MRCP-2 RECALLS, April 2013 HAEMO: 1. Malaena, on warfarin. Low plt, inr 8.4 , vit k givennxt..

Prothrombincomplex 2- Blood grouping scenarioantigen-antibody panel was given 3. prognosis of multiple myeloma >>> b2 microglobulin 4-Polycythemia rubra 5-Autoimmune haemolytic anaemianxt invDAT 6-54 yrs f with poscoital bleed, lethargy, with renal impairment, what next best investigation, ? Transvaginal ultrasound? 7-one q pt with bleeding and his father had bleed>>>w.v.b 8-VLaidn.-Loss of vision, previous episode, Fh of pulmonary embolism, normal APTT, positive ANCA. Factor v liden? Cardiolepin? 9-ttt of hodjikin lymphoma>>>combine chemotherapy. Red cell aplasia remove thymoma ????? 10-leukoerythroblastic pic on p,film..cause? 11-anemia of chr disease 11-Cholangiocarcinoma 13. Oral vitamin k for patient on warfarin with heigh INR but asymptomatic 14-Vit C deficiency case.old,poor diet, ecchymoses,gum bleed 15-Plasmapheresis..waldenstroms syndrome 16-Acquired Haemophilia 17- Gentleman on warfarin having intermittent haematuria, was polycythaemic and had normal renal USS Inv..PNH. 18-Post Femoral Bypass.??low BP..Cause Haemorhage Vs Other options?????? 19-Aptt prolong causeWhich drugs?????? 20-A case of Hsp purpura with rash, platelets not given 21-another qestion about multiple myeloma 21- fever in patient presented one week after getting back from trip to africa have Blister cells and henz bodies in blood film ( G6PD ) and fever and generalized abdominal pain and tenderness he took malaria prophylaxis only during the trip Dermatology 1. Doxycycline induced photosensitivity vs PCT..Different/same Qs. porphyria cutanea tarda for rash and evidence of scaring from previous sun exposure rash 2. Steroid first treatment for skin lesion Pemphigoid 3. Erythema multiform for patient changed treatment by adding allopurinol (DRESS)+ Interstitial Nephritis. 4. psoriasis for Picture of elbow .Calcipetriol 5. Pemphigoidimage vs Staphlococcal scalded skin..Same/Different Qs Fever,sorethro at-Necrosis dermo epidermal Junction 6-Pyogenic Granuloma.Image 7-Extensive hand Papillomas image Tx-Danthrol vs Cryotherapy. 8- Sq CC vs Basal CCImage ..half black 9-Kerato canthoma image ..Rx? 10-TEN scenario (toxic epidermolysis necrosis) 11- c1 defecieny in angioedema and family history 12-MycoplasmaErythema Multiform image infectious diseases 1. Milliary TB in one of the X rays 2. leptospirosis for farmer with hepatitis and other features 3. blood culture for female diabetic with fever and picture lower leg cellulitis 4- brucellosis for thoracic distructed spine picture in patient with fever and trip to rural area and eating unpasteurized diary products Asian lady TB.same/different Qs 5-flucloxacillin for skin staphylococcal infection MRSATeicoplanin/Tazocin..same/different Qs 6-Erythrovirus(Parvovirus).Lady.pregnant?......Plyarthralgia, fever, slapd cheek 7-Bartholin cyst..G-ve diplococcicTxCefixime. 8-infected venous UlcerGreen culture.Dx/Tx 9-TB +,Galactomann positve+,Pneumonia+AscitiesWhat asked? gentleman with ascites and pneumonia not responding to cipro . ATT / itraconazole ??? 10-Patient homeless, oral candidasis, fever, night sweats,wt loss-TB/others.next inv.HIV ab/INF gama etc..?

11-URTI..Influenza.myalgia 12-Hydrogen breath test..young man with IBD s/s of bacterial overgrowth 13-CMV infection in the azathioprine patient 14-CVL C/S---Stap epidermidis 15-shistosomiasis 16-Leishmaniasis.one Q like visceral Leishmania?? 17-Lyme disease 18-A case of Ch.cryptosporidium stool culture.Tx??? 19-Shocked febrile patient with some lose stool E coli versus staph aurius(staph toxic shock)Mild GE with marked instability 20- Capsacin cream/acyclovir/etc for patient with herpes zoster Cardiology 1. iliac atherosclerosis in patient with gluteal muscle exertional pain 2. case of statin induced myopathy 3. infero posterior infarction in ECG picture 4. Lisinopril cause of Facial edema 5. Risk factor of sudden death in HOCM Hypertrophic cardiomyopathy: management, risk stratification, and prevention of sudden death 6. Infective endocarditis for drug abuser ..staph aureus 7. iboprofen for treatment of acute pericarditis in young pt and chest pain patient with chest pain with echo findings of pericardial effusion 1cm..? Pericardiocentesis, ibuprofen 8. Echo study for patient with symptoms of aortic stenosis and ECG show LVH 9. Eplerenone should be added to patient with heart failure 10. severe left ventricular dysfunction.QRS.160,EF 28% Cardiac resynchronization 11. alcoholic cardiomyopathy 12. infective endocarditis MRSA infection not responding to flucloxaccilin 13. reassurance for BIGEMINI ECG image.anxious young lady 14. cholesterol embolisim picture 15. One case with restrictive cardiomyopathy..Next inv.. Mri of heart etc? 16-ECG.Atrial flutter 17-ECG-+LBBB/RBBB+AF 18-Scleroderma renal crisis + Accelerated HTN mixed scenario..Tx.Captopril 19-SOB,MR,Basal cackles,Renal involvement.Inv/DxEccho/Endocarditis1st Q..3rd Paper. 20-DDDR pace maker for ???Dont remember scenario?? Patient with pacemaker but had episode of blackout >>pacemaker adjustement/DDDR 21-Post MI, Post pacemakerSOB,Shock,pericardial effusion 22-One with vague two episodes of VT..ICD 23-25 lady with only pan systolic murmur 3rd lt parasternal no radiation s1s2 ECG CXR mvp,vsd 24-.post tibial and dorsalis pedis art not palpable---atherosclo of femo-popolt art 25-eissmnger synd--embolic stroke/thombus 26-post mi depressionsertaline 27-intermittent claudication --->?????spinal stenosis his ABPI was normal 28-Young patient with a fib previous electric cardio conversion 1 yr ago, represents with afib, what's the next best treatment? 29-postraumatic chest pain,xray clear=ecg.RBBB pattern v1-2 with t wave inversion=?.....cardiac contusion.Tx 30-cardiac tamponade after surgical procedure>>>to do echo 31-Cholesterol Embolization in patient post cardiac cath. Dyspnea and lower limb rash 32-Patient with AF on warfarin and targeted INR>>continue same ttt 33. AF-treated with digoxin,HR improved. still sob and discomfort what next Digoxinetc..complete digitalization 34. Ambulatory Bp monitoring for man was always having high Bp when he visited the GP (white Coat HTN) Respiratory 1- post breast cancer surgery developed severe dyspnea and tachypnea and picture show opacification e.g hemithorax

/Collapse? 2. Bronchiectasis shown in Ct scan of chest and case of cough and sputum production 3. Add teicoplanin for ICU patient with pneumonia unresponsive to meronim alone,,,,, Pseudomonas pneumonia on ventilatornext tx? 4. Intubation and ventilation for Patient with respiratory failure and COPD exacerbation.patient is collapsing,GCS low 6. Ligionalla antigen for patient with pneumonia came from Spain 7. COPD most important cause of dyspnea in a smoker with asbestosis ,. X Ray image.asbestosis+COPD mix.cause of SOB?????? x ray pctur of asbestosis but spirometry obstructive??? 8. Osltamivir for treatment of influenza 9. Diaphragmatic weakness for patient with supine reduced respiratory function 10. lung ca pt refuse rx--palliative radio 11. eosinophilic pneumonia or hypersensitivity pneumonitis in patient worked in soil and had high eosinophil more than 3 12. post irradiation pneumonitis in patien with dyspna post irradiation 13-severe pnemonia was augmentin and clarithro 14-Scenario of Mesothelioma.Pleural fluid drained,analysed..Next step??????? Lung caNxt CT.same or dif Q 15-Pneumothoraxdont remember the scenario???.....Tx..aspiration/drain 16- 19-Increased KCOPleural thickening 17-PFTs -Cryptogenic fibrosing alveolitis with restrictive defect and lw KCO -Pleural thickening with restrictive with KCO increase 18-Flow-Vol loop image.Dx??? 19-AspergillosisCT/X Rayopacity with surrounded by hyper intense sh adow 20-asthma,real impirement,eosinophiliaChurg Straus syndrome 21-Sarcoidosis scenario+XRay..supporting invest..ACE Transbronchial lung biopsy 22-Chilli exposureSOB..Reactive airway? 23-pt after bronchodilator fev1/fev improved---improvement was <15% diagnosis?boop v/s asthma and other options 24-PETypical scenario.increase RR,Resp Alk,ECg supporting 25-Lights criteria pleural effusions. parapneomonic pneumonia vs Empyema 26-Patient with pulmonary HTN,Limb edema and COPD>>oxygen therapy/bosentan 27-pt on some carcinoma tx VQ scan normalwht to do next? 28- PFTs for hamburger eating man developed inspiratory and expiratory wheezing.Large airway obstruction investigation? 29. Patient with pulmonary fibrosis, no ground glass shadowing- treatment was Observation Nephrology 1. Cefotaxime/Augmn for uti and renal angle pain and tenderness in pregnant lady 2. Continue peritoneal dialysis and give intra peritoneal AB for peritonitis pt 3. Fibro muscular dysplasia for picture of renal Angio 4. The 19 y boy with minimal change most likely to recover 5. HUS case 6-Interstitial Nephritis..?????2-3 Qs 7-Crescenteric GN 8-IGA nephropathy.. 9-features of facial lipodystrophy with GN ans-?? low c4 10-cause of hus--e.coli 11-RA membranous GN 12-.pt on icu on adrenaline inf,developed renal impairement----ATN/Cortical necrosis due to Shock/ adrenaline inf 13. chronic renal failure.symptomatic anemia give erythropoietin /transfusion GIT and Liver 1. Iv omprazol for locally treated bleeding vessel in ulcer base to reduce re bleeding risk 2. Picture of barrette esophagus 3. Hepatic vein thrombosis in patient with acute abdominal distention and tender hepatomegaly 4. Liver biopsy to diagnose heamocromatosis in patient ith secondary hypogonsdisim 5. Most important indicator for liver transplantation is bilirubin level /etc

6. Peglated interferon and ribavirin for hepatitis c treatment 7. TB peritonitis for ascetic tab with protein 40 and wcc 250 lymphocyte 8. Barium swallow picture achalasia cardia 9. Giardiasis for mal absorbtion with episodic bloating 10. Check phosphate for re feeding syndrome 11-Old lady,LIF pain,Constipation and dirrhoea..Diverticulosis-Ispaghola 12-Scenario of Pancreatitis+ Pleural effusion+X Ray 13-PAN scenario with mesenteric ischemia..Dx..PAN 14-Terlipressin. 15-Young man with sliding hiatus hernia, mgt? Nissens fundop/ ppi 16-Patient with ascites ca125 raised, known liver cirrhosis, nodular change in liver- ascites caused by.? Ovarian ca/ HCC 17-SBP 18-diverticulitis 19-Pt having melena past h/o aortic surgery 7 years +duodonal surgery for ulcer 12 ys===wt will be investigation UGI endoscopy colonoscopy /ct scan ??...Aorto enteric fistula 20-Vipoma, profuse diarrhoea , daily stools<200, 4days 21-intestinal psuedoobstruction 22-chron's on steriod with hypocalcemia ,hypokalemia and hypoalbumenemia>>>illeocolonic fistula? 23-A question about patient after carcinoid biopsy became unwell ? Cause 24-one q about chrons disease with sever malabsorption wt nxt inv? 25. Old lady with diarrhoea watery,on omeprazole-microscopic colitis 26. Patent with clostridia difficille and recovered after flagyl then relapse of dhearrea what investigation to do not repeat stool? Reumatology 1. Giant cell arteritis 2. in bone scan picture/Metastasis / Osteomyelitis 3. Reactive arthritis for patient with planter rash and other compatible presentation 4. Ankylosing spondylitis for bamboo spine picture 5-X-Ray showing disc calcification..Pseudogout.Haemochromatosis. 6-Osteomylitis cause- Salmonella 7-McArdle 8-Osteonecrosis of Jaw.InvXRay TMJ/Orthopantography?? 9-image of Muscle biopsy???What?? 10-T-ScoreOsteoporosisAlendronate 11-House bound.osteomalacia scenario 12-Paget disease scenario.pain Tx.Pamidronate. 13-weg granulo 14-RA.hand image?? 15-DQ Tenosynovitis 16-Post op osteomyelitis , next best investigationMRI 17-A question on Bechest with oral and genetial ulcers 18-i think Becker muscular dystrophy was another quetion?? 19--one q about pt was taking goserlin then devoloped infertility and something else wht was management>>> 20. Picture of left hip and also left upper leg-air seen in the leg xray, question is immediate next plan- surgery 21- Anti jo antibodies for dermatomyositis and lung involvement lady wid facial rash , proximal myopathy and bilateral crackles?? Endocrinology and diabetes 1. radio iodine/sub total thy therapy as definitive treatment of toxic adenoma 2. neomercazole for pregnant hyperthyroid patient 3.TFTs after amidarone use 4. sub acute thyroiditis in patient with mild thyrotoxicosis and neck pain and raised ESR 5. dislocated lens in picture in Homocysteinuria 6. kalman syndrome .Tall, Hypogonadotrophic hypogonadisim

7. Steroid intial treatment for pituitary failure & Adison??.....2Qs 8. Pseudohyparathyroidism in Boy with short stature and his little brother had short stature raised PTH 9. Pamidronate give to patient with hypercalcimia after normal saline 10. Add ramipril for patient with diabetes to improve prognosis 11. observation after stoping tegretol for asymptomatic hyponatrimia 12. metoclopramide for patient with diabetes and gastroparisis 13. one question regarding growth hormone continuation in achild answer was -- wrist xray /insulin tolerance test.same/different Qs 14-Na 124..Tx..Fluid restrict/+lasix/Hypertonic etc 15-Foam Cells.Gaucher Dis 16-Hyponatremia ?? Cause >>trigleceride or hypothyroidism? 17-Renin aldosteron ratio 18-Diabetic amyotrophy 19-Hypothalamic cause of amenorrhea I think in one of the question 20-one question asking cause of hyperkamaemia in a diabetic pt ..hyoranin hypoaldo(Type IV RTA) 21-women with nipple discharge..PRL-1400---microprl/Drugs 22-.pt on liqour but low renin,high aldPseudohypoaldo 23-microprolactinoma 24-one question pt htn with hypercalcemia and history of family thyroid cancer >> pheocromocytoma as part of men 2 25-Patient with growth hormone deficiency post head surgery>>insulin tolerance test 26=Cause of high ALP>>hyperparathyroidism?? 27-Patient with hypercalcemia and gastric upset>>>primary hyperparathyroidism Neurology 1. Streptococcus pneumoniae is the causative organism for meningitis in patient with sore throat 2. sub arachnoid hemorrhage in brain CT picture 3. cavernous sinus thrombosis in a case with orbital swelling and related cranial nerves palsies 4. branched retinal artery occlusion in patient with visual field defect and supporting picture 5. in case of occipital headache and compatible presentation basilar artery dissection / Cerebellar Haemorhage 6. intracerebral hemorrhage CT image 7. lewy body dementia 8. case of inclusion body myositis 9. multiple system atrophy in first paper 10. multiple system atrophy in third paper 11. intermitint urinary self catheterization for patient with bladder symptoms without UTI but residual volume of 200 cc in patient with multiple sclerosis 12. pituitary macro adenoma in mri picture 13. Restricted visual field in retinitis pigmentosa shown in picture 14. Acyclovir for patient with refractive error and contact lens and branched cor neal lesion .dendritic ulcer 15. Intact sleep wake cycle for patient with vegetative state 16. Bells palsy for patient with enhanced hearing in affected side 17. Water restriction for psycatric patient with bazaar water drinking and hyponatrimia 18. Delirium terminus for heavy alcohol drinker after few days of hospital admition 19. serotonin syndrome for the guy who has been started on Citalpram 20. Succide planning risk factor for future completed suicide In patient with History of suicidal attempt 21. Post traumatic seizure.head injury one year back and seizure 23-Anton type picture.Bilateral occipital infarction/ Charles Bonnet syndrome. marked diminised vison with hallucination 24-Basillar Migraine with sensory aura Female patient year developed episodes of by tingling sensation down her hand and face for few minutes then left with headache.? 25-JM Epilepsy..TxValproate 26-psychotic patientgiven Haloperidol,bcame akinetic muteTx..Dantroline/Bromocriptine 27-Old lady, falls fluctuating confusion..SD Hematoma 28-Dense stroke vs resolving TIA, already taking warfarin..??Propylaxis.Dipyridamol vs Clopidogrel

29- Bilateral super QuadrantanopiaPitut.Tumor 30- Propranolol for Benign Essential Tremor. 31-pneumococcal Meningitis..URTI+Otitis Media+Meningism 32-Fronto temporal demold man start internet shopping and using prostitutes. 33-Regional nerve block for pain management for some onco case,What? 34-Normal pressure Hydroceph 35-Optic neuritis vs BIHtn 36-.pt with spinal injury on suprapubic cath,,physician removed and put foly's cath..developed syncope----autonomic dysreflexia 37. Most common eye involvement in rheumatoid arthritis KC sicca 38. Patient cannot sleep, sleepwalking, narcolepsy/etc 39-one q headache and signs of cerebral edema wt to use>>>steroid or mannitol? Thera & Toxicology: 1-Iron overdose..Tratment? Desferoxamine 2-Which antiparkisonian drug leads to Eating disorder. Side effects of ropinrole 3-Causing PancreatitisPPl say Valproate..Azathiprine is correct.Not clear was it an option 4-Dexa decreased..some problem,fatigueincrease dexa 5-One patient with deranged lfts after starting azathiprine-aza toxicity/ terbinafin causing increase LFT 6-Patient with antidepressant medication stopped.-symptomatic.?withdrawal.next plan of treatment.? restart medication., ?give diazepam? 7-pt dnt want to tke anti parkins rx---Levodopawhat alternative?? 8-Post 1 yr renal transplant decreased renal functions, asymptotic , acute rejection/cyclosporine 9-co-amox--obst jaund 10-TCa overdose: IV bicarb