MRCP-1 RECALL- JAN-2014

CARDIOLOGY
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1. Drug that decreases mortality post-MI= Valsartan

2. Malignant HTN that is not controlled by oral
verapamil and bisoprolol, what next= i/v labetalol
3. Long apical diastolic murmur with pansystolic
murmur, atria dilated with permanent AF and
crackles in lungs, Dx= mitral stenosis?
4. 75 years man with high B.P has AF, Rx= warfarin
5. Patient with stroke alredy taking aspirin ,what next=
add dipyridamole
6. Cardiac
anomaly
with
pulmonary
HTN,
contraindication for surgery= pulmonary HTN
7. 2nd MI in a week , which test= ckmb

8. Canon waves= complete heart block

9. 25-30% carotid artery stenosis in a patient taking
aspirin, what next= continue aspirin?
10. VF, shock at 200, then 360..no improvement ,
what next=amidarone
11. Diference between cardiogenic edema and
ARDS= increase protein in fluid in ARDS
12. Cardiac effusion contain blood, characteristic
finding= increase JVP on inspiration
13. Patient taking warfarin presented with DVT,
what next= increase INR to 3.5+/-0.5?
14. Test of choice in HOCM= TTE
15. Most common finding in ECG of P.Emboli=
Tachycardia
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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

intervention
next=
terlipressin/transfuse
blood/endoscopy?
9. Patient being transfused twice weekly , now
develops anaphylactic reaction , cause=GVHD
10. Increase cret, anaemia, thrombocytopenia,
fever and confusion, Dx=TTP
11. CD20= Rituximab
12. Non-Hodgkins= EBV
13. Waldenstorms=Hyperviscosity syndrome
14. Factor 5 leiden= activated protein C resistance
15. Dx of Hypercalcemia of Malignancy
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PHARMACOLOGY
1. Digoxin prescribed to old age patient= volume of
distribution increases

2. INH acts on liver enzyme= Cyp3A4-p450

3. Patient on lithium treatment , Tfts are normal,
when to repeat test= 6 months
4. Clinical
presentation
of
steven-johnsons
syndrome was given, and the patient has known
epilepsy, cause= limotrigine
5. Contact prophlaxis of meningococcal meningitis=
single dose of ciprofloxacin/ 2 days on rifampicin?
6. SIADH cause = bendroflumethiazide
7. Diazepam and dosulpin overdosed, Rx= sodium
bicarb
8. Paracetamol overdosed, cause= alcoholic
9. Obese with T2DM, cret is 150, drug of choice=
pioglitazone
10. Patient taking morphine 75mg b.d, what to
prescribe for breakthrough pains= morphine elixir
11. Patient prescribed allupurinol 1 week ago
presented with pain in multiple joints now ,
cause= allupurinol
12. Patient presented with red eye was started on
cholaramphenicol eyedrops, now presents with
swelling of lid and erythema, cause= allergy to
chloramphenicol

13. Cocaine intoxication presentation= persistant

chest pain
14. Dx of amphetamine induced psychosis
15. Patient with rheumatoid arthritis being treated
with MTX and Sulfasalazine with no improvemt,
what next= etanercept/rituximab?
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CLINICAL/BASIC SCIENCES

1. Cause of increased anion gap= methanol

poisoning
2. Respiratory alkalosis with po2=32, dx=
psychological hyperventilation
3. CVID
association
with
infections=
meningococcal?

4. SIADH feature from scenario= urinary sodium of

60
5. Cystic fibrosis carrier rate?, mother had it and
also one other family member had it = 1 in 25?
6. X-linked disease in a child, cause? = maternal
grandfather
7. Breast adenoma, size 3cm, not movable!, which
stage of cell cycle is this= G1?
8. Centromere covene at the centre in = metaphase
9. Refeeding syndrome= hypophosphatemia
10.
Protein=western blot
11.
Dx of L4 radiculopathy
12.
Negative result when not diseased=
specificity
13.
Calculate specificity=40%
14.
Compare proportions= chi-square test
15.
Swaping and cross over in a study , = paired
t-test
16.
Rheumatoid arthritis= TNF-alpha
17.
NF-1= chr.17
18.
Use of PCR= cytogenetics/ protein
conformation?
19.
Liqorice=hypokalemia

20.
Rheumatoid arthritis= b-lymphocytes
21.
Gastric adenocarcinoma= signet ring cells
22.
Index finger flexion= flexor carpi
23.
Surfactant= type-2 pneumocytes
24.
Forearm pain, worse on extention , can not
use the pen= lateral epicondylitis
25.
Cd20= rituximab
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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

4. Ileostomy site ulceration, dx= Pyoderma

Gangrenosum
5. There was a question relating recurrent cellulites.
6. Extensive psoriasis, dry scaly skin , ist line
treatment= emoliants
7. Dx of hand, foot and mouth disease
8. Dermatitis herpetiformis , test to diagnose=
direct immunoflorescence of skin
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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

4. Cushings , test to Dx= Oral DST

5. Early morn sweating, with one such episode ,
blood glucose was 4, gets well with sugar diet,
Dx= Insulinoma
6. Pancreatic insufficiency, how to control diarrhea=
octreotide/pancreatin?
7. Patient taking quitepine has amenorrhea but not
galactorhea, cause?
8. Dx of Kallmans ( both FSH AND LH were low)
9. PKD, test ?= U/S abdomen
10. Adrenal mass, it was either pheocromocytoma
or primary hyperaldosteronism? They have asked
for Test to diagnose= urinary metanephrines/
ald-renin ratio! ( I opted for primary
hyperaldosteronism, which may be wrong )
11. True about thyroxine= increase gluconeogenesis
12. Retoncogene asosiation= medullary throid
cancer
13. Dx of acromegally= GTT and GH measurements

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GASTROENTEROLOGY

1. Bilirubin got raised after 1 week of starting coamoxiclav, cause= co-amoxiclave/ gilberts?
2. Dx a case of Achalasia ,and they asked for test of
choice= oesophageal manometry
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

9. Best test to Dx Giardiasis= Small bowel biopsy

10. Hx of bloody diarrhea after 1 week return from
travel= entameaba histolytica
11. Dx of Celiac disease ( vit-b12 was normal, Rbc
folate was low)
12. Contraindication of liver biopsy= dilatation of
bile ducts
13. Damage to liver= prothrombin time
14. Question relating MRCP ( Magnetic Resonance
Cholangi-Pancreatography)
15. Dx of pernicious anaema ( there was
autoimmune hepatitis, vitiligo and hemolysis).
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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
4. Dx of leishmaniasis
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)
10. Scenario of PCP, what is suggestive of Dx=
exercise desaturation
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= streptpneumonie

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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
6. IgA nephropathy poor prognosis= HTN
7. Comon with type-1 RTA= nephrocalcinosis
8. Recurrent UTI`s= Reflux nephropathy

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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NEUROLOGY AND OPHTHALMOLOGY

1. Essential tremor with head titubation Rx=

propanolol
2. Dx of multiple system atrophy
3. Parkinsonism characteristic= asymmetry of
tremor
4. Dx of cluster headache

5. Status epilepticus Rx= Lorazepam

6. Memory loss, personality and speech affected,
area involved= frontal lobe
7. Weber syndrome , site involved=midbrain
8. Possible Dx of perinauds, site of lesion= dorsal
midbrain
9. Hemi sensory loss from head to toe, area
involved= thalamus
10. Sub acute combined degeneration involves=
dorsal column
11. Syringomylia= prick sensation lost in arm
12. Dx of conus-medullaris syndrome
13. Dx of Fascio-scapulo-humeral dystrophy
14. GBS, respiratory monitoring = Vital capacity
15. Schwanoma= corneal reflex lost on same side
16. Dx of poliomyelitis
17. Bulbar palsy= small arteries hyalinosis
18. What is underlying cause of CRVO from the
given scenario= Glaucoma ( increased IOP )
19. Immediate referral= neovascularization on
retina
20. Dx of ischemic optic neuritis

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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
7. PCP scenario, O2 sat was less than 9, Rx= steroids
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
5. dermatomyosities= anti-jo

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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