ans was PiSzburningice, Jan 22, 2009
#78
289.
290.
291.
GuestGuesthi guys
292.
293.
294.
295.
296.
297.
asthma : give salmeterol as its long acting and wil cover him overnight
298.
299.
300.
301.
302.
303.
304.
305.
306.
307.
308.
GuestGuestwas there a question where the answer was --- is present in micro molar concentrations...
309.
310.
311.
in the letter they sent us they say the pass mark is decided and kept constant for several diets..
312.
what was the pass mark last time? 521?Guest, Jan 22, 2009#83
313.
314.
315.
316.
317.
last september it was 521......no one knows wts RCP procedure coz in 200 question some question are
just for trial there are no marks for these questions......and as i heard there diffrent marks on diffrent
question depending on their difficultyburningice, Jan 22, 2009#85
318.
319.
The question was what will you do next? eventually a decision might be made to withdraw treatment,
but 1st step is to contact the oncall hospital lawyer who will contact the oncall judge to take the
decision that this patient has full capacity to decide that he doesnt wish to be managed to the best of his
interet , it is just to cover the hospitals back to avoid the family challenging you in the court that you
didnt work to the patient's interest and that he was very ill to tak such a life ending decision)Guest, Jan
22, 2009#86
320.
321.
322.
GuestGuestthe discription was typical for myotonic (holmes-adie) pupil. Argyl robertson causes miosis
from the bigging not mydriasis and it accomodates but doesnt reactGuest, Jan 22, 2009#88
323.
GuestGuestdidnt they say in the question that accomadation was present but light reflex was not there?
324.
i remember something like that.. but i also remember something like mydriasis..sorry cant remeber the
question exactlyGuest, Jan 22, 2009#89
325.
GuestGuesti have seen someposts from our senior members.....i would appriciate if they will help us
Guest, Jan 22, 2009#90
326.
GuestGuestit was really a tough exam....i even didnot remember question from 2nd paper.wt they were
askingGuest, Jan 22, 2009#91
327.
328.
GuestGuestdoesnt TNF alpha act in endocrine and systemic fassion?Guest, Jan 23, 2009#93
329.
Guest56GuestGluteal Itch!
330.
331.
332.
333.
The pupil was myotonic Holmes Adie- for the reason someone gave before, the pupil was dilated.
Guest56, Jan 23, 2009#94
334.
335.
Pt with burkitts developed confusion and muscle cramps 24 hrs after chemo..... TLS
336.
337.
338.
339.
340.
341.
342.
343.
5. Patient admited with respiratory tract infection, chronic liver failure, poor prognostic feature - ???
Caput medusae
344.
345.
346.
8. Weakness in the deltoid, triceps. Absent biceps triceps and supinator reflexes - ??? C5 and C6 discitis
347.
9. Headache, fatigue on timolol for glaucoma, right eye sudden loss of vision. Fundoscopy - swollen,
pale optic disc - ??? Gaint cell arteritis, optic neuritis
348.
349.
11. Uretero enteric fistual what metabolic disorder - ??? Hypo chlorimic acidosis or calcificaiton of
fistula
350.
12. Pain radiating for buttocks down, foot drop, loss of sensation on lateral aspect of foot sciatic
neuropathy
351.
352.
353.
15. JVP raise 6 cm breast carcinoma took chemotherapy. Presented with SOB cause SVC
obstruction
354.
355.
356.
18. Fifth month pregnant which anti biotic quadra indicated - ??? ciprofloxacin
357.
358.
20. Blood film leuco erythroblasts . what clinical feature we expect - ??? answer please
359.
360.
GuestGuestthere were no chest sign...so i think it wasn`t SVC obstructionGuest, Jan 23, 2009#97
361.
GuestGuestn y caput madusea....i ans splenomegaly.it was tough questionGuest, Jan 23, 2009#98
362.
GuestGuestJVP raise 6 cm breast carcinoma took chemotherapy. Presented with SOB cause SVC
obstruction
363.
364.
for the above, what about constrictive pericarditis as the answer?( in large pericard effusion u may nt
get a rub)Guest, Jan 23, 2009#99
365.
366.
367.
what is the drug cause erectile dysfuction???????drmuns, january 2009 mrcp part 1 questions
Discussion in 'MRCP Forum' started by dr A, Jan 20, 2009.
1.TCAs>>>>>>bicarbonates
3.
2.solid/liquid.........achalasia
4.
5.
4.paget disease
6.
5.gingival hyperplasia............nifedipine
7.
8.
7.violaceous ulcer........p.ganger.
9.
8.MRSA.........hand washing
10.
9.imatinib..........tyrosin kinase
11.
12.
11.adrenaline injection........phentolamine
13.
12.2nd choice after valproate.....lamotrige because she was taking oral contraceptive pills and
phenytoin,carbamazepine decrease their effect.
14.
15.
16.
17.
16.pyschotic depression
18.
17.anticepation
19.
18.digoxin........half life??????
20.
21.
20.phaeochromocytoma.........phenoxybenzamine
22.
23.
24.
23.ct to VT.....verapamil
25.
24.xanthine oxidase....allopurinol
26.
27.
28.
27.pseudomembrane colitis........cipro
29.
28.avoided in pregnancy.....cipro
30.
31.
32.
33.
34.
i will recall more questions.hope success to all en shaa allah muns, Jan 23, 2009#101
35.
36.
33.the patient who was on salbutamol and steroids.......give salmetrolGuest, Jan 23, 2009#102
37.
GuestGuesthi guys,regarding the glycoprotein IIa/IIIb inhibitors,i searched on the net and i found that
the NICE guidelines said that if the patient is at high risk(age,previous history>we shouln't wait for the
clinical blood test(troponin)that makes me confused with the answer.what do u think????????Guest,
Jan 23, 2009#103
38.
39.
40.
41.
we made a nice disscusion until now, i have collected my recalled question and others posted by
wonderful members under theses topics.
42.
lets discusss with evidence support any confusing question to learn better and enjoy the mrcp
challenge. :wink:
43.
44.
Cardiology:-
45.
1- Indication for glycoprotein 11B- 111A inhibitors ...Chest pain with positive Troponin and awaiting
CA.
46.
47.
3- Pt on warfarin with INR 3-4 wants dental extraction to be undertaken ... continue warfrain.
48.
4- Chest pain with ST elevation from V1-V4 ... Total occluded LAD.
49.
5- sever curshing chest pain, what sign is most suggestive of aortic dissection: neurological signs in
LL, Back pain, HTN..?
50.
6- Male patient with Acute MI, after Coronary angiography by 24h., he developed dusky blue toe, O/E
loud bruit over femoral artery. CBC: Normal, Creatinine: 650. What is the cause: cholesterol
embolisation/Acute tubular necrosis.
51.
52.
53.
54.
55.
12- During preoperative assessment for cholecystectomy, there was a precordial systolic murmur, echo:
Normal valves, post. Pericardial effusion. What to do next proceed to operation, mammography.
56.
13- patient with acute MI, received thrombolytic, after 2 days she deteriorate. O/E apical systolic
murmur. What is the cause ... Rupture of papillary muscle.
57.
14- During assessment for PHTN, Right heart cath revealed increase of SO2 from SVC to RV. What is
15- Predictor of Good prognosis in IE... Isolation of Sterpt. Viridans from Blood culture.
59.
60.
61.
Basic science:
62.
1- Specificity
63.
2- Sensitivity.
64.
65.
3- Assessment of antihypertensive drugs in 2 groups then washout interval and reapplication in the
same groups ...paired t test, unpaired t test.
66.
67.
5- Pts with very low levels of alpha(10%) anti trypsin ..genotype is ZZ.
68.
69.
70.
8- Man with hemophilia A, his wife is carrier for the gene and now get pregnant, what is the percentage
of their daughter who will have the disease ....50%.
71.
9- TNF. --> can be measured in micromolar conc in plasma, acts on specifc nuclear receptor, Released
from single cell
72.
10- Turner syndrome, what CV abnormality common after coarcatation ... VSD, PS.
73.
11- Pt going in resp 2 failure and refusing ventilation, confused ... take consent from the next of kin,
consult the hospital lawyer, antibiotic alone.
74.
12- Best test for Fall risk Assessment... Barthel index, waterlow ?!
75.
76.
14- 20 y pt with Parkinson, his sister also developed Parkinson at 16 year, his 2 brothers dont have
the disease, also his parents 55y, 46y have no signs of Parkinson, why: autosomal gene mutation with
incomplete penetrance, recessive gene mutation, association??
77.
78.
79.
80.
81.
82.
4- 65 year with Aortic valve disease, presenting with pallor. CBC..Microcytic hypochromic anemia,
upper endoscopy normal. What is next...Colonoscopy.
83.
84.
6- Most common disease causing recuurent 1st trimester abortion: APS, heterzygote factor5,
antithrombin deficiency.
85.
86.
87.
9- old man with back pain IgA raised with IgA n IgM normal, X ray mid spondylosis, Ca
2.5...Monoclonal gammopathy of udertermined significance, myeloma
88.
10- Pt with burkitts developed confusion and muscle cramps 24 hrs after chemo..... tumor lysis
syndrome, hypercalcemia.
89.
11- chemotherapy for breast carcinoma from 12 months, now presenting with dyspnea, JVP raise 6
cm, chest exam is normal, cause Lymphangitis carcinomatosis, SVC obstruction, chemotherapy
induced cardiomypopathy, chemotheraphy induced lung fibrosis
90.
91.
92.
Pharmacology:
93.
94.
95.
96.
97.
98.
99.
100.
8- Pts with metastaic bone disease, now she is very drowsy in hospital coz on large doses of
morphine....change it to naproxen and decrease the dose of morphine, switch morphine to sliding scale.
101.
102.
11- Side effects of all the hypertensives (ankle swelling, gum hypertrophy and beeding, fatigue) what
will you use ... ramipril
103.
12- Elderly with uncontrolled HTN on thiazide, echo LVH, ttt ... perindopril.
104.
105.
14- Mechanism of Hypokalemia in thiazide ...increase flow to distal tubules, opening of K channel in
principal cells?.
106.
107.
108.
17- Man on multiple drugs for lymphoma devolped DVT ... Thalidomide.
109.
110.
111.
112.
113.
114.
115.
116.
Respiratory:
117.
1- 60 year man with 30 year history of smoking, lung function test revealed Obstructive pattern not
improving with steroid ... Emphysema.
118.
119.
3- 50 year old man with history of TB from 10 year, presenting now with recent weight loss,
hempoptysis and lethargy.
120.
121.
122.
4- 27 yrs old with 5 cigs daily -2 yrs of haemoptysis intermittently?? bronchial carcinoid, foreign body.
123.
5- female came for reviewing asthma treatment, she uses beclomehasine 800 mg, on demand salbutoml
inhaler abot 3 times daily, she is awakend by ashtam at nitght once or more by week...
124.
Add long acting salmeterol, continue same ttt, double dose of steroids, montelukast.
125.
126.
127.
128.
129.
Dermatology:
130.
131.
2- Red tender raised nodule with diarrhea, fever ... erythema nodusum.
132.
3- rosceasa.
133.
134.
135.
6- month history of transient urticarial wheal on trunk legs ....idiopathic alleric urticaria.
136.
7- 60 years old with Blisters with no mucous membrane involvement : Bullous Pemphigoid.
137.
138.
139.
Infectious disease:
140.
1- pt with pacemaker insertion presents with diarrhea and lower back pain ... staph discitis. (onx).
141.
2- Old lady with cough, breathlessness, confusion, diarrhea, fever ... Legionnaires' disease, Listeria
meningitis.
142.
143.
4- adult with chicken pox, fever , SO2 is 96% ... acyclovir, paracetamol, VZ Ig.
144.
5- MRSA..wash hands.
145.
6- HIV brain...lecoencephalopathy.
146.
147.
148.
149.
Endocrine:
150.
151.
2- Elderly with hypercalcemia, normal ESR ...Primary hrperparathroidism, breast metastasis, myloma.
152.
3- 60 y man with back pain, ca 2.5, X r back mild spondylosis, paraprotein 6. What is the diagnosis
... MGUS, myeloma, Walendstorm.
153.
4- 35 year old man with firm goitre and hypothyroid pic (T4:5 , TSH: 45) Iodine deficiency,
hasimoto thyrioditis.
154.
5) Most poor prognostic for plantar ulcers in diabetic- Loss of vibration sensation, previous ulceration
or loss of foot arch.
155.
156.
157.
158.
159.
160.
161.
Nephrology:-
162.
1- Old man, urine analysis revealed gross hematuria, plus protein with normal US. Next thing ...
cystoscopy.
163.
4- Patient with HTN, urine analysis +3 blood, +3 protein ... renal biopsy.
164.
5- cause of ARF in analgesic ingestion in Rhumatiod pt ... papillary necrosis, ATN, interstitial nephritis.
165.
6- Flank pain with hematuria ...scan and urine no stone ...renal vein thrombosis (anticadiolipin AB).
166.
167.
168.
169.
Gastroenterology:
170.
1- pt with stomach ulcer underwent partial gasterctomy 6 months ago, he was on long term H2 blocker,
now presenting with abdominal pain, endoscopy revealed active benign ulcer at the stomal site, what to
do next... gastrin levels, H pylori test.
171.
172.
173.
174.
175.
6) LC with worseneig jaundice, HBs AB +, all other negative ... previous HBV vaccination.
176.
177.
178.
9) Patient admited with respiratory tract infection, chronic liver failure, poor prognostic feature
Ascites, caput medusa, peripheral edema
179.
180.
181.
Rheumatology:-
182.
183.
184.
3- Pt with limited hip internal rotation ..knee pain but on X ray knee was normal X ray pelvis, x ray
femur, MR knee, arthroscopy knee.
185.
186.
5- Proximal muscle weakness, rash on the back, joint pain, CK 2500 dermatomyositis, SLE.
187.
188.
7- Patient with pulmonary Hemorrhage and Cresenttic GN which Antibody ... Antimyeloperxidase AB.
189.
8- Man devolped proctitis, then knee pain, aspiration ve for organism ... Celeoxib, intraarticular
steroids.
190.
9- Young female with dysuria, the devolped acute inflamed joint ... disseminated gonococci, staph.
191.
192.
11- pt with long history of RA,low heamoglobin,low mCV but Normal MCHC, platelets 151....aneamia
of chronic disease
193.
194.
195.
196.
Neurology:
197.
1- Sudden headache ...drowsy but responsive pt ... the right eye no perception of light, the left eye loss
of temporal field, BP 90/60 ...pituitary apoplexy.
198.
2- 48 year alcoholic woman who had manifestation of peripheral neuropathy from 18 months, O/E
raised JVP, hepatomegaly, ankle swelling. Creatinie 150. CXR: normal sized heart.
199.
200.
3- Girl with fever and neck stifness and CSF picture: increased protein, normal Glucose,
Lymphocytosis. Diagnosis .... viral meningitis
201.
202.
5- Dilated left pupil not reacting to light, on accomdation, the pupil become constricted even more than
Rt side: Myotonic pupil, Argyll Robertson
203.
204.
7- Tremors in old lady increase with movement with head nodding . Propranolol.
205.
206.
9- Old man with intermittent confusion for many weaks with some neurological signs..chornic subdural
heamtoma
207.
208.
209.
12- Recurrent headache over 3 weeks, not relived by paracetamol, and nasal discharge ...cluster
headache
210.
13- Weakness in the deltoid, triceps. Absent biceps triceps and supinator reflexes Syringomyelia
211.
14- Pain radiating for buttocks down, foot drop, loss of sensation on lateral aspect of foot . Sciatic
neuropathy.
212.
15- 65 years old man with history of MI from 10, presenting now with pain in the LL on walking,
relived by rest, especially on sitting down.
213.
O/E there is osteoarthritis in the knee, preserved dorsalis pedis, absent ankle reflexes. Diagnosis.
Spinal stenosis, Peripheral vascular disease.
214.
215.
Psychiatry:
216.
1- Person caught driving at very high speed on the road n he had a pressured speech. and he was very
agitated n asking why he was taken in to restriction...n he said he was riding on a cart pulled by horses
of Apocalypse... Mania, schizophrenia
217.
2- person was caught from a school shouting that he cud save all the children from the devil of drugs
3- 65 year old recently retired business man with early morning low mood, loss of interest, poor
memory and concentration worried abt money but his wife said there is no financial problems, on
mininmental score 26/30 ...depression, Alzheimer.
219.
220.
5- Patient with 2 years no job, Hx of suicide, hearing voices discussion about him, O/E he avoid eye
contact with disjointed speaking Psychotic depression.
221.
222.
7- Which support alcohol withdrawal - patient sees dog near bed in hospital.
223.
8-
224.
9- Person was told why not throw stones if your house made of glass, he said because it would
break. concrete thinking.
225.
226.
11- Man with episodic attack of derealizatoin lasting minutes Dissociative disorder Vs Non epileptic
seizure.
227.
228.
Ophthalmology:-
229.
230.
231.
232.
- Davidson 2006 " although almost any AB may be responsible, the most commonly implicated are
cephalosporins, ampicillin, clindamycin" page 931.
233.
- Wikipeida " The use of broad-spectrum antibiotics such as clindamycin and cephalosporins causes the
normal bacterial flora of the bowel to be altered". hey but if u continue u will find " Recently, evidence
has emerged to suggest that the use of ciprofloxacin (in addition to a primary causative antibiotic such
as clindamycin) is associated with increased mortality in patients with pseudomembranous colitis.
234.
235.
Dr IbnsinaGuestRegarding neuropathy:
236.
237.
the questions said that it is 18 history of PN with raised JVP, hepatomegaly and normal sized heart in
CXR.
238.
239.
Only amyloid can cause this clinical picture, as it leads to restrictive cardiomyopathy and PN at the
same time.Dr Ibnsina, Jan 23, 2009#106
240.
GuestGuestjust regarding the question of the lady with breast cancer and rib and back pain and was
drowsy...
241.
could could have 2 things...morphine toxicity or brain mets! Because she had advanced disease did she
not
242.
243.
244.
245.
has not the patient given a valid request/consent not to be ventilated and knew he could die. So to
continue with po antibiotic and that was his informed consent??Guest, Jan 24, 2009#107
246.
GuestGuestpt who refused to have mech ventilation.....the right ans is withdraw all the treatmnets....coz
question was like that:
247.
he refused mech ventilation,n agreed for oral antibiotics...it means he was on oral antibiotics
already....n the other main thing wich was mentioned in the question that pt knows that if will not take
vent he can die.....
248.
so the option is withdraw all the treatment.....same question in pastest....Guest, Jan 24, 2009#108
249.
Dr IbnsinaGuestThanks dr for ur comment, but he said clearly that she had breast cancer & rib
metastasis, then 4 phrases about her morphia regimen and persistant pain and incrasing breakthrough
dose to releive pain...etc
250.
but no clues regarding Acute neurolgical deficit to suggest brain met. only said "she becomes very
drowsy". What do u think?Dr Ibnsina, Jan 24, 2009#109
251.
252.
2.anaeamia of chrinic disease is always normochromic and normocytic...but there was hypochromic
253.
3.28 yr hymoptysis for 2 yrs:how it could be friegn body....n if there is carcinoid he must have any
other symptom of carcinoid.
254.
4.it wasnot essential tremor...coz it was unchanged during the action...i think benzohexol is the best
option...wt do u think guysGuest, Jan 24, 2009#110
255.
256.
An advance directive can be made by anyone who is over 18 years old, is of sound mind and cares
about the issues involved. Some people may be especially likely to choose the option including those
with incurable cancer, those with a progressive neurological disease and those with mild memory loss
as they are still of reasonably sound mind but at risk of progressing to dementia. Anyone who cares
greatly about the issues involved may wish to consider such a will.
257.
258.
If, as a doctor or healthcare professional, you are approached by someone who is considering such a
will there are several points to make:
259.
260.
Think very carefully about the content of such a will before committing yourself.
261.
Discuss it with those close to you and try to cover all eventualities.
262.
263.
264.
It is not possible to request interventions that the medical team regard as excessive and
inappropriate.
265.
266.
267.
It is not essential to make it via a solicitor but there may be some safeguards in doing so.
268.
Doctors and family should know that such a will exists and where it is lodged.Dr Ibnsina, Jan 24,
2009#111
269.
Dr IbnsinaGuest1- "The development of aspergilloma produces a tumor like opacity on X- ray BUTm
Asergilloma can usually be distinguished from a peripheral bronchial carcimoma by the presence od a
crescnt of air between the fungal ball and the upper wall of the cavity" DAVIDSON page 704.
270.
271.
- the question didnot mention any separation of this solid mass in the upper lobar cavity from the wall
by air, so what would br the most dangerous in 70 years male with weight loss and hemptysis and solid
mass in X ray :!: :!:Dr Ibnsina, Jan 24, 2009#112
272.
273.
" The anemia of chronic disease is usually associated with normal MCV, though this may be reduced in
long standing inflammation."
274.
In another paragraph " It is often difficult to distinguish the anaemia of chronic disease associated with
a low MCV from fe deficieny anaemia"
275.
276.
So, Dear Dr Guest there is anaemia of chronic with low MCV according to davidson. and other normal
parameter of CBC (wbc 8 , pl 151) are against pancytopenia.Dr Ibnsina, Jan 24, 2009#113
277.
GuestGuestA 34-year-old patient known with motor neurone disease was admitted with type 2
respiratory failure. He has chosen to die from respiratory insufficiency and does not want any
intervention, having stated this in writing on two previous admissions. His breathing deteriorates and
he becomes confused. What is the most appropriate next step?
278.
279.
Relieve any respiratory distress with opiates or other respiratory suppressants Correct answer
280.
281.
282.
283.
284.
In this case, where the patient has expressed a longstanding wish not to be ventilated then it would be
appropriate to relieve any distress. Intervention with intubation and ventilation may be classified as
assault.Guest, Jan 24, 2009#114
285.
mitsGuestabout the lady with brain mets when i worked in palliative medicine the first signs of brain
mets esp in oncology patients was decreased consciousness and before any neurological deficit because
it sometimes takes a bit of time to develop a neurological deficit as such...
286.
and the other thing about the patient and po antibiotic i dont understand if a patient deteriorates you
stop treatment.. the patient said he was happy to take the medication so you continue UNTIL he is on
the Liverpool care pathway... so until swallowing is dangerous...worsening of condition does not mean
he cant swallow. Antibiotics may help his symptoms?mits, Jan 24, 2009#115
287.
GuestGuestanyway dr Ibnisena............If you choose this name then ofcourse u will b genius
288.
289.
290.
GuestGuestthe 2nd paper was so hard what do u think guys the pass mark is>Guest, Jan 24, 2009#117
291.
Dr ZamanGuestReurrent rash over gluteal region (and wrist) is typical of Strongyloids stercoralis. But I
do not remember whether this option was there in the question. Dracanculosis causes generalized rash
not localized. Scistosomiasis causes swimmers itch at first at contact sites no predilection for gluteal
region. Anylostoma duodenale causes ground itch on feet.Dr Zaman, Jan 24, 2009#118
292.
Dr ZamanGuestRecurrent hemoptysis for 2 years + 5 cig/day + upper lobe collapse in CXR dx:
bronchial carcinoidDr Zaman, Jan 24, 2009#119
293.
in the question which u guys say the answer is bronchial carcinoid.. there werent any othr features
suggestive of carcinoid ..
294.
wouldnt bronchial carcinoma or foreign body be better options..?Guest, Jan 24, 2009#122
295.
296.
297.
298.
299.
both hypo and hyperthyroidism can cause osteoporosis.Guest, Jan 24, 2009#123
300.
GuestGuestSIADH is also a side effect of lithium, what do you say?Guest, Jan 25, 2009#124
301.
302.
303.
304.
305.
4. Suspected HOCM inv: I think trans thoracic echocardiography not TEE (TEE is particulary for
posterior part of heart e.g. atraial thrombus, atrial septum, and mitral valve and particularly prothetic
valve anomalies)
306.
307.
308.
309.
310.
confusional state
311.
8. Painful upperlimb with neuropathy dx: neuralgic amyotrophy(?)Dr Zaman, Jan 25, 2009#126
312.
Dr ZamanGuestBronchial carcinoid
313.
314.
It is a typical picture of bronchial carcinoid, long history of indolent endobronchial growth with
recurrent hemoptysis, I sugesst-search in Harrison. There may not be any feature of carcinoid
syndrome.Dr Zaman, Jan 25, 2009#127
315.
GuestGuestthe patient was 28 yrs old what is the mean age for bronchial carcinoid?Guest, Jan 25, 2009
#128
316.
Dr ZamanGuest1. ST segment elevation ans: 100% occlusionDr Zaman, Jan 25, 2009#129
317.
318.
319.
320.
321.
322.
323.
324.
GuestGuestBronchial carcinoids are rare, slow-growing neuroendocrine tumors arising from bronchial
mucosa that affect patients in their 40s to 60s.
325.
326.
Dr ZamanGuestLong QT
327.
328.
QT prolongation occurs maily due to prolongation of ST segment which coincides with phase 3 and
pase 4 repolarization of action potential which is due to potassium channel.Dr Zaman, Jan 25, 2009
#134
329.
GuestGuest. Alcoholic in hospital + visual hallucination (dogs) dx: acute confusional state
330.
331.
but this occured in the 4th day in hopsital, hes a known alcoholic..delerium tremens has it maximal
effect in 72 hrs..
332.
333.
Dr ZamanGuestLithium rather causes nephrogenic diabetes incipidus not SIADHDr Zaman, Jan 25,
2009#136
334.
335.
so cant it be TOE (not TTE) coz they asked for the best test to diagnose..not the most convinient..
337.
338.
339.
Raised JVP + heavy alcoholic + hepatomegaly + (?) normal preacordium + uraemia + peripheral
neuropathy dd(?): alcholic/ureamic/churg strauss etc?Dr Zaman, Jan 25, 2009#139
340.
341.
342.
Dr ZamanGuestPorgnosis in CLD
343.
344.
Prognosis in CLD: signs of decompensation i.e. ascites, jaundice and encepalopathy not caput medusae
or splenomegalyDr Zaman, Jan 25, 2009#141
345.
Dr ZamanGuestDiarrhoe in Mexico
346.
347.
Patient develops diarrhoea 5 days after arrival in Mexico. What is the likely cause?
348.
I think E coli, it is the commonest cause of traveller's diarrhoeaDr Zaman, Jan 25, 2009#142
349.
350.
GuestGuestit wasnt Giardiasis>>coz mucusal stool and abdominal cramps,bloatingGuest, Jan 25, 2009
#144
351.
GuestGuestE. coli is the most common cause but characteristic of stool fits with gardiasisGuest, Jan 25,
2009#145
352.
GuestGuestdr erum khalil it could be bronchioectasis but the lesion was in left upper lobeGuest, Jan 25,
2009#146
353.
354.
355.
356.
357.
GuestGuestDear .....
358.
359.
360.
361.
8)
362.
363.
364.
365.
it asked what reduces when you increase the cut offGuest, Jan 25, 2009#150
. Prognosis of ALL: t(9:22)
4. HOCM: TTE (well discussed in the forum)
34. Asbestosis: most common - I think, pleural plaques
38. Longstanding RA + renal impairment: rectal biopsy is for diagnosing renal amyloidosis, renal
biopsy causes uncontrollable hematuria
64. Girl with polyuria and polydipsia; high Posm (300) and low Uosm (200): indicates DI or
nephrogenic diabetes incipidus (may be drugs!)
73. Cortisol excess: initial investigation overnight dexamethason suprression test (or 24 urinary
cortisol, not included in DD in Jan 2009)
88. Minoxidil is not a good drug for routine use. Main SE of concern was ankle edema. So, ACEi is
suitable.
92. Difficult question: digoxin pharmacokinetics - for loading dose, I think VD is to be considered first,
but most prefers to half life
110. SLE like symptoms + mouth ulcer + arthritis: why not SLE! (than Behcet's!)
122. Crops of pustules etc (VZ): acyclovir within 24 hrs, Flucloxacin if signs of bacterial infection
123. Regular cannon wave: junctional rythm
127. Angioedem(?): in angioedema there should be no urticarial rash or itching
134. Pain on SLR indicates Sciatic nerve compression and sacroilitis. Sacroilitis is indicated by pain on
sacroiliac compression. Compression on ant-sup iliac spine with patient supine
135. Homonymous hemianopia may be right or left, (not bitemporal). Lesion is in Occipital lobe
150. Achilles tendonitis - quinolones
1.
2.
3.
4.
1. Normal XRay
5.
2.CT scan
6.
3. MRI
7.
4. Isotope scan
8.
9.
1. strept viridians
10.
11.
2. Staph epidemidis
12.
3. candida
13.
4. staph aureus
14.
15.
16.
17.
need sensitivity?
18.
19.
40%
20.
80%
21.
22.
Scaly patches on the scalp in a 16 year old boy with non scarring allopecia
23.
24.
1. Discoid lupus
25.
2. Psoriasis
26.
27.
28.
1 VIPOMA
29.
30.
31.
32.
33.
girl ate in chinese restaurant, presented with V ANd D, what is the organism...B. cereus, E coli, (old
question)
34.
35.
unkempt guy, came to a school claiming to save children from ill of the world, dia ...
36.
40s lady presented with some sort of rash over extensor surface, buttock, what investigation u wish to
order: viral swap from skin
37.
38.
lady 30-40, presented with proximal myopathy, rash over body. inve ...
39.
. Mother presented with a few days history of rash over the body and arthralgia. Also have similar
history among her children days/weeks ago, diagnosis: rubella, IM.......
40.
41.
40s lady presented with some sort of rash over extensor surface, buttock, what investigation u wish to
order: viral swap from skin
42.
43.
lady 30-40, presented with proximal myopathy, rash over body. investigation noted raised CPK: SLE,
dermatomyositis, RA........
44.
eldery lady in nursing home with genital discharge, vaginal swap noted N. gonorrhea, and was treated,
what you want to proceed: contact tracing, inform family, non-official inquiry.............
45.
46.
HIV positive with 2 months of cough, fever weight loss, which organism if grow from sputum
suggestive of AIDS: TB...............
47.
48.
Known IVDU on methadone for post-hepatitis immunization workupg, noted + HBsAg, - HBsIG, +
HCV. what is the cause of failed immunization: HIV +, chronic hepatitis C, Methadone
interaction...........
49.
50.
Man came from form summer holiday in Jerman, presented with CN lesions: cuases: Lyme ds..............
Guest, Sep 21, 2005#1
51.
52.
53.
. Mother presented with a few days history of rash over the body and arthralgia. Also have similar
history among her children days/weeks ago, diagnosis: rubella, IM.......
54.
55.
56.
4. Eldery lady known presented with right diabetic foot, with right 1st metatarsal amputation done,
presented now for 2 weeks history of right foot pain and rash. O?E tender, inflammed looding. what ix
you wish to order: right foot x-ray, ct, mri, white cell radioisotop, ?bone scan
57.
58.
GuestGuestby enroute
59.
60.
61.
62.
CMV/Toxoplasmosis/Mycobacterium
63.
64.
65.
66.
67.
68.
3. 22 yr old male come with h/o rashes on his face and hands last 2 years. He claims there is one
ointment that that cure his problem but he has not been able to find any proprietary medication that
worked. Examination is normal. What is the diagnosis:
69.
70.
71.
Second paper was tougher than the first. Will post more questions when I get time.Guest, Sep 21, 2005
#3
72.
73.
74.
ByRex 24
75.
76.
77.
78.
79.
3) Postural Hypotension with ataxia with parkinsonism features, recurrent falls -- Multisystem atrophy/
80.
81.
82.
83.
5) Sensitivity
84.
85.
86.
87.
7) asymptomatic with Essential thrombocytosis - platelet count > 800 - Treatment - Aspirin/
hydroxurea/ Platelet pheresis/ radioactive substance/ observation
88.
89.
90.
91.
92.
93.
94.
95.
96.
11) anticipation
97.
12) BIH
98.
99.
100.
101.
102.
103.
104.
105.
106.
Bye
107.
108.
109.
110.
Good LUCK
111.
112.
_________________
113.
114.
115.
116.
dr_osler
117.
Guest
118.
119.
120.
121.
122.
123.
Posted: Wed Sep 21, 2005 12:28 am Post subject: mcqs in sep 2005
124.
125.
126.
Could any one who has appeared in the exam today post any mcqs
127.
128.
129.
130.
131.
132.
133.
134.
135.
1. Eclampsia
136.
2. Pre eclampsia
137.
138.
139.
140.
1. Somatoform
141.
142.
143.
144.
145.
146.
147.
148.
1. avascular necrosis
149.
150.
151.
Drug C/I
152.
153.
154.
155.
156.
157.
158.
159.
160.
161.
1. Aspirate culture
162.
163.
164.
165.
166.
CA 125
167.
168.
169.
170.
171.
172.
GuestGuestViolaceous color and itching in the left arm (linear) and flexors
173.
174.
175.
176.
177.
178.
179.
180.
1. lipase
181.
182.
183.
184.
1.Alcohol
185.
186.
GuestGuestDiabetic with frozen shoulder -----> adhesive capulitisGuest, Sep 21, 2005#23
187.
188.
189.
1.B blocker
190.
191.
192.
1 Phenytoin
193.
194.
195.
196.
197.
198.
199.
200.
201.
202.
203.
204.
205.
1. CRP
206.
207.
GuestGuest19 year old 1.8 meter, small testes, low FSH, LH, Testestenor
208.
209.
1. Kalmman
210.
211.
GuestGuestPt with dyspepsia, +ve H. Pylori and mild ?? lymphoma of the stomach??
212.
213.
Treatment?
214.
215.
1. Eradication of H. Pylori
216.
217.
GuestGuestwellll... it is nice to see someone posting the examination questions...but please ...put them
in organized manner and if possible in specialty order.Guest, Sep 21, 2005#32
218.
GuestGuestDiagnosis of Insulinoma??
219.
220.
221.
222.
Treatment?
223.
224.
225.
GuestGuestGlomerulonephritis treatment??
226.
227.
228.
GuestGuestagain please ... it is nice to see someone posting the examination questions...but please ...put
them in organized manner and if possible in specialty order.Guest, Sep 21, 2005#36
229.
CliffGuest
230.
Clinical Pharmacology
231.
232.
233.
3. which term best describe the affinity of drug for its receptor -> ? Selectivity ? potency
234.
235.
Cardiac
236.
237.
238.
3. Case with AMI and malignant hypertension -> ? primary PTCACliff, Sep 21, 2005#37
239.
240.
241.
Hi ,
242.
I just wanted to share my impression from the exam and some useful tips for future candidates.
243.
1. Philip Kalra should be known from cover to cover. Every single sentence brings a lot of information.
244.
245.
3. There is no point to do as many questions as possible, because they always make new questions. The
proportion of repeated questions is only 20% - some from onexamination, some from pastest.
246.
4. It is more sensible to know as much theory as possible because you have the base to manipulate with
the information.
247.
248.
249.
250.
251.
3. Diagnosis of DH in patient without diarrhoea - IF of paralesional skin. Small intestine biopsy was an
option.
252.
253.
254.
255.
7. A case of sporadic colonic carcinoma, mechanism in tumorogenesis - p27 deletion. The other four
options were impossible because they showed either tumour supressor gene up-regulation or
protoncogene down-regulation. A killer question!
256.
257.
9. A lady post CS, given 3 U of blood, 30 min later shock - ABO incompatibility.
258.
259.
260.
12. Cocaine induced MI - Rx PTCA, not thrombolysis; the mechanism here is vasoconstriction rather
than clot formation.
261.
13. Food poisoning after tuna and wine, vomiting + facial flushing, cause - scombrotoxin.
262.
14. What is the lifetime risk for nephropathy in Type 1 DM in a 27 year-old man- between 20-39%.
Kalra actually says 30% risk over 40 years in Type 1 DM.
263.
264.
265.
18. A case of delayed puberty with low FSH, low LH, low testosterone - Kallman's syndrome. Nothing
mentioned about anosmia but remember Kallman= hypogonadotrophic hypogonadism= low FSH, low
LH, low testosterone, whereas Kleinfelter- hypergonadotrophic hypogonadism= high FSH, high LH,
low testosterone.
266.
19. A lady with fever, arthropathy, kids with rash a week ago - Parvovirus B19.
267.
268.
269.
270.
271.
272.
25. Criteria for thrombolysis - >1 mm ST elevation in two or more limb leads.
273.
274.
27. Asymptomatic 75 year old with high Ca, low PO4, no evidence for MM -primary
hyperparathyroidism.
275.
276.
277.
278.
I hope this will help you in your preparation for the exam,
279.
280.
The past is like the Atlantic Ocean, but the decisions I make - that's my mirror. And I have to live them
alone. And I can't erase it, no one can erase it.mac, Sep 22, 2005#38
281.
HajmiGuestHI FRIENDS,
282.
PAPERS WERE FAIRLY MADE. TOPICS THAT I CUD REMEMBERED SPLICING OCCUR AT
283.
COELIAC DISEASE
284.
CROHNS DIS
285.
BULIMIA NERVOSA
286.
287.
ULCERATIVE COLITIS
288.
SLE
289.
SJOGREN
290.
ALZ DISEASE
291.
292.
293.
CARBAMAZ POISONING
294.
LITH POISONING
295.
PARACETAMOL POISONING
296.
SOMATOFORM
297.
MANIA
298.
HYPOMANIA
299.
PANIC
300.
ANXIOLYTIC DRUGS
301.
SVT
302.
303.
N ACETYLCYSTINE MECHANISM
304.
BULIMIA NERVOSA
305.
CONDYLOMATA
306.
307.
GuestGuestvery nice ,Cliff,Mac and Hajmi....i hope that all of u did very well there and i hpoe also that
u will pass the part I examination with god's help.Guest, Sep 22, 2005#40
308.
309.
310.
311.
312.
313.
314.
315.
316.
317.
318.
319.
320.
321.
322.
11.PT WITH CCF AND A LARGE BOUT OF P/R BLEEDING.UPPER GI ENDOSC NORMAL DX
ANGIODYSPLASIA
323.
324.
325.
326.
327.
328.
17.PT WITH HEART VALVE RX AND SMALL VEG ON ECHO DX:STAPH EPIDERMIDIS
329.
18> FEMALE WITH HYPOGLYCEMIC EPISODE: STOP DRIVING FOR 3 MNTHS..I HOPE
330.
331.
332.
333.
22 O2 GIVEN TO A PT AND HIIS SAT FALLS FOR SOME TIME WHY? B/C OF PUL ARTEY
RELAXATION CAUSING MISMATCH B/W PERFUSION AND VENT
334.
335.
336.
25 Q OS PIT APOPLEXY
337.
26 MANY OPTH QS
338.
339.
340.
341.
342.
343.
344.
31.PT OF SCHIZOPHRENIA
345.
346.
347.
348.
349.
350.
37DERM INCOGNITO
351.
352.
353.
354.
355.
356.
357.
358.
359.
360.
361.
362.
363.
50ULNAR ENTRAPMENT
364.
51.BOORHAVE DISEASE
365.
52.TENSION HEADACHE
366.
53.KLINEFELTER SYNDROME
367.
368.
369.
370.
371.
58.SIADH
372.
59.CRANIAL DI
373.
374.
61 SAME IN AML?
375.
62.BULIMIA NERVOSA
376.
64 MANTOUX TEST
377.
65SCDSC
378.
66.OSTEOSCLERTIC LESION
379.
380.
68.MAEMOCHROMATOSIS
381.
69S/E OF ROSIGLTAZONE
382.
70ANTICIPATIO
383.
384.
72 VARICELLA ZOSTER
385.
73SCROMBOTOXIN
386.
387.
388.
389.
390.
77RENAL BIOPSY
391.
78LICHEN PLANUS
392.
79 CRITERIA OF MI
393.
SOMATIZATION SYNDROME
394.
80 MEDIAN NERVE
395.
81AIP
396.
82 ODANSETRON
397.
83DERMATOMYOSTIS
398.
84 REFEEDING SYNDROME
399.
400.
401.
I THTINK MRCP
402.
403.
Back to top
404.
405.
406.
407.
408.
pinkfeets
409.
Guest
410.
411.
412.
413.
414.
415.
Posted: Fri Sep 23, 2005 11:42 am Post subject: Re: SOME THEMES OF SEP EXAM
416.
417.
--------------------------------------------------------------------------------
418.
419.
I disagree with some of the answers you have put down.... open for discussion!
420.
421.
422.
423.
424.
425.
426.
427.
FEMALE WITH HYPOGLYCEMIC EPISODE: STOP DRIVING FOR 3 MNTHS (I believe that
sending her for diabetic education is the answer, am not sure about admitting her for 72 hours)
428.
429.
430.
431.
432.
433.
O2 GIVEN TO A PT AND HIIS SAT FALLS FOR SOME TIME WHY? B/C OF PUL ARTEY
RELAXATION CAUSING MISMATCH B/W PERFUSION AND VENT
434.
(I disagree, i think it is because when you administer nebulisers you usually do not administer oxygen
at the same time...that is why your p02 falls)
435.
436.
437.
438.
439.
440.
441.
442.
443.
444.
445.
446.
447.
448.
449.
anyway, i hope some of my answers have been helpful, i am open for discussion!
450.
451.
pinkfeets!
452.
453.
454.
455.
456.
457.
458.
459.
460.
461.
462.
463.
464.
465.
11.PT WITH CCF AND A LARGE BOUT OF P/R BLEEDING.UPPER GI ENDOSC NORMAL DX
ANGIODYSPLASIA
466.
467.
468.
469.
470.
471.
17.PT WITH HEART VALVE RX AND SMALL VEG ON ECHO DX:STAPH EPIDERMIDIS
472.
18> FEMALE WITH HYPOGLYCEMIC EPISODE: STOP DRIVING FOR 3 MNTHS..I HOPE
473.
474.
475.
476.
22 O2 GIVEN TO A PT AND HIIS SAT FALLS FOR SOME TIME WHY? B/C OF PUL ARTEY
RELAXATION CAUSING MISMATCH B/W PERFUSION AND VENT
477.
478.
479.
25 Q OS PIT APOPLEXY
480.
26 MANY OPTH QS
481.
482.
483.
484.
485.
486.
487.
31.PT OF SCHIZOPHRENIA
488.
489.
490.
491.
492.
493.
37DERM INCOGNITO
494.
495.
496.
497.
498.
499.
500.
501.
502.
503.
504.
505.
506.
50ULNAR ENTRAPMENT
507.
51.BOORHAVE DISEASE
508.
52.TENSION HEADACHE
509.
53.KLINEFELTER SYNDROME
510.
511.
512.
513.
514.
58.SIADH
515.
59.CRANIAL DI
516.
517.
61 SAME IN AML?
518.
62.BULIMIA NERVOSA
519.
64 MANTOUX TEST
520.
65SCDSC
521.
66.OSTEOSCLERTIC LESION
522.
523.
68.MAEMOCHROMATOSIS
524.
69S/E OF ROSIGLTAZONE
525.
70ANTICIPATIO
526.
527.
72 VARICELLA ZOSTER
528.
73SCROMBOTOXIN
529.
530.
531.
532.
533.
77RENAL BIOPSY
534.
78LICHEN PLANUS
535.
79 CRITERIA OF MI
536.
SOMATIZATION SYNDROME
537.
80 MEDIAN NERVE
538.
81AIP
539.
82 ODANSETRON
540.
83DERMATOMYOSTIS
541.
84 REFEEDING SYNDROME
542.
543.
544.
I THTINK MRCP[/quote]
545.
546.
547.
548.
549.
550.
551.
552.
553.
Regarding Endocarditis my answer was CRP but when I checked it in Harrison's, it is Blood culture
554.
555.
556.
557.
558.
rsukhon
559.
560.
561.
562.
563.
Posts: 53
564.
565.
566.
567.
568.
Thanks Pinkfeets for your comment, I totally agree with the you answersGuest, Sep 23, 2005#41
569.
570.
571.
572.
rsukhon said:Pt with dyspepsia, +ve H. Pylori and mild ?? lymphoma of the stomach??
573.
574.
Treatment?
575.
576.
1. Eradication of H. Pylori
577.
578.
579.
G-MATH1GuestHELLO
580.
IST OF ALL I WOULD LIKE TO COMPLAINT GLAD WHY MY NAME WAS REMOVED FRM
THE POST OF THESE 87 THEMES WHICH WERE ORIGINALLY WRITTEN BY ME.
581.
582.
583.
pinkfeetsGuestG math am very interested to see why you think my answers are wrong... anyhow, i
think it would be best if those who posted questions to try and explain the reasons behind the answers
they chose to the 'tough' not straightforward answer questions...pinkfeets, Sep 23, 2005#45
584.
GuestGuestQuestion No. 4
585.
586.
A 28 year old man who had had tuberculosis of the mediastinal lymph nodes diagnosed two weeks
previously and who had been started on chemotherapy with rifampicin, isoniazid and pyrazinamide
was admitted because of the increasing dyspnoea and stridor.
587.
Chest X-ray showed compression of both main bronchi by carinal lymph node enlargement.
588.
589.
590.
1. Start prednisolone
591.
592.
593.
594.
595.
596.
597.
Answer
598.
599.
600.
601.
Comments:
602.
The treatment of TB mediatinal lymphadenitis is the same as pulmonary TB. The nodes may enlarge
during or after treatment as a result of hypersensitivity. Corticosteroids is effective in reducing the
enlargement and hence will help the stridor and breathlessness.
603.
604.
605.
GuestGuestRelated to Harrison's Chapter 77. Gastrointestinal Tract Cancer; Chapter 135. Helicobacter
pylori Infections;
606.
607.
Excerpt: "Gastric mucosa-associated lymphoid tissue (MALT) lymphoma arises from mucosal
lymphoid tissue that is acquired usually as a reaction to Helicobacter pylori infection. Eradication of H.
pylori leads to complete regression of gastric MALT lymphoma in 75% of cases. However, prolonged
follow-up is necessary to determine whether a lymphoma responds to therapy. Clinical staging has been
extensively examined with the help of endoscopic ultrasonography, which has allowed the assessment
of the extent of tumor invasion to the gastric wall and to regional lymph nodes. In general, lymphomas
of stage IIE or above, in which gastric lymph nodes and adjacent or remote organs are involved, do not
respond to H. pylori eradication. In stage IE cases, in which tumors are confined to the gastric wall,
staging has limited value in predicting a response, although tumors that involve the muscularis propria
or serosa (stage IE2) have a higher failure rate than those of IE1. At the time of diagnosis, most gastric
MALT lymphomas are stage IE, so alternative prognostic markers are needed...."
608.
609.
610.
611.
612.
613.
614.
615.
616.
617.
618.
619.
620.
621.
11.PT WITH CCF AND A LARGE BOUT OF P/R BLEEDING.UPPER GI ENDOSC NORMAL DX
ANGIODYSPLASIA
622.
623.
624.
625.
626.
627.
17.PT WITH HEART VALVE RX AND SMALL VEG ON ECHO DX:STAPH EPIDERMIDIS
628.
18> FEMALE WITH HYPOGLYCEMIC EPISODE: STOP DRIVING FOR 3 MNTHS..I HOPE
629.
630.
631.
22 O2 GIVEN TO A PT AND HIIS SAT FALLS FOR SOME TIME WHY? B/C OF PUL ARTEY
RELAXATION CAUSING MISMATCH B/W PERFUSION AND VENT
633.
634.
635.
25 Q OS PIT APOPLEXY
636.
26 MANY OPTH QS
637.
638.
639.
640.
641.
642.
643.
31.PT OF SCHIZOPHRENIA
644.
645.
646.
647.
648.
649.
37DERM INCOGNITO
650.
651.
652.
653.
654.
655.
656.
657.
658.
659.
660.
661.
662.
50ULNAR ENTRAPMENT
663.
51.BOORHAVE DISEASE
664.
52.TENSION HEADACHE
665.
53.KLINEFELTER SYNDROME
666.
667.
668.
669.
670.
58.SIADH
671.
59.CRANIAL DI
672.
673.
61 SAME IN AML?
674.
62.BULIMIA NERVOSA
675.
64 MANTOUX TEST
676.
65SCDSC
677.
66.OSTEOSCLERTIC LESION
678.
679.
68.MAEMOCHROMATOSIS
680.
69S/E OF ROSIGLTAZONE
681.
70ANTICIPATIO
682.
683.
72 VARICELLA ZOSTER
684.
73SCROMBOTOXIN
685.
686.
687.
688.
689.
77RENAL BIOPSY
690.
78LICHEN PLANUS
691.
79 CRITERIA OF MI
692.
SOMATIZATION SYNDROME
693.
80 MEDIAN NERVE
694.
81AIP
695.
82 ODANSETRON
696.
83DERMATOMYOSTIS
697.
84 REFEEDING SYNDROME
698.
699.
700.
REGARDS DR GMATH.DR OA PLZ GIVE UR OPINION AS WELLDR G-MATH12, Sep 24, 2005
#48
701.
DR GMATH 12Guestdisagree with some of the answers you have put down.... open for discussion!
702.
703.
704.
705.
706.
707.
708.
709.
FEMALE WITH HYPOGLYCEMIC EPISODE: STOP DRIVING FOR 3 MNTHS (I believe that
sending her for diabetic education is the answer, am not sure about admitting her for 72 hours)
710.
711.
712.
713.
714.
715.
O2 GIVEN TO A PT AND HIIS SAT FALLS FOR SOME TIME WHY? B/C OF PUL ARTEY
RELAXATION CAUSING MISMATCH B/W PERFUSION AND VENT
716.
(I disagree, i think it is because when you administer nebulisers you usually do not administer oxygen
at the same time...that is why your p02 falls)
717.
718.
719.
720.
721.
722.
the patient would have died, so i think the answer was acting on behalf of the patient's best interests)
723.
724.
725.
726.
727.
728.
729.
730.
731.
anyway, i hope some of my answers have been helpful, i am open for discussion!
732.
733.
pinkfeets!
734.
HI PINKFEETS
735.
736.
737.
738.
739.
740.
741.
742.
743.
744.
VASO VAGAL SYNCOPE DOESNT CASUE INCONTINENCE OF URINE.U CAN SEE IN ANY
747.
748.
FEMALE WITH ONE HYPOGLYCEMIC EPISODE BAN FRM DRIVING. FOR 3 MNTHS TO
ALLOW BTR CTRL AND MONITORING.IF THERE HAD BEEN NO OPTION OF DRIVING U
WILL SAY EDU BUT IT IS IMP THAT PT REMAINS/ABSTAINS FRM DRIVING BUT I AM NOT
SURE OF THIS Q B/C I DONT KNOW IF IT IS BAN FOR 1 YR.IN THAT CASE I AM WRONG
749.
750.
THANNKS .I WISH U AND I AND ALL WHO TOOK EXAM PASS.NO HARD FEELINGS OK'
751.
752.
GuestGuestsep quest
753.
754.
755.
ans:strutrural proteins
756.
sclerosis
757.
758.
759.
ans-resurance
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MRCP 1 sep 05 ques by rsukhon/csngiu,pl. furthur post here
Discussion in 'MRCP Forum' started by Guest, Sep 21, 2005.
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Page 2 of 2
< Prev
1
2
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Prognosis of pt with type 1 Dm and life risk of getting nephropathy-?30% range given
11.
9) scarring allopecia-Lupus
12.
13.
11) pt with some restrictive defect and high TCO- alveolar haemorhage
14.
15.
16.
17.
18.
16) interesting ? on a patient with inferior MI who was hypotensive had already been thrombolysed had
pulmonary oedema and was bradycardic pulse 36-?fluids ?dobutamine?external pacing i put external
pacing
19.
20.
21.
19)amiodarone M.O.A
22.
20 LMWH M.O.A
23.
21 fleicanimide M.O.A
24.
25.
23 N acetylcysteine M.O.A
26.
24 pt with definite type 1 RTA and nephrocalcinosis-for some reason said Type 2
27.
28.
26 Rx in some pt with membranous GN and severe nephrotic syndrome ? cyclophosphamide for some
reason said ciclosporin
29.
30.
31.
32.
33.
34.
34 drug which improves prognosis in unstable angina total cholesterolo normal-?i saind isosorbide
mononitrate in retorospect answer is sitll probably simvastatin#
35.
35 BArters syndrome
36.
37.
38.
39.
39 hypogonadotrophic hypogondism-?Kallmans
40.
41.
42.
43.
43 some chap with a rash which he had which disappeared and he still thinks its present-?somatoform
44.
45.
45 some chap with haemolysis after taking a drug for Rx of a UTI i said G-6-PD im not sure
46.
47.
47 some trick question on TB and if it is an AIDS defining illness i said yes but on second thought not
too sure
48.
48 another trick TB question on someone with a blocked carini i RX as an ENT emergency and did
stenting but answer is prbabably steroids on second thought
49.
50.
50 some question on incubation periods of organisms causing food poisoning a chap would gone to a
chinese restaurant- got symtoms after 2hrs-?@b.cereus? c.perfringens i said E.coli 0157
51.
52.
53.
54.
55.
56.
57.
Pt treated for paracetamol poisning, risk factor for further attempt----lethality of the attempt
58.
59.
60.
61.
AF
62.
Smoking
63.
BP
64.
Cholesterol
65.
66.
67.
68.
69.
3.Cholestasis in pegnancy
70.
4.Pt on oral hydrocortisone and fludrocortisone developed D & V.What to con ...
71.
72.
ITP
73.
74.
75.
My answer is disequilib. BP 180/100 does not correlate with a pnemothorax to produce altered
sensorium sec to hypoxia.Guest, Oct 3, 2005#52
76.
77.
78.
79.
80.
81.
82.
83.
4. Young, back pain and morning stiffness, Dx ankylosing spondylitis, severe peripheral joints
involovement, X ray shows joint erosions. best treatment ... NSAID, steroids, sulphasalazine .... whts
the answer?
84.
85.
86.
87.
88.
89.
7. AML prognostic factor... Karyotype, rising LDH, blasts in Bone Marrow, Initial WBC at Dx etc.
90.
9. MOA of Low molecular weight heparin .... inhibits Xa, potentiate protein C , binds to thrombin.
91.
92.
10. Paracetamol poisining ... marker to evaluate effect .. CRP, ALT etc.
93.
94.
95.
96.
12. features of cushing's syndrome with pain in hip....fracture neck of femur, avascular necrosis of head
of femur etc.
97.
98.
13. A diabetic on number of medications with diarhea etc .... i am not sure of the scenario and options
but i wrote Metformin as a cause of his symptoms.
99.
100.
101.
102.
103.
104.
16. The risk of dying with placebo 15 percent and with tretment 10 percent in five years . what is the
NNT to prevent the disease...... 10, 20, 50, 100, 200
105.
106.
17. definitive diagnosis of empyema ..... WBC count, X ray, Pleural aspiration, .......
107.
108.
18. 82 years old lady with urethral discharge and high vaginal swabs confirmed gonnorrheal infection.
what would u do.
109.
110.
111.
19. sensitivity
112.
113.
114.
115.
21
116.
117.
2. Elderly woman with dementia and N gonorrhoea- elderly abuse - inform police
118.
2. Goodpasture's syndrome. best treatment with prednisolone and plasmapharesis for treatment
119.
4. SLE - antibody
120.
5. Monitoring Ca Colon
121.
122.
123.
I would recommend everyone to use http://www.onexamination.com. Brill site with lots of ques from
exam. Kalra good bok.Kash-back, Oct 7, 2005#55
124.
125.
126.
What glad and Dr.OA thinks abt the cutoff mark to pass the sepo5 mrcp 1 exam.? Was this exam an
easier one or tough comapared to previous? I think the cutoff of last xam was 60%?...Guest, Oct 8,
2005#56
127.
GuestGuestI've passed MRCP part 1 in sep05 from chennai. I would highly suggest candidates to take
online course on onexamination.com and read Philip kalra thoroughly.Guest, Oct 20, 2005#57
128.
129.
130.
131.
132.
133.
134.
135.
136.
137.
Prognosis of pt with type 1 Dm and life risk of getting nephropathy-?30% range given
138.
9) scarring allopecia-Lupus
139.
140.
11) pt with some restrictive defect and high TCO- alveolar haemorhage
141.
142.
143.
144.
145.
16) interesting ? on a patient with inferior MI who was hypotensive had already been thrombolysed had
pulmonary oedema and was bradycardic pulse 36-?fluids ?dobutamine?external pacing i put external
pacing
146.
147.
148.
19)amiodarone M.O.A
149.
20 LMWH M.O.A
150.
21 fleicanimide M.O.A
151.
152.
23 N acetylcysteine M.O.A
153.
24 pt with definite type 1 RTA and nephrocalcinosis-for some reason said Type 2
154.
155.
26 Rx in some pt with membranous GN and severe nephrotic syndrome ? cyclophosphamide for some
reason said ciclosporin
156.
157.
158.
159.
160.
161.
34 drug which improves prognosis in unstable angina total cholesterolo normal-?i saind isosorbide
mononitrate in retorospect answer is sitll probably simvastatin#
162.
35 BArters syndrome
163.
164.
165.
166.
39 hypogonadotrophic hypogondism-?Kallmans
167.
168.
169.
170.
43 some chap with a rash which he had which disappeared and he still thinks its present-?somatoform
171.
172.
45 some chap with haemolysis after taking a drug for Rx of a UTI i said G-6-PD im not sure
173.
174.
47 some trick question on TB and if it is an AIDS defining illness i said yes but on second thought not
too sure
175.
48 another trick TB question on someone with a blocked carini i RX as an ENT emergency and did
stenting but answer is prbabably steroids on second thought
176.
177.
50 some question on incubation periods of organisms causing food poisoning a chap would gone to a
chinese restaurant- got symtoms after 2hrs-?@b.cereus? c.perfringens i said E.coli 0157
178.
179.
180.
181.
182.
Dear Colleagues, I really appreciate everybody who have used there ATPs of their brains for
others...THNX againGuest, Nov 5, 2005#59
183.
GuestGuestDr. O A said:again please ... it is nice to see someone posting the examination
questions...but please ...put them in organized manner and if possible in specialty order.YES I AGREE
WITH DR OA IS DIFFICULT TO UNDERSTAND AND DIFFERENTIATE QUESTIONS FROM
ANSWERS PLEASE LET`S ORGANISE THEM PROPERLYGuest, Nov 13, 2005#60
184.
185.
Drug Contraindicated
186.
187.
GuestGuestA DVT patient who also had bleeding flare up of ulcerative colitis.
188.
189.
190.
191.
192.
193.
can you please send these questions .AND any ques mcqs i will appear in irish part 1 next month
thankssssss
194.
195.
GuestGuesthi dr osama,
196.
197.
198.
i am new to the forum and would like to enter mrcp1 in next jan
199.
200.
201.
202.
203.
thxxxxxxxxxxxxxxxxx so much
204.
205.
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1.
4. Abg
5. ? Type to lung ca harsh sound all over lung field peripheral location adenocarcinoma, brochoca
10 interstitial lung disease in coal worker what's improves outcome stop smoking
1. 51 yrs lady had fever+neck rigidity+headache. CSF showed bacterial meningitis. Organism
A.strept pyogen
B.strept.pneumoni
C.E.coli
D.listeria
2.F/O stroke:Left sided limb wkness, rt sided sensory loss, wkness in toungue
A.ant cerebral art
B.middle cerebral art
C.post cerebral art
D.post communicating art
E.vertebral art
3. A guy lived in africa for 12 yrs. presenting with frequent transient anal ? Rash /excoriation
A.strongyloid
B.giardiasis
C...
4.5. Acquaporin 2 associated wth
A.vassoprsin ??( Forgot all options)
?Pemphigus as I didn't see any of the usual suspects for SJ in the stem
Crescenteric - Goodpastures
Susceptibility to meningitis - I think c5-9 leaves you susceptible to N Meningitidis and as C5 was the
only one of these in the question
In VW - I gave DDAPV
Lithium pericarditis I went for haemodialysis as I thought the patient low GCS indicated urgency.
Pleural effusion I went for US to see if it was a complicated loculated one.
RF for suicide. I think on the pastest website it said that'whilst DSH may be seen as a cry for help it is
also the greatest indicator of successful completion of suicide
HIV with CT changes. I went progressive multifocal leukoencephalopathy. I would have been much
happier with a nice and easy ring enhancing lesion.
Meningitic 51 year old - sterp pneumo I think is most prevalent in this age range. If younger N
Meningitidis if pregnant, immunocompromised or elderly I would have gone Listeria
Herpes labialis - I think strep pneumonia. Though I am currently on Microbiology and my consultant
says she's not heard of this association ... uncomfortable
Neha Gupta, Jan 17, 2013
1.
4. Patient whose wife died in RTA later depressive, cant concentrate on work- post traumatic
stress disorder
5. Meta-analysis- Publication bias
6. Patient taking too much morphine dose- to add ?naproxen to lower morphine dose
7. patient with painful lesions both legs with Xray mediastinal widening- Sarcoidosis
8. patient with trivial trauma to leg a small ulcer, leter became bigger with red green
demarcation -?pyoderma gangrenosum ?necrobiosis lipoidica
9. Action of pioglitazone10. Completed suicide risk- unemployment
11. Patient with fever 2 weeks, severe myalgia, conjunctival congestion with renal
impairment- leptospirosis
13. pregnant lady with tachycardia, tachypnoea, features of CCF- peripartum cardiomyopathy
14.Rheumatoid arthritis RA factor -ve, do antiCCP
15. RA- painful eyes- fundoscopy normal, Visual acuity normal- ?anterior uveitis
15. Patient with recuurent oral ulcers, genital ulcers with h/o DVT- Behcets syndrome
15. Patient with widespread fasciculations with muscle wasting, no sensory involvementMotor neuron disease
15. Young lady with headache, drowsiness, CT showing temperoparietal attenuation- herpes
simplex encephalitis.
16. COPD patient with CO2 retention - NIV
17. patient with fever, sorethroat, dysphagia, lymphocytosis- paracetamol, maybe glandular
fever
18. patient with ulcerative colitis, active proctitis, increased CRP, immediate treatment- oral
steroid
19. patient with raised TKCO- Wegeners Granulomatosis
20. patient with sudden onset dyspnoea, PO2- low, rest normal, chest, CVS examination
normal- start low molecular heparin in view of PE
21. patient with painful hands has difficulty swallowing- eosophageal dysmotility
22. Patient with raynauds not responding to nifedipine- give ?Iloprost
23. patient with symptoms of UTI in sepsis- most common organism- E.coli Answered above
24. herpes labialis- Streptococcal pneumonia
25. Rx for pseudomonas- Ciprofloxacin
orgin
50. A pt with pain over a joint PS- many sickle cells, immediate treatment- ?give O2
Partha Sarkar, Jan 20, 2013
#3
2.
Partha SarkarGuest
2.Strongloides tx - albendazole
4.Boy with down syndrome and murmur and parasternal heave - Ebstein Abn
16. CNS- patient with ipsilateral and contralateral sisns - where is the lesion - lateral medulla
18 patient with a non secreting pituitary tumor - what could it cause a few yrs down the line - bitemp
hemianopia
20. Young man with haematuria and past history of deafness plus proteinuria - ??? Alports, IgA
nephropathy
23 patient with bloating with all those haematological signs - Myelodysplastic syn
26. Lady with increased ALP, what further test - Anti mitochondrail
28. Lady with altered bowel habit, past hx of depression - Irritable bowel synd
29. Young man with dyspepsia, no other signs - Urea breadth test
32. 19 year old with neck tremors and snoring in class - ? Wilson's dx
34. Man with polyuria, loss of libido and back pain - Do transferrin sat.
36. Patient with diarhoea, chest infection etc - X-linked agammaglobulinemia ( Wiskott Aldrich - i
think)
44. Man with insect bite from south africa ( no lymes !! ) - Rickettsia
50. CT scan multiple enhancing lesion , what to start after dexa - sulp + pyremerhamine
51. cANCA + symptoms - I chose Wegners - did anybody choose Microscopic polyangitis?
53. ST changes in V5-V6, what are you likely to see on coronary angio - Circumflex lesion
54. SVT , you gave adenosine 6 mg, nothing happens, what next - repeat adenosine
61. Man who had viral infection, now comes with rash - erythema multiforme
78. Girl with reduced consiousness and seizures when disturbed - ? complex partial ? primary
generalised
80. MND - with LMN and UMN signs - Amyotropic lateral sclerosis
82. Man with tumour of apex, which condition will you not operate - FVC 1.8 ??
84. Which intervention decreases risk of pre-ecclampsia - ?? aspirin... LMWH ( patient is 12 wks)
86. Woman with sudden onst SOB, just started chemo for BRCA - Anthracycline Cardiomyopathy ?
88. Man presented with urethral discharge - swab - neisseria gonococcus, but blood cultures negative,
why - co-existence of Chlamydia
90. Woman whose husband died, but she still sees him talking to her - ? PTSD ???
92. man convinced he had cancer despite all negative tests - hypochondriac
93. Man presenting with symptoms, despite tests he believed there still there - Somatisation
96. man with bloody diarrhoea, children's school mates recently had diarrhoea - ? rotavirus
1.
Partha SarkarGuest
2.
Partha SarkarGuest
3.
Partha SarkarGuest
* things move or spin with head position change = BPV = Dix Halpik maneuver.
* false positive VDRL = thinks about yaws (trponemal species)
* collapsed patient with no breath or pulse: chest compression ? (before AHA guidelines 2010 PP
argues abt asking for help).
*someone with Howel-Jowel = Coealiac (a known casue of hyposplenism).
* circular lesion on dorsum of the hand = granuloma annulare (thoguht not mentioned diabetic).
* multiple enhance ring in CT = crebral toxoplasmoisi = give pyrimeth+ sulfazianize (Co tir.)
elbow).
* malingering man asking fir sick report and he drinks alcohol = alcohol dependence.
* woman who sees her dead husband = ?readjustment.
* a young man diagnosed as crohn and started treatment =advice = stop smoking.
* ibsilateral facial loss + ibsl horner + con.lt weaknes = posterior inferoir cerebellar
*red eye with mild tenderness = epislcleritis
* digested into glucose and galactose = lactose.
* penumia in ICU improved then high fever with p effusions = empyema
* gout in CVS problem = cholcicine (others have risk of fluids retention).
* weird movements in class = tourret syndome.
1. Patient is unable to take his arm beyond or pain wen rising above 140-180 degree. ( Supraspinatus
tendinitis).
2.Sensory loss of middle finger and some other features. (C7 involvement).
3. Pt having diarrhea for last one month following passing holidays somewhere and stool microscopy
shows Strongolides. (Albendazole).
4. Protien 3D view. (western method)
5.Patient having recurrent chest infection. (Complement levels)..
6. Mechanism of Action of meglitinides. (DPP-4 inhibitor)
7. Mechanism of action of Flecanide. (sodium channel blocker).
8. Herpetic lesion on wrist then after few days macular rash over the body. (Erythema Multiforme).
9. Pt having low calcium, low phosphate, low Vit-D, ALP raised, parathyroid hormone raised. How to
manage. (Oral vit-D).
10. Pt having Ankylosing spondilitis. chose feature. (Global Axial decrease mobility)
11. Pt having itchy scales on sternum, eyelids, face, nasal bridge. (Sebohric dermatitis).
12. Pt having lesion on toes, microscopy shows Trychophytum rubrum. (terbinafine)
13. Pt having sever photosensitivity, malar rash and some other findings. (SLE).
14. Piercing pain in the eye. (trigeminal neuroglia) not sure on this.
16. Continuous bleeding from pt after vena puncture. PT-raised, APPT-raised, Fibronogen-low, Ddimers-raised. (DIC)
17. Poor prognostic factor in leukemia.
19. Vit- D Resistant rickets. (X-link Dominant).
20. Hereditary telangictasia (Autosomal Dominant)
21.Pt having dizziness, vertigo and eye examination was normal. (Mieniers disease)
22. Specify the site of lesion that pt is unable to abduct his eye and some other features. (PONS) not
sure,
23. There was a question in which a pt is having lower motor neuron lesion in upper limb and upper
neuron lesion in lower limbs. (Amytropic lateral sclerosis)
24. PCR...(fromation od DNA from RNA)
25. Where RNA splicing take place.
26. Pat had mastoid surgery for deafness and there was renal involvement showing blood+, Protien+ in
urine. (Alport syndrome).
27. PT diabetic and HTN having painless decrease vision in one of the eye. fundoscopy shows cotton
wools, haemorrhage. (Not sure)
28. CSF examination. glucose normal, protein normal, Lymphos raised, neutros normal. (Viral
infection)
29. Diagnosis of pt on basis of investigation , Von Willbrand antigen low, Von Willbrand activity low,
factor VIII low. (Von willbrand disease).
30. Pt having plasmodium Vivax infection. wt is the benefit of giving chloroquine+primaquine.
(Decrease resistant)
32. Pt having small lung carcinoma, having SOB. Increase cortisol level due to ectopic production of
ACTH.
33. Pregnant lady increase frequency of SOB and wheeze. she is on salbutamol inhaler. (Add steriods)
34. Pt on long term tx for rheumatoid arthritis. some other features. (Rectal biopsy for amyloidosis).
35. Pt having barret oesophagus on proven following endoscopy. (Acid suppression and repeat
biopsy).
36. Pt having dyspepsia for long time. (endoscopy)
37. Pt having sever chest infection and was admitted in the hospital. IV antibiotics are given. 10 days
after that pt feel SOB and x-ray shows large plural Effusion. (Empyema) not sure.
38. Pt had chemotherapy and presented SOB and muffled heart sounds. (Cardiac temponade)
39. MOA of Bivalirudin. ( direct thrombin inhibitor)
40. Pt having numbness on the lateral boarder of foot. (S1 lesion)
41. CREST complication. (Malabsorption)
42. Pt having lytic lesion on radio graphy. (Protien electrophoresis)
43. Rt sided apical lung cancer involving brachial plexus. Mode of tx. Not sure.
44. Which of the following causing upper lobe fibrosis. (Allergic Fibrosing alvelitis)
45. Which of the following cell is raised in Aspergiollus infection. (Eosinophill)
46. Pt having painlees or red urine and SOB. TX not sure
47. Pt going for chemoptherapy which of the measures should taken prior to tx. (Red pack cell
transfusion)
49. Tricyclic overdose. (IV NaHCO3)
50. Methnol Over dose. (Dialysis)
51. Pt collapse not breathig, no pulse, next step. ( Call for Help)
52. patient with abdomina lpain and vomitting and acidosis nothing about ketonemia mentioned given
insulin in infusion waht nest step. ( Normal Saline)
53. Hypertention and palpitaion thyroin cancer removed in the hx( carcenoma) what is the diagnosis:
pheochromocytoma.
54. Which drug will u give wen pt with pheochromocytomo going for surgery. (phenoxybenzamine)
55. ECG show st depression in V5 and V6. (Circumflex artery)
56. Pt with obstructive sleep apnea. CPAP, BIPAP, some instruments use. not sure in this senario.
Partha Sarkar, May 10, 2013
#1
1.
Partha SarkarGuest
39. catract
40.retinal vien obstruction
41, carotid artery dissection
42. alzehmars disease
43. clear airways / call for help
44.peritoneal dialyses
45. occupational asthma
46.copd
47 . mg sulphate
48.scleritis
50.s1 lesion
51.radial nerves branch lesion.
52.frozen shoulder
53.bph
54.ceolic disease
55. systemic sclerosis
56.osteomalacia
58.pagets disease.
59 cushings
60. graves
61. subacute thyrotoxicosis
94.yersinia
95.mechanism of inactivity of cortisol.
96.pcos
97.klienfilter
98.hypothriodism
99.myeloma
100.primary hyperparathyriodism
101.diuretic used in calcium stones
102.cml
104. 15.17 translocation
105.mylofibrosis
1o6.dic
107.myelofroliferative disorder
108.pnh
109.anaemia of chronic disease
110.vonwilbrand
111.bilirubin mild elevated next test
112. chronic hepatitis c -cryoglobinemia
113.paracetamol poising- pt
114.mitral valve severity.
115.heriditary angieoedema -c4 level
116.alopecia
117.small cell ca.
118. bpaspergilosis.
119.aspiration pneumonia
120.pregnanat treat asthma
121.prophylaxis in previous preeclampsia
122.iv bypass the first order kinectics 123.epiglotitis
124.oral painful ulcers.
2.
Partha SarkarGuest
20. Young man with haematuria and past history of deafness.. This should be IgA in view of
presentation. Creatinine reflected only mild impairment.. If alports likely worse creatinine expected..
Also patient went for mastoid surgery for the deafness whereas alports is a sensorineural deafness due
to collagen deficit in inner ear.. I don't think surgery corrects this? Possibly has both a conductive
hearing loss and IgA nephron arty
21. lady with purpuric rash - cryoglobulinemia
22. 9:22 translocation - CML
3.
***111. extertringic allergic alviolitis, investigation, CXR shows upper zone involvement
***112 Allergic bronchopulmonary aspergilosis, investigation - precipitins - most specific
113 Small cell carcinoma, one of its paraneoplastic syndromes was given
114. lambert eton syndrome, antibodies to VGCC
115. pain in fore arm on resistance of extension of wrist, lateral epicondolyitis
*116. Multiple sclesosis, patient with past histery of arm problem, now vision
117. hopital acquired pnemonia... tazosin
118. patient with fever and jaundice, picture of asending cholangitis, - CBD stone
119. patient with ingestion of 20 paracetamol pills, PT
** 120.feature of anemia of chronic disease
121. patient wid ulcerative collitis and now joint pains - enteropathic arthritis
122. dka, iv insulin was given, iv n saline
123. Test of Acromegaly, insulin with oral glucose toleance test
** 124. feature most strongly associated with tb recurrence - ?CXR granulomas indicate previous
infection
125. treament startd with acylovir, csf feature most strongly associated wid diagnosis - lymphocytosis
** 126 . man with 3 yrs h/o lesion on shin - Bowens disease
** 127. diabetic patient, poorly controlled, type of diabetes
128. Patient with pheochoromsytoma, what treatment shoud be started..?phenoxybenzamine
129. flash pulmonary edema.... renal artery stenosis
130. resistant hypertension, hypokalemic alkalosis - renin/aldo ratio
131. patient with early mornign stiffness and uper arms tenderness,, polymylgia rheumatica
132. patient with father with psoriasis, now with inflammatory oligoarthritis but no other systemic
features - spondyloarthropathy
133. ankylising spondolyits, clinical feature reduced joint excursion in all directions
134. patient with picture of RA, on nsaid, next treatment option - MTX
135. patient in hospital, got gout, treatment with colchicine
136. patient with hearing loss, tinnitus and vertigo.. ?meniere's disease
**137. sudden onset visual loss, retinal hemrges and cotton wool spots - CRVO
138. thyroid swelling, investigation.... FNAC
139. collapsed patient....call for help first - early access as per ACLS/BCLS
140. 3d image of protein - electron microscopy. Xray crystallography is for 3d visualisation of crystals
141. seborrhic dermatitis.. scaly lesion on face, nose scalp sternum i think
142. xray osteosclerosis ---osteoarthritis old lady with varus deformity 3 months pain
143. PCOD--- test... high LH/FSH ratio
144. boy with abnormal movements tourette syndrome
** 145. pt on chemotherapy was given ondansatron but vomiting not controlled - nabilone
146. Ciclosporin in post renal transplant - Tcell function suppressed
147. A subject with urethritis, gram neg intracellular diplococci, VDRL +ve - False positive VDRL
148.Creatinine increased after Trimethoprim - decreased tubular secretion (trimethoprim decreases
tubular secretion of creat)
149. things move or spin with head position change = BPV = Dix Halpik maneuver.
**150 circular lesion on dorsum of the hand = granuloma annulare (thoguht not mentioned diabetic). ?
BCC
**151. on lithium & hypertensive = give amlodipine (SHOULD BE alpha blocker)
152. a young man diagnosed with IBD (crohns) and started treatment what is the advice = stop
smoking
153. Mechanism of action of Flecanide. (sodium channel blocker).
154. Pt having low calcium, low phosphate, low Vit-D, ALP raised, parathyroid hormone raised. How
to manage. (Oral vit-D).
155. Pt having lesion on toes, microscopy shows Trychophytum rubrum. (terbinafine)
156. Continuous bleeding from pt after vena puncture. PT-raised, APPT-raised, Fibronogen-low, Ddimers-raised. (DIC)
157.Pt having dizziness, vertigo and eye examination was normal. (Mieniers disease)
158. Pt having lytic lesion on radio graphy. (Protien electrophoresis for myeloma)
159. Patient hiking in west scotland, has a bite on thigh but no other symptoms - observe
160. Tricyclic overdose. (IV NaHCO3)
**161. Pt with obstructive sleep apnea. CPAP
162.normal aonion gap metabolic acidosis- type II RTA
**163. ?Addison's disease
4.
"Many colon cancer prevention trials are based on the premise that most colorectal cancers develop
from adenomatous polyps. These trials use adenoma recurrence or disappearance as a surrogate
endpoint (not yet validated) for colon cancer prevention. Early clinical trial results suggest that
nonsteroidal anti-inflammatory drugs (NSAIDs), such as piroxicam, sulindac, and aspirin, may prevent
adenoma formation or cause regression of adenomatous polyps. The mechanism of action of NSAIDs
is unknown, but they are presumed to work through the cyclooxygenase pathway. Pooled findings from
observational cohort studies demonstrate a relative reduction in colorectal cancer incidence of
approximately 22%, and a relative reduction in colorectal adenoma incidence of about 28%, with
regular aspirin use; however, in two randomized controlled trials (the Physicians' Health Study and the
Women's Health Study), aspirin had no effect on colon cancer or adenoma incidence in persons with no
previous history of colonic lesions, at up to 10 years of therapy. The randomized controlled trials did
show an approximately 18% relative risk reduction for colonic adenoma incidence in persons with a
previous history of adenomas after 1 year's therapy.
Cyclooxygenase-2 (COX-2) inhibitors have also been considered for colorectal cancer and polyp
prevention. Trials with COX-2 inhibitors were initiated but an increased risk of cardiovascular events
in those taking the COX-2 inhibitors was noted, suggesting that these agents are not suitable for
chemoprevention in the general population.
Epidemiologic studies suggest that diets high in calcium lower colon cancer risk. Calcium binds bile
and fatty acids, which cause proliferation of colonic epithelium. It is hypothesized that calcium reduces
intraluminal exposure to these compounds. The randomized controlled Calcium Polyp Prevention
Study found that calcium supplementation decreased the absolute risk of adenomatous polyp
recurrence by 7% at 4 years; extended observational follow-up demonstrated a 12% absolute risk
reduction 5 years after cessation of treatment. However, in the Women's Health Initiative, combined
use of calcium carbonate and vitamin D twice daily did not reduce the incidence of invasive colorectal
cancer compared with placebo after 7 years.
The Women's Health Initiative demonstrated that postmenopausal women taking estrogen plus
progestin have a 44% lower risk of colorectal cancer compared to women taking placebo. Of >16,600
women randomized and followed for a median of 5.6 years, 43 invasive colorectal cancers occurred in
the hormone group and 72 in the placebo group. The positive effect on colon cancer is mitigated by the
modest increase in cardiovascular and breast cancer risks associated with combined estrogen plus
progestin therapy.
A case-control study suggested that statins decrease the incidence of colorectal cancer; however,
several subsequent case-control and cohort studies have not demonstrated an association between
regular statin use and a reduced risk of colorectal cancer. No randomized controlled trials have
addressed this hypothesis. A meta-analysis of statin use showed no protective effect of statins on
overall cancer incidence or death."
Guys this is a quoted text from Harrison's principle of internal medicine 18th edition.
According to this Aspririn would be preferred to COX2 inhibitors for prevention of colorectal cancer
Neha Gupta, May 11, 2013
#6
5.
Harrison's textbook of internal medicine (18th ed) mentions the following regarding viral
meningitis/encephalitis
"The most important laboratory test in the diagnosis of viral meningitis is examination of the CSF. The
typical profile is a lymphocytic pleocytosis (25500 cells/L), a normal or slightly elevated protein
concentration [0.20.8 g/L (2080 mg/dL)], a normal glucose concentration, and a normal or
mildly elevated opening pressure (100350 mmH2O). Organisms are not seen on Gram's stain of
CSF. Rarely, PMNs may predominate in the first 48 h of illness, especially with infections due to
echovirus 9, West Nile virus, eastern equine encephalitis (EEE) virus, or mumps. A pleocytosis of
polymorphonuclear neutrophils occurs in 45% of patients with West Nile virus (WNV) meningitis and
can persist for a week or longer before shifting to a lymphocytic pleocytosis. Despite these exceptions,
the presence of a CSF PMN pleocytosis in a patient with suspected viral meningitis in whom a specific
diagnosis has not been established should prompt consideration of alternative diagnoses, including
bacterial meningitis or parameningeal infections. The total CSF cell count in viral meningitis is
typically 25500/L, although cell counts of several thousand/L are occasionally seen, especially with
infections due to lymphocytic choriomeningitis virus (LCMV) and mumps virus. The CSF glucose
concentration is typically normal in viral infections, although it may be decreased in 1030% of
cases due to mumps or LCMV. Rare instances of decreased CSF glucose concentration occur in cases
of meningitis due to echoviruses and other enteroviruses, HSV-2, and varicella-zoster virus (VZV). As
a rule, a lymphocytic pleocytosis with a low glucose concentration should suggest fungal or
tuberculous meningitis, Listeria meningoencephalitis, or noninfectious disorders (e.g., sarcoid,
neoplastic meningitis)."
Neha Gupta, May 13, 2013
#7
6.
ecurrent URTIs and chronic diarrheoa are main features of CVID. W-A x-linked is characterized by a
triad of mailny URTIs, thrombocytopenia and eczema.
My confusion is not between Wiskott-Aldrich syndrome and CVID, but between CVID and
agammaglobulinemia (bruton's x-linked), which was also an option, (the option mentioned was X-
linked agammaglobulinemia). CVID and agammaglobulinemia (bruton's x-linked) have almost similar
features, except for the age of presentation (which isn't a very reliable factor).
Neha Gupta, May 15, 2013
#8
7.
A 71-year-old man with a history of chronic renal impairment and atrial fibrillation for which he takes
warfarin, presents with an acutely tender and red left big toe.
Investigations reveal:
Which of the following is the most appropriate treatment for this man's presentation?
Allopurinol
Colchicine
Diclofenac
Paracetamol
Prednisolone Correct
This man presents with acute gout, has chronic renal impairement, AF and takes warfarin.
Non-steroidal anti-inflammatory drugs (NSAIDs) would be the treatment of choice but may cause a
deterioration in renal function and would be associated with an increased risk of bleeding in the
elderly.
The adverse effects of colchicine (especially gastrointestinal symptoms) would be more likely in the
elderly and should probably be avoided in those with renal impairment of this degree.
Allopurinol may well precipitate/exacerbate acute gout and is used once the acute attack has settled
following adequate treatment.
This is a classic MRCP question since it is hard to answer this by just looking in textbooks. Steroids are
the last resort choice where NSAIDs and colchicine are deemed too dangerous to use and that is a
matter of judgement applied by physicians. There is plenty of evidence for their efficacy.
Neha Gupta, May 16, 2013
#9
8.
Q. The 3rd and 4th Lumbricals(lateral lumbricals) are supplied by the median nerve, not by ulnar
nerve.
Q Stronglyoides treatment is ivermectin (source google)
9.
10.
It is mentioned the most common source is Staphylococcus, reflecting origin from skin, which is
Staphylococcus epidermidis.
And most important, patients on peritoneal dialysis are normally patients staying at home.........in which
case pseudomonas and staphylococcus aureus are less common (mostly nosocomials)
The question had mentioned most common infection and not the most severe infection. In most severe
infection it could have been pseudo or staph (sp MRSA)
Neha Gupta, May 18, 2013
#12
11.
12.
diabetic retinopathy .at all stages, good control of diabetes and of any coexisting hypertension and
stopping smoking have shown to reduce sequelae Karla 3rd edition chapter ophthalmology page 488
diabetic retinopathy .
Neha Gupta, May 22, 2013
#14
13.
Partha SarkarGuest
meglitinides - is a non sulphonylurea secretogogue- its mec of action is binding to a ATP Dependent
Pottasium channel on the b- cells in similar manner but at a separate binding site.
it is not a DPP4 Inhibitor
Partha Sarkar, Jun 3, 2013
#15
1.
Pericarditis - ECG - PR depression.
Cushings - investigation.
SVT narraw complex - after vagal mano - what Rx?
Math on Neg Pred value, Relative risk reduction.
Acromegaly - investigation.
Myotonic dystrophy
Bacillus - fried rice.
upper lobe fibrosis cause
Ext allergic alveo by bird Rx
Lung Ca - contra of surgery
CKD with HTN - Rx
P value
IgA
TCA - ECG
Prevention of variceal bleeding
Achalasia
Ulcerative colitis
paget dis in elderly e anteroposterior bowing
coagulation profile in promyelocytic
rectal biopsy in myeloma
riluzole in motor neuron dis
cyclosporin ??? diarrhoea
pt was in kenya ??? cerebral malaria
44. Pt from Kenya - I dont remember what I marked. But this one was easy i guess. Please add
45. M/A Carbonic anhydrase inbiror. The drug name sounded like Acetazolamide...
46. Mitochondrial disease - optic atrophy
47. Th2 - IL-4 ( I got this one wrong. This time I had severe headache and i thought its Th1 and marked
Interferon Gamma)
48. Rituximab - CD 20
49. Azospermia - Salfasalazine
50. Hormone repla the - to decrease post menopausal symptoms.
51. Oral morphine to SC morphine - I marked 40. I dont know... she was taking 120 modified release.
52. LIthium Nephrogenic DI
53. Paracetamol Overdose - worse in Anorexia ( I marked alcohol :(.. I was really confused with
anorexia but then erased it and changed it to alcohol
54. DM neovasculariaztion Rx photocoagulation
55. Graves - Myxoedema. Was it lid lag or pretibial myxedema?
57. Increase APTT not improved with mix - cause. Lupus nephritis. ( one of the difficult question i
think)
58. A man says he is the dean of medical college. Shizo/mania? Pressure speech was also there
59. Patient with sore throat and psoriasis - Gutate ( I dont remember this question)
60. Patient with painless genital ulcer with painless LN- Treponema pallidum
61. Erythema Multiforme - Herpes simplex
62. A patient with ovaria failure data. Raiaed LH and FSH. Low estradiol
63. Infective endo in a prosth valve within 1 month - s epidermidis
64. Toxoplasma - pyrimethamine plus sulphadiazine
65. Pt with gonoc ureth on azith - add what? I marked ceftriaxone.
66. HIV with diarrhoea - Cryptosp
67. Cont of vaccine in pt on prednisolone - Yellow fvr
68. how emphysema in cystic fibrosis (dont remember this question exactly)
69. Dx of sleep apnea- pulse oximetry 1st line
70. Pneumothorax on tube after 72 hours - i referred the poor chap to thoracic surgeon
72. COPD - LTOT
73. a pt with churg sr syndrome - ANCA
74. Ank spoond- dont remember the question
75. Osteoarthritis rx - Paracetamol
76. Motor nuron dis - Riluxole
77. Amiodarone starting dose- i will never understand this question. Marked long half life though. I
counted this question as wrong
79. ? Study following adverse drug reaction- i initially marked A, that is withdraw the drug but later on
marked E, that is review adverse effects
80. p < 0.02- no idea
81. lp sample- gm positive diploccoci- streptococcus pneumonia
82. lp sample- increased protein, lymphocytes-viral meningitis
83. Persiveration which Lobe= Frontal
84. Medullary Syndtome Post inf cerebellar art
85. Allopurinol- inhibition of xanthine oxidase
86. man with BPH-Pagets
87. RA with drye eyes - Sicca syndrome
88. headache with ptosis - headache with ptosis was post communication aneurysm and headache with
miosis- carotid atery dissection
89. headache with high esr - giant cell arteritis
90. low glycated Hb in poorly controlled DM- Sickle Cell trait
91. abg- mixed metabolic acidosis and resp alkolosis
92. Raised left diaphragm in CXR- left phrenic n palsy
93. COPD LTOT
94. Lung Surgery contraindication- horner syndrome
95. Bird fancier's lung(avian proteins) Steroids
96. Foam Cells - Monocytes/Macrophages (I only knew its Macrophage but didnt know its origin.
Luckily i marked correct one) monocyte
97. Lady found with empty bottle,ecg wide qrs, tachycardic- amitriptlline
man noticed lump in neck while shaving. TSH normal... what to do next?
35 lady, diarrhea with mucus 4 month, no weight loss, relievd by defcation, one fresh blood in toilet,
Anti TTG neg, norml ESR, CRP (coelic , Chrons, ulcerative, IBS, GB stone)
one question... ischemia of index finger and synovitis of little and middle fingers on both hands....
goodpasture treatment additional drug? Cyclophosphamide..
spastic paraparesis of hand in multiple sclerosis at metacarpophalyngeal joint/. i hate this question
foot drop , cant dorsiflex, catn planter flex, cant invert, cant evert.... siatic nerve
A patient with ovaria failure data?
Infective endo in a prosth valve within 1 month - s epidermidis
Toxoplasma - pyrimethamine plus sulphadiazine
Pt with gonoc ureth on azith - add doxy ? (for chlamydia)
HIV with diarrhoea - Cryptosp
Cont of vaccine in pt on prednisolone - Yellow fvr
how emphysema in cystic fibrosis
Dx of sleep apnea
Pneumothorax on tube after 72 hours - sugery rfl?
COPD - LTOT
a pt with churg sr syndrome - ANCA
Ank spoond
Osteoarthritis rx - Paracetamol?
Time duration for resuming driving after pacemaker insertion- immediate?
Time duration for monitoring lithium levels after starting rx- 3months?
Lady thinks havin mrsa infection, twice tested negative, thinks lab people changed sample- delusional
disorder
Old mans wife died a year ago, insomnia,wt loss, slow response, withdrawn- depression?
Left arm pain,biceps, triceps reflex absent- C5 C6 radiculopathy
Bilateral asymmetric paraparasis,one limb with decreased pin prick sensation and temp, other limb loss
of vibration and position-?(ependymoma, meningioma, SCID,syringomyelia)
Old patient following surgery agitated, not stayin in bed, had 4g tds dexamethasone post 2 days, cause
of abnormal behaviour- steroid
2.
3.
Raised left diaphragm in CXR, presents with orthopnoea- left phrenic n palsy
Persistent headache for a week ,unilateral, eye pain, diplopia on lookin up??
Fatigue, loss of libido, hypotension, prolactin raised, cortisol decreased, FSH normal-(addisons,
prolactinoma, non pituatory tumour)
Santosh Jadhav, Sep 12, 2013
#5
4.
#6
5.
6.
Acth to dx cushings disease - No actually the definitive test is 24 hour urinary cortisol.
Prognostic in chr liver dsz - Ascites ( Ascites, Bilirubin, PT, Albumin & Encephalopathy are all part of
risk stratification)
Poor hep b vaccine response due to hiv (Immunocompromised) - It is actually the chronic Hepatitis C
inducing poor response, not HIV
Uti treatment in breast feeding mother who is allergic to aspirin - cephalexin - This patient has had
ANAPHYLAXIS to penicillin so you wont want to give cephalosporin
Cause of arf in liver failure pt - ? Intrarenal vasoconstric - Drug induced interstitial tubular damage
( causing ATN hence low urinary sodium)
Bleeding n prolonged ptt due to phenytoin - fx8 def - Lupus anticoagulant - if it was a factor def, that
50:50 mix would have fixed it , but it didnt
7.
serum creatinine - protein intake ?? (GFR if use C&G equation = (140 - age) x wt x constant /
creatinine & x 0.81 for female)
1.
1. A girl with RIF pain and mass. Endoscopy, Colonoscopy barium meal normal. Inv (CT Abdomen)
8. Patient having low/Normal Ca, low/normal P, raised ALP. (Pagets disease Tx alendronate)
21. Pt HBs -, HCV antibody +, HCV PCR -, HIV antibody +, HIV PCR +. (HIV+)
24. Pt known COPD and PO2 low, Co2 high, improve prognosis. (LTOP)
27. Long flight from Australia to UK and feels dizzy and weakness in one side. (Foramen Ovale)
29. Pt known case of cystic fibrosis died, post-mortem shown foam cell. (neutrophils???)
31. Pt with having hyper cholestrolemia and some other abnormal investigation. (lipoprotein lipase
deficiency)????
36. A child with neck swelling on one side and palpable L nodes. (FNAC)
37. Pt having rheumatoid arthritis and now gritty sensation in eyes. (Secca syndrome)
38. Patient with proximal small joint involvement, swelling and xray shows. (psoriatic arthritis)
39. Pt having pain in active abduction of arm but no pain when lifting with support/help. (supraspinatus
tendonitis)
40. Patient having pain in one side of the ear, vertigo, sensorineural hearing decrease. (Labrinthytis)
41. Pt concern of brain tumor and CT comes normal, but still not satisfied with results.
(Hypochondrial)
42. Na low, K low, pedal odema and lung bases crackles. Cant remember the exact scenario. (ADH
secretion extra pituitary cause)
50. Pt had sore throat 2 weeks back now present with multiple scally small lesions. (Guttate Psoriasis)
51. Pt with oral ulcers, eyes involvement some other features. Behcets disease
52. Lesion on nasal mucosa involvement and travel hx from America. (mucocutaneous leshminiasis)
56. Pt with rt side diaphragm high than left one. ( phrenic nerve palsy)
58. Pt present with symptoms of IBS, with blood on tissue paper. There was no option for
haemorrhoids. (IBS)
60. Pt with pnemothroax and chest drain inserted. Still bubbling in the tube. Appropriate measures to be
take. (ref to surgery)
62. Pt with low Na, High K, Low glucose etc. (Addison disease)
71. Pt with signs of sys sclerosis, pale stools and diarrohea, (bacterial Over growth)
72. Patient with chr pancreatitis and stool hard to flush. To see for pancreatic exocrine function. (Fecal
elastase)
73. Pt having recently change his life style and stop smoking, taking vegetables in meal and some other
changes. Develop ulcerative colitis.
Causative agent. ( stop Smoking)
75. Pt with dyspepsia for long time and now having sever vomiting showing metabolic alkalosis pic in
invstgation. Cause (Pyloric stenosis)
76. Pt with pain around the eyes ESR raised. (Giant Cell Atritis)
79. Pt having cushing features. How to diagnose cushing disease. (ACTH levels)??
81. Pt with features of Achalasia and difficult to pass endoscope thru sphincter into stomach. (failure of
relaxation of sphincter)
95. Pt had a stent 1 month back now present with three week hx of discomfort and fever. (S epidermitis
infection)
2.
3.
Urethritis
Patient with gonococcal urethritis is already receiving Azithromycin to cover for Chlamydia,so the
other antibiotic needed is Ceftriaxone to cover for N.gonorrhea
Doxicycline is the 2nd option,if Azithromycin is not available for the treatment of non-gonococcal
urethritis.
But the case in the exam states that he had gonococcal urethritis,so he should receive 1 antibiotic for
N.gonorrhea and 1 antibiotic for Chlamydia
So Azithromycin or Doxicycline to cover for Chlamydia along with Ceftrixaone to cover for
N.gonorrhea.
Since the patient was already on Azithromycin,we have to add Ceftriaxone for N.gonorrhea
High Cholesterol
The patient had isolated Hypercholesterolemia without Hypertriglyceridemia,so it's a case of primary
RA
Patient with RA should be started on DMARD,so the answer would be Methotrexate.
Santosh Jadhav, Sep 13, 2013
#3
4.
5.
12.Cyclosporine - Tremor
13.vertigo,tinnitus multiple episodes - Mnire's disease
106.Colonoscopy in new UC
108.Prognostic indicator in chronic liver dsz ascites ( Child Purgh classification)
109.Rash n bloody diarhoea -pyoderma
110.Aortic stenosis, anemia, normal scope - mesenteric angiography
127.RUQ pain and fever 6 wks after return from Nepal hepatitis A ( incubation 3-6wks)
128.Fever n middle lobe consolidation Mycoplasma Pneumonia
129.Proteinuria, urinary incontinence, worsening confusion/ consiousness after after Kenya - ? Dengue
Fever ? Cerebral Malaria
139.Riluzole in MND
140.Upper limb weakness with reduce pain/temp sparing joint/vibration-syringomyelia
141.Cerebellar sign, horner ,& contralateral limb weakness/ reduced sensation - PICA/lat medullary
142.Pain on shoulder abd? - ? supraspinatus tendinitis
143.Laughing and limb weakness cataplexy
144.Allopurinol xanthine oxidase inhibitor
146.Pt with limited sclerosis with diarhoea - bacterial overgrowth
182.Pt with symptoms of hemisection of spinal cord. sup combined deg of the spinal cord
6.
Thyroditis (Subacute thyroiditis) is associated with a negligible uptake on radioactive iodine uptake
scan
Anti Ro Ab is associated with "congenital" heart block,and if i'm not mistaken the question was about
the effect the antibody has on the patients (not the neonate) "cardio-vascular" system,so in that case
Many institutions including the CDC recommend starting patients with catheter related sepsis on
Vancomycin
the man with a joint swelling had WBC > 50,000 in the aspirate so he has Septic Arthritis.Gram Stain
and Culture are negative most of the time.
Patient with renal scarring and HTN should be started on an ACEi,because of its renoprotective effect.
Santosh Jadhav, Sep 14, 2013
#7
7.
Q.1 In a randomised controlled trial comparing drug A and placebo for treatment of
hypercholesterolaemia, a sample size needs to be calculated.
If the investigators assume that the mean cholesterol level of participants is 7 mmol/L, with
standard deviation of 1.5 mmol/L, in order to detect a difference of 1 mmol/L in cholesterol
level after treatment between the two groups, with a power of 90% at significance level of
0.05 by two-sided test, the sample size needed for each group is calculated to be N.
Which of the following statement is ?
(Please select 1 option)
If the standard deviation is 1.3 mmol/L, the sample size required for each group is greater than N
If the standard deviation is 1.7 mmol/L instead of 1.5 mmol/L,the power of the study is increased
If the standard deviation is 1.7 mmol/L instead of 1.5 mmol/L, the power of the study is reduced
In order to detect a difference of 1.5 mmol/L, the sample size required for each group is greater than N
The information given is insufficient to calculate the sample size
If the standard deviation is 1.7 mmol/L instead of 1.5 mmol/L, the power of the study is reduced.
If the standard deviation is reduced, the sample size required is smaller.
If the difference to be detected is increased, the sample size required is smaller.
The sample size can be calculated with the given information
Santosh Jadhav, Sep 23, 2013
#8
8.
Question: 2
In a study on the association between television watching and lung cancer, it was found that
patients who watched television for more than five hours a day had a 30% increased risk of
lung cancer (p=0.01).
Patients who watched television for more than five hours a day were more likely to be
smokers (p=0.02).
Which of the following statements is ?
(Please select 1 option)
Analysis of association between television watching and lung cancer should be stratified by smoking
status
It can be concluded from this study that smoking is associated with lung cancer
Multivariable linear regression can be used to analyse the data
Watching television is a stronger risk factor for lung cancer compared to smoking
Watching television is not associated with lung cancer
Stratified analysis eliminates the confounding of the stratified data.
Although previous studies showed association between smoking and lung cancer,
information is insufficient to make such conclusion from this study.
Multivariable logistic regression can control and minimise confounding by simultaneous
adjustment for multiple factors.
Information given in the question is insufficient to make conclusions as to whether watching
television is a stronger risk factor for lung cancer compared to smoking or whether watching
television is not associated with lung cancer
Santosh Jadhav, Sep 23, 2013
#9
9.
Question: 3
10.
Question: 4
A 16-year-old boy reports palpitations, excessive sweating and tremor occurring almost daily when he
walks past a car park where he was mugged four weeks ago. He is finding the symptoms very
troublesome and has started missing school to avoid the car park.
Which of the following psychiatric illnesses does he have?
(Please select 1 option)
Adjustment disorder
Agoraphobia
Anorexia nervosa
Cynophobia
Generalised anxiety disorder
Adjustment disorder occurs within three months of an identifiable stressor and lasts six months from
the withdrawal of the stressor. The patient will show either distress in excess of that expected or a
disruption of their day to day life.
The criteria for diagnosing generalised anxiety disorder are anxiety/tension, occasionally accompanied
by physical symptoms, on more days than not for more than six months. It is more a diagnosis of
exclusion however, as it may be due to prescription medication or another psychiatric illness.
Anxiety disorders can be treated with selective serotonin reuptake inhibitors (SSRIs) or monoamine
oxidase inhibitor (MAOI).
Benzodiazepines and beta blockers can be used on a PRN basis for patients who suffer with panic
attacks.
Cognitive behavioural therapy can also be of help.
Anorexia nervosa is an eating disorder with altered body image.
Agoraphobia is phobia of open spaces.
Cynophobia is phobia of dogs
Santosh Jadhav, Sep 24, 2013
#11
11.
Question: 6
A 64-year-old patient is discussed at the lung cancer MDT following a recent diagnosis of non-small
cell lung cancer (squamous sub-type).
He is a current smoker, and is known to have COPD for which he takes inhalers. The lesion appears
confined to the right middle lobe, but surgical resection would require a pneumonectomy.
Which of the following is a contraindication to his having radical surgery?
For an intervention to be considered curative there should be no evidence of metastatic spread, and
practical considerations such as a patient's respiratory function reserve need to be considered prior to
any operation.
The BTS recommends that pre-operatively a patient's FEV1 should be greater than 1.5L for a
lobectomy and greater than 2L for a pneumonectomy. This ensures that the risk of difficulty in
ventilation weaning is reduced, and that post-operatively the patient's respiratory function is not
severely compromised.
By CT criteria, lymph nodes greater than 1 cm are deemed to be malignant unless proven otherwise.
Paraneoplastic phenomena including clubbing, HPOA and electrolyte disturbances are not
contraindications
Santosh Jadhav, Sep 25, 2013
#12
12.
Question: 7
A 27-year-old British man presents with a two year history of progressively worsening,
atraumatic lower back pain and stiffness. The pain radiates to the gluteal region bilaterally
and is worse in the evenings. He reports some relief with exercise. Recently, he has also
noted intermittent pains in his left shoulder and the heel of his left foot.
Clinical examination demonstrated limited spinal flexion in the sagittal and frontal planes.
Left shoulder pain was reproducible with resisted abduction; there was a diminished left calf
squeeze test with a tender and swollen left Achilles tendon.
Given the probable diagnosis, which of the following is likely to be positive?
(Please select 1 option)
Anti-CCP antibody
HLA B*2705
HLA B*2706
Gonorrhoea antigen
None of the above
13.
Question:
A 22-year-old man returned from a back-packing holiday three weeks ago. While abroad he
developed bloody diarrhoea with abdominal pain. Stool cultures have confirmed Salmonella
typhi.
Which of the following antibiotics would be first line treatment?
(Please select 1 option)
Ampicillin
Ciprofloxacin
Erythromycin
Metronidazole
Tetracycline
Ciprofloxacin is the antibiotic of choice for the treatment ofSalmonella - 500 mg bd for 10-14
days.
Diarrhoea occurs due to increased water in the stool. The definition of chronic diarrhoea is
the abnormal passage of three or more loose or liquid stools per day for more than four
weeks and/or a daily stool volume > 200ml/day (weight > 200g/day).
Ampicillin or ciprofloxacin can be used for the treatment ofShigella.
Erythromycin is used in Campylobacter jejuni.
A 29-year-old man is referred to the respiratory clinic with increasing shortness of breath. He
smokes 5-10 cigarettes per day and drinks 30 units of alcohol per week. He reports wheeze
and a chronic cough so his GP has been managing him for asthma.
On examination his BP is 132/72 mmHg, pulse is 80 and regular. There is scattered wheeze
and coarse crackles on auscultation of the chest.
Investigations show:
Haemoglobin 13.5 g/dL (13.5-17.7)
White cell count 8.0 109/L (4-11)
Platelets 232 109/L (150-400)
Sodium 140 mmol/L (135-146)
Potassium 4.0 mmol/L (3.5-5)
Question: 10
A 23-year-old man presents to the Emergency department with sudden onset left sided pleuritic chest
pain. He has had a cough over the past few days and says the pain came on after a coughing fit.
On examination his BP is 148/82 mmHg, pulse is 82 and regular, his saturations are 95% on air. Chest
sounds appear normal.
Investigations show:
pH 7.42 (7.35-7.45)
pCO2 4.8 kPa (4.8-6.1)
pO2 10.2 kPa (10-13.3)
CXR Small left sided pneumothorax (<5%)
Which of the following is the most appropriate way to manage him?
(Please select 1 option)
Admit for overnight oxygen therapy
Chest drain
Discharge and review in 24 hours
Discharge and review in the clinic in two to three weeks
Pleural aspiration
This gentleman has a spontaneous pneumothorax. It is primary (defined as age less than 50y, no
significant smoking history, and no evidence of underlying lung disease).
Management depends on the size, and the patient's symptoms. If it is small, as in this case, the patient
can be discharged and reviewed in an outpatient clinic in 2-4 weeks. If the rim of air measures more
than 2cm at the level of the hilum, and/or the patient is breathless the pneumothorax can be aspirated.
A chest drain is indicated if aspiration fails in a large or symptomatic primary pneumothorax.
They can also be used in the management of secondary pneumothorax.
Supplemental oxygen accelerates reabsorption of air by a factor of four, but overnight treatment does
not feature as part of the current UK guidelines in small primary pneumothoraces
Santosh Jadhav, Sep 30, 2013
#16
14.
Question: 11
A 21-year-old man with known sickle cell anaemia comes to the Emergency department with
increasing shortness of breath which is now so bad that he is unable to walk.
He says a few days earlier there were symptoms of a non-specific mild flu-like illness but nothing else
of note.
On examination his BP is 124/72 mmHg, pulse is 95. He has severe left ventricular failure.
Blood gas examination reveals an Hb of 6.4 g/dl.
Which of the following is most likely to be responsible?
(Please select 1 option)
Coxsackie B virus
Cytomegalovirus
Epstein-Barr virus
Influenza A
Parvovirus B19
Parvovirus B19 is known to be associated with aplastic crises in sickle cell anaemia which can
precipitate severe anaemia and subsequent cardiac failure. Recovery may be spontaneous over the
course of a few weeks, but transfusion, particularly when there is associated cardiac failure is usually
required.
Whilst the other viruses listed may contribute to myocardial dysfunction and as such could precipitate
cardiac failure, they are not associated with aplastic crisis in sickle cell.
Therefore it is parvovirus which is the only possible answer here
Santosh Jadhav, Sep 30, 2013
#17
15.
Question: 12
June, a 45-year-old woman has had arthritis for 16 weeks. She has morning stiffness lasting two hours.
The hands, wrists, right elbow and knees are swollen. She also complains of painful feet.
The ESR is 41 mm/hr and C reactive protein is 34 mg/L. The full blood count is normal.
Which antibody test would you request if you suspected that she had early rheumatoid arthritis?
(Please select 1 option)
Antinuclear antibodies (ANA)
Anticyclic citrullinated peptide antibodies (anti-CCP antibodies)
Antineutrophil cytoplasmic antibodies (ANCA)
Antiphospholipid antibodies
Complement
High titres of antinuclear antibodies (ANA) are associated with a large number of autoimmune
diseases, most commonly systemic lupus erythematosus (SLE).
Anticyclic citrullinated peptide antibodies (anti-CCP antibodies) are highly specific and sensitive for
rheumatoid arthritis and their titre correlates with erosive disease. Anticyclic citrullinated peptide
antibodies should be used as one of the first line immunological investigations in suspected rheumatoid
arthritis.
Antineutrophil cytoplasmic antibodies (ANCA) are more commonly associated with vasculitides which
the history does not suggest in this case.
Antiphospholipid antibodies would be requested when the clinical presentation suggests a diagnosis of
antiphospholipid syndrome.
Complement is not an antibody test. Levels are generally performed in specific cases, for example,
cryoglobulinaemia and SLE
Santosh Jadhav, Sep 30, 2013
#18
16.
Question: 13
An 80-year-old female presents with recurrent falls. She has fallen a few times whilst walking to the
toilet at night to pass urine. She always feels light-headed prior to falling and denies palpitations.
She suffers from ischaemic heart disease, hypertension, diabetes mellitus,
hypercholesterolaemia, osteoporosis and hypothyroidism. She is taking gliclazide, metformin, ramipril,
doxazosin, levothyroxine, aspirin, simvastatin and weekly alendronate.
Her blood pressure is 130/70 mmHg and her pulse is 70 beats per minute and is irregular.
She undergoes a medication review as part of a multi-factorial risk assessment.
Which one of the following medications is most likely to be the culprit for her symptoms?
(Please select 1 option)
Alendronate
Doxazosin
Levothyroxine
Metformin
Ramipril
The patient has symptoms of postural hypotension and subsequent presyncope. It may be possible that
she has a degree of autonomic dysfunction secondary to diabetes mellitus that would put her at even
greater risk of postural hypotension with an alpha blocker. The most likely cause is the alpha blocker
doxazosin that is used for hypertension. Doxazocin is the most likely to cause postural hypotension
Santosh Jadhav, Sep 30, 2013
#19
17.
Question: 14
A 45-year-old male intravenous drug user (IVDU) presents to hospital with fever and a productive
cough.
On examination, a pansystolic murmur is heard at the left sternal edge. CXR reveals multiple cavitatory
lesions.
What is the likeliest explanation?
(Please select 1 option)
Aortic valve endocarditis with embolisation
Aspiration pneumonia
Mitral valve endocarditis with embolisation
Pulmonary TB
Tricupsid valve endocarditis with embolisation
IVDUs are susceptible to S. aureus tricuspid valve endocarditis due to auto-inoculation of S.
aureus during injection.
In IVDUs, pulmonary TB and aspiration pneumonia are less likely causes of multiple pulmonary
cavitatory lesions
Santosh Jadhav, Sep 30, 2013
#20
18.
Question: 15
A 45-year-old Ghanaian man presents to hospital with a right sided middle lobe pneumonia.
Streptococcus pneumoniae is isolated from blood cultures.
What is the likeliest underlying association?
(Please select 1 option)
Common variable immunodeficiency (CVID)
HIV
HTLV-1
IgA deficiency
Terminal complement deficiency
Streptococcus pneumoniae, is a Gram-positive diplococcus which is carried
asymptomatically in approximately 50% of people. It can cause both non-invasive and
invasive disease. Invasive pneumococcal disease (IPD) refers to disease in which the
bacterium enters a sterile site such as blood, cerebrospinal fluid, pleural fluid or pericardial
fluid.
Non-invasive disease includes otitis media, sinusitis, pneumonia and bronchitis. This
gentleman has grown the organism from his blood cultures, and therefore has IPD by
definition. This is a major cause of morbility and mortality in children and adults.
Invasive pneumococcal disease (IPD) is 20-30 times more common in HIV infected patients
compared to non-HIV infected patients. Consideration should be given to offering HIV testing
to all patients with IPD presenting to hospital.
Other immunodeficiency syndromes are associated with an increased risk of IPD, but the
majority of these present in childhood. These include X-linked (Bruton's)
agammaglobulinaemia, common variable immunodeficiency, asplenia (anatomical or
functional) and sickle cell disease.
The other causes of immunodeficiency are not associated with IPD
Santosh Jadhav, Oct 2, 2013
#21
19.
Question: 16
Ototoxicity is associated with vancomycin, and is more likely in patients with high plasma
concentrations, or with renal impairment or pre-existing hearing loss.
It may progress after drug withdrawal, and may be irreversible. Hearing loss may be
preceded by tinnitus, which must be regarded as a sign to stop treatment.
The important level to measure here is the trough level as opposed to the peak level with
gentamicin.
(Martindale
Santosh Jadhav, Oct 2, 2013
#22
20.
Question: 17
A 30-year-old mother with her 6-year-old daughter presents with itching of the scalp with hair
loss of one month duration.
Examination revealed patches of partial alopecia, sharply cut off circular in shape, with
numerous broken-off, dull grey hairs in the alopecic patches.
Wood's lamp examination revealed green fluorescence.
What is the most likely diagnosis?
(Please select 1 option)
Alopecia areata
Seborrhoeic dermatitis
Secondary syphilis
Tinea capitis
Trichotillomania
Tinea capitis or ringworm of the scalp is a common condition affecting children and
uncommonly adults, where the adults are usually secondarily infected.
The response to this infection is variable, depending on the type of hair invasion, the level of
host resistance and the degree of inflammatory host response. The appearance therefore
may vary from a few dull grey, broken-off hairs with a little scaling, detectable only on careful
inspection, to a severe, painful, inflammatory mass covering most of the scalp. Itching is
variable. Sharing of combs facilitates spread in the family.
Alopecia areata presents as non-itchy areas of hair loss with exclamation mark hairs.
Seborrhoeic dermatitis presents with diffuse greasy scaling. Hair loss in such localised
patches is not a feature.
Secondary syphilis presents with moth-eaten alopecia.
Trichotillomania presents as patchy hair loss with hair of varying lengths in different as well
as the same patch. Invariably there is a history of a family member having observed serial
plucking of hair by the patient
Question: 18
A 22-year-old woman attends the GP concerned that she has a positive pregnancy test. She
maintains that she never missed a pill over the course of the last three months.
Which of the following, when taken concurrently with the combined contraceptive pill, is most
likely to increase the risk of pregnancy?
(Please select 1 option)
Cimetidine
Erythromycin
Fluconazole
Fluoxetine
St John's wort
St John's wort is a potent CYP-450 inducer, and use can lead to rapid decreases in sex
steroids administered as the combined pill.
Fluconazole is a 2C9 inhibitor
21.
Question: 19
cough'.
It is important to remember that not all of the above features will be present at the same
time, CXR changes often lag behind. The key is to have a high index of suspicion and
monitor vital signs particularly oxygen saturations regularly and anticipate development of
possible acute chest syndrome. Early recognition and treatment is life saving.
Chest pain is often a feature of acute chest syndrome, either from the onset or presents later
during the course of disease.
Shortness of breath is an important feature of acute chest syndrome and one of the main
markers of deterioration indicating the need for possible exchange transfusion. All sickle
patients should have their oxygen saturations measured regularly on air.
Fever, usually temperature of greater than 38.5C is another recognised feature of acute
chest syndrome. All patients with temperatures more than 38C should have cultures sent.
Although new infiltrates are a characteristic feature of acute chest syndromes, it is important
to remember that they can lag behind, and treatment should not be delayed in the absence
of CXR changes if all other clinical signs suggest acute chest syndrome.
Acute chest syndrome is a combination of signs and symptoms, not all of them need to be
present for a diagnosis to be made.
Santosh Jadhav, Oct 4, 2013
#25
22.
Question: 20
A 35-year-old Nigerian female was assessed in an antenatal clinic. She was clinically well.
23.
Question: 21
care, as the protein is directly toxic to the tubules and this typically results in progression of
renal impairment
Santosh Jadhav, Oct 7, 2013
#27
24.
Question: 22
neutropenia
Hypercalcaemia - nausea, fatigue, confusion, polyuria, constipation
Weight loss is common
Hyperviscosity.
The hypercalcaemia is caused by osteoclast activating factors
Santosh Jadhav, Oct 7, 2013
#28
25.
Question: 23
For which of the following are blockers not recommended as first line therapy?
(Please select 1 option)
Angina
Chronic heart failure
Hypertension
Myocardial infarction
Permanent atrial fibrillation with rapid ventricular rate
The National Institute for Health and Clinical Excellence (NICE) guidelines on Hypertension
(CG127) advise against using beta-blockers as routine 'first line' therapy for uncomplicated
hypertension.
Review of several randomised controlled trials suggested that first line beta-blockers were
not as good at decreasing mortality as other classes of antihypertensive drugs and were less
well tolerated
26.
Question: 24
A 48-year-old patient presents to the clinic with a gradual change in her facial appearance,
swelling of her fingers so that her rings no longer fit, sweating, hypertension and worsening
problems with sleep apnoea. You understand she has recently had surgery for bilateral
carpal tunnel syndrome.
On examination she is hypertensive at 150/90 mmHg. She has coarsening of facial features
with prognathism which is obvious when you look at old photos from her album; her hands
and feet look enlarged.
Investigations show
Haemoglobin 14.1 g/dl (11.5-16.5)
White cell count 6.8 x 109/l (4-11)
Platelets 183 x 109/l (150-400)
Sodium 141 mmol/l (135-146)
Potassium 3.9 mmol/l (3.5-5)
Creatinine 102 mol/l (79-118)
TSH 3.1 mU/l (0.5-5.0)
Free thyroxine 13.2 pmol/l (10-25)
Glucose 4.6 mmol/l (4.5-5.6)
Which of the following is the investigation most likely to elucidate the underlying diagnosis?
1.
MMRGuest
1st time appeared & it was a horrible experience. can not concentrate on 2nd paper, so lengthy exam.
1. Tirofiban M/A - GP IIb/IIIa inhibitor (mine wrong put direct thrombin inhibitor)
3. Bitemporal Upper Quandrantopia - Pituitary Macroadenoma (mine wrong put Craniopharyngioma)
4. Ciclosporin M/A - IL2 inhibitor
5. Squamous cell Ca of Lung Surgery Contraindication - SVC Obstruction
6. after Chemotherapy recurrent URTI, which one reduced - T-cell/IgG/macrophage/Complement
7. Stemcell Therapy in Type 1 DM, prevent - Glycation/mutagenesis/oxidative stress/senescence
8. Acoustic Neuroma - Absent Corneal Jerk
9. GBS Respiratory Function Monitor - Vital Capacity
11. Pre-Pregnancy Checkup soft ejection systolic murmur - Bicuspid Aortic valve
12. cANCA +ve Renal biopsy finding - Crecentic GN
14. JAK2 Mutation Polycythemia Treatment - Hydroxycarbamide
15. Panton-Valentine Leukocidin +ve Staphylo aureus treatment - Clindamycin + Nasal Mupirocin
16. Teratoma Pt. planned to give 6 cycle Chemo, which one should given before starting chemo Allupurinol/Dexamethasone
17. Travelled from India now jaundice, high LFT - Hepatitis A/ Leptospira
18. Rheumatoid Arthritis Pt. with red eye, irritation Episcleritis ((Answered Above))
19. Meningococcal meningitis prophylactic drug - Rifampicin
20. Herpes zoster Neuralgia not relieved by NSAID, give - Carbamazepine
21. anti-Parietal antibody detection Biopsy from - Proximal Stomach/Distal stomach/Terminal ileum
22. Repolarization in cardiac Muscle due to - Pottasium Current/L type Calcium Current
23. after drinking Huge beer,polyurea occurs due to - decrease Aquaporin channel in collecting duct
24. Ejection Systolic murmur best heard on expiration in left sternum - ASD/AS/PS
25. CMV +ve HIV pt.(<100 CD4) besides HAART Treatment needed - iv
Ganciclovir/Valaciclovir/Aciclovir
24. 23 yrs man bloody diarrhoea 3 month, Colonoscopy continous inflammation in sigmoid with
scattered Diverticula - Ulcerative Colitis/Diverticolitis/inflamatory Colitis/Ischemic Colitis/Crohns
colitis
25. Bisphosphonate therapy problem if GFR<30/Ca+<2.5/BMI<19
26. penicillin allergy pt. but Methicillin sensitive strain, give Clarithromycin/Vancomycin/Linezolid/Ceftazidime
29. Aortic Stenosis poor prognosis - Aortic Regurgitation/severe valve calcification
30. Rheumatoid Arthritis Poor Prognosis - pt age 30 yrs/bony erosion/sudden onset
31. Temporary Single Chamber pacing, pacemaker wire should be placed - Right Atrium/RV apex/LV
apex/coronary sinus/Bundle of His (mine wrong LV apex)
32. Demyelinating Neuropathy - Decrease Motor nerve Conduction
33. Reading problem after Parietal Lobe infarction, due to - Hemianopia/amnesia/
34. Anti Thyroid Peroxidase +ve - Hashimoto Thyroiditis/Graves
35. Ret oncogene +ve in - Medullary Ca/papillary Ca/Follicular Ca Thyroid
36. 65 year man regular narrow complex tachycardia with 150 bpm Pulse - Atrial fibrillation/Atrial
flutter/AVRT/AVNRT
37. 65 yr man 3 yrs back MI contd. drug ACEi+Bendrothiazide, now Haemoglobin<9.5, PBFpolychromasia,poikiloSpherocyte, RBC finding - fragmented RBC/Target Cell/Howell Jollie
38. previously not immunised recent contact with TB pt. - do MT/BCG/Isoniazide
Last edited by a moderator: Jan 20, 2012
MMR, Jan 18, 2012
#1
2.
DrShaheenGuest
-pt. drink 4 litres of Alcohol after that he became diuresis what is the cause : BNP may be iam not sure
-there is question about Thoracic outlet syndrome
-blood film in HUS ; fragmented red cell
-scleroderma with abdominal bloating and vit b12 def treatment: tetracycline
-case of scleroderma with esophageal dysmotality
-in dehydrated pt. compenstatory water retention, which part of nephron still impermeable for water:
-IDA in elderly what how to establish diagnosis : ???fecal occult blood or colonoscopy
-case of refeeding syndrome: hypophosphatemia
-case of optic neuritis with pale disc and loss colour vision
-case of RA eye complication painless eye injection : ?episcleritis (Answered Above)
-case of acute painfull eye injection, blurred vision, dialated pupil with hypopyon : ? Acute closed
angle glaucoma
-case of horner syndrome in heavy smoker how to establish diagnosis : chest x ray
3.
DrShaheenGuest
4.
DrShaheenGuest
5.
MMRGuest
6.
MMRGuest
24) rheumatoid, factor -ve, joint erosions. worse prognosis- joint erosions
25) features on x ray of ank spond- osteosclerosis
26) raised CK on bloods- myoglobinuria
27) hypokalaemic alkalosis on bloods (bicarb-33) - hyperaldosteronism
39) fever, haemolysis (cold agglutinins), rash ? erythema multiforme- mycoplasma pneumoniae
40) preceding cold, then SOB, CXR b/l infiltrates- staph pneumonia
41) hill walker with concentric rash- lyme disease
145) 15 days post bone marrow transplant, jaundice, diarrhoea- graft versus host disease
146) lethargic lady, low sodium, high k+ (adrenal insuff) + high TSH (? hashimoto's), Ix- short
synacthen test
147) Bisphosphonates, blood check before starting- renal function
148) facial pain with ptosis, miosis, multiple episodes overnight- atypical facial pain
149) smoker, features of horners. Ix (? pancoast's tumour)- CXR
150) testing cholesterol levels in two groups- unpaired t test
150) testing cholesterol levels in two groups- unpaired t test
151) left hemiparesis, hypertensive, brachial ischaemia- aortic dissection
152) limb weakness, loss of temperature and sensation- anterior cord syndrome
153) man with haematuria. Father and uncle same problem- thin membrane disease
154) treatment of CMV, mouth ulcers- IV ganciclovir
155) amyloidosis, +ve bence jones- AL amyloid
156) 24 year old cyanosis, clubbing, ESM- tetralogy of fallot
158) Low Na 121, high urinary sodium ?SIADH. Na now 119 after fluid restriction. Rxdemeclocycline
159) Insulin, site of action- cytoplasmic membrane
160) rash on arm, exfoliation around it- dermatitis artefacta
161) Heparin induced thrombocytopenia, which factor?- factor 4
162) nephron, which part is impermeable to water?- ascending limb
163) single pacemaker, anatomical site to place- atrioventricular node
164) discitis, organism MSSA. Rx- vancomycin
165) seminoma, platelets 17 prior to chemo. management- platelet transfusion
166) started risperidone, raised prolactin, multiple abnormalities- risperidon effect
167) contact lenses, stratching, hypopyon- infective keratitis
168) depressive male patient attempts suicide. Feature of likeliness to succeed- planning of event
170) patient on CCU, witnessed to lose responsiveness, VF on monitor, immediate treatment- chest
thump
171) patient with HIV develops pleural effusion. Unable to tap, next investigation- ultrasound chest.
172) patient with features of right heart failure, has reduced ejection fraction on echo. Next
investigation- right and left heart catheter
173) most likely feature of parkinson's disease- asymmetrical bradykinesia
174) penicillin allergic (rash) patient develops meningitis. Abx- chloramphenicol
175) recent return from spending time with known sputum +ve TB person. Next step- quantiferon
176) pre-op, lymphocytosis. 1.5cm lymph node on examination. Next Ix (? CLL)immunophenotyping
177) NSAIDs- interstitial nephritis
178) primary hyperparathyroid, Ca-2.88. Management- parathryoidectomy
179) Drug most likely to cause confusion that patient is taking- digoxin
180) Worsening asthma, on aspirin and atenolol, and oters ? cause- atenolol
181) elderly patient with triad of nephrotic syndrome. Like cause- membranous gn
182) stroke, unilateral neglect, dysphagia, heminaopia, most likely to hinder recovery- homonymous
hemianopia
183) Why is verapamil used in a smaller dose IV than oral?- bioavailability
184) cause of lipaemia in pancreatitis- hyperchilomicronaemia
185) pernicious anaemia, biopsy most likely to be abnormal? distal stomach
186) osteoarthritic patient with swelling of hands including MCPs. Rx- prednisolone
187) phenytoin dose increased. When should a level be checked?- 1 week
188) lethargic woman post partum. What test should be done?- Tissue transglutaminase
189) What are stem cells protected against- mutations
190) active SLE. Blood test to assess activity- C3/C4
191) 20 something year old chap with ? tunnel vision. Appearance on fundoscopy- black bone spicules
192) Patient with HIV and drowsy, unable to answer questions, next appropriate action- Test for HIV
193) Patient with CLL on chemo, having recurrent infections. cause?- Immunoglobulin G deficiency
194) Post partum lady with a white leg, poor palpable pulses, and gross oedema upto groin- puerperal
lymphoedema
195) Lady with shoulder and pelvic aches. raised ESR- polymyalgia rheumatica
196) Patient with suspected gout, best test to confirm- synovial fluid aspirate
198) A female patient with oligomennorrhea and occasional galactorrhea prolactin level 700 whats the
diagnosis? PCOD , HYPOTHYROIDISM, PROLACTINOMA , CUSHINGS???
199) a young patient having burkitt lymphoma treated with whole body irradiation and then 3 month
combination chemo including cyclosporin presents with red rashes whole bode fever and neutropenia
whats the cause ?
cyclosporin toxicity
radiation toxicity ?????
199) loss of two point discrimination and gripping affected .but all other sensations intact (not affected)
where is the lesion?
periphral nerve
Brain
spinal cord
brachial plexus
200) A known cystic fibrosis patient had a travel history to thiland 6 month back ?? present with
chronic Non bloody offensive diarrohea
what is the diagnostic test? parasite and ova in stool, colonoscopy,, gastroscopy ,, duodenoscopy ,, fecal
elastase??
Last edited by a moderator: Feb 15, 2012
MMR, Feb 14, 2012
#7
7.
MMRGuest
The passmedicine site has added a batch of questions supposedly from Jan 2012. The questions appear
similar to the actual ones asked, and the answers given are as follows:
11) treatment for small bowel overgrowth- rifaximin (cant remember this being an option, I put
tetracycline)
12) man with right heart failure signs, ?TR, sign- left parasternal heave
13) Treatment for torsades de pointes- IV magnesium
14) non tender goitre + anti TPO+ high TSH- hashimotos
15) Russian sailor, lymphadenopathy, tonsillar swelling- diphtheria
16) Skin lesions ? erythema nodosum, most likely outcome- full recovery
17) DEXA scan, osteopenia vertebrae (-1.4), osteoporosis femoral neck (-2.7)
18) feature most consistent with Bell's palsy- hyperacusis
19) Shingles, painful, treatment- amitryptilline
20) action of tirofiban- glycoprotein 11b/111a inhibitor
21)Suspected cholesterol embolus, feature- eosinophilia
22) meningitis prophylaxis- rifampicin
23) alcohol, polyuria, mechanism- inhibits adh secretion (reduced aquaporin)
24) mantoux test, induration on forearm, ?due to- interferon gamma
25)SOB, early diastolic murmur- aortic regurgitation
26) history of hypertension, angina, low na and k+, muscle weakness- bendroflumethiazide
27) young person, tachycardic, dilated pupils, cause- cocaine
28) ?meningitis, penicillin allergic- chloramphenicol
1-72 female patient with AF and controlled bronchial asthma (clinically and by investigations) wt ttt to
give her >>> atenolol (my answer) or amidarone
gentamicin
6- sign of sever mitral regurge>>> displaced heaved apex
7-old patient with h/o mitral and aortic valve replacemet 10 years ago presente mith macrocyticanaemi
and high billirubin wt s the diagnosis>>>hemolysis from the valves(my answer)or vit B12 def. or folic
acid defeciency
10- old patient with HTN has akle edema as side effct of amlodipine asks to change tt wt to give
next>>>bedrofluthiazide
11-pt with chronic venous insuffeciency will travel long trip and worried ab out DVT was prescibed
elastic stockin and was given general advices wt to do next>>>dantoparin(low molecular weight
heparin my answer) or leg elvation or no more actions
12-pt post MI passed smoothly and has normal serum cholestrol wt to giv him fo rurther
protectio>>>simvastatin(my answer) or ramipril or atenolol
SYNCOPE
CLINICAL HEMATOLOGY & ONCOLOGY
18. A Patient taking medication for Ischemic Heart Disease including Clopidogrel, ACEI, Bet Blocker
is presented with HUS/ TTP; Which test would be abnormal--- Raised aPTT
30/8/2014 ONLY MRCP MCQs
INFECTION CMV20 21. patient with Renal impairment and neuroSgin : TTP22. Pokilo cell, with
fatigue, : mylofibrosis
23. Patient after Gastric Bypass : which is most common deficiency observed in these
patient.....Vitamin B12 Deficiency (most common) followed by Iron etc.24. Patient with Erythema
Nodosum, for investigations?sarcoidosis inves do CXR .. IN THIS QUESTION PATIENT HAD NO
RESP SYMPTOMS , BLOOD TEST COULD HAVE ALSO BEEN OFFERED as next step in
Diagnosis.
25. Patient with Backache, High Creatinine and High Calcium ....what is the most appropriate
investigation for this patient........serum electrophoresis for myeloma
26. HUS IN adults- female visited a farm and after that had diarrhea with inc creating ... so ecoli-0157
27. Young female with menorrhagia (family history present) - Von willibrand disease
29. Polycythemia rubravera which gene mutation will u expect: JAK2 mutation
30. splenomegally and bleeds- with gum hypertrophy, diagnosis..........AML
31. epistaxis stopped,ITP-what is the most appropriate treatment :- predinsolone
32. Female with fatigue and splenomegaly - Myelofibrosis ... I guess this is the question in which there
myeloid series cells on peripheral film n myeloblasts..aswell.........hmm I went for CML ..
CLINICAL PHARMACOLOGY,THERAPEUTICS & TOXICOLOGY33. BPH which drug should be
given to decrease the size of prostrate gland ?/- Finasteride- 5alfa redictase inhibitor
37. patient with nasal blockage , SOB :: Asprin
38. Patient on warfarin for afib, started on antituberculosis treatment lately, having the inr decreasing
from 2.5 to 1.3 which drug might be the reason ..... Rifampicin
39. patient on warfarin and started on metronidazole treatment , now adjusted dose of warfarin is
needed to maintain inr- Reason? .....cyp2c9 gene
40. Mechanism of Action of Allupurinol ..... inhibition of Xanthine oxidase enzyme41. Whats the
mode of action of Calcineurin,Imitanib=Tyrosine Kinase Activity inhibition
42. What is the Mechanism of Action of ..Ciclosporin-IL2 inhibition
43. Patient already taking Ciclosporin post Renal Transplant and stable is diagnosed with fungal
infection and started on Fluconazole .. after 10 days or so the patients creatinine jumps what is the
reason ....Ciclosporin toxicity sec to Fluconazole
44. Patient with Facial Hair growth and Acne, side effects of which drug :- Prednisolone... other
options were cyclosporine etc.
45. What is the site of action of the Thiazide Diuretics :- Prox.DistalConvulatedTubles
ht t ps : / / www. f ac ebook. c om/ g r oups / 1495489127329899/ per mal i nk/ 1530192607192884/ 2/
10
30/8/2014 ONLY MRCP MCQs
46. Paracetamol overdose with hepatic necrosis ,which is the best test for following the prognosis of
the patient ..... s/ creatinine
47. Patient with cholestatic LFT : amoxaclin ...I guess Augmentin is the one causes cholestasis with
Hepatits while Flucloxacillin causes cholestatsis with bile duct injury ...
48. Metronidazole and Lithim given together leads to .. increased lithium toxicity due to ..... dec renal
excretion of lithium .
49. Patient is started on Aspirin and dipyridamole post stenting ... what is the mechanism of action of
Dypyridamole .......... Phosphodieterase Inhibitor
CLINICAL SCIENCES
52.53. Patient with weakness of ant.thighmuscles,and weak flexion at the hip with absent knee reflex
and having area of sensory loss in lower leg lateral aspect ... where is the lesion ....Femoral N
55. Patient with pain at the medial epicondyle having difficulty dorsifelxing wrist against
resistance, ..what is the diagnosis... Medial Epiconylitis56. Patient with congenital Long QT syndrome,
scenario, then question asked which of the ions is reasonable for REPOLARIZATION,of cardiac action
potential.......K+ CHANNELS
57. Patient with weak flexion of the triceps muscle of right arm as compared to left with sensory loss at
the base of the right thumb difficulty extending the wrist ....where is the lesion....RADIAL Nerve
58. Down syndrome 47 XY +21 aneuploidy
59. Patient with Post.dudenal cap ulcer the artery affected? gastrododenual Artery supplies till mid of
2nd part and its part of anterior gut .. after that duodenum is supplied by mesenteric Artery ...Answer
is .......Gastrodudenal artery.......
60
61.
62. Turner syndrome associated - gonadal malignancy
63. Embryonic stem cell for DM management : protect itself from destruction ?? well I guess I read
somewhere that embryonic cells implanted in Type 1 dm (islet cell ) are put in a membrane to avoid
carcinogenic changes in these cells and not to avoid destruction or apoptosis...or senescence....so I went
for other option .. to avoid carcinogenic change.. I dont remember the exact wording now .
64. Alkaptanuria...... is it an amino acid metabolic disease or glycogen storage disease or enzyme defect
... 65. Which of the following stimulate the brain chemoreceptor for respiration......H+ions
66. Patient with difficulty opposing the palms of her hand with inability to close hand and the ring and
little fingers flexed ? .....Dupuytrens contracture..
69. Patient with dec food intake, now put on NG feeding , how to proceed with diet , the first
day .......50% of the dietery requirements
70. The genetic of DM and sensorineural hearing loss, mother had mild symptoms, sister had mild
symptoms, but the brother had severe symptoms - Mitochondrial disorder Or X-linked Dominant
...answer ....MIT OCHONDRIAL
71. Patient with cardiac arrest and you are resuscitating him , family including parents and girl friend
are present .. who Is going to decide to stop the Resuscitation ? .. Team leader of Resuscitation team
DERMATOLOGY72. Patient with a few pearly umblicatedpapular lesion on lower abdomen
suprapubic area ..what is the diagnosis......MOllascumContagiosum
73. IntraepidermalIgG- phemphigus as its IgG deposition , if it was igA then we should think
Herpitiformis
74.
75. patient with web space lesion itchy rash weeks back was given local steroids and the lesion
expanded further to reach the dorsal aspect of the foot spreading ever since. He was treated with a highpotency topical steroid cream, .....................answer was TINEA INCOGNITO ........
76. A young girl with history of paracetamol overdose who had rashes at the flexor surface, in linear
fashion previously had self-medicated - Dermatitis Artifacta
77. Acanthoysis nigrcans in obese ass e >> DM? or GI Malignancy ?ans ..Diabetes M.
78. Woman with Papules in vulva and a Macular rash in the Palms( and soles?)with Genital
Warts ......what is the most appropriate next step for Investigating the Conditions the options were
:HPV pcr/syphilis Serology VDRL = Syphilis Serology (Secondary Syphilis
79. Male from Ghana/Gambia .. comes back with multiple areas of skid depigmentation with sensory
loss , what is the condition.... Tuberculoid Leprosy.
ENDOCRINOLOGY80. BitemporalHeminopia : Cabergoline or Surgery as it is non secretory , and
causing pressure sx surgery is the best option81. A patient asks you about the best indication for the
constitutional delayed puberty, kallman, keinfleiter etc... and the answer was Simple Constitutional
Delayed puberty..
GERIATRIC MEDICINE93. Elder female e UTI ,, allergic to pen : TMP/SMX .. I think the empirical
treatment is either TMP/SMX or nitrofurantoin
94. Elderly man, had microscopic hematuria, kidneys were normal- flexible cystoscopy Or CT
abdomen ?? well the NEXT step would have been to do an Xray KUB to rule out stone first then to
refer to a urologist... this is what I think .. though it comes under a category of urgent referral to a
urologist
95. Old aged woman in garden-goes and gets heat exhaustion... what age related change has made her
more prone to this condition..................dec.Sweating
96. A study done shows that the Pulse pressure tends to increase with increasing age.. what do u think
is the reason for that ......reduce aortic compliance
GASTROENTEROLOGY97. Lipaemic serum pancreatitis - Chylomicrons
98. Patient with diarrhea blood stained , having itching ... labs showing increased bilirubin and alkaline
phosphatase while ALT is within normal range and USG abdomen is normal as well .. what is the most
probable cause-Primary Sclerosing cholangitis.
99. lady for 3 weeks hx of abdo pain and loos stools plain xray normal, with Ulcerative colitis, patient
doesnt improve in 3 days... what should u do next......X-Ray abdomen ( to rule out Toxic Megacolon)
100. Dumping syndrome 8 yr post Gastric surgery , having symptoms just after eating with nausea,
vomiting, flushing etc .. what to do ??.... It is Dietary Advise ..
101. Patient present e only high bilirubin , other LFTs fine Gilberts Syndrome
102. Patient with history of pyloric ulcer had an operation done 8 years back with suction splash
positive having vomiting and nausea .. what metabolic abnormality will he develop......Hypokalamic
Alkalosis103. Patient on long term Peritoneal Dialysis ... comes with abdominal pain, ascites .. the
Ascitic tap done... what will help u with diagnosis of peritonitis: High Neutrophils in Fluid
104. Patient presents with dysphaia of food and drinks both ,Dx..: Achalasia
105. Patient presents with jaundice.. serology given shows IgM for hepatitis A, IgGHep B, and antiHBC..whats the Dx...... Hepatitis A106. Female with itching and right abdominal pain , with sister
having the same disease and mother also affected, no history of hepatitis, drug use ... her s/anti
mitochondrial antibody is positive .. what is the diagnosis ... Primary Biliary Cirrhosis
107. Patient with malignancy not responding to morphine ,liver capsule pain in metastatic malignancysteroid dexamethasone
108. Nutrition for Patient with acute abdominal pain (severe pancreatitis due to gall stone) NPO109.
Patient with suspected longstanding Chrons Disease having stricture in the small intestine with capsule
ht t ps : / / www. f ac ebook. c om/ g r oups / 1495489127329899/ per mal i nk/ 1530192607192884/ 5/
10
30/8/2014 ONLY MRCP MCQs
endoscopy and later diagnose as Malignant Stricture.. what is the most common pathology ....
LYMPHOMA
110. Diagnosis of Giardia if not seen in stool -wet stool sample or Microscpe with Duodenal
Aspirate ??if stool culture not positive multiple times= RadioImmuoassay (CDC)
111. A girl with negative anti-TTG but presented with coeliac symptoms- Gastroscope with duodenal
Biopsy ?
112. gall stones in hereditary sickle cell disease=pigment stones 113. carcinod syndrome intial
symptom: facial flushing
114. Female Patient with Chrons disease smoker, with stable disease.. which association is going to be
most predictive of disease....Cigarette Smoking= 60%
INFECTIOUS DISEASES & GUM115. A School Teacher is diagnoses with Pneumococcal
Meningitis , there is no one else affected in the school what should we do for the contacts at school
....isolate & observe till one week
116. Patient with history of travel to spain had sex with two , come to you with dry cough , having on
blood dechemoglobin,normalwbc, peripheral blood pic of agglutination, ... ...Mycoplasma
117. Patient diagnosed with NisseriaMeningitidis Meningitis , what prophylaxis should be given to the
household contacts....Ciprofloxacin118. Child bit by a cat-it gets swollen and wond on hand get worsewhat is the most probalble organism = BartonellaHenslae
119. African tick bite- ricketsia coronii
120. Strongyloidsstercoralis...- wearing foot wear and avoid bare foot as it enters the skin
121. Epilepsy and malaria prophylaxis- mefloquine , Malarone
122. gonorrhea ttt UTI : ceftriaxone .. as treatment for chalymydia was already given n culture showed
gm negative diplococcic
123. Tonsils weren't coated but had exudates ??? :: diphtheria
124. Patient with Lyme Disease with multiple eschar/ erythema sites 2nd day of treatment with
anaphylaxsis and body reaction - EXPOSURE and INTERACTION WITH DEAD PATHOGENS ?
(JerishHerxheimer reaction)
125. Patient with tuberculosis for diagnosis , what is the most sensitive Pleural test for Tuberculosis......
Pleural Fluid LDH, Pleural Biopsy and culture, Sputum Culture, Pleural aspirate culture, Bronchial
lavage culture ..??? I dont know the answer ??
127. The hospital experiences multiple cases of MRSA , you are in hospital policy making committee...
what is the best way to decrease the MRSA hospital infection ...........answer was HAND WASHING
NEUROLOGY128. A typical hx of tuberous sclerosisa 22yr old girl, 4 yrhx of HTN , on
Amlodipine,came for r/v gives a family hx of Nephrectomy to her father following a cystic disease of
kidney.O/e- nodules round nose , macular patches on trunk Diagnosis?.(TUBEROUSSCLEROSIS)
Adult Polycystic kidney/Von HippelLindau dis
130. Highest risk for Alzheimer : Family HX ?? Increasing age is the greatest known risk factor for
Alzheimer's
NEPHROLOGY146. Simvastatin used by a patient having mascular pain and high creatinine, what will
u find on urine examination...... myoglobin
147. Patient with Medullary Sponge Kidney Disease, regarding the complication what is going to be
the final outcome of this patient ...NephroCalcinosis
148. A patient with SLE having increased creatinine, with IGa,IGg,IgM deposited in the glomerular
membrane what will u expect ..... Low C3 in Serum
149. Histology from renal biospy, neutrophils, eosinophils with normal renal capsule- AIN
150. Medication in diabetic renal pt-losartan
151. Beer and polyuria decreased EXPRESSION of aquaporin channels ...
153. A pt with multiple sclerosis , on Baclofen, developed urinary incontinence. Post voided volume
20ml.
Rx.1. Intra vesicalBotulinum toxin. 2.suprapubic catheter.3.tolterodine
BIOSTATISTICS & EPIDEMIOLOGY154. why we randomise people on study : ??TO decrese the
Type 1 error, To represent the whole Population etc155. what is the chance that the Test will be post
156. Chiquard study
157. A study has alot of confounding factors....??? analysis of confouctor ---as much as I could get
from internet search it comes to ........ Spearman Rank correlation
158. question for Drug trial in which two groups were studies one placebo , and the value was
nominal .. and we had to choose the test to compare before and after the treatment ......I rembere answer
was UNPAIRED T test ..
OPTHALMOLOGY159. Patient with Transit loss of Vision , Carotied 50% what to do?? : Aspirin
(endarterectomy from70-99%)
160. 161. Ehler Danlos e angioid present e sudden visual loss the cause---well the Choroidal
Neovascularization may lead to retinal haemmorhage in macula and loss of vision ..i dont remember
the option
P S Y C HI A T R Y
164. Hypochondrosis
165. post natal low mode with tearingPATIENT HAD DEPRESSIVE SYMPTOMS ,with tendency
to cry and low mood so I guess post natal depression was a better choice .. ??
166. A young male since child hood had grunting, abnormal movement and occationally falls- Tourrete
syndrome
168. Patient talking on its own and replying " no ididnt do that" , while u never asked such a
question ... what is she experiencing ........auditory hallucinations
169. Patient with chronic alcohol use presents to the ER with tachycardia agitation , abnormal behavior
and Dilated Pupils...What overdose has he taken .... Ecstacy
170. RESPIRATORY MEDICINE
172. After internal Jugluar line : Heaomothorax... I guess it was Pneumothorax as the lung was
collapsed and its a know complication of central lines
ht t ps : / / www. f ac ebook. c om/ g r oups / 1495489127329899/ per mal i nk/ 1530192607192884/ 8/
10
30/8/2014 ONLY MRCP MCQs
173. Patient with difficulty breathing, having dec FEV1, FVC and dec TLCO ,dec DLCO what is the
most probable diagnosis..... Pulmonary Fibrosis
174. Female pregnant already taking salbutamol, inhaled steroid 400mcg/day, and recently added long
acting Beta stimulants,still wakes up at night twice a week and has sob-what will u do next= Increase
the dose of Inhaled Steroid 800(beclomethasone)
175. Male Welder who gets sick at work having fever, body aches, running nose, difficulty breathing
immediately but stays well off it .Monday morning SOB FEV!/FVC 71% = Metal Fume Fever
176. COPD patient with reduced Sats 86% on Room air having tachypnea needs to be given oxygen
what is the best mode to deliver the oxygen .....Venturi Mask - Venturi mask ?
177. RA on methotrexate- Bronchiolitis obliterans Or MethotraxateToxicitiy Or Pulmonary vasculitits ?
178. Obese man with BMI of 41, feeling sleepy all day long having high score on epworth sleepless
ness scale 18 and having apnic episodes 4/hr ( normal less than 5)... what is the most important
intervention .. Weight reduction179. Pneumothorax risk : smoking there are two things which a patient
shouldnt do.. after pneumothorax correction as per bts guidelines... Smoking .. then to avoid scuba
diving and other is Contact sportsfor 6 weeks.
180. Abbreviated mental test score (AMTS) 7/10- Patient with confusion, having hr of 28, bp of
110/70?, tachypnea, which is the most important prognostic sign =Confusion
181. -Patient with respiratory distress, having high PCO2 and hypoxia ,drowsy , copd exacerbation ,
what is the best way to give oxygen ..... Non Invasive PPV
182. Patient with Cystic Fibrosis ,comes to you for vitamin suppliments what will is the most important
vitamin you will prescribe .. Vitamin A
183. Patient with history of childhood pneumonia,recurrent infections , having daily productive cough
with auscultatorycrepts at base......Bronchiectasis
184. Patient with recurrent DVT , with resp distress and leg swollen ..PE e DVT what is the best
investigation : CTPA ... CT pul Angiography
186. Female with marginally raised cpk, incesr, with macroglobulin in serum, tired, unable to stand
from chair, no muscle weakness, .. Polymyalgia Rheumatica-PMR
187. Young adult 29y , having back pain and gets better after he walks in morning , improves with his
exercise....Ankylosing Spondylitis
189. Patient with right hand small joint involment and left hand middle finger dactylitis,and having
metatarsophlangeal joint involvement ...... Psoriatic Arthritis
190. Old woman with Left wrist swelling- Pseudogout OR Ostomylitits ? people voted for
OsteoNecrosis mostly
191. Patient withHerbendenNodes and bouchards node + dip pain with normal labs .... Osteoarthritis
192. 45 years old with large joint involvement- RA ?193. Male with no history of STD but having
arthralgias and gastroenteritis 2-3 weeks-which organism can be involved-Reactive Arthritis=
CompylobacterJejuni
ht t ps : / / www. f ac ebook. c om/ g r oups / 1495489127329899/ per mal i nk/ 1530192607192884/ 9/
10
30/8/2014 ONLY MRCP MCQs
194. Patient with SLE is having ANA positive but forgot to order the Immunoglobin class . which class
does ANA belong to.... IgG
195. RA eye manifestation-episcleritis(Answered Above)196. Pt. e HTN ,raynad , SOB and cough >>>
systemic sclrosis
197. A young pt with recurrent DVT with family history of thromboembolism , with antiphospholipd
antibodies positive .. which is the common cause for thrombophelia in this patient ..protein C
Def/antithrombin Def./factor V Leiden mutation /polycythemia/protein S def-----answer=Factor V
leiden Mutation
MRCP 1 May 2015 Recall
1-endometrial ca plus gait problm....ANTI-GAD
2.microcytic anemia plus normal upper gi investigations...COLONOSCOPY
3.polucystic kidney disease...after normal U/S abdomen...after 30 age repeat or
reassure.
4.pancreatitis....CT ABDOMEN
5.hemophillia pattern on investigation...MOTHER,S BROTHER
6.APTT..98...INHERITED BY FATHER(very cheap question)...may b VONVILLIBRAND
7.LOW APTT(22)...MAY b PLATLET DYSFUNCTIOON
Tear 9.ATYPICAL LYMPHOCYTES.... INFECTIOUS MONONUCLEOSIS
changes...cardiomyopathy
59.Tall T-waves ....Tx Ca-gluconate
60.differnce betweeen radial and femoral bp ....CORACTATION OF Aorta
61.aortic disecction...i/v Labetalol
62.fasting glucose 6.3 1nd 6.2 ....impaired fasting glucose
63.hemchormatosis screening in familial cases..HFE gene
64.IGM nati bodies...raised billirubin with raises ALP in 58yr women....primary bill
cirhhosis
65.scale rash after throat infection...guttate or pityriasis rosea
66.84yr old women with raised ALP..Pagets dis
67.spasm in hand aftr repeated transfusions...hypocalcemia
68.drug contraindicated in gout....thiazide diuretic
70.b.p 90/60...hyponatremia....short synecthin test.
71.hyponatremia with hypokalemia...thiazide diuretics
72.upper arms temperature and pain loss..Syringomelia
73.16yr female with malar flush....SLE
74.acne rosasea treatment...oral tetracylcines
75.cells raised in atopy and allergy...EOSINOPHILLS
76.Red eye with photobia with retro orbital pain....???
77.unilateral pain on eye face and forhead with episodes more then 12 hrs ...liking
dark and quite room....Migraine
78.MRSA treatment...Linozolid or Vancomycin?
79.Anti CCP..rheumatoid arthritis
80.pain in knee,shoulder,wrist and hips in 71 yr old..osteoarthritis
81.electric boards manufacturing.....Occupational asthma
82.lesions on hands in a kitchen worker...wear protective gloves
83.plaques in lungs on xray in asbestos worker with norma respiratory functions and
oxygen saturation...mild asbestosis
84.pneumothorax.1.2cm.primary....discharge
85.Student T-unpaired test
unconciousness...epilepsy
115.coelia disease in 35y old with epigastric mass....bacterial overrgrowth or some
CA or lymphome???
116.right hemicolectome..diarhea..bileacids producing bacteria
117.drug cntraindicated in person with pink frothy sputum...pioglitazone
118.which test shud b done to confirm IBD after tissue
glutaminase...SEchat...hydrogen breath test...or somthing else??/
119.pneumonia investigation finding on CXR....air bronchogram
120.meddiastinal mass at carina...stents or prednisolone or mediastinoscopy or ct
chest???
121.hilar mass in chest xray....mediastinoscopy and biopsy??
122.SVT in young man..verapamil/radiofrequency ablation/vagal manuare teaching
123.mass causing intermittent tricuspid regurg...MYXOMA
124.pulmonay HTN...tricuspid regurg jet pressure..or lt atrial size or pulm artery
size???
125.hyperasthesia on face with absent corneal relex..5th
126.treatmnt of person with shooting face pain after nsaids...carbamezipine
127.microcytic anemia....lead poisoning
128.li poisoning ...hemodialysis
129.microscopic hemeturia in healthy man with family history...thin membrane disease
130.decreased Ca, dec PO4, dec 25-OH-cholcalciferol.....osteomalacia
131.hypoglycemia....oral glucose/i/v glucose 25 or 50%
132.sitagliptin MOA.
133.juvinaile artheritis....uveitis
135.CPR...30:2
136.sleep apnea with obesity....88-92%
137.tremor in outstretched hands,,,relived on rest with father history of head
nodding...essential tremor
138.cause of confusion...digoxin/atenolol.
139.history of breathlessness and stridor with lump in nck...flow vol loop
140.recurrent gout...allopurinol
141.adominnal pain with purpuric rash on legs...henoch schenolin purpura
142.pain knee worse on movment with a 2cm swelling on patella...pre patellar
bursitis
143.4th,5th and 6th nerve involvment...cavernous sinus
145.Mech of action ticagrelor....inhibit ADP binding
146.oral ulcers...behcets disease
147.HIV test...investigation???
148.bone metastasis...ca breast /colorectal/bladder
150.agent causing delayed woung healing ...steroids
152.valve replacment...early diastolic murmur...acute pericarditis
153.psuedo out...ca-pyrophosphate crustal
154.protective against colorectal CA..asprin
155.kaposi sarcome..HHV-8
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1endometrial
ca plus gait problm....ANTIGAD
2.microcytic anemia plus normal upper gi investigations...COLONOSCOPY
3.polucystic kidney disease...after normal U/S abdomen...after 30 age repeat or reassure.
4.pancreatitis....CT ABDOMEN
5.hemophillia pattern on investigation...MOTHER,S BROTHER
6.APTT..98...INHERITED BY FATHER(very cheap question)...may b VONVILLIBRAND
7.LOW APTT(22)...MAY b PLATLET DYSFUNCTIOON
9.ATYPICAL LYMPHOCYTES.... INFECTIOUS MONONUCLEOSIS
11.70 YR Female suicide...rsk factr for repeat...OLD AGE
12.promyelocytes ....15:17
13.PEMPHIGUS VULGARIS...IGG At dermoepidermal junct..may b
59.Tall Twaves
....Tx Cagluconate
60.differnce betweeen radial and femoral bp ....CORACTATION OF Aorta
61.aortic disecction...i/v Labetalol
62.fasting glucose 6.3 1nd 6.2 ....impaired fasting glucose
63.hemchormatosis screening in familial cases..HFE gene
64.IGM nati bodies...raised billirubin with raises ALP in 58yr women....primary bill cirhhosis
65.scale rash after throat infection...guttate or pityriasis rosea
66.84yr old women with raised ALP..Pagets dis
67.spasm in hand aftr repeated transfusions...hypocalcemia
68.drug contraindicated in gout....thiazide diuretic
70.b.p 90/60...hyponatremia....short synecthin test.
71.hyponatremia with hypokalemia...thiazide diuretics
72.upper arms temperature and pain loss..Syringomelia
73.16yr female with malar flush....SLE
74.acne rosasea treatment...oral tetracylcines
75.cells raised in atopy and allergy...EOSINOPHILLS
76.Red eye with photobia with retro orbital pain....???
77.unilateral pain on eye face and forhead with episodes more then 12 hrs ...liking dark and quite
room....Migraine
78.MRSA treatment...Linozolid or Vancomycin?
79.Anti CCP..rheumatoid arthritis
80.pain in knee,shoulder,wrist and hips in 71 yr old..osteoarthritis
81.electric boards manufacturing.....Occupational asthma
82.lesions on hands in a kitchen worker...wear protective gloves
83.plaques in lungs on xray in asbestos worker with norma respiratory functions and oxygen
saturation...mild asbestosis
84.pneumothorax.1.2cm.primary....discharge
85.Student Tunpaired
test
lymphome???
116.right hemicolectome..diarhea..bileacids producing bacteria
117.drug cntraindicated in person with pink frothy sputum...pioglitazone
118.which test shud b done to confirm IBD after tissue glutaminase...SEchat...hydrogen breath test...or
somthing else??/
09/05/2015 ONLY MRCP MCQ
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119.pneumonia investigation finding on CXR....air bronchogram
120.meddiastinal mass at carina...stents or prednisolone or mediastinoscopy or ct chest???
121.hilar mass in chest xray....mediastinoscopy and biopsy??
122.SVT in young man..verapamil/radiofrequency ablation/vagal manuare teaching
123.mass causing intermittent tricuspid regurg...MYXOMA
124.pulmonay HTN...tricuspid regurg jet pressure..or lt atrial size or pulm artery size???
125.hyperasthesia on face with absent corneal relex..5th
126.treatmnt of person with shooting face pain after nsaids...carbamezipine
127.microcytic anemia....lead poisoning
128.li poisoning ...hemodialysis
129.microscopic hemeturia in healthy man with family history...thin membrane disease
130.decreased Ca, dec PO4, dec 25OHcholcalciferol.....
osteomalacia
131.hypoglycemia....oral glucose/i/v glucose 25 or 50%
132.sitagliptin MOA.
133.juvinaile artheritis....uveitis
135.CPR...30:2
136.sleep apnea with obesity....8892%
137.tremor in outstretched hands,,,relived on rest with father history of head nodding...essential tremor
138.cause of confusion...digoxin/atenolol.
139.history of breathlessness and stridor with lump in nck...flow vol loop
140.recurrent gout...allopurinol
141.adominnal pain with purpuric rash on legs...henoch schenolin purpura
142.pain knee worse on movment with a 2cm swelling on patella...pre patellar bursitis
143.4th,5th and 6th nerve involvment...cavernous sinus
145.Mech of action ticagrelor....inhibit ADP binding
146.oral ulcers...behcets disease
147.HIV test...investigation???
148.bone metastasis...ca breast /colorectal/bladder
150.agent causing delayed woung healing ...steroids
150.agent causing delayed woung healing ...steroids
152.valve replacment...early diastolic murmur...acute pericarditis
153.psuedo out...capyrophosphate
crustal
154.protective against colorectal CA..asprin
155.kaposi sarcome..HHV8
157.horizontal gaze palsylesion
in pons
158.tumor at cerebello pontine anglevestibular
schwanomma.
159.sodium absorption occurs incollecting
duct ...
160.intermittent headache and HTNpheochromocytoma
so check urinary catecholamines.
161.bitemporal hemianopiacraniopharyngioma.
162.haemophilia A factor
8 deficiency (it was a twisted question)
163.C4 less ,C3 normal hereditary
angioedema.
164)anticipationseen
earlier in successive generations..
9/10/2015 mrcp4all
another year
-Cardiology:
1-Cardiac arrest in a patient who took methadone9 Long QT
2Qt interval 9 from beginningof Q to end of T
3-SHAZDSZVaSc9 Age=1 TlA=2 female=1, BP : 145/85 9 4
4-SVT, nt responding valsalva manuer, asthmatic..?nextstep? 9 Verapamil
5- MI in v5/v6issue 9 Left circumflex
7- hypokalemia9 U wave
8-Tricuspid Regurgitation 9 ProminentV wave
9-Pt on BB e Bradycadia; Atropine 3mg givin& Fail 9 Trasvenouspacing
11--MOA of LMWH9 anti factorX
12-Statins cause the ms tenderness and rhabdomylosis scenario
13- Angiodysplasia9 As
14-Marfan 9 Echo
15-Pregnant e VSD, what will increase her problem?
16-Marfan 9 Fibrill 1
17-DVLA rule for pt with arrythmogenicventricular dysplasia after ICD 9 Never drive
18-IE in normal prothaticvalve(C&S: Strept.) 9 Benzylpenicillin+ genta mycin
19-Sudden chest pain,back pain,Lt sded hemiplegia,Rt side loss of pu|se9Aortic dissection
-Rheumatologyz
1-Giant Cell Arteritis.. Question was Acute Loss of Vision in the left eye.??
2-Creptus ....means osteoarthitis
3-AnkylosingSpon -) sclerotic
4-Pain in the hip and abscent ankle reflex.. MRI of the lumbar spine?
S-lady45 yo fam hx of OP, her OP scores were -0.5--1? do nothing? Lifestyleadvice for her
6-Make patient with Paget's .. Give Risedronate
7-Discoid Lupus - hydroxychloroquine
8-Pt e RA, took iron but still anaemicfor 2 years, had short term 2-3 monthsof methotrezate,
what s the cause of anemia? iron deficiencyor folic deficiency or Ch. IllnessAnemia
9-Sulfasalsine safe in pregnancy
10-Sceniario Polymyositis....Antijo Antibody
12- PsoriaticJoint not responding to Steriods or so what next.. methotrexate
13anti CCP patient with familyhistory of Psoriasis - Rheumatoid arthritis
14-Route for Long term Enteral feeding - EndoscopicJejunostomy
15-finger extension impaired -- ? posterior interoseus nerve damage
16-Cryoglubinemia-ulow c4
17-tu berous sclerosis and lesion/nodular on nose and cafeaulaiton neck
18-Muscle in lateral epicondylitis Extensor carps ulnaris
19-infected toe stump? OM MRI
-Hematology:
1-Diagnosis of CLL immunophenotyping
2-Immune thrombocytopaenia
3-Burkettbefore chemo -) Rusbricuse
4-Tear drop -) Mylofibrosis
5-Von willibranddisease
6- Pt with hemorrhage after alteplase use -) Prothrombineoncent.
7-Pt of fatherwith hereditary spherocytosis with Jaundice What investigation after PBF Reticulocyte count or no further investigation??
9~CML
renin- Renal artery stenosis. 30.Hyperkalaemia- immediate Rx- IV Cakcium gluconate 31.Central
pontine myelinosis- water out of the cell GENETICS 33.CF parents with carrier chance-0%
34.Hemophilia A- 25% chance 35.Hereditary Hgic telengectasia- AD 36.Marfans-fibrillin 37.only
males affected- Xlinked recessive 38.chromatids into chromosomes- prophase,mine wrong- telophase
39.Klienfelters- chromosomal analysis 40.PCR-CSF viral meningitis 41.probe for DNA- in situ
hybridization DERMATOLOGY 42.Porphyria cutanea tarda 43 44.Scabies-Rx.topical insecticide,mine
wrong- topical antibiotic 45.Scaly rash with hair involvement- DLE 46.Rx for Acne rosaceatetracycline 47.Resistant rosacea- ????? ---------isotreton 48. 49.diplopia with cranila nerve- 6th cranial
nerve palpsy -----correct is IOP 50.Dermatits Herpitiformis- IGA 51 ENDOCRINOLOGY 52.Gproteinmenbranes 53.acromegaly- Inx- GTT with serial GH measurements 54.reduced FSH,LH,cortisolHypopitutuarism 55.Anorexia Nervosa-lanugo hair 56.Hypothyroid on RX- Increased TSH with NT4First complaince then t3 57.Ramipril- for HTN with DM with proteinuria 58..Elderly female-Primary
Hyperparathyroidism correct answer -----TSHpituirary tumer 59.low ca,low phos- Osteomalacia
60.Hypercalcaemia-cause- Thiazides 61.young onset DM- Insulin 62.Hypothyroid with wt loss with
borderline BP- IV Hydrocortisone 64.HTN with >70u alcohol,Na-138,K-3.8,obese,Urinary cortisol300- Alcohol induced i think -------correct is cushing diseease 65.Sick Eu thyroid-normal free T4
66.Post partum thyroiditis -----correct is hashimoto 67.MEN1- Parathyroid with prolactinoma
68.ACTH-Small cell CA 69.carcinoid-------------flushing or hymoptysis 70.PCOS-insulin resistance
GASTROENTEROLOGY 71.Elderly with reflux esophagitis with ?Barrets- Adeno Ca eosophagus
72.Chronic Pancreatitis- confirming Dx- CT. 73.UC- Reducing long term relapse- Azathioprine
74.IBS- no relief after defecation /wake up in the middle of night 75.pseudomembranous colitiscephalosporins 76.Diarrhea after cholecystectomy- Rx.Cholestramine 77.Diarrhea-HUS--- E.cole 0157
78.IV drug abuser with HCV Ab- Chronic HCV 79. PSYCHIATRY 80.Hypochondriac 81. 82.Paranoid
Schizophrenia- auditory halucinations with mild trace of cannabis 83.Depression- anhedonia
84.Dysthymia..one stem 85.AMPHYTAMIN INDUCED PSYCHOSIS RESPIRATORY 86.COPD on
inhalers, mildly confused-- nebulization with brochodilators/NIV 87.COPD with high pco2- stop O2
88.Another COPD with pneumonia and PH 7.2 - Intermittent ppv/Intubate and treat 89.Profound
vomiting- Metabolic alkalosis with hypokalaemia 90.occupational asthma- serial PEFR 91.EAABarley/Isocyanite 92.Ca lung, contraindication for surgery-- Brachial plexus invasion 93.Legionares
pneumonia- Urinary Ag 94. 95.Low PH and low glucose pleural fluid- TB 96.Pulmonary infarction..
reduced TCO 97.Pneumothorax ,1.5cm.. discharge 98.Reduced intensity of AS murmur- heart failure
99.Cardiac tamponade-pulsus paradoxus 100.75yrs man Paroxysmal AF- Rx-Flecainide/sotalol
101.Hemiparesis with AF-Warfarin/aspirin 102.50% Carotid stenosis with 3 TIAs in 2/52
Asprin/endarterectomy 103.Pt with edema,ascites,raised JVP- Constrictive pericarditis. 104.Stridor,
malignancy- Anaplastic Carcinoma 105.MI with CHB- RCA 106.Acute MI with ST changes- PCI
107.Acute MI with eosinophilia--- Cholesterol embolization syndrome 108.Drug Not removed by
Haemodialysis ? - protein binding/swater soluble/ist pass metabolism/ RHEUMATOLOGY AND CTD
109.Multiple myelome- next best investigation- Serum protein electrophoresis
110.Ruptured bakers/popliteal cyst in RA 111. 112.psoriatic arthritis-dactalitis 113.resolving symptoms
in lofgren syndrome 114.Steroid response expected in hypercalacemeia of systmeic sarcoid
115.Anticardiolipin ab for SLE with abortions 116.SLE with joint pains and rash-HCQ 117.
118.Temporal arteritis- prednisolone first 119.Ankylosing spondylitis- sacroiliac tenderness not
asymmetrical limitaion 120.Bechets-venous thrombosis 121.MI followed by ST elevation V2-V6-Ventricular aneurysm- arteriography Inx 122.Surfactant contains- Phospholipids 123.
124.ETHAMBUTOL +INH+PYRENZYMIDE+REFAMPICINE TO ADD PREDNISOLONE------FOR TB MENENGITIS IMMUNOLOGY 125.Live attenuated vaccine-yellow fever 126.Recurrent
infections- CHEDAK HIGASHI syndrome- Neutrophil. 127.CLL-hypogamaglobulinemia 128.probe
for DNA- in situ hybridization 130.High calorie-cheese 131FactorV mutation- activated protein
C.MINE WRONG. 132.IV-IG OPHTHALMOLOGY 134.RA-scleritis 137.bone pigment for the
tubular filed ??? -?? RP 138.asprin-rash, 139.fluocoacillin for that abscess question 140.Anxiety with
ambulatory ECG free during the attack--> observe 141.VSD - v/q more at the apex in upright lung
142.vital capacity for GB 143.Short term memory- Korsakoffs Psychosis 144.Neuroleptic malignant
syndrome-muscle rigidity PHARMACOLOGY 145.NHL-antiCD20 146.confusion and tremor-lithium
toxicity 147.Allopurinol-xanthine oxidase inhibitor 148.methhemoglobinemia-Ferrous to ferric
149.Prolactin-metaclopramide 150.teratogenic-Ciprofloxacin i think 151.Imatinib-tyrosie kinase
inhibitor INFECTIONS
153.E-coli..??First-Ciplox OR loperamide 152.Diarrhea in Nile cruise-shigella 153.MAC--???
GLOVES /??? pulmonary isolation 154.P.Vivax-First Rx-choloroquine 155.Tic typus 156.diptheria
157.WIGNER GLOMERULONEPHRITIS CASE 158.Recuurnet gononnhea-arthropathy
159.Rx.Gancyclovir 160.Osteomyelitis HAEMATOLOGY 161.symptom of Myelofibrosis-fatigue
162.ALL prognostic factor--BCR ABL mutation/Hypertension 163- one more controversial Q-??
pernicious anameia/cealiac disease/autoimmune hemolytic anemia 164.PV-jak 2 mutation 165.Patent
foramen ovale STATISTICS 166.I have put Chi square test 167.Sensitivity 168.Standard deviation
169.drug was removed from market, now for adverse effect chasing what to do systemic
review/metanalysis adverse effect mointoiring 170.10% /2% 171.GOOD PASTURES SYNDROM
CASE 172. 173.chromatin to chromosomes-prophase-again mine wrong 174.proteasome-mine wrong
175.Girl came after attending some camp, now wide spread rash, chest creps and conjunctivitis
Measles 176.Iv cefotaxime for peritonitis 177.Cause of meningititis in elderlyStreptococcus pneumonia/listeria 178.signet ring cell 179.pt on warfarin had mi and started on
medication, now INR is 4.... which drug potentiate the effect
aspirin/ramipril/statin/bisoprolol/verapamil 180.Drug induced DI- Lithium 181.AS- Sulphasalazine
182.Diarrhea-Mycophenolate mofetil 183.Systemic sclerosis-Malabsorption to develop 185.brainstem
herniation 186.Ramipril only- LV dysfunction with no cardiac failure 187.Post mastectomy - ???
reconstruction/?? Dumping syndrome. NOT SURE.. 188.Pancreatic ca--CA-19-9 189.Tooth extraction
in vwf DDAVP 190.coccain--------------heart block 191.osteoarthritis..Rx-paracetamol 192. pregnant
woman with TTP--------------PLASMA EXCHANGE 193.Eczematous skin lesions- gloves
194-radiological pnemonitis 195..NAC-- toxic metasbolites reduction by replenishing glutathione
197.Compressive Mediastinal lymphadenopathy---steroids 198.Increased Trop i-- ??????cardiac
failure/????? Systemic HTN 199: recurrent maninigiococcal meningitis due to complement defeincy.
atusomal dom or recessive?? autosomal recessive. 200: old man with anemia featuring Fe defecincy,
appropriate inv. barium enema. colonoscopy, small gut barium??----------COLONOSCOPY Macrocytic
anaemia in a patient with a history of hypothyroidism points towards a diagnosis of pernicious anaemia
Pernicious anaemia: investigation Investigation anti gastric parietal cell antibodies in 90% (but low
specificity) anti intrinsic factor antibodies in 50% (specific for pernicious anaemia) macrocytic
anaemia low WCC and platelets LDH may be raised due to ineffective erythropoiesis also low serum
B12, hypersegmented polymorphs on film, megaloblasts in marrow Schilling test Schilling test
radiolabelled B12 given on two occasions first on its own second with oral IF urine B12 levels
measured
Dermatology Q. A 55 year old woman was referred to the dermatology clinic after developing a rash on
her arms and legs, predominantly on the knees and elbows. The rash had been present for about a
month. She had a history of congestive cardiac failure and she had been started on treatment with
furosemide and ramipril by her General Practitioner 6 months previously. She also had a long history of
bipolar disorder and had been started on lithium 3 months previously by her psychiatrist having been
taking chlorpromazine for 5 years. Six weeks previously she had been given a course of
oxytetracycline for a dental abscess. Which of her medications is most likely to have precipitated the
rash? A- Chlorpromazine B- Furosemide C- Lithium D- Oxytetracycline E- Ramipril Ans C Drug
causing a cutaneous reaction which also fits in with the time of initiation in a temporal sequence.
ALMOST COMPLETE RECALL OF PART 1 MRCP 1/2011 ASSALAM ALIKOM DEAR
COLLEGUES , THANK YOU FOR YOUR INTERACTION AND RECALLS FOR THIS EXAM
THAT ENEBLED US TO RECALL ALMOST WHOLE EXAM SO THAT WE CAN CHECKOUR
SCORES APROXIMATELY AND NEXT COLLEGUES CAN BENEFIT ALSO .SO PLEASE ANY
ONE CAN ADD ANYTHIING OR INFORMATION WE ALL WILL BE APPRECIATED AND IF U
BENIFIT THIS EFFORT PLEASE PRAY FOR ME TO PASS AND OF COURSE I WILL PRAY FOR
YOU ALL TO PASS PLEASE REMIND AND CORRECT ME IF ANY MISTAKES AND ADD ANY
RECALLS THANK YOU 1*CARDIOLOGY: 2-PT WITH AF POST SUCCESFUL
CARDIOVERSION HOW TO RESTORE>>>>AMIODARONE 3- PULSUS ALTERNANS IN LVF
4-PT RECEIVED ADENOSINE 6MG AFTER SVT BUT STILL PERSISTENT THEN WT TO
GIVE>>>ADENOSINE 6 MG? 5-WT CIMPLICATION AFTER CORONARY ANGIO>>>MI
ANOTHER OPTION STROKE 6-YOUNG PT WITH SEVERE CHEST PAIN INCREASED WITH
BREATHING ST AND TROPONIN MILDLY ELEVATED>>>>PERICARDITIS 7-PT POST MI
WITHSIGN OF STROKE AND ABSENT PULSE (TRICKY)>>>STROKE OR AORTIC
DISECTION 8-REVERSED SPLITTING OF 2ND HEART SOUND>>>>LBBB 9-WHT CAUSE
DETERIORATION IN PREGNANT MOTHER AND ENDANGER HER
LIFE>>>PULMONARY HTN 10-WT S THE BENEFIT FROM BETA BLOKER?>>>DECREASE
HEART RATE OR DECREASE OXYGEN CONSUMPTION TO HEART 11-PANSYSTOLIC
MURMUR IN LT PARASTERNUM FOR VSD 12-SEVER CHEST PAIN WITH R AND T AND
V1,V2 ELEVATION WHICH C ARTERY AFFECTED>>>CIRCUMFLEX OR 1ST SEPTAL
BRANCH OF LAD? 14- -LONG QT SYNDROME>>>SERTRALINE 16-QT PROLONGATION IN
HYPOCALCEMIA 2*NEPHROLOGY 1-YOUNG PATIENT WITH RECURENT UTI AND NOT
IMPROVED>>>REFLUX UROPATHY 2-DM PATIENT WITH PTURIA AND RENAL
OR LIMITED PSJOGREN?(NOT SURE ABOUT THE RECALL 9-PT WITH KNEE PAIN AND
SWELLING AND X RAY SHOWED CALCIFICATION>>>PSEUDOGOUT 10-PATHOGENESIS
OF RHEMATOID ARTHRITIS>>>TNF 11-SLE DEFECIENY IN>>>C4 12-IL2 AND
CYCLOSPORIN 13-PT WITH OLD T.B ,LOW BACK PAIN AND WEAKNESS OF L.L WT TO
HELP DIAGNOSIS>>URINE HESITANCY(ACTUALLY CANT REMEMBER THIS BUT BROUT
IT FROM ONE RECALL) 14- PT WITH TENNIS ELBOW(RADIAL NEVRVE
INTRAPEMENT)>>>LATERAL EPICONDYLITIS 15 -PT WITH OSTEOMALICIA AND VIT D
DEFECIENCY DUE TO>>>LACK OF SUN EXPOSURE,VEGITARIAN DIET
11*DERMATOLOGY(IM NT SURE ABOUT ANY ANSWER) 1-FIRM LESION MORE THAN
3CM>>>NODULE 2-YELLOWISH WAXY LESION (NECROBIOSIS LIPODICA )WHICH
INVESTIGATION >>>FBS 34-HYPERKERATOTIC PLAQUES AROUD SCALE
MARGIN>>>PSORIASIS 5- PT WITH AXILLARY LESIONS >>>>NEOROFIROMATOSIS ? OR
NECROBISIS GANGRENOSUM? ? 7-STEVENS JONSON??(CANT RECALL) 8- PT WITH
ARM,BUTTOCK LESIONS NOT RESPONDED TO
STEROIDS>>>DERMATITIS HERPETIFORMIS?? 9-TTT OF GENITAL
WARTS>>>PODOPHYLLINE?/ 10- ONE ANSWER WAS ORAL TERBINAFINE(CANT RECALL
THE QUISTION) 11-TTT OF ACNE >>>ORRAL TETRACYCLINE?? 2-PT WITH ANXIETY
AFTER TRAUMA>>>POST TRAUMATIC STRESS DISORDER 3-PT WITH DEPRESSION
AFTER HIS WIFE DIED IN CAR ACCEDENT>>>GRIEF REACTION?? 4 -SCHIZOPHRENIC
PERSONALITY(CANT RECALL) 13*OPHTHALMOLOGY 1- PT WITH LOSS OF VISSION,
ANGIOID STREAKS>>>MACULAR HGE 2- PT WITH ASSYMETRICAL DILATED PULLIDIL
(HOLM,S ADDIE S) WH TO FIND ELSE>>>ABSENT PLANTAR REFLEXES 14*CLINICAL
SCIENCE -ANATOMY 1- PT WITH LOSS OF REFLEXES IN OUTER THIRD OF DORSUM OF
FOOT WHER S THE LESION>>>L5 2-LESION OF ULNER NERVE AFFECTS>>>3RD AND 4TH
5-AKAPTUNURIA DEFECIENCY IN>>>AMINO ACIDS 6-CYSTIC FIBROSIS
INHERITANCE>>>50% 7- PARKONISM DEFECT IN>>>TAU PTN 8- TRANSMITTED BY
POLYGENIC INHERITANCE>>>ANKYLOSIN SPONDYLITIS 9-IMMUNOLOGYIG A
DEFECIENCY>>>1RY OR SECONDERY IMMUNODEFECIENY OR COMMON VARIABLE
IMMUNODEFECIENCY? 10-INDICATION OF IMMUNO GLOBULIN>>>ITP 11- PT WITH
MUSCLE WEAKNES AND FAMILY HISTORY>>>LIMB GIRDLE OR DUCHENE
-PHYSIOLOGY
12- BNP ACTION>>>RENIN ANGIOTENSIN SYSTEM INHIBIRION 13-REFEEDIN SYNDROME
WT SHOULD CHECK>>>PHOSPHATE -BIOCHEMISTRY 14- REVERSE
TRANSCRIPTASE>>>DNA FROM RNA 15-WT IS ALLELE>>>PART OF
CHROMOSOME,DIFFERENT TYPE OF CHROMOSOME?? 16-CODONE>>>CODES FOR
AMINO ACIDS,MSNGER RNA? -STATISTICS 18-METANALYSIS>>>HISTOGRAM?? 19COMPARISON BETWEEN 2 DATA >>>UNPAIRED T TEST 20-NNT>>50? 21-WHICH BIAS TO
USE>>>PUBLICATION OR SUBJECTIVE?
1. 2. [PT HAS FAST ACETYLATORS AND RECEIVING ANTI T.B DRUG WHT IS THE PT
PRONE TO>>> Peripheral neuropathy (Isoniazid)] This was a controversial question. There is no
doubt in the fact that it is the slow acetylators who are more prone to neuropathy. Earlier it was thought
that fast acetylators are more prone to hepatitis, but the latest journals and Katzung says that this is not
true. Even the hepatitis is also more common in slow acetylators. In fast acetylators drug efficacy may
be affected but that too only in weekly doses format not in daily dosing or thrice weekly dosing. So
drug resistance is also a less likely answer. Kalra however very clearly says that fast acetylators are
more prone to hepatitis. Certainly this is not true but RCP may be looking for this answer.
Reply With Quote 3. 02-16-2011, 06:54 AM#12 OKO Guest [size=7][b]Speculation that fast
acetylators of isoniazid could be at increased risk of hepatotoxicity due to production of a hepatotoxic
hydrazine metabolite has not been supported; in fact, slow acetylators have generally been found to
have a higher risk than fast acetylators. This could reflect a reduced rate of subsequent metabolism to
non-toxic compounds. In addition, concentrations of hydrazine in the blood have not been found to
correlate with acetylator status.[/b][/size]
2-PT WITH AF POST SUCCESFUL CARDIOVERSION HOW TO RESTORE>>>>AMIODARONE
3- PULSUS ALTERNANS IN LVF
4-PT RECEIVED ADENOSINE 6MG AFTER SVT BUT STILL PERSISTENT THEN WT TO
GIVE>>>ADENOSINE 6 MG? 5-WT CIMPLICATION AFTER CORONARY ANGIO>>>MI
ANOTHER OPTION STROKE 6-YOUNG PT WITH SEVERE CHEST PAIN INCREASED WITH
BREATHING ST AND TROPONIN MILDLY ELEVATED>>>>PERICARDITIS 7-PT POST MI
WITHSIGN OF STROKE AND ABSENT PULSE (TRICKY)>>>STROKE OR AORTIC
DISECTION 8-REVERSED SPLITTING OF 2ND HEART SOUND>>>>LBBB 9-WHT CAUSE
BUT I THINK FLUCLOXACILIIN IS THE CORRECT ANSWER?? 11-PT WITH JOINT PAINS
AND H/O TRAVELLING ABROAD >>>>GONNOCOCCAL ARTHRITIS OR REACTIVE
ARTHRITIS 12- PT E BACK PAIN AND FEVER POST PACEMAKER INSERTION DUE
TO>>>STAPH DISCITIS 13-MOST CONTAGIOUS ORGANISM>>> SVARICELLA ZOSTER 14
TTT OF PSEUDOMONAS IN BRONCHIECTASIS>>>CIPROFLOXACIN OR
CLARITHROMYCINE 15 IMMUNOCOMPROMISED PT WITH INFECTION(VIRAL OR
FUNGAL)WT TO USE>>> AMPHOTERICIN B OR ACYCLOVIR? 16- PT RETURNED FROM
ENDONESIA WITH SEVERE MUSCLE PAINS, HYPOTENSION(DENGUE)HOW TO
TREAT>>>IV FLUIDS 6*GIT 1-PT WITH DYSPHAGIA ,WHEIGHT LOSS , BAD MOUTH
ODOUR>>>PHARYNGEAL POUCH 2-WT CAUSE OF VIT D DEFECIENCY IN PT POST
COLECTOMY AND ILLIECTOMY>>>LACK OF ABSORPTION 3-PT ALCOHOLIC , ASCITES
LIVER CIRROSIS HOW TO DIAGNOSE(POINTS TO SUB ACUTE BACTERIAL
ENDOCARDITIS?)>>>ASCITC FLUID MICROSCOPY 4-PT WITH LAXATIVE
ABUSE(MELANOSIS COLI) 5-PT DOWN SYNDROME WITH ACUTE ABOMINAL PAIN,
DISTENDED ABDOMEN AND AXR SHOWS DILATED COLON>>>INTUSUCCEPTION 6- PT
WITH RECTAL BLEADIN AND SKIN LESIONS AROUND HIS LIP>>>>ANGIODYSPLASIA?\ 7T DIAGNOSED WITH BARRET,S OESPHAGUS HOW TO MANAGE>>>ACID SUPPRESION
THEN ENDOSCOPY? 8- 9-PT WITH DIARHEA AND CRYPT ABCESS>>ULERATIVE COLLITIS
10- 11-OBSTRUCTIVE JAUNDICE AND PANCREATITIS WHERE IS THE
OBSTRUCTION>>>CBD, CYSTIC DUCT, HEPATIC DUCT??? 12-T WITH RT ILLIAC FOSSAN
PAIN F/H OF COLON CA HOW TO DIAGNOSE>>>CT ABDOMN AND PELVIS OR
COLONOSCOPY 13-WT IS THE MOST COMMON SITE OF ISCHEMIC
COLLITIS>>>>SPLENIC FLECTURE 14-HOW TO MONITOR PT GIVEN PROPHYLAXIS
AGAINST HEP B>>>Hbs antibodies 7*CLINICAL PHARMA AND TOXICOLOGY 1-SIDE
EFFECT OF SILDENAFIL(VIAGRA)>>>BLUISH VISION 2-PT ATE FISH THEN DEVELOPED
AND PAIN AND SKIN RASH WT IS THE CAUSE WT IS THE CAUSE>>>>>SCROMBOID
TOXIN?? 3-PT TOOK MORPHINE AND DIAZEPAM THEN DEVOLOPED EXTRA PYRAMIDAL
MANIFESTATIONS HOW TO TRAT>>>PYROCYCLIDINE OR NALOXONE? 4- WHICH CAUSE
HYPERKALEMIA>>>TACROLIMUS 5-PT HAS FAST ACETYLATORS AND RECEIVING ANTI
T.B DRUG WHT IS THE PT PRONE TO>>>HEPATITIS(SOME COLLEGUE SUGGESTED DRUG
Reply With Quote 2. 02-12-2011, 04:13 AM#6 DR-MUSLIM Guest THANK YOU DR GUEST
ACUALY I ANSWERED THIS QUESTION AS U SAID (PRETIBIAL MYXOEDEMA)AND I
SHOSE TFT BUT A SAW ALL ANSWERS IN THE FORUM SUGEESTING NECROBIOSIS
LIPOIDICA THEN I CHOSE FBS ACCORDING TO MAJORITY THANK YOU
1. 2. well patient with absent pulse and stroke ans is thromboembolism because iut was mentioned that
patient was in atrial fibrillation other wise best would have been takayasu artritis o Share
GASTROENTEROLOGY: 1. Histological finding of crypt abcess >> Ulcerative collitis STATISTICS:
1. What is the most appropriate test to use (the scenario sounds like a cohort prspective study)?
Relative risk Here are some answer suggestions to the first post: CARDIOLOGY: 1. A 47 year old
referred to you by his GP w 3months hx of intermittent palpitation. ECG: paroxysmal AF. What
medication? >> This is debatable as the age 47 is borderline, in some population, it can be considered
as old. Hence, the paroxysmal AF should ideally be controlled initially with a Beta blocker, and then to
be investigated the cause of it. However, in some population, 47 is a relatively young age, and hence
pill-in-the-pocket strategy with Flecainide is appropriate. ( I
answered Metoprolol, but i have the feeling that the correct answer is Flecainide as normally,
Bisoprolol is the preferred choice, not Metoprolol) 4. PT RECEIVED ADENOSINE 6MG AFTER
SVT BUT STILL PERSISTENT THEN WT TO GIVE? 12mg Adenosine 12. SEVERE CHEST PAIN
WITH tall R waves and ST depression V1 and V2, WHICH C ARTERY AFFECTED? Left circumflex
as True post MI ENDOCRINOLOGY: 1.Old lady WITH DIARrHoEA AND HYPERKALEMIA AND
HYPOTENTION. She was a diabetic too >>> Addison's GASTROENTEROLOGY: 6- PT WITH
RECTAL BLEADIN AND SKIN LESIONS AROUND HIS LIP>> Colon Ca (likely Peutz-Jagher's)
CLINICAL PHARMACOLOGY & TOXICOLOGY: 5. PT HAS FAST ACETYLATORS AND
RECEIVING ANTI T.B DRUG WHT IS THE PT PRONE TO>>> Peripheral neuropathy (Isoniazid)
CHEST 2. PT WITH MESOTHELOMA AND left sided pleural fluid and thickening. How to
appropriately investigate??>>> Debatable depending on clinical setting. The best answer is VATS
biopsy, however this might not be the case for if your in a small district general hospital. 3-NON
SMALL CELL CLINICAL SIGNS>>>>Whispering pectoriluquay 5-YOUNG PT WITH
HEMOPTYSIS MILD SMOKER AND UPPER LUNG COLLAPSE >>>CARCINOID TUMOUR
PSYCHIATRY: 3-PT WITH 3/12 hx of DEPRESSION and hallucination AFTER HIS WIFE DIED IN
CAR ACCiDENT>>> Pyschotic depression, normal grief is only upto 5/52. GENETICS: 11. Pt with
limbs muscle weakness and +ve family history >> likely Baker's dystrophy as the patient was very
young at time of presentation STATISTICS: 18. METANALYSIS>>> Forrest Plot
1. PT HAS FAST ACETYLATORS AND RECEIVING ANTI T.B DRUG WHT IS THE PT PRONE
TO>>> Peripheral neuropathy (Isoniazid)] This was a controversial question. There is no doubt in the
fact that it is the slow
acetylators who are more prone to neuropathy. Earlier it was thought that fast acetylators are more
prone to hepatitis, but the latest journals and Katzung says that this is not true. Even the hepatitis is also
more common in slow acetylators. In fast acetylators drug efficacy may be affected but that too only in
weekly doses format not in daily dosing or thrice weekly dosing. So drug resistance is also a less likely
answer. Kalra however very clearly says that fast acetylators are more prone to hepatitis. Certainly this
Reply With Quote 3. 02-16-2011, 02:57 PM#13 skin2 Guest Why RCP puts in these kind of
controversial questions....If they expect the candidates to be updated, then they should also be.....i guess
this question has been previously asked too....it has been discussed in this forum last year also.... o
Share
Reply With Quote 4. 02-18-2011, 05:02 PM#14 Guest result is out check it o Share
Reply With Quote 5. 02-20-2011, 09:10 PM#15 iman kotb Guest mrcp 2 course Hi all could anybody
help me with guidance on a good course for mrcp 2 ??? Thank you o Share
Reply With Quote 6. 03-01-2011, 03:11 AM#16 Guest I don't want to sound judgmental guys but i have
a bit of an advice to offer to all of you ...now you may kindly accept to take it or refuse to ...either way
i am ok with your choice but all what i want you to be sure about is the fact that what i am truly
interested in is the best interest of each one of you
So about posting the college questions on the forum ...i think this is a useless thing ..and i do
understand the good urges behind doing so and i am aware of the fact that the college repeats it self in
its exams ....but my major concern is this : most of the time .... MOST ....of the answers posted are
wrong ... Also the method of posting the answers without putting the question clearly is mis-leading to
many candidates!!!! and time consuming ,,,,this wasted time trying to memorize a very possibly wrong
answer for an unknown question makes the whole process in my humble opinion ,,,not only useless but
even harmful sometimes!!! PLEASE be aware of this fact !!! i know it is like a ritual or something
these days to gather post exam and recall the college exams ... but unfortunately no one is benefiting
from this ... not only that ..but some are even hurt ...if we are talking about future exam takers !! so you
may ask what are the alternatives?? and i suggest referring to the q Banks like on examination and pass
medicine ...at least you will not only get a true answer but with an explanation!! and a recommended
reference if you want any further persuasion...even if you are not ok with some answers still you can
look for it in the books ,,since you will be provided with the complete question theme.. Also this recall
thing ...have pretty unpleasant effect on the examinees awaiting the result ... it may spread either false
hopes or misery amongst them ...based on these non evidenced answers ..so again it is an invitation for
an unnecessary stress!!!... and it is needless to remind all of the unethical aspect of doing this !!!
wasting many candidates efforts by spotting the questions and answers...provided
that one was lucky enough to stumble on the right ones...passing the exam effortlessly ...while someone
else is busting his ass off over nothing !!! the college is actually ready to execute some extreme
punishments against those who do such posting!!!! so please guys be aware of that ..and try to invest
this time and effort in your studying ...instead of this cr** ....... again i wish you all the best of luck ....
and please consider it an advice and remember nothing is personal ...
AM#2 Guest Tip of the Day :idea: Aspirin should be avoided in thyroid crisis,as it can displace thyroid
globulin bound Thyroid hormones. :idea: o Share
Reply With Quote 4. 11-21-2006, 07:58 PM#4 Guest Hypogonadism Hypogonadism Secondary
Hypogonadism 1 Hypogonadotrophic Hypogonadism Failure of hypothalamus+Pitutary a)Decreased
FSH b)Decreased LH c)Decreased Testosetrone Pathology involving pituitary or hypothalamus eg
(1)Congenital defficiency of Gonadotrophins Kallaman Syndrome X-Linked recessive
(anosmia+tall+colour blindness+nerve deafness+hereditary bimanual synkinesis+cleft
palate+amennorhea in females) (2) HypoPituitarism Primary Hypogonadism 2 Hypergonadotrophic
Hypogonadism Failure of Testes a Increased FSH b Increased LH c Decreased Testosterone pathology
involving Testes Klinefelter's syndrome XXY 47 small testes+delayed speech+tall & centrally obese
pear shape abdomen+gynaecomastia+Mental retardation(Borat)
o Share
Reply With Quote 5. 11-21-2006, 08:19 PM#5 Guest PCO Polycystic ovarian syndrome Acne Obesity
Amenorrhea Infertility Insulin resistance (metformin) Increased LH Decreased FSH Increased FSH:LH
ratio 3:1 Increased Free Tesosterone Increased Androstendion o Share
Reply With Quote 6. 01-08-2007, 07:18 AM#6 Guest Thanks for sharing that with us.. I'll try to bring
in some questions too o Share
Reply With Quote 7. 01-13-2007, 02:50 AM#7 Guest wilson disease wilson disease AR HSM, jaundice
and cirrhosis heamolytic anemia Dementia,Parkinsonian disease,or choreoathetosis
[size=6](Suspect it in young patient have liver and or CNS lesion)[/size] ttt penicillamine o Share
diagnostic.definitive diagnosis with PCR Imediate treatment wth acyclovir is required on clinical
suspicion. Do not wait for confirmation
Thread: Recalls drom MRCP 1 Jan 2010 LinkBack Thread Tools Search Thread Display 1.
01-19-2010, 10:11 PM#1
01-20-2010, 12:39 AM#5 drrajib Guest 1. Skin lesion and lt ankle sweling..prognosis?? 2. Cause of
death in a renal pt receiving HD for 5 yrs?? 3. Causative organism for infected peritoneal dialysis
patient?? 4. Ant ST seg elevation MI following GI surgery..Rx option besides anti platelets?? 5. What
to do in a patient receiving clopidogrel prior to abd surgery?? 6. Empyema inv.??USG/CT? 7. Primary
pneumo with rim of air <2 cm?? 8. Anti TB with decreased visual acity?? 9. o Share
Reply With Quote 6. 01-20-2010, 12:51 AM#6 saadi10 Guest mrcp jan2010 1 suspected pe findings on
cxr 2 person has hematuria father and brother had same 3 herpetic virus 8 virus causes 4 type
amylodosis al /aa in person with myeloma 5speceked pattern with tight skin ?scl 70 6baby lupus ? ro
antibodies 8 restrictive lung function with raised KCO ?pul heamorraghe 9obstructive fev/fvc ratio
with reduced kco emphysema 10dna probe to identify rna l
. 01-20-2010, 01:27 AM#7 drrajib Guest 1. Resp Pathogen for CF pt? 4. Inf MI ECG? 5. Cons
pericarditis ECG?? 6. Poor outcome in a VSD pt with pg?? 7. Her angio neurotic oedema cause of
plasma leakage? 8. CxR of PE? 9. Dx of PE? 10. o Share
Reply With Quote 8. 01-20-2010, 01:30 AM#8 drrajib Guest 1.APCKD pt brother refused for kidney
donation? o Share
Reply With Quote 9. 01-20-2010, 01:31 AM#9 MRCPaspirant Guest * seizures, hypomelanotic
patches, multiple renal cysts, periungua fibromas -TUBEROUS SCLEROSIS o Share
Reply With Quote 10. 01-20-2010, 01:53 AM#10 Guest psychogenic aphonia or mustism in the woman
whom here son disobey here ATN OR AIN OR minimal change nephropathy In diclofenac in woman
aged 60 traces of canaboid ??? canboid abuse or psychotic depression HCM ?? lft vent out flow more
than 30 mmhg or septum thickness more than 3 cm burgada or rt vent hypoplasia or HCM in young age
collapse after football match ANKYLOSING SPONDYLIS WHAT TO SEE IN X RAY OF LUMBO
SACRAL XRAY IN PUL . EMBOLISM ??? CLOPIDOGREL STOP TO AVOID BLEEDING AFTER
24H OR STOP AND USE LMWH ODD RATIO ?? QUESTION PLEURAL EFFUSION DIDNT GET
ASPIRATED ?? I ANSWER LAT CHEST XRAY ANATOMY: SCIATICA AND LONG THORACIC
NERVE AND ABDUCTOR POLLICES PREVIS DISSOCIATED SENSORY LOSS ?? CENRAL
CANAL ! o Share
2symptoms of unwell diarrohea post terminal illeum removal ? bile salt irritation 3 lower quadrant
visual symptoms what next investigation 4 dilated pupil slowly reacting to light irregular ?adie pupil 5
raised cholestrol ,ldl,triglycerides tx atrorva /simvas 6 hypokalemia ecg shows U waves 8 smalll ca
with siadh 9jaw stiffness with multiple injected sites with discharging sinus tx? metronidazole /vac
10 presenting with bleeding pr and abdominal pain post recent surgery ?mesenteric artery occlusion o
Share
Reply With Quote 4. 01-20-2010, 02:21 AM#14 JAK-2 Mutation Guest Salaam all Paper one was
average, but 2 was a bit tough. Alhamdullilah I have done better than before. Following are the
remembered questions, please note that these are my answers and can be wrong, so please discuss to
make them right. Thanks 1.JAK 2 mutation --- PRV 2.Mother upset by her son's disobedience,
presented mute but movement ok-- Depression ??? 3. 4. ITP 2 questions 5. Tuberous Sclerosis
(periungual fibroma) 6. Pt seeing Dog lying in next bed--Alcohol withdrawal 7. Pt claiming to be dean
of medical faculty, after his girl friend left him--Mania 8. Boy behaving schezophrenic, Urine shows
mild canabiniod--Dont remember the answer exactly but i marked something related to schizophrenia.
9. Lady with hip pain but all movements normal--Osteoarthritis 10. Positive predicted value---I
screwed that up 11. Standard deviation 12. Lady with hypertension, hursutism and weight gain---PCOS
or CAH ? 13. Lyme 14. 15. Carbamazepine autoinduction 16. Respiratory depression in an overdose-Diazepam ?? 17.Ring Enhacing Lesion-Toxoplasmosis 19. Glucose Tolerance test with Plasma growth
hormone measurement 20. Man from india with jaunced picture--Hep A 21. Bloating, pain, long
standing diarrhoea--Giardiasis 22. Typpical picture of Multiple Myeloma with unmeasured extra
Immunoglobulins in blood + Bence John's Protein 23 24. Anti-Ro ----Heart block 25. Cyclosporin-Nephrotoxicity 26. FEV1/FVC low -- Emphysema 27. ABGs given -- Mixed Metabolic acidosis and
respiratory acidosis 28. Alopecia--Phenytoin 29. 30. Inflamatory infiltrates in lamina
propria+Granuloma --- Crohn's
31. Asymptomatic with low Hb but more markedly low MCV and Raised HbA2 --- Beta Thalasaemia
Trait 32. Mild haematuria, father and brother also had haematuria---Exercise related haematuria (I tried
to figure out if it can be hereditary but the option given was Alport's synd which is X-Linked dominant
so no male to male transfer) 33.Widespread ST elevation in anterior leads -- Constrictive Pericarditis
34.Another question with constrictive pericarditis picture and asked what else is found --- widespread
ST elevation 35. Rate control in AF in a heart failure patient already on Digoxin---Amiodarone (other
options were beta blocker but cant be used in heart failure) 36.Thyroid Nodule in a totally
asymptomatic patient---Fine Needle Biopsy ?? 37. Minimial Change disease 38. Henoch Schonlien
Purpura 39. Lorry driver with chest x-ray having calcification--TB 40.Hypokalaemia, what else is
found----U wave on ECG 41.Pleural effusion patient---Do bronchoscopy (It was the 1st question in
paper 1 I think) 42. Pt with history of influenza, now pneumonic picture-- Organism responsible
---Staph Aureus ?? 43.Cholesterol Embolisation with Levido Reticularis, what else is found -Eosinophilia 44. Hypertension in Pregnancy -- Methyldopa 45. Pt with low BP, Hickman Line insterted
presents with various electrolyte abnormalities, what else can be expected -- Hypophosphataemia 46. Pt
with low BP and AF -- DC cardioversion 49.. 50.Short Synacthen test 51. Pt on haemodialysis for 5
years 3 times per week. Cause of death -- Dilated cardiomyopathy ??? 52.Beta Blocker Toxicity with
very low blood sugar and bradycardia non-responsive to atropine -- Give Glucagon 53. 54. Coronary
Vasospam--give Calcium Channel Blocker 55.Drug in the marketr for 2 years and now a study claimed
to have found a serious side effect, what test will be used to check--- i wrote Case Control study
(Because Rand Cont Trial cannot be used for side effect measuremenst, but I can totally wrong, please
discuss) 56. Pt with typical DLE -- give HydroxyCholoquine 57. Pt seemed to have Seborrhoea or
Dandruff (Not sure) -- But I marked Ketoconazol cream, other options were totally irrelevent except
Metronidazole cream.....so i was in doubt and marked Keto. 58.Pt with alcohol abuse presents with
ataxia. Wats the reason? Options were various but I marked Vit E Deficiency....Please correct me. 59.
Lady after a fall, pain in neck with weakness but joint position sense and vibration sense and light
touch preserved--- Anterior spinal compression/Syndrone...??? 60. Patient presents with functional
symptoms but he also had a history of thinking he had a cancer 1 year ago, but now presents with some
functional symptoms--Somatoform disroder and not Hypochondriac disorder. 60.Lady with persistent
diarrhoea for 2 years without any cause, some other
functional symptoms were also given -- Somatoform disroder 61. Patient with SIADH -- Fluoxetine 62.
63.Lithium toxicity ---Concomittant use of ACE-Inhibitor 64. Rheumatooid Arthritis patient alread on
Diclofenac Sodium,what should be started next-- Methotrexate This is all I can recall by now. Please
share more to make a complete list. Thanks and good luck to all. May Allah pass us all...Ameen o
, 02:59 AM#15 saadi10 Guest ammeen alopecia is casued by valproate treatment of neuralgia is
Reply With Quote 6. 01-20-2010, 03:22 AM#16 Guest Salam 3aleekom i agree with most of ur choices
, those i recall 1-28 y with DM why type 1 age, bicarb, acetone i chose age
2-Melanoma Depth 3-18 y f eczema and recent small pustule at face and UL topical steroid 4- single
nucleotide polymorphism i chose predict protein 5-Huntington chance of sun to be carrier 50%???
however, let us discus these 7. Pt claiming to be dean of medical faculty, after his girl friend left him-Mania i thinnk its paranoid schizophrania 9. Lady with hip pain but all movements normal-Osteoarthritis i think bursitis arthritis would have limitation of active move 10. Positive predicted
value---I screwed that up---------50% 11. Standard deviation----------------SEM 12. Lady with
hypertension, hursutism and weight gain---PCOS or CAH ? -------PCO there was high LH:FSH ratio
16. Respiratory depression in an overdose--Diazepam ?? ------i chose dihydrocodien PLS discus
36.Thyroid Nodule in a totally asymptomatic patient---Fine Needle Biopsy ?? i chose scan discus 37.
Minimial Change disease--- MGN sicus 41.Pleural effusion patient---Do bronchoscopy (It was the 1st
question in paper 1 I think) ---------thoracoscopy pleural biopsy 51. Pt on haemodialysis for 5 years 3
times per week. Cause of death -- Dilated cardiomyopathy ??? -----------septicaemia 55.Drug in the
marketr for 2 years and now a study claimed to have found a serious side effect, what test will be used
to check--- i wrote Case Control study (Because Rand Cont Trial cannot be used for side effect
measuremenst, but I can totally wrong, please discuss) - I agree 57. Pt seemed to have Seborrhoea or
Dandruff (Not sure) -- But I marked Ketoconazol cream, other options were totally irrelevent except
Metronidazole cream.....so i was in doubt and marked Keto.---------metronidazol pls discus 59. Lady
after a fall, pain in neck with weakness but joint position sense and
vibration sense and light touch preserved--- Anterior spinal compression/Syndrone...???
---------------SYRNX dissociated sens loss 62. 63.Lithium toxicity ---Concomittant use of ACE-
Reply With Quote 8. 01-20-2010, 04:24 AM#18 saadi10 Guest few more that i can barely remember
plz help give answers testicular feminization ? male with female gentalia mitochondrial disease
shows ?optic atrophy polypeptide degradation occurs in ?? endoplasmic reticulum nurse presents with a
rash she has palmar rash and papules 0.4cm around gentalia renal failure /loss of left knee and right
ankle reflex with loss of power /urine positive for hematuria ? PAN/ SLE cause of pnuemonia in a 50
year old ?mycoplasm/h influenza a patients cxr showing 2-5mm calcified lesion ??? recent colonic
operation now severe chest pain management ? nitrates dx with cholecystitis 6months ago had stent
insertion on aspirin and clopidogrel tx ?? delay for 6 months plz tell patient tx for meningitis but after 4
days again confused and restless ? investigation ?urea/elec or MR scan brain dx of parkinsonism i
wrote repeated falls ( signifies ridigidty ) recently had chemotherapy now has neuropathy ? cause
cyclophosphamide /vincristine shin lesion with ankle swelling ?resolves cause of raised urinary sodium
treatment of immune thrombocytopenia o Share
Endocarditis blood culture alpha hemolytic which combination ? ben + rifa / benpen + genta 28 . GB
syndrome patient asking for Vital capacity i think 29 . 37 yr old patient with Upper and lower motor
sign father had similar problem at 78 yr of age ? amyotrophic lat sclerosis 30 . Bronchiectasis whic
organism common ? Kleb / Moraxella / H influenza 31. Pulmonary HTN best investigation ? Echo /
ctpa / vq scan 32 . caviating lesion with RF ? Wegners 33. weight loss / hemoptysis / hyponatremia
which lung ca ? small cell 34 . patient heavy smoker and asbestos exposure diagnose lung cancer which
account more i think smoking mainly 35 . testicular feminisation how will patient look like male with
female genitals / male with inguinal testis / femal with clitromegaly etc 36 . Type 2 dm obese which
medication first metformin
37. thyroid mass with normal TFT which investigation next ? FNAC ? radioisotope scan 39 . question
asking about absent ciliary reflex 40 . 41 . elder with fast AF but unstable hypotensive sys less then
80 ? cardiovert ? iv amiodarone / iv betablocker 42 . VSD want to become pregant which will be make
it difficult ? Pulmonary HTN / aortic regurg cant remember all 44. RTA which will be present renal
stones 45 . Cushing meatbolic alkalosis 46 . Patient investigated for palpitation all normal last yr think
he had cancer ? Hypochondriasis 47 . Mother stressed with disobeyed child suddenly unable to speak ?
akinetic mutism ? dpreseeion 48 . pastient with left hemiplegia and h/o of CABG 15 yrs , unable to find
right brachial and radial pulse . having head neck and back pain ? brachia site stenosis / dissection /
GCA 49 . Nurse from southern india experiencing wight loss and diarrhea facal elastase less then
normal ? tropical sprue ? coeliac 50 . lady with linear erythema and exfoliative margins on the shoulder
prv h/o of overdose ? factitious / psoraisis 51 . lady taking carbimazole develops hypopig around eyes ?
vitiligo 52 . Discoid lupus not responding to normal treatment what next 53 . MMSE 18 54 . qusetion
about drug induced Diabetes inspidus 55 . idiopathic PD ? symmetrical bradykinesia 56 . Acromegaly
invest OGGT and growth harmone 57 . copd with PE which invetigation ? CTPA ? V/Q scan
58 . patient blood gas showing mixed metabolic and resp acidosis 59 . patient blood gas showing type 2
resp failure diagnosis copd / Asthma 60 . RA anti ccp positve 61 . RA treatment metho / pred 62 .
patient ABPA admitted with exacerbation what to give first ? steroids ? itraconazole / neb saline / neb
steroids 63 . patient with Hypokalemia what will ECG shows 64 . patient with Pericardial rub What
will ECG shows ? small complex 65 . Ramipiril most common side effect cough 66 . pateint with facial
edema ? which medication ramipirl 67 . Patient on lithium HTN medication made levels high ? ACE 68
. Cholestrol emboli what will in the blood ? eosinophilia ? thrombopcytopia 69 Patient with features of
DIC what investigation ? coagultion ? d dimers 70. ITP treatment prednisolone 71.another question
with neutropnia what to give GCFactor 72 . question about reactive arthirtis affectiong knees ankle and
sole rash 73 . 2 questions of Herpes patient ? iv acyclovir 74 . myxoma where left atra / right atria /
ventricles 75 . clusture headache question 76 , Perxisome straight forward question 77 . Hypercalcemia
patient recieving fluids 4 hrs qhat next pamidranate 78 . Hypercalemia but low PO which is increasing
ca reabsorbtion ? PTH / 1 , 25 / Hypophostemia 79 . 2 questions of Primary Hyperparathyroid 80 .
Question about prolactinoma 81 . patient with renal failure and high total protien ? Multiple myeloma
82. Recent major surgery now 3 days later major MI after aspirin and clopidogrel
what next ? primary angio / thrmobolysis / LMWH / unfrac heaprin 83 . patient on clopidogrel and
aspirin awaiting surgery ? stop clopi and start LMWH 84 . 85 . question about PBC 86 question of
Autoimmune Hepatis 87 cystic fibosis what chance of sister being carrier or effected cant remember
the exact qyuestion ? 1:4 ? 2:3 88 . tubeorus scleosis two question asking association polycystic kidney
89 . diabetic patient with B/L small kidneys and protienuria and mild renal derangement ?
Amylodosis ? diabetic nehropathy ? renavascular both kidneys 91 . CML treatment Imatinib 92 .
question of grave disease 93 . megaobastic anaemia ileal resection 94 . another question with high
MCV cause ? b12 def ? folate def 95 . parietal lobe infarction patient unable to read ? agraphia 96.
patient with glucose in urine fasting and 2 hr normal feeling tired and lethargic ? Renal glucosuria 97 .
medical student think he is dean of the university 98 . hemibalissmus wher is lesion ? subthalamic ?
substania nigra ? caudate nucleus 99 . separate RNA from DNA ? northern blotting ? hybri 100 .
whome to isolate patient with MRSA septicaemia / pneumonia and MRSA in sputum / perotenal TB 1
day treatment / pulm TB 16 day treatment
-20-2010, 06:38 AM#20 aladdin80 Guest Stridor, dysphagia (Flow volume loop)
Causative organism for infected peritoneal dialysis patient?? 2. Anti TB with decreased visual acity??
3. person has hematuria father and brother had same 4. Cons pericarditis ECG?? 5. ANATOMY:
SCIATICA AND LONG THORACIC NERVE AND ABDUCTOR POLLICES PREVIS 6. intermittent
painful defecation with fresh blood in young lad (?polyp ? haemorrhoids ?anal fissure) 7. BLUE
VISION----SILDENFIL 8. Mild haematuria, father and brother also had haematuria---Exercise related
haematuria (I tried to figure out if it can be hereditary but the option given was Alport's synd which is
X-Linked dominant so no male to male transfer) 9. Another question with constrictive pericarditis
picture and asked what else is found --- widespread ST elevation 10. Lorry driver with chest x-ray
having calcificationTB 11. Huntington chance of sun to be carrier 50%??? 12. Male with severe pain
behind eye worse in the morning --? ?trigeminal neuralagia 13. Weight loss for obstructive sleep
apnoea 14. a patients cxr showing 2-5mm calcified lesion ??? 15. patient tx for meningitis but after 4
days again confused and restless ? investigation ?urea/elec or MR scan brain 16. renal transplant dont
remember the exact question but indicating cyclosporin toxicity 17. patient on cyclosporin LFT
become derange what investigation next to find the cause renal ultrasound / urea creatinine /
cyclosporin levels 18. caviating lesion with RF ? Wegners
19. question asking about absent ciliary reflex 20. Ramipiril most common side effect cough 21. pateint
with facial edema ? which medication ramipirl 22. another question with neutropnia what to give
GCFactor 23. clusture headache question 24. Perxisome straight forward question 25. Hypercalcemia
patient recieving fluids 4 hrs qhat next pamidranate 26. Hypercalemia but low PO which is increasing
ca reabsorbtion ? PTH / 1 , 25 / Hypophostemia 27. hemibalissmus wher is lesion ? subthalamic ?
substania nigra ? caudate nucleus 28. whome to isolate patient with MRSA septicaemia / pneumonia
and MRSA in sputum / perotenal TB 1 day treatment / pulm TB 16 day treatment 29. MANN whitney
U or chie sequard ?? 30. Duch Ms Dystrophy with grand children inheritance 31. girl with FH of 2
brothers with ?> weakness . mum negative..mode of inheritance? - SE of drug being compared on both
sides of face, best statistical rest ? 32. which patient can be left in multibed area - Legionell, Varicella
etc etc 33. Pregnant lady with raised amylase I definitely did not see these questions in the papers. Are
you sure they were there? Could anyone who gave the exam from India verify?
* Mediator for Hereditary angioedema - Bradykinin REF - Clinical Immunology,Volume 114, Issue 1,
January 2005, Pages 3-9 Posted: Wed Jan 20, 2010 6:06 pm Post subject: More Indian questions
-------------------------------------------------------------------------------- 1. Diarrhoea, jaundice etc. in postbone marrow transplant patient. Investigation? CMV PCR 2. Which patient to isolate-sputum positive
tuberculosis, sputum cultured
tubuerculosis, CSF cultured tuberculosis. Sputum positive tuberculosis. 3. Post-trnasplant patient with
skin lesion, diarrhea etc. What is the diagnosis? GVHD Share
can anyone say dm type 1 diagnosis best by age or ketone bodies o Share
Reply With Quote 01-20-2010, 06:40 PM#38 relaxed Guest more 21. poisoning with loss of vision
after 24 hrs- ? methanol 22. pt with chest pain ,hemoptysis- PE like pcitre commonest x ray findingnormal xray or wedge shaped infarct 23. ds caused by hhv 8 -kaposi sarcoma 24. b/l basal cylindircal
bronciectasis - likely organism ? staphy 25. operated 2 days back for colorectal ca, develos AMI- after
apsirin clop, best t/t : primary angioplasty 26. chest pain suggested of pericarditis ecg finding- diifuse st
elevation 27.acromegaly- invgnglucose tolerance with gh measurement 28. young lady with hypogly- what to measure next- insulin
and c peptide or sulphonylurea level will get back with more as i recollect. but my sure advise to all
those appearing is PASSMEDICINE is must..... o Share
Reply With Quote 01-20-2010, 06:42 PM#39 relaxed Guest dear friend i think type 1 is best by
ketosis, as MODY can occur at young age o Share
Reply With Quote 01-20-2010, 07:17 PM#40 Guest thanx relaxed i did it ketosis too about
PULMONARY EMBOLISM NORMAL CHEST X RAY IT IS WRITTEN AND IN MANY SITES
THAT WE ARE NOT DEPEND ON CHEST X RAY AS IT IS OFTEN NORMAL INSULIN AND C
PEPTIDE SURE PRIMANRY ANGIOPLASTY SURE IT IS SUPERIOR TO THROMBLYTICS
WHENEVER AVAILABLE WE SHOULD DO IT o Share
Reply With Quote 5. 01-20-2010, 10:20 PM#45 u1320918 Guest treatment of the lady with multiple
ST infections isolated candida, gonococci and vaginosis? o Share
Reply With Quote 6. 01-20-2010, 11:12 PM#46 Guest crp and insulin testing whilst having symptoms
to differentiate from endogenous source or if she was mis-using insulin so do it whilst having
symptoms. o Share
Reply With Quote 7. 01-20-2010, 11:38 PM#47 winner2010 Guest hi man with history of acute MI
gilbenclamide metformin 1v insulin s/c insulin in standard deviation which value doesnt come under
2sd??? 2 5.30 10 95 97.5 ECG changes in Hypokalaemia prominent U wave Test to diagnose
commonet site for Myxoma??/ RA/Rv Not able to abduct arm Nerve involved?? axillary N Man with
slight rise in Urinary proten 2+???
minimal change glomerular nephritis testicular feminisation?? o Share
1. hiya every1...here r da Q's i cud muster out ov ma short term memory... wish u all da best ...
1. wasting and fasiculation in UL and spasticity in LL - AML 2.Cyclosporin long term adverse effectnephrotoxicity 3.RTA 1 - nephrocalcinosis 4. 5. Carbamazepine- p450- auto induction 6.Angioedemabradykinin release 7.Pt taking throxine with low T4, low free T4, normal T3 , normal TSH- appropiate
thyroxine dose. 8.Afib on digoxin and warfarin uncontrolled with left ventricular dys-Amiadarone
10.Pt with some harmless PVC on ECG and was worried about cancer when all tests were normalhypochondriac 11.Student low mood, suspects teacher is conspiring against him-paranoid
pshsophrenia. 12-multiple symptoms but all normal normal-somatisation d/o 13. 14.35 y/o with IHD or
DM has TC 5.2 and LDL 3.2-simva 40mg 15.left hemiplegia with absent right brachial artery and
radial pulse , BP 160/80 -COA 16.DM first line-metformin 18.Chance of breast problem in population404/10000 19.Cfibrosis carrier in kids-1:2 20.HIV (CD count-80) with SINGLE ring enhancing
lession-TB 21. Androgen insensitivity0- female phenotype with external female features 22.MI after
colectomy on asprin+clopidrogrel-PCI 23.FEV 70% , FEV1/FVC 50% KCO2 50%- empysema 24.
25.purpura on legs in young-henosh scholein purpura 26.pt with alcoholic neuropathy needs chemoavoid vincristine 27.terlipressin-splanchnic vasoconstriciton 28.Asbetosis+smoking +hyponatremiasmall/mesothelioma 29.asbestosi+smoking-smoking caused increased chance of CA
30.muslim T2DM who wants to fast is on metformin 500 mg tds-take 500 in morning and 1000 mg in
evening 31.lady finds difficult to read scan shows parietal lobe infact-heminopia 32.herpes ,later
develops eruption-Erythema marginatum 33.hiker develops ring lession with central clearing-lyme
disease 34.foot drop,absent ankle reflex,lat loss of sensation, after hip surgery-common peroneal nerve
35. CML-Imatinib 36. 37.Parkinson disease-assymetrical bradykinesia 38.pt with APTT 30, platelets
30-ITP 39.ITP - steroids pred 40. Inferior MI- RCA 41.Haemochormotosis screening in familyTransferin saturation 42.Infective endocarditis with prostethic valve ,culture grew strep-b pencilin
+gent 43.19 yr old develops edema and proteinuria-minimal GN 44. Pt has arthritis in MCP,MT,writst
with negtive RF but positive CCP-RA 45. A spondolyis - Sclerosing of vertebra 46.ABGs-Mixed
respiratory metabloic acidosis 47.Cushing-met Alkalosis 48.LH:FSH ratio raised - PCOD 49.Wheeze,
Breathless, Stridor- Loop flow 50.GB syndrome-FVC 51.Bleeding PR - icolonoscopy 52. painfull
intermittent bleeding in young- anal fissure 53.sideroblastic anemia,hypochromic picture - lead
/basophilic 54.poikilocytosis + lethargy-myelofibrosis 55. bipolar develops hyponatremia-drug induced
56.pt on frusemide develops rash-drug induced/bullous pemhigus 57.prenicious anemia on endoscopy
finding in- gastric antrum 58.malaria how plasmodium exits red cells-effverce 59.seborrhic dermatitisketokonazole 60.JAK2 -poly cythemia ruba 61. 70 yr old headache 3 weeks sudden loss of vision with
papillodema-ESR 62.chickepox rash for 5 days-acyclovir 63.pupil slow reacting to light and
concesullay, assymetrical-adie/RAPD 64.P/C poisioing -anorexia nervosa 65.alcoholic,ataxic,
opthalmoplegia, -wernick korsakoff syndrome 66.glucose fasting raised, OGTT fasting 5.6 2 hr 7.2 BP
150/80 glycosuria-reanal glycosuria/cushing 67.pericardial rub-diffuse ST /low voltage 68.normal Ca,
low Phosphate, raised ALP-PTH 69.Subungual fibroma,hypopigmentation,epilepsy, cysitc kidney dzTuberous sclerosis 70.post partum 3 months with exopthalmos and TSH 0.01, raised T3 T4-Grave
disease 71. pt with CA confusion and Na 120 - SIADH 72. pul HTN-echo 73.pleural fluid on cxr but
can aspirate-USG 74.pt had hickmann for parenteral feed develops weakness-hyposphatemia
76.hyponatremia w/o renal pathology- addison 77.raised PTH, raised Ca, low Phosphate - primary
hyperparathyroidism
78.CXR b/l consolidation with hypotension after flue - S.aureus/mycoplasma 79.Crest patient with b/l
basal creps and cxr show basal shadowing-ILD 80.statin , develops myopathy after Ab - erythromycin
81. lithum + HTN started develops toxicity-ACE 82.african kid returns has arthritis in knee, ankle ,
wrist - gonococcal 83.young 25 yr old labile mood , choreathethoid movement, other neuropsychiatric
problems- wilson 84.young 16 yr old with lymphadenopathy, fever, WBC 17 ,lympho 11 and atypical
lymphocytes-glandular fever 85.All picture on full blood count with LN enlarged-Immunophenotyping
86.student has insomnia and pressured speech -mania 87.break downs protiens-proteosomes
88.appendicetomy, fever, hypotenstion- CRP (sepsis+MOF , prognostic value) 89.young low GCS, pin
point pupil-opiod oxy codine 90.back pain in elderly with raised ESR - M Myeloma 91. Myeloma - AL
amyloid 92. mitrochondrial disease- optic atrophy 93.RNA using DNA probe- northern blotting
94.Unable to move on sleeping and waking up with hallucination-sleep paralysis 95. acromegallyGH+ GTT 96. acoustic neuroma- absent corneal reflexes 97.hypokalemia on ecg- u waves 99.
Malignant melanoma- thickness 100.addison disease- short synacten test phewwwwwwwwwwww....
2010, 05:10 AM#54 Guest hey guys i c here common mistake with u plz seacrh for that: prothetic valve
with infective endocardits---------vancomycin+gentamicin+rifampcin 2nnd common perineal how ???
it is sciatica 3rd sure dilated bile duct in contra. (sure 100&) but anemia also and he wrote it in the
exam 4th why garves not toxic multi nodular goitre or toxic solitary nodule (graves post partum why)
5th amiodarone not used to control heart rate why use bb or ca ch blocker 6th simavastatin 40 mg we
start with metform in dm especially he obese 7th how TB make ring enahed lesion we always say cns
lympoma or toxoplasma 8th the question for appendectomy i think he asking about HELLP so i said
liver function plus question about egypt and bloody diarrhea?salm or shigella ACEI in black race ?
angiodema when to isolate i said pneumonai and postive acid fast bacillia culure thats all o Share
Reply With Quote 6. 01-21-2010, 06:56 AM#56 Guest What was the answer for hereditary
angioedema? isn't it C1 esterase. i dont remember the ques exactly o Share
Reply With Quote 7. 01-21-2010, 07:27 AM#57 Guest please discuss: 1.Mother upset by her son's
disobedience, presented mute - Depression ??? akinetic mutism 2.alcoholic with ataxia and
opthalmoplegia comes with hypoglycemia -first drug: thiamine/50% dextrose 50 ml iv/5% dextrose
500ml iv 3.Pt taking throxine with low T4, low free T4, normal T3 , normal TSH- appropiate thyroxine
dose 4.patient with glucose in urine fasting and 2 hr normal feeling tired and lethargic ,bp 150/80?
Renal glucosuria/cushing
-21-2010, 07:28 AM#58
Guest one more recalled ques .loss of sensations, all on one side including face,trunk and limbs- lesion
in thalamus o Share
Reply With Quote 9. 01-21-2010, 07:35 AM#59 drrajib Guest answer to heriditary angio was
bradykinin cause th question was asking which factor was responsible for the increased vascular
permeability in this condition. o Share
Reply With Quote 10. 01-21-2010, 07:37 AM#60 drrajib Guest alcoholic with ataxia and
opthalmoplegia comes with hypoglycemia -first drug: thiamine source: oneexam sept,2009 o Share
Reply With Quote 5. 01-22-2010, 03:00 PM#85 mannyl Guest I went for decompensated resp acidosis
in favour of COPD patient. o Share
Reply With Quote 6. 01-22-2010, 03:01 PM#86 giroop2003 Guest Hi, Guys in COPD its Mixed resp
and metabolic acidosis, In uncompansated Resp acidosis HCO3 will be normal not low o Share
Reply With Quote 7. 01-22-2010, 03:03 PM#87 giroop2003 Guest In Passmedicine if you look clearly
he has mentioned if it is confirmed Strept Vird then we should start Pen+Gent, Empirical Prosthetic
valve may be Vanco+Rifp+Gent o Share
Reply With Quote 3. 01-22-2010, 03:19 PM#93 ahmed M Guest mrcp i think for thyrotoxicosis before
any invasive manover frist isotope scan post viral,staph broncectsis ,h.influnza o Share
Reply With Quote 4. 01-22-2010, 03:21 PM#94 ahmed M Guest WHAT ABOUT LIVER DISEASE
AND IG A? IT IS ALCOHOLIC
o Share
Reply With Quote 5. 01-22-2010, 03:24 PM#95 mannyl Guest I went for autoimmune hepatitis. o
Share
Reply With Quote 6. 01-22-2010, 03:46 PM#96 ahmed M Guest Can any one correct me 1.size of RNA
using DNA ?pcr or northen 2.there is lyme disease in exam? 3.loss of ankel reflex with weakness of
knee?sciatic nerve 4.loss of abduction of thumb?median nerve 5.inferior infarction with heart block? rt
coronary 6. 7.contact dermatitis ?delayed hypersenstivity 8.poly peptid degradation? perostosome but i
do peroxisome 9.bloody diahrea?camplyobacter 10.kapose?HHV8 11.one egyption with picture of
meningitis and lymphoccyte in csf?polio 12.skin rash at hand with nodule at penis?syphalis 13.high lft
with tender liver?IG A 15.ANTIPARITEAL CELL ANTIBODY ? FUNDS OR BODY 16. o Share
Guest Here are my choices.. But might be wrong. 1.size of RNA using DNA ?pcr or northen... Northern
(PCR for DNA coding gene) 2.there is lyme disease in exam?... I didnt see.(may be diff paper) 3.loss of
ankel reflex with weakness of knee?sciatic nerve...I didnt remember( may be diff paper) 4.loss of
abduction of thumb?median nerve.....the same 5.inferior infarction with heart block? rt coronary.....the
same 7.contact dermatitis ?delayed hypersenstivity....the same 8.poly peptid degradation? perostosome
but i do peroxisome.....Proteosome 9.bloody diahrea?camplyobacter....the same 10.kapose?
HHV8.....the same 11.one egyption with picture of meningitis and lymphoccyte in csf?polio....the same
12.skin rash at hand with nodule at penis?syphalis....didnt remember( may be diff paper) 13.high lft
with tender liver?IG A.....Autoimmune hepatitis 15.ANTIPARITEAL CELL ANTIBODY ? FUNDS
OR BODY.....Fundus o Share
Reply With Quote 8. 01-22-2010, 04:22 PM#98 ahmed M Guest 16.2 QAUESTION one high IG A,one
high IG G 17.JAK 2?POLYCYTHEMIA 19.ALL adverse prognosis? phladiphia 20.one female 79
years with one lymph node ,lymphocytosis?immunophenotyping 21.low iron ?bone marrow most
specific 22.anemia high HBA2 and basophlic stabling?lead poisoning 23.most common finding in early
blood transfusion reaction?HBemia 24.CML ttt?imitinap 27.pt with petechia and low plt normal pt
.renal function?ITP 28.PT WITH lymph adnopathy and atypical lymph?IMN 30.anti ccp normal rf?
rhumatoid 31.rhumatoid activation?methotreaxat 32.multi pn and HTN AND KIDENY AFFECTION?
PAN 33.SYSTEMIC SCLEROSIS AND DYSPNEA?PROGREESIVE FIBROSIS 34.ANKLOSING X
RAY?CALCIFICATION OF VERTEBRAL JOINT 35.ASTHMA, STRIDOR ?FLOW CURVE
36.GULLIAN BS ?FORCED VITAL CAPACITY 37.HIGH KCO?PULMONARY HEMORRHAGE
38.LOW FEV1/FVC?EMPHYSEMA 39.HYPER VENTILATION?LOW H IN BLOOD
40.CUSHING?METABOLIC ALKALOSIS 41.CANCER LUNG CONFUSION?HYPERCALCEMIA
42.PLURAL EFFUSION NOT ASPIRATE?THORACOSCOBY 43.MESOTHELIOMA?TARC OF
MALIGNANCY ON ASPIRATION 44.ALLERGIC PULMONARY ASPERGILLOSIS?
PREDINSOLON 46..during exercise arrested not responding to CPR ?arrythmogenic cardiomypathy
48.x ray in pulmonary empolism? normal 49.pulmonary embolism in COPD?ct angio 50.ECG IN
pricartitis?wid ST elevation 51.ECG IN hypokalemia?u wave 52.mi after surgry?PCI 53.LOSS OF
PULSE ON RT HAND AND HORNER?AORTIC DISSECTION 54.INFECTIVE ENDOCARDITIS
IN PROTHETIC AND STREPT VIRDAN?PEN+GEN 55.VAVE REPLACEMENT AND ANEMIA
HIGH BILIRUBIN?HEMOLYSIS o Share
Reply With Quote 9. 01-22-2010, 04:39 PM#99 ahmed M Guest 56.FRIST DRUG IN TYPE 2 DM?
METFORMIN 57.MI+DM?INSULIN 58.GLUCOSURIA ,NORMAL BLOOD GLUCOSE HIGH
BLOOD PRESSURE?CUSHING 59.SKIN HYPOPIGMENTATION+THYROTOXICOSIS?
VITILIGO 60.LOW FREE T4 NORMAL TSH IN PT TAKING DRUH?ADEQUTE BUT I THINK IT
IS WRONG 61.OLD FEMAL HIGH CALICUM PLUS LOW PHOS?HYPERPARA 62.LOW
CALCIUM,PHOS.?DONT REMEMBER CHOICE 63.HYPOGLYCEMIA? INSULIN C PEPTIT
64.OLD AGE FATIGE BLURING OF VISION?WALDENSTORM 65.MULITIPELE MYLOMA
Reply With Quote 10. 01-22-2010, 04:48 PM#100 ahmed M Guest 71.MUSLIM AND ON
METFORMIN?1000MG AFTER BREKFAST AND 500 AT FAJER 72.CYSTIC FIBROSIS?2/3
CARRIER 73. 74.DRT ACIDOSIS?NEPHROCALCINOSIS 75.HIGH PTH IN CKD?LOW
CALCIUM 76.RENAL TRANSPLANT WITH DIARRHEA?CMV 77.PCKD BLOOD GROUP O HIS
FATHER45 YEAR BLOOD GROUP A NOT ACCEPT?STILL CHANCE TO BE PCKD
78.DICLOPHENAC?AIN 79.AMYLODOSIS IN KID?B2 MICROGLO 80CAUSE OF DEATH IN
ESRD?IHD o Share
hydrocortison 14-pt obese with family hx of DM and found to be Diabetic: MODY ,other
M typ1,DM type 2 15-diagnosis of cushing:24 hr free cortisol level 16-q about pt is not controled on
glgazid and has renal impairment extenide,other were metformin 17-q about hyperparathyrodism 18drug causes of gynecomastia
ption amidaron,pheothiazine...?!!! 19-pt with hyper prolactinemia and asking about what hormon will
be supreeses:growth hormon,thyroid,estrodiol,ADH???!!! 20-q about other feature of MENII
:medullary thyroid ca other option was inslinoma,..... 21-q about pt with gaining wt and intermettied
sweating??inslinoma,other option was cushing,acromegaly?? 22-pt which have gastric ligation which
will be reduce??folate,zinc,iron,vit k??? 23-excessof cortisol where will it go? bind 2 albumin bind to
fat others.....
24-healthworker had injured from pt with hiv +ve what is the persantge he will get hiv?? 1 in 3 1 in 30
1 in 300 1in 3000 1 in 30000 25-pt with DEXA of hip 2.1 and ??2.6 dose she has normal value
osteopenia of hip and osteoprosis of the femure osteoprosis in femur and osteopenia of hip both
osteopenic both osteoprosis 26-diagnosis of aspirglloma:lung function test,broncoscopy, 27-autosomal
ressive inhertance 28-autosmal domenat inhertance 29-q about pneumothorax: outpt aspiration,outpt
observation,inpt aspiration.inpt observation 30-criteria of ARDS:high protein pul odema 31-pt with hx
of influza develop pneumonia wht is the oragnsim:strep.pnemonia,staph aures.h.influnza 32-q about
lung function test option:asthma,COPD bronchitis,pul fibrosis 33-q about pt with copd with ABG and
ph 7.30 eco222 ,co2 high and o2 low and option was:non invasive ventillation,decrase inspired o2,iv
theophyllin 34: 35-prognostic feature on AML:intial wbc plz all share and add the option or the full q if
u remmber
09-22-2010, 02:30 AM#4 asya Guest 36-q about polycythemia rubrvera
37-q about waldenstorm`s macroglobulinemia 39-mechansim of alloprinol 40-machansim of imatinib
41-vomiting from ca what other you add to ondansetron:dexamethone,metochropromide 42-q about
ressident to action of protein C:factor V laden 43-q with hyper hypo k and high CL and
nephrocalcinosis:RTAI 44-what kind of IG ass with cryoglobulinemia II??!!! 45-q about minmal
change GN 46-q pt with RA on methotrexate with sob , 47-renal stone with abd xry shows staghorn
calculi and proteus infection it should be struvite bt it was not in the option ???!! option inculde
cystine,urate,ca 48-rt homnomuys hemonopia option
ost artery,post inf arety,ant inf aretry,middel cerebral artery 49-q about migrane pt already tried simple
Reply With Quote 4. 09-22-2010, 02:57 AM#6 Guest Alcohol + pustular facial rash (nonscarring)
Guest 66-OA 67-q about ankylosing spondyolitis
68-young with behaviour change?? 69-erythema nodusm 70-photosensitivity rash???porphyria cutanda
tarda???!!! 71-pt with alcholic and rash??rossea 72-blister with no mucosal involvement 73-pt with
cloctomy and a rash??pyoderma gangernosum 74-orf 75-herdietory angioodema with C1 diffecency
76-pt with HIV and ct show low attenuated:PML 77-dog bite: coamoxiclave 78-dengue
fever/lepospriosis??!!! 79-pt with grame -ve diplococci:gonorrhea what is ttt 80-3 to 4 q about
schs,manic psychosis, 81-pt with sudden loss of vision 82-???blephritis 83-pt with s/s of facial n,tangue
and plate where is lesion pons,cerbropontine,jugular formen 84-NNT 85-pt with ethenol poisining and
asking about the mechansim by which inhibation of alchol dehydrogens is done by fomepizole 86which drug can be givin with finsteride doxazin nitrate nicorandil ACEinhibitor 87-drug which cause
pancytopenia/aplastic an trimethoprin 88-drug lead to LN and wt gain?? phenytoin o Share
Reply With Quote 6. 09-22-2010, 03:27 AM#8 asya Guest please all to share and add whatever u could
remmber from exam o Share
Reply With Quote 7. 09-22-2010, 04:38 AM#9 Guest good good luck for everyone!!! o Share
Reply With Quote 8. 09-22-2010, 04:58 AM#10 Guest metformin for PCO TTT of grade II oes. varices
o Share
Reply With Quote 4. 09-22-2010, 07:43 AM#14 asya Guest 93- inv of renal vasular dis(this qis
repeated0 and itys answer was renal artiogram 94- ecg shows st elvation in V1 -V4 with some change
in inferior leads: a-total oculsion of LAD
b-total oculssion of RCA c-70%oculsion of LAD d-70% oculsion of RCA e-oculsion of LAD and rca o
22-2010, 07:52 AM#15 asya Guest 95-pt recive blood transfusion and presented after 3 week with j
and... a-CMV b-acute lung injusry if any one can remmber the complete option and q plz share o Share
Reply With Quote 6. 09-22-2010, 07:55 AM#16 Guest Delayed transfusion reaction ? o Share
Reply With Quote 7. 09-22-2010, 07:57 AM#17 asya Guest 96-pt presented with SOB following
successfully tt of MI mitral valve prolapse 97-pt presented with rash,femoral bruit,sob following pci
chlosterol embolism o Share
Reply With Quote 8. 09-22-2010, 07:59 AM#18 asya Guest 98-what will be a good indicator for
disease activity a-ccp b-ana c-c3 o Share
Reply With Quote 9. 09-22-2010, 12:45 PM#19 Guest hemochroatosis c282y gene? deletion expansion
am not sure of the answer the prognosis 26 hr after paracetamol poisoning? o Share
Reply With Quote 10. 09-22-2010, 01:34 PM#20 tatta Guest good luck 2 everyone! this exam sucked!
couldnt find this forum(guess im still hazy 4rom the exam) so thought people didnt start discussing yet,
had 2 start my own 2oday but thankgod i found it .......... some recalls -elderly lady wit ulcer on
nose.been there 4 more than 4 yrs:squamous cell ca,basal,trophic ulcer, lupus vulgaris
-renal transplant, earliest ab produced against what?HLA class 1 Ag i think -most imp HLA 4 renal
transplant matching?HLA A, HLA B, HLA DR......... -vague q about some erythematous rash on
legs??? cant remember - young man wit pain in rt buttock, 6 month ago had same pain in left buttock?
sacroilitis,gluteus medius tendonitis, lumber canal stenosis -confused febrile........invest negative
nitrites? leptospirosis, listeria meningitis..... cant recall plz help me wit answers 2 those o Share
Reply With Quote 3. 09-22-2010, 02:28 PM#23 Shez Guest it was a drug causing SIADH and the
answer was carbemazepine i think. o Share
Reply With Quote 4. 09-22-2010, 02:33 PM#24 tatta Guest thanx shez 4 making me feel better bout
that q!!! i wrote that too but alot of people thought it 2 be DI wit lithium as answer
o Share
Reply With Quote 5. 09-22-2010, 03:01 PM#25 mrcp-4 Guest one of the toughest exam after mrcp
may 2007.this is my 4th times... i m very dissapointed.i m trying to recalling the qs n will post as soon
possible...pls try everyone ... o Share
Reply With Quote 6. 09-22-2010, 03:36 PM#26 exam crammer Guest Glukokise enzyme, different
behavior in brain and liver ? affinity cortisol mech of inactivation bias reason in meta analysis abx for
pneumonia after influenza infection abx addition apart from amoxyl and claritho? derranged LFT in
preg ? cholestatsis way of giving oxygen to COPD pt ABPA diagnosis o Share
Reply With Quote 8. 09-22-2010, 03:44 PM#28 Shez Guest the migraine one i think the answer was
propanolol. cos she wasnt having an acute attack but was having very frequent migraines so i think the
were looking for preventeitve agent. ergotamine aint used any more cos of side effects o Share
Reply With Quote 9. 09-22-2010, 03:46 PM#29 exam crammer Guest Inx for renal failure, patchy
shadow lungs, prt and blood positive, pt with inc SOB Inx of choice for low hb, high prt, low alb, RF
sickle pt claiming to be in pain how can u check
odenestrone not helping post chemo , what next?
Guest i put precipitin test for the aspergillus one - dunno if thats right. yes tata alot of my collegues put
lithium and diabetes insipidus for that question but in my question the sodium was 116 and clearly
fitted siadh. so i think maybe it was one of the test questions - you know they put a few in each paper.
oh and the woman with the pericardial effusion noted incidentally??? i put preceed to op but i dunno if
that right i put subacute combined degeneration of the cord for an answer but i wasnt convinced cos the
haemoglobin was normal. MCV modestly high. couldnt really fir the signs with any of the other
options though o Share
Reply With Quote 3. 09-22-2010, 03:54 PM#33 exam crammer Guest @ shez for ABPA i put PFT , can
be wrong migraine --propanolol I put ant spinal art for T8 level low Na , i put carbamezepine too o
Share
Reply With Quote 4. 09-22-2010, 03:56 PM#34 exam crammer Guest there a Q with weakness and
postural hypotention a lady who had change , saying mean things to ppl with some gait impairment and
memory loss o Share
Reply With Quote 5. 09-22-2010, 03:59 PM#35 exam crammer Guest PMH of TA pt coming in with
fundal hge, had high BP another pt with visual change, pain ..cant recall well pt with 6th nerve palsy
Reply With Quote 6. 09-22-2010, 04:05 PM#36 Shez Guest what did u guys put for the patient who
had polymyalgia and had been taking steroids - then presented with acute visual loss, pulsatile temporal
arteries ???? i think i put the first answer central retinal artery but could be wrong? o Share
35-Ankylosing Spondylitis------ global immobile vertabera 36- QT----- K channel 37-MS other
vlave------- v wave 38-H.ployi--------- duodenal ulcer 39- diahrea + anaemia+ mouth ulcer----- celiac
41-macrophages containing periodic acid-Schiff------Whipples disease 42-pt. neck stifness csf gram
+ve bacilli------ listeria 43-O2 to COPD pt--------- venti mask 44-staghorn stone--------magnesium
ammonium phosphate 45-pt from india has vivx malaria----- chloroquine 46-diarrhea, TR, liver
impaired------Carcinoid syndrome 47-Metformin in PCVS----- inc glucose peripheral intake 48-typical
bic of cluster headache 49-pt. take steroid------ avscular necrosis 50-blood film after splenectomy----hollly jolly to be contentious..... o Share
tenden--- cipro 110-photosenetivity, blister , millia----- prophyria cutanea tarda 111-Glukokise enzyme,
different behavior in brain and liver ? affinity 112-cortisol mech of inactivation 113-bias reason in meta
analysis 114-way of giving oxygen to COPD pt venturi mask 115-sickle pt claiming to be in pain how
can u check a-symptology of pt b-HB s concentation on hb electrophoresis 117-turkish woman with
hepatosplenomegally: leshmaniasis a-ZZ b-MM c-MZ q of:drug causing of DI i did it lithum
about q of liver impairment during pregnancy it couldnt be chlostasis of pregnancy becoz gamaglutamt
is high which mean liver dis and the q provid high alp and high ast as i remmber i also was confused
about that q of migrane becouse it wasnt really clear on exam dose they mean prophylactic or next step
in acute mangment so i did prpoanol what was the answer for q asking what els to add for vomiting
following chemotherapy not improved with ondensteron dexamethasone,metochlopromide???? i also
put procssed with operation in pt incediently find to have pl.effusion h.pylori q its ass with gastric
ca(malt) pt from india has vivx malaria----- chloroquine:i cant remmber seeing such q??!!!!!
Reply With Quote 2. 09-22-2010, 07:14 PM#52 Guestq8 Guest pass mark does anybody know what is
the passmark for this exam diet? o Share
Reply With Quote 3. 09-22-2010, 07:38 PM#53 exam crammer Guest i have put GORD for H pylori
another Q pt with erythema nodosum and pl effsion i didnt see the malairia question either o Share
Reply With Quote 4. 09-22-2010, 07:41 PM#54 exam crammer Guest for protein structure I went for x
ray crystillography o
Reply With Quote 5. 09-22-2010, 07:43 PM#55 exam crammer Guest for sickle cell pt , i went for
Reply With Quote 6. 09-22-2010, 07:52 PM#56 Shez Guest i put non ulcer dyspepsia for the h.pylori
question - however i think the ans may be duodenal i was not sure at all about the HLA for renal
transpant (just been googling it tho and i think it may be HLA DR - which means i got it wrong
the young man with the buttock pain i put sacroilitis but i was toying between that and scheueramanns
disease - and ideas folks?? i did ctpa for the ?PE publication bias in meta analysis venturi for copd pizz
for the alpha 1 antitrypsin one dexamethasone for chemo induced vomit i put strongloydies for one in
the first paper - something about an eosinophila ???? any ideas folks was the answer to one question an
atrial septal defect???? yound lady normal? split of S2 the woman who was losing memory, ataxic and
being nasty to her kids - i put lewy body but im pretty sure thats wrong?! i think it might be
frontotemporal homonomous hemianopia ??posterior cerebral artery probs with swallow, tongue and
something else i put jugular foramen what about the one about the first line antibiotics for febrile
neutropenia?????? what bug they trying to fight against
o Share
Reply With Quote 7. 09-22-2010, 07:54 PM#57 Shez Guest also the one with fever and dilated bile
ducts i went for ercp - any other suggestions? o Share
Reply With Quote 8. 09-22-2010, 08:01 PM#58 exam crammer Guest i put non ulcer dyspepsia for the
h.pylori question - however i think the ans may be duodenal ulcer I USED GORD BUT I AM WRONG
SAME i was not sure at all about the HLA for renal transpant (just been googling it tho and i think it
may be HLA DR - which means i got it wrong I WENT FOR HLA-A DONT ASK WHY the young
man with the buttock pain i put sacroilitis but i was toying between that and scheueramanns disease and ideas folks?? THERE WAS ANOTHER OPTION GLUTEUS MEDIUS TENDONITIS , I WENT
FOR IT i did ctpa for the ?PE SAME publication bias in meta analysis IWENT FOR RESEARCHER
venturi for copd SAME pizz for the alpha 1 antitrypsin one .THIS WAS ONE MY FOOLISH
MISTAKE BUT U R RIGHT dexamethasone for chemo induced vomit I
i put strongloydies for one in the first paper - something about an eosinophila ???? any ideas folks
SAME was the answer to one question an atrial septal defect???? yound lady normal? split of S2
SAME the woman who was losing memory, ataxic and being nasty to her kids - i put lewy body but im
pretty sure thats wrong?! i think it might be frontotemporal homonomous hemianopia ??posterior
cerebral artery SAME probs with swallow, tongue and something else i put jugular foramen MINE
WRONG what about the one about the first line antibiotics for febrile neutropenia?????? what bug they
trying to fight against :x :x :cry: MRSA , DONT KNOW IF I AM CORRECT o Share
Reply With Quote 9. 09-22-2010, 08:06 PM#59 exam crammer Guest there was a question abt
anisopoikylocytosis ? myelodysplaisia o Share
Reply With Quote 10. 09-22-2010, 08:07 PM#60 Shez Guest hey exam crammer thanks for ur
responses. i have just looked in book for the sickle cell one. For some reason i put blood film. but that
is wrong. from what i can see and read at the moment i reckon the answer may have been the patients
symptomatology o Share
africa 6 months ago. Recently he has been having nightsweats and recurrnent pyrexia. what is the most
likely diagnosis 1. m. ovale 2. m. falcipirum 3. brucellosis 4. typhoid fever
---------------------------------------------------------------------------- A young boy <16, recently had a road
traffic accident and needed a splenectomy. He currently takes penicillin V. What organism is he likely
to be infected by? 1. Haemophilus influenzae 2. Streptococcus
-------------------------------------------------------------------------) warfarin inhibit the factor VII 3) 4) pulsus alternans in left heart failure 5) amiodarone for
maintainance of patient synus rythm after successful cardioversion 6) ST elevation on the ECG with
chest pain but the chest pain relieved on inspiration is pericarditis 7) small VSD is pansystolic murmur
with thrills 8) arm, buttock, thigh itchy rashes that is not response to prednisolone and a/w diarrhea are
dermatitis herpatiformis 9 10) patient with knee joint pain with raised ESR of 60 and urethral culture
and gram stained negative is it more towards reactive arthritis rather than gonoccocal arthritis as the
gonococcal usually culture will be positive and ESR is raised in reactive arthritis? 11) hyperkeratotic
plague is psoariasis 13) poor prognosis for hogkin is sweating (pass year)
14) colon CA a/w endometrial CA 15) haemoptysis with gromerulonephritis is anti GBM antibody 16)
after angiography the complications is MI 17) vancomycin is use for the chronic renal failure with IJC
because the most common organism is the staph epididimis? 18) optic chiasma lesion for patient with
assymetrical bitemporal hemianopial...as tract,ratiation,occipital and optic nv will cause homonymous
hemianopia or unilateral blindness 19) holme's Adie pupil a/w absent reflex 20) patient has history of
Mi and noted absent pulse in the left upper limb is thromboembolic disease? 21) amlodipin in lithium
22) RTA 23) syringo bulbia 24) herpes labialis a/w streptococcus pneumonia 24) pseudogout 25)
hydroxyurea use to treat essential thrombocytopenia 26) ulcerative colitis-patient with bloody diarrhea
and noted goblet depletion and crypt abscess 27) acanthosis nigrican in patient with fleckling in the
axilla as opposed to neurofibromatosis is the patient has no family history of similar picture and NFM
is inherited as Autosomal dominant and neurofibromatosis is present in pregnant and obese people 28)
paranoid personality disorder hand 31) SLe a/w C4 deficiency 32) in patient with blood result showing
hypocalcaemia the ECG changes is long Qt 33) refeeding syndrome check serum phosphate (pass year)
34) impingement syndrome in patient with pain and stiffness on shoulder ABD and rotation?
35) in patient with AML after so many of high class antibiotic still ahving fever is CMV or fungal?is
acyclovir shud add in the regime or amphotericin B?pass year written CMV but oxford written fungal
more common 36) major raised intracranial pressure-bradycardia(cushing reflex?) 37) polymyagia
rheumatica as the patient has stiffness and pain on the shoulder and wrist that is worse in the morning
38) patient with pneumothorax are life long prohibited from diving unless patient underwent
pleurecdomy (pass year) 39) LBBB a/s reversed splitting 2nd heart sound 40) CXR with mediastinal
enlargement and erythema nodosum suggestive of sarcoidosis 41) patient with maculo papular rash
with conjunctivitis and mucosa involvement is it SJS or toxic?as SJS is the milder form of toxic now.
42) 43) Hepatitis A in patient with maculopapular rash and fletting arthralgia and lympadenopathy
(pass year) \ 44) ovale malaria as patient back from african 5monthms ago and ovale malaria may have
hypnozoite in the liver 45) fronto temporal demential 47) lithium use to treat the patient wf the manic
syndrome 48) desmopressin release the stored factor VIII 49) myelofibrosis in patient with bld film
show tear drop 50) reduse exposure to sunlight in patient with low serum calcium low serum phosphate
and high ALP 51) carbimazole inhibit the iodinasation of thyroxin (pass year) 52) after splenectomy the
most important organism is strep pneumonia 53) WATERY DIARRHE A/W e. COLI 0157 54)
PATIENT ON pyrazinamide may hav the arthralgia 55) ulnar nerve supply the 3rd and 4th lumbrical
57) staph discitis in patient with pace maker implantation who present with low back pain? 58) Ct show
tempora... herpes simplex encephalitis (pass year) 59) penile and anal wart treat wf podophilline 60)
poster5ior infarction ?ciorcumfles artery? 61) amytryptilline toxicity use iv sodium bircarb 62) SAH
that develop confusion 5 days later in kumar and clark is hydrocephalus 63) aiodine deficiency or sick
euthyroid syndrome? 64) barrect esophagus with epithelial dysplasia is esophagectomy or PPI and
repeat scope?the kumar and clark mention if low grade dysplasia then nid PPI but high grade nid
surgery.the question did not mention high grade or low grade 65) tau in alzheimer kindly comment and
can sum1 please post more question on paper 1 as i almost foget all questions that i din in paper
1....thanks....kindly recall.... o Share
Reply With Quote 4. 01-20-2011, 09:59 AM#39 Guest statistics in paper 2: > unpaired t test i think >
50 in 1000 for NNT o Share
Reply With Quote 5. 01-20-2011, 12:20 PM#40 jka Guest heaven question 20, mi and absent arm
Reply With Quote 4. 09-23-2010, 09:32 AM#84 Guess_1 Guest I agree with you that ESR value and
biopsy of TA can't predict AION. Please see Medicine for Examination. Only 1 spot we see high blood
pressure, wan can't say that this patient had chronic hypertension than can contribute Hypertensive
Retinopathy with flame haemorrhage. However 10% AION will associated with CRAO than can lead
to cherry red spot. Endocrinology: 1. Acromegaly - GTT. 2. Microadenoma & prolactinoma - GH <. 3.
Uncontrolled Diabetes, Renal Impairment, on T. Gliclazide, BMI > - SC exanatide. 4. MEN II Medullary Thyroid Carcinoma. Genetic: 1. Genetic Variation - the most common was Single
Nucleotide Polymorphism (SNP). Around 4M according to OHCM. 2. Glucokinase in liver depend on
glucose level. Co factor (in this term is glucose) asscociated. Immunology: 1. Renal Transplant - HLA
DR. (DR should be 0 mismatch & B could be 1 mismatch, see Kalra). 2. Question regarding severe
wheat intolerance. o Share
Reply With Quote 5. 09-23-2010, 09:45 AM#85 Dr_Alpha Guest PSY: 1. Q regarding PTSD. 2. Q
regarding Depression. 3. Q regarding cataplexy. 4. Q regarding delusion. 5. Q regarding Paranoia.
6. Q regarding hypochondriasis. Neuro: 1. GBS - IVIg. 2. Q regarding brainstem demyelinating. 3. Q
regarding HIV with PML. 4. Homonymous hemianopia - PCA. 5. Slurred speech < 45 minutes Rankin Score 2. 6. Absent biceps reflex - C6 radiculopathy. 7. CPNL - absent foot dorsiflexion. o
abt the question risperidone it mainly acts on serotonin 5ht2a receptors i think from passmedicine one
question abt pain more with bending and coughing is spinal stenosis o Share
Reply With Quote 7. 09-23-2010, 12:51 PM#87 sle Guest pregnant with bmi 26 high glucose and mild
ketones probably dm-2 o Share
Reply With Quote 8. 09-23-2010, 12:53 PM#88 sle Guest sore throat and after 2 weeks with scaly
erythematous lesions -guttate psoariasis
o Share
Reply With Quote 9. 09-23-2010, 12:58 PM#89 Dr_Alpha Guest Ketone is typical for DM Type 1, and
non ketones is typical for Type 2. Atypical antipsychotic like Risperidone acts on both D2 and HT3
receptors, D2 is for antipsychotic, and HT3 is for antidepressant. o Share
Reply With Quote 10. 09-23-2010, 01:04 PM#90 guess Guest I think we have one question, patient
with neck pain, 6th nerve palsy and papiloedema. I answer vertebral artery dissection. RCP usually ask
the rare cases and the answer is sometimes unexpected. o Share
hbs antibody 68) IE- rush to surgery- pr prolongation 69) bleeding gums- von willibrands 70) refeeding
syndrome- phosphorus 71) pregnant with trombosis- sinus venous trombosis 72) confusing and
inappropriate urination- frontotemporal dementia 73) prostate hypertrophy with neuropathic paingabapentine 74) early morning wakefull- depression 76)q on ptsd 77) man covering himself in silver
foil- scizophrenia 78) alcoholic with delusions-? delutional behaviour 79) best treatment for BIH- csf
drainage 80) elderly lady admitted with off feet, normally fine. uti and confused on admission-??
haloperidol/temazepam 81) q on metabolic acidosis with normal anion gap- ? type1 renal acidosis 82)
best prophylaxis to avoid variceal bleeding- propronolol 83) q on generalised maculopapular rash- ?
measels 84) test for cushings- low dose dexamethasone 85) postural drop in bp with low na and high kadissons 86) low b12 following rt hemicolectomy- bacterial overgrowth syndrome 87) asian female
with low vit d- poor exposure to sunlight 88) men 2a - medullary ca of thyroid 89) young lady with
axillary freckles, no family history-? Neurofibromatosis 90) rash over the elbows- dermatitis
herpitiformis 91) crypt abscess on histology on a pt with bloody diarrhoea- ulcerative colitis 92) part of
intestine involved in a pt with bloody diarrhoea and abdominal pain, smoker- caecum 93) ecg changes
in pt on amiodarone- qt prolongation 94) elderly pt with aplastic anaemia picture- myelodysplasia 95)
angioma on fundoscopy with central loss of vision- sub-macular haemorrhage 96) docetaxelmicrotubules 97) RA- ? tnf alfa [98]) diarrhoea with hyperpigmentation- melanosis coli 99) rash on
forehead-?? saeborrhic dermatitis 100) which parameter of respiration improves after bullectomy????
101) facial puffiness on hypertensives- amlodipine 102) reverse transcriptase- rna to dna 103) statingrape juice 104) haemoptysis , rt upper lobe lesion??? 105) g6pd- pyramethamine
Tinnitus + SNHL27. Pneumothorax after Trumpet Usage Cant do scuba diving for life28. Wernickes
Aphasia Fluent but Word Neologism Comprehension Impaired Location ON superior Temporal gyras
30. Hayflick Theory of ageing of cell Involves Telomeres31. PICA Ipsilateral Ataxia, CN palsy
Contralateral limb sensory involvement32. Syringomyelia Diagnose from Clinical Picture33.
Phenytoin not effective appropriate blood levels not achieved next action ???34. Hemiballism
characteristics mentioned Subthalmic Nucleus in volved35. Headache + Loss Of Smell36. Cause of
Hematuria in Which anticytotoxi Cyclophosphomide37. Hereditary Spherocytosis Dx by Osmotic
fragility test38. Dignosis fro clinical picture PO2 is N, SPO2 is decreased Methaemglobinemia39.
PRV Rx by Hydroxy carbamide40. Clinical Picture of Bloods indicating Neutropenia in Middle
Eastern Person <1.5 Racial Variation
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41. Von willibrands disease Clinical picture APTT prolonged 42. ITP43. Sick euthyroid Syndrome44.
45. Exanetide GLP1 analogue46. Production Of Ketones in DKA Lipolysis47. Pheochromocytoma
associated with MEN 248. Carcinoid Syndrome Dx by HIAA49. Travellor coming from India
Bloody Diarhoea Amoebiasis50. Terlipressin Before doing Endoscopy and banding in UGI Bleed51.
52. Hypori causing MALToma Rx by Hpylori eradication therapy53. 54. Diabetes Long duration pain
after meals Chronic Pancreatitis55. Ulcerative Colitis Treatment56. Fulminant Hepatitis in Pregnant
lady Ex is Hepatitis E57. Streptococus Sanguinis diagnosis ???58. C3b nephritic Factor seen in
MCGN Auto antibody59. FSGN seen in HIV, IVdrug abuser60. Clinical features given Dx Lateral
Epicondylitis62. Mixed Cryoglobulenimia63. Psoriatic Arthropathy64. 65. HTN in pt. < 55yrs DOC
ACE Inhibitor66. Clinical picture indicating Dx of Cardiac Tamponade67. PET Scan Uses
Fluoeodeoxyglucose68. Mouth Ulcers seen in Nicorandil Usage69. Long QT syndrome associated with
KCNE1 gene involvement70. Pt. age >70yrs + severe Aortic Stenosis Rx by bioprosthetic valve
replacement 71. PAH Dx by Cardiac catheterization72. Clinical Picture of TOF indicating Ejection
Systolic murmur Pulmonary Stenosis 73. Low O2 delivery Low PCO274. Bronchial asthma severe
Rx by IV MgSO475. COPD Rx76. Pulmonary Embolism Dx by CTPA77. Pneumonia + clinical
Picture Of Erythema Multiformes Mycolplasma Pneumonia 78. 79. Bronchiectasis reason for
hempotysis80. Immunocompromised Pt. C.I vaccine Yellow Fever81. Reason for Resistance to anti
Retroviral Drugs82. Pan Valintino Leucocidin Gene involved in MRSA Rx ???83. Lyme Disease
Clinical Scenario Given Pn Allergic Rx by Doxycline84. Non Falciparum Malaria Rx85. Rx of
Gonorrhoea86. Painful Genital Ulcers with Painful Inguinal Lymhadenopathy87. Atypical
Lymphocytes seen in IM88. AntiHTN in Pregnancy MethylDopa89. Venous ulceration Mx by
Compression Bandaging90. Impetigo Clinical Picture given Rx91. Acnae Rosacea Rx by Topical
Metronidazole
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93. Somatisation Disorder Dx from Clinical Picture 95. Suicide Risk Factor
96. Catract97. Scleritis Painful RA98. Inhibition Of P450 by ERythroycin99. Supraventriculat
tachycardia in Asthmatics Rx by Verapamil100. Emollient usage dont smoke101. Post Flu
Pneumonia Staph Aureus probably102. Drug that decreases Wound healing Prednisolone103. Wilson
disease AR mother heterozygous general population risk is 1:100 in UK.. In this case if father is not a
carrier then risk is 1:200104: beakers muscular dystrophy..father had the disease.. No investigation
required in boy child coz x linked recessive...father to son transmission is not seen105: Costochondritis
?... Diagnosis106: dermatitis herpetiformis :107: Bed ridden pt. presents with hypothermia due to loss
of which reflex? Shivering108: AF + IHD add digoxin109: Diabetic pt. modifiable risk factor for
CVS ? Lowering TG levels 111: herpes simples encephalitis : clinical presentations + CT findings
given112: cell membrane around the daughter chromosome . Which phase of cell cycle ..telophase113:
MOA of ACE inhibitors114: Pt with increase prolactin level !!Investigation ?MR scan115: Pt on
CAPD..infection due to Staph epidermatides116: Antigen presenting cells > dendritic cell117: facial
pigmentation in pregnancy ... Melasma118: cryoprecipitate contents : fibrinogen119: buprenorphine :
partial miu agonist120: central respiration centre is controlled by? ??121: action of SO muscle :
depression & adductionThere were also many qs. from the following topics with overlapping features
which led to immense confusion in deciding upon the correct answer. Please go through these topics in
details :1. Role of calcium, phosphate, PTH and ALP in Various clinical scenarios. Believe me, I knew
all the tables by heart but still I got utterly confused2. Differentiating and correctly diagnosing diseases
relating to myopathy and arthiritis RA, Polymyositis, SLE, ANTi phospholipid syndromes,
pseudogout3. Presentation of different types of Lung cancer4. Primary amnorrhoea very confusing qs
for dx of PCOD, CAH, AISGOOD LUCK AND PLEASE DO PRAY FOR ME
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Alex Andra
5 hrs
1. Reactive Arthiritis asscociated b 27 6. patient with UC and feature of sclerosing cholangitis...most
diagnostic testMRCP 9. Hyponatremia Detailed Pathophysiology Changes in Intravascular and
Extravascular Compartment....gain of water + salt / gain of water10. S4 Corresponds to Pwave on ECG
11. Digitalis Toxicity PPt by Hypomagnesemia12.???13. Cause of Hyperuricemia in Tumor Lysis
Syndromeincrease nucleic acid release14. AntiCCP in Rheumatoid Arthiritis15. Eternacept Binds
with TNF16. IL2 inhibited by Cyclosporin17. Cystic Fibrosis Clinical scenario mentioned AR18.
19. Insulin Receptors Membrane Receptors20. 0 Phase of Depolarisation associated with Sodium 22.
Study Design What phase represents effectiveness of a drugphase 323. MOA of Doezolamide
Carbonic anhydrase inhibitor24. Porphyria Cutanea Tarda Clinical scenario mentioned
Photosensitive rash with bullaes + Hypertrichosis Defect in Uroporphyrin Decarboxylase25.
Menniere s Disease Triad Of Dizziness + Tinnitus + SNHL26. Pneumothorax after Trumpet Usage
Cant do scuba diving for life27. Wernickes Aphasia Fluent but Word Neologism Comprehension
Impaired Location ON superior Temporal gyras)29. Hayflick Theory of ageing of cell Involves
Telomeres30. PICA Ipsilateral Ataxia, CN palsy Contralateral limb sensory involvement31.
Syringomyelia (loss of vibration doesnt support this)/ cervical myelopathy ?? Diagnose from Clinical
Picture32. Phenytoin not effective appropriate blood levels not achieved next action ??? increase
dose/reload with 1 g?33. Hemiballism characteristics mentioned Subthalmic Nucleus in volved35.
Cause of Hematuria in Which anticytotoxi Cyclophosphomide36. Hereditary Spherocytosis Dx by
Osmotic fragility test37. Dignosis fro clinical picture PO2 is N, SPO2 is decreased
Methaemglobinemia38. PRV Rx by Hydroxy carbamide39. Clinical Picture of Bloods indicating
Neutropenia in Middle Eastern Person <1.5 Racial Variation40. Von willibrands disease Clinical
picture APTT prolonged
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41. ITP42. Sick euthyroid Syndrome44. Exanetide GLP1 analogue45. Production Of Ketones in DKA
Lipolysis46. Pheochromocytoma associated with MEN 247. Carcinoid Syndrome Dx by HIAA48.
Travellor coming from India Bloody Diarhoea Amoebiasis49. Terlipressin Before doing Endoscopy
and banding in UGI Bleed51. Hypori causing MALToma Rx by Hpylori eradication therapy52. 53.
Diabetes Long duration pain after meals Chronic Pancreatitis54. Ulcerative Colitis Treatmentmaslazine
enema.. (masalazine topical is superior to topical steroid) 55. Fulminant Hepatitis in Pregnant lady Ex
is Hepatitis E56. Streptococus Sanguinis ??57. C3b nephritic Factor seen in MCGN Auto antibody58.
FSGN seen in HIV, IVdrug abuser59. Clinical features given Dx Lateral Epicondylitisscenario of
multiple myeloma patient61. Mixed Cryoglobulenimia ?62. Psoriatic Arthropathy4. HTN in pt. < 55yrs
DOC ACE Inhibitor65. Clinical picture indicating Dx of Cardiac Tamponade66. PET Scan Uses
Fluoeodeoxyglucose67. Mouth Ulcers seen in Nicorandil Usage68. Long QT syndrome associated with
KCNE1 gene involvement69. Pt. age >70yrs + severe Aortic Stenosis Rx by balloon valvuloplasty..
(patient had iHD and duedoanl ulcers.. prosthetic valve wud require anticoagulation for 3 months..not
possible due to duodenal ulcers) 70. PAH Dx by Cardiac catheterization71. Clinical Picture of TOF
indicating Ejection Systolic murmur Pulmonary Stenosis72. Low O2 delivery Low PCO273.
Bronchial asthma severe Rx by IV MgSO474. COPD Rx decrease o2/ cpap??75. Pulmonary
Embolism Dx by CTPA76. Pneumonia + clinical Picture Of Erythema Multiformes Mycolplasma
Pneumonia 78. Bronchiectasis reason for hempotysis??79. Immunocompromised Pt. C.I vaccine
Yellow Fever80. Reason for Resistance to anti Retroviral Drugs reverse transcriptase gene81. Pan
Valintino Leucocidin Gene involved in MRSA Rx ???82. Lyme Disease Clinical Scenario Given Pn
Allergic Rx by Doxycline83. Non Falciparum Malaria Rxchloroquine84. Rx of Gonorrhoeaceftriaxone85. Painful Genital Ulcers with Painful Inguinal Lymhadenopathyhemophilus ducreyi86.
125. Large ulcer on shin .. With purple edge .. Treatment ...steroid126. One question : delta wave .
Short PR !Aoociated condition that present Ebstein anomaly ?( I didnt find secundum ASD in the
option ..) if it was there then that was the answer127. One question :Pt with rheumatoid arthritis ... Low
iron raised ferritin Anemia of chronic disease ? 128. 129. alytic error in ABG Answer ? D .... Every
thing was inappropriately raised..130. with SLE comes with DVT.. Investigation ? anti cardiolipin
/lupus...since patient was anticoagulated anti cardiolipin wud have been much better option...
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131. narrow complex tachycardia arise from which part of the conducting system... AV node132.
Patient in Indonesia with fever, chills rigors, tender hapatomegally, conjunctivitis...leptospirosis133.
MOA Thrombocytopenia in Heparin use antibodies against heparin attached to plasma fibrin134.
Orogenial ulcers behcets135. Detrosor activity increase excitability and decrease tone136. A
diagnosed case of HIV lost to follow up came with a cell count of 450 ( not exactly remember) but
question was by what mechanism virus replicate ? lymphoma ??137. alport or igA (sensorineual
hearing loss suggested alport but history was acute and patient age of 38 were pointer toward IgA
nephro 139. celiacpatient with abdominal signs and iron deficiency anemia140. intermittent diarrhea
+joint pains enteropathic arthropathy / whipples?141. apo e2142. patient returning from an island had
malarial prophylaxis mefloquine psychosis??143. parkinson patient seeing object and recognizing later
on that it wasnt there actually visua hallucination/illusion144. pancytopenia and rasied LDH
PNH or paroxysmal cold hemoglobinuria ??145. patient with aortic dissection surgery smoking
cessation146. stroke prevention aspirin147. risk of increase rhabdomyolisis amiodarone148. pt
with the features ofmultiple myeloma... investigation serum elctrophoresis149. raised cortisol plus
obesity but htn cushings150. obese pt with acne and hisutism slightly raised testosterone but normal
usg and normal lh fsh ... PCOS(dont remember the other options)151. postural hypotension...decreased
thyrid profilehypopituitarism152. female with rasied testosterone... lack of secondary sexual
characteristics..(androgen insensitivity syndrome)153. female with hirsutism ...masculine feature...and
inc hydroxyprogesteroe and raised testosterone.. CAH154. 155. raised ALP ..normal calcium nd
phosphate pain on thighspagets...systoms faovur oesteomalacia but labs favour pagets156. oldie with
oesteopenia do dexa scan157. asbestosis exposure stop smoking..( it multiply the risk)158. denovo
adpkd further transmission( no idea)tongue emoticon
159. 60 %penetrance 60% chance of developing sysmptoms160. 161. 162. diabetic nephrathy/
contrast nephropathy photocoagulation scars was a pointer toward diabetic nephropathy but recent
contrast was pointer toward contrast nephropathy163. 164. opaque corna and hypopion ?? 166.
obstructive picture on spirometry of an obese patient emphysema...167. occupational asthmareduced fev1/fvc168. rasied calcium nd phosphate in upper rangesi a patient taking muti vitamins..
vit D intxication 169. parvo virus/ IDA/ hemoglobin E ..(cant recall the question exactly)170. pt having
ona dn off seizures blah blah AV malformation / sclerosis of the temporal region171. post
angioplasty reduced BP iv fluids/ dobutamine
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172. patient already taking mesalazinestarted azathioprine and started to have muscle pains stop
mesalazine/ stop azathipine/give steroid?? 174. urge icontinenece in multiple sclerosis
175. patietn takig paroxitene and stops it..come with headaches... paroxitene withdrawl 176. somatic
hallucination/ over valued idea??177. A stat question abt relationship of two variables/outputs correlation178. another stat question abt the analysis meta analysis
179. lymphoma pateitn having tonic clonic seizure...drug ?180. mother with colon cancer...child with
iron deficency anemia > colonoscopy/ fecal occult / ion replacement181. Difference in the action of
Immunoglobulins and t cell receptos epitope recognition ??182. small cell cancer pt with stridor183.
polymyalgia rheumatica...stiffness plus raised esr184. common bile duct jaundice plus raised
amylase185. intrinsic factor antibody in patient with pancytopenia186. vit b12 used in red cell
nucleic acid sysntheses in the start187. folic acid defiency in a patient whose slide showed
hypersegmened neutrophis188. bleeding and rasied INR give prothrombin complex concentrate
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Dream .....
recall sep 2015 part 11. 2. Contact lens history + Hypopyon Uveitis3. Bupripion receptor action
partial agonist4. Most significant Suicide risk factor age? alcohol?5. 6. Paralysed patient. Cause of
hypothermia? Loss of shivering?7. Patient with decreasing visual acuity. Pinhole test reveals no
improvement. Cataract? Macular degeneration?8. Pregnant patient TFT panel. Normal FT4 and TSH,
Increased Total T4 Normal9. Paired test of comparing efficacy of two drugs using a scale of ordinal
variables Wilcoxon ranked sum test10. Studying drug efficacy Phase 2b trials.11. Patient with
osteoarthritis? Was this a question?12. Pt with DM. Most imp risk factor for CVD. BP?
Hypertryglycedemia?13. C3b Nephritic Factor what is it Autoantibody14. HTN in <55 years ACEi15.
Painful red eye + RA Scleritis16. Bicycle accident right side headache which later progressed to left
sided hemiparesis?17. PICA stroke?18. Enzyme responsible for resistance in HAART Reverse
transcriptase19. Hyperacute rejection IgG20. Neutropenia in a middle eastern man Racial variation?21.
MEN2 Pheochromocytoma22. Digitalis toxicity precipitation Hypomagnesimia23. Long QT
syndrome KCNE1 gene2425. difference between cryoprecipitate and FFP26. Down syndrome + late
systolic murmur + Increased JVP VSD? Tricuspid stenosis?27. Beckers MD. FHx Father and paternal
uncle has the disease. Xlinked recessive. 0% chance of transferring to child28. Which part of ECG does
S4 correspond P wave.29. What plays role in central respiration control.30. Drug causing
hypercalcemia Thiazide diuretic? Don't remember what were the options31. Immunoglobulin part
which attaches to macrophages Fc32. Phase 0 ion movement Sodium33. Insulin receptor location Cell
membrane.34. Prolonged aPTT, followed by normalization on mixing study vWD? Hemophilia? 36.
Pregnant women with face darkening Melasma38. Pulmonary Artery hypertension. Next best step or
investigation don't remember the question exactly. Cardiac catheterization or Echocardiography.39.
Patient with diarrhoea and CT scan shows hepatic mets Carcinoid or VIPoma?40. Five year study on
new drug and diabetes. Test? Kaplan mer41. Superior oblique muscle action Depression and adduction
CARDIOLOGY
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HEAM/ONC
1. spherocytes in peripheral blood film, what test to do next= DAT
2. bite cells in peripheral blood film after treatment of UTI with ciprofloxacin, cause= G6PD
Deficiency
3. menorrhagia with bruises, small rise in apt and small fall in platelets, Dx=Von-willebrands
4. 70 years old with lymphocytosis, Dx=CLL
5. 10cm splenomegaly with neutrophilia, Dx= Myelofibrosis/CML?
6. 56 years active blood donor has now been refused as blood donor, he is assymptomatic and
systemically well, blood film shows iron deficiency , likely cause= small intestine dysplasia/colon
cancer?
7. Recurrent abortions with Dvt, ECHO findings= normal
8. Patient with a Episode of Haemetemesis presented, now hb=100(130-150) , what
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PHARMACOLOGY
1. Digoxin prescribed to old age patient= volume of distribution increases
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CLINICAL/BASIC SCIENCES
1. Cause of increased anion gap= methanol poisoning
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DERMATOLOGY
1. Acne with scars, Rx= oral isotrtinoin
2. HIV +ve patient with pink patch on chest= Kaposi`s
3. Velvety lesions on flexures and neck ( dx=acanthosis nigricans), asosiation= gastinoma
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ENDOCRINOLOGY
1. characteristic of MODY= Family Hx
2. interpretiton of thyroid hormones, Dx= adequate dosing
3. hypothyroid patient presented with acute flare, Rx= Steroids
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GASTROENTEROLOGY
1. Bilirubin got raised after 1 week of starting co-amoxiclav, cause= co-amoxiclave/ gilberts?
3. Dx a case of Hepato-renal syndrome
4. Hepatitis C complication= PCT
5. Hepatitis C case= check for antibody
6. Anti-Tb meds caused hepatitis, now they are stopped , how to monitor response= liver enzymes
7. Best antiviral response to interferons if it shows = HbeAg ( Infective particle)
8. Dx of possible Laxative Abuse
INFECTIOUS DISEASES
1. LGV Rx= doxycycline
2. Lyme disease rash in pregnant, previous hx of allergic rash to penicillin, Rx=Cephalosporin
3. Migratory arthritis scenario, Dx= Lyme disease
5. Case of Reiters, asosiated eye findings=conjunctivitis
6. Ring enhancing lesion in parietal area , Dx= Toxoplasmosis
7. Black spot on thigh after return from Africa= Tick typhus
8. Immunocompromised old age patient comes in contact with a child having chickenpox= give VZIG
9. Meningococcal meningitis Dx=Culture ( antibiotics have not been given yet)
11. Patient with subarachnoid heamorrhage presented 12 hrs later, what test appropriate= LP
12. Best test to diagnose Mycoplasma= cold agglutinins/ throat swab for serology?
13. Community acquired pneumonia= strept-pneumonie
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NEPHROLOGY
1. Nsaid induced ATN
2. Penicillin induced AIN
3. Prevent contrast induced kidney damage in a patient known diabetic= normal saline
4. Colon cancer has been surgically removed in patient, his kidney functions have markedly improved,
dx= membranous GN
5. PAN= MPO
7. Comon with type-1 RTA= nephrocalcinosis
9. PKD= Ultrasound
10. C4 decreased= SLE
11. Dx of glomerolunephritis= renal biopsy
12. Long standing kidney disease , one kidney has size of 7cm now= amyloidosis?
13. Scenario of pyelonephritis
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RESPIRATORY MEDICINE
1. Dx of idiopathic pulmonary fibrosis
2. Upper lobe fibrosis with skin findings= sarcoidosis?
3. 3cm mass, suspected small cell cancer, Rx= chemo/surgery?
4. OSA Characteristic feature= excessive daytime sleep
5. Dx of chronic occupational asthma
6. Dx of psychological Hyperventilation
8. Increased survival in COPD= LTOT
9. Pulmonary edema not responsive to CPAP, Rx= NIV
10. Pleural effusion and thickened pleura (mesothelioma), best test to diagnose= pleural biopsy
11. Pulmonary emboli , most common ecg finding= tachycardia
12. Possible Dx of Emphysema( alpha anti-trypsin deficiency
13. Dx of Ext.Allergic Alveolitis
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PSYCHIATRY
1. Dx of global amnesia
2. Dx of Somatisation syndrome
3. Dx of Panic disorder
4. Dx of Depressive disorder
5. Dx of acute schizophrenia
6. Dx of anorexia bulimia
7. Dx of wernekes encephalopathy
8. Dx of amphetamine induced psychosis
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RHEUMATOLOGY
1. chondrocalcinosis= pseudogout
2. distal joint involved, mild morning stiffness, Dx= osteoarthritis
3. case of osteoarthritis, now same joint inflamed , swollen, Dx= septic arthritis
4. knee joint swollen,temp of 37.5, patellar tap absent, Dx= prepatelar bursitis
6. Dx of Limited systemic sclerosis
7. Pain in right hip joint , gets better with analgesia , now pain in left hip joint, Dx= Bilateral Hip
dysplasia/ reflex neuropathy?
8. Scenario of eosinophillic fasciitis
9. Migratory arthritis= lyme disease
10. Dx of Ankylosing spondylitis
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1.
GuestGuest
#1
2.
AYGuest
It was ok only...
let god help us this time..
Hi asya...
AY, May 11, 2011
#2
3.
Dr.AYGuest
NEUROLOGY
Neurology
1.NPH
2.CJD
3.Na Valproate and OCP-Lamotrigine
4.Syrinx
3.Thiazides- DCT
4.Ca Colon post OP- Membranous nephropathy
5.ARF with hypotension- ATN
6.Rhabdomyolysis with ARF
7.CRF with hyperkalaemia with uraemia- Haemodialysis
10.PVD with proteinuria with difff in lidney size- Ischaemic nephropathy
11.Poat renal transplant with acute rejection- Methyl prednisolone
12.RA with 4+ proteinuria- amyloidosis
13.IGA - Mesangial hypercellularity
14.HTN with HYPOKALAEMIA with increased renin- Renal artery stenosis.
15.Hyperkalaemia- immediate Rx- IV Cakcium gluconate
16.Central pontine myelinosis- water out of the cell
Dr.AYGuest
GENETICS
33.CF parents with carrier chance-0%
34.Hemophilia A- 25% chance
35.Hereditary Hgic telengectasia- AD
36.Marfans-fibrillin
37.only males affected- Xlinked recessive
38.chromatids into chromosomes- prophase,mine wrong- telophase
39.Klienfelters- chromosomal analysis
40.PCR-CSF viral meningitis
41.probe for DNA- in situ hybridization
DERMATOLOGY
42.Porphyria cutanea tarda
4.
AffyrajGuest
FEW MORE
LITHIUM TOXICITY--TREMOR
SPENOMEGALY, ANEMIA , HIGH LDH LEVEL , VITTILIGO---AUTOIMMUNE HEMOLYTIC
ANEMIA
INJECTION SITE ABSCESS---STAPH- I.E --FLUCLOXACILLIN
BREAKDOWN PEPTIDES--PROTEOSOMES
ONE ANSWER --CUSHINGS --OBESITY , BRUISES
REPEATED PYOGENIC INFECTION --COMPLEMENT DEFECIENCY
PARACETAMOL POISIONING ---ACETYLCYSTIENE-- INCREASE
CONJUGATION///DECREASE TOXIC METABOLITE
G PROTIEN RECEPTORS--MEMBRANE RECTORS--PLASMA MEMBRANE
CHOREA WITH ATAXIC GAIT, NO FAMILY HISTORY--WILSON (MORE)//FREDRICHS
ATAXIA
TEST TO DIAGNOSE A DISEASE--?? PPV//SENSITIVITY
HIGH ALP WITH LOW CA N LOW PO4--OSTEOMALACIA
GBS-- BEST PREDICTOR ---VITAL CAPACITY(FVC)
C.DIFFICLE TOXIN DIARRHOEA---CEFUROXIME
RIGHT HEMIPARESIS WITH AF ---START ASPIRIN
STENOSIS CAROTID --50 %--ASPIRIN TO START
VWB DEFECIENCY --DDAVP TO GIVE BEFORE TOOTH EXTRACTION
5.
Dr.AYGuest
GASTROENTEROLOGY
71.Elderly with reflux esophagitis with ?Barrets- Adeno Ca eosophagus
72.Chronic Pancreatitis- confirming Dx- ERCP.
73.UC- Reducing long term relapse- Azathioprine
74.IBS- no relief after defecation
75.pseudomembranous colitis- cephalosporins
76.Diarrhea after cholecystectomy- Rx.Cholestramine
77.Diarrhea-HUS--- E.cole 0157
78.IV drug abuser with HCV Ab- Chronic HCV
FACTOR V MUTATION --ACTIVATED C PROTIEN RESISTANCE ---- i put tpa activator..not sure..
6.
Dr.AYGuest
RESPIRATORY
86.COPD on inhalers, mildly confused-- nebulization with brochodilators
87.COPD with high pco2- stop O2
88.Another COPD- Intermittent ppv
89.Profound vomiting- Metabolic alkalosis with hypokalaemia
90.occupational asthma- serial PEFR
91.EAA-Barley....MINE WRONG
92.Ca-- Brachial plexus invasion
93.Legionares pneumonia- Urinary Ag
brown sequard,
ant spinal a,
brain abcess,
syrinx,
mnd,
vital capacity,
MG,
Short term memory,
brian stem herniation,
water +NA,
CJD
propraonolo,
Idiopathic parkinsonism,
Nucleus subthalamus Infarcation,
Ropinerol,
L5S1,
C6 radiculuopathy,
Sumatriptan,
NP hydrocelpahlus,
opticneuritis,
scleraitis,
6th cr n polsy,
macula smoking,
bone pigment for the tubular filed ???
BCC,
Cholesterol embolism,
lichnepalnus,
scapies,
emolltions,
Ig-a
tetracylicn,
isoretinoic,
porphyriacutanea tarda,
asprina rash,
INt =ve pr
intubae & ventialte,
pul metasis,
nebulizer salbutamol,
stnet,coial workers,
serail PEER,
phospholipid,
discharge OPC follow up,
pyridoxine,
AD,
polygenic,
transferring,
gonadotropin profile,
E;astase,
19-chromose for pancreas c,
Col adenocarcinoma,
adenocarcinoma,
MEN1
UC--> ciclosporin,
life style,
abd pain IBS
hypokalemic alkalosis
monometry,
cholestyramine,
retrograde MRCP
yellow fever,
HAV
Complement
hypogamaglobulin
swathernblot for DNA
pasta
protien c
IV-IG
myeloma,
osteoyleitis,
prednisiolone,
psoriasis (dactalitis)
resorve (lofgreen sarcodi)
hypercalacemeia (systmeic sarcoid)
osteomalcia
sarcoid,
anticardiolipin
anti rnb
Sle methotrixate
temporal arteritis,
lamotrigine
BB
Gancyclovir
CD20
li
carbamazeipine toxicity
xanthine oxidase
methb fe++
decrease toxic metabolite with nacetyl cystine
metaclopramide
cefuroxime
cefalosporin teratogenic
E-coli
shigella
loacal control measure
choloroquine
typus
typus
TB
dptheria
unrine ag
metronidazoloe
parvovirus
strept pneumonia
arthropathy with recuurnet gononnhea
CMN
amyloidosis
interstial nephrisits
renalosteodystrophy
cresent
membarnous
follow up prognosis by blpr monitoring
ADH
DCT
godpasteur
wegners
thick euthyroid
addisons
hashimoto
toxic thyrodi nodule
insulin
g-portien memebrane
avascualr necrosis
sterodi induced
increase insulin resisntan
unpairned t-test
50%
50%
metanalysis adverse effect mointoiring
snesnitivity
8
fatigue,
blast cells
pernicious anameia
tranceximic acid
jak 2
dextrose IV
heart block
brachialpleuss
hypochondirasis
behcet
felcanide
flushing
mall cell c
DDAV
prologn fast
bound to plasma protien
7.
calmGuest
one was type1 resp failure with tachypnea and tachy....give LMWH.
8.
calmGuest
young man with previous t9 level...then loss of everything from T5 to T9_____i wrote metastasis....it
didnt justify spinal art oclusion...because not everything thing was lost below T9...ie..it was a
i chosed pyelonephritis for renal failure cause in one question.fever,tender loin etc...
radiation pnemonitis in lady with post surgery and post readiotherapy chest pathology???? correct me!
renal art.stenosis
one was wegners and another was goodpasture....which one was with rash on lower limbs???
and Tick typhus in another...i m not sure!
Question was....
Females maternal grandfather had Hemophilia A.
So Her mother had 100% chance of carrier...
BUT she had only 50% chance of being a carier
Out of the 50%, Her SON had 50% chance of getting the disease.
So its 25%...
Am i clear..Any doubts..Pls clarify.
THey had asked CER not case event rate--- so its 100*100/1000=0%
CF Parents-- both genes affected------ so change of CARRIER STATE in their children is 0%...
Acute MI---PCI
9.
GuestGuest
eaa
10.
GuestGuest
11.
Dr.AYGuest
12.
StarguestGuest
They've specifically said pain and temperature slightly more affected.It is a consequence of
syrinx(affecting central portion of cord)
98.Reduced intensity of AS murmur- heart failure
99.Cardiac tamponade-pulsus paradoxus
100.Paroxysmal AF- Rx-Flecainide
101.Hemiparesis with AF-Warfarin
102.50% Carotid stenosis- Asprin
103.Pt with edema,ascites,raised JVP- Constrictive pericarditis.
104.Stridor, malignancy- Anaplastic Carcinoma
105.MI with CHB- RCA
106.Acute MI with ST changes- PCI
107.Acute MI with eosinophilia--- Cholesterol embolization syndrome
108.Not removed by HD- protein binding
Dr.AY, May 11, 2011
#26
13.
Dr.AYGuest
OPHTHALMOLOGY
134.RA-scleritis
135.macular degeneration-smoking, i put glaucoma
137.bone pigment for the tubular filed ??? -?? RP
14.
calmGuest
@dr Ay...in HS encephalitis CSF glucose becomes LOW so i chose sum other option.... :?:
.TB
.METCLOPOMIDE
.PROSTAGLANDIN E2
.SCELIRITIS
CORRECT ME PLEASE?
.ANTI CD20
.ICU ADMITION FOR COPD PT
Guest, May 12, 2011
#40
15.
calmGuest
I think 80 to 100 Questions would be attempted correctly by most individuals....the difficult ones were
about 60 to 80 questions that took us alot of time to think n re-think and we only can recall those tough
ones because we spent time on them......
ICU admission of COPD?...i doubt this....rest, urs are correct probably!
calm, May 12, 2011
#41
16.
GuestGuest
17.
GuestGuest
.HYPOPITUTRISM
.OSTEOMALACIA
.MEN1
.ASPIRIN CAUSE OF SKIN RASH
.SYRINX
.HAV
.OSTEOMYLITIS
PERNICIOUS ANEMIA
Guest, May 12, 2011
#43
18.
calmGuest
19.
GuestGuest
carcinoid..i wrote flushing but its wrong....flushing is the most common symptom og those carcinoids
which arise from midgut and the one arsing from foregut( i-e bronchial ca) present with hemoptysis
most comonly.
after a patient who suffers stroke we wait for 14 days if we are to start Warfarin....so i didnt start
warfarin immediatly after stroke in AF..i gave aspirin.
In carotid stenosis..if its less than 70 with no clinical features we give Aspirin and if it develops clinical
features,we give warfarin.
:?: :?: :?: :?: :?:
calm, May 12, 2011
#46
20.
calmGuest
@dr noona..i think it was chronic hepatitis C as acute Hep A presents with frank jaundice and fever and
chronic C presents with vague malisa and fatigue which this patinet presented with...
21.
GuestGuest
YES DR CALM I AGREE WITH YOU IN ALL EXCEPT THE LMWH FOR OVER
WARFARINIZATION IGUESS ALL THE REST TRUE I HOPE!
Guest, May 12, 2011
#48
22.
DR CALM I THINK WE SHOULD FIND THE HCV RNA OR LIVER BIOPSY TO CONFIRM THE
DIAGNOSIS OF CHRONIC HCV AND WHAT IS THE EXPLANATION OF HAV +VE IGM ABS
I THINK!
138.asprin-rash,
139.fluocoacillin for that abscess question
140.Anxiety with ambulatory ECG free during the attack--> observe
141.VSD - v/q more at the apex in upright lung
142.vital capacity for GB
143.Short term memory- Korsakoffs Psychosis
144.Neuroleptic malignant syndrome-muscle rigidity
PHARMACOLOGY
145.NHL-antiCD20
146.confusion and tremor-lithium toxicity
147.Allopurinol-xanthine oxidase inhibitor
148.methhemoglobinemia-Ferrous to ferric
149.Prolactin-metaclopramide
150.teratogenic-Ciprofloxacin i think
151.Imatinib-tyrosie kinase inhibitor
INFECTIONS
153.E-coli..??First-Ciplox OR loperamide
152.Diarrhea in Nile cruise-shigella
153.MAC--???GLOVES /??? pulmonary isolation
154.P.Vivax-First Rx-choloroquine
155.Tic typus
156.diptheria
157.Pneumonia with SIADH
158.Recuurnet gononnhea-arthropathy
159.Rx.Gancyclovir
160.Osteomyelitis
HAEMATOLOGY
161.symptom of Myelofibrosis-fatigue
162.ALL--BCR ABL mutation
163- one more controversial Q-??pernicious anameia/cealiac disease/autoimmune hemolytic anemia
164.PV-jak 2 mutation
165.Patent foramen ovale.
May 2011
1. Cause of cortical blindness
2. Nephrogenic DI cause - Lithium
3. Cystic Fibrosis inheritance - Autosomal recessive
essential tremors-benxhexol
ADPKD- US abdomen
velvetty skin-glucagonoma
9.acls adrenaline
10.skinprick penicciline test
11.high protein oedema
12.giant cell athritis
20.Pe on abg
21.cyclic dna -mitochondria
117.achalasia + monometry
118.pyoderma gangrenosum 119.recurrent uti ? Reflux
120. Gn post cancer ?
121.nsaid nephritis +
122.pulmonary renal dx ?
123. Swanoma + cronial reflex
124.pkd + us ren
125.blood film ?
126.mylofibrosis?
127.
128.chads + previous stroke
129.chads + warfarinize
130.rituximab + cd20
131.tube neuro dx ?
132.bulimia
133.wernick
134.septic athritis
135.gilbert
136.skin failure ?
137.malignant htn + labetolol
138.scleritis epescleritis?
139.
140.cushing dx overnight dexa
141.essential tremor + propanolol
142.leismaniosis
144.cat screch + bru
145.anti phospholipid normal echo
146.pheo 24 urine
147.ramipril
148.copd ltot
149.surfactant t2 pneumocytes
150.ra atnf
161.lyme dx
171. Limited ss
172. Junctional rhythm
173.acute pancreatitis alcohol vs gs
174.carotid stenosis plavix
175.gbs vc
176.metformin peripheral intake
177 sle -c4
178.osmosis
179.rhamdo
189. Afib echo la enlargement
190.sex attack elderly?
191.flexir polici brevis
192.thoracoscopy - mesothelioma
193. Thyroid pt -steroid
194.mi-statin increase survival
195.iga-htn indicator poor prog
samuel, Jan 17, 2014
#5
1.
samuelNew Member
rituximab-anticd20
gliclazide -treatment for DM2
sinus tachycardia. PE
primary myelofibrosis -73 yrs leukoerythrocyte normal wbb
2.
samuelNew Member
dsdna -mitochondrion
dvt e stroke and 2abortion,.normal echo
gram positive diplococci -streptoo pneumonia
INH -acetyltransferase
3.
KhaledNew Member
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2.Known RA,Now low fever,local rise of temp at knee joint,mild swelling at the ankle - ?Septic
arthritis ,?cellulitis.
3.Marfan's syndrome - Fibrillin
4.Q on hereditary hemorrhagic telangiectasia
5.Q on cystic fibrosis mutation(Only single mutation seen,WHY?)
6.Von willebrand disease(Hx of post partum hemorrhage)
8.80 year old, why to reduce digoxin dose - ?decreased creatinine clearance
9.Anal ulcers(CLEAN) in homosexual hiv positive - ?CMV
40.young girl standing still,one hand over head and one hand at the back,not responding - Factitious
disorder
41.Obese female with b/l papilledema - BIH
42.Decreased factor VIII - Von willebrand disease
43.Rash on the face with anemia - B19 virus
44.58 year old male 6 month h/o diarrhea,weight loss,respiratory symptoms,positive for strongylides
stercoralis,should be screened for - ?HIV
45.Bloody diarrhea - solmonella
46.Alcoholic ,ultrasound of liver hyper echogenecity - Fatty filtration
47.unable to abduct arm(painful and limited) - ?rotator cuff syndrome,Deltoid tear
48.Fever,rash,Retro orbital pain - Dengue fever
49platelet count 12,bleeding signs +ve, -?Platelet transfusion
50.Fever,sore throat after using amoxycillin - ?EB virus
51.Vaccine contraindicated in HIV pt - ?BCG,?Rubella
52.Gram +ve bacillus - Listeria meningitis
53.False negative rate - ?5/1000(Total no of Patients)
54.Normal glucose,elevated protein,lymphocytes - Viral menigitis
55.Epidydimitis treatment - Ceftriaxone + Doxycycline
56.Painful thumb movement - De quervans tenosinovitis
57.Post traumatic lesion - Poast traumatic syringomyelia
59.Q on signs of Congestive heart failure ,what to aim first?- ?decrease preload
60.Tricuspid regurgitation,Hepatic features - Carcinoid syndrome
61.Pt repeatedly coming to the hospital with different complaints,but all the tests are normal,now
attended the hospital c/o abdominal pain,and asking for morphine inj ,otherwise will commit
suicide,father died of pancreatic ca 8 years ago - ?Hypochondraisis,?Munchausen syndrome
62.Resolved pneumothorax,chest tube removed - ?discharge and repeat cxr after 2 weeks
63.ST elevation in V1-V4,ST depression in inferior leads - ?Complete Occlusion LAD
64.HLA B - Ankylosing spondylitis
65.DVT,Thrombus in arteries if leg - LMWH
67.Pt admitted with COPD,AF ; low tsh, low t3, Normal t 4 - Sick euthyroid state
1.
samuelNew Member
anti ccp-RA
NHL-anti cd-20
pemphigus vulgaris
bullous pemhigoid
von willebrand disease
marfan-fibrillin
gentamicin-acute tubular necrosis
CRF- secondary hyperparathyroidism
wernicke-korsakoff- IV thiamine
addisonian crisis- iv hydrocort
ITP-prednisolone
pulseless VT- non synchronised DC shock
wernicke-korsakoff- nystagmus
abduction of thumb pain- carpal tunnel
retrosternal chest pain- reflux esophagitis
pre angio drug to stop- metformin
2.
samuelNew Member
3.
samuelNew Member
4.
samuelNew Member
BNP_ VENTRICLES.
PERNICIOUS ANEMIA(ANTIPARITAL CELL ANTIBDY)- VITILGO
ANDROGENINSENSIVITY-KARYOTYPING
naproxen - arthritis(prevous peptic ulce)
opposite side of sternocledomastoid
discitis- post op
g protein coupled receptors
mast cell - release
daily potassium req-60
scenrio of catatonia
5.
samuelNew Member
22.scenario of SOMATIZATION
23. peripheral neuropathy--NITROFURANTOIN
24.cisplatin-- SENSORY NEUROPATHY
25. scenario on asthma treatment--ADD SALMETEROL
26. 4days of treatment with broad spectrum antibiotics for neutropenia has failed what is the next step-CHECK FOR CANDIDA
27.ecstasy--HUPONATREMIA
28. scenario of NEPHROGENIC DIABETES INSIPIDUS
29. which drug to stop before angioplasty--METFORMIN
30. findings of extrinsic allergic alveolitis -- UPPER LOBE FIBROSIS
31.DM patient with tender erythematous leisons on shin--ERYTHEMA NODOSUM
32. scenario of BULLOUS PEMPHIGUS
33. hypertension with hypokalemia--LIDDLE SYNDROME
34. RTA findings--HYPOKALEMIA
35. amiodarone mechanism of action-- CALCIUM CHANNEL BLOCKER
36. psoraisis exacerbation-- BETA BLOCKER
37.scenario of HOLME ADIE'S
39. SENSITIVITY
40.Lithium posioning-- hemodylasis
41.patient presented with unknown substance posioning with confusion and eye symptoms-METHANOL
42. role of terlipressin in hepatorenal syndrome-- VASOCONSTRICTION OF SPLANCHIC
CIRCULATION
43. IgE is produced by-- PLASMA CELLS
44. blood test prior to renal transplant--MHC II
45. vaccination in HIV patient that will cause active disease-- BCG
46. treatment of epididmytis-- IV CEFTRIAXONE, DOXYCYCLIN
47. source of BNP secretion-- CARDIAC VENTRICLES
50. bloody diarrhea on 3rd day-- SALMONELLA ENTERIDIS
51.prognositic factor for melanoma--DEPTH OF MELANOMA
viral meningitis
rt sternomastoid
no carotid intervention
jugular foramen
oral diclofenac
unipaternal isodisomy
achalasia
subdural hematoma
de quverian tenodosynovitis
Optic neuratis
adesive capsulitis
sec hyperparathroidism
Cetrizine
oral 5 fluro
dermatitis herptiformis
BB
steven jonnson
somatization
adjustment
mancausen
paranoid shizophrenia
salmonella
TB and HIV
strongyloid and HIV
samuel, Sep 24, 2014
#12
6.
samuelNew Member
Dengue
diphteria
progressive supra nuclear
staph discitis
diazepam withdrawl
lithium hemiodialysis
L5
ANTicipation
carcinoid
marfan fibrillin
abx prophylax
craniopharyngioma
skin patch
cisplastin neuropathy
catatonia
bartonella
herpes
B thalasemia
anaplastic thyroid
viral meningitis
sick euthroid
LBBB
flecanidie
low lean body mass
MDMa hyponatremia
S3 heart failure
testosterone
colchinine pericarditis
BNP ventricles
plysomnography
heamatochromatsis
psudogout
giant cell artritis
rheumatoid ccp
apoplexy
herniation
bladder Ca
samuel, Sep 24, 2014
#13
7.
samuelNew Member
Diagnostic and Statistical Manual Fourth Edition (DSM-IV) classification.[3] To diagnose major
depression, this requires at least one of the core symptoms:
8.
samuelNew Member
29.somatization sceniro
30.male sex with male nw ulcer in anal area ..gonococal proctitis
31.ticagrel m..o.a....ADP inhibtors
32.cardiogenic syncopy
33.echo in colapse for runing for bus
34.v.t...synchronizd shock
35.central cynosis n clubbing....Pulmonry stenosis
36.wilson...auto recesve
37.17 yrs old type 1 dm nw abgs low hco3 low k .hyprventilatng....Dka
38.paired t test
39.scater graph for data scenario
40.unpaird t test
41.false negative rate 495/500
43.scenioro of acromgly test OGTT WITH GRWTH MESURE
44.barter most specific hypokalemia
45.50.50 mixing stdy i mrkd hemoph A
46.itp..prednisolone
47.recurent T.i.a....warfarin
48.pas +ve...whipple
49.coeliac scenrio test anti ttg
50.antipareital atibx for pernicious
51.cystic fibrosis chnce of nxt child scenrio.. to effect 1 in 4
52n 53.also two othr on this topic for wilson n hemophilia tranmision to child
54.Cjd ...jrks
55.gbs
56.cervical cored compression nt sure
57.dermatitis herpit.
58.posiriasis worsng..bisoprolol
59.anticipation
60.whn to refer to opthalmolgy .... blot hemorhages seen
9.
samuelNew Member
108.scanario whr pt was counsld he may die aftr he rfused NIV N INTUBATION gvn informd consent
n thn deteriorated wt to do.continue with already gvn treat.
109. Person becoming drowsy 6 hours after confusion and headache vomiting episodescerebral
edema
110.man with fever his son had fever n facial rasherythrovirus b19
111.chromatids started to move opposite endsanaphase
112. Confirmatory for cardiac tamponade = Pulsus paradoxus
115. Person not getting relief after 200 mg of beclomethasone, next step = add Salmeterol
116. . Part of kidney impermeable to water Desending loop of henele?? Correct one is ascending
loop
117. Question on anti Cd 20= Lymphoma
118. s3( gallop rhythm)- poor prognosis in LVH
119. .ST elevation in V1-V4,ST depression in inferior leads - ?Complete Occlusion LAD
120. lung ca and GN- membranous GN
141. .Previously treated for Plasmodium falciparum and now c/o right upper qudrant pain - ?recurrence
of malaria,?HBV
142. Extrinsic allergic alveolitis which will sugest .presence of igE to allergen
143. Emphysema Pathophysiology - ?Dynamic airflow obstruction
144. Q on Mechanism of MODY GLUCOKINASE
146. DVT,Thrombus in arteries if leg - LMWH
147. Vaccine contraindicated in HIV pt - ?BCG
148. Fever,sore throat after using amoxycillin - ?EB virus
149. unable to abduct arm(painful and limited) - ?rotator cuff syndrome
150. Alcoholic ,ultrasound of liver hyper echogenecity - Fatty filtration
151. Bloody diarrhea in a child who been to a farm 3 times.ECOLI 0157
152. Obese female with b/l papilledema - BIH
153. Cells responsible for producing IgE - Plasma cells
154. Ig M ,Waldenstrom's - Hyperviscosity
155. Egg shell calcification hilar nodes - ?Silicosis
156. G proteins located at - Plasma membrane
157. 80 year old, why to reduce digoxin loading dose - ?decreased body mass
158.female with hirsute n obese family hx of mother death due to intracranial bleedAPKD
159.pt of r.a controlled on paracetamol now week hx of exb of asthma stoped paracetamol wt to
do.restart at same dose
160.pt treated for malignancy with chemo 4 days fever neutrophils 0.5 wt to dost antibiotic
prophylaxis
10.
samuelNew Member
Fluid therapy
The prescription of intravenous fluids is one of the most common tasks that junior doctors need to do.
The typical daily requirement is:
70-150mmol sodium
40-70mmol potassium
The amount of fluid patients require obviously varies according to their recent and past medical history.
MRCP PART 1 (9TH sept.2014) RECALL WITH CORRECTIONS
1.Cftr PATIENT ONLY 1 MUTATION FOUND WHYUNIDENTIFIED MUTATION ON CFTR
GENE as there are more than 1500 mutations on cftr GENE
3.cystinuria...recurent stones
4.marfan ..fibrillin
5.HYPOCHONDRIASIS ...wants morphine recurent er admissions THINKS HAS PANCRETIC
CANCER LIKE HIS FATHER WHO DIED BECAUSE OF IT
6.deprSSed on fluOxetine outside school claiming special powrs..ACUTE SUBSTANCE ABUSE
7.anti ccp....R.A
8.epididmytis...ceftri +doxy
9.cisplatin...PERIPHERAL NEUROPATHY
10.rasburicase...FORMS ALLANTOIN
11.acute renal failure...aspirin
12.penicillin induced nephritis
13.MACROLIDES DECREASE THE THRESHOLD FOR SEIZURES--CLARITHROMYCIN
14.tertiary hyperparathroidim with hypercalcemia n hyperphosp. N raised pth
15.primary hyperparaTHYROID
16.pain walking n lyng in dat side...trochentric brusitis
17.painless hematuria...bladder
46.itp..prednisolone
47.recurent T.i.a....warfarin
48.pas +ve...whipple
49.coeliac scenrio test anti ttg
50.antipareital atibx for pernicious
51.cystic fibrosis chnce of nxt child scenrio.. NO CHANGE AS IT IS AUTOSOMAL RECESSIVE
52n 53.also two othr on this topic for Wilson(AR) n haemophilia(XR) to child
54.Cjd ...jrks
55.gb SYNDROME
56.cervical cord compression
57.EXTENSOR SURFACE RASH UNRESPONSIVE TO STEROIDS--dermatitis herpit.
58.posiriasis worsng..bisoprolol
59.anticipation
60.whn to refer IN DIABETIC NEUROPATHY .... CHANGES IN THE MACULA
61.painfull eye mov n dec visual acuity....optic neuritis
62.d quravian tenosynovitis
63.recurent pericarditis...COLCHICINE
64. RECURRENT primAry pneumothorax aspiratd n dischrge AND xraY AFTER 2WEEKS AS ITS
RECURRENT
65.anaphlatic shck...i.m adrenaline
66.pitutry apoplxy gv hydrocortisone
67.MEN 2 scenario
68.thYroid area swelling bt labs normal mostly no sym...pregnancy induced
69.hogkin lymphoma treatd (WITH BLEOMYCIN) c.t chest 2 l.nodes small....FIBROSIS OF THE
NODES
70.raisd alt creatanine acutly in alcohlic n diazepam overdose with low body
temp...RHABDOMYOLYSIS
71.A.spondy...HLA B
72.klinefeltr scanario wich most ...valvular hrt dis
73..male with osteoprosis...chk testostrone
74.male pt with dec pubic n all 2ndry sexual charatr all testo lh fsh tsh low height
162cm....CRANIOPHARYNGIOMA
75.14 wk pregnat high bp....essential htn
76.painful penile ulcer hx of sex n recurnce...herpes
78.recurnt miscarges 3 IN FIRST TRIMESTER--ANTICARDIOLIPIN
79.LOW HBA2 AND ANEMIA- BETA THALASSEMIA TRAIT
80.iridated blood y....TO PREVENT HOST vs GRAFT DX
81.scanario with abx treat worseng of fever...glandular fever
82.wt to gv to lower k frm 7....i.v dextrose with insulin
83.copd with exb n deranged lfts....dont rembr wt i mark
84.terminal ileum removed now persistant diarhea...i markd biliary reason
85.excessive watery diarhea...VIPOMA
86.painless pr bleed family hx of ca colon AND BROWN MACULES ON lips...colorectal ca(PEUZ
JEGHER)
87.varicose vein drainage AZYGOUS
88.supply to pons ...BASILAR
89.CATATONIA
90.neck dystonia to left..RT sternocladomastod
91.homes adie scanario
92.anto yo/purkajie antobodies
93.gymnast preparong for competition hormone supresd....i mrkd prolactin
94.scanario of withdrwal of benzodiazipne
95.carcinoid with epidosic diarhea sweating wheeze n rt heart involmnt
96.pleural plaque calcification noted incidntly wt to do next i markd observe as thy r always benign n
almst never become malignant- YES DO NOTHING FOR CALCIFIED PLAQUES
97.pseudogout case
98.hx of rash whnever gloves used it was long hx ...skin patch test
99.on daily basis red itch patch formed thn dispaear in 30 min wt to gv...cetrizine
100.legs tense itch blisters....bulous pamphigoid
samuel, Oct 1, 2014
#18
11.
samuelNew Member
141. Previously treated for Plasmodium falciparum and now c/o right upper qudrant pain - HBV
142. Extrinsic allergic alveolitis which will suGgest .upper lobe fibrosis
143. Emphysema Pathophysiology - ?Dynamic airflow obstruction
144. Q on Mechanism of MODY GLUCOKINASE (HNF1APHA WAS NOT GIVEN)
146. DVT,Thrombus in arteries if leg - LMWH
147. Vaccine contraindicated in HIV pt - BCG
#19
12.
samuelNew Member
1-Corticobasa; syndrome
2-Which part of nephron remains impermeable to water in dehydration.
3-Patient taking multiple drugs(aspirin, amlodipine, ramipril) , having dehydration, dry oral mucosa .
Serum creatinine raised to 180 mg and pre renal picture. Which drug caused increase in creatinine ?
ANS _RAMIPRIL.
4-H/O -LITHIUM intake and different osmolarities given , not mentioned DDVP trial. Scenario was of
PSYCHOGENIC POLYDIPSIA , because serum osmolarity was 269 mmol/l.
samuel, Oct 2, 2014
#20
13.
samuelNew Member
FEV1 2.1 (2.6) FVC 4.5 (4.6) Rco normal Post bronchodilator FEV1 2.6 CXR and echo normal a
Emphysema B chronic bronchitis c heart failure d obstructive sleep apnoea e astham
174-Pregnant women with Hx of tonsillitis ,normal thyroid function ,with non tender thyroid goiter ?
answer iodine deficiency
samuel, Oct 2, 2014
#21
14.
samuelNew Member
Wernicke's encephalopathy
WE is characterized by the presence of a triad of symptoms;[4]
1.codeine
2.celecoxib relatively safer than ibuprofen.
3.pul HTN due to central cyanosis,murmur and clubbing.
15.
samuelNew Member
16.
samuelNew Member
GIT
1 Large amount of diarhea due to vipoma
2 diarhea wheeze lft derangd ,TR IS CARCINOID synd
3 perioral pigmentation ,bleeding due to ca colan
4 abd pain and distention ,fevr wl do neut count
5variceal bleeding due to gastrodudnal artery
6 clost dificle ist line oral metronidazle
7 obesity,ggt in biopsy fat cells
8 after iliostomy diarhea due to short bowel syndrom,bile salts in colon
9 pas +lymphad is whipples disease
10 bloody diarhea after 2 days of visiting farm area due to e.coli
RHEUMATOLOGY
CNS
1 Headach,6th nerve palsy,palliodema is IIH
2 Obesty+ocp headache .papliodema is BIH
3 TIA,afib give warfarin
4 oldage confusion due to SDH,EDH
5 ALL limb weakns+hypotnsion due to GBS
6OPTIC NEURITS painful eye movmnt,blurred vision
7 lft carotid 100%and ryt carotd 30% no intervention
8 vertical gaze parkinsonism due to PSP
9 PROGRSIV MEMORY LOSS due to CJD
10 AFTR truma few wekd latr toch ,temp loss is syringomylia
11 upr limb weakness sensory intact one ll weaknes(multifocal radiculopathy, CIDP,HSNM,cervical
neuropathy)
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Thread Status:
1.
GuestGuest
1. Normal XRay
2.CT scan
3. MRI
4. Isotope scan
Endocarditis in a patient with prosthetic valve. The possible micro organism is
1. strept viridians
2. Staph epidemidis
3. candida
4. staph aureus
coeliac disease positive test 40 negative test 10
Non celiac disease positive test 60 negative test 840
need sensitivity?
40%
80%
:
Scaly patches on the scalp in a 16 year old boy with non scarring allopecia
1. Discoid lupus
2. Psoriasis
Profuse watery diarrheoa even in fasting state
1 VIPOMA
girl ate in chinese restaurant, presented with V ANd D, what is the organism...B. cereus, E coli, (old
question)
unkempt guy, came to a school claiming to save children from ill of the world, dia ...
40s lady presented with some sort of rash over extensor surface, buttock, what investigation u wish to
order: viral swap from skin
lady 30-40, presented with proximal myopathy, rash over body. inve ...
. Mother presented with a few days history of rash over the body and arthralgia. Also have similar
40s lady presented with some sort of rash over extensor surface, buttock, what investigation u wish to
order: viral swap from skin
eldery lady in nursing home with genital discharge, vaginal swap noted N. gonorrhea, and was treated,
what you want to proceed: contact tracing, inform family, non-official inquiry.............
HIV positive with 2 months of cough, fever weight loss, which organism if grow from sputum
suggestive of AIDS: TB...............
Known IVDU on methadone for post-hepatitis immunization workupg, noted + HBsAg, - HBsIG, +
HCV. what is the cause of failed immunization: HIV +, chronic hepatitis C, Methadone
interaction...........
Man came from form summer holiday in Jerman, presented with CN lesions: cuases: Lyme ds..............
Guest, Sep 21, 2005
#1
2.
GuestGuest
. Mother presented with a few days history of rash over the body and arthralgia. Also have similar
history among her children days/weeks ago, diagnosis: rubella, IM.......
3.
GuestGuest
by enroute
3. 22 yr old male come with h/o rashes on his face and hands last 2 years. He claims there is one
ointment that that cure his problem but he has not been able to find any proprietary medication that
worked. Examination is normal. What is the diagnosis:
delusional disorder/somatoform disorder/hypochondriasis/obsessive compulsive disorder
3) Postural Hypotension with ataxia with parkinsonism features, recurrent falls -- Multisystem
atrophy/
5) Sensitivity
7) asymptomatic with Essential thrombocytosis - platelet count > 800 - Treatment - Aspirin/
hydroxurea/ Platelet pheresis/ radioactive substance/ observation
11) anticipation
12) BIH
BEST Way to prepare for exam ON EXAM atleast twice and KALRA and most important commonsense.
Good LUCK
will type in detail latter.
_________________
Good Luck guys and gals
Guest, Sep 21, 2005
#4
4.
GuestGuest
dr_osler
Guest
Posted: Wed Sep 21, 2005 12:28 am Post subject: mcqs in sep 2005
Could any one who has appeared in the exam today post any mcqs
i will try to send some
- the specific antibody in SLE : anti Sm(there was no antiDs)
- thyrotoxic A.F,immediate management : I.V amiodarone(100),cardioversion,anticoagulation
-Inf MI,bradycardia,hypotension,cvp 4 : temp pacing,dobutamine,I.V fluids
Guest, Sep 21, 2005
#5
5.
CliffGuest
1. ? ABO incompatibility
2. dark color urine after antibiotic
Cliff, Sep 21, 2005
#6
6.
GuestGuest
1. Eclampsia
2. Pre eclampsia
3. essential Hypertension
Guest, Sep 21, 2005
#7
7.
GuestGuest
1. Somatoform
2. Hypochondriasis
H/O Chest infection, took clarythromycin, Lt Supraventricular LN. Cold haemaglutinin
1. Rosiglitazone
Guest, Sep 21, 2005
#11
8.
GuestGuest
1. Aspirate culture
2. Ph of aspirate
Guest, Sep 21, 2005
#13
9.
GuestGuest
10.
GuestGuest
CA 125
CEA
Guest, Sep 21, 2005
#15
11.
GuestGuest
12.
GuestGuest
Violaceous color and itching in the left arm (linear) and flexors
2. Scabies???
Guest, Sep 21, 2005
#17
13.
GuestGuest
14.
GuestGuest
15.
GuestGuest
16.
GuestGuest
17.
GuestGuest
1.Alcohol
2. Ecstasy
Guest, Sep 21, 2005
#22
18.
GuestGuest
19.
GuestGuest
1.B blocker
2. observation
Guest, Sep 21, 2005
#24
20.
GuestGuest
1.
Guest, Sep 21, 2005
#27
21.
GuestGuest
1. Asthma
Guest, Sep 21, 2005
#28
22.
GuestGuest
1. CRP
2. bacterial Activity
Guest, Sep 21, 2005
#29
23.
GuestGuest
19 year old 1.8 meter, small testes, low FSH, LH, Testestenor
1. Kalmman
2. Klinfilter
Guest, Sep 21, 2005
#30
24.
GuestGuest
Treatment?
1. Eradication of H. Pylori
2. Surgical
Nephropathy, mildly elevated creatinine, protienuria >3.8 gm
Treatment?
1.ACE
Guest, Sep 21, 2005
#34
25.
GuestGuest
Glomerulonephritis treatment??
1. Prednisolone + cyclophosphamide
Guest, Sep 21, 2005
#35
26.
GuestGuest
again please ... it is nice to see someone posting the examination questions...but please ...put them in
organized manner and if possible in specialty order.
Guest, Sep 21, 2005
#36
27.
CliffGuest
Clinical Pharmacology
1. Amiodarone Class III agent -> K channel blocker
2. Cuases of lymphadenopathy -> Phenytoin
3. which term best describe the affinity of drug for its receptor -> ? Selectivity ? potency
Cardiac
1. sinus bradycardia with hypotension -> ? transvenous pacing
2. Criteria for thrombolysis in AMI
3. Case with AMI and malignant hypertension -> ? primary PTCA
Cliff, Sep 21, 2005
#37
28.
macGuest
Hi ,
I just wanted to share my impression from the exam and some useful tips for future candidates.
1. Philip Kalra should be known from cover to cover. Every single sentence brings a lot of
information.
2. OHCM is very good in some topics.
3. There is no point to do as many questions as possible, because they always make new questions. The
proportion of repeated questions is only 20% - some from onexamination, some from pastest.
4. It is more sensible to know as much theory as possible because you have the base to manipulate with
the information.
5. True/false format is complete waste of time.
3. Diagnosis of DH in patient without diarrhoea - IF of paralesional skin. Small intestine biopsy was an
option.
4. Mechanism of action of Ondansetron - 5-HT3 inhibitor.
5. Which drug is an ion channel opener - Nicorandil (K channel opener)
6. Mechanism of action of Amiodarone - K channel blocker.
7. A case of sporadic colonic carcinoma, mechanism in tumorogenesis - p27 deletion. The other four
options were impossible because they showed either tumour supressor gene up-regulation or
protoncogene down-regulation. A killer question!
8. Which enzyme is high in Gaucher's disease - Acid phosphatase.
9. A lady post CS, given 3 U of blood, 30 min later shock - ABO incompatibility.
10. A man bitten by a dog, infection, causative organism - Pasteurella multocida.
11. Cat scratch disease with lymphadenitis, cause - Bartonella henselae.
13. Food poisoning after tuna and wine, vomiting + facial flushing, cause - scombrotoxin.
14. What is the lifetime risk for nephropathy in Type 1 DM in a 27 year-old man- between 20-39%.
Kalra actually says 30% risk over 40 years in Type 1 DM.
16. A case of osteomyelitis, after 2 weeks, most useful test - X-ray.
18. A case of delayed puberty with low FSH, low LH, low testosterone - Kallman's syndrome. Nothing
mentioned about anosmia but remember Kallman= hypogonadotrophic hypogonadism= low FSH, low
LH, low testosterone, whereas Kleinfelter- hypergonadotrophic hypogonadism= high FSH, high LH,
low testosterone.
19. A lady with fever, arthropathy, kids with rash a week ago - Parvovirus B19.
20. Typical feature of PBC - peripheral neuropathy (because of lipid infiltration).
21. Antibody used in follicular B-NHL - anti CD 20.
22. A case for NNT, PPV and RRR.
23. First sign in CPA tumour - loss of corneal reflex.
24. Acute retention of urine, hypovolaemic - 0.9% saline before catheterisation.
25. Criteria for thrombolysis - >1 mm ST elevation in two or more limb leads.
26. Refeeding syndrome, cause - low phoshpate.
27. Asymptomatic 75 year old with high Ca, low PO4, no evidence for MM -primary
hyperparathyroidism.
I hope this will help you in your preparation for the exam,
The past is like the Atlantic Ocean, but the decisions I make - that's my mirror. And I have to live them
alone. And I can't erase it, no one can erase it.
mac, Sep 22, 2005
#38
29.
HajmiGuest
HI FRIENDS,
PAPERS WERE FAIRLY MADE. TOPICS THAT I CUD REMEMBERED SPLICING OCCUR AT
COELIAC DISEASE
CROHNS DIS
BULIMIA NERVOSA
IRRITABLE BOWL SYNDROME
ULCERATIVE COLITIS
SLE
SJOGREN
ALZ DISEASE
TUNA FISH TOXIN
INTERNAL CAPSULE INFARCTS
CARBAMAZ POISONING
LITH POISONING
PARACETAMOL POISONING
SOMATOFORM
MANIA
HYPOMANIA
PANIC
ANXIOLYTIC DRUGS
SVT
FLECANIDE MECHANISM
N ACETYLCYSTINE MECHANISM
BULIMIA NERVOSA
CONDYLOMATA
PRIMRARY BILIARY CIRRH
Hajmi, Sep 22, 2005
#39
30.
GuestGuest
very nice ,Cliff,Mac and Hajmi....i hope that all of u did very well there and i hpoe also that u will pass
the part I examination with god's help.
Guest, Sep 22, 2005
#40
31.
GuestGuest
64 MANTOUX TEST
65SCDSC
66.OSTEOSCLERTIC LESION
67 CAUDA EQUIA SYNDROME
69S/E OF ROSIGLTAZONE
70ANTICIPATIO
71 CAT SCRATCH DISEASE
72 VARICELLA ZOSTER
73SCROMBOTOXIN
774 CEA FOR COLRECTAL CA
75 PS3 UPREG COLON CA SPORADIC
76 N ACETYLCYSTEINE?DEC GLUTATHIONE REDUCTSAE?
BACILLUS CEREUS TOXICTY
77RENAL BIOPSY
79 CRITERIA OF MI
SOMATIZATION SYNDROME
80 MEDIAN NERVE
81AIP
82 ODANSETRON
84 REFEEDING SYNDROME
Back to top
pinkfeets
Guest
Posted: Fri Sep 23, 2005 11:42 am Post subject: Re: SOME THEMES OF SEP EXAM
--------------------------------------------------------------------------------
I disagree with some of the answers you have put down.... open for discussion!
FEMALE WITH HYPOGLYCEMIC EPISODE: STOP DRIVING FOR 3 MNTHS (I believe that
sending her for diabetic education is the answer, am not sure about admitting her for 72 hours)
O2 GIVEN TO A PT AND HIIS SAT FALLS FOR SOME TIME WHY? B/C OF PUL ARTEY
RELAXATION CAUSING MISMATCH B/W PERFUSION AND VENT
(I disagree, i think it is because when you administer nebulisers you usually do not administer oxygen
at the same time...that is why your p02 falls)
anyway, i hope some of my answers have been helpful, i am open for discussion!
pinkfeets!
79 CRITERIA OF MI
SOMATIZATION SYNDROME
80 MEDIAN NERVE
81AIP
82 ODANSETRON
84 REFEEDING SYNDROME
Regarding Endocarditis my answer was CRP but when I checked it in Harrison's, it is Blood culture
rsukhon said:
Pt with dyspepsia, +ve H. Pylori and mild ?? lymphoma of the stomach??
Treatment?
1. Eradication of H. Pylori
2. Surgical
pinkfeets, Sep 23, 2005
#42
32.
GuestGuest
33.
G-MATH1Guest
HELLO
IST OF ALL I WOULD LIKE TO COMPLAINT GLAD WHY MY NAME WAS REMOVED FRM
THE POST OF THESE 87 THEMES WHICH WERE ORIGINALLY WRITTEN BY ME.
SECONDLY I WILL REDISCUSS PINKFEET ANSWERS AND CORRECT HIM
IN NEXTPOST
G-MATH1, Sep 23, 2005
#44
34.
pinkfeetsGuest
G math am very interested to see why you think my answers are wrong... anyhow, i think it would be
best if those who posted questions to try and explain the reasons behind the answers they chose to the
'tough' not straightforward answer questions...
pinkfeets, Sep 23, 2005
#45
35.
GuestGuest
Question No. 4
A 28 year old man who had had tuberculosis of the mediastinal lymph nodes diagnosed two weeks
previously and who had been started on chemotherapy with rifampicin, isoniazid and pyrazinamide
was admitted because of the increasing dyspnoea and stridor.
Chest X-ray showed compression of both main bronchi by carinal lymph node enlargement.
What is the next step in management?
1. Start prednisolone
2. Mediastinoscopy and biopsy
3. Refer for stent insertion/tracheostomy
4. Refer for urgent CT scan of the mediastinum
5. The addition of ethambutol
Answer
Comments:
The treatment of TB mediatinal lymphadenitis is the same as pulmonary TB. The nodes may enlarge
during or after treatment as a result of hypersensitivity. Corticosteroids is effective in reducing the
enlargement and hence will help the stridor and breathlessness.
(From Onexamination)
Guest, Sep 23, 2005
#46
36.
GuestGuest
Related to Harrison's Chapter 77. Gastrointestinal Tract Cancer; Chapter 135. Helicobacter pylori
Infections;
Excerpt: "Gastric mucosa-associated lymphoid tissue (MALT) lymphoma arises from mucosal
lymphoid tissue that is acquired usually as a reaction to Helicobacter pylori infection. Eradication of H.
pylori leads to complete regression of gastric MALT lymphoma in 75% of cases. However, prolonged
follow-up is necessary to determine whether a lymphoma responds to therapy. Clinical staging has been
extensively examined with the help of endoscopic ultrasonography, which has allowed the assessment
of the extent of tumor invasion to the gastric wall and to regional lymph nodes. In general, lymphomas
of stage IIE or above, in which gastric lymph nodes and adjacent or remote organs are involved, do not
respond to H. pylori eradication. In stage IE cases, in which tumors are confined to the gastric wall,
staging has limited value in predicting a response, although tumors that involve the muscularis propria
or serosa (stage IE2) have a higher failure rate than those of IE1. At the time of diagnosis, most gastric
MALT lymphomas are stage IE, so alternative prognostic markers are needed...."
muscle is effected-?iliopsoas
Guest, Sep 23, 2005
#47
37.
DR G-MATH12Guest
79 CRITERIA OF MI
SOMATIZATION SYNDROME
80 MEDIAN NERVE
81AIP
82 ODANSETRON
84 REFEEDING SYNDROME
THE ABOVE POST WAS BY ME ORIGINALLY.
PLZ DISCUSS ANWSERS WITH ME
REGARDS DR GMATH.DR OA PLZ GIVE UR OPINION AS WELL
DR G-MATH12, Sep 24, 2005
#48
38.
DR GMATH 12Guest
disagree with some of the answers you have put down.... open for discussion!
FEMALE WITH HYPOGLYCEMIC EPISODE: STOP DRIVING FOR 3 MNTHS (I believe that
sending her for diabetic education is the answer, am not sure about admitting her for 72 hours)
O2 GIVEN TO A PT AND HIIS SAT FALLS FOR SOME TIME WHY? B/C OF PUL ARTEY
RELAXATION CAUSING MISMATCH B/W PERFUSION AND VENT
(I disagree, i think it is because when you administer nebulisers you usually do not administer oxygen
at the same time...that is why your p02 falls)
anyway, i hope some of my answers have been helpful, i am open for discussion!
pinkfeets!
HI PINKFEETS
I WASNT TARGETTING/INSULTING U .JUST WANNA DISCUSS. OK
THE Q OF SPLENECTOMY ASKED ABOUT VIRAL VACCINE PROPHYLAXIS AND AS U
KNOW ONLY H INF HAS HIB VACCINE SOO THAT WAS WHY I WROTE IT AS CORRECT IN
MY 82 Q RECALL WHICH I GAVE .REST OF OPSII ORG STREP ETC ARE BACTERIA AND Q
ON 2ND READ I FOUND WAS ASKING OF VCIINE .
VASO VAGAL SYNCOPE DOESNT CASUE INCONTINENCE OF URINE.U CAN SEE IN ANY
BIG MED TXTBOOK THAT ICONTINENT OF URINE IS EXCLUSSIVE TO GRAND MAL/TC
EPILEPSY
WILL SAY EDU BUT IT IS IMP THAT PT REMAINS/ABSTAINS FRM DRIVING BUT I AM NOT
SURE OF THIS Q B/C I DONT KNOW IF IT IS BAN FOR 1 YR.IN THAT CASE I AM WRONG
THANNKS .I WISH U AND I AND ALL WHO TOOK EXAM PASS.NO HARD FEELINGS OK'
ONCE AGAIN DR OA COMMENTS PLZ
DR GMATH 12, Sep 24, 2005
#49
39.
GuestGuest
sep quest
multiple sclerosis
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Thread Status:
1.
smaGuest
Finally, I'm a free person again, at least for some time...both the papers were tough especially paper 2,
lots of intermingling choices...will post them later after a good nights sleep. For the first question about
which drug inhibits purine synthesis...I put methotrexate, is that correct? then there was one with the
girl with Turners who had HTNa nd equal BP in both arms so I selected renal artery aplasia, what else
can I remember now... 2 about cluster headache....which is what I am about to get now so I better go
and get some rest...bye
paradoxical embolus____>transthoracic or transoesophagal echo???
Inferior MI____>Rt coronary artery
MOA of cisplatin______???
OA pt with swelling of wrist jt____>OM? Gout? RA?
realative risk____>???
2.
GuestGuest
I am not quite sure what my performance was.. but I guess I'll wait for next month... Don't rely on for
the answers:
3. Cisplatin action
20. Overdose of Diazepam and Disulopin: ECG??? there was tachycardia of 140
22. Sensitivity
24. NNT what does it mean!
28. MI then thrombolysed then got red dusky coloration of feet anf eosinophilia.. I just though it could
be cholestrol embolism
32. patient with some history of back pain: non-specific back pain
zf
36. optic neuritis or giant cell arteritis??? swollen pale disc + monoocular visual loss!
38. cortical thrombophlebitis?!?!? it was complicated question but the CT was very suggestive
46. There was partial third palsy and six nerve and the ophthalmo section of the fifth.. orbit apex???
48. question about P(A-a) O2..
51. two questions about autoimmune haemolytic anaemia: one of them was about dirst antiglobulin test
57. patient with past hx of alcohol presents with topheous gout.. he got Alluporinol two days later he
got pain in wrist, hands and knees.. one of the option was alcohol binge.. I liked it!
59. there was two question I choose colonscopy for.. I can remember them at all
3.
GuestGuest
tarekdeema
438 Credits
[ Donate ]
Posted: Wed May 17, 2006 6:12 pm Post subject: A funny question from may 2006
--------------------------------------------------------------------------------
there was a question about a group of elderly who travelled togethere to some place and some of them
developed pneumonia ,they where moving around all the time togethere but they where allocated to
different hotel ,the people who developed pneumonia where staying in the same hotel what is the most
likely causative organism:
1-steptococcus
2-staph
3-legionella
4-influenza
5-mycoplasma
a nice one::::::
Back to top
Guest, May 17, 2006
#4
4.
GuestGuest
hanoo
hanoo
Guest
Posted: Wed May 17, 2006 5:05 pm Post subject: MRCP 1 16 MAY
--------------------------------------------------------------------------------
Hi everyone,
exam was very tough esp. second part.
thyroid,diabetes,rhumatology and skin i think that topics were too much in exam.
3. treatment of gonnorhea
4. yratment of cholera.
Guest, May 17, 2006
#5
5.
GuestGuest
hi everyone the exam was tough but hoping against hope to pass.
some questions i remembered.
5.cluster headcahe
6.villous adenoma--colonoscopy
7.T3 toxicosis
9.a case of PE
12.sideroblastic anaemia
19.OSteomalacia and low calcium and low phosphate but high ALP.
23.CHronic pancreatitis in pregnant lady with loose stool and malabsorptive picture
MORE TO COME
THANKS
OREOLUWA
Guest, May 17, 2006
#6
6.
GuestGuest
Author Message
afsheensalman
AIPPG Fresher
156 Credits
[ Donate ]
Posted: Thu May 18, 2006 1:07 pm Post subject: may 2006 part1
--------------------------------------------------------------------------------
erectile dysfunction was another recurrent topic ... sildenafil contra indications- nifedipine or nicordil?
differential dagnosis for ED- perfomance anxiety or an organic cause (clue=normal early morning
erections)
Back to top
7.
GuestGuest
8.
kengladGuest
answer
9.
rahba septGuest
hello am first time for part 1 when i see the questions i thought it easy but then i was surprised all of it
is basic pharmacology and anatomy and investigation and antibiotic treatment and diabet thyroid
frequent questions i,ll post first remembering ones:
13-methadon ..
thank u
rahba sept, May 18, 2006
#10
10.
kengladGuest
some answers
i opted for giant cell arteritis as the patient very old and giant cell common is old age
intermittent loss of concious=ness with quick recovery and no residual neurological defect - definitely
vasovagal so answer is postural hypotension - its in harrison's
11.
GuestGuest
SMK Al rifae'ei
SMK Al rifae'ei
Guest
--------------------------------------------------------------------------------
dog bite...antibiotic
complement ,,,SLE
WHICH TENDON
PREDICTIVE VALUE
MEDIAN STUDY
PSEUDOMEMBRANEOUS COLITIS ANTIBIOTIC
ASSESS OPERATION RISK-MI
?MYOTONIA DYSTROPHICA
ESOPHAGEAL ULCER ALEDRONATE
MARFAN FIBRILLIN
TURNERS-- BP
PREGNANT WITH SVT
IG HYPERACUTE REACTION
ciclosporine mechnism
acyclovir mechanism
rhabdomylysis mange
repeat ?urine for protein
cluster headache?/?
?reactive arthritis
?prevent calcium stones
Guest, May 18, 2006
#12
12.
GuestGuest
13.
GuestGuest
A 17 year old boy with hypertrohpic cardiomyopathy tratment with best prognosis.
1-betablocker.
2-Alcholc aplation of septum.
3-implantable defibrilator automatic.
4-Another antiarthysmic.
implantable defibrilator is correct.
Guest, May 18, 2006
#14
14.
SMK Al rifae'eiGuest
igm-hyperviscosity
behget dvt
WHAT WAS THE OLD LADY WITH WRIST SWELLINGSMK Al rifae'ei, May 18, 2006
#15
15.
ACGuest
mrcp 1 may 16
a patient with tinnitus, 0.9 cm swelling in pituitary, with no hormones elevated- how do you proceed....
observation??
AC, May 18, 2006
#16
16.
ACGuest
mrcp 1 may 16
17.
rahba septGuest
another choisis for best indicator for tonsilitis abscess is continious fever
1-foramen ovale
3- scabis...
4-e coli
5-cholangio carcinoma ..
6-ulcerative cholitis...
7-mody ..
9-paroxetin...hypertension..
13-noctornal dysphasia
14-tachicardia ..diarrhia....anticholinergic...tox..
16-c4..c5..c6..c7....{c4}
17-vertebral prolapse....
18-3..6...trigemeni........pons
21-hematuria thrombocytopenia..anemia...imunoglobulin..iga..
22-hemophelia..
23- 1/2......1/4....1/6...1/8
25-hematuria....hypervescosity..syndrome
27-eozinophilia....nephrology....
thanks
rahba sept, May 19, 2006
#18
18.
rahba septGuest
19.
kennyGuest
answers2
its nothing for microadenoma.the effect is nil if size does not increase
so do nothing
this is for emran what in the whole wide world is spastic angina?
are u sure you took the mrcp part 1 may paper dude?
oh yeah wot about the chap with the allergy to seafood and his bp was 170/100
tachy at 110
spo2 98 on air
options were
iv adrenaline
sc adrenalin
im adrenaline
close observation
kenny, May 19, 2006
#20
20.
kengladGuest
educate me
1)chap presented with painful shin then malar rash with abdo pain and polyuria.which investiagtion
would clinch the diagnosis
me think it was chest x ray cuz u can see bilateral hilar lymohadenopathy of sarcoidosis no?
5)lady with severe hip oa goin for surgery with stable angina
how should u assess her?
probably thallium scan cuz she can't possibly go for a walk on the treadmill
wot with her painful hip and all that
6)chap with an MI who undergoes exercise treadmill and then has paroxysms of short lived vt
probably electrophysiological testing and ablation
9)thrid nerve palsy with pupillary sparing and 5th opthalmic branch involvement and 6th nerve
involvement
probably orbital apex no?
10)chap post renal transplant on cyclosporin and prednisolone and comes to u for an infection
twcc 3+ ie low
wots wrong
11)cant ankle dorsiflex,cant use extensor hallucis longus,medial aspect loss of sensation in the lower
limbs.wots wrong with this fella?
12)pregnant again question with background alcohol abuse with small babies,diarrhoea,low folate etc
wots wrong
-alcohol excess?
-chronic pancreatitis
-coeliac?
13)20 year old girl with dm on sc insulin keeps getting hypos and hba1c of 5.4.
is she anorexic?
14)crazy man hitting wife and claim nobody ain't gonna touch me cuz me got friends high up in the
police department
hypomonia?
paranoid schizophrenic
21.
kengladGuest
16)u are the SHO on call and u have limited isolation beds
which of these following organism spreads easiest
a)legionella
b)mycoplasma
c)varicella
d)staph
e)strep pneumonia
17)someone told me that its pearsons correlation for comparing the median between placebo and statin
tell me it aint true!
18)remember the one about the HIV chap with odynophagia etc
must be cmv oesophagitis huh?
can it possibly be candida?
kenglad, May 19, 2006
#22
22.
GuestGuest
sorry i wanted tosay spasm but some of your questions i did not saw in the exam.
Guest, May 19, 2006
#23
23.
kengladGuest
oh i see
spasm issit
hmm nope that's a diff question
i reckon some questions must be diff depending on ur centre of examination
kenglad, May 19, 2006
#24
24.
GuestGuest
PSYCHIATRY
1-a lady brought to casualty after the death of her maother sit on chair not resposive :CONVERSION
DISORDER this is typical in which there is a stressfull condition(death of mother) dissociated into
physical symptoms for the primary gain(alliavation of symptoms an escape phenonmena)
2-a man brought to casulty several time with abdominal pain recently brought with swaeting shivering
and said if u dont give me morphine i will commite suicide :MUCHUENSUS SYNDROME
(intentional production of symptoms for a primary gain which is MORPHINE its not somatisation
disorder ..
3-there was a question about post traumatic disorder i cant remember exactly
4Guest, May 19, 2006
#25
25.
2-test to confirm nickle skin sensitivity producing wheals and urticaria (PATCH TEST)this is for skin
hypersensitivity ,the prick test is for sytemic hypersensitivity like ASHTMA,ABA.
3-treatment of cholera DOXYCYCLINE
autoimmune hepatitis)
17-dog bit in hand with cellulitis give:B.PEICILLIN+FLUCLOXACILLIN to cover
staph,sterpt,pasturella
20-Pt with mody what from history suggest it :STRONG FAMILY HISTORY cuz its AD inhirited Type
2 in young
21-paraplegia with loss of pain and temp and sparing of post colum(ANT. SPINAL ATRTER
OCCLUSION
22-DOXORUBUCIN ILATED CARDIMYOPATHY
23-post transplant taking cyclosporin:NEPHROTOXICITY
24-UC+s2 cm lesion in liver (CHOLANGIOCARCINOMA)
26-carbimazole developed agranulocitosis (START PENICILLIN V )
28-Needle stick injury from HIV postive :COMMENCE THERAPY IMMEDIATELL with 3 drugs for
a month
29-the thalasamia trait family brought anxious about rishk to thier fetus THERE IS NO RISK TO THE
FETUS) the child HbF will take over ,roblems will appear at 9 months of age when the Gamma chain
transform into Beta chain and as they are alfa trait the prognosis is good the child will have a good beta
chain
good luck for all and welcome to any discussion will post the remaining when they come into memory
Guest, May 19, 2006
#26
26.
ACGuest
a patient with nocturnal cough, BMI- 22, probable diagnosis - asthma, GERD, obstructive sleep apnoea
27.
kulbitGuest
Hi,
i hope all of you have done well. it definitely wasnt a cakewalk. it fact it was a well- set and well
balanced paper. i think my performance was average. i am desperate to check out the answers. i
managed to recollect a few questions. i shall list them below with the few options i remember and the
answers that i think are correct.
1. The absence of which complement factor predisposes to the development of drug induced lupus.
Ans: C4.
2. A young athlete with a family H/o SCD. i episode of ill-sustained VT of 20 beats on exercise testing.
Next line of management.
a. Holter monitoring
b. Amiodarone
c. automatic implantable defibrillator
d. septal ablation
Ans: automatic inplantable defibrillator.
4. Patient with type 1 DM on insulin presents with 3 episodes of hypoglycemia. There is H/o weight
loss from 55-45 kg in 3 months. No significant clinical findings. Possibility
a. Anorexia nervosa
b. Hyperthyroidism
c. Cushings syndrome.
Ans: Anorexia nervosa.
5. H/o travel to africa 6 months ago, now presents with fever and chills.
a. Brucellosis
b. Falciparum malaria
c. Ovale malaria
Ans: Brucellosis
6. a patient with nocturnal cough and BMI of 22. most likely cause of his cough is
a. Asthma.
b. GERD.
c. OSA.
Ans: GERD.
8. Treatment of Cholera:
Ans: doxycycline.
12. If you are the SHO on call and u have limited isolation beds which of these following organism
spreads easiest
a)legionella
b)mycoplasma
c)varicella
d)staph
e)strep pneumonia
Ans: VZV.
14. A patient presented with painful shin lesions with abdominal pain and polyuria. Which
investigation would clinch the diagnosis
Ans: Chest X-ray to diagnose sarcoidosis
15. Lady with severe hip OA going for surgery with stable angina.How should u assess her?
Ans: Thallium scan.
18. A lady with 3 year H/o joint pains and malaise. Anti smooth muscle antibody is positive. Next line
of investigation is
a. LFT
b. Thyroid function test.
Ans: no idea
19. H/o sudden onset of pain in the right eye while hitting nail into the wall. Pain is severe and
continuous with occasional exacerbations. Right pupil is small and there is mild ptosis.
a. carotid artery dissection.
b. facial migraine.
c. cluster headache.
d. trigeminal neuralgia.
Ans: carotid artery dissedction.
20. Right 3 rd nerve palsy with papillary sparing with right 6th nerve palsy and loss of pinprick
sensation over the forehead. There is no proptosis. The possible site of lesion is:
a. orbital apex
b. cavernous sinus.
c. interpeduncular fossa.
d. midbrain
e. pons.
Ans: orbital apex/ cavernous sinus thrombosis
22. H/o difficulty in closing mouth after chewing for long periods, ptosis and distal muscle weakness.
a. MG
b. LEMS
c. Muscular dystrophy.
Ans: MG as there is easy fatigability but what about distal muscle weakness.
24. Patient with Pulmonary hypertension and upper GI bleed. The preventive therapy would be.
Ans: propranolol.
25. Patient presents with h/o fatigue, lassitude. Investigations reveal thyroid hormones in the lower
limit of normal, hyperkalemia and hyponatremia. Next line of investigation is
a. Short synacthen test
b. TSH
c. FT4
Ans: Short synacthen test as it is likely to be Addisons disease.
27. Throid profile showing increased T3, Low TSH and T4 in the lower limit of normal. The likely
possibility is
a. T3 toxicosis
b. familial dysalbuminemic hypothyroidism
c. tertiary hypothyroidism.
d. sick euthyroid syndrome
Ans: T3 toxicosis
28. a lady presents with 1 year h/o pain in the right hand progressing to involve the entire right upper
limb, scapular and pectoral regions. There is decreased pinprick in the hand and absent tendon reflexes,
but there is no significant wasting. The possibility is
a. brachial plexus infiltration
b. cervical sponduylosis
c. syringomyelia
Ans: Brachial plexus infiltration.
29. H/o vertigo on turning head like while crossing road, also present while turning around in bed.
a. BPPV
b. Carotid sinus hypersensitivity
c. chronic vestibulitis
Ans: BPPV
30. H/o sudden falls without loss of consciousness in an elderly lady. She recovers within 1 minute and
is able to continue.
a. cataplexy
b. myoclonic epilepsy
c. drop attacks
d. carotid sinus hypersensitivity
Ans: drop attacks.
31. A person attacks his friend and shows no remorse. Friend says that of late he is very abusive. Wife
says that he hasnt slept for 2 days. On examination he is aggressive. He says he cannot be punished as
he has contacts with high level police officials.
a. paranoid schizophrenia
b. manic episode
Ans: manic episode
32. A lady is silent and withdrawn since finding her dead mother in her room. She does not eat, or
move from her chair.
a. catatonic schizophrenia
b. major depression
c. conversion disorder.
Ans: major depression/ conversion disorder.
33. A patient has frequent nightmares and intrusive thoughts after witnessing the death of 2 colleagues.
Wife reports frequent episodes of crying.
Ans: post-traumatic stress disorder.
34. Patient presents with h/s/o psychosis. She was started on phenothiazines. She comes 6 months later
with h/o joint pains, raynauds phenomenon and dry mouth.
a. drug induced lupus
b. MCTD
Ans: Drug induced lupus.
35. A boy with hemophilia. Which of his relatives is likely to have the disease.
Ans: mothers brother
36. A lady has a brother with hemophilia. Assuming that her husband is normal what is the chance that
her daughter will be a carrier.
Ans: 1 in 2.
37. Patient with repeated episodes of clostridium difficele diarrhea has come with findings s/o UTI.
Treatment
Ans: Vancomycin.
40. A man was brought to the casualty with abdominal pain, sweating shivering and said if u dont give
me morphine I will commit suicide
Ans: Munchausens syndrome
41. A person develops allergy to sea food containing prawns I hour after consuming it and presents 3
hours later with hypertension and tachycardia. Next line of action
Ans: close observation.
42. A patient has been detected to have a pituitary tumor of 9 mm without any other abnormalities. A
repeat CT few months later does not shoe any increase in size. Next line of action
Ans: nothing to be done.
43. a patient with ulcerative colitis has a single hypoechoiec lesion in his liver. What is the possibility
a. focal nodular hyperplasia
b. cholangiocarcinoma
c. hemangioma
d. adenoma
Ans: cholangiocarcinoma/ adenoma.
44. A patient with ulcerative colitis continues to have rectal bleeding though he is on prednisolone.
Next line of management
a. iv hydrocortisone
b. oral azathioprine
c. iv cyclosporine
Ans: iv hydrocortisone or oral azathioprine.
Q32- THE ANSWER IS CONVERSION DISORDER as there was a stressfull precipitating cause
(death of mother) and dissociated into physical symptoms which are being silent and unresposive as an
escape phenomena (primary gain) belle indifferent to that thoughts ,,,its definately unlikely to be a
major depretion as in major depression there is no obvius cause it could have been right if it was
reactive plus from the q there was no SOMATIC feature (wt loss,diurnal variation,constipation....etc
q-THE DOG BITE you have a dog bite plus cellulitis so u should cover staph,strept and pasturela so u
give benzyl penicillin+flucloxacillin
Guest, May 22, 2006
#31
28.
kengladGuest
the answer is
otherwise i agree with u regarding the human genome project,manic episode,primary ovarian failure
however there was an answer for NNT it was the reciprocal of absolute risk reduction and that was
choice E
Regarding Q 20,,,,the answer was cavernous sinus thrombosis as there was lesion to cranial nerve 3,4,6
and opthalmic devesion of trigeminal nerve plus there were neither proptosis nor conjuctival injections
so orbital apex is unlikely
2-in acute renal rejection what is the anti HLA antibodies- IgG, M, E,D,A
3- 4 WEEKS POST RENAL TRANSPLANT REJECTION WHAT IS THE MECAHNISM- DUE TO
CYTOTOXIC t-cELLS
4- first action of aciclovir--- Inhibition of thyamidine kinase
5- Treat Of dog bite celliulities+lymphoedema- Fluxo+penicllin
6- ypug pt complaining of abdominal pain and threatens to commit suicide if not given Morphin--Munchehasen syndrome
7- Calculate Pos. Predective value from Agiven table-- 40/50=80%
8- Def. of NNT to treat the difference between Absoulut and realtive risks.
9- def. of sensetivity
10- calcuation the oral dose of 60 mg Morpgin--180mg
11-case of mania- beating his G/friend and saying he has police connections.
12-case of post traumatic stress syndrome- the guy envolved in accident witnesse his friends death.
13-Preg. lady Hx of alcoholism presented with diarroea in third trimester Foetal USS -IUGR--- chronic
pancreatitis
14- Preg. with SVT how to treat-- Verapamil, amiodarone, flecanide, misoprolol
15- which drugs needs dose adjustment in Renal failure-- Temazepam, metformin
16- medication to D/C if wants to start viagra-- Nicorandil
17- Treatment of gonnoreahea--- Amoxcillin
18-pt presented with nech stifness, headach and fever CSF: HIGH PROTIEN, normal gucose, high
lymphocytes-- TB meningitis
19-pt with Hx of seafood alargey, presented with tachyponea >35. BP 170/110 what will u do next-- IM
adrenalin
20-pt with URTICARIA how would u Tx-- Citizidine
21- Pt had Sx of UMN+LMN what is the diagnosis-- interior spinal artery oclusion
22- Pt presented with face and upper trunk URTICARIA for 6 months recently changed her facial
cleanser and take paracentamol for headach what is the Dx-- idiopathic URTICARIA .
23- Which on is Autosomal dom- HMSN1, Lebres Disease, Retinintis pig,
24- Guillan Barre monitoring-- Vital capacity
25- a case (cant remember) Ivx showing cryoglobulin-- Hep. C infection
26- post mi pt recieved thrombolysis, presented with dusky feet--- Chlosterol embolism
27-elderly with frequent fall what inX to R/O reversable cause- brain CT sacn.
81-Pt with featurs of Behcets disease prestens with left leg swelling and pain what is the Dx?---Venous thrombosis
82-Bursa on lateral epicondyle which movement will excerabate the pain?---pronation
82- Pt with mesothelioma and asbestosis exposure which statement is right?--- smoking increase the
risk of mesothelioma
83-Pt with urinary retention, loss of senation of medial aspect of thigh--- Lubosacral lesion
84- pt with common peroneal lesion
85- Pt with impotance, dismessed from work Dx?-- Performance anxiety
86-Medication enhancing Lithium Toxicity?---Thiazaide diuretics
87- Pt with recurrent nephrolitheasis, InVx showed Hypercalceuria how to manage?---Thiazaide
diuretics
88- Prophylaxis of pt going for dental procedure Hx AS+bicuspid valve?--- 3g Amoxixllin before the
procedure
89-case of polysurea pt Hx of bipolar disease Dx?---Drug induced Nephrogenic DI
90-Pt with Occupational asthma how tp confirm the Dx?--- Spirometry at work and after work
91- pt with imtrm. abdominal pain, urin turns dark on standing Dx----- Interm. Porohyria
92-most common cyclosporin complication?---Nephrotoxicity
93-mu r the medical incharge with one isolation room which infection to isolate?--Staph.ausrsu
94-Elderly pt with psychosis Dx as schizophrenia giviv Phenothiazin presented with Raynauds
phenomena, dry mouth, and invx low C4, pos Anti Ro and anti Sm Dx?--SLE
95-pT WITH CARBAMAZAPINE INDUCED NEAUTROPENIA WHAT TO DO NEXT?---I wrote
radioiodine Tx but I think the right answer is propathyureacyl.
96-Oesaphegeal vareces what prophylaxis?-- Propanolol
97-Pt with 2nd amennoreha high FSH LH Dx?---- PCODs
98-pt with hypopigementation, seizure and subingual fibroma Dx? Tuberous sclerosis
99-pt 24 years with polycyctic kidney grandmother died at 54 of P. kidney which statement is right?
PKD1 polycustin gene
100-Regarding lung Physiology ? Av gradient will deacrease with altitude .
101-pt with painfull wrist not relifed by NSAIDS what to do next? cortison injection of the joints
102- Pt with Hep B resistent to interferone presented with sudden hepatic apin, and jaudice,
29.
mrcp fighterGuest
great..
thx a lot.ur last ques nurse pricked with niddle of hiv patient ....there were two option one intravenous
zidovudine and start anti hiv drug.is there any zidovudine inj form.i am confused.i think the other is
correct.
mrcp fighter, May 24, 2006
#36
30.
GuestGuest
31.
GuestGuest
134-pt presentaed with steroid resistant UC, prsented with diarrohea and 10% wt loss refusing surgery,
how to Tx? cyclosporin
135-young eczematous pt presented with itchy postules,esp at nite sparing his head Dx? scabies
136- group of elderly, typical presentation of legionellar dis how to Dx? urinery Ag
137-def of wich complemet leads to-?-?-?- disease?--- C4
138-pt presented with polyurea, urinary Na 10, urinary osmo 295, plasma osmol low Hx of bipolar
disorder Dx? Drug induced Nephrogenic DI
139-which medciation causes galactorreah? metclopromide
140-pt with pleural effusion and high CA 125 origin of Tumor? Ovary
141-pt presents with lack of interst, depression and fatigue Dx? Chronic fatigue syndrome
142-S/E of Doxorubucin? Dialated cardiomyopathy
143-drug in phase one tria what dose it mean? I acnt recall my Answer
144-pt present with diarrohe and hematurea( HUS ) which organism? EColi
145- pt presented with abdominal bloatedness and diarrhea fro 2 weeks duration Dx? antamoeba
histolitica
146- statin induced myalgia which lipid lowering drug to avoid? I dont know the answer
147-pt preseted with back pain radiating to his shoulder after Hx of trauma for 6 monts past Hx of
similar problem resolevd spontanously over 8 mths Dx? non specific back pain
148-pt with left homounymos hemianopia with sensory inattention Dx? parteal lobe lesion
149-confuse and aggitated eldely Tx? Haloperidol
150-some qs about methadone i cant recall
151-Q about normal joint? the suprapetellar bursa is not related to knee joint
152-Rt hypochondrial pain after liver biopsy why? hemetoma collecton
153-pt with typical gout given allopurinal his condition deteriorated why? Allopurinol induced
154- pt already on meclopromide and still nauseated how to Tx? I cant recall the options or my answer
32.
EvangelosGuest
MRCP1
Looking back to the answers that are posted in this forum, I woud like to add that CIPROFLOXACIN
and not Trimethoprim is contraindicated in G6PD Deficiency!!!
Evangelos, May 24, 2006
#39
33.
mrcp fighterGuest
dr.osman
we want ur help.cause many persons sending ques with answers.but many are incorrect.plz give the
answer of this ques.
mrcp fighter, May 24, 2006
#40
34.
GuestGuest
regarding the question about G6PD deficiency cipro can cause haemolysis and ALL SULPHONES can
cause hemolysis like trimethoprim (THESE TYPE OF QUESTIONs MAKE ME THINK THAT RCP
ARE PUTTING VERY STUPID QUESTIONS WITH MORE THAN ONE TRUE ANSWER)...
Guest, May 24, 2006
#41
35.
EvangelosGuest
RE
WELL trimethoprim is a diaminopyrimidine and in the market is usually combined with sulphamides.
It is the sulphamides that cause the haemolysis in G6PD, not trimethoprim. On the contrary CIPRO
causes haemolysis in G6PD therefore is contraindicated in such patients.
I believe Cipro was the correct antibiotic.
GOOD Luck to everybody
Evangelos, May 24, 2006
#42
36.
mrcp fighterGuest
one ques was ..cause of galactorrhoea ...majority gave answer metoclopamide but the thing that meto
cause gynocomastia not galactor...the answer was omeprazole.this is the game of rcp.
mrcp fighter, May 25, 2006
#43
37.
EvangelosGuest
According to the eformulary of Doctors.net, based on the BNF, metoclopramide can cause
gynaecomastia AND galactorrhoea, whereas omeprazole or the other options do not cause
galactorrhoea as side effects
I also chose metoclopramide like the majority, but I have found so many other mistakes so i really hope
to the factor of luck as well.
Cheers
Evangelos, May 25, 2006
#44
38.
kengladGuest
i should have
haha i should haf sat next to you evangelos during the rcp exam
i knew trimethoprim was a bit suspect
anyways its cipro issit
good for u lad
kenglad, May 25, 2006
#45
39.
hussam aliGuest
some more qs
1old man with rt knee joint pain &swelling known case of OA on NSAID e out improvement on xray d r deformity narow cartiligenous space & cyst in perarticular area
management:
a-inra- articular steroid
b-total joint replacement
c-synevectomy
d-continou NSAID
I put total joint replacement by guess
2pt in her 32 weeks pregnansy c/o fatigue investigations shows SVT what u will give
a-adenosine
b-flecanide
c-dilti9azem
dI dont know the answer ??
3pt e tender erythematous rash on her legs and fatigue joint pain and polyuria o/e there papular rash
on her face and nazal pridge
invest
ANA weekly +ve 1/20
After dilution ?? 1/20
Urine + protein
Calcium 3.2 what u will do for her
1- CX ray
2- Ds DNA
I put x-ray
4pt c/o galactorhea known case of gasteritis on treatment what of the following ttt will cause
galagtorrhea
a- meticulopromide
b- omeprazole
c- spirinolactone
d- I think meticulopromide
a- mitoconderia
b- nucleus
c- riposome
d- golgi apparatus
isit mitoconderia?? But I know it is single strand any help??
9pt e st segment elevation in lead II & III ,avF, what vesel ocluded
art coronary artery
10old women with recurrent falls with out any precipitating cause and not preceded by any
symptoms whats the most common cause
aparkinsonism
bdrop attacks
cTIA
d
11old man admited to ER e severe agitation known on ttt of antidepressant what ttt u will give to him
aoral halopiridol
bI v diazepam
civ chlorpromazine
doral diazepam
all they select haloiridol but pt severly agitated and u r in ER how u will give oral halopiridol I think its
not correct!!??
hussam ali, May 25, 2006
#46
40.
GuestGuest
Hi guys
"...Compared to nonasthmatics, asthmatics have significantly more frequent and more severe day and
night GER symptoms and significantly more of the pulmonary symptoms (nocturnal suffocation,
cough, or wheezing) so often attributed to GER. The habit of eating before bedtime appears in
Also
Other papers have also shown a prevalence of 40% of GERD with nocturnal cough as well as the
aetiology of nocturnal cough in asthmatics being GERD!!!
1. A 27-year-old man with a history of IV drug use was found to have abnormal liver function tests
Further work-up including serologic tests for viral hepatitis show
Hepatitis B surface antibody (HBsAb) negative
Hepatitis B surface antigen (HBsAg) positive
Hepatitis core antibody (HBcAb) positive
Hepatitis B surface antibody (HBsAb) negative
Hepatitis B e antibody (HBeAb) positive
Hepatitis B e antigen (HBeAg) negative
Which of the following statements is true regarding this patient?
Answer: C
Explanation: In the interpretation of results of hepatitis B serologic tests, the following facts should be
considered: during the incubation period (i.e., before the onset of clinical manifestations) HbsAg,
HbeAg, and HBV DNA become detectable in the serum. At the onset of clinical symptoms (e.g.,
jaundice), an increase in the serum transaminases antibodies occurs and antibodies to HBc become
detectable (HBc antibodies). Initially, the HBc antibodies are IgM and thereafter IgG; these latter
antibodies persist for years. HBs antibodies become detectable late in convalescence. A rise in HBs
antibodies in combination with a loss of HbsAg, HbeAg, and HBV DNA indicate the presence of
immunity to HBV. HbeAg and HBV DNA are markers of active viral replication and thus indicate high
infectivity. The loss of HbeAg and appearance of anti-HbeAb indicates a less infective stage.
2. A 23-year-old woman experienced watery diarrhea, nausea, vomiting, and abdominal cramps 6 hours
after eating a salad and a hamburger in a local restaurant. The most likely organism causing her disease
is
Vibrio vulnificus
Listeria monocytogenes
Yersinia enterocolitica
Clostridium welchii
Staphylococcus aureus
Answer: E
Explanation: Staphylococcal food poisoning is manifested 2 to 6 hours after eating food (salad, potato
salads) contaminated by a preformed enterotoxin. Yersinia is most commonly associated with the
ingestion of improperly cooked meat, but symptoms generally begin more than 1 day after ingestion of
the contaminated food. Symptoms resulting from L. monocytogenes also occur more than 24 hours
after the ingestion of contaminated foods (milk, ice cream, and poultry). V. vulnificus-associated food
poisoning presents usually 24 to 48 hours after the ingestion of contaminated seafood (usually oysters).
C. welchii is not associated with food poisoning. The two clostridia associated with food poisoning are
C. perfringens and C. botulinum.
3. A 35-year-old man presents with diarrhea for 10 days, characterized by frequent, low-volume stools
with the presence of mucus. He also complained of subjective fever and lower abdominal pain. The
presence of leukocytes in stool is consistent with which organism?
Clostridium perfringens
S. aureus
Giardia lamblia
Enterobius vermicularis
Entamoeba histolytica
Answer: E
Explanation: The presence of large numbers of leukocytes in stool is diagnostic of colonic mucosal
inflammation and should suggest infection with enteroinvasive organisms such as Shigella, E.
histolytica, Salmonella, Campylobacter, invasive Escherichia coli, or Y. enterocolitica. Those
organisms that cause diarrhea by a noninvasive mechanism (Giardia lamblia, enterotoxigenic E. coli,
Vibrio cholerae) are not associated with leukocytes in the stool
4. Acetaminophen is an important cause of acute hepatic failure. All of the following statements about
acetaminophen toxicity are correct, except
Answer: D
Explanation: Acetaminophen overdose causes acute liver failure. Significant liver injury usually occurs
with doses of >10 to 15 g, most frequently taken in a suicide attempt. The liver injury is caused by
toxic metabolites of acetaminophen formed by the microsomal cytochrome P-450-dependent drugmetabolizing system. Because ethanol induces this cytochrome P-450 system, severe hepatotoxicity
can be seen in alcoholics, even with lower dosages of acetaminophen. N-acetylcysteine administered
early after ingestion (i.e., <24 hours) reduces the severity of liver necrosis. Acetaminophen and its
metabolites are not cleared by hemodialysis. Survivors of acute acetaminophen toxicity usually recover
completely without progressive or residual liver damage.
Answer: D
Explanation: Most esophageal cancers are asymptomatic, and at the time of diagnosis most are
unresectable. Barrett's syndrome is associated with adenocarcinoma of the esophagus. Despite the
increasing incidence of adenocarcinoma, the most common type of esophageal carcinoma in the United
States is squamous cell carcinoma, which generally is located in the distal third of the esophagus.
6. A 42-year-old man presents with intermittent dysphagia to solids and liquids and regurgitation of
food. He has lost 4 pounds in 2 months. His physical exam is normal. A barium swallow reveals a
dilated esophageal body, with the distal esophagus terminating in a narrow end. Which one of the
following options is the most appropriate long-term therapy?
Isosorbide dinitrate
Metoclopramide
Dilation with balloon
Nifedipine
Dilation with rubber tube (bougie)
Asnwer: C
Explanation: Achalasia is best treated with mechanical disruption of the lower esophageal sphincter.
Dilation with a large Hurst bougie may give temporary relief; a few patients have been maintained with
weekly self-dilations, but this treatment is no longer recommended. Much more effective is dilation
with a pneumatic balloon (bag) under radiographic control. A successful approach to long-term
pharmacologic management of achalasia has not been established. Short-term improvement in clinical
symptoms and in scintigraphic esophageal emptying may occur with isosorbide mononitrate, a longacting nitrate, or with nifedipine, a calcium-channel blocker. Promotility agents like metoclopramide
increase the lower esophageal sphincter pressure and thus are contraindicated in achalasia.
7. A 45-year-old male executive comes to your office complaining of epigastric pain for 2 months. His
primary physician prescribed him H2-blockers 3 weeks ago, which have produced only partial relief of
his symptoms. His weight is stable. His physical exam is normal. An upper endoscopy reveals a 1-cm
duodenal ulcer. Which of the following risk factors is not associated with the development of ulcer
disease?
Answer: C
Explanation: Although considered a risk factor in the past, several studies showed that emotional stress
is not a risk factor for the development of duodenal ulcer. Daily NSAID use significantly increases the
risk of ulcer disease (risk ratio, 10- to 20-fold). Gastric infection with H. pylori increases risk about
five- to sevenfold. Cigarette smoking doubles the risk of duodenal ulcer. At least 90% of those patients
with Zollinger-Ellison syndrome have duodenal ulcer.
8. A 20-year-old white woman presents with jaundice and malaise of 2 weeks' duration. Her boyfriend
had some form of hepatitis several months before. Initial laboratory studies reveal alanine transaminase
(ALT) of 211 U/L, aspartate transaminase (AST) of 194 U/L, and bilirubin of 5.4 mg/dL. HBsAg and
anti-HBc IgM are positive. Which of the following statements regarding acute hepatitis B is false?
Answer: D
Explanation: Ninety to 95% of otherwise healthy adult patients with acute hepatitis B recover
completely and become HBsAg negative. About 1% experience massive necrosis, and 5 to 10% of
patients who remain HBsAg positive beyond 6 months are at increased risk of chronic hepatitis.
Interferon given during acute hepatitis B infection has not shown any benefit.
9. A 51-year-old woman presents with abdominal pain, weight loss, early satiety, and night sweats. On
physical exam she appears cachectic, multiple enlarged lymph nodes are present in her neck
(supraclavicular area), and a mass is palpated in the epigastrium. Laboratory data reveal a hemoglobin
of 8 g/dL and a normal WBC count. Which of the following is the most appropriate next step in
establishing the diagnosis?
Upper GI series
Peripheral blood smear
CT of the abdomen
Upper endoscopy with biopsy
Exploratory laparotomy
Answer: D
Explanation: This patient has lymphoma of the stomach. Lymphoma of the stomach can resemble
superficially spreading carcinoma, linitis plastica, or solitary adenocarcinoma. Gastroscopy with
directed biopsy and brush cytology gives a higher yield than was previously appreciated, especially in
the presence of exophytic lesions. Lymphoma of the stomach frequently presents radiographically as a
bulky mass and less frequently as a diffusely infiltrating tumor-the most common form of secondary
lymphoma-giving the appearance of large folds on upper GI series, frequently associated with multiple
nodular defects and ulcerations. Although CT may be useful to evaluate the extent of disease, it will not
provide a specific diagnosis. Exploratory laparotomy is useful for staging and therapeutic resection
where possible.
10. Which of the following features best distinguishes Crohn's disease from ulcerative colitis?
Oral ulcers
Rectal bleeding
Continuous colonic involvement on endoscopy
Noncaseating granulomas
Crypt abscesses
Answer: D
Explanation: Oral ulcerations can occur both in Crohn's disease and ulcerative colitis. Rectal bleeding
and continuous involvement of the colon may be also seen in both Crohn's disease and ulcerative
colitis. The presence of crypt abscesses does not distinguish ulcerative colitis from Crohn's disease;
however, noncaseating granulomas, when present, are pathognomonic of Crohn's disease.
11. A 49-year-old man presents to the emergency room because of melena of 3 days' duration. He
denies abdominal pain. Vital signs reveal a resting pulse of 104 per minute and a 25-mm Hg orthostatic
drop in BP. Physical findings include bilateral temporal wasting, pale conjunctivae, spider angiomas on
his upper torso, muscle wasting, hepatosplenomegaly, and hyperactive bowel sounds without
abdominal tenderness to palpation. His stool is melenic. Nasogastric tube aspiration reveals coffee
grounds material. Hematocrit is 31%. The appropriate next step in the management of this man's illness
would be to
Answer: E
Explanation: After this patient has been hemodynamically stabilized, the next most important step is to
perform a diagnostic/therapeutic upper endoscopy. If the source of his bleeding is from esophageal
varices, then these can be obliterated with sclerosis or, preferably, endoscopic band ligation. The use of
a Sengstaken-Blakemore tube should be reserved for patients in whom upper endoscopy was
unsuccessful in controlling the hemorrhage. A TIPS should be considered in patients in whom medical
and endoscopic therapy have failed. Barium studies have no role in the evaluation of patients with
suspected variceal hemorrhage
Haematology
1. You are asked to see a 25-year-old white man who experienced marked weakness and dyspnea 4
days after being admitted for a compound arm fracture after falling from a tree. Estimated blood loss
from the initial fracture episode was 600 mL, and the patient was transfused with one unit of packed
erythrocytes. The initial crossmatch was reported as compatible by the transfusion service. The patient
has never been transfused before this incident and has no other serious medical illnesses. The patient's
arm fracture was treated with surgical pinning and prophylactic antibiotics consisting of cefotetan 2 g
IV every 12 hours. On examination, the patient is febrile and mildly tachycardic, with no evidence of
wound infection or compartment syndrome. Laboratory data show a hematocrit of 15%, absolute
reticulocyte count of 600,000 L, and total bilirubin of 70 umol/L with direct bilirubin of 9 umol/L.
The peripheral smear shows many spherocytes. No hemoglobinemia or hemoglobinuria is seen on
visual inspection of the plasma and urine. The transfusion service reports that the direct Coombs' test is
now strongly positive using anti-IgG and only weakly positive with anti-C3d antisera. They further
report that routine compatibility tests show no new erythrocyte antibodies in the patient's serum and
that, when they attempted to elute antibody from the patient's RBCs and test against normal RBCs, the
results were negative. What is the most likely diagnosis?
Asnwer: E
Explanation: Recognize drug-induced immune hemolytic anemia of the hapten type, classically
developing in patients exposed to high doses of penicillin. The other types of drug-induced immune
hemolytic anemia are the [agr ]-methyldopa type (the most common) and the quinidine type (occurring
with quinidine, quinine, stibophen, chlorpromazine, and sulfonamides). In this patient the strongly
positive direct Coombs test shows that this is an immune hemolytic anemia. Three findings suggest the
diagnosis of a drug-induced mechanism rather than an autoimmune mechanism: (1) the patient received
a cephalosporin known to induce a hapten-type reaction, (2) routine tests for RBC antibodies in the
patient's serum were negative even though the patient's RBCs were strongly coated for antibody, and
(3) eluate from the patient's RBCs was not reactive with normal RBCs. In most cases of drug-induced
immune hemolytic anemia, the RBC antibodies are detectable only if the offending drug is added to the
in vitro system.
Preeclampsia/eclampsia
Pregnancy-related ITP
Answer: B
Explanation: Pregnancy-related ITP, by definition, affects only the platelets. Microangiopathic
hemolytic anemia, which is caused by a variety of disorders, is an RBC fragmentation syndrome
resulting from fibrin deposition in partially thrombosed microvasculature. RBCs are caught on the thin
fibrin strands, and fragmentation of RBCs into various sizes and shapes results.
Preeclampsia/eclampsia, HELLP, and postpartum HUS can give rise to microangiopathic hemolytic
anemia. (Hoffman et al, Chs. 32-35; Lee et al, Ch. 49; Cecil, Ch. 169)
TTP
HUS
Vasculitis
Venoms
Disseminated intravascular coagulation (DIC)
Asnwer: D
Explanation: Venoms cause intravascular hemolysis, but not by a mechanism of microangiopathic
fibrin deposition. Other causes of intravascular hemolysis, but not by a mechanism of microangiopathic
hemolytic anemia, include valve hemolysis, exertional hemolysis, chemical agents, osmotic lysis,
thermal injury, infections, PNH, and cold agglutinin disease.
disorders of hemoglobin.
Thalassemias are always inherited disorders
Asnwer: A
Explanation: In the general classification schema, thalassemias can be classified as disorders of
quantitative abnormalities of hemoglobin, wherein the morbidity of the disease is usually a result of the
excess globin chains of the unaffected gene (e.g., [agr ]-thalassemia results in decreased [agr ] chains
and excess chains, with the precipitated excess chains causing the problems). Hemoglobinopathies
(e.g., hemoglobin SS, SC) are qualitative abnormalities of the hemoglobin chains usually as a result of
point gene mutations. Thalassemias are generally inherited, but acquired cases have been reported.
5. A 52-year-old black woman comes to you for another opinion regarding a history of anemia that has
been unresponsive to oral iron supplementation. She sought your opinion because her other physician
was recommending IV iron supplementation. She has been on nearly continuous iron supplementation
therapy ever since her second child was born 23 years ago. Over the years she says her doctors have
prescribed her to take anywhere from one to three pills daily, sometimes with vitamin C concomitantly.
Although she has never needed a transfusion, she says she has been told that her RBC count has never
completely normalized. She is otherwise healthy and has no unusual dietary habits. Her menstrual
history reveals relatively normal menstrual periods until about 3 years ago, when she attained
menopause. The patient believes that her mother was also iron deficient. Your physical exam is normal.
Laboratory values show a hemoglobin of 11.6 g/dL; hematocrit, 33%; MCV, 70 fL; normal WBC with
differential; normal platelet count; serum iron, 70 g/L; iron-binding capacity, 255 g/dL; and ferritin,
158 g/L. At this point you should next
Agree with the other physician and recommend IV iron supplementation because she does not appear
to be absorbing enough oral iron to totally correct her anemia.
Perform a hemoglobin electrophoresis.
Obtain a serum EPO level.
Discontinue iron supplementation.
Perform a bone marrow aspirate and biopsy.
Answer: D
Explanation: Recognize a clinical history suspicious for two-gene [agr ]-thalassemia. Deletion of two
[agr ] genes (-[agr ]/-[agr ] or -/[agr ][agr ]) results in mild to moderate microcytosis and mild anemia,
rarely with any progression or development of other signs or symptoms. It is probably the most
common hemoglobinopathy in the world, and the combination of one-gene or two-gene [agr ]thalassemia has an incidence of 20% or more among blacks. It is often mistaken for iron deficiency
anemia, and menstruating women with two-gene [agr ]-thalassemia are often treated for prolonged
periods with iron supplementation because it is presumed that the mild microcytic anemia is due to iron
deficiency. A hemoglobin electrophoresis is a useful test for -thalassemia wherein one looks for
increased levels of hemoglobin A2 and hemoglobin F. However, hemoglobin electrophoresis is
generally not helpful for the diagnosis of an [agr ]-thalassemia disorder. A globin chain synthesis study
is generally required for a conclusive diagnosis. Because these studies are not routinely available,
[agr ]-thalassemias are often diagnosed presumptively by ruling out other possibilities
6. A 25-year-old white woman presents to the emergency room with the complaint of extreme shortness
of breath of acute onset. She was actually seen in the same emergency room 24 hours previously where
she was diagnosed with a urinary tract infection and given prescriptions for phenazopyridine
(Pyridium) and sulfamethoxazole. She is overweight and sedentary and smokes two packs of cigarettes
a day. On physical exam she is markedly dyspneic and extremely cyanotic. Arterial blood gases fail to
reveal any hypoxia, but a ventilation-perfusion scan is obtained anyway, which is read as low
probability. What should be the next course of action?
Repeat the arterial blood gas to look for progression and development of hypoxia.
Proceed to pulmonary arteriography.
Begin anticoagulation.
Administer methylene blue.
Transfuse two units of packed RBCs.
Answer: D
Explanation: Recognize an individual with methemoglobinemia who has been exposed to an offending
agent. Rapid development of extreme dyspnea and cyanosis, in the setting of no hypoxia, should be the
clue to consider methemoglobinemia. In this case, the patient was exposed to two different known
medications (pyridium and sulfamethoxazole) associated with increased levels of methemoglobin in
susceptible individuals. Methemoglobin is the derivative of hemoglobin, in which the iron of the heme
group is oxidized from the ferrous to the ferric state. It is the oxidation status that determines the
oxygen-carrying capacity of hemoglobin. When iron is in the ferrous form (deoxyhemoglobin), oxygen
can easily bind, in contrast to the inability to bind to the ferric hemes of methemoglobin. Steady-state
methemoglobin levels in the blood are usually <1% but can increase markedly when susceptible
individuals (heterozygotes for methemoglobin reductase deficiency) are exposed to certain medications
or chemicals. Correct therapy is prompt institution of methylene blue, to which individuals will
respond rapidly with resolution of cyanosis.
7. A 50-year-old white man comes to see you because he was told he had "high blood." Physical exam
is normal except for a ruddy complexion, which he says he has had most of his adult life .He has
smoked two packs of cigarettes per day since he was 16 years old. A CBC shows a normal WBC count
and differential, normal platelet count, a hemoglobin of 18.4 g/dL, and a hematocrit of 57%. To work
up this elevated hematocrit, what is the next most appropriate test to order?
Asnwer: C
Explanation: An RBC mass study is the next most appropriate test to order to determine whether the
elevated hematocrit is a true polycythemia (erythrocytosis) or a spurious elevation (resulting from
reduced plasma volume). Because of the significant smoking history, this patient may have evidence of
chronic obstructive pulmonary disease with resultant abnormal arterial blood gases and pulmonary
function tests, but these tests will not distinguish a true polycythemia from a spurious one. An EPO
level may be indicated later in the work-up once a true polycythemia has been documented.
8. For the patient described in question 7, the next set of tests to order after the preliminary assessment
would include all of the following, except
Answer: E
Explanation: Once a true RBC mass elevation has been documented, a search for a cause must ensue.
The patient's history of nearly lifelong ruddy complexion could be due to tobacco abuse but may also
suggest a congenital polycythemia. Most congenital polycythemias are due to hemoglobin mutants with
high oxygen affinity. These abnormal hemoglobin affinities as well as abnormal levels of 2,3diphosphoglycerate (2,3-DPG) can be detected by measuring a P50 level on the oxygen
saturation/desaturation curve. Tumors and other disorders can lead to elevated levels of endogenous
erythropoietin. Arterial oxygen saturation and carbon monoxide determinations can rule out pulmonary
and environmental conditions. A bone marrow exam is rarely useful in the work-up of erythrocytosis,
even for a potential diagnosis of polycythemia rubra vera, in which culture of erythroid progenitor cells
for the detection of erythropoietin-independent colony growth is currently the closest thing to a
diagnostic test for this disease.
9.
10. A 62-year-old woman with a platelet count of 1,350,000/L has been diagnosed with essential
thrombocytosis after an exhaustive search failed to reveal any reactive causes for the elevated platelet
count. Her platelet count has been greater than 1 million for more than 6 months. The most appropriate
therapy now that a diagnosis of essential thrombocytosis has been established is
Platelet pheresis
Aspirin
Anagrelide
Hydroxyurea
Interferon-[agr ]
Answer: C
Explanation: Anagrelide is an oral imidazoquinazolin derivative that has been approved by the FDA as
a platelet-lowering agent in essential thrombocythemia. It appears to lower the platelet count by
interfering with the maturation of megakaryocytes. There are some side effects, but they are relatively
mild in most cases. It should not be administered in cases of reactive thrombocytosis because their risk
of complications from thrombocytosis is much less than in patients with thrombocytosis from inherent
marrow disorder. Because essential thrombocytosis patients are at risk for hemorrhage as well as
thrombosis, aspirin is not indicated in all cases. Hydroxyurea has a potential leukemogenic risk because
it is a chemotherapeutic, although this risk has not been substantiated. Anagrelide lacks this potential
risk because it is not a chemotherapeutic agent. Interferon has many more associated side effects with
less efficacy. Thus, anagrelide appears to offer the best therapeutic window with the fewest risks and is
the treatment of choice for essential thrombocythemia as long as it is tolerated by the patient.
11. A 54-year-old white man is admitted to the hospital because of abdominal pain and "black stools."
He has not seen a doctor in years. He smokes two packs of cigarettes daily. Physical exam reveals poor
dentition, normal cardiovascular exam, moderate splenomegaly with mild epigastric and left upper
quadrant tenderness, and a guaiac stool test positive for occult blood. Laboratory values reveal a
hemoglobin of 9.5 g/dL, hematocrit of 29%, WBC count of 14,500/L with a fairly normal differential,
a platelet count of 540,000/L, and a ferritin level of 4 g/L. Serum vitamin B12 levels are elevated. A
bone marrow exam shows hypercellularity without other specific findings, and chromosomes are
reported as normal. Endoscopy reveals a gastric ulcer and biopsies are negative for malignancy but
positive for Helicobacter pylori infection. Appropriate management at this stage should be
Splenectomy
Transfusion of two units of packed RBCs
Observation
Antibiotic treatment for the H. pylori infection and iron supplementation for the iron deficiency
anemia
Antibiotic treatment for the H. pylori infection
Answer: E
Explanation: Recognize that this patient has all of the manifestations of polycythemia rubra vera except
that his bleeding gastric ulcer has masked the development of polycythemia. Because of his bleeding
gastric ulcer, he has already become iron deficient, which is the goal of the cornerstone phlebotomy
therapy for polycythemia vera. Instituting iron supplementation at this point may very well give the
patient more morbidity because it could cause a rebound erythrocytosis. Rather, the H. pylori infection
should be treated to cure the gastric ulcer, and a further work-up for a probable diagnosis of
polycythemia vera should ensue, including culture of the patient's erythroid progenitor cells looking for
EPO-independent colony growth, a hallmark for the diagnosis of polycythemia vera.
Endocrinology
1. A 51-year-old white man was recently diagnosed with a solitary 2.7-cm papillary cancer of the
thyroid with no invasion of the capsule, no lymphadenopathy, and no distant metastases. He denies a
history of head and neck irradiation, hoarseness, pain, dysphagia, or hemoptysis. His physical exam is
otherwise normal, with no lab abnormalities. Which of the following measures is most appropriate for
his management?
Answer: E
Explanation: Thyroid cancer remains a significant medical problem in the United States; 12,000 new
cases are diagnosed and 1000 deaths are reported each year. Differentiated thyroid cancer is classified
into follicular and papillary (derived from the follicular cells) and medullary thyroid carcinoma
(derived from the C cells). Rarely, the thyroid is the site of involvement by lymphoma. Anaplastic
cancer arises from the papillary and follicular cancers. The most common type of thyroid cancer is
papillary cancer, which accounts for approximately 70% of all thyroid cancers. It is two to three times
more common in females and peaks in the third and fourth decades of life. Papillary cancer is usually
nonencapsulated and sometimes multifocal and tends to spread by the lymphatic route. Follicular
cancer is the second most common form of thyroid cancer, accounting for 15% of all thyroid cancers. It
affects a slightly older age group and is more commonly diagnosed in females than in males. Follicular
cancer tends to be encapsulated, is usually unifocal, and tends to spread via the hematogenous route;
early metastases are seen with small lesions. Thyroid cancer is now diagnosed at an early stage, and its
slow rate of growth makes for a favorable outcome in a majority of cases. Sometimes, however, thyroid
tumors are encountered that display aggressive features leading to early death despite aggressive
treatment. Moreover, the treatment modalities themselves can sometimes be attended by significant
complications, making the optimum treatment of thyroid cancer a highly controversial issue. Therefore,
an understanding of the factors that affect prognosis should guide selection of treatment modalities. In
papillary cancer, prognosis is affected by tumor size, presence or absence of metastases, patient age,
and degree of differentiation. Generally, the smaller tumors (<1.5 cm) carry an excellent prognosis in
the absence of metastasis, whereas larger tumors (>2.5 cm) tend to carry a poorer prognosis. Patient
age greater than 40 years at diagnosis tends to carry a poor prognosis in part because of poor
concentration of iodine by most tumors. Poorly differentiated tumors tend to run a more aggressive
course. The first line of treatment of thyroid cancer consists of surgical resection. Although the
optimum procedure is not known, the more aggressive tumors should be managed with more extensive
procedures (near-total or total thyroidectomy with or without lymph node dissection). RAI ablation
should be considered when residual or metastatic disease is present. Finally, thyroid hormone treatment
should be used with a goal of keeping the TSH level as low as possible without causing overt
hyperthyroidism. RAI ablation and thyroid hormone suppression have been shown to reduce recurrence
of thyroid cancer. In this patient, age and tumor size predict a poor outcome. Treatment should,
therefore, consist of near-total thyroidectomy, RAI ablation, and thyroid hormone treatment.
2. You saw a 71-year-old white woman nursing home resident who was brought in by her daughter for
a complete physical exam. Her complaints include a poor appetite, weight loss, cramps, and weakness.
She was diagnosed with Crohn's disease 10 years ago but is not taking any medications. Five months
ago she had a mammogram and flexible sigmoidoscopy, both of which were normal. Because her exam
was normal, she was given a 1-month return appointment and sent for blood work. At the end of the
day, your lab calls to report a panic value of calcium of 1.4 mmol/L (normal range, 2.2 2.6 mmol/L)
with an inorganic phosphate of 0.58 mmol/L (normal range, 0.8 1.5 mmol/L). She has a creatinine of
80 umol/L (normal range, 60 110 umol/L), albumin is 35 g/L (normal range, 37 49 g/L), and
alkaline phosphatase is 250 U/L (normal range, 42-98 U/L). Which of the following diagnoses is
compatible with these lab data?
Hypoparathyroidism
Hypomagnesemia
Vitamin D deficiency
Renal failure
Answer: C
Explanation: The causes of hypocalcemia, an abnormal reduction of serum calcium, can quickly be
determined by examining the serum phosphorus, creatinine, and calcium. In hypoparathyroidism, there
is reduced mobilization of calcium from bone, reduced renal reabsorption of calcium (along with
decreased phosphaturia), and reduced formation of 1,25-hydroxyvitamin D, resulting in reduced
intestinal absorption of calcium. Consequently, the hypocalcemia is accompanied by
3. A 38-year-old black woman draws your attention to a swelling in her neck, which she noticed 2 days
ago. She denies palpitations, diaphoresis, and weight loss. There is no pain, hoarseness, or dysphagia.
Her medical history is notable only for hypertension. Medications include only atenolol 50 mg once
daily. On exam, blood pressure is 150/80 mm Hg; pulse is 70. There is a 2 1-cm nontender nodule on
the right lobe of the thyroid. No lymphadenopathy is detected. The remainder of the exam is
unremarkable. Electrolytes, blood urea nitrogen (BUN), creatinine, liver function tests, calcium,
phosphorus, and CBC are normal. What would you do next?
Answer: E
Explanation: The clinically apparent (>1 cm) thyroid nodule is a common clinical finding; up to 5% of
the population is affected. It is more common in women than in men, and a majority (85%) are
hypofunctional or cold nodules. The likelihood of malignancy in a solitary thyroid nodule is low (4%);
cold nodules carry a higher risk than hot nodules (20% vs. 1%). Evaluation of a solitary nodule should
be aimed at detecting potentially malignant lesions so that as many cancers are removed with as few
operations as possible. A history of head and neck irradiation raises the likelihood that a thyroid nodule
is malignant, as does the presence of a family history of differentiated thyroid cancer or medullary
cancer of the thyroid (which can be a component of multiple endocrine neoplasia <MEN> type IIA or
IIB). Fine-needle aspiration of the thyroid gland is a cost-effective procedure with a high sensitivity
and specificity for malignancy. Fine-needle aspiration allows the nodule to be characterized
cytologically as benign, malignant, suspicious for malignancy, or indeterminate.
4. A 60-year-old white man comes to see you for chronic back pain, which worsened 1 week ago. He
has been wheelchair bound for 6 months because of severe osteoporosis with multiple lumbosacral
spine fractures. He has severe asthma, which has required large doses of glucocorticoids for many
years. The patient reports progressive loss of height and kyphosis over the past year. Other medications
include albuterol and ipratropium inhalers and long-acting theophylline 300 mg twice a day. Significant
physical findings include bilateral cataracts, multiple ecchymoses, and a prolonged expiratory phase
with bilateral wheezes. Which of the following measures may be helpful?
Answer: F
5. Regarding the patient in question 4, which of the following underlies his osteoporosis?
Answer: E
Explanation: Glucocorticoids are used in the treatment of chronic inflammatory diseases of the lungs,
connective tissue, and intestines as well as in transplantation because of their anti-inflammatory effect.
When long-term treatment is required, several complications (e.g., cataracts, truncal obesity, skinthinning, hyperglycemia) may be seen. A particularly disabling complication is bone loss, which can
lead to fracture; it can occur with or without the other complications of chronic steroid treatment. The
incidence of steroid-induced osteoporosis is unknown, but it appears to be related to the duration of
treatment, half-life of the steroid, and its dose. Risk factors associated with increased bone loss include
age, body mass index, and duration of use. Steroid-induced osteoporosis proceeds rapidly in the first 6
months of steroid use and slows thereafter. Trabecular bone and the cortical rim of the vertebral body
are most susceptible to the effects of steroids. Steroids induce bone loss by several mechanisms. First,
they inhibit calcium absorption in the GI tract while enhancing calcium loss in the kidneys. These
effects induce secondary hyperparathyroidism, which leads to increased bone resorption. Second, they
lower sex hormone levels through an effect on the gonadotropin levels and a direct effect at the gonadal
level, as well as by decreasing adrenal sex steroid synthesis by inhibiting ACTH release. Third, they
have a direct inhibitory effect on osteoblast proliferation, activity, and half-life, leading to decreased
bone formation. Fourth, they induce proximal muscle weakness. Short-term studies showed that
steroid-induced osteoporosis can be prevented or treated by using measures aimed at minimizing the
negative effects of steroids on calcium and bone metabolism. Deficiency of sex steroids should be
corrected. Physical therapy should be encouraged to prevent steroid-induced myopathy. Calcium and
vitamin D supplementation and diuretics have been used to enhance calcium absorption and minimize
calcium loss in urine, thereby preventing secondary hyperparathyroidism. Regular monitoring is
recommended to prevent hypercalcemia.
6. A 35-year-old black woman comes to see you for a complete physical exam. She has experienced
cold intolerance, weakness, and constipation for 3 months. Her menses are regular but scanty. Her
history is significant for hypertension and peptic ulcer disease, and her family history includes
hypertension and diabetes. The patient is married but has never been pregnant and takes cimetidine 400
mg at bedtime, sustained-release nifedipine 60 mg daily, and docusate sodium 100 mg three times a
day. Her pulse is 58 beats/minute with a blood pressure of 135/90 mm Hg. Her skin is dry and scaly,
and she has hung-up reflexes. The rest of her exam is normal, and the following labs are obtained:
serum chemistries are normal except for a creatine kinase of 300 U/L (normal range, 26-140 U/L);
CBC is normal, free thyroxine (T4) is 6.4 pmol/L (normal range,10 22 pmol/L), and thyroid
stimulating hormone (TSH) is 1.5 mIU (normal range, 0.3-5.0 mIU). Which of the following tests
would you order?
Answer: D
Explanation: This patient has central hypothyroidism and should be evaluated for pituitary and endorgan function as well as the presence of a pituitary tumor. The prolactin level should be measured and
the pituitary-adrenal, gonadal, and growth hormone axes assessed. The presence of a pituitary tumor
can be determined by imaging the pituitary gland with MRI or CT scan. Where appropriate, this should
be followed by evaluation of the visual fields. Measurement of the subunit, a glycoprotein shared by
FSH, LH, and TSH, may also be useful because some pituitary tumors secrete only this peptide.
7. A 38-year-old black woman comes to you for renewal of her medications. She has had hypertension
since her last pregnancy at age 30 and has been maintained on clonidine 0.2 mg twice a day. She gets
headaches, dyspnea on exertion, swelling of her feet, and orthopnea but denies chest pain. Her father is
also being treated for hypertension. She is married and does not smoke. She is five feet seven inches
tall and weighs 257 pounds. Her blood pressure is 180/110 mm Hg; pulse is 92 beats/minute. The rest
of her exam is remarkable for hypertensive retinopathy, bibasilar rales, and 1+ pitting edema bilaterally.
Initial labs were normal except for a serum potassium of 3.0 mEq/L (normal range, 3.5- 5.0 mEq/L)
and serum bicarbonate of 33 mEq/L (normal range, 22-28 mEq/L). You correct hypokalemia and obtain
a random serum aldosterone level of 25 ng/dL (normal range, 5-30 ng/dL) with a plasma renin activity
of 0.5 ng/mL/hour (normal range, 1.6- 7.4 ng/mL/hour) while the patient is on a normal diet. What
additional tests might be appropriate?
Answer: E
Explanation: Primary aldosteronism, a disorder characterized by hypertension, hypokalemia,
suppressed plasma renin activity, and increased aldosterone secretion, affects 0.05 to 2% of the
hypertensive population. This disorder should be suspected in hypertensive patients in whom
spontaneous or easily provoked hypokalemia develops that is slow to correct after discontinuation of
diuretics. As important as recognizing the presence of primary aldosteronism is the differentiation of
lesions that are surgically curable (60-70% of the cases in some series) from those that are best treated
medically. In this patient, the presence of hypertension, hypokalemia, and alkalosis appropriately
triggered screening for hyperaldosteronism, which led to the findings of an aldosterone-renin ratio of
greater than 30, which constitutes a positive screening test. Aldosteronism can be confirmed by the
finding of a 24-hour urine aldosterone secretion of 12 g in the salt replete state. Adrenal imaging is the
next step to differentiate adrenal adenoma from adrenal hyperplasia, although adenomas smaller than
1.5 cm can be missed and thus mistaken for hyperplasia. In confusing cases, adrenal vein sampling for
aldosterone measurements is used to localize adenoma with a 95% accuracy. The finding of a
lateralizing 10:1 aldosterone ratio in the presence of a symmetrical ACTH-induced cortisol rise
diagnoses and localizes an adenoma. Other features suggestive of adenoma include plasma 18-hydroxy
corticosterone of 100 ng/dL or more, spontaneous hypokalemia of less than 3 mEq/L, and an
anomalous postural decrease of plasma aldosterone concentration. Saline loading is inappropriate in
8. A 27-year-old white woman was admitted 2 days ago through the emergency room for seizures. She
has a history of moderate alcohol use. Two weeks ago she received benzathine penicillin for secondary
syphilis. She is complaining of muscle cramps, weakness, and headache. She received 1 g of phenytoin
on the day of admission and is now taking 100 mg three times a day. She is also taking acetaminophen,
multivitamins, and tapering doses of chlordiazepoxide. There is a history of seizures in her family. She
is 5 feet tall and weighs 120 pounds. Her blood pressure is 130/80 mm Hg; pulse is 90 beats/minute.
The rest of the physical exam is normal except for a round face, a short neck, short fourth and fifth
metacarpals, and bilateral cataracts. Abnormal labs include a calcium of 1.5 mmol/L (normal range,
2.2-2.6 mmol/L), phosphorus of 1.7 mmol/L (normal range, 0.8-1.4 mmol/L), and an intact parathyroid
hormone (PTH) of 200 pg/mL (normal range, 15-65). Which of the following is most likely?
Hypothyroidism
Hypogonadism
Basal ganglia calcification
Mental retardation
All of the above
Answer: E
Explanation: The findings of Albright's hereditary osteodystrophy (short stature, brachydactyly, and
soft tissue calcification) along with severe hypocalcemia and elevated PTH are diagnostic of
pseudohyperparathyroidism (Type IA). This is an autosomal-dominant disorder resulting from a G
protein (Gs) defect, which leads to PTH resistance. Hypothyroidism and ovarian failure are also seen
because Gs also couples to TSH and gonadotropin receptor signaling, respectively. Mental retardation
is seen in 70% of cases.
9. All of the following thyroid conditions are amenable to RAI treatment, except
Papillary cancer
Follicular cancer
Graves' disease
Thyroid lymphoma
Multinodular goiter
Answer: D
Explanation: Iodine 131 is a radioactive isotope of iodine (RAI) that is selectively concentrated in the
thyroid tissue and metabolized by the same pathways as naturally occurring iodine. This, together with
its long half-life (8 days), allows it to deliver high doses of radiation to the thyroid gland (-radiation)
sufficient to destroy thyroid follicular cells. Thus, 131I is used in the treatment of Graves' disease, toxic
multinodular goiter, and differentiated thyroid cancer. The doses of RAI used in the treatment of
Graves' disease and toxic multinodular goiter are relatively low compared with those used in the
treatment of thyroid cancer (in which it is used in conjunction with surgery). RAI has no place in the
treatment of thyroid lymphoma because lymphoma cells do not concentrate iodine.
Answer: D
Explanation: PTH, an 84-amino-acid peptide synthesized and secreted by the parathyroid gland, is a
potent regulator of the serum calcium level. Hypocalcemia stimulates the secretion of PTH acutely
(with increased PTH synthesis and parathyroid cell hypertrophy and hyperplasia after chronic
hypocalcemia), whereas hypercalcemia leads to decreased secretion of PTH. Hypomagnesemia inhibits
PTH secretion. Elevated 1,25-dihydroxyvitamin D affects PTH synthesis and secretion by directly
inhibiting the parathyroid gland and indirectly via hypercalcemia. Low levels of 1,25-dihydroxyvitamin
D have the opposite effect.
Rheumatology
1. 43-year-old woman presents with a 3-year history of progressive rheumatoid arthritis that has been
partially responsive to various nonsteroidal anti-inflammatory drugs (NSAIDs) and to low-dose oral
corticosteroids. After the examination, you decide to treat her active arthritis with methotrexate,
currently the most widely used and effective agent for rheumatoid arthritis. Some of the facts to tell her
about methotrexate therapy include
Therapeutic effects are delayed so that clinical improvement is not generally seen for 3 to 6 weeks after
initiation of treatment.
Adverse effects may include oral ulcers, nausea, vomiting, pneumonitis, bone marrow suppression, and
cirrhosis.
CBC, platelet count, alkaline phosphatase level, and serum glutamic-oxaloacetic transaminase (SGOT)
level should be obtained every 4 to 6 weeks to monitor therapy.
Birth control measures must be in use before methotrexate is started.
All of the above.
Answer: E
Explanation: All of the answers are correct. Methotrexate is currently the best drug used to treat
rheumatoid arthritis, with initial improvement seen in 3 to 6 weeks and peak efficacy in 4 to 6 months.
Adverse effects such as nausea, abdominal pain, and diarrhea are frequently seen, but serious toxicity is
rare. Methotrexate is taken orally (7.5-15 mg/week), and tolerance may be increased by spacing the
oral doses over 1 to 2 days, giving a single intramuscular injection each week and daily folic acid (1
mg/day) supplementation. Laboratory tests such as CBC, platelet count, alkaline phosphatase, and
SGOT are done every 4 to 6 weeks. The most toxic drug-related side effects are pancytopenia,
neutropenia, thrombocytopenia, pneumonitis, and cirrhosis; all are reasons to stop the medications.
Transient or sustained (1.5-2 times normal values) elevations in alkaline phosphatase and SGOT are
commonly seen and, in the majority of patients, generally do not portend the development of hepatic
fibrosis. Methotrexate is known to be teratogenic and should not be given to women with childbearing
potential unless they are using an adequate method of birth control. Because of its potential effect on
sperm, men should discontinue methotrexate 3 to 4 months before attempting conception.
2. 54-year-old woman complains of severe right shoulder pain localized mainly to the midhumerus but
also diffusely around the anterolateral shoulder. The onset was sudden and not precipitated by trauma.
Physical examination reveals limited abduction with point tenderness over the subacromial bursa and
the greater tuberosity of the humerus. A radiograph reveals a linear calcific density in the supraspinatus
tendon. All of the following statements are true, except
Treatment consists of cortisone injection into the subacromial bursa, NSAIDs, and physical therapy.
The calcific density is most likely calcium urate.
The diagnosis could not be made by an arthrocentesis.
Local tendon injury may be the major cause.
Answer: B
Explanation: The clinical features and radiographic pattern are characteristic for calcific tendinitis, an
extremely common rheumatic syndrome characterized by deposits of hydroxyapatite crystals within
injured rotator cuff muscles near the humeral attachment region. It most commonly involves the
supraspinatus tendon, but the infraspinatus and subscapularis tendons may also be involved.
Conservative treatment is indicated and is successful in the vast majority of cases.
3. A 74-year-old woman complains of worsening left knee pain with weight-bearing and ambulation.
Examination of the knee reveals a small effusion without warmth, bony enlargement, and crepitus with
flexion and extension of the knee. A diagnostic arthrocentesis is performed. Each of the following
Answer: E
Explanation: Clinically, the patient has osteoarthritis of the left knee. Synovial fluid in patients with
osteoarthritis is typically "noninflammatory," meaning that the leukocyte count is less than 2000/mm3.
A low level of glucose in the synovial fluid would not be found in this patient but is suggestive of
septic arthritis.
4. A 42-year-old woman with seropositive rheumatoid arthritis has become disabled by pain and
tightness behind the right knee. Physical examination reveals cystic swelling over the popliteal fossa
and semimembranous tendon. Which of the following is the most appropriate next step?
Answer: C
Explanation: The physical examination is suggestive of a distended Baker's cyst, but physical
examination alone is not diagnostic, particularly if there has been a dissection or rupture.
Ultrasonography has been found to be very useful in making a diagnosis of popliteal cyst with or
without dissection. An arthrogram could also demonstrate a popliteal cyst but is less desirable because
it is an invasive procedure. A venogram of the right lower extremity could be performed if a deep vein
thrombosis was suspected clinically but would not be indicated in this case
5. All of the following conditions involve the distal interphalangeal (DIP) joint, except
Multicentric reticulohistiocytosis
Erosive osteoarthritis
Psoriasis with nail changes
Juvenile chronic arthritis
Rheumatoid arthritis
Answer: E
Explanation: Although hand involvement is very common in rheumatoid arthritis and occurs in
approximately 95% of patients, DIP joint involvement is distinctly unusual. The most commonly
involved joints in the rheumatoid hand are the PIPs, MCPs, and wrist joints in a symmetric manner.
6.
7. An 82-year-old woman was hospitalized for treatment of congestive heart failure. She experienced a
warm, painful right knee on the 3rd hospital day. The most appropriate procedure would be
Answer: B
Explanation: Clinically, the patient has a monoarthritis most likely crystal induced, such as pseudogout
or gout. She could also have septic arthritis, although this would be less likely. Gout and pseudogout
can be rapidly and definitively diagnosed by proper examination of joint fluid, and infection can also
be ruled out in this manner.
8. A 46-year-old man on hemodialysis for 12 years complains of insidious onset of painful nocturnal
dysesthesias involving the thumb and three fingers, relieved by shaking the hand. Physical examination
of the hand reveals thenar wasting and numbness over the fingers. Each of the following statements is
true, except
Answer: E
Explanation: Clinically, the patient has carpal tunnel syndrome, an entrapment neuropathy in which the
median nerve is compressed within the carpal tunnel area. A new type of amyloid protein identified as
2-microglobulin has been demonstrated in bone and carpal tunnel tissue of patients undergoing longterm (usually greater than 10 years) hemodialysis. It is hoped that modifications of the dialysis
membranes may result in improved 2-microglobulin clearance with diminished tissue deposition.
9. Ophthalmologic manifestations of rheumatoid arthritis may include all of the following, except
Answer: E
Explanation: Ischemic optic atrophy is not routinely seen in patients with rheumatoid arthritis but may
be a major ophthalmic manifestation of giant cell arteritis, Wegener's granulomatosis, and, less
commonly, SLE.
10. All of the following are characteristic patterns of joint involvement in rheumatoid arthritis, except
Polyarticular involvement
Oligoarticular involvement
Symmetrical involvement
Involvement of the proximal interphalangeal (PIP), metacarpophalangeal (MCP) wrist, and
metatarsophalangeal (MTP) joints
Frequent cervical spine involvement
Answer: B
Explanation: Clinically, rheumatoid arthritis is a symmetrical polyarthritis especially involving the PIP,
MCP, wrist, and MTP joints. In many of these joints, definite articular deformities will develop over
time. Cervical spine involvement is common. Rarely is an oligoarticular pattern observed except in the
early course of this illness.
11. A 32-year-old woman presents with left inguinal and groin pain of 1 week duration that is worse
with weightbearing and ambulation. Physical examination reveals full range of motion of the left hip.
She walks with a limp. She had previously been treated with mechlorethamine, vincristine,
procarbazine, and prednisone therapy for Hodgkin's disease. An anteroposterior film of the pelvis
demonstrates no osseous abnormality. Which of the following tests would be most useful in making the
diagnosis?
Answer: C
Explanation: Osteonecrosis is one of the most common causes of hip pain and incapacity in patients
with a variety of diseases who have been treated with corticosteroids. A major problem in diagnosing
osteonecrosis relates to the lag between the onset of symptoms (pain and limp) and defined
radiographic changes. MRI has been shown to be extremely valuable in evaluating high-risk patients
who are symptomatic but radiographically normal.
12. Extra-articular manifestations of rheumatoid arthritis that may be associated with severe morbidity
or mortality include
Rheumatoid vasculitis
Pericarditis
Cachexia
Rheumatoid nodule within the aortic valve
All of the above
Answer: E
Explanation: All of the answers are correct. Rheumatoid arthritis may be associated with a number of
systemic features that may be associated with severe morbidity or mortality.
13. A 50-year-old white man is transferred to your hospital with a presumptive diagnosis of
tuberculosis. His chest radiograph shows nodular cavitary lesions in both lung fields. His urinalysis
shows 50 RBCs per high power field and 3+ proteinuria. He is scheduled for bronchoscopy with
transbronchial lung biopsy in the morning. That evening he has a sudden deterioration consisting of
massive hemoptysis and progressive renal failure. The most appropriate therapeutic intervention at this
IV corticosteroids
Antituberculous medications
IV cyclophosphamide 4 mg/kg
Oral cyclophosphamide 2 mg/kg
IV corticosteroids and IV cyclophosphamide 4 mg/kg
Answer: E
Explanation: The involvement of the lower respiratory tract as well as renal involvement suggests
Wegener's granulomatosis. Treatment of Wegener's granulomatosis with cyclophosphamide has
resulted in marked improvement in outcome of this condition. Because of the severity and sudden
deterioration, IV corticosteroids and IV cyclophosphamide would be indicated.
Answer: C
Explanation: Polymyalgia rheumatica is a common clinical syndrome in patients older than 55 years
and is characterized by stiffness and soreness in the shoulder and hip girdle areas. It is sometimes
associated with mild joint swelling. Laboratory findings include mormocytic/normochromic anemia
and elevated sedimentation rate. Weakness of the proximal upper and lower extremity muscles is
distinctly unusual and suggests a proximal myopathy such as polymyositis.
15. A 74-year-old man is noted to have purplish-discolored right third and fourth toes 4 days after
coronary angiography and a creatinine level of 2.4 mg/dL (creatinine level was normal on admission).
He has a history of adult-onset diabetes mellitus, hypertension, and 50 pack-years of smoking.
Cholesterol crystal atheromatous embolization is suspected. Which of the following may be present?
Livedo reticularis
Elevated erythrocyte sedimentation rate and/or leukocytosis and/or eosinophilia
Prominent gastrocnemius pain or claudication
Source(s) of the cholesterol emboli are usually the abdominal aorta or iliofemoral arteries rather than
the more distal arteries.
All of the above
Answer: E
Explanation: All of the answers are correct. Cholesterol crystal (atheromatous) embolization is a
common occurrence in patients with advanced atherosclerotic disease but is frequently either not
recognized or misdiagnosed as "vasculitis." The exact incidence is currently unknown, but it is
associated with significant morbidity and mortality. With a rise in the number of geriatric patients with
arthrosclerosis, the recognition of this disorder is critical to prevent unnecessary diagnostic studies and
treatment with high-dose corticosteroids/cytotoxic agents, which are of no benefit. The source of most
cholesterol emboli is the abdominal aorta or iliofemoral arteries, but cardiac and thoracic aorta sources
have been described
mak Posted: Mon Apr 18, 2005 5:38 pm Post subject: thanks
-------------------------------------------------------------------------------thanks for q
Anonymous Posted: Wed Apr 20, 2005 2:47 pm Post subject: Great work!
-------------------------------------------------------------------------------Dear ABCIXIMAB,
Thanks a lot for all the questions and the detailed explanations. Great way to learn and prepare for the
exam.
Allaboutielts
1.
drkashGuest
dear friend ;well done & thanks a lot for this great effort
drkash, Jul 29, 2006
#2
Thread Status:
1.
asdfgGuest
2.
GuestGuest
I think the answer for the man with 3 days history of dvt and why heparin should be used along with
warfarin is that because warfarin causes reduction in the level of protein c which causes a thromlabile
enviroment
thank you and hope to have more quetions and hope that all the ather who entered this exam to be
generous and provide us with more questions
Guest, Sep 19, 2006
#2
3.
halit2006Guest
mrcp1 12/9/2006
thanks alot
halit2006, Sep 19, 2006
#3
4.
halit2006.Guest
5.
halit2006..Guest
12/9/06 mrcp1
6.
GrMRCP1Guest
Cholestatic jaundice is a well known side effect of co-amoxiclav as well as amoxicillin alone (check
BNF), also of the oxy-penicillins. Flucloxacillin can cause cholestatic jaundice as well. So the problem
is which of the two is rarer side effect. Based on clinical evidence, it seems that amoxicillin causes
more often than flucloxacillin.
I put Amoxicillin.
7.
halit2005Guest
primary pnemothorax in hemodynamically stable patient and without shortness of breath the treatment
is aspiration, if failed the aspiration if failed then tube
thanks alot
halit2005, Sep 20, 2006
#7
8.
GrMRCP1Guest
I totally agree for primary small pneumothorax. But is 50% a small or large pneumothorax?
Furthermore, the question, if I remember well, does not state if the patient had SOB, chest pain or not!
Are the new British Thorasic Medicine guidelines suggest for large pneumothorax to try chest drain.
The oxford handbook of clinical medicine states to try aspiration and if not succesful then chest drain.
However if you see their references are back to 1993.
So the new British thorasic medicine guidelines favors chest drain for large pneumothorax.
GrMRCP1, Sep 20, 2006
#8
9.
GuestGuest
Dear GrMRCP1
I agree with you in the way you present your evidence. You always refer to your sources. I believe that
is the only way to support your opinion in a clear and consise way.
I would be delighted to see everyone in this forum to state their sources or references in order for the
forum to become more "scientific".
Medicine is not a matter of our personal opinion. We must be able to produce evidence of what we
write
Kind Regards,
papxxx
Guest, Sep 21, 2006
#9
10.
GrMRCP1Guest
Cheers
GrMRCP1, Sep 21, 2006
#10
11.
asdfgGuest
olsalazine..side effect
1.ulcerative colitis ....drud used for a prolong remission
2. t complainin of itch n sumthing crawling on her body...which acc to her comes out frm umblicus n
scalp...partner unaffected..she has collected some scrapins frm scalp....what wud b da findin under
normal microscpe....opions were..head louse ,body louse,scabies,fungal hyphe,squamous debris
3 ost MI pt...came for checkup...ventricular aneurism was da findin...drug to b added or replaced.
you are right regarding secondary pnemothorax where chest tube is the the treatment bu i think in
primary pnemothorax aspiration in case that the volume of pnemothorax is more than 15% or the
patient is short of breath the treatment first should be attempting aspiration
another question was about the pathogenesis of factor v leiden i think the answer was thst activated
protein c resistance?
another question was about the drug used for long term remisson in ulcerative colitis is it azathioprine
or sulfasalazine?
thank you all
halit2006, Sep 22, 2006
#17
12.
halit2006Guest
MRCP 1 12 9 2006
One of these cases involved a man who suffered a fatal internal hemorrhage. His blood clotting levels
increased dramatically six weeks after starting to drink cranberry juice.
In another case, blood clotting levels increased less dramatically but returned to the normal range after
cranberry juice was discontinued.
13.
halit2001..Guest
9 2006 mrcp1
One of these cases involved a man who suffered a fatal internal hemorrhage. His blood clotting levels
increased dramatically six weeks after starting to drink cranberry juice.
In another case, blood clotting levels increased less dramatically but returned to the normal range after
cranberry juice was discontinued.
14.
rahul79Guest
Exam was tough but counted about 30-40 questions from emrcp.com
15.
GuestGuest
Moderately tough,
Guest, Sep 23, 2006
#21
16.
rashdiGuest
23 ans pegets
24 ans flucloxacillin
28 and respiratory alkalosis
31 ans weigth gain
32 ans warfrin
33 ans observation
34 ans B interferon
35 ans malignant hyperthermia
37 ans angiodysplasia
38 ans S2
39 ans prostacyclin
others
1) gonorrhoria tx ans: ciprofloxin
2) cerative colitis ....drug used for prolong remission ans azathaioprim
3)pt complainin of itch n sumthing crawling on her body...which acc to her creature comes out frm
umblicus n scalp...partner unaffected..she has collected some scrapins frm scalp....what wud b da findin
under normal microscpe....ans squamous debris
17.
saleemasGuest
18.
saleemasGuest
19.
saleemasGuest
FOR UC MAINTAIN-- first Oral steroids ,then 5-ASA,but crohns---STEROID-then AZOTH-MTHOTREX&FINALLY INFLIXIMAB
saleemas, Sep 23, 2006
#25
20.
halit2006Guest
21.
halit2006Guest
22.
GuestGuest
I HOPE THE MODERATOR OR THE SUPERVISORS CORRECT THE HEADLINE FROM 2007
TO 2006
Guest, Oct 1, 2006
#28
23.
halit2006Guest
mrcp1 12 09 06
hi friends: thanks for all for your contributions in 12 sept 2006 mrcp1 forum.
thanks all
halit2006, Oct 2, 2006
#29
24.
Dr_Osama77Guest
Hi
I hope earier...
25.
Dr_Osama77Guest
Hi everybody,,
The results has just been published on the website.. Finally, I got pass. Wish you all the best..
Dr_Osama77, Oct 6, 2006
#31
26.
asdfgGuest
HURRAY I PASSED!!!!!!
ASDFG
asdfg, Oct 6, 2006
#32
27.
halit2006Guest
mrcp 1 12 09 2006
advice?
halit2006, Oct 7, 2006
#33
28.
Dr_Osama77Guest
Hi Halit2006
I guess you didn't chose to have your results published on the web..
If you chose to have your result published on the MRCP(UK) website but you are unable to find your
result please be aware that candidates with an incomplete application will neither receive their results
by post, nor have access to view their result online until their application is complete. Please contact
the relevant Administration Office if you believe that your application may still be incomplete.
Dr_Osama77
Dr_Osama77, Oct 7, 2006
#34
29.
halit2006Guest
mrcp1 12 09 06
30.
GuestGuest
PLZ IF SOME ONE CAN TELL WHAT WAS THE PASSING MARKS
Guest, Oct 8, 2006
#36
31.
Dr_Osama77Guest
32.
guest2006Guest
12 09 06 mrcp1
hi friends;
any one knows or expects the pass mark for 12 09 06 mrcp1 exam?
thanks alot
guest2006, Oct 9, 2006
#38
33.
rubGuest
34.
new to mrcpGuest
sept 12 09 06
one question was about a patient who was recently diagnosed with small cell lung carcinoma started on
etoposide and cisplatin developed tingling sensations in his hands and feet. cisplatin side effect?
cisplatin even though does not have much bone marrow suppression can be neurotoxic
sathyajith2006, Sep 22, 2006
#2
1.
halit2006Guest
mrcp 1 12 9 2006
the warfarin is interacting with carnberry juice as there was a question asking about it
One of these cases involved a man who suffered a fatal internal hemorrhage. His blood clotting levels
increased dramatically six weeks after starting to drink cranberry juice.
In another case, blood clotting levels increased less dramatically but returned to the normal range after
cranberry juice was discontinued.
2.
GuestGuest
ARey yaar Guys, those of you who have sat for the sept 2006 . Could you please come forward for
question discussions , plz
Guest, Sep 25, 2006
#4
3.
halit2005Guest
12 september 2006
why not lets come out foe the discussion of 12th september mrcp1 2006 questions if you like
thank you
halit2005, Sep 26, 2006
#5
4.
GuestGuest
hi
here are alot of question to discuss
55) Pt investigated for palpitations last year...found normal n reassured dat he is not suffring frm
serious heart disease..this time insistin dat he has cancer despite all normal findings...diagnosis
HYPOCHONDRIASIS
56) Pt complainig of joint pain ..normal findin...few months later comlainin abd pain..again
normal...next time another complain....no findins on exm, extensive tests performed, normal...diagnosis
SOMATOFORM DISORDER
57) Severe depression with psychosis.SEVERE DEPRESSION
58) Psychosis, started on haloperidol, now fever, wat on exam will suggest NMS? MS RIGIDITY
59) Pt complain of amnesia for 1 week..acc to his wife he left home was found wanderin in streets by
police..was complty consciuos and oriented but cudnt remember any thin abt himself...disturbed
relations wid partener...diagnosis? TRANSIENT GLOBAL AMNESIA
60) Female pt c/o itching & insects crawling all over body, no body else in her home has itching, she
has brought some insects in a matchbox, which she collected from hair, what do u expect to find?
SQUAMOUS DEBRIS
61) 40yr male, fever sorethroat n low platelet, Rx? STEROIDS, ITP?
62) Pt started on ATT, co dyspnea, airway obstruction, wat to do now? STEROIDS/ STENT??
63) Pt wid ca lung, edema rt hand, svc obstruction,wat to do next? RADIOTHERAPY
64) Female pt, itching L hand for a year, with scaling over palm n prominent palmer crease. Wat test
will u do to confirm ur diagnosis? SCRAPING UNDER WOOD LIGHT/ BIOPSY?
65) Coelic dis, dermatitis herpetiformis, biopsy taken, what will be deposited at dermoepidermal
junction? IgA
66) Black necrotic skin lesion on shins, for a year, not changing? KERATOACANTHOMA
67) 56 yr female, diagnosed TB, before starting ATT, vision was tested which showed color vision loss,
diagnosis?...........PREVIOUS OPTIC NERVE DIS/ CONGENITAL COLOR VISION LOSS?
68) Pregnancy, 12 wk, dyspnea, chest normal. Wat normal physiological change during pregnancy can
account for her dyspnea? INC. MINUTE VENTILATION
69) Dyspnea, PO2 low, PCO2 low, met acidosis, diagnosis? THROMBOEMBOLISM
70) 2/2 table, calculate specificity
71) Screening test was made, this was later stopped, reason for stopping? LOW SENSITIVITY
72) Data was collected, mean+ - 2SD was calculated. What % of population lie above this range? 2.5%
73) Data showed positively skewed distribution, wat is true abt it? MEAN IS MORE THAN MEDIAN
74) Pigmentation around mouth, came with PR bleeding, cause of bleeding?......CARCINOMA
75) Female pt wid h/o autoimmune dis, baby has heart block, which antibody will be positive? ANTIRO
76) Von-willibrand disease
77) Multiple sclerosis, now in remission, which Rx to start? IFN-B
78) Status epilepticus, 1st rx to give? LORAZEPAM
79) Pt came with malena, OGD showed benign looking gastric ulcer, Rx to start? I/V PPI
80) Pt with chest pain n dysphagia? ACHALASIA
81) A case of MEN 1 with insulinoma, test to diagnose? SUP MESENTERIC ANGIOGRAPHY
82) Bitemporal hemianopia, pituitary tumour with suprasellar extension, definitive Rx? SURGERY
83) Function of somatostatins? DEC. INT. SECRETIONS
84) Pt of ulcerative colitis, dg to keep in remission? AZT
85) Opioid addict, drowsy, shoulder pain, which analgesic to give?
86) Scenario of IBS
87) Case of IBS, which feature is against diagnosis? AWAKENING AT NIGHT WID PAIN
88) Hepatitis, inc IgM n IgG, diagnosis? AUTOIMMUNE HEPATITIS
89) Cholestatic jaundice, drug causing it? FLUCLOXACILLIN
90) Low Hb, low MCV, spleen enlarged? B-THALLASAEMIA MINOR
91) ECG, which finding is against LVH?
92) Aortic aneurysm repair, 2nd post op day hypotensive, what is the best Rx? BLOOD/ SALINE?
93) Pt taking cranberry juice for UTI. Which med is likely to b affected? WARFARIN
94) Pt started on antiepileptic, now needs high dose for same serum level, cause? TAKING ALCOHOL
95) Description of rash of DISCOID LUPUS
96) Malignant melanoma, breslow thickness 0.75, what to do? RE-EXCISE
97) A.Fib wid AV block, pacemaker? V V I R
98) Catheter dataCOARCTATION OF AORTA
99) Chloroquine toxicity, CNS symptoms, took 8 hr before, what to do? HEMODIALYSIS?
100) Scenario of chr pancreatitis wid diarrhoea, what Rx 4 diarrhoea? PAN ENZYME
SUPPLEMENTS
101) B-blocker over dose, heart block, atropine given, no response, detoriationg, wat 2 do? IV
GLUCAGON
102) Vasodepressor syncope, not responding to B-blockers, next Rx? SSRI/ FLUDROCORTISONE?
103) BNP secreted by? VENTRICLES
106) Pain on passive abduction of leg? INFL GREATER TROCHANTER?
108) 80 Yr male, bedridden, constipation? ISPHAGAUL HUSK
109) Ankylosing spondylitis, test? X-RAY SACROILLIAC JOINTS
111) Women getting radioiodine Rx, wat will be there after 10 yrs? HYPOTHYROIDISM
112) Old man, smoker, works in rubber industry, ca bladder? TRANSITIONAL CELL CA
113) Signs of hemisection of cord, diagnosis? SPINAL MENINGIOMA
114) Oxygen dissociation curve, shifted to R, cause? ACIDOSIS
115) DM, peripheral neuropathy, wat is accumulated for this finding? SORBITOL
116) Pain n swelling of knee joint, inflamed? SEPTIC ARTHRITIS
117) Scenario n data of pseudo gout, cause? OSTEOARTHRITIS
119) Data of polycythemia, renal cyst found on USG ?? ADENOCARCINOMA RCC
120) Post MI, thrombolysis done, still c/o pain, wat to do? PTCA
121) Essential tremors, Rx? B-BLOCKERS
122) Hearing loss, interpretation of weber n rinne, nerve deafness? SHWANOMA
123) Took antibiotic a week before, renal function detoriating, inc eosinophils, diagnosis?
INTERSTITIAL NEPHRITIS
124) IHD, came wid TIA, echo vent aneurysm, wat to add? WARFARIN
125) DCMP,new onset A.Fib, want to prevent further thromboembolism in next 48hrs, Rx? HEPARIN
126) Pregnancy, TTP, neurological signs Rx? FFP/ PLASMA EXCHANGE?
128) Pt came wid HONK, treated acc, when regained consciousness c/o blurring of vision not
improved by refraction correction, cause? LENS OSMOTIC CHANGE/ RETINAL HGE?
129) Common peroneal nerve injury....sensory loss? DORSUM OF FOOT
130) Pregnancy Losses 3 Times : which antibody will b +ve? ANTICARDIOLIPIN AB
132) Pt with hypertension .... abondened treatment due to adverse effect... which anti htn to be given to
avoid adverse effects like lethargy,gum hyperplasia.leg swelling, shortness of breath.ACEI
133) Malignant htn....treatment? NITROPRUSSIDE
134) Patient who was recently diagnosed with small cell lung carcinoma started on etoposide and
cisplatin developed tingling sensations in his hands and feet, cause? . CISPLATIN SIDE EFFECT
135) Old man with isolate Alk POSPH raised noramal ca po4 diagnosis......PAGETS
136) Investigation for PSC????? ERCP
137) Peanut butter allergy...serum igE levels normal...next investigation DO NOTHING
138) Widespread Skin Lesion With Comedone No Effect Of Tetra-Nxt Tt:ACITR
139) Meningitis...signs of raised ICP
140) Elderly home, outbreak of diarhea 0-3-10-8-1-0-0-0-0-0 cause? ASYMPTOMATIC
HEALTHCARE WORKER/ PERSON TO PERSON SPREAD?
142) Pain 1st carpometacarpal joint? OSTEOARTHRITIS
143) Pt self using local steroids for long time for some skin lesion, most common s/e to b seen? SKIN
ATROPHY
144) Definition of vesicle?
145) RECURRENT URTICARIA WHAT iG;Ig
i think regarding the screening for hemocromatosis, the question was asking specifically about
screening the family members , which i think is the genotype for c282y mutations as transferring
saturation is used for screening the general populaton?
what do u thin?
halit2006, Sep 28, 2006
#8
5.
GuestGuest
thanks
Guest, Sep 28, 2006
#9
6.
halit2006Guest
MRCP 1 12 09 2006
Bitemporal hemianopia, pituitary tumour with suprasellar extension, definitive Rx? SURGERY
WHAT DO U THINK?
halit2006, Sep 29, 2006
#12
7.
halit2006Guest
12 09 06 MRCP1
THE QUESTION DID NOT DECLARE CLEARLY THAT THE PATIENT HAS COLONIC
CARCINOMA BUT JUST MENTIONED THAT THIS HAS HAD ALTERED BOWEL HABITS
AND GENERALY THE MOST COMMON CAUSE OF IE IS STRP. VIRIDANS
8.
GuestGuest
" it is the most effective drug currently availible for raising HDL, because of its low cost & long term
safety" HARRISON 16 ED page 2297
Guest, Sep 29, 2006
#18
9.
GuestGuest
10.
sathyajith2006Guest
dear Doc5, You have quoted harrisons as the basis of your responses. Is it the best book to refer for
MRCP 1. I have bought kalra. Do I need to read harrisons as well :?:
sathyajith2006, Sep 29, 2006
#20
11.
sathyajith2006Guest
i hope that all the hard working AIPPG members pass the exam :hug
sathyajith2006, Sep 29, 2006
#21
12.
halit2005Guest
12 09 06 mrcp1
friends anyone can expect when the result of 12 09 06 mrcp1 can be dispatched on mrcpuk.org?
thanks alot
halit2005, Sep 29, 2006
#22
13.
GuestGuest
RESULT IS OUT
CHECK IT
I HAVE PASSED
Guest, Oct 6, 2006
#24
14.
GuestGuest
15.
KASHIGuest
TO doc5
16.
new to mrcpGuest
hi all dear friends, iam preparing for mrcp 1 nex january inshallah, hope to get ur advices?
anyone knows what is the pass mark for the last exam(12 09 2006 mrcp part one) compred to the past
two exams?
17.
GuestGuest
1.
melosqueakGuest
Hey guys,
1) Few questions on differential diagnoses of sore throat e.g. EBV vrs. Strep. pyogenes
3) stats: what type of test to use for a set of data, NNT calculations
4) Plenty of psych! e.g. personality disorder, differentiating this from suicidal intent
6) Alport's syndrome
2.
GuestGuest
3.
LJYGuest
- Dermatology .. red scaly circular lesions + very itchy...I thought the answer was Discoid eczema
- African lady with Ring enhancing lesions in the brain on scan - what is the Treatment? Pyrimethamine + Sulphadiazine
Respiratory system
b)central chest mass with muscle weakness ans small cell carcinoma.
4.
GuestGuest
spleen is connected to the greater curvature of the stomach by the gastrosplenic (gastrolienal) ligament;
it is connected to the left kidney by the splenorenal (lienorenal) ligament; spleen is covered by visceral
peritoneum on all of its surfaces
question on
1 ulnar nerve supplies which muscle digiti minimi
2factitious insulin
3 metaclopromide
4
apoptosis
the question about the mechenism of cell death in chemotherapy ---i selected Apoptosis any one got the
correct answer
Question regarding wasting all muscles of the hand was T1 root lesion
5.
valliGuest
2. What method to use for size specific RNA molecules with DNA probe?
4. Woman whose husband died 3 months ago suddenly after RTA. Since then, down and depressed,
visual and auditory hallucination of husband when out of house. --> Depressive psychosis
6. Acute epiglotitis in 20 year old man caused by what organism --> H.Influenzae
7. 5 year post renal transplant, sudden worsening of renal function --> late rejection/lymphoma?
10. Which receptors does apomorphine works on? --> I've checked its dopamine
valli, Jan 23, 2008
#10
6.
zax.Guest
most likly side effect of morphine sulphate <<<<psychosis,sweating,fecal incontinence not sure about
the other 2 options
a girl took a handfull of her mother medx presenting with neck spasm>>>metchlopromide
19 years with sore throat & atypcal lymphocutosis on blood film with low plt>>>>> EBV
von lindle girl with angioblastoma with no renal tumors what else to expect >>>i choosed cardiac
rabdomyomas & i dont know why
hamophilia trasmission >>i screwed that one because of my low IQ>>>non of the sons
52mother with mild diz ,daughter 21 with the diz, son with the sever form at 23 mods of inhertance
>>>i choosed mitochondrial (gentic anticipation)
warfarin stable dose started new drug high INR choosed carbamzbine >>>again another low IQ
question ,its not carbazinine itrs cipro
50 male with 2 days of chest pain ,pain now resolved with sublingual GTN ,troponin leak, whats next
70 years old female with MY 4 years ago with severe hip pains in the pre-operative clinic,how to asses
the myocardium>>>echo,ecg,tredmill stress test, doubtamine challenge ,i choosed doubtamine
challenage as she needs a stress test but her painfull knee is a contra-indication so the challenge is to
offer the best results
bloody diarrhea follewed by renal failure what to expect in blood film >>>>tear drop,penicil
cells,target cells,howell joly or red cell fragments ,i choosed red cell fragments as its HUS &
heamolysis is seen
hep c >>>cryogluibinlame
young male with negative diplococci in urethral discharge ,negative VDRL,positive trponemal particls
aglutinins, negative anti treponimal IG>>>i choosed false postive syphilis.not sure why but can u get
the particles with no anti bodies
young lady started working in a factory ,asthma how to confirm ,i choosed serial PFR at home & work
(i thaught it was one of the creiteria of diagnosis of athma)
young lady with parrot at home ,coughing with sob>>>> pistachi serology i think
there was small muscles of the hand wasting >>>cant recal my answer or the answers
a young lady with DVT post operative 2 years ago going on a long flight soon,was give instructions
,regular movement, drink fluids, restrict alcohol, what else ,there was 2 options that i choosed >>no
further action & given deltaparin before the flight ,i choosed the no further action option then in the last
minute i changed it to deltaparin,why? well in all the hospitals i worked in when the admit some one
with no history of dvt but expected to stay in for some days they give prophylactic sub cut heparin so
what about a young lady with proven DVT a couple of years ago ,again its all personal choices so dont
rely on me ,i have a very low IQ
some one with generalized lymphadenopathy on CT abdo & chest & HB was 0.1( n- 12--15) with right
iliac fossa mass >>>i choosed carcinomatosis >>>i dont know whats is that but i dont leave my answer
sheet blank
old lady with confusion ,was thirsty for a couple of weeks with signs of hepercalcime ,low hb ,xray
lytic lesions ,what the next immediate action ,i choosed electrphoresis as i was convinced thats myloma
but because of the work next immedicate i choosed ca levels as the preseting symptoms were confusion
& thirst & u need to establish the diagnosis of hypercalciema treat it then look for the mylome later ,not
sure if my theory was right or my LOW iq played again
cushings metabolic status >>i choosed hyocholremic acidosis & i am quite sure i am wrong
multiple ring enhancing in an IV drug user with low CD ci\oubt & positive HIV ,whats treatment i
chosed sulphadizne + pyrimethrine ( toxoplasmosis i think)
young lady with UC coming with itch & obstructibve pic on liver enzu\ymes but no hyperbilbrin ,i
choosed AMA
IV drug user with sob ,cxr shows plueral effusion ,failed aspiration what to do next,i stoped between 2
options CT chest & U/S then i choosed U/s as i think it was encysted & fluid stuff is better visualized
by u/s agaim i am not sure it might be my low IQ
shypyard worker with SOB with cxr showing some plaqhes,i choosed asbestosis
lady with morning stiffnes pains in shoulder joints,hips ,hands ,back ,kness with elevated CRP,i
choosed pmr
antichoinergic toxicity
renal transplant lady 5 years ago had some some vaginal discharge given a course of fluconazole ,urea
elvated 2 weeks aft6er that i choosed ciclosporin toxixty & dont aske me why
question about some one with night sweats ,red lesions on both chins on lower limsb ,i chosed CXR
looked like TB to me
scaly lesion in a tanned young man , i choosed scraping for mycology ,i think its veriscolor
some one with recurent hand & facial swelling >>levels of C1 esterase
some one had treatment for peptic ulcer presenting with dumping syndrome for 3 years ,i choosed rou
en y reconstruction
pt with diabetic symptoms + glucone in urine had ogt with normal values in fasting & post parandial
but persisting glucose in urine ,choosed renal glucisuria
there was a palliative treatment of gasrtic cancer & i choosed danazol (dont ask me why) prob low IQ
men type1 how to mointor >>low IQ made me choosed catecholamines in urine ,i should be shot in
public
whats the poor prognosis for a young girl with RA & erosions ,i choosed xray changes
russian sailer with greyesh exudate on his tonsils & confused >>>i chosed diph
previously well moderate alcoholic with 2 seizures with sugar 3.1>>i choosed alcohol related
pt diagnosed with influenza whats the fasts invest,i choosed PCR blood as the other options had viral
cultures of both sputum & blood & those would take at least 4 hours & the patient had viremia as he
had shivers & so(in my hospital it takes 4 hours to get pcr results dispite that we send to another
hospital for processing)
89 years old with unsteady gait which vit is diffecient i choosed thaimine ,the only other option that can
be right is pyrdoxine but didnt look like it
young man started living by himself had easy gum bleeding on tooth brushing ( as if he knew about
me) with anemia >>>>classic me ,vit c def ( i remember the only time i took vit c for a month i stopped
gum bleeding for over 4 months but i stopped i hate medicines & doctors aslan)
young girl referred from dentisit with tooth erosions ,low BMI with all low blood parameters,i choosed
bulimea nervosa
contra-indications for lung cancer operation >>>svc obsrt ,plerual effusion,i choosed svc
pt with scleroderma ,severe rynouds,sloughing of the finger tips despite nifidipine whats next to
use>>>warfarin,bosantan,moxodine,i chosed bosantan & i was lucky choosing it
http://en.wikipedia.org/wiki/Bosentan
root of sciatica (pt with typical sciatica pain which root is affected)
also pt warfarinized for af,succesful cardioversion,how long to be on warfarin for 6 months or 4 weeks
pt wiz recurrent syncope with displaced apex of the heart>>>ventricular tachycardia for sure
Quote:
thromboembolic disease
acute thromboembolic disease e.g. DVT is an absolute contraindication to flying - also see notes below
patients with a history of pulmonary embolism or DVT should be considered for full oral
anticoagulation
In a patient with a history of a DVT undertaking a long-haul flight, and not already on long-term oral
anticoagulant therapy, then another possible management strategy might be (2):
a patient with a history of a previous DVT should wear blow-knee compression stockings (if no
contraindications)
if the patient has only had one episode of DVT and there are no other risk factors then no other
measures are indicated
if the patient has other conditions that increase the risk of DVT e.g. inherited or acquired thrombophilia
state, gross obesity, a plaster of Paris of the lower limb, or has very long legs in a small seat space, then
some would recommend a prophylactic injection of low molecular weight heparin before leaving the
airport. This is in addition to use of compression stockings
http://www.gpnotebook[snip]/simplepage.cfm?ID=x20020722234917423730
zax., Jan 23, 2008
#11
7.
workhardGuest
Obese lady with infertility and type II diabetes treatment options i answered metformin
Question with absent corneal reflex i selected acoustic neuroma
one answer was staphylococcal infection
Question of carbanmazepine decreased effect --answer was carbanmazepine itself self induction
one answer was short sunacten test in pt having hyponatraemia and K 5.5
one question for hepatitis interpretation was previous hepatitis infection
I dont remember the choice of drug in Alzheimers disease
Dear friends, most of the answer to the questions in MRCP(UK) is in Oxford Handbook of medicine.
For your info, according to MRCP examiner , the gold standard book for MRCP is Oxford Textbook of
Medicine ( very thick) , so just read the handbook , all the required notes is there, plus with kalra-- sure
pass
MRCP 2008, Jan 23, 2008
st
Defidiency of Any factor needed in Intrinsic pathway causes prolongation of APTT.....so the answer
was Xl...
LJY, Jan 24, 2008
#14
8.
GuestGuest
i want to know the general impression about mrcp 1exam of yesterday ..was it bad or good...
Guest, Jan 24, 2008
#15
9.
GuestGuest
10.
docahmerGuest
OKAY BACK HOME FROM EXAM.....exam paper 1 -easy 2-tough lengthy and headache (but really
had the feeling of an mrcp exam paper which was lacking in paper 1)
heavily onexamination dependent qs in both papers...philippa easterbrooke book rocks , often
underestimated...kalra as usual hot favourite....pls guys all of u going for the exam
here are a few qs i wud like to comment upon.....heavily borrowed from adeel ayubs brainy recall.....
(ihope there r no copyrights) just tried to add my views and answers .....to help
new comers to have a reference handy for atleast a 100 qs with answers and references where there is
doubt....pls dont hesitate to comment on any of these answers....
2.AF 2 qs, one with heart failure- Rx digoxin (as basal crackles)
other without failure..-best Rx beta blocker (as given in onexam)
4.HEP B -man was previously infected and had immunity due to tht (as hbsag neg and anti hbc
positive)
6.RTA -1 coz hypokalemia, loin pain(calculus) and severe acidosis (mnemonic hypo-ren-cal-sev-dis=
hypokalemia, renal calculi, severe acido.sis)
10.DUMPING SYNDROME- MODIFY THE DIET OF THE PATIENT...coz hes having symptoms of
hypoglycemia after 30 mins...means he has to take a small meal of
12.NATURAL SOURCE VIT D- FISH OILS-not milk as milk and mmilk products are fortified with
vitd ...
14.PT HAD SINGLE EPISODE AF- WARFARIN FOR---6 months...if repeated then life long- refer
emrcp
20.70 years old female with MI 4 years ago with HIP OSTEOARTHRITIS FOR HIP REPLACEMENT
in the pre-operative clinic,how to asses the myocardium dobutamine
challenge .SHE needs a stress test but her painfull hip is a contra-indication ...
21.HEP C -CRYOGLOBULINEMIA
23.GUY COMES FROM SOME COUNTRY AND HAS PAINFUL PENILE ULCERS-( Chancroid is
a sexually transmitted infection characterized by painful sores on the genitalia.
Chancroid is known to be spread from one to another individual through sexual contact.--WIKIPEDIA)
this patient had already undergone banding and other options were spironolactone...which didnt suit)
correct
32.ASKED WHICH DECREASES PULM VASC RESISTANCE- NATURALLY- ADENOSINE-PGSMAY ALSO BE RIGHT( DISCUSSION WARRANTED)
34.ECSTASY -HYPERTHERMIA
36.FAMILY WITH PC KD....check usg of all as all relatives were greater than 20 yrs of age (if less
than 20 then genetic studies) -refer onexam
37.GUY WITH HEARING LOSS RINNE POSITIVE AND SEVERE HEADACHE IMM INV- here
do skull xray as pt is haveing pagets
38.guy with motor aphasia- lesion --brocas area posterior frontal (anterior frontal was also given)
40.ALPORTS PT- (Alport syndrome is a genetic disorder characterized by glomerulonephritis,
endstage kidney disease, and hearing loss. Alport syndrome can also affect the
eyes. The presence of blood in the urine (hematuria) is almost always found in this condition.WIKIPEDIA)
41.CARBAMAZEPINE AUTOINDUCTION
42.SPECIFICITY Q
43.NNT Q
44.PURPOSE OF CALCULATING POWER OF A STUDY-(to know which test is the best to useminimum 80 percent power required--easterbrook)
46.TORTICOLLIS - METOCLOPROMIDE
47.GUYS FLECAINADE IS GIVEN ONLY on hospital set up as its dangerous drug and never the first
choice
48.q on obsessive c d
tyrosine kinase receptors.Two alpha subunits and two beta subunits make up the insulin receptor. The
beta subunits pass through the cellular membrane and are linked by
disulfide bonds.-WIKIPEDIA)
52.CONFUSED FEMALE-old lady with confusion ,was thirsty for a couple of weeks with signs of
hepercalcemia low hb ,xray lytic lesions ,what the next immediate action
immediate thing is iv saline as pt had hypercalcemia which is an emergency later look for ur dear
multiple myeloma
56.guy with symmetric rash on nose chin and cheeks with papules and pustules was rosacea(not simple
acne)
61.immunophenotyping in CLL
64.MAN THIS WAS COOL---2 SAME QS I GOT BOTH RIGHT.....STEROIDS DECREASE THE
NUMBER OF EXACERBATION IN COPD AND DONT HAVE AFFECT ON
MORTALITY
65.Dexamethasone in pt. with liver mets suffering from anorexia & wt.loss (HERE Q WAS HOW DO
U IMPROVE THE SYMPTOMS)
67.two drugs op1 and op2 ,op1 binds with 10 times more affinity to the same receptor then means tht
op1 has more POTENCY
71.guy with absent knee jerk and sensory loss on anterior thigh with absent knee jerk(action of
quadriceps)-think was femoral nerve lesion discuss)
74.SPLENECTOMY PATIENT --HERE pt came 2 wks after getting splenectomy --guidelines acc to
onexam suggest immediate vaccination for pneumococcus--there no need for
77.Boy with one kidney absent & nephrotic proteinuria give steroid trial( BP 126/66)
78.hypomg due to thiazide diuretic (mnemonic remember this thoroughly- hyper GLUC fr thiazide
(glucose, uric acid, calcium--rest all DECREASED) --U WILL B AMAZED HOW
80.MS pt with 20 ml post void bladder vol. give anti-cholinergic( or intermittent catheterization)
--HERE Q SAID HOW DO U CONTROL THE PAT. SYMPTOMS OF
82. ret protooncogene -med carcinoma--mnemonic( pipapa for men1 : para.pheo.med for men2a:
muco.pheo.med for men2b)
83. ecstasy hyperthermia ...omg rcp loves to repeat qs and i love rcp
84.Lasix-enalapril in LVf ?? here pt didnt have edema (they said no edema in the q) and mild lvf
..options were digoxin, ramipril, and lasix---digoxin try to avoid in mild lvf..and
90. PT WITH VWF AND WAS ASKED WHT ABNORMALITY WILL U SEE...ITS THT THE
PLATELETS CANT ADHERE TO EACH OTHER DUE TO SOME PROBLEM WITH
GP 1
92. PT WITH RECURRENT CHEST INFECTIONS HAD CLL WAS ON PREDNISOLONE AND
ONE CYTOTOXIC I THINK CHLORAMBUCIL......HERE IMMUNOGLOBULIN
DEFICIENCY.....(REFER ONEXAM)
98.DONEPEZIL-DRUG IN ALZHEIMERS
APPRECIATED...
docahmer, Jan 24, 2008
#17
11.
part one
8)
what about mitrochondrial disorders transmission :
a) anticipation b) genetic imprinting c) hetroplasmy
d) recessive
doctor for mrcp, Jan 24, 2008
#18
12.
a a asifGuest
In your 7 no Q I think the answer was NO ARTERY WILL BE INVOLVED, one opsion was like this,
because V5 V6 there was only t inversion, there was no significant st elevation, if there is definete MI
then only artey will be blocked,otherwise its only ischaemia, am i right please comment.
a a asif, Jan 24, 2008
#19
13.
GuestGuest
The blood film is HUS is more likely to show red cell fragmentation:-
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1115131
http://www.medscape.com/viewarticle/535333_print
(as this paper also says you can in some cases commence flecainide out of hospital)
14.
ddGuest
hii.. anyone knows which the ques mentioned the monopost test and what was the
answer....theopylline ....
dd, Jan 25, 2008
#21
15.
My turnGuest
Participation
4) Thyorxine Causes
a) Enhance Insulin sensitivity
b) Dec Myocardial Oxgen demand
c) Dec elasticitiy
7)A pt known case of Asthma, PEFR normal, no chest finding, Atrial rate 100 in Af.Rx
a)Amiadarone
b)Digoxin
c)|Dilteiazem
8)A pt known case of epilepsy diagnosed 1 month back, now 8th wk pregnant?
a)Na Valproate
b) Phenytoin
c) No Rx
11) Pt with HBVc Antibody & HBVs Antibody +ve with all other -ve
a)Carrier
b)Prevoius Immunization
c)Previously infected , now recovered
16)Chemotherapy results in
a) Necrosis
b)Sensecence
c)Mitosis
18)Young Women with Crohn Disease, what will be the contributing factor
a) Age
b) Smoking
c) OCP
19)Two opiods are tested in same patients with results arranged in what
a) Paired T Test
b) Two Sample T test
c) Chi Square Test
20)A young male presnted with Aystole, CPR started, who is going to decide to stop CPR
a)Parents
b) Fiance
c) A & E Consultant
16.
GuestGuest
i think the woman 's test will be for PBC NOT sjorens synd i.e U SHOULD CHEEK THE AMA NOT
RO\LA ABS
Guest, Jan 25, 2008
#23
17.
a a asifGuest
RET proto-oncogene was first cloned in 1985. Mutations in RET gene are associated with multiple
endocrine neoplasia(MEN) type 2A &2b,Medullary thyroid carcinoma and Hirschsprung disease.
18.
marieGuest
hi friend
my impresion about the exam that it was easy but very tricky
and over quistion in psychatry
wat about ur opinion
by the the way wat collagen defect disorder in marfan fibrillin(as in comar)or fibronectin (as in other
book)
thank
marie, Jan 25, 2008
#25
19.
Dr. AdeelGuest
1) Pt. with CVa wats the deficit which is gonna hinder his rehabilitation.(hemiparesis/neglect???)
2) Pt. of COPD with type -2 failure . wat to do( Doxapram/non-invasive vent/ invasive vent???)
3) PKCD pt. with acute loin pain, wats the cause (cyst haemmorhage/calculi)??
4) Young man with painful genital ulcers (HSV/chancroid?????)
6) Pt. with S/S of CJD(??????) I opted for MR scan
7) Lady with BMI 13.5 severe pain on eating (phobia/body dysmorphea)
8) How does ace inhibitor dec. heart remodeling in CHF(inc. wall tension/dec. TPR)
10) 2(two) Q. of transplant rejection(????????)[one with CMV & other getting fluconazole]
11) Q. of transplant rejection(????????)[one with CMV & other getting fluconazole]
12) 52 yrs smoker with impotence dec LH, dec testosterone, dec SHBG, prolactin
470(N<360)panhypopituitarism?????
13) Pt. having difficulty in lifting objects with no pulse when arm raised above head no neurologic
sign(takayasus dis.???????)
14) Pt. thinks his ears ve gone bigger now keeps on visiting doc.(hypochondriasis/somatization????)
(aaaah WTF!!!!)
15) Women with GERD and recurrent RTIs not improved with PPI wat to do( I opted 4 surgery??)
16) Watery diarrhea with mucus & dec. K+ (villous adenoma or Z-E syndrome)
17) Pt. with slowly growing scaly lesions pruritic wat to do( skin scrap for mycology).
18) Coronary arteriography complication(coronary dissection/CVA/arrhythmia)
19) V-Wf disease??(absent/defective 1b receptor)??????
20) Asthmatic lady eith A-fib(paper-1)[amiodarone/flecainide/digoxin]
IX. Old lady taking Beta blockes, warfarin, diabetic medications & aspirin getting confused 4 last 5
weeks. Wats the cause(Beta blocker, ) I went 4 warfarin coz I thought she might B haning SD
hematoma.(no wonder they say : an empty brain is the Devils workshop)
X. Pt taking medics 4 HTN & others getting pedal edema wats the cause( only CCB mentioned was
diltiazem so I went 4 it)????
XI. Cushings dis. Causes Met. Alkalosis
XII. A Q of factor 11 def. (I wrote factor 10)
XV. PEFR both at work and home 4 occupational asthma.
XVI. Extrinsic allergic alveolitis(upper lobe infiltrates/antibodies)?????
XVII. Whoz gonna order for DNR ???????
XVIII. Pt. with 0.1 Hb on methotrexate (I went for carcinomatosis).But I think its due to
methotrexate.???????
XIX. MRSA (I chose flucloxxacillin) but my friend says pt. was penicillin allergic in that case its
linezolid [ need ya help 2 sort this one]
XX. 2 Q. of rejection(????????)[one with CMV & other getting fluconazole]
XXI. A pt. with diamorphic picture on CBC (I didnt write celiac dis. )???
XXII. Wats the quickest way 2 detect influenza( I went 4 Immno-assay).some say its PCR of
Blood/or/nasal secretions.
XXIII. Wats pathognomic of heart dis. In last trimester pregnancy(S3/inc.JVP/irregular HR)??
XXIV. Loss of corneal reflex in CPA lesion
XXV. Check serum Ca++ in 92 yrs old man with prostate Ca( I chose PSA, which is bull-shit)
XXVI. Pt. with repetitive dreams of her deceased husband who died in accident.(I chose adjustment
disorder) but correct answer may B PTSD.?????
XXVII. Pt. with inc. INR( answer was ciprox) I wrote HRT
XXVIII. Wats the mmost pathognomic of depression( I chose the option ending with
SEQUENCING) [need ya help 2 sort this one]
XXIX. A scientist wants to check for new viruses wats the pre-requisite?( I chose the 1st option saying
need 4 genome)???????
XXX. Effect of sotalol on cardiac cycle??????
XXXI. Omeprazole Vs ranitidine wats the edge of former( I went 4 dec. post-prandial acid
production)??????????
XXXII. Side-effects of temoxifen(hair-loss) I chose cataract., aaah I think I was having blue balls at
that time!!!!!!
XXXIII. Q. of power of test(in 2nd paper)
XXXIV. Q. of power of test(in 1st paper)
XXXV. Post-marketing trial( answer was adverde effects) I screwed this one!
XXXVI. Y the hell testicular tumor responds so well to chemotherapy(I opted for differentiation)??
[need ya help 2 sort this one]
XXXVII. Pt. on CLL Rx gets recurrent URtis wats the cause ??
XXXVIII. Woman with central cyanosis and pedal edema( I went for PPH, which is wrong) may B ans
is ASD with shunt reversal?
XXXIX. Pt. with ant. ST elevatation and Q waves without reciprocal changes (answer was VT)
Dr. Adeel, Jan 25, 2008
#26
20.
marieGuest
NOW IJUST REMEMBERD THE THE STRANGEST Q IN MRCP1 JAUN 2008 DRUG CAUSES
RUPTURE TENDON
21.
GuestGuest
i've made so many mistakes... is there a pass mark or cut off as to how many the college can pass? quite
concerned.
Guest, Jan 25, 2008
#28
22.
Dr. AdeelGuest
cut-off?????????
I think this paper is comparitively easy than last one so cut-off might B even higher which frankly is
quite intimidating and scary!!!!!
Dr. Adeel, Jan 25, 2008
#29
23.
LJYGuest
XXXVI. Y the hell testicular tumor responds so well to chemotherapy(I opted for differentiation)??
[need ya help 2 sort this one]
XXXVII. Pt. on CLL Rx gets recurrent URtis wats the cause ??
XXXVIII. Woman with central cyanosis and pedal edema( I went for PPH, which is wrong) may B ans
is ASD with shunt reversal?
XXXIX. Pt. with ant. ST elevatation and Q waves without reciprocal changes (answer was VT) .
shaheen., Jan 25, 2008
#34
24.
bossGuest
25.
GuestGuest
Am I only the one who simply assumed the Hb of 0.1 was a typing error and should have been 10.1? :?
Guest, Jan 26, 2008
#36
26.
bossGuest
27.
guest12345Guest
will try to recall more.the paper was comparatively harder than sept 2007,
there was no time to read the questions twice.
do hope to pass,insha allah
guest12345, Jan 26, 2008
#38
28.
marieGuest
PASS SCORE
29.
Musa.Guest
girl took a handfull of her mother medx presenting with neck spasm>>>metchlopromide
19 years with sore throat & atypcal lymphocutosis on blood film with low plt>>>>> EBV
von lindle girl with angioblastoma with no renal tumors what else to expect >>>i choosed cardiac
hamophilia trasmission >>i screwed that one because of my low IQ>>>non of the sons
52mother with mild diz ,daughter 21 with the diz, son with the sever form at 23 mods of inhertance
>>>i choosed mitochondrial (gentic anticipation)
warfarin stable dose started new drug high INR choosed carbamzbine >>>again another low IQ
question ,its not carbazinine itrs cipro
50 male with 2 days of chest pain ,pain now resolved with sublingual GTN ,troponin leak, whats next
>>>>>> heparinize for sure
70 years old female with MY 4 years ago with severe hip pains in the pre-operative clinic,how to asses
the myocardium>>>echo,ecg,tredmill stress test, doubtamine challenge ,i choosed doubtamine
challenage as she needs a stress test but her painfull knee is a contra-indication so the challenge is to
offer the best results
bloody diarrhea follewed by renal failure what to expect in blood film >>>>tear drop,penicil
cells,target cells,howell joly or red cell fragments ,i choosed red cell fragments as its HUS &
heamolysis is seen
hep c >>>cryogluibinlame
young male with negative diplococci in urethral discharge ,negative VDRL,positive trponemal particls
aglutinins, negative anti treponimal IG>>>i choosed false postive syphilis.not sure why but can u get
the particles with no anti bodies
young lady started working in a factory ,asthma how to confirm ,i choosed serial PFR at home & work
(i thaught it was one of the creiteria of diagnosis of athma)
young lady with parrot at home ,coughing with sob>>>> pistachi serology i think
there was small muscles of the hand wasting >>>cant recal my answer or the answers
a young lady with DVT post operative 2 years ago going on a long flight soon,was give instructions
,regular movement, drink fluids, restrict alcohol, what else ,there was 2 options that i choosed >>no
further action & given deltaparin before the flight ,i choosed the no further action option then in the last
minute i changed it to deltaparin,why? well in all the hospitals i worked in when the admit some one
with no history of dvt but expected to stay in for some days they give prophylactic sub cut heparin so
what about a young lady with proven DVT a couple of years ago ,again its all personal choices so dont
rely on me ,i have a very low IQ
some one with generalized lymphadenopathy on CT abdo & chest & HB was 0.1( n- 12--15) with right
iliac fossa mass >>>i choosed carcinomatosis >>>i dont know whats is that but i dont leave my answer
sheet blank
old lady with confusion ,was thirsty for a couple of weeks with signs of hepercalcime ,low hb ,xray
lytic lesions ,what the next immediate action ,i choosed electrphoresis as i was convinced thats myloma
but because of the work next immedicate i choosed ca levels as the preseting symptoms were confusion
& thirst & u need to establish the diagnosis of hypercalciema treat it then look for the mylome later ,not
sure if my theory was right or my LOW iq played again
cushings metabolic status >>i choosed hyocholremic acidosis & i am quite sure i am wrong
multiple ring enhancing in an IV drug user with low CD ci\oubt & positive HIV ,whats treatment i
chosed sulphadizne + pyrimethrine ( toxoplasmosis i think)
young lady with UC coming with itch & obstructibve pic on liver enzu\ymes but no hyperbilbrin ,i
choosed AMA
young lady with breathlessnes >>>pulm HTN
IV drug user with sob ,cxr shows plueral effusion ,failed aspiration what to do next,i stoped between 2
options CT chest & U/S then i choosed U/s as i think it was encysted & fluid stuff is better visualized
by u/s agaim i am not sure it might be my low IQ
shypyard worker with SOB with cxr showing some plaqhes,i choosed asbestosis
lady with morning stiffnes pains in shoulder joints,hips ,hands ,back ,kness with elevated CRP,i
choosed pmr
antichoinergic toxicity
renal transplant lady 5 years ago had some some vaginal discharge given a course of fluconazole ,urea
elvated 2 weeks aft6er that i choosed ciclosporin toxixty & dont aske me why
question about some one with night sweats ,red lesions on both chins on lower limsb ,i chosed CXR
looked like TB to me
scaly lesion in a tanned young man , i choosed scraping for mycology ,i think its veriscolor
some one with recurent hand & facial swelling >>levels of C1 esterase
some one had treatment for peptic ulcer presenting with dumping syndrome for 3 years ,i choosed rou
en y reconstruction
pt with diabetic symptoms + glucone in urine had ogt with normal values in fasting & post parandial
but persisting glucose in urine ,choosed renal glucisuria
there was a palliative treatment of gasrtic cancer & i choosed danazol (dont ask me why) prob low IQ
men type1 how to mointor >>low IQ made me choosed catecholamines in urine ,i should be shot in
public
whats the poor prognosis for a young girl with RA & erosions ,i choosed xray changes
russian sailer with greyesh exudate on his tonsils & confused >>>i chosed diph
previously well moderate alcoholic with 2 seizures with sugar 3.1>>i choosed alcohol related
seizures ,i think alcohol induced hypoglycaemia
pt diagnosed with influenza whats the fasts invest,i choosed PCR blood as the other options had viral
cultures of both sputum & blood & those would take at least 4 hours & the patient had viremia as he
had shivers & so(in my hospital it takes 4 hours to get pcr results dispite that we send to another
hospital for processing)
89 years old with unsteady gait which vit is diffecient i choosed thaimine ,the only other option that can
be right is pyrdoxine but didnt look like it
young man started living by himself had easy gum bleeding on tooth brushing ( as if he knew about
me) with anemia >>>>classic me ,vit c def ( i remember the only time i took vit c for a month i stopped
gum bleeding for over 4 months but i stopped i hate medicines & doctors aslan)
young girl referred from dentisit with tooth erosions ,low BMI with all low blood parameters,i choosed
bulimea nervosa
contra-indications for lung cancer operation >>>svc obsrt ,plerual effusion,i choosed svc
pt with scleroderma ,severe rynouds,sloughing of the finger tips despite nifidipine whats next to
use>>>warfarin,bosantan,moxodine,i chosed bosantan & i was lucky choosing it
http://en.wikipedia.org/wiki/Bosentan
root of sciatica (pt with typical sciatica pain which root is affected)
also pt warfarinized for af,succesful cardioversion,how long to be on warfarin for 6 months or 4 weeks
pt wiz recurrent syncope with displaced apex of the heart>>>ventricular tachycardia for sure
30.
GuestGuest
31.
ammarmohy77Guest
32.
ammarmohy77Guest
THERE ARE A LOT OF QS MY FRIENDS A SK ME A BOUT AND I READ HERE FROM YOUR
POSTS I DID NOT COMME IN THE EXAM!!!!
I GUSS I WAS NOT THERE!!!! SOME ONE PLZZ TELL ME WHY?WHEN THE RESULT?
ammarmohy77, Jan 26, 2008
#48
33.
marieGuest
i agree wiyh u totaly ammarmohy77 where was that exam they are speaking about abou 5-10 q they are
speaking abouti did not remember at all
SECOND
THER ONE QUISTION ABOUT TREMOR ON MOVMENT ALL PEOPLE ANSWERD IT BENIGN
ESSENTIAL TREMOR EXCEPT ME DO U KNOW WHY AS THE Q SAYED NO FAM HISTORY
AND THIS IS AGAINIS BET
AGAIN IT IS NOT PARKINSONS AS IN PARKINSON IT IS RESTING TREMOR
SO MY ITCHY MIND CHOOSED VASCULAR BY EXCLUSIION
U SEE HOW THE ITCHY MIND PUSHED ME DOWN HELL??? :cry:
marie, Jan 26, 2008
#49
34.
drvikGuest
Benign Essential Tremor may appear to occur randomly for unknown reasons (sporadically) or be
transmitted as an autosomal dominant trait.
drvik, Jan 26, 2008
#50
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1.
dr AGuest
what was the commnest maligancy assoicated with non hodgkin lymphoma
-multiple sclerosis unsteadiness of the gait and sensory loss spastic paraplegia
rasha27, Jan 21, 2009
2.
rasha27Guest
3.
phenytoin
antiglidan antibody-- typical sites of dermatitis herptiform
indication of surgrey in aortic valve stenois is the symptomatology of the patient not sure about this
amlodpine ---- causes gingival hyperplesia
staph discutis----- backpain and following pacemaker insertion
rasha27, Jan 21, 2009
#8
4.
rasha27Guest
5.
rasha27Guest
antimyleperoxidas----- cresent GN
rasha27, Jan 21, 2009
#10
6.
rasha27Guest
what about the pt who had mild anemia (112 hb) and lymphcytosis
observation _ chlorambcil_ fludrabine_ ( both could treat CLL)
rasha27, Jan 21, 2009
#11
7.
rasha27Guest
8.
burningiceGuest
9.
burningiceGuest
heamophilia----50%
1)nifedipine coz gingival hyperplasia .
chemo and pts having joint pain ? this one was very tough ...
4)young gal with headache n raised csf protein with normal glucose ? Viral/cryptococcal ? wbc 200
..and lymph 60%????
5)heamophilia father n mother is carried ... one of the daughter wud be carrier and one will have the
disease ... 25 or 35% ??? they asked percentage duaghter have heamophilia ... if the other duaghter has
a bar X chromosome .. then she cud have disease too rather than being a carrier ... so why not 35 % ???
6)back pain with N ca and Phosphate .. and raised alk PO...pagets
a man with left arm pain ... with lost bicep,tricep n flexor reflexes but preserved touch n
propioception ??? myelitis ?syringomylia ? cant recall wat were other options ...
10.
dr AGuest
hungtington ..is a trinucleatide disorder .. so anticipation is the answer ... more severity with ease
suscessive generations
1)pts with asthma .. on beclomethason 800microgm and salbutamole inhalar ..use it twice in a day and
wakes up one a wk with dyspnea ... continue same treatment ?
2)normal anion gap in pts with urerterosigmoidostomy...
pts with FEV1 1.2 and FVC 2.6 and transfer factor 55 %
improment after bronchodilartor .... FEV1 1.9 and FVC 3.8(somewat this much improvement ..not real
values cant recall em )
what is the condition ? asthma ..emphsema .. pul fibrosis .. embolism ? one more ... i calculated the
ratio was less than 58 percent .. ???transfer factor is very low...so i wrote pul fibrosis...cud it be
emphysema ?
dr A, Jan 21, 2009
#17
11.
Dr AGuest
1)pt have CCF ..on thizide but edema is still not decreasing... natirutric peptide is deficient ?
2)SIADH....and collapsed bronchus
3)pts has senile atrphy of the brain ... wat to give to improve dementia and agrresive
behaviour...denozipil ?
4)pt with urinary incontinence .. ,..anti cholinergic?
5)hypertensive pt... with side effect of ankle swelling etc (calcium channel blocker ) which drug to be
given ..i think thiazide was already being given or it was not in the list ...b blocker or losartan ... he is
70 plus of age
6)cannabis related schizopherina
Dr A, Jan 21, 2009
#18
12.
burningiceGuest
comment ! i will appreciate if those who give answers ..plz explain them a lil ..thanks !
7)digoxin..half life ??
8)thiazide work by increasing K excretion to distal tubule
9)peutrz jegher is autosomal dominant
10) pt with stomach ulcer... gastrin levels
11)6 month history of transient urticarial wheal on trunk legs ....idiopathic alleric urticaria
12)violacious ulcer ...pyoderma gangrionosum
13)young gal with mouth ulcers ,rash ,fever, SLE
14 )4 week acute jaundice after a travel ...hep A
15)hep c patient... vaculitic lesions ...cryoglobinura
16)hep B vaccine ...monitor with Hep B antibody
splenectomy pt ...at risk of peumococi infection
18)headache ...drowsy but responsive pt ... bitemopral heminopia ...pituitary apoplexy
19)pt diabetic and bipolar....which drug coz SIADH... does any of the hypoglycemics coz SIADH ? i
choose carbamazepine ..
20)pts with very low levels of alpha(15%) !anti trypsin def ...genotype is ZZ
i will post more as i remember em
dr A, Jan 21, 2009
#22
13.
newdayGuest
14.
dr AGuest
15.
dr AGuest
16.
dr AGuest
17.
burningiceGuest
18.
salboyGuest
-Patien with arthritis ,Alopecia and mouth ulcers ???? which marker would you find --- please answer
to this one
- CRF Pt with Lipodystrophy ?? which complment is effected ???C9
- A patient with Ci Inh def
- In Good pastures which Antibody ?? AMA
- Any one could recall the Stats
?? Chi squrd test
?? sensitivity will decrease with decrease number of subjects in a new drug testing
??
-For haemophilia A all daughters would be carrier therefore the naswer was 0%
- Pure motor lesion ??
-Any one wrote Gullianbarie Syndrome ina neurology
-age 50 + R heart cath - Oxygenation ?? PFO??ASD
-One of the response in Gastro with hepatorenal syndrome
-Accidental injury with Adrenaline what pharmacological treatment would you give
- Pateient with2 years no job Hx of sucide hearing voices discussion abt him??Psychotic depression
I am still collecting from my other friends please try to get as many as possible
I some one could response to my above recollections I would be very much obliged --Dr A
salboy, Jan 21, 2009
#33
19.
salboyGuest
#34
20.
dr AGuest
4)right catheterization ...with increase oxygenation in SVC and RT ven...atrail septal defect..the age
was arround 40...
5)spironolatone ...acts on distal tubule ...inhibit the action of aldosterone
6)pt going in resp 2 failure and refusing ventilation ... take consent from the near relative ...i am not
sure...wat u guys say ?
dr A, Jan 21, 2009
#35
21.
5555Guest
mrcp 2009
5555Guest
in pt with pallative care on modifed released morphine and sustanied relaes ???????????wot is the
answer
is cipro contraindicated in pregn
there were 2 qs about eldery gentaman admitted with pneumina and after 4 days he developed
confusion ... in the first he think the sister want 2 kill him and in rhe second he thought the doctor want
2 kill him.....wot is the answer DT or acute confusional state ...
13)psychostic depression
14)man shouting outside the school saying he have some xtra powers ... badly dressed
...schizophrenia ...hypomaniac are mostly euphoric and are not as agressive as maniacs....wat is
peamophilia..i think ths was also in the option list
15)pt with early morning low mood,worried abt money ,loss of interest ...depression
16)man stressed at work and feel like his soul detach from his body ...generalized anxiety
17)transient amnesia in elderly
anyone plz answer the ques regarding epipelpsy and side effect of na valproate ..which alternative to
choose ?
when the result will come ??
dr A, Jan 21, 2009
#38
22.
nnadGuest
hi everyone.....well the paper wuz very conceptual nothing as to just reproduce wat you straightaway
had in your head......on exam proved to be good but i think a subscription of two websites is needed...
well
there were some mcqs on the auditory hallucinations..person came wid hearing that someone tells him
to cut his throat
alc withdrawl/dependence dnt remember
cannabis
psychotic schizophrenia?
-a person was caught from a school shouting that he cud save all the children from the devil of perils(i
think_)he took flouxetin as a mood stabilizer.
i wrote misuse of drug?
- person caught driving at very high speed on the road n he had a pressured speech. and he was very
agitated n asking why he was taken in to restriction...n he said he was riding on a cart pulled by horses
(i think) don't remember the choices
nnad, Jan 21, 2009
#39
23.
nnadGuest
result is on the 13 of feb best of luck to every one....what is the general impression of the paper...how
wuz it...to me it wuz tough sp the second one
nnad, Jan 21, 2009
#40
24.
dr AGuest
pts drowsy in hospital coz on large doses of morphine for ca pain....change it to naproxen and decrease
the dose of morphine
dr A, Jan 21, 2009
#41
25.
dr AGuest
pt taking drugs and hearing voices to cut his throat ...cannabis schizopherinia
there was another ques of schizopherenia..with amphetamine is the answer i think
yea the paper were very conceptual ...esp second one i found it very difficult ! good luck to
everyone ! ... plz keep on posting ques as u remember them
dr A, Jan 21, 2009
#42
26.
dr AGuest
ques abt large cannon a wave on jvp ..i think they didnt mention the ecg changes ....complete heart
block ? morbitz type 2 block ?
what is the treatment for senile brain atrophy with dementia ???
27.
dr AGuest
in a pateint for suspected aortic dissection with sever curshing chest pain ...other feature that wud be
present wud be hypertension ...bp control is the mainstray of its treatment
accidental adrenaline injection what to give ???cant remember the choices ...
dr A, Jan 21, 2009
#44
28.
nnadGuest
1- pt on warfarin wid INR 3-4 i think..wid dental extraction to be undertaken; i chose change to subcut
unfractionated heparin
2- aortic stenosis wen to operate...i wrote first wen pt symptomatic
then changed it to 50 mmhg pressure at valve..? tell me
3- chest pain wid st elevation V1-V4 that makes LAD the option...i wrote 70 percent stenosis as i
29.
5555Guest
1- ithink the key is the incubation period... 4 week goes with hepatitis E (3-8weeks) while hepatits
A(15 days-45days)....
2-that Q of stool wt which improved with fasting doesn't suugest VIPOMA ...it's more likely laxative...
30.
GuestGuest
31.
GuestGuest
32.
dr AGuest
old man with senile dementia and brain atrophy ...wat to give to improve his symptom ?
2) transient rash on the gluteal region ... shistosomiasis or drunculosis?? the man was from africa?
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1.
ycGuest
Hello, I thought I'll contribute some of the questions I remembered from the exam. The answers are
what I have written and I am not certain about them.
Cardiovascular
Patient in heart failure. Which beta blocker would you give
Ans : Carvedilol
Pharmacology
Rash in sunlight
Ans : Amiodarone
Infectious Disease
Young lady, visiting West Africa. Came back with fever, petechial rash. No lymph nodes
Ans : Dengue, ?possibly Malaria
Respiratory
Small cell lung cancer, tumour growing on R main bronchus. How would you treat
Ans : laser therapy (most prob wrong) other options include radiotherapy, chemotherapy, surgical
Neurology
Patient with guillain barre syndrome. Severely breathless, Sats 95%. Unable to measure VC What
would you do
Ans : Intubate, ?increase O2 to 100%
Basic sciences
Breakdown of peptides
Ans : Peroxisomes, ?proteases
Gastroenterology
Watery diarrhoea, stool chart with weight + showing fasting
Ans : VIPoma (didn't made sense to me)
Long history of alcoholism, abdo pain, weight loss, clay coloured stool. Whats the diagnosis
Long history of alcoholism, abdo pain, weight loss, clay coloured stool. Best investigation
Ans : CT scan
Acute Medicine
Someone in anaphylactic shock
Ans : 0.5ml 1:1000 adrenaline IM.
Statistics
- Can't remember the questions but they were relatively straightforward
- Question on calculating NNT
- Question on calculating specificity (i think ans was 95+percent)
- Question on understanding p value <0.02
Rheumatology
Patient with asthma develops haematuria ?churg strauss
Ans : antimyeloperoxidase
Endocrinology
Patient develop polyuria, erectile dysfunction and avascular necrosis
Ans : check blood glucose, ?possibly cortisol
Psychiatry
Patient in uni, became withdrawn, thinks lecturers are against him. Hears auditory hallucination
Ans : ?cannabis induced schizophrenia. Not sure if it was cannabis, could be other drugs
Renal Medicine
Patient developing diarrhoea + renal failure --> HUS
Ans : Treat with dialysis?
2.
ycGuest
Rheumatology
Lady developing swollen knee, red eye ?cause
Ans : ?reactive arthritis, nongonococcal arthritis
Gastroenterology
Patient develop lesion on the anus
Ans : ?wart
Dermatology
Patient develop smooth lesion on forehead
Ans : sebaceous cyst
Cardiology
Patient with known clotting tendency, on warfarin for DVT. Develop hemiplegia. What will be seen on
echo
Ans : normal
Renal
Patient with grey legs, aortic thrill. Develops proteinuria
Ans : ?hepatic vein thrombosis
Psychiatry
Known IV drug abuser, complaining of pain. Yawning, pupils reactive to light
Ans : ?methadone
Neurology
Patient with SAH. Has aneurysm + polycystic kidney. How would you screen relative
Ans : ?to do kidney USS on 1st degree relative. Other option includes MRI relatives
Haematology
Which virus predisposed to hodgkin's lymphoma
Ans : EBV
Respiratory
pleural effusion - protein 40 glucose 1.5, what is the most likely cause
Ans : ?adenocarcinoma, mesothelioma, rheumatoid arthritis, don't remember the other 2 option
Infectious Disease
3.
GuestGuest
- There was a question regarding the cardiac enzymes to be used for diagnosing MI after 3 days. I dont
remember the answer.
- insurance company question..... serum urate level more than normal. which test to do ???
- PCR question....
Guest, Jan 26, 2006
#3
4.
NathGuest
1.
2.
3.
33. Lt knee sweeling in a girl after returning from holiday - Gonococcal
36. child with HUS ,treatment - Plasmapheresis
37. Tall guy with hypogonadotrophic hypogonadism - Kallmanns
38. raised calcium,Alp,next investigation - PTH
39. Pt with pagets,next investigation - Calcium
40. epoitin resistance,raised PTH - Hyperparathyroidsm
41. ligh micros of child with Sore throat and haematuria - no change by light microscopy?
42 - pt with s.clerosis,htn,drug - ACE inhibitor
43. pt with recurrent thromboembolism - 6 months warfarin
45. treatment for BEtremor - propanolol
46. pt with intermittent diarrhea and constipation - IBS
47. Pt with occ bloody diarrhea and siggy shows loss of houstr and erythematous friable
mucosa - UC?
48.PAS positive ,Diarrhea - Whipples
49.24hr h/o blood diarrhea - ? Sheigella
50.best inv for pancreatic ca - ERCP
51. endocarditis after 6 weeks of valve replacement - Str.epider
52. pt with fever,c3 low - SBE
53. Pt with septic arthritis ,invest - joint aspiration
54. Pt with stump infection,treatment - Fluclox + Penicillin
55. Antibiotic for Gram Neg Diplococci - Cipro
56. Pt with kyphoscoliosis,what Pulmonary f.test - Reduced VC
57.Pt with pul fibrosis ,PFT shows - PEFR of <50%
58.Monitoring of colon ca - CEA
PS. Q1 paper 2. returned from Visit in West Africa , fever, anemia thromboctypaenia, rash etc
options, malaria, dangue fever, Lassa, hiv seroconversion
92. asymptomatic hyperuricemia, next investigation - ? lipids profile (increase risk IHD)
93. pt with waldestrom's - cyroglobulinemia, etc
94. pt with cholestasis, which medication responsible - co-** ans: augmentin
95. ischemic ATN, long term HD prognosis - 20-30%?
96. solidary thyroid nodule, next step investigation - FNA, radioactive isotope uptake etc
97. pt with high calcium and phosphate and suppressed PTH ? hypercalcemia of malignancy;
initial management - IV lasix, IV normal saline, IV biphosphates
99. west africa visit with fever, anemia, thrombocytopenia and rash - dengue
100. what clinical signis would suggest Severe aortic stenosis - radiation to carotids, etc
101. Road traffic accident - 2 weeks later developed anxiety symptoms. Evaluated 6 months
after RTA. Diagnosis? - anxiety, PTSD, etc
102. h/o splenectomy - give pneumococcal vaccine
103. s/p kidney transplant with worsening renal function. biopsy shows acute rejection. What
150. suicidal attempt on TCAs. wide complex tachycardia without p waves. HR 160s. SBP 90.
course of action: Dc shock, amiodarone, hco3, MgSO4 etc
151. white nodular exudate on sigmoidoscopy: pseudomembraneous colitis?
152. diabetic with frozen shouder: adhesive capsulitis
Nath, Jan 26, 2006
#4
5.
GuestGuest
6.
GuestGuest
7.
NathGuest
Thanks Ahmadd,Its a group work and I hope some more friends would contribute to the remaining
questions.
Praying for all of us.
Nath, Jan 27, 2006
#7
8.
GuestGuest
R u sure that the answer for the man who travelled back from africa is Dengue & not HIV
Treatment of gonococcal urethritis-? 1st choice ceftriaxone not there in the given choices...dont exactly
remember the rest
R u sure that the rash on back is P Rosea & not dermatitis herpetiformis....
Treaatment of chroni fatigue syndrome: antidepressants. Behavioural therapy is the 1st choice whic's
not given...decond choice is antidepressants
9.
ycGuest
14.A young boy with history of depression and suicidal. Has paranoid delusions, Clinical examination
mental state is flat, withdrawn, admits to occasional cannabis use with schizophrenic symp - drug
induced schizo, psychotic depression
16 - Area where this occurs - breaking of polypeptide - Protease, golgi apparatus, endoplasmic
reticulum, mitochondrion, peroxisomes
20. Pt with MI, >2mm ST elevation in V2-6, with BP 205/115, already given morphine and aspirin - the
next appropriate management - iv GTN, iv streptokinase, iv tPA,
25 - A patient has a history of Raynaud's syndrome, which other clinical findings would be associated
with underlying connective tissue disease - history of Chilblains, recurrent abortions
31 - A man with a history of chronic Asthma presented with breathlessness of 4 weeks duration. CXR
showed Upperlode Collapse - Churg Staruss, acute bronchopulmonary aspergillosis
33. Lt knee sweeling in a girl after returning from holiday, also noted to have conjunctivitis, now
presents with bilateral ankle swelling - Gonococcal, reactive arthritis
40. A patient with renal failure on hemodialysis for a few years, has been on epoetin before, with
baseline Hb of 11-12. Now noted anemia, Hb 8.0, MCV low, with raised Ca, PO4 and raised PTH,
what is the cause of epoitin resistance - Hyperparathyroidsm, occult malignant disease, inadequate
epoetin dosing
42 - pt with systemic.clerosis, is now hypertensive with cotton wool spots on fundoscopy as well as
acute renal failure, what is the next management ,drug - ACE inhibitor, oral atenolol, iv nitruprusside,
iv labetalol
43. A lady with a past history of DVT is now on heparin due to a DVT confirmed on doppler. She
previously had abortions. What is the next appropriate managment - 6 months warfarin, warfarin
indefinitely
53. Pt with a long history of rheumatoid arthritis which is currently quiescent, complained pain of the
right knee. Patient is otherwise apyrexial. What is the next immediate investigation that you would do?
with septic arthritis - X-Ray of the right knee, joint aspiration, ESR, CRP
65.Another question on headache with hemiparesis that resolves after the attack - cerebral venous
thrombosis, migraine
81. Outbreak of diarrhea on the ward . patients resolving after 48hr. ?close ward, isolate patient, stop
visitors from coming, use bottled water for drinking
99. A lady who has been to west africa for 6 months returned. 4 weeks after presents with fever,
anemia, thrombocytopenia and rash - dengue, lassa fever, falciparum malaria, typhoid, acute HIV
seroconversion
100. what clinical signis would suggest Severe calcified aortic stenosis - radiation to carotids, loud
second heart sound A2, hyperdynamic apex beat
101. Road traffic accident - 2 weeks later developed anxiety symptoms, headache. Evaluated 6 months
after RTA and was found normal. Diagnosis? - anxiety, PTSD, post concussion syndrome
112. A young lady presents with difficulty swallowing solids and liquids. BMI within normal limits.
She vomits after taking 3 mouthfuls of food, OGD done, found food residues at the lower part of
esophagus. pt with odynophagia to both solids and liquids. next step investigation? esophageal
manomotry studies, barium follow through
114. admitted for AMI, which test would suggest reinfarction after 3 days? CK, AST, trop I, T
118. Young lady out drinking the night before, had a fall(?). Had a headache that woke her up and
associated with vomiting. has low grade temperature, admitted with neck stiffness. CT head normal.
investigation of choice: CSF investigation, MR brain, MR angiography
138. pt with polyuria, decreased libido, right hip pain. What tests to do in order to confirm the
diagnosis? ferritin level, cortisol level, blood sugar level
139. An African man has had depressive illness for the past 3 winters. Currently feeling suicidal. Also
known to smoke cannabis. What is the diagnosis? Schizophernia, cyclothymic disorder, seasonal
related affective disorder
140. 70yo lady has a history of facial rash exacerbated by sunlight and alcohol. Clinically there is an
arythematous papular rash with pustules. Weakly positive rheumatological markers. What is the most
approriate treatment? prednisolone, flucloxacillin, dapsone
141. 80yo lady c/o fatigue, polyarthralgias and alopecia. She has a history of Raynaud's phenomenon.
Clinically joints are normal. Diagnosis? Hypothyroidism, SLE, Sjogren's
142. Patient recently started on carbamazepine for seizures. Came in for breakthrough seizure a few
months after and noted subtherapeutic level of anticonvulsants. Pill count showed patient is compliant.
What is the explanation? Alcoholic binge, enzyme induction
143. An elderly gentleman was found to be in AF. Pulse 96, BP 124/84. What is the next step in
management? DC cardioversion, aspirin, warfarin
144. 48yo lady with type I DM for 2 years, but long history of rheumatoid arthritis. Urinanalysis
showed proteinuria. Likely renal pathology? amyloidosis, DM nephropathy, NSAIDS induced
nephropathy
155. Young lady with acute leukemia received chemotherapy that consisted of doxoburicin and
vincristine. 3 weeks later she complained of abdominal pain with constipation. What is the cause?
doxoburicin, vincristine, hypercalcemia
156. Young woman complained transient aphasia and left sided hemiparesis. She just returned to
London from Australia. What is the likely echo findings?
157. A patient recently started on oral prednisolone. What is the treatment of choice for steroid induced
osteoporosis? Ca/D, bisphosphanates
159. A pregnant woman with DM has episodes of loss of consciousness without any warning. What is
the cause? fetal insulin secretion, tight glycemic control
160. Patient came in for decompensated cardiac failure. JVP raised, oliguric, bilateral pedal edema.
What test can identify the cause of deterioration? echocardiogram, CXR, Urea and electrolytes, trop T
161. A patient with compensated type 2 respiratory failure. pH normal. What treatment improves
prognosis? Long term O2 therapy, O2 concentrator, pulmonary rehab
162. A young lady admitted for depression. There was history of recent bereavement. She was given
some medication that ran out 7 days ago. Clinically, distressed, tachycardic, has a tremor. What is the
likely diagnosis? benzo withdrawal, depression
163. A young boy with history of acne on minocycline still has acne with scarring. What is the next
171.pleural effusion - protein 40 glucose 1.5, what is the most likely cause - Mesothelioma
10.
GuestGuest
Yes man i think the same the person from west africa:::: ans::; aaacute HIV
Outbreak in the ward ::: self limiting :::: use bottle water
any comments
Guest, Jan 27, 2006
#10
11.
GuestGuest
there are 2 versions of the 'west african' scenario i think. my scenario was some guy returned from west
africa? zimbabwe? (can't remember exact place) presented with pancytopenia and rash (no mention of
lymphadenopathy nor any symptoms/signs of mononucleosis) and dx is likely dengue (a similar
question was on onexamination).
12.
ycGuest
HI all, just sat the MRCP part 1 in January, it wasn't as bad as I thought it would be, but I wouldn't say
it was easy. ONexamination.com's questions come very very close.
Resp
2. Scenario with community acquired pneumonis- you need to memorise the CURB 65 critieria by
heart
Cardio
1. Scenario with anterior MI, need to know contraindications to thrombolysis to answer this
2. 68yr old man with AS what wud reduce pressure gradient across valve, i think heart failure is answer
Resp
1. Small cell lung cancer, tumour growing on R main bronchus. How would you treat
How to manage anaphylactic shock, must choose the right does of adrenaline i.e. 0.5mg of 1:1000
Statistics
quite straight foward
1 was on calculating specificity, 2 were on calculating number to treat
1 was on a trial, with "an intention to treat" vs control, what exactly are they testing?
infectious
36yr from Zimbabwe with calcification in bladder on X-ray- Schisto.
gastro
gastric adenocarcinoma on biopsy. what histological features: columnar cells, signet ring cells,
diminished goblet cells, etc
yc, Jan 27, 2006
#12
13.
GuestGuest
Hi to all of u ,,
and wish u best of luck ,,,,,,,,,,,,,,,IT WASNT AN EASY EXAM
regarding the man who came from africa with fever,rash........etc
i remember that he developed the symptoms 6 weeks after arrival so its not dengue cuz dengue has an
incubation period of 3-7 days but from the list which also contained typhoid,brucellosis, hiv ,,,,HIV is
the most likely answer cuz it has the longest incubation period among all other options.
Guest, Jan 27, 2006
#13
14.
GuestGuest
Yes i'm also talking abt the same question with incubation period of 6 months.
and i agree with u ppl that this was not easy paper specially part 2 of the paper
Guest, Jan 28, 2006
#14
15.
kadhaum ALAMOIGuest
TREATMENT WARFARINE
16.
GuestGuest
Why not in a pregnant lady... propylthiouracil.....as there are symptooms present i:e palpitations.
Secondaly why is the diagnosis of a person on aeroplane getting CVA is "Patent Foramen Ovale"
Guest, Jan 28, 2006
#16
17.
kadhaum ALAMOIGuest
hello ahmaddd
regarding leady travel from australia to london she was health before
travel get dvt due to long tavel then emboli from vein to rt side of heart
throw patent foramine ovali to lt side to cerebral circulation.this is the senario of this qestion
thank
dr kadhaum
kadhaum ALAMOI, Jan 28, 2006
#17
18.
GuestGuest
74yr male. drowsy and confused. Normal anion gap acidosis: acetazolamide.
Other answers were causes of raised anion gap acidosis.
Questions on your list which I disagree with your answers. See what you think.
10. P value 0.01 means that there is a less than 1 in 50 cheance that the nul hypothesis is correct. "Fruit
juice is helpful in Crohns" implies causation, which a p value cannot tell you.
43. Recurrent thromboembolism - lifelong warfarin. (Give 6 months warfarin in 1st embolism, lifelong
in subsequent emboli.)
77. Anaphylaxis pt from prawns. I think the answer is do nothing because he was already hypertensive
and has normal sats and presented 2hrs after ingestion. Close observation would be the treatment and
steroids would be the real treatment, not further adrenaline.
161. Type II resp failure in COPD - I think longterm nebs but I'm not so sure about this one.
162. Young lady, depression. Recent bereavement. Stopped meds 7 dayys ago: I think benzo
withdrawal.
170 Forehead lesion: I think sebaceous cyst. (Although no punctum, nothing else fitted this description.
thank you Nath for all your work. I will continue to try to find out some answers.
God bless.
D.
Guest, Jan 28, 2006
#18
19.
sawsan sGuest
20.
GuestGuest
21.
GuestGuest
i think lower chest pain after liver biopsy ----------- subphrenic haematoma.
22.
kadhaum ALAMOIGuest
1-PATIENT WITH RT EYE PUPIL LARGE THAN LT EYE LOW RESPONCE TO LIGHT AND
ACCOMIDATION
23.
shabanaGuest
diabetic patient with new vessel formation at optic disc. visual acuity in both eyes not affected (6/9).
what is the managment?
24.
SHABANAGuest
WHAT WAS THE ANSWER FOR THE 62 YEAR OLD LADY WITH LETHARGY,
POLYARTHRALGIA AND HAIR LOSS. ON EXAMINATION..HORMAL JOINTS?
-SLE
-HYPOTHYROIDISM
-FIBROMYALGIA RHEUMATICA
For diabetic retinopathy,they mentioned in the question that there are new vessel formation near the
optic disc,So i think the correct ans is Photocoagulation.
25.
NathGuest
What was the answer for the pt presenting with complete obstruction of lt corotid with 40% stenosis on
rt side.
anyone...
cheers
Nath, Jan 30, 2006
#30
26.
kadhaum ALAMOIGuest
HFE GENE
-Regarding the carotid obstruction(from published evidances) its highly recommended to ectomize the
the artery if it stenosed more than 70% ,so in the question the answer is to remove the completed
obtructed one 100% stenosis and to leave the other one with 40%.
a diabetic parient with 60 mg protein/24 hour urine. what is the most likely subsequent complication?
-retinopathy
-myocardial infarction
-neuropathy
-renal failure
27.
NathGuest
\Hi
I think its Renal failure due to diabetic nephropathy.Any comments.
Nath, Jan 31, 2006
#35
28.
NathGuest
I think the question was .Pt on 5 yr haemodialysis,what is he most likely to die from.
Options were CAD,Dilated Cardiomyopahty.
I choose CAD as he is most likely to die from MI.
However,not sure,Any comments.
Nath, Jan 31, 2006
#36
29.
kadhaum ALAMOIGuest
30.
GuestGuest
Patient on haemodialysis dies of - The right answer is CAD as they die of IHD then next comes the
cardiac failure and the last cerebrovascular disease. REF - OHCM pg no.278 complications of dialysis.
A 65-year-old man presented with a four week history of pleuritic chest pain associated with shortness
of breath and dry cough. He also reported weight loss of nearly 10kg in the past six months.
He had a past history of myocardial infarction 20 years earlier from which he had made a good
recovery. He did not suffer from any exertional chest pain subsequently. He lived alone and had not
seen his general practitioner for two years. He seldom saw his General Practitioner, but had attended
the surgery twice recently with mild recurrent pain in his left knee that responded well to treatment
with simple analgesia. He was an ex-smoker of 15 cigarettes per day, having given up smoking 20
years previously. His only medication was aspirin.
On examination of his chest he had reduced expansion, dull percussion note and decreased breath
sounds on the right. A chest X-ray confirmed a right-sided pleural effusion.
Analysis of a pleural aspirate revealed:
Pleural fluid protein content 42 g/L
Pleural fluid glucose 1.3 mmol/L
What is the diagnosis?
[100]
5 ) tuberculosis
[0]
Comments:
The pleural fluid protein is greater than 30g/l which demonstrates it is an exudate and effectively
excludes cardiac failure. If pleural fluid protein is 25-35 g/l then Lights Criteria is more accurate in
determining whether the effusion is an exudate or transudate. It is an exudate if 1 or more of the
following criteria are met (a) pleural fluid protein divided by serum protein > 0.5 (b) pleural fluid LDH
divided by serum LDH > 0.6 (c) pleural fluid LDH > 2/3rds upper limits of normal serum LDH.
The pleural glucose level is very low. Levels less than 3.3 mmol/l are found in empyema, rheumatoid
arthritis, lupus, malignancy, oesophageal rupture and tuberculosis. The lowest levels are found in
rheumatoid effusions and empyema with pleural glucose in rheumatoid effusions rarely being above
1.6 mmol/l.
Registered users average score for this question is 37.2% (answered 4094 times)
The above two replies have been posted by the same guest in order to make all the MRCPians aware as
these questions can appear in the next forthcoming mrcp examThe question with PL effusion with Pr > 40 and Glu < 1.5 mmol/L which appeared in JAN 06 mrcp1 the right answer is RHEUMATOID ARTHRITIS as you could read the above copy of a question which
why was the answer to the patient with COPD and lobar pnemonia amoxicillin and not amoxicillin+
clarithromycin?
shabana, Feb 1, 2006
#43
31.
NathGuest
cheers
Nath, Feb 1, 2006
#44
32.
shabanaGuest
33.
kadhaum ALAMOIGuest
34.
shabanaGuest
what was the answer for the patient with left complete stenosis of the common carotid and 30%
stenosis of the right?
no surgical intervention or left carotid endarterectmy?
35.
shabanaGuest
36.
GuestGuest
spirometry
1.
zafar_nzrGuest
just returned from examination center. Paper 2 was very tough. Few recall questions are as follows ;
1. 2. trastuzumab started for a pt. for breast cancer; which factor predisposes to heart failure..... ? don't
remember the options; one was ...past anthracycline Rx ;
3. another question for trastuzumab and heart failure;
4. a pt. with ischemic stroke and AF with 150/min rate presented after 6 hours ; initial Rx ? ...
alteplase , aspirin , clopidogrel , dipyridimole, warfarin?
5. 18 yrs old male had excessive bleeding after dental extraction , APTT =86 , PT= normal ; deficiency
of which clotting factor? II , VII , V , X , XII or XI
Sorry friends, that's all i remember at this time; my mind is very tired; however, i'll post whenever i
remember any question.
zafar_nzr, Sep 22, 2009
#1
2.
Guest2001Guest
What I found out in paper 2 that there are many answers for the same question, its just how you chose
to answer it. I think for the atrial fibrillation the answer was Aspirin, as the question was 'whats the
next best management'.
Guest2001, Sep 23, 2009
#2
3.
M SOLIMANGuest
Prolonged diarrhoea
Acute Hep A infection
Anti TB adjovant = CSF
Prognosis of Rh A Acute onset
Macrocytic aneamia in Gastrectomy pt= U endosopy
tear drop= myelofibrosis
Wagner`s s =Pul hge+renal imp
Thrombocytopenia= ? Churg straus
A promylo leukemia
Transudae Pl eff= ? TB vs SLE not sure wt
Commonest Thrompophilia
4.
dr_mohammedGuest
5.
ImmoGuest
the question with renal failure and patient complaing of hemoptysis , they also gave the option of good
pasteur as well as wegners granulomatosis
* bad prognostic sign in rhumatoid arthritis is being a female not acute onset * it is not just spiliting of
the second heart sound it is a fixed and that mean atrial septal defect ASD which is the first option
*the patient with tachycardia is eldry around 60 years so AVNRT is more common with strucral heart
diseases
* the question about the immediate action after stroke , so aspirin is first then warfarin which take 72
hours to take full effect
Guest, Sep 23, 2009
#7
6.
GuestGuest
7.
ImmoGuest
Patient 75 yrs age , new onset AF with mild sob , planned to control rate only , no structural or vlave
disease cxr clear
digoxin
bisoprolol
dont remember other options
Immo, Sep 23, 2009
#9
-The stroke Pt should be given ASPIRIN.. Warfarin is never started b4 2 weeks even in Ischaemic soke
for hear of haemorrage into an infarct
-The strongest indicator for Liver transp in Paracet o/dose is pH!
- The described pl effusion was an Exudate, specifically EMPYEMA (bcoz low pH)
- SVC immediate ttt is Radiotherapy!
- Cyclosporin (and Tacrolimus too) axn inhibits IL2
- Both female sex and anti CCP are bad prognostics for Rh arthritis. I don't know which 1 they want but
probably female (I wish i chose it :shock: )!!!
Dark Knight, Sep 23, 2009
#13
8.
Majeed1974Guest
Regarding the atrial fibrillation for rate control, there was a similar question in onexamination, and the
answer is digoxin when there is an evidence of heart failure, otherwise, its a beta blocker. And true, the
low PH is an indication for liver transplantation. I believe there was a question on Henoch Schonlein
purpura too
GuestGuest
actually there is no anti CCp in the options it is already given in the stem above so being female is the
true answer
Guest, Sep 23, 2009
#15
9.
Majeed1974Guest
10.
Majeed1974Guest
Mohammed
it can also be the onset of valvular incompetence, as indicated by the onset of systolic murmur!
Immo
I think it is discoid based on the description of the hair follicle plugging, and the age and gender is
compatible with discoid lupus.
[/b]
Majeed1974, Sep 23, 2009
#19
11.
ImmoGuest
patient collapse 5 min after tetanus injection , local erythema and hypotensive which type of
hypersensitive reaction
Type 1 , Type 2 , type 3 ........ type 5
Immo, Sep 23, 2009
#20
12.
ImmoGuest
13.
GuestGuest
for atopic dermatitis you have to use a potent steroid as a second line which is clobetasone propionate
it is type 1 anaphaylaxisis
Guest, Sep 23, 2009
#22
14.
GuestGuest
was there a qs with an answer "secondary syphilis"? I think it was the chap who had exudative
tonsillitis (so SUPPOSEDLY had Penicllin) then developed a scaly rash
Guest, Sep 23, 2009
#23
15.
M SOLIMANGuest
16.
GuestGuest
regarding the rate control in atrial fibrilation here is a very informative piece of information
Atrial fibrillation: rate control and maintenance of sinus rhythm
The Royal College of Physicians and NICE published guidelines on the management of atrial
fibrillation (AF) in 2006. The following is also based on the joint American Heart Association (AHA),
American College of Cardiology (ACC) and European Society of Cardiology (ESC) 2002 guidelines
Agents used to maintain sinus rhythm in patients with a history of atrial fibrillation
sotalol
amiodarone
flecainide
others (less commonly used in UK): disopyramide, dofetilide, procainamide, propafenone,
quinidine
17.
ImmoGuest
prednisolone
platet transfusion
18.
ImmoGuest
10 weeks pregnant lady with pleuritic chest pain and left calf pain
what investigation
venogram
CTPA
dopplers leg
V/Q scan
Immo, Sep 23, 2009
#28
19.
GuestGuest
NOOOOOO platelet transfusion for ITP as antibodies will destruct the new platelets...Give
Immunoglobulins
Guest, Sep 23, 2009
#29
20.
GuestGuest
21.
GuestGuest
22.
GuestGuest
i think the pregnant lady only needs leg doppler. She has a very suggestive CXR and if leg doppler +ve,
no need for further scanning
Guest, Sep 23, 2009
#32
23.
M SOLIMANGuest
0 weeks pregnant lady with pleuritic chest pain and left calf pain
what investigation
thank u Immo
M SOLIMAN, Sep 23, 2009
#33
24.
ImmoGuest
elderly patient with left iliac fossa pain with mild temp , no sign of acute abdomen
? diverticulitis
patient with rectal bleeding and brown macules around lips ( pets jeug)
? colonic ca
? angiodysplasia
post ERCP patient develops abdo pain with mildly elevated amylase , erect cxr no free air
next option?
abx
surgical opinion
iv fluids analgesic
repeat ercp
Immo, Sep 23, 2009
#34
25.
GuestGuest
Pulmonary embolism is the leading cause of death in pregnancy. Despite the difficulties in clinical
diagnosis and the concerns regarding radiation of the fetus, the British Thoracic Society guidelines for
imaging pulmonary embolism do not specifically address the issue of imaging for pulmonary embolism
in this group. This communication discusses the difficulties of diagnosis and imaging pulmonary
embolism in pregnancy and proposes a suitable imaging protocol. Clinical exclusion of patients from
further imaging is recommended if the patient has a low pre-test probability of pulmonary embolism
and a normal d-dimer. It is advised that all remaining patients undergo bilateral leg Doppler
assessment. If this test is positive, the patient should be treated for pulmonary embolism; if negative, all
patients should be referred for CT pulmonary angiography. Ideally, informed consent should be
obtained prior to CT scanning
Guest, Sep 23, 2009
#35
26.
GuestGuest
one question about a diabetic patient 35 years old needs more doses of gliclazid and he have a ketones
in urine but no wt loss
options
dm type 1 or
late autoimmune DM ( LADA )
Guest, Sep 23, 2009
#36
27.
GuestGuest
I think its type 1 because the patient had ketones which is exclusive to type 1 DM....what do u think?
Guest, Sep 23, 2009
#37
28.
ImmoGuest
patient investigated for addison , using some steroids nasal drops and work night shifts
short synachten test 0900 high the normal dont remember the value
diurnal variation
?use of steroids
addison disease
Immo, Sep 23, 2009
#38
29.
GuestGuest
no wt loss in this patient , and typically ther is wt loss unless trteted with insulin , ketones also occur in
LADA
Guest, Sep 23, 2009
#39
30.
GuestGuest
elderly patient with left iliac fossa pain with mild temp , no sign of acute abdomen+ constipation so I
chosed Volvuls
patient with rectal bleeding and brown macules around lips:? Crhons
post ERCP patient develops abdo pain with mildly elevated amylase , erect cxr no free air(pancreatitis
so I picked iv fluids analgesic)
Guest, Sep 23, 2009
#40
31.
GuestGuest
don't forget plexus the patient presented with fever which goes with acute cholangitis and need of
antibiotics
Guest, Sep 23, 2009
#41
32.
GuestGuest
I thought of that during the paper but Abx will be important in all the possibilities.
Guest, Sep 23, 2009
#42
33.
ImmoGuest
lady with severe right forearm pain during weekdays , extension of wrist cause severe pain , unable to
hold pain or cup
95 yr old gentleman 4 admission with confusion 1 time chest infection 3 times UTI
next investigation
?cystoscopy
mycoplasma pneumonia , patient not toleratind clarithrymycin what to give alternate , no other
macrolide was in option
young lady with recently diagnosed PHT which will make her condition severe
fatigue
wheeze
syncope
Immo, Sep 23, 2009
#43
34.
GuestGuest
35.
GuestGuest
ttt of Strongyloidosis...?Albendazole
female 30 years with proximal weakness and ++CK....Limb and girdle myopathy
36.
GuestGuest
1: Patient with acute renal failure, high K 7.6 what is immediate intial managment: Bicarbonate
3: 30 year old with high glycaemia and HbA1c 10.0, Ketone 2: Latent diabets of adult
37.
ImmoGuest
nodular sclerosing hodgin lymphoma what will be the bad prognostic features
people recieving warfarin what will be common effect with all of them requiring adustment of daily
dose
Immo, Sep 23, 2009
#48
38.
zafar_nzrGuest
An 18 yrs old woman with 2 month h/o sudden altered consciousness in which she remains still for
about 20 mins; parents could help her sit; regains consciousness without any post-ictal state; aunt has
h/o epilepsy; parents had recently decided to separate.......conversion disorder? complex partial siezure?
cataplexy ? don't remember other 2 options. I chose cataplexy.
In the question for bad prognostic factor for Ra, there was option for anti-CCP .
In the question with pulm. - renal syndrome, ESR was given normal (10 only) ; so was it Wegner's or
Goodpauster??
A lady with itchy , scaly rash on the foot for 6 months; not improving with topical steroid; now rash has
started spreading to the leg with central clearing.... ?Boriella serology ; skin scraping for mycology?
skin scraping for gram stain? don't remember other options; I selected Boriella serology suspecting
erythema chronicum migrans....don't know if i was right.
a pt. with long h/o scleroderma presented with diarrhea, abdominal bloating etc. colonoscopy is normal
; best option for Rx? ... gluten free diet? prednisolone? tetracycline? don't remember other options.
A 6 weeks pregnant pt. with UTI; started on ?macrolide ; culture showed resistance to macrolide.
Alternative Abx? doxycycline? ciprofloxacin? , trimethoprim? don't remember other options. I chose
trimethoprim.
Gentamicin started for a pt. Creatinine deteriorated. Dosing interval increased to 12 hourly. What will
be affected? Bioavailability ? volume of distribution? half life? protein binding? non-renal clearance?
Commonest thrombophillia in norhtern europeans? factor V leydin heterozygous? protein C def.?
protein S def.? there was one more option with heterozygous state; don't remember .
25 yrs old woman with raised calcium and raised PTH; maternal uncle had primary
hyperparathyroidism at the age of 35 yrs and his son had....don't remember exactly...but pointing to
MEN I ; diagnosis for the woman...? ? hyperparathyroidism? MEN 2 ? vitamin D intoxication? don't
remember the rest.
A significant number of questions involving raised calcium levels.
A pt. with raised Ca and PO4- ; pt. has lethargy; CXR shows basal reticulo-nodular shadows bilaterally.
Dx ? fibrosing alveolitis? sarcoidosis? don't remember the other options.
A 40 yrs old male with painless rectal bleeding. No family h/o carcinoma of colon; pt. has brown
macules over lips. Cause of his rectal bleeding? carcinoma of colon? angiodysplasia?
Imatinib is an inhibitor of? tyrosine kinase
zafar_nzr, Sep 23, 2009
#49
39.
GuestGuest
fingers crossed!!!
PHD, May 11, 2010 #1
booster28
booster28
Guest
may2010 part 1
i found it tough
booster28, May 11, 2010 #2
Guest
Guest
Guest
hii,
cheeeeerz
Guest, May 11, 2010 #3
booster28
booster28
Guest
1.dilated pupil - holmes adie
2. 6 months of episodes of fatigue - chronic fatigue syndrome
3.HLA antigen compatibility for kidney transplant- HLA-DR
4. boy with head injury. lucid moment then LOC - epidural head injury
RESPIRATORY
6. pericardial effusion what will be the clinical sign ? pulses paradox ? rub ? jvp raised with
inspiration ? bp raised with inspiration etc
9. which drug restore sinus ryhtym flecainide
10.patient had acute now oliguric ? lvf ? rvf ? hypovoumia
12.angina on ett with st depression which drug shows improve prognosis ISMN / NITARES /
DILTAZEM
13.patient on high dose of diuretics still having pedal edema cause ? cant recall the options
14.patient having light headedness what will be significant on 24 hr tape ve , atrail ectopics , profound
sleeping brady / svt / transirnt mobitz type1
15.
HAEMATOLOGY
2. patient came for elective hip surgery wcc shwing 3500 ? cll ? cml
3. delayed transfusion reaction after 1 week what investigation ? direct coombs test
4 , most common infection via platelet transfusion Hep B / malaria / hiv/ staph line infection /
treponema
5. 15 minutes post transfusion patient sob / cxt pulm edema jvp not raised ? acute lung injury
8 soon starting chemo patient having agitation / suicidal thoughts ? steroids psychosis
11 .patient anaemic low ferritin low mcv ogd and colonscopy normal ? sideroblastic anaemia
14 pt collpase h/o of MI ecg showing st elevation without chest pain q waves and no reciprocal changes
? vt
17. patient on bendro still having high bp had side effects of fluid
retention / gum bleeding /lehtargy / with other HTN medication what next ? beta blocker
18 pericardial effusion what will be the clinical sign ? pulses paradox ? rub ? jvp raised with inspiration
? bp raised with inspiration etc
21. which drug restore sinus ryhtym flecainide
24.angina on ett with st depression which drug shows improve prognosis ISMN / NITARES /
DILTAZEM
25.patient on high dose of diuretics still having pedal edema cause ? cant recall the options
26.patient having light headedness what will be significant on 24 hr tape ve , atrail ectopics , profound
sleeping brady / svt / transirnt mobitz type1
29. father has copd , son non smoker but reduced fev1 and looks obstrictive picture ? obliterans
30. non smoker malignancy shadow on cxr but bronc normal ? adeno ? small cell
31. asthma not settling with steroids 800 and prn salbutamol ? add salmeterol
35. right upper zone shadow weight loss h/o of tb , aspergillus positive ?
ca ? tb ? aspergilloma
38.patient spray paint worker worse at work but settled laterin week investigation ? serial peak flow
40. patient suffering from pulmonary thromboemolic disease what will happen to his lung ? reduced
tlco ? increased compliance et
47 . heavy smoker past asbestos exposure asympotomatic what will show cxr ? pleural plaques
48 . life threating sign of asthma ? low Pco2 low peak flow less 35 % r/r30
54 . terminal ileum surgery bacterial overgrowth , similar question but high mcv i thik asking for
megaloblastic anaemia
65 . NNT - 1/ EER-CER
72. cellulitis showing MRSA what should be added along with vanco
81 diarrhoea e coli
82 . prolong bloody diarrhoea raised inflammatory marker what test ? stool microscopy ? rigid
sigmoidoscopy ? colonscopy ? axr
91 . sle c4 defieciency
93. recurrent lip / throat swelling beekeeper on ace inhibitor for 6 months ? c1 inhibitor ? drug
induced ? herede angioedema
94. HIV with unprotected anal intecourse now jaundice cd4 520 ? hep B ? cmv ?
101. right pupil large not reacting to light but on convergence become smaller then left ? Argyl
robertson ? home Adie
103. splenectmoy when to give pneumococcal vaccine 1 week or 1 month before no option of 2 week
118 . lady with ascites and liver mets raised all tumor markers pancreas / colon / ovary what will be
primary ( I dont know who cares )
119 . secondary amenorhea after stopping ocp doing vigorous exersize ? cause ? premature ovarian
failure / ? hypothamic / ? 2to ocp
120 . bony mets on morphine very drowsy need to cut down what to add naproxen
122. drug ( Alcohol ) induced porphyria , lady partying now abdo pain and agitated
124. wernicke / delerium tremens
128 . lady recieving chemo i think asking for for tumor lysis syndrome
129 patient recieving chemo in conatact with chicken pox give not vaccinated in the past ? IVIG ?
vaccine
134. pain in the wrist and forearm while using hammer ? lat epicon ? ulnar neuropathy ? tennis elbow
136 . Insominia / weight loss / lost his family in terrorist attack still pending compensation ? Post
traumatic ? depressive
137. patient agitated / mettalic taste after stopping her pshychiatric medications
138. swollen knee aspirated no organism given steroid relieved but reccur within a week wiith raised
infalmmatory marker what next ? iv antibiotic ? / reaspirate
139 . spontaneous pneumothrax aspirated , symptoms improved repeat cxt showing 1.5 cm ? oberve ?
aspirate
141. after starting gout painful wrist knees and elbows ? allpourinal induced
148. HUS and and anaemia what type of cells showing in microscopy howell / target / cast etc
Guest
Guest
Yes, they excluded q 85 in KUWAIT too.
by the way Q about post MI insulin S/C I think options were about the range of blood sugars rather
than rate of infusion... what do u think?
Guest, May 12, 2010 #14
imad
imad
Guest
qaust about skin rash valecious in flexure surfaces wat feautre else? oligo arthropathy? scabis?
pt with recurent ita raised st segement e out ercprocal changes cerebral embolism or vt
imad, May 12, 2010 #15
Immo
Immo
Guest
yes right they were asking the BM rate rather then infusion , to be honest i never realising while
practising how much it should be maintained most of the time i just sign the sliding scale and nurses
will keep it below 10
Immo, May 12, 2010 #16
Rony_dhaka
Rony_dhaka
Guest
Hello!
I sat in Dhaka.
2nd paper was so difficult for me.
Anybody know what mark could make us pass?
Any guess????
Rony_dhaka, May 12, 2010 #17
Guest
Guest
Guest
Pulse in PDA - Normal?
Cocain - hyperthermia?
Shape of crystals in gout? Needle bifringent?
Thx Immo for the great effort
PCR........?
Statistic table, which test?
Rash on scalp,....,... & nose ......Seboroid Dermatitis
Lady on treatment after mother death anxiety........Panic attacks?
boy ingested something in party.......ectasy?
Many questions on Rhaumatoid Arthritis
% of drug metablisez by first pass after 20 hours ???
Alfa feto protein
-ring emhansing lesion in Aids pat>>.......Toxoplasmosis
-duration of anti retroviral treatment after needle stick....1 or 3 mounths?
-organism in drug abuser>>......staff aur
-haem sat shift to the right>....increased co2 conc
-facial palsy treatment .....prednisolon
-organic versis psychiatric disorder??? presence of dementia or urinary incontinence?
-q about pancriatitis
Nasaa, May 13, 2010 #21
Guest
Guest
Guest
dementia+urinary incontinence+gait problems= N pressure hydrocephalus
Guest, May 13, 2010 #22
Guest
Guest
Guest
diarrohea questions almost 20percent
thanks very much immo for collecting so much questions i try to collect some more other than so that
we will have nearly all the questions then we can discuss the answers 1.surgery for crohns done 1 yr
before and now on mesalazine presenting with diarrohea -active crohns (not sure) 2.diabetic with 9
month diarrohea who have been treated many times for his ulcer with antibiotic-antibiotic related
3.miller-fischer syndrome -reduced reflexes with ophthalmologia and ataxia 4.child with dentist
presenting due to an episode of collapse and regain conscious after short period-complicated syncope
6.women with livedo reticularis and misccariage -anti phospholipid syndrome 5.pt with rheumatiod
arthritis presenting with kidney disease-rectal bopsy 7.halos with sudden loss of vision -closed angle
glaucoma 8.71 yr old with features of papilloedema-giant cell arteritis 9.24 yr old with blurred vision
and papilloedema-optic neuritis 10.parkinson disease treatment-ropinirole 11.restless leg syndromeropinirole 12.meninigitis with glucose 0.6 lymp 46 and neut 35 -enterovirus 13.trip to south america
with diarrohea-s.mansoni(?)
Guest, May 13, 2010 #23
Guest
Guest
Guest
14.exercise with fatique and how to improve o2 reaching more to tissues-inc glucose ?
15.ciprofloxacin-tendinopathy 16.vancomycin +rifampicin for mrsa 17.pruritic papules on flexor aspect
wat other findings-mucous membrane involvement 18.ithing with erythematic plaques dissappearing
after 2-3hours from 6 months-prednisole ? 19.light headedness plus 12 hour ecg normal wat is most
clinic significant a.atrial premature beats b.ventricular premature beats c.svt 4.mobiltz type 1 av block
etc i gave 4th dont know correct or not 20.renal stone with family h/o renal stones-custinuria
21.hereditary heamorrhagic telangiectasia-autosomal dominant 23.factor v deficiency 24. 25.chisquared test 26.2*2 table test analysis-paired t test i dont know? 27.nnt=20 28.npv=tn/tn+fn 29.meta
analysis (some people r lost during follow up) 30.thiazide causing hypokalemia????????????//////
2. patient came for elective hip surgery wcc shwing 3500 ? cll ? cml >>>CML
3. delayed transfusion reaction after 1 week what investigation ? direct coombs test
>>>HOMOSIDRENURIA
4 , most common infection via platelet transfusion Hep B / malaria / hiv/ staph line infection /
treponema >>>HEP B
5. 15 minutes post transfusion patient sob / cxt pulm edema jvp not raised ? acute lung injury >>SAME
8 soon starting chemo patient having agitation / suicidal thoughts ? steroids psychosis
>>>DEPRESSION??
11 .patient anaemic low ferritin low mcv ogd and colonscopy normal ? sideroblastic anaemia
>>>SAME
14 pt collpase h/o of MI ecg showing st elevation without chest pain q waves and no reciprocal changes
? vt >>>CEREBRAL EMBLOISM
17. patient on bendro still having high bp had side effects of fluid
retention / gum bleeding /lehtargy / with other HTN medication what next ? beta blocker >>>ACE??
18 pericardial effusion what will be the clinical sign ? pulses paradox ? rub ? jvp raised with inspiration
? bp raised with inspiration etc >>CANT REMEMBER
21. which drug restore sinus ryhtym flecainide >>>I PUT IT WRONG DIGOXIN
25.patient on high dose of diuretics still having pedal edema cause ? cant recall the options
26.patient having light headedness what will be significant on 24 hr tape ve , atrail ectopics , profound
sleeping brady / svt / transirnt mobitz type1 >>>SVT
29. father has copd , son non smoker but reduced fev1 and looks obstrictive picture ? obliterans CANT
REMEMBER
30. non smoker malignancy shadow on cxr but bronc normal ? adeno ? small cell CANT REMEMBER
31. asthma not settling with steroids 800 and prn salbutamol ? add salmeterol >>SAME
35. right upper zone shadow weight loss h/o of tb , aspergillus positive ?
ca ? tb ? aspergilloma >>ASPERGILLOMA??
37.inr decrease after starting tb medicine ? rifam >>I PUT IT WRONG INH
38.patient spray paint worker worse at work but settled laterin week investigation ? serial peak flow
>>SAME
40. patient suffering from pulmonary thromboemolic disease what will happen to his lung ? reduced
tlco ? increased compliance et >>CANT REMEMBER
41 . 2b 3a inhibitor 2 patient with trop positive awaiting for angoi >>CANT REMEMBER
43. after MI sliding scale what rate of insulin ? rate 6-8 >>SAME
44 . obese lady failed sulphonylurea low gfr what next ? exenatide >>SAME
47 . heavy smoker past asbestos exposure asympotomatic what will show cxr ? pleural plaques
>>SAME
48 . life threating sign of asthma ? low Pco2 low peak flow less 35 % r/r30>>SAME
49. raised ALP back pain pagets >>MALIGNANT PROSTATE WITH BONE METS??
55. one small kidney what investigation MR angio / arterio >>>>NOOOO IT IS RENAL BIOBPSY AS
BOTH KIDNEY ARE SMALL IN SINZE NOT ON SMALL AND THE OTHER IS NORMAL AT
THIS TIME WE CAN SUSPECT RENAL ARTERRY STENOSIS
72. cellulitis showing MRSA what should be added along with vanco>>RIFAMP
82 . prolong bloody diarrhoea raised inflammatory marker what test ? stool microscopy ? rigid
sigmoidoscopy ? colonscopy ? axr >>ABDOMINA X RAY(DONNU Y?!
93. recurrent lip / throat swelling beekeeper on ace inhibitor for 6 months ? c1 inhibitor ? drug
induced ? herede angioedema >>C1 INHIBITOR??
94. HIV with unprotected anal intecourse now jaundice cd4 520 ? hep B ? cmv ? >>CNMV??
101. right pupil large not reacting to light but on convergence become smaller then left ? Argyl
robertson ? home Adie >>HOLME ADDIE
103. splenectmoy when to give pneumococcal vaccine 1 week or 1 month before no option of 2 week
>>I MONTH
104. aortic dissection what else may present HTN >>>JAW PAIN DISCUS PLZ
109. autonomic features with parkinson shydrager (mutisystem atrophy)>>SAME MULTI SYSTEM
ATROPHY
111. alzhemer short term memory loss CANT REMEMBER
118 . lady with ascites and liver mets raised all tumor markers pancreas / colon / ovary what will be
primary ( I dont know who cares ) >>OVARIAN TUMOUR
119 . secondary amenorhea after stopping ocp doing vigorous exersize ? cause ? premature ovarian
failure / ? hypothamic / ? 2to ocp >>PCO
120 . bony mets on morphine very drowsy need to cut down what to add naproxen >>SAME
121 . noisy scertion palliative patient intracerberal bleed ? transdeermal hyoscine >>DIDNT C
122. drug ( Alcohol ) induced porphyria , lady partying now abdo pain and agitated >> ECTASY??
124. wernicke / delerium tremens CANT REMEMBER
125. phenytoin levels not decreaing in renal failure patient why >>AFFECTED BY RENAL
IMPAIRMENT??
128 . lady recieving chemo i think asking for for tumor lysis syndrome>>SAME
129 patient recieving chemo in conatact with chicken pox give not vaccinated in the past ? IVIG ?
vaccine >>VACCINE ??F DISCUSSION
133. patient on bendrofluthiazide having low k whats the mechanism >>INCRESAED EXRETION IN
DISTAL TUBULES??
134. pain in the wrist and forearm while using hammer ? lat epicon ? ulnar neuropathy ? tennis elbow
>>TENNIS ELBOW??
136 . Insominia / weight loss / lost his family in terrorist attack still pending compensation ? Post
traumatic ? depressive >>DIDNT C
137. patient agitated / mettalic taste after stopping her pshychiatric medications CANT REMEMBER
138. swollen knee aspirated no organism given steroid relieved but reccur within a week wiith raised
infalmmatory marker what next ? iv antibiotic ? / reaspirate >>REASPIRATE
139 . spontaneous pneumothrax aspirated , symptoms improved repeat cxt showing 1.5 cm ? oberve ?
aspirate >>OBSERVE
141. after starting gout painful wrist knees and elbows ? allpourinal induced >>SAME
148. HUS and and anaemia what type of cells showing in microscopy howell / target / cast etc>> I
THINK AS I REMEBER FRAGMENTED SOMTING LIKE THAT
Guest
ok ..this is my list.
mostly the items mentioned above (omg how did u remember all that!)
i just included the ones for which the answers i double checked ..so pretty sure about the answers...
:cry: one forth of these i got wrong
btw ...anybody knows whats a safe percentage score to pass?
what would be a good score?
to the list
alfa 1 zz
holmes adie
nonsmoker ...adenoca
asthna on 800 not controled... add laba
aspergilloma
spray paint worker worse at work but settled laterin week.... ige isocyanates
pt collpase h/o of MI ecg showing st elevation without chest pain q waves and no reciprocal changes ?
vt
VT cause ? low Magnesium
which drug restore sinus ryhtym flecainide
light headedness what will be significant on 24 hr tape svt
most common infection via platelet transfusion staph
minutes post transfusion patient sob / cxt pulm edema jvp not raised ? acute lung injury
syringomyelia ... loss of pin prick in hands
chemo patient having agitation / suicidal thoughts ? steroids psychosis
patient anaemic low ferritin low mcv ogd and colonscopy normal ? meckle's diverticulum
patient on bendro still having high bp had side effects of fluid
retention / gum bleeding /lehtargy / with other HTN medication what next ? ACEI
clopigogrel action ....adp receptor
for example i had question about what is the propability of woman will have 3 children to be all female
1/4 1/8 1/128?????????
2- crops of flat topped papules appearing on buttocks and other parts of HIV pt. resolving spont. and
some leaving scars behind and then new crops appear.
was this moluscum?
....immo where did u sit ur exam? i sat mine in dubai. coz some Q's u mentioned i can't recall at all.
maybe these r the experimental questions.
-----one Q with acid base values..asking which one is analytical error... answer was option A... HCO3
&pco2 both show acidosis but H+ show alk. ...or the other way arround.
Guest
Which drug improves prognosis in pt. with the chest pain? aspirin, nitrates?
Guest, May 14, 2010 #41
mansouooor
mansouooor
Guest
???
thanks[/b]
mansouooor, May 14, 2010 #42
walkojalko
walkojalko
Guest
thanks immo.U r right.
walkojalko, May 14, 2010 #43
Guest
Guest
Guest
hi
hyperkeratotic erythematous lesion description-red scaly? chronic kidney disease with erythropoitin
improves renal function or improves exercise
30-homozygous for HEF gene posibility of her children to carry the gene>>>>> 100% (not: just carry
the gene)
31-wilsons>>>>>>decreas ceruloplasmi
36-GPIIa IIIb >>>>>>>>>>>>>> before angioplasty
38-Q transient global amnesia
39-dementia>>>>>>>>>>> loss of recent memory
40- chines reustrant??????????? bacilus crreus
41-Q giardiasis
42- improvr prognosis>>>>>> asprin
43- bloody diarrhea of 2 months>>>>>>colonoscopy?????
44-AS anemia>>>... colonoscopy
45- cath. with increased o2 sat pul viene and rt ventricle >>>>>>>> ASD???
46-primary hyperpara thyroidism Q
47-chronic thrombo emblism >>..??? decrease TLco?????
48- restrictive lung disease non smoker his father die OPLD >>>>alpha 1 anty trpsin??????
49-pneumonia curb>>>>>>>>>>uria =9
50thyroid swelling and neck LN >>>>>papillary carcinoma
52-diarrhea Q >>>>> rota virus
53-hodgkin lymphoma Q
54-Pulmonary HTNQ?>>>>>>>>>>>> i think increase systemic venous congeesion????/
55-drug elemination after 20 hours>>>>> 1oo%?????/
56- Q ecstasy
57- coccain>>>.>>>>>>hyperthermia
58-posibiliyt to have 3 children femal>>>>>> 1/8 ?????
59- NNT>>>>>>>>>>>>>> 20
60-metanol toxicty GCS 3>>>> HD
61- MEMBRAOUS nephropathy>>>>ramipril( i am nephrologist)
62- dermo Q >>>>> cetrisine antihistaminic
63-Q salmonella entritis???????
64-asthma recent guidlines sever persistant>>>mag sulphat>>???
which sugar contains Galactose & Glucose --answers were lactose,Maltose, Mannose correct is lactose.
one question regarding Salbutamol overdose. enteric coated tablets what to do -gastric lavage,activated
charcoal
1. Skin lesion and lt ankle sweling..prognosis??
2. Cause of death in a renal pt receiving HD for 5 yrs??
3. Causative organism for infected peritoneal dialysis patient??
4. Ant ST seg elevation MI following GI surgery..Rx option besides anti platelets??
drrajib
drrajib
Guest
1.APCKD pt brother refused for kidney donation?
drrajib, Jan 20, 2010 #8
MRCPaspirant
MRCPaspirant
Guest
* seizures, hypomelanotic patches, multiple renal cysts, periungua fibromas -TUBEROUS
SCLEROSIS
MRCPaspirant, Jan 20, 2010 #9
Guest
Guest
Guest
psychogenic aphonia or mustism in the woman whom here son disobey here
HCM ?? lft vent out flow more than 30 mmhg or septum thickness more than 3 cm
burgada or rt vent hypoplasia or HCM in young age collapse after football match
CLOPIDOGREL STOP TO AVOID BLEEDING AFTER 24H OR STOP AND USE LMWH
ANATOMY: SCIATICA AND LONG THORACIC NERVE AND ABDUCTOR POLLICES PREVIS
Guest
Guest
Guest
EGYPT?? SALMONELA OR SHIGELLA
BLUE VISION----SILDENFIL
AF ---HAEMODYNAMIC LOW----DC
CSF WITH HIGH LYMPOCYTE AND PROTEIN AND GLUCOSE 3.3 ---GUILLAN BARRE OR
POLIO
Guest, Jan 20, 2010 #12
saadi10
saadi10
Guest
mrcp jan 2010
2symptoms of unwell diarrohea post terminal illeum removal ? bile salt irritation
3 lower quadrant visual symptoms what next investigation
4 dilated pupil slowly reacting to light irregular ?adie pupil
5 raised cholestrol ,ldl,triglycerides tx atrorva /simvas
6 hypokalemia ecg shows U waves
8 smalll ca with siadh
9jaw stiffness with multiple injected sites with discharging sinus tx? metronidazole /vac
10 presenting with bleeding pr and abdominal pain post recent surgery ?mesenteric artery occlusion
Paper one was average, but 2 was a bit tough. Alhamdullilah I have done better than before. Following
are the remembered questions, please note that these are my answers and can be wrong, so please
discuss to make them right. Thanks
22. Typpical picture of Multiple Myeloma with unmeasured extra Immunoglobulins in blood + Bence
John's Protein
24. Anti-Ro ----Heart block
25. Cyclosporin--Nephrotoxicity
26. FEV1/FVC low -- Emphysema
27. ABGs given -- Mixed Metabolic acidosis and respiratory acidosis
28. Alopecia--Phenytoin
30. Inflamatory infiltrates in lamina propria+Granuloma --- Crohn's
31. Asymptomatic with low Hb but more markedly low MCV and Raised HbA2 --- Beta Thalasaemia
Trait
32. Mild haematuria, father and brother also had haematuria---Exercise related haematuria (I tried to
figure out if it can be hereditary but the option given was Alport's synd which is X-Linked dominant so
no male to male transfer)
33.Widespread ST elevation in anterior leads -- Constrictive Pericarditis
34.Another question with constrictive pericarditis picture and asked what else is found --- widespread
ST elevation
35. Rate control in AF in a heart failure patient already on Digoxin---Amiodarone (other options were
beta blocker but cant be used in heart failure)
36.Thyroid Nodule in a totally asymptomatic patient---Fine Needle Biopsy ??
37. Minimial Change disease
38. Henoch Schonlien Purpura
39. Lorry driver with chest x-ray having calcification--TB
40.Hypokalaemia, what else is found----U wave on ECG
41.Pleural effusion patient---Do bronchoscopy (It was the 1st question in paper 1 I think)
42. Pt with history of influenza, now pneumonic picture-- Organism responsible ---Staph Aureus ??
43.Cholesterol Embolisation with Levido Reticularis, what else is found -- Eosinophilia
44. Hypertension in Pregnancy -- Methyldopa
45. Pt with low BP, Hickman Line insterted presents with various electrolyte abnormalities, what else
can be expected -- Hypophosphataemia
46. Pt with low BP and AF -- DC cardioversion
saadi10
Guest
ammeen
2-Melanoma Depth
3-18 y f eczema and recent small pustule at face and UL topical steroid
4- single nucleotide polymorphism i chose predict protein
5-Huntington chance of sun to be carrier 50%???
7. Pt claiming to be dean of medical faculty, after his girl friend left him--Mania i thinnk its paranoid
schizophrania
9. Lady with hip pain but all movements normal--Osteoarthritis i think bursitis arthritis would have
limitation of active move
12. Lady with hypertension, hursutism and weight gain---PCOS or CAH ? -------PCO there was high
LH:FSH ratio
16. Respiratory depression in an overdose--Diazepam ?? ------i chose dihydrocodien PLS discus
36.Thyroid Nodule in a totally asymptomatic patient---Fine Needle Biopsy ?? i chose scan discus
41.Pleural effusion patient---Do bronchoscopy (It was the 1st question in paper 1 I think)
---------thoracoscopy pleural biopsy
51. Pt on haemodialysis for 5 years 3 times per week. Cause of death -- Dilated cardiomyopathy ???
-----------septicaemia
55.Drug in the marketr for 2 years and now a study claimed to have found a serious side effect, what
test will be used to check--- i wrote Case Control study (Because Rand Cont Trial cannot be used for
side effect measuremenst, but I can totally wrong, please discuss) - I agree
57. Pt seemed to have Seborrhoea or Dandruff (Not sure) -- But I marked Ketoconazol cream, other
options were totally irrelevent except Metronidazole cream.....so i was in doubt and marked
Keto.---------metronidazol pls discus
59. Lady after a fall, pain in neck with weakness but joint position sense and vibration sense and light
touch preserved--- Anterior spinal compression/Syndrone...??? ---------------SYRNX dissociated sens
loss
63.Lithium toxicity ---Concomittant use of ACE-Inhibitor ----------Ca channel ??//increas toxicity
86. Increased fe,inc esr and crp,erythema nodosum,hepatomegaly,deranged lftsarcoidosis/hemochromatosis
1. Heart block after inferior MI. ?RCA occlusion
2. Guillain-Barre ?monitor respiratory function ?FVC
3. 13y after valve replacement. anaemic ? haemolysis
6. Lady with excessive hair --> SE of: ciclosporin
7. Acoustic neuroma --? absent corneal reflex
8. Betablocker overdose with bradycardia not respond to atropine. Next managment --> glucagon
(repeat question Jan 2006)
9. Hypopigmentated areas round the eyes in pt with thyrotoxcitosis ? vititligo
11. Unwell young pt with lymphoadenopathy --> grandular fever (EBV)
12. JAK2 mutation --> Polycythaemia ruba vera
13. Idiopathic parkinson --> ?tremor
15. Pt with polyarthritis and anti-CCP --> ?RA
1 . Alcoholic , weight loss , chest signs and symptoms , CXR shows pleural effusion aspiration
attmepted but failed whats the NEXT investigation
its clearly mention next not best investigation
bronch
ct chest
us chest
thoraco
2. carbamazemine autoinduction
5.patient suffered peripheral neuropathy , had chemo whic medication to stop ? vincristine
11. Patient having unequal pupil and Ptosis ( Horner) which investigation to confirm ? cxr
13. Ankylosing spondylosis what will present in Lumbar xray ? sclerosis / osteophyste / sydem/ wedge
shape
15. 2/52 renal transplant dont remember the exact question but indicating cyclosporin toxicity
16 . patient on cyclosporin LFT become derange what investigation next to find the cause renal
ultrasound / urea creatinine / cyclosporin levels
21. 19 yr old patient having heavy protien urea but no heamturia most common cause membranous /
minimal /FG / Ig A
22. routine medcial check showing iron deficiency with basophilic stripling , patient asymptomatic lead
poisonng / sideroblastic dont remember other options
23. elderly feeling lethatgic investigation showing Iron defeciency but no altered bowel symptoms
which investigation first ( gaasto / colonoscopy )
24. patient having blood diarrhoea / recent antibiotics for chest infection history of MI / diabetes ( c
.diff / ischaemic colitis / diverticulits )
25. patient having blood diarrhoea not respond to 5 days of metro ? campylo
26. IV drug abuser sign and symtoms of tetanus which antibiotcs ? metro ? doxy
27 . Endocarditis blood culture alpha hemolytic which combination ? ben + rifa / benpen + genta
29 . 37 yr old patient with Upper and lower motor sign father had similar problem at 78 yr of age ?
amyotrophic lat sclerosis
34 . patient heavy smoker and asbestos exposure diagnose lung cancer which account more i think
smoking mainly
35 . testicular feminisation how will patient look like male with female genitals / male with inguinal
testis / femal with clitromegaly etc
37. thyroid mass with normal TFT which investigation next ? FNAC ? radioisotope scan
42 . VSD want to become pregant which will be make it difficult ? Pulmonary HTN / aortic regurg cant
remember all
46 . Patient investigated for palpitation all normal last yr think he had cancer ? Hypochondriasis
47 . Mother stressed with disobeyed child suddenly unable to speak ? akinetic mutism ? dpreseeion
48 . pastient with left hemiplegia and h/o of CABG 15 yrs , unable to find right brachial and radial
pulse . having head neck and back pain
? brachia site stenosis / dissection / GCA
49 . Nurse from southern india experiencing wight loss and diarrhea facal elastase less then normal ?
tropical sprue ? coeliac
50 . lady with linear erythema and exfoliative margins on the shoulder prv h/o of overdose ? factitious /
psoraisis
53 . MMSE 18
59 . patient blood gas showing type 2 resp failure diagnosis copd / Asthma
62 . patient ABPA admitted with exacerbation what to give first ? steroids ? itraconazole / neb saline /
neb steroids
64 . patient with Pericardial rub What will ECG shows ? small complex
72 . question about reactive arthirtis affectiong knees ankle and sole rash
81 . patient with renal failure and high total protien ? Multiple myeloma
82. Recent major surgery now 3 days later major MI after aspirin and clopidogrel what next ? primary
angio / thrmobolysis / LMWH / unfrac heaprin
83 . patient on clopidogrel and aspirin awaiting surgery ? stop clopi and start LMWH
85 . question about PBC
86 question of Autoimmune Hepatis
87 cystic fibosis what chance of sister being carrier or effected cant remember the exact qyuestion ? 1:4
? 2:3
89 . diabetic patient with B/L small kidneys and protienuria and mild renal derangement ?
Amylodosis ? diabetic nehropathy ? renavascular both kidneys
91 . CML treatment Imatinib
94 . another question with high MCV cause ? b12 def ? folate def
96. patient with glucose in urine fasting and 2 hr normal feeling tired and lethargic ? Renal glucosuria
100 . whome to isolate patient with MRSA septicaemia / pneumonia and MRSA in sputum / perotenal
TB 1 day treatment / pulm TB 16 day treatment
These are some , if some one has good memory fill the rest of the parts
Thanks
CT 1, Jan 20, 2010 #19
aladdin80
aladdin80
Guest
Man with Back ache, multiple joint pains (father vague joint pain history) RF negative,
Anti CCP positive Answer should be Psoriatic arthritis - Explanation is Anti-CCP positivity
was a frequent finding in PsA and associated with symmetrical polyarthritis
/wwwspringerlinkcom/content/m24q5784428h2m3n/
because the period of maximum cytopenia is over(day8) and the cytopenias can only improve from
now on.
MRCPaspirant, Jan 20, 2010 #27
Guest
Guest
Guest
Hello friends!
Johny
Guest, Jan 20, 2010 #28
Johny
Johny
Guest
1.
2.
3.
4.
5.
PREVIS
6.
intermittent painful defecation with fresh blood in young lad (?polyp ? haemorrhoids ?anal
fissure)
7.
BLUE VISION----SILDENFIL
8.
Mild haematuria, father and brother also had haematuria---Exercise related haematuria (I tried
to figure out if it can be hereditary but the option given was Alport's synd which is X-Linked dominant
so no male to male transfer)
9.
Another question with constrictive pericarditis picture and asked what else is found ---
widespread ST elevation
10.
11.
12.
Male with severe pain behind eye worse in the morning --? ?trigeminal neuralagia
13.
14.
15.
patient tx for meningitis but after 4 days again confused and restless ? investigation ?urea/elec
or MR scan brain
16.
renal transplant dont remember the exact question but indicating cyclosporin toxicity
17.
patient on cyclosporin LFT become derange what investigation next to find the cause renal
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
whome to isolate patient with MRSA septicaemia / pneumonia and MRSA in sputum /
29.
30.
31.
32.
which patient can be left in multibed area - Legionell, Varicella etc etc
33.
I definitely did not see these questions in the papers. Are you sure they were there? Could anyone who
gave the exam from India verify?
Johny, Jan 20, 2010 #29
MRCPaspirant
MRCPaspirant
Guest
* Mediator for Hereditary angioedema - Bradykinin
REF - Clinical Immunology,Volume 114, Issue 1, January 2005, Pages 3-9
Posted: Wed Jan 20, 2010 6:06 pm Post subject: More Indian questions
--------------------------------------------------------------------------------
1. Diarrhoea, jaundice etc. in post-bone marrow transplant patient. Investigation? CMV PCR
2. Which patient to isolate-sputum positive tuberculosis, sputum cultured tubuerculosis, CSF cultured
tuberculosis. Sputum positive tuberculosis.
3. Post-trnasplant patient with skin lesion, diarrhea etc. What is the diagnosis? GVHD
MRCPaspirant, Jan 20, 2010 #30
MRCPaspirant
MRCPaspirant
Guest
Hi johnny...
I gave the exam in INDIA....i have listed the questions not seen in the indian MRCP paper in a previous
post!!
The papers are uniform in one centre...but not sure if they are uniform over countries or not!!
MRCPaspirant, Jan 20, 2010 #31
saadi10
saadi10
Guest
mrcp
suspected active TB which needs isolation how to diagnose ? spitting acid fast bacilli in sputum
saadi10, Jan 20, 2010 #32
aldosteron99
aldosteron99
Guest
MRCPaspirant,
Man with Back ache, multiple joint pains (father vague joint pain history) RF negative, Anti CCP
positive
I am aware that in the diagnosis of RhA, anti-CCP is preferred now as it is more specific.
However, its unlikely for a young 'male' with "backache" and symmetrical arthritis,with ?positive
family history to have RhA, more over anti-CCP can be falsely positive in PsA
(ref: quoted earlier) /wwwspringerlinkcom/content/m24q5784428h2m3n/.
I feel the anti-CCP was mentioned to misguide us(at least when i gave the exam).
can anyone say dm type 1 diagnosis best by age or ketone bodies
Guest, Jan 20, 2010 #37
relaxed
relaxed
Guest
more
gilbenclamide
metformin
1v insulin
s/c insulin
2
5.30
10
95
97.5
prominent U wave
testicular feminisation??
1-mode of action of docetaxel
prevent microtuble (i did it wrong)
i wrote it DNA:(
3-q with long hx of dysphagia for 18 month for both liquid and solid
achlasia
9-q about hypoK and HTN and answer was:ranin aldesteron ration
10-q about nephrogenic DI asking about drug causing it and answer was:lithum
11-inv to D acromegaly
glucose with growth hormon measuring
13-q mention hyop glycemia and hypotension and hyponatremia,which is best to give
hydrocortison
19-pt with hyper prolactinemia and asking about what hormon will be supreeses:growth
hormon,thyroid,estrodiol,ADH???!!!
1 in 3
1 in 30
1 in 300
1in 3000
1 in 30000
25-pt with DEXA of hip 2.1 and ??2.6 dose she has
normal value
osteopenia of hip and osteoprosis of the femure
osteoprosis in femur and osteopenia of hip
both osteopenic
both osteoprosis
33-q about pt with copd with ABG and ph 7.30 eco222 ,co2 high and o2 low and option was:non
invasive ventillation,decrase inspired o2,iv theophyllin
39-mechansim of alloprinol
40-machansim of imatinib
47-renal stone with abd xry shows staghorn calculi and proteus infection
it should be struvite bt it was not in the option ???!!
option inculde cystine,urate,ca
49-q about migrane pt already tried simple analgsic and trpitan what is
next:ergometrine,BB(propranol,NA valoprate
50-cluster headache
55-q about abscent ankel jerkwith extensor planter:subacute combined degenration of the cord????
59-ecg of pericarditis
61-pt with MS what els will indicate other valvular lesion:V wave in JVP
69-erythema nodusm
74-orf
78-dengue fever/lepospriosis??!!!
82-???blephritis
84-NNT
85-pt with ethenol poisining and asking about the mechansim by which inhibation of alchol
dehydrogens is done by fomepizole
doxazin
nitrate
nicorandil
ACEinhibitor
Guest
for the q about ttt of grade 2 oesphagel varices
option:
terlipssen
banding
propanol
asya, Sep 22, 2010 #11
Guest
Guest
Guest
What was the question about Gastrin action?
For the gastric cerclage question I am not sure but since it will reduce gastric emptying> cck is
reduced> bladder contraction down> less bile secreted> Vit k can be the answer.
91-pt dusring exercise test after 8 min his heart rate decrease from 140 to 70,why?
a-sinus arest
92-a senario about an old man with impaied glucose tolerancce test and asking wht is the mechansim of
that
a-increase insulin absorbtion
b-increase insulin insistivity??
c- i think decrease glucogensis (im nt sure from this option)
94- ecg shows st elvation in V1 -V4 with some change in inferior leads:
a-total oculsion of LAD
b-total oculssion of RCA
c-70%oculsion of LAD
d-70% oculsion of RCA
e-oculsion of LAD and rca
asya, Sep 22, 2010 #14
asya
asya
Guest
95-pt recive blood transfusion and presented after 3 week with j and...
a-CMV
b-acute lung injusry
if any one can remmber the complete option and q plz share
asya, Sep 22, 2010 #15
Guest
Guest
Guest
Delayed transfusion reaction ?
Guest, Sep 22, 2010 #16
asya
asya
Guest
couldnt find this forum(guess im still hazy 4rom the exam) so thought people didnt start discussing yet,
had 2 start my own 2oday but thankgod i found it ..........
some recalls
-elderly lady wit ulcer on nose.been there 4 more than 4 yrs:squamous cell ca,basal,trophic ulcer, lupus
vulgaris
- young man wit pain in rt buttock, 6 month ago had same pain in left buttock? sacroilitis,gluteus
medius tendonitis, lumber canal stenosis
i will post 1st what i sure about answer after that i recall the other:
what waz the answer????? & did they say test or sign????
bec theres difference between trendelinberg sign & test
think its straight leg>>tests 4 back pain, although its 4 disc prolapse not ankyl.
help me out! totally confused!!!!!!!!!!!!
tatta, Sep 22, 2010 #22
Shez
Shez
Guest
it was a drug causing SIADH and the answer was carbemazepine i think.
Shez, Sep 22, 2010 #23
tatta
tatta
Guest
thanx shez 4 making me feel better bout that q!!! i wrote that too but alot of people thought it 2 be DI
wit lithium as answer
tatta, Sep 22, 2010 #24
mrcp-4
mrcp-4
Guest
one of the toughest exam after mrcp may 2007.this is my 4th times... i m very dissapointed.i m trying
to recalling the qs n will post as soon possible...pls try everyone ...
ABPA diagnosis
exam crammer, Sep 22, 2010 #26
exam crammer
exam crammer
Guest
sensory loss at T8?
ABG of COPD pt
i put precipitin test for the aspergillus one - dunno if thats right.
yes tata alot of my collegues put lithium and diabetes insipidus for that question but in my question the
sodium was 116 and clearly fitted siadh. so i think maybe it was one of the test questions - you know
they put a few in each paper.
oh and the woman with the pericardial effusion noted incidentally??? i put preceed to op but i dunno if
that right
i put subacute combined degeneration of the cord for an answer but i wasnt convinced cos the
haemoglobin was normal. MCV modestly high. couldnt really fir the signs with any of the other
options though
Shez, Sep 22, 2010 #30
exam crammer
exam crammer
Guest
post splenectomy blood changes
migraine --propanolol
a lady who had change , saying mean things to ppl with some gait impairment and memory loss
exam crammer, Sep 22, 2010 #34
exam crammer
exam crammer
Guest
PMH of TA pt coming in with fundal hge, had high BP
what did u guys put for the patient who had polymyalgia and had been taking steroids - then presented
with acute visual loss, pulsatile temporal arteries ???? i think i put the first answer central retinal artery
but could be wrong?
Shez, Sep 22, 2010 #36
exam crammer
exam crammer
Guest
i had gone for hypertensive changes , totally unsure
exam crammer, Sep 22, 2010 #37
exam crammer
exam crammer
Guest
35-Ankylosing Spondylitis------ global immobile vertabera
36- QT----- K channel
37-MS other vlave------- v wave
38-H.ployi--------- duodenal ulcer
39- diahrea + anaemia+ mouth ulcer----- celiac
41-macrophages containing periodic acid-Schiff------Whipples disease
42-pt. neck stifness csf gram +ve bacilli------ listeria
43-O2 to COPD pt--------- venti mask
44-staghorn stone--------magnesium ammonium phosphate
45-pt from india has vivx malaria----- chloroquine
46-diarrhea, TR, liver impaired------Carcinoid syndrome
47-Metformin in PCVS----- inc glucose peripheral intake
48-typical bic of cluster headache
49-pt. take steroid------ avscular necrosis
50-blood film after splenectomy----- hollly jolly
to be contentious.....
dr.angel05, Sep 22, 2010 #40
Guest
Guest
Guest
Please
Guest, Sep 22, 2010 #41
Guest
Guest
Guest
1. Cryoglobulin - SC Lymph node - bronchial carcinoma?
2. Q about adenovirus conjuctivitis??
3. Pt RR 20 perminute, Respiratory Acidosis, clear lung - CO poisoning.
4. Infective bronchiectasis, Red Cell Mass >> - Primary Proliferative Policythaemia??
5. Migraine not response with triptan , I think should be given intravenous valproate.
6. GAA, blurred vission, fundal haemorrhage - I still answer Anterior Ischaemic Optic Neuropathy??
Guest, Sep 22, 2010 #42
Shez
Shez
Guest
i made too many silly mistakes esp for the malaria one and the staghorn calculus one :(
Shez, Sep 22, 2010 #43
Shez
Shez
Guest
@ leslie. i ahve different answers from you - dunno wats right.
6)same as you
Shez, Sep 22, 2010 #44
exam crammer
exam crammer
Guest
Shez I did many silly mistakes too esp one i knew well but in the last minute i rubbed it off and ticked
the wrong one :cry:
pancytopenia-trimethoprim
metaanalysis bias-publication
sle
sle
Guest
prognostic in aml-karyotype
sle,
MRCP 1: Recalled Questions of May 2011
IgA----------Dermatitis herpitiform
anorexia nervosa---------fine hair in face
collecting duct----------ADH
marfan-------fibrilin
acne rosare------------ tetracycline
scar of rosea----- isotriton
klinfilter------karyotype
ACTH tumer----smal cell ca
50% stenosis-------Asprin
c: 9:15------pancreatic ca
osteoarthritis--------paracetamol
rhynoid case----------malabsorption
recurrent abortion------anticardiolpin
poly cyctic ovarian--------increase insuline resistanse
CMV------IV GANCLOVIR
CIPROFLAXACINE---------CONTRA INDICATED IN PREGNENT
NEPHROLOGY
17.APKD- USG screening for all 1st degree relatives
19.Thiazides- DCT
20.Ca Colon post OP- Membranous nephropathy
21.ARF with hypotension- ATN
22.Rhabdomyolysis with ARF
23.CRF with hyperkalaemia with uraemia- Haemodialysis
25.PVD with proteinuria with difff in lidney size- Ischaemic nephropathy
GENETICS
33.CF parents with carrier chance-0%
34.Hemophilia A- 25% chance
35.Hereditary Hgic telengectasia- AD
36.Marfans-fibrillin
37.only males affected- Xlinked recessive
38.chromatids into chromosomes- prophase,mine wrong- telophase
39.Klienfelters- chromosomal analysis
40.PCR-CSF viral meningitis
41.probe for DNA- in situ hybridization
DERMATOLOGY
42.Porphyria cutanea tarda
44.Scabies-Rx.topical insecticide,mine wrong- topical antibiotic
45.Scaly rash with hair involvement- DLE
46.Rx for Acne rosacea-tetracycline
47.Resistant rosacea- ?????
ENDOCRINOLOGY
52.Gprotein- menbranes
53.acromegaly- Inx- GTT with serial GH measurements
54.reduced FSH,LH,cortisol- Hypopitutuarism
55.Anorexia Nervosa-lanugo hair
56.Hypothyroid on RX- Increased TSH with NT4- First complaince then t3
57.Ramipril- for HTN with DM with proteinuria
58.Elderly female-Primary Hyperparathyroidism
59.low ca,low phos- Osteomalacia
60.Hypercalcaemia-cause- Thiazides
61.young onset DM- Insulin
62.Hypothyroid with wt loss with borderline BP- IV Hydrocortisone
64.HTN with >70u alcohol,Na-138,K-3.8,obese,Urinary cortisol-300- Alcohol induced i think
65.Sick Eu thyroid-normal free T4
66.Post partum thyroiditis
67.MEN1- Parathyroid with prolactinoma
68.ACTH-Small cell CA
69.osteolytic bone lesions with MM- Serum protein electrophoresis
70.PCOS-insulin resistance
GASTROENTEROLOGY
71.Elderly with reflux esophagitis with ?Barrets- Adeno Ca eosophagus
72.Chronic Pancreatitis- confirming Dx- ERCP/CT.
73.UC- Reducing long term relapse- Azathioprine
74.IBS- no relief after defecation /wake up in the middle of night
75.pseudomembranous colitis- cephalosporins
76.Diarrhea after cholecystectomy- Rx.Cholestramine
77.Diarrhea-HUS--- E.cole 0157
78.IV drug abuser with HCV Ab- Chronic HCV
PSYCHIATRY
RESPIRATORY
86.COPD on inhalers, mildly confused-- nebulization with brochodilators/NIV
87.COPD with high pco2- stop O2
88.Another COPD with pneumonia and PH 7.2 - Intermittent ppv/Intubate and treat
89.Profound vomiting- Metabolic alkalosis with hypokalaemia
90.occupational asthma- serial PEFR
91.EAA-Barley/Isocyanite....MINE WRONG
92.Ca lung, contraindication for surgery-- Brachial plexus invasion
93.Legionares pneumonia- Urinary Ag
94.Alpha 1 antitrypsin- Neutrophil elastase inhibitor
95.Low PH and low glucose pleural fluid- TB
96.Pulmonary infarction.. reduced TCO
97.Pneumothorax ,1.5cm.. discharge
IMMUNOLOGY
125.Live attenuated vaccine-yellow fever
126.Recurrent infections- CHEDAK HIGASHI syndrome- Neutrophil.
127.CLL-hypogamaglobulinemia
128.probe for DNA- in situ hybridization
130.High calorie-cheese
131FactorV mutation- activated protein C.MINE WRONG.
132.IV-IG
OPHTHALMOLOGY
134.RA-scleritis
135.macular degeneration-smoking, i put glaucoma
137.bone pigment for the tubular filed ??? -?? RP
138.asprin-rash,
139.fluocoacillin for that abscess question
140.Anxiety with ambulatory ECG free during the attack--> observe
141.VSD - v/q more at the apex in upright lung
142.vital capacity for GB
143.Short term memory- Korsakoffs Psychosis
144.Neuroleptic malignant syndrome-muscle rigidity
PHARMACOLOGY
145.NHL-antiCD20
146.confusion and tremor-lithium toxicity
147.Allopurinol-xanthine oxidase inhibitor
148.methhemoglobinemia-Ferrous to ferric
149.Prolactin-metaclopramide
150.teratogenic-Ciprofloxacin i think
151.Imatinib-tyrosie kinase inhibitor
INFECTIONS
153.E-coli..??First-Ciplox OR loperamide
152.Diarrhea in Nile cruise-shigella
153.MAC--???GLOVES /??? pulmonary isolation
154.P.Vivax-First Rx-choloroquine
155.Tic typus
156.diptheria
157.Pneumonia with SIADH
158.Recuurnet gononnhea-arthropathy
159.Rx.Gancyclovir
160.Osteomyelitis
HAEMATOLOGY
161.symptom of Myelofibrosis-fatigue
162.ALL prognostic factor--BCR ABL mutation/Hypertension
163- one more controversial Q-??pernicious anameia/cealiac disease/autoimmune hemolytic anemia
164.PV-jak 2 mutation
165.Patent foramen ovale
STATISTICS
166.I have put Chi square test
167.Sensitivity
168.Standard deviation
169.drug was removed from market, now for adverse effect chasing what to do systemic
review/metanalysis adverse effect mointoiring
170.10% /2%
182.Diarrhea-Mycophenolate mofetil
183.Systemic sclerosis-Malabsorption to develop
185.brainstem herniation
186.Ramipril only- LV dysfunction with no cardiac failure
187.Post mastectomy - ???reconstruction/?? Dumping syndrome. NOT SURE..
188.Pancreatic ca--CA-19-9
189.Tooth extraction in vwf DDAVP
190.PV- ABG.. this is one more new Q
191.osteoarthritis..Rx-paracetamol
192. pregnant woman with ITP-steroids
193.Eczematous skin lesions- gloves.
++May 2011 last update
Neurology
1.NPH
2.CJD
3.Na Valproate and OCP-Lamotrigine
4.Syrinx
5.L5S1 disc prolapse
6.Motor neuron disease-long standing DM with both UMN and LMN
7.Hemisection of the cord
10.ropinirole- dopamine agonist
11.U/L tremor and rigidity- Idiopathic PD or multiy system atrophy
12.Young pt with seizures,N glucose, lymphocytosis- HS Encephalitis
13.Rx for Migraine- Sumatriptans
14.Rx for Essential tremor - Propranolol
15.Hemibalismus-C/L STN
16.Ptosis,diplopia and weakness- Myasthenia
NEPHROLOGY
17.APKD- USG screening for all 1st degree relatives
19.Thiazides- DCT
20.Ca Colon post OP- Membranous nephropathy
21.ARF with hypotension- ATN
22.Rhabdomyolysis with ARF
23.CRF with hyperkalaemia with uraemia- Haemodialysis
25.PVD with proteinuria with difff in lidney size- Ischaemic nephropathy
26.Poat renal transplant with acute rejection- Methyl prednisolone
27.RA with 4+ proteinuria- amyloidosis
28.IGA - Mesangial hypercellularity
29.HTN with HYPOKALAEMIA with increased renin- Renal artery stenosis.
30.Hyperkalaemia- immediate Rx- IV Cakcium gluconate
31.Central pontine myelinosis- water out of the cell
GENETICS
33.CF parents with carrier chance-0%
34.Hemophilia A- 25% chance
35.Hereditary Hgic telengectasia- AD
36.Marfans-fibrillin
37.only males affected- Xlinked recessive
38.chromatids into chromosomes- prophase,mine wrong- telophase
39.Klienfelters- chromosomal analysis
40.PCR-CSF viral meningitis
41.probe for DNA- in situ hybridization
DERMATOLOGY
42.Porphyria cutanea tarda
44.Scabies-Rx.topical insecticide,mine wrong- topical antibiotic
45.Scaly rash with hair involvement- DLE
46.Rx for Acne rosacea-tetracycline
47.Resistant rosacea- ????? ---------isotreton
49.diplopia with cranila nerve- 6th cranial nerve palpsy -----correct is IOP
50.Dermatits Herpitiformis- IGA
ENDOCRINOLOGY
52.Gprotein- menbranes
53.acromegaly- Inx- GTT with serial GH measurements
54.reduced FSH,LH,cortisol- Hypopitutuarism
55.Anorexia Nervosa-lanugo hair
56.Hypothyroid on RX- Increased TSH with NT4- First complaince then t3
57.Ramipril- for HTN with DM with proteinuria
58..Elderly female-Primary Hyperparathyroidism correct answer -----TSHpituirary tumer
59.low ca,low phos- Osteomalacia
60.Hypercalcaemia-cause- Thiazides
61.young onset DM- Insulin
62.Hypothyroid with wt loss with borderline BP- IV Hydrocortisone
GASTROENTEROLOGY
71.Elderly with reflux esophagitis with ?Barrets- Adeno Ca eosophagus
72.Chronic Pancreatitis- confirming Dx- CT.
73.UC- Reducing long term relapse- Azathioprine
74.IBS- no relief after defecation /wake up in the middle of night
PSYCHIATRY
80.Hypochondriac
82.Paranoid Schizophrenia- auditory halucinations with mild trace of cannabis
83.Depression- anhedonia
84.Dysthymia..one stem
85.AMPHYTAMIN INDUCED PSYCHOSIS
RESPIRATORY
86.COPD on inhalers, mildly confused-- nebulization with brochodilators/NIV
87.COPD with high pco2- stop O2
88.Another COPD with pneumonia and PH 7.2 - Intermittent ppv/Intubate and treat
89.Profound vomiting- Metabolic alkalosis with hypokalaemia
90.occupational asthma- serial PEFR
91.EAA-Barley/Isocyanite
92.Ca lung, contraindication for surgery-- Brachial plexus invasion
93.Legionares pneumonia- Urinary Ag
95.Low PH and low glucose pleural fluid- TB
96.Pulmonary infarction.. reduced TCO
97.Pneumothorax ,1.5cm.. discharge
98.Reduced intensity of AS murmur- heart failure
99.Cardiac tamponade-pulsus paradoxus
100.75yrs man Paroxysmal AF- Rx-Flecainide/sotalol
101.Hemiparesis with AF-Warfarin/aspirin
102.50% Carotid stenosis with 3 TIAs in 2/52 Asprin/endarterectomy
103.Pt with edema,ascites,raised JVP- Constrictive pericarditis.
IMMUNOLOGY
125.Live attenuated vaccine-yellow fever
126.Recurrent infections- CHEDAK HIGASHI syndrome- Neutrophil.
127.CLL-hypogamaglobulinemia
128.probe for DNA- in situ hybridization
130.High calorie-cheese
131FactorV mutation- activated protein C.MINE WRONG.
132.IV-IG
OPHTHALMOLOGY
134.RA-scleritis
135.macular degeneration-smoking, i put glaucoma
137.bone pigment for the tubular filed ??? -?? RP
138.asprin-rash,
139.fluocoacillin for that abscess question
140.Anxiety with ambulatory ECG free during the attack--> observe
141.VSD - v/q more at the apex in upright lung
142.vital capacity for GB
143.Short term memory- Korsakoffs Psychosis
144.Neuroleptic malignant syndrome-muscle rigidity
PHARMACOLOGY
145.NHL-antiCD20
146.confusion and tremor-lithium toxicity
147.Allopurinol-xanthine oxidase inhibitor
148.methhemoglobinemia-Ferrous to ferric
149.Prolactin-metaclopramide
150.teratogenic-Ciprofloxacin i think
151.Imatinib-tyrosie kinase inhibitor
INFECTIONS
153.E-coli..??First-Ciplox OR loperamide
152.Diarrhea in Nile cruise-shigella
153.MAC--???GLOVES /??? pulmonary isolation
154.P.Vivax-First Rx-choloroquine
155.Tic typus
156.diptheria
157.WIGNER GLOMERULONEPHRITIS CASE
158.Recuurnet gononnhea-arthropathy
159.Rx.Gancyclovir
160.Osteomyelitis
HAEMATOLOGY
161.symptom of Myelofibrosis-fatigue
162.ALL prognostic factor--BCR ABL mutation/Hypertension
163- one more controversial Q-??pernicious anameia/cealiac disease/autoimmune hemolytic anemia
164.PV-jak 2 mutation
165.Patent foramen ovale
STATISTICS
166.I have put Chi square test
167.Sensitivity
168.Standard deviation
169.drug was removed from market, now for adverse effect chasing what to do systemic
review/metanalysis adverse effect mointoiring
170.10% /2%
In one gene mapping technique, denatured deoxyribonucleic acid (DNA) from metaphase
chromosomes is hybridised with a radioactively labelled probe. This DNA is then exposed to film to
reveal the approximate chromosomal location of the DNA in the probe.
B. In situ hybridisation
D. Southern blotting
Guys..
Results tomorrow...
Q. A 55 year old woman was referred to the dermatology clinic after developing a rash on her arms and
legs, predominantly on the knees and elbows. The rash had been present for about a month. She had a
history of congestive cardiac failure and she had been started on treatment with furosemide and
ramipril by her General Practitioner 6 months previously. She also had a long history of bipolar
disorder and had been started on lithium 3 months previously by her psychiatrist having been taking
chlorpromazine for 5 years. Six weeks previously she had been given a course of oxytetracycline for a
dental abscess. Which of her medications is most likely to have precipitated the rash?
A- Chlorpromazine
B- Furosemide
C- Lithium
D- Oxytetracycline
E- Ramipril
Ans C
Drug causing a cutaneous reaction which also fits in with the time of initiation in a temporal sequence.
anisa, Jun 23, 2011 #14
anisa
anisa
Guest
Renal Medicine
Q. A 63 year old man is referred by his GP to renal outpatient clinic. He was recently started on an
ACE inhibitor for poorly controlled hypertension, but on checking his urea and electrolytes one week
later the GP was alarmed to find marked deterioration in his renal function. An MR angiogram
demonstrated a patent right renal artery and stenosis of the left renal artery. On examination the BP is
149/90 mmHg, urinalysis negative and and a normal physical examination. Which of the following is
the most appropriate?
A- Arrange renal biopsy
B- Arrange renal ultrasound
C- Check urinary catecholamines
D- Refer fro renal artery angioplasty+/- stenting
E- Start aspirin, simvastatin and amlodipine
Ans E
In accordance with the ASTRAL trial, no proven benefit is seen with angioplasty so the mainstay of
treatment is medical therapy including an anti-platelet agent, a lipid lowering agent and tight blood
pressure control and avoidance of ACE-i.
anisa, Jun 23, 2011 #15
meenal
meenal
Guest
Endocrinology
A 30 year old male is referred with hypertension and sweats of approximately 6 months duration. He is
adopted and does not know his birth parents.He does not smoke but drinks 30 units of alcohol weekly.
His GP has prescribed bendroflumethiazide 2.5 mg/day and ramipril 7.5 mg/day. His blood pressure on
examination was 186/100 mmHg and he has a BMI of 25.2 kg/m. Further investigations showed:
Urine free metadrenaline 16umol/24 hr (NR<5)
Fasting plasma calcitonin 90 ng/L (NR 0-11.5)
MRI scan of the abdomen revealed a 3.5 cm mass in the right adrenal gland. Based upon this
information, what other diagnosis is likely to be associated with this condition?
A- Acoustic neuroma
B- Gastrinoma
C- Hyperparathyroidism
D- Insulinoma
E- Prolactinoma
Ans C
MEN type 2
meenal, Jun 24, 2011 #16
durgesh2011
durgesh2011
Guest
A 58 year old male smoker presents to casualty with a history of central chest pain with mild left arm
ache of 5 hours duration. He is cardiovascularly stable and his ECG shows 1 mm ST elevation in leads
1 and aVL. There is also an evidence of ST-segment depression with symmetrical T wave inversion in
leads III and aVF. What is the most likely diagnosis?
A- Acute pericarditis
B- Inferior myocardial infarction
C- Lateral myocardial infarction
D- Non-ST elevation acute coronary syndrome
E- Posterior myocardial infarction
Ans C
ST-elevation in leads 1 and aVL points to lateral MI.
Q. A 36 year old woman presents with exertional breathlessness. Echocardiography shows bicuspid
aortic valve with severe aortic stenosis. She says that she and her husband would like to start a family.
What is the most appropriate management strategy?
A- Refer for percutaneous aortic valve valvuloplasty
B- Refer for bio-synthetic aortic valve replacement
C- Refer for mechanical aortic valve replacement
D- Treat medically and plan aortic valve replacement after delivery of her baby
E- treat medically and advise that pregnancy is to be avoided
Ans C
Well i probably would have picked option b and then replacement to a mechanical valve later but the
justification is that warfarin can be given with switch to heparin duirng pregnancy and the high
mortality associated with a redo surgery later.
upen, Jun 26, 2011 #19
upen
upen
Guest
Q. A 77 year old lady with history of diabetes and chronic renal failure (stage three) is admitted on the
medical take with left left cellulitis secondary to diabetic ulcer. Her medications include aspirin 75 mg
once a day, simvastatin 40 mg at night, insulin glargine 10 units at night and PRN paracetamol.
Systemically she is well, but has a small ulcer on her heel and cellulitis extending to her knee. Routine
investigations reveal the following:
Hb- 11.3 g/dl
WCC- 15X109/l
Platelets-384X109/l
C-reactive protein 120 mg/l
Urea-14 mmol/l
Creatinine-280umol/l
The rest of her biochemistry, including liver function tests, is normal. Blood sugar measurements taken
on the ward are 7-11 mmol/l. She is due to be commenced on antibiotic therapy. Which of the
following antibiotics listed below can be safely prescribed at a normal dose?
A- Benzylpenicillin
B- Clarithromycin
C- Clindamycin
D- Co-amoxiclav
E- Vancomycin
Ans C
measured at 200/100 mmHg. An MRI scan of her aorta and renal arteries shows severe atheromatous
stenosis in both renal arteries. What is the best way of treating her elevated blood pressure?
A- ACE inhibitor
B- Alpha blocker
C- Beta blocker
D- Bliateral renal stenting
E- Methyldopa
Ans D
Ans D
IgA----------Dermatitis herpitiform
anorexia nervosa---------fine hair in face
marfan-------fibrilin
acne rosare------------ tetracycline
CMV------IV GANCLOVIR
CIPROFLAXACINE---------CONTRA INDICATED IN PREGNENT
1.
anisaGuest
May 2011
Neurology
1.NPH
2.CJD
3.Na Valproate and OCP-Lamotrigine
4.Syrinx
5.L5S1 disc prolapse
6.Motor neuron disease-long standing DM with both UMN and LMN
7.Hemisection of the cord
NEPHROLOGY
17.APKD- USG screening for all 1st degree relatives
19.Thiazides- DCT
20.Ca Colon post OP- Membranous nephropathy
21.ARF with hypotension- ATN
22.Rhabdomyolysis with ARF
23.CRF with hyperkalaemia with uraemia- Haemodialysis
25.PVD with proteinuria with difff in lidney size- Ischaemic nephropathy
26.Poat renal transplant with acute rejection- Methyl prednisolone
27.RA with 4+ proteinuria- amyloidosis
28.IGA - Mesangial hypercellularity
29.HTN with HYPOKALAEMIA with increased renin- Renal artery stenosis.
GENETICS
33.CF parents with carrier chance-0%
34.Hemophilia A- 25% chance
35.Hereditary Hgic telengectasia- AD
36.Marfans-fibrillin
37.only males affected- Xlinked recessive
38.chromatids into chromosomes- prophase,mine wrong- telophase
39.Klienfelters- chromosomal analysis
40.PCR-CSF viral meningitis
41.probe for DNA- in situ hybridization
DERMATOLOGY
42.Porphyria cutanea tarda
43.
44.Scabies-Rx.topical insecticide,mine wrong- topical antibiotic
45.Scaly rash with hair involvement- DLE
46.Rx for Acne rosacea-tetracycline
47.Resistant rosacea- ?????
ENDOCRINOLOGY
52.Gprotein- menbranes
53.acromegaly- Inx- GTT with serial GH measurements
54.reduced FSH,LH,cortisol- Hypopitutuarism
GASTROENTEROLOGY
71.Elderly with reflux esophagitis with ?Barrets- Adeno Ca eosophagus
72.Chronic Pancreatitis- confirming Dx- ERCP/CT.
73.UC- Reducing long term relapse- Azathioprine
74.IBS- no relief after defecation /wake up in the middle of night
75.pseudomembranous colitis- cephalosporins
76.Diarrhea after cholecystectomy- Rx.Cholestramine
77.Diarrhea-HUS--- E.cole 0157
78.IV drug abuser with HCV Ab- Chronic HCV
PSYCHIATRY
80.Hypochondriac
RESPIRATORY
86.COPD on inhalers, mildly confused-- nebulization with brochodilators/NIV
87.COPD with high pco2- stop O2
88.Another COPD with pneumonia and PH 7.2 - Intermittent ppv/Intubate and treat
89.Profound vomiting- Metabolic alkalosis with hypokalaemia
90.occupational asthma- serial PEFR
91.EAA-Barley/Isocyanite....MINE WRONG
92.Ca lung, contraindication for surgery-- Brachial plexus invasion
93.Legionares pneumonia- Urinary Ag
IMMUNOLOGY
125.Live attenuated vaccine-yellow fever
126.Recurrent infections- CHEDAK HIGASHI syndrome- Neutrophil.
127.CLL-hypogamaglobulinemia
128.probe for DNA- in situ hybridization
130.High calorie-cheese
131FactorV mutation- activated protein C.MINE WRONG.
132.IV-IG
OPHTHALMOLOGY
134.RA-scleritis
135.macular degeneration-smoking, i put glaucoma
137.bone pigment for the tubular filed ??? -?? RP
138.asprin-rash,
139.fluocoacillin for that abscess question
140.Anxiety with ambulatory ECG free during the attack--> observe
141.VSD - v/q more at the apex in upright lung
142.vital capacity for GB
143.Short term memory- Korsakoffs Psychosis
144.Neuroleptic malignant syndrome-muscle rigidity
PHARMACOLOGY
145.NHL-antiCD20
146.confusion and tremor-lithium toxicity
147.Allopurinol-xanthine oxidase inhibitor
148.methhemoglobinemia-Ferrous to ferric
149.Prolactin-metaclopramide
150.teratogenic-Ciprofloxacin i think
151.Imatinib-tyrosie kinase inhibitor
INFECTIONS
153.E-coli..??First-Ciplox OR loperamide
152.Diarrhea in Nile cruise-shigella
153.MAC--???GLOVES /??? pulmonary isolation
154.P.Vivax-First Rx-choloroquine
155.Tic typus
156.diptheria
HAEMATOLOGY
161.symptom of Myelofibrosis-fatigue
162.ALL prognostic factor--BCR ABL mutation/Hypertension
163- one more controversial Q-??pernicious anameia/cealiac disease/autoimmune hemolytic anemia
164.PV-jak 2 mutation
165.Patent foramen ovale
STATISTICS
166.I have put Chi square test
167.Sensitivity
168.Standard deviation
169.drug was removed from market, now for adverse effect chasing what to do systemic
review/metanalysis adverse effect mointoiring
170.10% /2%
185.brainstem herniation
186.Ramipril only- LV dysfunction with no cardiac failure
187.Post mastectomy - ???reconstruction/?? Dumping syndrome. NOT SURE..
188.Pancreatic ca--CA-19-9
189.Tooth extraction in vwf DDAVP
190.PV- ABG.. this is one more new Q
191.osteoarthritis..Rx-paracetamol
192. pregnant woman with ITP-steroids
193.Eczematous skin lesions- gloves.
anisa, May 30, 2011
#2
2.
anisaGuest
Macrocytic anaemia in a patient with a history of hypothyroidism points towards a diagnosis of
pernicious anaemia
Investigation
anti gastric parietal cell antibodies in 90% (but low specificity)
anti intrinsic factor antibodies in 50% (specific for pernicious anaemia)
macrocytic anaemia
low WCC and platelets
LDH may be raised due to ineffective erythropoiesis
also low serum B12, hypersegmented polymorphs on film, megaloblasts in marrow
Schilling test
Schilling test
radiolabelled B12 given on two occasions
first on its own
second with oral IF
urine B12 levels measured
Dr.A.Y, May 31, 2011
#7
3.
anisaGuest
++May 2011 last update
Neurology
1.NPH
2.CJD
3.Na Valproate and OCP-Lamotrigine
4.Syrinx
5.L5S1 disc prolapse
NEPHROLOGY
17.APKD- USG screening for all 1st degree relatives
19.Thiazides- DCT
20.Ca Colon post OP- Membranous nephropathy
21.ARF with hypotension- ATN
22.Rhabdomyolysis with ARF
23.CRF with hyperkalaemia with uraemia- Haemodialysis
25.PVD with proteinuria with difff in lidney size- Ischaemic nephropathy
26.Poat renal transplant with acute rejection- Methyl prednisolone
27.RA with 4+ proteinuria- amyloidosis
28.IGA - Mesangial hypercellularity
29.HTN with HYPOKALAEMIA with increased renin- Renal artery stenosis.
30.Hyperkalaemia- immediate Rx- IV Cakcium gluconate
31.Central pontine myelinosis- water out of the cell
GENETICS
33.CF parents with carrier chance-0%
34.Hemophilia A- 25% chance
35.Hereditary Hgic telengectasia- AD
36.Marfans-fibrillin
DERMATOLOGY
42.Porphyria cutanea tarda
49.diplopia with cranila nerve- 6th cranial nerve palpsy -----correct is IOP
50.Dermatits Herpitiformis- IGA
ENDOCRINOLOGY
52.Gprotein- menbranes
53.acromegaly- Inx- GTT with serial GH measurements
54.reduced FSH,LH,cortisol- Hypopitutuarism
55.Anorexia Nervosa-lanugo hair
56.Hypothyroid on RX- Increased TSH with NT4- First complaince then t3
57.Ramipril- for HTN with DM with proteinuria
58..Elderly female-Primary Hyperparathyroidism correct answer -----TSHpituirary tumer
59.low ca,low phos- Osteomalacia
60.Hypercalcaemia-cause- Thiazides
61.young onset DM- Insulin
62.Hypothyroid with wt loss with borderline BP- IV Hydrocortisone
GASTROENTEROLOGY
71.Elderly with reflux esophagitis with ?Barrets- Adeno Ca eosophagus
72.Chronic Pancreatitis- confirming Dx- CT.
73.UC- Reducing long term relapse- Azathioprine
74.IBS- no relief after defecation /wake up in the middle of night
75.pseudomembranous colitis- cephalosporins
76.Diarrhea after cholecystectomy- Rx.Cholestramine
77.Diarrhea-HUS--- E.cole 0157
78.IV drug abuser with HCV Ab- Chronic HCV
PSYCHIATRY
80.Hypochondriac
RESPIRATORY
86.COPD on inhalers, mildly confused-- nebulization with brochodilators/NIV
87.COPD with high pco2- stop O2
88.Another COPD with pneumonia and PH 7.2 - Intermittent ppv/Intubate and treat
89.Profound vomiting- Metabolic alkalosis with hypokalaemia
90.occupational asthma- serial PEFR
91.EAA-Barley/Isocyanite
92.Ca lung, contraindication for surgery-- Brachial plexus invasion
93.Legionares pneumonia- Urinary Ag
95.Low PH and low glucose pleural fluid- TB
96.Pulmonary infarction.. reduced TCO
97.Pneumothorax ,1.5cm.. discharge
98.Reduced intensity of AS murmur- heart failure
99.Cardiac tamponade-pulsus paradoxus
100.75yrs man Paroxysmal AF- Rx-Flecainide/sotalol
101.Hemiparesis with AF-Warfarin/aspirin
102.50% Carotid stenosis with 3 TIAs in 2/52 Asprin/endarterectomy
103.Pt with edema,ascites,raised JVP- Constrictive pericarditis.
104.Stridor, malignancy- Anaplastic Carcinoma
105.MI with CHB- RCA
106.Acute MI with ST changes- PCI
107.Acute MI with eosinophilia--- Cholesterol embolization syndrome
108.Drug Not removed by Haemodialysis ? - protein binding/swater soluble/ist pass metabolism/
IMMUNOLOGY
125.Live attenuated vaccine-yellow fever
126.Recurrent infections- CHEDAK HIGASHI syndrome- Neutrophil.
127.CLL-hypogamaglobulinemia
128.probe for DNA- in situ hybridization
130.High calorie-cheese
131FactorV mutation- activated protein C.MINE WRONG.
132.IV-IG
OPHTHALMOLOGY
134.RA-scleritis
135.macular degeneration-smoking, i put glaucoma
137.bone pigment for the tubular filed ??? -?? RP
138.asprin-rash,
139.fluocoacillin for that abscess question
140.Anxiety with ambulatory ECG free during the attack--> observe
141.VSD - v/q more at the apex in upright lung
142.vital capacity for GB
PHARMACOLOGY
145.NHL-antiCD20
146.confusion and tremor-lithium toxicity
147.Allopurinol-xanthine oxidase inhibitor
148.methhemoglobinemia-Ferrous to ferric
149.Prolactin-metaclopramide
150.teratogenic-Ciprofloxacin i think
151.Imatinib-tyrosie kinase inhibitor
INFECTIONS
153.E-coli..??First-Ciplox OR loperamide
152.Diarrhea in Nile cruise-shigella
153.MAC--???GLOVES /??? pulmonary isolation
154.P.Vivax-First Rx-choloroquine
155.Tic typus
156.diptheria
157.WIGNER GLOMERULONEPHRITIS CASE
158.Recuurnet gononnhea-arthropathy
159.Rx.Gancyclovir
160.Osteomyelitis
HAEMATOLOGY
161.symptom of Myelofibrosis-fatigue
162.ALL prognostic factor--BCR ABL mutation/Hypertension
163- one more controversial Q-??pernicious anameia/cealiac disease/autoimmune hemolytic anemia
164.PV-jak 2 mutation
165.Patent foramen ovale
STATISTICS
166.I have put Chi square test
167.Sensitivity
168.Standard deviation
169.drug was removed from market, now for adverse effect chasing what to do systemic
review/metanalysis adverse effect mointoiring
170.10% /2%
191.osteoarthritis..Rx-paracetamol
192. pregnant woman with TTP--------------PLASMA EXCHANGE
193.Eczematous skin lesions- gloves
194-radiological pnemonitis
195.IGA nephropathy- control of BP for progression
4.
anisaGuest
In one gene mapping technique, denatured deoxyribonucleic acid (DNA) from metaphase
chromosomes is hybridised with a radioactively labelled probe. This DNA is then exposed to film to
reveal the approximate chromosomal location of the DNA in the probe.
Which technique does this best describe?
(Please select 1 option)
B. In situ hybridisation
D. Southern blotting
5.
anisaGuest
Dermatology
Q. A 55 year old woman was referred to the dermatology clinic after developing a rash on her arms and
legs, predominantly on the knees and elbows. The rash had been present for about a month. She had a
history of congestive cardiac failure and she had been started on treatment with furosemide and
ramipril by her General Practitioner 6 months previously. She also had a long history of bipolar
disorder and had been started on lithium 3 months previously by her psychiatrist having been taking
chlorpromazine for 5 years. Six weeks previously she had been given a course of oxytetracycline for a
dental abscess. Which of her medications is most likely to have precipitated the rash?
A- Chlorpromazine
B- Furosemide
C- Lithium
D- Oxytetracycline
E- Ramipril
Ans C
Drug causing a cutaneous reaction which also fits in with the time of initiation in a temporal sequence.
anisa, Jun 23, 2011
#14
6.
anisaGuest
Renal Medicine
Q. A 63 year old man is referred by his GP to renal outpatient clinic. He was recently started on an
ACE inhibitor for poorly controlled hypertension, but on checking his urea and electrolytes one week
later the GP was alarmed to find marked deterioration in his renal function. An MR angiogram
demonstrated a patent right renal artery and stenosis of the left renal artery. On examination the BP is
149/90 mmHg, urinalysis negative and and a normal physical examination. Which of the following is
the most appropriate?
A- Arrange renal biopsy
B- Arrange renal ultrasound
C- Check urinary catecholamines
D- Refer fro renal artery angioplasty+/- stenting
E- Start aspirin, simvastatin and amlodipine
Ans E
In accordance with the ASTRAL trial, no proven benefit is seen with angioplasty so the mainstay of
treatment is medical therapy including an anti-platelet agent, a lipid lowering agent and tight blood
pressure control and avoidance of ACE-i.
anisa, Jun 23, 2011
#15
7.
meenalGuest
Endocrinology
A 30 year old male is referred with hypertension and sweats of approximately 6 months duration. He is
adopted and does not know his birth parents.He does not smoke but drinks 30 units of alcohol weekly.
His GP has prescribed bendroflumethiazide 2.5 mg/day and ramipril 7.5 mg/day. His blood pressure on
examination was 186/100 mmHg and he has a BMI of 25.2 kg/m. Further investigations showed:
Urine free metadrenaline 16umol/24 hr (NR<5)
Fasting plasma calcitonin 90 ng/L (NR 0-11.5)
MRI scan of the abdomen revealed a 3.5 cm mass in the right adrenal gland. Based upon this
information, what other diagnosis is likely to be associated with this condition?
A- Acoustic neuroma
B- Gastrinoma
C- Hyperparathyroidism
D- Insulinoma
E- Prolactinoma
Ans C
MEN type 2
meenal, Jun 24, 2011
#16
8.
durgesh2011Guest
A 58 year old male smoker presents to casualty with a history of central chest pain with mild left arm
ache of 5 hours duration. He is cardiovascularly stable and his ECG shows 1 mm ST elevation in leads
1 and aVL. There is also an evidence of ST-segment depression with symmetrical T wave inversion in
leads III and aVF. What is the most likely diagnosis?
A- Acute pericarditis
B- Inferior myocardial infarction
C- Lateral myocardial infarction
D- Non-ST elevation acute coronary syndrome
E- Posterior myocardial infarction
Ans C
ST-elevation in leads 1 and aVL points to lateral MI.
Q. A 36 year old woman presents with exertional breathlessness. Echocardiography shows bicuspid
aortic valve with severe aortic stenosis. She says that she and her husband would like to start a family.
What is the most appropriate management strategy?
A- Refer for percutaneous aortic valve valvuloplasty
B- Refer for bio-synthetic aortic valve replacement
C- Refer for mechanical aortic valve replacement
D- Treat medically and plan aortic valve replacement after delivery of her baby
E- treat medically and advise that pregnancy is to be avoided
Ans C
Well i probably would have picked option b and then replacement to a mechanical valve later but the
justification is that warfarin can be given with switch to heparin duirng pregnancy and the high
mortality associated with a redo surgery later.
upen, Jun 26, 2011
#19
9.
Q. A 77 year old lady with history of diabetes and chronic renal failure (stage three) is
admitted on the medical take with left left cellulitis secondary to diabetic ulcer. Her medications
include aspirin 75 mg once a day, simvastatin 40 mg at night, insulin glargine 10 units at night and
PRN paracetamol. Systemically she is well, but has a small ulcer on her heel and cellulitis extending
to her knee. Routine investigations reveal the following:
Hb- 11.3 g/dl
WCC- 15X109/l
Platelets-384X109/l
C-reactive protein 120 mg/l
Urea-14 mmol/l
Creatinine-280umol/l
The rest of her biochemistry, including liver function tests, is normal. Blood sugar measurements
taken on the ward are 7-11 mmol/l. She is due to be commenced on antibiotic therapy. Which of the
following antibiotics listed below can be safely prescribed at a normal dose?
A- Benzylpenicillin
B- Clarithromycin
C- Clindamycin
D- Co-amoxiclav
E- Vancomycin
Ans C
Q. A 51 year old lady with a positive family history of stroke and hypertension is referred to the
outpatient clinic for the assessment of poorly controlled hypertension. Her blood pressure in clinic is
measured at 200/100 mmHg. An MRI scan of her aorta and renal arteries shows severe atheromatous
stenosis in both renal arteries. What is the best way of treating her elevated blood pressure?
A- ACE inhibitor
B- Alpha blocker
C- Beta blocker
D- Bliateral renal stenting
E- Methyldopa
Ans D
10.
mahakGuest
A 73 year old gentleman with a history of previous myocardial infarction and longstanding
hypertension presents to his general practitioner with a 2 month history of worsening exertional
breathlessness. Clinical examination reveals a resting sinus tachycardia and mild ankle oedema. Which
of the following medications is most likely to improve his symptoms and prognosis?
A- Amlodipine
B- Digoxin
C- Furosemide
D- Lisinopril
E- Metolazone
Ans D
Thread Status:
1.
smaGuest
Finally, I'm a free person again, at least for some time...both the papers were tough especially paper 2,
lots of intermingling choices...will post them later after a good nights sleep. For the first question about
which drug inhibits purine synthesis...I put methotrexate, is that correct? then there was one with the
girl with Turners who had HTNa nd equal BP in both arms so I selected renal artery aplasia, what else
can I remember now... 2 about cluster headache....
GuestGuest
2.
GuestGuest
I am not quite sure what my performance was.. but I guess I'll wait for next month... Don't rely on for
the answers:
3. Cisplatin action
20. Overdose of Diazepam and Disulopin: ECG??? there was tachycardia of 140
22. Sensitivity
24. NNT what does it mean!
25. phase I.. what happens in it?
28. MI then thrombolysed then got red dusky coloration of feet anf eosinophilia.. I just though it could
be cholestrol embolism
32. patient with some history of back pain: non-specific back pain
36. optic neuritis or giant cell arteritis??? swollen pale disc + monoocular visual loss!
38. cortical thrombophlebitis?!?!? it was complicated question but the CT was very suggestive
46. There was partial third palsy and six nerve and the ophthalmo section of the fifth.. orbit apex???
48. question about P(A-a) O2..
51. two questions about autoimmune haemolytic anaemia: one of them was about dirst antiglobulin test
53. E coli HUS.. question
57. patient with past hx of alcohol presents with topheous gout.. he got Alluporinol two days later he
got pain in wrist, hands and knees.. one of the option was alcohol binge.. I liked it!
59. there was two question I choose colonscopy for.. I can remember them at all
3.
GuestGuest
tarekdeema
438 Credits
[ Donate ]
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Posted: Wed May 17, 2006 6:12 pm Post subject: A funny question from may 2006
--------------------------------------------------------------------------------
there was a question about a group of elderly who travelled togethere to some place and some of them
developed pneumonia ,they where moving around all the time togethere but they where allocated to
different hotel ,the people who developed pneumonia where staying in the same hotel what is the most
likely causative organism:
1-steptococcus
2-staph
3-legionella
4-influenza
5-mycoplasma
a nice one::::::
Back to top
Guest, May 17, 2006
#4
4.
GuestGuest
hanoo
hanoo
Guest
Posted: Wed May 17, 2006 5:05 pm Post subject: MRCP 1 16 MAY
--------------------------------------------------------------------------------
Hi everyone,
exam was very tough esp. second part.
thyroid,diabetes,rhumatology and skin i think that topics were too much in exam.
3. treatment of gonnorhea
4. yratment of cholera.
Guest, May 17, 2006
#5
5.
GuestGuest
hi everyone the exam was tough but hoping against hope to pass.
some questions i remembered.
5.cluster headcahe
6.villous adenoma--colonoscopy
7.T3 toxicosis
9.a case of PE
12.sideroblastic anaemia
19.OSteomalacia and low calcium and low phosphate but high ALP.
23.CHronic pancreatitis in pregnant lady with loose stool and malabsorptive picture
MORE TO COME
THANKS
OREOLUWA
Guest, May 17, 2006
#6
6.
GuestGuest
Author Message
afsheensalman
AIPPG Fresher
156 Credits
[ Donate ]
Posted: Thu May 18, 2006 1:07 pm Post subject: may 2006 part1
--------------------------------------------------------------------------------
erectile dysfunction was another recurrent topic ... sildenafil contra indications- nifedipine or nicordil?
differential dagnosis for ED- perfomance anxiety or an organic cause (clue=normal early morning
erections)
Back to top
Guest, May 18, 2006
#7
7.
GuestGuest
8.
kengladGuest
answer
9.
rahba septGuest
hello am first time for part 1 when i see the questions i thought it easy but then i was surprised all of it
is basic pharmacology and anatomy and investigation and antibiotic treatment and diabet thyroid
frequent questions i,ll post first remembering ones:
13-methadon ..
thank u
rahba sept, May 18, 2006
#10
10.
kengladGuest
some answers
i opted for giant cell arteritis as the patient very old and giant cell common is old age
intermittent loss of concious=ness with quick recovery and no residual neurological defect - definitely
vasovagal so answer is postural hypotension - its in harrison's
11.
GuestGuest
SMK Al rifae'ei
SMK Al rifae'ei
Guest
--------------------------------------------------------------------------------
dog bite...antibiotic
complement ,,,SLE
WHICH TENDON
PREDICTIVE VALUE
MEDIAN STUDY
PSEUDOMEMBRANEOUS COLITIS ANTIBIOTIC
ASSESS OPERATION RISK-MI
?MYOTONIA DYSTROPHICA
ESOPHAGEAL ULCER ALEDRONATE
MARFAN FIBRILLIN
TURNERS-- BP
PREGNANT WITH SVT
IG HYPERACUTE REACTION
ciclosporine mechnism
acyclovir mechanism
rhabdomylysis mange
repeat ?urine for protein
cluster headache?/?
?reactive arthritis
?prevent calcium stones
Guest, May 18, 2006
#12
12.
GuestGuest
13.
GuestGuest
A 17 year old boy with hypertrohpic cardiomyopathy tratment with best prognosis.
1-betablocker.
2-Alcholc aplation of septum.
3-implantable defibrilator automatic.
4-Another antiarthysmic.
implantable defibrilator is correct.
Guest, May 18, 2006
#14
14.
SMK Al rifae'eiGuest
igm-hyperviscosity
behget dvt
WHAT WAS THE OLD LADY WITH WRIST SWELLINGSMK Al rifae'ei, May 18, 2006
#15
15.
ACGuest
mrcp 1 may 16
a patient with tinnitus, 0.9 cm swelling in pituitary, with no hormones elevated- how do you proceed....
observation??
AC, May 18, 2006
#16
16.
ACGuest
mrcp 1 may 16
17.
rahba septGuest
another choisis for best indicator for tonsilitis abscess is continious fever
1-foramen ovale
3- scabis...
4-e coli
5-cholangio carcinoma ..
6-ulcerative cholitis...
7-mody ..
9-paroxetin...hypertension..
13-noctornal dysphasia
14-tachicardia ..diarrhia....anticholinergic...tox..
16-c4..c5..c6..c7....{c4}
17-vertebral prolapse....
18-3..6...trigemeni........pons
21-hematuria thrombocytopenia..anemia...imunoglobulin..iga..
22-hemophelia..
23- 1/2......1/4....1/6...1/8
25-hematuria....hypervescosity..syndrome
27-eozinophilia....nephrology....
thanks
rahba sept, May 19, 2006
#18
18.
rahba septGuest
19.
kennyGuest
answers2
its nothing for microadenoma.the effect is nil if size does not increase
so do nothing
this is for emran what in the whole wide world is spastic angina?
are u sure you took the mrcp part 1 may paper dude?
oh yeah wot about the chap with the allergy to seafood and his bp was 170/100
tachy at 110
spo2 98 on air
options were
iv adrenaline
sc adrenalin
im adrenaline
close observation
kenny, May 19, 2006
#20
20.
kengladGuest
educate me
1)chap presented with painful shin then malar rash with abdo pain and polyuria.which investiagtion
would clinch the diagnosis
me think it was chest x ray cuz u can see bilateral hilar lymohadenopathy of sarcoidosis no?
5)lady with severe hip oa goin for surgery with stable angina
how should u assess her?
probably thallium scan cuz she can't possibly go for a walk on the treadmill
wot with her painful hip and all that
6)chap with an MI who undergoes exercise treadmill and then has paroxysms of short lived vt
probably electrophysiological testing and ablation
9)thrid nerve palsy with pupillary sparing and 5th opthalmic branch involvement and 6th nerve
involvement
probably orbital apex no?
10)chap post renal transplant on cyclosporin and prednisolone and comes to u for an infection
twcc 3+ ie low
wots wrong
11)cant ankle dorsiflex,cant use extensor hallucis longus,medial aspect loss of sensation in the lower
limbs.wots wrong with this fella?
12)pregnant again question with background alcohol abuse with small babies,diarrhoea,low folate etc
wots wrong
-alcohol excess?
-chronic pancreatitis
-coeliac?
13)20 year old girl with dm on sc insulin keeps getting hypos and hba1c of 5.4.
is she anorexic?
14)crazy man hitting wife and claim nobody ain't gonna touch me cuz me got friends high up in the
police department
hypomonia?
paranoid schizophrenic
21.
kengladGuest
16)u are the SHO on call and u have limited isolation beds
which of these following organism spreads easiest
a)legionella
b)mycoplasma
c)varicella
d)staph
e)strep pneumonia
17)someone told me that its pearsons correlation for comparing the median between placebo and statin
tell me it aint true!
18)remember the one about the HIV chap with odynophagia etc
must be cmv oesophagitis huh?
can it possibly be candida?
kenglad, May 19, 2006
#22
22.
GuestGuest
sorry i wanted tosay spasm but some of your questions i did not saw in the exam.
Guest, May 19, 2006
#23
23.
kengladGuest
oh i see
spasm issit
hmm nope that's a diff question
i reckon some questions must be diff depending on ur centre of examination
kenglad, May 19, 2006
#24
24.
GuestGuest
PSYCHIATRY
1-a lady brought to casualty after the death of her maother sit on chair not resposive :CONVERSION
DISORDER this is typical in which there is a stressfull condition(death of mother) dissociated into
physical symptoms for the primary gain(alliavation of symptoms an escape phenonmena)
2-a man brought to casulty several time with abdominal pain recently brought with swaeting shivering
and said if u dont give me morphine i will commite suicide :MUCHUENSUS SYNDROME
(intentional production of symptoms for a primary gain which is MORPHINE its not somatisation
disorder ..
3-there was a question about post traumatic disorder i cant remember exactly
4Guest, May 19, 2006
#25
25.
a patient with nocturnal cough, BMI- 22, probable diagnosis - asthma, GERD, obstructive sleep apnoea
26.
kulbitGuest
Hi,
i hope all of you have done well. it definitely wasnt a cakewalk. it fact it was a well- set and well
balanced paper. i think my performance was average. i am desperate to check out the answers. i
managed to recollect a few questions. i shall list them below with the few options i remember and the
answers that i think are correct.
1. The absence of which complement factor predisposes to the development of drug induced lupus.
Ans: C4.
2. A young athlete with a family H/o SCD. i episode of ill-sustained VT of 20 beats on exercise testing.
Next line of management.
a. Holter monitoring
b. Amiodarone
c. automatic implantable defibrillator
d. septal ablation
Ans: automatic inplantable defibrillator.
4. Patient with type 1 DM on insulin presents with 3 episodes of hypoglycemia. There is H/o weight
loss from 55-45 kg in 3 months. No significant clinical findings. Possibility
a. Anorexia nervosa
b. Hyperthyroidism
c. Cushings syndrome.
Ans: Anorexia nervosa.
5. H/o travel to africa 6 months ago, now presents with fever and chills.
a. Brucellosis
b. Falciparum malaria
c. Ovale malaria
Ans: Brucellosis
6. a patient with nocturnal cough and BMI of 22. most likely cause of his cough is
a. Asthma.
b. GERD.
c. OSA.
Ans: GERD.
8. Treatment of Cholera:
Ans: doxycycline.
10. Cardiotoxicity of Doxorubicin
Ans: Dilated cardiomyopathy.
11. Needle stick injury from a HIV positive patient.
Ans: commence post exposure prophylaxis with 3 drugs immediately.
12. If you are the SHO on call and u have limited isolation beds which of these following organism
spreads easiest
a)legionella
b)mycoplasma
c)varicella
d)staph
e)strep pneumonia
Ans: VZV.
14. A patient presented with painful shin lesions with abdominal pain and polyuria. Which
investigation would clinch the diagnosis
Ans: Chest X-ray to diagnose sarcoidosis
15. Lady with severe hip OA going for surgery with stable angina.How should u assess her?
Ans: Thallium scan.
18. A lady with 3 year H/o joint pains and malaise. Anti smooth muscle antibody is positive. Next line
of investigation is
a. LFT
b. Thyroid function test.
Ans: no idea
19. H/o sudden onset of pain in the right eye while hitting nail into the wall. Pain is severe and
continuous with occasional exacerbations. Right pupil is small and there is mild ptosis.
a. carotid artery dissection.
b. facial migraine.
c. cluster headache.
d. trigeminal neuralgia.
Ans: carotid artery dissedction.
20. Right 3 rd nerve palsy with papillary sparing with right 6th nerve palsy and loss of pinprick
sensation over the forehead. There is no proptosis. The possible site of lesion is:
a. orbital apex
b. cavernous sinus.
c. interpeduncular fossa.
d. midbrain
e. pons.
22. H/o difficulty in closing mouth after chewing for long periods, ptosis and distal muscle weakness.
a. MG
b. LEMS
c. Muscular dystrophy.
Ans: MG as there is easy fatigability but what about distal muscle weakness.
24. Patient with Pulmonary hypertension and upper GI bleed. The preventive therapy would be.
Ans: propranolol.
25. Patient presents with h/o fatigue, lassitude. Investigations reveal thyroid hormones in the lower
limit of normal, hyperkalemia and hyponatremia. Next line of investigation is
a. Short synacthen test
b. TSH
c. FT4
Ans: Short synacthen test as it is likely to be Addisons disease.
27. Throid profile showing increased T3, Low TSH and T4 in the lower limit of normal. The likely
possibility is
a. T3 toxicosis
b. familial dysalbuminemic hypothyroidism
c. tertiary hypothyroidism.
d. sick euthyroid syndrome
Ans: T3 toxicosis
28. a lady presents with 1 year h/o pain in the right hand progressing to involve the entire right upper
limb, scapular and pectoral regions. There is decreased pinprick in the hand and absent tendon reflexes,
but there is no significant wasting. The possibility is
a. brachial plexus infiltration
b. cervical sponduylosis
c. syringomyelia
Ans: Brachial plexus infiltration.
29. H/o vertigo on turning head like while crossing road, also present while turning around in bed.
a. BPPV
b. Carotid sinus hypersensitivity
c. chronic vestibulitis
Ans: BPPV
30. H/o sudden falls without loss of consciousness in an elderly lady. She recovers within 1 minute and
is able to continue.
a. cataplexy
b. myoclonic epilepsy
c. drop attacks
d. carotid sinus hypersensitivity
Ans: drop attacks.
31. A person attacks his friend and shows no remorse. Friend says that of late he is very abusive. Wife
says that he hasnt slept for 2 days. On examination he is aggressive. He says he cannot be punished as
he has contacts with high level police officials.
a. paranoid schizophrenia
b. manic episode
Ans: manic episode
32. A lady is silent and withdrawn since finding her dead mother in her room. She does not eat, or
move from her chair.
a. catatonic schizophrenia
b. major depression
c. conversion disorder.
Ans: major depression/ conversion disorder.
33. A patient has frequent nightmares and intrusive thoughts after witnessing the death of 2 colleagues.
Wife reports frequent episodes of crying.
Ans: post-traumatic stress disorder.
34. Patient presents with h/s/o psychosis. She was started on phenothiazines. She comes 6 months later
with h/o joint pains, raynauds phenomenon and dry mouth.
a. drug induced lupus
b. MCTD
Ans: Drug induced lupus.
35. A boy with hemophilia. Which of his relatives is likely to have the disease.
Ans: mothers brother
36. A lady has a brother with hemophilia. Assuming that her husband is normal what is the chance that
her daughter will be a carrier.
Ans: 1 in 2.
37. Patient with repeated episodes of clostridium difficele diarrhea has come with findings s/o UTI.
Treatment
Ans: Vancomycin.
40. A man was brought to the casualty with abdominal pain, sweating shivering and said if u dont give
me morphine I will commit suicide
Ans: Munchausens syndrome
41. A person develops allergy to sea food containing prawns I hour after consuming it and presents 3
hours later with hypertension and tachycardia. Next line of action
Ans: close observation.
42. A patient has been detected to have a pituitary tumor of 9 mm without any other abnormalities. A
repeat CT few months later does not shoe any increase in size. Next line of action
Ans: nothing to be done.
43. a patient with ulcerative colitis has a single hypoechoiec lesion in his liver. What is the possibility
a. focal nodular hyperplasia
b. cholangiocarcinoma
c. hemangioma
d. adenoma
Ans: cholangiocarcinoma/ adenoma.
44. A patient with ulcerative colitis continues to have rectal bleeding though he is on prednisolone.
Next line of management
a. iv hydrocortisone
b. oral azathioprine
c. iv cyclosporine
Q32- THE ANSWER IS CONVERSION DISORDER as there was a stressfull precipitating cause
(death of mother) and dissociated into physical symptoms which are being silent and unresposive as an
escape phenomena (primary gain) belle indifferent to that thoughts ,,,its definately unlikely to be a
major depretion as in major depression there is no obvius cause it could have been right if it was
reactive plus from the q there was no SOMATIC feature (wt loss,diurnal variation,constipation....etc
q-THE DOG BITE you have a dog bite plus cellulitis so u should cover staph,strept and pasturela so u
give benzyl penicillin+flucloxacillin
Guest, May 22, 2006
#31
27.
kengladGuest
the answer is
otherwise i agree with u regarding the human genome project,manic episode,primary ovarian failure
however there was an answer for NNT it was the reciprocal of absolute risk reduction and that was
choice E
me thot it unlike for it to be cavernous sinus thrombosis precisely because there were no cheimosis etc
as i thot these are characteristic features of cavernous sinus thrombosis.
2-in acute renal rejection what is the anti HLA antibodies- IgG, M, E,D,A
3- 4 WEEKS POST RENAL TRANSPLANT REJECTION WHAT IS THE MECAHNISM- DUE TO
CYTOTOXIC t-cELLS
4- first action of aciclovir--- Inhibition of thyamidine kinase
5- Treat Of dog bite celliulities+lymphoedema- Fluxo+penicllin
6- ypug pt complaining of abdominal pain and threatens to commit suicide if not given Morphin--Munchehasen syndrome
7- Calculate Pos. Predective value from Agiven table-- 40/50=80%
8- Def. of NNT to treat the difference between Absoulut and realtive risks.
9- def. of sensetivity
10- calcuation the oral dose of 60 mg Morpgin--180mg
11-case of mania- beating his G/friend and saying he has police connections.
12-case of post traumatic stress syndrome- the guy envolved in accident witnesse his friends death.
13-Preg. lady Hx of alcoholism presented with diarroea in third trimester Foetal USS -IUGR--- chronic
pancreatitis
14- Preg. with SVT how to treat-- Verapamil, amiodarone, flecanide, misoprolol
15- which drugs needs dose adjustment in Renal failure-- Temazepam, metformin
26- post mi pt recieved thrombolysis, presented with dusky feet--- Chlosterol embolism
27-elderly with frequent fall what inX to R/O reversable cause- brain CT sacn.
28- How to Dx idiopathic parkinsonism--- asymmetrical Bradykinesia
30-case of joint pain, dactilitis--- Psoriatic arthropathy
31- eczematous pt presented with pustular lesions overe face and trunck how would u mamange?
32-pt had painful nodule on the shin, followed by facial rash, apolyurea, which Invx-- CXR
33- SOME NEW LAW OF CALCULATING ALL LIPID PROFILE.
34- COMPARING POPULATION PERCENTAGE- Chi-squard
35- comparing the cholst. level between male and female-- pearson test
36- calculating the NNT , pts on warfarin risk of stroke 2% on Asprin 4% what is the NNT over five
years, 10,20, 30, 40, 100
37- How to Dx menigeaococcemiea-- Blood PCR, CSF microscopy, throat swab,
38- Rx of cholera- Doxycyllin
39-Pt with COPD and LRTI which common organisim- Staph aurus, L. pnemophilla, Mycoplasma..
40- Pt with cytic fibrosis and LRTI which Tx41- pt with low FEV/FVC low TLCO and High KLCO-- respiratory muscle weaksess
43-pt with longstading RA nd 9 years Hx of DM presented with protinurea, kideny USS shows 1.2
70-Pt with sudden severe back pain, Aortic aneuresim confirmed what do next?---- start Labetolol
71-pt with features of Turner syndrome what will casue high BP?--------Coarctation of aorta
72-Pt with features of marfan, which gene defect?---fibrillin
73-Q about human genome project? only few genes code for protien
75-Pt with diplopia, third and fifth (opthalmic) nerve palsy where is th lesion? cavernous sinus
thrombosis.
76-pt with headache which wakes up with pain hs wife noticed that during these attacks his eye
becomes red, 6 weeks ago he had minor head truama with whiplash injury, what is the diagnosis--- I
wrote cluster haedache but I think the right answer is cavero-orbital fistula
77- which medication inhibits purin synthesis?-- Azathioprin
78-features of polycythemia, itch, what to expect?--Hyperurecemia
79- Long QT what ppt. it?---- Hypocalcemia
80-pt with high IgM levels, what would be expected?-- Hperviscosity
81-Pt with featurs of Behcets disease prestens with left leg swelling and pain what is the Dx?---Venous thrombosis
82-Bursa on lateral epicondyle which movement will excerabate the pain?---pronation
82- Pt with mesothelioma and asbestosis exposure which statement is right?--- smoking increase the
risk of mesothelioma
83-Pt with urinary retention, loss of senation of medial aspect of thigh--- Lubosacral lesion
84- pt with common peroneal lesion
85- Pt with impotance, dismessed from work Dx?-- Performance anxiety
86-Medication enhancing Lithium Toxicity?---Thiazaide diuretics
87- Pt with recurrent nephrolitheasis, InVx showed Hypercalceuria how to manage?---Thiazaide
diuretics
88- Prophylaxis of pt going for dental procedure Hx AS+bicuspid valve?--- 3g Amoxixllin before the
procedure
89-case of polysurea pt Hx of bipolar disease Dx?---Drug induced Nephrogenic DI
90-Pt with Occupational asthma how tp confirm the Dx?--- Spirometry at work and after work
91- pt with imtrm. abdominal pain, urin turns dark on standing Dx----- Interm. Porohyria
92-most common cyclosporin complication?---Nephrotoxicity
93-mu r the medical incharge with one isolation room which infection to isolate?--Staph.ausrsu
94-Elderly pt with psychosis Dx as schizophrenia giviv Phenothiazin presented with Raynauds
phenomena, dry mouth, and invx low C4, pos Anti Ro and anti Sm Dx?--SLE
95-pT WITH CARBAMAZAPINE INDUCED NEAUTROPENIA WHAT TO DO NEXT?---I wrote
radioiodine Tx but I think the right answer is propathyureacyl.
96-Oesaphegeal vareces what prophylaxis?-- Propanolol
97-Pt with 2nd amennoreha high FSH LH Dx?---- PCODs
98-pt with hypopigementation, seizure and subingual fibroma Dx? Tuberous sclerosis
99-pt 24 years with polycyctic kidney grandmother died at 54 of P. kidney which statement is right?
PKD1 polycustin gene
100-Regarding lung Physiology ? Av gradient will deacrease with altitude .
101-pt with painfull wrist not relifed by NSAIDS what to do next? cortison injection of the joints
102- Pt with Hep B resistent to interferone presented with sudden hepatic apin, and jaudice,
deteriorating LFT Dx?--- Hep D superinfection
103- Pt with celiac dis, on ca, Vit D, and elandoronate, presented with dysphegia Dx?--- Drug induced
oesophageal ulcer
104- cANCA?--- Pos in wegner dis.
105- pt with Hypercal, high Alk.P Normal phosphate level Dx?---Pagets dis.
106- Autoimmune hemolytic anemia how to confirm the Dx? Pos DAG test
107- Pt with RA on brufen presetned with easy brusing Dx?--I cant remember
107- Pt on chronic warferin Tx which factor will be low?---7
108-young hypertnsive pt presented with optic hemmorahge Dx?-- Hpertensive retinopathy
109-C/I to lung surgery?--- SVC obstruction
110- 55 uears old lady presented with sudden loss of one eye dx? giant cell arteritis.
111- pt presented with tinitis, CT san showed interasellar pit enlargement on .95 cm no hurmonal dist,
no increase in size ofter one year what to do next?--- Nothing
112- pt with features of addisons dis, which test to confirm?---Short synthacten test
113-Pt with pain on abduction of arm Dx? Supracapsular lesion
114-most common site for atrial mexoma?--- left atrial
115- Nurse got pricked deeply with HIV post. Pt what to do next?-- Start zudivudin immediately for
one month
28.
mrcp fighterGuest
great..
thx a lot.ur last ques nurse pricked with niddle of hiv patient ....there were two option one intravenous
zidovudine and start anti hiv drug.is there any zidovudine inj form.i am confused.i think the other is
correct.
mrcp fighter, May 24, 2006
#36
29.
GuestGuest
histolitica
146- statin induced myalgia which lipid lowering drug to avoid? I dont know the answer
147-pt preseted with back pain radiating to his shoulder after Hx of trauma for 6 monts past Hx of
similar problem resolevd spontanously over 8 mths Dx? non specific back pain
148-pt with left homounymos hemianopia with sensory inattention Dx? parteal lobe lesion
149-confuse and aggitated eldely Tx? Haloperidol
150-some qs about methadone i cant recall
151-Q about normal joint? the suprapetellar bursa is not related to knee joint
152-Rt hypochondrial pain after liver biopsy why? hemetoma collecton
153-pt with typical gout given allopurinal his condition deteriorated why? Allopurinol induced
154- pt already on meclopromide and still nauseated how to Tx? I cant recall the options or my answer
30.
GuestGuest
148-pt with left homounymos hemianopia with sensory inattention Dx? parteal lobe lesion
149-confuse and aggitated eldely Tx? Haloperidol
150-some qs about methadone i cant recall
151-Q about normal joint? the suprapetellar bursa is not related to knee joint
152-Rt hypochondrial pain after liver biopsy why? hemetoma collecton
153-pt with typical gout given allopurinal his condition deteriorated why? Allopurinol induced
154- pt already on meclopromide and still nauseated how to Tx? I cant recall the options or my answer
31.
EvangelosGuest
MRCP1
Looking back to the answers that are posted in this forum, I woud like to add that CIPROFLOXACIN
and not Trimethoprim is contraindicated in G6PD Deficiency!!!
Evangelos, May 24, 2006
#39
32.
mrcp fighterGuest
dr.osman
we want ur help.cause many persons sending ques with answers.but many are incorrect.plz give the
answer of this ques.
mrcp fighter, May 24, 2006
#40
33.
GuestGuest
regarding the question about G6PD deficiency cipro can cause haemolysis and ALL SULPHONES can
cause hemolysis like trimethoprim (THESE TYPE OF QUESTIONs MAKE ME THINK THAT RCP
ARE PUTTING VERY STUPID QUESTIONS WITH MORE THAN ONE TRUE ANSWER)...
Guest, May 24, 2006
#41
34.
EvangelosGuest
RE
WELL trimethoprim is a diaminopyrimidine and in the market is usually combined with sulphamides.
It is the sulphamides that cause the haemolysis in G6PD, not trimethoprim. On the contrary CIPRO
causes haemolysis in G6PD therefore is contraindicated in such patients.
I believe Cipro was the correct antibiotic.
GOOD Luck to everybody
Evangelos, May 24, 2006
#42
35.
mrcp fighterGuest
one ques was ..cause of galactorrhoea ...majority gave answer metoclopamide but the thing that meto
cause gynocomastia not galactor...the answer was omeprazole.this is the game of rcp.
1old man with rt knee joint pain &swelling known case of OA on NSAID e out improvement on xray d r deformity narow cartiligenous space & cyst in perarticular area
management:
a-inra- articular steroid
b-total joint replacement
c-synevectomy
d-continou NSAID
I put total joint replacement by guess
2pt in her 32 weeks pregnansy c/o fatigue investigations shows SVT what u will give
a-adenosine
b-flecanide
c-dilti9azem
dI dont know the answer ??
3pt e tender erythematous rash on her legs and fatigue joint pain and polyuria o/e there papular rash
on her face and nazal pridge
invest
ANA weekly +ve 1/20
After dilution ?? 1/20
Urine + protein
Calcium 3.2 what u will do for her
1- CX ray
2- Ds DNA
I put x-ray
4pt c/o galactorhea known case of gasteritis on treatment what of the following ttt will cause
galagtorrhea
a- meticulopromide
b- omeprazole
c- spirinolactone
d- I think meticulopromide
d- golgi apparatus
isit mitoconderia?? But I know it is single strand any help??
9pt e st segment elevation in lead II & III ,avF, what vesel ocluded
art coronary artery
10old women with recurrent falls with out any precipitating cause and not preceded by any
symptoms whats the most common cause
aparkinsonism
bdrop attacks
cTIA
d
11old man admited to ER e severe agitation known on ttt of antidepressant what ttt u will give to him
aoral halopiridol
bI v diazepam
civ chlorpromazine
doral diazepam
all they select haloiridol but pt severly agitated and u r in ER how u will give oral halopiridol I think its
not correct!!??
hussam ali, May 25, 2006
#46
36.
GuestGuest
157-DIABETIC with albuminurea 90 mg/24 hour what to do next :ADD ACE INHIBITORS
158-syringomyelia qs
nocturnal cough and asthma/GERD??
Hi guys
"...Compared to nonasthmatics, asthmatics have significantly more frequent and more severe day and
night GER symptoms and significantly more of the pulmonary symptoms (nocturnal suffocation,
cough, or wheezing) so often attributed to GER. The habit of eating before bedtime appears in
asthmatics to have serious and life-threatening consequences."
Also
Other papers have also shown a prevalence of 40% of GERD with nocturnal cough as well as the
aetiology of nocturnal cough in asthmatics being GERD!!!
1.
kengladGuest
asthma
well doesnt asthma covers both GERD and nocturnal cough then
so best answer is asthma
kenglad, Jun 4, 2006
#52
2.
oreoluwaGuest
best answer is GERD NOT aSTHMA.tHE RESULT WILL BE OUT IN 10DAYS FROM NOW.
ALL THE BEST ALL
3.
mrcp fighterGuest
ok..what about that ques a nurse needle prick with an aid pt management start antiretroviral therapy or
inj zidovudine.is there any inj format zidovudine?i think the other should be correct.though i answered
zidovudine.by the way the previous question answer is gerd.
mrcp fighter, Jun 5, 2006
#54
4.
GuestGuest
Hi everybody
well I have to disagree with u all, I think the right answer for chronic nocturnal cough with normal
CXR is chronic sinusitis due to post nasal drip.
:roll:
regards
Guest, Jun 5, 2006
#55
5.
mrcp fighterGuest
pregnancy with svt can any body remember what was the option....is there was amidaron?
mrcp fighter, Jun 5, 2006
#56
6.
oreoluwaGuest
For the SVT in pregnancy-the guideline shows Metoprolol,there was no amiodarone there-wonder
about its safety in pregnancy.
I beg to disagree chronic sinusitis is not a likely cause.I think its GERD.aS Regards the needle stick
injury i chose Zidovudine which seems to be the only reasonable option to me.
Cheers
7.
GuestGuest
THE CORRECT ANSWER OF SVT IN PREG. WAS verapamil , its one the treatment option of SVT
& can be given safe in preg
im obst/physician
Guest, Jun 5, 2006
#58
8.
EvangelosGuest
Hi Guys,
I checked the 2006 guidelines concerning pregnancy and SVT. "...If adenosine fails, then IV
9.
OREOLUWAGuest
10.
EvangelosGuest
Like other autoimmune disorders, there is an increased risk of malignancy, with a B-cell malignant
lymphoma, the most common to arise within the gland. A rare association is a sclerosing
mucoepidermoid carcinoma which arises with fibrosing Hashimoto's disease.
11.
EvangelosGuest
How about the human genome project? I do not remember the other options but I put the 30,000 genes.
My option is favored also by the Human Genome Project website where it is stated that the estimated
number of genes in the human genome is 30,000.
Any views?
Evangelos, Jun 5, 2006
#62
12.
mrcp fighterGuest
no..30,000 is incorrect.more than 30,000.by the way i checked about svt in pregnancy in latest
guideline.its adenosine and verapamile.no b blocker.for needle prick injury anti retroviral drug .triple
therapy.there is no ziodovudine in inj form.for genetics one option was not all dna is codefor gene...i
forget that stem.by the way what about anticipation?expand trinucled repead in succicive generation.its
the resonable.crazy man physical assult to his wife and told i have fried high official in police no body
can harm me?whats it,,scizoid personality?
mrcp fighter, Jun 5, 2006
#63
13.
oreoluwaGuest
Yea 30,000 was the choice.There is no amiodarone on the guideline,maybe you can forward your
source and that will be wellappreciated.I think the guy with the police friends its likely paranoid
schizo.if i recollect very well.
oreoluwa, Jun 5, 2006
#64
14.
EvangelosGuest
Concerning SVT and pregnancy and metoprolol: Please look at the American College of Cardiology
Foundationhttp://www.acc.org/clinical/guidelines/arrhythmias/exec_summ/VI_special.htm
Concerning human genome project and estimation of genes please look at the related website
http://www.ornl.gov/sci/techresources/Human_Genome/project/info.shtml
"The total number of genes is estimated at 30,000 much lower than previous estimates of 80,000 to
140,000 that had been based on extrapolations from gene-rich areas as opposed to a composite of generich and gene-poor areas. "
Concerning the man with the police friends (it is grandiose thought?) I put mania!
cheers
Evangelos, Jun 6, 2006
#65
15.
mrcp fighterGuest
lump in nose,lump in neck and pulmonary infiltration...i think histocytosis.some body put sarcoidosis.i
am not agree.
best indicator for peri tonsilar abcess....one sided...?i forgot...can anybody help
mrcp fighter, Jun 6, 2006
#66
16.
mrcp fighterGuest
lady with severe pain complaining osteoarthritis with stable angina why thallium perfusion to see her
cardiac status why not ett ?is there any contraindication for ett in osteoarthritis?
one pr fall down and with out conciousnessness and after that he start to walk its cataplexy not like
vaso vagal..
A man was brought to the casualty with abdominal pain, sweating shivering and said if u dont give me
morphine I will commit suicide .some body is telling Munchausens syndrome ,but i didnt answer this
one.any idea?
in acute renal rejection what is the anti HLA antibodies...i think ig m
preg lady with Alpha thal trait+ husband trait wants to know the risk to the foetus-husband and wife
both affected...so answer to check antenatal condition of fetus...the exact stem i cant remember...
Pt with Hep B resistent to interferone presented with sudden hepatic apin, and jaudice, deteriorating
lft...many people wrote super infection hep d .but patient old i think hepatic ca.
can u remember ..one ques from anatomy ...muscles involve in flexion of knee or hip ..i forgot...what
was your answer?
plz discuss about these questions...latter we will discuss more other question?
mrcp fighter, Jun 6, 2006
#67
17.
rubGuest
18.
rubGuest
19.
tidaGuest
20.
mrcp fighterGuest
lady with severe pain complaining osteoarthritis with stable angina why thallium perfusion to see her
cardiac status why not ett ?is there any contraindication for ett in osteoarthritis?
one pr fall down and with out conciousnessness and after that he start to walk its cataplexy not like
vaso vagal..
A man was brought to the casualty with abdominal pain, sweating shivering and said if u dont give me
morphine I will commit suicide .some body is telling Munchausens syndrome ,but i didnt answer this
one.any idea?
21.
mrcp fighterGuest
22.
GuestGuest
I am so nervous about the result ............. i hope i pass inshAllah ............will it come out on the 12th for
certain ??
Guest, Jun 8, 2006
#73
23.
mrcp fighterGuest
24.
GuestGuest
hi every body
i passed
my name came on the net
25.
OREOLUWAGuest
Thank GOG i passed the exam.Evangelo and Mrcp fighter hope you passed too.
Oreoluwa.
I shoud say a very big thank you to this forum, those past exam questions helped a lot. Some advice
later for those preparing.
OREOLUWA
26.
OREOLUWAGuest
27.
GuestGuest
28.
kengladGuest
evangeloos
29.
oreoluwaGuest
Kenglad,why are you taunting Evangelos,give him some time to check.Most people thought the result
will be released on the 12th.I was just lucky while checking the forum noticed some Doctors had
checked their results.So I checked mine too
I still insist the answer was GERD.at least i passed so am confident to write it.
No hard feelings.
Cheers
God Bless us all.Please anyone with advice for Part 2 Written please.Thanks
oreoluwa, Jun 12, 2006
#80
30.
oreoluwaGuest
Kenglad,why are you taunting Evangelos,give him some time to check.Most people thought the result
will be released on the 12th.I was just lucky while checking the forum noticed some Doctors had
checked their results.So I checked mine too
I still insist the answer was GERD.at least i passed so am confident to write it.
No hard feelings.
Cheers
God Bless us all.Please anyone with advice for Part 2 Written please.Thanks
oreoluwa, Jun 12, 2006
#81
31.
kengladGuest
curious
32.
kengladGuest
continue
33.
oreoluwaGuest
Kenglad,
Curiosity kills the cat.Anyway let Evangelos rest,guess he will
re-surface with his good news shortly.MRCP exams is nobody's exam, you can either fail or pass.I was
among the lucky bunch and i passed.
34.
kengladGuest
how true
just one more question from the may paper for future examinees
answer - malingering
kenglad, Jun 14, 2006
#85
35.
OREOLUWAGuest
36.
oreoluwaGuest
PLEASE DOES ANYONE KNOW THE CUT OFF MARK FOR THE MRCP PART 1.
THANKS
oreoluwa, Jun 16, 2006
#87
37.
EvangelosGuest
I could not reply earlier for two reasons. First because I wad a series of night SHO shifts so I was
resting during the day and second because I could not remember if I had chosen to have my results on
the web or not!
Finally, I found out that I had chosen to have my results on the web so unfortunately I have not passed!
I am looking forward to receiving the results to see what exactly happened.
Anyway, congratulations for your success and luck!
If you are in london or planning to come we can arrange to meet for a coffee and continue our funny
conversations
Evangelos, Jun 16, 2006
#88
38.
OREOLUWAGuest
EVANGELOS,
You are a Guy to be respected,i definitely do.I really look forward to meeting up,am working in Dublin
but should be in London for the Part 2 exam.
I WISH YOU ALL THE VERY BEST AT THE NEXT SITTING.Just let me know how i could be of
help to you great lad .Cheers
OREOLUWA, Jun 16, 2006
#89
39.
EvangelosGuest
Thanks oreoluwa,
My email is e.visvardis@doctors.org.uk so when you come to London for your exam or holidays (and
If I am still here... ) we can arrange to continue our discussions. In the meantime I will be watching
both the forums of MRCP PartI and II for questions so...
40.
lordoye1Guest
41.
oreoluwaGuest
42.
kengladGuest
hey evangaloos
hey evangeloos!
dun worry old chap u juz keep goin
go for the september paper u'll pass i'm sure!
perhaps we'll meet one day
the measure of a great man is not when he falls but how he picks himself up after !
kenglad, Jun 18, 2006
#93
43.
oreoluwaGuest
44.
Cleo_SGuest
i received mine today --- not too happy with my score : 63.73 %
But i passed --- so... yippy !!! (shukar alhamdullilah)
Cleo
Cleo_S, Jun 22, 2006
#95
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1.
dr arifGuest
2.
muttasimGuest
features of poor prognosis of pneumonia :1/high BUN 2/RR >30 3/BP <90/60 4/ Age over 65
treatment of SVT with WPW
features of cluster headache
features of posterior cerebral atery aneurysm
features of churg struss syndrome
renovascular induced resistant hypertension
peri-articular osteopenia features of RA
plasma electrophoresis for multipale myloma
plasma exchange for TTP
autoimmunity is a cause of ITP
iv magnesium for severe asthma resistant to bronchodilaters & 1st treatment
muttasim, Sep 10, 2008
#3
3.
GuestGuest
4.
DrAbidGuest
watery diarrhoea-VIPoma
Fasting in Ramadan:500mg metfor in the morning and 1000 in the even
mycoplasm pneumonia:cold aggluti
rituximab-CD20
double straind DNA in which orgenel:nucleus/mitochondria?
tic bite:lyme disease
blister on skin and mucosa;pemphigius vulgaris
dermatitis herpetiformis assossiation-Mycoplas
MODY-family history
gastrin-stimulted by peptides
starch-amylase
Iv drug user-tetnus-metronidazol
extrinsic allergic alveolitis-upper zone fibroisi
macular degenration????????cause-i ans glaucoma
demopressin--excret VIII factor from endothil
trelipressin-splanchnic vasocnstriction
but it wasnt an easy exam
wht do u think guys
5.
DrAbidGuest
6.
satiaGuest
recall questions
recall questions
200/70something)
4.how do the kidney's prevent dehydration
7.
HatesRCPGuest
8.
mmmmmmmmmmmmGuest
recall questions
it was coarctation
why was it angioedema
was it predisolone or colchicine
acute rejection kidney?prednisolone
cavernous sinus or orbital apex?
post communicating aneurysm
renal vein thrombosis
fe for 3 more months according to parveen kumar for 6 months she had 4 3 months already
wpw in atrial fib flecainide?according to pass medicine doesnt mention adenosine in treatment
doxorubicin?for vague chest lung dysfuntion?or was it something else
mycoplasma serology not cold agglutinins
low c4 sle
aml testicular cancer
hbaic 1 month or 3?according to books its 6 wks it asked minimum period so i chose one
insulin in preg ith 12.5 random ogtt
mmmmmmmmmmmm, Sep 10, 2008
#14
9.
muttasimGuest
*pt with wpw no previose history now hr 160 ecg showing atril fibrilation drug need for tratment
-verapamil
-adenosine
-sotolol
-flecanide- i choose (b/c AF withno sign of HFor etc)
-?
*treatment for trigeminal neuralgia----carbamezipen
-chrug struss syndrom
multiple myloma ----plasma electrophereses
* pt came amphetamine abuser for evaluation vaccinatrd for HBV result showing , anti HBV is only 10
(<100), HBsAg neg ,test HIV+. HCV+ what is the cause of low anti HBV
-HIV
-HCV
-Amphetamine i choose ( i think it is wrong )
* double standerd DNA in Nucleuse (i choose B?C double helicle form is buty of DNA in nucleuse ) /
mitochondria?
* pt with diadetiees with diabetic retinopathy on metformen 5oo tid .need fasting in ramadan .wants to
take medicine before brekfast,and after evening meal.what is the plan
-stop metformin
-give insuline
-give metformine 500 mornig and 1000mg in evening-i choose this
-start gliclezide
-?
*pt with wpw no previose history now hr 160 ecg showing atril fibrilation drug need for tratment
-verapamil
-adenosine
-sotolol
-flecanide- i choose (b/c AF withno sign of HFor etc)
-?
*treatment for trigeminal neuralgia----carbamezipen
-chrug struss syndrom
multiple myloma ----plasma electrophereses
* pt came amphetamine abuser for evaluation vaccinatrd for HBV result showing , anti HBV is only 10
(<100), HBsAg neg ,test HIV+. HCV+ what is the cause of low anti HBV
-HIV
-HCV
-Amphetamine i choose ( i think it is wrong )
* double standerd DNA in Nucleuse (i choose B?C double helicle form is buty of DNA in nucleuse ) /
mitochondria?
BASIC ==
PAIN FOR ARM , HAND --- CARPAL TUN
WEAK, ANAS T--- ULNAR
C7 ROOT ?
DELTOID --- AXILLARY NERVE
NNT --- 20
RITUXIMAB -- CD 20
TRUSTUZUMAB INDIC --- ??
RENAL ===
STRUVITE STONE
REN TRANS CMV +, EP+ --- STEROID ? REJ
PREG + PTN -- ORTHOSTATIC
POLY CYSTE + HTN -- POLYCYTHEMIA
MASS RT KIDNEY --- ADENO CARC
SITE OF ACTION THIAZ --- PROX TUBU
RESP ===
DRY COUGH, RT VEN ++, TR -- ILD
ASTHA NOT REPSON -- MAGNESIUM
PT LOW FEV1 -- DORSAL KYPHOSIS
INFECTION IN INF SEASON --- STAPH
CHICKEN POS PNEUMONIA --- CICLOVIR
CREYPT FIBROSI ALV --- PLEURAL INV
EXTRINSIC ALL ALV --- UPP LOB FIBROSIS
HILA MASS --- BRONCHIAL BRE
LT ANKLE ARTH + ERY NOD --- CXR
PNEUM CYSTIS -- LAVAGE
RH + ILD -- METHOTREX
HEMATOLOGY ==
IRON DEF TTT --- 6 MO
AF + ANTI COA --- 6 M
LMWH F/U -- NOTHING
NECK LN, CONS L LOBE CLL -- IMNUPHENO
BACK PAIN, LYTIC LESIO IN SPINE, BREAST CAN --- PTN ELECTROP VS B-MICROGLOB
HYPERCALC IN MM --- ACTIV OSTOCLAST
PREG 23 WK, CONFUSION, RENAL, FRAGM RBC -- TTP --- IVIG VS PL EXCH
RH IN NOR -- 20%
FACIAL PALSY, ERYTHEMA -- BORREL AB
GRAN ANULAR
BASAL C C
DRUG CAUSIN EXTR PYR --- METOCHOPRAMID
DRUG FOR MOTION SICK --- PROCHORPERAZIN
TTT OF GOUT E WARFARIN,DIGOXIN --- PREDNISOLON
10.
natronboy!!!Guest
assalmu alikom
RENAL ===
STRUVITE STONE
REN TRANS CMV +, EP+ --- STEROID ? REJ
PREG + PTN -- ORTHOSTATIC
POLY CYSTE + HTN -- POLYCYTHEMIA
MASS RT KIDNEY --- ADENO CARC
RESP ===
DRY COUGH, RT VEN ++, TR -- ILD
ASTHA NOT REPSON -- MAGNESIUM
PT LOW FEV1 -- DORSAL KYPHOSIS
INFECTION IN INF SEASON --- STAPH
CHICKEN POS PNEUMONIA --- CICLOVIR
CREYPT FIBROSI ALV --- PLEURAL INV
EXTRINSIC ALL ALV --- UPP LOB FIBROSIS
HILA MASS --- BRONCHIAL BRE
LT ANKLE ARTH + ERY NOD --- CXR
PNEUM CYSTIS -- LAVAGE
RH + ILD -- METHOTREX
HEMATOLOGY ==
IRON DEF TTT --- 6 MO
AF + ANTI COA --- 6 M
LMWH F/U -- NOTHING
NECK LN, CONS L LOBE CLL -- IMNUPHENO
BACK PAIN, LYTIC LESIO IN SPINE, BREAST CAN --- PTN ELECTROP VS B-MICROGLOB
HYPERCALC IN MM --- ACTIV OSTOCLAST
PREG 23 WK, CONFUSION, RENAL, FRAGM RBC -- TTP --- IVIG VS PL EXCH
RH IN NOR -- 20%
FACIAL PALSY, ERYTHEMA -- BORREL AB
GRAN ANULAR
BASAL C C
LOWE RT WEAKNESS, + TONE + REFLEX, UPPER RT DELTOID, NORMAL SENSA --- MULT
SCLOSIS
ASTHAM ON BECLO 800 ,,NOT RESPONDING --- DOUBLIN DOSE
HIP PAIN,LOSS OF LIBIDO, POLYURIA -- FERRITIN
HCV +, HIV +,,, NOT RESPON TO HBV VACCIN --- HIV +
BCG T CELL RESPONSE --- TNF-a
LYMPHOCYTOSI , WHAT TO TELL PURE T CELL? --- HTLV-1 ??
LIVE ATTEN ---YELLOW FEVER
ORGANEEL E D-STRAND CIRC DNA -- MITOCHONDRIA
G-PTN RECEPTOR -- TRANS MEMBRANE
PNEUMOCOCCAL VACC BEFORE SPLENECTOMY --- 1 M BEFORE
ATOPIC ECZEMA, RASH, CRUSTED --- TOPICAL STEROID
TUBERS SCLEROSIS --- PERI UNGUAL FIBROMA
2 YR DIARRHEA, STOOL WT +++ --------- VIPOMA
ALCHOLIC, STATORRHEA, ABD PAIN -------- PANCRTITIS -- ABD XR
COMATOSED, EMPTY BOTTLE OF PHENYTOIN, NYSTAGMUS ----- RBC TRANSE
KETOLASE
PT ON SILDENAFIL,IHD , WHAT MED TO KEEP --- ACE-I
TB PROPHYLAXIS, STAY OFF WORK -- 2 WKS
UTI, G-VE DIPLOCOCUS --- NOT WELL IMPROVED -- CHLAMYDIA
RA RADIOLOGYU --- PERI ARTICULAR OSTEOPENIA
ANKYLOSING XR --- SYNDESMOPHYTE
PT ON THYROXIN FOR FOLL CANC ,, LAB TSH 0.01, T4 ++ --- REDUCE THYROXIN
GASTRIN --- ++ BY LUMINAL PEPTIDE
GASTRIC ADENO CARCINOMA --- COLUMNAR EPITH
PT DYSPHAGIA TO SOLID AND LIQUID, 2 Y GERD -- ACHALASIA
TERLIPRESSIN ACTION IN HEPATORENAL --- SPLANCHNIC VASO CONSTRITION
SERIOUS SIDE EF OF DRUG --- RANDOMIZED CONTROLLED
STUDY DESING --- WILCOXON
POSITIVE PREDICITIVE -- 60 %
11.
muttasimGuest
MRcp part1
Assalam alaikom
the exam was hard and some questions were based on issues not and will never see in real practice.
here are some of the questions which I remember:
Glucokinase activity in the brain is different to that in the gut: secondary to affinity?
Flomezenil activity: competitive inhibition
pt with different LV pres 200/10, aortic 200/70... i asked cardiologist . he said AR.. I respond with
Coarc.
MODY .. ++ BMI (think wrong)
I was hesitated with that woman IV abuser ... saying was it tetanus ??? however I've choosen
"Vancomycin"
sarcoid cause "erythema nodusom"m questio didn't mention any thing guide to it.. just erythem,clearing
centre!!, also for 5 wks,, I think matching with erythema ch mig of lyme !!
C1 estrase def .. you may got past history of idiopathic angioedema or abdominal pain or any thing
pointing to past...
kidney prevent dehydration by inc aquaporin in collecting duct .. inhancing the action of ADH ... I
think!!
HbA1c -- 4 m, this the life time of RBC
pregnant with ptn --- orthostatic,, nothing pointing to reflux !!! why?? I think the past h of mother had
had renal problem is distracting.. also I didn't remember whether she was Hyppertensive or not ... I
think: not mentioned...
precelapmsia... not before 20 wk gestation !!!!
natronboy!!!, Sep 11, 2008
#23
12.
natronboy!!!Guest
kaposi sarcoma with HIV... what other virus causin ... Ep. Barr
13.
Guest09092008Guest
I would like to end the argument about ? sarcoidosis >>>> Facial palsy is complication of
neurosarcoidosis & rash mentioned was erythema nodosum on leg. Hence investigation of choice will
be CXR
Guest09092008, Sep 11, 2008
#25
14.
Guest09092008Guest
Idiopathic hyperhydrosis>>>> Wikipedia link: Anxiety can exacerbate the situation for many sufferers.
A common complaint of patients is that they get nervous because they sweat, then sweat more because
they are nervous
Guest09092008, Sep 11, 2008
#27
15.
burningi_ceGuest
16.
burningi_ceGuest
17.
Shaan.Guest
Message
tahseen sabzwari
Guest
Posted: Thu Sep 11, 2008 1:14 am Post subject: sep 2008 mrcp
--------------------------------------------------------------------------------
it was realy tough one ,i sit in jan2008 but it is realy one that make me think twice .here is some
mamories
* pt with diadetiees with diabetic retinopathy on metformen 5oo tid .need fasting in ramadan .wants to
take medicine before brekfast,and after evening meal.what is the plan
-stop metformin
-give insuline
-give metformine 500 mornig and 1000mg in evening-i choose this
-start gliclezide
-?
*pt with wpw no previose history now hr 160 ecg showing atril fibrilation drug need for tratment
-verapamil
-adenosine
-sotolol
-flecanide- i choose (b/c AF withno sign of HFor etc)
-?
*treatment for trigeminal neuralgia----carbamezipen
-chrug struss syndrom
multiple myloma ----plasma electrophereses
* pt came amphetamine abuser for evaluation vaccinatrd for HBV result showing , anti HBV is only 10
(<100), HBsAg neg ,test HIV+. HCV+ what is the cause of low anti HBV
-HIV
-HCV
-Amphetamine i choose ( i think it is wrong )
* double standerd DNA in Nucleuse (i choose B?C double helicle form is buty of DNA in nucleuse ) /
mitochondria?
Hello Guys
You are right the paper was difficult
Scenarios were not clear
For the question with deranged U E in pregnancy its reflux nephropathy b/c it has heridiatery
component some time (b/c of mother)
Cause of death in Dialysis pt ?? Cardiomyopathy
Mechanism of action of metformin --- peripheral utilization of glucose
There was some kind of question with ??dose of pred equal the normal daily release of glucorticoids
Loss of dorsiflexion ?? where is the sensory loss -- ?Pos calf
loss of kne jerk -- loss of sensation on medial leg -L4
Prochlorperazine causes Torticolllis.
Metocloperamide causes galactorrhoea
Lots of Psych
Young guy with hypochondriasis disorder
Young woman afraid of birds and getting messages-acute para Schizophrenia
Young woman asks GP for wt loss drugs and dieting ? bulimaia ? Dysmorphia
Alcoholic feels insects crawling up skin-hallucination as it is a sensation in the absence of a stimulis
paper 1 was relatively easy but tricky.paper 2 was really mind numbing.i wish all very best of luck.may
ALLAH help us out through this tough time.
HTLV 1 virus
amyotrophic lateral sclerosis
multiple sclerosis
hypopigmented lesions>>> pernicious anaemia
primary sjoghren's synd
macular angiogenesis>>>>>photocoagulation
buproprion>>> epilepsy
scleroderma>>>>>>malabsorbtion
CLL>>>>immunophenotyping
erythema nodosum>>>>> CXR
deltoid>>>>axillary nerve
lewy body dementia
old agitated man>>>>>haloperidol
cerebral mets>>> steroids
post h.pylori eradication>>>>endoscopy n urease test
postural hypotension in old people>>>thiazides
cerebral thrombophlebitis
tats all i remember rt now.hopefully we'll be able to recall the whole paper by tonight.keep up the good
work. c ya.
ssssssss, Sep 11, 2008
#43
18.
salboyGuest
thanks SSSS
great work buddy for your contribution
salboy, Sep 11, 2008
#44
19.
salboyGuest
20.
salboyGuest
pt with excessive watering and salivation ??? which drug abuse-- ??heroin ?? amphetamine
recurrent meningococcus infection ?? which complement inh ?? -- C3
salboy, Sep 11, 2008
#46
21.
GuestGuest
I think the Sjogren's syndrome question refers to SLE cos the anti-Sm antibody was positive which is
highly specific for SLE
Also i feel re: recurrent neiserria infections the answer is c7 cos patient with c5-c9 deficiencies are
unable to prevent neiserria infections deficiency of c3 will predispose to all capsulated organsim
infection not just neiseria
Guest, Sep 11, 2008
#47
22.
omar elfarsiGuest
Assalam alaikom
I agree about the SLE diagnosis, tricky questions as you would be thinking about drug induced lupus in
first instance (malar rush and on phenothiazines) but the presence of anti-Sm makes the diagnosis of
SLE highly likely as it is usually absent in all other conditions including drug induced lupus.
I thing the recurrent neisseria infection is due to C3 deficiency (neisseria is encapsulated bacteria) as
the mac complements (c5-c9) deficiency causes neisseria septicaemia and the patients wasn't in sepsis.
Metoclopramide causes torticollus and galactorhoea
thiazides works on distal tubule
Alcoholics with abdo pain, most likely chronic pancreatitis, and the fisrt choice investigation would be
CT abdo as abdo xray can miss up to 40% of pancreatic calcifications (specific sign for pancreatitis)
omar elfarsi, Sep 11, 2008
#48
23.
burningi_ceGuest
c5-c9 defeciency can cause recurent neserial infection and i think the ans was c7.
withdraw of which drug can cause diarhhoea-amphetamine or heroin
burningi_ce, Sep 11, 2008
#49
24.
ssssssssGuest
RAMADAN MUBARAK
ghostreconGuesttumer need factor to provide blood supply = angiopoetin.ghostrecon, Sep 11, 2008#54
burningi_ceGuestoooooooooo
any body knows how to check the effectiveness of PEG AND INETRFERO therapy in hep c-i ans
LFT(i think its wrong)burningi_ce, Sep 11, 2008#55
burningi_ceGuest75 yr old man with a nodule of red colr in temporal region?it was basal cell or
sebaceous cyst?burningi_ce, Sep 11, 2008#57
burningi_ceGuesti didnt hear dat someone had cat bite i heard mostly abt scratchburningi_ce, Sep 11,
2008#58
ssssssssGuestpasteurellosis occurs with any domestic animal, bartonellosis occurs specificly with cat
bite or cat scratch.so thats why i chose it.ssssssss, Sep 11, 2008#59
salboyGuestHave we had HCV RNA in the answer well I am not sure but I choose LFT as well
Its ZZ
mokhlesGuestthis what i have answered anyt one have comment just help me
cluster headache
supraspinatous
mitochondria
angiodema
cerebellar thrombophlebitis
sarcoidosis
aortic regurgitation
systemic lupus
cat
zm
anti sm sle
hcv rna
dicodeine withdrawal
perirheral vasoconstrictor
c7 for neiseeria
yosefGuesttorsadis de pointes VTach. which one was the culprit? I answered Sotalol? was it correct?
I agree with CT abd for the patient with bulky diarrhes and recurrent central abd.pain ch.pancreatitis.
yosef, Sep 12, 2008#65
Old gentleman with back pain: Though it was Multiple Myeloma but immediate investigation of coice
is MRI spine as patient was developing spinal cord compression.
Chronic Pancreatitis immediate investigation of choice will be AXR (speckled appearnace) while
investigation of choice is CT abdomen (read between the lines)
Sarcoidosis is self limiting condition & hence no further treatment required will be the answer.
Neisseria infection: Given the choices, C7 is right answer as deficiency of all or one of the C1q, C1, C3
can cause picture. C7 was the only one mentioned amongst C5-9 complex
Minimal change nephropathy: pregnant lady (in 12 weeks gestation rule out pre-eclampsia) with (no
past history rules out reflux nephropathy). Proteinuri in nephrotic range but hallmark-feature is
hypoalbuminaemia.Guest110908, Sep 12, 2008#66
Shere KahnGuestRespiridone
Another Question asks about cat scratch disease not cat bite!
Girl presenting with marks on forearm-HX OF paracetamol OD- Dermatitis artefacta- she was self
harmingShere Kahn, Sep 12, 2008#67
- lyme
- temporal arteritis and sudden loss of vision---- anterior ishemic arteriopathy not crvtGuest, Sep 12,
2008#68
hi everyone,,,,I hope you all did well in the exam,,,to me the 2nd paper was much tougher than the 1st
one,,, anyway here is some of the questions that I have recalled so far. please correct me if u think my
answers r wrong:
4. galucoma.......tricyclic antidepressant
33. different arterial pressure reading in ascending aorta and femoral artery...............coarctaion aorta
I think the rest is just a repeat of others,,,,,, good luck everyone,,,, happy ramadan Kurdish doc, Sep 12,
2008#69
salboyGuestThanks Kurdish
I think the cut of would be 65% this timesalboy, Sep 12, 2008#70
but i think it was about the most associated viruses with kaposi S
-pat with lower limit of normal value CA, low PO4, High ALP
- in COPD>>>>lTOT?
Vit d levels
power of a test.
young boy,not working for last 4 months,brother died of SAH 6months back>>>>>>depressive episode
pneumococcal infection>>>>IgA2
chemo>>>>>granisetron
inc prolactin>>>>>>>>hypothyroidism
lupus anti-coagulant
renal carcinoma>>>>>>>adenocarcinoma
http://en.wikipedia.org/wiki/DNA
http://en.wikipedia.org/wiki/Mitochondrial_DNA
saying that , plasma pharesis is a complex sophisticated procedure, needs time, while Ig , can be given
easily at the mean time, till the P.exchange be avilableGuest, Sep 12, 2008#75
GuestGuestregarding that guy , who recieved a kidney transplant ,(he was CMV -ve,and recieved a
kideny from CMV +ve),
GuestGuestregarding the BOF , that pat. who got 3rd,6th, & oth.div of trigeminal ,
dermatitis artefacta
rash was raised mcv and hypothroididm?raised alp too celiacs or PBC
kummar & clarks mention continues for coming 6 months to restore iron store,
you can review the answere at page 188 in kumar & clark pocket book .Guest, Sep 12, 2008#79
not simvastatine , which is used in sparcle trilas to improve morbidity in CVAGuest, Sep 12, 2008#81
GuestGuestthat HIV patient , with cough fever for 2 weeks, if you look at the Pao2 & Paco2 , you will
find them both down , which only happens in 2 situations;
1- pulmonary embolism .
siadh
there was a question like this on ydr with female n g6pd def so it cant be 45x0mmmmmmmmmmmm,
http://en.wikipedia.org/wiki/Motion_sickness#Sea-sickness
as metoclopramide and prochlorperazine, although widely used for nausea, are ineffective for motionsickness prevention and treatmentGuest, Sep 12, 2008#84
not dopamine
it was coeliac not PBs , as there was dual def. of blood ie iron & mega.anemiaGuest, Sep 12, 2008#88
it was AMLS
so answere is IL2
the question mentioned in the end , that the lesion is spread all over the body ...
as leg weakness is a specific & diagnostic of frontal lobe ischemia which supplied by ant.cerebral ar.
Guest, Sep 12, 2008#93
if you read carefully till the end , it mentioned that , she can escape the birds , by hiding in her husband
socks.
yosefGuestThe old lady with minor trauma, I think it was reactive arthritis, as it is not necessary to be
blood inside the joint to be swollen.yosef, Sep 12, 2008#95
yosefGuestRisperidone is both Dopamin 2 receptor antagonist And 5HT3 receptor antagonist. I chose
Dopamin 2 receptor antagonist?. I dont remember what was written about 5HT was it written clearly
with 5HT3 antagonist or just 5ht antagonist. I am not sure, but I am sure it was written Dopamin2
receptor antagonist which is correct!.yosef, Sep 12, 2008#96
yosefGuestWhat is del 5 q? what was the question, can u reminde me?yosef, MRCP SEP 2008
RECALLED QUESTIONS
Discussion in 'MRCP Forum' started by dr arif, Sep 10, 2008.
Page 3 of 9
923.
924.
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926.
927.
928.
929.
930.
931.
932.
933.
934.
935.
936.
937.
938.
939.
Haemodialysis not benefit with which situation or drug.....ans water soluble????. NOT RIGHT,,, THE
right answer ; high proetin binding capacity
940.
941.
942.
943.
doxorubicin
944.
945.
glaucome tca?
946.
latent tb 2wks
947.
948.
hydroxyurea
949.
950.
951.
30 2 ratio
952.
how much do we need to get to pass any idea?mmmmmmmmmmmm, Sep 12, 2008#104
953.
ssssssssGuestbreath urease test usually false negative after h.pylori eradication therapy or even with
955.
956.
957.
958.
as i checked p.karla
959.
960.
961.
962.
963.
964.
965.
you can check oxford hand book , page 183Guest, Sep 12, 2008#107
966.
GuestGuestkumar n klark chapt oncology says u need a bone marrow transplant with 5q mutation as it
has a poor prognosis in amlGuest, Sep 12, 2008#108
967.
burningi_ceGuesthi guys
968.
969.
970.
971.
972.
973.
974.
975.
976.
977.
And what was the question for 30 2 ration? I cant remeber such questions? !!yosef, Sep 12, 2008#113
978.
koshan13Guestdr. yusof/ that was a case of pemph.gus , NOT pemphegoid......as there was an
involment of mouth, i mean ,mucose membren. typical distrib. with age of the pt. ----favoures
PEMPHEGOUSE as a diagnosis. thx. best of luckkoshan13, Sep 12, 2008#114
979.
yosefGuestThanks Dr. Koshan. For the lady with systemic seclerosis I think the answwr is interstial
fibrosis, because massive progressive fibrosis is a speciall entity related to other disease.yosef, Sep 12,
2008#115
980.
koshan13Guestdr. yusof/ may be u haven't any idea that -----RCP is puting in the exam. a few Qs. for
research purpose, those in fact carry NO marks. Your confusing Qs. amoung those. so don't worry.....
koshan13, Sep 12, 2008#116
981.
yosefGuestur second inquiry was chicken pox pneumonitis, i think it will be acyclovir.yosef, Sep 12,
2008#117
982.
983.
984.
yosefGuestFor Irritable bowel, it was the pain awake the patient from sleep correct answer.yosef, Sep
12, 2008#119
985.
986.
but tenesmus is not seen in IBS i think soburningi_ce, Sep 12, 2008#120
987.
burningi_ceGuesta lady with pain in the base of the thumb especially on adduction---de quevrian
syndovitisburningi_ce, Sep 12, 2008#121
988.
yosefGuestI remember I answered 2 questions for METOCLOPROMIDE, one for torticollis and the
other for prolactinemia?
989.
990.
And also 2 questions for doxorubicin, one for which drug is cardiotoxoc, and the other was the lady
who treated for breast cancer few months previously and develop heart failure now.
991.
992.
993.
koshan13Guest1.there was a Q. about 25.OHD3 ---can be used as a marker for VIT-D def. status.2. low
Na level, other values r normal along with completely normal kidney,,,,,what's the diagnosis????
.......CAH-----is the correct ans. i think. .............welcome for open discus....thxkoshan13, Sep 12, 2008
#123
994.
koshan13Guestregarding IBS-------I AM 2ND TO DR. YUSOF and i am sure it's CORRECT. 1 q. from
cardiology------CLOPIDOGRIL/ DISOPYRAMD-----should be given before CATH. I think---CLOPIDOGRIL.. is the CORRECT ans. command pl. best of luck.koshan13, Sep 12, 2008#124
995.
GuestGuestWhat does everyone think the pass makr will be?Guest, Sep 12, 2008#125
996.
EinasGuestI`v answered
997.
-Reactive arthritis
998.
-highly protein bound drugs not good for H dialysis. the ones with large volume of distribution are
dialysed well
999.
-regarding HelicB Pylori Kalra page 187 says : effective eradication should be assessed by EITHER
repeat biopsies OR breath testing
1000.
1001.
IQTGGuestFew Question
1002.
1003.
Salam everyone .
1004.
1005.
Hope everyone enjoyed the exam (just kidding ) .I aggreesd that thats the one of the worst medical
exam with mixed outcome .But in the mean time we can just pray to GOD about everyone success.
1006.
1007.
1008.
1009.
1) A 36 year old gentleman was admitted with the h/o weekness in the lower limbs ,gradulal in onset
from last 9 months , the only h/O available is that his father has developed weakness in his legs at the
age of 70.
1010.
Examination findings
1011.
1012.
Lower limb showed parapresis with bilateral upgoing planters with generalized hypereflexia in upper
lower limbs .There was no sensory loss
1013.
1014.
Investigations showed
1015.
1016.
1017.
1018.
1019.
WBC 3 (n: 5)
1020.
1021.
1022.
1023.
1024.
1025.
1026.
1027.
1028.
IQTGGuestSalam Again
1029.
1030.
Another question which i found frequently on that forum with (i think) wrong answer
1031.
1032.
1033.
A patient with the background of rheumatoid arthritis, depression and is medical treatment was
admitted with decreased vision.
1034.
1035.
1036.
1037.
1) hydroxychloroquine
1038.
2)Prednisolone
1039.
3)TCA
1040.
4)Methotrxate
1041.
1042.
Well i put answer hydroxychloroqine as iremembered that cause ireversible blindness but i was n't sure
and i checked withBNF and Kalra .Kalra suggest that TCA can aggravate glucaoma in a patient
susceptible to that condition
1043.
1044.
1045.
1046.
1. young woman with pruritic rash over hr shoulder and buttock with raised alkaline phosphatase and
MCV....
1047.
I think the answer is coeliac disease and not PBC because in primary biliary cirhosis there is NO rash
only pruritis, 2ndly it does not explain the high MCV, while coeliac disease can explain bothh. you
might argue that the patient does not have malabsorption features,,i encountered a question like that in
Onexamination it it says coeliac disease can present without diarrhoea.Kurdish doc, Sep 12, 2008#129
1048.
burningi_ceGuestguys do you wt thet ask abt IBS they didnt ask what is the characteristic of IBS they
asked which symptom describes the diagnos rather than IBS
1049.
1050.
1051.
shaheed.GuestAuthor Message
1052.
tahseen sabzwari
1053.
Guest
1054.
1055.
1056.
1057.
1058.
1059.
1060.
Posted: Thu Sep 11, 2008 1:09 am Post subject: 9/2008 topics
1061.
1062.
--------------------------------------------------------------------------------
1063.
1064.
it was realy tough one ,i sit in jan2008 but it is realy one that make me think twice .here is some
mamories
1065.
* pt with diadetiees with diabetic retinopathy on metformen 5oo tid .need fasting in ramadan .wants to
take medicine before brekfast,and after evening meal.what is the plan
1066.
-stop metformin
1067.
-give insuline
1068.
1069.
-start gliclezide
1070.
-?
1071.
1072.
*pt with wpw no previose history now hr 160 ecg showing atril fibrilation drug need for tratment
1073.
-verapamil
1074.
-adenosine
1075.
-sotolol
1076.
1077.
-?
1078.
1079.
1080.
1081.
* pt came amphetamine abuser for evaluation vaccinatrd for HBV result showing , anti HBV is only 10
(<100), HBsAg neg ,test HIV+. HCV+ what is the cause of low anti HBV
1082.
-HIV
1083.
-HCV
1084.
1085.
* double standerd DNA in Nucleuse (i choose B?C double helicle form is buty of DNA in nucleuse ) /
mitochondria?
1086.
1087.
1088.
nurse with ppd positive ,recent conversion...... i put off work and repeat cxr in 6 weeks,...i have seen a
similar word to word question on past papers comments please
1089.
1090.
a young lady with sweaty palms and feet and anxiety symptoms......i put pheo
1091.
1092.
power of study............i choose the last option as they were looking for defination not numbers
1093.
1094.
1095.
1096.
1097.
1098.
lady with oa and painful swollen and tender knee after trauma...hemarthroses...note labs
1099.
1100.
1101.
pictureyndesmophytes......ankolysing spondylitis.
1102.
1103.
1104.
1105.
statin to reduce mortality....as patient had elevated lipids and abnormal stress test not mi.
1106.
1107.
1108.
a case of patient with pain near ear and cheek...findings of horner syndrome.....ans was internal carotid
artrery dissection.
1109.
frontal lobe...perseveration.
1110.
1111.
1112.
which hormone will become deficient in pat with pit microadenoma..normal visualfields....i chose
cortisol.
1113.
1114.
1115.
1116.
a case of anemia in father whose son had fifths dis....parvovirus...pretty classic picture.
1117.
1118.
respidone.....dopamine.receptors
1119.
1120.
a case of pe.....hypotension is the best indication for thrombolytics.ref please see algorithm in ohcm.
1121.
1122.
1123.
1124.
1125.
1126.
1127.
1128.
1129.
flecanide for....wpw.
1130.
1131.
a case of female thyroid cancer survivor......keep same dose....you need to keep them on suppressed tsh
state.
1132.
asthmatic lady still not better on steriod.... i chose add long acting b agonist.
1133.
1134.
1135.
1136.
a lady on hd scenrio.....ans keep same meds.note alumium was under 3 and pth around 74.
1137.
a case of osteomalacia
1138.
1139.
1140.
1141.
1142.
1143.
thanks
1144.
1145.
muttasimGuestmuttasim
1146.
Guest
1147.
1148.
1149.
1150.
1151.
1152.
1153.
1154.
1155.
--------------------------------------------------------------------------------
1156.
1157.
1158.
1159.
1160.
1161.
1162.
1163.
1164.
LATER ON IWILL TRY TO REMEMBER THE OTHER QUESTIONSmuttasim, Sep 12, 2008#132
1165.
GuestGuestRegarding asthma -- the obvious answer is check inhaler technique !! Before you step up
therapy you need to first verify that compliance is adequate !!Guest, Sep 12, 2008#133
1166.
Shere KahnGuestThe asthma question describes a girl who has "episodic wheeze and breathlessness"It does not say she was diagnosed with asthma- This exact question came up in a book of 350 questions
by Helan Fellows- The answer according to them is to do serial PEFR's daily. If she actually has
asthma, this will diagnose her. Otherwise the cause of her symptoms will have to be further evaluated.
If she had asthma obviousl check inhaler technique but she was described as having episodic wheeze
and breathlessness ?related to what...Shere Kahn, Sep 12, 2008#134
1167.
yosefGuestDr. IQTG The answer is Amyotrophic lateral seclerosisyosef, Sep 12, 2008#135
1168.
gursuchiGuestMRCP 2
1169.
1170.
HI
1171.
1172.
1173.
1174.
1175.
1176.
do not know what to choose between Pass Test/Onexamination/Medical Masterclass. Can anyone
please guide?
1177.
1178.
Love
1179.
1180.
1181.
GuestGuestA young girl with worsening episodic wheeze already on beclomethasone 800 bd .... and
still not relieved by it. I think the diagnosis of asthma is pretty clear. peak flow measurements are not
needed if there is a high probability of asthma as in this case. The answer is therefore to check the
inhaler technique.
1182.
1183.
1184.
1185.
Lady with intermitent A.F warfaren will be continued for indifint time.
1186.
1187.
1188.
1189.
Aldronate tabl. taking fasting and not eat for 2 hours...ans Bioavailabilityyosef, Sep 12, 2008#138
1190.
yosefGuestCan any one tell me correct answer for The association with polycystic kidney disease.
Which one was the best answer?yosef, Sep 12, 2008#139
1191.
yosefGuestWhat was the culprit for macular degeneration. my ans was prednisolon ( i thought it will
indirectly cause hyperglycemia and the leads to macular degeneration). Am I right? plz any one can
correct me....yosef, Sep 12, 2008#140
1192.
1193.
1194.
very old lady can not come to the hospital, where to treat
1195.
1196.
1197.
1198.
yosefGuestI hope there will be some comments so that i can know wether i did it correct or not.
1199.
1200.
1201.
Lady with very high BMI,Low FEV1,high RV, Low kco...ans COPD.
1202.
1203.
Lady with follicular carcinoma and suprresed TSH...ans keep med.as it is.
1204.
1205.
1206.
1207.
1208.
This patient had increase tone in both UL and LL I could'nt find any of the LMN sign by any mean
thats why I was a bit reluctant to write AMLS .Also his father had also soem kind of neulogical
problem
1209.
1210.
Can any one justify AMLS is right under these findings PLEASEsalboy, Sep 13, 2008#145
1211.
IQTGGuestSalam Everyone,
1212.
1213.
I discussed this question with my consultants as well as different websites research the result is in deed
Herediry spastic paraparesis b/c in AMLS there is no increase protein in CSF + also there is no sensory
loss and thats not a typical UMN +LMn findings , its just isolated wasting b/c of denervation and there
is no hyporeflexia , no hypotonia and no fasciculations(hallmark of AMLS)
1214.
1215.
1216.
1217.
mokhlesGuestthanks for all ur answers,let us help each other,here is some what i have answered
1218.
1219.
1220.
1221.
1222.
alendronate bioavailability
1223.
nasal steroid for not improving bec she has nasal pklyps
1224.
1225.
bacillus cerius
1226.
plasma exchange
1227.
prot electrophoresis
1228.
1229.
1230.
1231.
1232.
1233.
1234.
dicodeine withdrawal
1235.
1236.
antin sm is sle
1237.
tetanus is vancomycin
1238.
1239.
1240.
hypochondrial
1241.
conversion
1242.
1243.
1244.
preservation in frontal
1245.
ant cerebral a
1246.
catatonia
1247.
ammonium in stone
1248.
1249.
steroid
1250.
1251.
1252.
1253.
1254.
c4 for sle
1255.
competitive inhibition
1256.
1257.
fluxotine is ssri do galactorhea and metocloprom but she take flucxo more
1258.
anular circular
1259.
pemphigus
1260.
herp acyclovir
1261.
1262.
mycoplasma is coldaglutinin
1263.
1264.
rheumatoid d 4
1265.
churgstruss
1266.
cluster headache
1267.
sarcoidosis
1268.
1269.
1270.
i will continue later some one say do i have a chance to passmokhles, Sep 13, 2008#148
1271.
1272.
1273.
1274.
1275.
asiaGuestregarding EAA .
1276.
1277.
1278.
1279.
look , the proper answer is NEUTROPHILIA , which is more common than upper zone shadowing .
1280.
1281.
1282.
1283.
despite that p.karla mentioned EAA as cause number 1 for uper zone shadowing in chronic cases, while
generalized shadowing in acute caes. page 674 & 683 ,asia, Sep 13, 2008#150
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MRCP SEP 2008 RECALLED QUESTIONS
Discussion in 'MRCP Forum' started by dr arif, Sep 10, 2008.
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146.
GuestGuestimportant note
147.
148.
hi all
149.
150.
i think all of you heard or read at the mrcpuk website , about the new marking system which would be
used from our exam mrcp1 sep 2008.
151.
152.
in the new system (EQUATING) ,there is no fix mark for any bof , as the mark depends on the diffiulty
of the question , i.e. a question could carry a range of marking from 1-10 as an example.out of a 999
total mark.
153.
not like the old system , that every BOF could get either 1 or 0 , independtly of question difficulty out
of 200.
154.
155.
the royal college mentioned that this weird system is used in USMLE & cambridge english test ,but
frankly speaking , i want to know , why the RCP wants to compare their selves with a general praction
test , and not even the american board .
156.
157.
also the announment of these changes only 10 days , before the exam , this is totally WRONG , and this
means , the guys who made these changes are never related to academic field , which should take in
concern the psychological status & stress of any doctor going through this tough exam .
158.
159.
in the end , i want to clarify that , there is no more 61 or 65 % pass score , as the result will come up
with pass mark out of 999 ..............
160.
161.
162.
163.
164.
yosefGuestHi
165.
166.
In new marking system, does it mean that we get more marks for answering difficult questions? and
how high? how different from easy questions it will be? I mean is it double? or is it relative to the
difficulty of question. Any one has any idea about how the system will recognize difficult questions?
167.
168.
169.
ssssssssGuestthis new marking is similar to that of australian medical council i guess.there, u get more
marks for clearing MASTERY questions n less marks for the easier ones and ur result comes as a rank
order not in %age.ssssssss, Sep 13, 2008#153
170.
171.
172.
about spastic paraparesis does not affect upper limb by nameGuest, Sep 13, 2008#154
173.
GuestGuestsorry guyz
174.
175.
176.
177.
178.
179.
as the case talked about some tear in the aorta or some thing like that ..
180.
181.
182.
183.
and what the equal dose of prednisolone ???Guest, Sep 13, 2008#155
184.
GuestGuestyehhhhhhhhh
185.
186.
this new system exactly came up at mrcpuk website 12 days before the exam , and this is totally
wrong ,,,
187.
188.
189.
190.
besides that the royal collge , should give sound & clear information about this system , e.g. what is the
mark of the easy or the difficult question or even what the medium ....
191.
192.
and what is the pass mark & how it would be decided, as we knew that every exam carries a pass
mark , but now it is vague & foggy ...
193.
194.
also they should clarify more about the exam time, at their website ,, not let us go & ask the old doc.
who passed the exam , becoz i believe the 1000 $ they are taking from us , is not a cheap price for 2
papers ,,,,Guest, Sep 13, 2008#156
195.
196.
197.
I dont remember the scenario, but I think it was marfan syndrom, and dissections tear could happen in
marfan as well. Thanksyosef, Sep 13, 2008#157
198.
199.
am i right
200.
201.
the question was about the equal dose of glucocorticoids.........Guest, Sep 13, 2008#158
202.
dr.manojGuestHi everybody....
203.
204.
can anyone guess....about what percentage of correct answer should be enough to pass...
205.
206.
In question of pneumonia related SIADH,how we can explain the increased RBS?dr.manoj, Sep 13,
2008#159
207.
GuestGuestHi all,
208.
209.
210.
211.
212.
213.
3)giant cell artereis not responding when loweering dose of perensiioone (was it to add azithiopurine)
214.
4)what kind of cells are seen in gastric cancerGuest, Sep 13, 2008#160
215.
yosefGuestI think signet cell was the answer for gastric cancer. The other questions i dont remember, if
u have more detailes about them, may be I will remember.
216.
217.
For the pneumonia with SIADH, I think the raised B.Sugar was not so high to be the cause of her
hyponatremia as I remember.yosef, Sep 14, 2008#161
218.
koshan13Guestregarding the treatment of acute GOUT with the h/o taking warferin and ??-- i think it is
not prednisolon ----colchicin will be the CORRECT ans. welcome for discusn. thx. best of luck
koshan13, Sep 14, 2008#162
219.
yosefGuestColchicin is very irritant to GIT especialy old age patients on warfaren. I wrote codiene? but
I support now the predisolone answer.yosef, Sep 14, 2008#163
220.
GuestGuestDid you mean goblet cell because i dont think there was an option for signet cell although i
may be wrong.
221.
222.
223.
224.
yosefGuestSignet cell was the last option as remember, because all other options was normal cells
found in stomach not cancer cells anyhow. I think it was signet cell.
225.
226.
227.
About acute gout, may be u are right, i dont know about prednisolon that it is enzyme inducer, but why
it could not be codien? may be my choice will be the right answer at the end!
228.
229.
230.
yosefGuestRetired man farmer developed small translucent nodule soft painless temper area,
transparent what was the culprit?
231.
232.
I wrote prednisolon ( he used predisolon for polymyelgia rheumatica i think). Any one remember that
question. What was the correct answer? Dont tell me the sun!
233.
234.
235.
236.
237.
238.
239.
240.
241.
mmmmmmmmmmmmGueston emedicine it says induced sputum shoud be tried first if negative then
try bal.any suggestions?mmmmmmmmmmmm, Sep 14, 2008#171
242.
Kaposi varicelliform eruption (KVE) is the name given to a distinct cutaneous eruption caused by
herpes simplex virus (HSV) type 1, HSV-2, coxsackievirus A16, or vaccinia virus that infects a
preexisting dermatosis. Most commonly, it is caused by a disseminated HSV infection in patients with
atopic dermatitis.
243.
244.
245.
246.
lets be positive that we will pass and start prep for part 2.
247.
248.
GuestGuestregarding;
249.
250.
251.
252.
i totally agree with u , as the other drugs can coz eye problem , but not inc IOP.
253.
254.
255.
koshan13Guestis there any dedicated and sincere doctor who can spend a bit-long time to make a
refresh list of all the Qs.(sep.08).those already posted by different doctors.???? The Qs, should be
enlisted ,system by system, so the less chance of repitation of the same Qs. It will be helpfull to review
our feedbeck. thx. a lot to everybody. ............Ramadan Kareemkoshan13, Sep 14, 2008#174
256.
koshan13Guestis there any dedicated and sincere doctor who can spend a bit-long time to make a
refresh list of all the Qs.(sep.2008).those already posted by different doctors.???? The Qs, should be
enlisted ,system by system, so that, less chance of repitation of the same Qs. It will be helpfull to
review our feedbeck. thx. a lot to everybody. ............Ramadan Kareemkoshan13, Sep 14, 2008#175
257.
dr.manojGuestdear friends...
258.
259.
260.
1.I read that the most imp feature of RA xray is juxtra articular osteoporosis or resorption ...though
there is also periarticular osteopenia.....both of them were options....which should i chose??
261.
262.
2.a woman presented with resp distress,mild creps,fever....blood pic of hyponatremia and increased
RBS....looks like pneumonia related SIADH but why increased RBS though the RBS range was not
high enough to cause that level of hyponatremia.....
263.
264.
265.
3.A pt with bilateral ankle arthritis,erythema nodosum and fever but nothing mentioned about bilat
lymphadenopathy on CxR which is classic of Loefgren''s synd in sarcoidosis and should not be treated.
266.
267.
268.
269.
270.
271.
272.
273.
274.
4.why not sclerosis in AS xray...though i answered syndesmophyte but sclerosis is also a good option.
275.
276.
277.
278.
279.
280.
http://en.wikipedia.org/wiki/Osteophyte
281.
282.
283.
284.
omar alfarsiGuestI agree, the whole Xray mark of early RA is juxtraarticular osteoporosis. and as it
wasn't one of the options, the closest answer would be periarticular osteopenia. Osteophytosis is a sign
of OA and not RA. Hope this calrifies and end the discussion of this question so that we can focus on
other questions.omar alfarsi, Sep 15, 2008#179
285.
yosefGuestPregnant lady with HELLP/TTP what was the correct answer, Plasma exchange or
Immunoglobulin? Thanks for clarifying this questionyosef, Sep 15, 2008#180
286.
287.
288.
289.
http://www.health.am/encyclopedia/more/vipoma/
290.
291.
292.
293.
294.
295.
296.
297.
298.
as they acclaimed that , plasma pharesis is a complex procedure , need time , so the first thing to do
mean while is Ig , till the Plasma exchange be avilable ( which is not avilable in every hospital in uk )
299.
300.
301.
302.
I agree heterozygot leiden mutation facter 5 is most commen thrombophelia in north europe.
303.
304.
Another nearly similar question was what is the most commen thrombophelia in recurrent dvt at all, I
wrote antithrombin defeciency. I am not sure about the answer. Can any one remember the question
and correct me if wrong. Thanks.yosef, Sep 15, 2008#186
305.
306.
307.
Dear doctors....
308.
After a prolonged effort,I made the list sequentially of my mrcp part 1 questions on september...And I
tried my best and at last could remind 184 questions....the answers i put here is open for discussion.
309.
310.
### GASTROENTEROLOGY :
311.
312.
313.
1.A man develops diarrhoea 2 hour after taking food in a chineese restaurant....BACILLIUS.
314.
315.
316.
317.
318.
4.A pt with abdominal pain,wt loss,history of taking alcohol for long time presents with
steathorrea...inv. should be done....I answered CT abdomen.
319.
320.
5.Dysphagia for solid and liquid,regurgitation and fluid level behind heart on CxR....Achlasia Cardia.
321.
322.
323.
324.
7.A pt with positive faecal occult blood test,perrectal exam normal,most common site...I answered
Sigmoid colon.
325.
326.
327.
328.
329.
330.
331.
332.
333.
334.
335.
336.
337.
338.
14.A pt with suspected IBS...which should not be clinical picture....Abdominal pain waking him from
bed.
339.
340.
15.A pt with alcoholic cirrhosis, mild hepatosplenomegaly on usg has ascities....Bacterial peritonitis.
341.
342.
16.A pt with Gastric carcinoma,cells found....Signet cell though i gave wrong answer of columner cell.
343.
344.
345.
346.
347.
### HAEMATOLOGY :
348.
349.
350.
351.
19.A pt with low back pain,increased calcium and phosphate..inv.to be done...plasma protein
electrophoresis.
352.
353.
354.
355.
356.
357.
358.
359.
360.
361.
362.
363.
364.
27.A woman with bruishing purpura and decreased Plt...Cause is Auto immunity.
365.
366.
367.
30.A 45 yr old pt with bruishing,purpura and increased WBC...i answered AML though I think the ans
should be CML.
368.
369.
32.A pt of IDA,received treatment with oral FeSO4 for 3 month but still Hb at lower normal range and
decreased ferritin...duration of further treatment...I answered 1 month but now i think its 3 month.
370.
33.Poor prognosis of AML....I answered 5 q deletion though now i think it should be Inv-16.
371.
372.
373.
374.
375.
376.
377.
40.A pt suffers dyspnoea while go upstairs..but normal at rest..getting ACEI and Frusemide...factors
improving prognosis...Ans is Bisoprolol though i answered Digoxin( An unwanted mistake)
378.
379.
380.
381.
382.
44.A pt with Ant MI,got heparin and aspirin...before CABG which should be started...I answered
Clopidogrel though still confused about GTN.
383.
384.
385.
386.
387.
388.
47.A pt with dyspnoea,increased JVP,Decreased heart sound...inv should be done...I answered Echo
though confused about CxR to see globular shadow.
389.
390.
### Endocrinology :
391.
392.
48.An athlet going for competition presents with fatigue...which hormone deficient....LH
393.
394.
395.
396.
397.
398.
399.
400.
401.
402.
403.
404.
405.
406.
407.
408.
58.A pt with creps on auscultation,dyspnoea and fever developed hyponatremia and hyperglycemia...i
answered hypothyroid as it is related to Heart failure and Autoimmune DM but probably the ans is
SIADH though that doesnt explain hyperglycemia
409.
410.
411.
412.
60.A pt getting thyroxine for hypothyroid,normal thyroid func now, develops follicular thyroid
ca...treatment options...i chosed stop thyroxine as i thought Follicular ca is a risk of hyperthyroid but
may be the ans is keeping same dose.
413.
414.
415.
416.
62.Most important fact of preventing DM Retinopathy...i chosed inhibit proteinuria but the ans may be
control HbA1C level.
417.
418.
###Neurology :
419.
420.
421.
422.
423.
424.
425.
426.
67.A pt with lost knee and lost sensation of medial side of leg...L4
427.
428.
68.A pt with lost abduction of thumb and lost sensation of flexor surface of forearm...I chosed C 7
lesion but the ans should be median nerve lesion.
429.
430.
431.
432.
70.A pt with unilateral facial palsy and annular rash...inv...Ab for Borrelia
433.
434.
435.
436.
437.
438.
439.
440.
74.A pt with increased reflex of both upper and lower limb with lower limb wasting....Confusing
question...i was wrong to chose CIDP.
441.
442.
443.
444.
445.
446.
77.A pt with pain from back of thigh to leg with lost ankle...Localization is...I answered L5/S1 but may
be S1/S2.
447.
448.
78.A pt unable to move limb before sleep and after waking...sleep paralysis.
449.
450.
79.a pt with High BP,Papilloedema,Mri showing low attenution and hge after sinusitis Rx...Cortical
Vein Thrombosis
451.
452.
###Respiratory :
453.
454.
455.
456.
457.
458.
459.
460.
461.
462.
463.
464.
465.
466.
467.
468.
469.
470.
471.
472.
473.
474.
475.
476.
477.
478.
479.
480.
93.A pt with bilat ankle arthritis,fever,erythema nodosum but no Bilat hilar lymphadenopath
mentioned...i gave wrong answer but no need to treat is debateable.
481.
482.
483.
484.
485.
486.
487.
488.
489.
490.
491.
492.
100.A new analgesic for postsurgical pain control studied on 2 groups....2 sample t test???
493.
494.
495.
### Skin :
496.
497.
498.
499.
500.
501.
502.
503.
504.
105.A pt with rash with raised borderpresent on dorsal aspect of hand...Granuloma annulare.
505.
506.
507.
109.A woman with H/O PC Overdose in the past presents with crusted lesion on upper arm...Dermatitis
Artefacta
508.
509.
510.
511.
###Rheumatology :
512.
513.
514.
515.
516.
517.
113.A pt with foot dro and haematuria and ARF...ab found ..ANCA
518.
519.
520.
521.
522.
523.
116.RA pt Xray feature...I ans Juxtra-articular resorption but i cant remember periarticular osteopenia
was present or not.
524.
525.
117.AS spinal xray..I answered Sclerosis as pt had spinal restriction..but confused about
syndesmophyte.
526.
527.
528.
529.
530.
121.A pt with OA..presents with red,tender,swelled joint after minor trauma....i answered
Haemarthrosis
531.
532.
533.
534.
123.A pt with arm plaster develops unable to abduct shoulder and arm mus atrophy..ans be Axillary
n.injury though i answered amyotrophic n. injury.
535.
536.
###Genetics/Molecular :
537.
538.
539.
540.
541.
542.
543.
544.
545.
546.
547.
548.
549.
550.
130.Most commom condition with Von-Hippel Lindau...i ans Retinal angioma...may be cerebellar
angioblastoma
551.
552.
###Metabolic :
553.
554.
555.
556.
557.
558.
559.
560.
134.A pt with Decreased Calcium and phosphate and Increased ALP...inv is...Though i ans S. PTH
measurement but it should be S.25-OH measure
561.
562.
### Nephrology :
563.
564.
135.A pregnat woman with fragmented RBC and neurological feature(TTP)...plasma exchange
565.
566.
567.
568.
569.
570.
571.
572.
573.
574.
575.
576.
141.A CRF pt gettin AlPO4 as binder but now Phosphate normal...I ans.Stop Phosphate binder &
follow up as i thought Aluminium is toxic
577.
578.
579.
580.
581.
582.
583.
584.
585.
###Immunology :
586.
587.
588.
589.
590.
###Phychiatry :
591.
592.
593.
150.A woman dont go outside due to fear of embarrasment...I ans Personality disorder...i am confused
594.
595.
596.
597.
152.A pt with repeatative dream of fire accident where his friend died..Post traumatic stress disorder
598.
599.
153.A pt fearing of having bird flu with birds flying outside her house and pre-occupated...i ans
specific phobia
600.
601.
154.A pt with increased tone in hand & feet,concious but mute..i ans Factitious disorder though may be
catatonia
602.
603.
604.
605.
606.
607.
###Infectous Disease :
608.
609.
610.
611.
612.
613.
614.
615.
616.
617.
163.A pt with penicillin,fluclox resistant cellulitis...I ans Gentamicin as i thought Clindamycin is used
in Toxic Shock Synd due to gm +ve cocci
618.
619.
164.A tooth extraction pt present with jaw pain...i ans fungal infection but its probably wrong..the
options..temperomandibular arthritis..
620.
621.
622.
623.
### Pharmacology :
624.
625.
626.
627.
167.Antiemetic in cancer...Granisetron
628.
629.
630.
631.
632.
633.
634.
635.
636.
637.
638.
639.
640.
641.
642.
643.
644.
645.
180.Cause of HBV vaccine failure in a HIV and HCV pt with Methadone taking history...ans is HIV
though i ans Methadone
646.
647.
648.
649.
182.Haemodialysis resistance...Increase protein bound though i was wrong to give low vol of
distribution/
650.
651.
###Opthalmology :
652.
653.
654.
655.
2-lady with anemia , to be checked 6 months, but she already has been on previous 3 , so the answere is
3 months not 6 months.
656.
657.
4-regarding that case of aphasia with leg paralysis , i thinl it is ant. cerebral art. as the leg very very
very very rare be affect in MCA
658.
5-the case of 3rd,6th plus opthalmic , it was a a orbital apex, not cavernous, as in typical cavernous ,
there should be congestion & ....
659.
660.
661.
i.e. meta analysis , not do a full cohort or case control , becoz of 1 side effect .
662.
7-old aged man with round lesion on temporal region with red,smooth edge
663.
664.
8- double strand DNA , it was nucleus not mitochondrai , which is single strand. ( you can check it on
the web) .
665.
666.
667.
668.
11-A pt restless due to intracranial metastasis of Malignant Melanoma...drug for restless ,, why not
chloropromazine???
669.
670.
671.
672.
673.
674.
answere ANGIOPOETIN
675.
676.
3-Glucokinase activity in the brain is different to that in the gut: secondary to affinity
677.
i think the answer is the presence of the CO FACTOR , as if you focus in the question , it mentioned
that peripheral glucokinase , only acts when there is glucose , which is the co factor ....( i guess so ) ..
Guest, Sep 16, 2008#190
678.
679.
680.
681.
682.
However:
683.
684.
1. Checking the wikipedia for cohort studies..."In medicine, a cohort study is often undertaken to obtain
evidence to try to refute the existence of a suspected association between cause and disease; failure to
refute a hypothesis strengthens confidence in it. Crucially, the cohort is identified before the
appearance of the disease under investigation. The study groups, so defined, are observed over a period
of time to determine the frequency of new incidence of the studied disease among them.
685.
686.
687.
688.
3. In the Addissonian Crisis question the patient was already HYPOGLYCAEMIC with a BM<3 it was
2.4 or something, so immediate action would be IV DEXTROSE with the HYDROCORTIZONE?
689.
690.
691.
692.
5. THE COPD patient had a PH<7.3 so does he meet the requirements for LTOT?
693.
694.
6. WHERE DID YOU FIND ABOUT HOW much time does the nurse with the TB exposure, nees off
work since she takes isoniazid prophylaxis. Why not nothing??
695.
696.
697.
698.
8. GOUT, I am afraid that the guidelines does not rule out NSAIDs which is the treatment of choise.
They just state that the patient needs more regular INR monitoring in such case.
699.
700.
9. Biphosphonate are not easily absorbed by stomach and small intestine so that's why they are given
without meals (so the answer must be bioavailability and not side effects). I got it wrong because I
wrote side effects
701.
702.
10. the man with the catatonic features has STUPOR (he is mute!!!), so I put schizophrenic stupor as
the answer, because catatonia refers to the posture. Actually stupor is a subtype of catatonia. Check
wikipedia.
703.
704.
11. The question about prednisolone and daily glucocorticosteroide needs? How much prednisole do
we need to replace the total daily glucocortisteroid in the body?
705.
706.
707.
However in more that 140 questions I agree with Dr Manoj with confidence so hopefully we will pass.
MRCP-PART1, Sep 16, 2008#191
708.
709.
710.
I agree that they were at least 10 questions different in my paper, howver, I just wanted to clarify few
points for once and for all:
711.
712.
respiridone is an atypical antipsychotics, which means that the main function is to block D2 dopamine
receptors (that's why they are antipsychotic and not antidepressants: selectively blocks the limbic
dopamine pathway). Any other actions on 5HT or any other receptor is secondary, if you want to argue
otherwise check the pharmacology books not oxford handsbook.
713.
714.
715.
716.
Palliative care for restlessness (brain mets): S/C midazolam: if you disagree check the handbook of
palliative medicine, I even asked a consultant in palliative medicine about it
717.
Hope this clarifies some questions, eventhough I got some of them wrongomar elfarsi, Sep 16, 2008
#192
718.
koshan13Guest1st of all i am very much thankful to DR. manoj for making such a wonderful task,
which is realy too hard ....There is no room for doubt that he will PASS , he is trualy very talent , and
he deserves it . I am giving congrads, in advance, to him. Best of ur luck. thanks----- Dr. koshan
koshan13, Sep 16, 2008#193
719.
koshan13Guest3 Qs. i would like to add to DR. manoj............ 185. a" wave in the JVP corresp. with
----atrial contraction(CORRECT ans. ) 186. a pt. with urinary loss of Na , and other elects. with kidney
function is normal-----diagnosis--CAH(CORRECT ans.) 187. regarding BIH----Which drug is
responsible---prednisolon ( CORRECT ans. ) .......field is open for discus. thx.
720.
721.
722.
723.
724.
725.
dr.manojGuestDear doctors...
726.
727.
Actually,I also noticed some difference with some other questions which didnt appear in my
paper...like...
728.
729.
Anyway...specially thanx to dr.Koshan for wishing me luck....but i am not enough confident to pass as
bcos the answer in fact depends upon wht the RCP think...as in many questions there is 2 dependable
answer with positive points in favour of both....like
730.
731.
Function of metformin...
732.
Xray finding of RA
733.
Xray of AS
734.
735.
736.
737.
koshan13Guestattent. dr. manoj/ from my shallow knowledge, i would like to clarify some Qs. -------1.
740.
741.
742.
q-pt nurse exposed to TB Pt. her Mantouse test was positive ,but xray chest negative .BCG history not
known-------looks to be latent TB ---no need to quit from job b/c Latent TB is non- infectiousetahseen
sabzwari, Sep 17, 2008#199
743.
744.
745.
dialysis pt increase mortility ---- coronary vascular diseasestahseen sabzwari, Sep 17, 2008#200
MRCP SEP 2008 RECALLED QUESTIONS
Discussion in 'MRCP Forum' started by dr arif, Sep 10, 2008.
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368.
koshan13Guestdr. tahseen/
369.
for haemodialysis case----the cause of death is cardiac disease , but this is more common in congest.
CARDIOMYOPATHY then to overt myocardial infarc.(coron. art. disease)------ref. P.kalra --page491.
Again regarding TB---- That nurse after taking a course of INH , she should be take also BCG
-----before going for her job. ...ref. P. KUMAR--6th ...page-934koshan13, Sep 17, 2008#201
370.
koshan13Guestdr. tahseen/
371.
for haemodialysis case----the cause of death is cardiac disease , but this is more common in congest.
CARDIOMYOPATHY then to overt myocardial infarc.(coron. art. disease)------ref. P.kalra --page491.
Again regarding TB---- That nurse after taking a course of INH , she should be taken also BCG
-----before going for her job. ...ref. P. KUMAR--6th ...page-934
372.
373.
374.
375.
376.
377.
which is ;
378.
379.
380.
381.
382.
383.
384.
385.
dr.manojGuestDear Dr.Koshan...
386.
Thanx for ur reply regarding those confusing questions which doesnt indicate at all ur shallo
knowledge.
387.
388.
Regarding xray of RA...I answered juxtra articular resorption..which was in my option list and i
thought a lot during exam to chose it rather than periarticular osteoporosis.
389.
Regarding xray of AS,I will be happy if the answer is sclerosis which i answered...i didnt collect any
satisfactory answer from anywhere but most of the doctors in this forum is saying the ans as
syndesmophyte.
390.
I also found that bisphosphonate is given bfore meal to increase its bioavailability from a google search
option about bisphosphonate...sorry,i forgot the site name...
391.
392.
Anyway...thanx a lot,dear.
393.
394.
395.
koshan13Guestattention to MRCP-UK candidate/ hai how r ??? i know 2 conditions --for antihypertensive resistent ------1. renovascular disease 2. According to the sinerio , mantioned in that Qs.
----the CORRECT ans. is going towards---RENOVASCULAR DISEASE. The similar Qs. i found in
passmedicine also . thanks. best of your luck.
396.
397.
398.
399.
400.
Hi all
401.
402.
I was surfing the RCP website, and I saw that notice about the marking system.
403.
Then I downloaded the related page & showed it to my friend, who is a lecturer in maths & statistics.
404.
405.
First of all, he said this system is one of the best ways to deceive and make the candidate fail in the
exam.
406.
407.
408.
409.
He said in word; in this system , it does not matter the quantity of the question u answer right, as the
most important is the quality ( type) of the question ,
410.
411.
He mentioned that in this system you will find a lot of easy question (this is applicable for our Sep
exam),
412.
e.g. the true percent of easy questions is 65% on the exam papers, yet even if you answer all the easy
questions correct, you will get only 30% of the total mark, as in the same time, we suppose that the
medium/hard difficulty question forms about 25%, so if you answer them all correct, you can ensure
more than 50% of the total mark.
413.
414.
In another word, if you made a single mistake in hard type questions, this could equal to burning 5-10
questions from the easy type.
415.
416.
And this can prove how dangerous this system , on us ,as doctors , and he said more , this system
,should not be applicable for doctors or vital fields as simple mistakes can lead to fatal consequences,
besides that , there is no such big benefit of comparing doctors among different years, as they would all
carry the name of the MRCP ,
417.
418.
419.
420.
421.
422.
423.
424.
425.
426.
dr.manojGuestDear doctors..
427.
As far I read and understood the equating system of MRCP ...they will take into account the to tal
number of correct questions answered and relative difficulty of the exam...not the difficulty of the
question.
428.
They introduced this rule to make clarification about the quality of the students who passed with a
different score in two different difficult exam e.g.score 65% in May,2008 and with 75% in sep,2008...
429.
So they want to avoid the misinterpretation of good marks of a relatively easy exam....according to the
431.
432.
Instead of a percentage overall score, candidates will now be given an overall scaled
433.
score. This score is a number between 0 and 999, which is calculated from the number of
434.
questions a candidate has answered correctly (out of the maximum possible) and takes
435.
into account the relative difficulty of the examination. Since no two examinations contain
436.
the same questions, it is inevitable that some papers may be slightly harder (or easier)
437.
438.
439.
440.
441.
442.
443.
444.
445.
Any body has an idea when the results appear on the website?yosef, Sep 18, 2008#208
446.
burningi_ceGuestresult ll appear on the week comemncing on 6th of Octburningi_ce, Sep 18, 2008
#209
447.
DR/ ALIGuestpt with increase joint laxity with cardiac murmur it Ehler Danlos syndrome the defect in
collagen type 1DR/ ALI, Sep 18, 2008#210
448.
449.
450.
hello all!
451.
This is dr. Rifat graduate 2005,i shall b very thankful if someone help me out of my confusion. I know
that the requiremnet for paces is 2 and half yr experince...can any anyone plz tell me what kind of
experince is required 4 elgibilty? is it any experice as a medical officer or it must b a residency?
452.
plz plz plz ans my query ...A lot of thanks in advaceGuest, Sep 18, 2008#211
453.
454.
455.
However I disagree with the answer to the post-chemo vomiting question...I think the correct answer is
dexamethasone as the question referred to delayedemesis...for 3 days.
456.
457.
Any one know are the RCP going to equate this exam with the previous ones? Something about a
committee of medical experts deciding the pass mark based on their assessment of the difficulty of this
sep 08 exam...
458.
459.
I had thought that it was simply the top 33% of candidates through, with the passmark calculated
accordingly.
460.
461.
All in all, that was a very tough exam, and I think the new equating system won't help any..
462.
463.
464.
465.
466.
467.
as not all the doctors are muslims,neither all the locations all over the world got muslim patinets
468.
469.
470.
dr_vikasGuestMRCP exam
471.
472.
i feel that there were some questions which were different in different papers..
473.
474.
and these are the questions which have probably been put up for reseach purpose..
475.
476.
these will not be marked and so if someone have answered these questions wrong... no need to worry
too much dr_vikas, Sep 19, 2008#214
477.
sandstormGuestdr. vikas,
478.
479.
480.
481.
482.
badriGuestOmar Alfarsi
483.
484.
Hi
485.
486.
Omar Alfari would you please share with u which questions u found to be different in ur exams
487.
488.
489.
mmGuestcpr ratio
490.
hydroxyurea?mech of action
491.
492.
hypercholeremic acidosis
493.
transtuzemab
494.
ankyolostoma
495.
i noticed that no one recalled these questions so only i got them i guessmm, Sep 19, 2008#217
496.
497.
and the pt who have hemiparesis and sensory loss at brt side of body and hyperreflexia at 4 limbs
where is the site of lesion
498.
and the pt who have sensory defect where ct show hyperlucence with 3 hgs inside 3 of those lesions
what was the diagnosis
499.
500.
GuestGuestDear Dr.Mokhles...
501.
Thanx for ur msg...No,I didnt pay on net for any as passmed is a free site and i had Q book of onexam
and pastest...
502.
The questions appeared on the exam...i think if anyone after completing ohcm and kalra,carefully solve
the question...he should find the exam with common questions...
503.
Anyway...the answers i mentioned there may be wrong as the answers depend on rcp.
504.
505.
middle cerebral art stroke,no need to treat for sarcoidosis,drugs used in cellulitis....and still confused
with the answer of xray finding of RA and AS...
506.
the questions u asked r among those confusing questions....dnt be depressed dear....just pray to god for
everyone....Guest, Sep 22, 2008#232
507.
508.
509.
510.
511.
512.
513.
514.
http://en.wikipedia.org/wiki/Anterior_cerebral_artery#Occlusion
515.
516.
517.
518.
519.
520.
http://www.emedicine.com/pmr/topic77.htm
521.
522.
thanxxxxxxxxxxxxxx
523.
524.
525.
guest,GuestDear mukhlus
526.
527.
I cant really recall any of the question u have mentioned. I dont think these were in my paper. Perhaps
these were research questions as some other questions were also not in all of candidates' exam.guest,,
Sep 22, 2008#234
528.
529.
GuestGuestOcclusion of the anterior cerebral artery may result in the following defects
530.
531.
Paralysis of the contralateral foot and leg Sensory loss in the contralateral foot and leg
532.
533.
Gait apraxia
534.
Urinary incontinence which usually occurs with bilateral damage in the acute phase
535.
536.
537.
538.
1-Main trunk occlusion of either side yields contralateral hemiplegia, eye deviation toward the side of
the MCA infarct, contralateral hemianopia, and contralateral hemianesthesia.
539.
2-Superior division infarcts lead to contralateral deficits with significant involvement of the upper
extremity and face and partial sparing of the contralateral leg and foot.
540.
541.
4- Finally, resultant temporal lobe damage can lead to an agitated and confused state.
542.
543.
544.
545.
546.
547.
sources;
548.
549.
http://en.wikipedia.org/wiki/Anterior_cerebral_artery
550.
http://www.emedicine.com/neuro/TOPIC16.HTM#section~Clinical (ACA)
551.
552.
553.
554.
555.
GuestGuestHi Guest...
556.
557.
558.
559.
560.
561.
562.
563.
564.
565.
566.
567.
568.
569.
570.
571.
572.
GuestGuestdear Dr manoj
573.
574.
despite that this topic was viewed by more that 8000 times, but the doctors who are participating are
less than 10
575.
576.
really SELFISH ,
577.
578.
579.
580.
581.
582.
583.
http://en.wikipedia.org/wiki/Ankylosing_spondylitis#Prognosis
584.
585.
586.
587.
588.
589.
590.
591.
3-Hba1c, minimum 2-3 months, andi i remember that the possible choice was 3 months,, not 1 month.
592.
593.
594.
595.
596.
597.
598.
599.
infact the word , was not uptake , it was some thing else, i can not remember.
600.
601.
602.
603.
604.
605.
606.
607.
in the end , welcome , hope we continue discussion about the exam .Guest, Sep 22, 2008#239
608.
609.
610.
i think all of you read the 182 questions, which was laid by one of the members,
611.
612.
just wander , how was your right perceent from these question , or what is your wrong
percent ???????????
613.
614.
615.
616.
617.
618.
619.
620.
by the way my correct answers is between 110- 120 i pray to all to passmokhles, Sep 22, 2008#242
621.
GuestGuestDear Guest,,
622.
623.
I am sure that i answered juxtraarticular resorption...for xray of RA...on the contrary cant remind about
the option of periarticular osteopenia...
624.
625.
The exact word for function of metformin...increase peripheral uptake disposal...is this the right
answer?but some books say that decrease hepatic glucose output is primary....
626.
627.
628.
629.
1.cause of 3rd,4th and opthalmic div of 5th nerve palsy...cavernous sinus or orbital apex....
630.
631.
2.Faecal OBT more positive in Caecal or sigmoid....sigmoid is the more common site for colonic ca....
632.
633.
I hope to get 140...but according to new scoring system...i am not expecting to pass...
634.
635.
636.
GuestGuesthello dr.manoj
637.
638.
do u know, that you are from the few members that keeps me to surf this forum , which is filled with
SELFISH members
639.
640.
ok
641.
642.
643.
1- i am sure that , there was no juxta artic, in my papers , as i asked my friend, who sat with me , no
JUXTA , only periartic osteopenia.
644.
645.
646.
647.
648.
metformin do both
649.
650.
651.
652.
3- it was orbital apex.... as no congestion ,which occures in cav. sinus, plus the eye pain .
653.
654.
655.
656.
as now in the last few years, the colonic cancers, has shifted from the left side to the right side ,
657.
i.e. more common in right ( cecum & ascending ) i.e. more difficult 2 dx.
658.
659.
660.
661.
ok ,,,,,,,,,,
662.
663.
thanxxxxxxxxxxx
664.
665.
666.
667.
668.
669.
670.
is this passing mark , according to the example in RCP notes about the new marking system ????
671.
672.
673.
guest,GuestDr Manoj is not expecting to pass with 140 but I would pass with 125 8) 8)guest,, Sep 23,
2008#246
674.
muttasimGuesti have 130 to 140 answer according to manjo answer is correct ( from 184 answers )
muttasim, Sep 23, 2008#247
675.
GuestGuestI get the impression from these figures that it was an easy exam or is it that only few of u r
getting such high figures,please post how may other people r getting :roGuest, Sep 23, 2008#248
676.
GuestGuestDear doctors..
677.
actually the thing is that with the new scoring system...some will fail with 140 correct questions and
some will pass with 125 correct ques only as all the question doesnt bear the same mark...
678.
679.
680.
681.
anyway...i had noticed that this MRCP 2008 RECALL QUESTION is the biggest of all post in this
forum and it is also inspiring for the participants that only in this time..we became able to solve most
questions of mrcp this time...
682.
683.
684.
685.
686.
687.
688.
if we feel that system is tough so better for us to be tough and comptent doctors rather than fear of
unknown
689.
690.
we need this MRCP and we need to be good physician. :lol: :lol: :arrow:Guest, Sep 23, 2008#250
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215.Discussion in 'MRCP Forum' started by dr arif, Sep 10, 2008.
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229.
koshan13Guestdr. tahseen/
230.
for haemodialysis case----the cause of death is cardiac disease , but this is more common in congest.
CARDIOMYOPATHY then to overt myocardial infarc.(coron. art. disease)------ref. P.kalra --page491.
Again regarding TB---- That nurse after taking a course of INH , she should be take also BCG
-----before going for her job. ...ref. P. KUMAR--6th ...page-934koshan13, Sep 17, 2008#201
231.
koshan13Guestdr. tahseen/
232.
for haemodialysis case----the cause of death is cardiac disease , but this is more common in congest.
CARDIOMYOPATHY then to overt myocardial infarc.(coron. art. disease)------ref. P.kalra --page491.
Again regarding TB---- That nurse after taking a course of INH , she should be taken also BCG
-----before going for her job. ...ref. P. KUMAR--6th ...page-934
233.
234.
235.
236.
237.
238.
which is ;
239.
240.
241.
242.
243.
244.
245.
246.
dr.manojGuestDear Dr.Koshan...
247.
Thanx for ur reply regarding those confusing questions which doesnt indicate at all ur shallo
knowledge.
248.
249.
Regarding xray of RA...I answered juxtra articular resorption..which was in my option list and i
thought a lot during exam to chose it rather than periarticular osteoporosis.
250.
Regarding xray of AS,I will be happy if the answer is sclerosis which i answered...i didnt collect any
satisfactory answer from anywhere but most of the doctors in this forum is saying the ans as
syndesmophyte.
251.
I also found that bisphosphonate is given bfore meal to increase its bioavailability from a google search
option about bisphosphonate...sorry,i forgot the site name...
252.
253.
I was surfing the RCP website, and I saw that notice about the marking system.
254.
Then I downloaded the related page & showed it to my friend, who is a lecturer in maths & statistics.
255.
256.
First of all, he said this system is one of the best ways to deceive and make the candidate fail in the
exam.
257.
258.
259.
260.
He said in word; in this system , it does not matter the quantity of the question u answer right, as the
most important is the quality ( type) of the question ,
261.
262.
He mentioned that in this system you will find a lot of easy question (this is applicable for our Sep
exam),
263.
e.g. the true percent of easy questions is 65% on the exam papers, yet even if you answer all the easy
questions correct, you will get only 30% of the total mark, as in the same time, we suppose that the
medium/hard difficulty question forms about 25%, so if you answer them all correct, you can ensure
more than 50% of the total mark.
264.
265.
In another word, if you made a single mistake in hard type questions, this could equal to burning 5-10
questions from the easy type.
266.
267.
And this can prove how dangerous this system , on us ,as doctors , and he said more , this system
,should not be applicable for doctors or vital fields as simple mistakes can lead to fatal consequences,
besides that , there is no such big benefit of comparing doctors among different years, as they would all
carry the name of the MRCP ,
268.
269.
270.
271.
272.
273.
274.
275.
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dr.manojGuestDear doctors..
278.
As far I read and understood the equating system of MRCP ...they will take into account the to tal
number of correct questions answered and relative difficulty of the exam...not the difficulty of the
question.
279.
They introduced this rule to make clarification about the quality of the students who passed with a
different score in two different difficult exam e.g.score 65% in May,2008 and with 75% in sep,2008...
280.
So they want to avoid the misinterpretation of good marks of a relatively easy exam....according to the
relative difficulty ....
281.
282.
283.
Instead of a percentage overall score, candidates will now be given an overall scaled
284.
score. This score is a number between 0 and 999, which is calculated from the number of
285.
questions a candidate has answered correctly (out of the maximum possible) and takes
286.
into account the relative difficulty of the examination. Since no two examinations contain
287.
the same questions, it is inevitable that some papers may be slightly harder (or easier)
288.
289.
290.
291.
292.
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Any body has an idea when the results appear on the website?yosef, Sep 18, 2008#208
297.
burningi_ceGuestresult ll appear on the week comemncing on 6th of Octburningi_ce, Sep 18, 2008
#209
298.
DR/ ALIGuestpt with increase joint laxity with cardiac murmur it Ehler Danlos syndrome the defect in
collagen type 1DR/ ALI, Sep 18, 2008#210
299.
300.
301.
hello all!
302.
This is dr. Rifat graduate 2005,i shall b very thankful if someone help me out of my confusion. I know
that the requiremnet for paces is 2 and half yr experince...can any anyone plz tell me what kind of
experince is required 4 elgibilty? is it any experice as a medical officer or it must b a residency?
303.
plz plz plz ans my query ...A lot of thanks in advaceGuest, Sep 18, 2008#211
304.
305.
306.
However I disagree with the answer to the post-chemo vomiting question...I think the correct answer is
dexamethasone as the question referred to delayedemesis...for 3 days.
307.
308.
Any one know are the RCP going to equate this exam with the previous ones? Something about a
committee of medical experts deciding the pass mark based on their assessment of the difficulty of this
sep 08 exam...
309.
310.
I had thought that it was simply the top 33% of candidates through, with the passmark calculated
accordingly.
311.
312.
All in all, that was a very tough exam, and I think the new equating system won't help any..
313.
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315.
316.
317.
318.
as not all the doctors are muslims,neither all the locations all over the world got muslim patinets
319.
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dr_vikasGuestMRCP exam
322.
323.
i feel that there were some questions which were different in different papers..
324.
325.
and these are the questions which have probably been put up for reseach purpose..
326.
327.
these will not be marked and so if someone have answered these questions wrong... no need to worry
too much dr_vikas, Sep 19, 2008#214
328.
sandstormGuestdr. vikas,
329.
330.
331.
332.
333.
badriGuestOmar Alfarsi
334.
335.
Hi
336.
337.
Omar Alfari would you please share with u which questions u found to be different in ur exams
338.
339.
340.
mmGuestcpr ratio
341.
hydroxyurea?mech of action
342.
343.
hypercholeremic acidosis
344.
transtuzemab
345.
ankyolostoma
346.
347.
and the pt who have hemiparesis and sensory loss at brt side of body and hyperreflexia at 4 limbs
where is the site of lesion
348.
and the pt who have sensory defect where ct show hyperlucence with 3 hgs inside 3 of those lesions
what was the diagnosis
349.
350.
351.
352.
353.
354.
355.
http://en.wikipedia.org/wiki/Anterior_cerebral_artery#Occlusion
356.
357.
358.
359.
360.
361.
http://www.emedicine.com/pmr/topic77.htm
362.
363.
thanxxxxxxxxxxxxxx
364.
365.
366.
guest,GuestDear mukhlus
367.
368.
I cant really recall any of the question u have mentioned. I dont think these were in my paper. Perhaps
these were research questions as some other questions were also not in all of candidates' exam.guest,,
Sep 22, 2008#234
369.
CORRECT ans . is MCR ............ thx. dr. koshankoshan13, Sep 22, 2008#235
370.
GuestGuestOcclusion of the anterior cerebral artery may result in the following defects
371.
372.
Paralysis of the contralateral foot and leg Sensory loss in the contralateral foot and leg
373.
374.
Gait apraxia
375.
Urinary incontinence which usually occurs with bilateral damage in the acute phase
376.
377.
378.
379.
1-Main trunk occlusion of either side yields contralateral hemiplegia, eye deviation toward the side of
the MCA infarct, contralateral hemianopia, and contralateral hemianesthesia.
380.
2-Superior division infarcts lead to contralateral deficits with significant involvement of the upper
extremity and face and partial sparing of the contralateral leg and foot.
381.
382.
4- Finally, resultant temporal lobe damage can lead to an agitated and confused state.
383.
384.
385.
386.
387.
388.
sources;
389.
390.
http://en.wikipedia.org/wiki/Anterior_cerebral_artery
391.
http://www.emedicine.com/neuro/TOPIC16.HTM#section~Clinical (ACA)
392.
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GuestGuestHi Guest...
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GuestGuestdear Dr manoj
414.
415.
despite that this topic was viewed by more that 8000 times, but the doctors who are participating are
less than 10
416.
417.
really SELFISH ,
418.
419.
420.
421.
422.
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http://en.wikipedia.org/wiki/Ankylosing_spondylitis#Prognosis
424.
425.
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427.
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431.
432.
3-Hba1c, minimum 2-3 months, andi i remember that the possible choice was 3 months,, not 1 month.
433.
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437.
438.
439.
440.
infact the word , was not uptake , it was some thing else, i can not remember.
441.
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445.
446.
447.
448.
in the end , welcome , hope we continue discussion about the exam .Guest, Sep 22, 2008#239
449.
450.
451.
i think all of you read the 182 questions, which was laid by one of the members,
452.
453.
just wander , how was your right perceent from these question , or what is your wrong
percent ???????????
454.
455.
456.
457.
458.
459.
460.
461.
by the way my correct answers is between 110- 120 i pray to all to passmokhles, Sep 22, 2008#242
462.
GuestGuestDear Guest,,
463.
464.
I am sure that i answered juxtraarticular resorption...for xray of RA...on the contrary cant remind about
the option of periarticular osteopenia...
465.
466.
The exact word for function of metformin...increase peripheral uptake disposal...is this the right
answer?but some books say that decrease hepatic glucose output is primary....
467.
468.
469.
470.
1.cause of 3rd,4th and opthalmic div of 5th nerve palsy...cavernous sinus or orbital apex....
471.
472.
2.Faecal OBT more positive in Caecal or sigmoid....sigmoid is the more common site for colonic ca....
473.
474.
I hope to get 140...but according to new scoring system...i am not expecting to pass...
475.
476.
477.
GuestGuesthello dr.manoj
478.
479.
do u know, that you are from the few members that keeps me to surf this forum , which is filled with
SELFISH members
480.
481.
ok
482.
483.
484.
1- i am sure that , there was no juxta artic, in my papers , as i asked my friend, who sat with me , no
JUXTA , only periartic osteopenia.
485.
486.
487.
488.
489.
metformin do both
490.
491.
492.
493.
3- it was orbital apex.... as no congestion ,which occures in cav. sinus, plus the eye pain .
494.
495.
496.
497.
as now in the last few years, the colonic cancers, has shifted from the left side to the right side ,
498.
i.e. more common in right ( cecum & ascending ) i.e. more difficult 2 dx.
499.
500.
501.
502.
ok ,,,,,,,,,,
503.
504.
thanxxxxxxxxxxx
505.
506.
507.
508.
509.
510.
511.
is this passing mark , according to the example in RCP notes about the new marking system ????
512.
513.
514.
guest,GuestDr Manoj is not expecting to pass with 140 but I would pass with 125 8) 8)guest,, Sep 23,
2008#246
515.
muttasimGuesti have 130 to 140 answer according to manjo answer is correct ( from 184 answers )
muttasim, Sep 23, 2008#247
516.
GuestGuestI get the impression from these figures that it was an easy exam or is it that only few of u r
getting such high figures,please post how may other people r getting :roGuest, Sep 23, 2008#248
517.
GuestGuestDear doctors..
518.
actually the thing is that with the new scoring system...some will fail with 140 correct questions and
some will pass with 125 correct ques only as all the question doesnt bear the same mark...
519.
520.
521.
522.
anyway...i had noticed that this MRCP 2008 RECALL QUESTION is the biggest of all post in this
forum and it is also inspiring for the participants that only in this time..we became able to solve most
questions of mrcp this time...
523.
524.
525.
526.
527.
528.
529.
if we feel that system is tough so better for us to be tough and comptent doctors rather than fear of
unknown
530.
531.
we need this MRCP and we need to be good physician. :lol: :lol: :arrow:Guest, Sep 23, 2008#250
Search Forums
b.
Recent Posts
Forums
558.
559.
Resources
560.Log in or Sign up
561.
562.
563.Forums
564.>
565.UK Medical Zone
566.>
567.MRCP Forum
568.>
569.MRCP SEP 2008 RECALLED QUESTIONS
570.Discussion in 'MRCP Forum' started by dr arif, Sep 10, 2008.
571.
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would you mind plz , to mention ; is there other mrcp 1 forums , else than
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RXPGONLINE . COM
588.
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591.
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would you mind plz , to mention ; is there other mrcp 1 forums , else than
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R X P G O N L INE . COM
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would you mind plz , to mention ; is there other mrcp 1 forums , else than
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R X P G O N L INE . COM
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GuestGuestI think cutoff for passing would be around 630/999.Guest, Sep 23, 2008#254
611.
612.
613.
614.
615.
616.
ie. you can not expect what is the mark for any specific question ,
617.
which is determinded my the exam difficulty , which is by the way , determined by RCP only
618.
619.
and even the example mentioned at RCP website , about the 140 (70%) correct , is not clear, neither
623.
GuestGuestit cannot be this high ,it was a tough exam so probably close to 550Guest, Sep 23, 2008
#256
624.
625.
626.
627.
628.
sorry can u plz clarify from where u made this number??Guest, Sep 23, 2008#257
629.
630.
Sorry dear...i dnt know anything else site for mrcp...to say frankly...even i heard the name of rxpgonline
from u and just registered there as one member in the name mithun123.
631.
632.
633.
634.
635.
mokhlesGuestthe q say frnakly there is no proptosis thats why it is cavernous definitely not orbital apex
mokhles, Sep 23, 2008#259
636.
637.
638.
Classic presentations are abrupt onset of unilateral periorbital edema, headache, photophobia, and
proptosis.
639.
640.
641.
642.
643.
644.
http://en.wikipedia.org/wiki/Cavernous_sinus_thrombosis#Clinical_Features
645.
646.
647.
648.
649.
650.
http://en.wikipedia.org/wiki/Superior_orbital_fissure
651.
652.
653.
i.e. THE PROPER ANSWER IS ORBITAL FISSURE SYNDREOME , As in the exam scenario , there
was no congestion or peri-orbital odema, which is 100% diagnostic of cavernous sinus thrombosis
Guest, Sep 23, 2008#260
654.
GuestGuestn.b
655.
656.
you can not depends on the proptosis , as a cut point , as it may not be appearant in cavernus sinus
thrombosis , till late time ,
657.
658.
659.
660.
661.
bbbbbbbbbGuesttheres a trick to finding ur result.apply for the jan diet on 26th.if ur application is
accepted it means u ve failedbbbbbbbbb, Sep 23, 2008#262
662.
GuestGuestsorry dude
663.
664.
665.
666.
667.
668.
GuestGuestDear doctors...
669.
as far i remember there was orbital apex as an option in the question which is quite impossible due to
absence of blindness...
670.
actually this one is a confusing question as the question only says about 3rd,4th and opthalmic division
of 5 th nerve palsy...no mention of blindness or exopthalmos which is hallmark of orbital apex or there
was no congestive feature mentioned which is a feature of cavernous sinus...
671.
672.
673.
674.
675.
676.
mokhlesGuestabd x ray is the initial and ct abdomen is diagnosticmokhles, Sep 24, 2008#266
677.
GuestGuestno ct abdomen
678.
679.
680.
681.
682.
683.
do you want the patient ,to have BLINDNESS ,till you diagnose him :shock: ????????? !!!!!!
684.
685.
686.
687.
688.
689.
690.
omar alfarsiGuestI agree, there was a similar question in YDR for chronic pancreatitis and the answer
was CT abdomen.omar alfarsi, Sep 24, 2008#270
691.
GuestGuestDear guest...
692.
I dnt want my pt to be blind to diagnose orbital apex synd...but the fact is that visual loss is a hallmark
of orbital apex....opthaloplegia and visual loss is the most common initial presentation of orbital
apex...i have tried a lot of websites and here is one of the address...u can also check emedicine...orbital
apex syndrome
693.
694.
http://www.sepeap.es/revisiones/archivos/10126.pdf
695.
696.
697.
Though xray abd can show calcification in 30% cases...but that is an incidental finding...not used to
diagnose or confirm chr.pancreatitis.
698.
699.
700.
701.
702.
703.
704.
GuestGuestHi dr.Koshan..
705.
I mailed u at koshan13@yahoo.com but no response yet...r u busy ...i am waiting for ur response
dear....Guest, Sep 24, 2008#272
706.
707.
708.
709.
it is really so useful .
710.
711.
712.
you are 100% correct that visual loss is a hallmark of orbital apex,
713.
714.
but
715.
716.
717.
718.
i mean , the patinet usually , present first with diplopia, paralysis of extraocular motions,
721.
722.
723.
i.e. visual loss is 100% specific for orbit.apex, but not occure at the first period of presentation .
724.
725.
726.
727.
728.
729.
730.
731.
732.
733.
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735.
736.
737.
738.
739.
740.
741.
742.
743.
744.
745.
746.
747.
Thanx for nice explanation...actually i wanted to say...orbital apex synd is also a probability as like as
cavernous sinus...as i cant exclude cavernous sinus due to absence of congestion and as well as i cant
exclude orbital apex due to absence of blindness...
748.
749.
750.
751.
regarding pancreatitis...
752.
I am convinced that really endoscopic USG is a well established modality for Chr.Pancreatitis,but it is
not that much available and The CT abdomen is the inv of choice to diagnose Chr.Pancreatitis with a
100% confidence level...
753.
754.
ERCP is diagnostic and therapeutic if the cause is gall stone and a procedure for stenting to maintain
patency of the duct...
755.
756.
757.
758.
759.
acnjGuestDear All,
760.
761.
Don't worry about the new marking scheme. I received a reply from the RCP that each question will
carry equal marks. So dont worry. Equating merely means that the overall mark is adjusted, so that all
exams are equal. Therefore it would have no bearing at all on whether you pass or fail. Instead of
giving varying pass marks at each exam, the new scheme will have a fixed pass mark after equating.
acnj, Sep 25, 2008#276
762.
763.
764.
765.
and it doesnt sound practical too that each ques carries different marks..
766.
otherwise that has to be mentioned in the q paper itselfdr_vikas, Sep 26, 2008#277
767.
MRCP1-CANDIDATEGuestRE
768.
769.
Can I ask if you think the answer to the question concerning retrocardiac fluid level is not achalasia
cardia but hiatus hernia (paraesophageal???).
770.
771.
772.
773.
774.
775.
MRCP1-CANDIDATEGuestRE
776.
777.
Can I ask if you think the answer to the question concerning retrocardiac fluid level is not achalasia
cardia but hiatus hernia (paraesophageal???).
778.
779.
780.
781.
MRCP1-CANDIDATEGuestRE
782.
783.
Can I ask if you think the answer to the question concerning retrocardiac fluid level is not achalasia
cardia but hiatus hernia (paraesophageal???).
784.
785.
786.
787.
788.
789.
Thanx 4 ur ques....by the way dnt take my answers as a standard...as i just express my own opinion
which can be wrong too....
790.
791.
Anyway,,,as u asked for my own opinion...regarding that question...the question was a man suffering
prob in swallowing liquid and solid and fluid level behind heart on CxR....which should be
ACLASHIA...
792.
793.
As u mentioned...Paraoesophageal Hiatus is often asymptomatic and if symp present the main symp is
chest pain and also occasionally dysphagia...
794.
795.
But the sentence...difficulty in swallowing for liquid and solid from the beginning is typically used for
ACLASHIA....
796.
797.
798.
799.
800.
Thanx 4 ur ques....by the way dnt take my answers as a standard...as i just express my own opinion
which can be wrong too....
801.
802.
Anyway,,,as u asked for my own opinion...regarding that question...the question was a man suffering
prob in swallowing liquid and solid and fluid level behind heart on CxR....which should be
ACLASHIA...
803.
804.
As u mentioned...Paraoesophageal Hiatus is often asymptomatic and if symp present the main symp is
chest pain and also occasionally dysphagia...
805.
806.
But the sentence...difficulty in swallowing for liquid and solid from the beginning is typically used for
ACLASHIA....
807.
808.
809.
GuestGuestDear acnj....
810.
811.
Thanx for ur information...but the fact that as far i have understood after reading the regulations of
equating system...each ques will not bear the same mark rather it will depend upon the difficulty level
of the ques....here i have just quoted few lines from mrcpuk.org////
812.
813.
A: Equating changes the way the results are calculated. Rather than just getting a mark for
814.
every correct question (and then this simply being converted into an overall
815.
percentage), the marks are instead adjusted to take into account the varying difficulty of
816.
each question. A candidates scaled score is therefore based on their ability, rather than
817.
the percentage of correct questions they achieved in an exam, and to avoid confusion
818.
819.
820.
821.
822.
823.
koshan13Guestregarding ACHALASIA---i wanna make U clear plz..... go through P. KUMER 6th. ed.
on page # 277.......it is clearly written the x-ray finding of ACHALASIA--------fluid level behind the
heart......so it's the CORRECT ans.
824.
825.
thx. to U all.
826.
827.
koshan13Guestregarding ACHALASIA---i wanna make U clear plz..... go through P. KUMER 6th. ed.
on page # 277.......it is clearly written the x-ray finding of ACHALASIA--------fluid level behind the
heart......so it's the CORRECT ans.
828.
829.
thx. to U all.
830.
831.
koshan13Guestregarding ACHALASIA---i wanna make U clear plz..... go through P. KUMER 6th. ed.
on page # 277.......it is clearly written the x-ray finding of ACHALASIA--------fluid level behind the
heart......so it's the CORRECT ans.
832.
833.
thx. to U all.
834.
835.
koshan13Guestregarding ACHALASIA---i wanna make U clear plz..... go through P. KUMER 6th. ed.
on page # 277.......it is clearly written the x-ray finding of ACHALASIA--------fluid level behind the
heart......so it's the CORRECT ans.
836.
837.
thx. to U all.
838.
839.
koshan13Guestregarding ACHALASIA---i wanna make U clear plz..... go through P. KUMER 6th. ed.
on page # 277.......it is clearly written the x-ray finding of ACHALASIA--------fluid level behind the
heart......so it's the CORRECT ans.
840.
841.
thx. to U all.
842.
843.
koshan13Guestregarding ACHALASIA---i wanna make U clear plz..... go through P. KUMER 6th. ed.
on page # 277.......it is clearly written the x-ray finding of ACHALASIA--------fluid level behind the
heart......so it's the CORRECT ans.
844.
845.
thx. to U all.
846.
847.
koshan13Guestregarding ACHALASIA---i wanna make U clear plz..... go through P. KUMER 6th. ed.
on page # 277.......it is clearly written the x-ray finding of ACHALASIA--------fluid level behind the
heart......so it's the CORRECT ans.
848.
849.
thx. to U all.
850.
851.
koshan13Guestsept.2008
852.
853.
regarding ACHALASIA---i wanna make U clear plz..... go through P. KUMER 6th. ed. on page #
277.......it is clearly written the x-ray finding of ACHALASIA--------fluid level behind the heart......so
it's the CORRECT ans.
854.
855.
thx. to U all.
856.
857.
858.
muttasimGuestbut the dysphagia is intermittently what ur explanation for this ?muttasim, Sep 26, 2008
#293
859.
860.
861.
862.
i.e. equally ,
863.
864.
865.
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890.
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GuestGuestDear Guest...
892.
Regarding the fireman...the scenario indicates the posttraumatic stress disorder...if u wish u can look at
psychiatry section of mrcpass question id no 565...
893.
894.
.also follow at psychiatry section of passmedicine...as there is only 3o question u can find the topic of
post trauma stress...
895.
896.
897.
sep 2008Guestok ,
898.
899.
900.
901.
902.
903.
904.
905.
906.
907.
908.
909.
910.
911.
regarding that 565 bof on mrcpass , it was not related , to what r we talking about .
912.
913.
914.
915.
916.
GuestGuestDear doctor...
917.
Actually at first we have to learn the definition of trauma which is not only physical...but also can be
mental...and the ability to identify the scenario is the actual trick of the
918.
919.
920.
A 40 year old man was involved in a war and has previously been tortured. He is having nightmares
and mood swings. Which of the following is most suggestive of post traumatic stress disorder?
921.
922.
923.
924.
925.
926.
927.
928.
the pt suffers from the devastating thought of war where he was tortured.....
929.
930.
And the question of passmed also indicate that the rememberance of a fearful event makes the post
traumatic disorder...
931.
932.
933.
934.
939.
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946.Next >
947.Share This Page
948.
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GuestGuestAs far i can remember that question .....the old man who see the dream of that fire accident
where he lost his friend....i thought that losing his friend in an accident caused him a mental trauma
which caused him later vivid dream of that accident which according to definition is in favour of post
trauma stress...
986.
987.
988.
989.
990.
991.
992.
993.
994.
995.
a lady present 8 months after her husband death , with depressed mood, can not enter his room , and
leave his cloths , as they were before his death , and always think about him .....
996.
997.
998.
999.
1000.
1001.
1002.
2-abnormal grief .
1003.
1004.
4-depression
1005.
5-?
1006.
1007.
1008.
1009.
so this is my idea <<<<< ie fireman case, is rather close to this lady scenario ...
1010.
1011.
1012.
MRCP1-CANDIDATEGuestRE
1013.
1014.
1015.
as the scenario mentioned in the end , that she felt safe as she was hiding in her husband socks , :shock:
1016.
1017.
1018.
1019.
i read a post on rxpg that what we need to do is to apply for MRCP-1 in jan 2009.. (apply overseas)
1020.
1021.
1022.
if u have passed, they display a message that u cant reappear in this exam as u have passed..
1023.
1024.
1025.
i read a post on r x p g that what we need to do is to apply for MRCP-1 in jan 2009.. (apply overseas)
1026.
1027.
if u have passed, they display a message that u cant reappear in this exam as u have passed..
1028.
1029.
1030.
Dr AWANGuestResults
1031.
1032.
The result is not declared yet. It ll be some time next week. Most probably end of week. You'd still get
the option of apply for the exam overseas on your "My MRCP" pageDr AWAN, Sep 27, 2008#310
1033.
muttasimGuestis there any question mentioned about pharyngeal pouchmuttasim, Sep 27, 2008#311
1034.
Dr ArifGuestany news when result is out? seems too long to wait now. is not it Guys. I wish very good
luck to all in this exam. and for Muslim brother happy Eid-ul fiter which is not very far from now.Dr
Arif, Sep 27, 2008#312
1035.
omar alfarsiGuestI also tried to apply for the MRCP1 overseas icon and the reply is that I passed part 1
in the last 7 years and I can't re-apply. I really don't know what it means in reality as the results are still
being prosessed, but possibly one of the skilled MRCP veterans can enlighten us with facts and the
myths of this technique.... :shock:omar alfarsi, Sep 27, 2008#313
1036.
mokhlesGuesti apply for ist part they r asking me to send cheque by 512 pounds to send
1037.
1038.
any one tried this can tell me is that true or the results not yet donemokhles, Sep 27, 2008#314
1039.
MRCP1-CANDIDATEGuestDear all
1040.
1041.
1042.
I am not sure at all if it was poor adjustment disorder because reading the wikipedia it clearly does not
say that it is expressed with NIGHTMARES.
1043.
1044.
It was another question about dysphagia on liquids and solids which the answer was achalasia, which I
put.
1045.
The question with the fluid level behind heart was a different one guys.
1046.
1047.
dr_flurestGuestDiabetes in pregnancy
1048.
1049.
Hypoglycaemic therapy
1050.
1051.
_ if lifestyle changes do not maintain blood glucose targets over a period of 12 weeks
1052.
1053.
_ regular insulin, the rapid acting insulin analogues aspart and lispro, and/or the oral hypoglycaemic
agents metformin3 and glibenclamide4 may be considered.
1054.
1055.
GuestGuestDear doctors...
1056.
1057.
Results r not yet released...the option in the my mrcp page is unreliable...i tried for it and they replied i
cant apply as i passed part 1 within last 7 year....
1058.
1059.
But i think we should not believe this...is there anyone who apllied in ihis my mrcp account and the
application is granted....
1060.
1061.
Yes...dr.arif...it is becoming tough day by day to wait for the result.....this last period is for pray for
each other...i wish all of us having a positive result.....Best of luckGuest, Sep 28, 2008#317
1062.
GuestGuestI just tried to re-apply for part 1 (pressing the 'Apply (Overseas)' button) and it said I'd
passed in the last 7 years and could not re-apply.
1063.
1064.
BUT I also tried to apply for part 2 (pressing the 'Apply (UK)' button) and it said I was already entered
to the 2008/03 Part 1 so couldn't enter part 2 2008/3.
1065.
1066.
Anyone been able to progress with re-applying for part 1?Guest, Sep 28, 2008#318
1067.
1068.
1069.
1070.
mokhlesGuestpressing apply overseas give me apply personal details and continue till the end
1071.
1072.
1073.
1074.
1075.
u mean to say ur application gets accepted for mrcp-1 overseas jan,2009?dr_vikas, Sep 28, 2008#321
1076.
GuestGuestWho r having their application for 2009 accepted may not have their result added to the
mrcp website database because they cant really add all the results by pressing one button,it does take
tome to do for all those who appeared in exam,probably numbering in thousands thats why the status
on website says results being processed.Guest, Sep 28, 2008#322
1077.
GuestGuestmokhles -one guy previously had your problem but passed the exam ... So don't be
disheartened .... But for those whom it says have passed the exam i guess (and hope) it must be true !!!
Guest, Sep 29, 2008#323
1078.
1079.
1080.
reults must out now i have hypertension stress post exam haram alihom
1081.
pls God help all of us and i cant wait seconds pass as hoursmokhles, Sep 29, 2008#324
1082.
GuestGuestdr .mokles
1083.
1084.
1085.
1086.
it is not the end of the world evev if you did not make it from your 1st try .
1087.
1088.
1089.
1090.
1091.
1092.
1093.
1094.
1095.
1096.
1097.
1098.
1099.
1100.
as the statsitics says that only third of doctors pass from their 1st try .
1101.
1102.
1103.
1104.
1105.
1106.
1107.
1108.
1109.
GuestGuesthi blokes any news on when the results will be out ???Guest, Sep 29, 2008#327
1110.
GuestGuestHi doctors...
1111.
Reslts may be available on friday....still 3 days...its really getting tough day by day to wait and i am not
really at all convinced with the procedure of registration for january 2009 to get the sep result though in
case of mine...it showed to be passed...but it is not dependable....
1112.
1113.
may god help us all....Eid Mubarok And Sharodiya WishesGuest, Sep 29, 2008#328
1114.
1115.
1116.
1117.
1118.
1119.
1120.
1121.
1122.
1123.
but just want to ask , i think all of us saw the 184 BOF , which was laid in this forum ,
1124.
1125.
yet , many of us , found that there are at least 10 BOF , never shown up in our papers,
1126.
1127.
so would you mind plz all , to share with us all , any BOF , u saw it came on ur paper & not appeared
on the 184 BOF on this forum
1128.
1129.
1130.
1131.
omar afarsiGuestTo be honest, my mind has frozen, I can't think of any BOF anymore. The only thing
to say is that I have already started doing passmedicine again and that what we should do as we need to
do it in all cases ( preparing for MRCP part 1 or 2) as it has taken a lot of time for the results to come
back.All my friends who did their MRCS on the same day as us got their results today, while us are still
waiting for whose gona be amongst the lucky top 1/3 of applicants.
1132.
1133.
Happy eid and make duaa for all of us to pass.omar afarsi, Sep 30, 2008#331
1134.
1135.
Actually my condition is as like as Dr.Omar..not in a condition to help u but if u go through all the post
in this forum,u will find a lot of question which i didnt mention in the 184 questions of my
paper....like...p wave association on ecg...and so on. if u need it too much,u pls go though the previous
post but My advice is...no more BOF...just enjoy ur eid and pray to god for all of us...TO ME U ALL R
NOW MY FAMILY...AS ALL DID SHARE THE SAME STRESS TOGETHER,
1136.
1137.
Yes,My wife did appear MRCS 1st part on this 9th sep and just today She got the result ...Thanx
god,She passed....
1138.
1139.
I am trying to forget my stress for the upcoming 3 days before result...i am just spending time by
enjoying movie and reading a lot of novels....These make me relax...so try something which make u
relax...and be prepared for anything....Do u think that if I failed this time...my future is uncertain...Not
that...On the contrary,I will study more ... ...actually I am trying a consolation for me....
1140.
1141.
Take Care Guys...And make frequent post...anything u like...getting a new post from a friend relaxes a
little...we should post more to relax each other...ByeGuest, Sep 30, 2008#332
1142.
dr mustaqeemGuestresults
1143.
1144.
hello everybody
1145.
i checked the trick at the website it tells me i have passed and need not apply
1146.
1147.
1148.
sandstormGuestAfter much hesitation....and trepidation I too pressed the button and it tells me I've
passed.. Given that the general consensus seems to be that if it says you've passed then you probably
have...and if it doesn't then you may have failed...or the result hasn't been uploaded to the database yet,
given all that I'm in a much better mood today.
1149.
1150.
Does anyone know of someone who used the button trick and was told he passed....only to discover
later that he'd failed?
1151.
1152.
And a Eid Mubarak and best wishes to all "comrades in arms"...who fought the good fight on Sep 9, in
the battle of the MRCP part 1 :lol:sandstorm, Sep 30, 2008#334
1153.
GuestGuesthi guys, i am really silly. i even don't know how to creat my online account. on page 1, they
asked "have you previously applied for an mrcp (uk) examination?". i clicked "yes" since i took part 1
in sept. then the webpage has no response at all. so i pressed "enter" key. it came with page 2, i put my
RCP number, date of birth and email, then webpage stuck there again. could not go to page 3. and i
have not received a verification email to my email address. what to do? how long should i wait for the
verfication email. i want to try to trick you guys mentioned. really nervous now. don't laugh at me
because i don't know how to creat an account. i have no brain in my head now.Guest, Sep 30, 2008#335
1154.
dr mustaqeemGuesthello
1155.
1156.
the trick says unambigously you have passed mrcp 1 ,it will be a nightmare if its not true.
1157.
for all who passed job well done, one who did not, best of luck, try harder dont give up, this is what i
think
1158.
study kalra
1159.
1160.
1161.
1162.
1163.
1164.
1165.
GuestGuesti was the silly guest who posted the previous message said i could not creat my online
account. it turned out to be purely computer problem. i got my account now and tried the trick. thanks
god. it says "i passed" hopefully it is true.Guest, Sep 30, 2008#337
1166.
1167.
1168.
1. stop pacing
1169.
2. stop defibrillation
1170.
3. stop both
1171.
1172.
1173.
1174.
yeh , this was one of the non mentioned BOF among the 184
1175.
1176.
1177.
1178.
1179.
1180.
As i could remember ;
1181.
1182.
RESET THE PACEMAKER OR SOME THING ABOUT PREVIOUS PACE MAKER DATA
1183.
1184.
1185.
GuestGuestdear doctors...
1186.
1187.
1188.
Do u really think that applying online with the sentence that''u have passed part 1 mrcp in last 7 yr &
may not reapply'' is dependable enough to be sure about pass....is there anyone who failed later though
the application in thi sway was not accepted saying that u have passed....
1189.
1190.
And i am also requesting the seniors who passed this exam before to make comment about this process
of gaining result....trying too much to stay cool...but u know..Its impossible....
1191.
1192.
1193.
GuestGuestdr .manoj
1194.
1195.
1196.
1197.
as i want to ask you , about the salary there for M.O & internal medicine specialist ???Guest, Sep 30,
2008#341
1198.
1199.
1200.
1201.
1202.
1203.
1204.
1205.
1206.
1207.
1208.
1209.
1210.
thanx god
1211.
1212.
1213.
GuestGuestI Passed too !!!!!!!!!!!!! Scored 757 Pass Score is 521 I don't know what this means
though !!! Who Cares any way !!!Guest, Sep 30, 2008#344
1214.
dr mustaqeemGuesti passed
1215.
thanks allah
1216.
1217.
1218.
1219.
omar alfarsiGuestAlhamdolillah brothers, I also passed (620), what a coincidence, today is eid here in
th uk and my mother's in law birthday. all the best for you brothers, how about dr menouj? hope u
passed and thanks for your helpomar alfarsi, Sep 30, 2008#347
1220.
1221.
1222.
1223.
1224.
1225.
1226.
1227.
dr mustaqeemGuesthappy eid
1228.
i scored687
1229.
1230.
1231.
1232.
1233.
Page 7 of 9
1234.
1235.
< Prev
1
1236.
1237.
1238.
1239.
1240.
1241.
1242.
1243.
1244.
Next >
1245.
1246.
1247.
1248.
1249.
Forums
1250.
>
1251.
UK Medical Zone
1252.
>
1253.
MRCP Forum
1254.
>
1255.
1256.
a.
Search Forums
b.
Recent Posts
Forums
1257.
1258.
Resources
1259.
1260.
CAN ANYONE EXPLAIN THIS Q...I CDNT UNDERSTAND cozTHEY SAID INTRAHEPATIC
BILE ducta r normal
1261.
1262.
A 35 year old man presents with lethargy and pruritus. He has had no abdominal pains and he is not
jaundiced on examination. Blood tests show a bilirubin of 16 mol/l, albumin 35 g/l, ALT 350 U/l, ALP
1200 U/l. ANA and AMA is negative. Ultrasound of the liver shows normal intrahepatic bile ducts and
increased echotexture of liver parenchyma. Which is the likely diagnosis?
A. Primary biliary cirrhosis
B. Chronic active hepatitis
C. Autoimmune hepatitis
D. Primary sclerosing cholangitis
E. Cholangiocarcinoma
1263.
1264.
Answer: d) primary sclerosing cholangitis. Primary sclerosing cholangitis is usually seen in males. It is
typically associated with ulcerative colitis. A positive pANCA can occur. The best investigation to
confirm this is ERCP, which will reveal multiple strictures in the biliary system. 10% of patients with
PSC will progress towards developing cholangiocarcinoma.
1265.
1266.
1.Very long background about patient with new onset glaucoma, list of meds, which caused it? Patient
complained of sudden loss of vision, History of RA and on medications. Increased intra-ocular
pressure, bilateral optic disc cupping on fundoscopy. Which of the following drugs is the cause?
1267.
You see a girl who admits to feeling depressed for a long time, she has no friends, prefers to stay at
home, uses cannabis, history of alcohol use and history of self-harm. What is the most likely diagnosis?
1268.
1269.
Responses:
1270.
1271.
Depressive disorder
1272.
1273.
4.Theme:
1274.
Psychiatry
1275.
1276.
Question:
1277.
A man with hypertension presents with 6 month history of memory loss and disinhibition. Most likely
diagnosis?
1278.
1279.
Responses:
1280.
Alzheimer's
1281.
Cerebrovascular incident
1282.
1283.
Psychiatry
1284.
1285.
Question:
1286.
A man with hypertension presents with 6 month history of memory loss and disinhibition. Most likely
diagnosis?
1287.
Alzheimer's
1288.
Cerebrovascular incident
1289.
1290.
1291.
Long stem, female patient brought to see you by her husband as she is pre-occupied and refuses to go
outside for the last 6 weeks, stating that she is afraid of catching avian flu, saying that she knows that is
likely because of all of the migrating birds outside her house. It is her husband's socks on the washing
line that can save her/have alerted her to this(!). What is the most likely diagnosis?
1292.
1293.
Responses:
1294.
1295.
Phobic disorder
1296.
1297.
8.Theme:
1298.
Psychiatry
1299.
1300.
Question:
1301.
A Fireman presents with insomnia, recurrent bad dreams and depressive symptoms after witnessing the
death of a colleague during an incident they attended. What is the most likely diagnosis?
1302.
1303.
Responses:
1304.
PTSD
1305.
Adjustment disorder
1306.
1307.
9.Neurology
1308.
1309.
Question:
1310.
A father found his daughter in her room in a mute state. One hand is on her head, the other over her
chest. Most likely diagnosis?
1311.
1312.
Responses:
1313.
Catatonia
1314.
1315.
10.Neurology
1316.
1317.
Question:
1318.
1319.
1320.
Responses:
1321.
Carbamazepine
1322.
Amitryptiline
1323.
1324.
11.Neurology
1325.
1326.
Question:
1327.
25-year-old man explains that he has experienced episodes where he is unable to move just before
onset of sleep, and just after waking. Each time it occurs it leaves him feeling frightened and anxious. It
is sometimes associated with visual disturbances. What is the most likely diagnosis?
1328.
1329.
Responses:
1330.
Panic disorder
1331.
Sleep paralysis
1332.
Periodic paralysis
1333.
Night Terrors
1334.
1335.
1336.
12.Theme:
1337.
Neurology
1338.
1339.
Question:
1340.
Patient presents with eye pain and diplopia of 2 days duration. No proptosis. On examination you see
VIth nerve palsy, partial CN III palsy, and CNV sensory changes. What is the most likely site of the
lesion
1341.
1342.
Responses:
1343.
Cavernous sinus
1344.
Orbital apex
1345.
Pons
1346.
1347.
13.Theme:
1348.
Nephrology
1349.
1350.
Question:
1351.
Lady who is 12 weeks pregnant presents with albuminuria. BP 142/62 mmHg Urinary albumin 0.8g
Creatinine 128 micromol/l Her mother has history of renal disease, but patient is well with no past
history of note. What is most likely cause of the albuminuria?
1352.
1353.
Responses:
1354.
UTI
1355.
Reflux nephropathy
1356.
Orothostatic proteinuria
1357.
Pre-eclampsia
1358.
1359.
1360.
14.Theme:
1361.
Molecular Medicine
1362.
1363.
Question:
1364.
1365.
1366.
Responses:
1367.
ribosome
1368.
peroxisome
1369.
mitochondria
1370.
nucleus
1371.
1372.
15.Theme:
1373.
Infectious Diseases
1374.
1375.
Question:
1376.
Patient complained of urethral discharge. Gram negative diplococci seen after investigation. Was
treated with cephalosporin but no resolution of symptoms was apparent. There is likely to be coinfection with?
1377.
1378.
Responses:
1379.
Candida spp
1380.
Chlamydia trachomatis
1381.
HSV
1382.
Syphilis
1383.
1384.
16.Theme:
1385.
Infectious Diseases
1386.
1387.
Question:
1388.
A patient will be undergoing an elective splenectomy, when should this patient receive pneumococcal
vaccination?
1389.
1390.
Responses:
1391.
1392.
1393.
1394.
1395.
postoperatively
1396.
1397.
17.Theme:
1398.
Infectious Diseases
1399.
1400.
Question:
1401.
1402.
1403.
Responses:
1404.
HHV8
1405.
EBV
1406.
HHV6
1407.
HTLV
1408.
1409.
18.Theme:
1410.
Infectious Diseases
1411.
1412.
Question:
1413.
You are consulted on a patient with cellulitis who is not responding to treatment with flucloxacillinbenzylpenicillin. What is the most appropriate next treatment step?
1414.
1415.
Responses:
1416.
co-trimoxazole
1417.
metronidazole
1418.
Gentamicin
1419.
Clindamycin
1420.
Vancomycin
1421.
1422.
19.Theme:
1423.
Immunology
1424.
1425.
Question:
1426.
1427.
20.Theme:
1428.
Hamatology
1429.
21.Theme:
1430.
Haematology
1431.
1432.
Question:
1433.
1434.
1435.
Responses:
1436.
IV heparin
1437.
Methylprednisolone
1438.
Immunoglobulin
1439.
Plasma exchange
1440.
Platelet transfusion
1441.
1442.
22.Theme:
1443.
Haematology
1444.
1445.
Question:
1446.
A man with a history of treated non-Hodgkin's lymphoma now presents with new symptoms of gum
bleeding. What is the most likely diagnosis?
1447.
1448.
Responses:
1449.
AML
1450.
ALL
1451.
CML
1452.
CLL
1453.
1454.
23.Theme:
1455.
Haematology
1456.
1457.
Question:
1458.
1459.
1460.
Responses:
1461.
Osteoclastic activation
1462.
1463.
1464.
24.Theme:
1465.
Haematology
1466.
1467.
Question:
1468.
A 70-year-old lady who had a lumpectomy for breast ca 20 years ago now presents with lower back
pain. Calcium (corr) 2.2, Phosphate low, ALP mildly raised, technetium bone scan normal. X-ray
Responses:
1471.
MR spine
1472.
1473.
1474.
1475.
25.Theme:
1476.
Genetics
1477.
1478.
Question:
1479.
1480.
1481.
Responses:
1482.
Autosomal recessive
1483.
Autosomal dominant
1484.
X-linked
1485.
1486.
26.Theme:
1487.
Genetics
1488.
1489.
Question:
1490.
Lady presents with lethargy. An ECHO shows dilated cardiomyopathy. Her son and brother have
muscular dystrophy. What is the genetic reason she has MD?
1491.
1492.
Responses:
1493.
1494.
Genomic mosaicism
1495.
Autosomal translocation
1496.
1497.
27.Theme:
1498.
Gastroenterology
1499.
1500.
Question:
1501.
Patient has suspected IBS. Which of the following would not be an expected finding for the clinical
presentation?
1502.
1503.
Responses:
1504.
1505.
Mucus in stools
1506.
1507.
1508.
1509.
28.Theme:
1510.
Gastroenterology
1511.
1512.
Question:
1513.
35-year-old patient with history of dysphagia, diagnosed with H. pylori after endoscopy and then
underwent eradication therapy. Best test to follow-up for and check up on Helicobacter pylori
eradication?
1514.
1515.
Responses:
1516.
1517.
1518.
1519.
Endoscopy
1520.
1521.
1522.
29.Theme:
1523.
Gastroenterology
1524.
1525.
Question:
1526.
Chronic alcoholic presents with steatorrhoea and chronic abdominal pain. What is the investigation of
choice?
1527.
1528.
Responses:
1529.
CT abdomen
1530.
Abdominal XR
1531.
CT pancreas
1532.
USS abdomen
1533.
1534.
30.Theme:
1535.
Gastroenterology
1536.
1537.
Question:
1538.
1539.
1540.
Responses:
1541.
Splanchnic vasoconstrictoin
1542.
1543.
31.Theme:
1544.
Gastroenterology
1545.
1546.
Question:
1547.
You see a patient with Crohn's disease who has been suffering diarrhoea >6 times/day which is
unresponsive to steroids and mesalazine (which he has been taking for 3 weeks). What is the most
appropriate next treatment?
1548.
1549.
Responses:
1550.
Azathioprine
1551.
Infliximab
1552.
Methotrexate
1553.
Surgery
1554.
1555.
32.Theme:
1556.
Gastroenterology
1557.
1558.
Question:
1559.
Pregnant woman with HELLP syndrome suggested by lab results. (Haemolytic anaemia, low platelets)
Best management?
1560.
1561.
Responses:
1562.
Plasma exchange
1563.
Prednisolone
1564.
1565.
IV heparin
1566.
1567.
33.Theme:
1568.
Endocrinology
1569.
1570.
Question:
1571.
1572.
1573.
Responses:
1574.
BMI>>
1575.
1576.
1577.
1578.
1579.
34.Theme:
1580.
Endocrinology
1581.
1582.
Question:
1583.
A lady presents with amenorrhoea and galactorrhoea. She has normal visual fields. Prolactin levels are
raised. MRI reveals a 7mm pituitary microadenoma. Which of the following hormones would you
expect to be low?
1584.
1585.
Responses:
1586.
ADH
1587.
cortisol
1588.
GH
1589.
thyroxine
1590.
LH
1591.
1592.
35.Theme:
1593.
Endocrinology
1594.
1595.
Question:
1596.
A 19-year-old female gymnast presents with complaints of headache and fatigue. Request is made for
routine hormone levels. Which is likely to be decreased?
1597.
1598.
Responses:
1599.
Cortisol
1600.
GH
1601.
LH
1602.
Prolactin
1603.
Thyroid
1604.
1605.
36.Theme:
1606.
Endocrinology
1607.
1608.
Question:
1609.
What is the equivalent dose of prednisolone that would be equal to the glucocorticoid produced
endogenously each day by the adrenals in a healthy individual.
1610.
1611.
Responses:
1612.
1mg
1613.
2.5mg
1614.
5mg
1615.
7.5mg
1616.
10mg
1617.
1618.
1619.
37.Theme:
1620.
Endocrinology
1621.
1622.
Question:
1623.
Pregnant woman with ?gestational diabetes OGTT results: 0 hour 5.6 2 hour 12.8 What is the best
management? Was that the gestational diabetes really I think only one time glucose levels were
geranged
1624.
1625.
Responses:
1626.
1627.
Soluble insulin
1628.
OHGA's
1629.
1630.
38.Theme:
1631.
Clinical Pharmacology
1632.
1633.
Question:
1634.
A patient is admitted to the ward with multiple fractures, one week later he displays nasal discharge,
hypersalivation and irritability. Use of which drug is to be suspected in a patient who presents with
withdrawal symptoms of hypersalivation and nasal discharge?
1635.
1636.
Responses:
1637.
Amphetamine
1638.
Cocaine
1639.
Heroin
1640.
Codeine
1641.
Alcohol
1642.
1643.
39.Theme:
1644.
Clinical Pharmacology
1645.
1646.
Question:
1647.
1648.
1649.
Responses:
1650.
After breakfast
1651.
1652.
1653.
1654.
1655.
1656.
40.Theme:
1657.
Clinical Pharmacology
1658.
1659.
Question:
1660.
1661.
1662.
Responses:
1663.
1664.
Histamine receptors
1665.
Serotonin receptors
1666.
5HT antagonist
1667.
1668.
41.Theme:
1669.
Clinical Pharmacology
1670.
1671.
Question:
1672.
When treating a methanol overdose with fomepizole what are the pharmacokinetics involved?
1673.
1674.
Responses:
1675.
Competitive inhibition
1676.
competitive agonist
1677.
Non-competitive inhibition
1678.
Allosteric
1679.
1680.
42.Theme:
1681.
Clinical Pharmacology
1682.
1683.
Question:
1684.
1685.
1686.
Responses:
1687.
CD20
1688.
CD19
1689.
CD21
1690.
CD22
1691.
1692.
43.Theme:
1693.
Clinical Anatomy
1694.
1695.
Question:
1696.
Hand anatomy, likely site of lesion in person with numbness of index finger and forearm and weakness
of thumb adduction?
1697.
1698.
Responses:
1699.
Median nerve
1700.
Radial nerve
1701.
Ulnar nerve
1702.
T7
1703.
1704.
1705.
44.Theme:
1706.
Clinical Anatomy
1707.
1708.
Question:
1709.
A patient who suffered a humeral fracture that has been in a cast for the past 8 weeks presents with
weakness in the deltoid, and sensory loss over the deltoid region. The likely site of the lesion is?
1710.
1711.
Responses:
1712.
brachial plexus
1713.
axillary nerve
1714.
radial nerve
1715.
ulnar nerve
1716.
Neuralgic amyotrophy
1717.
1718.
45.Theme:
1719.
Cardiology
1720.
1721.
Question:
1722.
Which of the following is the most specific ECG abnormality found in pericarditis?
1723.
1724.
Responses:
1725.
ST segment elevation
1726.
PR segment depression
1727.
T-wave inversion
1728.
1729.
46.Theme:
1730.
Cardiology
1731.
1732.
Question:
1733.
Patient with WPW presents with tachycardia (no known previous history). ECG shows AF with
ventricular rate of 180/min. What is treatment of choice?
1734.
1735.
Responses:
1736.
Flecainide
1737.
Verapamil
1738.
Adenosine
1739.
Sotalol
1740.
Digoxin
1741.
1742.
47.Theme:
1743.
Cardiology
1744.
1745.
Question:
1746.
Which antihypertensive would you start for a patient who is currently on lithium?
1747.
1748.
Responses:
1749.
ACE inhibitor
1750.
AT II antagonist
1751.
Indapamid
1752.
Thiazide
1753.
Atenolol
1754.
1755.
48.Theme:
1756.
Rheumatology
1757.
1758.
Question:
1759.
Most appropriate treatment for patient who presents with acute gout who is also on warfarin?
1760.
1761.
Responses:
1762.
Prednisolone
1763.
Colchicine
1764.
Diclofenac
1765.
Allopurinol
1766.
Indomethacin
1767.
1768.
49.Theme:
1769.
Rheumatology
1770.
1771.
Question:
1772.
What X-ray changes would you expect to see in a patient who has been diagnosed with Rheumatoid
Arthritis?
1773.
1774.
Responses:
1775.
Osteophytes
1776.
Perarticular osteopaenia
1777.
1778.
50.Theme:
1779.
Respiratory
1780.
1781.
Question:
1782.
1783.
1784.
Responses:
1785.
1786.
1787.
51.Theme:
1788.
Respiratory
1789.
1790.
Question:
1791.
Stem details can't remember then asked for best investigation to confirm EAA?
1792.
1793.
Responses:
1794.
Eosinophilia
1795.
Neutrophilia
1796.
1797.
Cyanosis
1798.
Clubbing
1799.
1800.
52.Theme:
1801.
Respiratory
1802.
1803.
Question:
1804.
CXR shows a speculated hilar mass. What would you expect to hear on auscultation?
1805.
1806.
Responses:
1807.
Monophonic wheeze
1808.
1809.
Whispering pectriloquy
1810.
1811.
53.Theme:
1812.
Respiratory
1813.
1814.
Question:
1815.
A nurse who has had a positive tuberculin skin test comes to you for advice. She had been in contact
with a patient who had pulmonary tuberculosis. She is well and her CXR is normal. She has started a
course of isoniazid. Which of the following is the most appropriate occupational health advice?
1816.
1817.
Responses:
1818.
1819.
Stay off work for 2 weeks while she is on the initial prophylactic isoniazid course
1820.
1821.
1822.
1823.
salboya
1824.
1825.
1-prednisolone
1826.
2-smoking
1827.
3-depression.
1828.
4-alzhemer.
1829.
5-depression (repeated)
1830.
6-alzhmer (rep.)
1831.
7-acute paranoia.
1832.
1833.
9-catatonia.
1834.
10-CABZ.
1835.
11-sleep paralysis.
1836.
12-orbital apex.
1837.
13-reflux.
1838.
1839.
15-chlamydia
1840.
1841.
17-HHV8
1842.
18-clindamycine.
1843.
20-parvovirus.
1844.
1845.
1846.
23-osteoclast activ.
1847.
24-XXXXXXXXXX
1848.
25-AD.
1849.
26-non-random
1850.
27-pain at nite.
1851.
28-14c
1852.
29-ct
1853.
30-Splanchnic vasoconstrictoin
1854.
31-Infliximab
1855.
1856.
33-strong family Hx
1857.
34-????????????
1858.
35-LH
1859.
36-?????????
1860.
37-insuline
1861.
38-heroin
1862.
1863.
40-5HT antagonist
1864.
41-Competitive inhibition
1865.
42-CD20
1866.
43-Median nerve
1867.
44-axillary nerve
1868.
45-?????????
1869.
46-Flecainide
1870.
47-???
1871.
48-Prednisolone
1872.
49-Perarticular osteopaenia
1873.
1874.
51-?????????? Neutrophilia
1875.
1876.
1877.
1878.
1879.
1880.
1881.
1882.
1883.
1884.
1885.
1886.
1887.
1888.
1889.
1890.
1891.
NICE published clinical guidelines on the diagnosis and management of irritable bowel syndrome
(IBS) in 2008
1892.
1893.
The diagnosis of IBS should be considered if the patient has had the following for at least 6 months:
1894.
1895.
bloating, and/or
1896.
1897.
1898.
A positive diagnosis of IBS should be made is the patient has abdominal pain relieved by defecation or
associated with altered bowel frequency stool form, in addition to 2 of the following 4 symptoms:
1899.
1900.
abdominal bloating (more common in women than men), distension, tension or hardness
1901.
1902.
passage of mucus
1903.
1904.
Features such as lethargy, nausea, backache and bladder symptoms may also support the diagnosis
1905.
1906.
1907.
rectal bleeding
1908.
1909.
1910.
1911.
28-serology remain positive upto 6 mnth so ans will b fecal antigen or c13 breath testnot c14
1912.
1913.
30-splachic vasoconstriction-
1914.
1915.
34-35 ans:LH
1916.
36= 7.5mg (1mg prednisolone = 4 md hydrocortizone..n v giv 20 mg am n 10mg nit total 30)Guest, Oct
15, 2008#415
1917.
mokhlesGuestdr manoji, dr mustaqueem , friends pls any one on this site have passed ist part 9/9/2008
pls send me score of % of correct answer bec the mrcp asking me to pay 100 pounds for recalculation
of my score so if i am sure from any other passer score i will send money to re calculate my score bec i
feel that i didnt take my real scoremokhles, Oct 18, 2008#416
1918.
1919.
1920.
1921.
1922.
1923.
mokhlesGuesthi dr manoji
1924.
sorry what i ment if u see up u will see my % answered correctly and i would like to compare with u
cardiology and nephrology and ,,,,,,, etc u seemokhles, Oct 18, 2008#418
1925.
mokhlesGuestand from where did u know that u answered 155 q correctmokhles, Oct 18, 2008#419
1926.
1927.
1928.
Dont waste your money. The variation in your marks and percentage is probably due to the new
'equating' system, where all questions do not carry same marks.
1929.
1930.
I got 646, but I made percentage using them and it was 72.9%. That means I answered more but got
less, and probably would get more if the previous system existed.
1931.
1932.
So, dont waste time and look forward for January 2009 for part 1.
1933.
1934.
1935.
mokhlesGuestno u know that i got 62% as a total and the final is 480 too much differ i know it less
about 8% but in my case more trhan 14% which is unusualmokhles, Oct 19, 2008#421
1936.
GuestGuestscore
1937.
1938.
hi dr mokhles
1939.
i have read your posts and looked at your performance numbers.you did very well in clinical science
parts unfortunatley your subspecialty scores were not good,there you see where to improve,i agree with
guest that score difference is due to equating, i got 687 my average percentage correct is 81 percent.
1940.
1941.
1942.
do all past papers from paid sites like mrcpass.com learn them well
1943.
1944.
1945.
1946.
1947.
mokhlesGuestthank u dr mustaqueem
1948.
1949.
1950.
God be with u at second part and keep in toutchmokhles, Oct 20, 2008#423
1951.
GuestGuestDear Mokhles = I worked out your score and it appears to be around 60% you seem to have
scored around 3-5% less than the pass mark (under the old method)
1952.
1953.
Remember your equated score is not a percentage score. The Pass mark is 521 and you scored 484,
which means you've scored around 3-5% less than the pass mark (roughly).
1954.
1955.
The new system makes no difference. It's just that for all exams the pass mark will always be 521 and
you score is equated accordingly.Guest, Oct 22, 2008#424
1956.
GuestGuestdear dr mokhles
1957.
u missed narrowly
1958.
1959.
1960.
1961.
1962.
1963.
1964.
1965.
and tell me what ur paper tells u when u rcv it ,, keep in toutch i am not studying rt now i have a lot of
work to do but i think i will study from the next month from free net site ,,mokhles, Oct 26, 2008#426
1966.
GuestGuesthello dr mokhkles
1967.
1968.
1969.
1970.
1971.
1972.
1973.
1974.
I would like to know whens the 1st part MRCP exm? Where can i get the required details? Like where
do i get the application?
1975.
1976.
1977.
1978.
1979.
This website is useful 4mrcp exams, contains alot of free MRCP questions
1980.
1981.
4mrcp
1982.
1983.
1984.
1985.
1986.
hi guys
1987.
i recently passed all parts of my mrcp exams and want to sell all my mrcp material for all parts [books
and course material] excellent material from very costly courses
1988.
1989.
07799552842[uk]
1990.
Log in or Sign up
1991.
1992.
1993.
Forums
1994.
>
1995.
UK Medical Zone
1996.
>
1997.
MRCP Forum
1998.
>
1999.
2000.
2001.
2002.
2003.
NHL-anti cd-20
2004.
pemphigus vulgaris
2005.
bullous pemhigoid
2006.
2007.
marfan-fibrillin
2008.
2009.
2010.
2011.
ITP-prednisolone
2012.
2013.
wernicke-korsakoff- nystagmus
2014.
2015.
2016.
2017.
2018.
2019.
2020.
2021.
2022.
2023.
2024.
2025.
2026.
2027.
wilson-autosomal recessive
2028.
2029.
2030.
2031.
2032.
2033.
2034.
Bibasilar crepts and 4 months h/o breathlessness and no relief after salbutamol= pulmonary fibrosis
2035.
Person not getting relief after 200 mg of beclomethasone, next step = add Salmeterol
2036.
2037.
A 16 yr old boy with proteinuria and had similar episode at the age of 7 years= minimal change disease
2038.
2039.
2040.
Termonal ileum resection afrter crohns disease and diarrhoea = bacterial overgrowth
2041.
2042.
2043.
2044.
2045.
2046.
2047.
2048.
2049.
A hypertensive and CAD pt taking too many medicines, presented with nephrotoxicity= Aspirin
induced
2050.
2051.
2052.
2053.
2054.
2055.
2056.
2057.
2058.
2059.
2060.
2061.
2062.
2063.
pons-basillar artery
2064.
pulmonary fibrosis
2065.
2066.
2067.
2068.
2069.
2070.
2071.
2072.
2073.
2074.
2075.
APS- anticardiolipin
2076.
2077.
2078.
2079.
pituitary apoplexy
2080.
hypochondriasis
2081.
somatoform disorder
2082.
OSA- polysomnography
2083.
2084.
2085.
2086.
2087.
2088.
2089.
2090.
2091.
2092.
cystinuria
2093.
2094.
2095.
2096.
2097.
2098.
2099.
2100.
2101.
2102.
2103.
2104.
2105.
2106.
2107.
2108.
2109.
Young woman, mute, one hand over head other behind back
2110.
2111.
2112.
Cardiogenic syncope
2113.
AS - echo
2114.
2115.
2116.
2117.
2118.
Rasburicase ?action
2119.
2120.
Man with IECOPD cannot tolerate NIV, only abx, unconscious, ?continue abx only
2121.
2122.
2123.
2124.
2125.
2126.
Papule over thigh, epidermal dysplasia with no invasion ?radiotherapy/5FU/steroid/...samuel, Sep 18,
2014#6
2127.
2128.
2129.
Calories-sugar/ cheese
2130.
Kyphoscoliosos- fvc/spirometery
2131.
Klinefelters- infertility
2132.
2133.
2134.
2135.
2136.
BNP_ VENTRICLES.
2137.
2138.
ANDROGENINSENSIVITY-KARYOTYPING
2139.
2140.
2141.
discitis- post op
2142.
2143.
2144.
2145.
scenrio of catatonia
2146.
2147.
2148.
arteriovenous dysplasia
2149.
2150.
2151.
2152.
2153.
2154.
2155.
2156.
L5/S1 - scenerio
2157.
2158.
2159.
2160.
2161.
Parkinsons scenerio
2162.
2163.
2164.
2165.
2166.
2167.
2168.
2169.
2170.
2171.
2172.
2173.
2174.
2175.
2176.
2177.
2178.
2179.
2180.
2181.
19.16 weeks pregnant lady with hypertension, ECG showing LVH-- ESSENTIAL HYPERTION
2182.
20.marfans--FIBRILLIN
2183.
2184.
22.scenario of SOMATIZATION
2185.
2186.
2187.
2188.
26. 4days of treatment with broad spectrum antibiotics for neutropenia has failed what is the next step-CHECK FOR CANDIDA
2189.
27.ecstasy--HUPONATREMIA
2190.
2191.
2192.
2193.
2194.
2195.
2196.
2197.
2198.
2199.
2200.
39. SENSITIVITY
2201.
2202.
41.patient presented with unknown substance posioning with confusion and eye symptoms--
METHANOL
2203.
2204.
2205.
2206.
45. vaccination in HIV patient that will cause active disease-- BCG
2207.
2208.
2209.
2210.
2211.
2212.
2213.
2214.
2215.
2216.
2217.
2218.
2219.
61. patient with injury to posterior chest is clinicaly stable and chest xray showed calcified pleural
plaque what is next step in management-- CT CHEST???
2220.
62. young guy with penumothorax developed 2nd time required chest tube. after infaltion of lungs
chest tube is removed now whats appropriate management-- CT CHEST??
2221.
63.HUNGTINTON ---ANTICIPATION
2222.
2223.
2224.
2225.
2226.
2227.
69. polymyositis
2228.
2229.
2230.
75. C.Difficle---METRONIDAZOLE
2231.
2232.
2233.
2234.
79.anti-CCP - RA
2235.
2236.
81. test for ascitic fluid which leads tpo diagnosis-- NEUTROPHIL COUNT
2237.
82. VT -- unsynchronized DC
2238.
2239.
2240.
85. rectal bleeding with clonoscopy, gastroscopy and barium normal-- ANGIODYSPLASIA
2241.
2242.
2243.
2244.
2245.
2246.
2247.
2248.
2-patient with pain in eye movement and decreased color vission?optic neuritis .
2249.
2250.
2251.
viral meningitis
2252.
rt sternomastoid
2253.
no carotid intervention
2254.
jugular foramen
2255.
oral diclofenac
2256.
unipaternal isodisomy
2257.
achalasia
2258.
subdural hematoma
2259.
avascular necrosis
2260.
de quverian tenodosynovitis
2261.
Optic neuratis
2262.
adesive capsulitis
2263.
2264.
samuelNew MemberCetrizine
2265.
oral 5 fluro
2266.
dermatitis herptiformis
2267.
BB
2268.
steven jonnson
2269.
somatization
2270.
adjustment
2271.
mancausen
2272.
paranoid shizophrenia
2273.
salmonella
2274.
2275.
TB and HIV
2276.
2277.
samuelNew MemberDengue
2278.
diphteria
2279.
2280.
staph discitis
2281.
diazepam withdrawl
2282.
lithium hemiodialysis
2283.
L5
2284.
ANTicipation
2285.
carcinoid
2286.
marfan fibrillin
2287.
abx prophylax
2288.
craniopharyngioma
2289.
skin patch
2290.
cisplastin neuropathy
2291.
catatonia
2292.
bartonella
2293.
herpes
2294.
B thalasemia
2295.
anaplastic thyroid
2296.
viral meningitis
2297.
sick euthroid
2298.
LBBB
2299.
2300.
MDMa hyponatremia
2301.
S3 heart failure
2302.
testosterone
2303.
colchinine pericarditis
2304.
BNP ventricles
2305.
plysomnography
2306.
heamatochromatsis
2307.
psudogout
2308.
2309.
rheumatoid ccp
2310.
apoplexy
2311.
herniation
2312.
2313.
2314.
2315.
2316.
Diagnostic and Statistical Manual Fourth Edition (DSM-IV) classification.[3] To diagnose major
depression, this requires at least one of the core symptoms:
2317.
2318.
2319.
2320.
2321.
2322.
2323.
3.cystinuria...recurent stones
2324.
4.marfan ..fibrillin
2325.
2326.
2327.
7.anti ccp....R.A
2328.
8.epididmytis...ceftri +doxy
2329.
9.cisplatin...hypocalcemia
2330.
10.rasburicase...M.o.a
2331.
2332.
2333.
2334.
2335.
2336.
2337.
17.painless hematuria...bladder
2338.
2339.
2340.
2341.
2342.
2343.
2344.
24.ca prostate with mets showng gagabsnt.tongue that side paralysd n numbnesd....mets to forman
ovale
2345.
2346.
2347.
2348.
28.erythema nodosum
2349.
29.somatization sceniro
2350.
2351.
2352.
32.cardiogenic syncopy
2353.
2354.
34.v.t...synchronizd shock
2355.
2356.
36.wilson...auto recesve
2357.
2358.
38.paired t test
2359.
2360.
40.unpaird t test
2361.
2362.
2363.
2364.
2365.
47.recurent T.i.a....warfarin
2366.
48.pas +ve...whipple
2367.
2368.
2369.
2370.
52n 53.also two othr on this topic for wilson n hemophilia tranmision to child
2371.
54.Cjd ...jrks
2372.
55.gbs
2373.
2374.
57.dermatitis herpit.
2375.
58.posiriasis worsng..bisoprolol
2376.
59.anticipation
2377.
2378.
2379.
2380.
63.recurent pericarditis...prednisolone
2381.
2382.
2383.
67.MEN scenario
2384.
2385.
2386.
70.raisd alt creatanine acutly in alcohlic n diazepam overdose with low body temp...i mrkd
hepatoreanal
2387.
71.A.spondy...HLA B
2388.
2389.
2390.
74.male pt with dec pubic n all 2ndry sexual charatr all testo lh fsh tsh low height
162cm....constituational delayd pubrty
2391.
2392.
2393.
2394.
2395.
2396.
2397.
2398.
2399.
2400.
2401.
2402.
2403.
2404.
2405.
2406.
2407.
2408.
2409.
2410.
2411.
96.pleural plaque calcification noted incidntly wt to do next i markd observe as thy r always benign n
almst never become malignant
2412.
97.pseudogout case
2413.
98.hx of rash whnever gloves used it was long hx ...skin patch test
2414.
99.on daily basis red itch patch formed thn dispaear in 30 min wt to gv...cetrizine
2415.
2416.
2417.
2418.
2419.
2420.
2421.
106.paget scanario
2422.
2423.
108.scanario whr pt was counsld he may die aftr he rfused NIV N INTUBATION gvn informd consent
n thn deteriorated wt to do.continue with already gvn treat.
2424.
109. Person becoming drowsy 6 hours after confusion and headache vomiting episodescerebral
edema
2425.
110.man with fever his son had fever n facial rasherythrovirus b19
2426.
2427.
2428.
115. Person not getting relief after 200 mg of beclomethasone, next step = add Salmeterol
2429.
116. . Part of kidney impermeable to water Desending loop of henele?? Correct one is ascending loop
2430.
2431.
2432.
119. .ST elevation in V1-V4,ST depression in inferior leads - ?Complete Occlusion LAD
2433.
2434.
2435.
2436.
2437.
2438.
2439.
2440.
129. Pleural effusion on the left,INC amylase,Left upper quadrant pain auscultation RUB heard n
tenderness on left upper abd..SPLENIC RUPTURE
2441.
2442.
2443.
2444.
2445.
2446.
134.scanario on PAN
2447.
2448.
2449.
2450.
2451.
2452.
2453.
2454.
141. .Previously treated for Plasmodium falciparum and now c/o right upper qudrant pain - ?recurrence
of malaria,?HBV
2455.
2456.
142. Extrinsic allergic alveolitis which will sugest .presence of igE to allergen
2457.
2458.
2459.
2460.
2461.
2462.
2463.
2464.
2465.
2466.
2467.
2468.
2469.
2470.
157. 80 year old, why to reduce digoxin loading dose - ?decreased body mass
2471.
158.female with hirsute n obese family hx of mother death due to intracranial bleedAPKD
2472.
159.pt of r.a controlled on paracetamol now week hx of exb of asthma stoped paracetamol wt to
do.restart at same dose
2473.
160.pt treated for malignancy with chemo 4 days fever neutrophils 0.5 wt to dost antibiotic
prophylaxis
2474.
2475.
2476.
2477.
2478.
165. blood test prior to renal transplant that can cause rejection ..ABO Incompatibility
2479.
166. patient presented with unknown substance posioning with confusion and eye symptoms-METHANOL
2480.
2481.
168. ecstasy--HUPONATREMIA
2482.
2483.
2484.
2485.
2486.
173. discitis- post op pacemaker insertion severe backache and l.m but I marked closd. Difficle though
due to antibiotics.samuel, Sep 25, 2014#16
2487.
2488.
2489.
The prescription of intravenous fluids is one of the most common tasks that junior doctors need to do.
The typical daily requirement is:
2490.
2491.
2492.
70-150mmol sodium
2493.
40-70mmol potassium
2494.
2495.
2496.
2497.
2498.
2499.
2500.
2501.
The amount of fluid patients require obviously varies according to their recent and past medical history.
samuel, Sep 25, 2014#17
2502.
2503.
2504.
3.cystinuria...recurent stones
2505.
4.marfan ..fibrillin
2506.
2507.
2508.
7.anti ccp....R.A
2509.
8.epididmytis...ceftri +doxy
2510.
9.cisplatin...PERIPHERAL NEUROPATHY
2511.
10.rasburicase...FORMS ALLANTOIN
2512.
2513.
2514.
2515.
2516.
15.primary hyperparaTHYROID
2517.
2518.
17.painless hematuria...bladder
2519.
2520.
2521.
2522.
2523.
22.tender calf ankle swelling AFTER SWELLING IN KNEE ONE WEEK BACK ... RUPTURE OF
POPLITEAL CYSTS
2524.
2525.
24.ca prostate with mets showng gag absnt.tongue that side paralysd n numbnesd....JUGULAR
FORMAENLOSS OF GAG REFLEX9,10,11CN
2526.
2527.
2528.
2529.
2530.
29.somatization
2531.
2532.
2533.
2534.
34.v.t...synchronizd shock
2535.
2536.
36.wilson...auto recesve
2537.
37.17 yrs old type 1 dm nw abgs low hco3 low k .hyprventilatng....INSULIN OVERDOSE
2538.
38.paired t test
2539.
2540.
40.unpaird t test
2541.
2542.
2543.
2544.
2545.
46.itp..prednisolone
2546.
47.recurent T.i.a....warfarin
2547.
48.pas +ve...whipple
2548.
2549.
2550.
2551.
52n 53.also two othr on this topic for Wilson(AR) n haemophilia(XR) to child
2552.
54.Cjd ...jrks
2553.
55.gb SYNDROME
2554.
2555.
2556.
58.posiriasis worsng..bisoprolol
2557.
59.anticipation
2558.
2559.
2560.
2561.
63.recurent pericarditis...COLCHICINE
2562.
64. RECURRENT primAry pneumothorax aspiratd n dischrge AND xraY AFTER 2WEEKS AS ITS
RECURRENT
2563.
2564.
67.MEN 2 scenario
2565.
2566.
69.hogkin lymphoma treatd (WITH BLEOMYCIN) c.t chest 2 l.nodes small....FIBROSIS OF THE
NODES
2567.
70.raisd alt creatanine acutly in alcohlic n diazepam overdose with low body
temp...RHABDOMYOLYSIS
2568.
71.A.spondy...HLA B
2569.
2570.
2571.
74.male pt with dec pubic n all 2ndry sexual charatr all testo lh fsh tsh low height
162cm....CRANIOPHARYNGIOMA
2572.
2573.
2574.
2575.
2576.
2577.
2578.
2579.
2580.
2581.
2582.
2583.
2584.
2585.
89.CATATONIA
2586.
2587.
2588.
2589.
2590.
2591.
2592.
96.pleural plaque calcification noted incidntly wt to do next i markd observe as thy r always benign n
97.pseudogout case
2594.
98.hx of rash whnever gloves used it was long hx ...skin patch test
2595.
99.on daily basis red itch patch formed thn dispaear in 30 min wt to gv...cetrizine
2596.
2597.
2598.
2599.
103.invasive aspergilosis..GALACTOAMANNAN
2600.
2601.
2602.
2603.
108.scanario whr pt was counsld he may die aftr he rfused NIV gvn informd consent n thn deteriorated
wt to do.IN THE BEST INTEREST OF THE PATIENT INTUBATE as he is confused and cannot
decide for himself.read GMC best practice to clear doubts
2604.
109. Person becoming drowsy 6 hours after confusion and headache vomiting episodescerebral
edema
2605.
110.man with fever his son had fever n facial rasherythrovirus b19
2606.
2607.
2608.
2609.
2610.
2611.
2612.
2613.
2614.
129. Pleural effusion on the left,INC amylase,Left upper quadrant pain auscultation RUB heard n
tenderness on left upper abd..SPLENIC RUPTURE
2615.
2616.
2617.
2618.
2619.
2620.
2621.
2622.
2623.
2624.
2625.
2626.
2627.
141. Previously treated for Plasmodium falciparum and now c/o right upper qudrant pain - HBV
2628.
2629.
142. Extrinsic allergic alveolitis which will suGgest .upper lobe fibrosis
2630.
2631.
2632.
2633.
2634.
2635.
2636.
2637.
2638.
2639.
2640.
2641.
2642.
2643.
157. 80 year old, why to reduce digoxin loading dose reduced creatine clearance
2644.
158.female with hirsute n obese family hx of mother death due to intracranial bleedAPKD
2645.
159.pt of r.a controlled on paracetamol now week hx of exb of asthma stoped paracetamol wt to
do.restart at same dose
2646.
160.pt treated for malignancy with chemo 4 days fever neutrophils 0.5 wt to dost antibiotic
prophylaxis
2647.
2648.
2649.
2650.
2651.
165. blood test prior to renal transplant that can cause rejection ..MHC CLASS 2
2652.
166. patient presented with unknown substance posioning with confusion and eye symptoms-METHANOL
2653.
2654.
168. ecstasy--HYPONATREMIA
2655.
2656.
2657.
2658.
2659.
173. post op pacemaker insertion severe backache it was PANCREATITISsamuel, Oct 1, 2014#19
2660.
2661.
2662.
3-Patient taking multiple drugs(aspirin, amlodipine, ramipril) , having dehydration, dry oral mucosa .
Serum creatinine raised to 180 mg and pre renal picture. Which drug caused increase in creatinine ?
2663.
ANS _RAMIPRIL.
2664.
4-H/O -LITHIUM intake and different osmolarities given , not mentioned DDVP trial. Scenario was of
PSYCHOGENIC POLYDIPSIA , because serum osmolarity was 269 mmol/l.samuel, Oct 2, 2014#20
2665.
samuelNew MemberFEV1 2.1 (2.6) FVC 4.5 (4.6) Rco normal Post bronchodilator FEV1 2.6 CXR and
echo normal a Emphysema B chronic bronchitis c heart failure d obstructive sleep apnoea e astham
2666.
2667.
2668.
174-Pregnant women with Hx of tonsillitis ,normal thyroid function ,with non tender thyroid goiter ?
answer iodine deficiencysamuel, Oct 2, 2014#21
2669.
Thoracotomy is opening of thorax. First, the question was not about recurrent pneumothorax as
Second, even if it was recurrent, you would not go for thoracotomy. Instead you would go for either
Tube thoracotomy and pleurodesis or VATSsamuel, Oct 2, 2014#23
2671.
2672.
1) elderly lady with hip arthritis choosing pain killers after paracetamol
2673.
2674.
2675.
2676.
2677.
1.codeine
2678.
2679.
2680.
2681.
PAIN CASES
2682.
1.RA patient on taking pcm develop AEBA. wat is the next thing you do?
2683.
2684.
2685.
2686.
3. pain on walking and lying on that side. x ray hip =narrow joint space.
2687.
a.trochantric bursitis b. OA
2688.
4.RA Pt on MTX develop pain in calf with low grade fever .ankle edema. one week before he had knee
joint pain.
2689.
a.septic athritis b. om
2690.
2691.
6.chemo//?RA?OA patient codiene pain not controlled with active peptic ulcer.
2692.
2693.
2694.
2695.
1.Anti CCP- RA
2696.
2.NHL- cd20
2697.
3.Cystinuria
2698.
4.Marfan-fibrillin
2699.
2700.
2701.
2702.
2703.
2704.
11.CRF-secondary hyperparathyroidism
2705.
2706.
2707.
2708.
2709.
2710.
18.Knee pain then lower limb edema with low grade temp- ruptured bakers cyst
2711.
2712.
20.Pt frm Thailand, fever with thrombocytopenia mildly elevated ALT- Dengue
2713.
2714.
2715.
2716.
2717.
2718.
27.Paired t-test
2719.
2720.
31.Bleeding post op, slightly low Factor 8, elevated APTT, mixing test normal- von Willebrand disease
2721.
2722.
2723.
2724.
2725.
2726.
2727.
39.Cervical myelopathy
2728.
2729.
2730.
2731.
2732.
2733.
2734.
2735.
2736.
2737.
2738.
2739.
51. Hypertensive pregnant lady < 20 weeks with ECG having LVH- essential HPT
2740.
2741.
2742.
2743.
2744.
57.Exudative pharyngitis with lymphadenopathy and h/o travel Eastern Europe- diphtheria
2745.
2746.
59.Bloating and diarrhea post terminal ileum resection- bile acid diarrhea
2747.
2748.
2749.
2750.
2751.
2752.
2753.
2754.
67. Wheeze and flushing with pulsatile liver and tricuspid regurg- carcinoid syndrome
2755.
2756.
2757.
2758.
2759.
2760.
2761.
75.Man frm Zambia with headache and CN palsy with neck stiffness- Cryptococcus meningitis
2762.
2763.
2764.
2765.
2766.
80. Child having rash contact having fever and red cell apalsia- Parvovirus B19
2767.
2768.
2769.
2770.
2771.
2772.
2773.
2774.
2775.
2776.
2777.
2778.
2779.
2780.
2781.
2782.
2783.
2784.
2785.
116.OSA- polysomnography
2786.
2787.
2788.
2789.
120.MDMA hyponatremia
2790.
2791.
2792.
123.Pulmonary fibrosis
2793.
2794.
2795.
2796.
127.Amyloid neuropathy
2797.
2798.
2799.
2800.
131.BNP- ventricles
2801.
2802.
2803.
2804.
samuelNew MemberCVS
2805.
2806.
2807.
2808.
2809.
2810.
2811.
7 after swimming ,collapse systolic murmur aortic area radiate to neck (echo,eeg, ecg)
2812.
2813.
2814.
2815.
2816.
2817.
2818.
2819.
15 AMAIDRONE( K OPNER)
2820.
2821.
2822.
2823.
2824.
INFECTIOUS DISEASE
2825.
2826.
2827.
2828.
2829.
5 diarhea 5 for weeks shingle contact shows neck stifness fever hepe encephlits,TBM,Cryptocal
mengitis
2830.
2831.
2832.
2833.
9 cambodia patient went to uk after few month fevr lymphadenopathy due to HIV
2834.
10 fevr for 1wek faint rash lft derangd due to dengu fever
2835.
2836.
2837.
2838.
2839.
2840.
GIT
2841.
2842.
2843.
2844.
2845.
2846.
2847.
2848.
2849.
2850.
2851.
11
2852.
2853.
2854.
2855.
15mothr hav ca colan at agr of 55yr daughtr hav iron dif anemia do colonoscopy
2856.
2857.
2858.
2859.
2860.
RHEUMATOLOGY
2861.
2862.
2 hodgkin lym cd 20
2863.
2864.
2865.
2866.
2867.
2868.
2869.
2870.
2871.
2872.
2873.
2874.
CNS
2875.
2876.
2877.
2878.
2879.
2880.
2881.
2882.
2883.
2884.
2885.
2886.
2887.
2888.
2889.
2890.
16 upper motor sign in lower limb and extensor plantor do( MRI,EMG,NCV)samuel,
2891.
2892.
2893.
2894.
2895.
i wrote it DNA
2896.
2897.
2898.
i wrote it sallmonella
2899.
2900.
3-q with long hx of dysphagia for 18 month for both liquid and solid
2901.
achlasia
2902.
2903.
2904.
2905.
2906.
2907.
2908.
2909.
2910.
2911.
2912.
ttt:radioactive iodine
2913.
2914.
2915.
2916.
2917.
2918.
9-q about hypoK and HTN and answer was:ranin aldesteron ration
2919.
2920.
10-q about nephrogenic DI asking about drug causing it and answer was:lithum
2921.
2922.
11-inv to D acromegaly
2923.
2924.
2925.
2926.
2927.
13-q mention hyop glycemia and hypotension and hyponatremia,which is best to give
2928.
hydrocortison
2929.
2930.
2931.
2932.
2933.
2934.
2935.
2936.
2937.
2938.
2939.
2940.
2941.
2942.
19-pt with hyper prolactinemia and asking about what hormon will be supreeses:growth
hormon,thyroid,estrodiol,ADH???!!!
2943.
2944.
2945.
2946.
2947.
2948.
2949.
2950.
2951.
2952.
bind 2 albumin
2953.
bind to fat
2954.
others.....
2955.
2956.
2957.
2958.
1 in 3
2959.
1 in 30
2960.
1 in 300
2961.
1in 3000
2962.
1 in 30000
2963.
2964.
25-pt with DEXA of hip 2.1 and ??2.6 dose she has
2965.
normal value
2966.
2967.
2968.
both osteopenic
2969.
both osteoprosis
2970.
2971.
2972.
2973.
2974.
2975.
2976.
2977.
2978.
2979.
2980.
2981.
2982.
2983.
2984.
2985.
2986.
33-q about pt with copd with ABG and ph 7.30 eco222 ,co2 high and o2 low and option was:non
invasive ventillation,decrase inspired o2,iv theophyllin
2987.
2988.
2989.
plz all share and add the option or the full q if u remmber itasya, Sep 22, 2010#3
2990.
2991.
2992.
2993.
2994.
2995.
2996.
39-mechansim of alloprinol
2997.
2998.
40-machansim of imatinib
2999.
3000.
3001.
3002.
3003.
3004.
3005.
3006.
3007.
3008.
3009.
3010.
3011.
3012.
47-renal stone with abd xry shows staghorn calculi and proteus infection
3013.
3014.
3015.
3016.
3017.
3018.
3019.
49-q about migrane pt already tried simple analgsic and trpitan what is
next:ergometrine,BB(propranol,NA valoprate
3020.
3021.
50-cluster headache
3022.
3023.
3024.
3025.
3026.
3027.
3028.
3029.
3030.
3031.
55-q about abscent ankel jerkwith extensor planter:subacute combined degenration of the cord????
3032.
3033.
3034.
3035.
3036.
3037.
3038.
3039.
59-ecg of pericarditis
3040.
3041.
3042.
3043.
61-pt with MS what els will indicate other valvular lesion:V wave in JVP
3044.
3045.
3046.
3047.
opning snape
3048.
3049.
3050.
3051.
3052.
3053.
3054.
3055.
3056.
3057.
3058.
3059.
3060.
3061.
69-erythema nodusm
3062.
3063.
3064.
3065.
3066.
3067.
3068.
3069.
3070.
3071.
74-orf
3072.
3073.
3074.
3075.
3076.
3077.
3078.
78-dengue fever/lepospriosis??!!
3079.
3080.
3081.
3082.
82-???blephritis
3083.
3084.
pons,cerbropontine,jugular formen
3085.
84-NNT
3086.
85-pt with ethenol poisining and asking about the mechansim by which inhibation of alchol
dehydrogens is done by fomepizole
3087.
3088.
doxazin
3089.
nitrate
3090.
nicorandil
3091.
ACEinhibitor
3092.
3093.
3094.
trimethoprin
3095.
3096.
3097.
3098.
asyaGuestplease all to share and add whatever u could remmber from examasya, Sep 22, 2010#8
3099.
3100.
3101.
3102.
3103.
3104.
option:
3105.
terlipssen
3106.
banding
3107.
3108.
3109.
3110.
For the gastric cerclage question I am not sure but since it will reduce gastric emptying> cck is
reduced> bladder contraction down> less bile secreted> Vit k can be the answer.
3111.
3112.
3113.
asyaGuest89-bostan:mode of action
3114.
91-pt dusring exercise test after 8 min his heart rate decrease from 140 to 70,why?
3115.
a-sinus arest
3116.
3117.
92-a senario about an old man with impaied glucose tolerancce test and asking wht is the mechansim of
that
3118.
3119.
3120.
c- i think decrease glucogensis (im nt sure from this option)asya, Sep 22, 2010#13
3121.
asyaGuest93- inv of renal vasular dis(this qis repeated0 and itys answer was renal artiogram
3122.
3123.
94- ecg shows st elvation in V1 -V4 with some change in inferior leads:
3124.
3125.
3126.
c-70%oculsion of LAD
3127.
3128.
3129.
asyaGuest95-pt recive blood transfusion and presented after 3 week with j and...
3130.
a-CMV
3131.
3132.
3133.
if any one can remmber the complete option and q plz shareasya, Sep 22, 2010#15
3134.
3135.
3136.
3137.
3138.
3139.
3140.
a-ccp
3141.
b-ana
3142.
3143.
3144.
deletion
3145.
expansion
3146.
3147.
3148.
3149.
3150.
3151.
couldnt find this forum(guess im still hazy 4rom the exam) so thought people didnt start discussing yet,
had 2 start my own 2oday but thankgod i found it ..........
3152.
3153.
some recalls
3154.
3155.
-elderly lady wit ulcer on nose.been there 4 more than 4 yrs:squamous cell ca,basal,trophic ulcer, lupus
vulgaris
3156.
3157.
3158.
3159.
3160.
3161.
3162.
3163.
- young man wit pain in rt buttock, 6 month ago had same pain in left buttock? sacroilitis,gluteus
medius tendonitis, lumber canal stenosis
3164.
3165.
3166.
3167.
3168.
dr.angel05Guestalslm alikm
3169.
3170.
3171.
i will post 1st what i sure about answer after that i recall the other:
3172.
3173.
3174.
3175.
3176.
3177.
5-allopurial---------Xanthine oxidase
3178.
3179.
3180.
3181.
3182.
3183.
3184.
3185.
3186.
3187.
3188.
3189.
3190.
3191.
19-18 month pt. c/o pysphagia both solid and fluid ----- achelesia
3192.
20-ADPOCK------ 50 % affected
3193.
3194.
23-pt with HTN and low k what investgestion------- aldestrone : renin ratio
3195.
3196.
3197.
3198.
26-male c/o back pain has vertebral collapse due to osteoprosis------ testosterone level
3199.
3200.
3201.
3202.
3203.
3204.
3205.
33-pic with liver imaired with high IgM----- PPSdr.angel05, Sep 22, 2010#21
3206.
tattaGuest-man wit ankylosing spondilitis, what test positive? trendelinberg, straight leg test..........
3207.
3208.
what waz the answer????? & did they say test or sign????
3209.
3210.
3211.
think its straight leg>>tests 4 back pain, although its 4 disc prolapse not ankyl.
3212.
3213.
ShezGuestit was a drug causing SIADH and the answer was carbemazepine i think.Shez, Sep 22, 2010
#23
3214.
tattaGuestthanx shez 4 making me feel better bout that q!!! i wrote that too but alot of people thought it
2 be DI wit lithium as answertatta, Sep 22, 2010#24
3215.
mrcp-4Guestone of the toughest exam after mrcp may 2007.this is my 4th times... i m very
dissapointed.i m trying to recalling the qs n will post as soon possible...pls try everyone ...mrcp-4, Sep
22, 2010#25
3216.
3217.
3218.
3219.
3220.
3221.
3222.
3223.
3224.
3225.
3226.
3227.
3228.
3229.
3230.
3231.
3232.
3233.
3234.
3235.
3236.
3237.
3238.
3239.
3240.
3241.
3242.
ABG of COPD pt
3243.
3244.
3245.
3246.
3247.
ShezGuestthe migraine one i think the answer was propanolol. cos she wasnt having an acute attack but
was having very frequent migraines so i think the were looking for preventeitve agent. ergotamine aint
used any more cos of side effectsShez, Sep 22, 2010#28
3248.
exam crammerGuestInx for renal failure, patchy shadow lungs, prt and blood positive, pt with inc SOB
3249.
3250.
3251.
3252.
3253.
3254.
3255.
3256.
3257.
3258.
ShezGuesti put precipitin test for the aspergillus one - dunno if thats right.
3259.
3260.
yes tata alot of my collegues put lithium and diabetes insipidus for that question but in my question the
sodium was 116 and clearly fitted siadh. so i think maybe it was one of the test questions - you know
they put a few in each paper.
3261.
3262.
oh and the woman with the pericardial effusion noted incidentally??? i put preceed to op but i dunno if
that right
3263.
3264.
i put subacute combined degeneration of the cord for an answer but i wasnt convinced cos the
haemoglobin was normal. MCV modestly high. couldnt really fir the signs with any of the other
options thoughShez, Sep 22, 2010#30
3265.
3266.
3267.
3268.
3269.
3270.
3271.
3272.
3273.
3274.
3275.
3276.
3277.
3278.
3279.
3280.
exam crammerGuesttest to know the structure of prtexam crammer, Sep 22, 2010#32
3281.
3282.
3283.
3284.
3285.
migraine --propanolol
3286.
3287.
3288.
3289.
3290.
3291.
3292.
3293.
a lady who had change , saying mean things to ppl with some gait impairment and memory lossexam
crammer, Sep 22, 2010#34
3294.
3295.
3296.
3297.
3298.
3299.
pt with 6th nerve palsy bilateral and papiledmeaexam crammer, Sep 22, 2010#35
3300.
ShezGuestwhat did u guys put for the patient who had polymyalgia and had been taking steroids - then
presented with acute visual loss, pulsatile temporal arteries ???? i think i put the first answer central
exam crammerGuesti had gone for hypertensive changes , totally unsureexam crammer, Sep 22, 2010
#37
3302.
exam crammerGuesti had gone for hypertensive changes , totally unsureexam crammer, Sep 22, 2010
#38
3303.
GuestGuestGuest
3304.
3305.
3306.
dr.angel05Guestcontinue...
3307.
34-alpha1-antitrypsin deficiency------ ZZ
3308.
3309.
3310.
3311.
3312.
3313.
3314.
3315.
3316.
3317.
3318.
3319.
3320.
3321.
3322.
3323.
3324.
3325.
3326.
3327.
3328.
3329.
3330.
5. Migraine not response with triptan , I think should be given intravenous valproate.
3331.
6. GAA, blurred vission, fundal haemorrhage - I still answer Anterior Ischaemic Optic Neuropathy??
Guest, Sep 22, 2010#42
3332.
ShezGuesti made too many silly mistakes esp for the malaria one and the staghorn calculus one Shez,
Sep 22, 2010#43
3333.
ShezGuest@ leslie. i ahve different answers from you - dunno wats right.
3334.
3335.
3336.
2) i put blepharitis
3337.
3) i put COPD
3338.
4)COPD
3339.
5) propanolol
3340.
3341.
exam crammerGuestShez I did many silly mistakes too esp one i knew well but in the last minute i
rubbed it off and ticked the wrong one :cry:
3342.
3343.
I have put the same ans as u except the last oneexam crammer, Sep 22, 2010#45
3344.
sleGuestconfused
3345.
3346.
3347.
3348.
3349.
3350.
3351.
3352.
pancytopenia-trimethoprim
3353.
3354.
metaanalysis bias-publication
3355.
3356.
3357.
3358.
3359.
3360.
it was bit more tougher than last one of may this is my second attempt may allah help us all and pray
that all passsle, Sep 22, 2010#46
3361.
asyaGuestsalam all
3362.
exam crammer,shez
3363.
3364.
3365.
3366.
can some one organiza all the q in one page and then we can discuss the option togeatherasya, Sep 22,
2010#47
3367.
exam crammerGuestasya you never know , you may pass so stay put and positive. I have done many
mistakes as wellexam crammer, Sep 22, 2010#48
3368.
3369.
asyaGuestsalam all
3370.
exam crammer,shez
3371.
3372.
3373.
3374.
can some one organize all th eq in one page and then discuss it togeather one by oneasya, Sep 22, 2010
#50
3375.
3376.
Page 1 of 25
3377.
3378.
3379.
3380.
3381.
3382.
3383.
3384.
25
3385.
3386.
Next >
3387.
3388.
3389.
3390.
3391.
Forums
3392.
>
3393.
UK Medical Zone
3394.
>
3395.
MRCP Forum
3396.
>
3397.
3398.
a.
Search Forums
b.
Recent Posts
Forums
3399.
3400.
3401.
3402.
3403.
3404.
Forums
3405.
>
3406.
UK Medical Zone
3407.
>
3408.
MRCP Forum
Resources
Log in or Sign up
3409.
>
3410.
3411.
3412.
3413.
Page 2 of 25
3414.
3415.
3416.
3417.
3418.
3419.
3420.
3421.
3422.
25
3423.
3424.
< Prev
Next >
asyaGuesti will start adding the q which was added by other collegues to which i have already writte
befor
3425.
3426.
3427.
deletion
3428.
expansion
3429.
3430.
3431.
3432.
3433.
a-PT
3434.
b-s.parcetamol level
3435.
c-s.creatinine level
3436.
3437.
100-eledry pt with ulcer on the nose a pic of her 4 yrs ago show same lesion
3438.
3439.
b-basal,
3440.
c-trophic ulcer,
3441.
d-lupus vulgaris
3442.
3443.
3444.
HLA class 1 Ag
3445.
3446.
3447.
a-HLA A,
3448.
b- HLA B,
3449.
d- HLA DR
3450.
3451.
103- young man wit pain in rt buttock, 6 month ago had same pain in left buttock?a- sacroilitis,
3452.
b-gluteus
3453.
c-medius tendonitis,
3454.
3455.
e-avascular necrosis
3456.
3457.
104- fomepizole :the mechansim for which it ttt ethanol poising consider: a-competitve inhibitor
3458.
3459.
3460.
a-Na-K ATPse
3461.
3462.
106-picture of PE investigation
3463.
a- CT angio
3464.
b-v/q mismatch
3465.
3466.
3467.
3468.
108-male c/o back pain has vertebral collapse due to osteoprosis------ testosterone level
3469.
3470.
3471.
3472.
3473.
3474.
3475.
3476.
3477.
3478.
3479.
3480.
3481.
venturi mask
3482.
3483.
3484.
a-symptology of pt
3485.
3486.
3487.
3488.
leshmaniasis
3489.
3490.
118-alpha1-antitrypsin deficiency------
3491.
a-ZZ
3492.
b-MM
3493.
c-MZ
3494.
3495.
3496.
about q of liver impairment during pregnancy it couldnt be chlostasis of pregnancy becoz gamaglutamt
is high which mean liver dis and the q provid high alp and high ast as i remmber
3497.
3498.
3499.
i also was confused about that q of migrane becouse it wasnt really clear on exam dose they mean
prophylactic or next step in acute mangment so i did prpoanol
3500.
3501.
what was the answer for q asking what els to add for vomiting following chemotherapy not improved
with ondensteron
3502.
dexamethasone,metochlopromide????
3503.
3504.
3505.
3506.
3507.
3508.
pt from india has vivx malaria----- chloroquine:i cant remmber seeing such q??!!!!!asya, Sep 22, 2010
#51
3509.
Guestq8Guestpass mark
3510.
3511.
does anybody know what is the passmark for this exam diet?Guestq8, Sep 22, 2010#52
3512.
3513.
3514.
3515.
3516.
i didnt see the malairia question eitherexam crammer, Sep 22, 2010#53
3517.
exam crammerGuestfor protein structure I went for x ray crystillographyexam crammer, Sep 22, 2010
#54
3518.
exam crammerGuestfor sickle cell pt , i went for HCTexam crammer, Sep 22, 2010#55
3519.
ShezGuesti put non ulcer dyspepsia for the h.pylori question - however i think the ans may be duodenal
ulcer
3520.
i was not sure at all about the HLA for renal transpant (just been googling it tho and i think it may be
HLA DR - which means i got it wrong
3521.
3522.
the young man with the buttock pain i put sacroilitis but i was toying between that and scheueramanns
disease - and ideas folks??
3523.
3524.
3525.
3526.
3527.
3528.
3529.
3530.
3531.
3532.
3533.
3534.
i put strongloydies for one in the first paper - something about an eosinophila ???? any ideas folks
3535.
3536.
was the answer to one question an atrial septal defect???? yound lady normal? split of S2
3537.
3538.
the woman who was losing memory, ataxic and being nasty to her kids - i put lewy body but im pretty
sure thats wrong?! i think it might be frontotemporal
3539.
3540.
3541.
3542.
probs with swallow, tongue and something else i put jugular foramen
3543.
3544.
what about the one about the first line antibiotics for febrile neutropenia?????? what bug they trying to
fight againstShez, Sep 22, 2010#56
3545.
ShezGuestalso the one with fever and dilated bile ducts i went for ercp - any other suggestions?Shez,
Sep 22, 2010#57
3546.
exam crammerGuesti put non ulcer dyspepsia for the h.pylori question - however i think the ans may
i was not sure at all about the HLA for renal transpant (just been googling it tho and i think it may be
HLA DR - which means i got it wrong I WENT FOR HLA-A DONT ASK WHY
3548.
3549.
the young man with the buttock pain i put sacroilitis but i was toying between that and scheueramanns
disease - and ideas folks?? THERE WAS ANOTHER OPTION GLUTEUS MEDIUS TENDONITIS , I
WENT FOR IT
3550.
3551.
3552.
3553.
3554.
3555.
3556.
3557.
pizz for the alpha 1 antitrypsin one .THIS WAS ONE MY FOOLISH MISTAKE BUT U R RIGHT
3558.
3559.
3560.
i put strongloydies for one in the first paper - something about an eosinophila ???? any ideas folks
SAME
3561.
3562.
was the answer to one question an atrial septal defect???? yound lady normal? split of S2 SAME
3563.
3564.
the woman who was losing memory, ataxic and being nasty to her kids - i put lewy body but im pretty
sure thats wrong?! i think it might be frontotemporal
3565.
3566.
3567.
3568.
probs with swallow, tongue and something else i put jugular foramen MINE WRONG
3569.
3570.
what about the one about the first line antibiotics for febrile neutropenia?????? what bug they trying to
fight against :x :x :cry: MRSA , DONT KNOW IF I AM CORRECTexam crammer, Sep 22, 2010#58
3571.
3572.
3573.
3574.
i have just looked in book for the sickle cell one. For some reason i put blood film. but that is wrong.
from what i can see and read at the moment i reckon the answer may have been the patients
symptomatologyShez, Sep 22, 2010#60
3575.
3576.
3577.
exam crammerGuesti am not shez as question was pt was demanding morphine and he said he had
sickle cell crises in the past and i think question asked about how can you be sure if he is in crises ? or
something like thatexam crammer, Sep 22, 2010#62
3578.
exam crammerGuestalso the one with fever and dilated bile ducts i went for ercp - any other
suggestions?
3579.
3580.
I WENT FOR MRCP ..AS I THOUGHT IT WOULD HELP REMOVING THE BLOCKAGE AS
WELL IF NEEDED BUT DONT KNOWexam crammer, Sep 22, 2010#63
3581.
3582.
3583.
3584.
HOW MANY DO U THINK WE CAN GET WRONG AND PASS. COS I CAN COUNT ALMOST
25-30 IVE DEF GOT WRONG AND THATS ONLY THE ONES I REMEMBERShez, Sep 22, 2010
#64
3585.
exam crammerGuestI think with 20-30 wrong you can pass but it should not be more then 40 .
3586.
3587.
3588.
3589.
3590.
3591.
exam crammerGuestyour reply of ERCP is right and there goes mine another wrongexam crammer,
Sep 22, 2010#66
3592.
3593.
ERCP
3594.
MRCP
3595.
3596.
3597.
3598.
so another q with man who has pain with walking and decrease with rest
3599.
3600.
3601.
asyaGuestwhat about the one about the first line antibiotics for febrile neutropenia?????? what bug they
trying to fight against
3602.
3603.
3604.
another q about lady with csf shows blood on it cerebral venous throbosis(i did so) or subdural
hematomaasya, Sep 22, 2010#71
3605.
exam crammerGuesti ad gone for MRSA as it asked abt abx but dont know
3606.
3607.
3608.
3609.
there was question of post partum women for Cavernous sinus thrombosis??exam crammer, Sep 22,
2010#72
3610.
asyaGuestyaa i meant same pt with the postpartum hgeasya, Sep 22, 2010#73
3611.
ShezGuestkool. did u guys have an absolute risk reduction calculation. i did and i put 3% but i dunno if
that was right?
3612.
3613.
3614.
3615.
how does dipyridamole work? i was stuck but put phosphodiesterase inhibitor.
3616.
3617.
3618.
3619.
i said phenytoin as the anti epileptic for the lymphadenopathy, and other vague symptoms.Shez, Sep
23, 2010#74
3620.
hatemmakaremGuestmrcp 1
3621.
3622.
pt wiht hypo Na (<127) + litheregy+ confusion drug is carbamazipine i think this is SIDHD
3623.
3624.
3625.
3626.
3627.
asyaGuestdid u guys have an absolute risk reduction calculation. i did and i put 3% but i dunno if that
was right?
3628.
3629.
3630.
3631.
same here
3632.
3633.
how does dipyridamole work? i was stuck but put phosphodiesterase inhibitor.
3634.
same
3635.
3636.
3637.
i said phenytoin as the anti epileptic for the lymphadenopathy, and other vague symptoms..sameasya,
Sep 23, 2010#76
3638.
tattaGuest-theres a q bout severe occipital headache+neck pain ......does anyone remember the q &
choices. what did u answer?
3639.
3640.
3641.
3642.
-biliary dilatation q, i changed 4rom ercp to mrcp bec noticed they put ecoli so thought dilitation iz due
2 infection therefore nothing 2 remove wit ercp......... but dont know seems most of u agree that its
ercp.........maybe infec due 2 stasis 4rom obst.........confusing
3643.
3644.
-HLA q think its A or B bec earliest ab produced r against HLA class 1 ag which r A,B,C
3645.
3646.
-pllllllllllllz anyone know answer 2 ankylosing spondilitis q what is the positive test??????tatta, Sep 23,
2010#77
3647.
mrcp-4Guesti m posting qs i remeber.pls discuss about the answer & contribute more...
3648.
3649.
HAEMATOLOGY
3650.
3651.
1.haemophilia-0%
3652.
3653.
3654.
3655.
6.Multiple myeloma diagnosis-Bone marrow exam As there was no option other correct
3656.
3657.
3658.
3659.
3660.
CVS
3661.
3662.
13.ECG- St elevation v1-v4 & reciprocal depression in inf leads-75% block of Lt descending artery?
3663.
3664.
15.Contraindicate in VT-Verapamil
3665.
3666.
3667.
3668.
19.Afro-carribean pt ,HTN-Amlodipine
3669.
3670.
-??Catheterization
3671.
3672.
3673.
3674.
3675.
3676.
3677.
3678.
3679.
3680.
3681.
3682.
3683.
3684.
PHARMA
3685.
3686.
3687.
32.Gynaecomastia cause-?boseralin?
3688.
33.Duptyrns contracture-phenytoin
3689.
3690.
35.Doxacetil-microtubles
3691.
3692.
3693.
3694.
39.Cholestasis-flucoxacillin
3695.
40.Paracetamol overdose-- PT
3696.
3697.
3698.
3699.
3700.
RENAL
3701.
3702.
42.Staghorn stone-NH4MGPO4
3703.
43.RTA-1--Renal stone
3704.
44.ADPKD-??50% affected
3705.
3706.
3707.
3708.
3709.
NEURO
3710.
3711.
3712.
3713.
3714.
3715.
3716.
52.Meningitis, Gm + bacilli---listeria
3717.
3718.
54.Transient Global A
3719.
3720.
3721.
3722.
ENDO
3723.
3724.
3725.
3726.
3727.
3728.
3729.
3730.
3731.
3732.
67.acromegaly diag---OGTT
3733.
3734.
3735.
RHEUMA
3736.
3737.
3738.
3739.
3740.
3741.
3742.
3743.
3744.
3745.
Derma
3746.
3747.
GASTRO
3748.
3749.
83.Ig M +---PBC
3750.
3751.
85.wheezing,diarrhoea---Carcinoid synd
3752.
3753.
3754.
3755.
i remmber another q was asking about giving vacine to young female to protect aginst cx canser(or
some thing like that)
3756.
3757.
3758.
3759.
3760.
GuestGuestI think they ask about Cushing DISEASE not Cushing SYNDROMES so the answer is
plasma ACTH concentration, not cortisol level. The minority of cryoglobulin come from malignancy.
As Lymphoma is commonly found at Cervical, Axillae, & groin, so I put Bronchial Carcinoma as the
answer. The lastest issue is intravenous valproate has been recognized as an acute treatment of
migraine, so I think it should be an option if patient failed to response with triptan. Propanolol &
Verapamil are too weak for migraine, and are inferior than tryptan.Guest, Sep 23, 2010#81
3761.
GuestGuestCardio:
3762.
1. VT - LBBB, I think AV dissociation is typical for AV block. P wave dissociation is not same with AV
dissociation.
3763.
3764.
3. ST elevation V1-V4, and ST depression II, III, aVF- Total LAD occlusion.
3765.
3766.
5. MS - another valve lession - EDM LLSB (suggest associated AR). The other option EDM
Pulmonary Area (PH), right ventricular heaving (RV Failure), and jugular v wave are one cluster with
mitral valve lession.
3767.
6. Asymtomatic, LBBB, normal resting Echo should be done non invasive testing first (Exercise ECG).
After obtaining sufficient data from noninvasive testing then can be proceeded to invasive testing (like
Coronary CT angiogram, Cardiac catheterization, etc).
3768.
3769.
8. Anxiety, pregnant woman come with palpitation, with history of VT 10 year ago - do none first. I
think palpitation should be come from anxiety. Once got symptoms from palpitation like
lightheadedness then can proceed to cardiac monitoring (rhythm strip).
3770.
3771.
3772.
Pharmaco:
3773.
3774.
3775.
3776.
4. Progesteron only pill - commonly irregular bleeding (means irregular menstrual bleeding) - see BNF.
3777.
3778.
3779.
3780.
3781.
3782.
3783.
3784.
Rheumato:
3785.
3786.
2. ANA - Ig.G.
3787.
3788.
3789.
3790.
7. Patient no contact with TB, got RA on TNF alfa inhibitor - drinking unpasterurized milk (M. Bovis
detected).
3791.
Pulmo:
3792.
3793.
3794.
3795.
3796.
5. COPD - NIV.
3797.
3798.
Renal:
3799.
3800.
3801.
Dermato:
3802.
3803.
Hemato:
3804.
3805.
3806.
3807.
3808.
Eye:
3809.
1. PMR, Normal ESR, Normal TA, fundal bleeding - no option other than Anterior Ischaemic Optic
Neuropathy + 10 % CRAO (Cherry Red Spot).
3810.
2. I think it will not anly be simple blepharitis, if lession involving nose & cheek - it could be
adenovirus conjuctivitis.
3811.
3812.
Infectious:
3813.
1. ORF.
3814.
3815.
Dr_JoseGuestContinuation
3816.
3817.
1. ABPA - precipitin.
3818.
3819.
Guess_1GuestI agree with you that ESR value and biopsy of TA can't predict AION. Please see
Medicine for Examination. Only 1 spot we see high blood pressure, wan can't say that this patient had
chronic hypertension than can contribute Hypertensive Retinopathy with flame haemorrhage. However
10% AION will associated with CRAO than can lead to cherry red spot.
3820.
Endocrinology:
3821.
1. Acromegaly - GTT.
3822.
3823.
3824.
3825.
Genetic:
3826.
1. Genetic Variation - the most common was Single Nucleotide Polymorphism (SNP). Around 4M
according to OHCM.
3827.
2. Glucokinase in liver depend on glucose level. Co factor (in this term is glucose) asscociated.
3828.
Immunology:
3829.
1. Renal Transplant - HLA DR. (DR should be 0 mismatch & B could be 1 mismatch, see Kalra).
3830.
3831.
Dr_AlphaGuestPSY:
3832.
1. Q regarding PTSD.
3833.
2. Q regarding Depression.
3834.
3. Q regarding cataplexy.
3835.
4. Q regarding delusion.
3836.
5. Q regarding Paranoia.
3837.
6. Q regarding hypochondriasis.
3838.
Neuro:
3839.
1. GBS - IVIg.
3840.
3841.
3842.
3843.
3844.
3845.
3846.
sleGuestabt the question risperidone it mainly acts on serotonin 5ht2a receptors i think from
passmedicine
3847.
3848.
one question abt pain more with bending and coughing is spinal stenosissle, Sep 23, 2010#86
3849.
sleGuestpregnant with bmi 26 high glucose and mild ketones probably dm-2sle, Sep 23, 2010#87
3850.
sleGuestsore throat and after 2 weeks with scaly erythematous lesions -guttate psoariasissle, Sep 23,
2010#88
3851.
Dr_AlphaGuestKetone is typical for DM Type 1, and non ketones is typical for Type 2. Atypical
antipsychotic like Risperidone acts on both D2 and HT3 receptors, D2 is for antipsychotic, and HT3 is
for antidepressant.Dr_Alpha, Sep 23, 2010#89
3852.
guessGuestI think we have one question, patient with neck pain, 6th nerve palsy and papiloedema. I
answer vertebral artery dissection. RCP usually ask the rare cases and the answer is sometimes
unexpected.guess, Sep 23, 2010#90
3853.
3854.
Dr_AlphaGuestPharmaco:
3855.
1. Cholestasis - Flucoxacillin.
3856.
2. Typhoid Fever 3/7 still pyrexia with Ciprofloxacin, then stop Cipro and changes to IV Ceftriaxone.
3857.
3.
3858.
3859.
Neuro:
3860.
1. Question about woman with behavioural abnormality, dementia, and withdraw from working. The
answer is Wilson Disease.
3861.
3862.
3863.
4. Impaired pain & temperature sensation, but preserved light touch - SYRINGOMYELIA.Dr_Alpha,
Sep 23, 2010#92
3864.
3865.
4-bloody diarrhea not respond to steriod sigmdscopy show infl. of anal margin? Colonscopy
3866.
3867.
3868.
3869.
3870.
3871.
3872.
3873.
3874.
dr.angel05Guestabout Q Asymtomatic, LBBB, normal resting Echo ? stress ECG hard to interpret in
LBBBdr.angel05, Sep 23, 2010#95
3875.
dr_shahi000Guestmy recalls
3876.
3877.
3878.
3879.
3880.
3881.
3882.
3883.
3884.
3885.
3886.
3887.
3888.
3889.
3890.
3891.
3892.
3893.
3894.
3895.
3896.
3897.
23.. pagets diseae like picture with nl Ca and Nl PO4 whith High alk phospatase.... treatment.
---residronate.
3898.
3899.
3900.
26.CKD with high PO4 And low Ca MIld elevated PTH.... treatment---alfacalcidol.
3901.
3902.
3903.
3904.
3905.
3906.
?? hypersplnism/??marrow suppression
3907.
32.post partum head ache .with csf blood ++ normal opening pressure??? sub arachaniod H"ge
3908.
3909.
3910.
3911.
3912.
3913.
3914.
3915.
3916.
43.old man cam with his wife forgetfulness and repeating words---transent global amnesia
3917.
3918.
3919.
3920.
treatment----propranalol
3921.
3922.
3923.
3924.
3925.
3926.
53.mitral steonosis associated another valvular leision---early diatolic murmur left sternal edge
3927.
3928.
3929.
3930.
3931.
3932.
59.hard nodule in the finger who is a farmer and has contact with cattles---orf
3933.
3934.
3935.
3936.
3937.
3938.
65.ocp progestron only pill most common side effect -- ?? breast pain
3939.
3940.
3941.
69.blood picture with CKD and K 7.1 --most rapid correction of K ---calcium gluconate
3942.
3943.
71.thyrotoxicosis picture with no thyroid enlargement- what is the investigation---radio isotope scan...
3944.
3945.
treatment-----radio iodine
3946.
3947.
3948.
3949.
3950.
3951.
77. features with weak ness of 9,10,11,and 12 cranial vervs --level of lession---???cerebellopontine
angle
3952.
3953.
3954.
3955.
3956.
3957.
3958.
3959.
85.afrocarebian antihypertensive---amlodipine
3960.
3961.
3962.
88.progressive waeknessof lowerlimb with pain and temp loss--- dorsal meningoma.
3963.
3964.
ketone+----??MODY/???type 1 DM
3965.
3966.
3967.
3968.
3969.
3970.
95.h/o pain during waliking a short distan , pain releaves on taking rest or siting----peripheral artery
disease
3971.
3972.
3973.
100pt with h/o travell with spleen 10 cn hepatomagally 4cm -viseral lesmaniasis
3974.
3975.
3976.
3977.
3978.
3979.
3980.
3981.
3982.
109.CURB---- confusion
3983.
3984.
3985.
3986.
3987.
3988.
3989.
116.pt on thiazide ,,RA slightly elevated.symmetrical arthralgia affecting proximal and distal
interphangial joint-----RA ?? psoedo gout
3990.
3991.
118.morpine in pt with lever mets and renal faiulure wht is the cause of toxixcity--- treatment with
erthromcin
3992.
3993.
3994.
3995.
3996.
123.COPD not responding to inhaled steroid and sortocosteroid injection ----non invasiv ventilation
3997.
3998.
3999.
4000.
4001.
128.red awellon knee(post travell) sinovial fluid Nuetroplia Gframstain Negative ---Nisseria
(gonococcal)
4002.
129.gastrin
4003.
4004.
4005.
4006.
133. q mention hyop glycemia and hypotension and hyponatremia,which is best to give
4007.
give 10%dextrose.
4008.
134. 16-q about pt is not controled on glgazid and has renal impairment
4009.
4010.
4011.
4012.
bind 2 albumin
4013.
bind to fat
4014.
others.....
4015.
4016.
4017.
4018.
4019.
4020.
4021.
143. pt with ethenol poisining and asking about the mechansim by which inhibation of alchol
dehydrogens is done by fomepizole----competitive inhibitor.
4022.
144. -pt dusring exercise test after 8 min his heart rate decrease from 140 to 70,why?
4023.
a-sinus arrest
4024.
145. a senario about an old man with impaied glucose tolerancce test and asking wht is the mechansim
of that
4025.
4026.
4027.
4028.
4029.
148. male c/o back pain has vertebral collapse due to osteoprosispsa
4030.
4031.
150. first line antibiotics for febrile neutropenia?????? what bug they trying to fight against
4032.
candida
4033.
4034.
4035.
4036.
4037.
4038.
4039.
157.alpha 1 antitrpsin-ZZ
4040.
4041.
4042.
4043.
4044.
4045.
4046.
164.parkinson tremorbenzhexol
4047.
4048.
166.parotitis----bacterial parotitis
4049.
4050.
4051.
GuestGuestdr_alpha
4052.
4053.
I agree with issue regarding Risperidone but with some comments. It is drug of choice for treating
acute onset schizophrenia by NICE. The reason is that acute schizophrenic attack can occur together
with manic-attack and autism. Or maybe it is difficult to differentiate between acute schizophrenic and
manic attack. D2 antagonist is property to treat schizophrenic (psychosis), and serotonin antagonist is
used to treat manic and autism attack.
4054.
In daily medical practice, primum non nocere (first do no harm) is essential to be dedicated to our
patient. Invasive investigation like Coronary Angiogram, CT coronary angiogram etc carry certain risks
like unexpected contrast induced nephropathy and to lesser extent, patient can die over the table during
procedure (0.5% in coronary angiogram). EST can give the important data for cardiologists, not only to
look for ST segment changes at maximal exercise. But the heart rate, blood pressure and
symptomatology (like chest discomfort, and breathless) are also important data to predict the presence
of cardiac ischaemic event. If BP drop or HR drop at maximal exercise or suffering chest pain or
breathless at maximal exercise or in recovery period, it will be very suggestive that this patient suffer
coronary artery disease, even it is difficult to interpret ST segment changes. Even we do coronary
angiogram, then we find coronary lession, we still need to do dynamic testing like EST to interpret
whether this lession is high or low risk. High risk refer that this lession can induce ischaemia whether
patient is on maximal exercise.
4055.
So I still feel that asymptomatic patient with LBBB, and normal resting echocardiogram, dynamic EST
is still very essential to be done before proceed to more invasive test.
4056.
4057.
It will be very difficult cases to be solved by junior doctors, who lacks come and work in the ward.
4058.
4059.
4060.
4061.
4062.
suggested that valproic acid may play a role in the prevention of ACM
4063.
4064.
4065.
therapy for ACM. We report here the case of a 12-year-old girl who
4066.
4067.
4068.
GuestGuestAIPPG
4069.
4070.
4071.
4072.
4073.
just a point about the primary pneumothorax one - i think the answer is outpatient observation.
4074.
4075.
as per the bts guidelines - The size of the pneumothorax, i.e. the amount of space in the chest taken up
by free air rather than air-containing lung, can be determined with a reasonable degree of accuracy by
measuring the distance between the chest wall and the lung. This is relevant as smaller pneumothoraces
may be treated differently. An air rim of 2 cm or more means that the pneumothorax occupies about
50% of the pleural cavity.
4076.
4077.
therefore a pneumothorax of 20% as in the question is smaller than a 2cm rim of air and therefore can
be managed as outpatient.
4078.
4079.
4080.
@leslie are you sure the migraine question was referring to trating an acute attack. im sure you are
correct but i had taken from the question that the were looking for a preventative agent
4081.
4082.
4083.
4084.
4085.
4086.
4-AML KARYOTYPE
4087.
5-MYCOPLASMA PNEMONIA
4088.
4089.
4090.
4091.
4092.
11-metphormin
4093.
4094.
13-imintabe-------tyrosin kinase
4095.
4096.
15-LITHIUM
4097.
16-acromegaly---gtt+groth hormone
4098.
4099.
4100.
4101.
4102.
4103.
4104.
23-hypochondrial disease-----cancer
4105.
4106.
4107.
4108.
4109.
28-whipple dis.
4110.
4111.
4112.
4113.
32-v wave
4114.
4115.
4116.
36-AF-----unstable------cardioversion
4117.
4118.
38-viagra-------ace inhibitor
4119.
4120.
4121.
41-staghorn calculus-----amonium+phosphate+magnisium
4122.
4123.
4124.
4125.
4126.
4127.
4128.
4129.
4130.
50-belpheritis
4131.
51-afro-caribian -----amlodipine
4132.
52-esonophilia------aspirgilosis
4133.
53-steroid--------avascular necrosis
4134.
54-thiazide--------hyperurecemia--------gout arthritis
4135.
4136.
4137.
4138.
4139.
4140.
4141.
4142.
63-stronglydosis-------esonophilia
4143.
64-microtubule------doxel chemothrapy
4144.
4145.
66-hypersplinisim case
4146.
4147.
4148.
4149.
70-case not benefit from TCYCLIC ANTI depres drug the case is post traumatic srtress syndrom
4150.
4151.
4152.
4153.
74-migrane----ergotamine
4154.
4155.
4156.
77-c6 radiculopathy
4157.
4158.
79-case QT K- chanel
4159.
80-proten-----westren blot
4160.
4161.
4162.
83-case MODY DM
4163.
85-case ORF
4164.
4165.
87-CASE hemophelia---0%
4166.
88-case TTP
4167.
4168.
4169.
4170.
92-case L5-S1
4171.
4172.
4173.
4174.
4175.
4176.
4177.
99-case myelodysplesia
4178.
100-case MRSA
4179.
101-CASE TB
4180.
4181.
4182.
104-rhabdomyosis case
4183.
4184.
4185.
4186.
4187.
4188.
110-pagets diseae like picture with nl Ca and Nl PO4 whith High alk phospatase.... treatment.
---residronate
4189.
4190.
4191.
114-progressive waeknessof lowerlimb with pain and temp loss--- dorsal meningoma
4192.
4193.
4194.
4195.
4196.
119-red awellon knee(post travell) sinovial fluid Nuetroplia Gframstain Negative ---Nisseria
(gonococcal)
4197.
120-q mention hyop glycemia and hypotension and hyponatremia,which is best to give
4198.
give 10%dextrose
4199.
121-case achalasia
4200.
4201.
4202.
4203.
4204.
4205.
127-c1 defecency
4206.
128-SLE c3 decrease
4207.
129-tendenitis of buttock
4208.
130-sholder supratendinitis
4209.
131-digoxin action
4210.
4211.
4212.
4213.
4214.
136-cortisole in activation
4215.
137-morphin toxicity
4216.
138-turkish leshmania
4217.
4218.
4219.
4220.
4221.
4222.
144-.CKD with high PO4 And low Ca MIld elevated PTH.... treatment---alfacalcidol
4223.
4224.
4225.
4226.
4227.
4228.
4229.
4230.
4231.
4232.
4233.
4234.
155-metaanalysis bias-publication
4235.
4236.
4237.
4238.
4239.
4240.
4241.
4242.
4243.
164-CURB---- confusion
4244.
4245.
4246.
167-COPD not responding to inhaled steroid and sortocosteroid injection ----non invasiv ventilation
4247.
4248.
4249.
4250.
171-.alpha 1 anparotitis----titrpsin-ZZ
4251.
172-case parotitis----
4252.
4253.
174-ECG of pericarditis
4254.
4255.
176-MAN SEE RED CAR OUTSIDE TRY TO SEE HIM DELUSION OF PERCEPTION
4256.
4257.
4258.
4259.
181-Patient no contact with TB, got RA on TNF alfa inhibitor - drinking unpasterurized milk (M. Bovis
detected).
4260.
4261.
4262.
4263.
4264.
4265.
4266.
4267.
Dear college can you remember the remaining 14 question if yes please added it
4268.
4269.
4270.
4271.
4272.
Thank you and hope the sucsees to allllllllllllllllllali weana ali, Sep 24, 2010#116
4273.
4274.
4275.
189- microscopic hematourea with normal renal funection----- thin membarne nephropathy
4276.
4277.
4278.
4279.
Dear angel
4280.
4281.
4282.
4283.
4284.
thanke you for you support.ali weana ali, Sep 24, 2010#118
4285.
GuestGuestguess
4286.
4287.
I think that our working experience in the ward is very important to answer MRCP questions, not only
just review the revision. MRCP value our clinical sense. Like the question regarding pneumothorax. If I
have patient with 20% pneumothorax, I'm affraid to do as outpatient needle aspiration. Please review
the algorithm in OHRM. The risk is too high. Failure of needle aspiration twice means you should do
chest drainage, otherwise patient will get worsening pneumothorax (tension pneumothorax), and he
could be die. I think 20% pneumothorax is still possible to bring patient first to hospital in situation like
in UK. Just give patient O2 first, then the A and E doctor will put close monitoring, arrange referral
letter to thoracic surgeon to prepare if patient will need chest drainage.Guest, Sep 24, 2010#119
4288.
4289.
4290.
4291.
case PPS
4292.
4293.
4294.
4295.
4296.
4297.
in q they siad act on G cell not from g cell so the answer is stimulate by peptide
4298.
4299.
4300.
4301.
4302.
4303.
4304.
4305.
4306.
terlipressin
4307.
4308.
4309.
4310.
4311.
ali weana aliGuestto mr. guest ward is thing and theory is something else
4312.
4313.
Pneumothorax
4314.
4315.
The British Thoracic Society (BTS) published guidelines for the management of spontaneous
pneumothorax in 2003. A pneumothorax is termed primary if there is no underlying lung disease and
secondary if there is
4316.
4317.
Primary pneumothorax
4318.
4319.
Recommendations include:
4320.
4321.
if the rim of air is < 2cm and the patient is not short of breath then discharge should be considered
4322.
4323.
4324.
4325.
4326.
Secondary pneumothorax
4327.
4328.
Recommendations include:
4329.
4330.
if the patient is > 50 years old and the rim of air is > 2cm and the patient is short of breath then a
chest drain should be inserted.
4331.
otherwise aspiration should be attempted. If aspiration fails a chest drain should be inserted. All
patients should be admitted for at least 24 hours
4332.
4333.
Iatrogenic pneumothorax
4334.
4335.
Recommendations include:
4336.
4337.
4338.
majority will resolve with observation, if treatment is required then aspiration should be used
4339.
ventilated patients need chest drains, as may some patients with COPD
4340.
Rate question:
4341.
4342.
4343.
GuestGuestGuess_1
4344.
4345.
Insulin & Dextrose have been proved to protect heart until the level of evidence based medicine (see
the DIGAMI study). On the other hand it will reduce K faster. I think the question put stress, how to
reduce K?Guest, Sep 24, 2010#122
4346.
4347.
4348.
Dear angel
4349.
4350.
4351.
4352.
4353.
4354.
4355.
4356.
4357.
4358.
GuestGuestGuess
4359.
4360.
4361.
Calcitonin Gene Related Peptide (CGRP) has been proved to be basic molecular pathogenesis in acute
migrain attack. MERCK Pharmaceutical Company has provided CGRP receptor antagonist
(Telcagepant) to limit the effect of CGRP. The drug has reached at Phase III, and readily for use in the
GuestGuestGuess
4363.
4364.
I think we should give intravenous form of drug to abort migraine that not response with triptan. We
don't have intravenous form of propanolol or ergotamine :cry: What do you think?Guest, Sep 24, 2010
#126
4365.
dr.angel05GuestOf course banding is the best but they ask about immadite ttt which is vasoconstractor
then we can go to bandingdr.angel05, Sep 24, 2010#127
4366.
Dr_AlphaGuestI agree with banding rather than terlipressin. In the emergency situation mechanical
treatment is more superior and beneficial to patient. If patient bleeds profusely, and falls in shock
condition, it will be very difficult to deliver terlipressin to target organ. Usually we do fluid
resuscitation, manage ABG, stabilized BP with inotropic drugs, and bring patient immediately to
endoscopic room for urgent banding. If we can't solve the bleeding by banding, we should put SB tube
at once. I think endoscopic procedure is essential for life saving in this scenario.Dr_Alpha, Sep 24,
2010#128
4367.
4368.
banding is the one for immediate treatment under direct visualisation of the bleeding varices.
telipressing only reduce the portal hypertention which do not stop a bleeding from a varices already
started bleedingdr_shahi000, Sep 24, 2010#129
4369.
4370.
i think its pulmonary artery wedge pressure rather than high protien pul edema.
4371.
4372.
4373.
4374.
4375.
4376.
4377.
* Acute onset
4378.
4379.
* Pulmonary artery wedge pressure < 18 mmHg (obtained by pulmonary artery catheterization), if this
information is available; if unavailable, then lack of clinical evidence of left ventricular failure suffices
4380.
* if PaO2:FiO2 < 300 mmHg (40 kPa) acute lung injury (ALI) is considered to be present
4381.
* if PaO2:FiO2 < 200 mmHg (26.7 kPa) acute respiratory distress syndrome (ARDS) is considered to
be present
4382.
4383.
To summarize and simplify, ARDS is an acute (rapid onset) syndrome (collection of symptoms) that
affects the lungs widely and results in a severe oxygenation defect, but is not heart failuredr_shahi000,
Sep 24, 2010#131
4384.
ShezGuestcan i please ask why p53 and not brca1? thanksShez, Sep 24, 2010#132
4385.
dr_shahi000Guestshez here is the ex[lanation from basic science for MRCP by phylipa J Easter Brook
4386.
4387.
p 53 is a central regulator of apoptosis. inactivation of which is the primary defect in the Li-Fraumeni
syndrome(a dominant inherited monogenic cancer syndrome characterdised by breast cancer sarcoma,
brain and other tumors
4388.
it is the most commonly mutated gene in tumors,and over50% of bladder,breast,colon and lung cancers
have p53 mutation clustered in a concerved rfegion of exon 5-10.
4389.
4390.
4391.
so inherited cancer syndrome i am sure is mainly due to p53.dr_shahi000, Sep 24, 2010#133
4392.
4393.
4394.
4395.
p53 is a tumour suppressor gene located on chromosome 17p. It is the most commonly mutated gene in
breast, colon and lung cancer
4396.
4397.
p53 is thought to play a crucial role in the cell cycle, preventing entry into the S phase until DNA has
been checked and repaired. It may also be a key regulator of apoptosis
4398.
4399.
Li-Fraumeni syndrome is a rare autosomal dominant disorder characterised by the early onset of a
variety of cancers such as sarcomas and breast cancer. It is caused by mutation in the p53 gene
4401.
b caz in the question stem there is no mention of acute migrain(the patient have been suffering fron
migrain for the past 4 year which is now increasing in intensity now which is not responding to the
treatment now
4402.
4403.
4404.
ShezGuestthanks dr shahi.
4405.
4406.
4407.
i also ahve seen the info on p53 but it says maily breast, sarcoma and lung.
4408.
in the question it was breast, ovarian, breast and prostate, which is why i put brca-1 which is hereditary
and implicated in all of those cancers. what do u guys think? im not saying im right i just would like
others opinions thanksShez, Sep 24, 2010#136
4409.
meeramaGuestMRCP part 1
4410.
4411.
Dear all,
4412.
4413.
Are there any repeaters here. How confident they are regarding their performance? I think the more I
read for this exam, the more I am confused. Oh god help me!!!!meerama, Sep 24, 2010#137
4414.
4415.
Certain variations of the BRCA1 gene lead to an increased risk for breast cancer. Researchers have
identified hundreds of mutations in the BRCA1 gene, many of which are associated with an increased
risk of cancer. Women who have an abnormal BRCA1 or BRCA2 gene have up to an 60% risk of
developing breast cancer by age 90; increased risk of developing ovarian cancer is about 55% for
women with BRCA1 mutations and about 25% for women with BRCA2 mutations.[19]
4416.
In addition to breast cancer, mutations in the BRCA1 gene also increase the risk of ovarian, fallopian
tube and prostate cancers. Moreover, precancerous lesions (dysplasia) within the Fallopian tube have
been linked to BRCA1 gene mutations. Pathogenic mutations anywhere in a model pathway containing
BRCA1 and BRCA2 greatly increase risks for a subset of leukemias and lymphomas.[6]
4417.
4418.
so I think BRCA is mainly for breast ovarian and prostate I dont know if p 53 is the right
answer.. there is a chance for BRCA 1 also
4419.
Log in or Sign up
4420.
4421.
4422.
Forums
4423.
>
4424.
UK Medical Zone
4425.
>
4426.
MRCP Forum
4427.
>
4428.
4429.
4430.
4431.
Page 4 of 25
4432.
< Prev
4433.
4434.
4435.
4436.
4437.
4438.
4439.
4440.
25
4441.
Next >
4442.
4443.
4444.
4445.
any one rember the details of itali weana ali, Sep 25, 2010#151
4446.
4447.
4448.
4449.
any one rember the detailsali weana ali, Sep 25, 2010#153
4450.
GuestGuestthe pass scor 521 about 135 questionGuest, Sep 25, 2010#154
4451.
4452.
4453.
occlsion of LAD ?
4454.
4455.
4456.
4457.
or what ?
4458.
4459.
4460.
4461.
4462.
4463.
4464.
4465.
GuestGuest1 pt with papule and pustule in the face increase with alchol , roscia
4466.
4467.
4468.
5 pt with loss of pain and temp in the arm and preservation of postion syrngomylia
4469.
4470.
7 pt with parotid swelling after treatment for pneumonia mump , paroditis , sarcodosis
4471.
4472.
9 pt with father of heamophilia how much of his childern will get the disease , no one
4473.
4474.
4475.
4476.
13 pt with rip metastisis what the next step in mangment riotherpy add pethdine
4477.
4478.
4479.
4480.
17 pt with dilated pupil not reactive to light but to accomdication holman die pupile
4481.
4482.
19 pt with central sctoma and paplodeamia optic nerve compresion , optic neurtits ,
4483.
4484.
4485.
22 pt on lasanpril found his renal profile dertord what would be regarding his mangment continus
lasopril
4486.
4487.
4488.
4489.
4490.
28 pt who work alone after one of men leave work with pain in the limb
4491.
4492.
4493.
4494.
4495.
34 pt with foot ulcer with cellutits which show sensitivity to fuisidic acid and vancomycine
4496.
35 pt with percaridal effusion diagnosis suddnly on investigation for operation to carry on for operation
4497.
4498.
4499.
4500.
4501.
4502.
i think i have more but iwill try to remmber the other [/code]Guest, Sep 25, 2010#156
4503.
4504.
GuestGuestMRCPian
4505.
4506.
Refer to your archimedes calculator regarding ABCD2 Stroke Score and compare that with Rankin
Score.
4507.
4508.
4509.
4510.
4511.
Diabetes - No.
4512.
The calculator will score 2. If speech impairment duration less than 10 minutes, it will score 1.
4513.
I think it is similar to Rankin Score. If slurred speech less than 10 minutes, than you can score 1, if less
than 45 minutes you should score 2. It is a very discriminative question.
4514.
Another discriminative question. Regarding discrepancy renal bipolar size 1.2 cm. Please review Kalra,
RAS/ARVD is considered if renal size discrepancy more or equal to 1.5 cm. On the other hand, the
recent UK style is not proceeding directly to Renal Angiogram, because the incidence of unexpected
CIN is quite worrying. The did Renal Vascular Doppler U/S firstly in skillful hand technician. If you
find suspicious flow problem from Doppler U/S, then you can proceed to angiogram. Again and again,
primum non nocere (firstly do no harm to patient). I think the answer is Renal Biopsy to confirm
Hypertension Nephrosclerosis.Guest, Sep 25, 2010#158
4515.
GuestGuestdr_Alpha
4516.
4517.
Infarct with ST segment elevation should be Totally Occluded. If you involve in Primary PCI, the
interventional cardiologist must provide thrombuster to suck the red thrombus out, put GP2B3A to
prevent subsequent thrombus formation, then do ballooning and finally with stent deployment. It is a
complicated PCI, not just only simple as elective PCI, because the respective red thrombus totally
occluded the Infarct Related Artery and high risk to recur.Guest, Sep 25, 2010#159
4518.
GuestGuestGuess
4519.
4520.
Are u sure that our successful in this exam only depend on how many the overall (cumulative) correct
answers that you have made? Not to emphasize per subspecialty subjects? for example: if opthalmo
questions got only 4 questions, you only make 2 correct answers, it will make you fail, even if you
have made high score in the other subspecialty area?Guest, Sep 25, 2010#160
4521.
4522.
4523.
is 70% occlusion insignificant ? And other question of the man who died
4524.
4525.
4526.
4527.
what are the opinions ? I hope we all succeed Guest, Sep 25, 2010#161
4528.
ShezGuestbasically in the occlusion question it was an anterior MI with reciprocal changes in the
inferior leads. if there are reciprocal changes it must be a transmural MI, and therefore a total
occulsion.
4529.
4530.
thanks for the info on the kidney size one leslie, i re-read kalra and i agree with you that biopsy should
be done as 1.2cm is not significant enough to march forward with an angiogram.
4531.
4532.
4533.
4534.
where is cortisol deactivated in the body btw??? any idea on answer to that question.Shez, Sep 25,
2010#162
4535.
4536.
4537.
4538.
what was the investigation for that... was it biopsy again??dr_shahi000, Sep 25, 2010#163
4539.
dr_shahi000Guestdear freinds ion 2006 one of the diet the pass percentage was 59.59% on of the guy
who passed the mrcp and got his resul letter has commented on this in aippg it gos like this
4540.
4541.
yes, the cut off is 59.59% for sure....i got the result letter...
4542.
4543.
they give you a complete analysis of your performance....they give you how many correct and incorrect
answers you did in each and every branch of the exam...
4544.
4545.
4546.
4547.
dr_shahi000Guestin some other diet they say it was 62%.... god knows...dr_shahi000, Sep 25, 2010
#165
4548.
GuestGuestGuess
4549.
4550.
4551.
I think you must have many clinical exposures, try to involve many procedures, understand and then
arm yourself with current clinical issue, like attending Round Table Discussion, CPD, etc. RCP may
know that candidates just only learn the review. They want us to master in every single detail of
particular topic. That's why they ask a discriminative question.
4552.
You must see yourself if your consultant or interventional cardiologist did Primary Percutaenous
Coronary Intervention to your patient with acute ST Segment Elevation. It is never not totally
occluded. Sometimes interventionist uses 2 or 3 thrombusters to suck the red thrombus out. I involved
one procedure, until we use splicer device to cut the red thrombus. Actually the term of ST Segment
and non ST Segment Elevation Myocardial Infarction was created by Eugene Braundwald, the father of
US Cardiology. He saw by himself by using angioscope the red thrombus in every patient with ST
Segment Elevation, and the white thrombus in every patient with Non ST Segment Elevation. Red
thrombus always gave total occlusion because it is very sticky, however the white thrombus gave
subtotal (99%) occlusion. Red thrombus was built by fibrin and RBC, however the white thrombus was
built by platelet.Guest, Sep 25, 2010#166
4553.
GuestGuestGuess
4554.
4555.
Another discriminative question that can throw the candidate out. I saw that many candidates answer
serotonin for risperidone question. Please review again your scenario in passmedicine. I have reviewed
it too. If I'm not mistaken, the review question was......The ATYPICAL antipsychotic effect of
risperidone is mediated by..... The answer was serotonin. I think this atypical psychotic refer to manic
and autism which commonly overlapping with acute schizophrenia attack, in which serotonin was the
physiology receptor. But our exam question was....The antipsychotic effect (WITHOUT word
"atypical") of risperidone is mediated by.....The answer should be Dopamin. Patient with Pulmonary
Renal Syndrome was usually VERY ILL, and prone to Systemic Inflammatory Response Syndrome
(SIRS) and Multi Organ Failure, if you do so unnecessary invasive procedure. Again and again, I think
the principal of Primum Non nocere should bear in our mind. However ANCA measurement is widely
available, very high sensitive and specific for Pulmonary Renal Syndrome disease. You should measure
baseline ANCA, then do plasmapheresis, then measure again post plasmapheresis ANCA to monitor
disease progression.Guest, Sep 25, 2010#167
4556.
GuestGuestdr_Alpha
4557.
4558.
In equality system, the criteria to pass the exam is quite tough. I worry that if we have made more than
20 mistakes, we begin to enter the dangerous zone.Guest, Sep 25, 2010#168
4559.
4560.
4561.
I know it's total occlusion and it's VF to be added to the ever growing
4562.
list ! but what about other questions like gastric bypass deficiency is it
4563.
4564.
" Folate absorption is facilitated by hydrochloric acid and occurs primarily in the upper one-third of the
small intestine.[30] Additionally, vitamin B12 acts as a coenzyme in converting methyltetrahydrofolate
to tetrahydrofolate, so a vitamin B12 deficiency may result in subsequent folate deficienc " Other
choose iron
4565.
4566.
4567.
4568.
4569.
dr_shahi000Guestlislie
4570.
the question about the pulmonary renal syndrome was (i think )about conformation of the dignosis
4571.
all the three major pulmonary renal syndrome are comfirme by histo pathological dignosis
4572.
4573.
4574.
so i think if you have to confirm the dignosis renal biopy (cresenti glomerulo nephritis with study of
ANCA.. wil not give you a defenitive dignosis as a negative result will not exclude the disease.. and
futher there are other anca positive vasculitis which do not present as pulmonory renal syndrome
dr_shahi000, Sep 25, 2010#171
4576.
4577.
if only 70% u will get only ischemic changes in ECG. you will not get a myocardial infarction with
70%oclution
4578.
there must complete lack of oxygen to the myocardium for a myocardial infarction which u get by a
complete oclusion of the coronaries.dr_shahi000, Sep 25, 2010#173
4579.
dr_shahi000Guestrisperidone
4580.
4581.
This drug belongs to a class of antipsychotic drugs known as atypical antipsychotics that have more
pronounced serotonin antagonism than dopamine antagonism, but risperidone is unique in this class
because it retains dopamine antagonism. It has high affinity for D2 dopaminergic receptors. It has
actions at several 5-HT (serotonin) receptor subtypes. These are 5-HT2C, linked to weight gain, 5HT2A,linked to its antipsychotic action and relief of some of the extrapyramidal side effects (EPS)
experienced with the typical neuroleptics.dr_shahi000, Sep 25, 2010#174
4582.
mrcp-4Guestit seems to become impossible fr me to pass mrcp!!!!guys how many qs u got wrong out
of?mrcp-4, Sep 25, 2010#175
4583.
dr_shahi000Guestdear friends
4584.
4585.
4586.
if it is an easy exam the pass mark could even go to 70 %for a score of 521
4587.
4588.
4589.
4590.
dr_shahi000Guesthere is the answer for ankylosing spondilitis question from med scape
4591.
4592.
4593.
physical examination
4594.
A thorough physical examination, particularly of the musculoskeletal system, is needed. Clinical signs
are sometimes minimal in the early stages of the disease. Examination of the sacroiliac joints and the
spine (including the neck), measurement of chest expansion and range of motion of the hip and
shoulder joints, and a search for signs of enthesitis are critical in making an early diagnosis of AS.
Important physical findings due to enthesitis that can be present but are often overlooked, especially
among juvenile-onset AS patients, include tenderness over sacroiliac joints, vertebral spinal processes,
iliac crest, anterior chest wall, calcaneus (plantar fasciitis and/or Achilles tendinitis), ischial
tuberosities, greater trochanters, and, sometimes, tibial tubercles. Tenderness and stiffness of the
paraspinal muscles often accompany the inflammation of the axial skeleton.
4595.
4596.
With longer disease duration and disease progression, the spine becomes increasingly stiff, leading to
loss of spinal mobility in all planes and restricted chest expansion. Although spinal ankylosis develops
at a variable rate and pattern, the typical spinal deformities of AS usually evolve after 10 or more years.
Spinal osteoporosis is frequently observed, especially in patients with severe AS of long duration,
partly as a result of lack of spinal mobility due to ankylosis, but it may also be related to mineralization
defect. The rigid osteoporotic spine is unduly susceptible to fracture even after a relatively minor
trauma, including events that the patient may not even rememberdr_shahi000, Sep 26, 2010#177
4597.
4598.
4599.
4600.
4601.
4602.
4603.
i accept most of the subject the q came from it as mrcp like specific one and they continue to repeat it
but still some times they put a word in the q which made u confused and u cant know what is exactelly
the correct answer for them!!!!
4604.
4605.
4606.
4607.
i dont know whta should my plan be to pass this exam??!!!!asya, Sep 26, 2010#179
4608.
sgfhGuestif some one has 46 mistakes from 200 q he will pass ore not.sgfh, Sep 26, 2010#180
4609.
gangwGuesthi, I think both of you guys will definately pass. I have more mistakes..gangw, Sep 26,
2010#181
4610.
ANCA has c subtype which is specific for WG, and p subtype which is specific for CSS. Usually we
measure also AGBM to confirm GPS. Whatever the subtypes are, it will not change the management.
That is PLASMAPHERESIS. We usually measure all subtypes and use them to monitor adequacy of
PLASMAPHERESIS. We always avoid such unnecessary invasive procedures. Imagine yourself if you
do biopsy to your patient with necrotizing vasculitis (WG), what will happen to him. He should have
good prognosis if we remove the antibody out by plasmapheresis. If you do renal biopsy to him, he will
get SIRS and MOF at once. That means you will change your patient's prognosis tremendously. I will
think RCP want us to become a good,precise, and smart doctor to our patients. They want us to protect
our patients. That is the philosophy created by King Henry, when he built College of Physician (later
become Royal College of Physician).Guest, Sep 26, 2010#183
4611.
GuestGuestpatient with hypercalcemia about the investigasion ? testesteron ? pth ? PSAGuest, Sep 26,
2010#184
4612.
w_balgGuestpatient with Ca3.1 about the Dx --> primary hyperparathyrodism? myloma?w_balg, Sep
26, 2010#185
4613.
#186
4614.
GuestGuestGuess
4615.
4616.
. Patient with history of chronic lung infection, then got antibiotic for Mycoplasma Pneumonia 3/12
ago, now come with supraclavicular lymph node. The said that they find cold agglutinin. They ask
what is the diagnosis?? Mycoplasma Pneumonia has been cleared by ABx, it seldom leave sequalae.
But supraclavicular lymph node disturb my mind. Please anyone mention me if find paper lymphoma
with supraclavicular lymph node?Becos I only recognise lymphoma in large glands like colly, axillae,
and groin. On the other hand, it is unusual that Lymphoma give history of chronic lung infection. A
very discriminative question.Guest, Sep 26, 2010#187
4617.
w_balgGuesti feel bad, i am still confuse regarding the correct answ :?: :shock:w_balg, Sep 26, 2010
#188
4618.
w_balgGuestat least i have 30 mist,,,, is there any possibility to pass????? w_balg, Sep 26, 2010#189
4619.
mrcp-4Guestcan any one wht about the qs pt with macroprolactinoma will hve which other hormone
deficit??
4620.
4621.
4622.
4623.
4624.
4625.
4626.
4627.
4628.
option was
4629.
a.trendelberg
4630.
4631.
4632.
GuestGuestguess
4633.
4634.
Regarding patient come with PMR with normal ESR, BP 160/90 mmHg, no mention about previous
medical history, on prednisolone 8 mg/day, now complaining visual loss with fundal haemorrhage. TA
was not tender and pulsatile. What is the eye diagnosis?
4635.
4636.
dr_shahi000Guesthi all i aready started preparing for the jan diet as i am sure my result will be a fail...
4637.
planing to register for the next diet on the next day of publishing the result..
4638.
any body else with me for the next diet???dr_shahi000, Sep 26, 2010#205
4639.
4640.
4641.
In most cases the actual risk of transmission of a blood borne pathogen following a needle-stick is
extremely low. The most commonly transmissible diseases of concern to nurses are the human
immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV).
4642.
Hepatitis B: Of these HBV is the most transmissible, with a risk of infection following exposure of
around 6-30%. (Staff that have achieved immunity after being covered with the hepatitis B vaccine are
practically immune.)
4643.
4644.
4645.
4646.
4647.
4648.
4649.
4650.
4651.
sleGuestmild ketonemia is acceptable in type 2 dm according to passmedicine i thinksle, Sep 27, 2010
#207
4652.
guest007Guesthyperkalemia associated with ecg changes is treated with calcium gluconate but without
changes insulin and dextrose can be given can anybody reply was it with ecg changes???
4653.
4654.
4655.
4656.
guest007Guestdr_shahi000 iam with you as iam also sure of not going through but lets pray anything
can be possible and hope positiveguest007, Sep 27, 2010#209
4657.
4658.
4659.
I don't know how they evaluate the answers and if questions differ
4660.
4661.
4662.
4663.
and hope we all can pass isa .Guest, Sep 27, 2010#210
4664.
4665.
4666.
4667.
4668.
1.tredelnberg
4669.
2.femoral stretch
4670.
4671.
4672.
4673.
4674.
4675.
GuestGuestNo sir the answer Calcium Gluconate , SureGuest, Sep 27, 2010#212
4676.
4677.
question asked which would lower the serum K+ quickest..... this def is insulin!
4678.
4679.
i think i'll be prepping for jan too shez, Sep 27, 2010#213
4680.
shezGuestoh an i chose anterior ischaemic optic neuropathy too leslieshez, Sep 27, 2010#214
4681.
w_balgGuesthyperkalemia associated with ecg changes is treated with calcium gluconate but without
changes insulin and dextrose can be given can anybody reply was it with ecg changes???
4682.
__________________
4683.
i think the qus was about the best way to shift the K to inside the cell , not about the emergency
treatment of hyper .
4684.
4685.
SO the correct answ. was insulin with Dextr.w_balg, Sep 27, 2010#215
4686.
mrcp-4Guestwht about the qs regarding ankylosing spondy??no commnts guys??mrcp-4, Sep 27, 2010
#216
4687.
dr.angel05Guesthi mrcp-4
4688.
4689.
4690.
2-tredelnberg test
4691.
3-femoral stretch
4692.
4693.
5-? i forget it
4694.
i think the answer in global immobile vertebrae because other tests unrelated to anklosingdr.angel05,
Sep 27, 2010#217
4695.
GuestGuestGuess
4696.
4697.
I got one easy question. They ask about pulmonary wedge pressure represent what heart chamber. The
answer is Left Atrium.Guest, Sep 27, 2010#218
4698.
4699.
4700.
2-tredelnberg test
4701.
3-femoral stretch
4702.
4703.
5-? i forget it
4704.
4705.
that which i mark and q was asking about sign 2 be find in pt with ASasya, Sep 27, 2010#219
4706.
dr_shahi000Guestdear guest007
4707.
4708.
4709.
4710.
4711.
4712.
4713.
4714.
4715.
4716.
4717.
4718.
4719.
4720.
4721.
shezGuestok can you tell us the risk of contracting HIV from a needlestick injury in a patient with
known HIV. the qustion stressed that the wound had been thoroughly cleaned under clean running
water
4722.
4723.
1 in 3
4724.
1 in 30
4725.
1 in 300
4726.
1 in 3000
4727.
4728.
dr_shahi000Guestdear shez the answer i am sure is 0.3% which is 1/333.i hope you have gone through
the previos post regarding this
4729.
4730.
4731.
3% is 3in100
4732.
0.3 is 3in1000
4733.
so 1t is roughly 1 in 333
4734.
4735.
dr_shahi000Guestdear shez
4736.
4737.
i am not sure ...but i think the answe will be rentinal vein thrombosis (as retinal hemorrhage is
characteristic of vein thrombosis .
4738.
the ischemic optic nueropathy you will get a pale optic disc than hemorrage.
4739.
Firstly the cholestatic pregnant lady, I initially was going for cholestasis in preganacy but she was only
14 pregnant, I thought cholestasis in preg occurs in third trimester. Not sure whether it was a trick
question?
4740.
4741.
The SIADH question, the answer is carbamezepine but out of interest, do sulphonylureas also cause
SIADH as the patient was a diabetic?
4742.
4743.
4744.
4745.
Finally, this question on varices is bugging me. No doubt the immediate mx is telipressin but they had
already done endoscopy to reveal grade 2 varices. Therefore was the answer banding? Thanks for your
help.
4746.
4747.
This was my first attempt having graduated 12 months ago. I am preparing for the next exam in
January and am depressed by my stupid errors as I think even 140/200 is unlikely to save me. Having
already completed passmedicine and onexamination, do u suggest I start another site such as
MRCPASS or I should go over onexam and passmed thoroughly again? Your time and help is much
appreciated.Guest 2009, Sep 27, 2010#237
4748.
guest007Guestatleast wait for the result brother as never know whats in store so keep fingers crossed
and hope for the best even though we have made mistakes but the forum is just a discussion and the
answers are with rcp only
4749.
4750.
was there a question on copd with best management smoking cessation??? not sure
4751.
guest007GuestThe overall risk of HIV infection after percutaneous exposure to HIV-infected material
in the health care setting is 0.3%.[14][15]
4752.
4753.
Estimates of the risk of a single injury indicate a risk of 300 HBV infections (30% risk), 30 HCV
infection (3% risk) and 3 HIV infections (0.3% risk) per 1,000 respective exposures.[8]
4754.
4755.
4756.
4757.
A combination of the Greek words poly (meaning multiple) and morph (meaning form), this term is
used in genetics to describe the multiple forms of a single gene that can exist in an individual or among
a group of individuals
4758.
can anybody have an idea abt the choices of polymorphism in a gene? the above defination from the
net.guest007, Sep 27, 2010#241
4759.
guest007Guesta bit confused on question on alpha 1 antitrypsin since i guess some activity was like
25percent i have marked sz i think iam wrong??can
4760.
Alpha-1 antitrypsin (A1AT) deficiency is a common inherited condition caused by a lack of a protease
Genetics
4763.
4764.
* located on chromosome 14
4765.
4766.
* alleles classified by their electrophoretic mobility - M for normal, S for slow, and Z for very slow
4767.
* normal = PiMM
4768.
4769.
4770.
4771.
4772.
Features
4773.
4774.
4775.
4776.
4777.
Investigations
4778.
4779.
* A1AT concentrations
4780.
4781.
4782.
Management
4783.
4784.
* no smoking
4785.
4786.
4787.
4788.
4789.
4790.
*trusted sources are split on which is a more accurate descriptiondr_shahi000, Sep 28, 2010#243
4791.
dr_shahi000Guestfrom wikipedia
4792.
4793.
As protein electrophoresis is imprecise, A1AT is analysed by isoelectric focusing (IEF) in the pH range
4.5-5.5, where the protein migrates in a gel according to its isoelectric point or charge in a pH gradient.
4794.
4795.
Normal A1AT is termed M, as it is migrates toward the center of such an IEF gel. Other variants are
less functional, and are termed A-L and N-Z, dependent on whether they run proximal or distal to the
M band. The presence of deviant bands on IEF can signify the presence of alpha 1-antitrypsin
deficiency. Since the number of identified mutations has exceeded the number of letters in the alphabet,
subscripts have been added to most recent discoveries in this area, as in the Pittsburgh mutation
described above.
4796.
4797.
As every person has two copies of the A1AT gene, a heterozygote with two different copies of the gene
may have two different bands showing on electrofocusing, although heterozygote with one null mutant
that abolishes expression of the gene will only show one band.
4798.
4799.
In blood test results, the IEF results are notated as in PiMM, where Pi stands for protease inhibitor and
"MM" is the banding pattern of that patient.
4800.
4801.
4802.
4803.
Alpha 1-antitrypsin levels in the blood depend on the genotype. Some mutant forms fail to fold
properly and are, thus, targeted for destruction in the proteasome, whereas others have a tendency to
polymerise, being retained in the endoplasmic reticulum. The serum levels of some of the common
genotypes are:
4804.
4805.
4806.
4807.
4808.
4809.
4810.
4811.
4812.
4813.
4814.
4815.
Other rarer forms have been described; in all there are over 80 variants.dr_shahi000, Sep 28, 2010#244
4816.
guest123456Guesti do think some of the posts regarding what the college are looking for are from
people on another planet.
4817.
4818.
a patient with a rapidly progressive glomerulonephritis MUST have a renal biopsy for a tissue
diagnosis; it is absolutely the key investigation. anyone who has worked in a proper renal unit will
know this. it is not a case of not doing harm by not undertaking the biopsy; it is an essential piece of
information.guest123456, Sep 28, 2010#245
4819.
4820.
4821.
4822.
this is also a cofusing question can any body help regarding this question...
4823.
then my answer (pizz is wrong again one more wrong answer to my long list)dr_shahi000, Sep 28,
2010#246
4824.
>
4825.
4826.
ali weana aliGuestthere is a q about prick test and option iclude histamineali weana ali, Sep 28, 2010
#251
4827.
ali weana aliGuestthere is a q pyodermagegerosum after crohn operation all the details same as pass
medicine qali weana ali, Sep 28, 2010#252
4828.
4829.
4830.
ali weana aliGuestthere is a case lithiumali weana ali, Sep 28, 2010#254
4831.
GuestGuestThanks Ali
4832.
4833.
4834.
4835.
4836.
4837.
4838.
guestjjjjjGuestI think that leslie_tjong is rather patronising in his tone, and is trying too hard to prove
that his answers are correct when they might not be. (leslie - from my perspective - you haven't quite
grasped what the RCP are really looking for in their candidates, and so perhaps you should stop giving
other people such one dimensional advice?! MRCP is not the stuff of case reports, and a lot of the stuff
that you've learnt from your vast clinical experience is not in line with UK guidelines!).
4839.
4840.
All - try not to stress yourselves too much - wait to see what happens before getting depressed! In my
view it's too early to start revising again (you'll wear yourselves out, and won't revise effectively). If
you fail, maybe it's time to read, and understand, a good textbook (rather than relying on the online
questions)? Maybe not - your choice.guestjjjjj, Sep 28, 2010#256
4841.
4842.
A 50-year-old man with a history of ulcerative colitis comes for review. Six years ago he had an
ileostomy formed which has been functioning well until now. Unfortunately he is currently suffering
significant pain around the stoma site. On examination a deep erythematous ulcer is noted with a
ragged edge. The surrounding skin is erythematous and swollen. What is the most likely diagnosis?ia
4843.
4844.
4845.
4846.
4847.
4848.
4849.
4850.
4851.
4852.
4853.
the chrons may be a distractor (i have given a post regarding this erlier with suporting article)
dr_shahi000, Sep 28, 2010#257
4854.
4855.
4856.
4857.
The infection begins locally, at a site of trauma, which may be severe (such as the result of surgery),
minor, or even non-apparent. Patients usually complain of intense pain that may seem in excess given
the external appearance of the skin. With progression of the disease, tissue becomes swollen, often
within hours. Diarrhea and vomiting are also common symptoms.
4858.
4859.
In the early stages, signs of inflammation may not be apparent if the bacteria are deep within the tissue.
If they are not deep, signs of inflammation, such as redness and swollen or hot skin, show very quickly.
Skin color may progress to violet, and blisters may form, with subsequent necrosis (death) of the
subcutaneous tissues.
4860.
4861.
Patients with necrotizing fasciitis typically have a fever and appear very ill. Mortality rates have been
noted as high as 73 percent if left untreated.[4] Without surgery and medical assistance, such as
antibiotics, the infection will rapidly progress and will eventually lead to death.[5]dr_shahi000, Sep 28,
2010#258
4862.
dr_shahi000Guestmost of our friends have put poderma gangrenosum as an answer for this question
4863.
i am not sure of my answer again . any body remembers the exact question ???
4864.
4865.
4866.
4867.
4868.
4869.
4870.
4871.
4872.
an 'atypical' form that is more superficial and occurs in the hands and other parts of the body
4873.
4874.
4875.
4876.
4877.
4878.
4879.
4880.
4881.
4882.
4883.
4884.
4885.
4886.
4887.
4888.
4889.
i think q was saying that lesion was ulcereted not just a mere change in skin color......but i dont
remember q well but still think pyo is the correct answer....actually hope it is i already hav enough
mistakes!tatta, Sep 28, 2010#260
4890.
GuestGuestdear tatta
4891.
lets hope for the best.. and thnx for the clarification.
4892.
as most of our friend has put pyoderma gangrenosm as answer i think that could be the correct one...
4893.
4894.
dr_shahi000Guestdear tatta
4895.
lets hope for the best.. and thnx for the clarification.
4896.
as most of our friend has put pyoderma gangrenosm as answer i think that could be the correct one...
4897.
4898.
4899.
4900.
4901.
GuestGuestthe question about hyperkalaemia.. i think the question was not to reduce serum potassium
but the immediate management... i think its calcium gluconate which is the correct answerGuest, Sep
28, 2010#264
4902.
mrcp-4Guestit was indeed to reduce hyperkalemia,not to protect heartmrcp-4, Sep 28, 2010#265
4903.
dr_shahi000Guestyes mrcp 4 the question was regarding how rapidly you can reduse the pottasium...
4904.
4905.
4906.
tattaGuesti feel that the more we discuss, the more fearful we grow
4907.
4908.
i wish u all good luck & for the ones who r as stressed as i am, we should relax 'cause honestly theres
nothing in our hands now put to pray for the best!!
4909.
4910.
the website states nothing about the result release date except that it'll be after 4 wks from exam date
but usually they release the results in 3 wks so 15 oct is a close approximationtatta, Sep 28, 2010#267
4911.
d.lissanGuestdr.shahi
4912.
the exam result will be within the 4th week after exam date
4913.
4914.
4915.
Dr albarwariGuest 38 years old Patient with recurrent hematuria at work with normal renal function
it was "Thin basement membrane disease" which is, along with IgA nephropathy, the most common
cause of asymptomatic hematuria. Most patients with thin basement membrane disease are incidentally
discovered to have microscopic hematuria on urinalysis. The blood pressure, kidney function and the
urinary protein excretion are usually normal. Mild proteinuria (less than 1.5 g/day) and hypertension
are seen in a small minority of patients. Frank hematuria and loin pain should prompt a search for
another cause, such as kidney stones or loin pain-hematuria syndrome. Also, there are no systemic
manifestations, so presence of hearing impairment or visual impairment should prompt a search for
hereditary nephritis such as Alport syndrome.Dr albarwari, Sep 28, 2010#270
4916.
4917.
Dr albarwariGuestRegarding the genetic case "Hemophilia" I see most people give option 0% but the
question was that ,,,,,in a pregnant woman ultrasound show male fetus,,,,her father has
hemophilia,,,,,,what is the chance of her son to have hemophilia,,,,,as you see the question is clear,,,,so
this lady must be CARRIER as her father has hemophilia,,,,so the chance of her son will be
50%,,,,,,,,hope it is clearDr albarwari, Sep 28, 2010#272
4918.
4919.
4920.
4921.
4922.
4923.
the father of the fetus had hemophilia not the father of mother so the the possibility of his son to
affected will be 0%
4924.
4925.
4926.
4927.
4928.
4929.
3- anmd most important the same q is in the on examination and the correct answer was ca gluconateali
weana ali, Sep 28, 2010#274
4930.
4931.
as always RCP will have some key words or points with which they confuse the candidates..
4932.
so if you do not read the question clearly .. sure we will be distracted ...
4933.
4934.
4935.
4936.
4937.
so .... actually in the exam i have spend some time on this question thinking "the fatherhood"...
4938.
finally i guessed it could be the father of the foetus... thats why i put th answer 0%
4939.
4940.
4941.
4942.
4943.
4944.
4945.
4946.
d.lissanGuestq about young adult with bloody diarrhoea , sigmoidscopy showed confluened
inflammatory changes , xray was normal , recieved hydrocortizone for 3 days no improvement wt is
next investigation
4947.
1 colonoscopy
4948.
2 repeat xray
4949.
3us
4950.
4 barium enema
4951.
my thinking was this pt with severe inflammatory bowl disease had developed toxic mega colon , i had
gone for repeat xray because itis used in monitoring acute disease see OHCM P266 , although iam not
sure true or false ,please discuss .....
4952.
4953.
shezGuesti put wrong i put colonoscopy. but you are right i think d.lissan. i would rpt the axr and im
sure this is what we would all do in our practiceshez, Sep 28, 2010#281
4954.
4955.
4956.
4957.
i got this answer from the pastest lecture (vedio) . third question inthe fisrt lecture of endocrinology is
the same question which was asked for the exam
4958.
4959.
4960.
4961.
4962.
4963.
d.lissanGuestdear ,shez and shahi there is chance for colonoscopy to be true we dont know sometimes
wt mrcp people want .
4964.
4965.
1 GH
4966.
2CORTISOL
4967.
3THYROXINE
4968.
4ADH
4969.
5 oestrogen??
4970.
4971.
4972.
4973.
dr_shahi000Guestshez
4974.
4975.
but i think i might have thought of a carcinoma colon secondary to inflamatory bowel disease....
presenting with bleeding with no response to steroid.(higher up in the colon.. sigmoidoscopy giving a
dignosis of IBD)
4976.
and i was not sure if a toxic megacolon would present as a bloody diarrohea....
4977.
if the condition given is toxic mega colon then ofcourse the answer will be repeat x ray....dr_shahi000,
Sep 28, 2010#285
4978.
dr_shahi000Guestif there was no option LH then GH could be the answer (again i am not sure ) though
GH defficincy is more common in craniopharyngioma than prolactima and other intracranian tumors..
dr_shahi000, Sep 28, 2010#286
4979.
w_balgGuestdear ,,, tha Q of haemophilia , iam sure it waa (( her father))w_balg, Sep 28, 2010#287
4980.
4981.
guest007Guestwas there a answer for copd smoking cessation???guest007, Sep 28, 2010#289
4982.
shezGuestyes shahi that was my thinking re. the colonoscopy too but i doubt my judgement on it.... if i
could go back and choose agin i would choose AXR
4983.
4984.
i put estrodiol for the prolactinoma question but i cant remember the finer details of the question to
know wheteher it is correct...shez, Sep 28, 2010#290
4985.
dr_shahi000Guestshez
4986.
estradiol can be a right answer as there is low LH in prolactinoma....dr_shahi000, Sep 28, 2010#291
4987.
4988.
4989.
GuestGuestwhat abt the question on bllod transfusion... i have read in the pastest notes a similar
question with acute onset of breathlessness. the answer being given acute lung injury not abo
incompatabilityGuest, Sep 28, 2010#293
4990.
GuestGuestthin membrane nephropathy is correct.. thats what i have put...Guest, Sep 28, 2010#294
4991.
Dr AlbarwaiGuestDear dr_shahi000 and Dr.shez,,,,be sure that the question regarding ulcerative colitis
the answer is COLONOSCOPY as history was typical for ulcerative colitis and what have been done
were segmoidoscopy which show inflammatory changes in anal canal with abdominal XR "of course to
exclude TOXIC Megacolon" which had been excluded so what is the value of repeating abdominal XR
what remain is COLONOSCOPY to see the inflammatory changes and taking biopsy :wink:Dr
Albarwai, Sep 29, 2010#295
4992.
4993.
Dr AlbarwaiGuestquestion about Hemophilia I am sure it was "Her father has hemophilia"Dr Albarwai,
Sep 29, 2010#297
4994.
MACROPROLACTINOMA with high BMI NOT 23 "AS IT IS NORMAL" the answer was GH
Deficiency,,,,,however we have Amenorrhea+microprolactinoma so the answer is definitly Oestradiol
4995.
read this "In women, a high blood level of prolactin often causes hypoestrogenism with anovulatory
infertility and a decrease in menstruation. In some women, menstruation may disappear altogether
(amenorrhoea). In others, menstruation may become irregular or menstrual flow may change"Dr
Albarwai, Sep 29, 2010#298
4996.
Dr AlbarwaiGuestAnother question about apatient presented with severe pain in the back of neck
,,,,,,then after 3 weeks presented with bilateral abducent palsy,,,the answer is Subarachnoid
hemorrhage,,,,as this is false localizing sign of increased intracranial pressure which may occure as a
result of secondary hydrocephalus due to SAHDr Albarwai, Sep 29, 2010#299
4997.
Dr AlbarwaiGuestI do not know why aippg do not allow me to put source of informations,,,,as they are
telling me spam not allowed for you it is only for whom are registered I tried to register before 6 days
but still waiting their response to send me email for activation,,,any how I will continue what I
remember questions not put here and ready for discussion of course the benefit for us an all others who
will come after us if we pass INSHAALLAHDr Albarwai, Sep 29, 2010#300
4998.
4999.
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25
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< Prev
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5013.
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5015.
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Forums
5017.
>
5018.
UK Medical Zone
5019.
>
5020.
MRCP Forum
5021.
>
5022.
5023.
a.
Search Forums
b.
Recent Posts
Forums
5024.
5025.
Resources
5026.
Log in or Sign up
5027.
5028.
5029.
Forums
5030.
>
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UK Medical Zone
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>
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MRCP Forum
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>
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25
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Next >
Dr AlbarwaiGuestAnother question regarding a lady post partum 3 weeks with severe headache with
photophobia CSF was normal glucose slight elevation in protein ,Cell lymphocte increased RBC
increased the answer I think is "Viral meningitis" postpartum was distracting for "cerebral venous
thrombosis" as 3 weeks is long period also photophobia is mostly feature of meningitisDr Albarwai,
Sep 29, 2010#301
5051.
GuestGuestwhat abt the question on blood transfusion... i have read in the pastest notes a similar
question with acute onset of breathlessness. the answer being given acute lung injury not abo
incompatability. please let me know if i am wrong....?Guest, Sep 29, 2010#302
5052.
5053.
Dr AlbarwaiGuestAbout Transfusion question I did not see that question in my papers and some other
questions here I had not seen them in the my exam center,,,,, some questions could be different from
center to other??????Dr Albarwai, Sep 29, 2010#304
5054.
d.lissanGuestdr.albarwai
5055.
regarding the question of IBD which is diagnosed by sigmoidoscpy and treatment started with
prednisolone, the big issue is fear of compication which are ;
5056.
perforation
5057.
toxic dilatation
5058.
massive hrge
5059.
5060.
5061.
5062.
5063.
wy do u think colonoscoy is the answer ,just for discussion .good luckd.lissan, Sep 29, 2010#305
5064.
5065.
5066.
5067.
5068.
I give answer cerebral venous thrombosis and that was there too .Guest, Sep 29, 2010#306
5069.
Dr AlbarwariGuestDear d.lissan
5070.
Now I am not sure what RCP want exactly from question of IBD but still I feel they are asking for
colonoscopy as it is written in OHIM "CLONOSCOPY show disease extent and allows biopsy" any
how you may be rightDr Albarwari, Sep 29, 2010#307
5071.
asdasGuestif some one in that exam has 140 corrects and 60 mistakes he will pass or not passasdas, Sep
29, 2010#308
5072.
Dr AlbarwariGuestA statistic question about,,,,what will invalidate the study test,,,I was between two
options first if test underpowered,,,second if sample size is small,,,,,I chose the small sample size
because here it will cause increase in false -ve "type 2 error" which mean you are accepting Nill
hypothesis "No significant difference" while in reality it should be Rejected "in Reality ther is
difference but the test show NO difference because the sample is small" I underpowered study does not
invalidate the test ,,,,ANY COMMENT PLEASEDr Albarwari, Sep 29, 2010#309
5073.
Dr AlbarwariGuestWhat is the most common side effect of progesterone only pill??? it was Nausea???
Dr Albarwari, Sep 29, 2010#310
5074.
5075.
d.lissanGuestdear Dr Albarwai
5076.
5077.
which invalidate the use of PAIRED T test and my answer was non normal distribution , idont know u
may had adifferent quesion in ur paperd.lissan, Sep 29, 2010#312
5078.
Dr AlbarwariGuestIV Drug abuser presented with fever cough,,,,,,,CXR Show bilateral cavity in
lung.....I put option of Tricuspid endocarditis as it cause secondary lung abscess giving this CXR
picture,,,,I was thinking of Pneumocystis carinii as this IV abuser at risk for AIDS but again this CXR
Picture is not typical for it????????????any comment???please CORRECT meDr Albarwari, Sep 29,
2010#313
5079.
GuestGuestThe most common side effect for women using Mini-Pills is irregular bleeding. While
many women on Mini-Pills have normal periods, others may have irregular periods, spotting between
periods or no periods at all. If you do not bleed for 60 days, call the clinic to arrange for a pregnancy
test but continue taking your pillsGuest, Sep 29, 2010#314
5080.
GuestGuestI Put Too Tricuspid endocarditis . May Allah help usGuest, Sep 29, 2010#315
5081.
Dr AlbarwariGuestDear d.lissan
5082.
I had not that statistic question regarding PAIRED T TestDr Albarwari, Sep 29, 2010#316
5083.
Dr AlbarwariGuestOh "Ya Elahi" about sign of severity of Aortic stenosis,,,,,,,I was between high
intensity of murmur and late peaking of murmur,,,,,I chose Late peaking of murmur as it will cause
prolongation of the murmur,,, as we know the duration of murmur is more important than the
intensity,,,,please correct me ,,,,where are you Dr.shez,,Dr.Shahi,,,to correct me pleaseDr Albarwari,
Sep 29, 2010#317
5084.
5085.
What remain regarding CT to show calcification of coronary arteries,,,I think it is NOT the option as
NICE said this test done if the probabilty is 10-29%,,,,our case probability is much above it
,,,,LBBB+Age 60+Family history of IH+Smoking,,,,,so I put option of "myocardial perfusion
scintigraphy" which is done if probability is 30-60% as NICE said.....but I am afraid if there was option
shezGuesti actually put TB for the cavitating bilateral CXR in drug user????? might be wrong.
5087.
5088.
5089.
5090.
i cannot remember the aortic stenosis question sorry.shez, Sep 29, 2010#319
5091.
shezGuesti also put hyrdocortisone for addisons questionshez, Sep 29, 2010#320
5092.
5093.
Dr AlbarwariGuestAbout question regarding culture and sensitivity for staph aureus,,,,,,they put
Methicillin sensitive,,,,,vancomycin sensitive,,,,I put option of Fluxacillin because it was methicillin
senstive "NOT Resistant to choose vancomycin"Dr Albarwari, Sep 29, 2010#322
5094.
Dr AlbarwariGuestElerly woman come from Kenya with confusion and fever urin incintinence urine
show +ve protein -ve nitrite,,,,I think Kenya was distrctor for cerebral malaria and the option
URINARY TRACT INFECTION was the correct one as anu infection may cause confusion in
elderly,,,,what you say shezDr Albarwari, Sep 29, 2010#323
5095.
Dr AlbarwariGuestPatient from Africa after 2 years???present with itching lesion in gluteal area with
Eosinophilia,,,,,,,I put option of schistosomiasis as it is more logical than Strongyloidosis,,,,,which
occur during swimming and we know schistosomiasis is common in AfricaDr Albarwari, Sep 29, 2010
#324
5096.
Dr AlbarwariGuestThe poatient with supraclavicular LN+ cold agglutinin,,,,,,I think it was Non
hodgkin Lymphoma,,,NOT Ca bronchus as I see some give it as correct option hereDr Albarwari, Sep
29, 2010#325
5097.
5098.
5099.
5100.
5101.
i do not rem the question re. older lady with uti... sorryshez, Sep 29, 2010#326
5102.
mrcp-4Guestregarding the qs LBBB there was option for cardiac catheterization...is it correct???mrcp4, Sep 29, 2010#327
5103.
shezGuestas far as i remember there was no option for shistoschomiasis...... strongloidies presents with
intense itch and eosinophilia
5104.
5105.
5106.
i also put non hodgkin lymphoma but i have to evidence for this and others say they have seen the
question before on websitesshez, Sep 29, 2010#328
5107.
5108.
wikipdia say "Genetic polymorphism is the simultaneous occurrence in the same locality of two or
more discontinuous forms in such proportions that the rarest of them cannot be maintained just by
recurrent mutation"Dr Albarwari, Sep 29, 2010#329
5109.
5110.
ali weana aliGuesti chose also cacinate after you remember me one correct answer
5111.
5112.
ali weana aliGuesti chose also calcinate after you remember me one correct answer
5113.
5114.
ali weana aliGuesti chose CINACALCET thank youali weana ali, Sep 29, 2010#333
5115.
ali weana aliGuestelderly person with weight loss more than 3 kilos with difficulty of swallawing solid
and water is it go with esophageal ca or with achalaciaali weana ali, Sep 29, 2010#334
5116.
ali weana aliGuestthere is a case of rupture of papilary muscle of the venricle of the heart
5117.
and its come in on examination and also in our examali weana ali, Sep 29, 2010#335
5118.
d.lissanGuestdear dr ali and dr albarwari q of high PO4 AND PTH NORMAL CA z answer is calcium
acetate its typical for one in mrcpass below
5119.
57 year old man with diabetic nephropathy has a plasma creatinine of 380mol/l. He has the following
blood results : potassium 5.2 mmol/l, calcium 2.20 mmol/l, albumin 42 g/l, phosphate 1.55 mmol/l, and
PTH 1.6 pmol/l (NR 1.1-6.8). Which of the following should be commenced?
5120.
5121.
A. Alucaps
5122.
B. Thyroxine
5123.
C. Vitamin A
5124.
D. Alfacalcidol
5125.
E. Calcium acetate
5126.
5127.
Answer: e) calcium acetate. Alfacalcidol could be considered for prophylaxis against renal bone
disease and progressive hyperparathyroidism. However, the patient's phosphate level is already
elevated, and vitamin D supplementation may increase this further.
5128.
Aluminium-containing phosphate binders (alucaps) carry the risk of aluminium accumulation and CNS
effects. Calcium acetate or calcium carbonate can be used. It should be taken with (or just before)
meals and may offer advantages over calcium carbonate.
5129.
5130.
5131.
Overall, this question has been attempted 564 times ( 32.62% correct) in an average time of 69 s.
5132.
5133.
5134.
i read most of ur posts and iam really hope from my heart u all pass inshaa allah
5135.
inshaa allah will go through jan 2011 test but ur posts make me soooo fraid
5136.
i think u had a tough exam even its answer not present in text books like kumar
5137.
plz can any one from his kindness and exam experience say which best way for preparing
5138.
5139.
5140.
GuestGuesti think the answer is cerebral malaria- history typically fits into it...
5141.
5142.
5143.
one patient with high calcium, low phosphorous, high PTH, but has a HIGH 24HR URINE CALCIUM
EXCRETION. ... will it not fit into secondary hyperparathyroidism...?? but how is it primary
hyperparathyroidism...as posted by many...?? please clarify...Guest, Sep 29, 2010#339
5144.
GuestGuesti think i also went for oesophageal carcinoma... dont remember properly... whats the correct
answer..????Guest, Sep 29, 2010#340
5145.
GuestGuestGuess
5146.
5147.
I think this forum just only makes us confused, until one got angry and want to fight with the other.
Exam has been over, whatever we want to discuss, it will not change our result. I will not think that it
will come back in the next diet. Just only want to make all depressed and reduce our quality of life.
Lets we pray for our best.Guest, Sep 29, 2010#341
5148.
5149.
Really I do not intend to make confusion for any body INSHAALLAH all of us will pass what I ment
and others to get benefit from our mistakes I am sure if time was allowed most of our silly mistakes
were not done,,,any how second thing this forum will be viewed by others who do not do the Exam yet
and so may get benefit,,,,,,,,,Dr Albarwari, Sep 29, 2010#342
5150.
Dr AlbarwariGuestAnother confusing question for me was a farmer woman dealing with farm animals
present with a painful papule at lateral side of finger,,,I am not sure but I put the option of
Staphylococcal furuncle,,,,,,most peaple here put option of orf why???? I think farmer animal was
distracting,,,does orf cause such painful papule????? please correct meDr Albarwari, Sep 29, 2010#343
5151.
GuestGuestGuess
5152.
5153.
5154.
5155.
5156.
5157.
5158.
The b/l sixth nerve palsy is benighn intra cranial hypertentio(sure about the answer___ given in on
examination and pastest )
5159.
I put sub arachnoid hemmorrage for the post partum question as the venous thrombosis will not present
with high rbc count in the csf(again not sure of the answer
5160.
I put ABO for blod transfusion ( not sure of the answer) the abo answer is also there in the pastest ) I
have seen both the answer for different question in pastest and on examination but I dont
know what exactly was RCP asking about..
5161.
5162.
I didnt have the statistics question you mentiond (but I had a question rearding paird t test in
validation I put non normal distribution as answer.
5163.
I put mastalgia(breast pain in the exam) as answer for the progestone only pil as answer..
5164.
I think thats the most commom one than others (not sure)
5165.
I v drug abuse I put pneumocustis as answer( I have seen the same scenario given in pastest(cavitation
can occur in severe pneummocystis) but what about the chance for a pulm TB than can ba an answer
too (but there is a chance for tricuspid vegitaion with murmur but will that present with cavitating
lung lesions??? Please clarify
5166.
i didnt have the aortic stenosis question ( insead I had mitral stenosis question for which opening
snap was the answer
5167.
the LBBB question there was angeography given and I put angeography as answer (not sure of the
answer.
5168.
The adddison question my answer is wrong as I put 10% dextrose as answer(I dont know what
made me to put this stupid answer)
5169.
5170.
The Kenya confusion question I put cerebral malaria as answer(not sure of the answer)
5171.
5172.
In stead I had some other question with eosinophelia (for wich I put strongiloids as answer)
5173.
The supra clavicular LN question I put non hodgkins (not sure of the answer)
5174.
5175.
I had a question with high calcium low PO4 and near normal PTH- I put the answer..primary hyper
parathyroidsm
5176.
Another question with low calciul low phosphate and high PTH vitamin d deficiency I put
cholecalciferol as answer
5177.
Another question with CRF with low calcim--- I put alfacalcidol(1 hydroxy chole calciferol as answer.)
5178.
But I didnt have the question with ,,,,with hgh PO4,,,Normal Ca,,,,High parathyroid
5179.
Dysphagia for both solid and liquid question was a tipical question of achalasia(I am sure of the answer
5180.
The animal contact question answer is orf I am sure of the answer..dr_shahi000, Sep 29, 2010#345
5181.
dr_shahi000Guesthi all the most commont side effect of progestrone only pill is irregular bleeding here
is some information regarding the same(thouh my answer is wrong)
5182.
5183.
5184.
At present, the POP seems to carry considerably less risk than the ordinary Pill but please
remember that while the long-term effects of the ordinary Pill have been extensively studied over
nearly 50 years, the amount of research into long-term effects of the mini-Pill has been rather less.
5185.
5186.
So its possible that unsuspected side-effects might emerge later in the 21st century. Currently, it is
believed that the mini-Pill might carry a slightly increased risk of breast cancer.
5187.
5188.
5189.
5190.
5191.
sometimes periods stop - this may be a worry to you, and you may need the reassurance of a pregnancy
test
5192.
if you did become pregnant while taking the mini-Pill, there is a chance that the pregnancy might be
ectopic, that is outside the womb - so if your period is late and you get pain in your lower tummy,
contact a doctor fast (ectopics are said to be rarer with Cerazette)
5193.
5194.
5195.
there's a small risk of cysts in the ovaries indeed, its best not to use the POP if youve
already had an ovarian cyst
5196.
women sometimes report nausea and headache and also dizziness, depression and weight change.
dr_shahi000, Sep 29, 2010#346
5197.
5198.
GuestGuestGuess
5199.
Hello, I'm coming back. I think it couldn't be considered as prolactinoma, becos prolactin level in my
question is less than 5,000. Please seewww.gpnotebook.co.uk, what is the definition is prolactinoma??.
So it is just pituitary adenoma. Then the result is local destruction, then lead to hypopituitarism (GH <).
High level prolactin is caused by stalk compression. In my question, I scrutized carefully, there is no
TB contact, normal Chest XRay, therefore I think it is not latent TB. It is just cross reaction (false
positive) result with Mycobacterium bovis, that you have indigested from unpasteurized milk.
5200.
5201.
If anyone don't believe me, that cold agglutinin can be caused by malignancy, then gpnotebook give
another explanation. They said that "like hypertension", the majority of cold agglutinin in adult is
idiopathic or primary cold agglutinin. If happen in children, then we can think that it was a secondary
cold agglutinin, like caused by mycoplasma pneumonia, & lymphoproliferative disease. They didn't
mention the sign of NLH like fever, weight loss, just only chronic lung infection. And in my case, it is
an adult patient come with cold agglutinin and supraclavicular lymph node, then with previous multiple
episode of lung infection. I will think that cold agglutinin is just a distractor for me, so I still choose
bronchial carcinoma, as it is more consistent with natural history of this patient.Guest, Sep 29, 2010
#348
5202.
GuestGuestguess
5203.
5204.
I put repeat AXR to flare up IBD. I think it is safer to be done, and can be an important piece of
diagnostic comparable with colonos. Moreover it is safer, because if patient got Toxic Bowel, invasive
colono could induce bowel perforation.Guest, Sep 29, 2010#349
5205.
GuestGuestGuess
5206.
5207.
Guidelines on stroke from the RCP state:3 Occlusion of the cerebral veins or dural venous sinuses may
present as a stroke syndrome, subarachnoid haemorrhage or as isolated raised intracranial pressure.
5208.
Since it happens after puerpurium, I will think that the culprit is occlusion of the cerebral vein.Guest,
Sep 29, 2010#350
5209.
5210.
Page 7 of 25
5211.
< Prev
5212.
5213.
5214.
5215.
5216.
5217.
5218.
5219.
5220.
25
5221.
5222.
Next >
5223.
5224.
5225.
5226.
5227.
Forums
5228.
>
5229.
UK Medical Zone
5230.
>
5231.
MRCP Forum
5232.
>
5233.
5234.
a.
Search Forums
b.
Recent Posts
Forums
5235.
5236.
5237.
5238.
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Resources
Log in or Sign up
5240.
Forums
5241.
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>
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5245.
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5250.
< Prev
5251.
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5260.
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5261.
5262.
Regarding the case of bilateral 6 nerve palsy I am sure what was put in the question it was, severe pain
at back of neck "which mean occipital" then after 3 weeks present with bilateral 6 nerve palsy,,,for that
I put the option of SAH
5263.
Regarding the postpartum headache also 3 weeks after labour,,,I am sure ther was photophobia which
goes with Meningitis,,,,CSF show RBC,,,But let me ask this question if it is SAH does it will cause
hemorrhagic CSF or Xanthochromic as we know we can differentiate between traumatic CSF and that
of SAH by centrifuging CSF Fluid if precipitation occur mean traumatic "RBC Present" while in SAH
it remain as it ,,,,,,,,,,,,,still NOT sure of my result I may be WrongDr Albarwari, Sep 29, 2010#351
5264.
5265.
5266.
staph can be acquired from animal contact "www dot hivinfo dot us/staph.",,,,,,,,,,About ORF does it
cause painful papule???????Dr
5267.
doubt regarding this) latest studies all support this.dr_shahi000, Sep 29, 2010#364
5268.
5269.
Alsalam o alaikum...believe me I want all to pass and my answers are not strange,,, I know this is a
difficult and hard time for all of us but simply I want to ask what is the benefit of this forum if we do
not discuss,,,if just when RESULTS will appear??it is written in MRCPUK website after 4
weeks,,,,,,Does I will pass????this what RCP know?? any how Dear Shahi I feel you are very active in
this forum so thank you for your contributions,,,,I do not intend to make any stress for any body and
this is only an Exam so what??we must learn from our mistakes because as we choose this way "MRCP
way" it is not easy we must spend from our time, energy to pass it,,,,if you feel we must stop I am
ready for that,,,,,Best regards to all peaople here one by one specially shez, shahi, ali weana
ali,,,,,,,,,,,,,,, " " ThanksDr Albarwari, Sep 29, 2010#365
5270.
mrcp-4Guesti think we must continue discussion as at least 10 qs will be repeated in the next
diet...moreover it will help who will appear in next diet....ther is no harm to discuss...we dnt knw wht
answer the RCP accepts but atleast we can discuss over the topics...MAY ALLLAH PASS USmrcp-4,
Sep 29, 2010#366
5271.
dr_shahi000Guestdear barwari...
5272.
5273.
but like i posted earlier... if we can remember the exact stem asked in the exam.. it will be of great help
in the discussion...
5274.
5275.
d.lissanGuestthere was q about homonomous hemianopia plus hemi sensory loss which artery oclusion
cause it ,my answer was medile cerebral artery other option was posterior cerebral A , i think it must be
MCA once hemisensory loss mentioned in additon any idias ???d.lissan, Sep 29, 2010#368
5276.
d.lissanGuestthere was q about homonomous hemianopia plus hemi sensory loss which artery oclusion
cause it ,my answer was medile cerebral artery other option was posterior cerebral A , i think it must be
MCA once hemisensory loss mentioned in additon any idias ???d.lissan, Sep 29, 2010#369
5277.
GuestGuesti really dony know how many more mistakes i have done with each questions coming out
with new different answers.. i wish the results pass or fail comes off fast... cant withstand this pressure
Guest, Sep 29, 2010#370
5278.
d.lissanGuestpost partum lady recieved blood transfusion presented 6 weeks later with jaundice +
cervical LN + hepatomegaly options were;
5279.
cytomegalo virus
5280.
hep B
5281.
hep C
5282.
hiv
5283.
my answer was CMV but not sure ?d.lissan, Sep 29, 2010#371
5284.
Guest 2009GuestSalaam everyone, quick question. In the drug induced cholestasis, the answer was
fluclox. Was there an option for coamoxiclav? If so, which would be the ideal answer?Guest 2009, Sep
29, 2010#372
5285.
5286.
5287.
5288.
my reasoning was that in the stem it said she was unable to dress herself, which i took as dressing
apraxia and a parietal infarct and therefore put middle cerebral aretry......
5289.
5290.
i was unsure re. the lady with jaundice 6 weeks post transfusion. you sure she had lymphadenopathy???
i put hep C. big liver and jaundice.... not sure bout this one anyone offer any advice.
5291.
5292.
i agress folks please continue the discussions it is helping us all think like mrcp candidates...shez, Sep
30, 2010#374
5293.
5294.
5295.
5296.
5297.
5298.
5299.
5300.
5301.
Drugs
5302.
5303.
Amiloride (Moduretic)
5304.
5305.
Amiodarone (Cordarone)
5306.
5307.
Amphetamines
5308.
5309.
Anabolic steroids
5310.
5311.
Antiandrogens (cyproterone)
5312.
5313.
5314.
5315.
Androgens
5316.
5317.
Busulfan (Myleran)
5318.
5319.
Captopril (Capoten)
5320.
5321.
Cimetidine (Tagamet)
5322.
5323.
Clomiphene (Clomid)
5324.
5325.
Diazepam (Valium)
5326.
5327.
5328.
Diethylpropion (Tenuate)
5329.
Digitalis
5330.
5331.
Domperidone
5332.
5333.
Estrogens
5334.
5335.
Ketoconazole (Nizoral)
5336.
5337.
Marijuana
5338.
5339.
Methyldopa
5340.
5341.
Metoclopramide
5342.
5343.
Nifedipine (Procardia)
5344.
5345.
Nitrosourea
5346.
5347.
Penicillamine
5348.
5349.
Phenothiazines
5350.
5351.
Phenytoin (Dilantin)
5352.
5353.
Reserpine
5354.
5355.
Spironolactone (Aldactone)
5356.
5357.
5358.
Tricyclic antidepressants
5359.
5360.
5361.
5362.
5363.
ashmatic lady in middle age , her medications were ; short acing b agonist + inhaled steroid 250 bd +
salmetrol ,she had good inhaler technique , persented complaining of 4 exacerbations in the last 18
month , here PEFR NOW IS 90% her BMI 32. wt is best mangement plan;
5364.
add montelucast
5365.
add thiophilline
5366.
5367.
revieow by dietician
5368.
5369.
5370.
PLEASE any one remeber for discussion ...d.lissan, Sep 30, 2010#376
5371.
d.lissanGuestdear third year my answer was also amiodarone , but it seems to be wrong as boserline
which is GHRH more likly to be true.d.lissan, Sep 30, 2010#377
5372.
5373.
5374.
try to put the all option of the questions to see what is bof of them
5375.
by this way the discussion will be bestali weana ali, Sep 30, 2010#378
5376.
5377.
5378.
pt dignosed with idiopathic parkinsons disease and said to doctor he had heared about anti parkinsons
that cause pathological gambling!!! and he didnt want any one of them! wt to give ;
5379.
5380.
l dopa
5381.
ropinrole
5382.
benztropine
5383.
cabergoline
5384.
comt inhibitor ?
5385.
5386.
i gues beztropine ?!
5387.
5388.
shezGuesti remeber the asthma question d.lissan and i also put increase steroid dose. this is correct
according to the BTS guidelines.shez, Sep 30, 2010#380
5389.
shezGuesti did not have the parkinsons questionshez, Sep 30, 2010#381
5390.
5391.
5392.
ropinrole
5393.
5394.
5395.
5396.
5397.
5398.
5399.
5400.
5401.
ali weana aliGuestdrug induced cholestasis AMPICILINE LIKE SO AMOXICLAVE THE CORRECT
ANSWERali weana ali, Sep 30, 2010#385
5402.
d.lissanGuestthanks for commends ,parkinson q could be one of test qsd.lissan, Sep 30, 2010#386
5403.
5404.
what was the options in the q of drug that cause gynicomastiaali weana ali, Sep 30, 2010#387
5405.
d.lissanGuesti remeber amiodarone and boserlin which is GHRH analouged.lissan, Sep 30, 2010#388
5406.
shezGuestcannot rmemebr the option but im 99% certain that buserelin is the answershez, Sep 30, 2010
#389
5407.
5408.
5409.
5410.
5411.
5412.
Dr AlbarwariGuestI also put the option of CMV for 6 weeks post transfusion mild jaundice with
generalized lymphadeopathy
5413.
I also put the option of HLA DR as the question said which HLA mismatch will cause rejection as I
remembered
5414.
There were 2 questions regarding obstructive jaundice induced by drugs one was flucloxacillin and
other was for co-amoxiclavDr Albarwari, Sep 30, 2010#392
5415.
5416.
5417.
5418.
Dr AlbarwariGuestLast question for this night for discussion,,,,,about psychiatric case A young patient
present with severe abdominal pain,,,on examination he has multiple scars in the limbs,,,,Options
5419.
Factitious
5420.
Hypochondriasis
5421.
I can not remember other options ,,,I chose factitiousDr Albarwari, Sep 30, 2010#396
5422.
5423.
Dr AlbarwariGuestI do not have the question regarding stress leg syndrom, Asthma, Parkinson case in
my papersDr Albarwari, Sep 30, 2010#398
5424.
Dr AlbarwariGuestFor homonymous H,,,, I also chose middle cerebral artery BUT may be wrongDr
Albarwari, Sep 30, 2010#399
5425.
d.lissanGuesti had psch q answer was hypocondriasis becuz talk about cancer .but not same q as urs i
mean no mention of leg lesionsd.lissan,
5426.
5427.
5428.
5429.
5430.
5431.
-asymmetrical parkinsonism
5432.
5433.
5434.
5435.
mrcp2011Guesti would request to those of you posting the question to put the whole question(or atleast
most part of the question with option which you could remeber ) so that the discussion on each
question will be more effective,,,mrcp2011, Jan 19, 2011#9
5436.
5437.
5438.
5439.
5440.
5441.
5442.
GuestGuestheey guys here is da MRCP heros let us recall more and more questions for Us and for da
poeple behind US let us rocke it this night come on guys we can do it ....alot of funGuest, Jan 19, 2011
#13
5443.
5444.
5445.
dear friends
5446.
this site is wondeful especially who are preparing for mrcp. please all those who appeared in exam if
they could write down the question along with the options they remember so it would enable us in
remembering and understanding the way question's are asked in mrcp.
5447.
5448.
GuestGuest-Nerve, 3rd and 4th Lumbricals supplied by deep branch of ulnar nerve ( Extensor carpi
Ulnaris supplies by Radial Nerve !
5449.
5450.
5451.
5452.
- Limb Girdlw
5453.
-Nitrofurotion
5454.
5455.
- Areflexia
5456.
- Urine hesitancy
5457.
-Anti HbSang
5458.
-Angiography ... Mi
5459.
-Primaquine .. G6pd
5460.
-Down .. Intuscception
5461.
-Malaria Ovale
5462.
- seudogout
5463.
- CF 50 %
5464.
-FrontoTemboral dementia
5465.
-Tau Protein
5466.
5467.
5468.
5469.
- Splenic flecture
5470.
- Endometrial Carcinoma
5471.
- Breast 15-3
5472.
- Pulsus alternals
5473.
- Stephin Jonson
5474.
5475.
GuestGuest-SLE c4
5476.
5477.
- Benzoxamine
5478.
-muscarinic antagonist
5479.
- doxazocin
5480.
- Doputamine ( Stress not due to knee problem )Guest, Jan 19, 2011#18
5481.
5482.
5483.
statistics?
5484.
the curve?
5485.
5486.
5487.
5488.
5489.
amitryptyline--> Nabiacarboante.
5490.
5491.
5492.
5493.
Schizophrenia.
5494.
Delusional disorder.
5495.
Pseudo psychogenicseziures.
5496.
grief reaction.
5497.
Irradaited blood.
5498.
IL2.
5499.
5500.
staph discitis.
5501.
statistic q-->NTT 50
5502.
CBD.
5503.
CT abdomen.
5504.
Drug induced.
5505.
Ulcerative colitis
5506.
podophyllline.
5507.
eythema nodosum.
5508.
Felcanide.
5509.
Amiodarone.
5510.
fetal insulin.
5511.
5512.
GuestGuestinsulin doesn't cross plecenta so answer is tight glysemic controlGuest, Jan 20, 2011#20
5513.
GuestGuestcbd stone is not raised amylase until it come cclouse to ampulla of vaterGuest, Jan 20, 2011
#21
5514.
guest9979Guestlimited scleroderma
5515.
sarcoidosis
5516.
5517.
5518.
temporl lobe
5519.
psudomembranous collitis
5520.
membranous nephritis
5521.
pericarditis
5522.
5523.
5524.
5525.
5526.
5527.
Which coronary?
5528.
5529.
1. LMS
5530.
2. prox LAD
5531.
3. mid LAD
5532.
4. circumflex
5533.
5534.
5535.
ANSWER: 4, circumflex.
5536.
5537.
5538.
5539.
5540.
ph 7.2
5541.
bicarb 11
5542.
potassium 2.1
5543.
sodium 131
5544.
chloride 30
5545.
5546.
So the ans is Chronic Alcohol, which I did not GuestGuestprophylaxis after splenectomy >
HaemophilusGuest, Jan 20, 2011#27
5547.
GuestGuesti think type I RTA is the right answer cause it causes hypokalaemiaGuest, Jan 20, 2011#28
5548.
Guest84GuestI thought so too, thats why I picked RTA 1, but renal function should be normal with
RTA, HMMMGuest84, Jan 20, 2011#29
5549.
GuestGuestwhat was the cause of GI bleeding in Peutz Jeghers ??Guest, Jan 20, 2011#30
5550.
GuestGuest- RTA
5551.
-Oral Terbinafine
5552.
5553.
-splenic flexure
5554.
-amlodipine
5555.
-amiodarone
5556.
-propanolol
5557.
-oraltetracycline
5558.
-doxycycline
5559.
5560.
5561.
5562.
5563.
5564.
5565.
5566.
5567.
5568.
5569.
-stroke(wwhich i chose
5570.
-mi?
5571.
6-murmer of vsd--->
5572.
5573.
-pan systolic-----------
5574.
5575.
5576.
dr-mahmoudGuestneoro
5577.
5578.
5579.
5580.
5581.
5582.
5583.
5584.
dr-mahmoudGuestendocrine
5585.
5586.
5587.
5588.
-ttt of pheocromocytoma---->phenoxylamine
5589.
-continues inhibition----->prolactine
5590.
5591.
5592.
5593.
here you go guys, i hope you find some of this useful. this is my first time attempting part 1! what an
exam.
5594.
5595.
i remembered some examples if ppl can remember additional bits of infomation for my questions that
would really help make them more complete
5596.
5597.
5598.
5599.
5600.
5601.
------------------------------------------------------------------------------
5602.
5603.
male, aged mid-20s, presents with haemoptysis. CXR reveal left upper lobe collape.
5604.
5605.
5606.
5607.
1. lung cancer
5608.
2. cystic fibrosis
5609.
5610.
-------------------------------------------------------
5611.
5612.
male, late 20s, has been working as a car mechanic, recently changed job to paint sprayer. presents with
respiratory symptoms. ausculation reveals widespead crackles and minimal end-expiratory wheeze.
5613.
5614.
5615.
5616.
5617.
5618.
1. asthma
5619.
2. hypersentivity pneumonitis
5620.
5621.
----------------------------------------------------------------------
5622.
5623.
Eldery male, present with confusion, left leg DVT and ulcer on toe.
5624.
5625.
5626.
5627.
5628.
5629.
1. Renal Failure
5630.
2. Hypercalcemia
5631.
3. TIA
5632.
4. Hyperviscosity syndrome
5633.
5634.
-----------------------------------------------------------------------
5635.
5636.
Young female 20s, presents with RIF pain and mass (??and vomitting). Mother has history of Crohn's.
5637.
5638.
5639.
5640.
1. CT Abdomin
5641.
5642.
3. Colonscopy
5643.
4. USS
5644.
5645.
------------------------------------------------------------------------
5646.
5647.
It has been decided that all research studies should be registered before commencing.
5648.
5649.
5650.
5651.
1. publication
5652.
2. subject
5653.
5654.
5655.
---------------------------------------------------------------------------
5656.
5657.
A young man returns from west africa 6 months ago. Recently he has been having nightsweats and
recurrnent pyrexia.
5658.
5659.
5660.
5661.
1. m. ovale
5662.
2. m. falcipirum
5663.
3. brucellosis
5664.
4. typhoid fever
5665.
5666.
----------------------------------------------------------------------------
5667.
5668.
A young boy <16, recently had a road traffic accident and needed a splenectomy. He currently takes
penicillin V.
5669.
5670.
5671.
5672.
1. Haemophilus influenzae
5673.
2. Streptococcus
5674.
5675.
5676.
jkaGuestps i know some of the answers but i wanted to avoid bias and see what other ppl thoughtjka,
Jan 20, 2011#37
5677.
heavenGuesthi i think these are the question i remember in paper 2...please give commend on the
answer...thank you all....
5678.
5679.
5680.
5681.
5682.
5683.
6) ST elevation on the ECG with chest pain but the chest pain relieved on inspiration is pericarditis
5684.
5685.
5686.
5687.
8) arm, buttock, thigh itchy rashes that is not response to prednisolone and a/w diarrhea are dermatitis
herpatiformis
5688.
5689.
10) patient with knee joint pain with raised ESR of 60 and urethral culture and gram stained negative is
it more towards reactive arthritis rather than gonoccocal arthritis as the gonococcal usually culture will
be positive and ESR is raised in reactive arthritis?
5690.
5691.
5692.
5693.
5694.
5695.
5696.
17) vancomycin is use for the chronic renal failure with IJC because the most common organism is the
staph epididimis?
5697.
18) optic chiasma lesion for patient with assymetrical bitemporal hemianopial...as
tract,ratiation,occipital and optic nv will cause homonymous hemianopia or unilateral blindness
5698.
5699.
20) patient has history of Mi and noted absent pulse in the left upper limb is thromboembolic disease?
5700.
5701.
5702.
5703.
22) RTA
5704.
5705.
5706.
5707.
5708.
5709.
24) pseudogout
5710.
5711.
5712.
5713.
26) ulcerative colitis-patient with bloody diarrhea and noted goblet depletion and crypt abscess
5714.
5715.
27) acanthosis nigrican in patient with fleckling in the axilla as opposed to neurofibromatosis is the
patient has no family history of similar picture and NFM is inherited as Autosomal dominant and
neurofibromatosis is present in pregnant and obese people
5716.
5717.
5718.
5719.
5720.
32) in patient with blood result showing hypocalcaemia the ECG changes is long Qt
5721.
5722.
5723.
5724.
34) impingement syndrome in patient with pain and stiffness on shoulder ABD and rotation?
5725.
5726.
35) in patient with AML after so many of high class antibiotic still ahving fever is CMV or fungal?is
acyclovir shud add in the regime or amphotericin B?pass year written CMV but oxford written fungal
more common
5727.
5728.
5729.
5730.
37) polymyagia rheumatica as the patient has stiffness and pain on the shoulder and wrist that is worse
in the morning
5731.
5732.
38) patient with pneumothorax are life long prohibited from diving unless patient underwent
pleurecdomy (pass year)
5733.
5734.
5735.
5736.
40) CXR with mediastinal enlargement and erythema nodosum suggestive of sarcoidosis
5737.
5738.
41) patient with maculo papular rash with conjunctivitis and mucosa involvement is it SJS or toxic?as
SJS is the milder form of toxic now.
5739.
5740.
43) Hepatitis A in patient with maculopapular rash and fletting arthralgia and lympadenopathy (pass
year)
5741.
5742.
44) ovale malaria as patient back from african 5monthms ago and ovale malaria may have hypnozoite
in the liver
5743.
5744.
5745.
5746.
5747.
5748.
5749.
5750.
5751.
5752.
5753.
50) reduse exposure to sunlight in patient with low serum calcium low serum phosphate and high ALP
5754.
5755.
5756.
5757.
5758.
5759.
5760.
5761.
5762.
5763.
5764.
57) staph discitis in patient with pace maker implantation who present with low back pain?
5765.
5766.
5767.
5768.
5769.
5770.
5771.
5772.
5773.
5774.
62) SAH that develop confusion 5 days later in kumar and clark is hydrocephalus
5775.
5776.
5777.
5778.
64) barrect esophagus with epithelial dysplasia is esophagectomy or PPI and repeat scope?the kumar
and clark mention if low grade dysplasia then nid PPI but high grade nid surgery.the question did not
mention high grade or low grade
5779.
5780.
5781.
5782.
kindly comment and can sum1 please post more question on paper 1 as i almost foget all questions that
i din in paper 1....thanks....kindly recall....heaven, Jan 20, 2011#38
5783.
GuestGueststatistics in paper 2:
5784.
5785.
5786.
5787.
jkaGuestheaven question 20, mi and absent arm pulses, type a dissectionjka, Jan 20, 2011#40
5788.
5789.
5790.
5791.
5792.
5793.
5794.
5795.
3.One question about stroke and pin point pupils? Pontine hemorrhage
5796.
5797.
4.Question about a patient with COPD which drug has precipitated an acute exacerbation? Atenolol
5798.
5799.
5.Question giving a ABG of inc PH , dec paco2 and dec pao2 ? Asthma
5800.
5801.
5802.
5803.
5804.
5805.
5806.
5807.
6) ST elevation on the ECG with chest pain but the chest pain relieved on inspiration is pericarditis
5808.
5809.
5810.
5811.
Cool arm, buttock, thigh itchy rashes that is not response to prednisolone and a/w diarrhea are
dermatitis herpatiformis
5812.
5813.
5814.
5815.
5816.
5817.
5818.
5819.
5820.
5821.
1Cool optic chiasma lesion for patient with assymetrical bitemporal hemianopial...as
tract,ratiation,occipital and optic nv will cause homonymous hemianopia or unilateral blindness
5822.
5823.
5824.
20) patient has history of Mi and noted absent pulse in the left upper limb is thromboembolic disease?
5825.
5826.
5827.
5828.
22) RTA
5829.
5830.
5831.
5832.
5833.
5834.
24) pseudogout
5835.
5836.
5837.
5838.
26) ulcerative colitis-patient with bloody diarrhea and noted goblet depletion and crypt abscess
5839.
5840.
27) acanthosis nigrican in patient with fleckling in the axilla as opposed to neurofibromatosis is the
patient has no family history of similar picture and NFM is inherited as Autosomal dominant and
neurofibromatosis is present in pregnant and obese people
5841.
5842.
5843.
5844.
5845.
32) in patient with blood result showing hypocalcaemia the ECG changes is long Qt
5846.
5847.
5848.
5849.
34) impingement syndrome in patient with pain and stiffness on shoulder ABD and rotation?
5850.
5851.
5852.
5853.
5854.
37) polymyagia rheumatica as the patient has stiffness and pain on the shoulder and wrist that is worse
in the morning
5855.
5856.
5857.
5858.
5859.
40) CXR with mediastinal enlargement and erythema nodosum suggestive of sarcoidosis
5860.
5861.
41) patient with maculo papular rash with conjunctivitis and mucosa involvement is it SJS or toxic?as
SJS is the milder form of toxic now.
5862.
5863.
43) Hepatitis A in patient with maculopapular rash and fletting arthralgia and lympadenopathy (pass
year)
5864.
5865.
44) ovale malaria as patient back from african 5monthms ago and ovale malaria may have hypnozoite
in the liver
5866.
5867.
5868.
5869.
5870.
5871.
5872.
5873.
5874.
5875.
5876.
50) reduse exposure to sunlight in patient with low serum calcium low serum phosphate and high ALP
5877.
5878.
5879.
5880.
5881.
5882.
5883.
57) staph discitis in patient with pace maker implantation who present with low back pain?
5884.
5885.
5886.
2) SAH that develop confusion 5 days later in kumar and clark is hydrocephalus
5887.
5888.
64) barrect esophagus with epithelial dysplasia is esophagectomy or PPI and repeat scope?the kumar
and clark mention if low grade dysplasia then nid PPI but high grade nid surgery.the question did not
mention high grade or low grade
5889.
5890.
5891.
5892.
68)-Oral Terbinafine
5893.
5894.
5895.
70)-oraltetracycline
5896.
5897.
71)-doxycycline
5898.
5899.
72)-angiodysplasia
5900.
5901.
73)limited scleroderma
5902.
5903.
5904.
5905.
5906.
75)temporl lobe
5907.
5908.
76)psudomembranous collitis
5909.
5910.
77)membranous nephritis
5911.
5912.
5913.
5914.
5915.
5916.
5917.
5918.
5919.
5920.
5921.
82)-ttt of pheocromocytoma---->phenoxylamine
5922.
83)-continues inhibition----->prolactine
5923.
5924.
5925.
5926.
5927.
85).One question about stroke and pin point pupils? Pontine hemorrhage
5928.
5929.
5930.
5931.
5932.
........
5933.
5934.
5935.
5936.
5937.
91)Nitrofurotion
5938.
5939.
5940.
94)-Down .. Intuscception
5941.
5942.
95)amioacide in alkabtunuree
5943.
5944.
5945.
5946.
97)-Pemvigus Vulgaris
5947.
5948.
98)sbroaic dermatitis
5949.
5950.
5951.
5952.
100)Schizophrenia
5953.
5954.
5955.
5956.
102)Pseudo psychogenicseziures.
5957.
5958.
103)grief reaction
5959.
5960.
104)BNP
5961.
5962.
105)cryoglopulin
5963.
5964.
106)CML
5965.
5966.
107)animyloperoxidase
5967.
5968.
108)allel
5969.
5970.
109)septic arthritis
5971.
5972.
110)creatine kinase
5973.
5974.
111)ascitic microscopy
5975.
5976.
5977.
5978.
113)reverse transcrptase
5979.
5980.
5981.
114)reduce weight
5982.
115)72h fasting
5983.
5984.
116)lateral epicondylities
5985.
5986.
5987.
5988.
5989.
5990.
119)VWD
5991.
5992.
120)nephrogenic DI aquaporin2
5993.
5994.
121)ESTACASY T40
5995.
5996.
122)tarcolimus hyperkalemia
5997.
5998.
5999.
6000.
6001.
6002.
6003.
6004.
6005.
6006.
127)promylocytic leukemia(15/17)
6007.
6008.
128)ramipril as tttt of GN
6009.
6010.
6011.
129)adrenal insufficency
6012.
6013.
6014.
6015.
6016.
6017.
6018.
133)PE
6019.
6020.
6021.
6022.
6023.
6024.
6025.
6026.
6027.
drhamazGuest10) patient with knee joint pain with raised ESR of 60 and urethral culture and gram
stained negative is it more towards reactive arthritis rather than gonoccocal arthritis as the gonococcal
usually culture will be positive and ESR is raised in reactive arthritis?
6028.
6029.
6030.
6031.
6032.
6033.
7) vancomycin is use for the chronic renal failure with IJC because the most common organism is the
staph epididimis?
6034.
6035.
6036.
6037.
6038.
6039.
6040.
6041.
6042.
3Cool patient with pneumothorax are life long prohibited from diving unless patient underwent
pleurecdomy (pass year)
6043.
6044.
6045.
6046.
6047.
6048.
6049.
-splenic flexure
6050.
6051.
6052.
6053.
6054.
6055.
6056.
6057.
6058.
4.Question about a patient with COPD which drug has precipitated an acute exacerbation? Atenolol
6059.
6060.
5.Question giving a ABG of inc PH , dec paco2 and dec pao2 ? Asthma
6061.
6062.
6063.
6064.
6065.
6066.
6067.
6068.
-Jugular Foramen
6069.
6070.
Limb Girdlw
6071.
6072.
-Primaquine .. G6pd
6073.
6074.
- Simvastatin .. grapefruit
6075.
6076.
6077.
6078.
Breast 15-3
6079.
6080.
periarticular erosion
6081.
6082.
FBS
6083.
6084.
muscarinic antagonist
6085.
6086.
- doxazocin
6087.
6088.
6089.
6090.
IL2.
6091.
6092.
CBD
6093.
6094.
CT abdomen.
6095.
6096.
Drug induced.
6097.
6098.
MG--> gentamycin.
6099.
6100.
alendronic acid
6101.
6102.
diclofenac
6103.
6104.
nicorandil
6105.
6106.
carvidilol
6107.
6108.
immunoglobulin
6109.
6110.
narcolepsy
6111.
6112.
6113.
6114.
6115.
6116.
6117.
6118.
- Neurofibromatosis ( tricky as some characters needed to diagnose it not all and may be family history
present or absent )
6119.
6120.
- Excess phytate ( high phytic acid content could contribute to occurrence of osteomalacia as well ...
Excess dietary P can result in nutritional secondary hyperparathyroidism )
6121.
6122.
6123.
6124.
- hemophelia A sure
6125.
6126.
6127.
6128.
6129.
6130.
I chose Von-Willebrand but I'm not sure !fido, Jan 21, 2011#48
6131.
6132.
3 - a case with sensory loss over dorsum of foot and great toe - common peroneal palsy.
6133.
6134.
6135.
6136.
6137.
6138.
6139.
6140.
11 - differentiation between toxoplasmosis and crytococcus ct findings - contrast enanched mass lesion
6141.
6142.
13 . alcoholic brought unconscious having high urea and creatine - inv to be done - creatinine kinase
6143.
6144.
15 - palate weakness , absent gag reflex , fasciculations in tongue , tongue deviation to left . -- ? lesion
in jugular foramen .
6145.
6146.
6147.
18 -pt with loose watery diarrhoea loss of weight , inv showing low b12 level - ? coeliac disease
6148.
6149.
6150.
6151.
6152.
6153.
- unpaired t test?
6154.
6155.
Dermatology
6156.
6157.
6158.
Psy
6159.
6160.
6161.
6162.
6163.
6164.
heavenGuestit need few criteria to diagnose Neurofibromatosis....i know the neurofibromatosis may
happen sporadically without family history,but the question just show the skin changes and not really
descripe other diagnostic criteria and mention no family history....so i think is more to the acanthosis
nigrican.
6165.
6166.
regarding the haemophilia A, i think it is not the correct answer here.although haemophilia A have low
factor VIII but in the present of low factor VIII and low vWB factor and the history saying thatpatient
has no history of bleeding tendercy but present with menorrhagial,this type of question more suggestive
of vWD.in haemophilia A the history usually is trauma and noted bleeding into joint and muscle or non
stop bleeding after surgery...so i think is more towards vWB deficiency....heaven, Jan 21, 2011#55
6167.
GuestGuestnephrology answers
6168.
6169.
-antimyeloperoxidase
6170.
6171.
6172.
-patient with linear deposition in basement membrane..good pasture(igm disease)Guest, Jan 21, 2011
#56
6173.
6174.
6175.
6176.
- unpaired t test?
6177.
6178.
Dermatology
6179.
6180.
6181.
Psy
6182.
6183.
6184.
6185.
i dint actually enter this one but i`m planning to enter next exam
6186.
6187.
6188.
6189.
6190.
6191.
6192.
5) amiodarone for maintainance of patient synus rythm after successful cardioversion ---same
6193.
6) ST elevation on the ECG with chest pain but the chest pain relieved on inspiration is pericarditis
---same
6194.
6195.
8- arm, buttock, thigh itchy rashes that is not response to prednisolone and a/w diarrhea are dermatitis
herpatiformis--dont remember2
6196.
6197.
6198.
6199.
6200.
16- optic chiasma lesion for patient with assymetrical bitemporal hemianopial...as
tract,ratiation,occipital and optic nv will cause homonymous hemianopia or unilateral blindness --i
think there was no optic chiasma lesion so the answer is --occipital cortex
6201.
6202.
20) patient has history of Mi and noted absent pulse in the left upper limb is thromboembolic disease?
--same??
6203.
6204.
22) pseudogout
6205.
6206.
6207.
24) ulcerative colitis-patient with bloody diarrhea and noted goblet depletion and crypt abscess --silly
mistake from me
6208.
6209.
25) acanthosis nigrican in patient with fleckling in the axilla as opposed to neurofibromatosis is the
patient has no family history of similar picture and NFM is inherited as Autosomal dominant and
neurofibromatosis is present in pregnant and obese people --i put it nf
6210.
6211.
6212.
6213.
6214.
32) in patient with blood result showing hypocalcaemia the ECG changes is long Qt ---same
6215.
6216.
6217.
6218.
34) impingement syndrome in patient with pain and stiffness on shoulder ABD and rotation?
6219.
6220.
6221.
6222.
6223.
37) polymyagia rheumatica as the patient has stiffness and pain on the shoulder and wrist that is worse
in the morning i put it ra?
6224.
6225.
6226.
6227.
6228.
40) CXR with mediastinal enlargement and erythema nodosum suggestive of sarcoidosis ---same
6229.
6230.
41) patient with maculo papular rash with conjunctivitis and mucosa involvement is it SJS or toxic?as
SJS is the milder form of toxic now---cant remember.
6231.
6232.
43) Hepatitis A in patient with maculopapular rash and fletting arthralgia and lympadenopathy (pass
year)i put it measeles?
6233.
6234.
44) ovale malaria as patient back from african 5monthms ago and ovale malaria may have hypnozoite
in the liver ---same
6235.
6236.
6237.
6238.
6239.
6240.
6241.
6242.
6243.
49) myelofibrosis in patient with bld film show tear drop ---same
6244.
6245.
50) reduse exposure to sunlight in patient with low serum calcium low serum phosphate and high ALP
---i put it vegeterian
6246.
6247.
51) carbimazole inhibit the iodinasation of thyroxin (pass year) silly mistake from me
6248.
6249.
6250.
6251.
6252.
57) staph discitis in patient with pace maker implantation who present with low back pain?---same
6253.
6254.
6255.
62) SAH that develop confusion 5 days later in kumar and clark is hydrocephalus ---saem
6256.
6257.
64) barrect esophagus with epithelial dysplasia is esophagectomy or PPI and repeat scope?the kumar
and clark mention if low grade dysplasia then nid PPI but high grade nid surgery.the question did not
mention high grade or low grade ---acid suppresion then endoscopy?
6258.
6259.
6260.
6261.
6262.
6263.
70)-oraltetracycline ---plaquinil??
6264.
71)-chlamida--doxycycline
6265.
6266.
72)-angiodysplasia
6267.
6268.
6269.
6270.
6271.
6272.
6273.
6274.
6275.
6276.
6277.
6278.
6279.
6280.
6281.
6282.
85).One question about stroke and pin point pupils? Pontine hemorrhage---cant remember
6283.
6284.
6285.
6286.
6287.
91)Nitrofurotion ---same
6288.
6289.
6290.
6291.
6292.
6293.
6294.
6295.
6296.
6297.
6298.
6299.
6300.
6301.
100)Schizophrenia ---same
6302.
6303.
6304.
6305.
102)Pseudo psychogenicseziures.
6306.
6307.
6308.
6309.
104)BNP ---??
6310.
6311.
105)cryoglopulin ---same
6312.
6313.
106)CML ---same
6314.
6315.
107)animyloperoxidase same
6316.
6317.
6318.
6319.
6320.
6321.
6322.
6323.
6324.
6325.
6326.
6327.
6328.
6329.
6330.
6331.
6332.
6333.
6334.
6335.
6336.
6337.
6338.
6339.
119)VWD ---same
6340.
6341.
6342.
6343.
6344.
6345.
122)tarcolimus hyperkalemia
6346.
6347.
6348.
6349.
6350.
6351.
6352.
6353.
6354.
127)promylocytic leukemia(15/17)
6355.
6356.
6357.
6358.
6359.
6360.
6361.
6362.
6363.
6364.
6365.
6366.
6367.
133)pe--same
6368.
6369.
6370.
6371.
6372.
136)pulmonary HTN maternal mortality --silly mistake from me psGuest, Jan 22, 2011#60
6373.
drhamazGuestBNP brain natruritic peptid inhibit rinine angiotensin systemdrhamaz, Jan 22, 2011#61
6374.
6375.
drhamazGuestrhumatoid arthirities as the patient has stiffness and pain on the shoulder and wrist that is
worse in the morning not ply mylgia rhumaticadrhamaz, Jan 22, 2011#63
6376.
drhamazGuestmaesels in patient with maculopapular rash and fletting arthralgia and lympadenopathy
not hapatities Adrhamaz, Jan 22, 2011#64
6377.
GuestGuestmeasles ..naaa that z long shot dude ..hep A is more reasonable...but i dint choose it
though ..ahhh silly meGuest, Jan 22, 2011#65
6378.
GuestGuestagree with RA ..come on ..guyz symmetrical wrist synovitis ....it z RA 8)Guest, Jan 22,
2011#66
6379.
6380.
6381.
of pulmonary fibrosis .
6382.
6383.
6384.
6385.
6386.
6387.
older than 60 Hydroxyurea .. Remeber the age ?Guest, Jan 22, 2011#67
6388.
6389.
3 - a case with sensory loss over dorsum of foot and great toe - common peroneal palsy. --L5
6390.
4 - cxr rt upper lobe collapsee with recurrent hemoptysis - carcinoid syndrome --WHY NOT
BRONCHIAL CA AS PT WAS SMOKER
6391.
6392.
6393.
6394.
6395.
6396.
6397.
11 - differentiation between toxoplasmosis and crytococcus ct findings - contrast enanched mass lesion
SAME
6398.
6399.
13 . alcoholic brought unconscious having high urea and creatine - inv to be done - creatinine kinase
SAME
6400.
6401.
15 - palate weakness , absent gag reflex , fasciculations in tongue , tongue deviation to left . -- ? lesion
in jugular foramen . CEREBELLO PONTUINE ANGEL?
6402.
6403.
17 - non small cell ca in lung - clinical sign --- ? monophonic rhonchi . CANT REMEMBER
6404.
18 -pt with loose watery diarrhoea loss of weight , inv showing low b12 level - ? coeliac disease CANT
REMEMBER
6405.
6406.
6407.
6408.
6409.
23CODON---MSNGER RNA?
6410.
24-DM NEPHROPATHY\
6411.
6412.
26-HYPERSINSITIVITY PNEUMONITIS
6413.
6414.
6415.
6416.
GuestGuestBasics
6417.
6418.
6419.
- Sildanafil
6420.
-Muscarinic Antagonist
6421.
-Circumflex
6422.
6423.
dr ali sidigGuestrecall
6424.
6425.
thyroid swelling in pt with pheochromocytoma diagnosis is MEN11dr ali sidig, Jan 22, 2011#71
6426.
6427.
6428.
realy if you know how much useful these recalls for every body of caurse i dont want any one to fail to
try this! but any way its realy useful!!
6429.
letgs start by me
6430.
6431.
-tnf for ra
6432.
-pt with seve pain and inabilty to reflex hip(as i remember) whis one is priority to invistigate?pain or
this hip flexion loss(sorry i cant recall the quistio properly)
6433.
6434.
6435.
6436.
6437.
6438.
6439.
GuestGuest-Ciprofloxacin was 2.20 times as potent as tobramycin against the first strain of
pseudomonas and 45.4 times as potent against the second strain
6440.
-IL2
6441.
-Pleural biopsy
6442.
6443.
6444.
6445.
1-lat medullary syndrome i think it is wrong as it is not a/w contralat hemiparesis as this patient has so
the most likly corect answer is ---brain stem infarct.
6446.
6447.
2-iis VWD as both factor VIII and vWF reduced while in Haemophilia A --vWF is normal.
6448.
6449.
6450.
6451.
4-VATS-(Video assisstant thoracoscopy )for pleural effusion and pleural thikining.katkoot, Jan 23, 2011
#75
6452.
katkootGuest
6453.
6454.
6455.
6456.
6457.
6458.
6459.
6460.
6461.
6462.
6463.
6-Carotid artery dissection as it was preceeded with neck pain and headach.katkoot, Jan 23, 2011#76
6464.
katkootGuest
6465.
6466.
2-Gabapentin-peripheral neuropathy.
6467.
6468.
6469.
6470.
6471.
6472.
8-Emphysema.
6473.
6474.
10-Adhesive capsulitis.
6475.
6476.
6477.
6478.
6479.
6480.
6481.
6482.
6483.
6484.
katkootGuest1-hypersensitivity pneumonitis--paint srayer exposed to diisocyantes-can cause--aoccpational asthma but without cxr finding
6485.
b-hypersensitivity pneumonitis with mid+lower zone nodular infilterate as in our case (in acute phase).
6486.
6487.
6488.
6489.
4-hyperviscosity syndrome.
6490.
6491.
6492.
6493.
6494.
9-Nephrogenic DI-Aquporin2
6495.
6496.
katkootGuest
6497.
6498.
2-limb girdle
6499.
3-jugular foramen.
6500.
4-pyazinamide--joint pain.
6501.
5-doxycyclin-chlamydia.
6502.
6-lymphogranuloma venerium.
6503.
6504.
8-Ecoli o157--HUS.
6505.
9-RTA type 1-hypercholaremic acidosis with normal anion gap--renal impairment 2ry to
nephrocalcinosis.
6506.
10-Ciprofoxacine--pseudomonas.
6507.
6508.
6509.
6510.
6511.
5-Hypocalcaemia-Long QT interval.
6512.
5-Sertraline-Torsed `s
6513.
6514.
6515.
8-Oval Malaria.
6516.
9-Pontine HG.
6517.
10-homonomus hemianopia-Occipital.
6518.
6519.
6520.
katkootGuest
6521.
1-Reduced C4-SLE.
6522.
2-Polygenic-Ankylosing.
6523.
3-Sildenafil-blue vision.
6524.
6525.
6526.
6- IV bicarbonate-Amitrypteline.
6527.
6528.
8-Addison`s.
6529.
6530.
10-Gentamycine-mythenia
6531.
11-Sever asthma.
6532.
12-Pulmonary Embolism.
6533.
6534.
katkootGuest
6535.
1-Factor VII-Warfarin.
6536.
2-Dog bite-Co-moxclave.
6537.
3-Nitrofurantoin.
6538.
6539.
6-Oral terbinafine.
6540.
7-(15:17)-APML.
6541.
8-Ulcerative colitis.
6542.
6543.
11-Shizophrenia.
6544.
12-Grief.
6545.
6546.
katkootGuest
6547.
6548.
2-Avascular necrosis.
6549.
6550.
4-Neurofibromatosis.
6551.
6552.
6553.
6554.
6555.
6556.
10-Nicornadil-mouth ulcers.
6557.
11-Streptococuus pneumonae--postsplenctomy.
6558.
6559.
13-Pemphigus vulgaris.
6560.
6561.
6562.
6563.
6564.
6565.
CceGuestAnyone remember the age for the patient with essential thrombocytopenia?
6566.
6567.
6568.
6569.
6570.
6571.
6572.
6573.
6574.
allergy/tuna+olive/anisakiasis(igE insenstive.)
6575.
6576.
katkootGuest
6577.
1-scrombotoxin---Tuna.
6578.
2-hepatitis--fast acytelaor(sure).
6579.
3-Primaquin----G6PD.
6580.
4-grap fruit---statin.
6581.
5-CML.
6582.
6583.
6584.
9-staphylococcal discitis.
6585.
6586.
6587.
6588.
6589.
katkootGuest
6590.
1-ITP----human immunoglobulin.
6591.
2-lat epicondylitis.
6592.
3-coronary spasm--cocaine.
6593.
6594.
5-Renovascular disease.
6595.
6-membranous glomerulonephritis.
6596.
7-10%-5 years survival --operated stage II non small cell CA(usually it is as maximum as 15% so can
not be 20%).
6597.
6598.
6599.
6600.
6601.
katkootGuest
6602.
6603.
6604.
3-Pericarditis.
6605.
4-frontotemporal dementia.
6606.
6607.
7-CT abdomen-iliac fossa swelling+postprandial abdomonal pain +mother has crohn`s--? carcenoid
with mesenteric occlusion--intestinal angina.
6608.
6609.
10-Nodule->0.5 cm.
6610.
11-Varicella-more communicable.
6611.
12-Myelofibrosis--tear drops.
6612.
13-ciclosporin-IL2.
6613.
14-Endometrial CA.
6614.
6615.
6616.
6617.
PARKINSON'S/ CARLEDOPA .
6618.
6619.
PSEUDOMONOUS/CIPROFLUXACIN
6620.
6621.
katkootGuestnot sure
6622.
6623.
6624.
6625.
6626.
6627.
6628.
6629.
6630.
6631.
10-?Essential HPT-i select glomerulonephritis in view of proteinuria-i can not remember it was dip test
or urine microscopy.
6632.
6633.
6634.
6635.
2-Parkinsonism patient has only mild bradychynesia --in that case monoamine oxidase
inhibitor(seleglen) is used to dalay the fullblon picture of the disease.
6636.
3-Low bach pain with h/o PTB--? spinal cord compression due to possible pott`s disease- urinary
hesitancy.
6637.
6638.
GuestGuestmaternal INSULINcan cross the placenta only with ABs (igG) BUT FETAL INSULIN can
cross the placenta.Guest, Jan 24, 2011#96
6639.
GuestGuest- Fetus and Insulin: Fetal insulin does not cross the placenta. Even though the baby makes
insulin by the 10th gestational week, the fetal insulin does not transfer into the mother's blood.Guest,
GuestGuestNote - Candidates should note that a number of test questions are included in the
Examination. These questions do not attract marks or contribute towards the final result but are
included for research purposes. The analysis of the scores is based on only the questions that contribute
towards the final result.Guest, Jan 24, 2011#98
6641.
GuestGuestCandidates results are processed using a method called equating. This method
makes results comparable between all MRCP(UK) Part 1 examinations.
6642.
6643.
Candidates' scores and the passing score established by MRCP(UK) Research Unit, in consultation
with NBME psychometricians and approved by the MRCP(UK) Part 1 Board, are reported as a
scaled score. This score is a number between 0 and 999, which takes into account the number
of questions a candidate answers correctly and the relative difficulty of the examination.Guest, Jan 25,
2011#99
6644.
6645.
6646.
Page 2 of 8
6647.
6648.
6649.
6650.
6651.
6652.
6653.
6654.
6655.
6656.
6657.
6658.
6659.
6660.
< Prev
Next >
6661.
6662.
Forums
6663.
>
6664.
UK Medical Zone
6665.
>
6666.
MRCP Forum
6667.
>
6668.
6669.
a.
Search Forums
b.
Recent Posts
Forums
6670.
6671.
Resources
6672.
Log in or Sign up
6673.
6674.
6675.
Forums
6676.
>
6677.
UK Medical Zone
6678.
>
6679.
MRCP Forum
6680.
>
6681.
6682.
6683.
6684.
Page 3 of 8
6685.
< Prev
6686.
6687.
6688.
6689.
6690.
6691.
6692.
6693.
6694.
6695.
Next >
GuestGuestam sure the entire no. of questions have been documented. can someone merge it together
so we can calculate the total no. failed?Guest, Jan 25, 2011#101
6696.
6697.
6698.
6699.
6700.
6701.
CceGuestWhat do guys think is the passing Mark or the correct answer required this time?Cce, Jan 25,
2011#103
6702.
6703.
heavenGuestso high!i think i must failed if the required question to be answer correctly is 140......
heaven, Jan 25, 2011#105
6704.
GuestGuestGuys really I can't imagin how we will be in 16 days it's really not good feeling and you
guys sure that the pass Mark is 140 if so I think alot of us will not pass this exam so guys let us rise our
hand and pray for da god to creat a miracle for us in this exam and all of us to pass this
exam..ameeeeeeeeeeeeeeeen ya rabGuest, Jan 25, 2011#106
6705.
6706.
6707.
6708.
6709.
6710.
3-?Post MI-i select 1st septal branch of lf descending. SAME(LASTLY FOUND ANOTHER
COLLEGUE ANSWERED LIKE ME
6711.
6712.
6713.
6714.
6715.
6716.
6717.
10-?Essential HPT-i select glomerulonephritis in view of proteinuria-i can not remember it was dip test
or urine microscopy. CANT REMEMBER
6718.
6719.
6720.
6721.
15-Pericarditis. SAME
6722.
6723.
6724.
18-CT abdomen-iliac fossa swelling+postprandial abdomonal pain +mother has crohn`s--? carcenoid
with mesenteric occlusion--intestinal angina. COLONOSCOPY?
6725.
6726.
6727.
6728.
6729.
24-ciclosporin-IL2. SAME
6730.
6731.
6732.
6733.
6734.
6735.
6736.
6737.
33-10%-5 years survival --operated stage II non small cell CA(usually it is as maximum as 15% so can
not be 20%). SAME
6738.
6739.
6740.
6741.
6742.
38-scrombotoxin---Tuna. SAME
6743.
6744.
40-Primaquin----G6PD. SAME
6745.
6746.
42-CML. SAME
6747.
6748.
6749.
6750.
6751.
6752.
6753.
6754.
6755.
6756.
54-Neurofibromatosis. SAME
6757.
6758.
6759.
6760.
58-Monophonic wheez--cxr with large Lt hilar mass. CANT REMEMBR BUT DIFFERENT
6761.
6762.
6766.
6767.
63-Pemphigus vulgaris.SAME
6768.
6769.
6770.
66-Nitrofurantoin. SAME
6771.
6772.
6773.
70-(15:17)-APML. SAME
6774.
6775.
6776.
6777.
74-Grief.
6778.
6779.
6780.
77-Polygenic-Ankylosing. SAME
6781.
6782.
6783.
6784.
6785.
6786.
83-Addison`s. SAME
6787.
6788.
85-Gentamycine-mythenia SAME
6789.
6790.
87-Pulmonary Embolism.SAME
6791.
6792.
6793.
6794.
6795.
6796.
6797.
94-Sertraline-Torsed `s SAME
6798.
6799.
6800.
6801.
6802.
6803.
6804.
6805.
6806.
6807.
6808.
105-doxycyclin-chlamydia. SAME
6809.
6810.
6811.
6812.
109-RTA type 1-hypercholaremic acidosis with normal anion gap--renal impairment 2ry to
nephrocalcinosis. SAME
6813.
110-Ciprofoxacine--pseudomonas. CLARITHROMYCIN?
6814.
6815.
6816.
b-hypersensitivity pneumonitis with mid+lower zone nodular infilterate as in our case (in acute
phase). . SAME
6817.
6818.
6819.
6820.
6821.
6822.
6823.
120-hyperkalaemiaTacolimus SAME
6824.
6825.
6826.
SAME
6827.
6828.
6829.
6830.
6831.
6832.
6833.
131-psoriasis -not seborheoic dermatitis as tests for fungus was -ve. SD?
6834.
6835.
6836.
6837.
6838.
137-Gabapentin-peripheral neuropathy.SAME
6839.
6840.
6841.
6842.
6843.
6844.
143-Emphysema. SAME
6845.
6846.
146-Adhesive capsulitis.SAME
6847.
6848.
6849.
6850.
6851.
6852.
6853.
6854.
6855.
6856.
6857.
6858.
6859.
6860.
154-Carotid artery dissection as it was preceeded with neck pain and headach. ? PLEASE RECALL
6861.
6862.
6863.
6864.
6865.
1-I select acute gout as joint aspiration --showed no growth and because of young age.
6866.
2-I select carbocistien not alendronate as i understood from the question which of the following from
his COPD medictions causing the patient symptoms ,may be i am wrong?.
6867.
6868.
4-Bronchial carcenoid is a highly vascular centrally located causing haemotysis in young age(this
question repeated from previous exam).
6869.
5-I select lymphogranuloma venerium as it was mentioned chlamydia serology was +ve.
6870.
6-I select ascitic fluid microscopy as the question was which of the following investigation will guide
for the managment(if wbc>250)-need iv antibiotic.
6871.
6872.
8-urine hesitancy--patient with history of pulmonary TB --had low back pain lower limb
weakness,urine histancy and constipation -which help to diagnose.katkoot, Jan 26, 2011#109
6873.
caashifGuestmrcp recall
6874.
6875.
hey guys
6876.
6877.
6878.
and was it adenosine or amiodarone cos yes adenosine 6mg if not responding go for further same dose
adenosine
6879.
6880.
in lithium toxicity i guess ca channel blockers exacerbate cns toxicity(philip karla) doxazosin could
have been the answercaashif, Jan 26, 2011#111
6881.
katkootGuestrecalls
6882.
6883.
2-Sudden unilateral painless visual loss in a patient with Ehler Danlos syndrome-i select central retinal
artery occlusion? not sure
6884.
3-patient hearing Helicopter with history being separated from his wife 6 month ago-- i select
depressive psychosis ? not sure
6885.
6886.
6887.
6888.
6889.
8-Creatinine kinase--old man found unconscious with hypothermia.katkoot, Jan 26, 2011#112
6890.
caashifGuestpatient taking anti tb and bendroflumethiaide it could be either pyrazinamide and bendro
as well as both can precipitate gout (hyperuricemia)
6891.
was it PMR or rheumatoid i went wid rheumatoid as age was less than 50 and there wwas symmetrical
involvement
6892.
there was one another question in which female had difficulty raising anything above her head it could
not b duchene or becker cos they are x linke recessive what about fascioscapulohumeral dystrophy as it
is autosomal dominantcaashif, Jan 26, 2011#113
6893.
katkootGuestregarding the no of questions sufficient to pass no body can tell as this depends on our all
performance as questions have different marks based on its difficulty. But li think last diet was 118
questions was enough to pass
6894.
so let us all pray to God to be same like last diet.katkoot, Jan 26, 2011#114
6895.
6896.
6897.
katkootGuestIn parkinson`s question it was mentioned that the patient has only bradykinesia so
seleglene is the drug of choice as can delay the need forlevodopa and benzhexole is used for tremores
which was not their.
6898.
6899.
Regarding SVT -- adenosine usually is given in 3 doses 6.12.12mg or .25mg/kg if not reverted can go
for others.
6900.
6901.
The buccal mucosa was a trick the picture of itchy vesicles at upper ,lower limbs and buttocks clssical
for dermatitis herpitiformis.katkoot, Jan 26, 2011#117
6902.
6903.
what about BNP i dunn think that inhibits renin angiotensin i guess will stimulate sympathetic cos will
cause natriuresis will drop the bp which in turn will stimulate sympatheticcaashif, Jan 26, 2011#118
6904.
6905.
.9% saline for the one going for angiography but WITH GFR < 20 will it b appropriate or dobutamine
6906.
6907.
katkootGuest-BNP has vasodilator effect so improving renal affrent arteriolar blood flow-so reducing
renin with subsequent reduction of aldosterone secretion i.e antagonising Renin-AngiotensinAldosterone system.katkoot, Jan 26, 2011#120
6908.
katkootGuest- The only proven preventive measure against contrast induced renal damage is
prevention of hypovolaemia before administeration of contrast.
6909.
,pre-hyderation with IV saline is of proven benifit.Usually 1 L infused during the 12 h before and 12 h
after contrast exposure.(can be reduecd according to the fluid status).
6910.
Acetylcysteine sometimes used for the same reason but benifit of question?katkoot, Jan 26, 2011#121
6911.
GuestGuestooh man katkoot you helped alot by that pass mark 118 now there is a hope 70 % just we
keep praying till 7th of febr...you know dude i was leaving very hard situation i didnit sleep well nither
eat well it was post exam syndrom man its very hard am asking my God for all of us success ...thanks
brother really i apprecate it,,,greaating from canadaGuest, Jan 26, 2011#122
6912.
6913.
i guess it was a man whose neice got cystic fibrosis,what are the chances he will get this
6914.
6915.
6916.
6917.
6918.
I get this wrong though. I put 25%. stupid me.Cce, Jan 27, 2011#125
6919.
6920.
6921.
6922.
6923.
but
6924.
6925.
6926.
GuestGuestThe MRCP(UK) Part 1 Standard Setting Group has determined that an overall scaled score
of 521 or greater will be considered a pass. Please note that this score will be subject to review and
candidates are advised to consult the website for the latest information.
6927.
6928.
Scaled scores are created when the number of questions that candidates answer correctly is
mathematically transformed so that the passing score equals 521 on a scale starting a 0 and ending at
999. This transformation is very similar to converting inches to centimeters; for example, a 10 inch
ribbon will be 25.4 centimeters long. The length of the ribbon has not changed, only the units of
measurement that were used to describe it.
6929.
6930.
Why scale the scores ?The use of scaled scores allows for direct comparison of scores from one
examination form to another because the passing standard will always be the same, a scaled score of
521.Guest, Jan 28, 2011#128
6931.
6932.
ACE inhibitors,ARBs (angiotensin receptor blockers),so the answer in the exam question---likly
candesartan.katkoot, Jan 28, 2011#129
6933.
PconGuestOn the pastest website they have that exact same question in their bank and the answer was
doxazosinPcon, Jan 28, 2011#130
6934.
CceGuestYa. I saw that question in pastes too. It is doxasocin.Cce, Jan 28, 2011#131
6935.
dr_rajibGuestits in the air that pass marks (or number of questions one has to make correct for passing,
according to the new marking system) are usually higher in January ... any thoughts on this guys ??
dr_rajib, Jan 28, 2011#132
6936.
PconGuestAlso, the question re the incongruous homonymous hemianopia is an optic tract lesion, as an
occipital lesion would give a congruous defect i.e. the same pattern of visual loss in both eyes...or
maybe my recall of the question is incorrect?!Pcon, Jan 28, 2011#133
6937.
dr_rajibGuestmaybe results will be out on the 11th Feb ...dr_rajib, Jan 28, 2011#134
6938.
6939.
6940.
it might sound funny but seriously there are some questions in the recall that i dunn seem to recall...) i
must say that site is really great i am from pk and i really appreciate this indian sitecaashif, Jan 29,
2011#135
6941.
caashifGuestreduced libido does any 1 know i mean for sure that the question asked abt the cause or
which of the hormones accumulate..?
6942.
6943.
6944.
and were there two questions in which answers were essential hypertension one i remember was with
pregnant and silver wiring along with LVH and the other one i am not really sure was only with LVH
caashif, Jan 29, 2011#136
6945.
caashifGuesti believe there are still around 9 or 10 questions which havent been recalled
6946.
6947.
there are few repeatations i mean in some recaalls questions are given still others with only answers
caashif, Jan 29, 2011#137
6948.
GuestGuestYes sir
6949.
6950.
6951.
6952.
6953.
6954.
6955.
6956.
I hope it will be helpfull for other members taken the tes January2011
6957.
6958.
6959.
6960.
6961.
6962.
6963.
6964.
6) cyclosporin- IL2
6965.
6966.
barrets oesophagus- repeat endoscopy in few weeks with high dose ppi
6967.
9) rabies- amoxicillin
6968.
6969.
6970.
6971.
6972.
6973.
6974.
6975.
6976.
6977.
6978.
6979.
6980.
23) ig in sle c4
6981.
6982.
6983.
6984.
6985.
6986.
6987.
6988.
6989.
6990.
6991.
6992.
6993.
6994.
6995.
6996.
6997.
6998.
6999.
7000.
7001.
7002.
47) q on NNT- 50
7003.
7004.
50) elderly lady with fall . left side weakness, pupils to right- ?haemorrhage
7005.
7006.
7007.
7008.
7009.
7010.
7011.
7012.
7013.
7014.
7015.
7016.
7017.
7018.
7019.
7020.
7021.
7022.
7023.
7024.
7025.
7026.
7027.
76)q on ptsd
7028.
7029.
7030.
7031.
80) elderly lady admitted with off feet, normally fine. uti and confused on admission-??
haloperidol/temazepam
7032.
81) q on metabolic acidosis with normal anion gap- ? type1 renal acidosis
7033.
7034.
7035.
7036.
7037.
7038.
7039.
7040.
7041.
7042.
7043.
92) part of intestine involved in a pt with bloody diarrhoea and abdominal pain, smoker- caecum
7044.
7045.
7046.
7047.
7048.
7049.
7050.
7051.
7052.
7053.
7054.
7055.
7056.
7057.
GuestGuestq about recurrent infection with igA diff/ answer common variable immnine diff. 8)Guest,
Jan 30, 2011#141
7058.
GuestGuestq about postpartum woman with headcahe and photophobia/ answer is viral meningitis
asthere is high protien and acellular as early viral meningitis can presnt like this beside cortical vein
thrombosis does not cause photophobia not high CSF protien and present with stroke like
7059.
7060.
7061.
7062.
7063.
GuestGuestIgA deficiency is the most common of the primary immunodeficiency diseases, with an
incidence record as high as 1:333 blood bank donors.
7064.
Many patients with IgA deficiency is clinically normal, but there are higher incidences of infectious,
allergic, collagen-vascular, and gastrointestinal disorders in patients with reduced IgA concentrations.
7065.
7066.
There is also an increased incidence of malignancy, particularly of the gastrointestinal tract, in IgAdeficient patients.
7067.
7068.
There are increased bacterial infections in the respiratory and genitourinary tracts.
7069.
7070.
Antibodies to food antigens, especially cows milk, are common and may be related to the high
incidence of malabsorption.
7071.
7072.
Autoantibodies are also frequent and are often related to clinically relevant autoimmune disease.
7073.
7074.
7075.
GuestGuestYES ITS CORTICAL THROBOSIS SURE BECAUSE SIMPLY THERE WAS NO VIRAL
MENINGITIS ANSWER!! I AM SUREGuest, Jan 30, 2011#145
7076.
GuestGuestAgree..
7077.
postpartum woman with headcahe and photophobia and high protien : cortical vein thrombosis:
presents with stroke likeGuest, Jan 30, 2011#146
7078.
7079.
7080.
7081.
7082.
GuestGuestan important note : some papers had different questions than others
7083.
7084.
and they may be slightly harder or easier than others . we dont necessary
7085.
7086.
7087.
samahGuestpeople pls dnt post wrong answers its just confusing! if not 100% sure about the answer
just post the question so we can all discuss without CONFUSIONsamah, Jan 31, 2011#150
7088.
7089.
Page 3 of 8
7090.
< Prev
7091.
7092.
7093.
7094.
7095.
7096.
7097.
7098.
7099.
7100.
Next >
7101.
7102.
7103.
7104.
7105.
Forums
7106.
>
7107.
UK Medical Zone
7108.
>
7109.
MRCP Forum
7110.
>
7111.
7112.
a.
Search Forums
b.
Recent Posts
Forums
7113.
7114.
7115.
7116.
7117.
7118.
Forums
7119.
>
7120.
UK Medical Zone
7121.
>
Resources
Log in or Sign up
7122.
MRCP Forum
7123.
>
7124.
7125.
7126.
7127.
Page 4 of 8
7128.
< Prev
7129.
7130.
7131.
7132.
7133.
7134.
7135.
7136.
7137.
Next >
7138.
7139.
7140.
caashifGuestyes i quite much agree with this i mean there should be some 1 who could put all (i mean
200) questions with their best answers not the rong ones best means there should be real consensus
caashif, Jan 31, 2011#152
7141.
samahGueston page 7 for examaple a list of confusing answers an obvious wrong answer was 29 poor
prognosis of RA is negative RF?? and many otherssamah, Jan 31, 2011#153
7142.
CceGuestHi,samah. I agree with you. There are some obvious wrong answer. Let's point it out and put
up the right answer with evidence.
7143.
7144.
7145.
1) which hormone deficiency would cause reduced libido? DHEA? I cannot get the info from any
book.
7146.
2) patient with essential thrombocytopenia - age? Tx : aspirin or hydroxyurea?Cce, Jan 31, 2011#154
7147.
caashifGuestwhich hormone deficient it will b dhea which will accumulate will b 17 progesterone
caashif, Jan 31, 2011#155
7148.
7149.
7150.
7151.
7152.
7153.
7154.
I'm not sure of age i donot remember exactly but sure of the base
7155.
7156.
7157.
7158.
GuestGuestWomen with complaints of decreased libido or sexual well-being may be treated with
DHEA replacement. DHEA should be discontinued periodically to assess ...
7159.
7160.
7161.
7162.
7163.
1) patient complaint of knee pain. Examination showed painful hip movement and normal knee X-ray.
Next investigation of choice? Pelvic X-ray, knee arthroscopy or MRI knee?
7164.
7165.
2) patient with knee pain. Examination showed swelling and tender only at anterior knee. Not sure if
there is info about knee aspiration. Dx- septic arthritis? Knee bursitis?
7166.
7167.
7168.
7169.
4) patient on atenolol, aspirin and statin. Blood count showed pancytopenia. Same result after 6
months. Causes? Drug induced? Or parvovirus? I read in harrison's textbook. Parvovirus only cause
transient aplastic anemia.Cce, Feb 1, 2011#159
7170.
dr-muslimGuestASSALAM ALIKOM
7171.
DEAR COLLEGUES , THANK YOU FOR YOUR INTERACTION AND RECALLS FOR THIS
EXAM THAT ENEBLED US TO RECALL ALMOST WHOLE EXAM SO THAT WE CAN CHECK
OUR SCORES APROXIMATELY AND NEXT COLLEGUES CAN BENEFIT ALSO .SO PLEASE
ANY ONE CAN ADD ANYTHIING OR INFORMATION WE ALL WILL BE APPRECIATED
7172.
AND IF U BENIFIT THIS EFFORT PLEASE PRAY FOR ME TO PASS AND OF COURSE I WILL
PRAY FOR YOU ALL TO PASS
7173.
lets start by cardio(my recalls are not exact questions but the core and key points are same)
7174.
(before we start i hope u all to pray for my country Egypt and ask ALLAH to save its nation)
7175.
thank you
7176.
7177.
1*CARDIOLOGY:
7178.
7179.
7180.
7181.
7182.
7183.
7184.
7185.
7186.
7187.
7188.
12-SEVER CHEST PAIN WITH R AND T AND V1,V2 ELEVATION WHICH C ARTERY
AFFECTED>>>CIRCUMFLEX OR 1ST SEPTAL BRANCH OF LAD?
7189.
15-LONG QT SYNDROME>>>SERTRALINE
7190.
7191.
dr-muslimGuest2*NEPHROLOGY
7192.
7193.
7194.
7195.
7196.
7197.
7198.
7199.
7200.
7201.
7202.
7203.
7204.
7205.
7206.
7207.
7208.
7209.
7210.
7211.
7212.
7213.
7214.
dr-muslimGuest3*ENDOCRINOLOGY
7215.
7216.
7217.
3-PT E CRONS WITH LOW TSH AND FT4 BUT NORMAL FT3 >>>SICK THYROID
(EUTHYROID) OR LOW IODINE INTAKE?,THYROID H RESISTANCE?
7218.
7219.
7220.
7221.
7222.
7223.
9- TTT OF PHEOCROMOCYTOMA>>>PHENOXYLAMIN
7224.
7225.
7226.
7227.
7228.
7229.
7230.
3-PT WITH BLEEDING TENDENCY HIGH PTT LOW FACTOR 8>>>VWD(SOME COLLEGUES
SUGGESTED HEMOPHILIA A?)
7231.
7232.
5-T WITH HIP PAIN WITH TTT OF CML >>>AVSCULAR NECROSIS OF HEAD OF FEMUR
7233.
7234.
7235.
7236.
7237.
7238.
7239.
7240.
7241.
7242.
17-DOCXCETEL>>>INHIBITON OF MICROTUBULE
7243.
7244.
7245.
7246.
7247.
1-PT WITH PAINFUL INGUINAL L.N ,PENILE LESION AND HISTORY OF TRAVELING
ABROAD AND CLAMYDIA SEROLOGY +VE>>> LYMPHO GRANULOMA VENEREUM OR
CHANCROID
7248.
7249.
7250.
7251.
5-PT CAME FROM AFRICA 6 MONTHS BEFORE WITH FEVER AND CHILLS
>>>PLASMODIUM OVALE
7252.
7253.
7254.
7255.
7256.
7257.
7258.
12- PT E BACK PAIN AND FEVER POST PACEMAKER INSERTION DUE TO>>>STAPH
DISCITIS
7259.
7260.
7261.
7262.
dr-muslimGuest6*GIT
7263.
7264.
7265.
7266.
7267.
7268.
5-PT DOWN SYNDROME WITH ACUTE ABOMINAL PAIN, DISTENDED ABDOMEN AND
AXR SHOWS DILATED COLON>>>INTUSUCCEPTION
7269.
7270.
7271.
7272.
7273.
7274.
7275.
7277.
7278.
7279.
2-PT ATE FISH THEN DEVELOPED PAIN AND SKIN RASH WT IS THE
CAUSE>>>>>SCROMBOID TOXIN??
7280.
7281.
7282.
5-PT HAS FAST ACETYLATORS AND RECEIVING ANTI T.B DRUG WHT IS THE PT PRONE
TO>>>HEPATITIS(SOME COLLEGUE SUGGESTED DRUG RESISTANCE?)
7283.
7284.
7285.
WT IS THE CAUSE>>>NITROFURANTOIN
7286.
7287.
7288.
7289.
7290.
7291.
7292.
7293.
7294.
7295.
7296.
7297.
7298.
7299.
7300.
dr-muslimGuest8*NEUROLOGY
7301.
7302.
7303.
7304.
7305.
7306.
7307.
7308.
7309.
7310.
7311.
7312.
7313.
7314.
7315.
7316.
7317.
7318.
7319.
7320.
7321.
GuestGuestany one can remember whether any question from Keloid scar?
7322.
7323.
7324.
7325.
7326.
- Jugular foramen
7327.
7328.
7329.
7330.
7331.
inhibitors januvia and lisinopril lisinopril versus enalapril ...Guest, Feb 1, 2011#170
7332.
7333.
7334.
7335.
7336.
7337.
7338.
7339.
7340.
-SEVER CHEST PAIN WITH R AND T AND V1,V2 ELEVATION WHICH C ARTERY
AFFECTED>>>CIRCUMFLEXGuest, Feb 1, 2011#171
7341.
caashifGuestRheumatology
7342.
1.limited scleroderma
7343.
7344.
3.lat epicondylitis
7345.
4.pseudo gout
7346.
5.periarticular erosion
7347.
6.septic arthritis
7348.
7349.
8.adhesive capsulitis
7350.
7351.
Pulmonology:
7352.
1.asthma acid base balance(i'm not sure but in that scenario if oxygen was high that could be
hyperventilation as 16 yrs gal) not surecaashif, Feb 1, 2011#172
7353.
caashifGuestPulmonology:
7354.
7355.
7356.
4.narcolepsy
7357.
7358.
7359.
7.monophonic wheeze
7360.
8.reactive pneumonitis
7361.
7362.
10.pleural biobsy
7363.
7364.
AS polygenic
7365.
sarcoidosis
7366.
alkaptonuria
7367.
7368.
caashifGuestPsychiatry:
7369.
2.schizophrenia
7370.
7371.
4.PTSD
7372.
5.paranoid personality
7373.
Dermatology
7374.
1. Acne rosacea
7375.
7376.
3.BCC
7377.
4.nodule
7378.
5.necrobiosis lipodica
7379.
6.SJS
7380.
7381.
7382.
caashifGuestMiscellaneous:
7383.
stats:
7384.
1.NNT 50
7385.
3.bias
7386.
5. p value
7387.
6.unpaired t test
7388.
[b]Psychiatry [
7389.
7390.
OTHERS:
7391.
1. tau protein
7392.
2.BNP
7393.
3.cystic fibrosis
7394.
4.reverse transcriptase
7395.
5.codon
7396.
6. iL 2
7397.
7.Ig
7398.
8.L5
7399.
7400.
10.essential HTN
7401.
7402.
7403.
13.increased CK for an unconsious patient found in street for rhabdo...caashif, Feb 1, 2011#175
7404.
caashifGuest1. lesion on lip cause of Gi bleed i guess more for peutz jeghers(perioral pigmentation)
than angiodysplasia
7405.
2.for parkinson treatment had it been tremor only then ist option benzhexol
7406.
if rigidity or bradykinesia then cocareldopa but considering the age which was 50 otherwise if younger
then apomorphine rather than selegeline(to avoid on/off) so answer which seems appropriate to me i
may b rong is careldopa
7407.
3.ovale malaria ok but incubation period 6 months i went thru a book which says no vivax in west
africans ovale common but incubation period upto 5 months y not falciparum malaria dunn really have
an idea about this question but wanted to correct myself thats y put it here
7408.
4.in derma a question was with hyperkeratotic scar was it sebboric or something else..?
7409.
5.in rheumatology a question which said .. patient with painful knee on examination no redness not hot
not tender what to do next
7410.
7411.
6. another question bacterial overgrowth was answer dunn remember the questioncaashif, Feb 1, 2011
#176
7412.
CceGuestHi, caashif. Thanks for putting up those burning questions. For that knee pain question. I put
pelvic x ray as pelvic pathology like hip OA can have referred pain at the knee. I won't suggest MRI
knee or arthroscopy knee as the initial knee examination and X-ray are normal.Cce, Feb 1, 2011#177
7413.
7414.
7415.
7416.
7417.
7418.
Cce : i made it Pelvic X-ray as referred pain from hip Guest, Feb 1, 2011#179
7419.
CCEGuestFindingHimo,
7420.
7421.
i think it is narcolepsy rather than OSA because in that scenario it mentioned patient has frequent
collapse episode. both OSA and narcolepsy has daytime sleepiness but only narcolepsy explained the
collapse episode.
7422.
7423.
malingering vs pseudoseizures -> very tricky questions. as the scenario didnt mention anything about
the patient has any attention seeking, so making malingering unlikely. however, diagnosis of
pseudoseizures supported by absent abnormal EEG wave which is not mention also. confusing
question. only RCP knows the answer.CCE, Feb 1, 2011#180
7424.
caashifGuestwell that was one out of those 6 what about rest of 5 plz some 1 explain those..caashif, Feb
2, 2011#181
7425.
7426.
7427.
7428.
7429.
3.ovale malaria
7430.
7431.
5.in rheumatology a question which said .. patient with painful knee on examination .. X-ray Pelvis
Guest, Feb 2, 2011#182
7432.
PconGuestLesion on lips with PR bleeding in 53 year old male- likely peutz jeghers syndrome and
therefore answer most likely colon caPcon, Feb 2, 2011#183
7433.
7434.
PconGuestI believe the phrasing of the question was 'perioral pigmentation' hinting heavily at PJ
syndrome, as opposed to vascular lesionPcon, Feb 2, 2011#185
7435.
7436.
7437.
Angiodysplasia may present as an isolated lesion or as multiple vascular lesions. Unlike congenital or
neoplastic vascular lesions of the GI tract, this lesion is not associated with angiomatous lesions of the
skin or other visceraPcon, Feb 2, 2011#186
7438.
7439.
7440.
7441.
> 50 yoa
7442.
7443.
7444.
7445.
PconGuestBut without mention of other previous Hx of AVMs/epistaxis, the fact that he was 50 plus
and virtually all patients with HHT suffer with haemorrhage before 40...I think this question was
unlikely to be alluding to HHT as there isn't enough history. Just a thoughtPcon, Feb 2, 2011#189
7446.
GuestGuestGuys we living very very difficult time ..anybody know the pass Mark or da number of
question you have done correctly to pass please we are living in hell ...sorry but little bit nervous ..
Guest, Feb 2, 2011#190
7447.
DR-MUSLIMGuest9*CHEST
7448.
7449.
7450.
7451.
7452.
7453.
7454.
7455.
7456.
7457.
7458.
7459.
7460.
7461.
EXAMINATION)
7462.
7463.
7464.
7465.
7466.
7467.
7468.
7469.
7470.
DR-MUSLIMGuest10*RHEUMATOLOGY
7471.
7472.
7473.
7474.
7475.
7476.
3-PT WITH KNEE PAIN, NORMAL XRAY , BACK PAIN AND OSTEPROSIS OF LT HIP HOW TO
DIAGNOSE LT KNEE PATHOLOGY>>>MRI KNEE ,PELVIC XRAY, DEXA SCAN ,OR
ARTHROSCOPY?
7477.
7478.
7479.
7480.
7481.
7482.
6-PATIENT WITH SWOLLEN KNEE ,RED AND PAINFULL >>>SEPTIC ARTHRITIS (ONE
COLLEGUE SUGGESTED GOUT?)
7483.
7484.
7485.
7-PT WITH SEVERE LOW BACK PAIN AND WHEN EXAMINED FOUND NOT ABLE TO FLEX
HIP WHICH IS PRIRITIZED TO WORK UP>>>BACK PAIN OR INABILITY TO FLEX HIP(VERY
STRANGE AND I COULDNT RECALL IT PROPERLY
7486.
7487.
7488.
7489.
7490.
7491.
7492.
7493.
7494.
7495.
12-CYCLOSPORIN>>>IL2
7496.
7497.
13-PT WITH OLD T.B ,LOW BACK PAIN AND WEAKNESS OF L.L WT TO HELP
DIAGNOSIS>>URINE HESITANCY(ACTUALLY CANT REMEMBER THIS BUT BROUT IT
FROM ONE RECALL)
7498.
7499.
7500.
DR-MUSLIMGuest10*RHEUMATOLOGY(CORRECTION
7501.
7502.
7503.
7504.
7505.
7506.
3-PT WITH KNEE PAIN, NORMAL XRAY , BACK PAIN AND OSTEPROSIS OF LT HIP HOW TO
DIAGNOSE LT KNEE PATHOLOGY>>>MRI KNEE ,PELVIC XRAY, DEXA SCAN ,OR
ARTHROSCOPY?
7507.
7508.
7509.
7510.
7511.
7512.
6-PATIENT WITH SWOLLEN KNEE ,RED AND PAINFULL >>>SEPTIC ARTHRITIS (ONE
COLLEGUE SUGGESTED GOUT?)
7513.
7514.
7515.
7-PT WITH SEVERE LOW BACK PAIN AND WHEN EXAMINED FOUND NOT ABLE TO FLEX
HIP WHICH IS PRIRITIZED TO WORK UP>>>BACK PAIN OR INABILITY TO FLEX HIP(VERY
STRANGE AND I COULDNT RECALL IT PROPERLY
7516.
7517.
7518.
7519.
CALCIFICATION>>>PSEUDOGOUT
7520.
7521.
7522.
7523.
7524.
13-PT WITH OLD T.B ,LOW BACK PAIN AND WEAKNESS OF L.L WT TO HELP
DIAGNOSIS>>URINE HESITANCY(ACTUALLY CANT REMEMBER THIS BUT BROUT IT
FROM ONE RECALL)
7525.
7526.
7527.
7528.
7529.
caashifGuestdoes ny 1 know that how many questions are not evaluated and whether its true or not and
if those questions are corrected by the candidate are those marks redistributed if any1 have an idea
please commentcaashif, Feb 2, 2011#194
7530.
7531.
7532.
7533.
7534.
Note - Candidates should note that a number of test questions are included in the Examination. These
questions do not attract marks or contribute towards the final result but are included for research
purposes. The analysis of the scores is based on only the questions that contribute towards the final
result.Guest, Feb 2, 2011#196
7535.
caashifGuestwat do u guys guess which cud b test questionsi wish for bias and metaanalysis questions
caashif, Feb 2, 2011#197
7536.
7537.
7538.
OMG..
7539.
am i the only one who z reaaly scared ..feels like i cant stand on my feet..
7540.
God i keep having those doubtz of doing really bad on this thingy ..
7541.
7542.
seriously guys ..how much correct answers we need to pass thru that hell/exam ..
7543.
7544.
pple keep asking about passing markz but no one seem to care enough to answer ..sorry i m so nervous
but i cant help it ...
7545.
7546.
7547.
7548.
Page 4 of 8
7549.
7550.
7551.
7552.
7553.
7554.
7555.
7556.
7557.
7558.
7559.
7560.
7561.
7562.
7563.
7564.
Forums
7565.
>
7566.
UK Medical Zone
7567.
>
< Prev
Next >
7568.
MRCP Forum
7569.
>
7570.
7571.
a.
Search Forums
b.
Recent Posts
Forums
7572.
7573.
Resources
7574.
Log in or Sign up
7575.
7576.
7577.
Forums
7578.
>
7579.
UK Medical Zone
7580.
>
7581.
MRCP Forum
7582.
>
7583.
7584.
7585.
7586.
Page 1 of 13
7587.
7588.
7589.
7590.
7591.
7592.
7593.
7594.
13
7595.
Next >
7596.
7597.
7598.
7599.
7600.
7601.
7602.
6. Empyema inv.??USG/CT?
7603.
7604.
7605.
7606.
saadi10Guestmrcp jan2010
7607.
7608.
7609.
7610.
7611.
7612.
7613.
7614.
7615.
7616.
7617.
7618.
7619.
7620.
7621.
7622.
4. Inf MI ECG?
7623.
7624.
7625.
7626.
8. CxR of PE?
7627.
9. Dx of PE?
7628.
7629.
7630.
7631.
GuestGuestpsychogenic aphonia or mustism in the woman whom here son disobey here
7632.
7633.
7634.
7635.
7636.
7637.
HCM ?? lft vent out flow more than 30 mmhg or septum thickness more than 3 cm
7638.
7639.
burgada or rt vent hypoplasia or HCM in young age collapse after football match
7640.
7641.
7642.
7643.
7644.
7645.
CLOPIDOGREL STOP TO AVOID BLEEDING AFTER 24H OR STOP AND USE LMWH
7646.
7647.
7648.
7649.
7650.
7651.
ANATOMY: SCIATICA AND LONG THORACIC NERVE AND ABDUCTOR POLLICES PREVIS
7652.
7653.
7654.
7655.
7656.
7657.
7658.
5. Young pt had appendicectomy then went into shock (?sepsis - abscess). investigations ?clotting
screen ?DIC
7659.
7660.
7661.
7662.
9. ?mediator in anaphylaxis
7663.
7664.
11. A student's girlfriend kicked his ass after he came back from USA. He thought he's the Dean (?
delusional syndrome or ? schizophrenia !!!!!!!)
7665.
12. Lady with abdo pain and all Ix NAD --> ?factious disorder
7666.
7667.
14. intermittent painful defecation with fresh blood in young lad (?polyp ? haemorrhoids ?anal fissure)
7668.
15. Jaundiced pt with deranged LFTs (AST 1453) and tender hepatomegaly recently come back from
holiday abroad (?Hep A)Guest, Jan 20, 2010#11
7669.
7670.
7671.
7672.
7673.
BLUE VISION----SILDENFIL
7674.
7675.
7676.
7677.
AF ---HAEMODYNAMIC LOW----DC
7678.
7679.
7680.
7681.
CSF WITH HIGH LYMPOCYTE AND PROTEIN AND GLUCOSE 3.3 ---GUILLAN BARRE OR
7683.
2symptoms of unwell diarrohea post terminal illeum removal ? bile salt irritation
7684.
7685.
7686.
7687.
7688.
7689.
9jaw stiffness with multiple injected sites with discharging sinus tx? metronidazole /vac
7690.
10 presenting with bleeding pr and abdominal pain post recent surgery ?mesenteric artery occlusion
saadi10, Jan 20, 2010#13
7691.
7692.
7693.
Paper one was average, but 2 was a bit tough. Alhamdullilah I have done better than before. Following
are the remembered questions, please note that these are my answers and can be wrong, so please
discuss to make them right. Thanks
7694.
7695.
7696.
2.Mother upset by her son's disobedience, presented mute but movement ok-- Depression ???
7697.
4. ITP 2 questions
7698.
7699.
7700.
7. Pt claiming to be dean of medical faculty, after his girl friend left him--Mania
7701.
8. Boy behaving schezophrenic, Urine shows mild canabiniod--Dont remember the answer exactly but i
marked something related to schizophrenia.
7702.
7703.
7704.
7705.
7706.
13. Lyme
7707.
7708.
7709.
7710.
7711.
7712.
7713.
22. Typpical picture of Multiple Myeloma with unmeasured extra Immunoglobulins in blood + Bence
John's Protein
7714.
7715.
25. Cyclosporin--Nephrotoxicity
7716.
7717.
7718.
28. Alopecia--Phenytoin
7719.
7720.
31. Asymptomatic with low Hb but more markedly low MCV and Raised HbA2 --- Beta Thalasaemia
Trait
7721.
32. Mild haematuria, father and brother also had haematuria---Exercise related haematuria (I tried to
figure out if it can be hereditary but the option given was Alport's synd which is X-Linked dominant so
no male to male transfer)
7722.
7723.
34.Another question with constrictive pericarditis picture and asked what else is found --- widespread
ST elevation
7724.
35. Rate control in AF in a heart failure patient already on Digoxin---Amiodarone (other options were
beta blocker but cant be used in heart failure)
7725.
7726.
7727.
7728.
7729.
7730.
41.Pleural effusion patient---Do bronchoscopy (It was the 1st question in paper 1 I think)
7731.
42. Pt with history of influenza, now pneumonic picture-- Organism responsible ---Staph Aureus ??
7732.
7733.
45. Pt with low BP, Hickman Line insterted presents with various electrolyte abnormalities, what else
can be expected -- Hypophosphataemia
7734.
7735.
7736.
51. Pt on haemodialysis for 5 years 3 times per week. Cause of death -- Dilated cardiomyopathy ???
7737.
52.Beta Blocker Toxicity with very low blood sugar and bradycardia non-responsive to atropine -- Give
Glucagon
7738.
7739.
55.Drug in the marketr for 2 years and now a study claimed to have found a serious side effect, what
test will be used to check--- i wrote Case Control study (Because Rand Cont Trial cannot be used for
side effect measuremenst, but I can totally wrong, please discuss)
7740.
7741.
57. Pt seemed to have Seborrhoea or Dandruff (Not sure) -- But I marked Ketoconazol cream, other
options were totally irrelevent except Metronidazole cream.....so i was in doubt and marked Keto.
7742.
58.Pt with alcohol abuse presents with ataxia. Wats the reason? Options were various but I marked Vit
E Deficiency....Please correct me.
7743.
59. Lady after a fall, pain in neck with weakness but joint position sense and vibration sense and light
touch preserved--- Anterior spinal compression/Syndrone...???
7744.
60. Patient presents with functional symptoms but he also had a history of thinking he had a cancer 1
year ago, but now presents with some functional symptoms--Somatoform disroder and not
Hypochondriac disorder.
7745.
60.Lady with persistent diarrhoea for 2 years without any cause, some other functional symptoms were
also given -- Somatoform disroder
7746.
7747.
62. Prophylaxis for Trigeminal Neuralgia-- I just marked Phenytoin. Please correct me.
7748.
7749.
64. Rheumatooid Arthritis patient alread on Diclofenac Sodium,what should be started next-Methotrexate
7750.
7751.
7752.
Please share more to make a complete list. Thanks and good luck to all.
7753.
7754.
saadi10Guestammeen
7755.
7756.
7757.
7758.
7759.
7760.
alcoholic patient with ataxia had blurring of vision 2 years ago therefore i wrote MS
7761.
respiratory depression i wrote codiene as its a morphine derivative and can cause resp depression and
low gcs
7762.
7763.
lady with previous hx of investigation for cancer i wrote hypochondriasis as it was major illness for
which she got investigated for dont know could be wrong
7764.
7765.
GuestGuestSalam 3aleekom
7766.
7767.
7768.
7769.
7770.
7771.
2-Melanoma Depth
7772.
7773.
3-18 y f eczema and recent small pustule at face and UL topical steroid
7774.
7775.
7776.
7777.
7778.
7779.
7780.
7781.
7782.
7. Pt claiming to be dean of medical faculty, after his girl friend left him--Mania i thinnk its paranoid
schizophrania
7783.
7784.
9. Lady with hip pain but all movements normal--Osteoarthritis i think bursitis arthritis would have
limitation of active move
7785.
7786.
7787.
7788.
7789.
7790.
7791.
12. Lady with hypertension, hursutism and weight gain---PCOS or CAH ? -------PCO there was high
LH:FSH ratio
7792.
7793.
7794.
36.Thyroid Nodule in a totally asymptomatic patient---Fine Needle Biopsy ?? i chose scan discus
7795.
7796.
7797.
7798.
41.Pleural effusion patient---Do bronchoscopy (It was the 1st question in paper 1 I think)
---------thoracoscopy pleural biopsy
7799.
7800.
7801.
51. Pt on haemodialysis for 5 years 3 times per week. Cause of death -- Dilated cardiomyopathy ???
-----------septicaemia
7802.
7803.
55.Drug in the marketr for 2 years and now a study claimed to have found a serious side effect, what
test will be used to check--- i wrote Case Control study (Because Rand Cont Trial cannot be used for
side effect measuremenst, but I can totally wrong, please discuss) - I agree
7804.
7805.
7806.
57. Pt seemed to have Seborrhoea or Dandruff (Not sure) -- But I marked Ketoconazol cream, other
options were totally irrelevent except Metronidazole cream.....so i was in doubt and marked
Keto.---------metronidazol pls discus
7807.
7808.
59. Lady after a fall, pain in neck with weakness but joint position sense and vibration sense and light
touch preserved--- Anterior spinal compression/Syndrone...??? ---------------SYRNX dissociated sens
loss
7809.
7810.
7811.
62. Prophylaxis for Trigeminal Neuralgia-- I just marked Phenytoin. Please correct me. carbamazepine
7812.
7813.
7814.
7815.
7816.
7817.
7818.
7819.
8. Betablocker overdose with bradycardia not respond to atropine. Next managment --> glucagon
(repeat question Jan 2006)
7820.
7821.
10. Male with severe pain behind eye worse in the morning --? ?trigeminal neuralagia
7822.
7823.
7824.
7825.
7826.
7827.
7828.
7829.
7830.
21. Lady with tenderness + pain lateral R hip --> I wrote bruisitis
7831.
7832.
7833.
7834.
7835.
26. Obese lady with deranged LFTs and USS prognostic --> Nonalcoholic steatahepatits
7836.
7837.
7838.
30. Serious SE (fluminant hepatitis) of a new drug as per a journal article. Best course of action is to do
metaanalysis of related clinical trials as this would give the strongest evidence.
7839.
7840.
7841.
33. Fall and loss of pain and temperature and joint sensation preserved --> ?cervical disc prolapse
dr.wesam, Jan 20, 2010#17
7842.
7843.
7844.
7845.
7846.
7847.
nurse presents with a rash she has palmar rash and papules 0.4cm around gentalia
7848.
renal failure /loss of left knee and right ankle reflex with loss of power /urine positive for hematuria ?
PAN/ SLE
7849.
7850.
7851.
7852.
dx with cholecystitis 6months ago had stent insertion on aspirin and clopidogrel tx ?? delay for 6
months plz tell
7853.
patient tx for meningitis but after 4 days again confused and restless ? investigation ?urea/elec or MR
scan brain
7854.
7855.
7856.
7857.
7858.
7859.
2. carbamazemine autoinduction
7860.
7861.
7862.
7863.
7864.
7865.
7866.
5.patient suffered peripheral neuropathy , had chemo whic medication to stop ? vincristine
7867.
7868.
7869.
7870.
7871.
7872.
8.
7873.
7874.
7875.
7876.
7877.
7878.
11. Patient having unequal pupil and Ptosis ( Horner) which investigation to confirm ? cxr
7879.
7880.
7881.
13. Ankylosing spondylosis what will present in Lumbar xray ? sclerosis / osteophyste / sydem/ wedge
shape
7882.
7883.
7884.
7885.
15. 2/52 renal transplant dont remember the exact question but indicating cyclosporin toxicity
7886.
7887.
16 . patient on cyclosporin LFT become derange what investigation next to find the cause renal
ultrasound / urea creatinine / cyclosporin levels
7888.
18. Contraindication to liver biopsy PT / obesity / platelets / ultrasound appearance of intra dilation of
biliary tree
7889.
7890.
7891.
7892.
7893.
7894.
21. 19 yr old patient having heavy protien urea but no heamturia most common cause membranous /
minimal /FG / Ig A
7895.
7896.
22. routine medcial check showing iron deficiency with basophilic stripling , patient asymptomatic lead
poisonng / sideroblastic dont remember other options
7897.
7898.
23. elderly feeling lethatgic investigation showing Iron defeciency but no altered bowel symptoms
which investigation first ( gaasto / colonoscopy )
7899.
24. patient having blood diarrhoea / recent antibiotics for chest infection history of MI / diabetes ( c
.diff / ischaemic colitis / diverticulits )
7900.
7901.
25. patient having blood diarrhoea not respond to 5 days of metro ? campylo
7902.
26. IV drug abuser sign and symtoms of tetanus which antibiotcs ? metro ? doxy
7903.
7904.
27 . Endocarditis blood culture alpha hemolytic which combination ? ben + rifa / benpen + genta
7905.
7906.
7907.
7908.
29 . 37 yr old patient with Upper and lower motor sign father had similar problem at 78 yr of age ?
amyotrophic lat sclerosis
7909.
7910.
7911.
7912.
7913.
7914.
7915.
34 . patient heavy smoker and asbestos exposure diagnose lung cancer which account more i think
smoking mainly
7916.
7917.
35 . testicular feminisation how will patient look like male with female genitals / male with inguinal
testis / femal with clitromegaly etc
7918.
7919.
7920.
7921.
37. thyroid mass with normal TFT which investigation next ? FNAC ? radioisotope scan
7922.
7923.
41 . elder with fast AF but unstable hypotensive sys less then 80 ? cardiovert ? iv amiodarone / iv
betablocker
7924.
7925.
42 . VSD want to become pregant which will be make it difficult ? Pulmonary HTN / aortic regurg cant
remember all
7926.
7927.
7928.
7929.
7930.
46 . Patient investigated for palpitation all normal last yr think he had cancer ? Hypochondriasis
7931.
7932.
47 . Mother stressed with disobeyed child suddenly unable to speak ? akinetic mutism ? dpreseeion
7933.
7934.
7935.
48 . pastient with left hemiplegia and h/o of CABG 15 yrs , unable to find right brachial and radial
pulse . having head neck and back pain
7936.
7937.
7938.
49 . Nurse from southern india experiencing wight loss and diarrhea facal elastase less then normal ?
tropical sprue ? coeliac
7939.
7940.
50 . lady with linear erythema and exfoliative margins on the shoulder prv h/o of overdose ? factitious /
psoraisis
7941.
7942.
7943.
7944.
7945.
7946.
53 . MMSE
7947.
7948.
7949.
7950.
7951.
7952.
7953.
7954.
7955.
7956.
7957.
7958.
59 . patient blood gas showing type 2 resp failure diagnosis copd / Asthma
7959.
7960.
7961.
7962.
7963.
7964.
62 . patient ABPA admitted with exacerbation what to give first ? steroids ? itraconazole / neb saline /
neb steroids
7965.
7966.
7967.
7968.
7969.
64 . patient with Pericardial rub What will ECG shows ? small complex
7970.
7971.
7972.
7973.
7974.
7975.
7976.
7977.
7978.
7979.
7980.
7981.
7982.
7983.
7984.
72 . question about reactive arthirtis affectiong knees ankle and sole rash
7985.
7986.
7987.
7988.
7989.
7990.
7991.
7992.
7993.
7994.
7995.
7996.
7997.
7998.
7999.
8000.
8001.
8002.
81 . patient with renal failure and high total protien ? Multiple myeloma
8003.
8004.
82. Recent major surgery now 3 days later major MI after aspirin and clopidogrel what next ? primary
angio / thrmobolysis / LMWH / unfrac heaprin
8005.
8006.
83 . patient on clopidogrel and aspirin awaiting surgery ? stop clopi and start LMWH
8007.
8008.
8009.
8010.
8011.
87 cystic fibosis what chance of sister being carrier or effected cant remember the exact qyuestion ? 1:4
? 2:3
8012.
8013.
8014.
8015.
89 . diabetic patient with B/L small kidneys and protienuria and mild renal derangement ?
Amylodosis ? diabetic nehropathy ? renavascular both kidneys
8016.
8017.
8018.
8019.
8020.
8021.
8022.
94 . another question with high MCV cause ? b12 def ? folate def
8023.
8024.
8025.
8026.
96. patient with glucose in urine fasting and 2 hr normal feeling tired and lethargic ? Renal glucosuria
8027.
8028.
8029.
8030.
8031.
8032.
8033.
8034.
100 . whome to isolate patient with MRSA septicaemia / pneumonia and MRSA in sputum / perotenal
TB 1 day treatment / pulm TB 16 day treatment
8035.
8036.
8037.
These are some , if some one has good memory fill the rest of the parts
8038.
8039.
8040.
GuestGuestalot of stastitcs ...MANN whitney U or chie sequard ??Guest, Jan 20, 2010#21
8041.
GuestGuesthey guys the question about the infective endocardits in prothetic valve we should give
vancomycin+gentamicin+rifampcinGuest, Jan 20, 2010#22
8042.
8043.
I thought the question said single Ring Enhacing Lesion, which should be CNS lymphomadrrajib, Jan
20, 2010#23
8044.
8045.
8046.
8047.
-X-ray changes in AS
8048.
8049.
8050.
8051.
- SE of drug being compared on both sides of face, best statistical rest ?Fed up, Jan 20, 2010#24
8052.
Fed upGuestwhich patient can be left in multibed area - Legionell, Varicella etc etcFed up, Jan 20, 2010
#25
8053.
MRCPaspirantGuestThe following are most likely TEST questions,(cos I dont recollect seen them
in the exam); so dont worry if youve got them wrong
8054.
8055.
8056.
8057.
8058.
8059.
8060.
7.Whom to isolate patient with MRSA septicaemia / pneumonia and MRSA in sputum / peritoneal TB
1 day treatment / pulm TB 16 day treatment
8061.
8062.
MRCPaspirantGuestAlso, thought Ill give my explanations for some questions with controversial
answers
8063.
8064.
Neutropenia on Post-chemo day 10 I think needs only careful monitoring Reason because
the period of maximum cytopenia is over(day8) and the cytopenias can only improve from now on
8065.
8066.
8067.
8068.
8069.
8070.
8071.
8072.
8073.
8074.
8075.
8076.
8077.
6. intermittent painful defecation with fresh blood in young lad (?polyp ? haemorrhoids ?anal fissure)
8078.
8079.
7. BLUE VISION----SILDENFIL
8080.
8081.
8. Mild haematuria, father and brother also had haematuria---Exercise related haematuria (I tried to
figure out if it can be hereditary but the option given was Alport's synd which is X-Linked dominant so
no male to male transfer)
8082.
8083.
9. Another question with constrictive pericarditis picture and asked what else is found --- widespread
ST elevation
8084.
8085.
8086.
8087.
8088.
8089.
12. Male with severe pain behind eye worse in the morning --? ?trigeminal neuralagia
8090.
8091.
8092.
8093.
8094.
8095.
15. patient tx for meningitis but after 4 days again confused and restless ? investigation ?urea/elec or
MR scan brain
8096.
8097.
16. renal transplant dont remember the exact question but indicating cyclosporin toxicity
8098.
8099.
17. patient on cyclosporin LFT become derange what investigation next to find the cause renal
ultrasound / urea creatinine / cyclosporin levels
8100.
8101.
8102.
8103.
8104.
8105.
8106.
8107.
8108.
8109.
8110.
8111.
8112.
8113.
8114.
8115.
8116.
8117.
8118.
8119.
8120.
8121.
28. whome to isolate patient with MRSA septicaemia / pneumonia and MRSA in sputum / perotenal TB
1 day treatment / pulm TB 16 day treatment
8122.
8123.
8124.
8125.
8126.
8127.
8128.
31. girl with FH of 2 brothers with ?> weakness . mum negative..mode of inheritance?
8129.
8130.
8131.
8132.
32. which patient can be left in multibed area - Legionell, Varicella etc etc
8133.
8134.
8135.
8136.
8137.
I definitely did not see these questions in the papers. Are you sure they were there? Could anyone who
gave the exam from India verify?Johny, Jan 20, 2010#29
8138.
8139.
8140.
8141.
8142.
Posted: Wed Jan 20, 2010 6:06 pm Post subject: More Indian questions
8143.
--------------------------------------------------------------------------------
8144.
8145.
1. Diarrhoea, jaundice etc. in post-bone marrow transplant patient. Investigation? CMV PCR
8146.
2. Which patient to isolate-sputum positive tuberculosis, sputum cultured tubuerculosis, CSF cultured
tuberculosis. Sputum positive tuberculosis.
8147.
3. Post-trnasplant patient with skin lesion, diarrhea etc. What is the diagnosis? GVHDMRCPaspirant,
Jan 20, 2010#30
8148.
MRCPaspirantGuestHi johnny...
8149.
I gave the exam in INDIA....i have listed the questions not seen in the indian MRCP paper in a previous
post!!
8150.
The papers are uniform in one centre...but not sure if they are uniform over countries or not!!Man with
Back ache, multiple joint pains (father vague joint pain history) RF negative, Anti CCP positive
8151.
8152.
8153.
8154.
can check at google search Anti-citrullinated protein antibodyaldosteron99, Jan 20, 2010#33
8155.
MRCPaspirantGuestTo aldosteron99,
8156.
8157.
I am aware that in the diagnosis of RhA, anti-CCP is preferred now as it is more specific.
8158.
8159.
However, its unlikely for a young 'male' with "backache" and symmetrical arthritis,with ?positive
family history to have RhA, more over anti-CCP can be falsely positive in PsA
8160.
8161.
8162.
I feel the anti-CCP was mentioned to misguide us(at least when i gave the exam). Anyway I could be
wrong.MRCPaspirant, Jan 20, 2010#34
8163.
8164.
8165.
this forum had been very helpful for giving part one , so i am back to post the questions.
8166.
8167.
8168.
2. cystic fibrosis : it was a patient with disease. what is the chance that his 17 year old sister is a
carrier.? 2:3
8169.
3. in a population males and females bp were compared ,which test used to comparebp in both groups
8170.
4. mesothioloma related question accurate statement- prob biopsy would cause involvement of tract
8171.
8172.
6. clopidigrel question was that pt had cabg 6 months backon aspirin and clopidogrel. diagnosed as
cholelithiasis. surgeon worried about bleeding-
8173.
stop clop
8174.
8175.
8176.
8177.
8178.
8179.
8180.
11. young girl with tooth erosion and decreased na, K , ca, ? bullemia nervosa
8181.
8182.
emphysema
8183.
14. decreased tlco and kco 150% of predicted? in pt of systemic sclerosis with prog breathlessness : ?
effusion or diaphgrammatic weakness
8184.
8185.
amoebic
8186.
balantidim coli
8187.
campylobatercryptosporidium
8188.
17. elderly with inferior quadrantonopia swelling in disc at upper pole with 3 week h/o headaches- first
invegn
8189.
ESR
8190.
18. young pt with 8 days fever, 2 red spots at junc of soft and hard palate, splenomegaly, gen
lymphadenpathy
8191.
ps atypical cells
8192.
8193.
20.alcoholic with ataxia and opthalmoplegia comes with hypoglycemia -fist drug: thiaminerelaxed, Jan
20, 2010#36
8194.
GuestGuestcan anyone say dm type 1 diagnosis best by age or ketone bodiesGuest, Jan 20, 2010#37
8195.
relaxedGuestmore
8196.
8197.
8198.
22. pt with chest pain ,hemoptysis- PE like pcitre commonest x ray finding-
8199.
8200.
8201.
8202.
25. operated 2 days back for colorectal ca, develos AMI- after apsirin clop, best t/t
8203.
: primary angioplasty
8204.
8205.
ecg finding-
8206.
diifuse st elevation
8207.
27.acromegaly- invgn-
8208.
8209.
28. young lady with hypogly- what to measure next- insulin and c peptide or sulphonylurea level
8210.
8211.
8212.
8213.
8214.
8215.
but my sure advise to all those appearing is PASSMEDICINE is must.....relaxed, Jan 20, 2010#38
8216.
relaxedGuestdear friend
8217.
i think type 1 is best by ketosis, as MODY can occur at young agerelaxed, Jan 20, 2010#39
8218.
8219.
8220.
8223.
8224.
8225.
8226.
8227.
u1320918Guesttreatment of the lady with multiple ST infections isolated candida, gonococci and
vaginosis?u1320918, Jan 20, 2010#45
8228.
GuestGuestcrp and insulin testing whilst having symptoms to differentiate from endogenous source or
if she was mis-using insulin so do it whilst having symptoms.Guest, Jan 21, 2010#46
8229.
winner2010Guesthi
8230.
8231.
8232.
gilbenclamide
8233.
metformin
8234.
1v insulin
8235.
s/c insulin
8236.
8237.
8238.
8239.
8240.
5.30
8241.
10
8242.
95
8243.
97.5
8244.
8245.
8246.
8247.
prominent U wave
8248.
8249.
RA/Rv
8250.
8251.
8252.
axillary N
8253.
8254.
8255.
8256.
minimal change
8257.
glomerular nephritis
8258.
8259.
8260.
8261.
GuestGuestDoes anyone remember the liver biopsy question ? I answered obesity as contraindication,
any other ideas ?
8262.
8263.
8264.
8265.
Uncooperative patient5
8266.
8267.
8268.
8269.
8270.
Recent use (within the last 7 days) of aspirin or nonsteroidal anti-inflammatory drugs (NSAID) or
antiplatelet class of medications
8271.
8272.
8273.
Ascites
8274.
8275.
8276.
8277.
8278.
8279.
8280.
8281.
8282.
3.RTA 1 - nephrocalcinosis
8283.
8284.
8285.
7.Pt taking throxine with low T4, low free T4, normal T3 , normal TSH-
8286.
8287.
8288.
10.Pt with some harmless PVC on ECG and was worried about cancer when all tests were normalhypochondriac
8289.
8290.
8291.
14.35 y/o with IHD or DM has TC 5.2 and LDL 3.2-simva 40mg
8292.
15.left hemiplegia with absent right brachial artery and radial pulse , BP 160/80 -COA
8293.
8294.
8295.
8296.
8297.
8298.
8299.
8300.
8301.
8302.
27.terlipressin-splanchnic vasoconstriciton
8303.
28.Asbetosis+smoking +hyponatremia-small/mesothelioma
8304.
8305.
30.muslim T2DM who wants to fast is on metformin 500 mg tds-take 500 in morning and 1000 mg in
evening
8306.
8307.
8308.
8309.
34.foot drop,absent ankle reflex,lat loss of sensation, after hip surgery-common peroneal nerve
8310.
35. CML-Imatinib
8311.
8312.
8313.
8314.
8315.
42.Infective endocarditis with prostethic valve ,culture grew strep-b pencilin +gent
8316.
8317.
8318.
8319.
8320.
47.Cushing-met Alkalosis
8321.
8322.
8323.
50.GB syndrome-FVC
8324.
51.Bleeding PR - icolonoscopy
8325.
8326.
8327.
8328.
8329.
8330.
8331.
8332.
8333.
8334.
8335.
8336.
8337.
8338.
66.glucose fasting raised, OGTT fasting 5.6 2 hr 7.2 BP 150/80 glycosuria-reanal glycosuria/cushing
8339.
8340.
8341.
8342.
70.post partum 3 months with exopthalmos and TSH 0.01, raised T3 T4-Grave disease
8343.
8344.
8345.
8346.
8347.
8348.
8349.
8350.
79.Crest patient with b/l basal creps and cxr show basal shadowing-ILD
8351.
8352.
8353.
8354.
83.young 25 yr old labile mood , choreathethoid movement, other neuropsychiatric problems- wilson
8355.
84.young 16 yr old with lymphadenopathy, fever, WBC 17 ,lympho 11 and atypical lymphocytesglandular fever
8356.
8357.
8358.
8359.
8360.
8361.
8362.
8363.
8364.
8365.
8366.
8367.
8368.
8369.
8370.
8371.
Guesthey guys i c here common mistake with u plz seacrh for that: prothetic valve with infective
endocardits---------vancomycin+gentamicin+rifampcin
8372.
8373.
8374.
8375.
3rd sure dilated bile duct in contra. (sure 100&) but anemia also and he wrote it in the exam
8376.
8377.
4th why garves not toxic multi nodular goitre or toxic solitary nodule (graves post partum why)
8378.
8379.
5th amiodarone not used to control heart rate why use bb or ca ch blocker
8380.
8381.
8382.
8383.
7th how TB make ring enahed lesion we always say cns lympoma or toxoplasma
8384.
8385.
8th the question for appendectomy i think he asking about HELLP so i said liver function
8386.
8387.
8388.
8389.
when to isolate i said pneumonai and postive acid fast bacillia culure
8390.
8391.
8392.
drrajibGuestGuest i agree with most of ur answers except the test questions...but not too sure about IE
anbiotic choicedrrajib, Jan 21, 2010#55
8393.
GuestGuestWhat was the answer for hereditary angioedema? isn't it C1 esterase. i dont remember the
ques exactlyGuest, Jan 21, 2010#56
8394.
GuestGuestplease discuss:
8395.
8396.
8397.
8398.
3.Pt taking throxine with low T4, low free T4, normal T3 , normal TSH-
8399.
8400.
8401.
4.patient with glucose in urine fasting and 2 hr normal feeling tired and lethargic ,bp 150/80? Renal
glucosuria/cushing
8402.
.loss of sensations, all on one side including face,trunk and limbs- lesion in thalamusGuest, Jan 21,
2010#58
8403.
drrajibGuestanswer to heriditary angio was bradykinin cause th question was asking which factor was
responsible for the increased vascular permeability in this condition.
8404.
8405.
8406.
8407.
Dr magandiGuestTOXOPLASMA can cause solitary or multiple enhanced lesion philip kalra page 258
second edition or page 205 the 3rd editionDr magandi, Jan 21, 2010#62
8408.
8409.
8410.
8411.
8412.
winner2010Guesthi
8413.
8414.
8415.
8416.
a thalaseemia
8417.
beta thalassemia
8418.
lead poisoning???
8419.
8420.
a platent with malaena.colonocopy normal .which of the investagtions shows its due to Upper GI
bleeding??
8421.
8422.
8423.
8424.
8425.
8426.
8427.
why combined metabolic and resp acidosis? why not decompnesated resp acidosis..if a pt develop resp
acidosis due to copd and cant compensate by met. alkalosis isnt it decompnesated
8428.
8429.
cystic fibrosis 1 2 1 4 2 3 i need explain ?? i know that cystic fibrosis carer gene in adult is 1 :25 need
explain the answer
8430.
8431.
painfull intermittent bleeding in young with history of valve ds angiodysplasia coz it ias associated
with A.S
8432.
8433.
70 yr old headache 3 weeks sudden loss of vision with papillodema-ESR ???how 1st i am sure he didnt
say sudden loss of vision and if he said that and u think about giant cell artrits ESR not diagnostic ESR
normal elvated in elderyDr magandi, Jan 22, 2010#69
8434.
JAK-2 MutationGuestI guess in this very scenerio the examiner wants us to know implications and
risks of temporal arteritis, of course we all know that, and to rule it out a temporal biopsy is the
investigation of choice, but to have a clue to embark towards a temporal biospy it is the high ESR
which is considered a cardinal feature, so in my opinion its the ESR which is to be done in such
situation. Please correct me....ThanksJAK-2 Mutation, Jan 22, 2010#70
8435.
8436.
8437.
8438.
8439.
8440.
8441.
1/4 no mutation
8442.
8443.
The brother was 19 (or 17) years old so we already know that he doesn't have the disease, so he is
either a heterozygous for the mutation or without the mutation. So in that case we calculate the
probability out of 3 not 4. So probability of being a carrier is 2/3
8444.
8445.
8446.
8447.
JAK-2 MutationGuestThe thiazides act on the proximal portion of the distal convoluted tubule to
inhibit sodium resorption and promote potassium excretion.JAK-2 Mutation, Jan 22, 2010#73
8448.
Dr MOALYGuestin the exam didnt say proximal of distal he saied ascending limb of distal is it the
same dr jak 2 mutuationDr MOALY, Jan 22, 2010#74
8449.
mannylGuestIt could be decompensated respiratory acidosis or Mixed resp & metabolic acidosis.
8450.
8451.
8452.
mannylGuestThe question said single sided loss of vision in patient with H/T and D/M and asked about
most appropriate I/V.
8453.
I went for Duplex doppler neck in favour of carotid artery stenosis.mannyl, Jan 22, 2010#76
8454.
mannylGuestIn UK exam paper, there was proximal DCT.mannyl, Jan 22, 2010#77
8455.
JAK-2 MutationGuestIn Riyadh too it was proximal part of distal convoluted tubule. I think even if it's
called ascending part of DCT, it should essentially be the same thing.JAK-2 Mutation, Jan 22, 2010#78
8456.
8457.
8458.
8459.
8460.
8461.
8462.
8463.
8464.
8465.
8466.
11) Case report showed drug associated with cancer, to do next.. RCT
8467.
8468.
8469.
8470.
8471.
16) Renal transplant blood group O and donor A.. Hyper acute rejection
8472.
8473.
8474.
dr_mdGuestdifferent views, different answers,every body has their own answers , n they r thinking am
rite please give the reference from which book or which site, many things have changed now,dr_md,
Jan 22, 2010#80
8475.
mannylGuestcorrection for No 7.
8476.
Young lady with low serum Na,K and high Ca.. laxative abusemannyl,
8477.
8478.
8479.
8480.
plz tll me what wa bicarbonate reading-- to call it as mixeddr_md, Jan 22, 2010#82
8481.
8482.
Pneumonia after viral illness.. mycoplasma > staph A.. ( Passmedicine)mannyl, Jan 22, 2010#83
8483.
mannylGuestsingle thyroid swelling without any abnormalities. FNAC is reasonable to know solid or
cystic character and also can get cells for cytology and culture.
8484.
8485.
mannylGuestI went for decompensated resp acidosis in favour of COPD patient.mannyl, Jan 22, 2010
#85
8486.
giroop2003GuestHi, Guys in COPD its Mixed resp and metabolic acidosis, In uncompansated Resp
acidosis HCO3 will be normal not lowgiroop2003, Jan 22, 2010#86
8487.
giroop2003GuestIn Passmedicine if you look clearly he has mentioned if it is confirmed Strept Vird
then we should start Pen+Gent, Empirical Prosthetic valve may be Vanco+Rifp+Gentgiroop2003, Jan
22, 2010#87
8488.
8489.
giroop2003GuestHi Mannyl, In laxative abuse you need not get oral findings, In fact in quetion it was
clarly mentioned patient not taking any medicinegiroop2003, Jan 22, 2010#90
8490.
giroop2003Guesthi mannyl Pneumonia after Viral fever is staph aurgiroop2003, Jan 22, 2010#91
8491.
8492.
Not so sure about not taking any medication. But can still choose laxative according to lab findings.
mannyl, Jan 22, 2010#92
8493.
ahmed MGuestmrcp
8494.
8495.
i think for thyrotoxicosis before any invasive manover frist isotope scan
8496.
post viral,staph
8497.
8498.
8499.
1.size of RNA using DNA ?pcr or northen... Northern (PCR for DNA coding gene)
8500.
8501.
3.loss of ankel reflex with weakness of knee?sciatic nerve...I didnt remember( may be diff paper)
8502.
8503.
8504.
8505.
8506.
8507.
10.kapose?HHV8.....the same
8508.
8509.
12.skin rash at hand with nodule at penis?syphalis....didnt remember( may be diff paper)
8510.
8511.
8512.
8513.
17.JAK 2?POLYCYTHEMIA
8514.
8515.
8516.
8517.
8518.
8519.
24.CML ttt?imitinap
8520.
8521.
8522.
8523.
31.rhumatoid activation?methotreaxat
8524.
8525.
8526.
8527.
8528.
8529.
8530.
38.LOW FEV1/FVC?EMPHYSEMA
8531.
8532.
40.CUSHING?METABOLIC ALKALOSIS
8533.
8534.
8535.
8536.
8537.
8538.
8539.
8540.
8541.
8542.
8543.
8544.
8545.
8546.
8547.
57.MI+DM?INSULIN
8548.
8549.
59.SKIN HYPOPIGMENTATION+THYROTOXICOSIS?VITILIGO
8550.
8551.
8552.
8553.
8554.
8555.
65.MULITIPELE MYLOMA
8556.
66.ACROMEGALY?GTT
8557.
67.HYPERKALEMIA+HYPOTENSION?SHORT SYNCHT
8558.
8559.
8560.
8561.
8562.
8563.
74.DRT ACIDOSIS?NEPHROCALCINOSIS
8564.
8565.
8566.
77.PCKD BLOOD GROUP O HIS FATHER45 YEAR BLOOD GROUP A NOT ACCEPT?STILL
CHANCE TO BE PCKD
8567.
78.DICLOPHENAC?AIN
8568.
8569.
8570.
8571.
8572.
74.DRT ACIDOSIS?NEPHROCALCINOSIS
8573.
8574.
8575.
77.PCKD BLOOD GROUP O HIS FATHER45 YEAR BLOOD GROUP A NOT ACCEPT?STILL
CHANCE TO BE PCKD
8576.
78.DICLOPHENAC?AIN
8577.
8578.
8579.
8580.
8581.
It said hirsutism, high BP, with weight gain (High BMI), amenorrhoea, high testosterone but I do not
recall whether the FSH: LH ratio was high, low or normal but seeing the high BP i opted for Congenital
adrenal hyperplasia while I see here many people opted for PCOS....any comments plz.......JAK-2
Mutation, Jan 22, 2010#102
8582.
ahmed MGuestTHE BODY MASS INDEX WAS NORMAL ,FSH NORMAL ,LH HIGHahmed M, Jan
22, 2010#103
8583.
8584.
8585.
8586.
8587.
8588.
8589.
8590.
24.CML ttt?imitinap
8591.
27.pt with petechia and low plt normal pt .renal function?ITP....the same
8592.
8593.
8594.
8595.
8596.
8597.
8598.
8599.
8600.
8601.
8602.
8603.
8604.
8605.
8606.
8607.
8608.
8609.
8610.
8611.
8612.
8613.
8614.
8615.
8616.
8617.
8618.
57.MI+DM?INSULIN....the same
8619.
8620.
59.SKIN HYPOPIGMENTATION+THYROTOXICOSIS?VITILIGO...
8621.
8622.
8623.
8624.
8625.
8626.
8627.
66.ACROMEGALY?GTT......OGTT+GH
8628.
8629.
8630.
8631.
8632.
8633.
8634.
8635.
8636.
8637.
77.PCKD BLOOD GROUP O HIS FATHER45 YEAR BLOOD GROUP A NOT ACCEPT?STILL
CHANCE TO BE PCKD
8638.
78.DICLOPHENAC?AIN....the same
8639.
8640.
80CAUSE OF DEATH IN ESRD?IHD....I got wrong with (DC)mannyl, Jan 22, 2010#104
8641.
8642.
8643.
8644.
8645.
8646.
8647.
8648.
87.ACTION OF TERPELISERN?SPLANCHANIC VC
8649.
8650.
8651.
8652.
8653.
8654.
94.PNUMOCYSTIC?COTRIMEXAZOL
8655.
95.RING ENHANCEMENT?TOXOPLASMOSIS
8656.
8657.
8658.
8659.
8660.
8661.
8662.
8663.
104.PNUMOTHORAX? OBSERVE
8664.
105.NEUTROPENIA .8?OBSERVE
8665.
8666.
107ENTECAPRON?TNF ANTAGONIST
8667.
8668.
109.CLUSTER HEADECHE
8669.
8670.
8671.
8672.
114.BELLS PALSY?HYPERASTHSISAE
8673.
115.ADI PUPILE
8674.
116.PARKINSON?ASYMMETRICAL
8675.
8676.
8677.
8678.
119.CANCER ?HYPOCHONDRISM
8679.
8680.
8681.
8682.
8683.
8684.
8685.
126.WRINKES TTT?THIAMIN
8686.
8687.
8688.
8689.
8690.
8691.
8692.
8693.
8694.
8695.
8696.
8697.
8698.
8699.
141.DKA?KETONURIA
8700.
8701.
8702.
8703.
8704.
145.+PREDICTIVE ?50%
8705.
146.SENSTIVITY
8706.
8707.
8708.
8709.
8710.
8711.
8712.
8713.
8714.
8715.
8716.
8717.
8718.
8719.
8720.
161.CICLOSPORING ?NEPHROTOXICITY
8721.
8722.
163.SIADH ?FLUOXTIN
8723.
8724.
165.PT TTT AFTER DRUG OVER DOSE HAVE BLURRING OF VISSION?METHYL ALCOHOL
8725.
8726.
8727.
8728.
8729.
8730.
8731.
8732.
8733.
aresGuestmy paper did not have the muslim n metformin question. different region has different qs?
mine in msia. others mostly sameares, Jan 22, 2010#110
8734.
8735.
8736.
8737.
8738.
8739.
8740.
8741.
8742.
8743.
8744.
8745.
8746.
94.PNUMOCYSTIC?COTRIMEXAZOL....the same
8747.
8748.
8749.
8750.
8751.
8752.
8753.
8754.
8755.
105.NEUTROPENIA .8?OBSERVE.....GCSFactor
8756.
8757.
8758.
8759.
8760.
8761.
8762.
8763.
8764.
8765.
116.PARKINSON?ASYMMETRICAL....Asymmetrical of bradykinesia
8766.
8767.
8768.
8769.
8770.
same
8771.
8772.
8773.
8774.
8775.
8776.
8777.
8778.
8779.
8780.
8781.
8782.
8783.
8784.
8785.
8786.
8787.
8788.
8789.
8790.
8791.
2- best stat. test for difference when applying one drug on half of face and another drug on the other
half: so we need a paired and non-parametric test.... answers: mann-whitny u test, chi-squared test,
student test and cant remember other two answers.
8792.
8793.
3- what is the percentage of values that r above two standard deviations from the mean (in normal
distributation):
8794.
Answers: 2.5% 5% 10% 95% 97.1% ( I think the correct answer is 2.5% because 95% are within 2
SD's of the mean above and below in addition to 2.5% that is below 2 SD's)
8795.
8796.
4- statistician is telling the authour that the sample size of the study might be too small to give an
accurate mean... what concept he in talking about:
8797.
8798.
8799.
answers: proteosome, peroxisome, golgi apparatus, ER.... lysosome was not given as an option
definitely. correct answer is proteosome as polypeptides are proteins. Also, peroxisome is for fatty acid
degradation.
8800.
8801.
2- a RIGHT-handed woman presented with difficulty reading.. CT brain showing a RIGHT parietal
lobe infarction. which of the following is likely to be contributing to her reading difficulty:
8802.
8803.
I think inattention was the only option caused by non-dominant parietal lobe infarction.
8804.
8805.
3- whom to isolate:
8806.
8807.
8808.
8809.
8810.
8811.
8812.
8813.
8814.
what ABx to give... I can not remember answers, but I know empirical Tx is as for penicillin allergic
(Vanc+Gent+rifampicin) but once we know the bug I presume we should give only 2 drugs.Guest, Jan
23, 2010#113
8815.
GuestGuesthi
8816.
patient 2 SD THE QUESTION ASKE ABOUT ABOVE ,I THINK 5%BECAUSE IF ASKE ABOVE
OR BELOW (2.5%)Guest, Jan 23, 2010#114
8817.
8818.
answers: proteosome, peroxisome, golgi apparatus, ER.... lysosome was not given as an option
definitely. correct answer is proteosome as polypeptides are proteins. Also, peroxisome is for fatty acid
degradation.
8819.
8820.
2- a RIGHT-handed woman presented with difficulty reading.. CT brain showing a RIGHT parietal
lobe infarction. which of the following is likely to be contributing to her reading difficulty:
8821.
8822.
I think inattention was the only option caused by non-dominant parietal lobe infarction.
8823.
8824.
3- whom to isolate:
8825.
8826.
8827.
8828.
8829.
8830.
8831.
8832.
8833.
what ABx to give... I can not remember answers, but I know empirical Tx is as for penicillin allergic
(Vanc+Gent+rifampicin) but once we know the bug I presume we should give only 2 drugs.Guest, Jan
23, 2010#115
8834.
patient 2 SD THE QUESTION ASKE ABOUT ABOVE ,I THINK 5%BECAUSE IF ASKE ABOVE
OR BELOW (2.5%)
8835.
8836.
Hi friend, I can not remember the exact question but it clearly gave a parametric example and above
here means HIGHER than the mean by two SD's (ie: if the mean is 50% then what percentage of values
r higher than the 97.4 percentile)Guest, Jan 23, 2010#117
8837.
8838.
8839.
8840.
8841.
146.SENSTIVITY....the same
8842.
8843.
8844.
8845.
8846.
8847.
8848.
8849.
8850.
8851.
8852.
8853.
8854.
8855.
8856.
8857.
8858.
8859.
8860.
8861.
8862.
8863.
8864.
169. Warfarin after MI and persistent AF.... 6 monthsmannyl, Jan 23, 2010#118
8865.
uziGuestHi guys, does anyone know the answer to the Q about the most likely cause of pancreatitis in
the pregnant woman?uzi, Jan 23, 2010#119
8866.
8867.
mannylGuestQ. Pregnancy with pancreatitis. Causes?? I went for idiopathic.mannyl, Jan 23, 2010#121
8868.
uziGuesti just remember that i chose gallstones, but can't remember the other options.uzi, Jan 23, 2010
#122
8869.
8870.
JohnyGuestDiabetes
8871.
8872.
8873.
2. Differentiating type 1 from type 2 diabetes on the basis of initial investigations low serum
bicarbonate
8874.
8875.
4. Proteinuria in someone with multiple underlying pathologies but also type 2 diabetes of 9 years
diabetic nephropathy
8876.
5. Lady with recent weight gain, low blood sugar during one of the hypoglycaemic episodes next
investigation, 72 hour supervised fasting not given insulin & C-peptide during next hypoglycaemic
presentation
8877.
Adrenal
8878.
8879.
8880.
8881.
Thyroid
8882.
8883.
7. Lady on thyroid replacement, low free T4 but euthyroid, normal TSH and T3 adequate thyroid
replacement
8884.
8885.
8886.
8887.
8888.
8889.
Parathyroid
8890.
8891.
10. Hyperparathyroidism
8892.
8893.
11. Hyperparathyroidism
8894.
8895.
Pituitary
8896.
8897.
8898.
8899.
POCS
8900.
8901.
8902.
8903.
8904.
SIADH
8905.
8906.
8907.
8908.
Lithium
8909.
8910.
16. Nephrogenic diabetes insipidus caused by Lithium patient on treatment for bipolar disorder
8911.
8912.
8913.
Buimia Nervosa
8914.
8915.
8916.
8917.
Autoimmune hepatitis
8918.
8919.
8920.
8921.
8922.
8923.
Malabsorption
8924.
8925.
23. Increased stool elastase in lady returning from India with diarrhea ? giardiasis
8926.
8927.
8928.
Diarrhoea
8929.
8930.
8931.
8932.
8933.
Chrons
8934.
8935.
8936.
8937.
Carcinoma colon
8938.
8939.
27. Man 51 or so with iron deficiency anaemia which most useful investigation next ?
ccolonoscopy
8940.
8941.
8942.
8943.
8944.
8945.
Carcinoma oesophagus
8946.
8947.
28. Progressive dysphagia to both solids and liquids, weight loss etc.
8948.
8949.
Pernicious anemia
8950.
8951.
8952.
8953.
8954.
8955.
8956.
31. Most probable cause of death in someone with CKD who has been on haemodialysis for 5 years
CAD
8957.
8958.
Drug addict
8959.
8960.
32. Found with fever, dehydration, renal failure, very high hepatic transaminases, etc. What other
abnormality will be found elevated CPK
8961.
8962.
Thiazide
8963.
8964.
8965.
8966.
RTA 1
8967.
8968.
8969.
8970.
Interstitial nephritis
8971.
8972.
8973.
8974.
Tuberous sclerosis
8975.
8976.
8977.
8978.
Alpha thalassemia
8979.
8980.
38. South Asian, asymptomatic, mild anaemia, basophilic stippling, elevated HbA2 etc.
8981.
8982.
Immunosuppression NHL
8983.
8984.
8985.
8986.
Multiple myeloma
8987.
8988.
8989.
8990.
8991.
8992.
8993.
42. Vasodilator
8994.
8995.
Telipressin
8996.
8997.
8998.
8999.
9000.
Mitichondrial DNA
9001.
9002.
9003.
9004.
9005.
9006.
9007.
Lateral medulla
9008.
9009.
48. Wallenberg
9010.
9011.
Spinal cord
9012.
9013.
9014.
9015.
Poliomyelitis
9016.
9017.
9018.
9019.
9020.
9021.
51. Not able to read after infarction of the right parietal lobe in a right-handed lady cause
inattention
9022.
9023.
AIDS
9024.
9025.
52. Single ring enhancing lesion with seizures in someone with CD4 count around 100
toxoplasmosis
9026.
9027.
9028.
Transplatation
9029.
9030.
9031.
9032.
9033.
57. CMV PCR for diarrhea, jaundice etc. during maximum immunosuppression
9034.
58. ADPKD man rejected graft transplantation from brother with no cysts in the kidneys by surgeons,
the donors blood group A Rh +ve, recepients, O Rh+ve why? acute graft rejection
9035.
9036.
61. S1 lesion
9037.
9038.
9039.
9040.
9041.
9042.
VII nerve
9043.
9044.
9045.
9046.
9047.
9048.
9049.
9050.
9051.
Adies pupil
9052.
9053.
9054.
9055.
9056.
Temporal arteritis
9057.
9058.
9059.
Multiple sclerosis
9060.
9061.
9062.
9063.
9064.
Parkinsonism
9065.
9066.
9067.
9068.
9069.
9070.
9071.
77. Hypochondriasis/somatoform
9072.
9073.
9074.
80. Narcolepsy
9075.
9076.
9077.
Pulmonology
9078.
9079.
9080.
9081.
9082.
9083.
9084.
9085.
88. ABPA acute exacerbation with bilateral infiltrates and lower lobe collapse treatment - ?oral
prednisolone
9086.
9087.
9088.
ABGs
9089.
9090.
9091.
9092.
92. Emphysema
9093.
9094.
9095.
9096.
Connective tissue
9097.
9098.
9099.
94. PAN
9100.
9101.
9102.
9103.
Skin
9104.
9105.
9106.
9107.
9108.
Cardiology
9109.
9110.
100. Right coronary occlusion causing acute IWMI with complete heart block
9111.
9112.
9113.
9114.
104. Ascending aortic dissection with left hemiplegia and absent right radial and brachial pulses
9115.
9116.
9117.
9118.
9119.
Pulmonology
9120.
9121.
9122.
9123.
Cardiology
9124.
9125.
9126.
9127.
9128.
9129.
9130.
9131.
Pharma
9132.
9133.
9134.
9135.
Cardiology
9136.
9137.
115. DES placed 6 months back requiring cholecystectomy stop clopidogrel 1 week before surgery
9138.
9139.
Pulmonology
9140.
9141.
116. CXR finding in acute PE with pleuritic chest pain peripheral infarct
9142.
9143.
Haematology/oncology
9144.
9145.
9146.
9147.
9148.
9149.
121. Myelofibrosis
9150.
9151.
9152.
125. Drug to be avoided in NHL man with alcoholic peripheral neuropathy vincristine
9153.
126
9154.
9155.
9156.
Cardiology
9157.
9158.
9159.
9160.
Immunology
9161.
9162.
9163.
Infection
9164.
9165.
9166.
133. ? HD/Toxoplasmosis 16 year old boy with throat pain, generalized lymphadenopathy &
atypical mononuclears
9167.
9168.
135. Drug addict young lady with multiple necrotic injection marks and opisthotonus
metronidazole
9169.
136. Alpha haemolytic streptococci causing prosthetic valve endocarditis benzyl penicillin plus
gentamicin
9170.
138. Old lady with acute meningitis, normal CSF sugar, protein 0.9, cells 100, 90% lymphocytes
TB/lysteria
9171.
9172.
9173.
143. Lumbar x-ray in ankylosing spondylitis of 3 years with lateral movement restriction
9174.
144. Most likely consequence of acute sarcoidosis with EN and BHL etc. resolution
9175.
9176.
9177.
9178.
Haematology
9179.
9180.
9181.
9182.
Pulmonology
9183.
9184.
9185.
9186.
9187.
Genetics/Cell
9188.
9189.
9190.
9191.
9192.
9193.
9194.
Pharma
9195.
9196.
9197.
156. Man with CAD presenting with bloody diarrhoe mesenteric ischaemia
9198.
9199.
Immunology
9200.
9201.
9202.
9203.
Poisoning
9204.
9205.
9206.
9207.
9208.
Endocrine
9209.
9210.
9211.
9212.
9213.
Polyendocrine deficiency
9214.
9215.
9216.
9217.
Pulmonology
9218.
9219.
9220.
9221.
9222.
Poisoning
9223.
9224.
9225.
9226.
Septicaemic shock
9227.
9228.
9229.
9230.
9231.
Poisoning
9232.
166. Beta blocker with severe bradycardia resistant to atropine pacing/calcite onin
9233.
9234.
Gastro
9235.
9236.
167. Obese lady with type 2 diabetes and elevated LFTs NAFLD
9237.
9238.
9239.
Oncology
9240.
9241.
9242.
9243.
9244.
9245.
Cardiology
9246.
9247.
172. Treatment of acute anterior myocardial infarction on 3rd post-colectomy day Primary PCI
9248.
9249.
Metabolic disease
9250.
9251.
9252.
9253.
Pharma
9254.
9255.
9256.
9257.
Immunology
9258.
9259.
9260.
9261.
Haematology
9262.
9263.
9264.
9265.
9266.
9267.
Maternal health
9268.
9269.
9270.
9271.
Infection
9272.
9273.
9274.
9275.
Statistics
9276.
9277.
9278.
9279.
9280.
9281.
ABGs
9282.
ahmed MGuestpatient with low k,ca and recieve oral contraceptive with dntal caris
9283.
9284.
9285.
9286.
9287.
GuestGuestIf the patient is on oral contraceptive, how can she get pregnant? There are several causes
for a raised alkaline phosphatase, including the pubertal growth spurt in which the girl is in. Also, how
will you explain the multitude of metabolic abnormalities? Dental caries do not form a physiological
manifestation of normal gestation!Guest, Jan 24, 2010#127
9288.
GuestGuestIf the girl was on oral contraceptive, how could she be pregnant? Pregnancy is not the only
cause of a high ALP, particularly in this girl. Her pubertal growth process is a cause, as well as the
persistent vomiting and its consequences, including malnutrition. Also, how may we explain the
multitude of other clinical and metabloic abnormalities in her, some of them classical of bulimia
nervosa?
9289.
d-dimer should be done next (what should be the investigation next was my question) as it identifies
DIC and is a powerful predictor of MOSF and death in septic chock.Guest, Jan 24, 2010#128
9290.
JAK-2 MutationGuestFriends, does anyone have an idea how many questions we need to have correct
to pass the exam ? I guess I marked almost 35 wrong....maybe more......so dont know where do I
stand.........any idea ?JAK-2 Mutation, Jan 24, 2010#129
9291.
ctGuestneed minimum 140 right to pass the exam , u can pass with 130 as well if correct those carry
high marksct, Jan 24, 2010#130
9292.
JAK-2 MutationGuestThanks.
9293.
9294.
Any insight into how to determine the difficulty level of a question ? What is the criteria ? Any idea plz
?
9295.
Which questions are called "easy" ?JAK-2 Mutation, Jan 24, 2010#131
9296.
9297.
9298.
also patient not malnurished duo to the BMI was normalahmed M, Jan 24, 2010#133
9299.
9300.
9301.
9302.
9303.
9304.
9305.
9306.
9307.
9308.
9309.
2010#136
9310.
Dr MOALYGuestdental caries i think it is the question which i did bulemia nervosa , in philip kalra git
mainifestation -----dental caries
9311.
9312.
horner syndrome ---chest xray due to pancoast tumor which damage the 1st and 2nd cervical rib and
the T1
9313.
9314.
question of Mi and the answer pseudomembarnous colits , there was one answer pseudomembarnous
colits but after course of ab and the dirahhea was bloody
9315.
9316.
hope we all pass it is my 2nd attempt after 498/521 to pass in sept 2009 which was worse than that
exam toooooo muchDr MOALY, Jan 25, 2010#137
9317.
Dr MOALYGuestpaarcetamol overdose was aneroxia nervosa i saw there question b4 but i dont know
whereDr MOALY, Jan 25, 2010#138
9318.
9319.
ctGuestYes unfortunately not every question carry equal marks , even some questions carry zero mark (
may be questions like somatization ) which you can correct without thinking too much.
9320.
9321.
9322.
Just pray we will all pass as passing ratio in part 1 is only 37 %ct, Jan 25, 2010#140
9323.
9324.
9325.
I have done silly mistakes too which could have been avoided, so lets see what comes up. I pary for
everyone's success here.JAK-2 Mutation, Jan 25, 2010#141
9326.
ctGuestfollowing appendicectomy it was a DIC like picture why D dimers instead of coagulation
screen ?ct, Jan 25, 2010#142
9327.
ctGuestalso beta blocker poisoning it cant be pacing or calcitonin the correct answer was Glucagonct,
Jan 25, 2010#143
9328.
uziGuestHi ct,
9329.
i think it is because D-dimers are more specific than coagulation abnormalities for the diagnosis of
DIC.
9330.
9331.
as for the Beta-blocker poisoning, i agree, i think glucagon is the right answeruzi, Jan 25, 2010#144
9332.
JAK-2 MUTATION,
9333.
9334.
you give a daily dose of carbamazepine to decrease the severity of attacks, so, i think because the drug
is taken every day whether there is an attack or not, it is also concidered as prophylaxis.uzi, Jan 25,
2010#146
9335.
JohnyGuestFor beta blocker poisoning causing cardiogenic shock resistant to atropine, glucagon is the
treatment. For severe bradycardia unresponsive to atropine, pacing is the treatment. However, sources
vary in their recommendations. BNF advises atropine followed by glucagon or pacing. So I feel only
the College will know the right answer! Sorry for typing calcitonin inadvertently. d-dimer will confirm
DIC the diagnosis of which has very important therapeutic and pronostic implications in septic shock.
Johny, Jan 25, 2010#147
9336.
JohnyGuestDental carries are not a physiological manifestation of normal pregnancy. Normal BMI
does not exclude malnutrition. Anorexia nervosa is a bad prognostic factor in papracetamol poisoning
due to glutathione depletion but smoking is far worse, so much so that a separate nanogram is used to
treat paracetamol poisoning in smokers (it is on passmedicine).Johny, Jan 25, 2010#148
9337.
JohnyGuestDental carries are not a physiological manifestation of normal pregnancy. Normal BMI
does not exclude malnutrition. Anorexia nervosa is a bad prognostic factor in papracetamol poisoning
due to glutathione depletion but smoking is far worse, so much so that a separate algorithm is used to
treat paracetamol poisoning in smokers (it is on passmedicine).Johny, Jan 25, 2010#149
9338.
JAK-2 MutationGuestThanks Uzi. So now I got 38 questions wrong JAK-2 Mutation, Jan 25, 2010
#150
9339.
9340.
Page 3 of 13
9341.
< Prev
9342.
9343.
9344.
9345.
9346.
9347.
9348.
9349.
13
9350.
9351.
Next >
9352.
9353.
9354.
9355.
9356.
Forums
9357.
>
9358.
UK Medical Zone
9359.
>
9360.
MRCP Forum
9361.
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9362.
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GuestGuesthi johny
9389.
9390.
HI johny ,
9391.
9392.
this statement is from Wikipedia they haven't included smoking as a bad prognostic signs in
paracetamol poisoning :
9393.
Risk factors for toxicity include excessive chronic alcohol intake, fasting or anorexia nervosa, and the
use of certain drugs such as isoniazid.
9394.
9395.
GuestGuest
9396.
9397.
GuestGuestfor my friend the best choice for acute hemolytic reaction after blood transfussion is
hemoglobinemia that happend after few secondsGuest, Jan 27, 2010#173
9398.
9399.
ctGuestit seems every one stopped discussion and concentrating on passing marks :wink:ct, Jan 28,
2010#175
9400.
JAK-2 MutationGuestTrue, rather counting again and again how many we questions we marked wrong
JAK-2 Mutation, Jan 28, 2010#176
9401.
enquiryGuestmrcp
9402.
9403.
9404.
9405.
-there was Q about phenytoin..shall continue or increase the doseenquiry, Jan 28, 2010#177
9406.
JAK-2 MutationGuestYeah I recall now the question was about a person on Phenytoin and had seizures
3 times in the past 6 months, he saw the doctor as a followup case, we were asked to opt the best of the
followings:
9407.
9408.
1. Stop Phenytoin
9409.
9410.
9411.
9412.
9413.
9414.
I am not sure of the options, maybe I wrote wrong here but it was something related.
9415.
9416.
My answer was to increase dose by 100mg. I dont know what the examiner really wanted, and I am
suspecting this to be a test question.JAK-2 Mutation, Jan 28, 2010#178
9417.
9418.
GuestGuest@ enquiry
9419.
9420.
yes it was RA as RF is positive in only 70% of patients, so negative RF does not rule RF. Also anti ccp
specific for RAGuest, Jan 28, 2010#180
9421.
ctGuestThere was another question asking which blood test will confirm acute bleeding i wrote urea
but not sure the other options
9422.
9423.
9424.
Patient asking for side effects of Ramipiril which will be most common ? coughct, Jan 28, 2010#181
9425.
9426.
the question asked about the best investigation in acute GIT bleeding
9427.
9428.
GuestGuestwhy urea??? i remmber that question but dont remmber other options , if one remmber
other options tell usGuest, Jan 29, 2010#183
9429.
enquiryGuest-that Q about GIT bleeding it was which one goes with upper GIT bleeding ?low mcv?
high urea(i choose low mcv) iam not sure
9430.
9431.
-there was Q about caes of tender hepatomegaly,U/s finding i dont remeber well(obstruction or mass)
but from the option there was amebiasis which i choose it
9432.
9433.
-Q about meningitis which deteriorate after 9 days(was on AB and steriod) i choose MR brian since i
suspect subdural empyema
9434.
9435.
-hyperglycemia following MI(random was 12.1)so i choose dietory restriction rather than S.C insulin
since it was one reading beside there is no history???????????
9436.
9437.
9438.
9439.
-there was Q about mild renal impairment and what is best to do i choose coming after 6 month for
doing serum creatine
9440.
9441.
-white yellow offensive vaginal discharge with multiple organism on swab(option was vaginosis and
trichomonus i choose vaginosis ????? i am not sure again
9442.
9443.
any one can give me the correct answers with explaination pleaseenquiry, Jan 29, 2010#184
9444.
guest1972Guestif i am not wrong one option was hct. why cant hct be the right choice?guest1972, Jan
29, 2010#185
9445.
mrcpinGuestjan 2010
9446.
9447.
Dear Doctors,
9448.
Here are some complete BOfs with correct answers from jan 2010 i will post more wish you all best of
luck and special regards to jak2mutation for his immense support
9449.
9450.
9451.
45-year-old woman is diagnosed with non-Hodgkin's lymphoma. She is a recovering alcoholic and has
been left with significant alcohol-related peripheral neuropathy. Which one of the following
chemotherapy agents should be avoided if possible, given her past history?ia
9452.
9453.
A.A Doxorubicinia
9454.
9455.
9456.
B.A Vincristineia
9457.
9458.
C.A Chlorambucilia
9459.
9460.
D.A Docetaxelia
9461.
9462.
E.A Cyclophosphamideia b
9463.
9464.
A 42-year-old man who was diagnosed with type 2 diabetes mellitus presents for review. During his
annual review he was noted to have the following results:
9465.
9466.
9467.
9468.
9469.
HbA1c 6.4%
9470.
9471.
His current medication is metformin 500mg tds. According to recent NICE guidelines, what is the most
appropriate action?ia
9472.
9473.
9474.
9475.
9476.
9477.
9478.
9479.
9480.
9481.
9482.
9483.
9484.
9485.
9486.
A.A Peroxisomeia
9487.
9488.
9489.
9490.
9491.
C.A Proteosomeia
9492.
9493.
D.A Ribosomeia
9494.
9495.
9496.
9497.
9498.
A 24-year-old man presents with rectal bleeding and pain on defecation. This has been present for the
past two weeks. He has a tendency towards consitipation and notices that when he wipes himself fresh
blood is often on the paper. Rectal examination is limited due to pain but no external abnormalities are
seen. What is the most likely diagnosis?ia
9499.
9500.
9501.
9502.
9503.
9504.
9505.
9506.
9507.
9508.
9509.
9510.
You are performing a study of blood pressure readings in patients with chronic kidney disease.
Assuming that the results are normally distributed, what percentage of values lie within two standard
deviations of the mean blood pressure reading?ia
9511.
9512.
9513.
A.A 95.4%ia
9514.
9515.
B.A 5.3%ia
9516.
9517.
9518.
C.A 98.3%ia
9519.
9520.
D.A 10%ia
9521.
9522.
E.A 97.5%ia a
9523.
A 41-year-old man is admitted with left-sided pleuritic chest pain. He has a dry cough and reports that
the pain is relieved by sitting forward. For the past three days he has been experiencing flu-like
symptoms. Given the likely diagnosis, what is the most likely finding on ECG?ia
9524.
9525.
A.A Large S wave in lead I, a large Q wave in lead III and an inverted T wave in lead IIIia
9526.
9527.
9528.
9529.
9530.
9531.
9532.
9533.
9534.
9535.
9536.
9537.
9538.
9539.
9540.
9541.
9542.
9543.
9544.
9545.
D.A Syringomyeliaia
9546.
9547.
9548.
9549.
A woman who is 34 weeks pregnant is admitted to the obstetric ward. She has has been monitored for
the past few weeks due to pregnancy-induced hypertension but has now developed proteinuria. Her
blood pressure is 162/94 mmHg. Which one of the following antihypertensives is it most appropriate to
commence?ia
9550.
9551.
A.A Moxonidineia
9552.
9553.
B.A Atenololia
9554.
9555.
9556.
C.A Methyldopaia
9557.
9558.
D.A Losartania
9559.
9560.
E.A Verapamilia c
9561.
9562.
A 64-year-old man with a history of type 2 diabetes mellitus is admitted with chest pain to the
Emergency Department. An ECG shows ST elevation in the anterior leads and he is thrombolysed and
transferred to the Coronary Care Unit (CCU). His usual medication includes simvastatin, gliclazide and
metformin. How should his diabetes be managed whilst in CCU?ia
9563.
9564.
9565.
9566.
9567.
9568.
9569.
9570.
9571.
9572.
9573.
9574.
9575.
9576.
9577.
9578.
9579.
A.A C1-INHia
9580.
9581.
B.A C3ia
9582.
9583.
9584.
9585.
D.A C6ia
9586.
9587.
9588.
9589.
A 45-year-old man presents with a painful swelling on the posterior aspect of his elbow. There is no
history of trauma. On examination an erythematous tender swelling is noted. What is the most likely
diagnosis?ia
9590.
9591.
9592.
9593.
B.A Haemarthrosisia
9594.
9595.
9596.
9597.
D.A Goutia
9598.
9599.
9600.
9601.
9602.
The parents of a 3-year-old boy with cystic fibrosis ask for advice. They are considering having more
children. What is the chance that their next child will be a carrier of the cystic fibrosis gene?ia
9603.
9604.
9605.
A.A 50%ia
9606.
9607.
9608.
B.A 100%ia
9609.
9610.
C.A 1 in 25ia
9611.
9612.
D.A 25%ia
9613.
9614.
E.A 66.6%ia a
9615.
9616.
A 43-year-old man from South Africa is reviewed in clinic. He has recently started treatment for
tuberculosis but is complaining of a deterioration in his vision. Which one of the following drugs is
most likely to cause decreased visual acuity?ia
9617.
9618.
A.A Rifampicinia
9619.
9620.
B.A Streptomycinia
9621.
9622.
C.A Isoniazidia
9623.
9624.
9625.
D.A Ethambutolia
9626.
9627.
E.A Pyrazinamidei d
9628.
A 31-year-old man who is known to be HIV positive presents with dyspnoea and a dry cough. He is
currently homeless and has not been attending his outpatient appointments or taking antiretroviral
medication.
9629.
Clinical examination reveals a respiratory rate of 24 / min. Chest auscultation is unremarkable with
only scattered crackles. His oxygen saturation is 96% on room air but this falls rapidly after walking
the length of the ward. Given the likely diagnosis, what is the most appropriate first-line treatment?ia
9630.
9631.
A.A Fluconazoleia
9632.
9633.
9634.
B.A Co-trimoxazoleia
9635.
9636.
C.A Erythromycinia
9637.
9638.
D.A Gancicloviria
9639.
9640.
9641.
A 20-year-old man present with facial and ankle swelling. This has slowly been developing over tha
past week. During the review of systems he describes passing 'frothy' urine. A urine dipstick shows
protein +++. What is the most likely cause of this presentation?ia
A Minimal change diseaseia
B. IgA nephropathyia
C. Membranoproliferative glomerulonephritisia
D. Polycystic kidney diseaseia
E.A Membranous glomerulonephritis
A 40-year-old man is investigated for abnormal liver function tests. It is decided to perform a
liver biopsy. Which one of the following is a contraindication to liver biopsy?ia
9642.
A 34-year-old female presents due to the development of a purpuric rash on the back of her legs. Her
only regular medication is Microgynon 30. She also reports frequent nose bleeds and menorrhagia. A
full blood count is requested:
9643.
9644.
Hb 11.7 g/dl
9645.
Platelets 62 * 109/l
9646.
9647.
9648.
PT 11 secs
9649.
APTT 30 secs
9650.
9651.
Factor VIIIc
9652.
activity Normal
9653.
9654.
9655.
9656.
9657.
9658.
9659.
9660.
9661.
A 30-year-old man comes for review. He returned from a holiday in Egypt yesterday. For the past two
days he has been passing frequent bloody diarrhoea associated with crampy abdominal pain.
Abdominal examination demonstrates diffuse lower abdominal tenderness but there is no guarding or
rigidity. His temperature is 37.5C. What is the most likely causative organism?ia
9662.
A.A Giardiasisia
9663.
9664.
9665.
D.A Salmonellaia
9666.
E.A Shigellaia e
9667.
A 50-year-old woman is investigated for weight loss and anaemia. She has no past medical history of
note. Clinical examination reveals splenomegaly associated with pale conjunctivae. A full blood count
is reported as follows:
9668.
9669.
Hb 10.9 g/dl
9670.
9671.
9672.
9673.
9674.
9675.
A.A Chlorambucilia
9676.
9677.
C.A Rituximabia
9678.
9679.
E.A Imatinibia e
9680.
You are reviewing a 65-year-old in the renal clinic. He has been on haemodialysis for chronic kidney
disease for the past 6 years. What is he most likely to die from?ia
9681.
A.A Hyperkalaemiaia
9682.
B.A Malignancyia
9683.
9684.
9685.
9686.
9687.
What chemical mediator is mainly reponsible for the tissue oedema seen in patients in hereditary
angioedema?ia
9688.
A.A Histamineia
9689.
B.A Serotoninia
9690.
9691.
D.A Bradykininia
9692.
9693.
A 42-year-old woman presents for review. Her husband reports that she has had an argument with their
son which resulted in him leaving home. Since this happened she has not been able to speak. Clinical
examination of her throat and chest is unremarkable. Which one of the following terms best describes
this presentation?ia
9694.
A.A Aprosodiaia
9695.
B.A Schizophasiaia
9696.
9697.
9698.
9699.
9700.
You are called to review a 78-year-old man on the surgical wards. He is three days post-op following a
colectomy. He was recently diagnosed with colon cancer (Duke's C) and has a history of polymyaglia
rheumatica. Current medications include co-codamol 30/500, prednisolone and porphylactic dose lowmolecular weight heparin. Five minutes ago he started to complain of severe central chest pain. An
ECG performed by the nurses shows ST elevation in the anterior leads. Aspirin and oxygen have been
given by the Foundation 1 doctor. What is the most appropriate treatment?ia
9701.
A.A IV diamorphine + increase low-molecular weight heparin to treatment dose + double his
prednisolone doseia
9702.
9703.
9704.
9705.
9706.
9707.
Question 11 of 50
9708.
A 22-year-old woman presents with lethargy, pyrexia and headaches. She is a student and returned
from a holiday in Ibiza ten days ago. These symptoms have been present for the past six days and she is
wondering whether she may need an antibiotic. She also has a history of menorrhagia and is concerned
that she may be anaemic. Clinical examination reveals a temperature of 37.9C and marked cervical
lymphadenopathy. You order a full blood count which is reported as follows:
9709.
9710.
Hb 12.1 g/dl
9711.
9712.
9713.
9714.
9715.
9716.
9717.
9718.
9719.
9720.
9721.
9722.
9723.
9724.
A 22-year-old man is investigated for weight loss and diarrhoea. A rectal biopsy is taken and reported
as follows:
9725.
9726.
9727.
9728.
9729.
9730.
9731.
9732.
C.A Tuberculosisia
9733.
9734.
9735.
9736.
Question 13 of 50
9737.
A 70-year-old man is admitted to the Acute Medicine Unit as he is pyrexial and feeling generally
unwell. He has a history of ischaemic heart disease and had a bioprosthetic mitral valve replacement 5
years ago. An echocardiogram is arranged which shows a vegetation around the mitral valve. Blood
cultures are taken which are reported as follows:
9738.
9739.
Streptococcus viridans
9740.
9741.
9742.
9743.
9744.
9745.
9746.
9747.
9748.
You review a 75-year-old man who complains of palpitations. He was diagnosed with atrial fibrillation
around four months ago and started on digoxin 125 mcg od and warfarin. Despite this treatment he still
feels his 'heart race' regularly. On examination his pulse is 96 / min irregularly irregular and respiratory
examination is unremarkable. What is the most appropriate next step in management?ia
9749.
9750.
9751.
9752.
9753.
E.A Make no change to his regular medication but prescribe flecanide as a 'pill in the pocker'ia d
9754.
9755.
9756.
9757.
9758.
9759.
9760.
9761.
You are reviewing a 40-year-old man who is known to have bronchietasis. What organism is most
likely to be isolated from his sputum?ia
9762.
9763.
9764.
9765.
9766.
9767.
A 40-year-old woman who is known to be HIV positive is admitted to the Emergency Department
following a seizure. Her partner reports that she has been having headaches, night sweats and a poor
appetite for the past four weeks. Blood tests and a CT head are arranged:
9768.
9769.
CD4 89 u/l
9770.
9771.
9772.
9773.
9774.
B.A Tuberculosisia
9775.
9776.
D.A Cryptococcusia
9777.
E.A Toxoplasmosisia a
9778.
9779.
This is a difficult question. Toxoplasmosis is the most common cause of brain lesions in HIV patients.
However, around 80% of toxoplasmosis cases involve multiple lesions and the history is suggestive of
lymphoma.
9780.
9781.
A 25-year-old man presents with a painful, swollen left knee. He returned 4 weeks ago from a holiday
in Spain. There is no history of trauma and he has had no knee problems previously. On examination he
has a swollen, warm left knee with a full range of movement. His ankle joints are also painful to move
but there is no swelling. On the soles of both feet you notice a waxy yellow rash. What is the most
likely diagnosis?ia
9782.
9783.
9784.
C.A Goutia
9785.
9786.
9787.
A 45-year-old woman presents with weight gain and recurrent 'dizzy' episodes. Over the past four
months she has gained 20 kg. The episodes occur on an almost daily basis and are characterised by
blurred vision, sweating, headaches and palpitations. Her GP checked a blood sugar during one of these
episodes which was record as being 1.4 mmol/l. What is the single most useful test?ia
9788.
9789.
9790.
9791.
9792.
9793.
9794.
An middle-aged woman is admitted to the Emergency Department with pleuritic chest pain ten days
after having a hysterectomy. There is a clinical suspicion of pulmonary embolism. What is the most
common chest x-ray finding in patients with pulmonary embolism?ia
9795.
9796.
B.A Normalia
9797.
9798.
9799.
9800.
9801.
9802.
9803.
I pray for you and all others here to pass in this attempt JAK-2 Mutation, Jan 30, 2010#188
9804.
giroop2003GuestDear Friend, MRCPian and JAK, Thank you very much for wonderful job of posting
quetion,
9805.
9806.
9807.
9808.
Regarding quetion Diabetes-2, with hypercholestremia, the treatment is to bring cholestrol down but
before starting meds we will working up further after trial life style modification, i am in opnion that
answer is Life style modification and Rept test after 3 months,
9809.
9810.
Regarding quetion 50 old lady with CLL, what is the indication here to start chemotherapy rather than
wt watch,
9811.
9812.
9813.
9814.
and/or thrombocytopenia
9815.
9816.
9817.
Progressive lymphocytosis
9818.
9819.
9820.
Systemic symptoms*
9821.
9822.
9823.
Extreme fatigue
9824.
Night sweats
9825.
9826.
giroop2003GuestRegarding Bronchitis there was choice, Morexella, I have answered that, and it is
given in Passmedicinegiroop2003, Jan 30, 2010#190
9827.
9828.
9829.
thank u dr mrcpian
9830.
9831.
but honestly....u made me worried about my result because u put strange answers different from what
we agreed in this forum especialy the lymphoma and the reactive arthritis
9832.
thank u again for recalling the question details which are very important
9833.
9834.
9835.
giroop2003GuestDear Muhamed, I think Lymphoma looks right answer, even I also answered
toxoplasmosisgiroop2003, Jan 30, 2010#192
9836.
mrcpinGuestDear Fellows,
9837.
I had double check the answers from the passmedicine i think RCP may have some different answers
like i guess they may be they chose toxo rather cns lymphoma they like some typical answers .
9838.
9839.
kind regards
9840.
9841.
GuestGuestDear MRCPin, Thank you so much for the hard work. But can you tell what are your
answers, decause I dont understand which one is your choice from the options. Or may be there is some
problem with my computer because after every option there is iea and I dont understand what is the
answerGuest, Jan 31, 2010#194
9842.
mrcpinGuestthe answers are written just apart from the last optionmrcpin, Jan 31, 2010#195
9843.
Dr MOALYGuestdoing cardiac catherisation for pul. htn ? i think it is echoDr MOALY, Jan 31, 2010
#196
9844.
GuestGuesthi guys,thanks for posting detailed questions.I would like to comment about few ques:
9845.
9846.
REgarding toxoplasmosis/lymphoma issue,i would quote from Kumarr and clark,seventh edition,pg
201
9847.
9848.
"in toxoplasmosis,Typically CT scan of brain shows multiple ring enhancing lesions.A single leion on
CT scan may be found to be one of several on MRI.A soltary lesion on MRI,however, makes a
diagnosis of toxoplasmosis unlikely"
9849.
9850.
so,its v clear from above text that on CT scan single lesion could be of toxoplasmosis.therefore true
answer should be toxoplasmosis.
9851.
9852.
9853.
Second thing about Xray finding in pulmonary embolism,as far as i remember it wasn't mentioned as
most common fining.They asked what could be the finding on chest xray and therefore i marked
segmental lobe infarct.
9854.
9855.
Third thing about standard deviations,they asked which value would lie more than 2 standard
deviations and not within 2 sndard deviations nd therefore answer was 97.5 as this was the only value
bove 2 standard deviation i-e95.4%
9856.
9857.
There could be variation in questions from place to place.As i appeared from Dubai,so my questions
could be different
9858.
9859.
PLease,other user must comment to confirm what were the exact questionsGuest, Jan 31, 2010#197
9860.
Wow. 181 questions of Jan, 2007, MRCP-1 Exam.by Jawad Dear doctors, colleagues, friends, A few
of my friends appear in MRCP Part 1 exam. on January 2007. I took an extensive review from them.
They have recalled a lot of questions when I was striving for it and real BRAINSTORMING
SESSIONS for them! Also I took many questions from forums. Here I am going to send all those
questions. The interesting thing is that I didnt appear in examination but I am enclosed herewith
following almost real exam. This is the result of my sheer hardwork and those who tolerated me which
asking BOF.Questions of January 2007. Dedicated & praying for the candidates of Jan.2007. Wish u all
the best, I am looking forward to your comments, critics, Thanking you in anticipation, Dr. Jawad from
Lahore. 2- Pt with COPD having diarrhea ,,which organism is likely?? 3- PT WITH ECOLI diarrhea, to
avoid resistance which ABX to add?? 4- PT WITH MULTIPLE SMALL JOINTS INVOLVEMENT
AND CHONDROCALCINOSIS, anti-Sm positive a- polyarticular gout b- cpdd c- SLE 5- Pt. is post
renal transplat with acute rejection non tender flank region with +1 hematuria? Pt with fever after14
days with normal biochemistry Cause? a- Dilated Cardiomyopathy b- Coronary artery disease ccyclosporin toxicity d- CMV infection e- acute rejection 6- Which cathecolamine is synthesized in
adrenal medulla? a- adrenaline b- noradrenaline c- metanephreine 7- 8- Pt with diagnosis of legonella
pneumonia inf? Drug of choice? a- Erythromyocin b- Clarithromyocin c- Ciprofloxacicni d- Third
How to diagnose von willibrand disease? a- Factor 8 activity of platlatet aggregation 69- A pt. with
panic attacks and taking 60 units of alcohol? a- anxiety depression b- panic attacks are releaved by
alchole 70- A woman in a nursing home developed water diarrohoe what's the causative organism? acl.difficile 71- An old immobile man with parkinsonism developed UTI and received trimethoprim and
developed penuemonia what's the organism? a- sterptococcus pneumnonae b- methicillin resistant
staph.aureus. 72- Which method for staging carcinoid tumour? a- Bronchoscopy b- CT scan thorax cAbdomen mediastanoscopy 73- Where is the site of the lesion in a pt who has developed ptosis? aBrain stem b- Pons 74- A pt. with constipation for 4 days notice blood in the toilet and has flatulence
and bloating and a history of anxity what's the investigation? a- Colonscopy b- Gut transit time 75Following gastrectomy developed ulcer after recieving eradication therapy 3 years ago? a- Reinfection
b- Failure of eradication therapy 76- How to know that the malena is due to an upper GI bleeding? aEndoscopy b- Liver colonscopy 77- What to do in the pt with swollen knee? a- Re- aspirate. barthroscopy with washout c- culture after joit aspirtion d- I/V abx e- MRI of knee joint 78- Pain relief
in pancoats tumour? a- radiotherapy 79- Animal Bite? Pus containing? a- Staph aureus b- P. multocida
80- Patient with high creatinine? Drug of choice for diabetes? a- Metformin b- Rosiglitazone 81Essential hypertension? a- Is it due to the size of the cuff? 82- A patient came from africa to UK with
"Shivering" and painful back (maybe site of bite). typical patient? a- Rabies 83- MOA of
biphosphonates? 84- Side Effectsof valproic acid? a- TREMOR b- Ankle swelling 85- 86- A patient
with hypokalemic paralysis from Asia (Chinese)? Invx? a- THYROID TEST.. 87- Papules with HIV?
a- Molluscum Contagiosum b- KAPOSI sarcoma 88- Sarcoidosis patient with erythema and Bilateral
Lymphadopathy? Lab.Diagnosis? a- X-ray 89- A patient with dry cough and usually bothered from
sleep? a- Chronic asthma 90- For diagnosis of asthma? a- PEFR>20 91- Emphysema patient? a- MM
92- A patient of APKD? Suspected? a- POLYCYTHEMIA 93- A school-teacher with diagnosed
Pulmonary TB? a- " Patient can go back IF the sputum is already negative" 94- A presents with scrotal
swelling. Likely viral infection? a- MUMPS (Orchitis) 95- The kidney donation and the patient is Rh
negative. Question is which relatives can donate? a- NONE b- we need to screen first the relatives
before donating there own organs. 96- Hypokalemia with normotention? a- Barter's syndrome 97Purpuric lesions and the palms were involved? a- SYPHILIS [snip]- LACTIC ACID? a- Glycolysis bGluconeogenesis 99- Active transport? a- Molecules move against b- an electrical c- concentration
gradient 100- Erectile dysfunction was asked? a- SILDEFINIL 101- Giardia lamblia? a- Small biopsy
in distal part of duodenum (small intestine) b- Fecalysis, you should take atleast 3 samples for
trophozoites c- Diagnostically speaking, BIOPSY 102- Warfarin-antibiotics interaction? aCARBAMAZEPINE 103- Sublcavian vein? a- Scalene anterior muscle b- posterior to scalenus c- it
joins with int jugular 104- RCP asked about an injury in the shoulder. He weigh heavy objects. Among
the elderly, biceps tendon ruptures near the shoulder are often associated with rotator cuff tears. aRotator cuff tendinitis b- Rupture of tendon biceps 105- Alcohol with elevated LDH??? aRhabdomyolysis 106- SLE with lupus arthritis? What will be management STEROIDS+??? aCyclophosphamide b- Methotrexate 107- Freidrich Ataxias case? 108- CLL or ALL? a- CD20 109Patient after an accident became sexually abusive? What part of the brain is involved? a- Thalamus btemporal c- Reticular activating system d- Parietal 110- Dihydrocodeine toxicity? 111- Cholesterol
embolism? 112 113- What is the appropriate INITIAL treatment with essential thrombocytosis? aASPIRIN 114- Question about Multiple myeloma? a- Bone Marrow aspiration 115- Patient with
Hypercholesterolemia? What is treatment? a- Thyroid hormones 116- Hypercalcemia and high
Phospate? a- HYPERPARATHYROIDISM 117- struvite Magnesium ammonium phosphate stones?
a- Staghorn Calculi 118- Pt. with fast AF previous pre-excitation? Rx a- VERAPAMIL 120- Hepatitis
profile? Which investigation? a- Hepatitis C b- HBV DNA 121- Best method to stage carcinoid
syndrome? a- Brochoscopy 122- Infected gangrenous diabetic foot triple therapy? a- Metronodazole,
Ofloxacin, and ??? 123- Treatment for HSV? a- Acyclovir 124- Case of SEVERE Pneumonia?
Regarding CURB-65. a- Urea 125- Patient who had drinking history of alcohol night before and
went to travel. Then He had seizure attack while on board. Diagnosis? a- Vasovagal b- alcohol related
d/o c- Cardiogenic syncope 126- Which one of the following is useful in assessing the need for
surgery? Patient with GORD? a- Oesophageal Manometry 127- Mechanism of action of aldosterone
what part of of nephron? a- Collecting duct b- proximal c- Distal part of Nephron 128- Patient with
stress and loss of hair? a- Trichotillomania (TTM) 130- 131- STATIN function? a- High HDL 132Drugs with has low affinity to D2 Newer drugs? a- Clozapine 133- A recent treated patient with heparin
then eventually had POST thrombotic syndrome? 134- Pt. not responding to carbamezapine? aAlcohol binges 135- 136- Common cause of death of Patient undergoing Hemodialysis? a- CAD 137Chronic fatigue syndrome? or Dysthimia.... Psych question.. dysthymic disorder is a form of the mood
disorder of depression characterized by a lack of enjoyment/pleasure in life that continues for at least
two years. It differs from clinical depression in the severity of the symptoms. Dysthymia can, though
not always, prevent a person from functioning, affecting sleep pattern and daily activities. 138Asymtomatic old patient with AF and heart rate of 120 what to give? a- flecainide b- warfarin cwarfarin d- sotalol 139- Contraindications to surgery in lung cancer i picked lung function but it is
wrong FEV1 should be less than 1.5 not 1.7? 141- Statistical test to compare between two tests? amann whitney test 142- A pt with a red painful eye? a- anterior uveitis. 143- Prophylaxis of infective
endocarditis in a penicillin allergis? a- ceftriaxone and gentamycin b- vancomycin 144- A pt with a
raised JVP? a- constrictive pericarditis 145- Sidde effect of rosiglitazone? a- edema 146- A pt with eye
pain on movement? a- optic neuritis 147- Unresponsive eye? a- lesion is in the optic nerve 148Another one with cotton wool spots? a- hypertensive retinopathy b- optic artery occlusion 149- A pt.
with unresponsive pupil? a- argyl robertson pupil b- horner's syndrome 150- rectus muscle guestion?
151- A pt. with loss of memory poor cognition? a- alzhiemer's disease.? 153- A pt. with severe back
pain? a- syringomylia. 154- Rectal Biopsy? a- Crohns disease 155- A pt. with severe heart burn
endoscopy normal 1 year ago? a- reendoscopy. 156- What's the cause of the low urea? a- reduced liver
synthesis. 157- In a jaundiced confused pt.? a- electroenchelogram 158- Whats the percentage that the
children of a pregnant lady will develop cystic fibrosis? a- 1/4. 159- Findings in cryptogenic fibrosis..
161- Pituatry apoplexy. 162- an athlet woman which hormone is reduced? a- liutenizing hormone. 163cystic tumour seen in MRI? a- craniophargioma 164- Hypertension not responding to treatment? aphaeochromocytoma. 166- -In atopy? a- immunoglobulin E 167- a coal miner? a- simple
pneumoconiosis 168- follow up in COPD? a- FEV1 169- Osteoarthritis Periarticular ospeopenia?
170- early RA periarticular osteopenia? 171- AntimyeloperoxidaseWegeners granulomatosis? 173Drugs that SPECIFIC to the Brain and Liver. They asked about AFFINITY, SPECIFICITY? 174SPONDYLOLISTHESIS? 175- Hemolytic-uremic syndrome Fragmented cells 176whispering pectoriloquy..Sign of bronchial breathing , patient with severe pneumonia? 177- A woman
who received heparin for a dvt whats answer? a- post phlebitic syndrome b- Heparin? 179- Treatment?
a- Hydroxyurea 180- Patient who is not responding to antidepressive drugs? a- ECT 181- Alopecia
areata 1. Antibiotic Prophlaxis: Options: Pacemaker, Isolated Secundum ASD, MVP widout
regurgitation 2. Treatment of WPW Sydrome: Options: Flecainide, Digoxin, Verapamil 3. Indication
for Thrombolysis, patient presented wid ant chest pain: Options: more dan 1mm ST elevation in
standard lead more dan 1mm ST elevation in chest lead more dan 1mm ST depression in chest lead
more dan 1mm ST depression in standard lead 4. In Physiology , wats Troponin T & I: Options:
structural protein, contractile protein, enzyme 5. Which Pituitary hormone is in constant inhibition:
Options: prolactin, TSH, ACTH, etc 6. Peutz Jeugher's Syndrome: Options: Autosomal Dominant 7.
Haemochromotosis: Options: Autosomal Reccessive 8. Vitamin D resistant rickets Options: X linked
dominant wid incomplete peneteration 9. Blistering disorrders: structure Options: dermo-epidermal
junctions, dermis epidermis 10. Gastric CA wid which of skin conditions: Options: Erythema Migrans,
Erythema gyratum repens etc 11. Action of Gastrin: Options: Stimulus for secretion amino acids in
antrum acts on G cells in antrum reduces pancreatic bicarb secretion 12. Treatment of chylamdia
Options: Doxycycline 13. 1 Statistics question, to find out senstivity, table was given Options: 80% 14.
Treatment of A. Fumigatus: Options: fluconazole, amphotericin, flucytosine, ketoconazole,
itraconazole 16. Patient presented wid hypomagnesemia, Reason: Options: diuretics treatment 17.
Catecholamine secreted only from adrenal medulla: Options: Adrenaline, noradrenaline, dopamine,
metadrenaline 18. Effect of NSAIDs on Kidney Options: Intersitial Nephritis, Papillary Necrosis 19.
Frontal Lobe Lesion: Options: Perservation 20. MOA of Selegeline: Options: Monoamine Oxidase
Inhibitors 21. 1 Question abt Somatoform Disorder 23. Typical history of Bechet's Disease
A 62-year-old man presents with progressively worsening dementia. He has a history of hypertension
and a previous
myocardial infarction some 7 years earlier. His BP is 155/90 mmHg on examination, and his pulse is
65/min and
regular. You send him to the psychiatrist who diagnoses him with Lewy Body Dementia. Which of the
following
features is most likely to be associated with Lewy Body dementia?
can also occur when bleeding from iris vessels fills the anterior chamber with blood. If there is enough
blood to settle
and form a level of blood, this is known as a hyphaema. Usually the hyphaema does not fill the entire
anterior
chamber, but can be described in terms of how far up the posterior corneal surface the level of blood
seems to be:
10% or 50%, for example. If the entire anterior chamber is full of blood and no iris can be seen (a
100% hyphaema),
the term 8-ball hyphaema has been used. Strict rest is vital if a hyphaema is present, as there is an
increased risk of
a second bleed in the initial period. This is why many do not dilate the pupil in the initial stage, even to
get a view of
the retina. By avoiding drops that dilate the pupil (such as anticholinergics) the iris remains stable and a
second bleed
is therefore less likely. Hyphaema, if it is large and doesnt disperse quickly spontaneously (which most
do), can
cause corneal staining, but the main risk in the acute stage is of raised intraocular pressure. This occurs
as red blood
cells clog up the trabecular meshwork impairing drainage of aqueous humour. Signs of significantly
raised intraocular
pressure include corneal oedema. Endothelial cells on the posterior corneal surface normally maintain
corneal
deturgescence. These cells can decompensate in the face of raised intraocular pressure and corneal
haziness
occurs. Although a slit lamp is needed to accurately assess intraocular pressure, palpation can at least
give some
idea of whether the eye feels very soft, fairly normal or very firm. Digital palpation should not be used
if a penetrating
injury is suspected. Topical b-blockers would lower intraocular pressure, but some systemic absorption
occurs even
after the administration of eye drops. The history of dyspnoea on exertion is therefore a
contraindication even to
topical b-blockers. Intravenous carbonic anhydrase inhibitors (such as acetazolamide) can cause
adverse reactions
(tingling of the fingers is a common side-effect) but will quickly lower the intraocular pressure, before
optic nerve
damage or even retinal artery compression and occlusion occur. Anterior chamber paracentesis would
also lower the
intraocular pressure, but medical treatment should be sufficient; and paracentesis has a risk of
introducing infection
into the eye. Examination under anaesthesia may be appropriate if a penetrating injury is seen or
suspected, for
example if the patient described falling onto a sharp object.
A 24-year-old man with a family history of congenital myotonic dystrophy visits you for advice about
starting a family.
He has the typical features of frontal male pattern balding and is beginning to develop features of
muscle weakness.
He has read on the internet about a phenomenon called anticipation which is associated with the
condition. What
does anticipation mean in this setting?
A Symptoms develop which prevents fathering children
B Symptoms begin at an earlier stage in successive generations Correct answer
C Symptoms are less severe in successive generations
D Warning signs appear which can pre-date the main symptoms associated with the condition
E Patients can anticipate the severity of their condition by looking at their parents
It is known that in patients with congenital myotonic dystrophy the age at onset becomes earlier and
symptoms are
more severe at an earlier age when compared with an affected parent. Other conditions which exhibit
genetic
anticipation include Huntingdons chorea, fragile-x syndrome, Friederichs ataxia and spinal cerebellar
atrophies.
A patient with Parkinsons disease on treatment with L-dopa and a dopa-decarboxylase inhibitor is
experiencing
troublesome tremor.Which drug would be most suitable to add to the treatment regimen?
A Amantadine
B Procyclidine Correct answer
C Selegiline
D Propranolol
E Ropinirole
When tremor is the predominant presenting symptom of Parkinson's disease or when tremor persists
despite
adequate control of other parkinsonian symptoms with low dosages of levodopa, an anticholinergic
agent such as
procyclidine may be the treatment of choice. In most patients, however, anticholinergics do not
significantly improve
bradykinesia and rigidity. The side effects of these agents are their limiting factor, particularly in the
elderly. Side
effects include memory impairment, hallucinations, dry mouth, urinary difficulties and blurred vision.
A 55-year-old man complains of nausea, loss of appetite and dyspepsia after meals for the last 2 weeks.
He is a
smoker and has a past history of pernicious anaemia. He is pale, cachexic and tender at the epigastrium.
His skin is
velvety and hyperpigmented at the neck and axillary folds. What is the diagnosis?
A Tylosis
B Pyoderma gangrenosum
C Acanthosis nigricans Correct answer
D Chloasma
E Lentigines
His clinical features suggest underlying stomach cancer. Acanthosis nigricans is commonly seen in
patients with
stomach cancer, insulin-resistant diabetes and obesity. It is characterised by a velvety thickening and
pigmentation of
the major flexures.
You are considering using a TNF-alpha antagonist in the treatment of a 45-year-old man with severe
psoriasis. The
patient wants to know more about this treatment and how it works.Which cells are mainly responsible
for production
of TNF alpha?
A Neutrophils
B B-lymphocytes
C Macrophages Correct answer
D T-lymphocytes
E Mast cells
TNF-alpha is a cytokine involved in inflammation and the acute phase response. It is produced in a
very wide range
of cells across the immune system, but in large part by macrophages. Other cells which produce TNFalpha exist in
the neuronal system and in adipose tissue. Anti-TNF agents are used in the therapy of rheumatoid
arthritis, psoriasis
and sero-negative arthritides and inflammatory bowel disease. In recent years it has however become
apparent that
use of anti-TNF may be associated with reactivation of tuberculosis and this has tempered use in some
patients.
You are referred a 68-year-old man who smokes 40 cigarettes per day and has suffered from a chronic
cough for the
past 6 months, increasingly associated with haemoptysis. He also has a dull ache on the left side of his
chest, and his
CXR reveals a left hilar mass suspicious of bronchial carcinoma. You are considering radical
radiotherapy in this
man.Which of the following is a relative contraindication to radical radiotherapy?
A SVC obstruction
B Tumour adjacent to the hilum
C Malignant pleural effusion Correct answer
D Adenocarcinoma Your answer
E FEV1 < 60%
It was previously thought that patients with FEV1<50% were at particular risk from post radiotherapy
pneumonitis,
although it now appears that some patients enrolled in radical radiotherapy trials with severe disease
actually showed
a small improvement in lung function. SVC obstruction and tumour adjacency to the hilum may
increase surgical
difficultly, but actually targeted radiotherapy may not be a problem in the majority of patients. Studies
have however
shown that presence of malignant pleural effusion is predictive of poor outcome in conjunction with
radical
radiotherapy.Acta Oncologica, Volume 31, Issue 5 1992 , pages 555
561http://erj.ersjournals.com/cgi/reprint/34/1/17.pdf
A 60-year-old man presents complaining of epigastric pain which radiates to his back, as well as nausea
and vomiting
for the past few weeks. He has lost 4kg in weight over the past 3 months. He drinks 4 pints of beer and
a bottle of
wine per day and smokes 20 cigarettes per day. On examination he looks thin, his BMI is 19 and he has
mild
epigastric tenderness only on palpation.Investigations;
Hb 10.9 g/dl
MCV 102 fl
WCC 8.1 x109
/l
PLT 210 x109
/l
Na+
141 mmol/l
K+
4.0 mmol/l
Creatinine 90 mol/l
Upper GI endoscopy moderate oesophagitis
Which of the following is the next most appropriate investigation?
A Colonoscopy
B CT abdomen Correct answer
C 24hr pH monitoring
D Repeat endoscopy following acid suppression
E ERCP
It is unlikely that moderate oesophagitis would account for the weight loss seen here, so that 24hr pH
monitoring, or
repeat endoscopy, whilst providing information about the oesophagitis will not in all likelihood provide
the answer to
his weight loss. Two differentials high on the list would include chronic pancreatitis related to his
alcoholism and
pancreatic carcinoma. Taking these two possibilities into account, a CT abdomen would therefore be
the next most
logical investigation.
A 55-year-old Caucasian man presents with a 2-year history of arthritis, fever, recurrent cough and
pleuritic chest
pain. He has spent the past few years working on a farm in the Netherlands and has just returned home
to the UK.
He has been feeling generally unwell and most recently he has developed diarrhoea and weight loss.
On examination
there is mild skin pigmentation and finger clubbing. On auscultation of the heart a pan-systolic murmur
is
heard.Investigations;
Hb 12.1 g/dl
WCC 10.5 x109
/l
PLT 183 x109
/l
Na+
140 mmol/l
K+
4.0 mmol/l
Creatinine 130 mol/l
ESR 45 mm/hr
Which of the following investigations would be most likely to confirm your clinical diagnosis?
A Echo
B Blood cultures Your answer
C Serology testing for coxiella Correct answer
D Small bowel biopsy
E Mesenteric angiogram
This man has worked on a farm and has symptoms that fit with chronic Q fever, with arthritis, pleuritic
chest pain and
endocarditis. Exposure to farm animals and small mammals such as cats increases the risk of
contracting Q fever,
and the two most recent outbreaks in Europe occurred in the Netherlands. In the presence of culture
negative
endocarditis, serology testing for Coxiella is the test most likely to deliver the diagnosis. Differentials
which might be
considered include both Coeliac and Whipples, but they are not usually associated with endocarditis.
Doxycycline
usually combined with another agent such as quinolone is the regimen of choice.
A 29-year-old woman with brittle asthma is admitted to the Emergency room with a viral exacerbation
of her asthma.
Her usual peak flow is around 490 l/min, and she is managed with a high dose seretide inhaler. On
examination her
BP is 145/80 mmHg, pulse is 105/min, regular. She has a respiratory rate of 40/min and looks
exhausted. On
auscultation you can hear wheeze and decreased air entry. Her peak flow is measured at 180
l/min.Investigations;
Hb 13.1 g/dl
WCC 8.1 x109
/l
PLT 249 x109
/l
Na+
141 mmol/l
K+
3.9 mmol/l
Creatinine 110 mol/l
PaO2 10.5 kPa
pCO2 6.4 kPa
Her peak flow has not improved 30 mins after admission, despite salbutamol and atrovent nebulisers
and IV
hydrocortisone. You arrange review by the ITU registrar.Whist you are waiting for her visit, which of
the following is
the most appropriate next management step?
A IV aminophylline
B IV salbutamol
C IV magnesium Correct answer
D Inhaled helium oxygen mixture
E NIPPV
A Cochrane meta-analysis showed some benefit from IV magnesium in acute asthma, and for this
reason it is
recommended in the British asthma guideline update from 2008 in patients who have failed to improve
on IV
salbutamol, atrovent and corticosteroids. Her pCO2 is just outside the upper limit of normal, for this
reason she
requires urgent ITU admission. IV aminophylline is not recommended routinely and should only be
used in specific
patients after consultation with senior staff.
You review a 67-year-old man with COPD. He has smoked 30 cigarettes per day for around the past 40
years.
Pulmonary function tests indicate that he has a predominantly emphysematous picture.Which of the
following is the
most important factor in airflow limitation in severe emphysema?
A Smooth muscle contraction
B Large airways obstruction
C Mucosal oedema
D Loss of elastic recoil Correct answer
E Mucus plugging
Emphysema is characterised by focal destruction limited to the airspaces distal to terminal bronchioles.
When the
disease is severe, it is loss of elastic recoil which drives airflow limitation. Although airflow limitation
is virtually
irreversible, the small inflammatory component may respond to high dose inhaled corticosteroids.
The 3-year-old child of 12-week pregnant 25-year-old woman develops a typical chickenpox illness.
The mother does
not recall having had chicken pox herself.What do you advise the mother to do?
A Avoid further contact with the child
B Test the mother for varicella-zoster IgG Correct answer
K+
4.3 mmol/l
Creatinine 100 mol/l
CK 430 U/l (24 - 195)
Given the likely diagnosis, which of the following is the strongest indicator of prognosis?
A Level of CK
B Vital capacity Correct answer
C Response to corticosteroid therapy
D 12 lead ECG
E FEV1
The history of facial, proximal limb and abdominal muscle weakness, in association with winged
scapulae and
elevated CK, is suggestive of facioscapulohumeral muscular dystrophy. Whilst respiratory muscle
involvement is rare
in this condition, it does occur in a small percentage of patients. Decreased vital capacity is associated
with increased
risk of both Type 2 respiratory failure and acute lower respiratory tract infection. Cardiac involvement
is also rare, with
atrial fibrillation occurring in only around 5% of patients. Apart from high tone deafness, retinal
telangiectasias are
also commonly seen in this condition.
A 75-year-old woman has suffered 6 transient ischaemic attacks (TIAs) involving transient weakness
and poor coordination
affecting the left side of her body. She has a history of hypertension which is managed with ramipril
and
indapamide, but no other significant past medical history. On examination her BP is 155/90 mmHg, her
pulse is
75/min and regular. There is a right carotid bruit.Investigations;
Hb 12.8 g/dl
WCC 6.1 x109
/l
PLT 209 x109
/l
Na+
140 mmol/l
K+
4.5 mmol/l
Creatinine 135 mol/l
Carotid doppler 50% stenosis of right internal carotid artery
Which of the following is the most appropriate way to manage her?
A Aspirin Correct answer
B Warfarin Your answer
C Clopidogrel
D Carotid endarterectomy
E Aspirin and dypridamole
Trials indicate that in patients with greater than 70% carotid stenosis there is significant benefit derived
from carotid
endarterectomy. When the stenosis is in the 50-69% range the potential benefit is marginal, and better
in male
patients, hence at this stage aspirin is the most appropriate option. If she suffered further TIAs after
commencing
aspirin then the combination of aspirin and slow release dypridamole as per the European Stroke
Prevention Study 2
would be the most appropriate option.
A 60-year-old man presents with difficulty fastening up the buttons on his coat when using his right
hand. He tells you
he had a car crash involving a rear shunt around 1 year earlier. On examination he has sensory loss
affecting the
medial aspect of his right arm around the elbow but the sensory supply to the hand appears intact. The
intrinsic hand
muscles are wasted on the right side. Where is the most likely lesion?
A Radial nerve
B Cervical nerve root C7
C Ulnar nerve Your answer
D Median nerve
E Thoracic nerve root T1 Correct answer
The T1 nerve root supplies the small muscles of the hands and sensation on the medial aspect of the
upper arm to
an area just below the elbow. C7 sensory supply is to the lateral aspect of the forearm and hand, and it
supplies
motor innervation to the triceps. It is likely that his road accident led to a brachial plexus injury and his
eventual
presentation.
A 60-year-old lady complains of a sensation of something crawling up her legs and then has an
irresistible urge to
move her legs just before falling asleep. She gets up several times per night, but finds the symptoms
settle around
5am and she can then sleep until 11am. She has an Hb of 11.6 g/dl and is currently being treated by her
GP for iron
deficiency anaemia. Investigations;
Hb 11.6 g/dl
WCC 6.7 x109
/l
PLT 190 x109
/l
Na+
141 mmol/l
K+
4.7 mmol/l
Creatinine 142 mol/l
141 mmol/l
K+
4.9 mmol/l
Creatinine 130 mol/l
Glucose 17.1 mmol/l
ECG Inferior ST elevation
Which of the following is the most appropriate intervention?
A Low molecular weight heparin
B Alteplase
C Streptokinase
D Percutaneous coronary intervention Correct answer
E Abciximab
Studies have shown that in patients with acute STEMI, percutaneous coronary intervention is superior
to
thrombolysis. As such PCI is recommended here above both streptokinase and alterplase. Whilst some
acute trusts
still do not yet have access to an acute angioplasty service, development of this has been made a
priority for the next
few years.
A 70-year-old man with a history of extensive acute myocardial infarction 4 years earlier comes to the
hospital with
his wife. He has suffered 4 episodes of collapse over the past 6 months, the most recent that morning,
when she
witnessed slurred speech, confusion and weakness of his right arm and leg. On examination he has no
chest pain,
his BP is 145/82 mmHg, and he is not in cardiac failure. His apex beat is displaced to the
leftInvestigations;
Hb 12.1 g/dl
WCC 5.9 x109
/l
crackles.Investigations;
Hb 12.1 g/dl
WCC 12.9 x109
/l
PLT 245 x109
/l
Na+
140 mmol/l
K+
4.5 mmol/l
Creatinine 140 mol/l
CXR Cavitating lesions involving the upper lobes
Which of the following is the most likely diagnosis?
A Tuberculosis
B Mycoplasma
C Legionella
D Pneumococcus
E Klebsiella Correct answer
Klebsiella pneumonia appears to occur with increased frequency in patients with a history of
alcoholism and the
typical picture is one of cavitating lesions predominantly affecting the upper lobes as is seen here.
Third generation
cephalosporins or quinolones are used as standard therapy for Klebsiella infection. Unfortunately
klebsiella carries a
mortality rate of up to 50%, patients who respond to therapy are at increased risk of lung abscess
formation.
You are reviewing a study which seeks to measure troponin I to estimate the level of cardiac
myonecrosis.In which
site in the cardiac myocyte is troponin present?
A Mitochondria
complications in patients who have undergone percutaneous coronary intervention. Aspirin inhibits
cycloxygenase,
and clopidogrel inhibits the platelet ADP receptor.
A 26-year-old who has developed a long-standing addiction to heroin which began 4 years earlier
whilst travelling
visits you for advice. He has tried going cold turkey on a number of occasions but develops
unacceptable
restlessness, anxiety, vomiting and diarrhoea. He now has a child and is determined to stop. There is a
place
available on the local drug counselling scheme. Which of the following is the most appropriate
prescription with
respect to medically managing his withdrawal?
A Buprenorphine
B Methadone Correct answer
C Diazepam
D Dihydrocodeine
E Chlorpromazine
Both buprenorphine and methadone may be considered for use as heroin replacements. Buprenophine
may be
associated with less risk in overdose, but NICE recommends that unless circumstances dictate
otherwise, methadone
should be the first choice therapy. Co abuse of alcohol and benzodiazepines may drive preferential use
of
buprenorphine as these agents increase the risk of significant CNS depression. Dihydrocodeine is not
indicated for
opiate withdrawal in the UK.
A 24-year-old woman undergoes resection of the terminal ileum with fashioning of an ileostomy for
Crohns disease.
Some 2 weeks after surgery, she is making a good recovery, and is eating a high-energy, low-residue
diet, but has a
high ileostomy volume, necessitating intravenous fluid replacement. Her serum calcium concentration
is 1.82 mmol/l,
phosphate 1.28 mmol/l, alkaline phosphatase 82 U/l (normal < 150), albumin 30 g/l, creatinine 80
mol/l. Prior to
surgery, her serum calcium concentration was 2.18 mmol/l, albumin 36 g/l. What is the most likely
cause of her
hypocalcaemia?
A Formation of insoluble calcium salts in the intestine
B Hypoalbuminaemia
C Hypomagnesaemia Correct answer
D Malabsorption of calcium
E Malabsorption of vitamin D
Impaired fat absorption can lead to the formation of insoluble calcium salts in the gut. Fat and calcium
are absorbed
in the proximal small intestine, so, too, is vitamin D. Although bile salts are absorbed distally, and
impaired absorption
can lead to a secondary decrease in proximal fat absorption, this is unlikely to be responsible for
hypocalcaemia
developing so quickly. The normal alkaline phosphatase level also militates against vitamin D
deficiency.
Hypocalcaemia would normally be expected to stimulate parathyroid hormone secretion and cause the
plasma
phosphate concentration to fall (PTH is phosphaturic). Patients with ileostomies can lose large amounts
of
magnesium through their stomas; hypomagnesaemia impairs PTH secretion and can cause
hypocalcaemia that is
resistant to an increased provision of calcium.
A 40-year-old woman complains of pain and stiffness in the small joints of her hands especially in the
mornings. An
X-ray shows only soft tissue swelling, but an MRI reveals erosions at the metacarpophalangeal
joints.Which of the
following indicates a worse than average prognosis?
A Anaemia occurring a year after onset
B Negative IgM rheumatoid factor
C Male patient
D Positive IgG rheumatoid factor Your answer
E Gradual onset over a few months Correct answer
This patient most probably has rheumatoid arthritis. A worse than average prognosis (with a predictive
accuracy of
80%) is indicated by being female, a gradual onset over a few months, a positive IgM rheumatoid
factor and/or
anaemia within 3 months of onset.
A 19-year-old girl with a history of Type 1 diabetes presents with confusion, hyperventilation and
dehydration. On examination she is hyperventilating, smells of pear drops and has a BP of 95/50
mmHg with a pulse of 105/min. Arterial blood gas measurement reveals a pH of 7.2. You suspect that
she has diabetic ketoacidosis (DKA). What is
the primary cause of ketoacidosis in Type 1 diabetes?
A Lipogenesis
B Lipolysis Correct answer
C Gluconeogenesis
D Glycolysis
E Glycogenolysis
Glycogenolysis and gluconeogenesis lead to severe hyperglycaemia, which accentuates dehydration
and
hypotension. Lipolysis increases the availability of free fatty acid substrate for hepatic metabolism
which leads to
accumulation of acid intermediate and end products (ketoacids and ketones such as acetoacetate,
betahydroxybutyrate
and acetone). Ketones are also seen in some situations of acute energy deficit.
A 32-year-old woman presents to the clinic with tiredness. She has 3 children and a full time job and is
finding it very
difficult to hold everything together. There is no significant past medical history. On examination her
BP is 145/80
mmHg, her BMI is 28. Investigations;
Hb 12.4 g/dl
WCC 6.7 x109
/l
PLT 204 x109
/l
Na+
141 mmol/l
K+
4.9 mmol/l
Creatinine 120 mol/l
Total cholesterol 5.0 mmol/l
TSH 7.8 U/l
Free T4 10.0 pmol/l (10-22)
Free T3 3.4 pmol/l (5-10)
Which of the following is the most likely diagnosis?
A Hypothyroidism
B Thyrotoxicosis
C Thyroid hormone resistance
D Subclinical hypothyroidism Correct answer
E TSH secreting tumour
The TSH here is outside the upper limit of normal, and the T3 and T4 levels are right at the lower end
of the normal
range. The suspicion is that her pituitary is having to work extra hard to drive a failing thyroid, so
called subclinical
hypothyroidism. Treatment with T4 replacement is controversial, with some clinicians treating based
on symptom
scoring, presence of autoantibodies /other autoimmune pathology, although no randomised controlled
trials exist to
support this approach.
A 72-year-old presents to his GP with anorexia, weight loss and increasing lethargy. He also complains
of Raynauds
phenomenon and increasing headaches over the past few months. Apart from a history of hypertension
there is no
other significant past medical history. On examination his BP is 155/92 mmHg. You detect
hepatosplenomegaly on
examination of the abdomen.Investigations
Hb 10.2 g/dl
WCC 11.1 x109
/l
PLT 104 x109
/l
Na+
142 mmol/l
K+
4.9 mmol/l
Creatinine 198 mol/l
Viscosity 2.9 mPa/s (1.5-1.72)
Total protein 82 g/l (61-76)
IgM paraprotein band
Urate 0.62 mmol/l (0.23-0.46)
Which of the following poses the most serious risk to this patient?
A Hyperviscosity syndrome Correct answer
B Severe anaemia
C Disseminated herpes zoster infection
D Meningococcal sepsis
E Invasive aspergillosis
This patient has Waldenstroms macroglobulinaemia, as evidenced by the bone marrow picture, raised
viscosity and
IgM paraprotein band. Hyperviscosity syndrome increases the risk of both cerebrovascular and
cardiovascular events
and deteriorating renal function. Initial therapy of choice is plasmaphoresis, followed by chemotherapy,
with alkalyting
agents and nucleoside analogues the traditional initial agents of choice. Anti-CD20 agents such as
rituximab are also
under investigation for the treatment of Waldenstroms.
30-year-old woman is admitted with a right sided hemiparesis. She returned two days earlier from
visiting her sister in
Australia. She has been generally well apart from occasional migraine headaches. Only medication of
note is the
progesterone-only contraceptive pill. On examination her BP is elevated at 152/89 mmHg and she has a
right sided
hemiparesis. You note that her right leg is swollen. Her flat mate tells you that she complained that the
leg was
aching just after she returned home.Investigations;
Hb 12.4 g/dl
WCC 6.1 x109
/l
PLT 210 x109
/l
Na+
140 mmol/l
K+
4.9 mmol/l
Creatinine 209 mol/l
ESR 10 mm/hr
Which of the following investigations would be most helpful in revealing the cause of her stroke?
A Carotid duplex
B Right leg venogram
C CT head
D Abdominal ultrasound scan
E Echocardiography Correct answer
It would appear that this patient has suffered a paradoxical embolus leading to a right sided stroke.
Migraine
headaches are thought to be commoner in patients with a patent foramen ovale (PFO), and the
condition may go
undiagnosed as the level of flow through the patent foramen may actually be quite small. Her swollen
leg is indicative
of a possible right leg DVT, providing the mechanism for a clot to travel through the right side of the
circulation. Whilst
A CT head or carotid duplex may be reasonable investigations in the context of a stroke they are not
likely to reveal
the underlying cause. Although some PFO may be visible with colour flow Doppler during standard
transthoracic
echocardiography, small PFOs often require trans-oesophageal echo with contrast studies to be
visualised.
A 50-year-old male comes to the clinic claiming his ears look large. He has 12 documented visits to
medical services
over the past year, all about this problem. On examination he is of completely normal appearance, with
normal sized
ears. This is explained to him, but he is absolutely insistent that they are too large. Apart from this he
has no past
medical history of note, and holds down a job running a small printing firm.Which of the following is
the most likely
diagnosis?
A Somatisation disorder
B Body dysmorphia Correct answer
C Obsessive compulsive disorder
D Depression
E Munchausens disease
Absolute belief that one part of the body is deformed, despite clear evidence that it is not, is typical of
body
dysmorphia. Patients may visit several physicians in succession, not happy with the opinion they
receive each time
they see the doctor. Those who have a family history of obsessive compulsive disorder are at increased
risk of body
dysmorphia disorder. Psychotherapy is a mainstay of therapy for body dysmorphia disorder, with
SSRIs being of
value in some patients. There are no symptoms to suggest depression, and no other examples of
behaviour
suggestive of obsessive compulsive disorder.
A 23-year-old lady on anti-psychotic medication for schizophrenia is referred to the endocrine clinic by
her GP. She
complains of significant galactorrhoea, particularly when her breasts are stimulated during sexual
intercourse with her
boyfriend. Since starting medication she has been able to hold down a job and form a stable
relationship, and she is
reluctant to discontinue it. On examination her BP is 125/80 mmHg, physical examination including
visual field testing
is unremarkable, but you can express milk on stimulation of her breasts.Investigations;
Hb 12.4 g/dl
WCC 6.4 x109
/l
PLT 232 x109
/l
Na+
140 mmol/l
K+
4.5 mmol/l
Creatinine 110 mol/l
Prolactin 900 mU/l (normal < 360mU/l)
FSH low
LH low
Which of the following is the most likely cause of her symptoms?
A Microprolactinoma
B Macroprolactinoma
C Olanzapine
D Clozapine
E Risperidone Correct answer
Risperidone is associated with significant hyperprolactinaemia, and hence suppression of both FSH and
LH. It is
quite possible at a level of around 900mU/l to see galactorrhoea. To consider a prolactinoma as the
possible
diagnosis, levels would usually be expected to be above around 1000mU/l. Other atypical antipsychotics such as
olanzapine, clozapine and quetiapine are not associated with significant increases in prolactin. If her
psychiatric
condition is stable then discussion could take place with her psychiatrist to broach the possibility of
changing to one
of these alternative medications.
A 72-year-old man presents to the clinic after referral from his GP with haematuria which he first
noticed 2-3 weeks
ago. On reflection a screening urine specimen taken 3 months earlier at the orthopaedic clinic was
positive for blood
and negative for protein. He has a history of hypertension controlled with amlodipine but is on no other
medications.
On examination his BP is 145/80 mmHg, otherwise clinical examination is
unremarkable.Investigations;
Hb 10.5 g/dl
WCC 9.2 x109
/l
PLT 342 x109
/l
Na+
140 mmol/l
K+
4.5 mmol/l
Creatinine 149 mol/l
ESR 59 mm/hr
Urine blood +++, protein
Renal Ultrasound unremarkable
Abdominal x-ray normal
Which of the following is the most appropriate next investigation?
A ANCA
B Cystoscopy Correct answer
C Renal biopsy
D IVU
E CT abdomen
The presence of macroscopic haematuria without proteinuria raises significant suspicion of bladder
carcinoma, and
the mild anaemia and raised ESR are also consistent with this. Given that the abdominal x-ray and
ultrasound were
unremarkable, cystoscopy is a better next choice versus CT abdomen. Smoking is the most common
risk factor for
carcinoma of the bladder; other risks are associated with exposure to potentially toxic substances such
as dye,
plastics, rubber and chemicals used in the printing industry. Limited tumours may be resected at the
time of
cystoscopy; as such many patients are amenable to management with regular surveillance cystoscopy.
A 29-year-old man returns from a holiday in India complaining of fever, diarrhoea and dizziness on
standing. He has
eaten widely from a number of places during his holiday including some local meat and fish dishes
from street food
sellers. On examination he is pyrexial 38o
C, looks dehydrated; BP is 120/70 mmHg with significant postural drop and
pulse 98/min regular. He has abdominal tenderness, especially in the right iliac fossa. You also notice
erythema
nodosum.Investigations;
Hb 14.3 g/dl
WCC 12.3 x109
/l
PLT 200 x109
/l
Na+
145 mmol/l
K+
3.2 mmol/l
Creatinine 184 mol/l
Given the suspected diagnosis, which of the following is the most appropriate treatment for him?
A Metronidazole
B Ciprofloxacin Correct answer
C IV hydrocortisone
D IV normal saline Your answer
E Erythromycin
The history of severe diarrhoea including abdominal / right iliac fossa pain is suggestive of possible
yersinia infection.
As such the most appropriate therapy is ciprofloxacin. Uncomplicated cases of yersinia may not require
treatment,
but the presence of pyrexia, renal impairment and a significant postural drop suggests antibiotics are
worthwhile. The
condition is usually self limiting, but yersinia bacteraemia with spread to distant organs results in
significant morbidity/
mortality.
A 17-year-old girl is admitted with a non-blanching rash suspicious of meningococcal septicaemia.
According to her
boyfriend she has had symptoms of a sore throat and head cold over the past few days, and over the
past 12hrs has
becoming increasingly drowsy and confused. The GP administered IV benzylpenicillin at home whilst
awaiting the
ambulance. On examination she is pyrexial 38.6o
C, BP 95/60 mmHg, pulse 105/min, and has an extensive petechial
rash consistent with meningococcal septicaemia, including over the area you are considering for
lumbar puncture.
She is drowsy and photophobic but you manage to get a view of her optic discs and she has evidence of
papilloedema.Investigations;
Hb 12.1 g/dl
WCC 15.6 x109
/l
PLT 210 x109
/l
Na+
138 mmol/l
K+
4.4 mmol/l
blind because he is not aware of the visual loss is a recognised feature of cortical blindness. Macular
degeneration is
associated with central scotoma and loss of central vision in the affected eye. Swelling of the optic disc
due to
papilloedema is often associated with tunnel vision. Acromegaly is typically associated with bitemporal
hemianopia.
A 23-year-old South African woman who has recently started the oral contraceptive pill comes to the
dermatology
clinic. She is concerned as the skin on her hands and forearms has become increasingly fragile with a
bullous rash.
In addition she has increased pigmentation and some hair growth on her face. Investigations;
Hb 12.2 g/dl
WCC 8.1 x109
/l
PLT 284 x109
/l
Na+
141 mmol/l
K+
4.9 mmol/l
Creatinine 110 mol/l
ANA positive
Which of the following is the most likely diagnosis?
A Polycystic ovarian syndrome
B Erythema multiforme
C Hereditary coproporphyria
D Porphyria cutanea tarda Correct answer
E SLE
This patients clinical picture is very typical of porphyria cutanea tarda. Anti-nuclear antibodies are
frequently seen in
patients with the condition. Use of oestrogens may precipitate development of the condition, hence her
presentation
shortly after commencing the oral contraceptive pill. Urinary porphyrins are raised in porphyria
cutanea tarda; the
cause is congenital deficiency of uroporphyrinogen decarboxylase (UROD). Assay of red blood cells
for UROD
activity is now available in many hospital laboratories. She should be encouraged to find another form
of
contraception apart from the oestrogen containing pill.
A 31-year-old woman who is 22 weeks pregnant is referred to the diabetes clinic with glycosuria. It is
her first
pregnancy. On examination her BP is 139/80 mmHg, her BMI is 32. She has no other past medical
history of
note.Investigations;
Hb 11.9 g/dl
WCC 5.9 x109
/l
PLT 178 x109
/l
Na+
140 mmol/l
K+
4.9 mmol/l
Creatinine 95 mol/l
Fasting glucose 9.2 mmol/l
She monitors her post-prandial glucoses and you decide that dietary intervention alone is unlikely to be
sufficient for
her. She is not keen on insulin therapy.How would you plan to manage her sugars initially?
A Persuade her to accept BD mixed insulin
B Persuade her that a basal bolus regime is the best thing for her
K+
4.5 mmol/l
Bicarbonate 22 mmol/l
Creatinine 130 mol/l
pO2 9.1 kPa
pCO2 7.2 kPa
pH 7.2
Which of the following is the most likely diagnosis?
A Acute respiratory acidosis Correct answer
B Acute on chronic respiratory acidosis
C Metabolic acidosis
D Mixed metabolic and respiratory acidosis Your answer
E Respiratory acidosis
This woman is hypercapnic with decreased pH. This has occurred too quickly for metabolic
compensation to occur
via renal bicarbonate reabsorption, as this takes 3-5 days to occur. As such it is an acute event such as a
COPD
exacerbation that is most likely to have led to her deterioration in symptoms. Therefore aggressive
management is
likely to return her to a reasonable level of function
A 67-year-old man presents with weakness and muscle aches. He has a history of hypertension and
dyslipidaemia
and is managed with ramipril and simvastatin. He also has COPD and is treated with a high dose
seretide inhaler.
You understand he was started by his GP on antibiotics a few days earlier for a lower respiratory tract
infection.Investigations;
Hb 12.1 g/dl
WCC 9.4 x109
/l
PLT 272 x109
/l
Na+
141 mmol/l
K+
5.9 mmol/l
Creatinine 190 mol/l
CK 890 U/l (24-195)
Which of the following is the antibiotic he is most likely to have been prescribed?
A Doxycycline
B Ciprofloxacin Your answer
C Amoxycillin
D Co-amoxyclav
E Clarithromycin Correct answer
Simvastatin is metabolised by CYP3A4, and the macrolide class of antibiotics, including
clarithromycin and
azithromycin are potent inhibitors of CYP3. This leads to simvastatin accumulation and possible
rhabdomyolysis. The
picture seen here with raised potassium, creatinine and CK fits with that picture. Because of this
interaction, caution
is recommended when considering macrolides in conjunction with simvastatin at higher doses, and
another antibiotic
should be used if possible.
A 54-year-old man presents with progressive cognitive impairment and personality change. He gives a
history of a
stroke 2 years before, which has left him with mild left hemiparesis, and prior to that had had several
mini-strokes.
His brother has a similar history, in that he too had several strokes between the ages of 40 and 55. Their
mother died
at 60 of dementia and his fathers medical history is unknown. He has four children in their late
twenties. His
daughter suffers from migraine and had what seemed to be a transient ischaemic episode during her
first pregnancy.
Another son also has frequent headaches, sometimes with associated transient weakness of one side of
his body.
On examination, the patient has signs of left hemiparesis, generally brisk reflexes and upgoing plantars.
He has an
apraxic gait. His Mini-Mental State Examination score is 24/30 with slow responses.What possible
unifying diagnosis
should be considered when investigating his cognitive problem?
A Mitochondrial encephalopathy with leucoencephalopathy and stroke-like features (MELAS) Your
answer
B Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leucoencephalopathy
(CADASIL)
Correct
answer
C Familial hemiplegic migraine
D Autosomal-dominant form of cerebral amyloid angiopathy
E Hyperhomocysteinaemia
CADASIL is the most common genetic form of vascular dementia. It has a very variable phenotype but
is
characterised by a high prevalence of migraine with aura (often atypical aura), strokes at a young age
and early
vascular (subcortical) dementia. Variability in presentation may partly reflect environmental factors, eg
smoking is
associated with an earlier age of onset. The affected locus is on chromosome 19q12 the NOTCH 3
gene and
several different possible mutations have been identified (missense mutations or deletions). MRI shows
leucoaraiosis
and infarction. Neuropathological studies show pathognomonic granular osmiophilic materials in the
media of small
Na+
140 mmol/l
K+
5.9 mmol/l
Creatinine 387 mol/l
USS renal
tract
no evidence of obstruction, left kidney smaller than the right with reduced renal parenchymal
thickness
Which of the following is the next most appropriate investigation?
A Renal biopsy
B MR angiography Your answer
C Micturating cystourethrogram Correct answer
D CT abdomen
E Autoimmune profile
The suspicion is that this patient has chronic reflux nephropathy, related to recurrent urinary tract
infections and
vesicoureteric reflux. The aetiology is much less likely to be autoimmune; hence the renal biopsy is not
the best next
investigation. MR angiography and contrast CT involve injection of IV contrast material; as such they
are less
preferable to the cystourethrogram. Management involves aggressive control of hypertension and
surgical opinion as
to whether any corrective intervention with respect to ureteric anatomy or intermittent antibiotic
therapy is required.
A 26-year-old man registers with a new GP and is noticed to have microscopic haematuria, so is
referred to the renal
clinic. You note on further questioning that his father had a history of deafness, but apparently his
parents divorced
and he has no further contact with his father and couldnt comment on his health now. On examination
his BP is
elevated at 150/85 mmHg.Investigations;
Hb 11.0 g/dl
WCC 7.8 x109
/l
PLT 197 x109
/l
Na+ 141 mmol/l
K+
4.9 mmol/l
Creatinine 190 mol/l
Urine blood +
Which of the following is the most likely diagnosis?
A IgA nephropathy
B Polycystic kidney disease
C Goodpasture's syndrome
D Alports syndrome Correct answer
E Renal carcinoma
The combination of deafness, microscopic haematuria and developing renal failure is highly suggestive
of Alports
syndrome. The underlying abnormality is one of Type IV collagen which leads to changes in the
glomerular basement
membrane. Skin biopsy is the least invasive way of confirming the diagnosis, with renal biopsy only
being required if
there is any doubt on analysis of the skin specimen. Renal transplantation is required for end stage
renal failure, and
is usually very successful.
A 62-year-old man comes to the cardiology clinic for review. He has a history of mitral stenosis and
presents with
increased shortness of breath. His BP is 142/108 mmHg. On auscultation there is a loud first heart
sound, an early
diastolic murmur loudest at the apex, and an early diastolic murmur loudest at the left sternal edge. The
second heart
sound is loud. There are prominent V waves on examination of the JVP. Auscultation of the chest
reveals evidence of
bibasal inspiratory crackles and he has peripheral pitting oedema.What finding on examination
suggests the
possibility of another valvular leak?
A Loud second heart sound Your answer
B Early diastolic murmur at the apex
C Early diastolic murmur at the left sternal edge Correct answer
D Loud first heart sound
E Bibasal inspiratory crackles
An early diastolic murmur at the left sternal edge is suggestive of pulmonary regurgitation. There are
other signs of
pulmonary hypertension on examination including prominent V waves which are a pointer towards
tricuspid
regurgitation and peripheral pitting oedema. Possible treatments include valvotomy or mitral valve
replacement. Fluid
can be offloaded from the left atrium by use of diuretics.
Which organ lies anterior in direct contact with the left kidney without separation by visceral
peritoneum?
A Spleen
B Left suprarenal
C Tail of the pancreas Correct answer
D Left psoas muscle
E Splenic flexure
A small area along the upper part of the medial border of the left kidney is in relation with the left
suprarenal gland,
and close to the lateral border is a long strip in contact with the renal impression on the spleen. A
somewhat
quadrilateral field, about the middle of the anterior surface, marks the site of contact with the body of
the pancreas, on
the deep surface of which are the lienal vessels. Above this is a small triangular portion, between the
suprarenal and
splenic areas, in contact with the postero-inferior surface of the stomach. Below the pancreatic area, the
lateral part is
in relation with the left colic flexure, the medial with the small intestine. The areas in contact with the
stomach and
spleen are covered by the peritoneum of the omental bursa, while that in relation to the small intestine
is covered by
the peritoneum of the general cavity; behind the latter are some branches of the left colic vessels. The
suprarenal,
pancreatic, and colic areas are devoid of peritoneum.
A 34-year-old obese woman with a history of polycystic ovarian syndrome (PCOS) comes to the clinic
with tiredness,
thirst and polyuria. She complains that she is unable to get pregnant, and that she has been trying for a
baby with her
partner for the past 3 years. On examination her BMI is 31, her BP is 155/90 mmHg. She also has acne
and a pattern
of hirsutism consistent with PCOS.Investigations;
Hb 13.4 g/dl
WCC 5.6 x109
/l
PLT 230 x109
/l
Na+
139 mmol/l
K+
4.9 mmol/l
Creatinine 110 mol/l
Fasting glucose 9.1 mmol/l
Which of the following is the most appropriate therapy with respect to both her fertility and Type 2
diabetes?
A Dietary advice
B Metformin monotherapy Correct answer
C Pioglitazone monotherapy
D Insulin
E Gliclazide
The lack of ovulation in PCOS may be related to ovarian insulin resistance; as such metformin is an
effective therapy
both for controlling blood glucose and inducing ovulation. Indeed, one study suggested that metformin
is potentially
as effective as clomiphene when used in PCOS. Pioglitazone and rosiglitazone reduce insulin resistance
more than
metformin and are also associated in case series with improvements in ovulation, but their association
with fractures
reduces their applicability in this population. Trials of metformin and glibenclamide in gestational
diabetes have also
suggested that these may be viable alternatives to insulin in appropriate patients.
A 67-year-old man with chronic AF who has failed cardioversion is started on long term oral digoxin
therapy by his
GP. He is started at an initial dose of 250mcg daily. He wants to know why he has to take a higher dose
at the
beginning and why it takes a while to work?
A Volume of distribution Correct answer
B Half-life
C Absorption
D Clearance
E First-pass metabolism
Digoxin has a very large volume of distribution, which is measured at 510 litres in healthy volunteers.
The half life of
digoxin is actually quite long: in patients with normal renal function it is around 36-48hrs, although this
may be
significantly prolonged in patients with abnormal renal function around 3-5 days. Drugs which are
affected by first
pass metabolism are those which undergo significant early hepatic metabolism, the prime example
being propranolol.
Bioavailability of oral digoxin is very good, being around 60-70% although it is affected by
administration with
food.http://www.emc.medicines.org.uk/medicine/2178/SPC/Lanoxin%20Tablets
%200.25mg/#PHARMACOKINETIC_
PROPS
A patient with liver cirrhosis develops metabolic alkalosis. What is the most likely pathological
mechanism?
A Bicarbonate loss due to ascites
B Reduced urea synthesis Correct answer
C Increased gastric acid production
D Reduced bicarbonate secretion from the pancreas
E Reduced lactate formation in skeletal muscle Your answer
Urea production is an important feature of hepatic metabolism. The production of each molecule of
urea (ultimately
from ammonium and carbon dioxide) is accompanied by the generation of two protons. Ureagenesis is
therefore a
potential acidifying mechanism. Most of the protons produced in ureagenesis are neutralised by the
bicarbonate
generated during the oxidation of the carbon skeleton of amino acids. Normally, however, a slight
excess of protons
is produced that has to be eliminated by the kidneys.
Urea synthesis and accompanying proton production are negatively regulated by acidosis, which
constitute another
acidbase regulatory system intrinsic to the liver.
A 54-year-old man with a history of obesity, Type 2 diabetes and hypertension presents to the clinic
complaining of
pain in his right 1st MTP joint. He takes orlistat, ramipril, indapamide, amlodipine and metformin and
has been taking
over the counter ibuprofen for intermittent bouts of the same pain that have occurred over the past 18
months. On
examination he has a BP of 149/90 mmHg and a BMI of 31. He has pain, swelling and redness over the
right first
MTP joint.Investigations;
Hb 13.1 g/dl
WCC 5.9 x109
/l
PLT 229 x109
/l
Na+
141 mmol/l
K 4.4 mmol/l
Creatinine 132 mol/l
X-ray reduced joint space and calcification
Which of his drugs should be discontinued?
A Ramipril
B Amlodipine
C Indapamide Correct answer
D Orlistat
E Metformin Your answer
This man has gout, a condition associated with insulin resistance, obesity and Type 2 diabetes.
Indapamide as a
member of the thiazide class is associated with raised serum uric acid, as such discontinuing
indapamide and
substituting another anti-hypertensive is the management of choice. Whilst metformin should be dose
reduced or
discontinued when creatinine rises above 140 mol/l or so in a male, in itself it is not associated with
increased risk of
gout. His acute gout should be managed with a short course of non-steroidal anti-inflammatory drugs.
A 23-year-old man who lives with his male partner consults you for an opinion. He has suffered anal
discharge and
pruritis for the past 3 days. There are also some symptoms of dysuria. A urethral smear reveals
intracellular
diplococci. What is the most likely infective agent to fit with this clinical picture?
A Neisseria gonorrhoeae Correct answer
B Chlamydia trachomatis
C Treponema pallidum
D Herpes simplex-type 1
E Herpes simplex-type 2
Gonorrhoea, a sexually transmitted bacterial infection, may manifest with urethritis, cervicitis,
salpingitis or anorectal
symptoms. Symptoms in men may be severe and include purulent discharge from the anterior urethra
and dysuria,
with rectal discharge where anal intercourse has taken place. Symptoms in women are often mild, with
urethritis and
cervicitis occurring a few days after exposure. In around 20% of cases, uterine invasion may occur with
signs and
symptoms of endometritis or salpingitis. Inflamed Bartholins glands may occur.
The cause is the Gram-negative intracellular diplococcus Neisseria gonorrhoeae. Their presence is
diagnostic in
male urethral smears, although there is a false-negative rate of 6070% in samples from women.
Gonococci require
culture in anaerobic media in an increased carbon dioxide environment. Patients should of course also
receive
screening for other sexually transmitted disease. The treatment of choice is with quinolone antibiotics,
but local
protocols should be referred to.
A 45-year-old lady who is taking a tapering dose of prednisolone for severe asthma presents with right
hip pain which
is so severe that she is unable to weight bear; apparently the pain came on very quickly. She smokes 20
cigarettes
per day and takes fluticasone high dose inhaler, tiotropium, theophylline tablets and currently 5mg of
prednisolone. In
total she has had 4 courses of oral corticosteroids in the past year. On examination her BP is 142/87
mmHg. She has
limitation particularly of hip flexion, internal and external rotation of the right hip. The left hip is
normal.Investigations;
Hb 12.3 g/dl
WCC 8.7 x109
/l
PLT 201 x109
/l
Na+
141 mmol/l
K+
4.3 mmol/l
Creatinine 110 mol/l
Right hip x-ray sclerosis of the femoral head
Which of the following is the most likely diagnosis?
A Pathological fracture
B Osteoporosis
C Pagets disease
significantly reduce the risk of irreversible visual loss and other focal ischaemic lesions. Intravenous
steroids are
indicated when there is sudden unilateral loss of vision to avoid vision loss in the other eye.
A 38-year-old man presents with progressive breathlessness, dry cough and difficulty in swallowing.
He also notes
that his hands become pale and painful when exposed to the cold and that his fingers are swollen and
stiff. His blood
pressure is 160/110 mmHg. Chest radiographs show patchy shadows in both mid-zones and bases.What
diagnosis
could best explain these findings?
A Sarcoidosis
B Limited cutaneous scleroderma Your answer
C Diffuse cutaneous scleroderma Correct answer
D Rheumatoid arthritis
E Sjgrens syndrome
Diffuse cutaneous scleroderma commences with swelling and stiffness of the fingers and is followed by
extensive
sclerosis. Heartburn, reflux or dysphagia is almost invariable. Raynauds phenomenon usually starts
just before, or
concomitant, with the onset of the disease, unlike in limited cutaneous scleroderma where Raynauds
phenomenon
precedes the disease by many years. Renal involvement may be acute or chronic and cause
hypertension. Lung
disease, both fibrosis and pulmonary hypertension, contribute significantly to mortality.
Sarcoidosis presents classically as bilateral hilar lymphadenopathy on chest X-ray. It is asymptomatic
in one-third of
cases. Dysphagia is usually not a feature. Raynauds phenomenon is not a feature of rheumatoid
arthritis. Sjgrens
syndrome is associated with keratoconjunctivitis sicca and/or xerostomia. Dysphagia, neuropathy, renal
involvement,
otitis media and hepatosplenomegaly are common. The lungs are not usually involved
A 26-year-old pregnant woman presents for her 24 week scan. It is her first child, and the father has
haemophilia A.
The scan shows that the child is a male fetus.Which of the following represents the likely percentage
chance that her
son will have haemophila A?
A 100%
B 50%
C 33%
D 25%
E 0% Correct answer
The prevalence of Haemophilia A is only around 20 per 100,000 male individuals. It is an X-linked
disorder, hence as
the affected male supplies his Y chromosome, then chance of the baby being affected by haemophilia A
is very to
0%, being around 50% of the carrier frequency for haemophilia A.
A 16-year-old boy presents with a purpuric rash affecting his legs and buttocks. He also complains of
joint pains,
especially affecting his knees and ankles, abdominal pain and vomiting. You understand that he
suffered an upper
respiratory tract infection a few days before presenting to the GP. Investigations;
Hb 12.1 g.dl
WCC 5.6 x109
/l
PLT 234 x109
/l
ESR 35 mm/hr
Na+
140 mmol/l
K+
5.0 mmol/l
Creatinine 120 mol/l
Urine blood+, protein+
Given the suspected diagnosis which of the following is the most likely finding on renal biopsy?
A Glomerular IgG deposition
B Microaneurysm formation
C Necrotising granuloma formation
D Glomerular IgA deposition Correct answer
E Glomerular sclerosis
Features seen in HSP on renal biopsy are similar to those seen in IgA nephropathy, with increased
presences of
inflammatory cells within the mesangium, crescent formation and IgA deposition. The severity of
features seen on
renal biopsy correlates closely with the patients clinical picture. Most patients with HSP recover with
conservative
management involving pain relief and use of anti-inflammatories. Where there is significant renal
impairment,
corticosteroids +/- steroid sparing agents such as cyclophosphamide are used.
A 52-year-old man with disseminated prostatic carcinoma comes to the Emergency room after his
family called an
ambulance. They are very concerned as he has become increasingly drowsy and they are now unable to
rouse him
from sleep. He is managed with prolonged release morphine but his dose has remained unchanged for
the past 4
weeks. It is only over the past 3 days that he has deteriorated. On examination he is unconscious and
groans in
response to vigorous stimulation. His BP is 100/50 mmHg, his respiratory rate is 9/min. Investigations;
Hb 10.2 g/dl
WCC 6.2 x109
/l
peripheral smear shows the presence of Heinz bodies and methaemoglobinaemia.Which of the
following medications
may most likely be responsible for this complication?
A Amlodipine
B Aspirin
C Metoprolol
D Isosorbide mononitrate Correct answer
E Verapamil
Methaemoglobinaemia results from the oxidation of ferrous iron in the haemoglobin to the ferric form.
This causes
precipitation as Heinz bodies, and eventually leads to haemolytic anaemia. Nitrates may cause this
reaction. It does
not occur with calcium-channel blockers, -blockers or aspirin.
A 67-year-old man is referred to the cardiology clinic with angina, progressive heart failure and two
episodes of
syncope. He has a history of hypertension managed with ramipril and indapamide and suffered an
inferior myocardial
infarction some 4 years ago. On examination his BP is 125/105 mmHg, and he has a soft ejection
systolic murmur
loudest at the apex. He has evidence of LVH and there are bilateral inspiratory crackles on auscultation
of the chest
consistent with LVF.Investigations;
Hb 12.4 g/dl
WCC 6.1 x109
/l
PLT 208 x109
/l
Na+
140 mmol/l
K+
4.3 mmol/l
Creatinine 185 mol/l
Which of the following is likely to be the most significant problem which is driving his symptoms?
A Coronary artery disease Your answer
B Mitral regurgitation
C Aortic stenosis Correct answer
D Cardiac arrhythmias
E Chronic renal failure
The triad of angina, LVF and syncope is classical with respect to aortic stenosis. Two confounders
exist: in the elderly
the more high frequency components of aortic stenosis may be heard best at the apex, the so called
Gallavardin
phenomenon, and the components of the murmur may be softened in situations where cardiac output is
reduced.
Given this man has evidence of coronary artery disease he may well have co-existent reduced cardiac
output. Hence
he requires assessment of both aortic valve and coronary artery status, with combined valve
replacement and CABG
likely to be the most appropriate way to manage him.
A 52-year-old male is undergoing exercise tolerance testing for coronary artery disease screening after
suffering
indigestion type pain whilst playing squash with a workmate. He reaches stage II of the Bruce protocol
when his BP is
210/100 mmHg and HR 170/min. ECG changes are noted.Which of the following is the strongest
indicator for
stopping the test?
A His BP of 210/100 mmHg
B His heart rate
C 2mm ST depression in the lateral leads Correct answer
D Patient request Your answer
unconscious with bilateral increased tone, upgoing plantars and very sluggish pupil reactions
bilaterally. What is most
likely to have happened?
A Embolic stroke
B Intracranial haemorrhage Correct answer
C Watershed stroke due to hypotension
D Intracerebral abscess
E Cavernous sinsus thrombosis
The rapid deterioration points to a catastrophic cerebral event. Data from the PROWESS and
ENHANCE studies
indicated increased risk of bleeding with drotecogrin alpha versus placebo. CNS haemorrhage rates of
0.6% were
seen in ENHANCE and 0.2% in PROWESS. In PROWESS overall bleeding rates were 24.9% in the
intervention
group and 17.7% in the placebo arm of the study.
http://emc.medicines.org.uk/medicine/10494#UNDESIRABLE_EFFECTS
You are reviewing a 45-year-old woman with chronic myeloid leukaemia (CML). You note that she is
Phildelphia
chromosome positive and you remember that this represents the BCR-ABL gene.What does the BCRABL gene code
for?
A Tyrosine kinase Correct answer
B Serine protease
C Alkaline phosphatase
D Xanthine oxidase
E Epidermal growth factor
The BCR-ABL fusion gene product codes for a tyrosine kinase which is essential in the massive
granulocytic
expansion that accompanies the chronic phase of CML. Imatinib is a tyrosine kinase inhibitor that
induces apoptosis
of BCR-ABL positive cells and is used in the treatment of CML and gastrointestinal stromal tumours,
inducing
remission in around 80% of CML patients.
A 28-year-old woman with a history of Von-Willebrands disease Type 1 comes to the haematology
clinic for review.
She has suffered from menorrhagia and required a 2 unit blood transfusion after removal of a diseased
molar tooth 1
year earlier. She now requires removal of one further tooth.How would you advise managing her with
respect to
potential blood loss?
A Give VWF containing factor VIII concentrate at the time of procedure
B Give FFP at the time of procedure
C Making whole blood available if needed
D Give cryoprecipitate at the time of procedure
E Give DDAVP a short time before the procedure Correct answer
Von Willebrands disease Type 1 (VWD type 1) is associated with a mild to moderate deficiency of
VWF to between
20 and 50% of normal levels. Treatment of choice is DDAVP, which raises levels of VWF, factor VIII
and ristocetin
cofactor activity within 30-60 mins of administration. Other options for more severe disease include
giving factor VIIIcontaining
products prior to the procedure.
A 54-year-old man presents with joint pains, anorexia, diarrhoea and intermittent fevers. He has lost
5kg in weight
over the past 6 months and feels washed out. There is a past history of hypertension which is
managed with
amlodipine 5mg but nil else of note. On examination he looks very thin, his BMI is 18, his BP is
138/72 mmHg, he has
inguinal lymphadenopathy. His abdomen appears distended and he has bilateral pitting oedema, but
there are no
T whippelii.
A 36-year-old nurse with a 15-year history of ulcerative colitis (UC) develops abnormal liver enzymes.
ALT 154 U/l,
alkaline phosphatase 354 U/l, bilirubin 12 mmol/l. An ultrasound is normal. She is antineutrophil
cytoplasmic antibody
(ANCA)-positive. What would you be most likely to suspect?
A Gallstones
B Mesalazine hepatitis
C Primary sclerosing cholangitis Correct answer
D Chronic active hepatitis
E Primary biliary cirrhosis
Primary sclerosing cholangitis (PSC) classically occurs with inflammatory bowel disease especially
ulcerative colitis
and is associated with a high risk of cholangiocarcinoma and colon cancer.
.
A 65-year-old woman presents with a tense blistering skin rash which predominantly affects the
flexural surfaces of
her arms and legs and she has some blisters forming on her torso. She has never had blisters inside her
mouth. On
examination she has a number of bullae, more severe on the flexor surfaces of her arms and legs. There
are no
visible oral lesions. She tells you that the bullae usually heal without scarring.Investigations;
Hb 13.1 g/dl
WCC 7.4 x109
/l
PLT 201 x109
/l
Na+ 141
mmol/l
K+ 4.4 mmol/l
pulmonary toxicity. Vincristine does not cause pulmonary toxicity the common side-effects of this
agent are sensory
neuropathy and alopecia.
An 11-year-old boy weighing 70 kg presents with limitation of abduction and internal rotation of the
hip. There is
tenderness in Scarpas triangle on examination. On flexing the hip, external rotation of the limb
occurs.What is the
most likely diagnosis?
A Perthes disease Your answer
B Slipped upper femoral epiphysis Correct answer
C Transient synovitis of the hip
D Tuberculosis of the hip
E Juvenile spondyloarthropathy
Slipped upper femoral epiphysis is the displacement of the proximal femoral epiphysis. The direction
of slip is always
posterior and often medial. The change in range of hip motion is usually diagnostic.
Perthes disease is osteochondritis of the head of the femur, which may be related to avascular necrosis
of the hip. It
occurs mainly in children aged 410 years and mostly presents with a painless limp. On examination,
the only striking
sign is moderate limitation of all hip movements with pain and spasm if movement is forced.
Transient synovitis of the hip is a benign non-traumatic self-limiting disorder that mimics septic
arthritis. The cause is
unclear, but it may be associated with immune responses to viral and bacterial antigens at the synovial
membrane.
The hip is usually held in flexion, abduction and external rotation. The joint is very painful and
resistant to movement.
Tuberculosis of the hip is rarely seen in the UK. Young adults are usually affected. The joint is swollen
and red. Pain
is mild. There may be a sinus discharging pus or a palpable abscess. Movements of the hip are not
impaired.
Juvenile spondyloarthropathy affects teenage and younger boys, mainly producing an asymmetrical
arthritis of lower
limb joints and enthesitis. It is associated with HLA-B27 and a risk of acute anterior uveitis.
A 54-year-old patient was admitted with central crushing chest pain and had a troponin rise to 3.2g/L
with anterior
ST depression. He has a past history of hypertension for which he takes ramipril 10mg, and smokes 20
cigarettes per
day. He was recovering on the cardiology ward after angiography and stenting when he started
suffering further
central chest pain 3 days later. Again his ECG showed anterior ST depression.Investigations;
Hb 13.1 g/dl
WCC 7.8 x109
/l
PLT 201 x109
/l
Na+
139 mmol/l
K+
4.9 mmol/l
Creatinine 120 mol/l
Which of the following is the most appropriate enzyme screen to look for further myocardial damage?
A Troponin T
B Troponin I
C CK Correct answer
D LDH
E AST
Troponin remains elevated for a few days after initial myocardial infarction, and LDH only begins to
reach a peak
within 3-6 days. In contrast, as long as serial CK measurements had been monitored since admission
then a new
increase in CK would be a good indication of a new event. An increase in white cell count and ESR is
also seen after
myocardial infarction. ESR may remain elevated for a number of days after infarction.
A 37-year-old woman underwent a second kidney transplant, some 7 years after her first, but
unfortunately the donor
kidney never functioned. A biopsy revealed pathological features consistent with acute rejection
associated with anti
HLA antibodies .Which type of Immunoglobulin is expected to account for this process?
A IgD
B IgA
C IgG Correct answer
D IgM
E IgE
Unfortunately it is most likely that this patient has developed anti-HLA IgG antibodies after her first
renal transplant
which have precipitated the acute rejection seen with her second. Antigen antibody complexes lead to
complement
activation and massive capillary thrombosis which leads to failure of vascularisation of the graft. The
kidney seems
more susceptible to hyperacute rejection than the liver, most likely because the liver has a dual blood
supply and
plays a role in the immune response itself.
A 32-year-old woman is reviewed 14 days after a live renal transplant from her sister. Initial studies on
the
transplanted kidney showed it to be functioning well. You examine her and she has mild tenderness
over the
transplant scar, but nil else of note. Her post operation notes show a very slight rise in temperature to
37.4o
C the day
after surgery.Investigations;
Hb 11.4 g/dl
WCC 9.8 x109
/l
PLT 201 x109
/l
Na+
139 mmol/l
K+
4.4 mmol/l
Creatinine 160 mol/l (145 1 week earlier)
Cyclosporin level 310ng/ml (normal<300)
Renal ultrasound normal sized kidney
Renal angiography blood flow appears normal within the transplant
Which of the following is the most likely cause of the slight deterioration in her creatinine?
A CMV infection
B Acute rejection
C Delayed graft rejection
D Anastamotic stenosis
E Ciclosporin toxicity Correct answer
Causes of acute deterioration in creatinine would centre here around acute rejection, infection or
ciclosporin toxicity.
A transient rise in temperature post transplant would be expected, and there have been no reports of
fever since and
the white count is in the normal range. Hence infection is unlikely. Acute rejection is associated with
defective
vascular flow within the transplant, again there is no evidence to suggest that there. In contrast, the
ciclosporin level
is above the level (300ng/ml) at which toxicity becomes a possibility. As such a dose reduction should
be executed,
with monitoring of the impact on serum creatinine.
A 57-year-old with cardiac failure is being managed in the high dependency unit. The decision has ben
made to
commence inotropic support. Of the following drugs, which is most likely to cause significant
tachycardia?
A Noradrenaline
B Dopamine
C Dobutamine
D Adrenaline Correct answer
E Phenylephrine
Phenylephrine and high-dose dopamine have adrenergic effects. Noradrenaline exerts largely effects,
although it is
also a weak -adrenergic agonist. All of these drugs, by causing vasoconstriction, will tend to cause
reflex
bradycardia. Adrenaline exerts agonist effects on both - and -adrenoceptors, and the effect will cause
significant
tachycardia. It stimulates both 1- and 2-receptors with approximately equal potency, unlike
dobutamine, which is a
relatively selective agonist for 1-receptors, hence causing less tachycardia at lower doses.
A 20-year-old teacher presents with a 4-day history of general malaise, conjunctivitis and a cough. He
is starting to
develop a maculopapular rash on his face and upper trunk. What is the most likely diagnosis?
A Parvovirus B19
B Measles Correct answer
C Rubella
D EBV
E Primary HIV
The 4-day prodrome with cough and conjunctivitis are typical of measles. None of the other conditions
is associated
with cough and conjunctivitis. The rubella prodrome is 3 days or less. The rash of parvovirus B19
appears in the
convalescent phase of the illness, a week or more after the acute febrile illness. The rash of EBV is
usually truncal.
Primary HIV rashes are associated with painful oral ulceration and lymphadenopathy.
A 54-year-old woman who suffers from systemic sclerosis is referred to the clinic with chronic
diarrhoea. She has a
previous history of chronic oesophageal reflux that has been managed with conservative measures such
as raising
the head of the bed. Based on the most likely cause of this diarrhoea, what would be the best initial
treatment option?
A Metronidazole therapy Correct answer
B Colestyramine therapy
C Codeine phosphate therapy
D Neomycin therapy
E Imodium therapy
Patients with systemic sclerosis have areas of stricture, dilatation and diverticulae within the small
bowel. This coupled with slow motility leaves them open to problems with bacterial overgrowth. The
usual responsible organisms include Escherichia coli and/or Bacteroides spp, which are capable of
unconjugating and hydrolysing bile salts. They are also capable of metabolising vitamin B12 and
interfering with intrinsic factor binding, which can result in vitamin
B12 deficiency (although this is rarely severe enough to result in neurological deficit). Bacterial
overgrowth is confirmed by the hydrogen breath test.
In cases such as systemic sclerosis, rotating antibiotics such as metronidazole and ciprofloxacin may be
necessary to prevent the re-occurrence of symptoms
A 28-year-old woman comes to the clinic. She is 24 weeks pregnant with a male fetus. Her partner is in
good health,
but her father suffers from Haemophila A. What is the percentage chance of the male fetus suffering
from
Haemophilia A?
A 100%
B 50% Correct answer
C 33%
D 25%
E 0%
If the grandfather of the child suffered from Haemophilia A, then he has a 100% chance of passing on
an affected xchromosome
to his daughter. In turn, she has a 50% ( 1 in 2) chance of passing her affected x-chromosome on to
any male offspring she may have. Female offspring also have around a 50% chance of being carriers of
the disease,
depending on which x-chromosome they inherit from the mother.
A 70-year-old man comes to the clinic complaining of blue vision. He has chronic atrial fibrillation and
hypertension
but has been passed fit to take sildenafil by his doctor. On examination he looks well, his pulse is
74/min, atrial
fibrillation, and his BP is 142/78 mmHg.Investigations;
Hb 13.1 g/dl
WCC 4.9 x109
/l
PLT 182 x109
/l
Na+
142 mmol/l
K+
4.5 mmol/l
Creatinine 105 mol/l
Which of the following is the most likely cause of his blue vision amongst the medications he has been
taking?
A Temazepam
B Sildenafil Correct answer
C Digoxin
D Bisoprolol
E Amlodipine
Digoxin is associated with yellow vision in overdose, and bisoprolol like all beta blockers is associated
with increased
dreams / possible night terrors. Sildenafil is a PDE-5 inhibitor, but also has some activity on PDE-6
which is involved
in the functioning of retinal photoreceptors. At high doses of sildenafil this effect becomes clinically
significant and
patients complain of blue vision. In total over half of men taking 200mg or more of sildenafil
experience some kind of
visual side effects.
A 70-year-old man is admitted with pruritus, jaundice, and a 2 kg weight loss of duration two weeks.
He had not drunk
any alcohol for at least eight years. One month previously, he had completed a course of co-amoxiclav,
which had
been prescribed by his general practitioner for sinusitis, and was also taking ibuprofen for hip
osteoarthritis.
Investigations reveal (normal range in brackets):
Albumin 38 g/l (3749)
Bilirubin 200 m mol/l (122)
Aspartate transaminase (AST) 150 IU/l (535)
Alkaline phosphatase 200 IU/l (50110)
Abdominal ultrasound reveals gallstones, but no biliary duct dilatation
What is the most likely cause of his jaundice?
A Co-trimoxazole
D Metformin therapy
E Repeat OGTT in four weeks
A strict definition of diabetes mellitus is applied in pregnancy because glucose excursions are known to
be associated
with increased rates of both intra-uterine death and inherited abnormalities (particularly
musculoskeletal). The goldstandard
treatment of gestational diabetes mellitus is insulin, but a recent study reported the successful use of
glibenclamide in mild gestational diabetes. Gestational diabetes is associated with an increased lifetime
risk of the
development of type 2 diabetes, and advice should be given about adhering to lifestyle measures. Given
the patients
body mass index (BMI), which is in the normal range, it is also possible that she may be presenting
with early type 1
diabetes
A 52-year-old man presents with an acute upper gastrointestinal (GI) haemorrhage, but has no further
bleeding after
the initial episode. Unfortunately upper GI endoscopy reveals a suspicious ulcer, which is biopsied.
This reveals the
presence of mucosa associated lymphoid tissue and Helicobacter pylori. What is the most appropriate
initial
treatment in this case?
A High-dose proton-pump inhibitor therapy
B Heliobacter pylori eradication therapy Correct answer
C Chemotherapy for lymphoma
D Surveillance endoscopy in 3 months
E Referral for surgery
Where there is localised mucosa-associated lymphoid tissue (MALT), co-existent with H. pylori
infection, there is
evidence that eradication of H. pylori may result in resolution of the MALT. However, for larger areas
of lymphoid
tissue or where the patient is H. pylori negative, eradication therapy is much less effective. It is thought
that H. pylori
infection leads to stimulation of B lymphocytes and that a B-cell clone can become autonomous after a
chromosome
1:14 translocation. Low-grade lymphomas may then become high-grade lymphomas through the
influence of p53
among other factors. It is now becoming clear that for larger tumours, the drug glivec may be an
important new
addition to the therapeutic armoury.
A 56-year-old diabetic male had an anterior myocardial infarction 5 years ago. He is receiving aspirin
150 mg once
daily and twice daily insulin. Baseline screen revealed a body mass index (BMI) of 34, blood pressure
150/90 mmHg ,
haemoglobin A1c (HbA1c) 6.9 %, serum cholesterol 3.6 mmol/l (normal < 5.1 mmol/l). Which of the
following
measures would delay deterioration in renal function?
A Orlistat
B Increase to 4 daily insulin
C Ramipril Correct answer
D Simvastatin
E Increase aspirin from 150 mg to 300 mg daily
Angiotensin-converting enzyme (ACE) inhibitors reduce proteinuria, by relaxing the efferent arterioles
in the
glomerulus, and slow the development of both nephropathy and retinopathy; some evidence points to
specific
beneficial effects in nephropathy, in addition to the lowering of blood pressure. ACE inhibitors do not
worsen blood
glucose or lipids, and may even improve insulin sensitivity.
A couple come to the Genetics clinic as they have had one child with Wiskott Aldrich syndrome who
died of bleeding
complications at the age of 12. They are now approaching their mid thirties and are interested in trying
for a child
again. They wonder if sex selection may help avoid having another child affected by the
condition.What is the usual
pattern of inheritance for Wiskott Aldrich?
A X-linked dominant
B X-linked recessive Correct answer
C Autosomal dominant
D Autosomal recessive
E Y-linked
Wiskott Aldrich syndrome (WAS) is a condition associated with IgM deficiency, low platelets, atopy
including eczema,
humoral immunodeficiency, autoimmune disease and haematological malignancy. The WAS gene is
found on the xchromosome
and is thought to be responsible for ensuring proper functioning of the actin cytoskeleton in
haematopoeic cells, mutations leading to abnormal growth and function of differentiated cells later on.
The disease
does have variable penetrance, which means that life expectancy can range from as low as 6 years of
age to as great
as 30 years. Bleeding complications, severe bacterial infection, and malignancy are the commonest
causes of death.
You are doing a stint as the chemical pathology reviewer for the local hospital. You are doing random
quality control
on the results. Which one of the following results sets is most likely to be the result of an analytical
error?
A pH 7.38; pO2 13.2 kPa; pCO2 3.9 kPa; bicarbonate 17mmol/l
B pH 7.2; pO2 13.8 kPa; pCO2 3.0 kPa; bicarbonate 24 mmol/l Correct answer
C pH 7.4; pO2 12.5 kPa; pCO2 5.4 kPa; bicarbonate 22 mmol/l
D pH 7.35; pO2 9.6 kPa; pCO2 7.0 kPa; bicarbonate 32 mmol/l
E pH 7.45; pO2 13.5 kPa; pCO2 3.4 kPa; bicarbonate 18 mmol/l
pCO2 is low, with bicarbonate in the normal range. This is consistent with a respiratory alkalosis. As
such a pH of 7.2
is inconsistent with the other results given. A) and E) have a low CO2 and slightly reduced bicarbonate,
hence the
virtually normal pH values are consistent with this. D is a compensated respiratory acidosis, likely due
to chronic
COPD, and C is an absolutely normal blood gas.
You are asked to see a 32-year-old immigrant who complains of chronic cough and weight loss over the
past few
months. Examination of sputum reveals acid and alcohol fast bacilli (AAFBs) and tuberculosis is
confirmed. You elect
to begin treatment with isoniazid, rifampicin, ethambutol and pyrazinamide as he is from an area where
high levels of
drug resistance are present.Which of the following blood tests is most desirable before starting therapy?
A Liver function testing Correct answer
B Serum calcium
C Platelet count
D Clotting
E Haemoglobin
Both isoniazid and rifampicin may be associated with significant hepatic dysfunction. In particular,
severe and
sometimes fatal hepatitis has been seen with use of isoniazid. Particular problems occur in slow
acetylators who have
markedly elevated serum isoniazid levels. In patients with existing liver dysfunction, rifampicin and
isoniazid should
only be used in cases of absolute clinical necessity. Even then, dose reduction of rifampicin is
recommended and
initial weekly monitoring of liver function tests should be carried out.
A 42-year-old man presents to his GP with symptoms of lower respiratory tract infection. This fails to
clear after 2
weeks of oral antibiotics and unfortunately chest X-ray reveals a suspicious mass in the central region
of the right
lung. At bronchoscopy the tumour is noted to be particularly vascular. Histology reveals small
polygonal cells with a
finely granular eosinophilic cytoplasm, and the nuclei are small and round. There is no evidence of
tumour
metastasis. Which of the following represents the most likely diagnosis in this case?
A Small-cell carcinoma of the bronchus
B Carcinoid tumour of the bronchus Correct answer
C Squamous-cell carcinoma of the bronchus
D Alveolar carcinoma
E Adenocarcinoma of the bronchus
The histological picture seen here, particularly with respect to granular eosinophilic staining of the
cytoplasm is highly
suggestive of a carcinoid tumour. Around 8090% of tumours develop in a bronchus of subsegmental
size or greater,
and hence patients often present with bronchial obstruction leading to lower respiratory tract infection.
Bronchial
carcinoid is thought to derive from stem cells of the bronchial epithelium known as Kulchitsky cells.
Bronchoscopic
tumour resection is not recommended, and total surgical resection should be attempted if there is no
evidence of
metastases. Trials of laser resection have been mooted for palliation where metastases exist.
A patient presents with multiple cutaneous nodules, predominantly on his trunk, but also on his hands
and face. He
also has a number of caf-au-lait spots and the GP reports axillary freckling. The GP is concerned that
he may have
neurofibromatosis Type 1.Which of the following is usually associated with neurofibromatosis Type 1?
A A gene defect on chromosome 17 Correct answer
B Juvenile cataracts
C Schwannomas
D Hyperparathyroidism
E Medullary carcinoma of the thyroid
Juvenile cataracts and schwannomas are usually associated with neurofibromatosis Type 2. Caf au lait
spots,
axillary/inguinal freckles, neurofibromas, optic nerve gliomas, Lisch nodules and sphenoid dysplasia
are all seen with
neurofibromatosis Type 1. Hypertension is strongly associated with neurofibromatosis Type 1; whilst
the usual cause
is essential hypertension, phaeochromocytomas also occur more commonly in association with the
condition and
should be excluded if hypertension is present.
A 67-year-old woman presents with syncope. She has suffered two or three episodes of collapse during
the past 6
months, the most recent whilst attending church on a Sunday morning. She has a history of
hypertension which is
currently managed with ramipril and bendroflumethiazide and dyslipidaemia treated with simvastatin.
On examination
her pulse is 40/min, blood pressure 100/50 mmHg. Her chest is clear and heart sounds are normal. You
notice
irregular cannon waves on examination of the JVP.Investigations;
Hb 12.1 g/dl
WCC 7.4 x109
/l
PLT 203 x109
/l
Na+
139 mmol/l
K+
4.9 mmol/l
although nalidixic acid has not been associated with cartilage disruption, use of quinolones in breast
feeding is at
present contra-indicated. Chloramphenicol and co-trimoxazole may both lead to blood dyscrasias and
as such should
be avoided. Ceftriaxone has excellent in vitro activity against S typhi and would be recommended in
this case. No
reports of significantly increased adverse events in pregnancy or breast feeding have been reported, but
as in any
prescribing decision, use of ceftriaxone is only considered when benefits outweigh the risks.
A 46-year-old man is admitted with a tachycardia. He has no previous medical history of note, but
admits to
excessive use of alcohol and caffeine associated with a particularly stressful period at work during his
job as a bond
trader. On examination his BP is 122/80 mmHg, his pulse is 180/min. His chest is clear and there are no
signs of
cardiac failure.Investigations;
Hb 12.1 g/dl
WCC 5.6 x109
/l
PLT 190 x109
/l
Na+
139 mmol/l
K+
4.8 mmol/l
Creatinine 110 mol/l
ECG Narrow complex tachycardia, rate 180/min
You try 3 and 6mg of adenosine IV with no effect. Which of the following is the most appropriate next
management
step?
A patient presents with eye pain and diplopia of 2 days duration. On examination there is no proptosis,
but a left
sided VIth nerve palsy, a partial left IIIrd nerve palsy, and left Vth nerve sensory changes over the
maxilla are
present. What is the most likely site of the lesion?
A Cavernous sinus Correct answer
B Orbital artery
C Vertebral artery
D Anterior cerebral artery
E Middle cerebral artery
The cavernous sinuses are paired venous structures on either side of the sella turcica. It contains the
carotid artery
and the accompanying sympathetic plexus, with the 3rd, 4th and 6th cranial nerves and the ophthalmic
and sometime
maxillary branches of the trigeminal nerve. Causes of pressure within the carotid sinus include
tumours, aneurysms,
caroto-cavernous fistulas and cavernous sinus thrombosis. MRI/MRA is the investigation of choice in
these patients.
A 72-year-old woman has recently returned from her 3 month winter holiday to the Spanish Riviera.
Over the past few
days she has suffered from increasing cough and breathlessness, other symptoms include a headache
and
diarrhoea. By the time she presented to the Emergency department with her daughter she was confused
and
incontinent of urine. On examination in the Emergency room she is pyrexial 38.4o
C with a BP of 100/60 mmHg and a
pulse of 105/min. She has bilateral wheeze on auscultation of the chest. Investigations reveal;
Hb 13.1 g/dl
WCC 13.2 x109
/l
9861.
pt breathless with pleural effusion, diagnostic tap done which is exudate-next step- CT GUIDED
biopsy/repeat aspiration
. Alcoholic , weight loss , chest signs and symptoms , CXR shows pleural effusion aspiration attmepted
but failed whats the NEXT investigation
its clearly mention next not best investigation
9862.
bronch
9863.
ct chest
9864.
us chest
9865.
thoraco
9866.
34. COPD-> TYPE II RESP. FAILURE-> CONFUSED -> INTUBATE
35. DWARFISM-> DECREASED IGF BINDING PROTIENS
36. GASTROPARESIS-> METOCLOPRAMIDE
37. PYLORIC STENOSIS-> HYPOCHLOREMIC HYPOKALEMIC METABOLIC
ALKALOSIS
38. MODY-> AUTOIMMUNITY AGAINST ISLET CELLS
39. RAISED GATRIN LEVELS-> ACHLORIDRIA
40. WEGENERS -> C-ANCA
41. VASCULAR DEMENTIA
42. PREGNANT LADY, HIV POSITIVE, INFLUENZA VACCINE GIVEN, NEXT> Hib
44. HTN-> ADD CALCIUM CHANNEL BLOCKER
46. SVT, CARDIOVERSION FAILED, NEXT-> AMIODARONE
47. POLYUREA, POLYDIPSEA, 15MMOL BLOOD SUGAR-> START TREATMENT.
48. CVID
49. CA BREAST -> METS-> MRI SPINE
50. PERICARDITIS
51. CKD PT WITH SOB-> HEMODIALYSIS
52. POST OP PATIENT.-> GIVE IV FLUIDS
53. LACTIC ACIDOSIS/KETOACIDOSIS/ASPIRIN POISONING/ DKA
54. INTERSTITIAL NEPHRITIS
55. BIAS?
56. ADRENALINE/NORARENALINE GRAPH
57. MENINGIOMA/GLIOBLASTOMA
58. GUNSHOT-> FISTULA?
59. LUNG ABCESS-> ENDOBRONCHIAL ISTULA
60. HALO NEVUS-> REASSURE.
62. TETRACYCLINE-> DONT GIVE WITH ANTACIDS.
63. GRAM STAIN SLIDE COCCI->?
64. P VALUE->?
65. FACIAL RASH-> STREPT VIRIDANS
66. TB-> CONFIRM BY SPUTUM INDUCTION AND CULTURE.
67. YOUNG MAN WITH GLOMERULONEPHRITIS , FATHER IS ON HEMODIALYSIS> FSGS? /MEMBRANOPROLIFERATIVE GN.
68. COPD -> GIVE CONTROLLED OXYGEN?/ NIV?
69. GALACTOREA WITH AMENORROHEA> ALNGWITH CHECKING PROLACTIN
LEVELS, WHAT ELSE TO CHECK> ESTRADIOL/TESTOSTERONE/TSH?
70. THORACIC CORD LEVEL INJURY OR LUMBOSACRAL PLEXUS INJURY?
71. ABO INCOMPATIBILITY> HOST Ab REACT WITH NTIGENS ON DONOR RBCs
72. HYPERCALCEMIA> HYDRATION FIRST.
2004 September:
1.
GuestGuest
RESPIRATORY
1. patient with FEV1 of 1.2 and FVC of 1.4, ask u to interpret
this,results firbrosing ds as
restrictive pattern/ asthma/- COAD as restrictive pattern/- COAD as
obstruction pattern/- fibrosing ds as obstrutctive pattern/2. small cell Ca lung- no metastesis, up to bronchus- treatment
chemotherapy/radiotherapy/surgery/transbronchial laser
3. COPD 70yrs greenish sputum- antibiotic of choiceteichoplanin/cefotaxim/erythro/amoxy
4. malignant mesothelioma- true statementFNAC lead to seedling/Prolonged duration so not mesotheioma/Curable/
5. 16yr recurrent cough with sputum and have DM, sibling died in
child hood b/o lung infection, dignosisCystic fibrosis/Alpha anti trypsin def./Dysmotility cilia syndrome
6. Suspected PE- CXR- basal haze present- diagnostic intestigation
HR CT/VQ scan/D dimmer
7. 16 f c/o dyspnoea, exam going, anxious- dignosis of asthma
considered if
>20% variation in PEFR/dyspnoea improve after exam
8. a question regarding prognosis in some fibrosing alveolitislung fibrosis-prognosis
9. 21 iv drug abuser- chestpain, dyspnoea- b/l cavity at apex on CXRdignosis
tricuspid endocarditis/pulmonary embolism
-?
10. a case of lung carcinoma with EATON LAMBORTVOLTAGE GATED CA CHANNEL AB /Anti-purkinje antibody
INFECTIONS
1. Legiona infection. Dignosisurinary antigen/serum IFA/sputum IFA/sputum culture
2. HIV chap CSF analysis low glc3.3 (serum glc 6.6),
lymphocytic:
cyptococcal mengingitis/tubercular meningitis
3. fever, headache, neck stiffness, multiple cranial nerve palsytubercular meningitis/sunarach hge
4. HIV chap with multiple enhancing lesions , had seizures. Give what
first ?
Steroids /cotrimoxazole
5. TURKISH LADY WITH emaciated, massive spleenomegaly/ hepatomegaly,
treat with what ?
pentavalent antimony /quinine/praziqental
6. a student developed heavy bloody diarrhoea 3 days after visited
the farm. ,possible pathogens? - salmoella/
entamoeba/ CASE OF SHEGILLA?
7-went on a cruise -ABDOMINAL CRAMPS AND BLOODY DIARRHOEAsalmonella/ CAMPYLOBACTER JEJUNI / Na
mono glutameth/
8- a 50 pt with gradually progressive dementia with myoclonic jerkscause- CJ disease/ hiv/ parkinsons/
alzihmers ds
9. protection against Plamodium vivex- which is absent?
Duffy/ Kell/ Rhesus
C5/ C3 / C4
3. 72 yr old lady with pain in L knee. Xray hand stophyte. Limited L
hip flexion. X-ray knee normal. What next ?
MRI of knee/ Arthroscopy of knee/ CT scan etc
4. Lady with whiplash injury 5 yrs ago. Now come with pain in neck,
shoulder unrelieved by 12 cocodamols a day. What next ?
amitryptilline/NSAIDs, physio, etc
5. 16 Girl with features of possibly ??psoriatic arthritis ( swollen
r wrist, l knee, r ankle) with positive ANA 1:60 with ve Rh factor.
What is she at risk of ?
uveitis/Erosive join disease/
6. Girl OD of paracetamol given N acetylcyctine. Developed tachy,
flushing, etc. Why ? igE hypersensitivity
reaction/ disulfiram type reaction/
7. Kid multiple staph infections, cousin died, what imune deficency
Neutrophil def/
8- . weakness plus very high ck- best investigation for diagnosisbiopsy( myositis)
9. young chap with rt hip pain,had left hip back previously, relieved
with NSAIDS- spine movements normal -? sacroilitis/gluteus medius
tendonitis / fracture etc
10. a patient with weakness, joint aches and gritty sensation in
eye,ANA++, RF++ what is the diagnosis?
Primary Sjogeran syndrome/ polymyositis/ reiter's sundrome/
PAN
11-SCLERODERMA RENAL CRISIS with TOD- RX
ORAL CAPTOPRIL /IV NITRO /
12. RESIST PAINFUL ABDUCTIONSUPRASPINATUS/ infraspinatus/
deltoid/ pectoralis major/ teres minor
13.loss of sensation over radial half of palm with paralysis of
abductor pollisus and oppones pollisus- which nerve?
media/ulnar/radial/posterior interosseous
14. positively bifringent crystals- diagnosiscalcium pyrophosphate/ urate/ calcium carbonate/
15. a man with asthma and renal dysfunction- which anti body??
ANCA/ ANA/ antiphospholipid/
16. a man with haemoptysis and renal dysfunction- antibody againstproteinase3/ smooth cell/ dsDNA
17. a boy develop red eye and rhinitis especially during the start of
the summer, what is the likely triggering agent?
Grass pollen/ house mite/ willow pollen/
18. a postmenopausal lady with a family history of osteoporosis, what
is for prevention??
ENDOCRINOLOGY
1. Lady with cirrhosis with post prandial glc of 16. Give what ?
pre-prandial
insulin, metformin, glibenclanide, glicazide etc
2. Man with gynaecomastia secondary to cirrhotic liver disease. What
caused the gynaecomatia ? reduced testoeteron
production , Reduced oestrogen metabolism, increased oestrogen
production, increased testesteron destruction etc
3. Pituitary tumor- which structure will be compressed first3 rd nerve/ optic nerve/ 6th
nerve/hypothalamus
4. boy with bilateral gynaecomastia, what points to hypogonadotrophic
hypogonadism? anosmia/- microphallus/small testes/- - hypospiadius
5. man with IDDM, asymptomatic, on followup- neovascularization on
optic disc- hbalc/bp suboptimal control what treatmentphotocoagulation/ followup after 3 months/ control diabetes/
better bp control
6. 50 lady with signs of hyperparathyroid and gastric ulcers, h.
plylori positive, ulcers not cured even after H. pylori eradication,
diagnosis?
MEN 1/ primary hyperparathyroid
7-BARTER ASSO WITHHYPOKALEMIA / hyperkalemia/ acidosis
GASTROENTEROLOGY
1. Man with 15 years of UC, al LFT, ALT & AST around 60, GGT 250,
bilirubin 15, Allk Phos 700 primary sclerosing
cholangitis/hepatic mets/ cholecystitis
2. a35 female 6 yrs hx for intermittent loose stool and
constipation.....inx normal what action next reassure/
3-H PYLORI MALTH pylori ERADICATION/ surgery
4-ASYMTOMATIC GALL STONESlap cholecystectomy/ ECSW/
OBSERVATION
5-ANTI SMOOTH MUCLE ANTIBODIESDO LFT /
6 60 lady- folte def anemia, fe def anemia, malabsorption-- what
is the diagnosis -CASE OF COELIAC Ds7. ASSOCIATION WITH CHRONIC HEP CPOLYARTERITIS NODOSA /PORPHYRIA CUTANA
TARDA /
8. MARKER- PANCREATIc carcinoma
CA199/ CA 125- / CEA
9. a patient of alcoholic cirrhosis with ascites, and fever, what
next?
Diagnostic tap/ albumin infusion/ blood culture
DERMATOLOGY
1. Man with skin rash on forhead and handporphyria cutanea tarda
2. man with clinical pisture of erythroderma with psoriasis- initial
treatmentoral steroid/ cooling with air/ topical tar/ topical steroid/
topical soft white paraffin
3. 60 yrs lady, venous ulcer on leg, Doppler normal. Appropriate
managementcompression dressing/ leg elevation/ antibiotics
4. man with multiple pustular lesion with crust on head and trunkthe most appropriate in managementIV flucoxacillin/ steroid/ paracetamol
5. a 26 yrs boy presents with recurrent urticatia which last for 20
minutes and subsides it self, what is management?#
non curable/ H2 receptor antagonist/ avoid NSAID
6. a 22 yrs girl develop weezing and flushing of face, what
investigation?
C1 easterase inhibitor level/ patch test with latex/ prick
test with latex/
7. pat. with urticaria after eating chinese dish
peanut allergy, idiopathic
urticaria, monosodium glutamate allery
ONCOLOGY
1. Lesion behind ear after chemotherapy ciclosporin, azathioprin?
squmas cell ca/ basal cell
ca/
2. Unemployed man, smoker with pustular lesion leading to ulcersinus on Right side of cheek. Whats the diagnosis?
Basal
cell ca/ discharging sinus/
3. Lady with breast ca and mets . Severe back pain . Already on
regular cocodamol and diclofenac. Give what next ?
Slow release morphine, Fast release morphine, Sc
morphine, TENS machine
4.70 male hip pain, urinary retaintion, enlarges prostrate- ca-2.8,
psosphate-0.8, alp 2800-, psa 6-------- metastaic
from prostate, multiple myeloma, pagets ds og hip, osteomalasia,
5. cause of hypercalcemia in multiple myelomaosteoclatic activity
increased/ hyperparathyroid/ decrease osteoblastic activity
STATISTICS
1. a trial- 1000 pts-NNT is 20, what does it mean20 lives saved by treating 1000/ 50 lives saved by treating
1000
20 lives saved by treating 100/ 50 lives saved by treating 100
2. a trial- 5 yrs- annual mortality in placebo- 2.4%, treatment 1.2
%, absolute risk reduction over 5 years6%,1.2%, 2.4,16%
3. a trial a q on efficiency a 40 b 10 c 60 d 890
40/50, 40/ 100, 60/950, 60/
890
4. a trial evaluated a relationship between body weight and some
other variable(HT) what is test is used?
Coefficient of linear regression/ log rank test / chi square
test/ student t test.
5. giving two percentage results of a study, ask u to calculate the
one with largest reduction in absolute risk
trial RRR mortality in placebo
1 35 18
2 27 27
3 54 34
4 20 16
5 12 24
GENETICS
1. Pregnant lady with maternal grandfather with haemophila. Risk to
baby 25%/ 12.5%/ 50%
2. NEUROFIBROMATOSIS 1 abnormalityCHR 17
3. SCREENING TEST FOR HAEMOCHROMATOSIS IN FAMILIESDO DNA ANALYSIS / ferritin/ liver biopsy
ETHICS
1.demented woman has to undergo b'scopy for inhaled foreign body, ask
about the consent - need specific assessment/okay if MMSE > 20/30/- should consult psychi/- no need as
intervention is urgent
Answers given here are what I feel is correct, could be otherwise. The questions here may not be 100%
accurate, but will give you some rough idea what sort of qs came Feedback and other questions
recalled welcome.
Q1: Commonest type of endocarditis post valve surgery
A: Staph Epidermidis
Q2: 45 year old man with gram ve cocci meningitis. Which Abx?
A: Cefotaxime
Q3: Drug that could cause Torsade de Pointes
A: Amiodarone
Q4 rug that most likely to keep pt in sinus rhythm post cardiversion for AF
A: Amiodarone
Q5: Adverse effects of cyclosporine
A: Nephrotoxicity
Q6: Overdose of quinine sulphate. Established problem is
A: Blindness
Other answers : Brady, low bp etc
Q7: I think there was 2 questions on non-gonococcal urethritis. Whats the treatment ?
A: Doxyclicline
Q8: 75 year old man, post elective inginal hernia repair, developed swollen ankle. T 37.5C. Takes
diuretics for ?hypertension . What is the diagnosis?
Septic arthritis, gout, pseudogout, reactive synovitis
Q9 : Question on NIPPV. A pt with COPD improved after this invervention. Why ?
Q10: 40 yr old chap with total cholesterol of 20. Fasting Triglyceride of 7. High LDL & Low HDL.
ApoE positive, homozygous. Take alcohol.
A: ?
Likely to get dementia,
abstaining alcohol will reduce trig level,
to treat with fibrates,
to treat with statin.(this one is my answer)
Q11: Girl came in with overdose .Has tachycardia and long QT. What did she take?
A. ?
Amytritillin, Ecstacy etc
Q12: 20 yr old chap. Found unconscious at 3am. High BP, small pupils. What did he take?
A: ?
Chlorpromazine , diazepam , ecstacy etc
Q13 euthz Jagger
A:Autosomal dominant
Q14:Boy with large testicles, maternal uncle has same problem
A:Fragile-X
Q15: Statistics questions. Over period of 5 years- 1000 took placebo , 100 of them had MI. 1000 took
the drugs,80 from this group had MI . What is the yearly risk of MI in placebo.
A: 100/1000 = 10% . 10%/5years = 2% per year
Q16:Statistics question on antibodies in diagnosing DM
A: 890/(890+60)
Q17 Stats question on comparing number of days spent in hospital for man and women post MI
compared to other reasons for admission. The average number of days .
A: Mean.
Other answers given were Median, Mode, SD, SE
Q18: 75 year old man, post elective inginal hernia repair, developed swollen ankle. T 37.5C. Takes
diuretics for ?hypertension . What is the diagnosis?
Septic arthritis, gout, pseudogout, reactive synovitis
Q19: Pt with calcium stones in urine. How to reduce it?
A: Give thiazide diuretics
Q20: Parents with son with CF. Whats the likelihood the next child is a carrier?
A:50%
Q21: Infection that most likely result in complete resolution in CXR
A: Strep pneumoniae.
Other choices of answers were mycobacterium, staph aureus, brucello.
Add more here
All the best.
1.
) a 25 yrs old male healthy presents with preemployment check up cxr pleyral calcification
1-previuos chicken pox
2-silicosis
3-histocytosis x
2) 50 years old man , good past health, admitted for fever , CXR showed consolidation and ABG
showed decrease pO2
what antibiotic :
1) amoxil + erythromycin
2) Co amoxiclav
3) diabetic elderly with isolated systolic HT b.p 188/88. what is the antiHT of first choice.
1) calcium channel blocker
2) B bloker
3) valsartan
4) thiazide diuretic
4) a 78 yrs oldfemale presnets with back pain.examination shows dorsal kyphosis otherwise she looks
well
urea 9 crea 135 esr 12 ca 2.7
1- mmyelma
2-hyperparathyrodism
3-bone metastases
5) patient with mutiple muscle tenderness , diagnosis is fibromyalgia , what is the 1 st choice of
treatment :
1) Naprosyn
2) amitriptyline
3) cognitive behaviour therapy
4) steroid
6) known history of depression under treatment with anti depressant , come to school with snaked and
claimed he can saved the child from suffering, what is the likely diagnosis:
1) hypomania
2) schizophrenia
3) over treatment with antidepressant
4) paedophilia
7) 60 man with symptomatic bradykinesia,clinically suggestive of Parkinsonism ,what is the 1 st choice
of medication :
1) L dopa
2) artane
3) seligilene
4) bromocriptine
5) carbidopa
farmer with paronychia and lymphagitis , present with shock and fever,what is the diagnosis
1) toxic shock syndrome
2) Orf
....
9) HIV + VE CD4 < 50 P/C WITH 3 M HX OF CONFUSION + LT ATAXIA + LT HEMINAMOUS
HEMANOPIA.
CT SCAN LOW ATTENUATION DIFFUSELY BUT NO MASS EFFECTS OR ENHANCEMENT
1- PML
2- TOXOPLAMOSIS
3- CERBERAL LYMPHOMA
4- HIV REALTE DEMENTAIA
-10) in ms which tx can cause diplopia
1- baclofen
2- botium toxin
11) a 65 yrs old male with hx of pyschiatric disorder is being abusive to the nuses what is the best
choice of drug:
1-im chlorpromazine
2-recal diazepam
3-iv medazolom
4-oral halperidol
5-wait psyachatrist
12) 58 yrs old male wh hx of driplling + hesitancy .
alp is very high
ca + phosp arenormal
psa is 5 ttt :
aldrenoate
ehyltest
voltaren
13) MOLE IS EQUIVALENT TO
1- 100 MICROMALE
2- 1000 MILLMOLE
3- 1 MILLIEQUIVALNET MOLE
14) boy with known allergy to bee sting, admitted after bee sting of the cheek , what is the most likely
reaction:
1) anaphylactic shock
2) uticaria rash
3) stridor
4) local redness
15) IV DRUG ABUSER WAS GIVEN HEPATITIS B VACCINATION
HBSAG < 10 LESS THAN N RANGE
HBSAG -VE + HBCAG -VE
ANTIHBC -VE
THIS COULD BE DUE TO
1-HIV + VE
2-CHRONIC HEPATITIS C
3-NATURAL IMMUNIATY TO HEB B
4-PAST INFECTION WITH HEP B
1 A 70 year old woman with established aortic stenosis attends for annual review. Which one of the
following factors is the most important in deciding the timing of surgery? Available marks are shown in
brackets 1 ) Aortic valve gradient of 50 mmHg [0] 2 ) Left ventricular hypertrophy [0] 3 ) Valvular
calcification 4 ) The Patient's symptomatology 5 ) The intensity of the murmur
19) A 70 year old male with a 5 year history of type II diabetes mellitus presents for annual review with
a blood pressure of 188/88 mmHg.
Clinical examination was normal. An ECG reveals evidence of left ventricular hypertrophy.
Which one of the following drugs is the most appropriate treatment for this patients hypertension?
Available marks are shown in brackets
1 ) Atenolol
2 ) Amlodipine
3 ) Bendrofluazide
4 ) Doxazosin
5 ) Valsartan
19) A 32 year old woman presented with a six week history of 7kg weight loss and heat intolerance.
Investigations revealed:
free T4 45 pmol/L (10-22)
TSH <0.05 mU/L (0.5-5)
Which of the following features would support a diagnosis of Graves disease? Available marks are
shown in brackets 1 ) Family history of Radio-iodine treatment [0] 2 ) Lid lag [0] 3 ) Multinodular
goitre [0] 4 ) Pretibial myxoedema [0] 5 ) Unilateral exophthalmos [100]
20) A 29 year old female presents with acute right sided weakness. She has one child aged 4 years and
had two spontaneous abortions in the past. After the birth of her child she developed a DVT and
required three months anticoagulation with warfarin. Examination revealed a right hemiparesis. A CT
head scan showed a left middle cerebral artery territory infarct. What is the most likely finding on
echocardiography? Available marks are shown in brackets 1 ) Arterial septal defect [0] 2 ) Bicuspid
aortic valve [0] 3 ) Left atrial myxoma [0] 4 ) Normal appearances [100] 5 ) Ventricular septal defect
[0]
21)
A clinical investigation examined the effectiveness of a new test for diagnosing Panceatic carcinoma.
The sensitivity was reported as 70%. Which one of the following statements is correct?
Available marks are shown in brackets
1 ) 70% of people will be correctly classified as having or not having the disease [0]
2 ) 70% of people with an abnormal test result will have the disease [100]
3 ) 70% of people with a normal test result will not have the disease [0]
4 ) 70% of people with the disease will have an abnormal test result [0]
5 ) 70% of people with the disease will have a normal test result [0]
22) TETANOUS TOXOID , WHICH IS INVOLVED FISRT:
1- SPLEEN
2- HLA MOLECULES
3- MEMORY CELLS
4- CYTOTOX T CELLS
23) 29 YRS OLD FEMALE PRESENTS WITH PURELNT COUGH ON WAKENING . BMI IS 32
MOST LIKEY CAUSE OF COUGH. NO HX OF ATOPY
1- OSA
2- SINSITIS
3- ASTHMA
4-reflux oesphagitis
24) MOST LIKELY OUTCOME OF WALDENSTORM MACRO IS
1- HYPERVISCOSITY
2- HYPER CA
3- CRF
25) 35 YRS OLD MALE PRESNTS WITH FLUSHING + PALPIATIONS + ABDOMINAL PAIN
AND DIARRHAOE FOR 1 M. HIS PAST MEDICAL HX IS UNREMARAKABLE APART FROM
RECENT ONSET OF ITCHY PAPULAR LESIONS ON THE TRUNKAND PAST PUD. THE MOST
LIKELY TEST THAT WILL REVEAL THE DIAGNOSIS WILL BE:
1-24 URINARY VMA
2-URINARY HIAA
3- URINARY METHLYHISTAMINE
I THINK IT IS 3 SINCE THE MOST LIKELY DIAGNOSIS IS SYTEMIC MASTOCYTOSIS SINE
THE DERMATOLOGICAL CONDTION PRESCRIBED IS MOST LEIKEY TO URTICARI
PIGMENTOSA
26) ANOREXIA NERVOSE PT PRESENTS WITH CRUSTING PAPULAR LESIONS AROUND
THE MOUTH
LIKELY DEFICIENCY IS
1- ZINC
2-NICTIONAMIDE
3- VIT B12
4-PYRODOXINE
5- MG
I THINK IT IS ZINC WHICH IS COMMON IN AN AND CAUSES ALOPECIA + ATOPIC
DERMATITIS
27) 58 yrs old male presnets with odema. 24 h urine proteinuria 12g/l. he fails to responds to
steroids.renal biopsy : LM+ IF NORMAL
MOST LIKELY DIAGNOSIS:
1-MINIMAL CHANGE DISEASE
2-MEN\MBRANOUS GN
3- FSGN
4-MYELOMA
5-PROLIFERTATIVE GN
I THINK TEH NASWER ID MYELOMA [ MYELOMA CAUSES AMYLOIDOSIS WIICH CAUSES
SECONADRY GD PRESNTING WITH NEPHROTIC SYNNDROME MCH IS NOT COMMMON
AT THIS AGE AND 90% WILL RESPOND TO STEROIDS>
2 patient with history of AMI and heart failure , which medication are contraindicated ?
1) bisoprolol
2) labetalol
3) metaprolol
4) sotalol
5) propranolol
29) a child present with sezisure while drilling of his teeth by a dentist, regain consciousness after
admission , also incontinence.
what is the diagnosis :
1) pseudoseizure
2) complex syncope
....
30) mechanical properties of the skin maintained by
Dermis
S.corneum
S.basalis
Dermis
31) 76 yrs old man presents with supraclavicular lymphadenopathy
with cold agglutinin and DAT positive........
answers..
NHL
MYCOPLASMA
31) Post MI CHB.
Artery affected
RCA
32) lady with 2 week hx of intermittent confusion.b.p 190/100
Is it
a) normal pressure hydrocephalus
b) chronic subdural?
c) subarachnoid hge
d) cerebral hge
33) 70 y man treated and under control 4 hypertension. 4 a long time. now is resistant wat is the cause?
a)pheocromo
b)renal artery stenosis
c)cronic renal failure
d)renal cysts
34) 18 years old girl with delayed puberty and altered bowel habit.....with Hb-8.0 and mcv -65 and low
albumin,low calcium ,raised alk.phosph
a)anorexia nervosa
b)crohn disease
c)gluten enteropathy
d)thal intermedia
e)turner's syndrome
35) aman who goes on holidays along with his fam.,returns one month ago and
76)16 yrs a patient developed henoch-schonlein purpura with renal problem...which statement you
should tell the patient
- prone to relapse
-complete remission
- developed to chronic remission
77) which test is the best test to diagnose cushing....
-24 urine cortisol
7 type 1 von willebrand's disease how to mesure activity
- prolonged ptt
- increased bleeding time
factor 8
79) asking about inheritance of vit D resistant rickets - sex- linked dominant
80) biopsy of stomach showed helicobacter bacter and lymphoma
- eradication of hp
81) patient with infective endocarditis with GIT symptoms
-strep bovis , staph...etc
82) a question about X ray which showed collapsed of left lower lobe
-? whats the diagnosis....
- bronchial CA ,
bronchial carcinoid
83)patient who taken some drugs in a party with raised ck
- MDTA,
84) question about NASH
85) the best way of diagnosis DM
- the question gave 50gGTT ....not 75g...don't know whether is a tricky question
86)drug causing oligohydramnios- ace inhibitor
87) theophylline toxicity...best option
8 aids pt with cryptococcus prophylaxis....which drug? i thought oral fluconazole
89) pt on maintanance treatment for ALL....pain in hip...i thought steroid induced avascular necrosis of
femoral head.
90) preg pt with relative with factor v leiden mutation...no personal history of dvt..
.i thought...come to doc when u have pain in legs...no treatment req now.
91).whats the role of the bcr-abl gene anyway? any body ???
93) a patient who developed AF but resistant to amiodarone
- start anticoagulation
DC cardioversion
94) pt with lt arm and both legs symptoms,onxray,outlet foraminia widened at thoracic level
a.neurofibroma
b.meningioma
c.av malformation
95) old man found collapsed at home,urine blood++,protein+++,creatinine 555,ura 54
a.rhabdomyolysis
b..paracetamol poisoning
96) pt had an exposure to coal dust 10 yrs ago,fev1/fev ratio showed restrictive problm
a.copd
b.simple pneumoconiosis
97) old man had taken antibiotic course 4 wks ago,comes with diarrhea,t/m wud b
a metro
b.loperamide
9 26 yr old comes to uk from thailand with headache confusion,which is she least likely to have,keepin
in mind her travel history
a.aids
btyellow fever
c.toxoplasmosis
99) methaemoglobinea (typical presentation and investigations results)
100) pt with frontal lobe syndrome
101) post surgical pt with anuria, treatment?
102) apdk what is investigation?
103) neurofibromatosis, mode of inheritence?
104) dilated cardio mypoathy, what is the drug to be added(frusemide given)
105) indication of thrombolysis- cardiac leads
106) pt with childs criteria c for cirrhosis, what b- blocker is indicated?
107) pt with winging of scapula, brachioradialis weakness...... c5 c6 radiculopathy?
108) insulinoma- investigation- 72 hrs fasting?
109) radio lucent stone
110) acalasia cardia- treatment
111) pepetic ulcer vs chr pancreatitis
112) vaccine to be avoided in hiv
113) pt with heamoptysis with 2 cavities in Lt lower lobe
114) pt with early morning stiffness without weakness- ? pmr
115) pt had a fight with boy freind, attempts sucide with paracetomal and alcohol,........? anybody
remember
116) pt with ms has spaticity of the gluteaus muscle, was given treatment, she develops diplopia- cause
of the diplopia.
117) hiv pt with acid fast baclli onsputum- t.b was not the choice( m. avium
118) pt takes about 40 units of alcohol. his mcv is high, anemia, low platelets, low wbc- ? alcohol
induced
119) young lad with AF, alcohol levels 43- ( life style changes)
120) pt with sob, with rt heart failure, echo showing bi atrial enlargement- diagnosis
121) pt with cml positive for ph chromosome and abr-abl-( tyrosine kinase)
122) pt with aml, to know the prognosis what is the inv( bone marrow karyotypig, age, ldh)
123) DM patient with vomiting and wt loss. what is the drug to prevent(cyclizine, metaclopramide,
hycocine)
124) pt post mI, with non sustained VT- next step in mangement
125) DM pt with cental scotoma.(optic nueritis)
126) pt on heamodialysis comes with fatigue and sob. with low hb, to relive the symptoms(eptoin)
127) question about NASH- they have increase insulin resistance, obese, echogenicity on U/s because
of fatty infiltration.
128) renin secreting cells r located where on the tubules or glomerulus
129) 4severely itchy lesions on elbows and knees responsive to steroids...eczema
130) beta blockers in heart failure- choose which would be the best
131) exudative pleural effusion-mesothelioma
132)wt.loss,diarrhea-Giardiasis
133) anorexia nervosa pt admitted and put on ng feeding,develops altered consciousness,what inv shud
b done
zinc
mg
ca
sugar
134) pt with pyloric obstruction,which abgs do u expect
135) pt with bulmia nervosa,what wud support the diagnosis
is afraid that wont b able to control binge of eating
having bad life with partner
136) surfactant in the lung---phospholipid.,
137) one of the following decreases pul htn---prostacyclin
138) pat. undergone emergency splenectomy what infection
step pneum
h.influenza
t.b
139) predictor of prognosis in small cell ca , hyperca -cavitation
140) pat on cholysteramine what of the following will be affected , vit D given as option
141) pat. with malabsorption what investigation to establish the diagnosis , duodenal biopsy one of the
options, elastase
142) pat on cholysteramine what of the following will be affected , vit D given as option
143) case about gram -ve diploccoci menegitis what treatment, benzylpenicillin
ampicillin
gentamycin
cipro
cfuruxime
144) case about high prolactin what drug, metochlopramide given
145) qs about prion , proteinaceous material
146) 22 yr with minimal nephropathy percentage for recovery, 60-80 ,>80, 50....
147) typical scenario of behcet
148) scenario about primary biliary cirrhosis what investigation , antimitochondrial ab given
149) pat with oesophgitis on lansprosole develop thrombocytopenia, with giant megakaryocytes,
immune thrombocytopenia , amegkaryocytic thromb. drug iduced
150) pat with erythema nodosum & sore throat duration 2 wks investigation to reach diagnosis, ASO
tit. -swab for strep. ......
151) pat with hyperthyroidism on carbmazole developed neutopenia what alternative treatment,
propylthiouracil......
187 recalls(source 1)
1.) Patient with a positive family history of Sudden cardiac death takes methadone and Collapses.
Long QT syndrome
2.) How to measure QT interval - From beginning of Q to the end of T)
3.) CHA2DS2VASc score of a female patient, 65 years, TIA and BP of 140/85. 4
4.) Patient with Atrial fibrillation of about 3 months not controlled on BB. Next line of Care
Add Digoxin. Use of Calcium channel blocker and BB Blocker is discouraged.
5.) Patient with Angina and ST-T changes in v5/v6 Left circumflex artery likely affected
6.) Patient takes cocaine and has signs of toxicity what else to expect in the patient
Cardiac pain
7.) Features of Hypokalaemia on ECG U wave
8.) Examination findings of Tricuspid Regurgitation large V wave
9.) Patient with BB poisoning and symptomatic brdycardia not responding to Atropine. Next
line of care IV glucagon or Transcutaneous Pacing. (Unsure of which)
10.) Poor Prognostic sign in HOCM Spetal thickness greater than 3mm
11.) Mechanism of Action (MOA) of LMWH Anti Factor Xa
12.) Patient with muscle pain while taking anti hypertensive and Simvastatin Simvastatin
13.) Cardiac condition associated with Angiodysplasia Aortic Stenosis
14.) Patient with a family history of Marfans in his sibling who had sudden cardiac death. Best
follow up for cardiac problems Echocardiography
15.) Question about contraindication to pregnancy in a patient with VSD Pulmonary
Hypertension
16.) DVLA rule for a lorry driver who had ICD for ARVD Never drive
17.) Patient with sudden onset weakness of the body, with associated BP difference between
the two arms (Popular answer aortic dissection)
18.) Indication to stop exercise tolerance test BP fall
19.) Treatment of Infective endocarditis with confirmed Strep Viridans as the cause IV
benzyl Penicillin and Gentamycin
20.) Patient has 3 episodes of Palpitation in a week with no significant finding on examination
Patient activated ECG recorder.
21.) Acute exacerbation of ABPA with features of Lung Collapse. Whats the next best line of
management Oral Steriods or Nebulised saline. (Unsure)
22.) Patient with features in keeping with Pulmonary Embolism presents 2days after onset of
symptoms. What investigation result will be in keeping with the diagnosis - Normal Chest
xray
23.) Patient with primary pneumothorax about 3.5mm from the chest wall. Aspiration
24.) Patient with TB. Which feature would indicate patient being nursed in isolation - Smear
Positive TB
25.) Patient with SLE has increased TLco Alveolar Haemorrhage
26.) Patient with acute exacerbation of COPD who had been nebulized and given oxygen for
2hours. However patient not getting relieved with SaO2 = 90%, PC02 of the patient at 2hours
was 7.0Kpa. Whats the next best line of Management: Non Invasive ventilation or Increase O2
or leave patient.
27.) 28year old male non smoker presents with tumour in the upper lung zone and
haemoptysis Bronchial Carcinoid
28.) Patient diagnosed with Motor Neuron Disease presents with 2 month history of increasing
difficulty in breathing which has made the patient to be sleeping in his chair. Patient also
complains of early Morningheadaches and excessive daytime sleepiness. He is also a smoker
about 10sticks per day .On examination, patient had bilateral crackles and wheeze. Cant remb
the values that were given.. Likely cause of the breathing difficulty. COPD or Respiratory
Muscle paralysis or Chronic Aspiration or Pulmonary Oedema.
29.) Patient with Upper airway Obstruction Flow Volume loop
30.) Patient with HNPCC and MSH1 mutation, daughter is at increased risk of uterine
Tumour
31.) First line diuretic in a patient with ascites Spironolactone
32.) Patient with An adenoma who presented for routine CA colon screen programme and was
observed to have a focus of Carcinoma. Whats the likely genetic cause APC mutation
33.) Patient treated with antibiotics 6weeks ago presents with abdominal pain and bloody
diarhoea Pseudomembranous Colitis or ischaemic Colitis
34.) Measure of Bile acide Malabsorption SeHCAT
35.) Features of Chronic Hepatitis B virus
36.) Gilberts Syndrome
37.) Patient with features of Coeliac Disease Anti endomysial Antibody
38.) Patient with upper GI bleeding with features of shock. Next best line of care IV
saline
39.) Pathophysiology of Hepatorenal Syndrome Splanchnic vasodialation
40.) How to differentiate between Upper GI bleeding and Lower GI bleeding High Urea
41.) 65 year old Patient with iron deficiency anaemia. Next line of action Colonoscopy
42.) Histology features of Ulcerative colitis
43.) Patient with right iliac fossa mass, not guarding. Next best line of investigation. CT
abdomen or small bowel enema
44.) Patient with Positive AMA and negative ANA with Raynolds. Next line of
investigation Popular answer is Liver function test. Cant remember the other options
45.) Apart from Potassium, which other ion to monitor in Refeeding syndrome Phosphate
23.) 44 year old male Patient with Obstructive sleep apnoea. BMI was 28. Management.
Continuous positive Pressure ventilation. Other options included Mandibullar advancement
devices and weight Loss
24.) Classical features of Normal Pressure Hydrocephalus
25.) Elderly patient with Pneumonia and Myasthenia gravis. Which drug will worsen
myasthenia gravis in this patient? Clindamycin or Doxyclycline or levofloxacin or
Ceftriaxone
26.) Elderly Patient with restlessness and agitation following UTI and patient is already on
Trimetroprim, next line of action haloperidol
27.) Patient with 5 episodes of gradually loss of vision on the left which usually starts in the
center and spreads to the periphery in 10 minutes and resolves in 30minutes. Carotid TIA
other options included Occipital Seizures
28.) Chronic alcoholic presents with confusion nystagmus and increasing agitation. RBS was
2.8mmol/l. Next line of action. Thiamine or IV glucose (5% glucose or 50% glucose)
29.) 80 year old man with intracerebral hemorrhage Likely cause amyloid angiopathy
30.) Site of action of Ondasetron Medulla Oblongata
31.) Patient with Lithium and currently on NSAIDS presents with lithium toxicity
32.) Right handed patient presents with right Parietal bleed and is unable to read. What is the
cause of patients inability to read? Visual Inattention
33.) 54 year old Patient presents with features of Parkinsons and dementia over a period of
8months. On examination. Patient had Cogwheel rigidity and appeared to exaggerated
movements. What is the likely diagnosis? Options included Parkinsons, Neuroacanthosis,
Lewy Body Dementia
34.) Patient presents with bilateral ptosis and weakness of the hip and shoulder girdles. O/E
patient had Bilateral Ptosis and Bilateral facial nerve weakness. Options included Myasthenia
Gravis and Myotonic dystrophy
35.) Elderly Patient with UTI on trimetroprim had about 2 falls within 12 hours of admission.
Next best line of action ? Transfer to a well lit room. Other options included Haloperidol
36.) Elderly woman with detrusor overactivity Trospium
37.) Patient with Cataplexy
38.) Elderly patient complains that food doesnt really appeal to him anymore. What is the
explanation for this complaint? Reduced Gastric Emptying or reduced Metabolic rate or
reduced sensitivity of the taste buds
39.) Chronic alcoholic Patient with auditory hallucination after a binge of alcohol about 2
weeks ago and has progressively worsened over the last 2 weeks. Alcoholic hallucinosis .
other options included paranoid schizpophrenia
40.) 27 year old male unemployed regular cannabis user presents with self harm. What is the
most consistent risk for suicide in this patient. Cannabis use or history of self harm or
unemployment
41.) 32 year old woman presents to you saying she thinks she had picked up an MRSA during
a hospital visit about 6months earlier. Patient had presented twice on account of the same
thoughts and had be investigated this twice but unconvinced despite a negative MRSA
investiagation. Likely diagnosis. Obsession or Delusion
42.) Funstion of P53 Cell cycle regulation
43.) 19 year old with Nephrotic syndrome Focal segmental Glomerulosclerosis or
minimal Change.
44.) Ig invoved in Dermatitis Herpetiformis IgA
45.) Mediator involved in Herediatary Angioedema Bradykinin (other option included C1
esterase but that is not the mediator)
46.) Patient on amlodipine and Perindropril has occasional facial puffiness. Likely cause?Perindropril more likely as Amlodipine is more of Paedal Oedema
47.) Complement Depleted in Cryoglobulinaemia C4
48.) Hypercalcaemic Diuretic Thiazide