MRCP May 2016 recalls

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:

Enthesopathy or enthesitis, reflecting inflammation at tendon or ligament insertions into bone,

is observed more often at the attachment of the Achilles tendon and the plantar fascia to the calcaneus
with the development of insertional spurs
Dactylitis with sausage digits is seen in as many as 35% of patients
Skin lesions include scaly, erythematous plaques; guttate lesions; lakes of pus; and
erythroderma

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:

Asymmetrical oligoarticular arthritis

Symmetrical polyarthritis
Distal interphalangeal arthropathy
Arthritis mutilans
Spondylitis with or without sacroiliitis
See Clinical Presentation for more detail.
Diagnosis
Classification of psoriatic arthritis
The Classification Criteria for Psoriatic Arthritis (CASPAR)[1] consist of established inflammatory
articular disease with at least 3 points from the following features:

Current psoriasis (assigned a score of 2)

A history of psoriasis (in the absence of current psoriasis; assigned a score of 1)
A family history of psoriasis (in the absence of current psoriasis and history of psoriasis;
assigned a score of 1)
Dactylitis (assigned a score of 1)
Juxta-articular new-bone formation (assigned a score of 1)
RF negativity (assigned a score of 1)
Nail dystrophy (assigned a score of 1)
Laboratory findings

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:

Pencil-in-cup deformity (seen in the image below)

Arthritis mutilans (ie, "pencilin-cup" deformities).

Joint-space narrowing in the interphalangeal joints, possibly with ankylosis
Increased joint space in the interphalangeal joints as a result of destruction
Fluffy periostitis
Bilateral, asymmetrical, fusiform soft-tissue swelling
Unilateral or symmetrical sacroiliitis
Large, nonmarginal, unilateral, asymmetrical syndesmophytes (intervertebral bony bridges,
seen in the image below) in the cervical, thoracic, and lumbar spine, often sparing some of the
segments

Lateral radiograph of the cervical spine shows

syndesmophytes at the C2-3 and C6-7 levels, with zygapophyseal joint fusion. Courtesy of Bruce M.
Rothschild, MD.
Magnetic resonance imaging studies

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

Arthroscopic synovectomy has been effective in treating severe, chronic, monoarticular

synovitis
Joint replacement and forms of reconstructive therapy are occasionally necessary
Patients in severe pain or with significant contractures may be referred for possible surgical
intervention; however, high rates of recurrence of joint contractures have been noted after surgical
release, especially in the hand
Hip and knee joint replacements have been successful
Arthrodesis and arthroplasty have also been used on joints, such as the proximal
interphalangeal joint of the thumb
The wrist often spontaneously fuses, and this may relieve the patient's pain without surgical
intervention
For arthritis mutilans, surgical intervention is usually directed toward salvage of the hand;
combinations of arthrodesis, arthroplasty, and bone grafts to lengthen the digits may be used
Physical therapy
The rehabilitation treatment program for patients with psoriatic arthritis should be individualized and
should be started early in the disease process. Such a program should consider the use of the following:

Rest: Local and systemic

Exercise: Passive, active, stretching, strengthening, and endurance
Modalities: Heat, cold
Orthotics: Upper and lower extremities, spinal
Assistive devices for gait and adaptive devices for self-care tasks: Including possible
modifications to homes and automobiles
Education about the disease, energy conservation techniques, and joint protection
Possible vocational readjustments

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:

Microcytic anemia due to iron deficiency

Macrocytic anemia due to vitamin B-12/folate deficiency

Polyneuropathy due to vitamin B-12 deficiency

Steatorrhea due to lipid malabsorption
Tetany due to hypocalcemia
Night blindness due to vitamin A deficiency
Dermatitis due to selenium deficiency
Bacterial overgrowth syndrome has been linked to rosacea[6]
Cachexia due to protein-energy malnutrition
Physical
A complete physical examination should be performed with emphasis on abdominal examination and
examination for signs of malabsorption of various nutrients. No specific physical examination
techniques are required for bacterial overgrowth syndrome.
Disorders or structural abnormalities that disrupt the protective mechanisms that guard against
increasing bacterial burden can lead to bacterial overgrowth syndrome.
Patients with the following medical conditions are at increased risk for bacterial overgrowth syndrome:

History of upper intestinal tract surgery

Irritable bowel syndrome[4, 2]
Liver cirrhosis[4, 2]
Celiac disease[7, 8]
Immune deficiency (eg, AIDS, IGA deficiency, severe malnutrition)[4, 2]
Short bowel syndrome[2]
End stage renal disease[4]
Gastrojejunal anastomosis
Vagotomy, but not selective parietal cell vagotomy
Antral resection
Pancreatic exocrine insufficiency
Abnormal small intestinal motility due to the following may result in bacterial overgrowth syndrome:

Diabetic autonomic neuropathy

Scleroderma
Pseudo-obstruction
Amyloidosis
Neurological diseases (eg, myotonic dystrophy, Parkinson disease)
Radiation enteritis[4, 2]
Crohn disease[4, 2]
Hypothyroidism
Blind pouches from the following may result in bacterial overgrowth syndrome:

Side-to-side or end-to-side anastomoses

Intra-abdominal reservoirs
Duodenal or jejunal diverticula
Segmental dilatation of the ileum
Blind loop syndrome
Biliopancreatic diversion
Chagasic megacolon
Abnormal bowel communication due to the following may cause bacterial overgrowth syndrome:

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:

Diabetic autonomic neuropathy

Scleroderma
Pseudoobstruction
Amyloidosis
Achlorhydria
Vagotomy
Surgical Care
In the absence of underlying structural abnormalities that limit normal bowel function, surgery is not
generally unwarranted.
Repair postoperative strictures and blind loops; for example, a Billroth type II may need conversion to
a Billroth type I.
Strictures, fistulae, and diverticula may require surgical correction.
Consultations
Patients refractory to standard medical or surgical treatment or those who have severe symptoms
should be referred to a gastroenterologist/infectious disease specialist.

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

The patient with severe stabbing pain in the face

Trigeminal neuralgia is most commonly a disorder of the elderly and is caused by nerve irritation by
an overlying
tortuous blood vessel
Multiple sclerosis may be the cause in a younger patient
The maxillary and mandibular divisions are most commonly affected in trigeminal neuralgia and the
patient is
usually aware of a trigger zone
Facial sensory loss is not a feature
In older patients surgical treatment by microvascular decompression of the trigeminal nerve is usually
very
effective
Before undertaking surgical treatment, carbamazepine is the treatment of choice
Medscape notes:
Trigeminal neuralgia (TN), also known as tic douloureux, is a distinctive facial pain syndrome that may
become recurrent and chronic. It is characterized by unilateral pain following the sensory distribution
of cranial nerve V (typically radiating to the maxillary or mandibular area in 35% of affected patients)
and is often accompanied by a brief facial spasm or tic. See the image below.
Microscopic demonstration of demyelination in prim
Microscopic demonstration of demyelination in primary trigeminal neuralgia. A tortuous axon is
surrounded by abnormally discontinuous myelin. (Electron microscope; 3300).
Signs and symptoms
TN presents as attacks of stabbing unilateral facial pain, most often on the right side of the face. The
number of attacks may vary from less than 1 per day to 12 or more per hour and up to hundreds per
day.
Triggers of pain attacks include the following:
Chewing, talking, or smiling
Drinking cold or hot fluids
Touching, shaving, brushing teeth, blowing the nose
Encountering cold air from an open automobile window
Pain localization is as follows:
Patients can localize their pain precisely
The pain commonly runs along the line dividing either the mandibular and maxillary nerves or the
mandibular and ophthalmic portions of the nerve
In 60% of cases, the pain shoots from the corner of the mouth to the angle of the jaw
In 30%, pain jolts from the upper lip or canine teeth to the eye and eyebrow, sparing the orbit itself
In less than 5% of cases, pain involves the ophthalmic branch of the facial nerve
The pain has the following qualities:
Characteristically severe, paroxysmal, and lancinating
Commences with a sensation of electrical shocks in the affected area
Crescendos in less than 20 seconds to an excruciating discomfort felt deep in the face, often contorting
the patient's expression
Begins to fade within seconds, only to give way to a burning ache lasting seconds to minutes
Pain fully abates between attacks, even when they are severe and frequent
Attacks may provoke patients to grimace, wince, or make an aversive head movement, as if trying to
escape the pain, thus producing an obvious movement, or tic; hence the term "tic douloureux"
Other diagnostic clues are as follows:
Patients carefully avoid rubbing the face or shaving a trigger area, in contrast to other facial pain
syndromes, in which they massage the face or apply heat or ice

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

4. (Previous question) A 58-year-old publican presented with haematemesis and

malaena. He was transfused. Gastroscopy showed
small oesophageal varices that were not bleeding and multiple bleeding areas in the stomach.
What is the most appropriate management to reduce long-term risk of bleeding?
Variceal banding
Adrenaline (epinephrine) injection
Intravenous ethanolamine
Oral propranolol
Intravenous octreotide
Portal hypertensive gastropathy
This patient has only small varices, with no evidence of bleeding from them on this occasion,
but there is evidence of
multiple areas of haemorrhage in the stomach. Oral propranolol in a dose sufficient to reduce
the resting pulse rate by
25% has been shown to decrease portal pressure. It has been shown to decrease the
frequency of variceal re-bleeds
and reduces bleeding from portal hypertensive gastropathy. Unfortunately a significant
number of patients either have
contraindications to (3-blockade or are intolerant of the treatment due to side-effects.
Surveillance gastroscopy is
advised for the future, with variceal banding in patients who look likely to bleed.

Medscape Esphageal varieces

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.

Large esophageal varices with red

wale signs seen on endoscopy. Courtesy of Wikimedia Commons.

Uphill esophageal varices. Barium swallow demonstrates multiple serpiginous

filling defects primarily involving the lower one third of the esophagus with striking prominence around the
gastroesophageal junction. The patient had cirrhosis secondary to alcohol abuse.

Signs and symptoms

Signs and symptoms of liver disease include the following:

Weakness, tiredness, and malaise

Anorexia, weight loss (common with acute and chronic liver disease)
Sudden and massive bleeding, with or without shock on presentation

Nausea and vomiting; abdominal discomfort and pain

Jaundice or dark urine
Edema and abdominal swelling (ascites); splenomegaly
Spider angiomas
Males: Gynecomastia, testicular atrophy (common with cirrhosis)
Pruritus: Usually associated with cholestatic conditions
Spontaneous bleeding and easy bruising
Symptoms of encephalopathy: Sleep-wake cycle disturbance; intellectual function
deterioration, memory loss, and an inability to communicate effectively at any level; personality
changes; and, possibly, displays of inappropriate or bizarre behavior
Impotence and sexual dysfunction
Muscle cramps (common in patients with cirrhosis), muscle wasting
Dupuytren contracture
Palmar erythema and leukonychia: May be present in patients with cirrhosis
Asterixis ("flapping tremor," "liver flap")
Complications of portal hypertension in patients may present with the following symptoms:

Hematemesis or melena: May indicate gastroesophageal variceal bleeding or bleeding

from portal gastropathy
Mental status changes: May indicate the presence of portosystemic encephalopathy
Increasing abdominal girth: May indicate ascites formation
Abdominal pain and fever: May indicate spontaneous bacterial peritonitis, although this
disease also presents without symptoms
Hematochezia: May indicate bleeding from portal colopathy
Signs of portosystemic collateral formation include the following:

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:

Pallor: May suggest active internal bleeding

Parotid enlargement: May be related to alcohol abuse and/or malnutrition
Cyanosis of the tongue, lips, and peripheries: Due to low oxygen saturation
Dyspnea and tachypnea
Telangiectasis of the skin, lips, and digits
Fetor hepaticus: Occurs in portosystemic encephalopathy of any cause (eg, cirrhosis)
Small-sized liver
Venous hums: Continuous noises audible in patients with portal hypertension; may be
present as a result of rapid, turbulent flow in collateral veins
Tarry stool (digital rectal examination): Suggests upper gastrointestinal (GI) bleeding
Hemorrhoids

See Clinical Presentation for more detail.

Diagnosis
Laboratory testing

Complete blood count

Liver diseaseassociated blood tests (eg, aspartate aminotransferase [AST], alanine
aminotransferase [ALT], bilirubin, alkaline phosphatase [ALP])
Type and cross-match
Coagulation studies (prothrombin time [PT], partial thromboplastin time [PTT],
international normalized ratio [INR]): Prolonged INR is suggestive of impaired hepatic synthetic
function
Albumin: hypoalbuminemia is common. (impaired hepatic synthetic function)
Blood urea nitrogen, creatinine, and electrolytes
Arterial blood gas (ABG) and pH measurements
Hepatic and viral hepatitis serologies, particularly hepatitis B and C serologies
Other laboratory tests may include the following:

Antinuclear antibody, antimitochondrial antibody, antismooth muscle antibody

Iron indices
Alpha1-antitrypsin deficiency
Ceruloplasmin, 24-hour urinary copper: Consider this test only in individuals aged 3-40
years who have unexplained hepatic, neurologic, or psychiatric disease
Imaging studies

Duplex Doppler ultrasonography of the liver and upper abdomen

Computed tomography (CT) scanning and/or magnetic resonance imaging (MRI): Can be
used when ultrasonographic findings are inconclusive
Bleeding scan or angiography: Used when bleeding is obscure and the source is unclear
Procedures

Liver biopsy and histologic examination

Hemodynamic measurement of the hepatic venous pressure gradient (HVPG): A criterion
standard for assessment of portal hypertension
Upper GI endoscopy (or, esophagogastroduodenoscopy [EGD]): A criterion standard for
assessment of portal hypertension
See Workup for more detail.

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

Airway, breathing, and circulation evaluation

Nasogastric tube placement with hemodynamically significant upper GI bleeding
Nothing by mouth; establish 2 large-bore venous accesses
Volume resuscitation, with or without blood product transfusion

Portal pressure reduction (ie, anti-secretory agent infusion)

Patient transfer to tertiary center with liver transplant service for uncontrolled bleeding
from portal hypertension
Control and prevention of bleeding from esophageal varices
Prevention of complications (eg, prophylactic antibiotics, combination
endoscopic/pharmacologic therapy)
Administration of vasoconstrictors (eg, octreotide [agent of choice in acute variceal
bleeding], vasopressin)
Endoscopic therapy (variceal ligation [EVL] [preferred], injection sclerotherapy)
Balloon-tube tamponade
Percutaneous transhepatic embolization (PTE)
Endoscopic administration of cyanoacrylate monomer
Transjugular intrahepatic portosystemic shunt (TIPS)
Primary prophylaxis

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]

Signs and symptoms

Features that typically begin in adolescence or young adulthood in patients with BPD include the
following[3] :

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:

Dialectic behavior therapy (DBT), a modification of standard cognitive-behavioral

techniques, [6] is currently the only data-supported treatment for BPD
For children and adolescents with BPD traits, family-oriented interventions appear to
provide superior benefits
Most children and adolescents with traits of BPD appear to benefit from structured day
programs with strong behavioral management components [7]
Psychotherapy is often difficult because of regression, overwhelming affect, and impulsive
behavior
Hospitalization may be necessary because of suicidal or other self-injurious behavior
Pharmacologic treatment may be necessary for impulsivity, affective instability, and psychosis.
Medications are at times useful. See the following:

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

6. (Repeated question) You are working on your PhD project

into the underlying basis for an inherited neurological

condition. Part of your project involves identifying a protein
expressed in an abnormal cell line.
Which one of the following is the appropriate method for
identifying such a protein?
O Northern blot
Southern blot
O Eastern blot

O Western blot
O RT-PCR

Blotting methods

Western blotting uses gel electrophoresis to separate proteins by

polypeptide length

the proteins are then transferred to a membrane at which point they can
be probed with antibodies to a specific
protein

Southern blotting is used to detect specific DNA abnormalities

Northern blotting is the name of the technique for RNA detection
Far-Eastern blotting is the name of the technique used for detecting lipid
abnormalities

7.

SLE want to ask about developing neonatal Lupus which antibody present ? Anti Double Ds ?
Answer is Anti Ro ?

History and Physical Examination

Roughly half of the mothers of patients with neonatal lupus erythematosus (NLE) are healthy at the
time of childbirth and do not have signs or symptoms of lupus erythematosus (LE) or other
collagen-vascular disorders; the remainder have some symptoms of LE, Sjgren syndrome, or
another collagen-vascular disease. Most mothers of children with NLE develop signs of collagenvascular disease if followed for a long enough period.[17] When carefully questioned, these mothers
may report dry eyes, arthralgia, myalgia, or arthritis. One report linked the presence of
hypothyroidism in mothers with Ro antibodies with an increased risk of congenital heart block. [18]
Many seropositive mothers with anti-SSA and anti-SSB antibodies give birth to infants who do not
show signs and symptoms of NLE; only roughly 1-2% of seropositive mothers will give birth to an
infant with NLE. However, in those who have had a baby with NLE, the risk of cardiac and/or skin
disease for a future pregnancy is roughly 15-25%.

Neonatal lupus erythematosus

The mother usually discovers NLE that affects the skin shortly after birth. In some instances, the
mother notes that the infant is sensitive to sunlight or cutaneous lesions are noted after
phototherapy given for neonatal jaundice.
Cutaneous findings
Cutaneous lesions occur in roughly 70% of patients with NLE.[13] The cutaneous findings are
transient and resemble those of subacute cutaneous lupus erythematosus (SCLE). NLE lesions
are typically annular erythematous plaques with a slight scale, which appear predominately on the
scalp, neck, or face (typically periorbital in distribution) (see the image below), but similar plaques

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.

Neonatal lupus erythematosus.

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.

This child presented with petechial

lesions, hepatosplenomegaly, and thrombocytopenia. Initially, he was thought to have histiocytosis (LettererSiwe disease); however, a skin biopsy revealed an interface dermatitis, and his mother had circulating
autoantibodies.

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]

Lupus erythematosus of childhood

LE of childhood has similar clinical manifestations to LE occurring in adults, although in children,
the disease course may be more severe, and certain cutaneous manifestations may have a
stronger link with systemic disease. Photosensitivity, arthritis/polyarthritis, arthralgia, and fever may
be the presenting symptoms of childhood LE. The patient may also report having a malar rash,
which manifests with edematous and erythematous plaques and is strongly associated with
systemic disease. In addition, patients may present with discoid LE (DLE) or SCLE lesions.
Cutaneous lesions of DLE appear as erythematous plaques with scaling and associated follicular
plugging, dyspigmentation, and atrophy and frequently resolve with scarring. Cutaneous lesions of
SCLE are generally annular, erythematous patches and plaques with associated scaling and
crusting and may resolve with dyspigmentation, but without scarring.
Adults with DLE have a low risk of systemic disease; however, the risk of systemic disease and
progression to systemic involvement appears to be greater in children, with one report suggesting
rates of 50%. Along the same lines, although SCLE is strongly associated with systemic disease in
the adult population, data suggest this link is even greater in children, with approximately 83% of
children progressing to systemic involvement.[1] Therefore, children with DLE or SCLE lesions
should undergo a complete review of systems, including questions regarding symptoms of
pleuritis, pericarditis, and neurologic or renal involvement.

Drug-induced lupus erythematosus

Drug-induced LE may develop in children and adolescents. Reports have described multiple cases
of an LE-like syndrome in patients who take minocycline for acne. These patients often
demonstrate fever and polyarthralgia or arthritis. Reports also describe drug-induced LE occurring
as a result of antitumor necrosis factor- medications in the pediatric population.

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.

Cardiac Imaging Studies

Frequent ultrasonographic monitoring of the fetal heart rate during pregnancy is recommended in
women with autoimmune disorders. Prenatal ultrasonography may help identify neonatal lupus
erythematosus (NLE) that affects the heart. Echocardiography may reveal various types of
structural deformities in the heart; combined electrocardiography and 24-hour Holter monitoring
may reveal various cardiac conduction disorders, which lead to different types of heart blocks.

Skin Biopsy and Histologic Features

Skin biopsy may be useful in patients with either neonatal lupus erythematosus (NLE) or
cutaneous lesions of lupus erythematosus (LE) during childhood.
Histologic examination of all LE-specific lesions of cutaneous LE show interface dermatitis with
vacuolar degeneration in the basal cell layer. Moderate hyperkeratosis, follicular plugging,
thickening of the basement membrane, and epidermal atrophy may also be found. In cases with an
intense inflammatory infiltrate, bulla may develop and can be seen histologically.
Although not frequently necessary to make the diagnosis of NLE or pediatric cutaneous LE,
immunofluorescent examination of a skin biopsy reveals a granular deposition of immunoglobulin
G at the dermoepidermal junction; immunoglobulin M and C3 deposition may also be evident.

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.

This child was one of a pair of fraternal

twins. Her sibling was not affected, although the mother and both infants had similar autoantibodies in their
circulations. Eventually, the lesions seen here resolved and healed without sequelae.

Treatment should be supportive and depends on the specific manifestations present.

Treatment of cutaneous NLE is not required as lesions resolve without scarring. However, in cases
in which therapy is desired, treatment includes mild topical corticosteroids, antimalarial agents,
and, possibly, laser treatment for residual telangiectasia. Photoprotection such as sunscreen and
protective clothing is highly desirable, because solar exposure may precipitate skin lesions.
The type of treatment and the long-term prognosis for neonates with cardiac rhythm and
conduction disturbances depends on the presence of underlying congenital heart abnormalities.
Systemic corticosteroids may be used to treat or prevent cardiac NLE, but they are generally not
recommended for established third-degree heart block as this condition is typically irreversible.
While intravenous immunoglobulin (IVIG) has not been helpful in preventing congenital heart
block, IVIG combined with corticosteroids administered prenatally to mothers may be helpful in
preventing fetal cardiomyopathy or endocardial fibroelastosis. [31, 32] In severe cases, NLE that affects
the heart may result in cardiac failure and death. A pacemaker is often necessary.
Consider transfer to a tertiary care center for all children and neonates with lupus erythematosus
(LE). Consultations with specialists in dermatology, cardiology, rheumatology, nephrology,
neurology, hepatology, immunology, and hematology may also be indicated.
Management of cutaneous and systemic LE in children is similar to management in adults and
depends on specific disease manifestations. Therapy is directed towards any internal organ
involvement and the prevention of dyspigmentation, disfigurement, and scarring as a result of
cutaneous disease.

Prevention and Long-Term Monitoring

Observe mothers with positive autoantibodies and/or mothers who give birth to a child with
neonatal lupus erythematosus (NLE).[33] Mothers of such neonates, particularly neonates with
congenital heart block, have at least a 2- to 3-fold increased risk of subsequent affected neonates.
An estimated 15-25% of subsequent pregnancies are affected. [33] Therefore, carefully monitor

subsequent pregnancies with serial ultrasonography and echocardiography, particularly at 18-24

weeks gestation.
Fluorinated systemic steroids may help prevent NLE. Intravenous immunoglobulin (IVIG) merits
evaluation as a potential prophylactic approach in mothers who have previously had an affected
child.[34] While neither of 2 recent studies demonstrated benefit in outcome IVIG, [35, 36] a recent study
suggests that prenatal administration of IVIG along with corticosteroids may decrease the risk for
fetal cardiomyopathy or endocardial fibroelastosis. [32]
The use of hydroxychloroquine for anti-Ro/SSApositive mothers with systemic lupus
erythematosus (SLE) has been associated with a lower rate of NLE during pregnancy.[37] In
addition, aggregate multinational data have revealed that maternal use of hydroxychloroquine
reduces the risk of NLE in subsequent pregnancies for mothers who are anti-Ro/SSA positive and
have previously given birth to an infant with cardiac NLE, regardless of maternal health status. [38]
Consult an obstetrician with experience with high-risk pregnancies, and consider administration of
prednisolone or fluorinated steroids during subsequent pregnancies to prevent NLE. In at least one
instance, congenital heart block was prevented with the use of systemic corticosteroids beginning
at 10 weeks gestation, azathioprine shortly thereafter, and plasmapheresis beginning at 18 weeks
gestation.[39]
Children with NLE need continued follow-up, especially before adolescence and in cases in which
the mother herself has an autoimmune disease.[40] Although the child may not be at increased risk
of developing SLE, the development of some form of autoimmune disease in early childhood may
be of concern.
Patients with NLE and cardiac involvement require regular monitoring to assess cardiac function
and the need for a pacemaker. Thus, serial echocardiography to monitor for a prolonged PR
interval may be warranted.
Patients with cutaneous NLE do not require monitoring after lesions resolve. Although children with
cutaneous disease may be more prone to develop lupus erythematosus (LE) later in life, this
reflects genetic predisposition, rather than the occurrence of NLE earlier in life. Nonaffected
siblings are also at risk for the development of SLE.

8.

(Previous question) Rheumatoid Arthritis: related to HLA? a- DR4 b- DR3 c- DR2 d- B27

The prevalence of rheumatoid arthritis in the UK population is approximately 1%

Rheumatoid arthritis: epidemiology
Epidemiology
* peak onset = 30-50 years, although occurs in all age groups
F:M ratio = 3:1
* prevalence= 1%
* some ethnic differences e.g. high in Native Americans
associated with HLA-DR4 (especially Felly's syndrome}

9. An 28-year-cld man is investigated tor recurrent lower bach pain. A

diagnosis of ankylosing spondylitis
is suspected. Which one of the following investigations is most useful?
ESR
X-ray of the sacro-iliac joints
HLA-B27 testing

 X-ray of the thoracic spine

0 CT of the lumbar spine
may not De seen for many years after the onset of symptoms

Ankylosing spondylitis: investigation and management

Ankylosing spondylitis is a HLA-B27 associated spondyloarthropathy It
typically presents inmales (sex
ratio 3 1) aged 20-30 years old
Investigation
inflammatory markers (ESR. CRP) are typically raised although normal
levels do not exclude ankytosing
spondylitis
HLA-B27 IS of little use in making the diagnosis as it is positive in

90% of patients with ankylosing spondylitis

10% of normal patients

Plain x-ray of the sacroiliac joints is the most useful investigation in
establishing the diagnosis
Radiographs may be normal early in disease, later changes include

sacroilitis subchondral erosions, sclerosis

squaring of lumbar vertebrae
'bamboo spine' (late & uncommon)

syndesmophytes due to ossification of outer fibers of annulus fibrosus

chest x-ray. apical fibrosis

40-year-oldmale There Is typical appearance of bamboo spine with a sinole central

radiodense line related to ossification of supraspinous and mterspinous ligaments which
is called dagger sign Ankylosingis detectable in both sacroiliac joints

Lateral cervical spine Complete fusion of anterior and posterior elements in

ankylosing
spondylitis, so called bamboo spine

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

is due to osteitis of anterior comers. Syndesmophytes are due to ossification of outer

fibers of annulus fibrosus

Spirometry may show a restrictive defect due to a combination of

pulmonary fibrosis, kyphosis and
ankylosis of the costovertebral joints
Management
The following is partly based on the 2010 EULAR guidelines (please
the link for more details)

encourage regular
physiotherapy

exercise such

as

swimming

see

NSAIDs are the first-line treatment

the disease-modifying drugs which

are used fo treat rheumatoid arthritis

(such as suiphasaiaane)
are onty really useful if there is penpheral joint involvement

the 2010 EULAR guidelines suggest 'Anti-TNF therapy should oe given

topatients with
persistently high disease activity despite conventional treatments'
research is ongoing to see whether anti-TNF therapies such as
etanercept and adaiimumab
should be used earlier in the course of the disease

10. INFERIOR MI with complete heart block :PCI? What to do? Asked severally not sure f the
answer

11. East Africa :hepatomegaly and lympaedopathy? Diagnosis

12. A 43-year-old man with a history of bipolar disorder is admitted with

acute contusion. Whilst being
transferred to hospital he had generalised seizure which terminated
spontaneously after around 30
seconds. On arrival in the Emergency Department his GC5 is 14/15 and he is
noted to have a coarse
tremor. A diagnosis of lithium toxicity is suspected Intravenous access is
obtained bloods are taken
and a saline infusion is started. Blood results reveal the following:
Lithium level 4.2 mmol/l
IMa+ 136 mmol/l

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

13. Hyperkalemia in dialysis patient

14. patient with hypopigmented lesions on hands and past history of hypothyroidism, presents
with circular patches of hair loss on head.
a. alopecia areata
b. sle
c. hypothyroidism

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

15. Question about ALL Poor prognosic factor:

Prognostic factors for children with ALL

Children with ALL are often divided into risk groups (such as standard-risk, high-risk, or very
high-risk), with more intensive treatment given to higher risk patients. Generally, children at
low risk have a better outlook than those at very high risk.
While all of the following are prognostic factors, only certain ones are used to determine
which risk group a child falls into. (The first 2 factors age at diagnosis and initial white blood
cell count are thought to be the most important.) Its important to know that even children
with some poor prognostic factors can often still be cured.
Age at diagnosis: Children between the ages of 1 and 9 with B-cell ALL tend to have better
cure rates. Children younger than 1 year and children 10 years or older are considered highrisk patients. The outlook in T-cell ALL isnt affected much by age.
Initial white blood cell (WBC) count: Children with ALL who have very high WBC counts
(greater than 50,000 cells per cubic millimeter) when they are diagnosed are classified as
high risk and need more intensive treatment.
Subtype of ALL: Children with pre-B, common, or early pre-B-cell ALL generally do better
than those with mature B-cell (Burkitt) leukemia. The outlook for T-cell ALL seems to be about
the same as that for B-cell ALL as long as treatment is intense enough.
Gender: Girls with ALL may have a slightly higher chance of being cured than boys. As
treatments have improved in recent years, this difference has shrunk.
Race/ethnicity: African-American and Hispanic children with ALL tend to have a lower cure
rate than children of other races.
Spread to certain organs: Spread of the leukemia into the cerebrospinal fluid (the fluid
around the brain and spinal cord), or to the testicles in boys, lowers the chance of being
cured. Enlargement of the spleen and liver is usually linked to a high WBC count, but some
doctors view this as a separate sign that the outlook is not as favorable.
Number of chromosomes: Patients are more likely to be cured if their leukemia cells have
more than 50 chromosomes (called hyperdiploidy), especially if there is an extra chromosome
4, 10, or 17. Hyperdiploidy can also be expressed as a DNA index of more than 1.16. Children
whose leukemia cells have fewer chromosomes than the normal 46 (known as hypodiploidy)
have a less favorable outlook.
Chromosome translocations: Translocations occur when chromosomes swap some of their
genetic material (DNA). Children whose leukemia cells have a translocation between
chromosomes 12 and 21 are more likely to be cured. Those with a translocation between
chromosomes 9 and 22 (the Philadelphia chromosome), 1 and 19, or 4 and 11 tend to have a
less favorable prognosis. Some of these poor prognostic factors have become less
important in recent years as treatment has improved.

Response to treatment: Children whose leukemia responds completely (major reduction of

cancer cells in the bone marrow) within 1 to 2 weeks of chemotherapy have a better outlook
than those whose leukemia does not. Children whose cancer does not respond as well may
be given more intensive chemotherapy.

16. A full blood count for a 38-year-old man is reported as follows:

Hb 12.9 g/dl
Platelets 225 " 109/l
WBC 6.2 * 109/l
Film Numerous Howell-Jolly bodies and pencil cells seen
Which one of the following conditions is most likely to produce these results?
Coeliac disease
HIV infection
Sickle-cell trait
Autoimmune hemolytic anaemia
Liver disease
Howell-Jolly bodies are seen in hyposplenism and pencil cells are a feature of iron-deficiency. Both of
these are seen in coeliac 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.

Premature ovarian failure

Premature ovarian failure is defined as the onset of menopausal symptoms
and elevated
gonadotrophin levels before the age of 40 years.
Causes
* idiopathic -the most common cause
* chemotherapy
* autoimmune
* radiation
Features are similar to those of the normal climacteric but the actual
presenting problem may differ
* climacteric symptoms: hot flushes, night sweats
* infertility
* secondary amenorrhoea
* raised FSH LH levels

18. A new blood test which can show signs of myocardial damage within
one hour of the onset of chest pain

is developed In a trial of 100 patients presenting with chest pain 40 of the

patients are later proven to
have had myocardial ischaemia by conventional troponin tests. Of these
patients the new test was
positive in 20 cases. The new test was also positive in 20 of the remaining GO
patients later shown to
have a negative troponin.What is the negative predictive value of the new
test for myocardial
ischaemia?
0.5
0.66
O.S
Cannot calculate
0.33
The new test was negative in 20 of the patients later shown to have
myocardial ischaemia (false
negative) and negative in 40 patients confirmed not to have myocardial
ischaemia (true negative)

Negative predictive value = TN / (TN + FN)

= 40 /(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 iists 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 TN / (TN + FP) Proportion of patients without the condition who
have a negative test result
Positive predictive value TP / (TP + FP) The chance that the patient has the
condition if
the diagnostic test is positive
Negative predictive
value
TN / (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
ft - 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
19. sildenafil mode of action:

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

16. Patient with cCKD on HD came with breathlessness : pulmonary oedema

17. Heart failure patient still breathlessness..cxr upper lobe diversion : add b blocker or spironolactone?

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

Patent ductus arteriosus

Overview

* acyanotic congenital heart defect

connection between the

pulmonary trunk and descending aorta

* more common in premature babies born at high altitude or maternal rubella

infection in the first
Trimester

Features

* left subclavicular thrill

* continuous 'machinery' murmur
* large volume bounding, collapsing pulse

wide pulse pressure

* heaving apex beat

Management
* indomethacin closes the connection in the majority of cases
* if associated with another congenital heart defect amenable to surgery then
prostaglandin E1 is
useful to keep the duct open until after surgical repair

19. AORTIC STENOSIS low hb upper endo normal? Further investigation capsule enteroscopy
21. Reverse split S2? LBBB

Paradoxical Splitting (split appears with expiration)

caused by delayed onset of LV systole:

Left Bundle Branch Block (LBBB)

Right Ventricular Pacemaker

22. . Eye pain 4-5 times a day : cluster headache

Physical Examination

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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] :

Ipsilateral lacrimation (84-91%) or conjunctival injection

Nasal stuffiness (48-75%) or rhinorrhea
Ipsilateral eyelid edema
Ipsilateral miosis or ptosis
Ipsilateral forehead and facial perspiration (26%)
Alcoholic products and tobacco may precipitate an attack. Other triggers include hot weather,
watching television, nitroglycerin, stress, relaxation, extreme temperatures, glare, allergic rhinitis,
and sexual activity.
During an attack of CH, as many as 90% of patients may become agitated and extremely restless.
They do not like to lie down to rest; instead, they prefer to pace or move around. In desperation,
patients may rock, sit, pace, bang themselves against a hard surface, scream in pain, or crawl on
the floor.
Structural lesions have been described with CH and should be suspected if the presentation is
atypical. Atypical features may include the following:

Absence of a periodic pattern

Residual headache between exacerbations
Bilaterality
Incomplete or minimal response to standard therapy
Presence of lateralizing findings on examination (other than Horner syndrome)

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

Parasympathetic overactivity - Ipsilateral lacrimation, conjunctival injection, rhinorrhea or

congestion
Ocular sympathetic paralysis - Mild Horner syndrome (eg, ptosis, miosis, and anhidrosis),
which may persist between attacks
Bradycardia
Facial flushing or pallor
Scalp and facial tenderness
Ipsilateral carotid tenderness (in some patients)
Patients often are in severe distress. They may lower the head and press on the site of pain,
sometimes crying or screaming. Physical exercise may afford a degree of relief. In cases of
especially severe or intolerable pain, patients may even threaten suicide.

Approach Considerations
Pharmacologic management of cluster headache (CH) may be classified into 2 general
approaches as follows:

Abortive/symptomatic (eg, oxygen, triptans, ergot alkaloids, and anesthetics)

Preventive/prophylactic (eg, calcium channel blockers, mood stabilizers, and
anticonvulsants)
Olanzapine[11] and kudzu[12] have also been used to treat CH, but their effectiveness has not been
determined. Antihistamines, such as chlorpromazine, do not appear to be helpful in relieving CH
symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be given for pain relief.
Various procedures may be performed on trigeminal nerve or autonomic pathways, including
alcohol injections and section or avulsion of nerves for chronic refractory cases. Surgical treatment
may be initiated if the patient has contraindications to medications or if medications are not
effective; it is employed only in strictly unilateral cases. Radiofrequency (RF) thermocoagulation of
the trigeminal ganglion has had promising results in some patients with intractable pain.
Treatment guidelines are available from the American College of Emergency Physicians, the
National Headache Foundation, and Institute for Clinical Systems Improvement. [13, 14, 15] Neurologic
consultation may be useful if the diagnosis is in doubt or for management of difficult cases.

Management of pregnant patients

CH is rare during pregnancy, but when it does occur, episodes tend to have the same character
and severity as in nonpregnant patients.[16] Treatment options for pregnant women are poorly
documented. The first line of treatment is pure oxygen via a nonrebreather mask (see image
below). Triptans and ergot alkaloids should be avoided. The use of selected preventive
medications, which are rated pregnancy category B, should be discussed thoroughly with the
patient and her obstetrician.[17]

Non-rebreather oxygen mask with reservoir

for the acute treatment of cluster headache. Courtesy of Wikipedia Commons.

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.

Nerve Blocks, Ablative Procedures, and Brain Stimulation

Various invasive nerve blocks and ablative neurosurgical procedures (eg, percutaneous RF
ablation, trigeminal gangliorhizolysis, and rhizotomy) have been implemented successfully in
cases of refractory CH.
Percutaneous RF ablation may achieve success in 50% of patients, with fair-to-good results in
20% and failure in about 30%. Side effects include facial dysesthesia, corneal sensory loss, and
anesthesia dolorosa. Gamma-knife radiosurgery is a less invasive alternative for pervasive CH but
is associated with a significantly increased risk for facial sensory disturbances. [22] Botulinum toxin
injections to manage CH have produced limited success.[23] Greater occipital nerve block may be
beneficial in aborting CH.[11, 24]
Deep brain stimulation with implantation of stimulating electrodes under stereotactic guidance into
the ipsilateral posterior inferior hypothalamus is another potential option for chronic CH refractory
to pharmacologic therapy.[25, 26, 27, 28]This technique is invasive and is associated with significant risk

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.

23. A 35-year-old man complains of paroxysmal stereotyped episodes

consisting of a rising epigastric sensory feeling, and fear. The

episodes last up to a minute and are followed by confusion lasting up

to an hour. During

the episodes his wife has seen him performing lip-smacking, chewing and

swallowing movements. He also has butterfly sensation in his stomach

What is the most likely diagnosis?

O Frontal lobe epilepsy
Idiopathic generalised epilepsy
Occipital lobe epilepsy
Q Parietal lobe epilepsy
Temporal lobe epilepsy

Answer is temporal lobe epilepsy

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:

Somatosensory and special sensory phenomena:

Olfactory, auditory and gustatory illusions and hallucinations may

occur.

Patients may report distortions of shape, size and distance of

objects.

These visual illusions differ from the visual hallucinations

associated with occipital lobe seizure in that there is no formed visual
image.

Objects may appear smaller or larger than usual.

Vertigo may occur with seizures in the posterior superior temporal

gyrus.

Psychic phenomena:

Feeling of dj vu (familiarity) or jamais vu (unfamiliarity).

Depersonalisation (ie feeling of detachment from oneself) or

derealisation (surroundings appear unreal).

Fear or anxiety.

May describe seeing their own body from outside.

Autonomic phenomena: changes in heart rate and sweating. Patients

may experience an epigastric fullness sensation or nausea.

Following the aura, a temporal lobe focal dyscognitive seizure begins with a wideeyed, motionless stare, dilated pupils and behavioural arrest.

Lip-smacking, chewing and swallowing may be noted.

Manual automatisms or unilateral dystonic posturing of a limb may also occur.

A focal dyscognitive seizure may evolve to a generalised tonic-clonic (GTC)

seizure.

Patients usually experience a postictal period of confusion. The postictal phase

may last for several minutes.

Amnesia occurs during a focal dyscognitive seizure because of bilateral

hemispheric involvement.

Possible underlying causes

[2]

Past infections - eg, herpes encephalitis or bacterial meningitis.

Head injury producing contusion or haemorrhage that results in

encephalomalacia or cortical scarring.

Hamartomas.

Gliomas.

Vascular malformations (ie arteriovenous malformation, cavernous angioma).

Cryptogenic: a cause is presumed but has not been identified.

Idiopathic (rare).

Hippocampal sclerosis produces a clinical syndrome called mesial temporal lobe

epilepsy, which begins in late childhood, then remits but reappears in adolescence
or early adulthood in a refractory form.

Febrile seizures: some children with complex febrile convulsions appear to be at

risk of developing TLE in later life.

PatientPlus

Anticonvulsants used for Focal Seizures

Epilepsy in Elderly People

Epilepsy in Children and Young People

Lennox-Gastaut Syndrome

Read more articles

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.

Excessive daytime somnolence - eg, due to a sleep apnoea or narcolepsy.

Periodic limb movement disorder.

Tardive dyskinesia.

Panic attacks.

Occipital lobe epilepsy: may spread to the temporal lobe and be clinically
indistinguishable from a temporal lobe seizure.

Psychogenic seizures: patients with psychogenic seizures may also have

epileptic seizures.

Investigations

[3]

Interictal EEG: one third of patients with TLE have bilateral, independent,
temporal interictal epileptiform abnormalities.

MRI is the neuroimaging investigation of choice.

Positron emission tomography (PET) using radioisotope fluorodeoxyglucose (18 F)

(FDG-PET) is useful when the MRI result is normal.

Single-photon emission computed tomography (SPECT) is useful for candidates

for surgical intervention.

Video-EEG telemetry is used as part of the pre-surgical evaluation. It is also used

if the diagnosis of TLE is still uncertain.

Management

[4][3]

See also the separate Anticonvulsants used for Generalised

Seizures and Anticonvulsants used for Focal Seizures articles.

Decision aids

Doctors and patients can use Decision Aids together to help choose the best
course of action to take.

Compare the options

Carbamazepine or lamotrigine are the drugs of choice for focal seizures.

Levetiracetam, oxcarbazepine or sodium valproate should be considered if
carbamazepine and lamotrigine are unsuitable or not tolerated.

Adjunctive treatment: offer carbamazepine, clobazam, gabapentin, lamotrigine,

levetiracetam, oxcarbazepine, sodium valproate or topiramate as adjunctive
treatment if first-line treatments are ineffective or not tolerated.

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.

Related blog posts

How epilepsy awareness affects us all

Read more blog posts

Treatments for refractory TLE

Vagus nerve stimulation (VNS) with a high-frequency stimulation rate may be

effective in reducing seizure frequency. A battery-operated stimulator device is
implanted in the left vagus nerve in the neck.

Anteromedial temporal resection is the most frequently performed operation for

medial TLE.[6]

Prognosis

[3]

Patients with refractory TLE have an increased risk of sudden death.

Seizure-free state two years after anterior temporal lobectomy is predictive of

long-term seizure-free outcome.

About half of patients become seizure-free with medical treatment.

After three first-line AEDs have failed, the chance for seizure freedom is greatly
reduced.

Surgery in well-selected patients with refractory TLE leads to a seizure-free

outcome rate of about 70.

Patients with refractory TLE typically have deficits in memory function.

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

66) medication to stop pre angio - metformin

67) foam cells - macrophages.
68) reactive arthritis - gonnorhea culture
69) break through pain, regular morphine mr - morphine elixir
70) osteomyelitis - foot xray
71) payernal uncle and grandfather affected son too. Mode of inheritance - X linked dominant
72) fast af, very small trop rise ? Cause - af
73) recurrent urticaria like rash - chronic urticarial

75)
76)
77)
78)

condition presenting earlier - anticipation

oral thrush - fluconazole
requesting dexa, normal score - no treatment
lung ca commonest symptom cough

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?
-

idiopathic intracranial htn vs. colloid cyst

fasci-scapulo-humeral
L5/S1 vs S1/S2 radiculopathy
optic neuritis....color vision change
anterior ischemic neuropathy...temporal art
strep milleri brain abscess....metronidazole + cefotaxime
basilar artery branch
transient global amnesia vs tia
syringomyelia...initial symptoms
spinal stenosis
simultagnosia
alzheimer....age is risk factor
cluster headache...vs...trigeminal headache
carbamezepine for trigeminal neuralgia

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

75 condition presenting ealirer: anticipation

76 Oral thrusg : fluconazole
77 Requeting dexa, normal score: no treatment

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 ?

39. Man with acute gout and negatively bifringent crystals

40. Hepatitis serology positive for Hep A igM and HCV ab
41. Hepatitic picture in woman who gave birth recently IgG raised
What treatment should be
administered for an aggressive, potentially
psychotic patient with no history of mental
illness ==== Lorazepam

2.basophilic stipling...lead poisoning

3.pneumothorax...avoid swimming.
4.sjogrens syndrome...anti LA
5.LBBB...reverse split of s2
6.mycophenolate mofetil...diahrrae..
7.NNT for asprin patient...25.
8.adenocarcinoma of esophagus.
9.acute gout..
10.anticipation.
11.pie chart..sex.
12.negative predictive value..800/900
13.heart block..bradycardia..inferiar MI..PCI
14.oral candiasis...oral fluconazole.
15.analgesic induced headace..headache 4 to 5 time in a day.
16.high calorie..cheese..
17.rash on chest...acyclovir..
18.kappsi sarcoma.
19.linchin planus..violacious flat top..
20.SLE..anti ro.
21. toxic thyroid nodule.....RAI
22. osteomylitis..x ray of ankle.
23. alopecia areata.
24. trigeminal neuralgia...carbamazepine.

25. amyotrophic lateral syndrome.

26. idiopathic intracranial hypertension
27. iron deficiany anemia...pencil cell
28. pyrazinamide...hyperuracemia.
29. anti phospholipid syndrome...pulmonary emoblism.
30. melanoma...thickness.
31. vomiting in parkinson...domperidone.
32. latex allergy..banana..
33. pakistani boy hyertension...ramipril.
34. basilar artery divide into post cereberal artry.
35. miller fischer syndrome.
36. bartonella hensale..cat skrach..
37.lipid lade macrophage...foam cell.
38.primary syphill..benzathine penicillin..
39. parkinson..ropinorol..
40.dermatomyositis..
41. rituximab..cd20
42. rhematoid..hla dr4
43.ankylosing spondylis..HLA b27
44. biphosphonate..osteonecrosis of jaw.
45. slidenafil...pde inhibitor..
46. generalized itching..oral cetrizine.
47. parcetamol overdose...ph low..acidosis..referal
48. constant inhibition..prolactin.
49. coelic disease.
50. chadv criteria...6
51. western blot..protein.
52. ovarian failure.
53. episcleritis.
54. parncreatic exocrine function...elastase.

55. long qt...potessium..

56. typical angina...ETT or angiography
57. heart failure..drug to add...bisoprolol.
58. philadelphia chromose....bad prognosis in ALL
59.seborrhic dermititis..hiv test..
61. axillary pink lesion..no investigation.
62. optic neuritis..painful eye moment.
63. beer...polyurea...aquaporine decrease..
64.drug to stop before angiography..metformin.
65. diabitis and ocp...necrobiosis lipodica or erythema nodusum
66. maintaing remission in UC..azothiopurine.
67. lip smacking...temporal lobe
68. prognosis in chronic liver failure...caput medusae.
69. lithium toxicity...hemofiltration,..
70. polychethimia vera...isovolemic venesection.
71. polychethemia vera..jek 2
72.dobutamine..b1 agonist.
73.most common symptom of lung cancer............cough.
74.rheumatoid artheritis..next drug after methotrexate...tnf..entracept..
74. magnet on pacemake...stop defibrillator but continue pacing.
75. increase urine calcium excretion....furosimide
76. bulemia nervosa...vomiting..bmi normal..patient thinks she is obese.
77. menorrhagia..von willibrand disease.
78. prperidine deficiancy..x linked recessive.
79. noisy breathing in elderly...dont know answer.
80. esophageal verices..propanolol..easiest one.
81. goitre causing stridor..anaplastic
82. cystic fibrosis...50%
83. hypogonadotropic hypogonadism...for me its small testes which is most common symtom..for
others its anosmia because of kallman..question was about most common symptom not about kallman.

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.

142. patient on honymoon..reactive artherits.

143. mysthenia gravis.
144. leg pain releived with rest...spinal stenosis.
145. genital ulcer..Hsv
146. tip toe...achilis tendon
147. radio idiodine..teratogenic.
148. patient with chemotherapy...wbc is low...whats management..nothing.
149. retinal vein occlusion.
150.bordarline personality disorder..
151.trasiant globular amenesia.
152.tropinin level...ACS
153. ascitis..raise plasma volume.
154.salicylate overdose...repiratory alkalosis.
155.subdural hematoma.
156.chronic low mood..dysthemia.
157.scurvy.
158.IDA..colonscopy.
159. primary hperparatyhyroid.
Continous inhabition hormone ...prolactin
Acanthosis nigricans-gastric cancer
Ques with lanugo hair, I chose lanugo hair to b investigated as it is a paraneoplastic syndrome
I think the scenario was like anorexia with features of low cortisol (cold peripheries)
There was a question about pt with aml and chemotherapy started. What is the 1st line antibiotic
against?
Pt with pseudomanas aeruginosa,whats the antibiotic should be started?
Lady with amnesia fr 50 mins- transient global amnesia
Vit b12 role-dna synthesis
Ques with rif pain bowel thickening coccobacilli- yersiniosis
Ct finding in abpa- central bronchiectasis
Ques with prolonged fever hepatosplenomegaly with lymphadenopathy, leucopenis- leishmaniasis
Number needs to treat question- 25
Lady with perseveration and aphasia: tia. Not global amnesia

Ct finding in abpa: tree in bud opacities

Pt with recurrent Neisseria meningitis complement pathway
MODY >glucokinase mutation
Elderly with h/o headche came with sudden loss of vision , high ESR with pale edematous disc
Ischemic optic neuropathy
Febrile leukopenia give antipseudomonal
Known Parkinson with active tremors and rigidity brought with agitation , what to give ??
Middle age female treated recently with Diverticulitis but has persistent fever &diarrhea for >6weeks
& RIF pain on colonoscopy ileal granuloma & stool g+ve cocoobacilli >> yersiniosis
pt with severe seborrhic dermatitis what is next > HIV testing??
Bilateral axillary mulloscum contagious >> whaat to do
syphilis treatment - b.pencillin, sle mother which which will cause neonatal sle- i think ds-dna( active
form ), bilateral axillary lesion- no treatment,
what is the tendon involved (posterior to medial malleolu) - tip toe not possible?
These are the ones I remember and I think are right - I have a list of wrong and ? Too
2) HIV with rash - hsv 8
3) Number needed to treat - 25
5) Primary prevention bleeding varacies - propnolol
6) ccf additional med - bisoprolol
9) Cf sufferer, partner carrier - chances of offspring having cf 50%
10) Vt, don't give - verapamil
11) Heavy menstruation - vin willebrands
12) Basophilic stippling - lead poisoning
13) Tick bite on walking holiday - doxy
14) Genital ulcers and lymphadenopathy - hsv
16) St elevation mi & 1st degree heart block - pci
17) Leg pain relieved with sitting - spinal stenosis
20) Red car, thinks secret service - illusion
21) Senile pruritis - emollient
22) Young man, spiro picuture copd - alpha 1 antitrypsin
23) Night time cough, sob, - asthma
24) Hx psoriasis, swollen fingers - psoriatic arthropathy
25) Latex allergy - banana
26) bisphosphonates - osteonecrosis of jaw
27) dexa -2.1 and -2.6 - osteopenia and osteoporosis
28) Negatively big ringer crystals - gout
29) Most kcal per g - cheese
30) Alcohol withdrawal - Librium
31) Highest risk of ulcer recurrence - previous ulcer
32) Best dmard in pregnancy - azathioprine
33) Noisy breathing - joys one patch
34) Obese, headache, enlarged blind spot - benign inter cranial htn
35) Aches and gotrens papules - dermatomyositis
36) Facial, arm and pelvis weakness - facioul... Dystrophy
37) Sedation in Parkinson's - lorazepam
38) Continuous inhibition - prolactin
39) Lambert eaten - acth antibodies
41) Standing 1 minute - increase diastolic
42) dobutamine - b1 agonist
43) Cat scratch - bartonella
44) htn 38 Pakistani - ace I
45) Granuloma, gram negative- yeresinia
46) rivaroxiban - 10a
47) Actin - cytoskeleton
48) Recurrent infection - b lymphocytes
49) Odd eye symptoms - Miller fisher
50) RA failed methotrexate and sulfasalazine - etanercept

51) wcc nadir - 10-13 days

52) Ra eye problem - episcleritis
53) chronic low mood - dysthymia
54) acanthosis nigricans - gastric ca
55) continuous inhibition - prolactin
58) high lh and fsh - ovarian faliure
59) abdo pain - tacrolimus
60) rash v itchy on shins - venous eczema
61) deranged lft, echo bright liver - fatty liver of pregnancy
62) frontal, temporal curcular bald patches -aloplecia areat

From facebook
21. . Thyroid eye problem? Highlight risk due to smoking or high iodine uptake?
Rania Mahadi L5 /S1
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Rania Mahadi Loss of ankle reflex
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Rania Mahadi Dobutamin

Alfa adenorecepter...
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Ahmed Moneim Badra No B1 agonist
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Rania Mahadi Recall with me please
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Rania Mahadi Respiratory alkalosis

Hyperventilation
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Farah Elaila was there an answere compensated metabolic alkalosis? is it the same questions?
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 No
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Ahmed Moneim Badra Bromocriptin

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Metformin IGT prolactin was just above normal e normal testosterone
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Rania Mahadi Metabolic acidosis with normal anion gap

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Ahmed Moneim Badra 25 stat.See translation
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Rania Mahadi Common syptom on lung ca
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Pardeep Kumar cough
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Nadia Irfan I did cough
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Rania Mahadi Hypotrophic hypogonadism

Small tests
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Mai T Elhadedy AnosmiaSee translation
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Nadia Irfan Small testis
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Rania Mahadi Osteopreosis of vertibra with osteopena on hip

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Pardeep Kumar sleep deprivation
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Narcolepsy sleep paralysis
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Pardeep Kumar cataplasy

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Pardeep Kumar actin is the component of which orgenelle...cytoskeleton
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Rania Mahadi Cyctic fibrosis ttt clarthromycin
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Rania Mahadi S.aregonosa
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Musaab Karrar I think cipro is anti pseudomonal
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Pardeep Kumar alzhemirr...family history??

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Nadia Irfan Idid family but smoking iwas confused
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Farah Elaila i have chosen family hx
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Rania Mahadi Macrophage

Atheroslerosis
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Pardeep Kumar syringomyelia....pinprick hand

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Rania Mahadi Heredatry spastic pa
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Amyotrophic lateral sclerosis
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Pardeep Kumar mody...glucokinase mutation..

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Mai T Elhadedy Why not HNF?
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Nadia Irfan Hnf not is options
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Rania Mahadi Facioscapulohumural

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Rania Mahadi Pt like MYTONIC D. plus winging scapula
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Mai T Elhadedy She had hip problem i solved myasthenia
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Pardeep Kumar bulemia nervosa...vomiting..bmi normal..

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Pardeep Kumar properdine deficiany...x linked recessive...
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Rania Mahadi What was the Q
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Rania Mahadi PCI ttt for ST elevation anferior MI and heart block
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Nadia Irfan I did venous pacemaker but i think pci was right
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Pardeep Kumar menorrhagia...von willibrand disease...

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Rania Mahadi Antiphospholipd syndrome
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Pardeep Kumar long qt...potessium..
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Pardeep Kumar latex allergy...banana
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I read it in pastest but there was no peanut in answers I think it is peanut more than banana
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Rania Mahadi Lupus and natal risk

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Rania Mahadi ??
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Nadia Irfan Ro i did
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Pardeep Kumar calorie....cheese...

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Rania Mahadi Some say passta
Me white bread???
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Nadia Irfan I did cheese as cholesterol
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Pardeep Kumar melanoma...thickness

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Mohammed Gilood depth=width is correct
Pardeep Kumar idipathic intracranial hypertension
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Rania Mahadi Glioma she has tinnitis
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Rania Mahadi May be
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Pardeep Kumar anorexia nervoxa...parotid gland..

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Dry eye and parotid sjogren s
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Pardeep Kumar pyrazinamide...hyperuracemia..

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Rania Mahadi The man with joint pain and TB ttt
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Rania Mahadi ??
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Pardeep Kumar penicil cell...IDA..

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Pardeep Kumar lipid laden macrophage...foam cell..

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Pardeep Kumar bertnella hensale...cat skratch..
Like Reply 6 16 hrs
Pardeep Kumar primary syphills...benzathine penicillin..
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Pardeep Kumar pakistani hypertensive young boy...ramiprl..
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Pardeep Kumar rituzimab...cd 20
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Samah Ali I think iL2
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Pardeep Kumar nop..
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Rania Mahadi Bisprolol

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Pardeep Kumar yes
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Musaab Karrar Is this the angina pt with echo evidence of LVF why not spironolactone
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Pardeep Kumar pancreatic exocrine function...elastase..

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Rania Mahadi Pt with rheumatoid arthritis next ttt TNF
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Pardeep Kumar entacept???
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Nadia Irfan Yes
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Pardeep Kumar slidenafil...pde inhibitor...

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Pardeep Kumar constant inhibition....prolactin..
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Rania Mahadi Ilike this Q
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Pardeep Kumar episcleritis???

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Ahmed Moneim Badra YesSee translation
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Rania Mahadi Recall with us dont stop please
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Pardeep Kumar beer...polyurea...aqueporin..

Rania Mahadi Cealic disease
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Ahmed Fathalla Is this the question of the symptoms improving on lactose free diet?
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Nadia Irfan Hyposplenism howeljoly bodies
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Rania Mahadi Pt with ulcer on foot and diagnosis of osteomylitis

Xray
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Nadia Irfan Xray
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 No crp it will detect infection more than xray

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Rania Mahadi Bisphosphnate and jow necrosis

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Rania Mahadi He have ca
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Rania Mahadi Ifection and chemotherapy

3_5 days??
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Pardeep Kumar 6 t0 9...
such a vague question..
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Rania Mahadi Very confused
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Pardeep Kumar axillary nerve???

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Rania Mahadi Problem with abduction
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Rania Mahadi What about respiratory

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Rania Mahadi
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Rania Mahadi Very deficult Q
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Write a reply...

Pneumothorax.smoking
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Pardeep Kumar nop its swimming..
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Ahmed Moneim Badra No flying

Rania Mahadi Ulcerative colitis and smoking

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Azathioprine not sure
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Mohammed Gilood yes azathSee translation
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Thyroid eye smoking

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Rania Mahadi Iodin supplemet???
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Nadia Irfan Radio iodine it was goitre but not graves
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Pardeep Kumar vitamin b 12...dna sythesis?

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Nadia Irfan Yee
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 Statistic ppv890/900
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Nadia Irfan Yes
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Farah Elaila option E righy
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Rania Mahadi Spacifity

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Ahmed Fathalla I think sensitivity
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Nadia Irfan Did specificity ?dont know as qs says those who have mi
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sensitivity??
Ahmed Fathalla Mesenteric angiography?
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Ahmed Moneim Badra Mesentric angio
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Is there any Q leshmaniasis?

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Rania Mahadi Lymphogranuloma venorium

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Ahmed Moneim Badra Painful ulcer
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Mai T Elhadedy Herpes simplex
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Write a reply...

Pardeep Kumar Lewy body with vomiting

Ahmed Moneim Badra Mesentric angio
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Mohammed Gilood
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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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Rania Mahadi is there dopamin?

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Ahmed Moneim Badra RopinolSee translation
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Rania Mahadi Yes
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Write a reply...

Or ropinirol
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Pardeep Kumar sjogrens...anti laSee translation
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Ahmed Fathalla Congenital. Anti ro?
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Rania Mahadi Arthritis and skin lesion on joint
Dermatomyositis
Rania Mahadi Pt with red eye
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Ahmed Moneim Badra ConjuctivitisSee translation
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Ahmed Fathalla Conjunctivitis?
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CoSee translation
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Ventricular tachycardia verapamil
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Episcleritis
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DysthymiaSee translation
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Depression not affecting work dysthmia
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Rania Mahadi Pt with hyper parathyrodism

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Rania Mahadi Parathyredictomy

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Rania Mahadi Hypercalcemia
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Ahmed Fathalla Positive chovstek sign?

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Rania Mahadi You remember the senario?
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Ahmed Fathalla hypocalcemia and positive chovstek sign what is the cause
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Rania Mahadi Pt with headach an eye pain five time per day
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Rania Mahadi No responce to opoid
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Rania Mahadi Stabbing headach
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Ahmed Fathalla Miller fisher syndrome

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Ahmed Fathalla Wernicke encephalopathy
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What Q??See translation
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Ahmed Fathalla the one with the phenytoin bottle
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Rania Mahadi Pt on hany moon with arthritis and diarr

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Ahmed Fathalla Reactive i think
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Reactive I
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Voltage gated ca??

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No comment?See translation
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Nadia Irfan Lambert was voltage gated antibodies
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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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Rania Mahadi LES mythenia gravisSee translation

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Pardeep Kumar lead poising...basophillic stiplling
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Rania Mahadi Pt Hemophilia A
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Rania Mahadi Iforget the senario

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Ahmed Fathalla They were many
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Rania Mahadi Pt standing 1min

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Ahmed Moneim Badra Vascular resistant ???
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Ahmed Fathalla Decrease peripheral vascular resistance
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Thyroxin.decrease myoca oxg demand

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Rania Mahadi Increase ostioclast activity
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Rania Mahadi SE of thyroxin IHD
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Pardeep Kumar 14 weeks gestation

Bp 170/100
Urinalysis +1...See more
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Essential
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Rania Mahadi Essintial
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 Is thr
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Rania Mahadi Respiratory alkalosis
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Asprin?See translation
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Ahmed Moneim Badra HyperventilationSee translation
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Rania Mahadi Pt collapse with crisis and hypoglycemia

10% glucose
Predenslon
Like Reply 1 15 hrs
Ahmed Moneim Badra 10 glucose
Like Reply 2 15 hrs
DificultSee translation
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Ahmed Fathalla Secondary amenorrhea?

Like Reply 15 hrs
Rania Mahadi Pt with Increase LH ,FSH
Like Reply 15 hrs
Rania Mahadi Ovary failure
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Cause of acidosis in diapetic?

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Ahmed Fathalla Chloride?

Like Reply 15 hrs
Cl not sure
Like Reply 6 hrs
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Rania Mahadi Any answer ciprofloxacin

Eldary pt with diarr
Like Reply 15 hrs
Ahmed Moneim Badra Oral rehydration
Like Reply 4 15 hrs
Prain abscesSee translation
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Rania Mahadi Pt with itchy on feet

Flariasis
Shistosomiasis
Like Reply 15 hrs
I think bilhariziasis like swimmer itch ?
Like Reply 6 hrs
Mohammed Gilood yes i think
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Rania Mahadi To cases of CLL

Like Reply 15 hrs
Tear drop myelofibrosis what was ttt
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?
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 Haematology is so diffic
Like Reply 1 15 hrs
also oncology
Like Reply 1 15 hrs
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...

Rania Mahadi Red car

Delution
Like Reply 2 15 hrs
Is there depresive psyc
Like Reply 4 15 hrs
Nadia Irfan I did who lose wt
Like Reply 4 hrs
Write a reply...

Rania Mahadi JAK 2See translation

Like Reply 3 15 hrs
YesSee translation
Like Reply 14 hrs
Nadia Irfan Yes
Like Reply 4 hrs
Write a reply...

Rania Mahadi TTB

Like Reply 1 15 hrs
Rania Mahadi TTP
Like Reply 15 hrs
YesSee translation
Like Reply 14 hrs
Write a reply...

Patient seen car in garding or something like that!!

Like Reply 2 14 hrs
Rania Mahadi Yes red car
Delution
Like Reply 14 hrs
Nadia Irfan Delusion
Like Reply 4 hrs
Write a reply...

Rania Mahadi Temporal

Parital
Like Reply 1 14 hrs
Rania Mahadi Idont remember th senario
Like Reply 14 hrs
Rania Mahadi Temporal
Like Reply 14 hrs
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Optic neuritisSee translation

Like Reply 2 14 hrs
Is it there
Like Reply 1 14 hrs
Nadia Irfan Yes
Like Reply 4 hrs
Write a reply...

 Anterior sc optic neuropathy

Like Reply 3 14 hrs
Is it there?
Like Reply 14 hrs
Write a reply...

Patient with retinal hge by fundoscopy

Like Reply 1 14 hrs
Crvo
Like Reply 5 hrs
Write a reply...

sory lhave something wrong in my phone

Like Reply 14 hrs
Tomorrow will continue till complete all q inshaa allah
Like Reply 1 14 hrs
Rania Mahadi -2___+2 distribution 95%
Like Reply 5 14 hrs
Rania Mahadi 50% risk in CF
Like Reply 8 14 hrs
Mustabshra Khan .
Like Reply 14 hrs
Ashraf Ahmed El-bllal Anas Salah Eldin Zeinab Lasheen Maram Saeed
Like Reply 12 hrs
Ashraf Ahmed El-bllal Iam preparing for the next exam and I heard that passmedicicne and on exam
was not helpful is that true ??
Like Reply 12 hrs
Maram Saeed False
Like Reply 11 hrs
Mahmoud Elhoriny Kindly write in new post
Like Reply 9 hrs
Write a reply...

Sohail Ahmed Khan FSee translation

Like Reply 9 hrs
Mahmoud Elhoriny Basilar artery branch of ?
Like Reply 1 9 hrs
Terminals posterior cerebrals
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Mahmoud Elhoriny not vertebral ?
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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
Like Reply 8 hrs
Musaab Karrar Statistics such a crab
Like Reply 7 hrs
Mahmoud Elhoriny hahaha its shit man grin emoticon
Like Reply 7 hrs
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Amr Mohamed Elyasaky Ahmed Ezzat

Like Reply 8 hrs
Nadia Irfan Isoniazid metabolism did p45oC??

Like Reply 1 8 hrs

Farah Elaila that was my answer too
Like Reply 8 hrs
N acetyl tra sferase acetylator status
Like Reply 1 5 hrs
Write a reply...

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
Write a reply...

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
Like Reply 8 hrs
Musaab Karrar Me too
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Nadia Irfan Negative cocoo bacilli ?See translation

Like Reply 1 8 hrs
Farah Elaila what were the choices i cnt remember
Like Reply 8 hrs
Musaab Karrar Pts admitted and treated for diverticlutis with no responce colonscopy granulmas but
stool culutured G_ve coccobacilli
Psoriasis nail pitting
Like Reply 1 5 hrs
Write a reply...

Musaab Karrar Pemphigus vulgarisSee translation

Like Reply 1 8 hrs
5 Replies 3 hrs

Musaab Karrar Ralovxaban MOA

Like Reply 8 hrs
5 Replies 5 hrs

Musaab Karrar Parkinson pt had urosepsis and got confused and agitated ttt?
Like Reply 8 hrs
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

Musaab Karrar RA and HLA association

Like Reply 7 hrs
4 Replies 4 hrs

Musaab Karrar Medullary sponge kidney compilication

Like Reply 1 7 hrs
6 Replies 4 hrs

Mahmoud Elhoriny pt was vision loss in examination there is hge with white spots
Like Reply 1 7 hrs
7 Replies 4 hrs

Mahmoud Elhoriny pt with chemotherapy wbc is low , wats ur management

Like Reply 1 7 hrs

6 Replies 4 hrs

Musaab Karrar Pt with hypothyroidism and presented with adrenal crises treament
Like Reply 7 hrs
4 Replies 6 hrs

Musaab Karrar Candida infection what is ttt

Like Reply 7 hrs
4 Replies 4 hrs

Musaab Karrar Guys what about the on line feedback thing

Like Reply 7 hrs
4 Replies 4 hrs

Farah Elaila any answer was emollient cream ? XD

Like Reply 1 7 hrs
7 Replies 3 hrs

Mahmoud Elhoriny Hepatitis pt wat is the diagnosis i get confused

Like Reply 5 hrs
11 Replies 2 hrs

Reem M. Al-Aila Reham M Ghzo Ahlam Lutfi

Like Reply 5 hrs
Rania Mahadi CLL COMPLICATION
Outoimmuno hemolytic anemia
Like Reply 4 hrs
9 Replies 3 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

Nadia Irfan Pt with unable to read,neglect?

Like Reply 4 hrs
1 Reply

Hussien Mahmoud Reversed splitting? ?

Mahmoud Ahmed Irradiated blood ???
Like Reply 3 hrs
4 Replies 3 hrs

Mahmoud Ahmed Patient with ra want to be pregnant ??

Like Reply 3 hrs
1 Reply

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

Mahmoud Ahmed Chad score ??

Like Reply 3 hrs
5 Replies 1 hr

Mahmoud Ahmed Adenocarcinoma oesph in gerd

Like Reply 2 3 hrs
Mahmoud Ahmed Ttt of myelodysplasia ??

Like Reply 1 3 hrs

Mahmoud Ahmed Is there was plasma exchange .. i think i chose it wrong
Like Reply 3 hrs
Mahmoud Ahmed Female with noisy bresthing ?
Like Reply 3 hrs
6 Replies 3 hrs

Mahmoud Ahmed Female with morphine 75 .. what next ?

Like Reply 3 hrs
1 Reply

Mahmoud Ahmed Acquired hemophilia A ?

Like Reply 1 3 hrs
Amera Lebab

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

Mahmoud Ahmed InspiratorY filling ?

Like Reply 3 hrs
Mahmoud Ahmed There was respiratory q about obstructive pattern .. and chooses include athma and
alpha1 decrease .. what was the answer ?
Like Reply 1 3 hrs
3 Replies 1 hr

Hanana Osman That pt with irrctile dysfunction what drug is correct

Like Reply 2 hrs
3 Replies 1 hr

Mahmoud Ahmed Thyroid mass with stridor ?

Like Reply 1 2 hrs
6 Replies 1 hr

Musaab Karrar Solitary thyroid nodule tttt

Like Reply 1 hr
4 Replies 59 mins

Everyone get 130 mark wil pass is it true

Like Reply 1 hr
Mohamed Abdalla FSee translation
Like Reply 21 mins
Nizar Abdulaziz What is total score
Like Reply 1 15 mins
Spontaneous pneumothorax what activity should be avoided : smoking or contact sport or swimming
Like Reply 8 hrs
Hanna Hanna How u detect size of protein
Like Reply 8 hrs
Risala Nimairy westren!!See translation
Like Reply 6 hrs
Muzaffar Khan Yep
Like Reply 6 hrs

Write a reply...

Hanna Hanna RA what type of HLA

Pt on HD 3 times a week, attended routine dialysis but told u he severely feels unwell, on examination
HR 40, BP 98/65, K 7.9, ECG CHB, what is most immediate treatment : 1- HD, 2- calcium gluconate.
3- temporary pacemaker 4- insulin & dextrose
Like Reply 8 hrs
Hanna Hanna Rituximab- mechanism of action
Like Reply 8 hrs
Muzaffar Khan CD20
Like Reply 1 6 hrs
Write a reply...

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)

Like Reply 8 hrs

Hanna Hanna Highest calories
1- cheese 2- pasta 3- white bread4- red meal
Like Reply 8 hrs
Muzaffar Khan Was that white bread or cheese ? Answer is between them
Like Reply 6 hrs
Hanna Hanna I choose white bread but I think cheese is the correct answer
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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
Like Reply 8 hrs
Muzaffar Khan Hydrocort
Like Reply 6 hrs
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Hanna Hanna Treatment of polycythemia

Like Reply 8 hrs
Hanna Hanna The best test to confirm polycythemia Like Reply 8 hrs
Muzaffar Khan Jak 2See translation
Like Reply 6 hrs
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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

Like Reply 8 hrs

Nafia Muqeet Pci
Like Reply 8 hrs
Write a reply...

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
Write a reply...

Hanna Hanna Sildinafill mechanism of action

Like Reply 8 hrs
Nafia Muqeet Phospho inhibitor
Like Reply 8 hrs
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Hanna Hanna Treatment of erectile dysfunction

Like Reply 8 hrs

Nafia Muqeet SildenafilSee translation

Like Reply 8 hrs
Muzaffar Khan Patient had prolactinoma. Brocriptine I think best
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Hanna Hanna Case about Lyme disease- what is the treatment

Like Reply 8 hrs
Nafia Muqeet Observe
Like Reply 8 hrs
Hanna Hanna Doxycycline
Like Reply 1 7 hrs
Write a reply...

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....
Like Reply 7 hrs
Write a reply...

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

Write a reply...

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
Write a comment...

Faisal Hemeda feeling crazy.

20 hrs
exam in egypt ... what about ur first mrcp?
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Mai T Elhadedy Traumatising experience
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Soha Kamal Elmonofy All said bad exam....why ???mean cancel if we want to try or what feeling
confused
Like Reply 10 hrs
1 Reply

It is bad but we will pass isa

January 2016 recalls

Theme: cauda equina syndrome (Asked 3 times)

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

Answer: 3- MRI spinal cord

This patient has a number of features of cauda equina syndrome. There is distal weakness, with
associated sensory loss. Whilst classically patients present with a sensory level, this is variable in
clinical practice.
Causes of cauda equina syndrome include herniation of a lumbar disc (at L4/L5 and L5/S1), tumour
(metastases, lymphoma, primary spinal tumours), trauma and infection (epidural abscess).
Clinical presentation is varied, but can include low back pain with unilateral or bilateral lower limb
motor and/or sensory abnormality and bowel and/or bladder dysfunction with saddle and perineal

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

Answer is Lamniectomy and Fusion

Cauda equina syndrome

This patient has features of cauda equina syndrome, presumably due to acute lumbar disc prolapse.
This is an acute neurosurgical emergency. Alternating or bilateral sciatica with accompanying sensory
symptoms and weakness in the lower limbs and feet and urinary retention suggest the diagnosis. Unless
urgent neurosurgical assessment and treatment is initiated, chronic neurological damage may result.

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

Theme: Eye manifestations of RA asked 11 times.

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

Scleritis is painful, episcleritis is not painful

Rheumatoid arthritis: ocular manifestations

Ocular manifestations of rheumatoid arthritis are common, with 25% of patients having eye problems
Ocular manifestations
-

keratoconjunctivitis sicca (most common) (dry eyes)

episcleritis (erythema)

scleritis (erythema and pain)

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

Which one of the following is the most likely diagnosis?

O Renal vein thrombosis
O Acute tubular necrosis
O Renal artery stenosis
O Cholesterol embolism
O Femoral artery embolism

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.

Features of cholesterol embolism:

-

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

Theme. Urinary tract infection asked twice

29. patient with symptoms of UTI in sepsis- What is the most common causative organism
- E.coli

Definitions Bacteriuria: Bacteria in the urine; may be asymptomatic or symptomatic.

UTI: The presence of a pure growth of >105 organisms per mL of fresh MSU.
Lower UTI: urethra (urethritis), bladder (cystitis), prostate (prostatitis). Upper UTI:
renal pelvis (pyelonephritis). Up to a third of women with symptoms have negative
MSU (= abacterial cystitis or the urethral syndrome).
Classification UTIs may be uncomplicated (normal renal tract + function) or complicated (abnormal
renal/GU tract, voiding diffi culty/obstruction, renal function, impaired host defences, virulent
organism, eg Staph. aureus).

Risk factors , sexual intercourse, exposure to spermicide (by diaphragm or

condoms), pregnancy, menopause; decreased host defence (immunosuppression, DM); urinary tract:
obstruction stones, catheter, malformation. NB: in pregnancy, UTI is common and often
asymptomatic, until serious pyelonephritis or premature delivery ( fetal death) supervenes, so do
routine dipstick in pregnancy. Urine in catheterized bladders is almost always infectedCSUS and
are pointless unless the patient is ill.
Organisms E. coli is the main organism (7595% in the community but >41% in
hospital). Occasionally other enterobacteriaceae such as Proteus mirabilis and
Klebsiella pneumonia, and other bacteria such as Staphylococcus saprophyticus.
Symptoms
Acute pyelonephritis: High fever, rigors, vomiting, loin pain and tenderness, oliguria
(if acute kidney injury).
Cystitis: Frequency, dysuria, urgency, haematuria, suprap ubic pain.
Prostatitis: Flu-like symptoms, low backache, few urinary symptoms, swollen or
tender prostate on PR.
Signs Fever, abdominal or loin tenderness, foul-smelling urine. Occasionally distended
bladder, enlarged prostate.
Tests If symptoms are present, dipstick the urine; treat empirically if nitrites or leucocytes are +ve
while awaiting sensitivities on an MSU. If dipstick is ve but patient symptomatic, send an MSU for
lab MC&S to confirm this. Send a lab MSU anyway if male, a child pregnant, immunosuppressed or
ill. A pure growth of >105 organisms/mL is diagnostic. If <105 organisms/mL and pyuria (eg >20

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

Causes of sterile pyuria:

TB
Treated UTI <2 weeks prior
UTI with fastidious culture requirement
Inadequately treated UTI
Papillary necrosis (eg DM or analgesic excess)
Appendicitis Tubulointerstitial nephritis
Calculi; prostatitis
Polycystic kidney
Bladder tumour
Chemical cystitis (eg cyclophosphamide)
Blood tests: FBC, U&E, CRP, and blood cultures if systemically unwell (urosepsis).
Consider fasting glucose and PSA (wait 6 months, as UTI causes false +ves).
Imaging: Consider USS and referral to urology for assessment (CTKUB, cystoscopy,
urodynamics) for UTI in children; men; if failure to respond to treatment; recurrent
UTI (>2/year); pyelonephritis; unusual organism; persistent haematuria.
Prevention of UTI Drink more water. Antibiotic prophylaxis, continuously or postcoital,
UTI rates in females with many UTIS. Self-treatment with a single antibiotic
dose as symptoms start is an option. Drinking 200750mL of cranberry or lingo berry
juice a day, or taking cranberry concentrate tablets, risk of symptomatic recurrent
infection in women by 1020% 5 (may inhibit adherence of bacteria to bladder uroepithelialcells; avoid
if taking warfarin). There is no evidence that post-coital voiding, or pre-voiding, or advice on wiping
patterns in females is of benefi

Theme: .Infective Endocardidts: (asked seven times)

30. ECG indictaions of surgery in infective endicarditis....prolonged PR interval due to formation

of abcess

Theme: Antihyperglycemic (New Question)

31. pt with Diabetes mellitus...hypoglycemia..what is the culpril drug?

.GLIMEPRIDE (sulfony urea)

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

Theme ADH hormone

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

risperidone mechanism of action repeated three times

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

Answer is 5HT2 receptors.

Risperidone
Risperidone is a novel antipsychotic belonging to the benzisoxazole derivative class
It is a high-affinity D2 and 5-HT-2 receptor antagonist
To a lesser extent, risperidone is also an antagonist at a-padrenergic receptors, H1-histaminergic and
c<2adrenergic receptors
Common adverse effects listed in the summary of product characteristics (SPC) include:

 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

Theme: ..donezepil....(asked twice) though in the questions the MMSE was 18

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.

35. Donepezil (Aricept) belongs to which class of drugs?

Anticonvulsant
Acetylcholinesterase inhibitor
Antidepressant
Antipsychotic
Mood stabilizer

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:

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.

Theme: H pylori Theme Repeated 6 times

37. A slim 39-year-old deputy head teacher has a 3-month history of dyspepsia, particularly at
night, that is relieved by milk. He had a trial of proton-pump inhibitor 1month ago and his
symptoms have returned. He has not lost
any weight. On examination there is some mild epigastric tenderness.
The most useful next management step would be?

Heliobacter pylori antibodies and eradication therapy if positive

Course of H2 antagonists/proton-pump inhibitors
Upper gastrointestinal endoscopy
13C urea breath test and eradicate if positive
H.pylori eradication therapy
Helicobacter testing
The risk of upper gastrointestinal cancer in this patient is low. If he is Helicobacter pylori-positive, it
would be reasonable to try eradication therapy and only investigate further if his symptoms do not
improve or are recurrent.
H. pylori antibodies are cheap but non-specific. Breath testing is the most specific and sensitive noninvasive way of establishing the presence of current H. pylori infection and costs about the same as
serology testing.
According to oxford, you check again for eradication with UBT. If still positive you treat again. After
treating if still positive third time, do not treat. Do endoscopy

Theme: Drug induced pancreatitis

38. A 32-year-old man presents with epigastric tenderness and fever. He is known to be on
treatment for epilepsy. On examination he has a blood pressure of 100/60 mmHg, pulse of 110

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

Diagnosing hereditary angio-oedema

The history is suggestive of hereditary angio-oedema, which is inherited in an autosomal-dominant
manner
It is due to C1 esterase inhibitor deficiency, which modulates the intravascular activation of
complement. Clinical features may not appear until adult life
A non-hereditary acquired form of the disease occurs in association with lymphoproliferative
disorders
The other options (e.g. mycoplasma or cold agglutinins suggestive of infection) would be associated

with a more subacute presentation

Arterial blood gases, whilst potentially showing hypoxia, would be non-specific with respect to
determining the underlying cause of the SOB
Symptoms
A prodromal rash, evident as mild erythema or erythema marginatum, may precede attacks
Patients present with airway obstruction and abdominal pain secondary to visceral oedema
Treatment
Acute attacks may respond to fresh-frozen plasma
-

Long-term treatment is with stanazol or danazol

Achalasia:

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.

Theme: Dysphagia investigationsAsked over 10 times.

41. A 35-year-old man was referred with sudden-onset dysphagia, initially to liquids and then, 2
months later, to solids. His weight has been stable. In the past week he has woken up coughing
during the night. An upper gastrointestinal endoscopy performed at the onset of his symptoms
was reported as being normal.What is the most useful diagnostic test?
24-hour oesophageal pH study
Barium follow-through
13C urea breath test
Oesophageal pull-through manometry
Repeat upper gastrointestinal endoscopy
The Answer Comment on this Question
Achalasia
The history is that of achalasia - an abrupt-onset dysphagia, often without weight loss. Liquids often
cause more of a problem than solids. He is rather too young to have an oesophageal carcinoma.
Achalasia, failure of relaxation of the
lower oesophageal sphincter, is a rare cause of dysphagia. The sphincter is often hypertensive. The
oesophagus dilates and loses the normal pattern of peristaltic waves - these are often replaced by
simultaneous contraction of the oesophageal body or loss of all activity. It is important to recognise
symptoms of regurgitation and aspiration a night-time cough or recurrent sore throats in the morning
could point to this.
Investigation
Investigation consists of upper gastrointestinal endoscopy to rule out pseudo-achalasia due to a
carcinoma, a bariumswallow showing the rats' tail appearance of the lower sphincter, and pull-through
manometry. Pull-through manometry
is the diagnostic test and demonstrates the hypertensive sphincter and motility disorder.
Theme: Endocarditis. Asked 3 times:

42. A 41-year-old male has been diagnosed with infective endocarditis.

Which of the following is associated with the best prognosis?
Aortic valve infection
Intravenous drug abuse
Prosthetic valve infection
Staphylococcus aureus infection
Streptococcus viridans infection
Answer is S viridans
Features suggestive of a worse prognosis are:
Acute endocarditis (Staphylococcus aureus)
Heart failure
IV drug abuse (often left and right sided disease)
Prosthetic valve infection
Infection of the aortic rather than mitral valve, and
Associated rhythm disturbance.
Subacute bacterial endocarditis (Streptococcus viridans) has a better prognosis about 98%).

Theme: Artheroma and macrophages (new question)

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

(96%), ataxia of gait (87%), and a global confusional state (90%)

All three elements of the triad need not be present to make the diagnosis
Causes
Alcoholism is an important but not exclusive cause of the disorder
Other causes include carcinoma of the stomach, pregnancy, dietary insufficiency
Treatment and prognosis
Treatment is by urgent parenteral thiamine administration, but a large proportion (80%) go on to
develop the chronic Korsakoff state
Korsakoff syndrome
Korsakoff syndrome is the related psychiatric disorder and affects memory as follows:
normal registration
markedly impaired short-term recall
anterograde amnesia
patchy and variable retrograde amnesia
Confabulation
Confabulation is often provoked by the interviewer rather than being spontaneous, and is common
The condition generally follows Wernicke's encephalopathy owing to thiamine deficiency rather than
alcohol toxicity
However, it may develop from other causes such as herpes simplex encephalopathy, or carbon
monoxide poisoning
Pathology
The pathological changes are symmetrical lesions in the walls of the third ventricle and
periaqueductal grey matter, with subsequent atrophy of the mammillary bodies
Lesions of the cerebral cortex are rarely seen
Chronic alcohol use can lead to cerebral and cerebellar atrophy and ventricular dilatation
Central pontine myelolysis is a rare but often fatal disorder associated with alcohol misuse, which
leads to quadriplegia and pseudobulbar
Theme: HCV and cryoglobulin (asked 4 times)
45. A 48-year-old man, with a history of chronic intravenous drug abuse, presents with a severe
subacute neuropathy. Nerve conduction studies show evidence of a multifocal axonal
neuropathy. He is also noted to have
nailfold infarcts in his hands and feet and hepatomegaly.
Which one of the following diagnoses is the most likely?
Cytomegalovirus polyradiculoneuropathy
Systemic toxoplasmosis
Hepatitis-B-related Guillain-Barre syndrome
Hepatitis-C-related Guillain-Barre syndrome
Hepatitis-C-related cryoglobulinaemia
The patient with vasculitic neuropathy
The presence of nailfold infarcts and the multifocal nature of the neuropathy indicate that a vasculitic
cause is most likely
Hepatitis C infection may be associated with cryoglobulinaemia, which causes a vasculitic syndrome
including neuropathy
Treatment
Treatment of the vasculitis may include one or several of the following
high-dose intravenous steroids
plasma exchange
intravenous immunoglobulins
In addition, interferon therapy may be indicated for clearance of the hepatitis viral load; the latter is
usually decided in conjunction with gastroenterology colleagues
Other notes
Other conditions associated with vasculitic neuropathy include
polyarteritis nodosa
Churg-Strauss syndrome
rheumatoid arthritis
systemic lupus erythematosus

 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.

Theme: Lichen Planus asked over 10 times

57. A 55-year-old woman known to suffer from primary biliary cirrhosis complains of a rash over
her
wrists and ankles. She also mentions that purplish lesions develop wherever she scratches herself.
She has recently seen her gastroenterologist who has told her to continue taking cholestyramine.

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

Theme: Ptyriasis vesicolor

58. A 20-year-old male presents with extensive, coalescing, hypopigmented, slightly scaly lesions
on his back and
chest.
The rash had been present for two years and had gradually become more extensive. He had otherwise
been in
good health. The lesions were not symptomatic but he was concerned about their appearance.
What is the most appropriate treatment for his condition?
Aciclovir cream
Ketoconazole cream
Nystatin cream
Oral itraconazole
Oral terbinafine
The patient presents with an asymptomatic eruption on his trunk. The lesions are scaly, hypopigmented
and are not associated with any systemic disease. This is characteristic of pityriasis versicolor, which is
caused by
the unicellular yeast Pityrosporum ovale and Pityrosporum orbiculare. The yeast is lipophilic and is
encouraged

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)

Theme: Latex allergy:

61. A nurse who is known to have an allergy to latex develops a widespread urticarial rash and
facial oedema shortly after eating lunch. Which food is she most likely to have consumed?
Orange
Apple
Grapes
Pear
Banana
The nurse is likely to suffer from latex-fruit syndrome.
Latex allergy
Sensitivity to latex may cause a number of problems:
type I hypersensitivity (anaphylaxis)
* type IV hypersensitivity (allergic contact dermatitis) delayed
irritant contact dermatitis
Latex allergy is more common in children with myelomeningocele spina bifida.
Latex-fruit syndrome
It is recognised that many people who are allergic to latex are also allergic to fruits, particularly
banana. pineapple, avocado, chestnut, kiwi fruit, mango, passion fruit and strawberry.
62. A 15-year-cld girl presents with an urticarial rash angioedema and wheezing Her mother states
that
she has just come from her younger sister's party where she had been helping to blow up balloons.
What is the most likely diagnosis?
Ct-esterase deficiency (hereditary angioedema)
Allergic contact dermatitis
Peanut allergy
Latex allergy
0 Irritant contact dermatitis
This is a typical history of latex allergy. Adrenaline should be given immediately and usual
anaphylaxis management followed
Hypersensitivity
The Gell and Coombs classification divides hypersensitivity reactions into 4 types
Type I -Anaphylactic
antigen reacts with IgE bound to mast cells
anaphylaxis, atopy (e.g. asthma, eczema and hayfever)
Type II - Cell bound
* IgG or IgM binds to antigen on cell surface

* autoimmune haemolytic anaemia ITR Goodpasture's, pernicious anemia acute hemolytic

transfusion reactions rheumatic fever bullous pemphigoid pemphigus vulgaris
Type III - Immune complex
* free antigen and antibody (IgG. IgA) combine
* serum sickness, systemic lupus erythematosus post-streptococcal glomerulonephritis, extrinsic
allergic alveolitis (especially acute phase)
Type IV - Delayed hypersensitivity
* T cell mediated
* tuberculosis, tuberculin skin reaction, graft versus host disease, allergic contact dermatitis.
scabies extrinsic allergic alveolitis (especially chronic phase), multiple sclerosis. Guillain-Barre
syndrome
In recent times a further category has been added
Type V
antibodies that recognise and bind to the cell surface receptors, either stimulating them or blocking
ligand binding
Graves' disease, myasthenia gravis
63. A 55-year-old nurse developed bronchospasm and urticaria twenty minutes into surgery under
general anaesthesia. The mast cell tryptase concentration confirmed an acute allergic reaction.
Later, it transpired that she had developed allergic reactions at her dentist and had developed
frequent episodes of wheezingwhen assisting at sterile procedures.
What is the most likely diagnosis?
Allergy to anaesthetic induction agents
Allergy to local anaesthetic agents
Latex allergy
Pressure urticaria
Systemic mastocytosis
This patient developed anaphylaxis during a surgical procedure and it appears that she had problems
with allergies during dental treatment and whilst assisting during sterile procedures.This would suggest
that she is allergic to latex rather than induction agents or local anaesthesia as latex would be present in
all three of the above procedures.
Systemic mastocytosis is a disease which usually affects the elderly and is associated with:
Urticaria pigmentosa
Diarrhoea
Hypotension
Sclerotic bone changes, and
Mast cell infiltration of organs such as spleen, liver, and kidneys.
64. A 24-year-old nurse is admitted to the Emergency department with symptoms of anaphylaxis.
She is known to be allergic to latex and collapsed whilst having a fruit salad for her lunch with
colleagues. You suspect that she
has the latex fruit syndrome. On examination her BP is 95/60mmHgand her pulse is 105. She has
audible stridor and a very flushed facial appearance. She responds to treatment with IV hydrocortisone,
nebulised salbutamol and s/c adrenaline.
Which of the following inflammatory mediators is thought to be important in anaphylaxis?
IL1
IL2
IL4
IL6
IL10
Answer is IL4 . Mediators involved in the development of anaphylaxis include histamine, leukotrienes.
prostaglandins and platelet aggregating factor, which are generated by mast cell degranulation.
Additional factors include

 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

Answer is latex allergy

Allergic reactions
Latex can induce allergy through IgE bound to mast cells
Morphine, radiocontrast media and colloid plasma expanders induce histamine release via their direct
effects on mast cells
Scombroid fish poisoning is related to the heat-stable toxin in, for example, tuna, mackerel and mahi-

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

The Answer Comment on this Question

YOUR ANSWER WAS INCORRECT
Allergy
This patient is exhibiting an immediate hypersensitivity reaction, which is IgE-mediated
Delayed-type hypersensitivity, (type 4) eg contact dermatitis, has an onset that usually exceeds 24 h
Complement-mediated (type-2 hypersensitivity) and immune complex (type-3 hypersensitivity)
reactions typically
produce vascular damage, and therefore bullae and petechiae would predominate in the skin
A man presents with an eczematous rash on his hands suggestive of contact dermatitis, possibly related
to
wearing latex gloves at work. He requests confirmatory tests.
Which one of the following tests would be most appropriate to help establish the diagnosis?
S
Atopy patch testing -i
Skin prick testing
Patch testing CORRECT ANSWER i
i
Intradermal testing
Direct exposure tests to gloves
F
The Answer Comment on this Question
YOUR ANSWER WAS INCORRECT
Allergy testing
Patch testing is the classical method for investigating contact dermatitis (which is T-lymphocyte
mediated)
Skin prick testing investigates IgE-mediated reactions, typically to aeroallergens and food
Skin prick testing with latex extracts is sensitive, specific and rapid, however it carries the risk of
anaphylaxis
The atopy patch test is a research tool used to investigate the possible role of food in exacerbations of
eczema
Direct exposure to gloves will simply support the history
Intradermal testing is usually reserved in the UK for drug testing
Theme: facial carcinomas
71. There are prominent telangiectatic vessels on the surface of the lesion. The border of the
lesion is translucent, looks pearly-white and is slightly raised. What diagnosis fits best with
this clinical picture?
Superficial basal-cell carcinoma
Nodular basal-cell carcinoma
Sebaceous hyperplasia
Keratoacanthoma
Melanoma
Nodular basal-cell carcinoma
This lesion has the typical appearance of an early basal-cell carcinoma (BCC) of the nodular type
Nodular BCCs are the commonest type (21%), morpheaform lesions being the least common (1%)
A mixed pattern is present in around 40% of cases
The major risk factor for BCC is sun exposure
BCC is the commonest cutaneous neoplasm in humans, 85% of cases are on the head and neck region
Superficial BCCs occur more frequently on the trunk and extremities and present with a scaling black
appearance, again with the characteristic pearly-white raised border
Morpheaform lesions present with a yellowish or white appearance similar to localised scleroderma
Sebaceous hyperplasia is a disorder characterised by generalised enlargement of the sebaceous glands
Keratocanthoma clinically and pathologically resembles a squamous cell carcinoma, but is a low
grade malignancy
Melanoma would be expected to arise in a pre-existing naevus, which doesn't fit with the picture seen
here

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.

75. Eczema herpeticum

Eczema herpeticum describes a severe primary infection of the skin by herpes simplex virus 1 or 2. It
ismore commonly seen in children with atopic eczema. As it is potentially life threatening children
should be admitted for IV aciclovir
76. Management of the skin condition below:

answer: . HERPES SIMPLEX PIC. -> ACICLOVIR

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

Theme: Forest plot

81. Which of the following would be the most appropriate means of demonstrating a metaanalysis assessing the
impact of ACE inhibitor therapy versus standard antihypertensive therapy on nephropathy in type 2
diabetes?
Bland-AJtman plot
Forest plot
Kaplan-Meierplot
Regressive partitioning analysis
Survival log table
The most appropriate way of graphically depicting the results of this meta-analysis would be with a
forest plot.
A Bland-Altman plot compares different measurement techniques.
A Kaplan-Meier curve reveals survival differences.
Forest plot explained

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

Psoriasis: exacerbating factors

The following factors may exacerbate psoriasis
* trauma
* alcohol
* drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and
ACE inhibitors
withdrawal of systemic steroids

Theme: Myesthenia Gravis

84. A 29-year-old woman with a past history ot hypothyroidism presents to the surgery
complaining of weakness, particularly of her arms for the past four months She has also
developed double visiontowards the end of the day, despite having a recent normal
examination at the opticians. What is themost likely diagnosis?
LambertEaton myasthenic syndrome
Polymyositis
Polymyalgia rheumatica
Multiple sclerosis
Myasthenia gravis

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

 antibiotics: gentamicin, macrolides, quinolones, tetracyclines,

86. Antibodies to which one of the following are found in patients with myasthenia gravis?
Acetylcholine esterase
Acetylcholine receptors
Myelin
Striated muscle
Tensilon
Answer is b. Explained above
87. A 29-year-old woman with a past history ot hypothyroidism presents to the surgery
complaining of weakness, particularly of her arms for the past four months She has also
developed double visiontowards the end of the day, despite having a recent normal
examination at the opticians. Which one of the following tests should be used to monitor her
respiratory function?
Arterial blood gas
Chest expansion
FEV1/FVC ratio
Peak expiratory flow rate
Vital capacity
Answer is VC
Diaphragmatic weakness occurs in one-third of patients with patients with Guillain-Barre syndrome
and
involvement of the neck muscles, tongue and palate leads to further respiratory compromise.
Respiratory muscle function is best monitored by frequent assessment of the forced vital capacity
(FVC).
ITU admission is recommended when FVC is less than 20 mL/kgand intubation is recommended in
most
cases when FVC is less than 15 mL/kg.
FVC is also the best way to monitor respiratory function in any neurological disorders that can affect
the
respiratory muscles (e.g. GBS, myasthenia gravis).
88. A 40-year-old man presents to the Emergency Department with difficulty breathing and
swallowing. Examination
is normal. Chest X-ray shows an enlarged upper mediastinum, so you arrange a computed tomography
scan,
which is performed the next day. This shows an enlarged thymus gland.
What would you do next?
Arrange a fine-needle aspirate of the thymus
Arrange a biopsy of the thymus
Refer to the surgeons for thymus excision
Refer to the oncologists for radiotherapy
Await the results of antibody testing prior to making a decision
Thymoma
This man has a thymoma, which is a tumour of epithelial origin arising in the thymus. Between 30%
and 40% of
patients with a thymoma have myasthenia gravis and will have positive anti-acetylcholine-receptor
antibodies; 20% of
patients with myasthenia gravis have a thymoma. The myasthenia often does not improve after the
thymus is
removed.
Management

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

Alpha-1 -antitrypsin deficiency

The combination of liver disease, severe exertional dyspnoea with a diagnosis of COPD despite a
history of very light smoking and a family history of lung disease suggests a diagnosis of a-i-

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

Centromere covene at the centre in = metaphase

Theme: polyarteritis nodosa
101.A 30-year-old man complains of weakness in his upper limbs and has digital infarcts involving
the
middle and ring fingers of his right hand. On examination, his blood pressure is 160/100 mmHg.
Investigations show Hb 10 g/dl; WCC 14 x 109/l; platelets 450 x 109/I; ESR 69 mm/1st hour.
Urinalysis shows proteinuria and microscopic haematuria with no casts. Which one of the
following is the most likely diagnosis?
Polyarteritis nodosa
Q Systemic lupus erythematosus
Wegener's granulomatosis
O Polymyositis
O Cryoglobulinaemic renal disease
Polyarteritis nodosa
Polyarteritis nodosa (PAN) is a vasculitis affecting medium-sized arteries with necrotizing
inflammation
leading to aneurysm formation. PAN is more common in middle-aged men and is associated with
hepatitis B infection
Features
* fever, malaise, arthralgia
* weight loss
* hypertension
* mononeuritis multiplex sensorimotor polyneuropathy

* 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??

105.Cocaine abuser, hypertension, sys BP 250, Rx?.............PHENOXYBENZAMINE

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

Non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) is now the most common cause of liver disease in the
developed world It is largely caused by obesity and describes a spectrum of disease ranging from:
* steatosis - fat in the liver
* steatohepatitis - fat with inflammation, non-alcoholic steatohepatitis (NASH), see below
* progressive disease may cause fibrosis and liver cirrhosis
NAFLD is thought to represent the hepatic manifestation of the metabolic syndrome and hence
insulin
resistance is thought to be the key mechanism leading to steatosis
Non-alcoholic steatohepatitis (NASH) is a term used to describe liver changes similar to those seen
in
alcoholic hepatitis in the absence of a history of alcohol abuse. It is relatively common and though
to
affect around 3-4% of the general population The progression of disease in patients with NASH may
be

responsible for a proportion of patients previously labelled as cryptogenic cirrhosis

Associated factors
* obesity
* hyperlipidaemia
* type 2 diabetes mellitus
* jejunoileal bypass
* sudden weight loss/starvation
Features
* usually asymptomatic
* hepatomegaly
* ALT is typically greater than AST
* increased echogenicity on ultrasound
Management
* the mainstay of treatment is lifestyle changes (particularly weight loss) and monitoring
* there is ongoing research into the role of gastric banding and insulin-sensitising drugs (e.g.
Metformin)

107.With which of the following is non-alcoholic steatohepatitis associated?

(Please select1 option)
A benign course in all cases
Alcohol abuse
Insulin resistance
Normal level of liver enzymes
Viral hepatitis
Non-alcoholic steatohepatitis (NASH) is associated with insulin resistance, hyperlipidaemia and
chronic moderately elevated liver enzymes.
The diagnosis is made only by histology of liver biopsy which shows lesions suggestive of ethanol
intake in a
patient known to consume less than 40 g of alcohol per week.
It is not necessarily benign: cryptogenic cirrhosis in patients is a substantial number of probable endstage
NASH.

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

Thyrotoxicosis with tender goitre = subacute (De Quervain's} thyroiditis

Whilst Grave's disease is the most common cause of thyrotoxicosis it would not cause a tender goitre
In the context of thyrotoxicosis this finding is only really seen in De Quervain's thyroiditis
Hashimoto's thyroiditis is an autoimmune disorder of the thyroid gland. It is typically associated
with
hypothyroidism although there may be a transient thyrotoxicosis in the acute phase The goitre is
non-tender in Hashimoto's.
Subacute (De Quervain's) thyroiditis
Subacute thyroiditis (also known as De Quervain's thyroiditis} is thought to occur following viral
infection
and typically presents with hyperthyroidism
Features
* hyperthyroidism
* painful goitre
* raised ESR
reduced uptake on iodine-131 scan
Management
* usually self-limiting - most patients do not require treatment
* thyroid pain may respond to aspirin or other NSAIDs
* in more severe cases steroids are used particularly if hypothyroidism develops
111. A 62-year-old man presents with lethargy. A full blood count is taken and is reported as
follows:
Hb 10.2 g/dl
Platelets 330 ~ 109/l
WBC 15.2 * 109/l
Film Leucoerythroblastic picture. Tear-drop poikilocytes seen
What is the most likely diagnosis?
Myelodysplasia
Chronic lymphocytic leukaemia
Myelofibrosis
Chronic myeloid leukaemia
Post-splenectomy

Thrombocytopenia and leucopenia are seen in progressive disease

Blood films: typical pictures

Hyposplenism e.g. post-splenectomy
target cells
Howell-Jolly bodies
Pappenheimer bodies
siderotic granules
acanthocytes
Iron-deficiency anaemia
target cells
'pencil' poikilocytes
if combined with B12/folate deficiency a 'dimorphic' film occurs with mixed microcytic and
macrocytic cells
Myelofibrosis
'tear-drop' poikilocytes
Intravascular haemolysis
schistocytes
Megaloblastic anaemia
hypersegmented neutrophils
112.A 53-year-old woman comes to see you regarding a possible diagnosis of essential
thrombocytosis. She says her gynecologist has noted a platelet count of >550,000/L on three
separate occasions over the past 2 years. Apart from two uneventful childbirths, the woman
says she really has no significant medical history. She says she has never been told she was
anemic. Lab values reveal a normal hemoglobin, hematocrit, and MCV. The platelet count is
580,000/L. Your review of the peripheral smear reveals no microcytosis or hypochromia but
does show RBC Howell-Jolly bodies. The platelet count on the smear appears elevated, but
there are no giant platelets or platelet clumps. What is the next most appropriate step in your
diagnostic work-up?
Perform bone marrow aspirate and biopsy.
Obtain a C-reactive protein and a sedimentation rate, looking for a state of chronic
inflammation.
Obtain a ferritin level to confirm that there is no iron deficiency.
Go back and obtain a more thorough history and repeat the physical exam.
Perform chest, abdominal, and pelvic CT scans, searching for an occult malignancy.
Answer: D
Explanation: The RBC Howell-Jolly bodies should be the tip-off that the patient has had a
prior splenectomy. Further questioning would reveal that the patient failed to mention a
splenectomy at the age of 14 after splenic injury in a motor vehicle accident. You missed the
surgical scar on physical exam. Postsplenectomy patients can sometimes have lifelong mild
elevations of either their WBC count or their platelet count. The gynecologist was correct to
obtain several platelet counts over time to make sure the platelet elevation was persistently
increased. Reasons for reactive thrombocytosis include iron deficiency, splenectomy,
postsurgical state, infection or inflammation, and occult malignancy. There is currently no
diagnostic test for essential thrombocytosis. It remains a diagnosis of exclusion and can be
entertained only after all forms of reactive thrombocytosis have been ruled out.

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

g/l) and Howell-Jolly bodies are seen.

Which one of the following is the most likely diagnosis?
O Thalassaemia
Sickle-cell disease
Aplastic anaemia
O Myeloma
Acute lymphocytic leukaemia
Sickle-cell anaemia
This patient presents with sickle-cell anaemia
Sickle-cell anaemia is an autosomal-recessive genetic disorder caused by a defect in the HBB gene,
which codes
for haemoglobin
Examination findings
Typically the haemoglobin levels are in the 60 to 80 g/l range with a reticulocyte count of 10-20%
There is chronic, mild icterus with an elevated bilirubin level
Examination of the peripheral blood film shows anisochromia and poikilocytosis with a variable
number of sickled
erythrocytes
There is hyposplenism as evidenced by the blood film, this means that sickle-cell anaemia is much
more likely than
thalassaemia
As the children grow older the haematological changes of hyposplenism develop with the appearance
of pits on the
surface of the red cells, Howell-Jolly bodies and distorted red cells
The white cell and platelet counts are usually normal or slightly elevated
Growth and development are usually otherwise normal, although there may be some skeletal
deformities, including
frontal bossing of the skull due to expansion of the bone marrow
Chronic leg ulceration is also common
114.A 35-year-old woman with a history of recurrent anaemia was noted to have target cells and
Howell-Jolly
bodies on a blood film examination.
Investigations revealed:
Haemoglobin 70g/L (115-165)
MCV 77 fL (80-96)
MCH 26.2 pg (28-32)
Serum B12 140 pg/L (160-760)
Red cell folate 95 pg/L (160-640)
Serum ferritin 10 pg/L (15-300)
What disease specific antibody is most likely to be present?
(Please select 1 option)
Anti-gastric parietal cell
Anti-glutamic acid decarboxylase
Anti-intrinsic factor
Anti-mitochondrial
Anti-tissue transglutaminase

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

Stop warfarin and give IV vitamin K

Stop warfarin and give IV vitamin K and prothrombin complex concentrate
This patient is hypotensive and tachycardic with melaena suggesting a major bleeding episode on
warfarin.
Treatment is bases on the severity of bleeding independent of the INR.
In these circumstances guidelines are: stop warfarin, give IV vitamin K (10 mg), and prothrombin
complex
concentrate (PCC) .
Local guidelines will be available in every NHS Trust. You must be familiar with these. If in doubt
consult with
the haematologist on call. FFP may not completely reverse the effects of warfarin so is not
recommended in
many local guidelines.
The rate of fatal haemorrhage in patients receiving warfarin approaches 1%.
120.A 67-year-old man on warfarin for atrial fibrillation presents with epistaxis. On examination
he is tachycardic with
a BP of 95/60 mmHg, and requires emergency treatment from the Ear, Nose and Throat Service. It
transpires that
he has inadvertently taken too much warfarin and his INR is 8.7.
Which of the following would be the most appropriate management (Prothrombin complex concentrate
is
not available)?
O Vitamin K
Cryoprecipitate
O Fresh-frozen plasma and vitamin K
Desmopressin
O Tranexamic acid
Warfarin overdose
An INR around 8.7 is accompanied by serious bleeding problems and is best treated by giving freshfrozen plasma
Cryoprecipitate is a rich source of the factors involved in the intrinsic pathway, eg factors VIII and
IX, and is used
to treat people with haemophilia and those with von Willebrand's disease
Vitamin K (phytomenadione) is useful in warfarin overdose but it takes hours to act and may last for
weeks
this may not be a satisfactory situation especially if the patient is suffering from a condition that
requires
anticoagulation
It is preferable to give fresh-frozen plasma to reduce the risk of bleeding, which is high with an INR
of 8.7
Vitamin K is useful for reversing the antagonism of warfarin
Tranexamic acid is an antifibrinolytic agent and can be used in the treatment of haemophilia and von
Willebrand's
disease (as is desmopressin, which releases the factor into the blood transiently)
Where available prothrombin complex concentrate is used ahead of FFP
An 84-year-old female is admitted for a urinary tract infection. On the second night of admission she is
found wandering outside the ward in an agitated state. Despite appropriate antibiotic therapy, nursing
care and modification of her environment she remains agitated and aggressive and it is judged a
potential danger to herself What is the most appropriate management?
Haloperidol 5 mg orally
Lorazepam 2 mg intramuscularly
Haloperidol 0 5 mg orally

 Lorazepam 0.5 mg orally

Ask for on-call psychiatric opinion for consideration of section under the Mental Health Act

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

Male student with history of illicit drug - mania

6.Stands in front of school and speaks to students- Mania

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.

124.action of cisplatin--cell metaphase arrest (mitotic)

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)

Which of the following is the most likely diagnosis?

A Diabetes insipidus
B Psychogenic polydipsia
C Hyperosmolar diabetic crisis
D Proximal renal tubular acidosis
E Distal renal tubular acidosis
His 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 proximal 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.

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

* drugs: e.g. acetazolamide

* ammonium chloride injection
* Addison's disease
Raised anion gap
* lactate: shock, hypoxia
* ketones' diabetic ketoacidosis, alcohol
* urate: renal failure
* acid poisoning salicylates, methanol
Metabolic acidosis secondary to high lactate levels may be subdivided into two types:
* lactic acidosis type A: shock, hypoxia, bums
* lactic acidosis type B metformin

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

Inability to acidify urine secondary to lupus-associated renal impairment.

129.A 52-year-old woman is sent to see you with an unsteady gait. She reports that this has been
coming on over
about 9 months. She specifically has trouble on stairs, coming down as well as going up, but is not too
bad on
the flat. There are no symptoms in her arms or head/face. On examination she has a broad-based gait,
with
impaired heel-toe walking. Tone power and reflexes are normal. There are no upper limb abnormalities.
The only
abnormality on testing the cranial nerves is that there is evidence of downbeat nystagmus.
What is the most likely cause?
Brainstem lacunar stroke
Foramen magnum meningioma
Arnold-Chiari malformation CORRECT ANSWER

Adult-onset cerebellar ataxia

Paraneoplastic cerebellar ataxia
The Answer Comment on this Question
YOUR ANSWER WAS INCORRECT
The patient with cerebellar gait ataxia
The history of difficulty coming down stairs and the presence of downbeat nystagmus is highly
suggestive of a
structural lesion at the foramen magnum
A meningioma could certainly cause this picture, but it might also be associated with corticospinal
signs in her legs
A mild type-l Arnold-Chiari malformation (displacement of the cerebellar tonsils into the upper part
of the cervical
canal without displacement of the medulla) would be less likely to produce corticospinal tract
involvement
With diagnosis being readily performed using cerebral MRI the incidence of this condition is higher
than previously
thought in the pre-MRI era at around 0.1-0.5%
The slow onset of symptoms is not consistent with a stroke
Adult-onset cerebellar ataxias are a heterogeneous group of rare genetically determined conditions (eg
the
numerous variations of spinocerebellar ataxias (SCA), numbered 1-27 at present, with identified
genetic
mutations) presenting with a variety of cerebellar, pyramidal and extraocular signs
In general presentation of such dominantly inherited progressive cerebellar ataxias occurs earlier in
adult life, and
the relatively late presentation, as well as the absence of other signs, makes such a diagnosis less likely
in this
case
Structural lesions need to be ruled out before making such a diagnosis

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

Answer: 1- Transthoracic echocardiogram

Relatives of patients with HOCM should be offered screening especially in the context of a fatality.
The best form is transthoracic echocardiogram, and beyond that genetic testing may be helpful.

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.

A person with haemochromatosis disease heterozygous, and population of Haemochromatosis in UK is

1 in 100. What is the chances f their son being affected, 1 in 200

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

Creatinine 130 mol/l

LDH 420 U/l (70-250)
Sats 92% on air, 89% after walk test
CXR Diffuse bilateral infiltrates
Which of the following is the most likely diagnosis?
A Tuberculosis
B Endocarditis
C Klebsiella pneumoniae pneumonia
D Pneumocystis jiroveci pneumonia Correct answer
E Staphylococcus aureus pneumonia
The clinical picture seen here, with relatively little to find on auscultation, but with chest x-ray changes
and desaturation on exercise is very typical of pneumocystis jiroveci. This may be diagnosed on the
basis of a sputum sample, although bronchio-alveolar lavage may be required to obtain a suitable
sample, the yield for BAL samples is over 90%. Co-trimoxazole or pentamidine are both proven
treatments for the condition. Given the possible diagnosis he should be screened for HIV.

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

Answered above (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)

157.pneumocystis pneumonia what investigation to isolate organism?

Answer is bronchioalvelar lavage as seen above

158.A 46-year-old woman is admitted to hospital with a community-acquired left basal
pneumonia. She is on the
appropriate antibiotics. She is still pyrexial 4 days after admission and a chest X-ray confirms a left
pleural
effusion. A diagnostic tap is performed under ultrasound.
Which one of the following is an indication to insert a chest drain?
Pleural fluid protein level more than 50% of serum protein level
Pleural fluid lactate dehydrogenase (LDH) more than 60% of serum LDH
Haemorrhagic pleural fluid
Pleural fluid pH < 7.2
Pleural fluid glucose < 1.6 mmol/l

Infected pleural effusion

This woman has a parapneumonic effusion. The indications for chest tube insertion in patients with an
infected pleural
effusion are:
Presence of organisms on a Gram stain of the pleural fluid
Frankly purulent pleural fluid
Pleural pH < 7.2 in the setting of an infected pleural effusion
Loculated pleural effusions
Poor clinical progress despite antibiotic treatment

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

activity, very high activity, high activity, low activity, minimal

mineralocorticoid mineralocorticoid mineralocorticoid mineralocorticoid
activity, activity, activity activity
Fludrocortisone Hydrocortisone Prednisolone Dexamethasone
Betmethasone
Side-effects
The side-effects of corticosteroids are numerous and represent the single greatest limitation on their
usage Side-effects are more common with systemic and prolonged therapy.
Glucocorticoid side-effects
* endocrine impaired glucose regulation increased appetite/weight gain hirsutism.
hyperlipidaemia
* Cushing's syndrome: moon face, buffalo hump, striae
* musculoskeletal osteoporosis, proximal myopathy, avascular necrosis of the femoral head
* immunosuppression: increased susceptibility to severe infection, reactivation of tuberculosis
* psychiatric: insomnia, mania depression psychosis
* gastrointestinal: peptic ulceration, acute pancreatitis
* ophthalmic: glaucoma cataracts
* suppression of growth in children
* intracranial hypertension
Mineralocorticoid side-effects
* fluid retention
* hypertension
Selected points on the use of corticosteroids:
* patients on long-term steroids should have their doses doubled during intercurrent illness
the BNF suggests gradual withdrawal of systemic corticosteroids if patients have: received more
than 40mg prednisolone daily for more than one week, received more than 3 weeks treatment or
recently received repeated courses
160.New question. A 19-year-old woman i& reviewed in the genitourinary medicine clinic. She
presented with vaginal
discharge and dysurra. Microscopy of an endocervical swab showed a Gram-negative coccus that was
later identified as Neisseria gonorrhoea This is her third episode of gonorrhoea in the past two years.
What is the most likely complication from repeated infection?
Lymphogranuloma venereum
Cervical cancer
Arthropathy
Infertility
Uterine abscess
Infertility secondary to pelvic inflammatory disease (RID) is the most common complication of
gonorrhoea It is the second most common cause of RID after Chlamidia. Arthropathy may occur but it
is far less common.
Lymphogranuloma venereum iscausedby Chlamydia tracnomatis.
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
* rectal and pharyngeal infection is usually asymptomatic
Local complications that may develop include urethral strictures epididymitis and salpingitis (hence
may
lead to infertility). Disseminated infection may occur - see below
Management
* ciprofloxacin 500mg PO used to be the treatment of choice
* however, there is increased resistance to ciprofloxacin and therefore cephalosporins are now
used
* options include cefixime 400mg PO (single dose) or ceftriaxone 250mg IM

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)

...syphillis...aortic root dissection

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

Dry macular degeneration - no current medical treatments

Wet macular degeneration
* photocoagulation
photodynamic therapy
* anti-vascular endothelial growth factor (anti-VEGF) treatments' intravitreal ranibizb

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

Reduced ankle reflex

Positive sciatic nerve stretch test
Pvlanagement
* similar to that of other musculoskeletal lower back pain: analgesia . physiotherapy, exercises
* if symptoms persist then referral for consideration of MRI is appropriate
166.Low molecular weight heparin (foundoparinaux) has the greatest inhibitory effect on which
one of the following proteins
involved in the coagulation cascade'?
Factor IXa
0 Factor Xla
Factor Xa
Thrombin
Factor XIla
Heparin
There are two main types of heparin - unfractionated 'standard' heparin or low molecular weight
heparin (LMWH). Heparins generally act by activating antithrombin ih Unfractionated heparin forms a
complex which inhibits thrombin, factors Xa IXa Xla and Xlla LMWH however only increases the
action
of antithrombin III on factor Xa
The table below shows the differences between standard heparin and LMWH
Standard heparin
Low molecular weight heparin
(LMWH)
Administration Intravenous Subcutaneous
Duration of
action
Short Long
Mechanism of
action
Activates antithrombin III Forms a
complex that inhibits thrombin,
factors Xa IXa. Xia and Xlla
Activates antithrombin hi Forms a
complex that inhibits factor Xa
Side-effects Bleeding
Heparin-induced thrombocytopaenia
(HIT)
Osteoporosis
Bleeding
Lower risk of HIT and osteoporosis with
LMWH
Monitoring Activated partial thromboplastin time Anti-Factor Xa (although routine
(APTT) monitoring is not required)
Useful in situations where there is a Now standard in the management of
Notes high risk of bleeding as venous thromboembolism treatment and
anticoagulation can be terminated prophylaxis and acute coronary
rapidly syndromes
Heparin-induced thrombocytopaenia (HIT)
* immune mediated - antibodies form which cause the activation of platelets
* usually does not develop until after 5-10 days of treatment
* despite being associated with low platelets HIT is actually a prothrombotic condition
* features include a greater than 50% reduction in platelets, thrombosis and skin allergy
* treatment options include alternative anticoagulants such as lepirudin and danaparoid
Both unfractionated and low-molecular weight heparin can cause hyperkalaemia. This is thought to be
caused by inhibition of aldosterone secretion
Heparin overdose may be reversed by protamine sulphate, although this only partially reverses the
effect of LMWH

167.A 62-year-old female with a known history of a sigmoid adenocarcinoma is admitted to

hospital with
shortness of Preath and pyrexia On examination a murmur is heard and an echo reveals a vegetation
on the aortic valve Which one of the following organisms is most characteristically associated with
causing infective endocarditis in patients with colorectal cancer?
Escnertcftta colt
Enterococcus faecalis
Salmonella
Campylooacter
Streptococcus bovis
Streptococcus bovis endocarditis is associated wtth colorectal cancer
Infective endocarditis
The strongest risk factor for developing infective endocarditis is a previous episode of endocarditis.
The following types of patients are affected:
* previously normal valves (50%, typically acute presentation)
* rheumatic valve disease (30%)
* prosthetic valves
* congenital heart defects
* intravenous drug users (IVDUs e.g Typically causing tricuspid lesion)
Causes
* Streptococcus viridans (most common cause - 40-50%)
* Staphylococcus epidermidis (especia11y prosthetic vaIves)
* Staphylococcus aureus (especially acute presentation. IVDUs)
* Streptococcus bovis is associated with colorectal cancer
* Streptococcus mitis (viridans streptococcus): following dental work
* non-infective, systemic lupus erythematosus (Libman-Sacks). malignancy, marantic endocarditis
Culture negative causes
* prior antibiotic therapy
* Coxiella burnetii
* Bartonella
* Brucella
* HACEK: Haemophilus, Acttnobacillus, Cardiobacterium, Eikeneila, Kingeila)
Following prosthetic valve surgery Staphylococcus epidermidis is the most common organism in the
first
2 months and is usually the result of perioperative contamination. After 2 months the spectrum of
organisms which cause endocarditis return to normal except with a slight increase in Staph, aureus
infections

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

77...paracetamol....risk of succide (incomplete Q)

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

* rapid weight gain may be seen

* high insulin, raised proinsulin:insulin ratio
* high C-peptide
Diagnosis
* supervised, prolonged fasting (up to 72 hours}
* CT pancreas
Management
* surgery
* diazoxide and somatostatin if patients are not candidates for surgery
175.
A 70-year-old man is admitted to hospital in a comatose condition. His wife gives a history of
past episodes of
sweating and palpitations, confusion, fits and occasional abnormal behaviour. On examination his pulse
is 92
bpm and his blood pressure is 140/90 mmHg. His plasma catecholamine level is normal and blood
glucose is 1.9
mmol/l (normal range 3.0-6.0 mmol/l).
What is the most probable diagnosis?
Multiple endocrine neoplasia type 2(MEN 2)
Phaeochromocytoma
Insulinoma
Pseudodementia
Epilepsy
Insulinoma as above
176.A 24-year-old female with a history of anxiety is taken to the Emergency Department
following an acute
onset of shortness of breath. On examination the chest is clear to auscultation but the respiratory rate
is raised at 40 breaths per minute. A diagnosis of hyperventilation secondary to anxiety is suspected.
Which of the following arterial blood gas results (taken on room air) are consistent with this?
pH = 7.56; pC02 = 2.9 kPa: p02 = 10.1 kPa
pH = 7.24; pC02 = S.4 kPa; p02 = 12.7 kPa
pH = 7.34; pC02 = 2.7 kPa' p02 = 15.4 kPa
pH = 7.54; pC02 = 2.4 kPa; p02 = 14.1 kPa
pH = 7.54; pC02 = 4.9kPa; p02 = 13.3 kPa
Hyperventilation will result in carbon dioxide being 'blown off causing an alkalosis.
Whilst the gases in answer A show a respiratory alkalosis the hypoxia could not be explained by
hyperventilation
Respiratory alkalosis
Common causes
anxiety leading to hyperventilation
pulmonary embolism
salicylate poisoning*
* CNS disorders: stroke, subarachnoid haemorrhage encephalitis
* altitude
* pregnancy
overdose leads to a mixed respiratory alkalosis and metabolic acidosis Early stimulation of
the respiratory centre leads to a respiratory alkalosis whilst later the direct acid effects ot salicylates
(combined with acute renal failure} may lead to an acidosis
Enter your

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.

Pagets disease of the bone

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

 Phenothiazines (chlorpromazine) also have the same problem

Temazepam and lorazepam are short-acting benzodiazepines, hence withdrawal is harder
184.low wells score...next inv???? computed tomography pulmonary angiogram (CTPA). If there
is a delay in getting the CTPA then give
low-molecular weight hepann until the scan is performed
If the patient has an allergy to contrast media or renal impairment
if a PE is 'likely* (more than 4 points) arrange an immediate computed tomography pulmonary
angiogram (CTPA). If there is a delay in getting the CTPA then give low-molecular weight heparin
until
the scan is performed
99...pulmonary embolism in pregnant
185.A 38-year-old woman presents with a recent history of pruritus, fatigue and jaundice.
Liver biopsy revealed: Shows periportal fibrosis with periportal inflammation and prominent
enlargement of
the portal tracts.
Which one of the following antibodies is most likely to be found in the blood?
(Please select 1 option)
Anticardiolipin
Anticentromere
Antimitochondrial
Antimyeloperoxidase
Antinuclear
Primary biliary cirrhosis (PBC) is a slowly progressive autoimmune disease of the liver that primarily
affects
women in their fifth decade.
It is characterised by portal inflammation and immune-mediated destruction of the intrahepatic bile
ducts
which results in reduced bile secretion and retention of toxic substances. This leads to further hepatic
damage.
fibrosis and cirrhosis.
Serologically, PBC is characterised by antimitochondrial antibodies, which are present in 90-95% of
patients
(often before clinical signs develop) and have a specificity of 98%.
These antibodies are specific for the E2 subunit of the pyruvate dehydrogenase complex and it is
unclear why
they affect only the liver when all nucleated cells contain mitochondria. Twin and family studies
suggest there
is a significant genetic predisposition. Treatment is empirical and patients may go on to require a liver
transplant.
Anticardiolipin antibodies are most commonly associated with antiphospholipid syndrome which
increases the
risk of thrombosis.
Anticentromere antibodies are associated with limited systemic sclerosis.
Myeloperoxidase is the antigen which p-ANCA (antineutrophil cytoplasmic antibodies) targets. It is
associated
with a number of vasculitides but most classically microscopic polyangiitis.
Antinuclear antibodies are associated with 80-90% of cases of systemic lupus erythematosus but are
also
found with Sjogren's syndrome, rheumatoid arthritis, autoimmune hepatitis, systemic sclerosis and
polymyositis and demnatomyositis.
186.A 2 9-year-eld woman presents with dysuria and frequency tour weeks after giving birth.
The antenatal

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.

Amitriptyline and dosulepin (dothiepin) are particularly dangerous in overdose

Early features relate to anticholinergic properties dry mouth, dilated pupils agitation, sinus
tachycardia blurred vision.
Features of severe poisoning include
* arrhythmias
* seizures
* metabolic acidosis
* coma
EGG changes include
* sinus tachycardia
* widening of QRS
* prolongation of QT interval
Widening of QRS > 100ms is associated with an increased risk of seizures whilst QRS1160ms is
associated with ventricular arrhythmias
Management
* IV bicarbonate may reduce the risk of seizures and arrhythmias in severe toxicity
* arrhythmias' class 1a (e.g Quinidine) and class Ic antiarrhythmics (e.g. Flecainide) are
contraindicated as they prolong depolarisation. Class ill drugs such as amiodarone should also
be avoided as they prolong the QT interval Response to lignocaine is variable and it should be
emphasized that correction of acidosis is the first line in management of tricyclic induced
arrhythmias
* dialysis is ineffective in removing tricyclics

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

Atrial myxoma - commonest site = left atrium

The most common site of atrial myxomas is atthetossa ovalis border in the left atrium
Atria! myxoma
Overview
75% occur in left atrium
* more common in females
Features
systemic: dyspnoea fatigue, weight loss, fever clubbing
* emboli
atrial fibrillation
* mid-diastolic murmur, 'tumour plop'
* echo pedunculated heterogeneous mass typically attached to the fossa ovalis region of the
interatrial septum

194.September 2015 exam

A patient presents to Medical Outpatients with diplopia.
Which one of the following suggests that the IVth cranial nerve (the trochlear nerve) is involved?
The diplopia is horizontal
The diplopia is episodic
The diplopia is worse at night
The diplopia is torsional CORRECT ANSWER
The diplopia is worse for distance- than near-vision
IVth nerve palsy
The trochlear nerve supplies the superior oblique muscle, which depresses the eye and rotates it

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

 Pupillary and accommodation reflexes are characteristically normal

Two-thirds of patients with myasthenia gravis have thymic hyperplasia and 10-15% will have
thymoma
The creatinine phosphokinase (CPK) is typically normal
Graves' disease
Exophthalmos and diplopia are suggestive of Graves' disease
There is restriction in upward and/or outward gaze; this is due not to weakness of the superior eye
muscles but to
swelling and fibrosis of the inferior rectus and inferior oblique muscles beneath the globe

Fluent aphasia + Bad comprehension lesion Superior temporal gyrus (Wernickes)

197.pt with temporal lobe epilepsy - has memory problem Which part of brain involved?
Hippocampus
198.A 17-year-old girl was admitted to the Emergency Department after suffering a generalised
tonic-clonic seizure at
0700 hours. She admits she went to a nightclub the night before and only went to bed at 0100
hours. A detailed
history reveals that her upper limbs twitch daily in the early morning, but only for a few seconds.
Neurological
examination is normal. CT brain is normal. An outpatient EEG is requested.
What is the most likely diagnosis?
Diagnosis cannot be made with the above information
O Frontal lobe epilepsy
O Juvenile myoclonic epilepsy
Symptomatic epilepsy
O Temporal lobe epilepsy

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

Epilepsy medication: first-line

* generalised seizure: sodium valproate
* partial seizure: carbamazepine
Epilepsy: treatment
Most neurologists now start antiepileptics following a second epileptic seizure. NICE guidelines
suggest
starting antiepileptics after the first seizure if any of the following are present:
* the patient has a neurological deficit
* Prain imaging shows a structural abnormality
the EEG shows unequivocal epileptic activity
* the patient or their family or carers consider the risk of having a further seizure unacceptable
Sodium valproate is considered the first line treatment for patients with generalised seizures with

carbamazepine used for partial seizures

Generalised tonic-clonic seizures
* sodium valproate
* second line: lamotrigine. carbamazepine
Absence seizures* (Petit mal)
sodium valproate or ethosuximide
* sodium valproate particularly effective if co-existent tonic-clonic seizures in primary generalised
epilepsy
Myoclonic seizures
* sodium valproate
second line: clonazepam, lamotrigine
Partial seizures
* carbamazepine
* second line: lamotrigine**. sodium valproate
Carbamazepine may actually exacerbate absence seizure
**the 2007 5ANAD study indicated that lamotrigine may be a more suitable first-line drug for partial
seizures although this has yet to work its way through to guidelines

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

Head injury: types of traumatic brain injury

Basics
primary Drain injury may De local (conlusiorvhaematoma) or diffuse (diffuseaxonal injury)
diffuse axonalinjury occurs as a result of mechanical shearing following deceleration causing
disruption and teanng of axons
intra-cramal haematomas can be extradural, subdural or intracerebral while contusions may
occur adjacent to (coup) or contralateral (contre-coup) to the side of impact
secondary brain injury occurs when cerebral oedema ischaemia infection tonsillar or tentonai
herniation exacerbates the original injury The normal cerebral auto regulatory processes are
disrupted following trauma rendenng the Dram more susceptible to Wood flow changes and
hypoxia
the Cushings reflex (hypertension and bradycardia) often occurs late and is usually a pre
terminal event
Type of injury Notes
Extradural Bleeding into the space between the duramater and the skull. Often results
(epidural) from acceleration-deceleration trauma or a Wow to the side of the head The
haematoma majority of epidural haematomas occur In the temporal region where skull
fractures cause a rupture of the middle meningeal artery
Features
features of raised intracranial pressure
some patients may exhibit a lucid interval
Subdural Bleeding into the outermost meningeal layer Most commonly occur around
haematoma the frontal and parietal lobes
Risk factors include old age alcoholism and anticoagulation

Slower onset of symptoms than a epidural haematoma

Subarachnoid Usually occurs spontaneously in the context of a ruptured cerebral aneurysm
haemorrhage but may beseen in association with other Injuries when a patient has
sustained a traumatic brain injury

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

204.pt with headache and anosmia

Meningioma

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 ??

209.A pt with previous history of DVT had stroke

Prophylaxis for DVT?
LMW heparin
Diagnosis
NICE published guidelines in 2012 relating to the investigation and management of deep vein
thrombosis (DVT).
If a patient is suspected of having a DVT a two-level DVT Wells score should be performed:
"IVvo-level DVTWells score
Clinical feature Points
Active cancer (treatment ongoing, within 6 months, or palliative) 1
Paralysis, paresis or recent plaster immobilisation of the lower extremities 1
Recently bedridden for 3 days or more or major surgery within 12weeks requiring general 1
or regional anaesthesia
Localised tenderness along the distribution of the deep venous system 1
Entire leg swollen 1
Calf swelling at least 3 cm larger than asymptomatic side 1
Pitting oedema confined to the symptomatic leg 1
Collateral superficial veins (non-varicose) 1
Previously documented DVT 1
An alternative diagnosis is at least as likely as DVT -2
Clinical probability simplified score
DVT likely: 2 points or more
DVT unlikely: 1 point or less
If a DVT is 'likely' (2 points or more)
a proximal leg vein ultrasound scan should be carried out within 4 hours and. if the result is
negative a D-dimer test
if a proximal leg vein ultrasound scan cannot be carried out within 4 hours a D-dimer test should
be performed and low-molecular weight heparin administered whilst waiting for the proximal leg
vein ultrasound scan (which should be performed within 24 hours)
If a DVT is 'unlikely' (1 point or less)
perform a D-dimer test and if it is positive arrange:
a proximal leg vein ultrasound scan within 4 hours
if a proximal leg vein ultrasound scan cannot be carried out within 4 hours low-molecular weight
heparin should be administered whilst waiting for the proximal leg vein ultrasound scan (which
should be performed within 24 hours)
Management
Low molecular weight heparin (LMWH) or fondaparinux should be given initially after a DVT is
diagnosed.
a vitamin K antagonist (i.e warfarin) should be given within 24 hours of the diagnosis
the LMWH or fondaparinux should be continued for at least 5 days or until the international
normalised ratio (INR) is 2.0 or above for at least 24 hours, whichever is longer i.e. LMWH or
fondaparinux is given at the same time as warfarin until the INR is in the therapeutic range
warfarin should be continued for at least 3 months. At 3 months. NICE advise that clinicians
should 'assess the risks and benefits of extending treatment'
NICE add 'consider extending warfarin beyond 3 months for patients with unprovoked proximal
DVT if their risk of VTE recurrence is high and there is no additional risk of major bleeding'. This
essentially means that if there was no obvious cause or provoking factor (surgery, trauma.
significant immobility) it may imply the patient has a tendency to thrombosis and should be given
treatment longer than the norm of 3 months. In practice most clinicians give 6 months of warfarin
for patients with an unprovoked DVT/PE
for patients with active cancer NICE recommend using LMWH for 6 months
Further investigations and thrombophilia screening
As both malignancy and thrombophilia are obvious risk factors for deep vein thrombosis NICE make
recommendations on how to investigate patients with unprovoked clots.
Offer all patients diagnosed with unprovoked DVT or PEwho are not already known to have cancer the
following investigations for cancer:
a physical examination (guided by the patient's full history) and
a chest X-ray and

 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

Anti-Jo1 antibodies are more commonly seen in polymyositis than dermatomyositis

Extractable nuclear antigens
Overview
specific nuclear antigens
usually associated with being ANA positive
Examples
* anti-Ro Sjogren's syndrome SLE. congenital heart block
* anti-La: Sjogren's syndrome
* anti-Jo 1: polymyositis
* anti-scI-70 diffuse cutaneous systemic sclerosis
* anti-centromere. limited cutaneous systemic sclerosis
211.Which one of the following is true regarding the investigation of a patient with
dermatomyositis?
Creatine kinase is characteristically normal
Muscle biopsy is contraindicated
Anti-Jo-1 antibodies are usually negative
Antinuclear antibodies are always negative
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
* anti-Jo-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
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

CK high, vasculitic lesion and ANA pos- dermatomyositis

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)

New q Structure if Immnoglobulin-Binding sites- Fc binds to Phagocytes

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)

The AHA/ACC/SCAI/ACS/ADA published recommendations in 2007 stressed the importance of 12

months of dual antipiatelet therapy after placement of a drug-eluting stent (DES)
Ctopidogrel
Clopidogrel is an antiplatelet agent used in the management of cardiovascular disease. It was
previously used when aspirin was not tolerated or contraindicated but there are now a number of
conditions for which clopidogrel is used in addition to aspirin for example in patients with an acute
coronary syndrome Following the 2010 NICE technology appraisal clopidogrel is also now first-line in
patients following an ischaemic stroke and in patients with peripheral arterial disease.
Clopidogrel belongs to a class of drugs known as thienopyridines which have a similar mechanism of
action Other examples include
* prasugrel
ticagrelor
* ticlopidine
Mechanism
antagonist of the P2Y-is adenosine diphosphate (ADR) receptor, inhibiting the activation of
platelets
Interactions
concurrent use of proton pump inhibitors (PPIs) may make clopidogrel less effective (MHRA July
2009}
this advice was updated by the MHRA in April 2010 evidence seems inconsistent but omeprazole
and esomeprazole still cause for concern. Other PPIs such as lansoprazole should be OK please see the link for more details

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

If there is a positive response to acute vasodilator testing

* oral calcium channel blockers
If there is a negative response to acute vasodilator testing
* prostacyclin analogues: treprostinii iloprost
* endothelin receptor antagonists: bosentan
* phosphodiesterase inhibitors: sildenafil

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

bilateral crackles audible on examination. CXR confirms bilateral consolidation.

Which one of the following is most likely as a cause?
1- Legionella
2- Mycoplasma
3- Streptococcus pneumoniae
4- Klebsiella
5- staphylococcus aureus
Answer & Comments
Answer: 5- staphylococcus aureus
Normal incidence of staph aureus pneumonia is 2%, However this is significantly increased in
iv drug users and influenzae virus infections. Post influenzae staph aureus pneumonia is
characterised by rapid clinical deterioration with septicaemia.

1. TIA TERRITORY -> VERTEBROBASILAR ARTERY

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

ganglia output to reinforce the cortical

mechanisms that prepare and execute the
commands to move. The first line treatment is
with L-dopa which is the metabolic precursor of
L-dopa. Benzhexol is an anticholinergic drug
(used to alleviate tremors in parkinson's
disease), and is not effective against
bradykinesia.
Dopamine agonists (bromocriptine) and MAO
inhibitors (selegiline) are used as adjuncts to
patients who have motor fluctuations on Ldopa.
Parkinson's disease: management
Currently accepted practice in the management of patients with Parkinson's disease (PD) is to delay
treatment until the onset of disabling symptoms and then to introduce a dopamine receptor agonist. If
the patient is elderly, levodopa is sometimes used as an initial treatment.
Dopamine receptor agonists
* e.g. Bromocriptine, ropinirole, cabergoline. apomorphine
* ergot-derived dopamine receptor agonists (bromocriptine, cabergoline. pergolide*) have been
associated with pulmonary, retroperitoneal and cardiac fibrosis. The Committee on Safety of
Medicines advice that an echocardiogram, ESR, creatinine and chest x-ray should be obtained
prior to treatment and patients should be closely monitored
patients should be warned about the potential for dopamine receptor agonists to cause impulse
control disorders and excessive daytime somnolence
* more likely than levodopa to cause hallucinations in older patients. Nasal congestion and
postural hypotension are also seen in some patients
Levodopa
usually combined with a decarboxylase inhibitor (e.g. carbidopa or benserazide) to prevent
peripheral metabolism of levodopa to dopamine
* reduced effectiveness with time (usually by 2 years)
* unwanted effects: dyskinesia (involuntary writhing movements), 'on-off1 effect, dry mouth.
anorexia, palpitations, postural hypotension, psychosis, drowsiness
* no use in neuroleptic induced parkinsonism
MAO-B (Monoamine Oxidase-B) inhibitors
* e.g. Selegiline
inhibits the breakdown of dopamine secreted by the dopaminergic neurons
Amantadine
* mechanism is not fully understood, probably increases dopamine release and inhibits its uptake
at dopaminergic synapses
side-effects include ataxia, slurred speech, confusion, dizziness and livedo reticularis
COMT (Catechol-O-Methyl Transferase) inhibitors
* e.g. Entacapone. tolcapone
* COMT is an enzyme involved in the breakdown of dopamine, and hence may be used as an
adjunct to levodopa therapy
* used in conjunction with levodopa in patients with established PD
Antimuscarinics
block cholinergic receptors
now used more to treat drug-induced parkinsonism rather than idiopathic Parkinson's disease
* help tremor and rigidity
e.g. procyclidine, benzotropine. trihexyphenidyl (benzhexol)
*pergolide was withdrawn from the US market in March 2007 due to concern regarding increased
incidence of valvular dysfunction
227.
A 54-year-old man with intermittent claudication was found to have renal impairment.
Investigations revealed:
Serumcreatinine 180 umol/l (60-100)
Urinalysis Protein++

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

12. HYPOVOLEMIC HYPONATEMIA-> INCREASED ALDOSTERONE LEVELS

13. ADRENAL CRISiS WITH AC. APPENDICITIS
231.
A 24-year-oId woman is found to have a blood pressure of 170/100 mmHg during a routine
medical
check. She is well and clinical examination is unremarkable Blood tests show:
Na+ 140 mmol/I
K+ 2.6 mmol/l

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

Hyperaldosteronism/Conns syndrome: aldosterone impacts distal tubules & collecting ducts of

nephron sodium and water retention, potassium retention blood pressure

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?

brainstem demyelination(internuclear opthalmoplegia in Multiple sclerosis)

237.
Rheumatoid factor may be present in each of these conditions, except
Adult Still's disease
Subacute bacterial endocarditis
Vasculitis syndromes
Sarcoidosis
Sjgren's syndrome
Answer: A
Explanation: Patients with adult Still's disease are "seronegative" and lack serum rheumatoid
factor. Rheumatoid factors are antibodies specific for the region of the Fc portion of human
IgG. Although present in 75 to 80% of rheumatoid arthritis patients, primarily those with
HLA-DR4 haplotype, they are by no means specific for this disorder and are found in normal
individuals as well as patients with a variety of other inflammatory illnesses.
238.A 20-year-old man presents with a 4-day history of high spiking pyrexia and arthralgia. On
examination he has a
maculopapular, salmon-pink rash on his trunk and arms and his distal interphalangeal joints are
swollen.
Hepatosplenomegaly is present.
What is the most likely diagnosis?
Hepatitis C infection
Adult Still's disease CORRECT ANSWER
Infectious mononucleosis
Rheumatoid arthritis
Behcet's disease
The Answer Comment on this Question
YOUR ANSWER WAS INCORRECT
Adult Still's disease
Adult-onset Still's disease is found worldwide, with an incidence of 1-3 per million, most commonly in
the age range
16-35 years and affecting males and females equally in most populations. There is no consistent human
leucocyte
antigen (HLA) association. Common features are the high, spiking pyrexia, arthralgia or arthritis, and a
characteristic
rash.
Clinical features
The fever typically appears in the evening. Spikes in excess of 39 C are typical, though a return to a
normal

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

22. AFP IN HCC

240.A 39-year-old man returns from a two week business trip to Kenya Four weeks after his return
he
presents complaining of malaise, headaches and night sweats. On examination there is a symmetrical

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

* if severe toxic megacolon may develop

Diagnosis is made by detecting Clostridium difficile toxin (CDT) in the stool
Management
* first-line therapy is oral metronidazole for 10-14 days
* if severe or not responding to metronidazole then oral vancomycin may be used
* for life-threatening infections a combination of oral vancomycin and intravenous metronidazole
should be used
242.Another questin asked diagnosis of C.DIFF-> TOXIN LEVELS TO CHECK in stool culture
243. What toxin does clostridium difficile produce - exotoxins
244.
GENTAMICIN-> HAIR CELLS LOSS CAUSING DEAFNESS
The current prevailing view is that aminoglycoside toxicity is associated with death of inner ear hair
cells one to two days after exposure, while spiral ganglion cell loss occurs three to fifteen days postexposure (Alharazneh et al 2011, Zilberstein et al 2012). The auditory ganglion is spared.
87.can not appreciate voices in noice...loss of hair cell in cochlea

245.Which of the following is least likely to be a precipitating factor in digoxin toxicity?

Hypernatraemia
Hypocalcaemia
Hypokalaemia
Hypothermia
Hypomagnesaemia
Hyper- not hypocalcaemia may be a precipitating factor in digoxin toxicity
Digoxin and digoxin toxicity
Digoxin is a cardiac glycoside now mainly used for rate control in the management of atrial
fibrillation.
As it has positive inotropic properties it is sometimes used for improving symptoms (but not mortality)
in
patients with heart failure.
Mechanism of action
* decreases conduction through the atrioventricular node which slows the ventricular rate in atrial
fibrillation and flutter
* increases the force of cardiac muscle contraction due to inhibition of the Na+/K* ATPase pump.
Also stimulates vagus nerve
Digoxin toxicity
Plasma concentration alone does not determine whether a patient has developed digoxin toxicity. The
6NF advises that the likelihood of toxicity increases progressively from 1.5 to 3 mcg/l
Features
* generally unwell lethargy, nausea & vomiting, anorexia., confusion, yellow-green vision
* arrhythmias (e.g. AV block, bradycardia}
Precipitating factors
* classically: hypokalaemia*
increasing age
renal failure
myocardial ischaemia
* hypomagnesaemia hypercalcaemia hypernatraemia acidosis
hypoalbuminaemia
hypothermia

* 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

246.Digoxin toxicity ECG

In digoxin toxicity, the finding of frequent premature ventricular beats (PVCs) is the most
common and the earliest dysrhythmia. Sinus bradycardia is also very common. In addition,
depressed conduction is a predominant feature of digoxin toxicity. Other ECG changes that
suggest digoxin toxicity include bigeminal and trigeminal rhythms, venticular bigeminy, and
bidirectional ventricular tachycardia

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.

28. SUCRALFATE WILL RELIVE SYMPTOMS WITHOUT ACID SUPPRESSION

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

* rectal and pharyngeal infection is usually asymptomatic

Local complications that may develop include urethral strictures epididymitis and salpingitis (hence
may
lead to infertility). Disseminated infection may occur - see below
Management
* ciprofloxacin oOQmg PO used to be the treatment of choice
* however, there is increased resistance to ciprofloxacin and therefore cephalosporins are now
used
options include cefixime 400mg PO (single dose) or ceftriaxone 250mg 1M
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)

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

mesangial proliferation, immunostaining demonstrates IgA deposits. Hypertension is managed

aggressively with ACE
inhibitors as the backbone of therapy. Immunosupression with corticosteroids/ cyclophosphamide may
be considered
for patients with rapidly progressive disease.
253.A 17-year-old man is referred to the local nephrology unit tor investigation. He reports
having several
episodes of visible haematuria There is no history of abdominal or loin pain. These typically seem to
occur within a day or two of developing an upper respiratory tract infection. Urine dipstick is normal.
Blood tests show the following:
Na+ 141 mmol/l
K+ 4.3 mmol/l
Bicarbonate 25 mmol/l
Urea 4.1mmol/l
Creatinine 72 pmol/l
What is the most likely diagnosis?
Chlamydia
Bladder cancer
IgA nephropathy
Rhinovirus-associated nephropathy
Post-streptoc oc ca1 g1omeru1onephritis

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.

smoking, hyperlipidaemia. ACE genotype DD

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

 Nephrotic: heavy proteinuria (>1.5 g/day); little or no haematuria, significant oedema

examples: minimal change disease, focal glomerulosclerosis, amyloid, diabetic nephropathy

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?

1- Glomerular IgG deposition2- Microaneurysm formation3- Necrotising granuloma formation

4- Glomerular IgA deposition
5- Glomerular sclerosis
Answer & Comments
Answer: 4- Glomerular IgA deposition
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 patient's clinical picture. Most
patients with HSP recover with conservative management involving pain relief and use of antiinflammatories. Where there is significant renal impairment, corticosteroids +/- steroid sparing agents
such as cyclophosphamide are used.

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

Answer & Comments

Answer: 5- Mesangial hypercellularity
The age , sex and almost simultaneous presentation of sore throat with haematuria suggests IgA
nephropathy.
It is a common cause of macroscopic haematuria in a child. It also occurs commonly in young adults.
Episodes of haematuria are often simultaneous with periods of viral infection (sore throat) and flank
pain. The urine may be frankly bloody or may be cola colour. There are clots in urine. It usually
resolves spontaneously within
4-7days.Renal biopsy will show mesangial IgA deposition on immunofluorescence, light microscopy
will show mesangial hypercellularity with matrix expansion.
257.32-year-old woman with IgA nephropathy attended the clinic shortly after having a positive
pregnancy test.
On physical examination, pulse rate was 60 / minute and blood pressure was 145/83 mmHg. Fundi and
cardiac
examinations were normal. There was no pedal oedema.
Urine protein measured 0.7 g daily. Her serum creatinine level was 60 pmol/L. Medications at that time
were
lisinopril and folic acid.
Which of the following recommendations is most appropriate?
(Please select 1 option)
Continue the folic acid and lisinopril.
Continue the folic acid and lisinopril. but advise to stop lisinopril in the second half of pregnancy.
Change lisinopril to losartan. X Incorrect answer selected
Stop lisinopril. This is the correct answer
Target blood pressure of < 120/80mmHgduring pregnancy.
Both ACE inhibitor and angiotensin-receptor blocker are contraindicated in pregnancy.
The use of ACE inhibitor during the second half of the pregnancy (the second option) has been well
known to
be associated with oligohydramnios (probably resulting from impaired fetal renal function) and
neonatal
anuria, and fetal death.
Although the old teaching might allow the use of lisinopril during the first trimester, an observational
retrospective cohort study that included women with exposure to ACE inhibitors in the first trimester,
as
reported in 2006, raised the issue that the drug is associated with increased odds for cardiovascular
defects
and central nervous system defects.
By extrapolation, other blockers of renin-angiotensin system should also be switched to other class of
antihypertensive drugs (before conception, if possible). In other words, the second and third options are
not
appropriate.
Blood pressure goal during pregnancy, in general, is less aggressive (the fifth answer option); a very
tight blood
pressure control is linked with an increased risk of fetal growth restriction. Pre-pregnancy doses of
antihypertensive medications are not infrequently reduced, particularly in the second trimester.

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

nephropathy. Patients should

be managed aggressively with respect to BP control, with ACE inhibitors forming the backbone of
therapy. Where creatinine
is deteriorating, there is limited evidence for immunosupression with a combination of corticosteroids
and
cyclophosphamide. In the majority of patients the disease follows a benign course, but some element of
chronic renal failure
may develop in up to around 30% of patients.

IGA nephropathy- control of BP for progression 196

Man with IgA nephropathy, doubled Cr for a year, outcome - CRF without ESRD.

260. PULMONARY EDEMA treatment: Diamorphine for the pain

00% if no pre-existing lung disease
IV access and monitor ECG
Treat any arrhythmias, eg AF (p118125)
Investigations whilst continuing treatment
Diamorphine 1.255mg IV slowly
Caution in liver failure and COPD
Furosemide 4080mg IV slowly
Larger doses required in renal failure
GTN spray 2 puff s SL or 2 0.3mg tablets SL
Dont give if systolic BP <90mmHg
Necessary investigations, examination, and history
If systolic BP 100mmHg, start a nitrate infusion,
eg isosorbide dinitrate 210mg/h IVI; keep systolic BP 90mmHg
If the patient is worsening:
Further dose of furosemide 4080mg
Consider CPAPimproves ventilation by recruiting more alveoli, driving fl uid out
of alveolar spaces and into vasculature (get help before initiating!)
Increase nitrate infusion if able to do so without dropping systolic BP <100
If systolic BP <100mmHg, treat as cardiogenic shock (p814) and refer to ICU

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?

(Please select 1 option)

Cavernous sinus thrombosis X Incorrect answer selected
Compression of the optic nerve
Glaucoma
Optic neuritis This is the correct answer
Retinal vein occlusion
The acute presentation with central scotoma, reduced visual acuity and a swollen optic disc in a young
female
suggests a diagnosis of multiple sclerosis with an optic neuritis.
Optic neuritis is a broad term which can be used to describe inflammation, degeneration or
demyelination of
the optic nerve. It encompasses a number of conditions, including:
Papillitis (anterior optic neuritis) - the intraocular portion of the nerve is affected, and the optic disc is
swollen
Retrobular neuritis - the distal portion of the optic nerve is affected, and the disc is therefore not
swollen
Neuroretinitis - optic disc and adjacent temporal retina are affected.
Also important to note is that the disc changes in papilloedema may closely resemble those of papillitis
but
visual acuity is markedly reduced in papillitis and not papilloedema.

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

Painful third nerve palsy = posterior communicating artery aneurysm

Given the combination of a headache and third nerve palsy it is important to exclude a posterior
communicating artery aneurysm
Third nerve palsy
Features
* eye is deviated 'down and out1
* ptosis
* pupil may be dilated (sometimes called a 'surgical' third nerve palsy)
Causes
* diabetes mellitus
* vasculitis e g temporal arteritis. SLE
* false localizing sign* due to uncal herniation through tentorium if raised ICR
* posterior communicating artery aneurysm (pupil dilated)

* cavernous sinus thrombosis

* Weber's syndrome', ipsilateral third nerve palsy with contralateral hemiplegia -caused by midbrain
strokes
* other possible causes: amyloid multiple sclerosis
*this term is usually associated with sixth nerve palsies but it may be used for a variety of neurological
Presentations

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

abdominal pain aggravate by food............

..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)

3- Pulmonary function test in asbestosis

MRCP May 2014

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

Homocystinuna - give vitamin Bb (pyridoxine)

Homocystinuria
Homocystinuna 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, iivedo reticularis
Diagnosis is made by the cyanide-nitroprusside test, which is also positive in cystinuria

Treatment is vitamin B6 (pyridoxine) supplements

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

Homocystinuna - give vitamin Bb (pyridoxine)

Homocystinuria
Homocystinuna 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, iivedo reticularis
Diagnosis is made by the cyanide-nitroprusside test, which is also positive in cystinuria
Treatment is vitamin B6 (pyridoxine) supplements

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

Atrial fibrillation - cardioversion: amiodarone + flecainide

Atrial fibrillation: pharmacological cardioversion
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) 2012 guidelines
Agents with proven efficacy in the pharmacological cardioversion of atrial fibrillation
* amiodarone
* flecainide (if no structural heart disease)
* others (less commonly used in UK): quinidine, dofetilide. ibutilide. propafenone
Less effective agents
* beta-blockers(includingsotalol)
* calcium channel blockers

* 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

HUS or TTP? Neuro signs and purpura point towards TTP

The combination of neurological features, renal failure, pyrexia and thrombocytopaenia point towards a
diagnosis of thrombotic thrombocytopenic purpura
Thrombotic thrombocytopenic purpura
Pathogenesis ot thrombotic thrombocytopenic purpura (TTP)
* abnormally large and sticky multiiners of von Willebrand's factor cause platelets to clump within
vessels
* in TTP there is a deficiency of ADAMTS13 (a metalloprotease enzyme) which breakdowns large
multimers of von Willebrand's factor
* overlaps with haemolytic uraemic syndrome (HUS)
Features
* rare, typically adult females
* fever
* fluctuating neuro signs (microemboli)
* microangiopathic haemolytic anaemia
* thrombocytopenia
* renal failure
Causes
* post-infection e.g. urinary, gastrointestinal
* pregnancy
* drugs: ciclosporin. oral contraceptive pill penicillin, clopidogrel aciclovir
* tumours
* SLE
* HIV

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

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
Reduced ankle reflex
Positive sciatic nerve stretch test
Pvlanagement
* similar to that of other musculoskeletal lower back pain: analgesia . physiotherapy, exercises
* if symptoms persist then referral for consideration of MRI is appropriate
270.A 40-year-old man presents with pain in his lower Pack and 'sciatica' tor the past three days.
He
describes bending down to pick up a washing machine when he felt 'something go1. He now has severe
pain radiating from his back down the right leg On examination he describes paraesthesia over the
anterior aspect of the right knee and the medial aspect of his calf. Power is intact and the right knee
reflex is diminished The femoral stretch test is positive on the right side. Which nerve root is most
likely
to be affected?
0 Common peroneal nerve
Lateral cutaneous nerve of the thigh
L5
L3
L4

L4 nerve root compression Sensory loss anterior aspect of knee

Weak quadriceps
Reduced knee reflex
Positive femoral stretch test
271.An 18-year-old woman has a history of panic attacks. She notices that during her attacks she
feels disconnected
from herself as if she is unreal
What is the best description of this symptom?
Hallucination
Illusion
Depersonalisation
Derealisation
Retardation of thought

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

274.What is the purpose of irradiating blood products?

1- Inactivation of residual donor lymphocytes
2- Reduce bacterial contamination

3- Inactivation of host lymphocytes

4- Depletion of number of donor lymphocytes
5- Apoptose CMV virus
Answer: 1- Inactivation of residual donor lymphocytes

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

7. PCP scenario, O2 sat was less than 9, Rx= steroids

278.A 33 year old male with HIV presents unwell. He has a cough productive of green sputum, is
short of breath and is pyrexial. He is noticed to desaturate on minimal exertion. On
examination there is a few crackles bibasally. A chest X ray reveal perihilar bilateral diffuse
infiltrates.
What is the most likely diagnosis?
1- Staphylococcus aureus pneumonia
2- Mycoplasma pneumoniae pneumonia
3- Klebsiella pneumoniae pneumonia
4- Legionella
5- Pneumocystis jiroveci pneumonia Answer & Comments
Answer: 5- Pneumocystis jiroveci pneumonia

9- **Poor Sign of alzheimer : Poor Identification of Time ? POOR ORIENTATION OF TIME

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

Presentation with melaena = 1

Presentation with syncope = 2
Hepatic disease = 2
Cardiac failure = 2
Patients with a Blatchford score of 0 may be considered for early discharge
Resuscitation:
ABC, wide-bore intravenous access * 2
platelet transfusion if actively bleeding platelet count of less than 50 x 10*9/litre
fresh frozen plasma to patients who have either:
a fibrinogen level of less than 1 g/litre, or
a prothrombin time (international normalised ratio) or activated partial thromboplastin
time greater than 1.5 times normal
prothrombin complex concentrate to patients who are taking warfarin and actively
bleeding
Endoscopy:
should be offered immediately after resuscitation in patients with a severe bleed
all patients should have endoscopy within 24 hours

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 ??

22- **amaurosis fugax :: MCA or Carotid .. ..Internal Carotid Artery

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

25- patient with nasal blockage , SOB :: Asprin

26-** Occipital Headach : Bailar Migraine(symptoms of vertebrobasilar insufficiency, which may
precede the headache=Basilar Migrane.)
27- why we randomise people on study : ??
28-** Pokilo cell : mylofibrosis
29- **after internal Jugluar line : Heaomothorax I guess it was Pneumothorax as the lung was
collapsed and its a know complication of central lines
30- **after Gastric Bypass : Iron .. I guess its B12 which is most common as iron deficiency is less
common and other problem is Dumping sydrome
31-** gastroparesis :.. I guess its the question in which patient had Dumping syndrome , having
symptoms just after eating with nausea, vomiting, flushing etc .. what to do ??. It is Dietary
Advise ..
32-** patient with K 7.9 : IV ca gluconate or temporary pace maker ?? one of the cardiologist I
discussesd with , says we have to give iv first then go for pacemaker later
** Your all Answers collected in ONE POST :::
CORRECT ANSWERS FROM YOU ( PLEASE ALSO DOUBLE CHECK ) ::
33. Rifampicin induces Warfarin
34. Warfarin metabolise by CYPC29
35. aLLUPURINOL Xanthine oxidase
36. HRT Main indication- Postmenopausal symptoms control
38- Marginally raised CK- lady unable to stand from chair- no muscle weakness- I did PMR
39- years with low back pain- ?Ankylosing spondylitis
40- Dec dlco and dec tlco- Pulmonary fibrosis
41- Imitanib- Tyrosine kinase
42- Ciclosporin- IL2
43- Ciclosporin toxicity sec to Fluconazole
45. ECG features of VT - AV dissociation
46- Parietal lobe - inferior quadrantopia,acalculia
47- Nephrocalcinosis- medullary sponge
49- SLE - low c3
50- ciclosporin induce >>> hypertrichosis
51- THiazide site of action>>> proximal DCT
52-** sarcoidosis inves>>> do CXR .. IN THIS QUESTION PATIENT HAD NO RESP
SYMPTOMS , BLOOD TEST COULD HAVE ALSO BEEN OFFERED TO DIAGNOSE THE
CAUSE FOR ERYTHEMA NODOSUM !!
53- pt. present e only high bilirubin >> Gilberts
54- Hypochondrosis
57- pyloric stenosis >>> hypokalamic alkalosis
58- pt e HTN DM colon CA and sweating>>> acromegaly
59- in Gulian B >>> FVC
29. Male with Gynaecomastia, Low testosterone and raised FSH and LH - Klinefelter
61- Histology from renal biospy, neutrophils, eosinophils with normal renal capsule- AIN
62- Repolarization : k channels
63- paracetamol overdose- creatinine
64- serum electrophoresis for myeloma
65- diagnosis of peritonitis: high neutrophils
66- dysphaia of food and drinks: achalasia
67- hepatitis A
68- medication in diabetic renal pt-losartan
69. Pain on walking relieved on sitting - Spinal stenosis
70- b/l 6 nerve and papilloedema :: BIH
71-**post natal blues PATIENT HAD DEPRESSIVE SYMPTOMS ,with tendency to cry and low
mood so I guess post natal depression was a better choice .. ??

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

112-Antibodies in SLE ----> IgG (?).

113- **Rt lung lesion and hyponatraemia (115) and urine Na 65 : fluid Restrcition the first step in
SIADH
115- acanthoysis nigrcans in obese ass e >> DM? or GI Malgianncy ?
116-** pt recurrent headache HTN ,, high urinary catecholamine ,,,family history of thyroid CA ass?
>>>>> medullary Ca Thyroid .. men2
117- **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 .dudenal cap post I
guess comes in Gastrodudenal area.splenic A doesnt supply duodenum
119-** 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 options ..
120-**marfan secnario ,, eye feature with pes escavatum . ectopia lentis
121- premature mature ovrian failure
122- **Nurse with atex allergy to gloves 10 yr back gets allergy again on wearing gloves how is it
mediated by>>>> typer 4 reaction
123- **post MI pulse 60 BP 90/60 high JVP the coronary affectedProximal Right coronay
124- **elder female e UTI ,, allegic to pen : TMP/SMX .. I think the empirical treatment is either
TMP/SMX or nitrofurantoin.
125- **Paitent with raised calcium and PTH, taking calcium and vitamin D - Tertiary
hyperparathyroidism
126- **Tonic clonic seziure , Alcholic and blood sugar 3.1 >>> idiopathic epilpsy or alcohol releated
seizure ? it was a young adult but all labs were within normal limit and also ecg .. so I went for
idiopathic Epilepsy .. diagnosis of exclusion
128- **Elderly man, had microscopic haematuria, 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 catogery of urgent reffral to a
urologist
129- Turner syndrome associated - gonadol malignancy
130-** Diagnosis of Giardia if not seen in stool ova and cysts -wet stool sample or Microscpe with
duodenal Aspirate ?? if stool culture not positive multiple times then RadioImmuoassay ..as per CDC
131- **A young male with breathlessness and had a systolic murmur at the base of the heart-It was
Pulmonary Stenosis .the murmur increased with Inspiration and it was not pansystolic .. so PS
132- A girl with negative anti-TTG but presented with coeliac symptoms- Gastroscope with
duodenal Biopsy ?
133- A young girl with history of paracetamol overdose who had rashes at the flexor surface, in linear
fashion previously had self medicated - Dermatitis Artefacta
134- A young male since child hood had grunting, abnormal movement and occationally fallsTourrete syndrome
xxxxxxxxxx135- A person who had lesion at the suprapubic which was umbilicated with pearly
papules- ?
molluscum contagiusum (Repeated Question see Question #91)
136- dipyradmole : adenosine uptake ?
137- **post PCI with incrased Eosinophils, Creatinine, ,change in color of the foot . It was :
Cholestrol embolism
138-** Ascites+ early diastolic murmur + x and y descent ? : constrictive pericarditis ..i guess it was
Superior Vena Cava Syndrome as the face was flushed and on chest auscultation right heart was clear
no addes sounds were there jvp was raised . I went for SVC syndrome instead
139- gall stones in hereditary spherocytosis ----pigment stones
140-**African tick bite- ricketsia coronii
141- **what is the chance that the Test will be post ice :: Positive predictive value it was some thing
lke 380/405 I guess..
142-chiquard study

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 .

SO FIVE QUESTIONS ARE REPEATED .. IT MAKES THE ABOVE QUESTIONS A TOTAL OF

165
.. LETS TRY TO REMEMBER THE NEXT 35 QUESTIONS. PLEASE JOIN IN
166-.question for alkaptanuria...... is it an amino acid metabolic disease or glycogen sorage disease or
enzyme defect ...
167. what stimulates the brain ..resp centers.... H ions.. or bicarbonate.. or oxygen
168-. another psychiatry question in which patient talking on its own and replying " no i didnt do that" ,
while u never asked such a question ... what is she experiencing .............................auditory
hallucinations.
169-Endo: Hormone which leads to increased hunger . Ghrelin( leptin,etc )
170-.Resp: Patient with respiratory distress, having high PCO2 and hypoxia ,drowsy , copd
exacerbation , what is the best way to give oxygen .. Non Invasive PPV ( ventilator, antibiotics etc)
171-Gastro: Patient with Cystic Fibrosis ,comes to you for vitamin suppliments what will is the most
important vitamin you will prescribe .. Vitamin A ..( vitamin B, vitamin C,etc)
172-General:Patient with difficulty opposing the palms of her hand with inability to close hand and the

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....

MRCP part 1 MAY 2012

1. Q: 4 month old pregnant lady with intermittent palpitations, prev similar episode when dx
svt 10 yrs ago. what is the initial investigations?
a. 7 days monitor
b.electrophysiological study
c. Exercise tolerance test
d. none

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.

e, left subclavian artery stenosis

11. 58 year old man lethargy and tired. c/o erectile dysfunction. his FBS 7.5, testosterone 6,
FSH low. LH low, TSH normal, prolactin 400 (360 normal). How will you treat his erectile
dysfunction?
a. alprostel
b. testosteron
c. metformin
d. bromocriptine
e. ?
12. Q. dermatomyosistis? antibody
a.anti jo 1
13. raynauds, tight swollen fingers. ?systemic sclerosis. antibody
a. anticentromere
14. obese man with DM 2. on gliclazide. HbA1c 9.7. add tx?
a. acarbose
b. exenatide
c. metformin
d. pioglitazone
e.
14. flaccid blisters trunk, elderly lady?
a.bullous pemphigoid
b.
c.
d.
e. pemphigus vulgaris
15. holiday in suuny day. now purpuric rash
a. porphyria cutanea turda
16. farmer lady with right index finger pain. o/e granuloma at right lateral aspect of finger.
a.
b.orf
c.
d. staphylococcal
17. Lyme suspected. what next investigations?
a. blood culture
b. blood fimm
c. pcr
d. ELISA
e.
18. in 60's lady with abdo pain. OGD : multiple superficial erosions in gastric antrum,
histology: mild villous atrophy, with ?eosinophil.
a.
b. chronic drug /NSAIDs induced
19. peptic ulcer disease peration. now diarrhoea
a.
b. bacterial overgrowth
c.
d.
e.
20. ileal operation. since diarrhoea. cause

a. bile salt reaching colon

b. unabsorn solute causing osmotic diarrhoea
c.
d.
e.
21. Q: membranous GN.
a. ciclosporin
b. cyclophosphamide
c.
d.
e.
22. Q: adult PKD, now came with pain. o/e: tender over right kidney, urine blood+1,
protein+1.
a. cyst hmg
b.cyst torsion
c. renal stone
d.
23. elderly man or lady . hb: 69, MCV 159, wcc1.8, neutrophil <0.8?, plat ??? high or low,
a.
b. myelodysplasia
c.
d.
e. perniciou anaemia
24. COPD + right HF. PO2 low. improve mortality.
a.
b.
c. oxygen LTOT
25. MI tx with thrombolytic. refuse PCI. Tx to add
a.
b.
c. Ramipril
26. Q. spontaneous Pneumothorax with no lung disease. aspiration done still 1.5 cm air. next
tx.
a. chest drain
b. observation
c. supplemental oxygen
d.
27. Pneumothorax. tall man ? Marfans. which feature will be assoc.
a.
b.
c.
d. lens dislocation/ ... lentus
e. retinitis pigmentosa
28. Mydriasis
a. argyl robertson pupil
b. holmes adie
c.
d.
29. third nerve palsy, mild dilated pupil, accommodation ok. ????
30. left horners, right spinothalamic??? where is lesion

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

44. chronic steroid therapy

a. avascular necrosis
45. investigation for osteomyelitis?
a. Ct scan
b.
c.
d. MRI
e. Plain X Ray
46. ? sinusitis, breathless, pulmonary hmg
a. good pastuer
b. post strepto
c. wegeners granulomatosis
d. charg struass
47. in which condtion in SLE, TLCO increase
a. alveolar hmg
b.
c.
d.
e. pulmonary fibrosis
48. arthralgia, malar rash
a. ? sle
49. arthralgia, ...... ? noules in shin, CXR: bilateral hilar lymphadenopathy. sarcoidosis ...
tx
a.
b.
c. observation
d.
e.
50. sorethroat. tx with amoxicillin.
a.

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

4- amyloidosis in kidney (microscopic picture )

160- FMF? a- amyloidosis in renal biopsy
1.

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

Anti ccp bodies in rheumatiod arthritis

1.S. sanguinis- infective endocarditisinvestigation OPG (from teeth/mouth)
2.Pneumonia post flu- staph aureus
3.Patient with sore throat, myalgia, atypical lymphocyte- I wrote HIV(might be EBV)
4.Which enzyme , pt on HAART medsreverse transciptase
5.ABG reaults, which did not co relate- I wrote B in which pO2 9, PCO2 7, HCO3 22, H+ ions
around 30 (I thought H+ should be much higher as this is resp acidosis picture)
6.T lymphocyte-- dendrites bring antigen to them
7.T lymphocyte binds to epitope??
8.Cyclosporin inactivates T cells (not IL-2)???
9.BEnce jones protein ?? light chain?? I did it wrong
10.Fc/Fab ? binds to antigen?? I wrote Fab but maybe its Fc
11.Old patient, hypothermic ? physiologic response not present (I wrote catecholamine sensitisation)??
12.Ketonuria: physiology ?? dehydration
13.Patient who was well, mild Ulcerative colitis (4 bloody diorrheoa/day). I wrote rectal mesalazine
14.Young patient with microcytic anaemia, mum died of colon cancer. 15.Whether faecal occult blood
or colonoscopy??
16.Patient came from india, diorrhoeatyphoid/ Salmonella
17.Pregnant girl, travelled to Nepal, presented with ascites, der LFTS, ans ?? hep C/ hep B ??
18.Syrian lady pregnant 3rd trimester, sudden breathlessnessPE (it cant be cardiomyopathy as it was
very quick presenatation)
19.Patient on anthracycline chemo, hypotensive, raised JVP, tachycardiac, soft heart sounds chest pain,
breathlessness- initially I thought PE, but changed it to cardiac tamponade which is more appropriate as
per the info
20.Penetrance definition ??
21.Negative pred value 895/900
22.Mitosis phase ans was telophase when nuclear membrane starts enveloping chromosomes(I wrote
anaphase )

RECALLS 8TH SEPTEMBER 2015

10. Hyponatremia- Detailed Pathophysiology- Changes in Intravascular and Extravascular

Compartment
11. S4 Corresponds to Pwave on ECG
12. Digitalis Toxicity PPt by Hypomagnesemia
13. Action Of Parathyroid Hormone on Metabolism of Phosphate and Calcium
14. Cause of Hyperuricemia in Tumor Lysis Syndrome
15. Anti-CCP in Rheumatoid Arthiritis
16. Eternacept Binds with TNF

18. Cystic Fibrosis Clinical scenario mentioned AR

20. Insulin Receptors Membrane Receptors

21. 0 Phase of Depolarisation- associated with Sodium
23. Study Design What phase represents effectiveness of a drug
24. MOA of Doezolamide Carbonic anhydrase inhibitor
25. Porphyria Cutanea Tarda Clinical scenario mentioned Photosensitive rash with bullaes +
Hypertrichosis Defect in Uroporphyrin Decarboxylase
26. Menniere s Disease Triad Of Dizziness + Tinnitus + SNHL
27. Pneumothorax after Trumpet Usage- Cant do scuba diving for life
28. Wernickes Aphasia Fluent but Word Neologism Comprehension Impaired- Location ON superior
Temporal gyras
30. Hayflick Theory of ageing of cell Involves Telomeres
31. PICA Ipsilateral Ataxia, CN palsy Contralateral limb sensory involvement
32. Syringomyelia Diagnose from Clinical Picture
33. Phenytoin not effective appropriate blood levels not achieved next action ???
34. Hemiballism characteristics mentioned Subthalmic Nucleus in volved

35. Headache + Loss Of Smell

36. Cause of Hematuria in Which anticytotoxi Cyclophosphomide
37. Hereditary Spherocytosis- Dx by Osmotic fragility test
38. Dignosis fro clinical picture PO2 is N, SPO2 is decreased Methaemglobinemia
39. PRV Rx by Hydroxy carbamide
40. Clinical Picture of Bloods indicating Neutropenia in Middle Eastern Person <1.5 Racial Variation
41. Von willibrands disease Clinical picture- APTT prolonged

43. Sick euthyroid Syndrome

45. Exanetide GLP1 analogue

46. Production Of Ketones in DKA- Lipolysis
47. Pheochromocytoma associated with MEN 2
48. Carcinoid Syndrome Dx by HIAA
49. Travellor coming from India Bloody Diarhoea- Amoebiasis
50. Terlipressin Before doing Endoscopy and banding in UGI Bleed

52. Hypori causing MALToma Rx by Hpylori eradication therapy

54. Diabetes- Long duration- pain after meals- Chronic Pancreatitis
55. Ulcerative Colitis Treatment
56. Fulminant Hepatitis in Pregnant lady Ex is Hepatitis E
57. Streptococus Sanguinis- diagnosis ???
58. C3b nephritic Factor seen in MCGN- Auto antibody
59. FSGN seen in HIV, IVdrug abuser
60. Clinical features given Dx Lateral Epicondylitis

62. Mixed Cryoglobulenimia

65. HTN in pt. < 55yrs DOC ACE Inhibitor
66. Clinical picture indicating Dx of Cardiac Tamponade
67. PET Scan Uses Fluoeodeoxyglucose

68. Mouth Ulcers seen in Nicorandil Usage

69. Long QT syndrome associated with KCNE1 gene involvement
70. Pt. age >70yrs + severe Aortic Stenosis Rx by bioprosthetic valve replacement
71. PAH Dx by Cardiac catheterization
72. Clinical Picture of TOF indicating Ejection Systolic murmur Pulmonary Stenosis
73. Low O2 delivery Low PCO2
74. Bronchial asthma severe Rx by IV MgSO4
75. COPD Rx
76. Pulmonary Embolism Dx by CTPA
77. Pneumonia + clinical Picture Of Erythema Multiformes Mycolplasma Pneumonia

79. Bronchiectasis reason for hempotysis

80. Immunocompromised Pt. C.I vaccine Yellow Fever
81. Reason for Resistance to anti Retroviral Drugs
82. Pan Valintino Leucocidin Gene involved in MRSA Rx ???
83. Lyme Disease Clinical Scenario Given- Pn Allergic Rx by Doxycline
84. Non Falciparum Malaria Rx
85. Rx of Gonorrhoea
86. Painful Genital Ulcers with Painful Inguinal Lymhadenopathy
87. Atypical Lymphocytes seen in IM
88. Anti-HTN in Pregnancy MethylDopa
89. Venous ulceration Mx by Compression Bandaging
90. Impetigo Clinical Picture given Rx
91. Acnae Rosacea Rx by Topical Metronidazole

93. Somatisation Disorder Dx from Clinical Picture

95. Suicide Risk Factor

96. Catract
97. Scleritis Painful RA

98. Inhibition Of P450 by ERythroycin

99. Supraventriculat tachycardia in Asthmatics Rx by Verapamil
100. Emollient usage dont smoke
101. Post Flu Pneumonia Staph Aureus probably
102. Drug that decreases Wound healing- Prednisolone
There 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 confused
2. Differentiating and correctly diagnosing diseases relating to myopathy and arthiritis RA,
Polymyositis, SLE, ANTi phospholipid syndromes, pseudogout
3. Presentation of different types of Lung cancer
4. Primary amnorrhoea very confusing qs for dx of PCOD, CAH, AIS
GOOD LUCK AND PLEASE DO PRAY FOR ME...

Focal segmental glomeruloscelerosis in iv drug abuser

Adenosine for svt
Heamophilus ducyri cause painfull genital ulcer with inguinal lymphadenopathy
H pylori eradication for MALT cancer
Yellow fever live attinuated vaccine contra indicated in low immunity
Quick deterioration in a pregnant lady suffering from hep:
Hep E
dorzolamide-carbonic enhidrase inhibitor
drug causing hypercalcaemia-indapamide
Plasmodium vivax-Primaquine
SVT with asthma-Verapamil
Atrial fibrillation with heart failure-Digoxin

1) post flu pneumonia organism

2) how does ramirpril cause AKI
4) rash on face in 30 years old whixh gets worse on alcohol intake - treatment
5)there were loads of questions from ophthalmology
Asthma management : iv magnesium
Ipsilateral limb ataxia, horners and contralateral sensation loss: whixh artery involved?
post flu pneumonia-Stap Areus
ramipril reduces renal artery resistance/causes dilatation
drug inhibits wound healing - ? MTX
45 yrs old who had some head injury at work with loss of consciousness for 1 minute feeling difficult
to get back to work - post traumatic or adjustment disorder
q)There was a question where a lady hits her shin, minor trauma and then develops a 6cm ulcer.
q)Etarncept, how it acts.
q)lady with SLE develops ?dvt, what antibody?
q)I think there was a Primary sclerosing chloangitis q = mrcp I guess was the answer
Acne Rosacea Rx-metronidazole
heparin induced thrombocytopenia -against whice one-?
asthma Rx followed by swealing upto led,urine look for ?(Eosinophil/ACR/osmolarity...)

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

Antibody for dermatolomyositis

CYSTIC FIBROSIS :AR

some multiple myeloma questions with renal failure hyper calcaemaia and back pain : serum

electrophoresis

Where does bence Jones protein attach on immunoglobulin? Fab/fc/??

drug inhibits wound healing - ? MTX
P.vivax chloroquine?
enzyme in porpherya cutana tarda uroprophopylengen decarboxylase
In psychaitry more than one answer is adjustment disorder?
Q1 papper 2 caue of anaemia
Anaemia of chronic disease
Pancytopenia +splenomegly :mylodysplasia
Paper 1: pregnant lady with cardic problem: antepartum cardiomyopathy
Patient with fever hepatosplenomegly lymphocytosis and atypical lymphocyte: EPV
Treatment of PRV: hydroxycarbamide
painless hematurea-cyclophsphmide
chlymedia trachomatis-cause painless genital ulcer with painfull inguinal lymphadenopathy
Verapamil because asthma was there
Post partum lady has exopthalmus thyrotoxicosis very low tsh palpitation what is
managment.propranolol or carbimazol?
Cause of progressive central loss of vision in old man?
Cod blockage .pt with jaundice and amylase high.
drug inhibits wound healing- Prednisolone
both were was non standardized .... 1 dimensional picture ... i had though mrcp must have some logical
questions but disappointed from there pattern .. way inferior than usmle ..
[/b]
Man underwent vagatomy presented with anemia what antibodies found in him?
Lady with upper limb weakness and extensor reflexes in lower lomb with impairment of sensation
.what is the disgnosis?
What is the level of drug study to ensure it is effective?

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

alcohol induced myopathy???

asbesthosis-stop smoking
alcerative colitis involving rectum and descending colon-oral prednisolole
iron deficiency anemia-if oral iron tablets???
dense hemiparesis - give asprin
African boy found unconscious at home-carbon mono oxide poisoning
epigastric pain + vomiting- chronic pancreatitis
H-pylori eradication test-stool antigen????
lung cancel with media stunnel widening - large cell carcinoma????
hypokalemia + hypertension- cushing syndrome
anthrax cycline induced cardiomyopathy
reduce cardiovascular risk - tight glycemic control??
jerky moment - subthalamic nucleus
emollient- don't apply more than twice\don't apply on wet skin\smoking\wear gloves??
limited systemic sclerosis
lady presents with infertility before menses-???
wpw association - ASD?
junctional rhythm - AV note???
patient with hear failure-change oral to IV furosemide?
down syndrome- VSD?

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

ECG was hypokalemia

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

Rheumatism with splenic enlargementand neutropenia-- felty syndrome

in the images was it venous ulcer/ diabetic ulcer
intrinsic factor deficiency and B12 deficiecy
RPGN-Goodpastures --hyponatremia-- carbamazepine/
pts Hba1c 8/fbs 11mmol what rx- he is making insulin shown by c- peptide levels just below normalmetformin/ basal and bolus insulin/short acting insulin preprandial
Question of carotid artery was internal carotid artery ulcerative..something like that.

Incarcinated hernia

Back pain with breast ca... Radio plus bisphosphonates.

Gout...allopurinol with colchicine

Gout with gram stain negative...intra articularvsteroid injec

Food poisoning of staph aureus with spontaneous relieve after 10 hrs

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

Group A strep for peianal swellung

And staphylococcus for leg cellulitis.

Case of MS

Hypocalcemia case with calvium chloride to give

MI initial treat they asked... I think aspirin plus clopidogrel

Case of autoimmune polyendocrinopahthy type 1===pt had featires of addisons n hypoparathy

Cervical myelopathy case

Cervical dytonia for unilateral sternocleidomastoid muscle enlargment.

.
Speceficity question

Another weired statistics question.

PE in 2 questions

Diphtheria question

Ace inhibitors in 2 questions for limiting proteinuria

Correct me if mistakes please.

question on stopping naproxen

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...

Lithiasis question... 2 questionz were there regarding them

Bladder ca question...patient had painless hematuria.

a question on protein electrophoresis in multiple myeloma (Image)
a question on Gangrene, at first the level of demarcation was low after few hours the level has risen
upto high , pt diabetic . what was the organisms responsible-- answers were Cl perfringes/ stap aureus/

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...

2. Cf brain was showing calcification...so it was av malformation

3. Compound Naveus of Nail vs Nail bed hematoma
4. A question about chlamydia infec. Dysuria with no discharges...not gonorrhea
5. blood loss >2000 for blood pressure low to 80 n pulse 142
6. ECG /? hypokalemia
7. Multinodular goiter vs Graves Image
8. images one from osephageal crcimnoa
9. osteomalcia vs hyperparathyroidism....raised alkaline phosphatase ---Vit D levels check

10. Pulmonary embolism after operation

11. another question on Pulmonary embolism also
12. VSD cxray showing biventricular enlargement
13. bronchial asthma needing icu admission
14. giant V wave--? Liver pulsating?? dont know other options
15. question on pulse more than 150 n SBP 80... afib?v tach?
16. Familial hyperlipidemia
17. internal carotid artery ulcer//insufficiency
18. IBS Rx----tricyclics, fibrates, diet regulation
19. question on Incarcinated Hernia on xray findings
20. breast ca with metastasis n back pain---tt radiotherapy plus bisphosphonates
21. perianal abscess - organisms group A streptococci
22. leg cellulitis---staphylococcus Aur
23. food poisoning one hour after eating egg cheese with vomiting and abdominal cramps----- relieved
after 10 hours------- Staph poisoning
24. C1 inh deficiency -lip swelling hereditary angioedema
25. started on ACE reported hereditary angioedema
26. slow down of Diabetic nephropathy--rampril
27. weakly positive birefregrent molecules (gout) treatment already on allopurinol-- continue
allopurinoal with colchicine
28. MI treatment----- aspirin plus clopidogrel
29. Rheumatism with splenic enlargementand neutropenia-- felty syndrome
30. images ---- venous ulcer
31. intrinsic factor deficiency and B12 deficiecy
32. RPGN-Goodpastures ?????? not sure
33. renal biopsy membranous, minimal change, mesangioproliferative
34. hyponatremia-- carbamazepine ????????????? not sure
35. high blood sugar with strong family history in a young male pt....what to give...sulphonyl urea (i
thought of MODY)
36. Case of MS

37. Hypocalcemia case with calvium chloride to give

38. Case of autoimmune polyendocrinopahthy type 1===pt had featires of addisons n hypoparathy
39. Cervical myelopathy case
40. Cervical dytonia for unilateral sternocleidomastoid muscle enlargment.
41. Speceficity question
42. Another weired statistics question.
43. Diphtheria question
44. question on stopping naproxen
45. image of blood picture showing stellate cells --ask the pt to avoid sulpha drugs ??????????not sure
46. Lithiasis question for pain in flank n no fever...hematuria was there also
47. another lithiasis question
48. bladder ca with painless hematuria
49. A question on syringomyelia
50. gilberts syndrome??????vs other?? not sure
51. protein electrophoresis in multiple myeloma (Image) ???
52. colonoscopy question
53. gord question---PPI (H K ATPase inhibitors
56. optic chiasm defectbitemporal hemi anopia was given
57. a case of 5 days old CVA and had urinary incontinence after trying to control for somtime. All signs
of hemicord or brown seq were negative like perianal sensation and anal tone... they asked where was
lesion..... cerebral coretex ( other options were brownsequard and hemicord and lesion at L1)
58. a case of lateral rectus palsy.... 6th cranial nerve
59. protection of aspiration pneumonia case with absent gag reflex----- jejunostomy tube insertion (to
avoid emesis)
60. a questions on urticaria with itching and rash all over body
61. a case of wt loss pt n also had chronic cough 6 monthsalso had some biochemical problems---thought of paraneoplastic syndrome----- lung ca
62. gout pt on allopurinol already---continue allopurinol and start colchicine
63. gout case of knee swollen but gram stain negative------ intra articular steroid inj

65. pulsus bispheriens--- mixed aortic valve disease case

66. Thromboangitis obilitrans (bergers Diseas) treatment-- Symphytectomy ?
67.
optic chiasm defectbitemporal hemi anopia was given : decussating fibres
female pt with 2 sisters having SCA , pt was in desert complaining of loin pain .she was dehydrated :
sickle cell trait
there was a question on miller fischer syndrome (desending weakness with opthalmoplegia)
a question in which pt was putting out grey sputum, x ray shows fibrosis -- what is the next inv -- ct
chest/ bronchoscopy
Which q of sub arachanoid hmg??

Yes it was staph poisoning

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..

Diphgheria q was abou vaccination...yes

Myeloma q with spikes.. Q 67

Optic chiasm with decussating fibres

Pt with SCA...wasnt retics Normal????

Hirsuitism...i choose cushings

PMR??? Do u remember stem in detail??

69.. q on melinoma..take open biopsy

70.. q on protein more than 30

71. Miler Fischer syndrome

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

73. Q on Rhabdomyelysis...i dont know what i choose

74. Q on pt having epileptic fits in emergency department...give iv diazepam

75. Q on risk factors of cad/mi..... Smoking

76. Q on coarctation of aorta?????also dont remeber this in detail..

77. Q on pt with recurrent chest pain.. PCI done..showed 30stenosis in lad n 40stenosis in lt
circumflex.whats the cause of chest pain...options were.
Coronary spasms
Atherosclerotic plaques
Owsophageal spasm
Gord etc

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

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

9.ATYPICAL LYMPHOCYTES.... INFECTIOUS MONONUCLEOSIS

10.ALL...9:22 POOR PROGNOSIS
11.70 YR Female suicide...rsk factr for repeat...OLD AGE
12.promyelocytes ....15:17
13.PEMPHIGUS VULGARIS...IGG At dermoepidermal junct..may b
14.history of STD ....KERATODERMA BLENORHGICA
15.diAbetes plus hyperthyroidism....PRETIIBIAL MYXDEMA...
16.1st sign in hypovolemic shock...TACHYCARDIA
17.common paroneal nerve palsy.SENSORY LOSS IN DORSUM OF FOOT
18.trip to southasia..jaundiced...pre jrny vacc done...HEP A or HEP E
19.Alpha 1 anti trypson defic...Autosomal co dominant...but it was not an option so it was autosomal
recessive as per text
20.wilson diseasse...1 in 100
21.HIV diagnosis...investigation with consent or without consent
22.patient think of nurses planing against him and trying to poison hiim...PARANOID PSYCHOSIS
23.neighbour controlling thoughts.....schizophrenia
24.hallucinations plus cog impairment plus rigidity....LWI BODY DEMENTIA
25.Man with drug poisoning belief of supernatural healing power....DELUSION

26.CARBIMAZOL...MOA..THYROID PER OXIDASE INHIBITOR.

27.Hep C ...CRYOGLOBINEMIA
28.Aplastic picture...erythro virus.B19
29.REPEATED infections after chemotherapy..cause...compliment def or immunoglobin def..
30.repeated neiseria inf....COMPLEMENT DEFICIENCY
31.Meningial TB...12MONTHS treatment
32.tonsillitis ...with hemeturia....post infectious glomerulonephritis
33.metastasis to vertibral column...acute pain and sensory loss...tx..surgical decompression or
radiotherapy or steroids...
34.IMITANIB ...tyrosine kinase inhibitor
35.GOLIMUMAB...MOA..TNF-ALPHA inhibitor
36. Investigation b4 METHOTRAXATE...THIOPURINE METHYL TRANSFERASE
37.Pregnancy with crohn ...which to discontinue...AZATHIOPRIN,MESALAZINE,STEROID???
38.OLANZAPINE most common side effect...weight GAIN
39.Lesion on shins....OCPs
40.erythema nodosum...prognosis...SPONTANEOUS RECOVERY
41.Carbamezipine induced skin lesion in Chineese...HLA Genotype .(confirmed it with google on
chineese population )
42.chiken pox with pneumonia...ACYCLOVIR

44.GREYISH color on TONSILLS e lyphadenopathy...DIPHTHERIA

45.Allergic to egg...INFLUENZA VACCINE CONTRAINDICATED
46.ORAL ,KIDNEY AND LUNG HAEMRHGES....micro angitis
47.2 POPULATIONS AND TWO RESULTS IN NORMAL DISTRIBUTION....UNPAIRED T TEST
48.FALSE POSITIVE RATE.....55/1000 or 55/950
49.percentage with positive results...SENSITIVITY
50.PERSON WITH POSITIVE... EMV....AND one bactarial inf positive....EMV or CMV...with
generalized lymphadenopathy
51.lesion under the breasst fold and abdominal folds in 80 yr women...sebbhoric or candida
52.cervical lyphadenopathy with ankle swelling plus pupuric rash on skin....SARCOIDOSIS

53.friends history of food poisoning...2day history..bloody diarrhea with RT illiac fossa

pain...compylobacter
54.history of STD with conjunctivitis with arthritis....Reactive artheritis or GONNOCOCCAL
infection
55.HLA 1... CD 8
56.PERIPARTAL CARDIOMYOPATHY
57.Takayasu arteritis...loss of radial pulse when hands held above head
58.exercise induced collapse twicely without family history with no ECG 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
69.decreased K level with HTN...conn,s syndrome
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
86.Mann whitney...2 populations with unpaired data and non parametric
88.superior homononymus quadrantinopia.....temporal lobectomy
89.inferior homononymus quadrantinopia....parietal lobe
90.Low FSH,LH, nd high PROLACTIN...pregnancy
91.galactorhea...risperidone
92.haloperidol....drug induced parkinsonism or subdural hematoma..
93.thiazide diuretics...distal convulated tubules
94.low HCO3.....may b prox conv tubule
95.movemnet of particles across membrane.....with hydrostatic pressure....Osmosis
96.patient on simvastatin and other IHD drugs...omeprazole is contraindicated
97.syphilis in pregnancy...Erythomycin or azithro
98.patient treated with ceftriaxone with STD but still symptoms....chlaymedia
99.ring enhancing lesions on CT...toxoplasmosis
100.man took part in swiming then came back to country with some symptoms....stool ova test or
somthing elsE???
101.Itch in aus in mothher and children...entrobius vermicularis
102.type 1 diabetes...AGE..KETONE...????
103.Young man with balanitis ...mody???
104.SIADH.....fluid restriction or desmopressin???
105.meningitis....normal glucose ..inc prot...lyphocytes raised??? mumps or tb???
106.CT normal after SAH...then do LP
107.drug contraindicated in pregnancy...Cipro
108.ankle clonus....Gastronemius

109.meningococcal soghn with non blanching rash...meningococcal pcr....

110.anemia with 8.8 hb in preg..cant tolerate oral iron...Parentral shud b given
111.pcr used for...detection of virus....cyto genetics
112.tall mai 1.83m height...low fsh and lh and testosterone....kallman synd
114.sweating nausea loss of conciousness for 1min with jerking movments during
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
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
One question was about

* Anticipation
* Renal Transplant (60 y.o. wife wanted to be a kidney donor for her husband)

My recall some MRCP may 2015 question

1.Post partum cardiomyopathy.

2.Post partum thyroiditid.
3.Enteribious vermocularis.

4.Carbamazole-Mach of action-ani peroxidase.

5.Benzothiazide-site of action DCT.
6.Imitanib-Tyrosine kinase inhibitor.
7.Na reabsorption-PCT.
8.Pregnency antibiotic contraindicated-Ciprofloxacin.
9.ADP inhibitor.
10.AML t(15-17)
11.CML(Philadelphia positive) Bad prognosis high leucocute count.
12.Sitagliptin mach of action increatin level.
13.Ketonuria.
14.IGTT.
15.Drug induced parkinsonism.
16.Fronto temporal dementia but question has dementia with hallucination so rt answer is lewis body
dementia.
17.Pagets disease-Increased alakaline phsophatase.
18.Osteomalacia.
19.SIADH synd
20. Sensineural defness in old age cochlear pathology.
21.Jevunile RA-Scleritis.
22.Clonus-Gasrtocnemius
23.Shiny lesion on tibia-OCP.
24.Amlodipine-Pulmonary edema.
25.Digitalis Confusion.

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

17.hill walker, rash....erthema chronicum...

lyme disease
18.CHADv......4 or 5?? Confuse??
19.narrow complex tachcardia, asthma....Verapamil
20.QT interval... beginning of Q wave and end of T
21. Bradycadia, Atropine Fail......Trasvenous pacing
22. Sceniario Polymyositis....Anti jo Antibody
24.live attenuated vaccine....Yellow fever
26. Burkit chemo....Rusbricuse
27 . tuberous sclerosis. ...adenoma sabecum
28.kitten.....Bartonella hansale
29 . contraindication of lung surgery....Vocal cord paralysis
30. DM, increase creatinine, 25 GFR...stop Metformin
Like
1) 76 year old lady with acute onset mono-ocular vision loss with pale and swollen optic disc
-Question: What's the likely diagnosis?
Shouldn't the answer be giant cell arteritis? Although no history of headache/jaw claudication, given
her age group and fundoscopic finding, I thought GCA is more likely than optic neuritis

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

8 pt allergic to egg - which vaccine contraindicated

9.left lower homonymonimous quadrantanopia - parietal lobe
10.DIDMOD - mitochondrial disease
11 pt on immunosupression - yellow fever vaccine contra
12.chadvas score
13.Alteplase reversal
14.ABPA exacerbation
15.bloody diarrhoea in cruise
16. Sensitivity ans 60
17. Def with sensitivity
18.primary pneumothorax - needle aspiration

20.prev of osteoporosis in a symptomatic woman

21.senescence - whic process is low in rate
22.dextusor instability
23.about gene
24.cataplesy
25. Avascular necrosis - MRI scan
1. TR.... gaint V wave
2. ST depression on ECG.... LCX occlusion
3. pt with VSD planning pregnancy.... pulmonary hypertension
4. streptococcal endocarditis .... benzyl penicillin + gentamicin
5. SVT with asthma, vagal maneuvor failed .... verapamil
6. mode od action of LMDWH .... inhibit Xa
7. site of action of granisetron... medulla oblongata
8. renal transmembrane transporter... furesomide???
10. chemo in burkitts... rasburicase
11. ABPA exacerbation... oral prednisolone
12. CT to lung resection.... vocal cord palsy
13. downward lens dislocation with learning disabilities... cystathionine synthatase

14. scenario of cushing... metabolic alkalosis

15. CKD... stop metformin
16. scenario of NPH
19. low Ca, low P04, low VIT D, high AP, high PTH.... vitamin D deficiency
20. scenario of primary hyperparathyroidism
21. hypokalemia... U wave on ECG
22. sucidal thoughts, on beta blocker now in bradycardia, atropine failed... IV glucagon
23. CHADS score....4
25. optic neuritis scenario

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

49. Bacterial vaginosis... metronidazole

50. liver nile, 3days bloody diarrhea.. shigella
51. IgA... henoch scholien purpura
52. scenario of cryoglobinemia.. subacute endocarditis
53. hypercalcemia.. thiazide diuretic
54. alteplase overdose... prothrombine concentrate???
56. long QT scenario
57. adenoma sebacum
58. hyponatremia... water restriction
59. when to stop ETT... BP 90/50
60. pt with CLD presented with hematemesis SBP 50, immediate step..IV fluid
61. mechanism of hepatorenal syndrome.. splanchnic vasoconstriction???
62. secretin
63. pressure sores... waterlow???
64.bile salt malabsorption.. SEHACT
68. angidysplasia.. AS???
69. Thamine
70. acetylcystine... hepatic glutathion
71. gilbert syndrome... isolated hyperbilirubinemia
72. rhabdomyolysis scenario
73. HCOM... septal wall thickness 3.3
1-Type of hypersensivity reaction after vaccination .
2-Refeeding syndrome ,which electrolyte to check.
3-Malignant melanoma -prognosis marker.
4-value of 2 standard deviation.
5-ppl experiencing same environment and disease --cohort study
6-Idiopathic parkinsonism - assymetrical trmor
7-Treatment of bradykinesia in parkinsonism
8-Smoker with H/O of left ptosis and constricted pupil - which investigation.
9-Hemolytic anemia , sherocyte ,which further investgation - reticulocyte count

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

3. Anemia in 55 yrs old man and next investigation

4. How to assess upper Gi bleed?
5. Cml
6. Myelofibrosis
7. Action of DDAVP on factor 8
8. Alteplase toxicity antidote or management
9. Sodium val side effect about alopacia
10.carcinoid syn in lungs
11. Hormone Inc pancreatic Sec and water
12. Pnemothorax size 3.5

15.regading gene in chromosome

16. Knee swelling and crepitus
Patient with pectus escavatum and similar collagenopathy features which other investigation?
Echocardio
Most common valvular disease with angiodysplasia? Aortic stenosis
Patient had splenectomy which pathogen is vulnerable to? Strept pneumoniae
Fibrosis on cxr causative drug? Methotrexate
Anaemia with low mcv in patient with long hx of RA what cause? Chronic disease anaemia
Patient with dvt 2 yrs earlier coming back with sob, resp alcalosis low co2 ph 7.43 and normal
examination what is likely on cxr? Normal cxr
Pain referred to buttock which investigation? Back mri ( was thinking sciatica basically)
Recurrent blurred vision with no headache in a female patient lasting 15 30 min? Migraine
1). The lady with High BP, hypertensive retinopathy but normal renal function - options were
Coarctation of Aorta, essential hypertension, etc.

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

Cause of mortality in hemodyalisis? Sepsis

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Thu Jan 15, 2015 7:43 am (6 months ago) #79

In cocaine use other than agitation what is the feature?

A right handed lady with reading difficult and right parietal infarction- which
aspect is affected?
Testicular feminisation feature.

Above are just a few I remembered

Upper GI bleed urea

Vsd next pregnany ?Pulm htn
Hhv8 kaposoi
Chlamydia doxycycline
Elderly broad gait incont mem prob normal press hydrocephalus

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

) Patient with Marfan

Next investigation should be heart ECHO?
They are at risk of aortic root dilatation and mitral valve prolapse

2) Top cause of mortality in patient on hemodialysis is

Ischemic heart disease/ACS

3) Methadone prolongs QT interval.

So the girl who collapsed had long QT syndrome
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Thu Jan 15, 2015 9:32 am (6 months ago) #84

For the lady with detrusor instability? What's the answer

chuan

Oxybutinin was not in the option I think?

Senior Member
I was left out with propantheline and Trospium

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Thu Jan 15, 2015 9:55 am (6 months ago) #85

The patient with androgen insensitivity syndrome(Testicular

feminisation syndrome)
-Will have female appearance and normal female genitalia

chuan
Senior Member

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Credits: 449

What are the other options?

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Thu Jan 15, 2015 10:40 am (6 months ago) #86

drlornoxicam
Experienced Member
ohh with all these confusions paper looked moderately fine, but
it wasn't easy. it was tough... a lot of mind game.
Posts: 19
Credits: 260

how many wrong if we do, still we can hope for pass????

Aim UK Exams

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Fri Jan 16, 2015 3:54 am (6 months ago) #87

Hi. Was the second paper harder than the first or was I just
tired? Thanks for the answers.
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Ihibabe
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Posts: 14

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Fri Jan 16, 2015 4:38 am (6 months ago) #88

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

what they want.

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Fri Jan 16, 2015 4:41 am (6 months ago) #89

lady with no risk factor present with transient ischemic attack

and found atrial fibrillation with converted to sinus rthym

spontaneously, BP: 140/84, no neurological deficit. what will
her CHA2DS2VASc score.

ulhadijawed
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Fri Jan 16, 2015 4:48 am (6 months ago) #90

lady was 66 years,

C: hear failure.... score 0
H: Hypertension... score: 0
A2: age more than 75: score 0
D: diabetes: score : 0
ulhadijawed
Serious Member

Stroke/TIA: score : 2
V: Peripheral vascular: score: 0
A: age 65: score: 1

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Sc: sex category: female: score: 1

total score : 04 for this patient.
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Fri Jan 16, 2015 5:09 am (6 months ago) #91

Thanks. Paper was alright, scenarios were a bit tough but

ofcourse RCP have exhausted the question bank so we accept
these kind of questions. There is no right or wrong reading list
and course is extensive and you can't prepare hundred percent.
If you prepared 70% then should be enough to pass rest is guess
uksharks
Titan

work. The pass mark is 60-64% depending on paper difficulty

level. Secondly every question has different marks such as
question from medicine and pharma will have more weightage
than Clinical sciences...You need 521 to pass from overall score

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oe equation of 999. Good luck

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Fri Jan 16, 2015 5:53 am (6 months ago) #92

Thanks
I was hesitating between a score of 4 or 5

I remember the BP was 140/85, so theoratically did not meet the

definition of hypertension ?

chuan

Hehe...I chose 4 as the answer as well

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Fri Jan 16, 2015 8:21 am (6 months ago) #93

drlornoxicam
Experienced Member
Large cerebral bleed, Av malformation at this age of 90 ,
doubtful, however, amyloid neuropathy is well known for its
Posts: 19
Credits: 260

cerebral aneurysms formation and intracranial bleed in elderly...

what u think?

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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Fri Jan 16, 2015 8:29 am (6 months ago) #95

drlornoxicam
Experienced Member
patient with gastric ca what types of cell most likely present.....
columner cells or signet ring cells were there.
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Last edited by drlornoxicam on Fri Jan 16, 2015 8:51 am, edited
1 time in total
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Fri Jan 16, 2015 8:31 am (6 months ago) #97

drlornoxicam
Experienced Member
there was a case of facial acne like feature.. but hyperemia and
not acne itself.... oxytetracycline or isotretinoin?
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2011 questions I remember

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?

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

11- PT WITH CUSHIG(HTN OBESE) HOW TO DIAGNOSE>>>OVER NIGHT

DEXAMETHASONE SUPPRESION TEST
12 ONE ANSWER WAS >>>REDUCE WEIGHT BUT I COULDNT RECALL THE
QUESTION!!

4*HEMATOLOGY AND ONCOLOGY

1-PT E HIGH IG M AND PULMONARY EMBOLISM(WALDENSTROMS)WHT THE
COMPLICATION>>>>HYPERVISCOSITY SYNDROME
2-PT WITH DRUG INDUCE HEMOLYTIC ANEMIA HOW TO DIAGNOSE>>>DIRECT
ANIGLOBULIN TEST
3-PT WITH BLEEDING TENDENCY HIGH PTT LOW FACTOR 8>>>VWD(SOME COLLEGUES
SUGGESTES HEMOPHILIA A?)
4-PT WITH FATIGUE, SPLENOMEGALY AND HIGH WBC>>>CLASSIC CML
5-T WITH HIP PAIN WITH TTT OF CML >>>AVSCULAR NECROSIS OF HEAD OF FEMUR
6-PT WITH ANAEMIA ,SKIN RASH AND HEP C>>>CRYOGLUBINEMIA
7-PT WITH ACUTE PROMYLEOCYTIC LEUKEMIA PROGNOSIS>>>T15-17
10-ACTION OF DESMOPRESSIN>>EXTRACT STORED FACTOR V
11-CANCER COLON INCREASE SUSSEPTABILITY OF >>>ENDOMETRIAL CA
12-PT WITH THROMBOCTHYSEMIA HOW TO TREAT>>>HYDROXYURIA
13-PT WITH ANAEMIA AND TEAR DROP IN BLOOD FILM>>>MYELOFIBROSIS
14- WARFARIN ACT ON >>>FACTOR 7
15-OLD PT WITH PETICHAE AND PERSISTENT PANCYTOPENIA>>>MYELODYSPLASIA
16-5 YEARS SURVIVAL OF NON SMALL CELL BRNCHOGENIC CA IF GOOD
ELLIMINATED>>>10%OR 20%
17-DOCXCETEL>>>INHIBITON OF MICROTUBULE
18-BREAST CA PROGNOSI BY>>>> 15:3
19-BAD PROGNOSIS IN HODJIGINS LYMPHOMA>>>SWETTING

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

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?\
7-T DIAGNOSED WITH BARRET,S OESPHAGUS HOW TO MANAGE>>>ACID SUPPRESION
THEN ENDOSCOPY?
89-PT WITH DIARHEA AND CRYPT ABCESS>>ULERATIVE COLLITIS
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 RESISTANCE?)

6-WT CAUSE FACIAL SWELLING>>>AMLODIPINE OR ACE INHIBITOR

7-PT WITH PICTURE OF ?PULMONARY FIBROSIS OR COPD
WT IS THE CAUSE>>>NITROFURANTOIN
8-AMYTRTRYPTALINE OVER DOSE HOW TO TREAT>>>NA BICARB
WHICH DRUG USED FOR MANIA>>>LITHIUM
9-PT WITH PARACETAMOL OVER DOSE HOW TO MONITOR>>>PT
10-INTERACTION BETWEEN STATIN AND>>>GRAPE FRUIT
11- PT WITH ABDOMINAL PAIN ,DIARHEA WHICH DRUG RESPONSILE>>>ALEDROIC
ACID?
13-WHICH ANTI HTN DRUG SAVE TO USE WITH PT TAKIN LITHIUM>>>AMLODIPINE?
14-PT WITH G6PD AND WILL TRAVEL TO AFRICA WHICH DRUG TO
AVOID>>>PRIMAQUINE
15- PT TAKING ANTI T.B(RIPE)AND BENDROFLUROTHIAZIDE AND HAS JOINT PAIN
WHICH DRUG IS RESPONSIBLE>>>PYRIZINAMIDE OR BENDROFLUROTHIAZIDE?
(DEBATABLE)
16-WHICH DRUG CAUSE MOUTH ULCER>>>>?NICORADINIL
17 -ONE QUISTION ABOUT NA VALPROATE
18- ONE QUISION ABOUT ECTASY
19- ONE DRUG ACTS ON MUSCARINIC RECEPTORS
(ACTUALLY CANT REMEMBER LAST FOUR QUISTIONS
BUT I SAW IT IN THE POSTS)

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

7-PT WITH PROGRESSIVE MEMORY IMPAIREMENT

AND URINATED IN FRONT OF PEOPLE WT THE DIAGNOSIS>>>FRONTO TEMPORAL
DEMENTIA
8-PT WITH PICTURE OF ENCEPHALITIS AND LESION ON TEMPORAL LESION IN CT
BRAIN>>>HERPES ENCEPHALITIS
9 OLD PATIENT AGITATED WT TO GIVE>>> HALOPERIDOL
10-PT IN PURPUERIUM AND HAS HEADACHE AND >>>CAVERNUS SINUS
THROMBOSIS
11-PT WITH PAINFULL PERIPHERAL NERVE PAIN(PERIPHERAL NEUROPATHY HOW TO
MANAGE HIS PAIN>>>GABAPENTIN
12- PT WITH BITEMPORAN HEMIANOPIA>>>LESION IN OPTIC CHIASMA
13- HOMONYMOUS HEMIANOPIA WHERE IS THE LESION>>>OCCIPITAL LOBE
14-PT WITH HORNER AND LOSS OF REFLEXES (LATERAL MEDDULLARY SYNDROME)
>>>POSTERIOR INFERIOR CEREBELLAR ARTERY LESION(ONE COLLEGUE SUGGESTED
BRAIN STEM LESION ACTUALLY BOTH CAN B!!)

16-WT IS MOST RELIABLE SIGNE IN INCRESED INTA CRANIAL HTN?>>>BRADYCARDIA

OR VOMITING?
17- HOW TO DIAGNOSE HIV PT WHITH TOXOPLASMOSIS>>>MASS OCCUPYING LESION
IN CT BRAIN
18-ONE QUISTION I CANT REMEMBER BUT BY EXCLUSION >>>SYRINGOBULBIA!!
19-PT WITH PARKINSONISM DISEAES AND BRADYKINESIA HOW TO
MANAGE>>>BENZHEXOL OR SELEGLINE?

9*CHEST

1-PT WITH DYSPNEA DURING HIS WORK(PAINTING?) AND RESTRECTIVE LUNG

PATTERN>>>HEPERSENSITIVITY PNEUMONITIS?

2- PT WITH MESOTHELOMA AND PLEURAL FLUID HOW TO DIAGNOSE>>>CLOSED LUNG

BIOPSY,FINE NEEDLE ASPIRATION,THORACOSCOPY?(DEBATABLE)

3-NON SMALL CELL CLINICAL SIGNS>>>>MONOMORHIC RHONCHI?

4-PT WITH DYSPNEA , RESP ALKALOSIS AND HYPOXIA FOR ONE

MONTH>>>PULMONARY EMBOLISM?

5-YOUNG PT WITH HEMOPTYSIS MILD SMOKER AND UPPER LUNG COLLAPSE

>>>CARCINOID TUMOUR OR BRONCHIAL CARCINOMA?

6-PT WITH DYPNEA ,CHEST PAIN AND INCREASED TLCO>>>>PULMONARY HE

7-PT WITH SEVER DYSPNEA,RESPIATORY ALKALOSIS (COULDNT REMEMBER THE

REST OF QUISTION?)BUT WE AGREED THE ANSWER IS B ASHMA(AS PER ON
EXAMINATION)

8- PT WITH DYSPNEA , SKIN LESIONS AND BULKY MEDIASTINUM ON CXR>>>

SARCOIDOSIS

9- PT WITH PNEUMOTHORAX WHT TO AVOID>>>TRAVEL BY PL ANE FOR 3 MONTHS OR

FOREVER OR AVOID DIVING FOR 3 MONTH OR FOREVER
10-WHT IMPROVE AFTER BULLECTOMY>>>FEV1 OR VITAL CAPACITY?

11-LONG STANDING SMOKER PT WITH OBSTRUCTIVE PATTERN AND CXR SIGNS

OF>>>>EMPHYSEMA??

12-WT TO MONITOR PT WITH EHLER DANOLOS S? ,WITH DYSPNE(AS I

REMEMBER)>>>VITAL CAPACITY

13- PT OBESE BMI 32 AND DAYTIME SOMNOLENSE AND SUDDEN LOSS OF

CONSIOUSNESS IN FRONT OF TV>>THIS QUISTION IS EXTREMELY VAGUE BUT I THINK

OBSTRUCTIVE SLEEP APNEA IS MORE CORRECT THAN NARCOLEPSY

10*RHEUMATOLOGY

1-ELDERLY ALCOHOLIC PATIENT FOUND COLLAPSED,HYPOTHERMIA

(RHABDOMYOLYSIS)WT TO CHECK>>>CREATININE KINASE

2-PT DM,WITH LIMITED MOVEMENT OF SHOULDER JOINT IN ALL

DIRECTION>>>ADHESIVE CAPULITIS?

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?

4-WHICH ONE HAS BAD PROGNOSIS IN RHEUMATOID ARTHRIITIS>>>PERIARTICULAR

EROSIONS,MORE THAN 2HOUR MORNING STIFFNESS

5-PT WITH JOINT PAIN ,MORNING STIFFNESS, NO MUSCLE WASTING RH

+VE>>>>RHEMATOID ARHRITIS

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

8- PT WITH CREST AND ANTICENTOMERE +VE >>>1RY PSJOGREN 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

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

4-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??

12*PSYCHIATRY

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 LUMBIRICALS

-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

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??
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.

Typical presentation of necrobiosis lipoidica on the lower pretibial legs.

[ CLOSE WINDOW ]

Typical presentation of necrobiosis lipoidica on the lower pretibial legs.

AND NOW PRETIBIAL MYXEDEMA

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.

Bilateral erythematous infiltrative plaques in the pretibial areas.

[ CLOSE WINDOW ]

Bilateral erythematous infiltrative plaques in the pretibial areas.

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

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

Guest, Feb 15, 2011
#10

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

mrcp 12 jan 2016 recalls..

1.ques abt hypertrophic obstructive cardiomyopathy??? ans is autosomal dominant
2/
2.Pul stenonsis Loud 2nd heart sound ESM Pul htn sign symp
3.one ques with paget disease....next investigation??? hip xray
4.pt with diarrhea offensive smell stool and alcoholic treatment??? Cholestyramine
5. partial fracture with low vit d3 ?? Cholecalcifero was next treatment right
6.Tattoo marks site lesions wala???
7.De quervain thyroiditis case
8.The first question centromeres wala Metaphase?
9.One was acute angle closure glaucoma
10.Neurofibromatosis linked to 17
11.Anasthetic patch with mononeuritis multiples it was tuberculoid leprosy right
12.Reiter syndrome b27
13.major risk factor for diabetic retinopathy.??
13

14.Pregnant lady with pain in hand???deq.tenosinovitis

15.and wt was tht ques jis ma pregnant lady ki calf pain...doppler negative....xray chest nothn....then wt
next?Ctpa
16.Que was of subacute thyroidits
17.one ques with warfarin wala...vit k?INR was 10 ,ans was vit k as prothambin complex already given
18.Also was trasferrine satu. For screening of hemochromatosis
19.One was normal pressure hydrocephalus.... csf drainahe
20.And then obse patient with headache and blurr vision 6th nerve palsy??..intracranial hypertension?
21.and was there any ques abt polyarteritis nodosa?
22.One was minimal change disease? Jo 20 years old m tha
23.Prolonged pr interval aortic root abcess
24.Kallman syndrome
25.polycystic ovary disease?
26.Pitutary microadenoma 1year same size no symtoms Ans fr ths?wht can hapn in future?No
symptoms
27.And precarditis with ecg change st elevation
28.Ppv 45/100
29.Then...CHF no current symtom what meds to add...i wrote aspirin
3o.Guy beat his partner then saying cant arrest because he know police--mania
31.Fondaparonox anti Xa
32.Heparin indused thrombosed thrombocytpenia
33.Asthmatic on steroid, avascular necrosis of femoral head
34.one with SLE....low C3 C4?
35.Easy one was hereditary angioedema c1
36.Complete heart block Variable intensity of s1
37.Anaphylaxis S Mast cell tryptase
38.Ther ws a lady with UTI alergic to pencilin. Options wer cipro i think n trimethotrim. Ans?
39.Lady after angiography livedo reticularis cholestrol emboli
40.good prognosis in endocarditis strep viridans?

41.aur paracetamol wale ma PT time?

42.syphilis...anuerysm
43.acha one was wth guy with stab wound on chest ....sweating....aorta ya right ventrile?
44. Mrcp
45.Iliostomty sit wound --pyoderma ganrenosum
46.Howell joly target cell??asplenism
47.Nurse ...hypoglycemia ....sulfonyl urea abuse
48.Normal,pressure hydrocephalus, Csf drainage
49.Vit b12 def was metformin
50.Post pci ..... cholesterol embolism
51.Bleeding after tooth extraction?? Factor 11
52.and lady with hypopigmentation ...nystatiin cream?
53.PEt.versi
54.Benzodiazipine... flumazehnil
55. Doselphin intoxication Iv bicorb
56.Donepezol MOA Its anticholinestarase
57.cocaine ....ischemic heart disease
58.Hypernatreamia....in old lady...due poor water intake?
59.Surgery n catheter was placed in abdomen answer ws S.aureus?
6o.Also prolactinoma first line treatmnt if visual field defects present??? dopamine agonist or surgery??
61.Cicloaporin n IL related to it? IL2
62.methemoglobinemai????? Cyanosis Decrease PO2,nrmal ABG
63.Its herpes iv aciclover
64.dosulpin...tht is Tricyclic antidepressent...and tht cause wide QRS complex in toxicity
67.Neuro case pain n temp loss n limb weakness? Anterior spinal occlusion?
68. Lady is hitting husband n he is afraid she has high contacts psych case ..what was the answer?
H.personality disorder
69.One question related to kidney..invg? renal biopsy?

70.Pt with atrial fibrillation,,,,give bisoprolol

71. Blood cholesterol ..ldl cholesterol TG raised. Anwer? Apo B 100?
72.NeisseriA, wale main long term repeated infection? Answer arthropathy?
73. Loss of libido is due to deficiency of? 17 hydrpxypg andersterione..I answered DHT
74.Solid n liquid dysphagia..investigation? Manometry?
75.RTA i guess hyperchloremic metabolic acidosis
76.Insulinoma scenario?
77.
prolong fasting test with serial measurement
77.One q was about treatment of epilepsy focal type? Topiramate it was
78.One question related to ans mammilary body, pt with retrograde amnesia! ??
79.Barter syndrome answer? Hypokalemia?
80. Reperidon 5HT2
81.Scenario on minimal change disease treatment prednisolone?
83.Alcohol withdrawal ma I wrote chlordiazepoxide ....I studied in pastest
In passmed lorazepam
84.ADH ka I wrote cortical collecting duct
85. That que with cryoglobulinema was it hep.c
86,There was leshmaniasis also central america travel
87.Atherosclerosis main macrophages
88.Hiv patient with resp symptoms what was diagnosis P.jero ya
89.Lesion site of wernicks encephalopathy Mammillary body
90.Pseudogout with x ray chondrocalcinosis
91.One more pt taking thiazide was psudogput
92.One was shogrens with anti ro ab
93.From git......non alcoholic fatty liver disease
95. rheumatoid arthritis?yes lady with symetrical join pain

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

121.psoriasis scenario, clobetasone didn't work, what next

122. Hep e scenario

123.another lady with normal breasts and scanty pubic hair and amenorrhoea ANDROGEN
INSENSITVITY.....
124.which part of the Ig is bence jones protein sticked to? fc
125.pregnant lady with graves and exophtalmos ? treatment carbimazole?
126.men with flushing and diarrhoea ? 5-HIAA( answer a)
127. checking rats under the table??? obssesive compulsive disorder
128.retro sternal crushing pain died in the way to hospital VF
129.ulecer in face beveld edge?? bcc
130.Septic arthritis
131.Creatinine is affected most by muscle mass?
132,Drug that will decrease morphine dose needed naproxen
133.One was co poisoning
135 .parkinsonism and cancer.ttt??
136.Coarctation of aorta most likely association = Bicuspid
137.Central line with dullness at lung base = hemothorax
138.Wide QRS complex with TCA overdose =IV bicarbonate
139.Infective endocarditis indication of surgery was...... Prolong PR
140.Normal calc normal po4 but high Alk phos..... Investigation = bone scan
141. Low calcium, low phosphate and higj Alk po4,treatment = vitamin D
142.H.pylori eradication-urea breath test
143.metformin
145.research vs audit ??
146.hypokalemia in pyloric stenisis
147.tripoly
148.standard deviation
149.forest plot

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

wat is TTT of pheochromocytoma? and phenoxylamine?

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Seborrhoeic dermatitis- Ketoconazole
MAI- Respiratory isolation please
Contagious care needed: TB in the sputum (risk of droplet infection)
Alteplase reversal- FFP
Detrosur instability- Trospium
Tumour lysis syndrome- Rasburicase
Alopecia, wt gain tremor- Sodium valproate
Granisetron- Medulla oblongata
Young girrl, high bp, AV nipping- Pheochromocytoma

HHV8- Kaposi Sarcoma

HSV- Erythema Multiforme
Snail track + itch on Rt buttock- Larva migrans- Sunbathing as cutaneous penetration

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.

What do you think?

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

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
lithium toxicity- HD

acute knee pain with ligament clcification- pseudogout

cat scratch- bartonella henslae
pseudomembranous colitis- metronidazole
return from eastern europe with dysphagia- diphteria
before start anti TB- check LFT
cardiogenic syncope- do ECHO

lung ca and GN- membranous GN

headache and gram pos bacilli- listeria meningitis
epididimoorchitis-parenteral ceftriaxone n doxycyline
wilson-autosomal recessive
tricuspid regurg with flushing n wheeze- carcinoid syndrome

s3( gallop rhythm)- poor prognosis in LVH

LVH in pregnant 14 weeker- essential HPT
Question on RCA territory
Question on anti Cd 20= Lymphoma
Part of kidney impermeable to water - Distal collecting duct
Bibasilar crepts and 4 months h/o breathlessness and no relief after salbutamol= pulmonary fibrosis
Person not getting relief after 200 mg of beclomethasone, next step = add Salmeterol
Breast carcinoma nd cerebellar symptoms = anti-Yo antibody
Esophageal varices = azygous vein
Termonal ileum resection afrter crohns disease and diarrhoea = bacterial overgrowth

Confirmatory for cardiac tamponade = Pulsus paradoxus

TIA and AF = Warfarin
WPW and Af = Flecainide
Chromatin separation = Telophase
A question on Lyme's disease
A elderly male with recurrent jerks = creutzfeldt Jacob disease
Person becoming drowsy 6 hours after confusion and headache = Herniation
A question on pituitary apoplexy
A hypertensive and CAD pt taking too many medicines, presented with nephrotoxicity= Aspirin
induced
Question on cervical myelopathy
Postitve predictive value
False negative rate
Wilcoxon sign rank question

Wilson's = autosomal recessive

Becker's disease - X linked recessive
Huntigton's disease = incomplete penetrance

jus returned frm cambodia rx for malaria n resolved- hepatitis b

jus returned frm thailand- dengue
HIV pt taking vaccination can cause clinical- rubella
post chemo spiking temp- cmv
ix for invasive aspergillosis- galactomannan
pons-basillar artery
pulmonary fibrosis
post traumatic syringomyelia
phenytoin- zero order kinetics

amiodarone- K channel blocker

painless hematuria- bladder tumour
acromegaly- GH and OGTT
obese woman with nerve palsy n headache- BIH
nephrocalcinosis next step- urine pH
peritonitis- high neutrophil count
APS- anticardiolipin
anti yo- paraneoplastic cerebellar
lithium n polydipisa- nephrogenic DI
bloody diarrhea- e coli 0157

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

dilated pupils- adie tonic

ascending weakness n arreflexia- GBS
T1DM girl investigated for ?seizures with hypoK- insulin overdose
cystinuria
IgM paraproteinemia- hyperviscosity
highest calorie food- red meat
LUQ pain- ?splenic infarct
post duodenal artery bleed
NAFLD- fatty infiltration
MDMA overdose- hypoNa
DM shin lesion- necrobiosis lipoidica
Infective exarcebation COPD with deranged TFT- sick euthyroid
Man frm Zambia with chronic diarrhea n confused- cryptococcus neoformans
strongyloides- screen for HIV
Some stupid question on cystic fibrosis heterozygous
Unsure about answersRt to left shunt ?aa gradient
Bleomycin, lymph node ?fibrosis
Rasburicase ?action
Pneumothorax second presentation ?...
Man with IECOPD cannot tolerate NIV, only abx, unconscious, ?continue abx only
Pleural plaques ?no further investigation
Man with birds, most consistent finding ?upper zone fibrosis
Respiratory presentation ?do spirometry
Pain control scenarios ?...
Psoriasis, aggravated by drugs ?ARB/ beta blocker/ diuretic
Papule over thigh, epidermal dysplasia with no invasion ?radiotherapy/5FU/steroid/..
Pleural calcification- next investigation
Foot drop and decrease sensation on outer foot border- level
Calories-sugar/ cheese

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

L5 Vs Peroneal nerve diff ???

RASBURiCASE mech: of action in tumerlysis syndrome
scenario of sensory and motor neuropathy
ST elevation V1-V4, with resiprocal- RCA involved
Parkinsons scenerio
lupus anticoagulant-2nd time abortion
Neurofibromatosis -50% chance(autos: dominant)
rasburicase mode of action
162cm guy with low testosterone and no pubic hair and smal testis
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
11.Separation of chromatids and reaching the poles - Anaphase
12.Wilsons disease - Autosomal recessive
13.Beckers muscular dystrophy in brother,Chance with another husband who has no family Hx
abnormal(2nd marriage)getting the disease in son - ?50%
14.PCR - ?to know nucleotide sequence.
15.Huntingtons disease - Anticipation
16.Gentamicin - ATN
17.G proteins located at - Plasma membrane
18.Recurrent Meningiococcemia - C5 deficiency
19.Cisplatin toxicity - sensory neuropathy
21.Bleomycin toxicity - Fibrotic tissue in the nodes of lung
22.
23.Citrulline peptide - RA

24.Rasburicase before chemotherapy ,MOA - Uric acid will be converted in to allontoin

25.Gross hematuria in a smoker - Bladder ca
26.Egg shell calcification hilar nodes - ?Silicosis,?Asbestosis
27.Ig M ,Waldenstrom's - Hyperviscosity
28.Before starting anti TB meds - check LFTs
29.Pregnancy 14 weeks,LVH - Essential HTN
30.Cells responsible for producing IgE - ????Plasma cells,Dendritic cells,Eosinophils,Mast cells
31.Impermeable to water - Ascending loop of henle
32. TIA and AF - warfarin
33.Difference between L 5 radiculopathy and peroneal nerve palsy - ?Inversion of foot
34.Dilated pupil - Adie pupil
35.Pons blood supply - ?Basilar artery
36.SLE miscarriages - Anticardiolipin antibodies
37.Rash on the LL,UL,Conjunctivitis - Stevens johnson syndrome
38.3 month h/o difficulty in swallowing in a female - ?Oesophgeal spasm,Reflux
esophagitis,Achalsia,esophageal tumor
39.cerebellar signs with tumor in breast tissue - YO/Purkinje cells
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
68.Recurrent pericarditis treatment - ?Colchicine,?Prednisolone
70.Cardiac tamponade sign - Pulsus paradoxus
72.Q on Mechanism of MODY
73.Emphysema Pathophysiology - ?Dynamic airflow obstruction,?Smooth muscle contraction
74.Aspirin toxicity
75.Vitiligo + ?pernicious anemia ,Dx - Anti parietal cell antibodies
77.Extrinsic allergic alveolitis - B/L apical fibrosis
78.Q about diagnosis of Invasive aspergillosis
79.Previously treated for Plasmodium falciparum and now c/o right upper qudrant pain - ?recurrence of
malaria,?HBV
80.Terlipressin in hepatorenal syndrome - Splanchnic vasoconstriction
81.PAS - whipples disease DX
82.Bacterial peritonitis - Neutrophil count

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???

5.behcet disease-- HLA B

6. scenario on PITUITARY APOPLEXY
7. recurrent first trimester miscarriage --- ANTIPHOPHOLIPID SYNDROME
8. syncope on swimming-- ECHO
9. scenario of CARDIOGENIC SYNCOPE
10. wilson's disease-- AUTOSOMAL RECESSIVE
11.some scenario on genetics of cystic fibrosis
12.pathophysiology of emphysema--DYNAMIC COMPRESSION OF AIRWAY
13.highest calorie value food--CHEESE
14.ECG Findings of LAD OBSTRUCTION
15.patient faking symptoms for morphine-- FACTITIOUS
16.depression-- EARLY MORNING WAKENING
17. tamponade--PULSUS PARADOXUS
19.16 weeks pregnant lady with hypertension, ECG showing LVH-- ESSENTIAL HYPERTION
20.marfans--FIBRILLIN
21. scenario of ethics-- CONTINUE WITH ANTIBIOTICS
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
52. sleep apnea diagnostic test
53. egg shell calcification-- SILICOSIS
54.pulse of PDA- BOUNDING PULSE
55. separation of chromatins occur--TELOPHASE
56. TR, wheezing, flushing-- CARCINOID SYNDROME
57. episodic diarrhea not relived by fasting-- VIPOMA
59. vitiligo and acidity history-- ANTIPARITAL ANTIBODIES
60.
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???
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??
63.HUNGTINTON ---ANTICIPATION
64. test to do prior to prescribing ATT-- LFTs

65. G Protien is present on-- CELL MEMBRANE

66.WPW syndrome with atrial fibrilation- FLECANIDE
67. Stroke with atrial fibrillation-- WARFARIN??
68. surgical contraindication-- SVC obstruction
69. polymyositis
71. exudate on tonsils + cervical lymphadenpathy-- GLANDULAR FEVER
72. one scenario seems BARTONELLA HENSALE???
74. scenario of ITP- PREDNISOLONE
75. C.Difficle---METRONIDAZOLE
76. Scenario of MENS2
77. scenario of APKD
78. immediate treatment of neutropenia-- ANTIBIOTIC PROPHYLAXIS
79.anti-CCP - RA
80. prophylaxis for dental extraction-- none
81. test for ascitic fluid which leads tpo diagnosis-- NEUTROPHIL COUNT
82. VT -- unsynchronized DC
83. DM,Knee joint arthritis -- HEMACHROMATOSIS
84. malignancy- MEMBRANOUS GN
85. rectal bleeding with clonoscopy, gastroscopy and barium normal-- ANGIODYSPLASIA
87. biopsy showed PAS postive macrophages n villous atrophy--- WHIPPLE
88. scenario of creudzfelt syndrome
89. scenario of idiopathic intracarnial hypertension
90. CSF Analysis- enterovirus
91. blood supply of pons-- BASILAR ARTERY

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

1.a question on familial hpercalcemic hypocalciuria

2. A man with osteoporosis investigation to be done testosterone leves
3.A woman with hisuite and pcod -serum testosterone levels
Pregnant women with abnormal tfts n slight throid glad swelling ...... Oregnancy induced
1-patient with anorexia nervousa ,what feature ?low LH
2-patient with pain in eye movement and decreased color vission?optic neuritis .
3-urgent referral to opthalmolegist ?macular exudate
4-homosexual man with recal bleeding ?gonococcal proctitis

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

PENILE ULCERS WITH LYMPHADENOPATHY- HERPES

ANAL ULCER WITH BLEEDING IN A HOMOSEXUAL MAN- GONOCOCCAL
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

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
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?

A pt with 2nd time Pneumothorax.what is the ans?

MAQ901 sept.2014 marcp 1
1.Cftr mutation only in paternal gene y?
2.Newly d.m nw joint pain liver enlrge..hemocgromotosis
3.cystinuria...recurent stones
4.marfan ..fibrillin

5.muchensn ...wants morphine recurent er admissions

6.depred on fluixetine outside school claiming special powrs...mania
7.anti ccp....R.A
8.epididmytis...ceftri +doxy
9.cisplatin...hypocalcemia
10.rasburicase...M.o.a
11.acute renal failure...aspirin
12.penicillin induced nephritis
13.thiophyline n clarithro reaction
14.tertiary hyperparathroidim with hypercalcemia n hyperphosp. N raised pth
15.primary hyperpara sceniro also
16.pain walking n lyng in dat side...trochentric brusitis
17.painless hematuria...bladder
18.ecg sinus tachy with lbbb....reversed s2 split
19.wpw with af...flecanide
20.amiodarone ...k chnl blkr
21.svt...first step carotid massage
22.tender calf ankle sweling ...celulitis
23.l5 radiculopathy...loss inversion
24.ca prostate with mets showng gagabsnt.tongue that side paralysd n numbnesd....mets to forman
ovale
25.post trauma syrinx
26.dengue rash n fever low plt inc Alt
27.strongloude what else chk HIV ?
28.erythema nodosum
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

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

66.pitutry apoplxy gv hydrocortisone

67.MEN scenario
68.thtroid area sweling bt labs norml mostly no sym...pregnancy induced
69.hogkin lymphoma treatd c.t chest 2 l.nodes small....normal
70.raisd alt creatanine acutly in alcohlic n diazepam overdose with low body temp...i mrkd
hepatoreanal
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....constituational delayd pubrty
75.14 wk pregnat high bp....essential htn
76.painful penile ulcer hx of sex n recurnce...herpes

78.anticardio anbodies in scanario of recurnt miscarges 3 of thm i think

79.alpha thalasemia trait scanario
80.iridated blood y....i markd to lower cmv transmission
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 n pigmntation at lips...colorectal ca
87.varicose vein drainage i marked hepatic
88.supply to pons ...basilar or mCa?
89.scenario of catatonia i gues bt i thought dystonia
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
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
101.meningitis cultur gram pos. Bacilius....listeria
102.mengitis pic in HIV pt...crptococus
103.invasive aspergilosis..test igE precipitant
104.menungococus mengigits .. complemnt out of 5 to 9 only 7 was gvn so i pickd 7
105.daily k requirmnt it was in mmol ..60
106.paget scanario
107.for pcr ....known nucleotide sequnce if to develop diagnostic test
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

121. before start anti TB- check LFT

122. cat scratch- bartonella henslae
123. pre angio drug to stop- metformin
124. retrosternal chest pain- reflux esophagitis
126. wernicke-korsakoff- nystagmus
129. Pleural effusion on the left,INC amylase,Left upper quadrant pain auscultation RUB heard n
tenderness on left upper abd..SPLENIC RUPTURE
130. . invasion of surrounding structures - Anaplastic thyroid ca
131. .contraindication to surgery of lung ca - ?superior vena caval obstruction
132. Lung function testing in kyphoscoliosis
check Kco reduced
133. Flat effect,auditory hallucination - schizophrenia
134.scanario on PAN
135.pt. with sob and dec oxy satCTPA
136.reason y pt no improving on oxygen with hx of cardiac defecthypoxemia result of blood
mixing
137. Bipolar disorder RX -Lithium
138. Pheochromocytoma - MEN
139. Bacterial peritonitis - Neutrophil count
140. Terlipressin in hepatorenal syndrome - Splanchnic vasoconstriction

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
161.pleural effusion ph 7.02 .chest drain
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 ..ABO Incompatibility
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--HUPONATREMIA
169. peripheral neuropathy--NITROFURANTOIN
170. depression-- EARLY MORNING WAKENING
171. .highest calorie value foodCHEESE
172. vit B21 def: -hyperseg neutrophil+megaloblast
173. discitis- post op pacemaker insertion severe backache and l.m but I marked closd. Difficle though
due to antibiotics.

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
18.ecg sinus tachy with lbbb....reversed s2 split
20.amiodarone ...k chnl blkr
21.svt...first step carotid massage
22.tender calf ankle swelling AFTER SWELLING IN KNEE ONE WEEK BACK ... RUPTURE OF
POPLITEAL CYSTS
23.l5-S1...loss inversion AND ANKLE REFLEX ABSENT
24.ca prostate with mets showng gag absnt.tongue that side paralysd n numbnesd....JUGULAR
FORMAENLOSS OF GAG REFLEX9,10,11CN
25.post trauma syrinx
26.dengue rash n fever low plt inc Alt
27.strongyloide what else CHECK HIV AS IT PREDISPOSES TO OPPORTUNISTIC

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

33.echo in colapse for runing for bus IN A PERSON WITH AS

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....INSULIN OVERDOSE
38.paired t test
39.scater graph for data scenario
40.unpaird t test
41.false negative rate CALCULATION
43.scenioro of acromgly test OGTT WITH GRWTH MESURE
44.barter most specific FINDING-- hypokalemia
45. SLIGHTLY LOW FACTOR 8..VON WILEBRANDS
46.itp..prednisolone
47.recurent T.i.a....warfarin
88.Another COPD with pneumonia and PH 7.2 - Intermittent ppv/Intubate and treat
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

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
101.meningitis cultur gram pos. Bacilius....listeria
102.mengitis pic in HIV pt...crptococcus MENINGITIS
103.invasive aspergilosis..GALACTOAMANNAN
104.menungococus mengigits .. MANNOSE BINDING LECTIN
105.TPN daily k requirmnt it was in mmol ..60
106.paget scanario
107.for pcr ....A THERMOSTABLE DNA POLYMERASE IS REQUIRED
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
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 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

121. before start anti TB- check LFT

122. cat scratch- bartonella henslae
123. pre angio drug to stop- metformin
124. retrosternal chest pain- reflux esophagitis
126. wernicke-korsakoff- nystagmus
129. Pleural effusion on the left,INC amylase,Left upper quadrant pain auscultation RUB heard n
tenderness on left upper abd..SPLENIC RUPTURE
130. . invasion of surrounding structures - Anaplastic thyroid ca
131. .contraindication to surgery of lung ca - superior vena caval obstruction
132. Lung function testing in SEVERE kyphoscoliosis
reduced vital capacity
133. Flat effect,auditory hallucination paranoid schizophrenia
134. scanario on PAN
135. pt. with sob and dec oxy satCTPA
136. reason y pt no improving on oxygen with hx of cardiac defecthypoxemia result of blood
mixing

138. Pheochromocytoma - MEN 2

139. Bacterial peritonitis - Neutrophil count
140. Terlipressin in hepatorenal syndrome - Splanchnic vasoconstriction

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

03 - Lithium Toxicity enhanced by - OPTIONS INCLUDED METRONIDAZOLE WHICH IS

CYTOCHROME P450 INHIBITOR SO INCREASING TOXICITY

04 - What is ALLOPURINOL - XANTHINE OXIDASE INHIBITOR

05 - Warfarin metabolized by which pysiological mechanism - CYPC29

06 - Activation of Cyclosporin mediated by - IL2

07 - Antibodies found in a patient with SLE - IgG

09 - Which sound in Severe Aortic Stenosis - S4

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

16 - Parameter to measure in GB Syndrome - Forced Vital Capacity

17 - Isolated high Bilirubin levels in a female patient - GILBERT's DISEASE

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)

21 - Mos common feature in Marfan's Syndrome - UPWARD LENS DISLOCATION (ECTOPIC

LENTIS)

23 - 5ml Testis on each side with norml FSH, LH and Testosterone, height little taller KLIENFELTER's SYNDROME

24 - Site of action of Thiazide diuretics on a nephron - PROXIMAL DISTAL CONVULATED

TUBULES

25 - Side effect of Cyclosporin - HYPERTRICHIOSIS

26 - Patient on Cytotoxics given Fluconazole for some skin infection presents with Toxicity CICLOSPORIN INDUCED FLUCONAZOLE TOXICITY

27 - One of the eitiological factors causing Chron's disease - SMOKING

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

34 - Organism causing Cat Scratch Disease - BARTONELLA HANSALE

35 - Mode of Action of DYPYRIDAMOLE - POTENTIATION OF ADENOSINE INHIBITION OF

PLATELET FUNCTION and INHIBITS PHOSPHODIASTERASE ENZYME THAT BREAK DOWN
cAMP

36 - Genetics of Hemachromatosis - AUTOSOMAL RECESSIVE (metabolic)

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

44 - Factor which do not increase in heart failure - BNP ????

45 - Paracetamol Overdose - PREDICTOR WAS PH 7.2

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

49 - What is Imatinib - TYROSINE KINASE INHIBITOR

50 - Type of Gall Stones formed in a patient with Sickle Cell Disease - BILE PIGMENT STONES

51 - Presence of Target Cells and Howell Jolley Bodies - HYPOSPLENISM

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)

55 - High Hb levels and Platelets. Which Gene to be detected - JAK2 MUTATION

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

69 - How to decrease the Prostate Size - FENASTRIDE

70 - Initially symptom in Carcinoid Tumor - FACIAL FLUSHING

71 - Dysphagia for solids and now with fluids, Dx - ACHLASIA

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

74 - Reduced FEV1/FVC and decrease TLCO - PULMONARY FIBROSIS

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

81 - Worsening condition in a patient with thyroid eye disease - RADIOIODINE

82 - A girl with menorrhagia, her sister had same problem - VON WILLEBRAND DISEASE
170 Questions Collected here and ONLY 30 LEFT

2- (#161-history of lumpectomy, now backache ?? next investigation )

i dont remember this question at all .. any body else does ???

3-(#169- pt. on ch. hemodyalsis ,,invest ?? )

is it a part of question we have already discusses else where or is it a separate question.../??

4-questions regarding CYCLOSPORINS .. we had one question regarding the Mechanism of

Action..i.e IL2 Inhibitor, other question was when given with fluconazole caused the renal failure....
Was there a third question on cyclosporin as well?? in which they asked
for the side effect ? and answer was Hypertrichiosis...
or was it a part of 2nd question..

i hope if we get the right answers to above queries.. we can get the
TOTAL Recall

2014 may attempt

regards
Eplerenone in HF mortality? 2 questions i think.

DOC in cataplexy?

Ear pic that looked like some fried thing..relapsng polychondritis?

16 yr old depression fluoxetine?...webmd says prozac which is fluoxtine (fluke for me)

Lady with compression # of a vertebre?

Coagulase -ve culture? Repeat culture?

Spina bifida guy with some bugs in urine?

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

empyma gallbladder,aortic valve replacement,multiple cerebral atrophy,hypogycaemic stop

sulphonylurea,lumber puncter in bih,,restrictive pic-obesity,aortic valve replacement,mri spine,adhesive
capsulitis,dictal invasive carcinoma breast- radiotherary risk factor myopathyduloxetin in diabetic
neuropathy
craniopharyngioma,adult onset still disease,macroprolictinoma or non functional pitutay???
pcos,alzheimers,annular lesion antifungal,scabies,lyme disease
ulcerative colitis,ards,bullous phamphigoid,add steroid in copd,phamphigus vulgaris rx
milliary tb pix,modafinil rx in narcolepsy ?? alzeimers, ,atonic seizure

ecg hyperkalaemia,stop ramipril in elevated creatinine ?? legionella,osteonecrosis,

,fomipezol,amitryptillin overdose-sodium bicarbonate??
intubation nd ventilation,non invasive ventilation
chrons pt with loin pain hematuria - renal stone disease,varicella pneumonia
gbs,dm pt with impotence??htn rx in young adult with hypoproteinaemia nd hypoalbuminaemiaramipril
membranous glomerulonepritis,adnal insufficiency,calculation of itt
abdominal pain,constipation,hypochromic microcytic anaemia-lead poisoning
Paper 3- rest tremors-parkinson, leptospira treatment, DLB,
ECG- av nodal reentrant tachycardia, prolonged pr,
Pneumoccal pneumonia
Skull xray- fracture? ?
Chest xray with mets- Ix beta HCG
IBS
Diver with cellulitis and ear infection- pseudomonas??
Tb patient in isolation ward- negative pressure with mask??
Chest xray image with raised eosinophils- ? Eosinophilic pneumonia/ ? Hypersensitivity pneumonitis
The ECG was WPW, but WPW would not explain the clinical presentation of chest pain. I think it was
an NSTEMI, since he had ST depressions.
1. AIH 2 due to amiodarone ---> prednisolone
2. Aortograph in pics ...Takayasu arteritis?

3. Invasive ductsl ca risk factors...alcohol (w)

4. Shoulder xray?? Ruptured tendon?
5. Familial growth thing
6. Turner?

8.allopecia and nail pitting..psoriasis (w)

9. Gall bladder empyema?(w)
10. Farmer xray miliary tb?(w)
11. Pyoderma gangrenosum on uc patient pic. Prednisolone
12. Lesion on foot not respondimg to? Antifungal??
13. Fompizole in alcohol guy?.
14. Ursodeoxycholic acid in PBC.
15. Long standing diarrhea fecal elastase?
16. GCA additiomal drug?(w)
17. Cardiac cath VSD.
18. Hiv +ve patient with unilateral visual acuity loss..toxoplasmosis?
19. Commonest association with celiac disease...hepatic cysts?
20. Moderate Aortic stenosis and calcification...avr?
21. Huntington guy with depression...respect his will?
22. Acute gout attack due to lack of colchicine...stop allopurinol?
23. Recurrent gout attack...adive low purine diet?
24. Girl taking grandma's painkillers...buprenorphine??
25.copd exacerbations...ltot?
27. African patient with cxr...kaposi sarcoma?
28. Calcium scan Ct?
29. Post mastectomy lung infiltration that relapses after stopping prednisolone...lymphangitis
carcinomata?
30. Prolonged diarrhea with low fecal elastase...pancreatic exocrine deficiency
31. Lady with celiac disease sister having 8 months diarrhea...irritable bowel?

32. MIBI scan..inferior fixed?

33. Pneumococcal pneumonia
1.statistic - inattention to treat analysis, how many pts to include? need to include all pts both treated
and discontinued
2.PCKD - the most frequent accompanying pathology: liver cysts (also berry aneurism, mitral valve
prolapse)
3. after acromegaly treatment, human growth hormone still slightly elevated: what is the most frequent
complication: IHD
4. woman with tattoo and deranged liver enzymes, rash on tattoo. Ix?
viral hep screen?
autoantibody
serum caeroplasmin
5. Woman had surgery, extubated, sudden pleuritic chest pain in the R side. X ray - r sided
opacification, tracheal and mediastinum shift towards the pathology (lung collapse?) treatment : chest
drain?

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:

acute fatty liver of pregnancy?

12. inclusion body myositis: proximal leg weakness, distal muscle weakness of hands
13. guliian barre with TLC 1.5 litters - classic discretion
14. drug abuser with paraparesis and diplopia: botulism
15. X-ray pleural effusion (also option lung collapse there)
18. lesion on the chin picture: BCC? squamous papilloma?
19.diabetic on annual review, retina pic. Rx:
photocoagulation, observation?
on pic - pre-profilirative retinopathy, is there haemorrhage in the macula region?
20. diabetic N cholesterol, low HDL, high triglicerides, quite poor diabetic control. How to improve his
lipids:
tight control of diabetes (?)
fibrates
statins

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:

1. Girl with Htn, sister also had it - phaeochromocytoma

2. Guy with s bovis- rt knee aspiration
3. Aorta gram - ? Takayasu
4. Question on aortic dissection
5. Girl with Turners features
6. Eplerenone to improve mortality in uncontrolled chronic heart failure
7. Eplerenone to reduce 1 year mortality...
8. Girl with'fluttering' - ectopic beats
9. The Huntington guy with VT - give treatment
10. Foreigner with past history of Scarlett fever - constrictive pericarditis

12. Next treatment for copd - tiotropium

13. One question with Sarcoid

15. Duodenal biopsy for coeliac

16. Duodenal biopsy again?
17. PBC with raised IgM - ursodecolic acid
18. Inflliximab for uncontrolled crohns
19. Stop ramipril
20. Bacterial overgrowth in multiple surgery patient for IBD
21. Cause of acid base balance in a pregnant lady - lactic acidosis
22. Boy with recurrent chest, ear infections - CVID
24. Middle aged with haematoma - acquired haemophilia
25. Methanol/ethylene glycol - fomipezole
26. Non functional macroadenoma

27. Na valproate for the seizures patient

28. Hypothyroid myopathy for the lady who couldn't get up
29. TTP
30. Convulsing man, septic - cerebral abscess
31. Severe diarrhoea and renal dysfunction in a returning traveller - cause of renal - ATN
33. Returning traveller with myalgia and lymphadenopathy - HIV serology
34. Old man with hypertension - nephrosclerosis
35. Wound breakdown and pus and sepsis - surgical exploration
36. Boy with reiters - doxy
38. Possible bronchial cancer with glomerulonephritis - membranous glo
39. Asian lady had transfusion 19 yrs ago, now presents with jaundice what serology ?
40. Copd man, regular ITU, now in severe type 2 RF - intubate!

Mrcp

1- temporal arthritis additional treatment - aspirin

3- pregnant lady with reflux - alginate
4- takayasu arthritis

6- farmer with tattoos - hypersensitive pnemonitis

7- copd patient with t2 respiratory failure - niv
8- pyoderma gangrenosum - prednisolone
9- old gentleman returned from holiday has pneumonia signs and abdo pain - legionella
10- young lady with pneumonia symptoms confused - legionella
11- 25 year old lady come for review f/h of colon cancer at the age 70 - no treatment required
12- patient with asymptomatic aortic stenosis - outpatient review
14- lady with osteomalacia - treatment calciferol
15- anaemia with zinc protoporhyrin test - lead toxicity
17- multi system atrophy
18- good pasture

20- acute hepatitis patient hep b and a negative - hepatitis e

21- chrons patient severe flare already on azathioprine- infliximab
22- pagets - skull xr and bone scan was given
23- ECG with tented to waves - hyperkalemia
24- still disease
25- sleep apnea patient snoring at night bmi 27 and not sleepy during the day- mandibular advancement
device
26- epileptic girl on topiramate and phenytoin, comes with movement of her arms and legs - non
epileptic seizure
27- myo epilepsy - valproate
28- lady depressed, constipation and 3 kg weight lost, lost her husband 6 months ago - reassurance

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

72- thyrotoxicosis patient on AF what to give - propranolol

73- CTPA shows pulmonary embolus treatment , this was the first question of first paper I cannot
remember the story but it was consistent with pe - treatment lmwh
75- paracetamol overdose , ph 7.1, pt > 100, creatinine > 300 asking what would be the life saving
intervention, I cannot remember whether the patient had encephalopathy but I think it was iv n acetyl
cysteine
76- tall young guy, gh not suppressed - gigantism
77- diabetic patient with background retinopathy comes with sudden visual loss, fundoscopy shows
large heamorrhage - branch vein occlusion
78- patient on metformin and gliclizide started on exenitide now lost weight and hba1c improving but
has frequent hypo attacks - stop gliclizide
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 - asbestosis
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 - 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.

Inclusion body: CMV: Ganciclovir

Diarrhea post colon resection crohns pt.: prednisolone?
FLOATERS AND FLASH OF LIGH: retinal detachment
angioedema:FFP
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Fri Jul 11, 2014 5:34 am (1 year ago) #81

Questions as i remember ..

1) ecg .. Recent MI .. VT like ecg ...> SVT WITH

ABBARANT CONDUCTION
2) ecg .. Dextrocardia?
3) ecg changes ... Deep a iv v1 ... Pulmonary
embolus
4) patient with chemo .. R lung pneumonia
..pneumococus
5) rigitity hallucinations,memory ... Levy body
dementia
6) patient with symtoms and tremors ..
PARKINSONS
7) patients with dopamine agonists ...psycotic
symtoms. ??side 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 ??

17) old lady bullous pamphigoid

18) a girl with rash (e.nodosum ) and sob.. Inv ?

CXR
19 dermatitis herpitiformis radh scenario
20) HUS .. Paper 1
21) paper 3 girl with diarhea ..rash .. HUS??
HSP
22) Aids patient with vision one eye .. CMV
ratinitis .. Gancyclovir
23) lumber puncture .. 400 neutrophills ..
Meningiococcal meningitis
24) another luber puncture with high protient
some cells ... Viral
24) diabetic eye .? Neovascularization.
Photocoagulation
25 ) myopic patient .. Eye shadow .. Ratinal
deachment
26 ) 2 questiins .. Eplerenone
27) after angio infarcts/lesions on foot ...
Cholesterol embolization
28) ear photo.. Relapsing polychondritis
29) ear jnfection .. Pseudomonas
30) vertigo ..BPPV
31) lady with unsteady walk .. Tatto .. Liver
failure hepatomegaly .. Ceruloplasmin
32) lady with blood transfusion... Hepatitis C
33) cryoglobinimia... Hepatitis C
34) CT scan .. Patient with obstrctive sob...
Thymoma
35) CTPA .. Enoxaparin??
36) haemorage in temporal lobe MRI.. HSV

37) sholdr x ray .. ??

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

2)
45) myocardial scan..?
46) cardiac cath .. Ventricular septal rupture

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

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

CXR-Mets in a young man-BHCG-Possible testicular Ca

ECGS-Sinus Tachy , WPW , V.T , Proloned PR
Pyogenic granuloma-Pic with hx of easy bleeding

pic with rt ear-polycondritis

few xrays - Rh arthritis , skull # near rt side of the ear on elderly lady with fall and warfarin , padgets
disease , raised eosinophils i=on pt who was farmer with cxr changes on lt side-aspergillosis
LBD
PT with polydepsia-water deprivation test given-Normal response

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

Cinacalcit-for raised phosphate

alpha calcidol-osteomalacia
Cystic fibrosis
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Sat Jul 12, 2014 8:54 pm (1 year ago) #107

For this hyperkalemia with rahbdomyolysis ca gluconate increase

the muscle destruction so to give insulin and dextrose
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Sat Jul 12, 2014 9:04 pm (1 year ago) #108

1) ecg .. Recent MI .. VT like ecg ...> SVT WITH ABBARANT

CONDUCTION
2) ecg .. Dextrocardia?
3) ecg changes ... Deep a iv v1 ... Pulmonary embolus
4) patient with chemo .. R lung pneumonia ..pneumococus
ziarehman1
Experienced Member

5) rigitity hallucinations,memory ... Levy body dementia

6) patient with symtoms and tremors .. PARKINSONS
7) patients with dopamine agonists ...psycotic symtoms. ??side

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 ??

17) old lady bullous pamphigoid

18) a girl with rash (e.nodosum ) and sob.. Inv ? CXR
19 dermatitis herpitiformis radh scenario
20) HUS .. Paper 1
21) paper 3 girl with diarhea ..rash .. HUS?? HSP
22) Aids patient with vision one eye .. CMV ratinitis ..
Gancyclovir
23) lumber puncture .. 400 neutrophills .. Meningiococcal
meningitis
24) another luber puncture with high protient some cells ... Viral
24) diabetic eye .? Neovascularization. Photocoagulation
25 ) myopic patient .. Eye shadow .. Ratinal deachment
26 ) 2 questiins .. Eplerenone
27) after angio infarcts/lesions on foot ... Cholesterol
embolization
28) ear photo.. Relapsing polychondritis
29) ear jnfection .. Pseudomonas
30) vertigo ..BPPV
31) lady with unsteady walk .. Tatto .. Liver failure
hepatomegaly .. Ceruloplasmin
32) lady with blood transfusion... Hepatitis C
33) cryoglobinimia... Hepatitis C
34) CT scan .. Patient with obstrctive sob... Thymoma
35) CTPA .. Enoxaparin??
36) haemorage in temporal lobe MRI.. HSV
37) sholdr x ray .. ??

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

45) myocardial scan..?

46) cardiac cath .. Ventricular septal rupture

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

Few queries:(my thoughts-may be i am wrong

Pt with gradient of 80,he is elderly and asymptomatic-i think clinic
followup

Unsteady,liver failure,tattoo-Hep B, i focused on

ceruloplasmin,but hx not going in that favour
Diabetic eye-pt asmptomatic-I think-just observe
Age related cognitive impairement-Alzheimers
Amphetamine OD-agressive and agitated lady with police

Here is a comprehensive recall with as much more questions as I can remember. Please, correct for the
wrong answers.

1- Lewy body dementia Scenario.

4- Guillian Barre Syndrome.

5- Botulism.
7- Photo of bullous pimphigoid.
8- Scenario of Henoch Schonlein purpura.
9- Cause of retinitis in HIV pt >>> cytomegalo virus.
10- Cytomegalovirus treatment >>> ganciclovir.
11- Sarcoid scenario asking for investigation >>> CXR.
11- CSF analysis (High opening pressure , Neutrophilia+low CSF glucose ) >>> meningococcal
meningitis.
12- CSF analysis ( High opening pressure+lymphocytosis+low CSF glucose) >> TB meningitis.
13- CSF analysis with temporal lesions >>> Herpes meningitis.
14- Scenario of retinal dettachment.
15- Scenario of cholesterol embolization.
16- Relapsing polychondritis - photo.
17- Case of benign positional vertigo.
19- Charcot joint with diabetes >>> immobilization.
20- A case of PKD with loin pain >>> diagnosis is acute rupture to cyst.
21- Catheter interpretation >> ventricular septal rupture.
23- Temporal arteritis - next step to start aspirin.
24- Pregnant with dyspepsia >> give alginate.
25- Pyoderma gangrenosum treatment >> steroids.
26- A case of legionella pneumonia.
27- A case of mycoplasma pneumonia.
28- No screening required for a young girl with grandpa having colon cancer.

30- Infliximab for uncontrolled Crohn's.

31- ECG >> hyperkalaemia.
32- ECG >> VT.
33- EcG >> WPW syndrome.
34- ECG >> prolonged PR.
35- Epilepsy treatment >> valproate.
36- Budd chiari syndrome >> To do doppler abd. US.
37- Na-bicarb for tricyclic overdose.
38- Ursodeoxy cholic acid for PBC.

40- A case of Ostenecrosis of the jaw.

41- Pregnant >>> stop ramipril.
42- Amyodarone-thyrotoxicosis >> prednisolone.
43- Which factor in the pt history is associated with increased cancer risk >> radiotherapy.
44- Which factor in the pt history is associated with increased risk of stroke >> previous stroke.
45- CKD with 2ndary hyperparathroidism >> give cinacalcet.
46- A scenario of TTP.
47- Treatment of diabetic neuropathy >> diluoxetine.
49- A case of vasodepressor syncopy.
50- A case of Stokes Adams attacks.
51- Treatment of thyrotoxic AF >> propranolol.
52- A scenario of vegetative state.
53- EDTA for lead poisoning.
54- A scenario of myeloma.
56- Terminally ill pt with seizures and irritable >> SC midazolam.
57- Elderly pt febrile and confused >> haloperidol.
58- Cause of ear infection >> pseudomonas.
59- A case of cystic fibrosis.
60- Acute fatty liver of pregnancy.
61- Restrictive PFT with eosinophilia >> esinophilic pneumonia.

62- CT >> hydronephrosis.

64- Disseminated gonorrhoea.
65- Hyperthyroid Myopathy.
66- Duodenal biopsy for celiac.
67- Diabetic with elevated TG >> fenofibrate.
68- Treatment of bed sores >> pressure relieving cushions.
69- AIDS patient with acute psychosis and aggressive >> amphetamine abuse.
70- Fomepizole for alcohol poisoning.
71- Tetanus infection >> urgent surgical depridement.
72- Membranous glomerulonephritis.

74- Diagnosis of PE >> CTPA.

75- Lung metastates CXR >> do BCG for testicular cancer.
76- Antivoltage gated channels for Lambert Eaton.
77- Diabetic pt with lab features of DKA >> to give 9% NS.
78- The commonest cause of mortality in acromegaly >> IHD.

80- Lyme disease case.

81- Flaicanide for WPW.
82- A case of adhesive capsulitis.
83- A case of PCOS.
85- Primary hypoadrenalism scenario.
86- Photo of pyogenic granuloma.
87- Eplerenone fo heart failure.
88- Another herat failure case to add epleronone.

90- A scenario of HUS.

91- Progressive primary MS.
92- HCV screening for the Asian lady.
93- Stable angina - what to do >> exercise stress test.

94- Unstable angina - what to do >> coronary angigraphy.

96- Diagnosis for burkitt's lymphoma >> lymph node biopsy.
97- Which factor should be corrected in pyelonephritis >> urine output.
99-Turner syndrome.
100- Capsule endoscopy.
101- Pt. with abd pain following several abd surgeries >> Intestinal adhesions.
102- PE pt presented after 48 hours >> LMWH.
103- Familial tall stature.
105- Lady with stroke , previous pianist and social activist >> adjustment disorder.
106- Pt. with acute abdominal pain and bloody diarrhea - urgent investigation >> plain abd. X-ray.
107- sisters with hypertension and renal bruit >> fibromuscular dysplasia.
108- Huntigton pt >> respect his will.
109- Suspected HIV patient >> wait until he regains consciousness and gives consent.
110- Manic disorder >> give lithium.
111- CXR >> pulmonary Kaposi sarcoma.
112- Annular lesions not improved by steroid >> give antifungal.
113- Cause of erectile dysfunction in diabetic >> autonomic dysfunction.
114- Spondylarthropathy.
116- Patient taking cyclophosphamide and developed frank haematuria >> diagnosis bladder cancer
( haemorrhagic cystitis not mentioned in options).
117- CXR >> lung metastases.
118- IV drug user with stahylococcal infection >> flucloxacillin + gentamicin.
119- Most appropriate treatment for hyperparathyroidism >> parathyroidecomy.
120- Tumour with inferior quadrantanopia >> craniopharyngioma.
121- Tumour with superior quadrantanopia >> nonfunctional pituitary adenoma.
122- Hepatic tumour with coarse outlines on US >> hepatocellular carcinoma.
123- A girl with diastolic murmur and bounding pulse >> aortic regurg.
124- Myotonic dystrophy case.
125- Ca-gluconate for hyperkalaemia.
126- AIDS pt with uraemic encephalopathy and deranged liver function >> haemodialysis.

127- Pt with focal segmental glomerulosclerosis >> start ramipril.

128- Anemic patient with CKD >>> IV iron therapy.
129- Factor associated with adverse prognosis in breast cancer >> lymph node spread.
130- Elderly female with urinary incontinence >> pelvic floor exercise.
131- Female 48 years with psychosis >> menopause.
131- Pt with primary ovarian failure, tall with hypogonadotropic hypogonadism >> Kallman's
syndrome.
132- Patient with right hypochindrial and epigastric pain with pleural effusion >> pancreatic
pseudocyst.
133- CT >> occipital bleeding following trauma >> give dexamethasone.
134- Pt with brain metastasis with high ICP>> give dexamethasone.
135- Patient with chest pain and breathing difficulty , CXR abnormality >> pleural plaques.
136- Spanish man with huge spleen (10 cm) >> visceral leismaniasis.
137- Febrile patient with recent travel Hx and hepatosplenomegaly >> salmonellosis.
138- A girl with painful loss of vision of eyes >> bilateral optic neuritis.
139- Pt with recent travel presented with pharyngitis and lymphadenopathy >> HIV serology.
141- Essential tremor.
142- APKD , mostly associated with >> hepatic cysts.
143- Doxycycline for reactive arthritis.
144- Lansoprazole-induced diarrhoea.
145- Inclusion body myositis.
146- Stop warfarin 3 days before surgery and commence LMWH.
147- Psoriasis case with alopecia and nail pitting.
148- Varicella pneumonia.
149- Scabies.
150- Girl with painful rash and breathing difficulty , diagnosis >> sarcoidosis.
151- Aspirin overdose presented after 1 hour >> oral activated charcoal.
152- After DDAVP urine osmolality low and plasma osmolality low >>> primary polydepsia.
153- Obese diabetic with hypoglycemia >> stop gliclazide.
154- Pt with alcohol poisoning and deranged liver function , which is life saving >> haemodialysis.

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 .

162- Pt with hypopigmentd scaly lesions >> itraconazole.

163- Case of post-partum thyroiditis.
164- ECG long QT , which drug to stop >> furosemide.
165- A diabetic following trauma with high bp and evidence of grade 3 hypertensive retinopathy , CT
given , I could not recognize phaeocromocytoma in CT, the only positive finding is haematoma in the
right renal pelvis most probably as a result of trauma. Furthermore, his HTN seems more essential and
long-standing which explains the complication of retinopathy. Which antihypertensive to give >>> as
the patient is diabetic I went to ramipril .

5.
6.
7.
8.
9.

After surgery Siadh _ levopremazine or Carbamazepine

A case of Nephrogenic diabetes insipidus
Marathon runner ?diuretic abuse or polydipsia (Urinary sodium was 15mmol/l)
Patient with low ACTH/FSH/LH/GH and Prolactine of 900 -?Non functioning Pitutary
Patient with elevated TSH and Prolactin also on Fluoxetine - ?Primary Hypothyroidism or

drug induced
10. PBC Long term treatment treatment ?Ursodeoxycholic acid

11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.

55 year old woman with jaundice and Diabetes Ca Pancreas / Glucagonoma

ECG of Torsades de pointe /Vtach
Patient with TB and pleural effusion Bronchial washing or Pleural fluid aspirate
Immunosuppressed woman whose husband was Hep A positive - Reasure
Patient with maculopapular rashes after contact with a child - ?Measles
Patient presents with Fever, headaches and Jaundice - ?Dengue
Patient with Red cell cast and granular cast on urine microscopy - Leptosporiosis
Patient presents with intermittent dysphagia after visit to Asia -???Chagas
MRI of PML
Pseudoseizure -Refuse to open eyes
CT of man with temporal lobe enhancement Herpes encephalitis
Young lady with multiple painful genital ulcers and Dysuria -Herpes Genitalis
CSF picture of a diabetic woman with raised Neutrophils/Raised RBCs/ raised Protein and

24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.

Normal glucose - Listeriosis or Herpes or TB meningitis

Patient with raised transaminases N acetyl cystein
Gout prophylaxis _ Febuxostat
Patient with Low c3 and nephrotic -Mesangioproliferative
Patient with URTI and haematuria - IgA nephopathy
DM patient with photomicrograph - Neovascularisation
Patient with affectation of lower quandrant of vision = BRAO
Nephrotic patient with loin Pain and haematuria -Renal Vein thrombosis
Elderly man with AF and heart block - Rate responsive Ventricular pacing
Pregnant lady with PE -Compression ultrasound of the leg
Elderly woman with detrusor overactivity - Oxybutinin
Tetraplegic patient with Autonomic dys -check that the catheter is
DM woman with Lipodermatosclerosis
Patient with Acne rosacea - Tetracycline
Umbilical lesion Flexural Psoriasis
A nursing sister with generalized pruritus - Scabies
Patient with rashes lasting 72 hours - Urticaria Vasculitis or Angioedema
Scenerio where APTT doesnt normalize with mixing - APS
Duration of anticoagulation in APS For life
Patient with Pyogenic liver abscess -Percutaneous drainage of liver abscess
Scenerio of a patient with downbeat nystagmus and c5/6 lesion Chiari malformation and

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

with HB of 3- Diagnosis - Aplastic anaemia or Pulmonary Hypertension

59. Patient with Hyperkalaemia 5.5mmol/l - recheck in 2 weeks or withdraw Ramipril.
60. Patient with uncontrolled hypertension and hyperkalaemia Doxasocin or Monoxidine

61.
62.
63.
64.
65.
66.
67.
68.
69.
70.
71.
72.
73.
74.
75.
76.
77.
78.
79.

Simvastatin and ramipril withdrawal in Pregnancy

Morphine breakthrough dose 30mg
Thyroid scan of patient with neck pain - Viral thyroiditis
Patient with cerebral metastasis - Increase dexamethasone or mannitol
Patient with Bone metastasis and stage 4 renal disease Zolendronic acid or morphine?
Patient with Colles fracture and Dexa score of - 3.4
Patient with isolated ALP - Pagets X rays
Epidural CT scan
Elderly man with reduced consciousness - ?Chronic bilateral subdural
Melanoma Pix
Percutaneous biopsy or PET Scan - in a patient with peripheral Lung tumour
Colonoscopy in a patient with Iron deficiency (low MCV and ferrin) and non bleeding PUD
Left common carotid missing on CT angio
Depressive psychosis man whose Girlfriend just left
Risk of suicide _ 2 weeks of planning
Patient with Kussmals sign - Tb pericarditis
Steroids or Colchicine for uraemic pericarditis
IV iron for Patient not responding to EPO
Pregnant lady with s3,grade 2/6 murmur in the left 2nd intercostal space - Normal pregancny

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

155.History of cat and Innoculation of Multicoda

156.Patient with features and laboratory values in support of CVID
157.Patient with features of Carcinoid 5HIAA measurement
158.Patient with features of neuropathic ulcer - Low pressure shoes
159.Patient with stroke presents within 2 hours of onset of the hemiplegia -Alteplase
160.55 year old woman with slight abdominal pain and hyperpigmented lesions at the site of pain.
Also has issues with sugar control . Whats the cause of the elevated serum glucose
Glucagonoma or CA pancrease
161.Patient with features of portal hypertension and hepatic encephalopathy IV terlipressin or
Lactulose
162.Lab features of Heparin induced thrombocytopenia, what to start - Danaparoid
163.After resuscitation of a patient with Upper GI bleeding, next line of management iv
omeprazole for 72 hours or IV terlipressin for 72 hours
164.Patient with features of Lumbar canal stenosis
165.COPD patient with Pneumothorax and continuous bubbling after applying sunction to refer
to surgery
166.Post transplant loss of renal function - Tacrolimus toxicity
167.Stop allopurinol for azathioprine
168.Patient develops painful gynaecomasteia on spironolactone what drug improves mortality in
place of spironolactone .Eplerenone
169.Patient with abdominal pain, bleeding per rectum and Normal DRE - Ischaemic Colitis
170.Patient with features in keeping with -Bile salt induced diarhoea
171.Patient with features of Takayatsus
172.Patient with features of PSP
173.Refeeding syndrome
174.Drug cause of Hypomagnesemia - Thiazide
175.Morphine or diazepam to ease breathing problems
176.Patient with features of laxative abuse
177.Yound lady with features of Spondilolisthesis
178.History and features of MEN 1
179.Patient keeps having diarhoea early in the mornings after an episode of food poisoning - IBS
180.A case scenario of interaction with macrolides
181.Patient with features of autoimmune hepatitis Start steroids
182.Enoxaparin induced hyperkalaemia
183.CKD patient on ramipril found to have K of 5.5 in clinic- To repeat in 2 weeks or withdraw
ramipril
184.Dapson induced haemolysis
185.Patient with features in keeping with lymes doxycline
186.Lymphoma patient with deranged E/U/Cr - ????? tumour lysis syndrome (no mention was
made that patient was commenced on chemotherapy)
187.History and lab features of ectopic ACTH secretions
188.Patient with lab features in keeping with thombotic angiopathy
189.Patient with hypokalaemia and hypertension to mesure serum renin/aldosterone
190.One feature of PCP after renal transplant
191.Patient with 100% carotid artery stenosis on affected side do nothing
192.Patient with histology of granuloma Sarcoidosis or giant granuloma lymphoma
193.Patient whose SPO2 refuses to rise with INO2- ??? alveolar haemorrhage
194.Patient with elevated CK Muscle biopsy
195.Patient with CA pancreas or Chronic pancreatitis CT abdomen or MRCP or CA 19.9
196.Patient in septic shock Norepinephrine
197.Features in keeping with pregnant woman with normal pregnancy changes
198.Elderly man with confusion and features of SOL in the right - ? Bil Chronic subdural.

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

6- farmer with tattoos - hypersensitive pnemonitis

7- copd patient with t2 respiratory failure - niv
8- pyoderma gangrenosum - prednisolone
9- old gentleman returned from holiday has pneumonia signs and abdo pain - legionella
10- young lady with pneumonia symptoms confused - legionella
11- 25 year old lady come for review f/h of colon cancer at the age 70 - no treatment required
12- patient with asymptomatic aortic stenosis - outpatient review

14- lady with osteomalacia - treatment calciferol

15- anaemia with zinc protoporhyrin test - lead toxicity
17- multi system atrophy
18- good pasture
20- acute hepatitis patient hep b and a negative - hepatitis e
21- chrons patient severe flare already on azathioprine- infliximab
22- pagets - skull xr and bone scan was given
23- ECG with tented to waves - hyperkalemia
24- still disease
25- sleep apnea patient snoring at night bmi 27 and not sleepy during the day- mandibular
advancement device
26- epileptic girl on topiramate and phenytoin, comes with movement of her arms and legs non epileptic seizure
27- myo epilepsy - valproate
28- lady depressed, constipation and 3 kg weight lost, lost her husband 6 months ago -

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

management - s/c lmwh

56- suspicious looking lesion - ?excision biopsy ?punch 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 change to
once daily dosing
64- patient on warfarin comes with uppergi bleed - give pcc
65- patient had syncope when having a shave - carotid hypersensitivity
66- 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 meckels scan
71- patient comes with abdo pain background of several abdo surgeries, colonoscopy was
normal - pseudo obstruction
72- thyrotoxicosis patient on AF what to give - propranolol
73- CTPA shows pulmonary embolus treatment , this was the first question of first paper I
cannot remember the story but it was consistent with pe - treatment lmwh
74- paracetamol overdose , ph 7.1, pt > 100, creatinine > 300 asking what would be the life
saving intervention, I cannot remember whether the patient had encephalopathy but I think it
was iv n acetyl cysteine
75- tall young guy, gh not suppressed - gigantism
76- diabetic patient with background retinopathy comes with sudden visual loss, fundoscopy
shows large heamorrhage - branch vein occlusion
77- patient on metformin and gliclizide started on exenitide now lost weight and hba1c
improving but has frequent hypo attacks - stop gliclizide

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

130- narcolepsy - modafanil

131- and I chose craniopharngioma
132. non functional adenoma
133. Girl with Htn, sister also had it - phaeochromocytoma
134. Guy with s bovis- rt knee aspiration
135. Aorta gram - ? Takayasu
136.Question on aortic dissection
137.Girl with'fluttering' - ectopic beats
138.The Huntington guy with VT - give treatment

140. Next treatment for copd - tiotropium

141. One question with Sarcoid
142. Cause of acid base balance in a pregnant lady - lactic acidosis
143.. Boy with recurrent chest, ear infections - CVID
144. Methanol/ethylene glycol - fomipezole
145. Convulsing man, septic - cerebral abscess
146. Old man with hypertension - nephrosclerosis
147. Wound breakdown and pus and sepsis - surgical exploration
148. Boy with reiters - doxy
150. Possible bronchial cancer with glomerulonephritis - membranous glo
151. Copd man, regular ITU, now in severe type 2 RF - intubate!
152.AIH 2 due to amiodarone ---> prednisolone
153. Invasive ductsl ca risk factors... ?regional lymph nodes
154. Shoulder xray?? Ruptured tendon
155. Long standing diarrhea fecal elastase?
156. GCA additiomal drug - aspirin
157. Hiv +ve patient with unilateral visual acuity loss..toxoplasmosis? ?CMV
158. Commonest association with APKD disease...hepatic cysts
159. Acute gout attack due to lack of colchicine...add colcichine
160. Girl taking grandma's painkillers... ?tramadol

161. African patient with cxr...kaposi sarcoma? ?TB

162.. Prolonged diarrhea with low fecal elastase in a CF px...pancreatic exocrine deficiency
163. MIBI scan..inferior fixed?
164.commonest cause of death in persistent acromegaly IHD
165. girl with tattoo, phychiatric symptoms and deranged lfts- Serum ceruloplasmin
166. Lesion on chin pic - ? squamous pappiloma?
167. Intention to treat -750 px
168.CT: left upper lobe collapse
169. pic seborrhoric keratosis
170. frontal lobe meningioma
171. patient eith toxoplasmosis ?? HIV.. Check if medical decision , patient intesrest
172. lumber puncture .. 400 neutrophills .. Meningiococcal meningitis
173. another luber puncture with high protient some cells ... Viral
174. diabetic pic background retinopathy - observe
175. myopic patient .. Eye shadow .. Retinal deachment
176. after angio infarcts/lesions on foot ... Cholesterol embolization
177. ear photo.. Relapsing polychondritis
178. haemorage in temporal lobe MRI.. HSV
179. diabetic with foot xray red hot tender .. Charcoat >> immobilisation
180. primary progressive multiple sclerosis

2182. cardiac cath .. Ventricular free wall rupture

183. patient with low 20% ihd risk .?? Investigation.. Exercise tredmill? Myoscan?
184. APACHE score .. Icu patient .. VBG? Urine output?
185. Aspirin intoxication activated charcoal
186. Girl whose father died at 70 of colon cancer reassure

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.

208- CSF analysis ( High opening pressure+lymphocytosis+low CSF glucose) >> TB

meningitis. .

209- A case of PKD with loin pain >>> diagnosis is acute rupture to cyst.

210- Pregnant with dyspepsia >> give alginate.

213- Lung metastates CXR >> do BCG for testicular cancer.
214- Antivoltage gated channels for Lambert Eaton.

216- Flaicanide for WPW.

217- Stable angina - what to do >> exercise stress test. .

219- Which factor should be corrected in pyelonephritis >> urine output.

220- Pt. with abd pain following several abd surgeries >> Intestinal adhesions.
221- Cause of erectile dysfunction in diabetic >> autonomic dysfunction.
222- Patient taking cyclophosphamide and developed frank haematuria >> diagnosis bladder
cancer ( haemorrhagic cystitis not mentioned in options).
223- machinery murmur - PDA
224- Anemic patient with CKD >>> IV iron therapy.
225- Elderly female with urinary incontinence >> pelvic floor exercise.
226- Female 48 years with psychosis >> menopause.
227- Patient with chest pain and breathing difficulty , CXR abnormality >> pleural plaques. .
228- Febrile patient with recent travel Hx and hepatosplenomegaly >> salmonellosis.
229- Essential tremor.
230- Varicella pneumonia.
231- Patient with frequent ashma attacks >> increase the dose of inhaled steroid.
232- Patient with scarring alopecia and joint pains , which autoantibody to do >> Antinuclear
antibody.
234. Itraconazole for Aspergilloma
235. A case of ? Lebers optics
236. Old lady with cognitive impairment Alzheimers
237. Px convinced he had symptoms which proves he had cancer despite everytest and he was
depressed - ? hypochondriac, ? dysmorphophobic
238. Mycoplasma pneumonia with erythema multiforme.
239. Hypokalemic periodic paralysis

240.xray of wrist HPOA

241.catheter interpretation with high pressures RA Tricuspid regurg
242. Correct hypomangnesemia first
243. High ALP, low Ca, low phosphate Osteomalacia
244. ramipril in deteriorating Renal function stop the ramipril
245.Woman with ? post partum thyroiditis ? sick euthyroid
246. Young girl who took some grandma drugs and is now comatose +convulsion - ?
Tramadol toxicity
247. old man with COPD, chronic retainer now on 60% O2 PCO2 10, PO2 12 ( was Pco2
7.5 ) on discharge after previous admission what next to do reduce O2 to 28%
248. CXR with metastases, what inv - ? Renal USS for renal cell carcinoma ?beta HCG
249. CXR- plueral plaques
250. Osteonecrosis of jaw - alendronate

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.

195- Pt with cognitive decline >> Alzheimer.

197- Scenario of major depression.
199- Elderly with AF and IHD developed bloody diarrhoea >> ischaemic colitis.
200- Pt with breathlessness and there was X ray given asking for the cause of breathlessness. Any
feedback on this question?
198- CXR >>> progressive massive fibrosis.
199- Case of extrinsic allergic alveolitis.
200- Sleep apnoea case , his BMI is 27 which is close to high normal level (25), he has only 4 cycles
per 24 hours which indicates mild disease>>> most appropriate action is to reduce weight but not sure.
201- Pic >> nodular melanoma.

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

0.ropinirole- dopamine agonist

11.U/L tremor and rigidity- Idiopathic PD
12.Young pt with seizures,N glucose, lymphocytosis- HS Encephalitis
13.Rx for Migraine- Sumatriptans
14.Rx for Essential tremor in elderly- Primidone
15.Hemibalismus-C/L STN
16.Ptosis,diplopia and weakness- Myasthenia

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.

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- ?????
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

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
80.Hypochondriac

82.Paranoid Schizophrenia- auditory halucinations with mild trace of cannabis/amphetamines

83.Depression- anhedonia
84.Dysthymia..one stem
85.one with MANIA-- grandoise delusions.

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

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
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
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
124.Aortic valvular disease with bloody diarrhea---?Colonoscopy
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
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

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%

171.Patient with fever and loin pain- acute Pyelonephritis

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 elderly- Streptococcus 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.PV- ABG.. this is one more new Q
191.osteoarthritis..Rx-paracetamol
192. pregnant woman with ITP-steroids
193.Eczematous skin lesions- gloves.
1.

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

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
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

76.Diarrhea after cholecystectomy- Rx.Cholestramine

77.Diarrhea-HUS--- E.cole 0157
78.IV drug abuser with HCV Ab- Chronic HCV

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
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.

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
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
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
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
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%

171.GOOD PASTURES SYNDROM CASE

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 elderly- Streptococcus 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
196.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

MRCP 2012 DEC Recalls

Discussion in 'MRCP Forum' started by Neha Gupta, Dec 17, 2012.

1.

Neha GuptaActive Member

Pictures:
1) Mobitz Type 1 degree heart block

2) Inferior STEMI -> PCI

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

14) Cluster headache - Sumitriptan for relief

15) 46 year Old lady with high oestroden and Prolaction: - Pregnancy

16) Young girl with secondary amenorrhoea: Anorexia Nervosa

17) The classic verm rash on the abdomen wheezy high eisonophil count: Strongyloides

18) Diabetic patient uncontrolled with Metformin and Glic: Start Insulin

19) Patient with Heart failure, next step: Start Spironolactone

20) Bilateral swelling of hands and painful wakes up at nigh: Carpal Tunnel

21) High CK and painful: Polymyositis

22) Diffuse tenderness but normal blood ix: Fibromyalgia

25) Hypertension in Pregnancy, methyldopa not effective: Labetalol
26) Non alcoholic fatty liver disease, recommnded treatment: Weight Loss
27) Most effective treatment for increase in exercise tolerance in COPD: Pulmonary Rehab
28) Why is Cypretone Acetate given with Goserlin: Prevent Tumour Flare
29) Dog bit what abx to give: Coamoxiclav
30) Pleural effusion secondary to TB: Pleural biopsy & Aspiration
Dermatology
1 granuloma anulare
2 seborric keratitis
3 molluscom cotagiosum

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

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

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

Diarrhea, chest pain next test 5HIAA

Peripheral neuropathy ( cause of unsteadines)
Polymyositis
Locked In Syndrome
Amyotrphic neuralgia
ABPA
SQ CELL vs pyogenic garnuloma
EXCISION of skin lesion after transplant
TB meningitis CSF analysis
Citalopram
No treatment for low ionized Ca pateint
Cervical Myloptahy
Partha Sarkar, Dec 17, 2012
#3

2.

Partha SarkarGuest

1. Oral Cipro.renal cyst UTI

2. Hip xray.. paget
3. MRI Osteoprotic fracture
4. MRI Vertebral Metz
5. XRAY Hydroprnumothorax
6. Regional pain Complex
7. CERVICAL RIB VS cubital fossa syndrome

9. Diarrhea , and chest pains next test 5HIAA

10. Peripheral neuropathy ( cause of unsteadines)
11. Polymyositis
12. LOCKED IN Syndrome
13. ONE SIDE WEAKNESS?? Cause ..one option was basilar artery, I forgot other options
14. Amyotrphic neuralgia.. pain, winging scapula..
15. ABPA .. asthmatic with proximal bronchiectasis
16. pyogenic garnuloma
17. EXCISION of skin lesion after transplant
18. TB Meningitis
19. Citalopram
20. No treatment for low ionized CA pateint
21. Cervical Myloptahy
22. What is the Underlying cause of low GCS HYPOXIA//? Other option was acyclovir toxicity
23. Underlying confusion low Na . What drug.. ? proxetine
24. Digoxin in AF with heart failure
25. Heart failure management spironolactone vs dual chamber
26. Dual chamber for another question pt came with syncope
27. Dog bite augmentin
28. Pregnant BP labetalol
29. Pregnant pneumonia Clarithromycin
30. Hospital acquired tazocin

31. Pci vs plavix

32. Complete heart block vs second degree type 1

34. Staph aureus food poisning

35. Prednisolone CLL
36. Ulcerative colitis prednisolone vs mesalazine supositry
37. Iv fluids.. N saline 200 ml in 15min
38. Distal RTA.. sjogren
39. Sinus of VALSALVA Rupture
40. Actinic keratosis
41. Pemphigus valgarus.. Check Direct Immunoforence
42. ???S. PARATHYPHI.. CSF
43. LEPTOSPIROSIS
45. RHEUMATIC FEVER
46. FIBROMYLGIA
47. Anorexia nervosa
48. GOSERELIN.. give cytrprotene to reduce Tumor Flare
49. Check Paracetalmol level in female with high liver enzymes, and high PT
50. HEP An ( pt came from Egypt)
51. Start INSULIN very high HBA1c
53. Rafsum disease
54. Macro adenoma
55. Pregnancy.. 46 yr lady with amenhorea
56. Adrenal adenoma
57. PCO sta58. Occipital headache .. first test do CT head
59. Frontal headache..Cluster vs Migraine drug??
60. Post inf glumerulonephritis
61. Tubulointerstital nephritis
62. Pleural eff..do thoracoscopy
63. COPD.. exerc tolerance.. pulm rhab vs Inhaled steroids

64. Gi bleeding .. next step after negative endoscopy .. do capsule endoscopy

65. Xray picture multiple lesions, high calcium young male malignancy vs TB
67. Primary Sjogren
68. Alopecia aerate
69. Cause of acidosis diarrhea
70. Peripheral Edema stop amlodipine
71. SEND Plt ANTIBODY for HIT
72. Pain management , not controlled by paracetamol next step OXYCODONE
73. Check haptoglobin
75. Strongyloidosis
76. Epilepsy add lamotrigine
77. Esophegeal varices.. asthmatic, .. repeat after one year
78. Nodular Goitre.. After stoping carbimazole pt will again become thyrotoxic
79. Give heparin Heparin in Pulm HTN
80. One case answer was Pulm HTN
81. Bangladeshi man with heart failure. Cause? Alcoholic cardiomyopathy vs restrictive 82. CT
contrast enhancing lesion.. mengioma vs tuberculoma
83. Pneumothorax managmemt. Insert chest drain
84. Another q about pneumothorax.. refer to thoracic surgeon
85. Sleep study
87. Increased lnsulin levels, low c peptide- exogenous insulin
88..reheated meat-staph aureus
89. Alendronic acid as first line for osteoporosis
90.alcoholic hepatitis
91. CLL WITH ITP
92.TTP- plasma exchange
93.hyperviscosity syndrome,high bp,engorged blood vassels wiith haemorrhage on fundoscopy-plasma
exchange.?
94.myositis-anti jo 1 antibodiea
95.tuberculous pericarditis

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

101.pneumothorax with persistent leakage- refer to thoracic surgeon

102. 103. Pt with hypokalemic metabolic alkalosis with high renin aand high aldosterone- renal artery
stenosis
104.pt with nodular thyroid and nodular tongue? Sarcoidosis
105.increased uptake on thyoid scan, lig lag- grave's disease
106. Pt with increased glucose, rash on back(like necrolytic erythema),increased ferritin- glucagonoma
107. Gardner with abrasion on foot -nodular lesions on thigh- sporotrichosis(sporothrix)
108.pt with acne type rash on face not resolving with retin A, hypopigmented areas on trunk ,thickened
skin patch in sacral area- tuberous sclerosis

110.101 drug contraindicated in alzeimr wd copd , anticholinergics

111. pt with parkinson and pulmonary fibrosis. pergolide was given before-----which drug to avoid
next-cabergoline
112.first line rx of prolactinoma encroaching cavernous sinus- cabergoline

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

115.treatment of hypertryglyceridemia ...... fenofibrate ( it ws in addition to a qs in which combined trg

nd cholestrole wr high nd treatment ws statin)

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

121/thin septum +thick apex tacupso cardiomyopathy in japanies man ?

122. herpes encephalitis on mri brain ?
123.a pt wd palpable bladder due to retension ( dnt remembr exact senario) askd abt drug
treatment .......... oxybutynin
124. african man with fevr .... cerebral malaria
125. pressure profile of inferior mi with reight sided heart failure
126. cyanide poisining in patient receiving angisid drip
127 man with himianopia , mri with pituitry mass,lh,fsh and tsh normal non functioning pituitary
tumor/macroadenoma

128. picture of visual fields: pituitary tumor

129. lupus nephritis for patient with SLE and acute renal failure
130. uti in pregnant patient give furadantin/nitrofurantoin
131. acute septicimia ,severe sore throat streptococal pyogen
132. cmv after transplantation
133. question was about hypercalcemia. they gave IV fluids but still high calcium. what will u give
next?? calcitonin sub cutaneous OR pamidronate- furosemide is the answer
134.pt with panhypopituitarism with adrenal crisis- first line hydrocortisone
135. botulism
136. Cardiac tampond senario gvn nd askd worse prognostic factor ........... drop in bp more than
25mmhg wd inspiration
137. a pt remaind admitted in icu d then dischargd home , presentd aftr 1month or so wd complain of
hearing loss , derrangd rfts , cause ?? gentamicin
138. pt on lithium,very well controlled bipolar for years , lithium in normal range , having
DIABETESE INSIPIDUS , WT TO DO? STOP LITHIUM/GIV demeclocycline?
139. SIADH ...... stop fluoxetine
140. one more pt having some dec in mental status bt recovrd nd now symptom free, labs showing
hyponatremia , wt to do? 0.3 n/s , 0.9 /ns , fluid restriction
141. What to be done before starting iv bisphosphonates- dental assessment

142. Torsades de pointes: mgso4

143. prolonged QT : beta blocker
144. heparin induced thrombocytopeania inpatient with low platletes and thrombosis after prophylactic
heparin in surgury
145.heparin induced thrombocytopeania in young man with cva and systolic murmur
146.HEART FAILURE PT SUFFERING FROM OCCASIONAL SYNCOPE , ECG SHOWING
SOME ARRYTHMIA , WT DO? BIVENTRICULAR PACING
147. what was the answer f question with draining sinus at hip.. was it actinomyces israeli or
Tuberculosis??
148. another senario of diabetes inspdus in which desmopressin gvn bt no improvment in serum

osmolality , wts Dx ? nephrogenic DI

149.DNT REMEMBR EXACTLY BUT PT WD BLEEDING DISORDER , DID NT IMPROV ON
MIXING STUDIES .... Dx .... acquired factor 8/won willibrand disease ( i think coag corrected after
mixing)
150.nails pic? chronic paronychia

was there any answer as adult onset still disease

Partha Sarkar, Dec 17, 2012
#5

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

158.one was coeliac disease

159: lateral medullary syndrome in young with history of neck injuryPICA or vertebral dissection
160. History of previous Breast lumpectomy but develops neurolgical signs up and lower limbs:

Multiple Metasistis / ?MND

161. adhesive capsulitis
Partha Sarkar, Dec 17, 2012
#6

5.

Partha SarkarGuest

162. One q answer was osteomalacia..

163. One q answer was check Vit D level
164. Perphieral edema stop amlodipine
165. one q of rhematiod.. now SOB, CT showed honey combing but no ground glass.. symptomatic
treatment
166. genital ulcers plus tender lymhp nodes plus some systemic symptoms.. answer genital herpes
167. dendritic ucler of herpez
168. one q answer was Start ACE inhibitor (DM plus albuminurea)

169. started ARB ,, creatinine went up slightly.. but BP still high.. increase the doe of ARB
170. One q answer was Nesendoscopy

171. one ws esophageal rupture

172. one about aortic dissection askd what next? sodium nitropruside for bp control
173. one about a female who had two times complete body paralysis when wokeup at morning , could
nt get out bed but ws normal in an hour or so. dnt knw what dy askd then
174. one female who was suffering two types attacks , on sitting she wld strongly close her eyes nd
lasts for abt 5min , on occasion she wld lie down on floor unconsiously but when tried to wake her up

she start jerking moments of body . they askd diagnosis.

175. one man having anaemia , upper gi endoscopy normal , colonoscopy normal . what to do next
invetigation 4 cause of anaemia????
176. one pt having drug reaction , mild wheeze , no rash no sob vitally stable what do next??
chloephenaramine/adrenaline/hydrocortisone
177. pt with addison disease , what to giv ? iv hydrocortisone
178. pt with follicular ca of thyroid . what treatment? thyroidectomy

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.

one answer was cryptococcus abdominal pain and immunocompromised.

the umilicus picture i think psoriasis and the nail picture dermatitis the nails were normal.

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.

According to the American Psychiatric AssociationsDiagnostic and Statistical Manual of Mental

Disorders, Text Revision (DSM-IV-TR), to meet the criteria for diagnosis of schizophrenia, in most
cases the patient must have experienced at least 2 of the following symptoms[52] :

Delusions
Hallucinations
Disorganized speech
Disorganized or catatonic behavior
Negative symptoms
Only 1 symptom is required under the following circumstances:

The delusions are bizarre

Auditory hallucinations occur in which the voices comment in an ongoing manner on the persons
behavior
Two or more voices are talking with each other

See behaviour of idealizing someone,, and suicidal tendency are not part of schizophrenia..

Partha SarkarGuest

174. Cluster - Sumitriptan

175. Strongyloides

176. Bilateral parotid swelling: Primary Sjogrens

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

180. Pulmonary HTN

181. COPD best treatment to increase exercise tolerance: Pulmonary Rehab

182. Valve replacement (AVR)

183. Subacute Stent thrombosis

184. Reduce Lithium

185. Cerebral Malaria

186. Pressure profile post inferior MI

187. Cyanide Poisoning post Sodium Nitroprusside

188. Pic with bitemporal visual deficits mainly in upper outer segments of visual fields. pituiatry
tumour or craniopharyngioma?

189. Nitrofurantoin for pregnant lady

190. CT head for Breast cancer lady with confusion

191. Crohns: Stop Smoking

192. Pic: Sebhorroic dermartitis

193. Pic of HSV encaphilitis: Do PCR

194. ECG acute anterior mi then arteial thrombosis

195. Normal Saline for low BP in Right heart failure next step

196. Membranous GN

197. Irridated blood in Transplantation? what were the options here?

200. Fundus: macular oedema vs macular degeneration?
Obstructive sleep apnea Polysomonography. Pulse Oximetry is net step

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

11 normal saline for patient with rheight sided heart failure

12 aortic valve stenosis re evaluate in 1 year
13 cyanide poisining in patient receiving angisid drip
14 do ventricular pacemaker for patient with heart failure and AF and very slow rate 38-40 beat per
minute
15 BETABLOCKER long qt , treatment?
16 renal artery stenosis for Hypertension with high renin and aldosterone
17 Sinus of VALSALVA Rupture for compatable clinic senario
18 increase the doe of ARB for patient started ARB ,, creatinine went up slightly.. but BP still high..
19 pulmonary hypertention in patient with compatable clinical examination and history of some
sliming pills

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

5 Alendronic acid as first line for osteoporosis

6 myositis-anti jo 1 antibodie

8 Adhesive capsulitis for patient with shoulder pain

9 MRI Osteoprotic fracture
10 osteomalacia
11 patient with acute arthrits with calcification of the joint space (pseudogout ) next investigation do
joint aspiration
12 to prove ankylosing spondylitis prove sacroiliaitis

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 Nephrogenic DI on water deprivation test
6 case with insulin miss use with reletive with diabetes
7 PCOS Obese lady, secondary amenorrhea, infertility - increase LH/FSH RATIO
8 No treatment for low ionized Ca pateint with hyperventilation
9 Metformin for PCOS, treatment for infertility
10 Nodular Goitre.. After stoping carbimazole pt will again become thyrotoxic
11 glucagonoma in Pt with increased glucose, rash on back(like necrolytic erythema),increased ferritin
12 fenofibrate treatment of hypertryglyceridemia .
13 hydrocortisone is first line for pt with panhypopituitarism with adrenal crisis

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.

Neha GuptaActive Member

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?

Couple of questions about painful inguinal lymphadenopathy.

Neha Gupta, Dec 25, 2012
#15

7.

Neha GuptaActive Member

Dermatology 1 granuloma anulare 2 seborric keratitis 3 molluscom cotagiosum 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 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

Pregnancy with pneumonia - clarithromycin

Every one is saying clarithromycin for pneumonia in pregnancy, why not amoxiccllin.

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:

1. What bias in meta analysis - Publication bias

3.Commonest place for ulcerative colitis - rectum
4. Boy with fulminant hepatitis, whats most important inv ( no PT in option)- serum creatinine b/c of
hepatorenal syndrome
5. Drug treatment for ulcerative colitis found on biopsy - rectal mesalazine
6. Azathioprine - check TPMP
7. The patient who travelled to africa and had amastigotes - sodium stiboguconate

8. alport syndrome - x linked dom

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

12.Blisters with mucosa involvement - phemphigus vulgarise

13. 20 week old pregnant with new shiny lesion - Acanthosis nigricans ?

14. question about cause of hypokalemia and patient is hypertensive - ? Liddles syndrome

15. genital ulcers etc - Behcet's dx

16. Mechanism of dx in hepatorenal syndrome - ?? splanchnic dilatation

17.Which cell cycle stage do the nuclei cover the 2 daughter cells - telophase ( i think)

18. which GIT hormones secrete bicarbonates - ? cck

19. restriction in hip flexion which nerve root - L1-L2???

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

21.which product when broken down gives highest

energy ? -???????? glycogen

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 ??

26.when to give pneumoccocal vaccine before elective splectomy - ? 4 weeks

27. man presents with recurrent bacterial chest infections, what is deficient - C4 complement

28. What predisposes to recurrent menningococal meningitis - C5

29. what is entanercept - TNF alpha inhibitor

30. drug treatment for idipathic parkinsons only ( no dopamine agonists in option) - ithink options were
entacapone, amantadine, benxhexol, sellegilline, levodopa

31. patient with CT scan and signs of Herpes simplex encephalitis

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

42.Patient with parkinsons and impairment of gaze

when looking up stairs - progressive supra nuclear palsy

43. Man who makes repeated uncontrolled neck movements and unintentional sounds - Gilles de
tourettes

44. woman with headache and horners - carotid artery dissection

45. Scenerio in which a patient had hyocalcemia and low PO4, question is what caused the
hypocalcemia - hypomagnesemia

46.Woman with lived reticularis, c3 low, ana - SLE

47. Patient with clamydia , treatment - doxycycline

48. man with acromegaly - OGTT and somatastotain measurement

50.Lady who came in with endocrine problems but tells you her sister had hyparathyroid surgery and
the other sister had liver surgery. what condition do you think she might also have - ?? Carcinoid

51. Girl comes in with graves disease but has eye complications - carbimazole. radioiodine contraind

52. mechanism of action of thiazolidinediones - ? increase glucose secretion

53. Gilrl with de quevian thyrioditis

54. Doctor prescribes digoxin for patient and says it will take some time before effect seen, why - half
life

55. murmur associated with VSD - pansystolic

56.Patient with hypotension, what immediate next step - IV 0.9%

58. what causes long QT - potassium channel blockade

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)

60. Man with cerebellar signs - Anti Yo ( i think)

61.what ecg changes in acute pericarditis - convex ST elevation

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)

64. Pregnancy HTN - methyldopa

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

70. Man who was a miner presents with lower lobe

crackles. HRCT showed ground glass changes, cause ( lower lobe fibrosis) - asbestosis

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

74. lady with acute SOB and several other co-morbidities - PE

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)

80. H pylori more associated with - DU

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

88. Drug affected by acetylator status - isoniazid

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

92. Lady with severe acne - isotretinoin

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???)

96. Mechanism of action of thiazolidindiones - decrease peripheral insulin resistance

97. Accoustic neuroma - absent corneal reflex

98. Woman presenting with severe expression of both comprehension and expression of language global aphasia

99. Monitoring of breast cancer - CA15-3

100. Lady with confusion, thrombocytopenia and renal failure - TTP

15th Jan 2013 MRCP1 Recall/Discussion

collected these questions from your messages i need your comments on it

recall 2004
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
5-CHRONIC CARRIER OF HEP B

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?

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

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
presents with hepatitis(symptoms are 3 days only.what could be the awnser
hep. A,B.OR C.,d,e

36) Cystic Fibrosis with genetic councelling

A-No famly members will be affected.

37) Cystic Fibrosis complication(I think in P-2)

A.- Male infertility.

3 Old Pt. With dry skin etc.Rx of choiceA.-Emolients.

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.

41) .Pt. with DIC with reduced fibrinogen Rx?

A.-Cryoprecipitate.

42) . Pt with G-6-PD characteristics findingsA-haemoglobinuria.

43) .Lower limb nerve lesionA-Sciatic nerve.

49) .Description consistent with Lateral medullary syndrome(Post. Inf. Cerebellar A)

50) .Young Pt with speech problems with jaundice Dx?

A-Wilsons Disease.

51) .Respiratory Pt. With FEV1/FVC ratio was less than.80%(After calculating) Dx?
A-C.O.P.D.

52) .Pt. with Obstructive features normal diffusion capacity Dx?

A-Bronchial Asthma.

53) .C.O.P.D. Pt long term O2 Tharapy indicationsA-PaO2 Less than 7.3

54) .Oral Nitroglycerine vs sublingual nitroglycerine dose variation What mechanism ?

A-1ST Pass metabolism.

55) .Common Variable Immunodeficiency manifestationA-Recurrent pneumonia.

57) a patient diagnosed with chorea, where is the lesion:
a. hippocampus
b. basal ganglia
c. amygdala
d.caudate nucleus

5 which condition is caused by immune complexes formed by antigen antibody...

a. late transfusion reaction
b. extrinsic allergic alveolitis
59) hodgkins lymphoma, wat indicates the worst prognosis:
a. enlarged mediastinal lymph nodes
b. vena caval obstruction
c. pruritis
d. fever

60) contraindication for lung small cell carcinoma surgery:

a. pleural effusion
b. vena caval obstruction

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.

5. A pt of GIT problem with mouth ulceration. What is the cause ?

Ans-folic acid deficiency.(probably due to celiac disease. Other stems present in the question e.g.-VitB12 def. does noy fit the answer. )

6. A Pt of GIT problem with growth abnormality / retardation.What will be the +ve investigation
finding ?
Ans- Antigliadin antibody. ( coeliac disease )

7. A Pt GIT problems suggestive of ulcerative colitis. Confirmatory Diagnostic investigation ?

Ans- Involvement of the mucosa on rectal Biopsy.
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.

11.A Pt with anosmia, reduced level of FSH & LH . what is the Dx ?

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---Ans- 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.

15.+Ve Lab investigation in Anorexia nervosa ?

Ans- Reduced TSH level ( ? ?-Any comment)

16.Queston characteristics of Psoriatic Arthritis.

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?

Select only 1 answer

1 ) Blood transfusion
2 ) Conservative management
3 ) Coronary angiography +/- angioplasty
4 ) Haemodialysis
5 ) IV furosemide

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 ?

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.

5. A pt of GIT problem with mouth ulceration. What is the cause ?

Ans-folic acid deficiency.(probably due to celiac disease. Other stems present in the question e.g.-Vit-

B12 def. does noy fit the answer. )

6. A Pt of GIT problem with growth abnormality / retardation.What will be the +ve investigation
finding ?

Ans- Antigliadin antibody. ( coeliac disease )

7. A Pt GIT problems suggestive of ulcerative colitis. Confirmatory Diagnostic investigation ?

Ans- Involvement of the mucosa on rectal Biopsy.

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.

11.A Pt with anosmia, reduced level of FSH & LH . what is the Dx ?

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----

Ans- 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.

15.+Ve Lab investigation in Anorexia nervosa ?

Ans- Reduced TSH level ( ? ?-Any comment)

16.Queston characteristics of Psoriatic Arthritis.

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 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

dr.s irfanGuestmost of them are correct i will comment on

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

1.PREGNANT 38 WEEKS PRESENTS WITH CHICKEN POX.

A.HIGH OF PNEUMONITIS.

B.RISKOF TRANSMISSION TO BABY IS LOW

C.MOTHER HAS TO BE ADMINISTERED IgG

2.aTOPIC ECZEMA PATIENT PRESENTING WITH VESICLES ON THE AFFECTED AREA.

A.IV ACICLOVIR

B.IV ANTIBIOTICS

C.LOCAL ACICLOVIR

D.TOPICAL STEROIDS

3.DRUG CAUSING HYPERKALEMIA.

IN THE OPTIONS GIVEN IT WAS DIGOXIN

4.DRUG CAUSING TORSADE DE POINTES

IN THE OPTIONS GIVEN IT WAS SOTALOL

5.OVERDOSE- PATIENT WITH SINUS TACHYCARDIA AND BROAD QRS COMPLEXES.

TRICYCLICS

6.CLOPIDOGREL MECHANISM OF ACTION.

PREVENTS ADP MEDIATED BINDING TO PLATELETS

7.QUININE OVERDOSE -WHAT IS THE MOST CHARECTERISTIC FEATURE?

BLINDNESS MOST PROBABLY

OTHER CHOICES

HYPOTENSION

NEPHROTOXICITY

HYPERGLYCEMIA

8.WHICH STRUCTURES COMES ANTERIORLY TO LEFT KIDNEY WITHOUT PERITONEUM

INTERFRING?

PANCREAS, STOMACH, COLON

10.PATIENT DIAGNOSED TO HAVE ANKYLOSING SPONDYLITIS 6 MONTHS AGO,WHAT IS

THE MOST PROBABLE FINDING.

A.TENDERNESS OVER THE SACROILIAC JOINTS

B.DECREASED FLEXION IN THE LUMBAR SPINE.

C.BAMBOO SPINE

11.A PATIENT WITH PROLACTIN LEVELS OF MORE THAN 1000IU.WHAT IS THE

POSSIBUILITY?

A.MICROPROLACTINAEMIA

B.STRESS

C.DRUGS

12.MODE OF TRANSMISSION OF PEUTZ ZEGHERS SYNDROME.

AUTOSOMAL DOMINANT

13.DIALYSIS IS LESS EFFECTIVE IF

A.HIGH PLASMA PROTEIN BINDING

B.HIGH WATER SOLUBILITY

C.HIGH VOLUME OF DISTRIBUTION

D.HIGH FIRST PASS METABOLISM

E.LOW BIOAVAILABILITY

14.LATE ONSET OF ACTION OF DIGOXIN IS DUE TO

A.HALF LIFE

B.FIRST PASS METABOLISM

C.RENAL EXCRETION

D.HIGH VOLUME OF DISTRIBUTION

15.IN A PATIENT WITH STABLE ANGINA WHICH DRUG IMPROVES SURVIVAL?

A.ASPIRIN

B.BISOPROLOL

C.NITRATES

D.ACE INHIBITORS

16.WHICH IS BEST TO PREVENT STEROID INDUCED OSTEOPOROSIS?

A.HRT

B.SERM

C.CALCIUM AND VIT D

D.ALENDRONATE

E.DIET

17.PATIENT SENSITIVE TO PENICILLIN AND COTRIMOXAZOLE IS DIAGNOSED TO HAVE

RHEUMATOID ARTHRITIS.WHICH DRUG SHOULD NOT BE USED?

A.ASPIRIN

B.SULPHASALAZINE

C.PENICILLAMINE

D.GOLD

E.METHOTREXATE

18.A PATIENT WITH PANCYTOPENIA AND PATCHES OF DEPIGMENTATION MIGHT BE

SUFFERING FROM,

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

D.PROFOUND SLEEP BRADYCARDIA

20.WHICH INDICATES SEVERITY IN AORTIC STENOSIS?

21.WHICH INDICATES POOR PROGNOSIS IN HOCM?THICKNESS OF SEPTUM

23.WHEN DO YOU TREAT A PATIENT WITH SARCOIDOSIS WITH SYSTEMIC STEROIDS?

24.SOURCE OF PULMONARY SURFACTANT?TYPE 2 PNEUMOCYTES

25.MOST CHARECTERISTIC FEATURE OF CYSTINOSISGuru, Jun 7, 2004#1

dr s irfanGuest1- ZIG,IF CHILD BORN WITH IN 5 DAYS SHOULD ALSO GET ZIG

6- torsadose de pointes- terfenadine-sotolol??

7-quinine overdose-irrevesible blindness like methanol poisining.

8-pancrease i guess????

9-root will be S1nerve will be common peroneal

10-ASearly sign will be retention of lumber lordosis during spinal flexion.radiological evidence of AS
will be late feature.

11-prolactine level >1000 is suggestive of pituitry adenoma.

12- high plasma binding with protien -un dialysable.

13- high vol of distribution.

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

17-sulfa group is common-frusemide,becterim

18-pernicios anemia is associated with other autoimmune disorders like vitiligo

19-vent-ectopics with R ON T phenomena are more dengerous.

20- intensity of murmor,will be quiter in severe stenosis

25-CYSTINOSIS-2 TYPES

1-NEPHROPETHIC-FANCONI SYNDROME+VISUAL IMPAIRMENT

2-non-nephropethic-visual impairment only.

thanks,

Dr.s irfandr s irfan, Jun 8, 2004#2

bhattiGuest15 - bisoprolol

b blockers are now proved to prolong life in IHD

8 May 2004 Q&A

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

Q4rug 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

Q13euthz 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, brucellosis etc

2003

sarcoidosis : erythema nodosum and mediastianal mass

primaquine and G6pd
EBV: classical picture
cimitidine enzyme inhibitor and theophyline
ciprofloxacin and warfarin
klebsiela pneumonia..classical picture
addisson disease 2 Q
comlpications of Hemodialysis B2 macroglobulinemia amylodosis
panic disorder clinical senerio typical
hyperprolactinemia drug causes metclopromide
obstructive sleep apnea: diurnal sleepiness is a feature
limited scleroderma- anticentromere Ab
Felty syndrome-neutropenia in RA
Mantoux test : is it cell mediated immunity or B cell mediated
prognostic factors in paracetamol posoining..PT
VIt K in ttt of Warfarin overdosage
heparin in pregnancy low molecular weight or unfractionated
hypomagnesemia and hyper magnesemia
coronary blood supply to the heart..Case of MI
managment of malignant hypertension
herpes simplex encephalitis
antibiotic of choice for salmonela typhemiurum ..Cholarmphenicol..ceprolfloxacin
plasmodium ovale
Difference between dementia and depression:agitation-loss short memory.

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

more BOF's may 2003

-brain stem encephalitis- investigation with pcr
-drugs in depression

-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

-unconscious patient with hypernatremia,normal anion gap,

inc se osmolarity . which poisoning.carbamazepine;ethanol;methanol;....???
-72 yr old psted with TIA;h/o anterior MI;ECG shows
vent aneurysm;/mgmt? TPA;immediate CT brain;.....???
-type ii DM;obese;
failed Tt with gliclazide ;inc urea&creatinine;
?next drug to add.acarbose;guargum;metformin;rosiglitazone;.....???
-vertigo following whiplash injury
-typical pstation of cerebellar hge
- --asymptomatic hyperuricemia;mgmt
-severe blding in a lady after tooth extraction;similar past h/o+;
no other relevant h/o bldg ;?diagnois
-FSGN mgmt
-????horner's synd with reduced sweating in upper face;
site of lesion.
-pstation of sjogrens given;what other finding to expect
-????clinical scenarios of CML;GCA;MM;C/C sub dural hge;
HSP;whipple d/s;....not sure
sorry!
first question-it was hyponatremia with se osmolaity of 380.

79. features of hypersplenism

80.iv saline for hypotension
81. Cause of confusion in tpn------------metabolic(hypermagnesaemia, etc)
82. Rx of agitation of an inpatient------diazepam
83. lewy body dementia
84. diff between dementia and depression - ----urinary incontinence
--------another question in the same theme--------?poor in testing/memory loss, etc
85. neurology --------symptoms more in legs than arms----------anterior cerebral A
86. AR condition---------Friedericks ataxia
87. polygentic disorder - ?porphyria
88. blood transfusion, delayed reaction------------fragmented red cells
89. CSF- ----enteroviral meningitis
------- another question in the same theme-------?herpes simplex/pyogenic abscess
90.Legiionnelares----------2Qurine Ag
91. another question in the same theme------cant remember
92. Platelets, RBC, whitecells elevated-------------essential polycythaemia
93. Man, appetite not good,esp meat, macrocytosis------pernicious anaemia/hypoplastic anaemia
94. essential tremor
95. RS-recurrent episodes, what reduces the relapses---------steroids, bronchodilators
96. hyperkalemia Rx------------iv calcium
97. metabolic acidosis, resp alkalosis-----salicylate poisoning
98. alcoholic gastropathy Rx propranolol
99. single episode of haematemesis gastric erosions
100. Radiotherapy for ca cervix, malabsn---------radiation induced, etc
101. clinical features similar to IBS ----------lactose intolerance, microscopic colitis
102. ischaemic colitis
103. features of lumbar canal stenosis
104. pemphigoid
105. telogen effluvium
106. why measure digitoxin level after 6 hrs--------saturation kinetics, vol of distribution
107. statistics---------?cost benefit/effectiveness/adverse reactions/
108 sensitivity
109. specificity
110. mn

111. diabetic nephropathy/analgesic/ hypertensive nephropathy

112/ cause of unsteadiness and ataxia in a pt with multiple drugs------amitryptiline/etc/thiazides
113 how to delay progression in diabetic nephropathy-----. lisinopril
114.mi what is the best Rx-----------ramipril
115. copd woth normal pO2 and increased pco2----------noninvasive ventilation/intubation/etc
117. food poisoning in 6 hrs staph aureus
118. features similar to tetanus
119. returned fromholiday family h/o psoriasis aspiration- only pus cells---------reactive
arthritis/psoriatic arthritis
120. infective endocarditisviridans
121. ??? hiv abdo symptoms, no cryptosporidium,---------CMV
121. painful genital lesions-------herpes/hiv??
122. Iron - .1% circulates in plasma??
123. HCM- family h/o ---mgt--------assess risk for sudden death
124. ?? I am not sure about this question hyperlipidaemia-----------sta

-person with learning difficulty & ectopia lentis;

,marfan
-26 yr old with birth injury& mild retardation recently
creating trouble tc caretakers.coz??depression;schizo;
early onset dementia
-DNA analysis is helpfull in diagnosis of??-lady psting with multiple nodules & cafe au lait spotsManagement of lady with thyroid cancer
- Glandular Fever
- CREST associations
- Conversion of dose of hydrocortisone to pred
- Mechanism of action of gastrin
- Difference between rofecoxib and naproxen
- Pain management in patient with terminal metastatic malignancy
- Treatment of asthma, patient on beclometasone inh + slabutamol prn. Next step?
- Discoid Lupus
- 36 yr old patient with pubic scabs and itchiness

- 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.

sidsGuest) mass in anterior mediastinum -thymus,heart,bronchi,oesophagus

2)mass in anterior mediastinum- CT scan finding -next appropriate investigation

biopsy of mass,fibreoptic bronchoscopy

3)in splenectomy pneumovax is given

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.

5)wasting of intrinsic muscles of hand ,loss of pinprick sensation in right hand .

Syringomyelia

6)Amiodarone induced hyperthyroidism- treatment-

carbimazole,radioiodine,prednisolone.

7)most common adverse effect of radioiodine treatment-

hypothyroidism,thyroid cancer .

8)cushing syndrome-BMI-35 ,24 hr free urine cortisol-550 ,investigation of choice

low dose dexamethasone suppression test,high dose ,CRH test,serum ACTh levels

9)Pheochromocytoma - initial drug

atenolol ,phenoxybenzamine,hydralazine.

10)features of systemic sclerosis ESR^^^ ,A dsDNA- neg ,RF-neg most common finding

erythema nodosum,malabsorption,uveitis

11)MDMA- complication-hypernatremia ,hypokalemia,metabolic acidosis.

12)following head injury complaints of polyuria- appropriate investigation

water deprivation test.

13)Suspected SIADH most commom finding

urine flow rate of 15 ml/hr ,urine osmolalityof ?,serum osmolality of?

14)drug which causes weight gain

carbamazepine,valproate,phenytoin.

15)methotrexate and ocp and ibuprofen ,becomes pregnant 14 weeks

approriate step- FOLinic acid supplementation

16)Itchy rash ,vesicles and excoriations on extensor surface of forearm and elbow investigation

direct immunofluoresence staining of perilesional skin,all skin investigations.

17)itchy violaceous papules over flexor aspect of wrist ,most common finding of this condition

involvement of buccal mucosa

18)scarring alopecia ,lesions over face

discoid lupus erythematosus

19) SLE + membranous nephropathy + hypertension +pregnant most appropriat treatment

anticoagulation with warfarin ,control of BP with ramipril,immunosuppression with cyclophosphamide

or corticosteroid

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

Blood transfusion,IV iron,IV erthropoetin,sc epoeitn,PT coronary angioplasty.

21)on Hemodialysis ,complains of muscle weakness , K-^^^^^ ,appropriate first step

lower potassium in dialysate

22)16 yr boy with father tested sputum + for TB,boy -tuberculin test -negative ,chest xray-normal next
step

immediate bcg vaccination,antitubercular chemotherapy,isolation of father,follow up testing after 2

weeks.

23)Slow acetylators - drug which can cause adverse effect-

HYDRALAZINE

24)LV systolic dysfunction on ramipril and frusemide which other drug can be added to improve
prognosis

atenolol,amlodipine,digoxin,isosorbide

25)patient started on siledafinil for impotence ,which drug is contraindicated

isosorbide dinitrate

26)post streptococcal glomerulonephritis,risk of ESRF

<10%,10-20%,etc

27)leftsided musle weakness of leg ,right sided loss of pin prick sensation of foot

left spinal cord lesion.

28)acute onset of severe headache ,progressive drowsiness BP 170/110 mm Hg most likely cause.

brainstem herniation ,poor control of BP,pituatary apoplexy etc.

29)left hemisensory inattention ,partial left homonymous hemianopia,likely site of lesion.

frontal lobe,parietal lobe ,occipital lobe,tempoarl lobe

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.

S aurues ,S epidrmidis,coxiella burnetti,S viridans,Candida.

32)H/o of diarrhoea and back ache ,patient on pacemaker most likely cause

ischemic colitis,pseudomembranous colitis ,S discitis

33)NSAID induced small bowel changes.

34)suspected constictive pericarditis ,confirmatory finding

equalisation of end diastolic pressures in both ventricular chambers.

35)central cyanosis - Pa O2-6.3kpa Pa O2-(60%)-6.8kpa ,Pa CO2-normal,diagnosis

right to left cardiac shunt .

36)Oral antibiotic for 4 days blood film -bite cells.

autoimmune hemolytic anemia ,PCH,G6PD deficiency,drug inducedhemolytic anemia

37)generalised brusing ,platelet count < 50 .

Autoimmune thrombocytopenia ,TTP

38)ST elevation in lead 2,3 ,AVF which artery is involved.

right coronary ,left anterior descnding ,left mainstem

39)cocaine abuse-chest pain ,mechanism

coronary artery spasm

40)difficulty in elevation of eye ,diplopia on lateral gaze to left side ,pain in eye cause

Grave disesase,cavernous sinus thrombosis,PCA aneurysm,spheniod sinusitis.

41)tension type headache not relieved by full dose paracetamol,next drug to be added

nortryptiline ,sertraline ,naproxen ,ibuprofen.

42)Teichopsia at onset of headache ,recurrent attacks ,female.appropriate treatment.

ergotamine suppository at onset of next attack,sumatriptan at next attack,paracetamol

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

atlantoaxial subluxation ,high cervical cord lesion,central cauda equina lesion.

45)12 yr old girl-mild sore throat ,throat swab -N.Menigitidis +,immediate step

blood culture,Lumbar puncture,Rifampicin to all contacts,observation,IV ceftriaxone for 7 days.

46)fever cough friends had similar complaits ,blood-macrocytic features,chest xray- bilateral hazy

shadow ,cause

S.pneumoniae,S aureus,Adenovirus

47)Brethlessness due to right sided effusion Protein -^^^^,glucose-1.3 mmol/l

Bronchial Ca,pleural mesothelioma,tuberculosis

48)calcification over hemidiaphragm,asymptomatic,most likely condition

TB,mesothelioma,asbestosis.

49)Noisy breathing ,inspiratory stridor appropriate investigation.

flow volume loop,PEFR,FEV1,FVC.

50)exertional dyspnea,dry cough ,bilateral basal crackles,appropriate investigation-

CT scan chest ,measurement of diffusion capacity.

51)breast ca mastectomy+ Radiotheray,chest xray-dense shadow on lateral aspect of right

midzone,diagnosis.

plmonary infarct,pulmonary hemorrhage,radiation pneumonitis.

52)return from holidaykenya ,confusion,headache and diarrhoea ,likely cause

cerebral malaria,lyme disease,legionella,leptospirosis,listeria meningitis.

53)most common adverse effect of Cyclosporin

alopecia,hepatotoxicity,nephrotoxicity

54)pregnantdevelops acut pyelonephritis,H/o of recurrent childhood infections ,most likely

phsiological urine statsis,Bladder outlet obstruction,reflux nephropathy,renal stone disease.

55)40 yr old woman asymptomatic gall stones-normal serum biochemisty appropriate next step.

ESWL,LAP cholecystectomy,observation,ursodeoxycholic acid,chenodeoxy

56)H/o of sweating ,hunger episodes recurrent and weight gain since 6 months plasma glucose -6.8
mmol/L next appropriate investigation

fasting Insulin and C-peptide levels,CT pancreas

57)acute myocardial infarction -frank diabetes findings- appropriat treatment

acarbose,sc insulin,glicazide,metformin,pioglitazone.

58)drug of choice for atrial fibrillation.

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-

antissa ,antissb,anti RNP.antiSm,antiJO1

61)linear deposition of Ig G in GBm ,ARF most likely finding

antiGBM,anca,pnca etc

62)H/o suggestive of PAN

antineutrophil cytoplasmic antibodylevels

63)Bone changes in RA

subperiosteal resorption ,periarticular osteopenia,periosteal reaction.

64)Rheumtoid Arthritis -useful to make diagnosisof severity

morning stiffness ,articular erosions on xray of hand.

65)difficulty in getting up from squattiing postion ,progressive in nature blood normal

polymyalgia rheumatioca,osteoarthritis,diabetes mellitus,cushing syndrome.

66)muscle weakness,progressive ,multiple tender points on bach muscle ,blood tests normal ESR^^^

fibromyalgia,polymyositis,myasthenia gravis

67)cAMP -second messenger for

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

Mallory wiess syndrome,oesophageal varces,gastritis,oesophageal ulceration.

70)patient on coamxiclav ,ibuprofen LFTs suggestive of cholestasis most likely due to

coamoxiclav,Ibuprofen,hepatiits B.

71)which is correct of gamma glutamyl transferase.

elevation is indicative of hepatic fatty deposition.

72)progresive deterioration of mental functions ,abnormal LFts next investigation

alphaantitrypsin levels ,serum ceruloplasmin levels

73)cholestaticLFt findings,USg-no duct dilatation diagnosis

hepatitis b ,primary sclerosing cholangitis,Ca pancreas.

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.

75)major depression not responding to drugs ,correct statement is

ECt improves patients mood

76)BMI-normal,no H/o of change in menstruation and bowel habit blood findings suggestive of iron
deficiency ,diagnosis

coeliac disease,crohns disease,hypothyroidism,Bthallassemia minor,anorexia nervosa.

77)H/o of chest pain ,in woman who has H/o of multiple previous symptoms after her father who died
of MI

factitious disorder,somatitsation disorder,hypochondiacal

78)Anxiety disorder which finding is likely

elevation of BP during attack ,etc

79)asthmatic on beclomethsone -200mg and salbutamol inhaled ,but condition not yet improved next
step

add aminophylline,add montelukast increase dose of beclo,substitute with salmeterol.

80)paracetamol overdose-1/2 hr

oral activated charcoal50g

81) paracetamol overdose- 60 hr prognostic value.

serum prothrombin time .

82)48 hrs after first MI attack ,patient has second attack, serum marker which is of value

trponin I,troponinT,serum LDH,CK-MB levels.

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.

85)longstanding hypertension ,Investigation to find cause

isotope scan,USG abdomen ,renal angiography.

86)patient on renal transplant for six months develops ARf likely cause

acute rejection,due to nephrotoxicity of cyclosporin,acute urinarytract obstruction.

87)patient asthmatic on salmeterol ,presents with titubation and postural tremor ,cause

parkinsonism,salmeterol induced tremor,essential tremor,thyrotoxicosis.

88)H/o sudden unsteadiness in gait ,headache ,vomitting and raised BP,cause

acute cerebellar hemorrhage,subarachnoid hemorrahage.

89)patient presents with intermittent tetanic spasms ,serum corrected calcium-1.8 mmol/l next
appropriate investigation to find cause

serum V it D levels,serum PTH levels,CT brain.

90)patient presents with solitary cervical lymph node ,on biopsy -papillary Ca thyroid ,thyroid glandnormal.treatment.

radioiodine,external irradiation,radical cervical node dissection,total thyroidectomy.

91)patient presents with malaabsorption ,small bowel biopsy-PAS laden macrophages in lamina
propria,diagnosis

whipple disease,coealic disease.

92)A 16 yr female brought with thyrotoxic features(blood),mother on long term thyroxine replacement
therapy diagnosis

factitious hyperthyroidism,graves disease,subacute thyroiditis.

93)patient presents with generalised erythema and pustules,past h/o of psoriasis and patient put on
corticosteroids for past 2 weeks.appropriate management

hospital admission ,PUVA,oral erthyromycin on outpatient basis

94)in Ankylosing spondylitis which is true-

positive trendelunberg test,global restriction of LS movement,increased lumbar lordosis,decreased

angle of stretch test.

95)In enteropathic arthritis which is most likely

inflammation of sacroiliac joint.

96)patient with RA for 20 yrs,renal function-protein-++++,hematuria-++ presnts withCRF ,most likely

due to

secondary amyloidosis

97)patient presents with deteriorating vision,confusion and headache,serumIgM-+++,ESR-^^^ ,cause

myeloma,monoclonal gammopathy of undetermined origin ,waldenstom macroglobulinemia.

98)which of the following test is of prognostic value in Leukamia

cytogenic karyotyping,cytochemistry,immunophenotyping,bone marrow trephine biopsy.

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

measels ,rubella,lyme disease,gonococcalarthritis

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 ?

rofecoxib acts on different enzyme than naproxen .

103)patient is put on Carbamazepine 200mg and asked to stop taking alcohol,after 4 days ,his
requirement goes to 400mg .cause

autoinduction of carba,autoinhibiton by carba,decreased bioavailablility,increased first pass effect.

104)which of following is likely in delayed blood transfusion reaction?

conjugated hyperbilirubinemia,hemoglobinuria,hemosiderinuria,positive coombs test.

105)patient presents with muscle ache and ARF ,hematuria+++ cause

Rhabdomyolysis.

106)patient presents with headche ,dizziness ,O/E plethoric ,hb-18.9,pcv-0.56 platelet count-500+,next
appropriate investigation

red cell mass ,LAP score,USG abdomen,Bone marrow biopsy

107)patient presents with decreased vibration sense in foot and muscle weaknes of leg,H/o of
pernicious anemia,likely due to

Vit B12 defieciency

108)patient presents with fatigue-blood-spheroctes appropriate investigation-

RedCell osmotic fragility test,HB electrophoresis,USG abdomen,bone marrow biopsy

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

excision of draining lymphnodes,chemotherapy,excision of mole with a margin of normal

skin,radiotherapy

111)patient presents with acidosis Na ,K,Cl,HCo3 and ph values ,calculate anion gap

25 mmol,10,15,20,5 .

112)patient presents with itchy lesions in pubic area ,likely cause

infestation with lice,scabies,pityrsorum folliculitis.

113)114)patient complains of difficulty in flexing ring and little fingers ,o/e hypothenar wasting ,which
other movement is affected

adduction of thumb,abduction of thumb,extesion of ring finger.

115)patient undergoes brachial artery catherisation ,deveops weakness of long flexors except ring and
little finger,with difficulty in abduction of thumb ,cause

carpal tunnel syndrome,median nerve lesion at elbow,anterior interosseus nerve palsy.

116)patient complains of tingling and numbeness of lateral aspect of right thigh O/e loss of sensation
over anterolateral thigh .cause

lateral cutaneous nerve of thigh,femaral nerve lesion,obturator nerve

117)patient presents with pain over the arm ,loss of abduction of thumb etc etc ,cause

C6 radiculopathy,thoracic outlet obstruction,brachial plexus injury.

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

silicosis,simple coal workers pneumoconiosis,progressive massive fibrosis.

120)patient presents with excessive facial hair and menstraul disturbances which of following test is
diagnostic of PCOS

serum androstenedione levels.

121)patient presents with becker X linked muscle dystrophy ,which is correct?

50%of daughter 's sons will have the disease.

122)which of following has polygenic inheritance

fragile X syndrome,huntington disorder etc.

123)which of following statements favours cryptococcal meningitis in favour of toxoplasma in AIDS

normal contrast CT scan, CD count >500,hiv viral 100,000copies/ml etc

124)which of following karyotype presents with short stature

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

conjunctivitis ,scleritis,acute closed angle glaucoma ,uveitis

126)patient presents with cough and brethlessnes chest Xray-dense shadow in right upper lobe.likely
cause

aspergilloma,Tb,invasive bronchopulmonary aspergillosis.

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

129)isolated B cell defieciency

prednisone,cyclophosphamide,azathioprine,methotrexate.

130)An MI patient prescribed with Aspirin,mechanism of action

Inhibits cyclooxygenase activity

131)patient on valproate becomes pregnant what is likely effect

neural tube defect in foetus.

132)opening snap in MS is indictive of

that the valve is mobile.

133)patient presents with ankle swelling bilateral ,elevated JVP ,clear lung fields ,

RVF infarction,cardiogenic shcok,pericardial tamponade,pulmonary artey hypertension.

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.

136)drug of choice for L pneumophila-

Doxycycline,erythromycin.

137)nurse has needle stick injury what is immediate step?

wash hands thorughly under running water,antiretoviral treatment,test for hb a ,hb c ,hiv ,etc...

138)patient with dysuria ,urethral swab-neutrophils ,no organism.drug of choice

metronidazole,ciprofloxacin,nitrofurantoin.

139)patient presents with multiple lustreless nails and no other skin lesions.investigation

nail clippings for mycology ,examine nail under wood light.

140)which is suggestive of glomerular nephritis

presence of red cell casts in urine.

141)patient presents with breathlessness ,chest xray-bilateral hilar adenopathy,next appropriate

investigation

serum ACE activity.

143)patient develops extensive facial and tongue oedema after taking food ,also develops rash to
contact with cosmetics serum C3 C4 levels are normal.

C1 esterase defieciency,idiopathic angioedema,food allergy,mastocytosis.

144)patient with unilateral knee swelling is tapped ,the joint fluid is sterile .One week later he develops
paiful knee swelling ,next appropriate step

start IV antibiotics,arthroscopic washout.

145)patient presents with ulcer above the medial malleolus,appropriate investigation

venous duplex scan,ankle-brachial artery pressure index etc.

146) pateint with prepatellar bursitis is confirmed by

joint line tenderness ,quadriceps muscle wasting .

147) treatment of monoarticular joint pain in gout

IBuprofen

148)dry cough in ACE inhibitor therapy is due to accumulation of

Bradykinin

149)During drug trial ,injection causes elevation of BP .which of following is the likely drug?

angitensin1,angiotensin2,

good luck to one and all

150)which of following statement is true

the direct nephrotoxic potential of diclofenac is increased by Lithium

151) ward outbreak of MRSA which is appropriate

antibiotic treatment culture positive patients

152)question on control of pain even after nsaid and opioid

153) change from hydrocrtisone to predisone ,calculate dose based on hydrocortisone value.

154) frank diabetes and BMI-35 which is appropriate drug ?

metformin,acarbose,glibenclamide,weight reduction.

155) drug which reduces tremor in parkinsonism

amantidine,selegiline

mrcp april 2008 recalled questions

Discussion in 'MRCP Forum' started by sheikoo, Apr 12, 2008.
Page 1 of 2
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Next >
sheikooGuestvery tough nausating exam allah mawgoood

here r some questions hope every one share

1/ vancomycin side effect anaphylaxis

2/ methicilin resistant staph ttt vancomycin

3/lithium toxicty predisposed by diuretics

4/ carbamazipine overdose within 2 hour what to do think mutiple activated charcoal

5/ prophylaxis of cluster headache think verapamil

6/ intial ttt of hypocalcaemia in pt with renal failure

is ca carbonate or alpha

7/ photo orf

8/ photo molloscum

9/ photo necrobiosis lipiodcum as chest x ray negative

10/ pt on anti TB ttt develop nausea and elevated enzyme what to do

stop all or continue

11/ diagnosis of acromegaly gtt

12/ i think there is case of compulsive water drinking

13/ radio iodine therapy in pt with graves make eye signd deteriorated

14/ prognostic sign of pneumonia urea more than 7

15/case of statin myopathy

16/ photo SAH

17/ flouxtine as cause of SIADH

18/ pt with severe depression on flouxtine stop ttt since one weak what do

restart it or change or give diazepam

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

found paper he do not want the life what to do

21/ photo bronchiatasis

22/ pt with haematemesis after sever vomiting mallory weis syn

23/ pt with syphilis has sensitivity to penicillin star with doxycyclin what more to
do ????..........................

24/ orlistat for over wt

25/ statin induced myopathy

26/ pt with tetanus what to give human antibodis

27/ pt with ulcerative colitis what is the cause of elevated alkaline phosphatase

psc

28/ ttt of brain abcess flagyl+ ceftrixone or flucloxacin + cef

29/ drug cause jaundice

clarthromycin amoxicillin flucloxacin

30/ photo pyoderma gangrinosum

31/ how to prevent contrast induced nephropathy

plenty of fluids

32/ is there any cat scratch disease

33/ overstimation in echo in AS is it AR

34/ PT WITH MI HAS PANSYSTOLIC MURMUR

TRANSTHORACIC ECHO

35/ RELEIFING THE SYMPTOMS OF MENOPAUSE GINE OESTROGEN

36/ CASE OF PAROXYSMAL SVT

37/ PT OM WARAFARIN AND MECHNICAL VALVE HAS DLEEDING STOP WARA

WHAT TO DO GIVE HEPARIN

38/ NON ALCOHOLIC HEPATITIS

39/ PT WITH RH ARTHRITIS + VERY HIGH FERRTIN

STILL DISEASE

42/ ESSENTIAL TREMORS

43/ CAUSTIVE ORGANISM TO CHOLECYCTITIS E COLI OR BACTEROIDS

44/ TRANSUDATE PLEURAL EFFUSION HEART FAILURE

45/ HPEROSMOLAR NON KETOTIC STATE

46/ ACUTE HEPATITIS B PT TTT IS IT SUPP OR ALPHAENTERPHERON

47/ TTT OF CHRONICH MYLOID ALPHA ENTER OR TRANSPLNAT

48/ PT WITH PAINLESS LYMPH NODE FINE NEEDLE NOT DIAGNOSTIC WHAT TO DO
EXCESION BIOPSY ???

49/ AMIODARONE INDUCED THYROID MANY CASES

50/ PT HAS RENAL FAILURE START DIALYSIS DEVELOP CONVULSION WHAT IS THE

CAUSEsheikoo, Apr 12, 2008#1

adelaliDODOGuestHOPE AND HELP

SALAMO ALYCOM ...

HOPE FOR ALL TO SUCCESS

I'm planning to sit the next diet 2/2008 please advice me sooooon

THANKSadelaliDODO, Apr 13, 2008#2

rafGuestcomments on questions

Assalaamu alaikkum evry1,

Comments on above questions and answers. Please correct me if I am wrong.

1 Vancomycin psudoanaphylaxis , cause he was given vancomycin twice daily.he developed

the rash only for the first dose.

5. cluster headache prophylasis lithium

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.

10 continue ATT as Lfts r not elevated much

12 - Case of DI cos Plasma osm was high and given urine osml was low with concentrated blood pic
( high normal na and k)

18. restart paroxitine

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

47. Asymptomatic CML Imatinib

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

assalaamu alaikkum ,adelaliDODO

go for - sanjay sharma ( rapid review of clinical medicine for mrcp - 2)

- Onexamination part - 2

- Ecgs , x- rays .

Dont forget to review once what u have studied for part 1 (exp basic science and stats)

Practice mcqs under time pressure.

Dont waste more time for pictures.

All the best.raf, Apr 13, 2008#4

sheikooGuest7/ orf is not photo think case description

47/ cml ttt is alphe inerpheron

1/ bnf mension anaphylaxis not pseudo in vanco

8/ i think it is umblicated small lesionsheikoo, Apr 13, 2008#5

sheikooGuest1/ streptococcus bovis in pt malignancy and infective endocarditis

2/ photo barrets or .....

3/ pt with ca oesaphegus stent apply develop sudden dysphagia to fluids and solid completely

food bolus/ stent move // malignancy

4/ hyperparathyroid in elder with hyper ca

5/ prognosis in heart failure nyha 2 spironolactone

6/ family pedigree ca breast is it BRCA2 OR P53

7/ pt with unilateral optic atrophy with other side papilloedema is it meningioma or

8/ one case of PAN

9/ case RTA TYPE I

10/POLYCYCTIC KIDNEY associated mitral valve prolapse

11/ case of MEN 2

12/ PT WITH MALT positive helico pyllori ttt erradication of helico

13/ case of rhabdomyolysis

14/ hiv pt low cd tb avium

15/ eaton lambert diseae

16/ retinitis pegmentosa + deafness

visual deffect central/ periphral/ high alititude

17/ bloody diarrhia is shegilla?????????????

18/very elder i think 90 year with sone ttt endoscopy / surgical / lithotripsy

19/ pt with residual urine in bldder 230 ml ttt

perminant catherter / once catheter/

20/ elder with urinary incontinance + hypertension which drug used for

HTN doxasin / diuretics/ amlodipine / lisinoprilsheikoo, Apr 13, 2008#6

rafGuestpictures in part - 2

These r the pictures came this time.

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

2. Picture of rash in leg -Necrobious lipo

3.Picture of ulcerative leision (with elevated margins)near lt ear - ?BCC

4.Picture of CT chest ( compleately forget the scenario)-came in 1st paper treatment choice asprin,
dexamethazone, etc

5.CT chest picture bronchiactasis

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

8. pic of pyoderma gangrenosum

9.Erethema nodosum pic bechets

10.Chest x-ray with b/l infiltration I think scenario of haemoptysis - ??? cause ???malignancy

11.Chest x- ray with crecentic 2 air filled leision - ?? Aspergilosis

12.X-ray pelvis (female)? Pagets

13.Retinitis pigmentosa picture- reduced Periphera vision

14.Ecg of svt known asthmatic management verapamil

15.Ecg of torsadis de pon - hypotension and unstable dc shock

16.Echo Atial myxoma

17.Ecg of posterior wall mi with ? inf wall management sterpto / altepase

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

22.Ct of subarconoid haemorrhage

23.Endoscopy of oesophagus barrets oesophagus

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

25.Ct brain with frontal abscess management ??? antibiotics combination

26.X-ray of Thoracic spine with fracture (male) with sensory signs _- ? malignant infiltration, ?
osteoporotic #, ? osteophytes

27.Picture of face (47 yr old female) Rocacea

28.Ecg of inferior wall MI- ? cause - plaque rupture

29.Ecg of compleate heart block

30.Chest x-ray h/o malignant melanoma - ? malignant infiltration

31.Ecg of digoxin toxicity reversed tick

32.Ct abdomen adrenal carcinoma

33.Ct skull - ?pitutary calcification

34.ECg showing > 3mm st depression in lateral leads (NSTEMI) management angio

35.Skin biopsy (pat with h/o celiac disease and rash) Dermatomyositis

36.Specimen of kidney polycystic kidney associated leision MV prolapse

This much pictures only came I think. if anything more please mention,

And please place your valuable comments.raf, Apr 13, 2008#7

rafGuestAssalaamu alikkum sheikoo,

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

In your 2nd set of questions

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

think tuberculosis option was there.

17 boody diarrhea, h/o travel , rt upper quadrent abd pain - ?? amoebiasis

18 90 yrs old with frcture hand with cast, cbd dilated - I think ERCP

19 Multiple sclerosis patient with residual urine intermittent catheterization.

20 elderly with urinary incon I think I didnt attent this ques.

thank you.raf, Apr 13, 2008#8

sheikooGuest1/ think there is acase of normal pressure hydrocephalus

2/ what about MRI thoracic spine oteo or metas

3/ pt with hodgkin complete 5 cycles therapy in need of blood transfusion what to give CMV

seroneative / kell/ full bloodsheikoo, Apr 13, 2008#9

rafGuestassalaamu alaikkum,

s, there was a cas of normal pressure hydrocephalus

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

1/ pt minimal change GN respond to steroid what is the fate

2/ pt on thalidomide what do condom /ocp / both /nothing

3/ 2 cases of pt with sleep dist and snoring and abnormal movement at night ttt and diagnosis

4/ ulnar nerve compression what to do x ray cevical / thoracic / nerve conduction

5/ is there any case of cryoglobulin

6/ pt took drug at nightclub what is that ecstay/ lysergic/ amphet

7/ coeliac disease on diet deteriorate

biopsy / dairy food / antibodies

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

melaonoma / keratosissheikoo, Apr 13, 2008#11

sheikooGuestmrcp april 2008

hi every one what is going on where the questions why not share with questions comment so get
benefit all so plzzzzzzzzzzzzzzzzzzzzz[

pt with chest pain troponin negative after 12 hour what to do

stress test / echo / angiographsheikoo, Apr 13, 2008#12

dregyptGuestnew

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

for about hoursdregypt, Apr 14, 2008#13

dregyptGuestss

antibiotics

1 one q about brain abcess cef + metronidasol

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

4 vancomyci and PSUDO allergy ,

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

6 pnumonia but I dont remem,ber the q

7 fulloxacillin and cholestatic juandicedregypt, Apr 14, 2008#14

dregyptGuestee

plz ALLAH to make me pass..

caeliac with good intial responce then no response >>>>>>>>>>food diary

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

8 chronic pancreatitis and CT

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

1 tow pict for WPS

2 one lung cancer and heamatemsis laser

3 apical ct with extensive small cysts

4 ct abd and rt adrenal carcinoma

5 ct thoracic spin and fever >>> the was one vertebra and in its middle there is necrosis with sclerotic
margin so I chose osteomalitis

6 PCKD and MItral prolaps

7 Echo of mitral myxoma but in the qs ther was apical systolic murmure

8 VT

9 inferior MI d2 rupture of atherosclerotic plaque

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

15 avascular necrosis of hummer head

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)

the choise was behcet crohons, iliac TB or yersinia)

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

2 verapamil for cluster

3 skul base metastasi for pt with 8,9,10 cr nerve

4 subdural for old with 6th cr and mild heamiparisi

5 faciscapulo myopathy

6 3 epilipsy as i was post

7 AD

8 lews body dementia

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

14 amoidaron and thyrotocicosi and normal TPO i chose stop it

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

17 ulnar nerve lesion >> i chose nerve conduction

18 MND ??nerve and EMG

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

24 carbamazepin with mulidose activated charchol

25 GABA toxicity

26 farmer with paraqut toxixitydregypt, Apr 14, 2008#17

dregyptGuestss

1 forestry with pnumonia I chose chly psitassi

2 bat colony caves with pnumonia I chose coccidomyucosis bu i think its histoplasmosis

3 typhoid clasiic pict

4 amebiasis

5 schistosomiasis classic

6 liptospirosis

7 Mycobactrium avium in AIDS

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

11 1rr adrenal hypre

12 essential HTN

13 renal artery stenosis in young femal

14 men2

15 many thyriod and supra renal qs

16 HRt FOR SYMPTOMS

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

MY ansewr just reflect my oponion it my be wrongdregypt, Apr 14, 2008#18

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

thanks dregypt for this nice job

i agree with most answers

the questions for reserch purpose is different from paper to other

CT chest with haematemesis i chose embolisation for bronchialartery

pt with bloody diarrhea what is inestig stool cluture and microscopy

pt with anti tb therapy all anti tb cause elvation of livern enzyme]

to stop all or contiue

pt with folate def i think it is dietry

/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

what is cause perinephric abscess /

3/ case of transfusion related lung injury

4/ is there any cyanide toxicty??????????????

5/ diabetic pt with diarrhea what is the cause

6/pt on methotrexate follow up think blood film

7/ pt with rh arthritis on minocycline and non steroids what to add

hydroxychloroquine or methotrexatesheikoo, Apr 14, 2008#20

Dr.ANHGuestmrcp april 2008

Hi All, Hope u all to pass this hard exam

Here some recall Q

1-Pt wit h venous ulcer.....gradual bandage

2-pt with orf or cut. anthrax

3- pic. with BCC

4-pic. with necrobiosis lipodica.

5-pic. pyoderma gangrenosa.

6-pt. with tato......

7-pt. with wart develope non melanotic melanoma.

8- pic. with rozecea

9-pic. for pt with painfull rash....herpis zoster.

10-pt alcoholic with feature of chronic pancreatitis...do CT abdomen.

11-pt with family Hx of autoimmune disease present with autoimmune hepatitis...do anti smooth
muscle Ab.

12-female with pruritis.....PBC.

13-ptwith UC and develope DVT treatment heparin.

14-old man with stone in common bile duct...do ERCP.

15-pt with non- alcoholic hepatitis.

16-pt with rapid rise in transaminase....ischemic hepatitis.

17-pt with pseudomembranous colitis.

18-pt with chron's disease and dietry advice..low unsaturatted fatty acid or high protiene diet.

20-pt with paracetamol over dose do liver transplant.

21-pt with colagenous colitis treatment........

22-pic. for pt with Barrett's oesophagous.

23-pt with prosthetic oesophageal tube blocked within 12 hrs..bollus block.

24-pt with mallery wies syndrome.

25-pt with ascitis drug with prognostic benfit...spironolactone.

26-pt on warferine INR 2.4 need paracentisis...give fresh frozen plasma.

27-pt with alcoholic acute pancreatitis.

28-same pt with alcoholic cardiomyopathy.

29-pt with MALT....erradicate H.pylori.

30-pt with cealiac disease

31-pt with cealiac disease what investigation

32-pt do upper Gastroscopy and sigmoidoscopy.....do colonoscopy.

33-operated pt with CA colon and liver metastesis...chemotherapy.

34-pt with CA colon and liver metastesis...do surgery.

35-pt with WPW syndrome.do ablation.

36-ECG diagnosis WPW.

37-pt with recurrent palpitation.SVT.

38-ECG2nd degree heart block.

39-ECG.complete heart block.

40-drug improve prognosis.epironone.

41-pt with anterior descending artery stent develop posteroinferior MI .atheromatous plaque.

42-pt with antroseptal MI what is the bad pregnosis.pulmonary oedma.

43-CPR question what to do after DC shockdo 2 min cpr.

45-pt. need biventricular pacing.

46-pt with aortic stenosis and dypsnea need bisoprolol.

47-overestimation in aortic stenosisAR.

48-pt with posterior MI give actplase.

49-ECG pt with unstable angina and negative troponineangiography.

50-pt need implantable DC after successful rescistation.

51-pt develop acute dypsnea after 24 hours post MI.do transthorathex or transoesophagous echo or
swan ganz catheter.

52-pt with recurrent anaphylaxis on adrenalineb-blocker

53-echo pic. With atrial myxoma.

54-female with fall in bathroom.syncopal attack.

55-pt on amiodarone develop thyrotoxicosisstart carbimazol.

56-pt with pericardial effusionacute pericarditis.

57-WHO performance 3..inactivity.

58-transudate effusion.heart failure.

59-pt with arterial thrombosis what investigation?

60-pt with Gullian beri disease.

61-male pt with Mysthenia gravis.

62-MND..do EMG and nerve conduction study.

63-ulner nerve ..do nerve study.

64-pt with normal pressure hydrocephalic.

65-pt with lewy body dementia.

66-pt with base of skull metastesis?

67-pt with basilar migraine

68-pt with electricity in face and arm.epilipsy.

69-pt with subfrontal meningioma.

70-pt with retinitis pigmintosa pic.constructed vision.

71-alzhimer dementia.

72- pt with Parkinson disease what treatment u will give.

73-pt with essential tremer.

74-ct head with SAH.

75-brain abscess what antibiotic treatment.

76-pt with sudden visual loss.retinal detachment or vitrous he or central vien occlusion.

77-pt with subdural haematoma ?

78-pt with restless leg syndrome or periodic limb movement.

79-pt with wernick encephalopathy.

81-CML.imitinab.

83-pt with ITP did cbc what is next.antiplatlate Ab.

84-pt with menorrhagia and high APTTvon willbrand disease.

85-anticardiolipin.

86-pt with lymphoma need transfusion what blood you give.gama radiated.

87-pt develop dypsnea after blood transfusionacute transfusion lung injury.

88-pt with myloma.

89-AL Amyloidosis.

90-p53

91-pt with Dx sarcoidosis.

92-acute asthma not responding I.V mg

93-acute asthma improvingcontenou O2 or nebulization every 6 hours.

94-pt with COPDnoninvasive ventilation.

95-pt with COPDdecrease O2.

96-pt with bilateral emphaseama what make him contraindicated for surgery.

97-pt with allergic bronchopulmonary asperglosis.

98-pneumonia bad prognosis.urea> 7.

99-indication for long term O2paO2 <7.2.

100-CT with honeycomb appearance..extrensic allergic alveolitis.

101-pt with pleural effusion and wt loss.CA lung.

102-pt with CGD and not responding pneumonia.add Amphotricin.

103-pt with non small ca lungradiotherapy.

104-diaphramatic weakness.

105-cxr with pulmonary vasculitis.

106-asthmatic pt develop churg struss syndrome

108- pt with proteinuria .add valsartan

109-pt with cryglobulinaemia

110-pt with lipodystrophy .low c3 comp.

111- membranoproliferative gn

112-failure of erythropoietin in crfiron def. anaemia

113-pic of polycystic kidney.. mv prolapse

114-pt with recurrent minimal change gn prognosis.recovery

115-acute tubulointerstitial nephritis.

116-prevent contrast nephropathy .hydration.

117-pt with acute tubular necrosis.improve with non specific treatment.

118-perinephric abscess?

119-obstructive nephropathy.

120-pt with rhabdomyolysis.

121-pt with RTA1.

122-pt with persistant hypokalaemiahypomg.

123-MEN 2.

124-CT abdomen.adrenal CA.

125-Acromegaly.GTT.

126-pregnant with high prolactine.reassurance.

127-pt with sick euthyroidism.

128-obeise uncontrol DMadd metformin.

129-uncontrol DM ..add insuline.

130-pt with adrenal adenoma or congenital adrenal hyperplasia.

131-pregnant use predinsolone come with cushing syndrome not suppressed by overnight
dexamethasone.

132-pt with B. suger 53.hyperosmolar non ketotic coma.

133-diabetic pt with blood suger30..anexiety.

134-CT pituitary area..macroprolactinoma?

135-pt with pcos.

136-pt with high rennin and high aldestrone with low k renal artery stenosis.

137-pt with primary hyperthyroidism.

138-female with family Hx of osteoprosis.vit D toxicity.

139-renal failure with low ca and high ph ca carbonate.

140-pt with 2ndary hyperthyroidism.

141-pt with drug induced SLE.stope minocycline.

142-pt on antituberculus develop high transaminase.continuo treatment.

143-prophylaxis from cluster headache.lithium or verapamil.

144-tricyclic over doseNa bicarbonate.

145-pt stope paroxitin since week develop agitationdiazepam or restart paroxitin.

146-restless leg syndrome treatment.carbimazole or

147-depression develop schizophrenia.olanzapine

148-methaemogloblinaemia..methyline blue.

149-obeise pt need wt reduction..orlistat.

150-prostatic valve endocarditis..vancomycine +gentamycin.

151-carbamazine overdose.multiple oral charcoal.

152-vancomycine anaphylaxis.

153-alcohol with listria meningitis.ampicillin+gentamycin.

154-methotrexate overdose.full blood count.

155-lithium toxicity increased by diuretic.

156-pt with culture and sensivity what oral antibiotic to give..chloramphenicol.

157-pt with behcet syndrome.

158-pt with wegner on predinsolone what medicine to add..cyclophosphamide.

159-pt with PAN?

160-pt with gout.

161-gout in heart failure..use predinsolon.

162-X-Ray hand tophaceous gout.

163-haemochromatosis.ferritin test.

164-adult still disease.

165-X-Ray pelvis..pagets disease.

166-pagets treatment ..biphosphanate pamidronate.

167-X-Ray humerus avascular necrosis.

168-muscle biopsy..dermatomyositis.

169-PMR.

170-polymyositis.

171-Henoch schonlin purpura.

172-leptospirosis case.

173-pt with Toxoplasmosis?

174- pt came from Egypt.typhoid fever.

175-female came from India..Salmenlosis??

176-schestosomiasis.

177-woman in bat cave?

178-HIV with MRI brain widen sulcci and cortical atrophy..PML, Lymphoma.

180-chlamedia treartment in Reiters ..Azithromycin.

181-psittacosis case.

182-cholecystitis causeE.coli

183-malaria not respond to quinineadd i.m artemether.

184-CXR aspergiloma.

185-syphilis pt .reassurance.

186-tetanus antibodies.

187-botulisim?

188-ct spine.osteomylitis.

189-case of strep. Bovis.

190-culture negative endocarditis.coxiella or actinomyces.

191-HIV with sclerosing colingitis.

192-hepatitis case..i.v metaclopramide

193-chancroid.

194-legionella.

195- Mycoplasma pneumonia.

196-methisilin resistant staph.vancomycin.

197-pt with psychogenic water drinking.

198-Diabetes inspidus.

199-radioiodine side effect..exaggurate eye sign.

200-huntigtone disease suicidegive full treatment

201-ulcerative colitis..PSC or metastesis.

202-cholestasis cause..flucloxacillin.

203-main indication of ostrogen replacement therapyrelief symptoms of menopause.

204-fixed lymph node enlargedexcisional biopsy.

205-indication for descent in high altitude cerebral oedma.chin stock breathing or unsteadiness or
headache.

206-SVT with asthmaverapamil.

207-pt with VF..DC shock.

208-male use thalidomide what contraceptive use?

209-pt with urgent & nocturnal diarrhea.diabetic autonomic neuropathy.

210-pt with haemodialysis develop fit what is the causecerebral oedma, hypocaceamia.

211-pt with pulmonary HTN.nifidpin.

212-pt with pulmonary HTN > 65 with Dyspnea.heparin?

213-pt with bulimia

214pt with wegner.ANCA.

215- pt with proctitis 7cm......mesalasine supp.

216-pt with bleeding DU fail to control by OGD adrenaline infusionangio and embolization.

Dr.ANH, Apr 15, 2008#21

sheikooGuestmrcp april 2008

hiiiiiiiiiii DR ANH

THANKS ALOT FOR MEMORISING GOOD NUMBER

GOOD LUCK CONGRATULATIONS FROM NOW

HOPE TO PU MORE AND MOREsheikoo, Apr 15, 2008#22

GuestGuestthanx dr.ANH

I think the face rash was pemphigus vulgaris

recurrent arrhythmia in a youngman is RVOT-VT

rear colleagues pls commentGuest, Apr 15, 2008#23

sheikooGuestmrcp april 2008

hi dr anh

can i add some questions

217/ pt with ca had pain not releif bt dihydrocodiene chose 2 to give

voltaren / morphine every 4 hour / slow release morphine/paracetamol

218/ pt with lung fuction test also chose 2

restrictive / obts / type 1 res failure / type 2 /

219/ tt of acute heptitis b

suppotine / alptha inter / rabivirin

220/flouxtine causing siadasheikoo, Apr 15, 2008#24

Dr ANHGuestdear guest

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

As i remember that young man with palpitations had attacks of near-syncope

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?

notice he was breathing comfortably. i chose the "set" reflecting

COMPONSATED metabolic acidosis. any comments?Guest, Apr 15, 2008#27

Dr.ANHGuestthere was pt with captopril induced angiooedma

pt with mechanical valve induced haemolysisDr.ANH, Apr 15, 2008#28

sheikooGuestmrcp april 2008

1/ pt with recurrent pneumonia what is the cause

2/ pt with metabolic acidosis cause think diarrhea

3/ pt on metformin has sepsis and acidosis what is cause lactic acidosis/ ketoacidosis

4/ ttt of tremors and agitation in pt with parkinson

5/ chest x ray is it metastesisor .....

6/ tt of pt with heart failure and gou think colchcinesheikoo, Apr 15, 2008#29
elnzrGuesthi everybpdy

best of luck

can anyone guesss the pass mark for this exam?

plse replyelnzr, Apr 16, 2008#30

GuestGuest54%

54%Guest, Apr 16, 2008#31

rafGuestThalidomide

Assalaamu alaikkum,

Regarding contraceptive when a male patient is on thalidomide , the answer is a single barrier method.

This is a bit of article , searched in net.

Because of the known human teratogenicity of thalidomide, thalidomide is contraindicated in women

who are or may become pregnant and who are not using the two required types of birth control or who
are not continually abstaining from heterosexual sexual contact. If thalidomide is taken during
pregnancy, it can cause severe birth defects or death to an unborn baby. Thalidomide should never be
used by women who are pregnant or who could become pregnant while taking the drug. Even a single

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

we are waitingsheikoo, Apr 17, 2008#34

GuestGuest123doc

hi every body hope all pass im planning to jon mrcp2 2008/2

i wander if any body hav 123 doc to share it withe me i have cd for clinical examination and history for
paces

if any body interested send for me my e m a i l is

abdullamarie@yahoo.comGuest, Apr 18, 2008#35

BRJGuestMRCP-2,April..2008.

1.Homosexualman..inv:??Rectal swab.

2.Tr of Restless leg syn. Is there any option for..Pramipexole or Ropinirole...??Maaaaybe I put
Pramipexol.

3..Viral wart...sensitive to....Contact/atopic dermatitis??

4.Af..Tr..Propafenone(normal heart)

5.Ecg..dextrcardia..I can'nt remember..!!!

6.Maybe i put one ans..CLC.on buttock & uper thigh.Dx.strongyloidiasis.

7.Can anybody explain repeated anaphylaxis By adrenaline Ans. Betablocker..plz??

8Single terminal index finger calclfication..L.sleroderma..maynotbe..gout..???

9.Torsades de pointes..ECG Tr.i.v Mg..???

10.cause of increase Alpo4...PBC.

11.Farmer..Typical Paraquat poisioning..mouth ulcer..etc.

12.Ca-lung..contraindication to surgery..severe airway obstraction..??

:?BRJ, Apr 20, 2008#36

infinity guestGuestresults

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

ALhamd LLAH I pass I havw got 69.32

THANKS TO ALLAH it was diffecult examGuest, May 2, 2008#40

sheikooGuestmrcp april 2008

hiiiii every one

alhamdolillah i passed this tough exam

to all who pass congratulations

to those not succed go on do not stop will reach at the end

thnkssssssssssssssssssssssss to allahsheikoo, May 3, 2008#41

GuestGuestsalam to all of you....congrats for those who passed..and hard luck for those who didn't...i
heard that it was difficult..well we hope to sit in december inshalla...would u advice what kinds of
books u read from and what are the websites u used.....Guest, May 3, 2008#42
Dr.EGuestPBUY all.By Allah's grace I passed both part 1 & 2 at one chance.I personally think that,
though onexam is good for part 1 it isnt as good for part 2.It fails to give you a picture of the real
exam,which is much harder.

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

some answers here r wrong Guest, May 4, 2008#44

medicGuestHi although the MRCP exam doesnt concern me yet, the questions and possible answers
people post on here from their mrcp exams, do some of them come up for the following mrcp exams
for other docs?medic, May 4, 2008#45
GuestGuestiam not able to get the results in site

it shows

No results found for the selected exam type and RCP Code

can anybody guide pleaseGuest, May 5, 2008#46

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...

salamGuest, May 6, 2008#48

Dr.EGuestSalam to u all.

I hope the following helps u,guest-

Onexam=onexamination.com

K & C=Kumar & Clark

OHCM=Oxford handbook of clinical medicine.

I haven't read Sharma,but some of my seniors have found it useful.Dr.E, May 6, 2008#49
GuestGuestadvice

Alsalamo Alikom, and I hope to all pass the exam

my advice for new mrcp 2 candidate is

1) read sharma twice at least

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:
Log in or Sign up

Forums
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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
1
2
3
Next >
1.

anaGuestHELLO.

2.

ANYONE SAT FOR mrcp PART ONE NEED TO DISCUSSana, May 16, 2007#1

3.

guest88Guestyes plsguest88, May 17, 2007#2

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.

guest88Guestm of action of bisphosphonate

6.

side effect of bisphosphonate... oesophagitis

7.

R Arthritis... lung complcation..... interstitial lung disease

8.

Gout, a post surgical patient on diuretic, devolped genrized arthritis

9.

CREST.... antibodies present Anti co

10.

A question from dermatomyositis

11.

Endocarditis.. ECG changes....

12.

From where the cardiac myoxoma arise... left atrium

13.

Two question from Carcinoid tumour

14.

Lyme disease

15.

Acanthosis nigricans.... association hypothyroidism

16.

shin lesion with talengectasia... diabetic libadicourm

17.

a pt presented with moter complication after his father deat.... conversion disorder

18.

there was a question from phobic disorder

19.

Two questions from hypoparathyrodism

20.

polycystic ovarian syndrome

21.

crohn disease.... feature

22.

pontine stroke

23.

pariatal lobe lesion ... viusal field changes

24.

a pt with pigmenation on palms and sole and genital ulcer... syphills invistagaion

25.

downbeat nystagmus.... Arnold chaire malformation

26.

cluster headach , medication for pain not responding to diclofinic.. sumatriptan

27.

a pt developed seizures post delivery... cortical thrombophlebitis

28.

drug used for chemotherapy induced nausea... odensetro

29.

a pt with gain cell arthritis.. treatment.. prednislone

30.

a pt with type 1 tubular acidosis.. complication... nephrocalcinosis

31.

the site of portion of nephoron where thiazide diurtic acts.. proximal convulted tubule

32.

wait... i will post more latter onguest88, May 17, 2007#5

33.

vikesGuestmay 07

34.
35.

some more questions

36.
37.

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

38.
39.

1. Which is the antibody responsible for acute hyper rejection of graft?

40.
41.

igg

42.

igm

43.

iga

44.

ige

45.

igd

46.
47.

ans: ?igm

48.
49.

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?

50.
51.

due to abo incompatilbilty

52.

due to risk of polycstic in brother

53.

due to ????

54.
55.
56.

ans due to abo incomp

57.
58.

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

59.
60.

lyme disease

61.

leptospirosis

62.

malaria

63.

trapanosoma

64.
65.

ans lyme

66.
67.

4.a man comes back from india and after some time develops fatigue and lethagry with hepatomegaly
butno splenomegaly

68.
69.

malaria

70.

leptospirosis

71.

glandular fever

72.
73.

??

74.
75.

5. contraindication of OCP in a patient with frequent migranes

76.
77.

migrane on every mestruation

78.

???

79.
80.

6. which is the most early sign in carcinoid syndrome

81.
82.

diahrea

83.

facial flushing

84.

other were not important

85.

86.

ans facial flushing?

87.
88.

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?

89.
90.

def of factor1

91.

92.

93.

10

94.

von willebrand

95.
96.

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

97.

ESR slighly raised

98.

cacium normal

99.

PTH high

100.

tsh very low

101.

t3 and t4 high

102.
103.

what is the cause

104.
105.

primary hyperparathroidism

106.

PMR

107.

thyrotoxicosis

108.
109.

???

110.
111.
112.

will post more questions as remembervikes, May 17, 2007#6

113.

vikesGuest9 moa od goserelin in prstatic cancer

114.
115.

competitive antagonism

116.

receptor something??

117.

??

118.

??

119.

??vikes, May 17, 2007#7

120.

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.

which test defines the accuracy(efficency)of the test

132.
133.

sensitiviy

134.

specificity

135.

+pred vaue

136.

_ pred valuevikes, May 17, 2007#8

137.

GuestGuesti will share

138.

1- role of alcole in managmentof ethylen glycol ?

139.

2-ckd osteodystrophy which will be elevated first ? phphorus

140.

3-which will make mitral regurge considered as sever ? phypertention

141.

4-multifocl atrial tach. what is the treatment of choice?

142.

5-pregnant wityh cardiac disese which will make here as a very sever risk ? p htn

143.

6-Guest, May 18, 2007#9

144.

guest ukGuestHere are all the dermatalogy mcqs

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

surface of the fingers... answer was dermatomyositis

150.

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.

drsjGuestwhat's the benefit of the double blind study.

155.

what to give in nausea in chemotherapy.

156.

what to give for a pt who recieved morphine and developed nausea.

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.

was there an answer hypochondiosis.

160.

there was a question in haematology which i can't recall please help in which there was an option
bruises.

161.

in a healthy man which lung function test will deteriorate.

162.

in old people was the answer poor compliance of peipheral arterioles.

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.

166.

when to take simvastatin answer needed please.

167.

asian woman with hypocalceamia:subcutaneous synthesis failure,excessive phytate ingestion,low

intake or skin pigmentation.

168.

a woman with amobiosis what to do was it liver ultrasound.

169.

HIV and bloody diarrhoea was it cryptococcus.

170.

i think in haematology it was factor 2 defieciency because pt and aptt were normal.

171.

i think in pulmonary embolism v/q scan.

172.

wat's the contraindication for oral contraception.

173.

how to follow up mitral stenosis was it meauring the pulmonary artery pressure.

174.

severity of aortic stensis was it inauduble aortic second heart sound.

175.

was there an answer SIADH in a woman with cough and distress.

176.

in non invasive ressucitation of a pt with COPD what's the benefit was reduced need for tracheal
intubatin.

177.

was there an answer basilar migraine.

178.

what the ansewer for that pt who was told not to throw stones if your house is made of glass.

179.

what's the accuracy 92%.

180.

which test afeected by sample size was it SEM.

181.

which test to use i answered mann whitney test i think it's wrong though.

182.

what to do in a woman with leg ulcer i answered tight bandage.

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

186.

aedos

187.

AIPPG Fresher

188.
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Joined: 07 Sep 2006

191.

Posts: 3

192.

Location: saudi arabia

193.

191 Credits

194.

[ Donate ]

195.

[ Modify aedos's Cash ]

196.
197.

Posted: Wed May 16, 2007 7:44 am Post subject: MRCP 1 UK may 15 exam how was it??

198.
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--------------------------------------------------------------------------------

200.
201.

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

203.

which compliment component deficiency predisposes to meningococal meningitis----c1,c2,c6 and

properdin and some thing else

204.

vsd lady planning to get pregnant

205.

however the paper was generally much easier than january exam

206.

will post some more if remeber

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guest88

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Posted: Thu May 17, 2007 6:17 pm Post subject:

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the answer for question with recurrent meningitis is properdin

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Guest

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Posted: Thu May 17, 2007 8:24 pm Post subject:

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246.

no it was c6 def, because both the AH50 and CH50 were 0

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252.
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aedos

254.

AIPPG Fresher

255.
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257.

Joined: 07 Sep 2006

258.

Posts: 3

259.

Location: saudi arabia

260.

191 Credits

261.

[ Donate ]

262.

[ Modify aedos's Cash ]

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264.

Posted: Fri May 18, 2007 3:07 am Post subject:

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yeah some more questions

269.

one in which serial stool weight was given

270.

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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Posted: Fri May 18, 2007 3:49 am Post subject:

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288.
289.

helloo gust 88

290.

actually this is my second tim in this exam but i get frustrated

291.

those ppls why they are doing this ? exam should be balanced ? any way i wolud like to forget all of
this

292.

i dlike to ask u how did u find the exam as regard ur previous entry?

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298.
299.

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.
311.

What is reverse transcriptinase

312.

Moa of clopidogrel

313.

Radical prostate ca, chances of sec malignayc in next 10 yrs

314.

Pt with hepatic pain, ca, high dose opioids given, what to give next

315.

Pt with OA, what to give, paracetamol

316.

Pt with epilepsy, with peripheral neuropathy, which drug_ phenytoin

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.

Rx of multifical atrial tachycardia---

321.

Girl with Hb 9, grnad father with colonic Ca, what to do with her? Gastrocscopy+duodenal apspira?

322.

Pt with weight gain, sweating.insulinoma

323.

Urine d/r shows protein, blood, HTN what to do,renal biopsy

324.

Female with partner diagnosed as Chlamydia, she taken samples for neisseria, Chlamydia, what to give
her.acyclovir + Chlamydia

325.

Pt with coronary angioplasty done be4, gets SOB on lying down----LVF

326.

ABG.was it uncompensated respiratory acidosis?

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.

Female with median neuropathy?

332.

Which indicates CPA tumor==== loss of cornela reflex

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.

Qs about raised Trop I,,,,,I answered it pul embolism

339.

One qs about fever, I answered it sub acute bacterial endocarditos

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.

Moa of polyethylene glycol, case was pt has chronic constipation

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.

Case of syringomyelia---wasting of hand muscles?

350.

What will happen in pt with coaciane abuse-----cardiac pain(ischemia)_????

351.

Pt with Parkinson, on cabergoline, mild tremor, severe akinesia..what to give---co carbedopa????

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.

which compliment component deficiency predisposes to meningococal meningitis----c1,c2,c6 and

properdin and some thing else I think it was C6?????

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.

m of action of bisphosphonate ---apoptosis of osteoclasts

361.

side effect of bisphosphonate... oesophagitis

362.

R Arthritis... lung complcation..... interstitial lung disease

363.

Gout, a post surgical patient on diuretic, devolped genrized arthriti

364.

CREST.... antibodies present Anti centromere

365.

A question from dermatomyositis

366.

Endocarditis.. ECG changes.... st segment elevation

367.

From where the cardiac myoxoma arise... left atrium

368.

Two question from Carcinoid tumour

369.

Lyme disease

370.

Acanthosis nigricans.... association hypothyroidism or was it Ca stomach? I think it was hypothyroidm

since the age was around 20 yrs or sodamn it~

371.

shin lesion with talengectasia... diabetic libadicourm

372.

a pt presented with moter complication after his father deat.... conversion disorder ???

373.

there was a question from phobic disorder

374.

Two questions from hypoparathyrodism

375.

polycystic ovarian syndrome

376.

crohn disease.... feature

377.

pontine stroke

378.

pariatal lobe lesion ... viusal field changes

379.

a pt with pigmenation on palms and sole and genital ulcer... syphills invistagaion

380.

downbeat nystagmus.... Arnold chaire malformation

381.

cluster headach , medication for pain not responding to diclofinic.. sumatriptan

382.

a pt developed seizures post delivery... cortical thrombophlebitis

383.

drug used for chemotherapy induced nausea... odensetro

384.

a pt with gain cell arthritis.. treatment.. prednislone

385.

a pt with type 1 tubular acidosis.. complication... nephrocalcinosis

386.

the site of portion of nephoron where thiazide diurtic acts.. proximal convulted tubule

387.

wait... i will post more latter on

388.

hx of menorrhagia an hx of menorrhagia in her ..diagnosis von willbrand dis///

389.

pt. with haemocromatosis and DM how to follow up him....hb...pcv...HbA1c...ferritin...iron?

390.

p---+low ca++and hiPTH/......1ry hyperparathyroidism...

391.

1.when to get a right hb1ac reading

392.

2wweks, 2months ,90days ,6months

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.

a she should continue to work in hospital

399.

b her titer should be checked

400.

c she should not work with immunocompermised pts4.

401.

402.
403.
404.

pt with difuse retinal hemorrhages----retinal vein thrombosis

405.

-pt can speak well, but u cannot undertsand him comprehension...??? temporal lobe lesion?

406.

-pt with lower homo quad--- parietal lobe

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.

- confirmatory diagnosis for PE----pul angio

410.

- pt taking warfarin, diagnosed as TB, started on ATT, inr raised...cause---isoniazid

411.
412.

- was there a q's about Peutz jegher's.....( autosomal dominant?)

413.

- was there a case about celiac disease?

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.

- also q's on common peronal nerve palsy..right?

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

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Posted: Fri May 18, 2007 3:02 pm Post subject:

456.
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458.
459.

Here are all the dermatalogy mcqs

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.

i will post unit by unit later on thanksGuest, May 18, 2007#12

469.

GuestGuestguest88

470.

Guest

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474.
475.

476.
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Posted: Thu May 17, 2007 5:21 pm Post subject:

478.
479.

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480.
481.

m of action of bisphosphonate

482.

side effect of bisphosphonate... oesophagitis

483.

R Arthritis... lung complcation..... interstitial lung disease

484.

Gout, a post surgical patient on diuretic, devolped genrized arthritis

485.

CREST.... antibodies present Anti co

486.

A question from dermatomyositis

487.

Endocarditis.. ECG changes....

488.

From where the cardiac myoxoma arise... left atrium

489.

Two question from Carcinoid tumour

490.

Lyme disease

491.

Acanthosis nigricans.... association hypothyroidism

492.

shin lesion with talengectasia... diabetic libadicourm

493.

a pt presented with moter complication after his father deat.... conversion disorder

494.

there was a question from phobic disorder

495.

Two questions from hypoparathyrodism

496.

polycystic ovarian syndrome

497.

crohn disease.... feature

498.

pontine stroke

499.

pariatal lobe lesion ... viusal field changes

500.

a pt with pigmenation on palms and sole and genital ulcer... syphills invistagaion

501.

downbeat nystagmus.... Arnold chaire malformation

502.

cluster headach , medication for pain not responding to diclofinic.. sumatriptan

503.

a pt developed seizures post delivery... cortical thrombophlebitis

504.

drug used for chemotherapy induced nausea... odensetro

505.

a pt with gain cell arthritis.. treatment.. prednislone

506.

a pt with type 1 tubular acidosis.. complication... nephrocalcinosis

507.

the site of portion of nephoron where thiazide diurtic acts.. proximal convulted tubule

508.

wait... i will post more latter onGuest, May 18, 2007#13

509.

vikesGuest11. a nurse just back from spain with features of sle

510.

511.

canca

512.

crp

513.

lymphopenia

514.

neutrophilia

515.

eiosinphiliavikes, May 18, 2007#14

516.

Kris.Guestpt having tremors after salbutamol and theophilline????

517.
518.

lead poisonimg urine findings???

519.
520.

one was b/w milkalkali or vitd intoxication

521.
522.

a pt with azospermia andheight what test testicular biopsy,karyotype,genetic test??

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.

another q on doble blind control test.....elimination of bias

529.
530.

a question on pt having falls after laughing?/ cataplexy

531.
532.

how to detect antibody// elisa, imunocytology>..............Kris., May 19, 2007#15

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.

when 2 give iia3b in m.i pt

537.
538.

actyl choline receptor question??/

539.
540.

think i wrote karyotyping for the azospermia case

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.

Al khaja.Guest1-Commenest antibiotics to cause Vancomycine resisited bacteria,ans cefuroxime.

547.
548.

2-how to manage warfarin over dose, a case of adult presenting with hematemesis and INR 10.

549.
550.

3-case of microcytic anemia and low folate, ans coeliac disease.

551.
552.

4-lady with exertional SOB, old Hx of uvitits, presentig with extensor skin lesion, ans sarcoidosis.

553.
554.

5-case of HIV with P.carini, how to diagnose, ans BAL

555.
556.

6-hep B serolgy which on first detected, ans HepBsAg

557.
558.

7-mode of inheritance of heridatory hemorrahgic telangictasia, ans Autosomal Dominant.

559.
560.

8-case of COPD suspect PE which inv, ans pulm angiography.

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.

11-how to R/O UC, Ins normal small bowel barium enema.

567.
568.

12-case discribing pyoderma gang, what treatment, ans prednisolone.

569.
570.

13-acute asthma, given o2,salbutamole and prednisolon, what next, ans Mg

571.
572.

14-goserline in prostate cancer MOA,ans neg feed back

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.

-how to R/O UC, Ins normal small bowel barium enema.

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.

1-case of anorexia nervousa would be involved in which activity, ans purging.

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.

4-CREST syndrome what to expect, joint erosion or pulm htn,,,

587.
588.

5-young pt with joint pain and rash ans still disease.

589.
590.

6-cause of death in pt on haemodialysis, ans corornary heart disease.

591.
592.

7-commonest presentation of myelofibrosis, ans fatigue.

593.
594.

8- elderly with blood pict of leukemia, ans CLL ( I cant remeber the case properly)

595.
596.

9-T-cell def predisposes to which infection, ans....

597.
598.

10-case of low FEV &FVC slightly improved after nebuliser, dx? ans COPD

599.
600.

11- another case of low FEV& FVC reducred KCO

601.

Dx, I answered emphysemia (I think i might be wrong)

602.
603.

12- a man with COPD presenting with PE how to confirm it ans Pulm Angipraphy

604.
605.

13-elderly with urinary sx and backache Dx pagets disease.

606.
607.

14-Which one gose up when GFR falls belw 30 ans Vit D

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.

-Al khaja., May 19, 2007#17

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.

3. BMI, HEART RATE is related by correlation regression(The y=mx+c graph)

626.
627.

4. CKD osteodystrophy is due to lack of 1,25-Vit D. Phosphate raise after that.

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.

13. The site of action of thiazide is proximal part of DCT.

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.

16. Lead poison shows urinary porpyrin( case of PCT)

652.
653.

17. Aging will increase lung compliance just like emphysema.

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.

19. CREST -Pulmonary HPT

659.

20. R/O UC with barium studies?. UC can also cause terminal ileitis.Guest, May 19, 2007#19

660.

mazharGuestsimvastatin to be given when?

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.

mazharGuestwarfarin treatment which factor reduced?

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.

GuestGuest1.Treatment for pyoderma gangrenosum ?

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.

2. Diabetic pt with dyspepsia . Side effect of ?.Ans.. Metformin

677.
678.

3. Medication that is contraindicated in pt with LV systolic dysfunction. Ans ..Isosorbide mononitrate?

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.

3. BMI, HEART RATE is related by correlation regression(The y=mx+c graph)

694.
695.

4. CKD osteodystrophy is due to lack of 1,25-Vit D. Phosphate raise after that.

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.

13. The site of action of thiazide is proximal part of DCT.

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.

16. Lead poison shows urinary porpyrin( case of PCT)

720.
721.

17. Aging will increase lung compliance just like emphysema.

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.

19. CREST -Pulmonary HPT

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.

2. Diabetic pt with dyspepsia . Side effect of ?.Ans.. Metformin

732.
733.

3. Medication that is contraindicated in pt with LV systolic dysfunction. Ans ..Isosorbide mononitrate?

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.

7. Test for effectiveness of venesection in pt w haemochromatosis. Ans ? serum ferritin

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.

medication contraindicated lv dysfn-dilzem

751.

left eye ptosis,miosis-carotid angio

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.

Dr.LatikaGuestampicillin allergy- vancomycin [source aha guidelines]

759.

pinch nerve-ulnar

760.

chlamydia/urethritis-swab review one week [ohcm]

761.

lead poisoning -coproprphyrin is correct

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.

-i think for the HbAlc , the ans is 3 months

765.

- ampicillin allergy, its surely clindamycin~ repeat question..also present in onexaminationDr.Latika,

May 20, 2007#29

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.

Dr.kashGuesta pt having tremors after salbutamol and theophilline????

768.
769.

lead poisonimg urine findings???

770.
771.

one was b/w milkalkali or vitd intoxication

772.
773.

a pt with azospermia andheight what test testicular biopsy,karyotype,genetic test??

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.

another q on doble blind control test.....elimination of bias

780.
781.

a question on pt having falls after laughing?/ cataplexy

782.
783.

how to detect antibody// elisa, imunocytology>..............Dr.kash, May 20, 2007#31

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.

when 2 give iia3b in m.i pt

788.
789.
790.
791.

actyl choline receptor question??

792.
793.

sorry having a headache due to fear of failing will post more latterDr.kash, May 20, 2007#32

794.

DLCGuest1-Commenest antibiotics to cause Vancomycine resisited bacteria,ans cefuroxime.

795.
796.

2-how to manage warfarin over dose, a case of adult presenting with hematemesis and INR 10.

797.
798.

3-case of microcytic anemia and low folate, ans coeliac disease.

799.
800.

4-lady with exertional SOB, old Hx of uvitits, presentig with extensor skin lesion, ans sarcoidosis.

801.
802.

5-case of HIV with P.carini, how to diagnose, ans BAL

803.
804.

6-hep B serolgy which on first detected, ans HepBsAg

805.
806.

7-mode of inheritance of heridatory hemorrahgic telangictasia, ans Autosomal Dominant.

807.
808.

8-case of COPD suspect PE which inv, ans pulm angiography.

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.

11-how to R/O UC, Ins normal small bowel barium enema.

815.
816.

12-case discribing pyoderma gang, what treatment, ans prednisolone.

817.
818.

13-acute asthma, given o2,salbutamole and prednisolon, what next, ans Mg

819.
820.

14-goserline in prostate cancer MOA,ans neg feed back

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.

18-how to R/O UC, Ins normal small bowel barium enema.

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.

GuestGuestassociations of acanthosis , why can't it be diabetes???

831.
832.

post transplant patient with donor cmv ... gangciclovir or pred???Guest, May 22, 2007#36

833.

GuestGuest1)Granisetron is used for chemotherapy induced vomitting

834.
835.

2)the answer for statistics questions

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.

3)Alendronate(Bisphonates) cause reflux oesophagitis.

839.
840.

4)Ataxia,neuropathy,lymphadenopathy: due to phenytoin.

841.
842.

5)Haemodialysis less effective if low volume of distribution .

843.
844.

6)Oral contraceptive contraindicated in Migraine with focal aura...i think many wrote obesity.

845.
846.

7)Zumatriptan for Migraine

847.
848.

8)C6 Deficiency leads to repeated Neisseria infections( we had a option of C5-C9)

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.

10)Thiazides precipitate gout.

853.
854.

Hope this were useful......

855.
856.

We need to post more...commom evryone....Guest, May 23, 2007#37

857.

GuestGuestHow to monitor the effectiveness of venesection in Haemochromatosis?

858.

Referred hematology guidelines but got no clear answer..the ans is btw transferrin or ferritin

859.
860.

Pt with resting hand and head nodding.Rx...Ans Propranolol

861.
862.

One question on carrier rate of an ? AR disease ( Ans 1:2)

863.
864.

ABG results ? Mixed Met ans Resp Alkalosis

865.
866.

Good prognostic factor in Acute Leukemia.

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.

GuestGuestDiabetic pt with visual lost ...? MaculopathyGuest, May 23, 2007#40

871.

guest ukGuestThe answer of Asssociation of Acanthosis nigrancans .... is Hypothyrodism, because it

was given that , A young femal obese patient, and hypothyrodism does run with out being notice by
young obese female,...guest uk, May 23, 2007#41

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.

5ht1 agonistsfor acute atack: sumatriptan,zumatriptan,ergotamine

877.

5ht2 antagonists for prophylaxis: pizotifen,methyergideGuest, May 23, 2007#42

878.

GuestGuestreply to medsri question

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.

1) Hereditary Haemorrhagic telengectasia:Autosomal dominant

884.
885.

2)Trihexiphenydyl(benzehexol) for parinsonian tremor

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.

GuestGuestmore posts needed...

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.

In Tuberous sclerosis, Renal involvement is usually manifested by angiomyolipomas

897.

Ref: Emedicine

898.
899.

2)Melanosis coli Na picosulphate

900.
901.

3)GOSERLIN hormone antagonist

902.
903.

4) High risk HOCM septal thickness

904.
905.

5) Distal RTA Nephrocalcinosis

906.
907.

6) Gr +ve bacilli meningitis LISTERIA

908.
909.

7) Acromegaly sweat gland hypertrophy

910.
911.
912.

8) severe Mitral stenosis

913.

9) severe Aortic stenosis

914.
915.

10)HBA1c measurement after blood transfusion WHEN????

916.
917.

11) MIGRAINE 2nd line ttt acute attack triptans

918.
919.

12) Anti RNP Mixed connective tissue disease

920.
921.

13) TTT asthma in Pregnancy 2nd line Beclometasone

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.

GuestGuest1) Melanosis coli is caused by laxative senna(anthroquinone group of laxatives)which also

include cascara sagrada)...refernce K.D TRIPATHI...Pharmacology...page n0.613....5th edition

2.
3.

2)Severity of Aaortic stenosis...following features indicate it.

4.

a)symptoms of syncope or LVF

5.

b)presence of S4

6.

c)soft single S2 or parodoxically split A2

7.

d)late peaking of long murmur

8.

e)valve area less than 0.5 sq cm on echo

9.

f)presence of precordial thrill..these are all the features...ref..karla

10.
11.

In exam the option was presence of S4.

12.
13.

3) i am sure there was a question regarding kdney angiomyolipoma...the answer was tuberous sclerosis.

14.
15.
16.

4) there was question with the features..calcinosis,raynauds,eosphageal

dysmotility,sclerodactyly,telengiectasia...which antibody....anti centromere.......Guest, May 25, 2007#52

17.

GuestGuest1)Post delivery..there was a case of cortical thromophlebitis

18.
19.

2)Parietal lobe feature:inferior homonymous quantropia

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.

5)Osteoarthritis: frst drug to be used is paracetomolGuest, May 25, 2007#53

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.

DOC-KASHGuestYAR I THINK THERE ARE TWO PAPERS WHICH HAVE ABOUT 6

QUESTIONS DIFFRENT.THIS I GOT TO KNOW ON THE EXAM DAYDOC-KASH, May 25, 2007
#55

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.

GuestGuest1)Myelofibroisresenting symptom is fatigue(lasstitude)

35.
36.

2)HIV....watery diarrhoea:cryptosporidium

37.

Bloody diarrhoea:cytomegalovirus

38.
39.

3)patient with weight gain,sweating:insulinoma

40.
41.

4)patient with past history of angioplasty done,Patient gets breathlessness on lying down: LVFailure

42.
43.

5)there was one answer of uncompensated respiratory acidosis

44.
45.

6)lower zone fibrosis question:asbestosis

46.
47.

7)a case of recurrent DVT,antiphospholipid syndrome: Life long warfarin

48.
49.

If first attack: then 6 months warfarin

50.
51.

8)SLE associated with lymphopenia

52.
53.

9)Patient with azoospermia,do karyotyping

54.
55.

10)Patient having falls after laughing(emotional): CataplexyGuest, May 28, 2007#59

56.

GuestGuestdrug to increasing HDL

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.

guest ukGuestsorry ,on 11th of june,guest uk, Jun 3, 2007#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.

kindly post ur question with answers after result declared

69.
70.

thanxeafreen, Jun 6, 2007#64

71.

GuestGuestyes best of luck for allGuest, Jun 7, 2007#65

72.

GuestGuestfriends

73.

result is expected tommorow

74.

May Allah Pass us all

75.

AmeenGuest, Jun 10, 2007#66

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.

GuestGuestresults are ready in the siteGuest, Jun 11, 2007#72

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.

guest u kGuestThanks God, i passedguest u k, Jun 11, 2007#79

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.

GuestGuestpass marks r 62.05

96.

i got 60.95

97.

Allah malik haiGuest, Jun 11, 2007#86

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.

Good luck to everyonevikes, Jun 11, 2007#91

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.

the royal college is really making this a HIGH STANDARD exam.

116.
117.

ok. back to mcqs again.Guest, Jun 11, 2007#92

118.

GuestGuestI passed, but only just

119.

I got the exact pass mark 62.05%

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.

I passed with 77.44%

127.
128.
129.
130.

See you ...Guest, Jun 12, 2007#94

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.

vikesGuesti am not sure.

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.

so nice of all those who reply

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.

food allergy in woman who had pruritis?

3.

verapamil C/I in VTGuest, Jan 21, 2009#51

4.

GuestGuestpatient on inhaler- add salmeterol?

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.

GuestGuestJan 2009 cardiology questions

11.
12.

Salamo alekom everybody,

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.

2- Investigation 4 HOCM is--> TTE.

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.

7- Young athlete died during sport, most likely--> HOCM.

23.

8- Reversed splitting of S2 --> LBBB.

24.

9- Most important factor in assessment for aortic valve replacemnt-->symptomatic pt.

25.

10- VT, which drug is CI --> Verapmil.

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.

16- Long QT syndrome --> K channelGuest, Jan 22, 2009#53

31.

dr AGuesthi every one ...dr_osler

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.

dr AGuesta large cannon A wave on jvp...wat the ecg will show ?

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.

also was the crescentic glomerulonephritis antimyeloproliferative Abs?

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.

GuestGuestSee also MANAGEMENT OF THE DENTAL PATIENT ON WARFARIN on googleGuest,

Jan 22, 2009#58

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.

28%?mrcp0235, Jan 22, 2009#59

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.

Dr A u r doing really well...i appriciate your effortsburningice, Jan 22, 2009#61

58.

burningiceGuestdr osler

59.

y u think that long QT is k blockade

60.

procainamide blocks Na amiodaron blocks K but it blocks Na as well..

61.

n there are too many types of Long QT and too many MA

62.

so its really confusing

63.

i ans Na blockburningice, Jan 22, 2009#62

64.

dr AGuestconfirmd from an EMJ journal ... intradermal injection of adrenaline ...injection of

phentolamine is the treatment of choice to overcome digital ischemia and paindr A, Jan 22, 2009#63

65.

Dr M EGuestMRCP1 Jan 09

66.
67.

Hi all

68.
69.

- pt declined ventilation....antibiotic alone

70.

- urinary incon + dementia....normal pressure hydrocephalus

71.

- Reverse transcripta...DNA from RNA

72.

- old chap...transient amnesia

73.

- high anion gap...methanol poisoning..?

74.

- pain for 6 month + kyposis...? myeloma ? mets lung

75.

-FEV1 improved....empysema

76.

- 1st organ hypoxia...? renal

77.

- phaechromocytoma...phenoxybenzamine

78.

- lady with headache + loss of vision...giant cell art

79.

- sensory level....not sure ? meningoma ? tabes dorsalis ??? plz advice

80.

- alternative antiepileptic...lamotrigine

81.

- ankylosing sp....increase lumbar lordosis..?

82.

- homonomys homonopia....occipital lesion

83.
84.

lets be more active and share more questions...Dr M E, Jan 22, 2009#64

85.

GuestGuest1.pregnancy: avoid cipro

86.

2.pale disc: cholesterol emboli

87.

3.ALL: <20 yrs

88.

4.HOCM: TOE

89.

5.recurrent ulcers: gastrin level

90.

6.firm thyroid: i2 def/hashimoto

91.

7.NSAIDs renal injury: papillary necrosis?

92.

8.post splenectomy: pneumovax

93.

9.anti Ro: congenital heart

94.

10.heliotropic rash/dermatomyositis: wht other feature will be present?

95.

11.pupil reacting to accomodation, not to light: Argyll Robertson

96.

12.dementia,urinary incontinence: normal pressure hydrocephalus

97.

13.schizophrenia: concrete thinking

98.

15.tremors in old lady: Rx? Propanolol? (essential?)

99.

16.Blisters : Bullous Pemphigoid

100.

16.Areas not tanned: P Versicolor

101.

17.Itchy lesions over extensor surface: ? antibody(not antigliadin as bowel habits N)

102.

18.AS surgery indication : LVH?

103.

19.Back pain following pacemaker: Staph discitis

104.

20.Typical finding of Aortic disection: pericardial rub?

105.

21.Crescent GN: antimyeloperoxidase

106.

23.Woman with difficulty to solids/liquids: Achlasia

107.

24.Suicidal attempt and hearing voices: Psychotic depression

108.

25.suddent onset of confusion for few hrs/normal after: Global Amnesia?

109.

26.Base of thumb and 1st carpomatacarpal jnt tenderness: OA/scaphoid Avas Nec.

110.

27.After Hb Vaccine: monitor HbsAb

111.

28.Dark urine after 4 wks return from Africa: Hep A

112.

29.High Alk Phos with normal Ca/Phos: Pagets

113.

31.HIV diarrhoea not responding to Abx: Cryptosporodium

114.

32.HIV, brain attenuation lesions: progressive myelo/ Toxo

115.

33.TCA tox. : Bicarb.

116.

34.Most common lesion in asbestos factory worker: some pleural calicification

117.

35.MALT: H. Pylori eradication

118.

36.C. Diff. : after cephalosporin

119.

37.Pseudomonas in C. Fibrosis: Cefotaxime/Pip. Tazo ?

120.

38.long standing RA/ renal impairment : Renal Biopsy

121.

39.HUS : E. Coli 0157

122.

40.SLE: Membranous

123.

41.Huntington: Anticipation

124.

42.Peutz Jehger: AD

125.

43.BNP: decrease renin/aldo

126.

44.Spironolactone: distal tubule

127.

45.QT prologation: Ca blockade? (same in Hypocalcemia)

128.

46.VT contraindication : Adenosine?

129.

47.Megaloblastic after gastric resection: small bowel bacterial overgrowth

130.

48.Recurrent hemoptysis in 20 something man : FB?

131.

49.indicator pointing towards SIADH: collapsed upper lung lobe

132.

50.Haliotosis/recurrent aspiration: Surgical resection

133.

51.incidental finding of pericardial effusion: Mantoux

134.

52.Knee pain, WBC normal: Joint aspiration

135.

53.Pain in knee, loss of ankle reflex, sensory loss lat margin: Disc Prolapse L4/5?

136.

54.Sensory loss lower limbs/gait disturbance in alc. : Subacute Degen. of cord

137.

55.Indicator for DM ulcer: previous ulcer

138.

56.Hip pain after Chemo: Avas. Necrosis

139.

57.Hemophilic % of daughters in hemophilic father/carrier mom: 50%

140.

58.Worst prognosis: Follicular with mets or Anaplastic

141.

59.Girl with HA, raised protein/ Lympho : Viral?

142.

60.Man with left arm pain, no biceps, triceps reflex: Myelitis/C5/6 disc herniation

143.

61.Pt on OCP/alt. for Valporate: Lamotrigzine (not inducer)

144.

62.Test before initiating anti TB meds: LFTs

145.

63.On warfarin, INR decreaseInducer: Rifampicin

146.

64.Polyuria/Polydipsia girl, Posm:300, Uosm:200: DI/Psychogenic

147.

65.Man seeing him out of his body: Dissociative

148.

66.Man with 3rd person hallucinations and -ve syptoms: Schizophrenia

149.

67.Itchy rash on buttocks, Africa: Dranuclosis?

150.

68.Itchy rach on extensor surface: immunoflorescense

151.

69.Maxillary Nerve: F. Ovale

152.

70.Oesophagal erosions/villous blunting: NSAIDs use?

153.

71.Melena, upper GI endocopy -ve, next step: Colonoscopy

154.

72.Anemia,spherocytosis: osmotic fragility

155.

73.Cortisol excess, initial investigation: SST

156.

74.pt with asthma awaking him from sleep: double the steroid

157.

75.Metformin action: also useful with no pancreatic islet fn.

158.

76.pt with low FEV1/FVC, after nebs FVC improves but not FEV1: Emphysema

159.

77.pt with senile atrophy of brain: Donepezil

160.

78.Pt with urinary incontinence: anticholenergic

161.

79.pt with urinary retention after change of meds, culprit? : doxazosin?

162.

80.meds for pheochromocytoma: phenoxybenzamine

163.

81.meds for accidental adrenaline injection: Labetolol(nonselective)

164.

82.pt with overdose of diazepam and alc., LFTs high, cause: paracetamol ingestion

165.

83.Prognostic factor in paracetamol poisning : increased PT

166.

84.HTN pt with lots of SE, next : Minoxidil?

167.

85.alpha1 antitrypsin low: ZZ?

168.

86.acromegaly diagnosis: low GH post GTT

169.

87.anorexic refeed: hypophos.

170.

88.monoclonal spike, IgG raised: Waldenstorm?

171.

90.dental extraction , on warfarin: no change?

172.

91.ST elevation and inversion in V1-6 and inf. leads: 100% rt artery occlusion?

173.

92.loading dose of digoxin: distribution, (half life in maintainance dose)

174.

93.mech of thiazide diuretics: increase K to distal tubule?

175.

94.pt with HTN, low K, normal Na: abdominal MRI

176.

95. HTN, rt kidney:6 cm, left normal: Angiography

177.

96. HTN, both kidney same size: biopsy

178.

97. old F with high fever, cough and diarrhoea: legionella

179.

98. painless hematuria, renal USG normal, next: Cystoscopy

180.

99. Imatinib: inhibits Tyrosine kinase

181.

100. man has special powers to save children: hypomania

182.

101. alcoholic aggressive and thinks docs want to kill him: DT

183.

102. most likely feature of alcohol withdrawl: pt seeing dog by bedside

184.

103. if cut off goes up what increases: specificity?

185.

104/05. compare 2 diff. means: t-test/chi square/man whitney

186.

106. splenomegaly in CML, wht else? : Hepatomegaly

187.

107. Colostomy site ulcer: pyoderma/dermatitis artefacta?

188.

108. Good prognosis in endocarditis: S. Viridians (SABE)

189.

109. antibody in Goodspasture(man with hematuria and hemoptysis) : ?

190.

110. mouth ulcer, arthritis, SLE type symptoms: Bechets

191.

111. b/l leg pain, double incontinence: cauda equina

192.

112. LFTs high, ascites, Urea/Creat: high: Hepatorenal Synd.

193.

113. man with rt lobar consolidation 3 wks after d/c from hospital: Gm +ve (CAP)

194.

114. Hemoptysis, Upper lobe lesion : ABPA

195.

115. pt refusing intubation, cant tolerate ventilation, now confused, next: proceed with ventilation(
hasnt refused this, has he? )

196.

117. o2 gradient diff. in SVc and left ventricle: ASD?

197.

118. pt with bone pain sec. to mets, on morphine and drowsy, next: reduce morphine, add steroids/ or
amytryptiline?

198.

119. pt getting recurrent calcium stones: add HCTZ

199.

120. honey crusted lesions in girl : Impetigo

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.

123. Regular cannon waves : Vent. Bigeminy

203.

124. Pt with diarrhoea, stool 0 on day 2, normal thereafter: Laxative abuse

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.

128. Pt after angio, urea/creat. V. high + bruit : ATN

208.

129. new LBBB : reverse fixed splitting?

209.

130 : VT, CI drug : Verapamil?

210.

131. post MI, pain and murmur radiating to axilla : pap. Muscle rupture

211.

132. High anion gap : Methanol poisoning

212.

133. Lady with HA and sudden loss of vision : Giant cell

213.

134. pt with ank. Spondilysis : pain on SLR (sacroilits)

214.

135. bitemp. Homonymous hemianopia : optic chiasma

215.

136. MRSA prevention : wash hands/ wear gown and masks?

216.
217.

lets compelete and discuss it guys. please add and no. it aswell. thanksGuest, Jan 22, 2009#65

218.

GuestGuestResults &Equating

219.

220.

Equating MRCP ( UK ) part 1 Examination

221.

Report candidates results using Equating

222.

What is equating ?

223.

What is response theory?Guest, Jan 22, 2009#66

224.
225.

138)hypertrichosis...porphyria cutanea tarda

226.

139)IgA raised with IgA n IgM normal ...Monoclonal gammopathy of udertermined significance

227.

140)AF ...flecainide

228.

141)post MI pain ... papillary muscle rupture

229.

142)focal segmental necrosis ..myeloperoxidase

230.

143)pin point pupil patient unconscious...pontine heamorrhage

231.

144)parital lobe ..acalculia

232.

145)new onswet of confusion in young gal ...herpes encephalitis

233.

146)old man with confusion for many weaks with some neurological signs ..chornic subdural
heamtoma ?

234.

147)noral anion gap with uretersigmoidostomy

235.

148menthol coz of raised anion gap

236.

149)osteoarthritis of the thumb

237.

150)archilis tendonitis .. phenytion ?

238.

151)nefidipine for gingival hypertrophy

239.

152)side effects after hypertensive drug ankle edema etc... ramipril

240.

153)concrete thinking

241.

154)primary billiary chirrosis

242.

155)paralysis .. GB syndrome

243.

156)multiple sclerosis

244.

157 membranous GN for SLE proteinuria

245.

158)bone marrow karyotyping for AML

246.

159)amphetamine causing schizophrenia

247.

160)long term oxygen therapy for COPD

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.

165)aneamia with combs postitive

253.

166)human derived immunoglobins for use in ITP ???dr A, Jan 22, 2009#67

254.

burningiceGuestcommon guys das really good effort

255.

Metformin.stop after MI(causes lactic acidosis)

256.

old lady-not essential tremor coz it was unchanged with acitivities-benzohexol

257.

Aortic disection-back pain

258.

Hiv brain...lecoencephalopathy....not toxo(ring lesion)

259.

asbestos...mesothelioma

260.

VT contra...verapamil

261.

pericardial rub....observe

262.

pt decline ventilayion.....withdraw all treatment(pastest same question)

263.

alpha-antitrypsin def....smoker PiSz....nonsmoker PiZZ(pastest same question)burningice, Jan 22, 2009

#68

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.

GuestGuestso is the answer SZ or ZZ for the alpha 1 anti trypsin question?

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.

so salmeterol is the answer..i thinkGuest, Jan 22, 2009#73

271.

GuestGuestcomplement deficincy in SLE is C4Guest, Jan 22, 2009#74

272.

GuestGuestThere is an article in NEJM regarding ankylosing spondylosis. one in 2008.

273.

(you can google it)

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.

anyones comments pls?Guest, Jan 22, 2009#76

282.

burningiceGuestthere is lot of confusion abt asthma treatment:

283.

as written on pastest i add antagonist montelukast

284.

according to pastest:first short acting..if not then add inhaled steroid

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.

dracunoculosis????? i ans stranglydosburningice, Jan 22, 2009#77

288.

burningiceGuesthe smoked 5 cigaretes in a day;;;so i think the ans was PiSzburningice, Jan 22, 2009
#78

289.

burningiceGuestmelanoma prognosis.....depth of the melanomaburningice, Jan 22, 2009#79

290.

burningiceGuest45 yr man osteoprosis.......check testosteronburningice, Jan 22, 2009#80

291.

GuestGuesthi guys

292.

i sat for the exam in london

293.

paper 2 really hard

294.

i've got some comments:

295.

gluteal rash is strongloidosis

296.

copd with respiratory failure: contact hospital lawyer

297.

asthma : give salmeterol as its long acting and wil cover him overnight

298.

aortic dissection : sign is hypertension

299.

ankylosing spondylitis: maybe trendelenberg?

300.

achilles rupture is ciprofloxacin

301.

HOCM transthoracic (no need for TOE)

302.

PUPIL : myotonic ouoil not argl robertson

303.

Hep after a visit to africa A???E??

304.

hemoptysis : foreign body

305.

macroscopic hematouria is IVU (cystoscopy is for MICROscopic hematouria)

306.
307.

i hope we all passGuest, Jan 22, 2009#81

308.

GuestGuestwas there a question where the answer was --- is present in micro molar concentrations...

309.

cant remembr the stem of it..Guest, Jan 22, 2009#82

310.

GuestGuestdoes anybody know the pass mark..

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.

burningiceGuestCOPD:stop all the treatment(its writen in pastest)

314.

Exam was tough..........Allah will help all of us

315.

and InshAllah we wll passburningice, Jan 22, 2009#84

316.

burningiceGuestyes pass score is 521

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.

GuestGuestRegarding the COPD question:

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.

GuestGuestwas it myoyonic pupil or argyll tobertosn pupil?

321.

it didnt say that the pupil ws irregularGuest, Jan 22, 2009#87

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.

GuestGuestquestion regarding TNF alpha, present in macromolar concentration or acts in a paracrine

fashion?Guest, Jan 22, 2009#92

328.

GuestGuestdoesnt TNF alpha act in endocrine and systemic fassion?Guest, Jan 23, 2009#93

329.

Guest56GuestGluteal Itch!

330.
331.

The gluteal itch was definitely the swimmers itch of schistosomiasis!

332.
333.

The pupil was myotonic Holmes Adie- for the reason someone gave before, the pupil was dilated.
Guest56, Jan 23, 2009#94

334.

GuestGuestmode of action of epirubicin.... intercalating in DNA

335.

Pt with burkitts developed confusion and muscle cramps 24 hrs after chemo..... TLS

336.

gene of heamochromatosis.......HFEGuest, Jan 23, 2009#95

337.

LeenaGuestJan 2009 MRCP questions I recalled

338.
339.

1. Allopurinol mode of action - Xanthine oxidase

340.

2. Patient with auditory hallusinations - concrete thinking

341.

3. Head tremor - ??? Proponalol

342.

4. Cognitive impairment which antibody - ??? Anti centromere antibody

343.

5. Patient admited with respiratory tract infection, chronic liver failure, poor prognostic feature - ???
Caput medusae

344.

6. Imitinab - MOA - Tyrosine kinase inhibitor

345.

7. TNF mode of action - ??? Specific cell receptors

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.

10. Increased anion gap Methonol poisioning

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.

13. Type 2 diabetes, renal failure, raised LFT hemochromatosis

352.

14. Renal faliure hypertension Losarton

353.

15. JVP raise 6 cm breast carcinoma took chemotherapy. Presented with SOB cause SVC
obstruction

354.

16. 18 year old golden crust lesions on chin rosasea

355.

17. Chlamydia treatment doxycyline

356.

18. Fifth month pregnant which anti biotic quadra indicated - ??? ciprofloxacin

357.

19. Trigeminal nerve - ??? foramen

358.

20. Blood film leuco erythroblasts . what clinical feature we expect - ??? answer please

359.

21. Large blisters what investigation skin biopsy

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.

drmunsGuestprolactin is the hormone which undergoes continuous inhibition.

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.

Page 3 of 11munsGuesthello everyone,hope u all did well on the exam

1.
2.

1.TCAs>>>>>>bicarbonates

3.

2.solid/liquid.........achalasia

4.

3.idiopathic parkinsonism.........asymmetrical tremors

5.

4.paget disease

6.

5.gingival hyperplasia............nifedipine

7.

6.peutz jegher...........autosomal dominant

8.

7.violaceous ulcer........p.ganger.

9.

8.MRSA.........hand washing

10.

9.imatinib..........tyrosin kinase

11.

10.change to naproxen and decrease morphine dose

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.

13.af to restore sinus rhythm.........flicainide

15.

14.tooth extraction..........continue warfarin

16.

15.high anion gap...........methanol

17.

16.pyschotic depression

18.

17.anticepation

19.

18.digoxin........half life??????

20.

19.INR of warfarin decreases.............rifampicin

21.

20.phaeochromocytoma.........phenoxybenzamine

22.

21.prognosis of paracetamol tox.......inc in prothrombin time

23.

22.drug to be avoided im MI........metformin(due to lactic acidosis)

24.

23.ct to VT.....verapamil

25.

24.xanthine oxidase....allopurinol

26.

25.oedema of the ankle....ramipril

27.

26.long QT.........k channel blochage

28.

27.pseudomembrane colitis........cipro

29.

28.avoided in pregnancy.....cipro

30.

29.erythropiotin......improved exercise tolerance

31.

31.investigation for HOCM........TTE

32.

32.hormone which undergoes continuous inhibition........prolactin

33.

34.

i will recall more questions.hope success to all en shaa allah muns, Jan 23, 2009#101

35.

GuestGuest32.pneumonia poor prognosis.........urea>7m.mol/l

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.

Dr IbnsinaGuest160 q from jan 2009

39.
40.

Salamo alekom every MRCPIAN

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.

2- Investigation 4 HOCM is TTE.

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.

7- Young athlete died during sport, most likely: HOCM.

52.

8- Reversed splitting of S2: LBBB.

53.

9- Most important factor in assessment for aortic valve replacemnt---symptomatic pt.

54.

10- VT, which drug is CI ... Verapmil.

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

the cause ...ASD.

58.

15- Predictor of Good prognosis in IE... Isolation of Sterpt. Viridans from Blood culture.

59.

16- Long QT syndrome... K channel blockade.

60.
61.

Basic science:

62.

1- Specificity

63.

2- Sensitivity.

64.

3- Chi square test

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.

4- Which invalidate t test...non normal distribution of data.

67.

5- Pts with very low levels of alpha(10%) anti trypsin ..genotype is ZZ.

68.

6- peutrz jegher is autosomal dominant.

69.

7- Metabolic acidosis with increased anion gap... methanol ingestion.

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.

13- Manifestation of hereditary appears earlier... Anticipation

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.

15- Reverse transcriptase ...DNA from RNA.

78.

16- Hypoxia causes VC in which circulation ....Pulmonary

79.

17- Latex allergy

80.

2- Worst prognostic factor for ALL .... t(9,22).

81.

3- splenectomy pt ...at risk of peumococi infection.

82.

4- 65 year with Aortic valve disease, presenting with pallor. CBC..Microcytic hypochromic anemia,
upper endoscopy normal. What is next...Colonoscopy.

83.

5- splenomegaly with leukodystrophic pic, what is associated... hepatomegaly, lymphadenopathy ......

84.

6- Most common disease causing recuurent 1st trimester abortion: APS, heterzygote factor5,
antithrombin deficiency.

85.

7- human derived immunoglobins for use in ITP

86.

8- AML, predictor for prognosisbone marrow karyotyping

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.

12- Auto-immune hemolytic anemia with cold agglutinin. NH lymphoma

91.
92.

Pharmacology:

93.

1- Na valproate alternative, pt on COCs ...lamotrigine, topiramate.

94.

2- digoxin loading dose depends on ..volume of distribution, half 1/2.

95.

3- Accidental injury with adrenaline ..phentolamine.

96.

4- Imatinib tyrosine kinase inhibitor.

97.

5- BNP inhibits renin anldesterone.

98.

6- A.B to avoid in pregnancyciprofloxacin

99.

7- pseudomembranous colitisce cause Cefuroxime.

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.

10- Chemotherapy induced Hematuria ... cyclophsphamide.

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.

13- spironolactone, site of action ... DCT. (jan. 2007)

105.

14- Mechanism of Hypokalemia in thiazide ...increase flow to distal tubules, opening of K channel in
principal cells?.

106.

15- warfarin with decreased INR ...rifampicin.

107.

16- gingival hyperplasia, PN, lymphadenopathy... phenytoin.

108.

17- Man on multiple drugs for lymphoma devolped DVT ... Thalidomide.

109.

18- Phaechromocytoma, initial treatment ...phenoxybenzamine

110.

19- Metformin...stop after MI(causes lactic acidosis)

111.

20- TCAs overdose >>>>>>bicarbonates.

112.

21- prognosis of paracetamol tox.......increase in prothrombin time.

113.

22- xanthine oxidase....allopurinol

114.

24- achilles rupture is ciprofloxacin

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.

2- Bronchietasis ... postural drainage.

119.

3- 50 year old man with history of TB from 10 year, presenting now with recent weight loss,
hempoptysis and lethargy.

120.

Serology : Aspergillus + , CXR: solid mass occupying the RT upper lobe

121.

Diagnosis: bronchial carcinoma, Aspergoilloma, Invasive aspergillosis.

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.

6- COPD mortality benefits long term oxygen therapy.

126.

7- Pneumonia poor prognosis.........urea>7m.mol

127.

8- Asyptomatic, with history of asbestos exposure calcified pleural plaque

128.
129.

Dermatology:

130.

1- IBD with violacious ulcer ...pyoderma gangrionosum.

131.

2- Red tender raised nodule with diarrhea, fever ... erythema nodusum.

132.

3- rosceasa.

133.

4- hypopigmented lesion on tanned skin with scaly surface pitrysis versicolour.

134.

5- hyperkeratotic plaques on the scalp, mycology ve ... psoriasis.

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.

8- hypertrichosis with blistering worse on summer...porphyria cutanea tarda.

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.

3- Rash at the gluteal region Dracunculiasis.

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.

7- Chlamydia treatment doxycyline.

147.

8- Staph aureus. Change to flucloxacillin.

148.
149.

Endocrine:

150.

1- Pt diabetic and bipolar....which drug coz SIADH .. carbamazepine.

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.

6) SIADH ... Collapsed upper lobe.

156.

7) C/P of Cushing, Ix ... Low dose dexamethasone suppression test.

157.

8) 45 yr man osteoprosis.......check testosterone.

158.

9) Hormone which undergoes continuous inhibition........prolactin.

159.

10) episodic sweating with weight gain.. insulinoma.

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.

7- SLE proteinuria..membranous GN.

167.

8- Recurrent stones with hyprercalciuria. Thiazide.

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.

2- LC with deteriorating condition, oliguria, increased creatinine ... Hepatorenal syndrome.

172.

3- Pt with longstanding RA on NSAID, complaining from epigastric pain endoscopy multiple

superficial gastric ulcer, mild villous atrophy, small increase in lymphocytes infiltration. What is the
cause... NSAID, chrons

173.

4- Hepatitis c patient... vaculitic lesions ...Cryoglobulinemia

174.

5) hep B vaccine ...monitor with HBV surface antibody.

175.

6) LC with worseneig jaundice, HBs AB +, all other negative ... previous HBV vaccination.

176.

7) Dysphagia to solid and liquids.Achalasia.

177.

8) Hepatitis after 4 week from a visit to north africa . HBV, HAV.

178.

9) Patient admited with respiratory tract infection, chronic liver failure, poor prognostic feature
Ascites, caput medusa, peripheral edema

179.

10) Type 2 diabetes, Joint pain, raised LFT . hemochromatosis

180.
181.

Rheumatology:-

182.

1- Young gay with mouth ulcers ,rash ,fever ...SLE

183.

2- Congenital heart block Anti Ro antibodies.

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.

4- 60 year old female with painful base of thumb ... osteoarthritis.

186.

5- Proximal muscle weakness, rash on the back, joint pain, CK 2500 dermatomyositis, SLE.

187.

6- Patient with arthritis ,Alopecia and mouth ulcers ... ANA.

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.

10- Ankylosing sp...Global restriction of movement .

192.

11- pt with long history of RA,low heamoglobin,low mCV but Normal MCHC, platelets 151....aneamia
of chronic disease

193.

12- Girdle pain with isolated rise in ALP Pagets disease.

194.

13- ANA isotype in SLE IgG, IgM, IgA ?!

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.

Diagnosis: Amyloid neuropaty

200.

3- Girl with fever and neck stifness and CSF picture: increased protein, normal Glucose,
Lymphocytosis. Diagnosis .... viral meningitis

201.

4- Sensory level at T10.... Dorsal meningoma, tabes dorsalis

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.

6- Dementia, urinary incontinence, unsteady gait . normal pressure hydrocephalus

204.

7- Tremors in old lady increase with movement with head nodding . Propranolol.

205.

8- what with Parkinsonism . Asymmetrical tremors.

206.

9- Old man with intermittent confusion for many weaks with some neurological signs..chornic subdural
heamtoma

207.

10- Parietal lobe ..acalculia

208.

11- Pin point pupil patient, unconscious...pontine hemorrhage

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

and sex. He took flouxetin as a mood stabilizer ...misuse of stimulant.

218.

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.

4- Transient global amnesia.

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.

6- Psychotic depression for another question

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.

10- Amphetamine causing schizophrenia.

226.

11- Man with episodic attack of derealizatoin lasting minutes Dissociative disorder Vs Non epileptic
seizure.

227.
228.

Ophthalmology:-

229.

1- Lady with headache + loss of vision...giant cell arteritis.

230.

2- homonomys homonopia....occipital lesion.Dr Ibnsina, Jan 23, 2009#104

231.

Dr IbnsinaGuestlets start with pseudomembranous colitis:

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.

welcome to any comment.Dr Ibnsina, Jan 23, 2009#105

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.

so the answer could be give Dex and reduce morphine??

243.
244.

and the other question about ventilation

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.

GuestGuest1.pt with ex TB had aspergilloma...(any previous site of Tb or abcess)

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.

Dr IbnsinaGuestWho should make an advance directive (living wills)?

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.

It is a valid legal document that cannot be over-ruled by family.

263.

It is not possible to request illegal action such as euthanasia.

264.

It is not possible to request interventions that the medical team regard as excessive and
inappropriate.

265.

It can be changed or revoked at any time if you are competent to do so.

266.

It must be signed, dated and witnessed.

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.

Dr IbnsinaGuest2- Davidson page 1030

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.

Relatives to sign informed consent for ventilation

279.

Relieve any respiratory distress with opiates or other respiratory suppressants Correct answer

280.

Ventilation without the patients permission

281.

Antibiotics but no ventilation

282.

Hydrocortisone but no ventilation

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.

thanx for all efforts and detailed explanations....

289.

Wish u Good luck..Guest, Jan 24, 2009#116

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.

GuestGuest45 yr man osteoprosis.......check testosterone.

296.
297.

for this question? what about thyroid funtions?

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.

GuestGuestosteoporosis is associated with hyperthyroidism not with hypothyroidism unless it is over

treated with thyroxine.(orphine toxcine)Guest, Jan 25, 2009#125

302.

Dr ZamanGuest1. Headache + visual field defect + hypotension dx: pituitary apoplexy

303.

2. Dementia + ataxia + incontinence + grasp reflex dx: normal pressure hydrocephalous

304.

3. Spastic paraparesis + sensory level at T10 dx: dorsal meningioma

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.

5. Regular cannon wave in JVP : junctional rythm

307.

6. Asthma on prn Beta agonist + 800 mc beclomethason + night symptom

308.

next step to add Salmeterol

309.

7. Alcoholic in hospital + visual hallucination (dogs) dx: acute

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.

GuestGuestregarding that question about osteprosis:there is no doubt about hyperthyroidism but

318.

if it is man then testosteron is most useful investigation...

319.

i ans bronchial carcinoma>>>

320.

foriegn body for 2 yrs???? there must be atelectas or collapse

321.

carcinoid>>>>there are no other signs..Guest, Jan 25, 2009#130

322.

GuestGuestcant it be bronchiectasis ?Guest, Jan 25, 2009#131

323.

GuestGuestyes lithium can cause SIADH (medicalmasterclass).Guest, Jan 25, 2009#132

324.

GuestGuestBronchial carcinoids are rare, slow-growing neuroendocrine tumors arising from bronchial
mucosa that affect patients in their 40s to 60s.

325.

(merck manual)Guest, Jan 25, 2009#133

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.

so cant it b alcohol withdrawal?Guest, Jan 25, 2009#135

333.

Dr ZamanGuestLithium rather causes nephrogenic diabetes incipidus not SIADHDr Zaman, Jan 25,
2009#136

334.

GuestGuestfor any condition TOE gives the clearest picture..

335.

so cant it be TOE (not TTE) coz they asked for the best test to diagnose..not the most convinient..

Guest, Jan 25, 2009#137

336.

Dr ZamanGuestYes, alcohol withdrawl, which is another cause of acute confusional state in

hospitalized patient (see list of causes of acute confusion state in OHCM). And the picture does not fit
with delirium tremens.Dr Zaman, Jan 25, 2009#138

337.

Dr ZamanGuestWhat about that big question?

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.

GuestGuestthe answer was pericrdial effusion?

341.

(big effisions wont give a rub)Guest, Jan 25, 2009#140

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.

GuestGuesti also think eschirichia coliGuest, Jan 25, 2009#143

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.

GuestGuestwas there a question with the answer as E.coli 0157?

354.

somethin question with HUS?

355.

i cant corretly remember the question...Guest, Jan 25, 2009#147

356.

GuestGuestyes there was a question HUSGuest, Jan 25, 2009#148

357.

GuestGuestDear .....

358.

How many correct answers to get 521

359.

according to a new equating

360.

Good luck for all

361.

8)

362.

Dr :shock:Guest, Jan 25, 2009#149

363.

GuestGuesti got an answer saying false positives..

364.

in the question where the scientist increases the cut of level..

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.

iabetic pt. Gangrene in his big toe. Next investigation

3.
4.

1. Normal XRay

5.

2.CT scan

6.

3. MRI

7.

4. Isotope scan

8.

Endocarditis in a patient with prosthetic valve. The possible micro organism is

9.

1. strept viridians

10.
11.

2. Staph epidemidis

12.

3. candida

13.

4. staph aureus

14.

coeliac disease positive test 40 negative test 10

15.

Non celiac disease positive test 60 negative test 840

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.

Profuse watery diarrheoa even in fasting state

27.
28.

1 VIPOMA

29.
30.
31.

following questions were posted by csngiu

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.

GuestGuestmrcp 1 sept eaxm contd by csngiu

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.

2. RNA splising occurred at : nucleus, peroxisome, golgi, ribosom

55.

3. Sporotic ca colon, the mutation occurred............ can't remember

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.

5. none-scarring alopecia............Guest, Sep 21, 2005#2

58.

GuestGuestby enroute

59.
60.

Here are a few:

61.

1. Cause of monooclar Blindness in AIDS patient:

62.

CMV/Toxoplasmosis/Mycobacterium

63.
64.

2. Most important side effect of Amiodarone:

65.

Phototoxicity/QT Interval prolongation/Hypothyroidism/Corneal deposits/

66.

NO lung fibrosis in the choice.

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.

delusional disorder/somatoform disorder/hypochondriasis/obsessive compulsive disorder

70.
71.

Second paper was tougher than the first. Will post more questions when I get time.Guest, Sep 21, 2005
#3

72.

GuestGuestPosted: Wed Sep 21, 2005 1:01 pm by Rex24 Some MCQs

73.
74.

ByRex 24

75.

1- Hypokalemia with acidosis, Low HC03, Nephrocalcinosis - TYPE 1 RTA.

76.
77.

2 - Splicing of RNA - Nucleus/ Ribosome/ peroxisome/ lysosome/ golgi

78.
79.

3) Postural Hypotension with ataxia with parkinsonism features, recurrent falls -- Multisystem atrophy/

80.
81.

4) Number needed to treat.

82.
83.

5) Sensitivity

84.
85.

6) Postive predictive value

86.
87.

7) asymptomatic with Essential thrombocytosis - platelet count > 800 - Treatment - Aspirin/
hydroxurea/ Platelet pheresis/ radioactive substance/ observation

88.
89.

Prosthetic valve a month ago - MCC of IE - Stap epidermidis

90.
91.

9) % of DM type 1 developing diabetic nephropathy -

92.
93.

10) Marfan disorder - fibrillin

94.
95.
96.

11) anticipation

97.

12) BIH

98.
99.

13) GBS - Enmg finding

100.
101.

14) Rifampicin and OCPs

102.
103.

15) action of N acetyl cystiene

104.
105.

16) and many more i will type latter

106.

Bye

107.
108.

BEST Way to prepare for exam -

109.

ON EXAM atleast twice and KALRA and most important commonsense.

110.

Good LUCK

111.

will type in detail latter.

112.

_________________

113.

Good Luck guys and galsGuest, Sep 21, 2005#4

114.

GuestGuestPosted: Wed Sep 21, 05 12:28 am Post subject: mcqs dr_osle

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.

i will try to send some

128.

- the specific antibody in SLE : anti Sm(there was no antiDs)

129.

- thyrotoxic A.F,immediate management : I.V amiodarone(100),cardioversion,anticoagulation

130.

-Inf MI,bradycardia,hypotension,cvp 4 : temp pacing,dobutamine,I.V fluidsGuest, Sep 21, 2005#5

131.

CliffGuest1. ? ABO incompatibility

132.

2. dark color urine after antibioticCliff, Sep 21, 2005#6

133.

GuestGuestPregnant lady 14 wks found HTN, ECG lt vent. hypertrophy

134.
135.

1. Eclampsia

136.

2. Pre eclampsia

137.

3. essential HypertensionGuest, Sep 21, 2005#7

138.

GuestGuestPatient with facial reddness and itching. Nothing found by doctor

139.
140.

1. Somatoform

141.

2. HypochondriasisGuest, Sep 21, 2005#8

142.

GuestGuestH/O Chest infection, took clarythromycin, Lt Supraventricular LN. Cold haemaglutinin

143.
144.

1. NHL (non hodgkin lymphoma??)Guest, Sep 21, 2005#9

145.

GuestGuestAsthmatic on intermittent high prednisolone, c/o of hip pain 4 or 8 wks

146.

can't tolerate weight bearing

147.
148.

1. avascular necrosis

149.

2. osteoporosis with fractureGuest, Sep 21, 2005#10

150.

GuestGuestPatient with heart failure and diabetes

151.

Drug C/I

152.
153.

1. RosiglitazoneGuest, Sep 21, 2005#11

154.

GuestGuestMechanism of action of Amiodarone

155.
156.

1. Potassium chanel blocker

157.

2. Sodium Chanel blocker

158.

3.Guest, Sep 21, 2005#12

159.

GuestGuestHow can diagnose Empyema in a fast way

160.
161.

1. Aspirate culture

162.

2. Ph of aspirateGuest, Sep 21, 2005#13

163.

GuestGuestMutaion, there was P53 and P27Guest, Sep 21, 2005#14

164.

GuestGuestFollow up colon carcinoma

165.
166.

CA 125

167.

CEAGuest, Sep 21, 2005#15

168.

GuestGuestLeft PHRENIC NERVE PALSY

169.
170.

1. lt hemidiaphragm paradocical movement

171.

2. Rt. hemidiaphragm paradocical movementGuest, Sep 21, 2005#16

172.

GuestGuestViolaceous color and itching in the left arm (linear) and flexors

173.
174.

1. Similar lesions in the oral mucosa??? Lichen planus

175.

2. Scabies???Guest, Sep 21, 2005#17

176.

GuestGuestMarfan -----> fibrillinGuest, Sep 21, 2005#18

177.

GuestGuestCEA is correct (checked)Guest, Sep 21, 2005#19

178.

GuestGuestCEA confirmed (checked)Guest, Sep 21, 2005#20

179.

GuestGuestPancreatitis. The most sensitive test for pancreatic exocrine

180.

1. lipase

181.

2. amylaseGuest, Sep 21, 2005#21

182.

GuestGuestAgitated and confused lady after a party

183.
184.

1.Alcohol

185.

2. EcstasyGuest, Sep 21, 2005#22

186.

GuestGuestDiabetic with frozen shoulder -----> adhesive capulitisGuest, Sep 21, 2005#23

187.

GuestGuestECG deta wave asymptomatic treatment

188.
189.

1.B blocker

190.

2. observationGuest, Sep 21, 2005#24

191.

GuestGuestParasthesia and LN enlarged in axilla and neck is a side effect of:

192.

1 Phenytoin

193.

2. lamotrigineGuest, Sep 21, 2005#25

194.

GuestGuestNASH associated with:

195.
196.

Insulin resistantGuest, Sep 21, 2005#26

197.

GuestGuestO2% goes down during a nebuliser. Why?

198.
199.

1.Guest, Sep 21, 2005#27

200.

GuestGuestNormal Alveoli seen in

201.
202.

1. AsthmaGuest, Sep 21, 2005#28

203.

GuestGuestHow to monitor SBE

204.

205.

1. CRP

206.

2. bacterial ActivityGuest, Sep 21, 2005#29

207.

GuestGuest19 year old 1.8 meter, small testes, low FSH, LH, Testestenor

208.
209.

1. Kalmman

210.

2. KlinfilterGuest, Sep 21, 2005#30

211.

GuestGuestPt with dyspepsia, +ve H. Pylori and mild ?? lymphoma of the stomach??

212.
213.

Treatment?

214.
215.

1. Eradication of H. Pylori

216.

2. SurgicalGuest, Sep 21, 2005#31

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.

72 hr fastigGuest, Sep 21, 2005#33

220.

GuestGuestNephropathy, mildly elevated creatinine, protienuria >3.8 gm

221.
222.

Treatment?

223.
224.

1.ACEGuest, Sep 21, 2005#34

225.

GuestGuestGlomerulonephritis treatment??

226.
227.

1. Prednisolone + cyclophosphamideGuest, Sep 21, 2005#35

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.

1. Amiodarone Class III agent -> K channel blocker

232.

2. Cuases of lymphadenopathy -> Phenytoin

233.

3. which term best describe the affinity of drug for its receptor -> ? Selectivity ? potency

234.
235.

Cardiac

236.

1. sinus bradycardia with hypotension -> ? transvenous pacing

237.

2. Criteria for thrombolysis in AMI

238.

3. Case with AMI and malignant hypertension -> ? primary PTCACliff, Sep 21, 2005#37

239.

macGuestmy experience of sept part 1 exam

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.

2. OHCM is very good in some topics.

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.

5. True/false format is complete waste of time.

248.
249.

Here is some of the stuff:

250.

1. Where does the RNA splicing take place - nucleus.

251.

3. Diagnosis of DH in patient without diarrhoea - IF of paralesional skin. Small intestine biopsy was an
option.

252.

4. Mechanism of action of Ondansetron - 5-HT3 inhibitor.

253.

5. Which drug is an ion channel opener - Nicorandil (K channel opener)

254.

6. Mechanism of action of Amiodarone - K channel blocker.

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.

8. Which enzyme is high in Gaucher's disease - Acid phosphatase.

257.

9. A lady post CS, given 3 U of blood, 30 min later shock - ABO incompatibility.

258.

10. A man bitten by a dog, infection, causative organism - Pasteurella multocida.

259.

11. Cat scratch disease with lymphadenitis, cause - Bartonella henselae.

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.

16. A case of osteomyelitis, after 2 weeks, most useful test - X-ray.

264.

17. A case of Bartter's syndrome with high urine potassium.

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.

20. Typical feature of PBC - peripheral neuropathy (because of lipid infiltration).

268.

21. Antibody used in follicular B-NHL - anti CD 20.

269.

22. A case for NNT, PPV and RRR.

270.

23. First sign in CPA tumour - loss of corneal reflex.

271.

24. Acute retention of urine, hypovolaemic - 0.9% saline before catheterisation.

272.

25. Criteria for thrombolysis - >1 mm ST elevation in two or more limb leads.

273.

26. Refeeding syndrome, cause - low phoshpate.

274.

27. Asymptomatic 75 year old with high Ca, low PO4, no evidence for MM -primary
hyperparathyroidism.

275.
276.

A lot of basic stuff, especially pharmacology.

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.

IRRITABLE BOWL SYNDROME

287.

ULCERATIVE COLITIS

288.

SLE

289.

SJOGREN

290.

ALZ DISEASE

291.

TUNA FISH TOXIN

292.

INTERNAL CAPSULE INFARCTS

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.

PRIMRARY BILIARY CIRRHHajmi, Sep 22, 2005#39

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.

GuestGuestPosted: Thu Sep 22, 2005 11:03 pm byDR GMATH,rsukhon

309.
310.

HERE ARE SOME QS FM SEP 20.FOR DR OA AND OTHERS

311.
312.

1.PT ALLERGIC TO PENICILLIN : DONT GIVE : CEPHRADINE <CROSS ALLERGY>

313.

2.ASSOCIATION WITH SYSTEMIC SCLEROSIS: PUL HTN

314.

3.ABS IN CREST : ANTI CENTROMERE ABS

315.

4..MOST LIKELY ASSOC OF PBC:VITILIGO

316.

5.CAUSE OF CHB AFTER MI: RT CORONARY ARTEY OCCLUSION

317.

6TREATMENT FOR POLYCYTHEMIA: HYDROXYUREA

318.

7.MOST COMMON CAUSE OD DEATH IN ACROMEGALY: LVF

319.

8.P20 PROTEIN IS IMP B/C : CAUSES EXPULSION OF CYTOTOXIC DRUGS

320.

9.MOST IMP SIGN OF IDIO PARKINSONISM: ASSYMET REST TREMOR

321.

10.NONSUSTAINED VT TREATMENT: MG+ I/V

322.

11.PT WITH CCF AND A LARGE BOUT OF P/R BLEEDING.UPPER GI ENDOSC NORMAL DX
ANGIODYSPLASIA

323.

12.MAN WITH MEDIASTINAL LN ENLAGEMENT HAS STRIDOR ANND LN OBST BRONCH

WAT TO DO MEDIASTINOSCOPY.

324.

13MALT RT ERADICATION THERAPY

325.

14 EPO IMPROVES : EXERCISE TOLERANCE

326.

15.FEMALE WITH BULKY STOOLS AND BLOATING IBS

327.

16 ENDOCARDITIS MONITORING : BLOOD CULTURES

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.

19>ISOLATED SENSORY LOSS IN A PT>LACUNAR INFARCT

331.

20.DETERIORATING CONSC IN A FEMALE WITH AD:SUBDURAL HEAMATOMA

332.

21CHILD UNDERGOING TOOTH EXTRACTON SUFFERS UNCONSC,JERKS AND INCONT OF

URINE: DX TONIC CLONIC SEIZURES

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.

23 INC KCO CAUSE ALV HMG

335.

24PT WITH PRGO SOB CAUSE UL THROMBIEMBOLISM

336.

25 Q OS PIT APOPLEXY

337.

26 MANY OPTH QS

338.

1.AC GLAUCOMA PAIN SUDDEN 6/60 VA

339.

2.RA PT WITH SEVERE PAIN NORMAL VA: ANT UVEITIS

340.

27 SCHIZOPHRENIC REFUSES INTUB WAT TO DO..CONSENT FM KITH AND KIN

341.

28 WAT TO DO IN A PT WITH SSRI RESISTANCE NOT RESPONDING TO IT:LITHIUM

ADDITION

342.

29Q OF MESENTERIC ISCHEMIA

343.

30.PT OF HYPOMANIA PRESSURIZZED SPEECH

344.

31.PT OF SCHIZOPHRENIA

345.

32STATS SENSITIVITY WAS 60

346.

33STATS RANDOMIZATION AWFUL ONE

347.

34 STATS PAIRED COMPARSON WITH MEDIAN AS REF/? CHI SQ?

348.

35STATS POSITIVE PREDICTIVE VALUE AWFUL

349.

36DERMA SCARRING ALOPECIA DLE

350.

37DERM INCOGNITO

351.

38 RENAL BARTER SYNDROME HYPOKALEMIA WITHOUT HTN Q

352.

39 TYPE 1 RTA NEPHROCALCINOSIS AND ETC

353.

40 PT OF HYPERVENTILATION SYNDROME WAT WAS UT THEY ASKED?

354.

41 METABOLIC ACIDISIS FINDINGS IN A Q

355.

42 RELAXATON RT FOR A PT OF PANIC ATTACK RIGHT?

356.

43 PHARMA NICORANDIL OPENS ANN ION CHANNEL

357.

44.CLIPPING OF NAIL FUNFGAL INFECTION DX

358.

45 SOB WITH NORMAL KCO ASTHMA'

359.

46SINGLE CAVITATING LESION PNEUMONIA : KLEBSIELLA

360.

47.CF ORGANISM: PEUDOMONAS

361.

48.FEMALE WITH GIANT CELL ARTERITIS

362.

40FTN OF FEMORAL N : ADDUCTOR

363.

50ULNAR ENTRAPMENT

364.

51.BOORHAVE DISEASE

365.

52.TENSION HEADACHE

366.

53.KLINEFELTER SYNDROME

367.

54.AIDS PT ORG BURHOLDERIA

368.

55PT OF AIDS WITH BRAIN ATROPHY?AIDS ENCEPHALOPATHY AS ALL OTHERS CAUSED

LESIONS AND NO LESION IN THIS CASE

369.

56 UNILAT VISUAL LOSS IN AIDS PT TOXOCARA

370.

57 PROPHLAXIS OF SPLENECTOMY INFLUENZAE ..ONLY VIRAL ORG

371.

58.SIADH

372.

59.CRANIAL DI

373.

60 POOR PXIC FACTOR I ALL 9:22

374.

61 SAME IN AML?

375.

62.BULIMIA NERVOSA

376.

64 MANTOUX TEST

377.

65SCDSC

378.

66.OSTEOSCLERTIC LESION

379.

67 CAUDA EQUIA SYNDROME

380.

68.MAEMOCHROMATOSIS

381.

69S/E OF ROSIGLTAZONE

382.

70ANTICIPATIO

383.

71 CAT SCRATCH DISEASE

384.

72 VARICELLA ZOSTER

385.

73SCROMBOTOXIN

386.

774 CEA FOR COLRECTAL CA

387.

75 PS3 UPREG COLON CA SPORADIC

388.

76 N ACETYLCYSTEINE?DEC GLUTATHIONE REDUCTSAE?

389.

BACILLUS CEREUS TOXICTY

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.

BYE FOR NOE PRAY 4 ME

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.

ENDOCARDITIS MONITORING : BLOOD CULTURES (I believe CRP is the answer)

422.
423.
424.

MAN WITH MEDIASTINAL LN ENLAGEMENT HAS STRIDOR ANND LN OBST BRONCH

WAT TO DO MEDIASTINOSCOPY (I believe predinisolone is the answer)

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.

21CHILD UNDERGOING TOOTH EXTRACTON SUFFERS UNCONSC,JERKS AND INCONT OF

URINE: DX TONIC CLONIC SEIZURES (no, this is a classic case for vasovagal syncope! and he is
suffering from perhaps a complex symcope)

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.

RA PT WITH SEVERE PAIN NORMAL VA ANT UVEITIS (epscleritis)

438.
439.
440.

SCHIZOPHRENIC REFUSES INTUB WAT TO DO..CONSENT FM KITH AND KIN (there is no

such thing in england as taking consent from next of kin in england...plus by the time they take consent
the patient would have died, so i think the answer was acting on behalf of the patient's best interests)

441.
442.
443.

28 WAT TO DO IN A PT WITH SSRI RESISTANCE NOT RESPONDING TO IT:LITHIUM

ADDITION (personally i think addition of lithium is not an easy thing because it is a dangerous drug
that requires monitoring and he does not suffer from bipolar disorder to require it so i think giving him
a trial on an alternative class like TCA would be the choice - i am not sure if this is the right answer )

444.
445.
446.

PROPHLAXIS OF SPLENECTOMY (encapsulated organisms like strep pneumonia)

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.

1.PT ALLERGIC TO PENICILLIN : DONT GIVE : CEPHRADINE <CROSS ALLERGY>

456.

2.ASSOCIATION WITH SYSTEMIC SCLEROSIS: PUL HTN

457.

3.ABS IN CREST : ANTI CENTROMERE ABS

458.

4..MOST LIKELY ASSOC OF PBC:VITILIGO

459.

5.CAUSE OF CHB AFTER MI: RT CORONARY ARTEY OCCLUSION

460.

6TREATMENT FOR POLYCYTHEMIA: HYDROXYUREA

461.

7.MOST COMMON CAUSE OD DEATH IN ACROMEGALY: LVF

462.

8.P20 PROTEIN IS IMP B/C : CAUSES EXPULSION OF CYTOTOXIC DRUGS

463.

9.MOST IMP SIGN OF IDIO PARKINSONISM: ASSYMET REST TREMOR

464.

10.NONSUSTAINED VT TREATMENT: MG+ I/V

465.

11.PT WITH CCF AND A LARGE BOUT OF P/R BLEEDING.UPPER GI ENDOSC NORMAL DX
ANGIODYSPLASIA

466.

12.MAN WITH MEDIASTINAL LN ENLAGEMENT HAS STRIDOR ANND LN OBST BRONCH

WAT TO DO MEDIASTINOSCOPY. (

467.

13MALT RT ERADICATION THERAPY

468.

14 EPO IMPROVES : EXERCISE TOLERANCE

469.

15.FEMALE WITH BULKY STOOLS AND BLOATING IBS

470.

16 ENDOCARDITIS MONITORING : BLOOD CULTURES

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.

19>ISOLATED SENSORY LOSS IN A PT>LACUNAR INFARCT

474.

20.DETERIORATING CONSC IN A FEMALE WITH AD:SUBDURAL HEAMATOMA

475.

21CHILD UNDERGOING TOOTH EXTRACTON SUFFERS UNCONSC,JERKS AND INCONT OF

URINE: DX TONIC CLONIC SEIZURES

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.

23 INC KCO CAUSE ALV HMG

478.

24PT WITH PRGO SOB CAUSE UL THROMBIEMBOLISM

479.

25 Q OS PIT APOPLEXY

480.

26 MANY OPTH QS

481.

1.AC GLAUCOMA PAIN SUDDEN 6/60 VA

482.

2.RA PT WITH SEVERE PAIN NORMAL VA: ANT UVEITIS

483.

27 SCHIZOPHRENIC REFUSES INTUB WAT TO DO..CONSENT FM KITH AND KIN

484.

28 WAT TO DO IN A PT WITH SSRI RESISTANCE NOT RESPONDING TO IT:LITHIUM

ADDITION

485.

29Q OF MESENTERIC ISCHEMIA

486.

30.PT OF HYPOMANIA PRESSURIZZED SPEECH

487.

31.PT OF SCHIZOPHRENIA

488.

32STATS SENSITIVITY WAS 60

489.

33STATS RANDOMIZATION AWFUL ONE

490.

34 STATS PAIRED COMPARSON WITH MEDIAN AS REF/? CHI SQ?

491.

35STATS POSITIVE PREDICTIVE VALUE AWFUL

492.

36DERMA SCARRING ALOPECIA DLE

493.

37DERM INCOGNITO

494.

38 RENAL BARTER SYNDROME HYPOKALEMIA WITHOUT HTN Q

495.

39 TYPE 1 RTA NEPHROCALCINOSIS AND ETC

496.

40 PT OF HYPERVENTILATION SYNDROME WAT WAS UT THEY ASKED?

497.

41 METABOLIC ACIDISIS FINDINGS IN A Q

498.

42 RELAXATON RT FOR A PT OF PANIC ATTACK RIGHT?

499.

43 PHARMA NICORANDIL OPENS ANN ION CHANNEL

500.

44.CLIPPING OF NAIL FUNFGAL INFECTION DX

501.

45 SOB WITH NORMAL KCO ASTHMA'

502.

46SINGLE CAVITATING LESION PNEUMONIA : KLEBSIELLA

503.

47.CF ORGANISM: PEUDOMONAS

504.

48.FEMALE WITH GIANT CELL ARTERITIS

505.

40FTN OF FEMORAL N : ADDUCTOR

506.

50ULNAR ENTRAPMENT

507.

51.BOORHAVE DISEASE

508.

52.TENSION HEADACHE

509.

53.KLINEFELTER SYNDROME

510.

54.AIDS PT ORG BURHOLDERIA

511.

55PT OF AIDS WITH BRAIN ATROPHY?AIDS ENCEPHALOPATHY AS ALL OTHERS CAUSED

LESIONS AND NO LESION IN THIS CASE

512.

56 UNILAT VISUAL LOSS IN AIDS PT TOXOCARA

513.

57 PROPHLAXIS OF SPLENECTOMY INFLUENZAE ..ONLY VIRAL ORG

514.

58.SIADH

515.

59.CRANIAL DI

516.

60 POOR PXIC FACTOR I ALL 9:22

517.

61 SAME IN AML?

518.

62.BULIMIA NERVOSA

519.

64 MANTOUX TEST

520.

65SCDSC

521.

66.OSTEOSCLERTIC LESION

522.

67 CAUDA EQUIA SYNDROME

523.

68.MAEMOCHROMATOSIS

524.

69S/E OF ROSIGLTAZONE

525.

70ANTICIPATIO

526.

71 CAT SCRATCH DISEASE

527.

72 VARICELLA ZOSTER

528.

73SCROMBOTOXIN

529.

774 CEA FOR COLRECTAL CA

530.

75 PS3 UPREG COLON CA SPORADIC

531.

76 N ACETYLCYSTEINE?DEC GLUTATHIONE REDUCTSAE?

532.

BACILLUS CEREUS TOXICTY

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.

BYE FOR NOW PRAY 4 ME

544.

I THTINK MRCP[/quote]

545.

546.
547.
548.
549.
550.

Posted: Fri Sep 23, 2005 11:56 am Post subject:

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.

AIPPG Senior Member

560.
561.
562.

Joined: 05 Feb 2005

563.

Posts: 53

564.
565.

Posted: Fri Sep 23, 2005 12:00 pm Post subject:

566.
567.
568.

Thanks Pinkfeets for your comment, I totally agree with the you answersGuest, Sep 23, 2005#41

569.

pinkfeetsGuestanswer is eradication of h pylori

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.

2. Surgicalpinkfeets, Sep 23, 2005#42

578.

GuestGuestI checked it, its H. Pylori eradicationGuest, Sep 23, 2005#43

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.

SECONDLY I WILL REDISCUSS PINKFEET ANSWERS AND CORRECT HIM

582.

IN NEXTPOSTG-MATH1, Sep 23, 2005#44

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.

What is the next step in management?

589.
590.

1. Start prednisolone

591.

2. Mediastinoscopy and biopsy

592.

3. Refer for stent insertion/tracheostomy

593.

4. Refer for urgent CT scan of the mediastinum

594.

5. The addition of ethambutol

595.
596.
597.

Answer

598.
599.

Start prednisolone - (No. 1)

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.

(From Onexamination)Guest, Sep 23, 2005#46

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.

muscle is effected-?iliopsoasGuest, Sep 23, 2005#47

609.

DR G-MATH12GuestHERE ARE SOME QS FM SEP 20.FOR DR OA AND OTHERS

610.
611.

1.PT ALLERGIC TO PENICILLIN : DONT GIVE : CEPHRADINE <CROSS ALLERGY>

612.

2.ASSOCIATION WITH SYSTEMIC SCLEROSIS: PUL HTN

613.

3.ABS IN CREST : ANTI CENTROMERE ABS

614.

4..MOST LIKELY ASSOC OF PBC:VITILIGO

615.

5.CAUSE OF CHB AFTER MI: RT CORONARY ARTEY OCCLUSION

616.

6TREATMENT FOR POLYCYTHEMIA: HYDROXYUREA

617.

7.MOST COMMON CAUSE OD DEATH IN ACROMEGALY: LVF

618.

8.P20 PROTEIN IS IMP B/C : CAUSES EXPULSION OF CYTOTOXIC DRUGS

619.

9.MOST IMP SIGN OF IDIO PARKINSONISM: ASSYMET REST TREMOR

620.

10.NONSUSTAINED VT TREATMENT: MG+ I/V

621.

11.PT WITH CCF AND A LARGE BOUT OF P/R BLEEDING.UPPER GI ENDOSC NORMAL DX
ANGIODYSPLASIA

622.

12.MAN WITH MEDIASTINAL LN ENLAGEMENT HAS STRIDOR ANND LN OBST BRONCH

WAT TO DO MEDIASTINOSCOPY.

623.

13MALT RT ERADICATION THERAPY

624.

14 EPO IMPROVES : EXERCISE TOLERANCE

625.

15.FEMALE WITH BULKY STOOLS AND BLOATING IBS

626.

16 ENDOCARDITIS MONITORING : BLOOD CULTURES

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.

19>ISOLATED SENSORY LOSS IN A PT>LACUNAR INFARCT

630.

20.DETERIORATING CONSC IN A FEMALE WITH AD:SUBDURAL HEAMATOMA

631.

21CHILD UNDERGOING TOOTH EXTRACTON SUFFERS UNCONSC,JERKS AND INCONT OF

URINE: DX TONIC CLONIC SEIZURES

632.

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.

23 INC KCO CAUSE ALV HMG

634.

24PT WITH PRGO SOB CAUSE UL THROMBIEMBOLISM

635.

25 Q OS PIT APOPLEXY

636.

26 MANY OPTH QS

637.

1.AC GLAUCOMA PAIN SUDDEN 6/60 VA

638.

2.RA PT WITH SEVERE PAIN NORMAL VA: ANT UVEITIS

639.

27 SCHIZOPHRENIC REFUSES INTUB WAT TO DO..CONSENT FM KITH AND KIN

640.

28 WAT TO DO IN A PT WITH SSRI RESISTANCE NOT RESPONDING TO IT:LITHIUM

ADDITION

641.

29Q OF MESENTERIC ISCHEMIA

642.

30.PT OF HYPOMANIA PRESSURIZZED SPEECH

643.

31.PT OF SCHIZOPHRENIA

644.

32STATS SENSITIVITY WAS 60

645.

33STATS RANDOMIZATION AWFUL ONE

646.

34 STATS PAIRED COMPARSON WITH MEDIAN AS REF/? CHI SQ?

647.

35STATS POSITIVE PREDICTIVE VALUE AWFUL

648.

36DERMA SCARRING ALOPECIA DLE

649.

37DERM INCOGNITO

650.

38 RENAL BARTER SYNDROME HYPOKALEMIA WITHOUT HTN Q

651.

39 TYPE 1 RTA NEPHROCALCINOSIS AND ETC

652.

40 PT OF HYPERVENTILATION SYNDROME WAT WAS UT THEY ASKED?

653.

41 METABOLIC ACIDISIS FINDINGS IN A Q

654.

42 RELAXATON RT FOR A PT OF PANIC ATTACK RIGHT?

655.

43 PHARMA NICORANDIL OPENS ANN ION CHANNEL

656.

44.CLIPPING OF NAIL FUNFGAL INFECTION DX

657.

45 SOB WITH NORMAL KCO ASTHMA'

658.

46SINGLE CAVITATING LESION PNEUMONIA : KLEBSIELLA

659.

47.CF ORGANISM: PEUDOMONAS

660.

48.FEMALE WITH GIANT CELL ARTERITIS

661.

40FTN OF FEMORAL N : ADDUCTOR

662.

50ULNAR ENTRAPMENT

663.

51.BOORHAVE DISEASE

664.

52.TENSION HEADACHE

665.

53.KLINEFELTER SYNDROME

666.

54.AIDS PT ORG BURHOLDERIA

667.

55PT OF AIDS WITH BRAIN ATROPHY?AIDS ENCEPHALOPATHY AS ALL OTHERS CAUSED

LESIONS AND NO LESION IN THIS CASE

668.

56 UNILAT VISUAL LOSS IN AIDS PT TOXOCARA

669.

57 PROPHLAXIS OF SPLENECTOMY INFLUENZAE ..ONLY VIRAL ORG

670.

58.SIADH

671.

59.CRANIAL DI

672.

60 POOR PXIC FACTOR I ALL 9:22

673.

61 SAME IN AML?

674.

62.BULIMIA NERVOSA

675.

64 MANTOUX TEST

676.

65SCDSC

677.

66.OSTEOSCLERTIC LESION

678.

67 CAUDA EQUIA SYNDROME

679.

68.MAEMOCHROMATOSIS

680.

69S/E OF ROSIGLTAZONE

681.

70ANTICIPATIO

682.

71 CAT SCRATCH DISEASE

683.

72 VARICELLA ZOSTER

684.

73SCROMBOTOXIN

685.

774 CEA FOR COLRECTAL CA

686.

75 PS3 UPREG COLON CA SPORADIC

687.

76 N ACETYLCYSTEINE?DEC GLUTATHIONE REDUCTSAE?

688.

BACILLUS CEREUS TOXICTY

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.

THE ABOVE POST WAS BY ME ORIGINALLY.

699.

PLZ DISCUSS ANWSERS WITH ME

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.

ENDOCARDITIS MONITORING : BLOOD CULTURES (I believe CRP is the answer)

704.
705.
706.

MAN WITH MEDIASTINAL LN ENLAGEMENT HAS STRIDOR ANND LN OBST BRONCH

WAT TO DO MEDIASTINOSCOPY (I believe predinisolone is the answer)

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.

21CHILD UNDERGOING TOOTH EXTRACTON SUFFERS UNCONSC,JERKS AND INCONT OF

URINE: DX TONIC CLONIC SEIZURES (no, this is a classic case for vasovagal syncope! and he is
suffering from perhaps a complex symcope)

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.

RA PT WITH SEVERE PAIN NORMAL VA ANT UVEITIS (epscleritis)

720.
721.
722.

SCHIZOPHRENIC REFUSES INTUB WAT TO DO..CONSENT FM KITH AND KIN (there is no

such thing in england as taking consent from next of kin in england...plus by the time they take consent

the patient would have died, so i think the answer was acting on behalf of the patient's best interests)
723.
724.
725.

28 WAT TO DO IN A PT WITH SSRI RESISTANCE NOT RESPONDING TO IT:LITHIUM

ADDITION (personally i think addition of lithium is not an easy thing because it is a dangerous drug
that requires monitoring and he does not suffer from bipolar disorder to require it so i think giving him
a trial on an alternative class like TCA would be the choice - i am not sure if this is the right answer )

726.
727.
728.

PROPHLAXIS OF SPLENECTOMY (encapsulated organisms like strep pneumonia)

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.

I WASNT TARGETTING/INSULTING U .JUST WANNA DISCUSS. OK

736.

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 .

737.
738.

REGARDING UR COMMENT ON EPISCLERITIS.I AM SURE THERE WAS OPTION OF

SCLERITIS: PAINLESS, GLAUCOMA:VISION LOSS OCCURS.THEY ASKED ABOUT
REDNESS,NORMAL VA AND PAIN RADIATING TO FOREHEAD ..THERE WAS NO OPTION
OF EPISCLERITISAINFUL SO AS ANT UVEITIS HAS ALL FEATURES AF THE GIVEN PATHO

739.
740.

REGARDING LITHIUM.IT IS GIVEN IN RESISTANT CASES REF TO KALRA

741.
742.

REGARDING O2 : O2 WAS GIVEN CONTINUOSLY TO PT IN THAT CASE ,U KNOW

DILATORS CAUSE INC DILAT OF ALVEOLI SO PUL ART PRESSURE /RESISTANCE FALLS
SO RELATIVE DEF OF O2 WRT SURFACE AREA WILL BE SEEN

743.
744.

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
745.
746.

IE BLOOD CULTURES U CAN C IN ANY BIG TXTBOOK

747.

REGARDING PREDNISOLONE U R RIGHT

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.

ONCE AGAIN DR OA COMMENTS PLZDR GMATH 12, Sep 24, 2005#49

752.

GuestGuestsep quest

753.
754.

what are cardiac troponin

755.

ans:strutrural proteins

756.

sclerosis

757.
758.

asymptomatic wpw synd-rx of choise

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.
Thread Status:
Not open for further replies.
Page 2 of 2

< Prev
1
2
1.

HeenaGuestQues. I remembered and blunders i made

2.
3.

1) where does rna splicing occur-nucleus

4.

2)findings in Myasthenia gravis-low potentials in EMG

5.

3) antihypoglycaemics in Heart comrpmised pt-rosiglitazone put metformin

6.

4) Gauchers disease-acid phosphatase

7.

5) some pt with worsening of skin rask with clobetasone-tinea incognito

8.

6) some pt with helicotropic rash and increased Creatine phosphokinase -Deramtomyosis

9.

7) some pt with ? Irritable Bowel syndrome

10.

Prognosis of pt with type 1 Dm and life risk of getting nephropathy-?30% range given

11.

9) scarring allopecia-Lupus

12.

10) nonscarring allopecia-alloepcia areata

13.

11) pt with some restrictive defect and high TCO- alveolar haemorhage

14.

12) some pt with cold autoimmune haemoglobinura-?Non-Hodgkins lymphoma

15.

13) some pt with lymphadenopathy- ans phenytoin i answered vigabatrine

16.

14) pt on fluoxetine not improving after 3 months - continue upto 6 months

17.

15) interaction warfarin/carbamzepine

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.

17)some pt with multiprotuberant lesions on glans-condyloma acuminata

20.

1 cat scatch disease organism

21.

19)amiodarone M.O.A

22.

20 LMWH M.O.A

23.

21 fleicanimide M.O.A

24.

22 respiratory disease with nomal alveoli- asthma

25.

23 N acetylcysteine M.O.A

26.

24 pt with definite type 1 RTA and nephrocalcinosis-for some reason said Type 2

27.

25 some pt with hemiplegia said anterior cerebral ans was lacunar

28.

26 Rx in some pt with membranous GN and severe nephrotic syndrome ? cyclophosphamide for some
reason said ciclosporin

29.

27Rx of 1 thrmobocythaemia ? aspirin i said hydroxyurea

30.

28 rapid dx of empyema i said ph of aspirate ? culture was an option

31.

29 serial echo as way of monitoring I.E

32.

30)Mantoux intrademal injeciton not sub cut

33.

33 Prolonged QT syndrome Mx ? Mg2+ ect..

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.

36 diagnosis of fungal nail infection-? UV light ? nail clippings culture

37.

37 causes of death in acromegaly-LVHF

38.

38 monitoring in Ca colon- CEA

39.

39 hypogonadotrophic hypogondism-?Kallmans

40.

40 some fellow with -? Vit B12 and SCDC

41.

41 Organism in valve replacment and I.E. s. epidermitis

42.

42 immediate Mx of pt in fast AF- i said anticoagulate

43.

43 some chap with a rash which he had which disappeared and he still thinks its present-?somatoform

44.

44 Ondansterone -M.O.A-5HT blocker

45.

45 some chap with haemolysis after taking a drug for Rx of a UTI i said G-6-PD im not sure

46.

46 some acute transfusion reaciton probably ABO incompatibility

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.

49)HIV and monocular blindness-?CMV retinitis?toxocariarsis

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.

51)some question of a traveller answered dengue fever

52.

52 tuna poisoning scrombotoxinHeena, Oct 1, 2005#51

53.
54.
55.

loss of vision in a lady following intoxication---methanol

56.

Recurrent epilepsy on a pt started with carbamazepine---Increase the dose of drug

57.

Pt treated for paracetamol poisning, risk factor for further attempt----lethality of the attempt

58.
59.

Carpal tunnel,median nerve involvement--which muscle test---Abductor pollicis brevis

60.

Following decrease the risk of stoke?

61.

AF

62.

Smoking

63.

BP

64.

Cholesterol

65.
66.

Parkinsonism pt, admitted in ward, developed bilateral basilar shadows,likely organism--MRSA,H.influenza,klebsi

67.

1.Dental erosion in a young lady- Bullimia

68.

2.Hypercalcaemia in CRF-- Alfacalcedol treatment

69.

3.Cholestasis in pegnancy

70.

4.Pt on oral hydrocortisone and fludrocortisone developed D & V.What to con ...

71.

: A 19 year old woman presents with recurrent epistaxis.she a

72.

ITP

73.

Topic: A CONFUSIED DISORIENTATED PT WITH AC RENAL FAILURE

74.

: A CONFUSIED DISORIENTATED PT WITH AC RENAL FAILURE

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.

GuestGuest1 What would you advise to control in UK population to prevent stroke?

77.

Diabetes, smoking, hypertension etc .... i think HTN.

78.
79.

2. girl 22yrs, increased BMI , headaches .... ? BIH

80.
81.

3. band like severe headaches more at evening ... tension headaches.

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.

5. Gastric MALT with H pylori, Tx ..... eradication of H Pylori

86.
87.

6. acid base balance ... ? metabolic acidosis

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.

11. Marfan's syndrome abnormality .... elastin, fibrilin.

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.

14. ? one q of normal pressure hydrocephalus.

101.
102.

15 pt on warfarin INR 9 , immediate reversal with .... FFP, vit K.

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.

informal inquiry, inform next of kin, nothing, inform police

110.
111.

19. sensitivity

112.
113.

20. definition of volume of distribution

114.
115.

21

116.

1. Action amiodarone - K channel

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.

GuestGuestResult cut off

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.

purpleGuestsome questions contd.

129.
130.

1) where does rna splicing occur-nucleus

131.

2)findings in Myasthenia gravis-low potentials in EMG

132.

3) antihypoglycaemics in Heart comrpmised pt-rosiglitazone put metformin

133.

4) Gauchers disease-acid phosphatase

134.

5) some pt with worsening of skin rask with clobetasone-tinea incognito

135.

6) some pt with helicotropic rash and increased Creatine phosphokinase -Deramtomyosis

136.

7) some pt with ? Irritable Bowel syndrome

137.

Prognosis of pt with type 1 Dm and life risk of getting nephropathy-?30% range given

138.

9) scarring allopecia-Lupus

139.

10) nonscarring allopecia-alloepcia areata

140.

11) pt with some restrictive defect and high TCO- alveolar haemorhage

141.

12) some pt with cold autoimmune haemoglobinura-?Non-Hodgkins lymphoma

142.

13) some pt with lymphadenopathy- ans phenytoin i answered vigabatrine

143.

14) pt on fluoxetine not improving after 3 months - continue upto 6 months

144.

15) interaction warfarin/carbamzepine

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.

17)some pt with multiprotuberant lesions on glans-condyloma acuminata

147.

1 cat scatch disease organism

148.

19)amiodarone M.O.A

149.

20 LMWH M.O.A

150.

21 fleicanimide M.O.A

151.

22 respiratory disease with nomal alveoli- asthma

152.

23 N acetylcysteine M.O.A

153.

24 pt with definite type 1 RTA and nephrocalcinosis-for some reason said Type 2

154.

25 some pt with hemiplegia said anterior cerebral ans was lacunar

155.

26 Rx in some pt with membranous GN and severe nephrotic syndrome ? cyclophosphamide for some
reason said ciclosporin

156.

27Rx of 1 thrmobocythaemia ? aspirin i said hydroxyurea

157.

28 rapid dx of empyema i said ph of aspirate ? culture was an option

158.

29 serial echo as way of monitoring I.E

159.

30)Mantoux intrademal injeciton not sub cut

160.

33 Prolonged QT syndrome Mx ? Mg2+ ect..

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.

36 diagnosis of fungal nail infection-? UV light ? nail clippings culture

164.

37 causes of death in acromegaly-LVHF

165.

38 monitoring in Ca colon- CEA

166.

39 hypogonadotrophic hypogondism-?Kallmans

167.

40 some fellow with -? Vit B12 and SCDC

168.

41 Organism in valve replacment and I.E. s. epidermitis

169.

42 immediate Mx of pt in fast AF- i said anticoagulate

170.

43 some chap with a rash which he had which disappeared and he still thinks its present-?somatoform

171.

44 Ondansterone -M.O.A-5HT blocker

172.

45 some chap with haemolysis after taking a drug for Rx of a UTI i said G-6-PD im not sure

173.

46 some acute transfusion reaciton probably ABO incompatibility

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.

49)HIV and monocular blindness-?CMV retinitis?toxocariarsis

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.

51)some question of a traveller answered dengue fever

179.

52 tuna poisoning scrombotoxinpurple, Oct 21, 2005#58

180.

GuestGuestAll of U R really wonderful

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.

GuestGuestHepatitis C and CRF

185.

Drug Contraindicated

186.

Ribavirin - excreted by kidneysGuest, Dec 11, 2005#61

187.

GuestGuestA DVT patient who also had bleeding flare up of ulcerative colitis.

188.

Ans-?compression stocking/?Dalterin /WarfarinGuest, Jan 3, 2006#62

189.

dr__neilGuestemail me if somebody wants all past papers from 2001 onwards.

190.

totally free of cost.dr__neil, Jan 3, 2006#63

191.

GuestGuestcud u pl give ur email id dr neil.Guest, Jan 22, 2006#64

192.

sheikhGuestdear dr osama greeting

193.

can you please send these questions .AND any ques mcqs i will appear in irish part 1 next month
thankssssss

194.

my e mail sheikhna10@yahoo.comsheikh, Mar 31, 2006#65

195.

GuestGuesthi dr osama,

196.

thanks for all your efforts

197.
198.

i am new to the forum and would like to enter mrcp1 in next jan

199.

i know i must study very hard

200.
201.

can you please send me the mock questions too

202.
203.

thxxxxxxxxxxxxxxxxx so much

204.
205.

my e-mail is marian_carolien@yahoo.comGuest, Jun 11, 2006#66

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Discussion in 'MRCP Forum' started by Neha Gupta, Jan 16, 2013.

1.

Neha GuptaActive Member

1. Cold sore then pneumonia

2. Alfa 1 anti trypsin genetics

3. Copd patients 100 O2 in ambulance , abg , reduce oxygen to 24%

4. Abg

5. ? Type to lung ca harsh sound all over lung field peripheral location adenocarcinoma, brochoca

6. Low O2 in other healthy person, rx low doses heparin

7.pneumothorax rx what is contraindicated after rx

8. Pleural effusion next investigation of choice lateral x ray

9. Couple of question on niv,

Copd with low ph 7.3

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)

1. MEN-1 : either insulinoma or gastrinoma

2. Sotalol - K channel
3. Drug that inhibits warfarin - cipro
4. Pregnant mother with hypoglycemia - fetal production of insulin?
5. Mechanism of action piogliptazone
6. Heavy smoker with supraclavicular lymph node - bronchoalveolar or squamous CA?
7. Meta-analysis : publication or randomisation?
8. How to treat acute SLE - prednisolone or azathioprine
9. Rahes in alcoholic - niacin?
10. Cause of hypokalemia in lady with truncal obesity - cushing?
11. Statistic for heart failure - survival?
12. Crescentric glomerulonephritis - Goodpasture?

13. Bloody diarrhea with oral ulcer - UC or Crohn

17. Membranous nephropathy - carcinoma ?
18. Sclerodema - oesophageal dysmotility
19. Hep B antigen that appears first - surface antigen?
20. Susceptible for meningitis - C3 deficit?
21. Uncle required kidney transplant - Alport?
22. Thyrotoxicosis initial treatment - carbimazole?
23. Aquaporin 2 - nephrogenic DI
25. Fasciculation - motor neuron disease
26. Initial treatment for severe COPD - neb?
27. Type 1 respiratory failure but SPO2 100 - carbon monoxide poisoning?
28. Rotational vertigo - benign positional
29. Confabulation - Korsakoff
30. Nerve root for hip flexion - L1-L2
31. Helicobacter pylori - duodenal ulcer
32. Young pt. developed fever and sore throat with dysphagia - tamiflu?
33. Abdomen mass - biopsy?
34. Platlets 43000 with 1% falciparum - transfuse platelet?
35. Von Willebrand - before dental procedure - DDAVP
36. Bleeding von Willebrand - additional treatment after factor VIII - give vitamine K?
37. Lewy bodies - alpha synculin
38. RA - anti cyclic citrilluted peptide antibody
39. Painful eye and genital ulcer - Behcet syndrome
40. Blood stain sputum, ?low O2 , increased transfer factor - Wegener?

42. Wife died in accident - post traumatic stress disorder?

43. Obesity in DM - enexetide
44. Pericarditis - concave ST elevation
45. Uremic pericarditis - urgent hemodialysis
47. COPD patient with pH 7.3 - NIPV

48. Prophylaxis for tuberculosis avium - standard ward hygiene?

49. Alpha 1 antitripsin inheritance - autosomal recessive
50. Small VSD - pansystolic murmur with thrill
51. Contraindication for pneumothorax - ?
52. Pleural effusion - US? thoracotomy?
53. Stroke management - aspirin? clopidrogel?
54. Rheumatoid arthritis with painful eyes - scleritis
55. Red car passing by everyday - overvalued idea?
57. CT temporal lobe lesion - herpes simplex
58. Drug to avoid in G6PD deficiency - primaquine
59. Titubation - essential tremor
60. Unable to understand, write and read - global aphasia
61. Prophylaxis for migrane - propanolol
62. Weakness in flexion of foot - sensory loss in dorsum
63. Risk factor for suicide - unemployment
64. Right hand tremor - idiophatic Parkinson
65. CT low area of attenuation - ?progressive multifocal leukoencephalopathy
Neha Gupta, Jan 16, 2013
#1

young patient with blisters and mucosal involvement and conjunctivitis:

?Pemphigus as I didn't see any of the usual suspects for SJ in the stem

RF for stroke - duration of TIA (as part of ABCD2 score)

In UC if I remember right smoking actually reduces the number of relapses.

Pseudomonas - I went cipro thought it had the best gram negative cover

Azathioprine - I went for that thiopurine methyltransferase

With the TTG I think the question paper actually helped us out later on Ig A
As the patient having the medical didn't have angina I thought an angiography might have been a bit
gung ho. I went for another imaging given high high predicted mortality.

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

Sensorineural deafness - I think is X-linked

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.

Acoustic neuroma- absent corneal reflex

2. patient extratalketive, with symptoms of grnadeur- maniac episode

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

26. Rx for chlamydia- ????

27. Most common cause of bacterial meningitis in a 51 yr old woman- ?Steptococcus
pyogenes
28. patient has falciparum malaria- parasite index 1%, has anaemia, plt 45,000, already started
on quinine, ????no rx needed for low platelet
29. Patient with amastigotes- sodium stibogluconate
30. patient with rash buttocks with eosinophilia- ?strongyloidosis ?schistosomiasis
31. patient with MI- give clopidogrel (new guidelines)
32. patient with colonoscopy patchy inflammation in ileum- ?Chrons
33. patient with smoking having recurrent active proctitis- long term remission ? stop
smoking
36.A patient with some fibrosing alveolitis had chest xray lesion, renal biopsy showed
membranous glomerulonephritis- ?Ca bronchus
37.A trumpet player with primary pneumothorax- advice ?no scubadiving lifelong ? stop
trumpet playing 6 months
38.Obese diabetic patient on Metforimin hbA1C high- add exenatide
41. A patient with positional vertigo- BPPV
42. A patient with long standing steatorrea, epigatric pain,vomiting- ?chronic pancreatitis- test
to do CT abdomen
45.A 21 yr old patient with family h/o PCKD USG done now is normal, options no further
investigation or is it to repeat USG at 30 yrs.
46. Patient with Von willebrand pevious h/o bleeding now before doing dental procedure give
DDAVP.
47. A man taking steroids for asthma has cushingoid features- cortisol high, its
Pseudocushings
48. A patient having amenorrhea, galactorrhea, microprolactinoma, which other hormone
deficient- ?GH ?Thyroid, ?Cortisol
49. An african pt with thalasssemia trait has persistent neutropenia has blood picture
pancytopenia, peripheral smear normal, ?Myelodysplastic, ?Due tothalassemia trait, ?Ethnic

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

THIRD heart sound cariomyopathy

pansystolic murmur VSD
unilateral ptosis third cranial nrve leision posterior communicating artery aneurysm
conduction aphasia
delusion

permanent pacemaker third degree block

htn papilloedema - oral ace i
infective endocarditis - 2 months after prosthatic valve . staphylococci
type 1 respiratory failure PE
metabolic acidosis with normal anionic gap rta 1
increased ca low phosphate - primary hypoparathyroidism
increased tsh normal t4 subclinical hypothyroidism
patient with palpitation with hyperthyroidism - beta blocker
migrane prophylaxis propranolol
virulism - adrenal tumor
botilium endotoxin
remmision uc prednisolone

igA DEFICIENCY coeliac

alcoholic cardiomyopathy

Recall Q MRCP 1 May 2013

Discussion in 'MRCP Forum' started by Neha Gupta, May 9, 2013.

A few Qs MRCP1 7th May,

1.Adenosine mech of action - G-couple receptors

2.Strongloides tx - albendazole

4.Boy with down syndrome and murmur and parasternal heave - Ebstein Abn

5.Pregnant lady with worsening asthma - beclomethasone

6.Lady known diabetic with postural drop - hypopitutarism

8. what rhematoid factor target - ? citrulline

9. Boy with hypercalcemia and xray changes - sarcoidosis

11. Man U whitney for the question about blood pressures

12. another statistics - sensivity 9 is the answer)

13. Question about pernicious anemia - anti parietal cell antibodies

14. What causes repolarization - pottasium channels

15. What causes prolongation of QT - pottasium channel blockage

16. CNS- patient with ipsilateral and contralateral sisns - where is the lesion - lateral medulla

17 Patient with mark-gunn pupils - lesion in occipital lobe

18 patient with a non secreting pituitary tumor - what could it cause a few yrs down the line - bitemp
hemianopia

19. Lady with bleeders on colonoscopy Hb 9.2 - i said to transfuse(?)

20. Young man with haematuria and past history of deafness plus proteinuria - ??? Alports, IgA
nephropathy

21. lady with rash and signs of - ITP

22. 9:22 translocation - CML

23 patient with bloating with all those haematological signs - Myelodysplastic syn

25. line infection - s epidermis

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

30. Young lady, pneumothorax 1.5 cm no SOB - outpatient xray

31. old man with pagets disease, no fractures - ? residronate

32. 19 year old with neck tremors and snoring in class - ? Wilson's dx

33. Barretts oesophagus - Endoscopy surveillance

34. Man with polyuria, loss of libido and back pain - Do transferrin sat.

35.Villous adenoma - can remember question

36. Patient with diarhoea, chest infection etc - X-linked agammaglobulinemia ( Wiskott Aldrich - i
think)

37. Loss of sensation dorsum of foot etc - S1 root compression

38. Question about - frozen shoulder

39. Another one with answer as - ulnar neuropathy

40. Lady with recurrent bacterial pneumonia - check immunoglobulins

41. Ramipril induced angioedema, what cause - Bradykinin

42. Hereditary Haemorrhagic telangiectasia - Autosomal dominant

43. What does primaquine do in vivax plasmodium - destroy gametes- i think

44. Man with insect bite from south africa ( no lymes !! ) - Rickettsia

45. Anorexia on NG feeding - hypophosphatemia

46. DM - Action of Sitalgliptin - DDP-4 inhibitor

47. Before starting on warfarin - P450

48. which cell organelle splices RNA to protein - Ribosome

49. reverse transcriptase - amplifies DNA

50. CT scan multiple enhancing lesion , what to start after dexa - sulp + pyremerhamine

51. cANCA + symptoms - I chose Wegners - did anybody choose Microscopic polyangitis?

52. Marfan's syndrome - Aut dominant

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

55. Vit D resistant ricketts - X linked dominant

56. Young man , bipolar, with polyuria - Lithium

57.Patient on clarithromycin, dont give - simvastatin

58. Bivarudin , mech of action - direct thrombin inhibitor

59. Amitriptylline overdose, low GCS - IV bicarb

60. Methanol overdose, GCS 5 - Haemodyalysis

61. Man who had viral infection, now comes with rash - erythema multiforme

62. Red eye pain - scleritis

63. Intermittent blurred vision - normal on corrected - cataract ?

64. First order kinetics - bioavailability

65. LVF, what med to add - Digoxin

67. Dementia, loss of inhibition - Lewy body

68. Dementia recurrent falls - stop haloperidol

69. Patient with worsening renal fxn - I will stop metformin

70. Severe acne - isotretinoin

71. Lorazepam - increases GABA activity

72. 70 yr old man with LVF, which antiHTN - I chose ramipril

73. Ashtmatic - severely acute, not responding - IV Mg sulphate

74. Patient on pergolidine - organise ECHO

75. Anti HBc positive, HBsAG negative - Do Hep E serology

77. Man with neck stiffness, headache - AV malformation

78. Girl with reduced consiousness and seizures when disturbed - ? complex partial ? primary
generalised

79. Headache piercing the eyes - Cluster headache

80. MND - with LMN and UMN signs - Amyotropic lateral sclerosis

81. Girl with menorrhagia - Activated protein C resistance

82. Man with tumour of apex, which condition will you not operate - FVC 1.8 ??

83. Which intervention decreases colon cancer - etoricoxib ???

84. Which intervention decreases risk of pre-ecclampsia - ?? aspirin... LMWH ( patient is 12 wks)

85. leukaemia good prognosis - t(15:17)

86. Woman with sudden onst SOB, just started chemo for BRCA - Anthracycline Cardiomyopathy ?

87. Uncomplicated clamydia treatment - Doxycycline

88. Man presented with urethral discharge - swab - neisseria gonococcus, but blood cultures negative,
why - co-existence of Chlamydia

89. Man with painful genital ulcers - chanchroid

90. Woman whose husband died, but she still sees him talking to her - ? PTSD ???

91. Man with low mood, no eye contact, 2nd person

auditory hallucination, drinker, suicidal - ? psychotic depression ?

92. man convinced he had cancer despite all negative tests - hypochondriac

93. Man presenting with symptoms, despite tests he believed there still there - Somatisation

94. man with parkinsons, agitated, abusive - haloperidol

95. Joint sepsis - staph aureus

96. man with bloody diarrhoea, children's school mates recently had diarrhoea - ? rotavirus

97. lady admitted with sweating and palpitations - Phaeochromocytoma

98. Complete heart block - variable intensity S1

100. African lady, symptoms suggestive of leprosy - biopsy a skin lesion.

Neha Gupta, May 9, 2013
#1

1.

Partha SarkarGuest

Mixed respiratory and metabolic acidosis

ETT, strongest indicator to stop
Heart murmur in 2nd and 3rd ic space,
mitral stensis, indicator of severity
infective endocarditis risk
cardiogenic, ?vasogenic syncope in patient wid 1st degree heart block
physiologic change after one minute of standing
maximum absorption of Na in salt and water depleted patient
treatment option for mild heart failiur with no edema
?cardiac temponade, patient with markedly elevated jvp
treatment of hypertension in patient wid peripheral vascular disease
alcholic, camunity acuired pnemonia, treated in icu, again fever, ?empyema
idiopathic pulmonary fibrosis, finding on xr
extertringic allergic alviolitis, investigation, ?esoinophilia
Allergic bronchopulmonary aspergilosis, investigation
Small cell carcinoma, one of its paraneoplastic syndromes was given
lambert eton syndrome, antibodies
Systemic sclerosis, wot next can be affcted
pain in fore arm on resistance of extension of wrist, ?epicondolyitis
osteoarthritis of hip, treatmnet option
patient with problem of speech, carotid artery diseciton etc were options
Multiple sclesosis, patient with pst histery of arm problem, now vision
?hopital acquired pnemonia... tazosin
patient wid fever and juandice, picture of asending cholangitis, where is the promblem? cbd etc were
options
spontaneous becteriia peritonitis, organism
patient wid ingestion of 20 paracetamol pills, PT
? VOn wilibrand disease, patient with menoragia
feature of anemia of chronic disease
patient wid ulcerative collitis and now joint pains

dka, iv insulin was given, iv n saline

patient wid low TSH, cortisol etc, hypopiturism
Test of Acromegally, insulin toleance test?
feature most strongly associated wid tb
treament startd wid acylovir, csf feature most strongly associated wid diagnosis
man wid 3 yrs h/o lesion on shin
diabetic patient wid episodic loss of conciousness ?automic neuropathi
diabetic patient, poorly controlled, type of diabetes
Patient wid pheochoromsytoma, wot treatment shoud be started..?phenoxybenzamine
flash pulmonary edema.... renal artery stenosis
resistand hypertension, wot inx should be done
patient wid early mornign stiffness and uper arms tenderness,, polymylgia?
patient wid fater has soriasis, now joint pains
ankylising spondolyits, clinical feature
patient wid picture of RA, on nsaid, next treatment option
patient in hospital, got gout, treatment?
patient wid hearing loss, tinnitus and vertigo.. ?meniere's disease
sudden onset visual loss, retinal hemrges and cotton wool spots
thyroid swelling, investigation.... ?FNA
Partha Sarkar, May 10, 2013
#2

2.

Partha SarkarGuest

colon cancer-- aspirin

more qs...
=collapsed patient.... compression first
=reactivation of TB test...gamma interferon
=case of ketoacidosis dehydrated what next after insulin.... normal saline
=3d image of ? protien test?
=case of pulmonary stenosis

patient with dyspnea...echo or V/Q perfusion to confirm sec to emboli

=seborrhic dermatitis.. scaly lesion on face, nose scalp sternum i think
=xray osteosclerosis ---osteoarthritis old lady with varus deformity 3 months pain
=PCOD--- test... high LH/FSH ratio .. increased androgen
=boy with abnormal movements ? tourette syndrome
=recurrent uri ---- to check for complement def
=weak extension at elbow and wrist with some sensory loss--? post interosseos nerve another q was on
cervical radiculomylelopathy
=one patient with heart failure ...was on ramipril, furosemide aspirin ? need to ad bisoprolol
Partha Sarkar, May 10, 2013
#3

3.

Partha SarkarGuest

-collpased pt-i think u give rescue breaths first

-diabetic pt 15 yrs-collapsed,no postural drop , prolonged pr interval-SA Node.
-pt on chemo,vomiting-i went for steroids,as this chemo is highly ematoigenic and we give steroids for

another few days to help with same

-colon ca-aspirin
-pt on lithium and started frusemide,polyuria.only low urine osmolality,i went for frusemide as it does
not fit with DI secondary to lithium ?
-cluster headaches
-carotid dissection
CCF-add B.Blockers
-loss of sensation dorsum foot/ankle reflex ? i think L5
-methanol OD with low GCS,I think that methanol levels were very high,in that case i went for
Haemodialysis,ethanol infusion will be an answer if the levels were not high enough,now i dont know
500 is mildly/or highly raised
- 70 yr old LVF - Bendroflu
-man with tumour at apex lung-i think he had metastatic disease ,i did not went for FEV's
-pregnant lady,known pre eclampsia,i went for salt restriction?do we give aspirin in pregnancy
-diarrhoea,recently children had it in school-rota virus
-pt had acute gout with ccf-steroids to start with
-worsening renal fuction-continoue.creatinine still < 150
-girl with syncope,but normal after the episode-vasovagal.

Pergolide - echo (causes valvular heart disease and cardiac fibrosis)

3D structure of protein - Xray crystallography
Ciclosporin in post renal transplant - Tcell function suppressed
A subject with urethritis, gram neg intracellular diplococci, VDRL +ve - False positive VDRL
Creatinine increased after Trimethoprim - decreased tubular secretion (trimethoprim decreases tubular
secretion of creat)
Down's syndrome valvular HD - VSD
Myelofibrosis - fatigue commonest symptom
The question on ABG - mixed metabolic and respiratory acidosis
Relative afferent pupillary defect - Optic nerve is site of lesion
Lesion in pituitary (0.9 cm) not increasing in size over one year - a probable incidentaloma...no effect

* 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.)

* on lithium & hypertensive = give amlodipine

* contraindication to samll cell caner = infliltration of brachial plexus (or volue < 1.5 not 1.8 in
options)
*lambert eaton syndrome = antibodies to post synaptic Ca voltage gated channels
* pain in the forearm worst by wrist extension = radial tunnel syndrome ( more distal than tenis
elbow).
* malingering man asking fir sick report and he drinks alcohol = alcohol dependence.
* woman who sees her dead husband = readjustment.
* a young man diagnosed with IBD (crohns) and started treatment what is the advice = stop smoking

*recurren vertigo = BPV = Dix Halpik maneuver.

* false +ve VDRL = yaws (trponemal species).
* collapsed pt & breath or pulse: chest compression ? (before AHA 2010 PPl argued abt asking for
help).
* Howel-Jowel =hyposplenism = Coealiac.
* circular lesion on dorsum of the hand = granuloma annulare.
* multiple enhance ring in CT = c.toxoplasmoisi =pyrimeth+ sulfazianize.
* on lithium & hypertensive = give amlodipine
* contraindication to samll cell caner = infliltration of brachial plexus (or volue < 1.5 not 1.8 in
options)
*lambert eaton syndrome = antibodies to post synaptic Ca voltage gated channels.
* pain in the forearm worst by wrist extension = radial tunnel syndrome ( more distal than tenis

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.

MRCP part-1 recall MCQS 07/05/2013

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

topics asked were .

1. lateral epicondyitis
2. ischaemia mesenteric
3.ra
4.sle
5.htn treatement in more than55
6.malignant htn
7.hf
8.vsd
9.ps or aortic valve bicuspid ?
10.normal aonion gap metabolic acidosis
13.nonparametric test
14.exercise tolerance test
15.ihd location of artey
16.men 2 pheochromocytoma
17.treatment of pheochromocytoma
18.infective endocarditis
19. rf
20.ankylosing spondylosis
21.gout
22. oa
23.septic arthrits
24.septic arthritis
25 psoritic arthritis
26 enteric arthritis
27.metronidazole -ileic involvement in chrons
28.dka
29.addisons disease

30 hypertension with low potasium.

31.mechanism of action of spirinolactone
32 direct thrombin agonist
33.eea
34.iaa
35.telangestasia
36 marfans
37,complement

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

62.unequal blood pressures

63.psedomonas.
64.hypochondriasis.
65.schizophrenia,
66.seizures
67. head tremor
68 .motor neuron disease.
69.pons
70.intrasellar piytutary
71.hypopitutarism
72.smivastativ+clarithromycin
73.meiners disease.
74.tertiray hyperparathriodism
75.acromegaly
77.di lithium.
78. siadh.fluxetine
79. fluoxitine in young patient
80.alcohol piosing
81.wegeners
82 alport
83.hsp
85.erythrema multiforme
86.bullous pempigoid
87.seboric dermatits
88.psoriasis
89. granuloma annulare
90.ulnar nerve leision
91.dyspepsia.
92.uc
93.ibs

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.

125 treatement of toxoplasmosis

126.xlinked dominant rickets
127.tlco reduced in lung fibrosis
128.plural effusion
129.cluster headache
130.tricyclic overdose' bicarbonate
131.adenosine first in svt then give again
132.adenosine mechanism
133.inflixanib
134.risk factor crohons smoking
135-omega 3 use
Partha Sarkar, May 10, 2013
#2

2.

Partha SarkarGuest

*which is correct---cluster or analgesia induced headache

*which is correct ---to prevent colon cancer--w3 or vit -3 or etoricoxib
*in preclamsia--treament--salt restriction or nifedipine
*occupational asthma---is it correct --do pefr to do work and away from work
*following uti with red urine ,mastoid surgery-iga or alport
*in plasmodium vivax -primaquine used due to reduce gamate or liver stage
*diabetic retinopathy---stop smoking correct or no*
*sciatic or s1 nrve compressio*
*

*severe dyspepsia after treatment-do endoscopy or others

*in ra ---ig or citrulline

*optic nerve or occiptal lobe-maccunn

*in severity of ms --which one correct i la size or pul artery pressure
*in ulner nerve anatomy-1 st or 2nd lumbrical
*psudomona-tazobactam or cefotaxime
*esbl -impenem or other
*bowens or granloma annulare
*gilbert ----iv nicotinamide or fasting 48 hours
*in eyes---osmolality change or cataract
*in youge age af ---flecainide or digixoin
*recurren vertigo = BPV = Dix Halpik maneuver.
* false +ve VDRL = yaws (trponemal species).
* collapsed pt & breath or pulse: chest compression ? (before AHA 2010 PPl argued abt asking for
help).
* Howel-Jowel =hyposplenism = Coealiac.
* circular lesion on dorsum of the hand = granuloma annulare.
* multiple enhance ring in CT = c.toxoplasmoisi =pyrimeth+ sulfazianize.
* on lithium & hypertensive = give amlodipine
* contraindication to samll cell caner = infliltration of brachial plexus (or volue < 1.5 not 1.8 in
options)
*lambert eaton syndrome = antibodies to post synaptic Ca voltage gated channels.
* pain in the forearm worst by wrist extension = radial tunnel syndrome ( more distal than tenis
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.
* asian woman with unequal blood pressur = Takayasu
*cholangitis with 4-fold rise in S.amylase = stone as pancreatic duct?
* discritpiton of sata disribution around mean = SD?
*pituitary incidentalom prognosis = no progress

1.Adenosine mech of action - G-couple receptors

2.Strongloides tx - albendazole
4.Boy with down syndrome and murmur and parasternal heave - VSD?
5.Pregnant lady with worsening asthma - beclomethasone
6.Lady known with pallor, diabetic with postural drop - hypopitutarism
8. what rhematoid factor target - RF is a IgM/IgA or IgG that is targeted at IgG
9. Boy with hypercalcemia and xray changes - sarcoidosis
11. Paired t test for question on new topical treatment for facial hemangioma
12. another statistics - sensivity
13. Question about pernicious anemia - this one should be red cell folate.. Reason because patient is
post gastric surgery for PUD (likely respected Parietal cells and so b12 deficient), and recently had
trimethoprim therapy (folate antagonist).. Red cell folate provides reflection of baseline folate levels
14. What causes repolarization - potassium channels
15. What causes prolongation of QT - potassium channel blockage
16. CNS- patient with ipsilateral and contralateral signs - where is the lesion - this answer is right
pons.. Had CN 6 and CN7 with crossed hemiparesis... Both nerves from mid to lower pons
17 Patient with RAPD - lesion in optic nerve
18 patient with a non secreting pituitary tumor - tumor is small and non functioning.. Likely to be
asymptomatic.. 'Incidentaloma'
**19. Lady with bleeders on colonoscopy Hb 9.2 - transfuse in view of symptomatic anaemia..
Tranexamic acid contraindicated - bladder fibrosis

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

25. CAPD peritonitis - staph epidermidis

26. Lady with increased ALP and GGT what further test - Anti mitochondrial antibodies for PBC
27. Patient with IBS with non specific presentation. I think this should be celiac disease.. Patient may
sound like IBS but red flags are anaemia with both folate and ferritin low - celiac can present this way.
28. Lady with scleroderma now with watery diarrhea - malabsorption syndrome
29. Lady with CREST - may suffer from malabsorption in the future
30. Young man with dyspepsia, no other signs - Urea breath test
32. old man with pagets disease, no fractures - bisphosphonates
33. Barretts oesophagus - Endoscopy surveillance

35.Villous adenoma - 81 female with mucous stool, hypokalemia and hypochloremia

**36. Patient with diarrhoea, chest infection etc - X-linked agammaglobulinemia ( Wiskott Aldrich - i
think) - not sure, could be CVID
37. Loss of sensation dorsum of foot etc - S1 root compression
38. Question about patient with shoulder pain, this should be impingement syndrome, qn describes
Hawkins and Neers
39. Ulnar nerve impairment- loss of 3/4 lumbricals
40. Lady with recurrent strept bacterial pneumonia - check complement (capsulated bacteria)
**41. High fever hypotension severe cellulitis, sounds like nec fasciitis. Strept pyogenes. Give clinda
and. Penicillin
**42. Most common cause of SBP - community acquired should be strept pneumonia, nosocomial is
gram negative

43. Ramipril induced angioedema, what cause - Bradykinin

44. Hereditary Haemorrhagic telangiectasia - Autosomal dominant
45. What does primaquine do in vivax plasmodium - destroy gametes in liver. - i think
46. Man with insect bite from south africa - Rickettsia
47. Anorexia on NG feeding - hypophosphatemia
48. DM - Action of Sitalgliptin - DDP-4 inhibitor
49. Before starting on warfarin - P450
50. which cell organelle splices RNA to protein - This is nucleus. mRNA spliced out introns in nucleus
before migrating to ribosomes in RER
51. reverse transcriptase - transcribes RNA to DNA
**52. CT scan multiple enhancing lesion , what to start after dexa - sulfapyridine/pyrimethamine
53. cANCA + symptoms - Wegners
54. Marfan's syndrome - Aut dominant
55. ST changes in V5-V6, what are you likely to see on coronary angio - Circumflex stenosis
56. SVT , you gave adenosine 6 mg, nothing happens, what next - repeat adenosine
57. Vit D resistant ricketts - X linked dominant
58. Young man , bipolar, with polyuria - Lithium
59.Patient on clarithromycin, dont give - simvastatin
60. Bivarudin , mech of action - direct thrombin inhibitor
61. Amitriptylline overdose, low GCS - IV bicarb
***62. Methanol overdose, GCS 5 - hemodialysis
63. Man who had viral infection, now comes with rash - erythema multiforme
**64. Red eye pain - scleritis
65. Intermittent blurred vision - normal on corrected - cataract from osmolality changes
**66. First order kinetics - NOt sure what question means... Shouldn't be bioavailability because they
described IV administration so bioavailability should be equal amongst all subjects. I chose half life (5
half lives to steady state)
67. LVF, what antihypertensive to add - ramipril aids left ventricle remodeling
**68. patchy hair loss - only in frontal and temporal regions - no other hair loss.. I put trichotillomania
**69. Dementia, loss of inhibition - ?alcoholic dementia vs vascular dementia

70. Dementia recurrent falls - stop haloperidol

71. Patient with worsening renal fxn - Leave it alone! Cr can rise 15% with ace inhibitor (allowed).
Metformin only needs to stop when Cr >150-200
72. Severe atopic dermatitis - tacrolimus
73. Lorazepam - increases GABA activity
74. 70 yr old man with LVF - add bisoprolol
75. Ashtmatic - severely acute, not responding - IV Mg sulphate
**76. Patient on pergolidine - organise ECHO
**77. Anti HBc positive, HBsAG negative - Do Hep C serology. Patient immune to hep B and hep A.
Hep E usually in pregnant women?
78. Man with neck pain and neurology - carotid artery dissection
79. Girl with reduced consiousness and jerks only when disturbed.. Sounds like malingering
80. Headache piercing the eyes, history of analgesia - analgesic induced headache
81. Arm and bilateral lower limb involvement, history of neck and back pain - cervical
radiculomyelopathy
82. Girl with menorrhagia - VWD.
**83. Man with tumour of apex, which condition will you not operate - FVC 1.8 ?? This one is
strange.. I thought the criteria was <1.5?? Not sure
84. Which intervention decreases colon cancer - etoricoxib
85. Which intervention decreases risk of pre eclampsia- aspirin
86. leukaemia good prognosis - t(15:17)
87. Woman with sudden onst SOB, just started chemo for BRCA - Fulfills becks triad for tamponade
88. Man with painful genital ulcers - LGV
89. Woman whose husband died, but she still sees him talking to her - PTSD.
90. Man with low mood, no eye contact, 2nd person auditory hallucination, drinker, suicidal Psychotic depression
91. man convinced he had cancer despite all negative tests - hypochondriac
92. Man with poor work performance, alcohol - alcohol dependence. Mental status exam was normal
so it's not depression
**93. man with parkinsons, agitated, abusive -? Lorazepam - all others are antipsychotics that can

cause EPSE even if atypicals..

94. Joint sepsis - staph aureus
95. man with bloody diarrhoea, children's school mates recently had diarrhoea - campylobacter.. Rota
causes secretory diarrhea
96. lady admitted with sweating and palpitations - Phaeochromocytoma
97. Complete heart block - variable intensity S1

99. African lady, symptoms suggestive of leprosy - biopsy a skin lesion.

100.Mixed respiratory and metabolic acidosis
Neha Gupta, May 11, 2013
#4

3.

Neha GuptaActive Member

101. ETT, strongest indicator to stop - angina

**102. Heart murmur in 2nd and 3rd ic space - PS
**103. mitral stenosis, indicator of severity - Degree of Pulmonary capillary wedge pressure
(pulmonary HTN)
104. infective endocarditis risk highest with previous IE
105. Patient with cardiogenic syncope - SA dysfunction
106. physiologic change after one minute of standing - increased cardiac output
**107. maximum absorption of Na in salt and water depleted patient - still proximal tubule and TAL ?

109.alcholic, camunity acuired pnemonia, treated in icu, again fever, ?empyema

**110. idiopathic pulmonary fibrosis, finding on xr - lower zone heart border blurring

***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

164. location of mechanism of action of spirinolactone

165. Occupational asthma - monitor PEFR on weekdays and weekends
**166. Diplopia and proximal myopathy - MG
167. Unequal blood pressures in both arms in asian lady - Takayasu's arteritis
**168. which anti depressant to use in young type I DM patient? mirtazapine? others were
SSRI/venlafaxine
169. Rash and renal impairment - HSP
** 170. mechanism of inactivation of cortisol - ?free excretion
171. klienfilter syndrome - small testes, primary testicular failure
** 172. Patient with hypocalcemic hyper calciuria. How to treat? **173. Red urine, facial swelling amongst symptoms - likely PNH over PCH
174. bilirubin mild elevated and other LFT normal next test - reticulocytes
175. Organism causing epiglottitis - Hib
176. Lung fibrosis finding? - Reduced TLCO
** 177. Patient with newly diagnosed Chron's disase, started on prednisolone, which is next best
treatment advice - mesalazine vs quit smoking
178. Type I DM not well controlled on OHGAs, looks like will be insulin requiring - LADA
Neha Gupta, May 11, 2013
#5

4.

Neha GuptaActive Member

Chemoprevention of colorectal cancer:

"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.

Neha GuptaActive Member

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.

Neha GuptaActive Member

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.

Neha GuptaActive Member

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:

Serum creatinine 200 mol/L (50-100)

Serum urate 0.5 mmol/L (0.12-0.42)

Which of the following is the most appropriate treatment for this man's presentation?

(Please select 1 option)

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.

Thus steroids are probably the best option.

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.

Neha GuptaActive Member

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)

wekipedia source lumbericals

The first and second lumbricals are innervated by the median nerve. The third and fourth lumbricals are
innervated by the deep branch of the ulnar nerve.
second question i think ivermectin was not the option of those five this question is added in
passmedicine with correct answer albendazole and ivermectin in no option.
Neha Gupta, May 18, 2013
#10

9.

Neha GuptaActive Member

PERITONEAL DIALYSIS-RELATED INFECTIONS RECOMMENDATIONS

THERAPY FOR EXIT-SITE AND TUNNEL INFECTIONS

The most serious and common exit-site pathogens are Staphylococcus aureus and Pseudomonas
aeruginosa. As these organisms frequently lead to peritonitis (Evidence), such infections must be
treated aggressively.
Neha Gupta, May 18, 2013
#11

10.

Neha GuptaActive Member

Harrison's In ternal medicine (18 th ed)

"Peritonitis typically develops when there has been a break in sterile technique during one or more of
the exchange procedures. Peritonitis is usually defined by an elevated peritoneal fluid leukocyte count
(100/mm3, of which at least 50% are polymorphonuclear neutrophils); these cutoffs are lower than in
spontaneous bacterial peritonitis because of the presence of dextrose in peritoneal dialysis solutions and
rapid bacterial proliferation in this environment without antibiotic therapy. The clinical presentation
typically consists of pain and cloudy dialysate, often with fever and other constitutional symptoms. The
most common culprit organisms are gram-positive cocci, including Staphylococcus, reflecting the
origin from the skin. Gram-negative rod infections are less common; fungal and mycobacterial
infections can be seen in selected patients, particularly after antibacterial therapy. Most cases of
peritonitis can be managed either with intraperitoneal or oral antibiotics, depending on the organism;
many patients with peritonitis do not require hospitalization. In cases where peritonitis is due to
hydrophilic gram negative rods (e.g., Pseudomonas sp.) or yeast, antimicrobial therapy is usually not
sufficient, and catheter removal is required to ensure complete eradication of infection. Nonperitonitis
catheter-associated infections (often termed tunnel infections) vary widely in severity. Some cases can
be managed with local antibiotic or silver nitrate administration, while others are severe enough to
require parenteral antibiotic therapy and catheter removal."

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.

Neha GuptaActive Member

what about these mcqs :

1-proteins-westren blot
2-heper ca - 3 hyper-para
3-parkinsons ass w hallucinations-haloperidol
4-ANA - SLE
5-dementia-alzahemer
6-wound healing-steroids
7.bigger number-smaller number
8-radial tunnel syndrome
9-ulnar nerve
10-siatatic nerve
11-ACEi-c4
12-cealic -TTG
13-HYPOTHYRODISM
14-donpeizol
15-ctx vomiting-Dex
17-severity MS -valve area
18-colon cancer - aspirin
19- CLL - imunophenotyping
20 T1DM 12yea r- fluxoteine
Neha Gupta, May 19, 2013
#13

12.

Neha GuptaActive Member

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.

Lyme disease - investigation.

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

Cardiac involvement 0 Anti Ro

Hypocondiasis
HIV post exposure Rx
APML inv=cytogenetics
Lwy body dementia = increae with neuroleptics
Catalepsy
Syringomyelia

Lateral Medullary Syndtome Post inf cerebellar art

Acute confusional state Rx Halop
Oculogyric crisis Rx Procyclidine
Persiveration which Lobe= Frontal
Burkits Lymphoma = t 8,14
Bronchiectasis - postural drainge
A1anti trypsin def which cell
ACE inhib how cause dry cough
Hereditary angioedema def of C1 Est
n APML asked about investigation which is guiding the immediate Mgx in pt presenting e epistaxis and
petichae= DIC = coagulation profile is the answer.
ACE = histamine release
A1 anti trypsin= elastase
pagets dis of bone
Cyclosporin Tremor?
Pt from Kenya - C malaria or Listeria?
M/A Carbonic anhydrase inbiror
Mitochondrial disease - optic atrophy
Th2 - IL-4
Rituximab - CD 20
Azospermia - Salfasalazine
Hormone repla the - to dec post men sym
Amiodarone
Oral morphine to SC morphine - 60 ?
LIthium Nephrogenic DI
Paracetamol Overdose - worse in Anorexia
DM neovasculariaztion Rx photocoa
Graves - Myxoedema
Alcohol withdrawl Rx
Increase APTT not improved with mix - cause

Patient with sore throat and psoriasis - Gutate

Patient with painless genital ulcer with painless LN
Erythema Multiforme - Herpes simplex
MRCP september 2013 RECALL
(some answers are wrong)
1. Pericarditis - ECG - PR depression
3. Lyme disease - what is the 1st line investigation. I marked Borrelia burgodferi Serology
4. Cushings's disease - Plasma ACTH levels
5. SVT narraw complex - after vagal mano - what Rx? Adenosine
6.
7. Math on Neg Pred value. I calculated this. It took some time but i was sure about the answer...
Option D.
8. Relative risk reduction = I calculated the values but could not divide them as they were in points. I
ran away from maths and I didnt know i will face it in mrcp1 as well..
9. bullus pemphigoid
10. Acromegaly investigation... OGTT
11. Myotonic dystrophy
12. Bacillus - fried rice (I dont even know whether this question was in exam or not? If yes then I
would have surely marked this Biryani wala option.
13. upper lobe fibrosis cause AS
14. Ext allergic alveo by bird Rx.. Prednisolone
15. Lung Ca - contra of surgery I marked Horner's syndrome. :D
18. P value- I dont remember exactly.. i think i marked option 1. Significance.
19. IgA. Dermatitis herpitiformis
20. TCA - ECG
21. Prevention of variceal bleeding- Propanolol is the correct answer. Another beta blocker was also in
option :P
22. Achalasia- endoscope not passing... failure of relaxation of lower esophageal sphincter
23. Lady with pain in RIF. There is a mass on examination. Temprature raised. Pulse above hundred.
BP normal. Next best investigation? I was confused between colonoscopy and CT scan.
24. Anti Ro- SLE patient has high risk of CVS event
26. Hypocondiasis- Woman is convinced she has a brain tumour
27. HIV post exposure Rx- combination therapy for 4 weeks.
28. APML inv=cytogenetics (I remember this was the last question of paper B and I marked
Immunophenotyping :D .. hehe im wrong I know.
29. Lwy body dementia = increae with neuroleptics. Yes Sensitivity to neuroleptics
30. Catalepsy- sudden paralysis after laughter
31. Syringomyelia- spastic paralysis, pain and temprature loss.
32. Lateral Medullary Syndtome Post inf cerebellar art
33. Acute confusional state- As the patient was very old and had co-morbidities so i marked
midazolam. Passmed.
34. Oculogyric crisis Rx Procyclidine
35. Persiveration which Lobe= Frontal
37. Burkits Lymphoma = t 8,14
38. Bronchiectasis - postural drainge
39. A1anti trypsin def which cell- this question... i had no idea. I marked i think mass cell stabilizer cuz
protease was not in options.
40. ACE inhib how cause dry cough- I marked release of histamine which people say is wrong. They
think stimulation of sensory nerve is correct
41. Hereditary angioedema def of C1 Est
42. pagets dis of bone- raised ALP 185 I think
43. Cyclosporin side effect: Tremor

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

98. AF to maintain sinus rhytmn- Sotalol

99. Ebstein anamoly- dont remember the question
100. paineless genital ulcer Treponema
101. Septic shock prognosis lactate
102. HIV Needle Stick - Post exposure prophlaxis
104. Ulcerative collits exacerbation reason? smoking cessation
105. Cryoglobins in Nephritic - Hep C
106. AML indicator for immediate ttt - Cytogenetics
107. imatinib mechanism in stromal cancer - epidermal growth factor receptor. This question should go
to hellll... i marked vascular growth factor :dD
108. Pencil shaped RBC 110. Graves- Pretibial myxedma
111. Thyroditis - negligible uptake
112. Water derprivation test - Nephrogenic Di
113. Hormone replacement - post menopausal symptoms
114. Nephrotic - Anti-thrombin III
116. ADH - Collecting Duct
117. Dermatitis herpetiformis - IgA deposits
119. Old patient following surgery agitated, not stayin in bed, had 4g tds dexamethasone post 2 days,
cause of abnormal behaviour- steroid
Steroid Psychosis
120. Depression following death of wife
121. Time duration for resuming driving after pacemaker insertion- immediate or 1 week?
122. Time duration for monitoring lithium levels after starting rx- 3months? Or 6 months?
123. Lady thinks havin mrsa infection, twice tested negative, thinks lab people changed sampleobssessive compulsive??
124. Left arm pain,biceps, triceps reflex absent- C5 C6 radiculopathy
125. Bilateral asymmetric paraparasis,one limb with decreased pin prick sensation and temp, other limb
loss of vibration and position-?(ependymoma, meningioma, SCID,syringomyelia) syringomyelia
126. Fatigue, loss of libido, hypotension, prolactin raised, cortisol decreased, FSH normal-(addisons,
prolactinoma, non pituatory tumour, apoplexy) I dont remember...
127. vertigo,tinnitus multiple episodes - Mnire's disease
128. Thyroid nodule next investigation - ? FNAC
129. Hyponatremia and hyperkalemia Addisons
130. Bullous pemphigoid
131. M/A Carbonic anhydrase inbiror
132. Mitochondrial disease - optic atrophy
133. elderly with vomiting and wt loss with metabolic alk with di ?? Brain tumour, pyloric obstruction
134. Achalasia: mechanisom of LES
135. Genome project- sequence of mRNA can be detected.
136. Cervical LN enlarged in last 3 months, and another LN FNA LN biopsy, LN excional biopsy
137. 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)
138. Patent foramen ovale- woman after flight of australia developed hemiplegia
139. Monoclonal gammopathy. Back pain but slight elevation of IgG... the back pain was due to
spondylosis and they had mention this in the last sentence.
140. what should be present most likely in a patient suffering from primary pulmonary artery
hypertension at rest? I didnt know the answer but marked Normal wedge pressure...
141. cypriat woman presented with lethargy. her brother was diagnosed to have G6PD. she has
HB. 109. (normal 115--)
mcv- 71
ferrtin 8 (normal < 15)
howel joly bodies
HBA2- raised?
diagnosis? I was hell confused between celiac and thalessemia...
Child with Cervical LN enlarged in last 3 months, and another LN what to do FNA LN biopsy or LN
exscional biopsy

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

Santosh Jadhav, Sep 12, 2013

#3

2.

Santosh JadhavActive Member

lp sample- gm positive diploccoci- streptococcus pneumonia

lp sample- increased protein, lymphocytes-viral meningitis
Allopurinol- inhibition of xanthine oxidase
abg- mixed metabolic acidosis and resp alkolosis
Lady found with empty bottle,ecg wide qrs, tachycardic- ?amitriptlline
AF to maintain sinus rhytmn- amiodarone
Investigation for lyme dis- IgM
Intermittent visible hematuria next day after onest of sore throat- Ig A nephropathy
Santosh Jadhav, Sep 12, 2013
#4

3.

Santosh JadhavActive Member

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.

Santosh JadhavActive Member

Uncontrolled HTN with LVH and gout-add acei

DOC for HTN with b/l renal scarring on USGKid with cervical lymph nodes for 1 year- Next step? Excison Biopsy
Diplopia on looking to the left - ? CN VI palsy
Supra normal FVC(100% predicted),no h/o of smoking - ?Asthma
Lady with symptomatic peritonitis - Rx ?Tap
VFib has been refractory to an initial shock -Shock
Cardiac pacemaker driving- after 1 week
Lithium monitoring - 3 months
Empyema-pH of pleural fluid
Pneumothorax fails treatment 48hrs -Refer
Marfan-fibrillin
Paradoxical embolus-PFO
abd distension,diarrhea,relieved by opening bowel -Irritable bowel syndrome
Osteoporosis - Alendronate
Dexa Osteoporosis: (T score -2.5). Osteopenia: (T score less than -1 but above -2.5).
Adult poly cystic kidney family screening(all > 20 yeas age)-?USG for all first degree relatives
Santosh Jadhav, Sep 12, 2013

#6

5.

Santosh JadhavActive Member

Cause of pulsus paradoxus - reduced left atrial filling

Cause of IE post valve replacement staph epidermidis
Finding in severe ms - presystolic accentuatiom
Cardiac cath finding in chronic pe at rest ??
Causr of high co2 btw svc n rt ventricle ??
Management in vf after failed shock - cpr
Meds causing long QT - citalopram
Meds to treat familial long QT - ? Beta block ? Fleicanide
Cholesterol emboli ? Eosinophilia

Lung function test findings ? Asthma

Pleural fluid in empyema - pH
Mx of failed chest tube in pneumothorax - rfr surgical

Diabetic eye new vessel mx - photocoag

DFU in diabetic - prev ulcer
High tsh in pt on thyroxine meds - ask compliance
Mx of neck lump ? Fnac
Acth to dx cushings disease
Dx of acromegaly gtt
Craniogenic DI in pt with lithium

SIADH in pt with lung infection

Persistent vomiting? Pyloric

Achalasia poor lower esophageal relaxation
Diarhoea n bloating in IBS
Fecal occult blood in pt with anemia
Coeliac ds in PBC with rash
Colonoscopy in new UC
Stop smoking precipitate UC
Prognostic in chr liver dsz
Poor hep b vaccine response due to hiv (Immunocompromised)
Rash n bloody diarhoea -pyoderma
Aortic stenosis, anemia, normal scope - mesenteric angio

Uti treatment in breast feeding mother who is allergic to aspirin - cephalexin

Protein c def in nephtotic
Cause of arf in liver failure pt - ? Intrarenal vasoconstric
Staph infection treatment in ijc cath - fluclox
Cause of breathlessness in pt (esrf n aps) ? PE
Ecoli infection in elderly with rash abd pain n proteonuria
Screening in ADPKD us in first degree relative
Recovery in HSP ??
Metabolic acidosis in sjogren - distal

Findings in CLL ? Hepato megaly

Cause of low plt in elderly pt ITP
Use of human ig ? ITP
MGUS
Pt with high esr, igg, n calcium ? Check serum electrophoresis

Bleeding n prolonged ptt due to phenytoin - fx8 def

Strep meningitis in very high protein low glucose

Viral meningitis in borderline high protein
Yellow fever vaccine c/I in pt on steroid
Cryptosporidium in hiv
Pyrimethamine on cerebral toxo
ART in hiv post exposure
Rocephine in gonorhoea
Skin lesion hypopigmented centre leprosy
Painless ulcer treponema
Burdogferi igm in lyme
RHC pain with fever ? Amoebic liver dzs

Fever n middle lobe consolidation ? Cause

Proteinuria n fever pt came back fr kenya ? Cerebral malaria

Neuroleptic sensitivity in lewy dzs

Parkinsom pt with dystonia procyclidine
Bilateral horizontal diplopia ? INO
Medial finger weakness abd digiti minimi
Fixed flex finger ? Flexor digitorum superficialis
Unable to flex n ext foot sciatica nn
Unilateral eye pain n partial ptosis cluster headache
Vertigo tinnitus hearing loss menieres
Weakness after painting house carotid aa dissection
Gradual drowsiness in alcoholic SDH
Frontal lobw findings
Weakness LL sparinh sensory MND
Riluzole in MND

Upper limb weakness with reduce pain/temp sparing joint/vibration-syringomyelia

LL weakness with rt reduced pain/temp n left side reduced joint/position -ependymoma
Cerebellar sign, horner ,& contralateral limb weakness/ reduced sensation - PICA/lat medullary
Pain on shoulder abd? Supraspinatus tendonitis
Laughing and limb weakness cataplexy

Small hand jts pain with neg RhF -RA

Sulfazalazine cause low sperm
Allopurinol xanthine oxidase inhibitor
Pt with limited sclerosis with diarhoea - bacterial overgrowth
Low plt, reduced hearing, proteinuria ? PAN
Headache, gradual eye vision loss, high esr - GCA
Gritty eyes esp in the wind - sicca eye
Arthralgia, oral ulcer -behcet
Sle with heart problem - anti ro
Dm with knee pain n fever, gram staim n crystal negative ? Septic arthritis
Ciclosporin cause tremor
Analgesia in OA ? PCM ? nsaid
Xray finding in osteomyelitis ??

Cause of erythema multiforme ? Mycoplasma? Herpes

What affect creat clearance - ms mass
Dexa scan finding
Acute phase reactant - ferritin
Cause of high ldl, normal tg - ldl rec def
Abg finding mixed resp alkalosis met acidosis ? But pt's rr 22
Fracture with bowed knee , and prostatomegaly ? Paget ? Osteomalacia ? Bone mets
Fibrillin in marfan
Mitochondrial dzs - optic atrophy
Use of hrt - reduced menopause sx

Dorzolamide carbonic anhydrase

Th2 interleukin 4
Recur neisseria meningitis complement def
Angioedema and abd pain c1 est inh deficiency
Rash following urti - guttate psoriasis

Oral ulcer and crusted lesion over face/scalp pemphigus vulgaris

Foam cells macrophage

Statistic neg pred value

Relative ratio 10%
P value
Drug adverse effect - fastest is to review all adverse effect report
Power of calculation

Girl with bleeding vwf

Yellow palm, tachy - what concern will be lanugo hair (anorexia)

Headache n request ct brain hypochondriacal
Guy losses wife depression

Pancreaticc exocrine enzyme - faecal elastase

Salt requirement 6g
RA pt not controlles on nsaids - add on methotrexate
Hemidiaphragm - phrenic nerve
Suicidal pt with prolonged qrs ? Amitryptylline
Pain over thumb c5/6 radiculopathu
Lithium check every 3 mths

Loading dose amiodarone - short half life

Marker in sepsis- lactate

Steroid psychosis
Santosh Jadhav, Sep 12, 2013
#7

6.

Santosh JadhavActive Member

Meds to treat familial long QT - ?Beta block ? Fleicanide -Beta blocker...

Flecainide is class 1 c antiarrythmic - prolongs qt too

Cholesterol emboli - Eosinophilia

Lung function test findings Asthma

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

Protein c def in nephtotic - no. answer is Antithrombin III deficiency.

Cause of arf in liver failure pt - ? Intrarenal vasoconstric - Drug induced interstitial tubular damage
( causing ATN hence low urinary sodium)

Cause of breathlessness in pt (esrf n aps) ? PE - yes

Recovery in HSP ?? - Full renal recovery ( emphasis on RENAL)

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

Frontal lobw findings - preserveration

Low plt, reduced hearing, proteinuria ? PAN - Systemic Sclerosis

Xray finding in osteomyelitis ?? - periosteal rxn

Cause of erythema multiforme - Herpes

Fracture with bowed knee , and prostatomegaly - Pagets

P value - the chance that nulls is true is less than 2%

Power of calculation - probabilty of making type 1 error

Santosh Jadhav, Sep 12, 2013
#8

7.

Santosh JadhavActive Member

Lungs Fx test - emphysaema (FVC 100% ~ 4.6L "too high")

Headache N CT scan - somatization

loading dose amiodarone - volume of distribution (?)

anaemia with normal upper lower scope - capsule enteroscope

meningitis with diplococci - strep isn't diplococci ??

serum creatinine - protein intake ?? (GFR if use C&G equation = (140 - age) x wt x constant /
creatinine & x 0.81 for female)

MRCP Part 1 RECALL MCQS 10/09/13 with Explanation

Discussion in 'MRCP Forum' started by Santosh Jadhav, Sep 12, 2013.

1.

Santosh JadhavActive Member

1. A girl with RIF pain and mass. Endoscopy, Colonoscopy barium meal normal. Inv (CT Abdomen)

2. SVT fails to respond to valsulva manure . Give adenosine

3. HIV meningitis taking pyremethamine. Add sulphdiazine.

5. Pt found unconscious with low PH, low HCO3, low PCO2 and high O2. ABGs taken on 24%
oxygen mask. (Metabolic Acidosis or Respiratory alkalosis and metabolic acidosis).

6. Patient in VF shock given, no response. (Next step Chest compression)

7. Patient with numbness on thumb. (C6 reculopathy)

8. Patient having low/Normal Ca, low/normal P, raised ALP. (Pagets disease Tx alendronate)

9. Pt with raised CA, low P and raised ALP. (Primary Hyperthyroidism)

10. Paracetamol over dose pt at risk more. (Anorexia Nervosa)

11. Rt atrium and superior venacava raised O2 conc. (ASD???)

12. Pericarditis, PR depression.

13. Primary hypertension cause, chest clear. (Peripheral resistance)

14. Long QT and poly morphic ECG changes. (Atenolo)

15. Patient on lithium and increase urine freq. (Nephrogenic DI)

16. Pt after renal transplant on chemotherapy. (CMV PCR)

17. Pt afrocrabian HBA1c high. (sickle cell anemia)

19. Acute phase protein. (Ferritin)

20. Finger prick from HIV + pt. (antiviral tx)

21. Pt HBs -, HCV antibody +, HCV PCR -, HIV antibody +, HIV PCR +. (HIV+)

22. Lyme disease. (Borellia)

23. Scabies. (permithrin)

24. Pt known COPD and PO2 low, Co2 high, improve prognosis. (LTOP)

25. Lt upper lobe lung fibrosis. (Ankylosing Spondylitis)

26. Pt SOB known HIV positive. (Invtigation Broncoalveolar lavage)

27. Long flight from Australia to UK and feels dizzy and weakness in one side. (Foramen Ovale)

28. Pt having bronchiectasis and recurrent infection. (postural drainage)

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)????

32. Dermatitis herpitiformis. (IgA deposition)

34. Pt confused and abnormal RFTs. (TTP)

35. Pt with hemolitic uremic syndrome, cells on smear. (Fragmented cells)

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)

43. Nephrotic syndrome, protein loss, HCV +(heroin???)

44. A pt with osteoarthritis tx. (Paracetamol)

45. Cardiac involvement in SLE. (Anti-Ro)

46. Neovascularisation in DM tx. (Photo laser)

47. Pt having erythema multiform lesion causative agent. (Herpes simplex)

48. Th 2 cells production. (IL-4)

49. Pt with motor neuron disease Tx. (Riluzole)

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)

53. Pt with (Mania).

54. Lewy body dementia cause by (neuroleptic drugs)

55. Pt with swelling of the hands of joint RA. (prednesalone)

56. Pt with rt side diaphragm high than left one. ( phrenic nerve palsy)

57. Old Pt presents with pain in abdomen and bloody diarrhea. (

58. Pt present with symptoms of IBS, with blood on tissue paper. There was no option for
haemorrhoids. (IBS)

59. Hemocystinoria prevention (Pyridoxine)

60. Pt with pnemothroax and chest drain inserted. Still bubbling in the tube. Appropriate measures to be
take. (ref to surgery)

61. Eye drops for glaucoma. (carbonic anhydrase deficiency)

62. Pt with low Na, High K, Low glucose etc. (Addison disease)

63. Action of ADH on. (Collecting tubules)

64. Pt with acromegaly investigation. (Glucose tolerance test and GH levels)

65. Burkit Lymphoma. (18,14)

66. Painless ulcer on penis and rubbery LN. (Treponema Pallidum)

67. Uti cultures shows diploccoi taking azithromycin. Add (doxycycline)

68. Pt with cataract, DM, muscle weakness. (myotonic dystrophy)

69. Pt having raised APTT other tests normal. (Wonwillbrand)

70. Pt investigation shows AML investigation. (Cytogenetics)

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)

74. Allopurinol MOA. (Inhibitor of xanthine oxidase)

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)

77. Angioedema C1 deficiency.

78. Pt taking ACE inhibitor and having dry cough. (Histamine)????

79. Pt having cushing features. How to diagnose cushing disease. (ACTH levels)??

80. Prevention of vereceal bleeding. (Propranolol)

81. Pt with features of Achalasia and difficult to pass endoscope thru sphincter into stomach. (failure of
relaxation of sphincter)

82. codes. (Each cell express special type of code)????

83. HRT to reduce postmenopausal symptoms.

84. Pt in hospital having cancer and agitated. (Midazolan)

85. Old Pt irritable (haloperidol)

86. Oculogyris pt. (Procyclidine)

87. Preservation. (frontal Lobe)

88. Pt on treatment of cyclosporine. (tremer)

89. Rituximab. (CD20)

90. A young Pt with AF. Long term Tx. (Amiodarone)

91. Azospermia (Sulphasalazine)

92. Graves disease. (mexadema)

93. S/C morphine dose calculated near to (60mg)

95. Pt had a stent 1 month back now present with three week hx of discomfort and fever. (S epidermitis
infection)

96. Diarrohea in HIV pt caused by. (cryptosp)

97. No live vaccination in during prinesalone tx. (Yellow fever)

98. Dx of sleep apnea ????

99. Pt with symptoms of hemisection of spinal cord. Cause???

100. Lateral Medullary Syndtome Post inf cerebellar art .

102. Bird fancier's lung(avian proteins) - Steroids

103. Septic shock prognosis lactate

104. Nephrotic - Anti-thrombin III

105. imatinib - epidermal growth factor receptor

106. Polycythemia - JAK 2

107. Steroid Psychosis

Santosh Jadhav, Sep 12, 2013
#1

2.

Santosh JadhavActive Member

1-post PCI cholestrol emboli ---- esinophilia

2- vitnami pt----leprosy
3- cyprus female anemia --- thalassemia
4-complet heart block post pacemaker driving---- one week
5-amiodaron loading dose--- ???
6-DEXA
7-young pt parotid enlargment,cold extrimits,orange plam---???parotid gland
8-freqent pe--- low transfer factor
9-dry cough +anemia +normal WBC---mycoplasma
10-CML+ huge spleen--- lymphadenopathy
11-diabetic ulcer risk--- previous ulcer
12-pneumonia risk,serial test---crp??? urea
13-RHD more risky sign--- LVF

Santosh Jadhav, Sep 13, 2013

#2

3.

Santosh JadhavActive Member

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

According to passmedicine the 2nd option is doxicycline....

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

Vertigo and hearing loss

The patient p/w h/o "recurrent" episodes of vertigo and hearing loss,so Mnire's disease is more
likely

High Cholesterol
The patient had isolated Hypercholesterolemia without Hypertriglyceridemia,so it's a case of primary

Hypercholesterolemia and is due to LDL-receptor deficiency

RA
Patient with RA should be started on DMARD,so the answer would be Methotrexate.
Santosh Jadhav, Sep 13, 2013
#3

4.

Santosh JadhavActive Member

1. pt with active RA. 1st option steroids to settle down inflamation.

2. Pt with vertigo and pain in the ear, suggestive of labrinthytis. I think there is no pain in menears
disease.

Labrinthytis vs Mnire's disease

Labrinthytis - SINGLE episode

Mnire's disease - MULTIPLE episodes

The patient in the case had 4-5 episodes,suggestive of Mnire's disease

Santosh Jadhav, Sep 13, 2013
#4

5.

Santosh JadhavActive Member

Hemisection of spinal cord - ependymoma

Low bicarbonate low ph - type 1 rta - distal tubule
Optic atrophy ass/w mitochondrial disorder : DIDMOAD
diabetes insipidus + mellitus, optic atrophy, deafness

1 type dm having microalbuminuria whats the other clinical finding -retinopathy

2 cells involved in adaptive immunity
3 csf with raised proteins and lymph counts rasied-?viral meningitis
4 flexion deformity with s sclerosis ?flexor digi prof
5 sudden loss of consciuness with emotion-cataplexy
6 drug causing hep failure next best step-?look into adverse effects
7 rituxmab -cd20
8-disease with mitochondrial inher-optic atrophy
9-young girl with htn 180/104 with bilateral scarred kidenys and s.cr 186micromol with k 4.6-??acei
10-hypopigmented lesions on the face ??
11-crust forming lesions on the face ass with oral mucosal ulceration?-steven jh

1. site of adh action{distal tubule b'coz in d option no medullary cd}

2. o2 sat more b/w svs &r.v{ASD}
3 sensitive indicator of pericarditis{PRdepresion}

5 oral& mucous memb. involvement{pemphigus vulgaris}

6. discrepancy b/w HbA1C & glucose{ sickle cell.A}

7 pt. with gritty eyes & R.A{ not sicca syndrome b'coz sicca synd. is primary sjogren without involving
any other C.T dis.}
8 child with Lx swelling painless, palpable. DEFINITIVE{ excisional L.N Bx}
9. Sjorens and M.acidosis{ DISTAL b'coz it causes distalRTA}
10.burkits{ t(8;14)
11. last Q200 about AML-promyelocyte .TEST which is imp. for MX{ coagulation screen}
12. Dx of sleep apnea { oximetry}
13. imatinib{ C-KIT}
14. MYELOFIBROSIS and splenomagaly. other feature{ hepatomegaly}
15. mitochondrial { optic atrophy}
16. APKD......... initial Ix{ USG of 1st degree relatives}
17. Li++ monitoring { every 6 mnths}
18. CYSTIC FIBROSIS, postmortem finding( lymphocytes?????????)

Sep 13, 2013

2.Relative risk reduction = 50%

3.Study following adverse drug reaction what to do to establish the association - ? cohort
(prospective )
4.p < 0.02 the chance that nulls hypothesis is true is < 2%
5.Power of a study probability of type 1 error
6.Pie chart - ethnicity
7.lp sample- gm positive diploccoci- streptococcus pneumonia
8.lp sample- increased protein, lymphocytes-viral meningitis
9.Frontal - perserveration
10.Lateral Medullary Syndtome Post inf cerebellar art
11.Motor nuron dis - Riluxole

12.Cyclosporine - Tremor
13.vertigo,tinnitus multiple episodes - Mnire's disease

14.Allopurinol- inhibition of xanthine oxidase

15.Osteoarthritis rx - Paracetamol
16.A pt with churg sr syndrome - ANCA
17.Subfertility/azoospermia - Sulfasalazine
18.RA with dry eyes - Sicca syndrome
19.Headache with ptosis carotid artery dissection
21.Ab with Cardiovascular involvemnent in SLE - ? anti ro
22.Low glycated Hb in poorly controlled DM- Sickle Cell disease

23.Abg- mixed metabolic acidosis and resp alkolosis

24.Raised left diaphragm in CXR- left phrenic n palsy
26.COPD - LTOT
27.Bird fancier's lung(avian proteins) - Steroids
28.Lung Surgery contraindication - ? peripheral neuropathy
29.B/l apical fibrosis Ank Spond
30.Respiratory physiology question Tidal volume
31.Foam Cells - Monocytes/Macrophages
33.Lady found with empty bottle,ecg wide qrs, tachycardic- amitriptlline
34.AF to maintain sinus rhytmn- amiodarone
35.PR depression - Pericarditis
36.SVT - Adenosine
37.Ebstein anamoly reduced rt ventricular pressure

38.Investigation for lyme dis- Bordetella IgM

39.Painless genital ulcer - Treponema
40.Gonococcal urethritis - ceftriaxone
41.Vaccine contraindicated - yellow fever

42.Septic shock prognosis - lactate

43.HIV +ve male with low HBsAb chronic hep c
44.HIV Needle Stick - Post exposure prophlaxis
45.HIV with diarrhea - Cryptospo
47.Pancreatic exocrine function - feacal elastase
48.Ulcerative collits - smoking
50.Cryoglobins in Nephritic - Hep C
51.Nephrotic - Anti-thrombin III
52.AML - Cytogenetics
53.Burkits Lymphoma = t 8,14
55.Imatinib - vegfr receptor
56.Rituximab - CD 20
57.Polycythemia - JAK 2
58.Pencil shaped poikilocytes RBC - Iron Defeciency
59.Girl with recurrent bleeding and elevated APTT - vWF
61.Graves- Pretibial myxedma
62.Thyroditis ?anti TPO
63.Water derprivation test on lithium - Nephrogenic Di
64.Hormone replacement - post menopausal symptoms
66.Cushings - 24 hr urine cortisol
67.Thyroid nodule next investigation - ? FNAC
68.Acromegaly - GTT
69.Hyponatremia and hyperkalemia - Addisons

70.Dermatitis herpetiformis - IgA deposits

72.Px on dexamethasone -Steroid Psychosis

73.Young man with grandiose delusion -Mania
74.Depression following death of wife/ ? B12 def
75.Uncontrolled HTN with LVH and gout-add acei

76.DOC for HTN with b/l renal scarring on USG- Amlodipine

77.Diplopia on looking to the left - ? CN VI palsy
78.Supra normal FVC(100% predicted),no h/o of smoking - ?Asthma
79.Lady with symptomatic peritonitis Rx ascitic tap
80.VFib has been refractory to an initial shock - CPR
81.Cardiac pacemaker driving- after 1 week
82.Lithium monitoring - 3 months
83.Empyema-pH of pleural fluid
84.Pneumothorax fails treatment 48hrs -Refer Surgeons
85.Marfan-fibrillin
86.Paradoxical embolus-PFO
87.Abd distension,diarrhea,relieved by opening bowel -Irritable bowel syndrome
88.Osteoporosis - Alendronate
89.Dexa Osteoporosis: (T score -2.5). Osteopenia: (T score less than -1 but above -2.5).
90.Adult poly cystic kidney family screening(all > 20 yeas age)-?USG for all first degree relatives
91.Cause of pulsus paradoxus - reduced left atrial filling
92.Cause of IE post valve replacement -staph epidermidis
93.Finding in severe ms - ? length of murmur, ? preaccentuation
94.Cardiac cath finding in chronic primary pulm hypertension ? mean arterial pressure elevation?
95.Amyloid Restrictive cardiomyopathy
96.Causr of high co2 btw svc n rt ventricle - ASD
97.Meds causing long QT - citalopram
98.Meds to treat familial long QT - Beta block
99.Cholesterol emboli - Eosinophili

100.Diabetic eye new vessel mx - photocoag

101.DFU in diabetic - prev ulcer
102.High tsh in pt on thyroxine meds - ?ask compliance
104.Achalasia- poor lower esophageal relaxatio
105.Coeliac ds in PBC with rash

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

111.Cause of arf in liver failure pt - ? Intrarenal vasoconstric

112.Staph infection treatment in ijc cath - fluclox
113.Cause of breathlessness in pt ESRF on dialysis - PE
114.Screening in ADPKD Ultrasound scan in first degree relative
115.Recovery in HSP full renal recovery
117.Metabolic acidosis in sjogren - distal
118.Findings in CLL -? Hepato megaly ? Bibasal crackles
119.Cause of low plt in elderly pt - ITP
120.Use of human immunoglobulins - ITP
121.Raised Immunoglobulins, and monoclonal antbodises - MGUS
122.Renal pathology, bleeding,n prolonged APTT due to phenytoin Lupus anticoag
123.Yellow fever vaccine c/I in pt on steroid

124.Pyrimethamine on cerebral toxoplasmosis

125.HIV post exposure HAART
126.Drug to add in gonorhea - ceftriaxone

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

130.Neuroleptic sensitivity in lewy dzs

131.Daughter with fit n clumsiness - ? non-epileptiform seizure disorder syndrome

132.Parkinsom pt with dystonia - procyclidine
133.Medial finger weakness abd digiti minimi
134.Fixed flex finger - Flexor digitorum superficialis
135.Unable to flex n ext foot- sciatica nerve
136.Unilateral eye pain n partial ptosis - cluster headache

137.Weakness after painting house carotid artery dissection

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

147.Headache, gradual eye vision loss, high esr - GCA

149.SLE with heart problem - anti ro

150.DM with knee pain n fever, gram staim n crystal negative - pseudogout
151.Xray finding in osteomyelitis periosteal reaction

152.Cause of erythema multiforme - Herpes

153.What affect creat clearance - muscle mass
154.Acute phase reactant - ferritin

155.Abg finding mixed resp alkalosis met acidosis

156.Fracture with bowed knee , and prostatomegaly - Paget dx
157.Fibrillin in Marfan

158.Mitochondrial dzs - optic atrophy

159.Dorzolamide - carbonic anhydrase inh
160.Th2 - interleukin 4
161.Mediators of acute response - ?T cells
162.Recurrent Neisseria meningitis -complement def
163.Angioedema and abd pain - c1 est inh deficiency
164.Rash following urti - guttate psoriasis
166.Oral ulcer and crusted lesion over face/scalp - pemphigus vulgaris

167.Yellow palm, tachy - what concern will be lanugo hair (anorexia)

168.Headache n request ct brain - hypochondriacal

169.Pancreatic exocrine enzyme - faecal elastase

170.Salt requirement - 6g
171.RA pt not controlled on nsaids - add on methotrexate

172.Loading dose amiodarone - ?long half life

173.Pericarditis - ECG - PR depression

174.SVT narraw complex - after vagal mano - what Rx - Adenosine

175.Bacillus - fried rice.

176.Bronchiectasis - postural drainge

177.Oral morphine to SC morphine - 60 mg

178.Dx of sleep apnea overnight oximetry

179.Paracetamol over dose pt at risk more. (Anorexia Nervosa)

180.Pt with hemolyitic uremic syndrome, cells on smear. (Fragmented cells)

181.Man with staph aureu isolated from recurrent boils, what strain of staph? - ?? leucocidin?

182.Pt with symptoms of hemisection of spinal cord. sup combined deg of the spinal cord

183.Frequent PEs low transfer factor

184.CML with huge spleen what other sign - ? lymphadenopathy, ? hepatomegaly, ? bibasal
crackles
185.RHD poor sign left ventr hypertrophy
186.Man with pneumonia, what other test to assess severity urea ( CURB-65 score)
187. DM px having microalbumin what other finding retinopathy
188.female with hypo and family history of taking thyroxine?dyshormogenesis
189. Cystic fibrosis dead, what will you find on autopsy - ???lymphocytes?
190. AF to maintain sinus rhythm amiodarone
191. Mechanism of ACEi causing dry cough Histamine release
Santosh Jadhav, Sep 14, 2013
#6

6.

Santosh JadhavActive Member

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

shouldn't antiphospholipid antibodies be the correct answer?

The guy had depression following the wife's death,not B12

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.

Staph aureus has the TSST (toxic shock syndrome toxin)

Cough produced by Histamine is different from cough produced by an ACEi,

which is due to Bradykinin deposition which causes bronchoconstriction and alters vessel
permeability.

Patient with renal scarring and HTN should be started on an ACEi,because of its renoprotective effect.
Santosh Jadhav, Sep 14, 2013
#7

7.

Santosh JadhavActive Member

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.

Santosh JadhavActive Member

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.

Santosh JadhavActive Member

Question: 3

In a double blind, randomised, placebo controlled trial of drug A for treatment of

hypercholesterolaemia, 100 patients received drug A and 100 patients received placebo. In the
treatment group, serum cholesterol decreased from a mean of 6.5 to 5.5 mmol/L. In the control group,
cholesterol decreased from a mean of 6.8 to 6.1 mmol/L. The authors concluded that drug A was
effective in reducing cholesterol as p=0.01 (2-tailed test).
Which of the following statements is ?
(Please select 1 option)
A one-tailed test should be used
Both type I and type II error rates cannot be determined because of inadequate information
The power of the study is 99%
Type I error rate is 0.01
Type II error rate is 0.01
Type I error rate is the probability of wrongly rejecting the null hypothesis and type II error rate is the
probability of wrongly accepting the null hypothesis.
In this case the p value is below 0.05 and we accept the alternative hypothesis in favour of the null
hypothesis, that is, we conclude that drug A is more effective than placebo.
The p value of 0.01 represents that there is a probability of 0.01 of observing the results if the null
hypothesis is true. Thus if we reject the null hypothesis, we may be wrong with a probability of 0.01,
which is the type I error rate.
Type II error rate is 0 as we have not accepted the null hypothesis.
The power of study requires further information to be calculated.
Two-tailed test is usually more appropriate as it is usually assumed that the direction of effect is
unknown
Santosh Jadhav, Sep 24, 2013
#10

10.

Santosh JadhavActive Member

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.

Santosh JadhavActive Member

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?

(Please select 1 option)

Clubbing
FEV1 1.8L
Hypertrophic pulmonary osteo-arthropathy (HPOA)
Hyponatraemia
Mediastinal lymph node measuring 0.9 cm on staging CT

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.

Santosh JadhavActive Member

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

This question aims to cover the following learning points:

Distinguishing features of chronic inflammatory back pain
Population specific HLA association
Common differentials for ankylosing spondylitis.
This man has ankylosing spondylitis (AS).
The commonest subtype HLA associations are HLA B*2705 (Caucasians), B*2704 (Chinese,
Japanese) and B*2702 (Mediterranean). The B*2706 subtype is weakly associated and
commonly found in normal south east Asian individuals.
Chronic (more than three months) back pain characteristics that favour a spondyloarthritic
aetiology include:
Age of onset before 40 years
Insidious onset
Amelioration with exercise
Refractory with rest
Night pain (with improvement upon arising).
His associated extra-articular manifestations include enthesitis of the Achilles and
supraspinatus tendons
Santosh Jadhav, Sep 27, 2013
#13

13.

Santosh JadhavActive Member

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.

Tetracycline is given for Yersinia enterocolitica

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)

Creatinine 115 mol/L (79-118)

Alanine aminotransferase 110 U/L (5-40)
CXR Predominant lower lobe emphysema
Pulmonary function testing obstructive defect, FEV 42% of predicted
According to NICE, which of the following is the most appropriate treatment?
(Please select 1 option)
Alpha-1-antitrypsin
Home oxygen therapy
Inhaled corticosteroids and long acting beta agonist therapy
Ipratropium as required
Rotating antibiotics
The fact that this man has presented with predominantly lower lobe emphysema and is less
than 30 years of age, raises the possibility of alpha-1-antitrypsin deficiency, and the raised
ALT, a possible pointer towards liver disease supports this diagnosis. The catch here
however is that NICE does not support the use of recombinant alpha-1-antitrypsin and
suggests that patients should be optimised with recognised COPD therapies instead.
Short acting inhaled bronchodilator therapy is indicated in COPD, irrespective of underlying
cause or FEV1, either using a B2-agonist or anti-muscarinic agent. Those with persisting
breathlessness or exacerbations despite short acting reliever inhalers should be offered
further treatment based upon their FEV1.
If >50% predicted NICE recommends a long-acting B2-agonist or anti-muscarinic agent.
Those with an FEV1 <50% predicted should receive either a long-acting anti-muscarinic
agent or combination inhaled corticosteroid and long-acting B2 agonist preparation. In those
not tolerating inhaled steroids a long-acting B2 agonist and anti-muscarinic agent can be
trialled. Note that any short-acting anti-muscarinic agent should be stopped if prescribing a
long-acting anti-muscarinic agent, short- and long-acting B2-agonists can be co-prescribed.
Alpha-1-antitrypsin is not recommended by NICE.
We are not told about any criteria which qualify this man for home O2 therapy.
PRN ipratropium whilst symptom relieving does not impact on his prognosis.
Rotating antibiotics may only be of value for frequent infections

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.

Santosh JadhavActive Member

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.

Santosh JadhavActive Member

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.

Santosh JadhavActive Member

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.

Santosh JadhavActive Member

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.

Santosh JadhavActive Member

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.

Santosh JadhavActive Member

Question: 16

Mr YB is admitted on your ward with endocarditis and is prescribed vancomycin IV.

You monitor the patient for signs of toxicity as it has a narrow therapeutic index.
Which of the following is a result of vancomycin toxicity?
(Please select 1 option)
Bradycardia
Dry mouth
Erythema multiforme
Hepatoxicity
Ototoxicity

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.

Santosh JadhavActive Member

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

Fluoxetine a 2C19 inhibitor

Erythromycin a 3A4 inhibitor
Cimetidine an inhibitor of 1A2 and 2D6.
As such all four of the other potential choices should not affect contraceptive effectiveness
because they do not lead to a decrease in sex steroid levels.
Potent enzyme inducers which may cause significantly decreased pill effectiveness include
rifampicin and carbamazepine.
Other antibiotics such as the tetracyclines which may be used in this population for example
in the treatment of acne, are known to lead to decreased pill efficacy
Santosh Jadhav, Oct 4, 2013
#24

21.

Santosh JadhavActive Member

Question: 19

Which of the following are features of acute chest syndrome?

(Please select 1 option)
Chest pain
Evidence of new infiltration on CXR
Fever
Shortness of breath
All of the above
Acute chest syndrome is defined as a 'new infiltrate consistent with consolidation at least
segmental in size, and one of: chest pain, a temperature > 38.5C, tachypnoeic, wheezing or

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.

Santosh JadhavActive Member

Question: 20

A 35-year-old Nigerian female was assessed in an antenatal clinic. She was clinically well.

Antenatal screening for syphilis revealed the following results:

Treponemal EIA total Detected
Treponemal EIA IgM Not detected
Treponemal TPPA Detected 1:160
Treponemal RPR Not detected
What is the likely diagnosis?
(Please select 1 option)
Acute syphilis infection
Early latent syphilis infection
Late latent syphilis infection
Non-specific reactivity
Yaws
It is important that the serology is ly interpreted and during pregnancy this lady is referred to
a GU clinic for treatment with benzathine penicillin if not previously treated.
The detection of treponemal EIA total is confirmed by treponemal TPPA so this result is not
a false positive. As treponemal IgM is not detected this is not consistent with acute infection.
In the absence of symptoms, late latent infection is more likely than early latent infection.
These results are unlikely to be cross reactivity secondary to yaws
Santosh Jadhav, Oct 4, 2013
#26

23.

Santosh JadhavActive Member

Question: 21

A 62-year-old gentleman is being investigated for normochromic, normocytic anaemia. He is

diagnosed with diabetes mellitus type II and essential hypertension.
His haemoglobin is stable at 9.5 g/dL, his creatinine clearance is calculated at 45 mls/min,
ferritin at 50 g/L and his serum erythropoietin level comes back at 8 (normal range: 4-24
mU/mL).
Which of the following is the most appropriate management?
(Please select 1 option)
Commencement of subcutaneous darbepoietin
Intravenous iron supplementation
Check haemoglobin at 6 monthly intervals
Transfusion aiming for Hb of 10-12 g/dL
Transfusion aiming for Hb of 12-14 g/dL
This patient has CKD stage 3A (borderline 3B). Renal-related anaemia can start to develop
at this stage as alteration in erythropoietin production occurs. It is worsened by reduced
dietary intake of iron due to anorexia, impaired intestinal absorption of iron, toxic effect of
uraemia on erythroid precursors and reduced red blood cell survival.
It is imperative that renal patients avoid repeated blood transfusion, unless in extremis, so
that future renal transplantation will not be precluded by allo-sensitisation.
Before initiation of recombinant erythropoiesis-stimulating agents the patient should be iron
replete. The serum ferritin and transferrin saturation should be checked, as most patients will
be iron deficient.
Targets for treatment are:
Haemoglobin 10.5-12.5 g/dL
Ferritin: >100 g/L in pre-dialysis and peritoneal dialysis patients, >200 g/L in
haemodialysis patients
Transferrin saturation >20%
This patient should also be referred to a nephrologist, as early assessment of the causes of
his renal impairment is benefical. Patients with CKD stage 3A, who are non-proteinuric, have
a low risk of progression and can usually be managed in the community following initial
assessment by a nephrologist. Those with proteinuria are usually managed in secondary

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.

Santosh JadhavActive Member

Question: 22

Which one of the following is a common feature in the presentation of myeloma?

(Please select 1 option)
Hypercalcaemia
Hyperglycaemia
Hypocalcaemia
Hyponatraemia
Polycythaemia

The following are presenting clinical features of multiple myeloma:

Older adults - median age 60 years; male more than female
Anaemia
Bone pain - most common in the back or ribs; may present as a pathologic fracture
following minimal trauma, especially of the femoral neck
Infection - commonly with encapsulated organisms such asStreptococcus
pneumoniae,Haemophilus influenzae; due to suppression of antibody production and

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.

Santosh JadhavActive Member

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

Santosh Jadhav, Oct 7, 2013

#29

26.

Santosh JadhavActive Member

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?

(Please select 1 option)

Glucose tolerance test with growth hormone monitoring
Growth hormone releasing hormone
Insulin tolerance test with growth hormone monitoring
Prolactin
Random growth hormone level
This patient's features are consistent with a diagnosis of acromegaly.
A glucose tolerance test with growth hormone measurement is useful with respect to
screening as growth hormone is usually suppressed by hyperglycaemia to a level below 0.3
mcg/l.
Serum IGF1 is also particularly useful as it has a long half life and is elevated in conjunction
with acromegaly.
MRI is useful for tumour localisation.
Prolactin may of course be elevated because of local pressure effect from a growth hormone
producing adenoma
Santosh Jadhav, Oct 7, 2013
#30
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MRCP 1: Recalled Questions of January 2012

Discussion in 'MRCP Forum' started by MMR, Jan 18, 2012.

1.

MMRGuest

1st time appeared & it was a horrible experience. can not concentrate on 2nd paper, so lengthy exam.

some recalled questions...

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

here some of questions trying to remember :

-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

- case of UC with sclerosing cholangitis: MRCP best diagnostic

-case of traveller diarrhea in egypt: shegilla

there is alot in my mind when i recall i will post it here

DrShaheen, Jan 20, 2012
#2

3.

DrShaheenGuest

it is a very hard rated MRCP exam

DrShaheen, Jan 20, 2012
#3

4.

DrShaheenGuest

That's good but i dont know where is my post!

DrShaheen, Jan 21, 2012
#4

5.

MMRGuest

Alhamdulillah. passed MRCP part 1.

MMR, Feb 10, 2012
#5

6.

MMRGuest

I have collected some questions from another forum.

1) Stats- greatest risk reduction (27%, 54%)

2) Drug causing low sodium, low potassium- bendroflumethiazide
3) metformin in PCOS- increases peripheral glucose uptake
4) stats tables death/survival- chi sq test
6) Uncertainty of mean- Standard error of mean
7) action of ciclosporin- IL-2 inhibitor
8) polyuria in alchol intoxication- decreased aquaporins
9) cholesterol embolism association- eosinophilia
10) drug causing haematuria- cyclophosphamide
11) tuberculin skin reaction- interferon gamma (t helper was not there)
12) allergic reaction- type 1 hypersensitivity

14) anaphylaxis, what route of epinephrine- IM

15) Paracetamol OD, useful test for management- PH
16) illicit drug causing mydriasis- cocaine
17) confusion with visual problems- methyl alcohol poisoning
19) action of tirofiban- glycoprotein 11b/111a inhibitor
20) early diastolic murmur- aortic regurgitation
21) Right heart failure, pansystolic murmur ? TR, feature- left parasternal heave
22) AntiCCP +ve- Rheumatoid arthritis

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

29) fasting glucose 6.0-6.9 on 2 occasions- impaired fasting glycaemia

31) MEN 1 association- insulinoma
32) painless ulcer + rash + lymphadenopathy- syphilis
33) bronchiectasis on CT, low IgA and IgD- Common variable ID
34) asthma, ominous blood result- raised PCO2
35) COPD acidotic, low PO2, ?Rx- NIV
36) anaemia, dysphagia, Ix- gastroscopy
37) 55 year old fe def anaemia, Ix- colonoscopy

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

44) acoustic neuroma, sign- loss of corneal reflex

45) lower back pain, loss of ankle reflex- L5/S1 prolapse
46) thigh weakness, sensory level to medial lower leg- L4 radiculopathy
47) loss of facial hair, normal FSH/LH, low testosterone- klinefelters
48) difficulty swallowing solids and liquids- achalasia
49) man with wilsons, wife 1/100 chance of carrier, kids chance- 1/200
52) absent brachial pulse on raising arm- thoracic outlet syndrome
53) diarrhoea, weight loss, high anion gap acidosis, normal Cl- villous adenoma
54) Reversed splitting of 2nd heart sound- LBBB
55) Rx mycoplasma, allergic to erythromycin- doxycycline
56) prophylaxis of meningits- rifampicin
57) loss of colour vision, visual loss after 3 days- optic neuritis
58) urinary incontinence in MS, Rx- anticholinergics
59) superior bitemporal quadrantanopia- pituitary tumour
60) parietal lobe stroke, problems reading, why?- inattention
61) weakness in grip, loss of two point discrimination in hand- parietal lobe
62) multiple investigations for symptoms. All normal- somatization disorder

63) Manic, unable to stop talking- pressure of speech

64) suspicious individual, withdrawn- paranoid schizophrenia
65) Similar case to 64- schizophrenia

67) weakness during waking from sleep, hallucinations- sleep paralysis

69) Return from Egypt, blood diarrhoea- Shigella dysenteriae

70) traveller, raised LFTs jaundice- Hep A
71) +ve Anti-HBc, +ve AntiHbs, -ve HBs antigen, previous infection, now immune
72) Ulcerative colitis, obstructive LFTs ? PSC- MR cholangiogram
73) colonoscopy- inflammation to sigmoid, diverticula- ulcerative colitis
75) weakness areflexia (Guillain barre), monitoring- Forced vital capacity
76) Guillain barre, feature- low conduction velocity
78) confusion, multiple ring enhancing lesions- cerebral toxoplasmosis
80) haemolytic uraemic syndrome on bloods, blood film- fragmented cells
81) raised platelets, jak 2 +ve (? PRV, but normal Hb!), Rx- hydroxycarbide
82) treatment for CML- imatinib
83) heart rate 150, likely ECG finding- atrial flutter
84) treatment for torsades de pointes- IV magnesium
85) Long QT syndrome, responsible for ventricular repolarisation- potassium
86) Feature of hypothermia on ECG- Long QT (J wave not a feature)
87) pregnant asthmatic, stopped taking steroid inhaler and salmeterol, management- restart inhalers
88) renal failure, high calcium, high protein, low albumin- myeloma
89) sinusitis, C-ANCA +ve, finding on renal biopsy- crescentic gn
90) arthritis, rash on soles of feet (?keratoderma blenorrhagica)- reactive arthritis
91) steroid injection to knee, later fixed flexion to 20 degrees, effusion ? septic arthritis
92) before chemotherapy, uric acid 0.65- allopurinol
93) Fast AF, dizzy, BP<90- DC cardioversion
94) occupational asthma, spirometry- reduced FEV1/FVC ratio
95) smoker, suspicious CXR, hyponatraemia- Small cell lung ca

96) Contraindication to lung cancer surgery- Superior vena cava obs

97) temporal lobe attenuation on CT- herpes simplex encephalitis- aciclovir
[snip]) hypertension in young adult resistant to 4 drugs, bilateral shrunken kidneys- fibromuscular
dysplasia
99) indwelling line, likely cause of infection- staph epidermidis
100) ST elevation, had aspirin, clopidogrel, next treatment- Angioplasty
101) pancytopenia, likely drug- azathioprine

103) purpuric rash on buttocks- henoch-schonlein purpura

104) Most likely feature of acute tubular necrosis- UrineOs<300
105) DEXA scan, osteopenia vertebrae, osteoporosis hip
106) low K+, Low Ca, ? cause- Low Mg
107) starting Total parental nutrition, likely abnormality- hypophosphataemia
108) CXR findings most likely in PE- normal
110) widespread eruption after throat infection- guttate psoriasis
111) porphyria cutanea tarda, treatment- venesection
112) on phenytoin, unwell in skin separation, fever- toxic epidermal necrolysis
113) primaquine in malaria- kills liver stage
114) 9 months hallucations post event- post traumatic stress disorder
115) vomiting, altered body image, normal BMI- bulimia nervosa
116) abnomal lymphocytes on blood film- glandular fever
117) Feature of bell's palsy- hyperacusis
118) Boils treated, now MRSA carrier (+ve PCR)- mupirocin and chlorhexidine
119) spirometry- obstructive, high TLCO- emphysema
120) small bowel overgrowth, tx- tetracycline
121) blood film- basophilic stippling, raised HbA2- thalassaemia
122) erythema nodosum, likely outcome- full recovery
123) goitre, anti TPO +ve- hashimoto's
124) post herpetic neuralgia, rx- amitryptilline
125) strongest indicator for type 1 DM- ketones

126) grave's disease, most associated- pretibial myxoedema

127) 2l O2 nasal cannula, domicillary o2- 28%

129) Anticipation- presents at younger age in successive generations

130) RET oncogene- medullary thyroid cancer
131) renal failure, high phosphate, management- Phosphate binders
132) Cystic fibrosis, malabsorption, test- faecal elastase
133) Turner's syndrome, commonest defect- bicuspid valve.
134) Ecstacy, feature- hyponatraemia
135) Physiological change on standing from lying- increased salt and water excretion
136) patient drops out of trial before starting chemo- discard (no intention to treat option)
137) From Brazil, hypopigmented face, tingling sensations, loss of eyebrow- leprosy
138) Russian sailor, toxic, exudative tonsillar features- diphtheria
139) patient in LVF, echo aortic stenosis with calcifications, LVH on ECG and echo, worst prognosisLVF
140) 25 year old woman, scalp rash, and over face and nasolabial fold ? seborrhoeic dermatitis- topical
ketoconazole
141) Collapse, BMs-45, treated. Now cannot see, reason?- lens refractive changes
142) bloods- anaemic, cold agglutinins, ? test- cryoglobulins

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:

1) COPD, SOB, clubbed, hyponatraemic ? diagnosis- small cell lung cancer.

2) Old man confused, renal failure, hypercalcaemia, raised total protein- multiple myeloma.
3) Man with central line, pyrexial, likely organism- staph epidermidis
4) Man with recent contact of TB, test for latent TB- mantoux test
5) Patchy haemorrhagic lesions in temporal lobe on MRI - IV aciclovir (herpes simplex encephalitis)
6) High platelets, Jak2+ve, treatment- hydroxycarbamide
7) Man, flu like illness then signs of pneumonia- staphylococcal pneumonia
8) Prior to start of chemotherapy, what treatment to start- allopurinol
9) palpitations, heart rate 150- atrial flutter
10) Pregnant lady on inhalers, has stopped them. management- restart as usual

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

mrcp 1 sept 2011 recalls

1-72 female patient with AF and controlled bronchial asthma (clinically and by investigations) wt ttt to
give her >>> atenolol (my answer) or amidarone

2- sign of hypokalmia>>>u wave in ECG

4- ttt of MRCA infective endocarditis in patient allergic to vancomycin>>>refampicin???-other option

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

8-pregnat patient wt carries risk to her >>>pumonary HTN

9-old patient with HTN at to give>>> amlodipine

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

30/8/2014 ONLY MRCP MCQs

2. Patient with wide qrs having ventricular tachycardia.. whatecg featuresdiffertiates it from SVT with
aberration...... - AV dissociation
3. Patient with infective endocarditis, on treatment already having long PR , which of the signs will
reflect an immediate need for surgery....... Prolongation of PR interval
4. Patient with severe Aortic Stenosis , what sign is going to depict the severity of the AS ....Dec

intensity of 2nd Heart Sound

5. Patient with A Fib , is to go for Radiofrequency ablation procedure, which part of the heart will give
best result - Pulmonary veins catheter ablation with 85%success rates.
6. Patient with Antero-Lateral MI , with ST elevation went through Cardiac Catheterization and
Primary PCI done , now back to floor, the ecg shows wide complex tachycardia 108, patient with
normal BP ,-IV what will you give the patient, ... do nothing- no treatment required as it is
idioventricular rhythm
7. Patient with chest pain having Bradycardia and low bp, pulse 60 BP 90/60 high JVP with st
elevations admitted- which coronary artery is affected,...Proximal Right Coronary artey.
8. YoungPatient with breathlessness and systolic murmur at the left sternal border, which increases with
inspiration , what is the possibility..Pulmonary Stenosis
9. Ascites+ early diastolic murmur + x and y descent ? : constrictive pericarditis ..i guess it was
Superior Vena Cava Syndrome as the face was flushed and on chest auscultation right heart was clear
no addes sounds were there jvp was raised .... I went for SVC syndrome instead
11. cadiovascular risk assment-which are related to the increased cardiovascular risk... answer is HDL
and TG as Dec HDL and inc TGS are independent risk factors for CardioVascular Diseases
12. Old man with A-fib, started on warfarin therapy , is having dm with following medicationsramipril, furosimide,etc what are you going to add ? ------- Bisoprolol
13. patient with K 7.9 : IV cagluconate or temporary pace maker ?? one of the cardiologist I discussesd
with , says we have to give iv first to stabilize the heart then go for pacemaker later
14. levels do not increase in heart failure nor drenaline,endothelin ? Natriuretic Peptide
15. post PCI with incrasedEosinophils, Creatinine, ,change in color of the foot, .... It was : Cholestrol
embolism
16. 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
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

Hormone Replacement Treatment, .....for Postmenopausal symptoms control

82. pt e HTN DM colon CA and increased sweating ..Dx. .Acromegaly
83. Patient with cough, drowsy, having right upper lobe lesion on cxr , with labs showing
Hyponatremia ... 115 and urinary Na 65 .. what is going to be the most appropriate management
.....Fluid Restrictionthe first step in SIADH
84. Patient with Recurrent Headaches, high Urinary Cathecholamines =pheochromocytoma: with
family history of Thyroid disease /Nodule ... which thyroid Condition can be associated with it ....
Mecullary CA ... thinking MEN 2 syndrome
85. Marfan scenario ,eye feature with pesescavatum .... Ectopia lentis
86. 19y Female with facial hair,acne obese( had all features of pcos) but lab results for premature
ovarian failure but clinically not ???premature mature ovarian failure or PCOS ?
87. Patient on long term Hemodialysis having vit D and Calcium with the labs showing high serum
calcium, high phosphates, high PTH.. what is the reason for this ........Tertiary Hyperparathyroidism
88. Hormone which leads to increased hunger .... Ghrelin
ht t ps : / / www. f ac ebook. c om/ g r oups / 1495489127329899/ per mal i nk/ 1530192607192884/ 4/
10
30/8/2014 ONLY MRCP MCQs
89. Patient with lid lag, thyroid nodule .. treatment with which modality will worsen the thyroid eye
disease - RADIOIODINE
90. Patient with type T1DM received blood transfusion.. the optimal time for measure of HA1c? 6
months 91. Male with Gynaecomastia, Low testosterone and raised FSH and LH Klinefelter
92. 16 Y OLD BOY with less height than his class fellows, with lack of secondary sex characteristics
and small testes ..( volume around 4 ml or less), while others in the class had pubic hair , facial hair ,
labs were fine and no other abnormality observed.. what is the cause of his delayed puberty......simple

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

30/8/2014 ONLY MRCP MCQs

131.
132. Occipital Headache : Bailar Migraine(symptoms of vertebrobasilar insufficiency, which may
precede the headache=Basilar Migrane.)
133. Patient with vision defects lately having accidents .. is having right inferior quadrantopia and
unable to calculate....where is the lesion.. Left Parital Lobe
134. Patient diagnosed with GB syndrome, how will you monitor his respiratory function ....FVC
(Forced Vital Capacity)
135. Patient with Occipital Headache, neck stiffness , 2 weeks with Bilateral 6th nerve Palsy
andpapilledemaand CT scan is normal.. what is the diagnosis.. BIH
136. Pain on walking relieved on sitting - Spinal stenosis137. Korsakoff syndrome - Short term
memory loss138. Patient with ataxia and nystagmus - Posterior inferior cerebellar artery
139. Tonic clonicseziure , Alcholic and blood sugar 3.1 >>> idiopathic epilpsy or alcohol releated
seizure ? it was a young adult ...but all labs were within normal limit and also ecg .. so I went for
idiopathic Epilepsy .. diagnosis of exclusion
141. A patient with ant spinal cord syndrome with all limbs paresis, loss of temp/, while fine touch
AND Vibrations are preserved ...what is the diagnosis...............Anterior Spinal cord lesion/ Syndrome
142. A female with parkinson's disease having upgaze palsy recurrent fall -------- p.supranuclear palsy
144. Patient with NON Hodgkins Lymphoma treated with Vinca Alkaloids 2 years back , presents with
Pins and Needles and impaired vibration and position sense in Big Toe .. Labs showed Lower Levels of
B12 in Serum and also folate in lower Range... No MCV given in details... what is the cause of his
symptoms...... well i guess B12 Deficiency was the answer ..
145. 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... ANSWER ....ADD CARBIDOPA

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

10.ALL...9:22 POOR PROGNOSIS

11.70 YR Female suicide...rsk factr for repeat...OLD AGE
12.promyelocytes ....15:17
13.PEMPHIGUS VULGARIS...IGG At dermoepidermal junct..may b
14.history of STD ....KERATODERMA BLENORHGICA
15.diAbetes plus hyperthyroidism....PRETIIBIAL MYXDEMA...
16.1st sign in hypovolemic shock...TACHYCARDIA
17.common paroneal nerve palsy.SENSORY LOSS IN DORSUM OF FOOT
18.trip to southasia..jaundiced...pre jrny vacc done...HEP A or HEP E
19.Alpha 1 anti trypson defic...Autosomal co dominant...but it was not an option so
it was autosomal recessive as per text
20.wilson diseasse...1 in 100
21.HIV diagnosis...investigation with consent or without consent
22.patient think of nurses planing against him and trying to poison hiim...PARANOID
PSYCHOSIS
23.neighbour controlling thoughts.....schizophrenia
24.hallucinations plus cog impairment plus rigidity....LWI BODY DEMENTIA
25.Man with drug poisoning belief of supernatural healing power....DELUSION
26.CARBIMAZOL...MOA..THYROID PER OXIDASE INHIBITOR.
27.Hep C ...CRYOGLOBINEMIA
28.Aplastic picture...erythro virus.B19
29.REPEATED infections after chemotherapy..cause...compliment def or immunoglobin
def..
30.repeated neiseria inf....COMPLEMENT DEFICIENCY
31.Meningial TB...12MONTHS treatment
32.tonsillitis ...with hemeturia....post infectious glomerulonephritis
33.metastasis to vertibral column...acute pain and sensory loss...tx..surgical
decompression or radiotherapy or steroids...
34.IMITANIB ...tyrosine kinase inhibitor
35.GOLIMUMAB...MOA..TNF-ALPHA inhibitor

36. Investigation b4 METHOTRAXATE...THIOPURINE METHYL TRANSFERASE

37.Pregnancy with crohn ...which to discontinue...AZATHIOPRIN,MESALAZINE,STEROID???
38.OLANZAPINE most common side effect...weight GAIN
39.Lesion on shins....OCPs
40.erythema nodosum...prognosis...SPONTANEOUS RECOVERY
41.Carbamezipine induced skin lesion in Chineese...HLA Genotype .(confirmed it with
google on chineese population )
42.chiken pox with pneumonia...ACYCLOVIR
44.GREYISH color on TONSILLS e lyphadenopathy...DIPHTHERIA
45.Allergic to egg...INFLUENZA VACCINE CONTRAINDICATED
46.ORAL ,KIDNEY AND LUNG HAEMRHGES....micro angitis
47.2 POPULATIONS AND TWO RESULTS IN NORMAL DISTRIBUTION....UNPAIRED T TEST
48.FALSE POSITIVE RATE.....55/1000 or 55/950
49.percentage with positive results...SENSITIVITY
50.PERSON WITH POSITIVE... EMV....AND one bactarial inf positive....EMV or
CMV...with generalized lymphadenopathy
51.lesion under the breasst fold and abdominal folds in 80 yr women...sebbhoric or
candida
52.cervical lyphadenopathy with ankle swelling plus pupuric rash on
skin....SARCOIDOSIS
53.friends history of food poisoning...2day history..bloody diarrhea with RT illiac
fossa pain...compylobacter
Page 1
MRCP 1 May 2015 Recall
54.history of STD with conjunctivitis with arthritis....Reactive artheritis or
GONNOCOCCAL infection
55.HLA 1... CD 8
56.PERIPARTAL CARDIOMYOPATHY
57.Takayasu arteritis...loss of radial pulse when hands held above head
58.exercise induced collapse twicely without family history with no ECG

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

86.Mann whitney...2 populations with unpaired data and non parametric

88.superior homononymus quadrantinopia.....temporal lobectomy
89.inferior homononymus quadrantinopia....parietal lobe
90.Low FSH,LH, nd high PROLACTIN...pregnancy
91.galactorhea...risperidone
92.haloperidol....drug induced parkinsonism or subdural hematoma..
93.thiazide diuretics...distal convulated tubules
94.low HCO3.....may b prox conv tubule
95.movemnet of particles across membrane.....with hydrostatic pressure....Osmosis
96.patient on simvastatin and other IHD drugs...omeprazole is contraindicated
97.syphilis in pregnancy...Erythomycin or azithro
98.patient treated with ceftriaxone with STD but still symptoms....chlaymedia
99.ring enhancing lesions on CT...toxoplasmosis
100.man took part in swiming then came back to country with some symptoms....stool
ova test or somthing elsE???
101.Itch in aus in mothher and children...entrobius vermicularis
102.type 1 diabetes...AGE..KETONE...????
103.Young man with balanitis ...mody???
104.SIADH.....fluid restriction or desmopressin???
105.meningitis....normal glucose ..inc prot...lyphocytes raised??? mumps or tb???
106.CT normal after SAH...then do LP
107.drug contraindicated in pregnancy...Cipro
108.ankle clonus....Gastronemius
109.meningococcal soghn with non blanching rash...meningococcal pcr....
110.anemia with 8.8 hb in preg..cant tolerate oral iron...Parentral shud b given
Page 2
MRCP 1 May 2015 Recall
111.pcr used for...detection of virus....cyto genetics
112.tall mai 1.83m height...low fsh and lh and testosterone....kallman synd
114.sweating nausea loss of conciousness for 1min with jerking movments during

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
Page 308/05/2015 mrcp4all
data:text/html;charset=utf8,%
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3A%20helvetica%2C 1/4
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

14.history of STD ....KERATODERMA BLENORHGICA

15.diAbetes plus hyperthyroidism....PRETIIBIAL MYXDEMA...
16.1st sign in hypovolemic shock...TACHYCARDIA
17.common paroneal nerve palsy.SENSORY LOSS IN DORSUM OF FOOT
18.trip to southasia..jaundiced...pre jrny vacc done...HEP A or HEP E
19.Alpha 1 anti trypson defic...Autosomal co dominant...but it was not an option so it was autosomal
recessive as per text
20.wilson diseasse...1 in 100
21.HIV diagnosis...investigation with consent or without consent
22.patient think of nurses planing against him and trying to poison hiim...PARANOID PSYCHOSIS
23.neighbour controlling thoughts.....schizophrenia
24.hallucinations plus cog impairment plus rigidity....LWI BODY DEMENTIA
25.Man with drug poisoning belief of supernatural healing power....DELUSION
26.CARBIMAZOL...MOA..THYROID PER OXIDASE INHIBITOR.
27.Hep C ...CRYOGLOBINEMIA
28.Aplastic picture...erythro virus.B19
29.REPEATED infections after chemotherapy..cause...compliment def or immunoglobin def..
30.repeated neiseria inf....COMPLEMENT DEFICIENCY
31.Meningial TB...12MONTHS treatment
32.tonsillitis ...with hemeturia....post infectious glomerulonephritis
33.metastasis to vertibral column...acute pain and sensory loss...tx..surgical decompression or
radiotherapy or steroids...
34.IMITANIB ...tyrosine kinase inhibitor
35.GOLIMUMAB...MOA..TNFALPHA
inhibitor
36. Investigation b4 METHOTRAXATE...THIOPURINE METHYL TRANSFERASE
37.Pregnancy with crohn ...which to discontinue...AZATHIOPRIN,MESALAZINE,STEROID???
38.OLANZAPINE most common side effect...weight GAIN
39.Lesion on shins....OCPs
40.erythema nodosum...prognosis...SPONTANEOUS RECOVERY

41.Carbamezipine induced skin lesion in Chineese...HLA Genotype .(confirmed it with google on

chineese
population )
42.chiken pox with pneumonia...ACYCLOVIR
44.GREYISH color on TONSILLS e lyphadenopathy...DIPHTHERIA
45.Allergic to egg...INFLUENZA VACCINE CONTRAINDICATED
46.ORAL ,KIDNEY AND LUNG HAEMRHGES....micro angitis
47.2 POPULATIONS AND TWO RESULTS IN NORMAL DISTRIBUTION....UNPAIRED T TEST
48.FALSE POSITIVE RATE.....55/1000 or 55/950
49.percentage with positive results...SENSITIVITY
50.PERSON WITH POSITIVE... EMV....AND one bactarial inf positive....EMV or CMV...with
generalized
lymphadenopathy
51.lesion under the breasst fold and abdominal folds in 80 yr women...sebbhoric or candida
52.cervical lyphadenopathy with ankle swelling plus pupuric rash on skin....SARCOIDOSIS
53.friends history of food poisoning...2day history..bloody diarrhea with RT illiac fossa
pain...compylobacter
54.history of STD with conjunctivitis with arthritis....Reactive artheritis or GONNOCOCCAL infection
55.HLA 1... CD 8
56.PERIPARTAL CARDIOMYOPATHY
57.Takayasu arteritis...loss of radial pulse when hands held above head
58.exercise induced collapse twicely without family history with no ECG changes...cardiomyopathy
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
08/05/2015 mrcp4all
86.Mann whitney...2 populations with unpaired data and non parametric
88.superior homononymus quadrantinopia.....temporal lobectomy
89.inferior homononymus quadrantinopia....parietal lobe
90.Low FSH,LH, nd high PROLACTIN...pregnancy
91.galactorhea...risperidone
92.haloperidol....drug induced parkinsonism or subdural hematoma..
93.thiazide diuretics...distal convulated tubules

94.low HCO3.....may b prox conv tubule

95.movemnet of particles across membrane.....with hydrostatic pressure....Osmosis
96.patient on simvastatin and other IHD drugs...omeprazole is contraindicated
97.syphilis in pregnancy...Erythomycin or azithro
98.patient treated with ceftriaxone with STD but still symptoms....chlaymedia
99.ring enhancing lesions on CT...toxoplasmosis
100.man took part in swiming then came back to country with some symptoms....stool ova test or
somthing elsE???
101.Itch in aus in mothher and children...entrobius vermicularis
102.type 1 diabetes...AGE..KETONE...????
103.Young man with balanitis ...mody???
104.SIADH.....fluid restriction or desmopressin???
105.meningitis....normal glucose ..inc prot...lyphocytes raised??? mumps or tb???
106.CT normal after SAH...then do LP
107.drug contraindicated in pregnancy...Cipro
108.ankle clonus....Gastronemius
109.meningococcal soghn with non blanching rash...meningococcal pcr....
110.anemia with 8.8 hb in preg..cant tolerate oral iron...Parentral shud b given
111.pcr used for...detection of virus....cyto genetics
112.tall mai 1.83m height...low fsh and lh and testosterone....kallman synd
114.sweating nausea loss of conciousness for 1min with jerking movments during
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
08/05/2015 mrcp4all
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
08/05/2015 mrcp4all

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
08/05/2015 mrcp4all
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.
09/05/2015 ONLY MRCP MCQ
From rxpg .. recall for first part may 2015 mrcp .....
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

10.11.70 YR Female suicide...rsk factr for repeat...OLD AGE
12.promyelocytes ....15:17
13.PEMPHIGUS VULGARIS...IGG At dermoepidermal junct..may b
14.history of STD ....KERATODERMA BLENORHGICA
15.diAbetes plus hyperthyroidism....PRETIIBIAL MYXDEMA...
16.1st sign in hypovolemic shock...TACHYCARDIA
17.common paroneal nerve palsy.SENSORY LOSS IN DORSUM OF FOOT
18.trip to southasia..jaundiced...pre jrny vacc done...HEP A or HEP E
19.Alpha 1 anti trypson defic...Autosomal co dominant...but it was not an option so it was autosomal
recessive as per text
20.wilson diseasse...1 in 100
21.HIV diagnosis...investigation with consent or without consent
22.patient think of nurses planing against him and trying to poison hiim...PARANOID PSYCHOSIS
23.neighbour controlling thoughts.....schizophrenia
24.hallucinations plus cog impairment plus rigidity....LWI BODY DEMENTIA
25.Man with drug poisoning belief of supernatural healing power....DELUSION
26.CARBIMAZOL...MOA..THYROID PER OXIDASE INHIBITOR.
27.Hep C ...CRYOGLOBINEMIA
28.Aplastic picture...erythro virus.B19
29.REPEATED infections after chemotherapy..cause...compliment def or immunoglobin def..
30.repeated neiseria inf....COMPLEMENT DEFICIENCY
31.Meningial TB...12MONTHS treatment
32.tonsillitis ...with hemeturia....post infectious glomerulonephritis
33.metastasis to vertibral column...acute pain and sensory loss...tx..surgical decompression or
radiotherapy or steroids...
34.IMITANIB ...tyrosine kinase inhibitor
35.GOLIMUMAB...MOA..TNFALPHA
inhibitor
36. Investigation b4 METHOTRAXATE...THIOPURINE METHYL TRANSFERASE

37.Pregnancy with crohn ...which to discontinue...AZATHIOPRIN,MESALAZINE,STEROID???

38.OLANZAPINE most common side effect...weight GAIN
39.Lesion on shins....OCPs
40.erythema nodosum...prognosis...SPONTANEOUS RECOVERY
41.Carbamezipine induced skin lesion in Chineese...HLA Genotype .(confirmed it with google on
chineese
population )
42.chiken pox with pneumonia...ACYCLOVIR
44.GREYISH color on TONSILLS e lyphadenopathy...DIPHTHERIA
45.Allergic to egg...INFLUENZA VACCINE CONTRAINDICATED
46.ORAL ,KIDNEY AND LUNG HAEMRHGES....micro angitis
47.2 POPULATIONS AND TWO RESULTS IN NORMAL DISTRIBUTION....UNPAIRED T TEST
48.FALSE POSITIVE RATE.....55/1000 or 55/950
49.percentage with positive results...SENSITIVITY
50.PERSON WITH POSITIVE... EMV....AND one bactarial inf positive....EMV or CMV...with
generalized
lymphadenopathy
51.lesion under the breasst fold and abdominal folds in 80 yr women...sebbhoric or candida
52.cervical lyphadenopathy with ankle swelling plus pupuric rash on skin....SARCOIDOSIS
53.friends history of food poisoning...2day history..bloody diarrhea with RT illiac fossa
pain...compylobacter
54.history of STD with conjunctivitis with arthritis....Reactive artheritis or GONNOCOCCAL infection
55.HLA 1... CD 8
56.PERIPARTAL CARDIOMYOPATHY
57.Takayasu arteritis...loss of radial pulse when hands held above head
58.exercise induced collapse twicely without family history with no ECG changes...cardiomyopathy
09/05/2015 ONLY MRCP MCQ
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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

86.Mann whitney...2 populations with unpaired data and non parametric

88.superior homononymus quadrantinopia.....temporal lobectomy
89.inferior homononymus quadrantinopia....parietal lobe
90.Low FSH,LH, nd high PROLACTIN...pregnancy
91.galactorhea...risperidone
92.haloperidol....drug induced parkinsonism or subdural hematoma..
93.thiazide diuretics...distal convulated tubules
94.low HCO3.....may b prox conv tubule
95.movemnet of particles across membrane.....with hydrostatic pressure....Osmosis
96.patient on simvastatin and other IHD drugs...omeprazole is contraindicated
97.syphilis in pregnancy...Erythomycin or azithro
98.patient treated with ceftriaxone with STD but still symptoms....chlaymedia
99.ring enhancing lesions on CT...toxoplasmosis
100.man took part in swiming then came back to country with some symptoms....stool ova test or
somthing elsE???
101.Itch in aus in mothher and children...entrobius vermicularis
102.type 1 diabetes...AGE..KETONE...????
103.Young man with balanitis ...mody???
104.SIADH.....fluid restriction or desmopressin???
105.meningitis....normal glucose ..inc prot...lyphocytes raised??? mumps or tb???
106.CT normal after SAH...then do LP
107.drug contraindicated in pregnancy...Cipro
108.ankle clonus....Gastronemius
109.meningococcal soghn with non blanching rash...meningococcal pcr....
110.anemia with 8.8 hb in preg..cant tolerate oral iron...Parentral shud b given
111.pcr used for...detection of virus....cyto genetics
112.tall mai 1.83m height...low fsh and lh and testosterone....kallman synd
114.sweating nausea loss of conciousness for 1min with jerking movments during
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??/
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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..

..165) sick euthyroid syndrome

167) graves disease ( some says post partum thyroiditis) pt had unilateral exophthalmos, she had
anterior
neck swelling ,she was post partum !
Sept 2015

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

20-Most compelling reason to stop Exercise ECG. 9 Bp fall

21-Pt e palpitation "no collapse occurs 3times a week9 loop recorder
-Pulmonology:
1-Immediatettt bronchpulmonaryaspragellosis e Lung co|lapse9 Oral steroid
2-PE 9 normal CXR
3-1ry Pneumothorax> 3.5 cmm 9 needle aspiration
4Pt with Pleural plague, Effusion :high protein low suger 90% lympho2%mesothelial(tb)9 TB
5-SLE low TLCO 9 alveolar Hge
6- COPD exacerbation9 NIMN
7-Hemoptysis in a patient with breathlessness9 Bronchial Carcinoid
8-Patient withMND presents with worsening of breathingand has decided to sleep sitting with
wheeze and bilateral crackles9 COPD or chronic aspiration or PE.
~GFh
2-First line diuretic in a patient with Cirrhosis -> Spironolactone
3-Colorectal ca.....Apc mutation
4-Mesentric ischemia
5-se HCAT test for Bile acid
6-HB Ag + and anti core positive) Chronic HBV
7-45 yo gentlemanwith high Bil-High unconga bili.,other LFT normal-) Gilbert
8-Ceiliac-9 Antiendomysial
9-Patient with upper GI bleed and low BP and fast heart rate... IV saline ?, Terlipressin
10- Cause of hepato renal sydrome. Portosystemic shunt or Splanchinicvasodilitation
11-blood per rectum what suggest upper git bleeding-) high urea
12-pt e bloating,diarrhoea, familyh/o of lBD?? ocult blood , colonoscopy,ct abdo, small
int.enema
-Endocfine:
1-Primary hyper parathyroid
2-hypo calcimia after surgery is due to 9 Vit D defciency???
3Seconary HTN in VHL->Do24hour metanephrin
4Androgrn insensitivity -9 Female withclitromegaly

S-acromegalydiagn test -)9 GH measurementand GTT

6-Liver function-) in pt e we AMA
7-Thyroid enlargement in 33 yr MALE with hypothyroidism-) hashimoto's...
8-Pheochromocytoma
9-ProlactinIncrease....Metac|opromide
10- Cushing sceniario + low K metabolicalkalosis
11- incomplete androgen insentivity Syn.(testicfeminisat}-) Female e female external genitalia
12-Alcoholicgiven glucose&2nd attackthiaminethen develop hypoglycemiaagain?Dep|eted glycogen
13-reccurent hypoglycemia .low c peptide -) external insulin
14|oss of dm control during sepsis becauseof -) Cortisol
15-alcoholice low glucose, in 2 hours still low after IV glucose. whet you do next?. 500 ml 10%
or 50 ml 20%
16-35 yrs M born e Sensorineural deafness+Familyh/oluncle)of DM ,his FBS & HBA1C: High
T1DMor TZDM or M00 or Mitochondrial Diabetes
17-frontal headache raised pro|actin??pit adenoma or Pregnancy???
18- teriary,hyperpara thyroid
19hypoca|cmicbone surgery
20Diabetes insipidus in an elderly - Demecleocyline?
siada ttt fluid restriction- Demecleocycline
-Neuro, Psychiatry :
1-Alzahimar9 Donepazll
2-I-ISV encephalitis: fronto temperal changes in imaging meninism fever confusion
3-Anorexia nervosa -> Phosphate
4-Patient with depression -)Fluoxetine
S-Benign Essential tremor -) Propanolol
7Na Valproate Toxicity -3* wt gain
8-Sleep apnea -) CPAP
11-Halopridol to prevent furtherfall as pt is confused
13-scenrio of Wernike Encephalopathy. Thiamine
14Intra cerebral bleed in elderly ? cause is -9 Medial calciic sclerosis

15-Site of action of granisetronlantiemetici-> medulla oblongata

16- Lithium-)neutoleptic
17-intt vision.....Parietallobe
18-acutecerebral hemmorahge+htn....avmalformation
19-Myotonicdystrophy
20-88 year old man had a fall after admission, transfer to well lit room
21-Low carbamazepine in someone with Bing drinking
22-Elderly F with UTI and urge incontinencecurrently on Trimethoprim-Next line, propantheline
23-Cataplexy. Pt takes alcohol , looses muscle strength but still conscious and sleeps excessively
24-Reduce appetite in elderly pt?? -> reduced metabolic rate
25-F e bilateralptosis- wasting-weaknesses -)Myastheniagravies or myotonia dystroph.?
26-role of p53 -)cell cycle control
27- paranoid shisophrenia
28-anorexia nervosa scenrio....finehair on face
29H/o influenza, lower and upper limb wekness....GBsynd
30-Elderly non hypertensive with lobar Hge is amyloid angiopathy
Senile Amyloid.Commonest cause of Cerebral Hemorrhage in elderly...
-Nephro:
2-lgA -9 dermatitis herpaticform
3-Bradykininfor ACEi
4-Facial puffiness perindopril
S-Glomerularfinding in Proteinuria in Nephrotis Syndrome - FSGS
6-hypercalcemia drug.... thiazide
7-Patient's renal function deteriorated after ramipril, D/Cramiprll
8-Patient presents with EGFR of 14, stop metformin
9-Low c3 - cryoglobulinaemia
10-Contraindicationto Tumour resection- Paralysis of Vocal cord
11-drug with direct membraneeffect ?? acetazolamide?
12-Most comn cause of death in CKD is cardiovascular
13-increaseNa in urine with normal kidney function -) Cortisol deficiency

-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

10-Desmopressin can be used to promote the release of von Willebrandfactor

lnfection:
I-HIV zprogressive leukoencephalopathy
2-small spot in center and hallow and clean centre betweenthe spot and hallow -9 Lyme
3-Live attenuated vaccines-)Yellow fever
4-Vaccinesassociated with Egg protein allergy 9 influenza
5-lady went to carribeand now has funny borrows on her buttock. what did she get that
from>?water?sex?sunbathing??-->Larva migrans on the lady thatwent to carribean
6what risks]bust are you susceptible after splenectomy -9 pneumococci
7-Thailand- Dengue
8-shigella
9-Tetanus booster dose
10-with the new kitten... Bartollena Henselae
11-Mycobacterimavim preventive measure!! - Normal ward hygiene or respiratory isolation:
12-BacterialVaginosis Metronidazole
13-HHV 8 - KS
14-Travel to india hrpatomegalyfever dky high enzymes ->HAV
15-Fever +rigor 6monthafter travel to tropic=plasmodiumovale -Oval malaria
16-Anaphylaxiswas type I hypersensitivity
17-hill walker, rash....erthemachronicum... lyme disease
-Opthalmologyz
1-Visual hallucinations+macu|ardegenration...Char|esBonte syndrome
2-Acute monocular b|indness....opticneuritis
-derma:
12-Malignant melanoma best prognosis???? thickness
3-Patientscared of MRSA infection who requested repeated test Obsession
4-Erythema Multiforme following herpetic infection in the hand
S-sebaceousadenoma
6-Chronic idiopathicurticaria

1-Cha nces of two parents withAchondroplasia having a normal child -) S0 %

2- Plot, , odds of a disease after a positive test 50% i

1. MRCP 1: Recalled Questions of May 2011 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 o
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Reply With Quote 2. 05-30-2011, 01:10 PM#2 anisa

Senior Member Join Date May 2011 Posts 440
++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 9. 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 18 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 24.CRF in young with renal
scarring- Reflux nephropathy 25.PVD with proteinuria with difff in lidney size- Ischaemic nephropathy
26.Poat renal transplant with acute rejection- Methyl prednisolone 27.RA with 4+ proteinuriaamyloidosis 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 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

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 56-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 8GOODPASTURE 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 11- PT WITH CUSHIG(HTN OBESE) HOW TO
DIAGNOSE>>>OVER NIGHT DEXAMETHASONE SUPPRESION TEST 12 ONE ANSWER WAS
>>>REDUCE WEIGHT BUT I COULDNT RECALL THE
QUESTION!! 4*HEMATOLOGY AND ONCOLOGY 1-PT E HIGH IG M AND PULMONARY
EMBOLISM(WALDENSTROMS)WHT THE COMPLICATION>>>>HYPERVISCOSITY
SYNDROME 2-PT WITH DRUG INDUCE HEMOLYTIC ANEMIA HOW TO
DIAGNOSE>>>DIRECT ANIGLOBULIN TEST 3-PT WITH BLEEDING TENDENCY HIGH PTT
LOW FACTOR 8>>>VWD(SOME COLLEGUES SUGGESTES HEMOPHILIA A?) 4-PT WITH
FATIGUE, SPLENOMEGALY AND HIGH WBC>>>CLASSIC CML 5-T WITH HIP PAIN WITH
TTT OF CML >>>AVSCULAR NECROSIS OF HEAD OF FEMUR 6-PT WITH ANAEMIA ,SKIN
RASH AND HEP C>>>CRYOGLUBINEMIA 7-PT WITH ACUTE PROMYLEOCYTIC

LEUKEMIA PROGNOSIS>>>T15- 10-ACTION OF DESMOPRESSIN>>EXTRACT STORED

FACTOR V 11-CANCER COLON INCREASE SUSSEPTABILITY OF >>>ENDOMETRIAL CA 12PT WITH THROMBOCTHYSEMIA HOW TO TREAT>>>HYDROXYURIA 13-PT WITH
ANAEMIA AND TEAR DROP IN BLOOD FILM>>>MYELOFIBROSIS 14- WARFARIN ACT ON
>>>FACTOR 7 15-OLD PT WITH PETICHAE AND PERSISTENT
PANCYTOPENIA>>>MYELODYSPLASIA 16-5 YEARS SURVIVAL OF NON SMALL CELL
BRNCHOGENIC CA IF GOOD ELLIMINATED>>>10%OR 20% 17-DOCXCETEL>>>INHIBITON
OF MICROTUBULE 18-BREAST CA PROGNOSI BY>>>> 15:3 19-BAD PROGNOSIS IN
HODJIGINS LYMPHOMA>>>SWETTING 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 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? 8T 9-PT WITH DIARHEA AND CRYPT ABCESS>>ULERATIVE
COLLITIS 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
RESISTANCE?) 6-WT CAUSE FACIAL SWELLING>>>AMLODIPINE OR ACE INHIBITOR 7-PT
WITH PICTURE OF ?PULMONARY FIBROSIS OR COPD WT IS THE
CAUSE>>>NITROFURANTOIN 8-AMYTRTRYPTALINE OVER DOSE HOW TO TREAT>>>NA
BICARB WHICH DRUG USED FOR MANIA>>>LITHIUM 9-PT WITH PARACETAMOL OVER
DOSE HOW TO MONITOR>>>PT 10-INTERACTION BETWEEN STATIN AND>>>GRAPE
FRUIT 11- PT WITH ABDOMINAL PAIN ,DIARHEA WHICH DRUG
RESPONSILE>>>ALEDROIC ACID? 13-WHICH ANTI HTN DRUG SAVE TO USE WITH PT
TAKIN LITHIUM>>>AMLODIPINE?
14-PT WITH G6PD AND WILL TRAVEL TO AFRICA WHICH DRUG TO

AVOID>>>PRIMAQUINE 15- PT TAKING ANTI T.B(RIPE)AND BENDROFLUROTHIAZIDE

AND HAS JOINT PAIN WHICH DRUG IS RESPONSIBLE>>>PYRIZINAMIDE OR
BENDROFLUROTHIAZIDE?(DEBATABLE) 16-WHICH DRUG CAUSE MOUTH ULCER>>>>?
NICORADINIL 17 -ONE QUISTION ABOUT NA VALPROATE 18- ONE QUISION ABOUT
ECTASY 19- ONE DRUG ACTS ON MUSCARINIC RECEPTORS (ACTUALLY CANT
REMEMBER LAST FOUR QUISTIONS BUT I SAW IT IN THE POSTS) 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 7-PT WITH PROGRESSIVE MEMORY
IMPAIREMENT AND URINATED IN FRONT OF PEOPLE WT THE DIAGNOSIS>>>FRONTO
TEMPORAL DEMENTIA 8-PT WITH PICTURE OF ENCEPHALITIS AND LESION ON
TEMPORAL LESION IN CT BRAIN>>>HERPES ENCEPHALITIS 9 OLD PATIENT AGITATED
WT TO GIVE>>> HALOPERIDOL 10-PT IN PURPUERIUM AND HAS HEADACHE AND
>>>CAVERNUS SINUS THROMBOSIS 11-PT WITH PAINFULL PERIPHERAL NERVE
PAIN(PERIPHERAL NEUROPATHY HOW TO MANAGE HIS PAIN>>>GABAPENTIN 12- PT
WITH BITEMPORAN HEMIANOPIA>>>LESION IN OPTIC CHIASMA 13- HOMONYMOUS
HEMIANOPIA WHERE IS THE LESION>>>OCCIPITAL LOBE 14-PT WITH HORNER AND
LOSS OF REFLEXES (LATERAL MEDDULLARY SYNDROME) >>>POSTERIOR INFERIOR
CEREBELLAR ARTERY LESION(ONE COLLEGUE SUGGESTED BRAIN STEM LESION
ACTUALLY BOTH CAN B!!) 16-WT IS MOST RELIABLE SIGNE IN INCRESED INTA
CRANIAL HTN?>>>BRADYCARDIA OR VOMITING? 17- HOW TO DIAGNOSE HIV PT
WHITH TOXOPLASMOSIS>>>MASS OCCUPYING LESION IN CT BRAIN 18-ONE QUISTION I
CANT REMEMBER BUT BY EXCLUSION >>>SYRINGOBULBIA!! 19-PT WITH
PARKINSONISM DISEAES AND BRADYKINESIA HOW TO MANAGE>>>BENZHEXOL OR
SELEGLINE? 9*CHEST 1-PT WITH DYSPNEA DURING HIS WORK(PAINTING?) AND
RESTRECTIVE LUNG PATTERN>>>HEPERSENSITIVITY PNEUMONITIS? 2- PT WITH
MESOTHELOMA AND PLEURAL FLUID HOW TO DIAGNOSE>>>CLOSED LUNG

BIOPSY,FINE NEEDLE ASPIRATION,THORACOSCOPY?(DEBATABLE)

3-NON SMALL CELL CLINICAL SIGNS>>>>MONOMORHIC RHONCHI? 4-PT WITH
DYSPNEA , RESP ALKALOSIS AND HYPOXIA FOR ONE MONTH>>>PULMONARY
EMBOLISM? 5-YOUNG PT WITH HEMOPTYSIS MILD SMOKER AND UPPER LUNG
COLLAPSE >>>CARCINOID TUMOUR OR BRONCHIAL CARCINOMA? 6-PT WITH
DYPNEA ,CHEST PAIN AND INCREASED TLCO>>>>PULMONARY HE 7-PT WITH SEVER
DYSPNEA,RESPIATORY ALKALOSIS (COULDNT REMEMBER THE REST OF
QUISTION?)BUT WE AGREED THE ANSWER IS B ASHMA(AS PER ON EXAMINATION) 8- PT
WITH DYSPNEA , SKIN LESIONS AND BULKY MEDIASTINUM ON CXR>>> SARCOIDOSIS
9- PT WITH PNEUMOTHORAX WHT TO AVOID>>>TRAVEL BY PL ANE FOR 3 MONTHS OR
FOREVER OR AVOID DIVING FOR 3 MONTH OR FOREVER 10-WHT IMPROVE AFTER
BULLECTOMY>>>FEV1 OR VITAL CAPACITY? 11-LONG STANDING SMOKER PT WITH
OBSTRUCTIVE PATTERN AND CXR SIGNS OF>>>>EMPHYSEMA?? 12-WT TO MONITOR PT
WITH EHLER DANOLOS S? ,WITH DYSPNE(AS I REMEMBER)>>>VITAL CAPACITY 13- PT
OBESE BMI 32 AND DAYTIME SOMNOLENSE AND SUDDEN LOSS OF CONSIOUSNESS IN
FRONT OF TV>>THIS QUISTION IS EXTREMELY VAGUE BUT I THINK OBSTRUCTIVE
SLEEP APNEA IS MORE CORRECT THAN NARCOLEPSY 10*RHEUMATOLOGY 1-ELDERLY
ALCOHOLIC PATIENT FOUND COLLAPSED,HYPOTHERMIA (RHABDOMYOLYSIS)WT TO
CHECK>>>CREATININE KINASE 2-PT DM,WITH LIMITED MOVEMENT OF SHOULDER
JOINT IN ALL DIRECTION>>>ADHESIVE CAPULITIS? 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? 4-WHICH
ONE HAS BAD PROGNOSIS IN RHEUMATOID ARTHRIITIS>>>PERIARTICULAR
EROSIONS,MORE THAN 2HOUR MORNING STIFFNESS 5-PT WITH JOINT PAIN ,MORNING
STIFFNESS, NO MUSCLE WASTING RH +VE>>>>RHEMATOID ARHRITIS 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 8- PT WITH CREST AND ANTICENTOMERE +VE >>>1RY PSJOGREN

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

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? 13- 1415-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 5 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 8GOODPASTURE SYNDROME DEPOSITION OF ANTI GMB 9-YOUNG PT WITH
HEMATURIA>>>IG A NEPHROPATHY 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) 6MECHANISM 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 10AQUAPURINE 2 PRESENT IN>>>NEPHROGENIC DIABETES INSIPIDUS 11- PT WITH
CUSHIG(HTN OBESE) HOW TO DIAGNOSE>>>OVER NIGHT DEXAMETHASONE
SUPPRESION TEST 12 ONE ANSWER WAS >>>REDUCE WEIGHT BUT I COULDNT RECALL

THE QUESTION!! 4*HEMATOLOGY AND ONCOLOGY 1-PT E HIGH IG M AND PULMONARY

EMBOLISM(WALDENSTROMS)WHT THE COMPLICATION>>>>HYPERVISCOSITY
SYNDROME 2-PT WITH DRUG INDUCE HEMOLYTIC ANEMIA HOW TO
DIAGNOSE>>>DIRECT ANIGLOBULIN TEST 3-PT WITH BLEEDING TENDENCY HIGH PTT
LOW FACTOR 8>>>VWD(SOME COLLEGUES SUGGESTES HEMOPHILIA A?) 4-PT WITH
FATIGUE, SPLENOMEGALY AND HIGH WBC>>>CLASSIC CML 5-T WITH HIP PAIN WITH
TTT OF CML >>>AVSCULAR NECROSIS OF HEAD OF FEMUR 6-PT WITH ANAEMIA ,SKIN
RASH AND HEP C>>>CRYOGLUBINEMIA 7-PT WITH ACUTE PROMYLEOCYTIC
LEUKEMIA PROGNOSIS>>>T15-17 DONORS LEUKOCYTE 10-ACTION OF
DESMOPRESSIN>>EXTRACT STORED FACTOR V 11-CANCER COLON INCREASE
SUSSEPTABILITY OF >>>ENDOMETRIAL CA 12-PT WITH THROMBOCTHYSEMIA HOW TO
TREAT>>>HYDROXYURIA 13-PT WITH ANAEMIA AND TEAR DROP IN BLOOD
FILM>>>MYELOFIBROSIS 14- WARFARIN ACT ON >>>FACTOR 7 15-OLD PT WITH
PETICHAE AND PERSISTENT PANCYTOPENIA>>>MYELODYSPLASIA 16-5 YEARS
SURVIVAL OF NON SMALL CELL BRNCHOGENIC CA IF GOOD ELLIMINATED>>>10%OR
20% 17-DOCXCETEL>>>INHIBITON OF MICROTUBULE 18-BREAST CA PROGNOSI BY>>>>
15:3 19-BAD PROGNOSIS IN HODJIGINS LYMPHOMA>>>SWETTING 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 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

RESISTANCE?) 6-WT CAUSE FACIAL SWELLING>>>AMLODIPINE OR ACE INHIBITOR 7-PT

WITH PICTURE OF ?PULMONARY FIBROSIS OR COPD
WT IS THE CAUSE>>>NITROFURANTOIN 8-AMYTRTRYPTALINE OVER DOSE HOW TO
TREAT>>>NA BICARB WHICH DRUG USED FOR MANIA>>>LITHIUM 9-PT WITH
PARACETAMOL OVER DOSE HOW TO MONITOR>>>PT 10-INTERACTION BETWEEN
STATIN AND>>>GRAPE FRUIT 11- PT WITH ABDOMINAL PAIN ,DIARHEA WHICH DRUG
RESPONSILE>>>ALEDROIC ACID? 13-WHICH ANTI HTN DRUG SAVE TO USE WITH PT
TAKIN LITHIUM>>>AMLODIPINE? 14-PT WITH G6PD AND WILL TRAVEL TO AFRICA
WHICH DRUG TO AVOID>>>PRIMAQUINE 15- PT TAKING ANTI T.B(RIPE)AND
BENDROFLUROTHIAZIDE AND HAS JOINT PAIN WHICH DRUG IS
RESPONSIBLE>>>PYRIZINAMIDE OR BENDROFLUROTHIAZIDE?(DEBATABLE) 16-WHICH
DRUG CAUSE MOUTH ULCER>>>>?NICORADINIL 17 -ONE QUISTION ABOUT NA
VALPROATE 18- ONE QUISION ABOUT ECTASY 19- ONE DRUG ACTS ON MUSCARINIC
RECEPTORS (ACTUALLY CANT REMEMBER LAST FOUR QUISTIONS BUT I SAW IT IN THE
POSTS) 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 7-PT WITH PROGRESSIVE MEMORY
IMPAIREMENT AND URINATED IN FRONT OF PEOPLE WT THE DIAGNOSIS>>>FRONTO
TEMPORAL DEMENTIA 8-PT WITH PICTURE OF ENCEPHALITIS AND LESION ON
TEMPORAL LESION IN CT BRAIN>>>HERPES ENCEPHALITIS 9 OLD PATIENT AGITATED
WT TO GIVE>>> HALOPERIDOL 10-PT IN PURPUERIUM AND HAS HEADACHE AND
>>>CAVERNUS SINUS THROMBOSIS 11-PT WITH PAINFULL PERIPHERAL NERVE
PAIN(PERIPHERAL NEUROPATHY HOW TO MANAGE HIS PAIN>>>GABAPENTIN 12- PT
WITH BITEMPORAN HEMIANOPIA>>>LESION IN OPTIC CHIASMA 13- HOMONYMOUS
HEMIANOPIA WHERE IS THE LESION>>>OCCIPITAL LOBE 14-PT WITH HORNER AND
LOSS OF REFLEXES (LATERAL MEDDULLARY SYNDROME) >>>POSTERIOR INFERIOR

CEREBELLAR ARTERY LESION(ONE COLLEGUE SUGGESTED BRAIN STEM LESION

ACTUALLY BOTH CAN B!!) 16-WT IS MOST RELIABLE SIGNE IN INCRESED INTA
CRANIAL HTN?>>>BRADYCARDIA OR VOMITING? 17- HOW TO DIAGNOSE HIV PT
WHITH TOXOPLASMOSIS>>>MASS OCCUPYING LESION IN CT BRAIN 18-ONE QUISTION I
CANT REMEMBER BUT BY EXCLUSION >>>SYRINGOBULBIA!! 19-PT WITH
PARKINSONISM DISEAES AND BRADYKINESIA HOW TO
MANAGE>>>BENZHEXOL OR SELEGLINE? 9*CHEST 1-PT WITH DYSPNEA DURING HIS
WORK(PAINTING?) AND RESTRECTIVE LUNG PATTERN>>>HEPERSENSITIVITY
PNEUMONITIS? 2- PT WITH MESOTHELOMA AND PLEURAL FLUID HOW TO
DIAGNOSE>>>CLOSED LUNG BIOPSY,FINE NEEDLE ASPIRATION,THORACOSCOPY?
(DEBATABLE) 3-NON SMALL CELL CLINICAL SIGNS>>>>MONOMORHIC RHONCHI? 4-PT
WITH DYSPNEA , RESP ALKALOSIS AND HYPOXIA FOR ONE MONTH>>>PULMONARY
EMBOLISM? 5-YOUNG PT WITH HEMOPTYSIS MILD SMOKER AND UPPER LUNG
COLLAPSE >>>CARCINOID TUMOUR OR BRONCHIAL CARCINOMA? 6-PT WITH
DYPNEA ,CHEST PAIN AND INCREASED TLCO>>>>PULMONARY HE 7-PT WITH SEVER
DYSPNEA,RESPIATORY ALKALOSIS (COULDNT REMEMBER THE REST OF
QUISTION?)BUT WE AGREED THE ANSWER IS B ASHMA(AS PER ON EXAMINATION) 8- PT
WITH DYSPNEA , SKIN LESIONS AND BULKY MEDIASTINUM ON CXR>>> SARCOIDOSIS
9- PT WITH PNEUMOTHORAX WHT TO AVOID>>>TRAVEL BY PL ANE FOR 3 MONTHS OR
FOREVER OR AVOID DIVING FOR 3 MONTH OR FOREVER 10-WHT IMPROVE AFTER
BULLECTOMY>>>FEV1 OR VITAL CAPACITY? 11-LONG STANDING SMOKER PT WITH
OBSTRUCTIVE PATTERN AND CXR SIGNS OF>>>>EMPHYSEMA?? 12-WT TO MONITOR PT
WITH EHLER DANOLOS S? ,WITH DYSPNE(AS I REMEMBER)>>>VITAL CAPACITY 13- PT
OBESE BMI 32 AND DAYTIME SOMNOLENSE AND SUDDEN LOSS OF CONSIOUSNESS IN
FRONT OF TV>>THIS QUISTION IS EXTREMELY VAGUE BUT I THINK OBSTRUCTIVE
SLEEP APNEA IS MORE CORRECT THAN NARCOLEPSY 10*RHEUMATOLOGY 1-ELDERLY
ALCOHOLIC PATIENT FOUND COLLAPSED,HYPOTHERMIA (RHABDOMYOLYSIS)WT TO
CHECK>>>CREATININE KINASE 2-PT DM,WITH LIMITED MOVEMENT OF SHOULDER
JOINT IN ALL DIRECTION>>>ADHESIVE CAPULITIS? 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?

4-WHICH ONE HAS BAD PROGNOSIS IN RHEUMATOID ARTHRIITIS>>>PERIARTICULAR
EROSIONS,MORE THAN 2HOUR MORNING STIFFNESS 5-PT WITH JOINT PAIN ,MORNING
STIFFNESS, NO MUSCLE WASTING RH +VE>>>>RHEMATOID ARHRITIS 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 8- PT
WITH CREST AND ANTICENTOMERE +VE >>>1RY PSJOGREN 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) 14PT 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) 1FIRM LESION MORE THAN 3CM>>>NODULE 2-YELLOWISH WAXY LESION
(NECROBIOSIS LIPODICA )WHICH INVESTIGATION >>>FBS 3-?? 4-HYPERKERATOTIC
PLAQUES AROUD SCALE MARGIN>>>PSORIASIS
5- PT WITH AXILLARY LESIONS >>>>NEOROFIROMATOSIS ? OR NECROBISIS
GANGRENOSUM8- 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
LUMBIRICALS -GENETICS 3-PEUTS JECHER>>>AUTOSOMAL DOMMINAT 4- 5AKAPTUNURIA 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?? 16CODONE>>>CODES FOR AMINO ACIDS,MSNGER RNA? - 18METANALYSIS>>>HISTOGRAM?? 19-COMPARISON BETWEEN 2 DATA >>>UNPAIRED T
TEST 20-NNT>>50? 21-WHICH BIAS TO USE>>>PUBLICATION OR SUBJECTIVE?
1. yellow waxy lesion was bilateral and most appropriate answer is TSH,,, pretibial myxoedema????
dr;jehanzeb pak o Share

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

is not true but RCP may be looking for this answer.

Reply With Quote 2. 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] o Share

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 3. 11-21-2006, 07:57 AM#3 Guest Hyperparathyroidism

Primary Hyperparathyroidism 1 PTH increased 2 Calcium Increased 3 Phosphate Decreased Secondary
Hyperparathyroidism 1 PTH Increased 2 Ca low or normal 3 phosphate increased (renal failure
increases phosphate which is a direct stimulus for PTH release) Band keratopathy is an irregular region
of calcium phosphate deposition at the medial and lateral limbic margins of the cornea. It is a rare but
classical sign of hyperparathyroidism. 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

tHE SAME IN PCOS LH :FSH not FSH:LH

AM#10 8) herpes simplex encephalitis CLINICAL FEATURES Confusion Focal symptoms(eg musical
hallucination) Focal signs(right sided weakness and aphasia CSF: Lymphocytosis is
characteristic.LOW SUGAR A temporal location is typical. EEG: lateral periodic discharge at 2 hz
pattern is seen but it is not

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

Reply With Quote

1. 1. Subacute IE. treatment? Benpen + gent 2. litium toxicity. precipitant. ?ramipril 3. chronic CML, (?
not candodate for imintab). ? a-interferon or ?hydroxycarbamide 4. Discoid lupus on steroids. ?next
treatment. ? hydroxychloroquine. 5. Young pt had appendicectomy then went into shock (?sepsis abscess). investigations ?clotting screen ?DIC 6. Pt with face swelling (on ACEi, Statins ..) ?
precipitant 7. Macrocytic aneamia with antibodies to parietal cells. ?biopsy (?gastric wall) 8. chikenpox
developed pneumonia ?treatment 9. ?mediator in anaphylaxis 10. ?test to confirm transfusion
haemolytic reaction 11. A student's girlfriend kicked his ass after he came back from USA. He thought
he's the Dean (?delusional syndrome or ? schizophrenia !!!!!!!) 12. Lady with abdo pain and all Ix
NAD --> ?factious disorder 13. Pt thinks he's got cancer --? hypochondria disorder 14. intermittent
painful defecation with fresh blood in young lad (?polyp ? haemorrhoids ?anal fissure) 15. Jaundiced pt
with deranged LFTs (AST 1453) and tender hepatomegaly recently come back from holiday abroad (?
Hep A)
Reply With Quote 2. 01-20-2010, 02:00 AM#12 Guest EGYPT?? SALMONELA OR SHIGELLA
ANKLE SWELLING----CA CH BLOCKER BLUE VISION----SILDENFIL CONTROL HT RATE IN
AF ---BISOPROLOL AF ---HAEMODYNAMIC LOW----DC BELLS PALSY---- LACRIMATION
OR SALIVATION OR HYPERACUSIS OR HYPERATHESIA CSF WITH HIGH LYMPOCYTE
AND PROTEIN AND GLUCOSE 3.3 ---GUILLAN BARRE OR POLIO 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

carbamazepine pt on digoxin /warfarin still af uncontrolled i wrote bioprolol ?? pt on dialysis i wrote

ischeamic heart disease something related alcoholic patient with ataxia had blurring of vision 2 years
ago therefore i wrote MS respiratory depression i wrote codiene as its a morphine derivative and can
cause resp depression and low gcs thyroid nodule i agree it can only be FNA 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 atn sec to 10 day use of diclofenac o Share

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-

Inhibitor ----------Ca channel ??//increas toxicity o

Guest 1. Heart block after inferior MI. ?RCA occlusion 2. Guillain-Barre ?monitor respiratory
function ?FVC 3. 13y after valve replacement. anaemic ? haemolysis 4 5 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 10. Male with severe pain
behind eye worse in the morning --? ?trigeminal neuralagia 11. Unwell young pt with
lymphoadenopathy --> grandular fever (EBV) 12. JAK2 mutation --> Polycythaemia ruba vera 13.
Idiopathic parkinson --> ?tremor 14. Tear-drop poikilocytes --> myelofibrosis 15. Pt with polyarthritis
and anti-CCP --> ?RA 16. Northern blotting to detect RNA 17. Weight loss for obstructive sleep apnoea
18. Prophylaxis in trigeminal pain --> carbamezipine 19. New AF in compromised pt --> DC shock 20.
AF with CCF not respond to digoxin --> give bisoprolol as per NICE 21. Lady with tenderness + pain
lateral R hip --> I wrote bruisitis 22. A question on sensitivity 23. Positive predicted value TP/FP+TP
24. Respiratory depression due to overdose --> dihydrocodeine 25. Ring enhancing lesion -->
Toxoplasmosis 26. Obese lady with deranged LFTs and USS prognostic --> Nonalcoholic steatahepatits
27. Hypokalemia --> flattened P wave 28. Refeeding syndrome --> low phosphate
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. 31. DLE -->
hydroxychloroquine 32. Dandruf --> ketoconazole 33. Fall and loss of pain and temperature and joint
sensation preserved --> ?cervical disc prolapse o Share

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

Reply With Quote 9. 01-20-2010, 05:03 AM#19 CT 1 Guest

Hi all of you Just back from exam Happy after paper 1 , devastated after paper 2 I think same topics but
with variety of questions may be I need more practice Here are some questions which i remember ,
answers might be wrong but please discuss and add if remember more 1 . Alcoholic , weight loss ,
chest signs and symptoms , CXR shows pleural effusion aspiration attmepted but failed whats the
[b]NEXT[/b] investigation its clearly mention next not best investigation bronch ct chest us chest
thoraco 2. carbamazemine autoinduction 3. valporate hair loss 4. cyclosporin excessive hair 5.patient
suffered peripheral neuropathy , had chemo whic medication to stop ? vincristine 6. mismatch blood
transfusion what test to confirm ? direct coombs test 7. Ring enhancing lesion on CT aids patient ( toxo
) 8. 10. Mild headache in elderly which investigation ? ESR 11. Patient having unequal pupil and Ptosis
( Horner) which investigation to confirm ? cxr 12. CSF showing 100 lympho plus high protien ? TB 13.
Ankylosing spondylosis what will present in Lumbar xray ? sclerosis / osteophyste / sydem/ wedge
shape 14. patient with hip pain and lateral tenderness ? Osteoarthritis 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 19 . patient on 5 HTN medications develops ankle
edema amlodipine/ doxazocin / monoxidine 20 . Preg HTN methyldopa 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 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 5. 01-21-2010, 05:17 AM#55

drrajib Guest Guest i agree with most of ur answers except the test questions...but not too sure about IE
anbiotic choice 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

MRCP 1: High Yield Topics High Yield Topics 1. Young girl suspect Anorexia Nervosa linugo hair,
finctional hypogonadotrophic hypogonadism -> amennorhea. LH and FSH both low. All other
hormones are usually normal. Ferritin low. 2. Reiters Syndrome arthritis, uveitis, urethritis
Chlymidia, campylobacter,
Yersinia, Salmonella, Shigella. Balanisits. 3. PKD aut dom Chr 16/4 assoc berry aneurysm,
mitral/aortic regurg 4. Porphyria photosensitivity, blisters, scars with millia, hypertrichosis 5. Heart
sounds: Aortic Stenosis s2 paradoxical split, length proportional to severity 6. Vitiligo commonest
assoctions pernicious anaemia >>> type 1 dm, autoimmune addisons, autoimmune thyoid dx 7. Gout
blood urate high/low/normal, joint aspirate pos birif, ppt thiazides, NO allopurinol/aspirin in acute
phase 8. Peripheral neuropathy a) B12 rapid, dorsal columns (joint pos, vibration), sensory ataxia,
pseudoathetosis of upperlimbs b) diabetic slow, spinothalamic (pain, temp?) c)alcohol slow
progressive, spinothalamic d) Pb motor upper limbs 9. CNS abnormalities in HIV: toxoplaasmosis
(ring enhancing), lymphoma (solitary lesion). HIV encephalopathy, progressive multifocal
leucoencephalopathy (PML demylination in advanced HIV, low attenuation lesions) 10. Travellers
diarrohea: chronic (>2 WEEKS) giardia (incidious onset rx. Metronidazole), salmonella (serious
systemic illness), E.coli (rx. Ciprofloxacin) , Shigella 11. Renal syndrome minimal change disease,
membanous, 12. If you see blood on urinalysis forget about RAS 13. Thyroid Malignancy tend to be
non-functional, anaplastic has worse prognosis, local infiltration -> dysphagia, vocal cord

fasciculations -> Motor neurone diease silvery white scale ->

pretibial myxoedema --> Graves (NOT lid lag, NOT exopthalmus)

1. correction for No 7. Young lady with low serum Na,K and high Ca.. laxative abuse
Reply With Quote 4. 01-22-2010, 02:57 PM#84 mannyl Guest single thyroid swelling without any
abnormalities. FNAC is reasonable to know solid or cystic character and also can get cells for cytology
and culture. Other options are not. 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

1. hi mannyl Pneumonia after Viral fever is staph aur
Reply With Quote 2. 01-22-2010, 03:17 PM#92 mannyl Guest If it is 4 days , it must be contact
dermatitis. Not so sure about not taking any medication. But can still choose laxative according to lab
findings. 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

66.ACROMEGALY?GTT 67.HYPERKALEMIA+HYPOTENSION?SHORT SYNCHT

68.HYPOADRENALISM,HYPOTHYROID HIGH LH FSH?OVERIAN FALIURE
69.AMENORHEA +HIGH LH ,TESTOSTERON?PCO 70.TESTICULAR FEMINAZATION?
FEMALE PICTURE+EXTERNAL FEMAL GENITALIA o Share

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

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Last
1. 1-mode of action of docetaxel prevent microtuble (i did it wrong) i wrote it DNA
2-one q about pt admitted on the word and develop diarriha after 48 hr i wrote it sallmonella 3-q with
long hx of dysphagia for 18 month for both liquid and solid achlasia 4-q about action og gastrin?! 5-q
about drug causes of cholastatic picture flucloxacillin,other option was parcetamol,tramdol
6-q mention chch feature of ejunal biopsy of whipples dis 7-q qbout toxic thyroid nodules with feature
of thyrotoxicosis and neck us shows increase uptake ttt:radioactive iodine other option inculde
ropranol.predinsolone,carbamezabine 8-q about s/e of progesteron : option inculde:nausea,breast
pain,headache 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 12-drug causes constipation and option were:metformin,glagazid and
other??? 13-q mention hyop glycemia and hypotension and hyponatremia,which is best to give

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

analgsic and trpitan what is next:ergometrine,BB(propranol,NA valoprate 50-cluster headache 51-q

about hemiballisim 52-q about tt of essential tremor 53-2 or 3 q about numbness of the thumb 54-q
about other feature of common peroneal nerve injury: 55-q about abscent ankel jerkwith extensor
planter:subacute combined degenration of the cord???? 56-q about progressive supranuclear palsy 57vt what is contra indicating:verapamil 58-what favvour of vt:hr of 180,RBBB,anteriventricular
disociation, 59-ecg of pericarditis 60-pt with sub acute bacterial endocarditis what inv:colonscopy
61-pt with MS what els will indicate other valvular lesion:V wave in JVP 62-pt with MS what will
indicate co ass with MR?? displaced heaving apex beat??? opning snape 63-long QT syndrom:due to
blockge of k channel 64-what is inv for mycordial ischemia:angiography,ct, 65-pt with high k:ca
gluconate o Share

Reply With Quote 3. 09-22-2010, 02:55 AM#5 Guest Bosentan o Share

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

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1. for the q about ttt of grade 2 oesphagel varices option: terlipssen banding propanol
Reply With Quote
2. 09-22-2010, 07:32 AM#12 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. I am just thinking any answer anybody?
09-22-2010, 07:40 AM#13 asya Guest 89-bostan:mode of action 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) 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

1. alslm alikm this is my 1st attempt paper 1 is diffecult but 2 is ok i will post 1st what i sure about
answer after that i recall the other: 1- fomepizole ------ competitve inhibitor 2- imatimb---------tyrosine kinse 3-ARDS ------------- high protein 4-digoxin ----------- Na-K ATPse 5-allopurial--------Xanthine oxidase 6- bosentan-------- endothelin- receptor blocker 7- high aion gap------- methanol 8migraine ------------ ergotamine 9-drug C.I in VT ------ verapamil 10-ECG in pericarditis -------- ST
elevetion concave 11- picture of PE investigation ----- CT angio 12- ucler at site of ileostomy------pyoderma gang. 13- organism of pnemonia after influenza------ staph. aureus 14-Q picture of
cholesterol embolism 15-Q picture of global transit amnesia 16-MS with MR ------- displaced apex
beat 17- IE and bovi------- colonscopy 18-father has hemophillia chance his son------ 0% 19-18 month
pt. c/o pysphagia both solid and fluid ----- achelesia 20-ADPOCK------ 50 % affected 21- drug contiue
wiht sildenafil------ ACE- 23-pt with HTN and low k what investgestion------- aldestrone : renin ratio
23-Dx of cushing------ 24hr urine for cortsione 24- pic of toxic nodule goite------- radiate iodine 25acromegaly investigation------ glucose tolerance test
26-male c/o back pain has vertebral collapse due to osteoprosis------ testosterone level 27-pic of
cholestatic ----- flucoxcillin 28- rupure of tenden--- cipro 29-female pain at base of thumb with
swelling----- osteoarthritis 30-numbness in thumb and something in biceps---- C6 31- photosenetivity,
blister , millia----- prophyria cutanea tarda 32-sing of common pearneal n.--------- weakness of
dorsiflexation of foot 33-pic with liver imaired with high IgM----- PPS
Reply With Quote 2. 09-22-2010, 02:12 PM#22 tatta Guest -man wit ankylosing spondilitis, what test
positive? trendelinberg, straight leg test.......... 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!!!!!!!!!!!! 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

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7. 09-22-2010, 03:43 PM#27 exam crammer Guest sensory loss at T8? LMN signs at upper limb with
loss of temp/sens ABG of a pt , heroin abuser ABG of COPD pt ABG of metabolic acidosis Which
hormone low in prolactinoma 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

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1. ost splenectomy blood changes pt with fluctuating consciousness and left sided weakness turkish
woman with hepatosplenomegally SLE associated immunoglobin angioedema associated complement
SVT recurrent inx of choice
Reply With Quote 2. 09-22-2010, 03:52 PM#32 exam crammer Guest test to know the structure of prt o
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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

bilateral and papiledmea o Share

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

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1. i will start adding the q which was added by other collegues to which i have already writte befor
hemochroatosis c282y gene? deletion expansion am not sure of the answer this q was not in my
paper??!!!! 99- prognosis after 26 hr of paracetamol a-PT b-s.parcetamol level c-s.creatinine level 100eledry pt with ulcer on the nose a pic of her 4 yrs ago show same lesion a-squamous cell ca, b-basal, ctrophic ulcer, d-lupus vulgaris 101-renal transplant, earliest ab produced against what? HLA class 1 Ag
102-most imp HLA 4 renal transplant matching? a-HLA A, b- HLA B, d- HLA DR 103- young man wit
pain in rt buttock, 6 month ago had same pain in left buttock?a- sacroilitis, b-gluteus c-medius
tendonitis, d- lumber canal stenosis e-avascular necrosis 104- fomepizole :the mechansim for which it
ttt ethanol poising consider: a-competitve inhibitor 105-digoxin mode of action: a-Na-K ATPse 106picture of PE investigation a- CT angio b-v/q mismatch 107-Q picture of global transit amnesia
108-male c/o back pain has vertebral collapse due to osteoprosis------ testosterone level 109-rupure of

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

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1. this question puzzled me for a long time here you go guys, i hope you find some of this useful. this is
my first time attempting part 1! what an exam. i remembered some examples if ppl can remember
additional bits of infomation for my questions that would really help make them more complete i have
remembered maybe 25 more which i will post keep posting stuff then i can remember more questions!
------------------------------------------------------------------------------ male, aged mid-20s, presents with
haemoptysis. CXR reveal left upper lobe collape. what is the diagnosis? 1. lung cancer 2. cystic fibrosis
------------------------------------------------------- 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. CXR-small nodular shadowing whats the
diagnosis? 1. asthma 2. hypersentivity pneumonitis
---------------------------------------------------------------------- Eldery male, present with confusion, left leg
DVT and ulcer on toe. Immunoglobulins show IgM ++++ What is the most likely complication? 1.
Renal Failure 2. Hypercalcemia 3. TIA 4. Hyperviscosity syndrome
----------------------------------------------------------------------Young female 20s, presents with RIF pain and mass (??and vomitting). Mother has history of Crohn's.
What is the next approprate investigation? 1. CT Abdomin 2. Small bowel enema 3. Colonscopy 4.
USS ------------------------------------------------------------------------ It has been decided that all research
studies should be registered before commencing. what bias is this trying to avoid? 1. publication 2.
subject --------------------------------------------------------------------------- A young man returns from west

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

pulses, type a dissection

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1. 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.
Reply With Quote 2. 09-23-2010, 09:02 AM#82 Guest Cardio: 1. VT - LBBB, I think AV dissociation
is typical for AV block. P wave dissociation is not same with AV dissociation. 23. ST elevation V1-V4,
and ST depression II, III, aVF- Total LAD occlusion. 4. Mixed Mitral Valves - Diplaced apex beat. 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. 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). 7. Small Posterior
Pericardial Effusion - proceed to cholecystectomy. 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). 9. Post cath - cholesterol embolization. 10. Diastolic dysfunction - decrease myocardial
relaxation. Pharmaco: 1. Bosentan - endothelin receptor antagonist. 2. Dipyridamol - Phosphodiestrase
inhibitor. 3. Digoxin - Na/K/ATPase inhibitor. 4. Progesteron only pill - commonly irregular bleeding
(means irregular menstrual bleeding) - see BNF. 5. Suicidal ideation - Verenicline (Champix). 6.. 7.
Gynaecomastia - Buserelin (LHRH analog). 8. Allopurinol - Xantin oxidase inhibitor. 9. Parkinson &
aortic stenosis - Benhexol.
10. Benign Essential Tremor - Propanolol. 11. Migraine not response with triptan - valproate.
Rheumato: 1. Cryoglobulinaemia, history of mycoplasma infection 3/12, come with supraclavicular

lymphadenopathy - Bronchial carcinoma. 2. ANA - Ig.G. 3. Cryoglobulin - Rheumatoid Factor. 4. SLE

disease activity - ANA (p<0.007), followed by anti dsDNA (p<0.009) from SLE disease activity index
(SLEDAI). 5. Pulmonary Renal Syndrome - ANCA. 6. Shoulder pain - Rotator cuff tear. 7. Patient no
contact with TB, got RA on TNF alfa inhibitor - drinking unpasterurized milk (M. Bovis detected).
Pulmo: 1. Cryptogenic Fibrosing Alveolitis - transfer factor. 2. Decrease transfer factor - Pulmonary
Fibrosis. 3. Q regarding Pulmonary Artery Hypertension. 4. COPD - ventury mask. 5. COPD - NIV. 6.
Acute breathlessness & 20% pneumothorax - inpatient needle aspiration. Renal: 1. Nephrocalcinosis Type I RTA. 2. Staghorn calculus - Ca oxalate (80%). 3Dermato: 1. Sore throat + scalling lession gutate psoriasis (triggered by. Streptococcus). 2. Not involving mucosa blister - Pemphigoid. Hemato:
1. Anaemia in CLL - Autoimmune. 2. Sickle Cell Crisis - must see blood film. 3. Splenectomy - Howell
Jolly. 4. Transfussion reaction - ABO incompatibility. Eye: 1. PMR, Normal ESR, Normal TA, fundal
bleeding - no option other than Anterior Ischaemic Optic Neuropathy + 10 % CRAO (Cherry Red
Spot). 2. I think it will not anly be simple blepharitis, if lession involving nose & cheek - it could be
adenovirus conjuctivitis. 3. Q regarding Optic Neuritis. Infectious: 1. ORF. 2. Parotitis - Mumps. o
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Reply With Quote 3. 09-23-2010, 09:19 AM#83 Dr_Jose Guest

Continuation 1. ABPA - precipitin. 2. EST then HR drop - AV block? o Share

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

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1. MRCP JAN 2011 EXAM MCQS 1) LVF- associated with pulsus alterans 2) no proximL Wakness ,
RF positive- polymyositis 3) amioacid metabolism- alkaptonuria 4) increased KLCO- alveolar
haemorrhage 5) bitemporal arteritis- optic chaisma 6) cyclosporin- IL2 7) statistic q on association with
disease- ? p value
8) barrets oesophagus- repeat endoscopy in few weeks with high dose ppi 9) rabies- amoxicillin 10)
infective endocarditis no response to ab- acyclovir 11) back pain post pacemaker-staphalococal discitis
12) differentiate coccidio from toxoplasmosis- ?sol in ct 13) reversed split- LBBB 14) sildenafil- blue
vision 15) paint worker, car mechanic- ?reactive pneumonitis 16) q on holmes- adie pupil- ?
ptosis/nystagmus 17) increased igm - hyperviscosity syndrome 19) immune thrombocythaemiaimmunoglobulins 20) tca poisoning- soda bicorb 21) peut- jeghers- AD 22) statistics q on unpaired test
23) ig in sle c4 24) q on s5/l1 lesion 25) ulnar nerve- ? pronator muscles 26) ankylosing spon- lumbar
x- ray 27) non enhancing lesion on ct- cerebral abscess 28) alcoholic hepatitis- best inv-?? ct abd 29)
worst prognosis in ra- ?rf negative 30) spleenomegaly- cml 31) 32) tear drop cells- myelofibrosis 33)
34) t(17, 19)- APML 35) haemolysis in MAHA- DCT + 36) spleenectomy- s. pneumonniae AR 38)
cancer ass with colonic ca- endometrial ca 39) axillary freckles- neurofibromatosis 40) scalp ulcer- ?
BLL 41) ERYTHEMA nodosum- sarcoid 42) decrases TSH and T3, T4-? thyroid harmone resistance
43) post dc cardoversion- amiodarone 44) harmone under negative supression???? 45) harmone for
libido???? 46) q on positive pred value 47) q on NNT- 50 48) necrobiosis lipoidicum- check BM 49)
50) elderly lady with fall . left side weakness, pupils to right- ?haemorrhage 51) lymphnodes, clamydia
positive- lymphogranuloma venerum 52) infective endocraditis in iv abuser- ?vancomycin 53)epistaxix
and renal failure- wegeners 54) PR3 ab- wegeners 55) goodpastuers renal failure- anti gm ab 56) q on
renal failure in hep c- cryoglobulins 57) renal failure associated with malignacy- membranous 58)
59) poor prognosis in hodgkins- night sweats
60) q on mechanism of bnf???/ 61) q on abg's- ??? co poisoning 62) q on abg's==pulmonary
thromoembolism 63) avoid pregnancy in primary pulmonary htn 64) epistaxis and essential
thrombocythaemia, immediate management-?? hydroxyurea/ aspirin 65) q on brutons
agammaglobulinaemia 66) post h. pylori treatment- hydrogen breath test 67) ab in hep b immunisation-

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

10. Hyponatremia Detailed Pathophysiology Changes in Intravascular and Extravascular Compartment

11. S4 Corresponds to Pwave on ECG12. Digitalis Toxicity PPt by Hypomagnesemia13. Action Of
Parathyroid Hormone on Metabolism of Phosphate and Calcium14. Cause of Hyperuricemia in Tumor
Lysis Syndrome15. AntiCCP in Rheumatoid Arthiritis16. Eternacept Binds with TNF17. IL2 inhibited
by Cyclosporin18. Cystic Fibrosis Clinical scenario mentioned AR 20. Insulin Receptors
Membrane Receptors21. 0 Phase of Depolarisation associated with Sodium 23. Study Design What
phase represents effectiveness of a drug24. MOA of Doezolamide Carbonic anhydrase inhibitor25.
Porphyria Cutanea Tarda Clinical scenario mentioned Photosensitive rash with bullaes +
Hypertrichosis Defect in Uroporphyrin Decarboxylase26. Menniere s Disease Triad Of Dizziness +

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.

Atypical Lymphocytes seen in IMebv87. AntiHTN in Pregnancy MethylDopa88. Venous ulceration

no antimicrobial required89. Impetigo scenario(golden crusted lesions) Clinical Picture given staph
aureus90. Acnae Rosacea Rx by Topical Metronidazole
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92. Somatisation Disorder Dx from Clinical Picture 9394. Suicide Risk Factor age/ alcohol
95. Catract?96. Scleritis Painful RA97. Inhibition Of P450 by ERythroycin98. Supraventriculat
tachycardia in Asthmatics Rx by Verapamil99. Emollient usage dont smoke100. Post Flu
Pneumonia Staph Aureus probably101. Drug that decreases Wound healing Prednisolone102. 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 1:200103. beakers muscular dystrophy..father had the disease.. No investigation
required in boy child coz x linked recessive...father to son transmission is not seen104.
Costochondritis ?... no investigation required105. dermatitis herpetiformis : IgA106. Bed ridden pt.
presents with hypothermia due to loss of which reflex? Shivering107. AF + IHD add digoxin (people
suggest spironolactone too)108. Diabetic pt. modifiable risk factor for CVS ? Lowering TG levels110.
herpes simples encephalitis : clinical presentations + CT findings given111. cell membrane around the
daughter chromosome . Which phase of cell cycle ..telophase112. MOA of ACE inhibitors decrease the
efferent pressure113. Pt with increase prolactin level !! Investigation MR scan114. Pt on
CAPD..infection due to Staph epidermatides115. Antigen presenting cells > dendritic cell116. facial
pigmentation in pregnancy ... Melasma117. cryoprecipitate contents : fibrinogen118. buprenorphine :
partial miu agonist119. central respiration centre is controlled byH+ ( co2 enter blood brain barrier...
h20+co2 h+ Hco3 and H+ stimulates the receptos120. action of SO muscle : depression &
adduction121. 122. One question what chart should be used to show combined result of diffrent studies
? pie chart or whatever no ideatongue emoticon
123. group of people who were suppose to check the result of a topical drug on face.. the result was to
be graded on the scale of 5. Man whitney u test??124. Patient had bilateral eryhtma nodosum ...next
investigation (CXR to rule out 2 major causes..(TB or Sarcpidosis)

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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9/11/2015
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

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?
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
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
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

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?
9. Refeeding syndrome= hypophosphatemia
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

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 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

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)
14. Question relating MRCP ( Magnetic Resonance Cholangi-Pancreatography)
15. Dx of pernicious anaema ( there was autoimmune hepatitis, vitiligo and hemolysis).

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

NEUROLOGY AND OPHTHALMOLOGY

1. Essential tremor with head titubation Rx= propanolol
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
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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Forums > UK Medical Zone > MRCP Forum >

recall mrcp 1 2/2011

Discussion in 'MRCP Forum' started by Guest, May 11, 2011.

Page 1 of 121 2345612Next >

1.

GuestGuest

just back from exam

over all i think it was ok

2nd paper more difficult than 1st

many of their favourit subject didnt appear

waiting for those who enter the exam to contribute

shall we try to remmber the q??!!!
Guest, May 11, 2011

#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

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
12.Young pt with seizures,N glucose, lymphocytosis- HS Encephalitis
13.Rx for Migraine- Sumatriptans
14.Rx for Essential tremor in elderly- Primidone
15.Hemibalismus-C/L STN
16.Ptosis,diplopia and weakness- Myasthenia

1.APKD- USG screening for all 1st degree relatives

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

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.
Dr.AY, May 11, 2011
#5
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 :shock:
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
:lol:
Dr.AY, May 11, 2011
#6

4.

AffyrajGuest

FEW MORE

these are other questions diffrent from above posts.

CIPROFLOX --TERATOGENIC WITH BREAST FEEDING
PNUMOTHORAX --DISCHARGE
ISOCYNATES--OCCUPATIONAL AASTHMA
PEFR AT WORK N HOME --OCCUPATIONAL AASTHMA

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

FACTOR V MUTATION --ACTIVATED C PROTIEN RESISTANCE

LIVE VACCINE --YELLOW FEVER

GALACTORRHEA-- DOMPERIDONE
HEART BLOCK --RIGHT CORONARY

ACHALSIA CARDIA --24 HRS PH MONITORING

DYSPHAGIA FOR LIQUIDS -- ADENOCARCINOMA OESOPHAGUS
LIVEDO RETICULARIS , MISCARRIAGE 1 ST TRIMESTER--ANTI CARDIOLIPIN ANTIBODY
CONTAINDICATED SURGERY FOR LUNG CANCER-- ONLY 1 DIFF OPTION INVASION TO

BRACHIAL PLEXUS ( STAGE III B /IV)

PERITONITIES --IV CEFTRIAXONE
HEMOPTYSIS WITH RENAL INVOLVMENT --GOOD PASTURE//WEGENERS
EPISTAXIS WITH RENAL ----WEGENERS
BLODDY DIARRHEA --WEST NILE--SHIGELLA
JAAK 2 MUTATION --POLYCYTHEMIA
ONE STATS QUEST.-- ATTRIBUTABLE RISK PERCENTAGE --5
METHHEMOGLOBINEMIA --FE +2--F2+3
TLCO LESS --?PULMONARY INFARCTION( PE)
PARATHYROID WITH PROLACTINOMA--MEN 1
CARCINOID --FLUSHING
ACTH ECTOPIC --SMALL CELL

MALARIA ,PARASETIMIA < .1%--CHLOROQUINE

DM , HYPERTENSION , RENAL FUNCTION BAD-- RAMIPRIL

ANTI TPO AB --HASHIMOTTOS THYRODITIS

STRIDOR , THYROID MALIGNANCY (MASS EFFECT)--ANAPLASTIC CA

struggles keeping up at uni: canabis induced psychosis.

long standing low mood, wife left: dysthymia

can t cope with diagnosis: ? adjustment disorder

(can t remeber question): schizophrenia
Guest, May 11, 2011
#8

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

PNUMOTHORAX --DISCHARGE.. She had symptoms OR >2cm-- so guideluines says needle

aspirate and discharge.
ISOCYNATES--OCCUPATIONAL AASTHMA--- it was asked EAA- so barley.. even i got it wrong
INJECTION SITE ABSCESS---STAPH- I.E --FLUCLOXACILLIN
MACULAR DEGENERATION --STOP SMOKING...i put glaucoma
BREAKDOWN PEPTIDES--PROTEOSOMES...u r correct..i did it wrong to put peroxisomes
ONE ANSWER --CUSHINGS --OBESITY , BRUISES
REPEATED PYOGENIC INFECTION --COMPLEMENT DEFECIENCY------ its CHEDAIC
HIGASHI SYNDROME---- Neutrophil Deficiency..
PARACETAMOL POISIONING ---ACETYLCYSTIENE-- INCREASE
CONJUGATION///DECREASE TOXIC METABOLITE---- its increased glutathione production or
reduced toxic metabolite

CHOREA WITH ATAXIC GAIT, NO FAMILY HISTORY--WILSON (MORE)//FREDRICHS

ATAXIA ----- its dementia,myoclonus with ataxia--CJD
TEST TO DIAGNOSE A DISEASE--its SENSITIVITY
RIGHT HEMIPARESIS WITH AF ---START WARFARIN

FACTOR V MUTATION --ACTIVATED C PROTIEN RESISTANCE ---- i put tpa activator..not sure..

CONTAINDICATED SURGERY FOR LUNG CANCER-- ONLY 1 DIFF OPTION INVASION TO

BRACHIAL PLEXUS ( STAGE III B /IV)
HEMOPTYSIS WITH RENAL INVOLVMENT --ITS GOOD PASTURE not WEGENERS
ONE STATS QUEST.-- ATTRIBUTABLE RISK PERCENTAGE --5 ----- 10% Event rate was asked
100P100/1000
TLCO LESS --PULMONARY INFARCTION( PE)
CARCINOID --FLUSHING---- only 5% carcinoid syndrome- HAEMOPTYSIS

HTN with >70u alcohol,Na-138,K-3.8,obese,Urinary cortisol-300- Alcohol induced i think... labs do

not fit into cushings... alcoholics can have increased urinary cortisol..
Dr.AY, May 11, 2011
#12
PSYCHIATRY
80.Hypochondriac

82.Paranoid Schizophrenia- auditory halucinations with mild trace of cannabis/amphetamines

83.Depression- anhedonia
84.Dysthymia..one stem
85.one with MANIA-- grandoise delusions.
Dr.AY, May 11, 2011
#13

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

95.Low PH and low glucose pleural fluid- TB

96.Pulmonary infarction.. reduced TCO
97.Pneumothorax.. simple needle aspiration
Digoxin,
fluocoacillin,
trancient pacing,
decrease AS mermar--> ??? i wrote it ASD,
benzthiazied,
HTN 77yrs + DM --> i worte it CCB
Anxiety with ambulatory ECG free during the attack--> observe.
TIA asprin,
Pulsus pardox,

VSD --> ??? v/q ration

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,

Amp induced pscyhosis,

paranoid Schiz,
Dysthymia,
nonepileptic attack,
langue hair

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,

pcr csf virus,

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

fasting glucose test & growth hormone

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

meflo cause diarrhea

PDA
fibrillin
proeosnaes
meseneric angio
restrictive cardiomayopathy
discoid
rhabdomyalisis
tyrosie kinase
us' to all memebres
adjusstment
ca gluconate
haemodalisis
Guest, May 11, 2011
#16

7.

calmGuest

few arguements regarding reacalled answers pasted above....

carcinoid...i wrote flushing..but its hemoptysis.

carorid stenosis with tia in youg....start warfarin.

one is paranoid schizophrenia.

blisrtering rash in patient on treatmnet for MI and HTN....GTN or Aspirin?...not sure.

sarcoidosis treatmnet criteria...hypercalcemia

ALL poorprognosis....T cell phenotype

I think NO answer was Churg strauss...?..correct me!

EAA.....i think laboratory animals...NOT barley..correct me!

one was type1 resp failure with tachypnea and tachy....give LMWH.

old man with CJD

old man with parkinsons tremor

young man..mania OR amphetamine psychosis?...correct me!

calm, May 11, 2011
#17

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

segmental loss,from t5 to t9........correct me!

lambert eaton with ectopic ACTH

Acute MI....do thrombolysis.

rate control in AF..i wrote sotalol. NOT fleca or amiodarone..correct me!

i gave IV imunoglobulins in 1 patient...dont remember question.

i chosed pyelonephritis for renal failure cause in one question.fever,tender loin etc...

0 percent risk of transmission in one question.

50percent of kids being carrier in one.

best test for chronic pancreatitis.....is CT abdomen ( confirmed )

radiation pnemonitis in lady with post surgery and post readiotherapy chest pathology???? correct me!

Empyeme??or sumthing else?....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

It was <5 days--- paroxysmal AF-- Flecainede

Dr.AY, May 11, 2011
#20

9.

GuestGuest

eaa

dr calm i think EAA was barley , malt workers lung

Guest, May 11, 2011
#21

10.

GuestGuest

AS murmur could be both ASD and failure. i wrote failure

Guest, May 11, 2011
#22

11.

Dr.AYGuest

cardiac failure is the correct answer..

Dr.AY, May 11, 2011
#23

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

RHEUMATOLOGY AND CTD

109.Multiple myelome- next best investigation- Serum protein electrophoresis
110.Ruptured bakers/popliteal cyst in RA
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

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

124.Aortic valvular disease with bloody diarrhea---?Colonoscopy

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

mrcp1 may 2011

about 119: i wrote 'Sclerosis' as a feature of ankylosing spondilitis........correct me! :?:

calm, May 12, 2011
#31

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?

Pg E2..i cant recall this one...the other 3 are correct...i hope!

.ADENOCARCINOMA OF ESOPH

.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

YES I GOT IT WRONG

SURFACTANT -PHOSPHOLIPID NOT PG E2 :shock:
Guest, May 12, 2011
#42

17.

GuestGuest

.HYPOPITUTRISM
.OSTEOMALACIA
.MEN1
.ASPIRIN CAUSE OF SKIN RASH

.SYRINX
.HAV
.OSTEOMYLITIS
PERNICIOUS ANEMIA
Guest, May 12, 2011
#43

18.

calmGuest

dont agree with hepatitis A... :?: rest correct i hope!

calm, May 12, 2011
#44

19.

GuestGuest

HAV IGM POSITIVE

HCV RNA -VE
HCV ANT IGM ABS +VE
HBV SURFACE ANTIGEN -VE

HBV S ABS +VE

CORRECT ME I THINK HE IS NOT HBV SINCE THIS IS VACCINATION ABS
few comments on dr AY's answers...
pnemothorax...young age asymptomatic less than 2.5 cm air cushion...discharge and review as out
patinet ( confirmd)

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...

calm, May 12, 2011

#47

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

4. HHT inheritance - Autosomal dominant

5. definition of sensitivity
6. Cause of tremor - Lithium toxicity
7. Man with increased INR whilst on warfarin - cause was aspirin
8. Anorexia feature - fine hair
9. Wheals rash - aspirin
10. TTP treatment - haemodialysis
11. Galactorrhoea, increased prolactin - cause metoclopramide
13. Live attenuated vaccine - yellow fever
14. Sick euthyroid - normal TSH, low T3, low T4
15. MEN 1
16. Woman, back pain, high calcium - Multiple myeloma
17. PCR mechanism
18. Bloody diarrhoea cause - Shigella
19. 24hrs of watery diarrhoea treatment - observe
21. G Protein coupled receptors - cell membrane
22. AML prognosis - based on cytogenetics
23. Right sided weakness after a flight - Patent Foramen Ovale
24. PCOS - increased insulin resistance
25. bullae, skin fragility on face and dorsal aspect of the hands - Porphyria Cutanea Tarda
26. Aortic stenosis murmur - quiet due to LVF
27. Ropinirole - dopamine agonist
28. IVDU - chronic hepatitis C?
29. Patient with UMN and LMN signs and fasciculations - MND?
32. Aortic valve replacement + warfarin + fatigue - investigate with colonoscopy
33. collapse + ARF - rhabdomyolysis
34. Factor V Leiden deficiency - activated Protein C deficiency
36. question on Goodpastures
37. GN in malignancy - membranous
39. decreased TLCO - PE?atypical pneumonia?

40. C.difficile - due to IV cefotaxime

41. Hodgkins disease - CD20
42. Southern Blotting detects DNA
43. elderly and fluctuating consciousness - subdural
44. 50% carotid stenosis, CHADS2 score 3-4 - aspirin/warfarin
45. Klinefelters syndrome investigation - Karyotype
46. Ca pancreas - ca 19-9
47. polycythaemia rubra vera - JAK2mutation screen
48. breakdown of oligopeptides - lysosomes
49. fracture of ankle, low calcium, low phosphate, low vitamin D - osteomalacia
50. 2 sets of patients looking at 1 measure - unpaired t test

52. RA + DMII, ankle swelling, proteinuria cause - amyloidosis

53. Acute red eye, decreased vision - acute glaucoma
55. recurrent bacterial infections - hypogammaglobulinaemia
56. IBS least consistent symptom - waking up at night with the pain
57. Right coronary artery - complete HB
58. increased K+ initial treatment - IV calcium gluconate
5960. standard deviation definition
61. Heart failure 1st line treatment - enalapril
62. sarcoidosis indication for treatment - high calcium
63. A1AT deficiency - decrease protease inhibitor
64. surfactant composition - phospholipid

66. Erythema nodosum - spontaneously resolves

67. USS kidneys for PCKD - 1st degree relatives
68. Temporal arteritis treatment - prednisolone
69. Korsakovs - short term memory loss
70. small cell lung cancer - ectopic ACTH
71. question on Legionairres

72. Acne rosacea - tx - oxytetracycline

73. Tremor at rest, rigidity, bradykinesia - PD
74. Benign essential tremor treatment - propranolol
75. Methaemoglobin - decreased NADH
76. Acromegaly - oral glucose tolerance test and GH measurements
77. Marfans syndrome - fibrillin
78. osteoarthritis initial treatment - paracetamol
79. ciprofloxacin in pregnancy - arthropathy
80. Thiazides site of action - prox convoluted tubule
81. ADH site of action - collecting duct
82. stroke immediate management after CT (no bleed)- aspirin
83. lung surgery contrindication - metastases or FEV <1.5
84. question on systemic sclerosis - answer malabsorption
85. question on somatisation disorder
86. imatinib mechanism - BCR-ABL
87. pneumothorax <2cm - discharge
88. Triptans - contraindicated in IHD

90. question on cell cycle and the formation of chromosomes

91. myeloma investigation - ?B2 microglobulinaemia
92. IgA GN - post infection
93. Bendroflumethiazide - increased calcium
94. Neuroleptic malignant syndrome - rigidity
95. HUS organism - E-Coli 0157
96. Behcets disease can lead to - DVTs
99. prednisolone - vascular necrosis
100. discoid lupus erythematosis - rash, scaly, erythematous
101. bronchial carcinoid - wheezing, follicular plugs
102. acne treatment after trying minecycline - oral isotretinoin
103. meningitis - most common organism - strep pneumonia

104. Von willebrands patient attending dentists - tx - DDAVP

105. tick bite then unwell - Lyme disease
106. cardiac tamponade - pulsus paradoxus
107. plasmodium vivax - chloroquine
108. painful eyes in RA - scleritis
109. dusky appearance on the legs of a patient - cholesterol emboli
110. question about gallstones - abdominal ultrasound
111. Ulcerative colitis long term remission aim - azathoprine

113. Guillaine Barre Syndrome investigation - vital capacity

114. Hemiballismus - subthalamic nucleus
115. MODY - treatment - sulphonylurea
Neiserria infection-ceftriaxone
LP-strep pneumoniae
CXR with consolidation-strep pneumoniae
Phaeochromocytoma-24hr urine catecholamines
DOC to preserve renal fx-ramipril
hereditary spherocytosis-direct antiglobin test
bite cells in pbf- G6PD def
mycoplasma diagnosis-cold agglutinins
cresenteric glomerulonephritis-anti-MPO ab
1.What is the for the risk of carrier gene in husband who is first cousin?
2. Boy returned from pakistan, lower limb weakness???
3. Tumour cells in which phase of cell cycle???

essential tremors-benxhexol
ADPKD- US abdomen
velvetty skin-glucagonoma

10 cm spleen- primary myelofibrosis

anemia with vitiligo bilirubin high and LDH high- AIHA
rheumatoid arthritis- C4
adverse prognosis in leukemia- philadelphia chromosome
DOC in RA after failed metotrexate- rituximab
RA immunology- TNF alpha
widespread rash with scab in ankle-tick typhus

reticulonodular findings in CXR-interstitial fibrosis

acute pericarditis-PR depression

ring enhancing lesion in CT-cerebral toxo

cat scratch-bartonella henslae
cat bite- bartonella
woman with DVTs and miscarriage- normal ECHO
essential tremor - propranolol
man thinking God sent him to rule the globe- ?mania
condrocalcinosis dg-pseudogout

ECG changes for PE-?right axis deviation

woman with cystic fibrosis marries 1st grade cousin-his chances to be a carrier are 1/25 as the general
population, as he can be from the branch of the family that is not affected
1.anaphase
2.m phase
3.rituximab cd 20
4.cyclic cell mitochondria
5.metal fume fever
6.nf1 chromosome 17
7.rat oncogen medullary thyroid ca

9.acls adrenaline
10.skinprick penicciline test
11.high protein oedema
12.giant cell athritis

14. Asymetrical tremor

15.propanolol
16.etenecept for ra
17.specificity x 2
18.ckmb
1.fume metal fever(welding occupational lung dx)
2.copd - passive smoker from father
3.bipap for t2rf in pulmonary ordema
4.pulmonary fibrosis upper lobe +
5.mycoplama pneumonia?
6.meningitis diplococus gram positive streptococcus pnemonia +
7.sah -lp
9.crohn dx-surgery-diarrhoea- choletyramine
10.Chronic pancreatitis +pancreatin
11.Spherocyte + coomb
12.Philodephia chrome
13.osteoporosis
14.Rheumatoid athritis etenecept
15.methotrexate + skin lesion
16.coceine + ischemic chest paim
17.ie + toe
18.asd closure - phtn

20.Pe on abg
21.cyclic dna -mitochondria

22.m phase + breast ca

23.anaphase +
24.upper gi bleed + blood transfussiom
25.microcystic anaemia-angio dysplasia vs malignancy
26.pe ecg + sinus tachy
27.acromegaly + glucose tolerance test
29.reactive hypoglycaemia
30.Statis epilepticus + lorazepam
31.specificity
32.specificity
33.sensitivity
35. Statitic?
36.statistic ?
37.genetic + cf 1/4
38.nf1 + chromosome 17
39.rat onco gene - medullary ca
40.tb meningitis
41.disc prolapse + l5s1
42.sacro iliatis
43.hh
44.aki nsaid vs ischemic ?
45.renal transplant immunoglobulin
46.prophylaxis meningitis -ciproxin
47.ebv lymphoma
48.karposis sarcoma hhv8
49.acanthosis nigrican + gastric ca
50.singlet cell + gastri ca
51.digoxin -body distribution
52.pericarditis ecg low voltage vs pr depressiom
53.cardiac enzyme + ckmb

55.pericarditis sign pericardial rub vs kussmall sign

56.hep b ?
57.hep c -viral load
60.myositis anti jo
61.ckd bone dx + increased pth 1st
62.ibs vs laxative ?
63.liqurice -hypokalaemia
64.dsh
65.delusional disorder-avian flu lady
66.Psychosis vs depression drive car wrong way
67.panic attack + awaiting interview
68.adjustment disorder + retired recently
69.dvt + warfarin 6 months
70.mody - family hx
71.initial treatment t2dm -insulin
72.ankle dorsi flex weakness +cpn
73.ankle dorsi flex weakness +cpn
74.epigastric ct abdo
75.menorrhagia -von
76.hand foot mouth ??? No clue
77.
78.pseudogout +
79.allopurinol + induce acute gout
80.small cell lung ca + chemo

83.paracetamol overdose + inr

84.lyme dx
85.
86.toxoplasma + ring lesiom

87.quadranopia ? Parietal lobe

88.pons lesion
89.midbrain lesion
90.idiopatic parkinson + assemetrical
92.diabetic retinopathy -disc proliferation
93.giant cell athritis
94.cluster headache
95.glioma left side
95.
96.
97.allergic reaction -patch vs prick test
98.desensitivity low ige
99.lithium + 12 monthly
100.sick throid syndrome cs adequate dose
101.hypecalcaemia hyperparathyroid
102.refeeding syndrome + low phosphate
103.hyponatreamia + adrenal insufiency
104.methanol poisoning?
105.
106.
107.palliative + morphine elexir
108.jamaica man??
109.
110.cannon a wave +
111.ards + high protein oedema
112.pcr ? Viral
113.pneumothorac + needle aspiration
114.osa + day time sleepiness
115.kallman syndrome
116.pregnancy hyperprolactimia

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

essential tremor - propanolol

Pulmonary embolism - sinus tachycardia
genetics for cystic fibrosis - 1/8?
samuel, Jan 18, 2014
#6

2.

samuelNew Member

dsdna -mitochondrion
dvt e stroke and 2abortion,.normal echo
gram positive diplococci -streptoo pneumonia
INH -acetyltransferase

TIA ( i.e. full recovery) Aspirin + Dipyridamole SR

but completed stroke ( neurodeficit) - Clopidogrel
As the person had TIA so add Dipyridamole

Pericarditis.....>>>.other ECG finding PR depression

Metformin>>> MOA inc insulin sensitivity

infective endocarditis>>>...blood culture

Recurrent DVT...>>>.continue warfarin for next 6 month
Small Cell Ca Lung...>>management Surgery (no mets on CT scan)
COPD...>>>.LTOT

Giant a wave. CHB

Diarrhea. Due to ch.pancreatitis. Octrotid
Syringomailia. Fasiculation s
Khaled, Jan 22, 2014
#8

3.

KhaledNew Member

Erythroderma due to psoriasis. Treated with systemic steroid

Khaled, Jan 22, 2014
#9
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Forums > UK Medical Zone > MRCP Forum >

MRCP Latest Questions 2014

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

11.Separation of chromatids and reaching the poles - Anaphase

12.Wilsons disease - Autosomal recessive
13.Beckers muscular dystrophy in brother,Chance with another husband who has no family Hx
abnormal(2nd marriage)getting the disease in son - ?50%
14.PCR - ?to know nucleotide sequence.
15.Huntingtons disease - Anticipation
16.Gentamicin - ATN
17.G proteins located at - Plasma membrane
18.Recurrent Meningiococcemia - C5 deficiency
19.Cisplatin toxicity - sensory neuropathy
21.Bleomycin toxicity - Fibrotic tissue in the nodes of lung
22.
23.Citrulline peptide - RA
24.Rasburicase before chemotherapy ,MOA - Uric acid will be converted in to allontoin
25.Gross hematuria in a smoker - Bladder ca
26.Egg shell calcification hilar nodes - ?Silicosis,?Asbestosis
27.Ig M ,Waldenstrom's - Hyperviscosity
28.Before starting anti TB meds - check LFTs
29.Pregnancy 14 weeks,LVH - Essential HTN
30.Cells responsible for producing IgE - ????Plasma cells,Dendritic cells,Eosinophils,Mast cells
31.Impermeable to water - Ascending loop of henle
32. TIA and AF - warfarin
33.Difference between L 5 radiculopathy and peroneal nerve palsy - ?Inversion of foot
34.Dilated pupil - Adie pupil
35.Pons blood supply - ?Basilar artery
36.SLE miscarriages - Anticardiolipin antibodies
37.Rash on the LL,UL,Conjunctivitis - Stevens johnson syndrome
38.3 month h/o difficulty in swallowing in a female - ?Oesophgeal spasm,Reflux
esophagitis,Achalsia,esophageal tumor
39.cerebellar signs with tumor in breast tissue - YO/Purkinje cells

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

68.Recurrent pericarditis treatment - ?Colchicine,?Prednisolone

70.Cardiac tamponade sign - Pulsus paradoxus
72.Q on Mechanism of MODY
73.Emphysema Pathophysiology - ?Dynamic airflow obstruction,?Smooth muscle contraction
74.Aspirin toxicity
75.Vitiligo + ?pernicious anemia ,Dx - Anti parietal cell antibodies
77.Extrinsic allergic alveolitis - B/L apical fibrosis
78.Q about diagnosis of Invasive aspergillosis
79.Previously treated for Plasmodium falciparum and now c/o right upper qudrant pain - ?recurrence of
malaria,?HBV
80.Terlipressin in hepatorenal syndrome - Splanchnic vasoconstriction
81.PAS - whipples disease DX
82.Bacterial peritonitis - Neutrophil count
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

MRCP 1 >>9 SEP. 2014 EXAM RECALL DISCUSSION

Discussion in 'MRCP Forum' started by samuel, Sep 13, 2014.

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

acute knee pain with ligament clcification- pseudogout

cat scratch- bartonella henslae
pseudomembranous colitis- metronidazole
return from eastern europe with dysphagia- diphteria
before start anti TB- check LFT
cardiogenic syncope- do ECHO

lung ca and GN- membranous GN

headache and gram pos bacilli- listeria meningitis
epididimoorchitis-parenteral ceftriaxone n doxycyline
wilson-autosomal recessive
tricuspid regurg with flushing n wheeze- carcinoid syndrome
s3( gallop rhythm)- poor prognosis in LVH
LVH in pregnant 14 weeker- essential HPT
samuel, Sep 13, 2014
Question on RCA territory
Question on anti Cd 20= Lymphoma
Part of kidney impermeable to water - Distal collecting duct
Bibasilar crepts and 4 months h/o breathlessness and no relief after salbutamol= pulmonary fibrosis
Person not getting relief after 200 mg of beclomethasone, next step = add Salmeterol
Question on whipple's disease
Breast carcinoma nd cerebellar symptoms = anti-Yo antibody
Esophageal varices = azygous vein
Termonal ileum resection afrter crohns disease and diarrhoea = bacterial overgrowth

Confirmatory for cardiac tamponade = Pulsus paradoxus

TIA and AF = Warfarin
WPW and Af = Flecainide
Chromatin separation = Telophase
A question on Lyme's disease

A elderly male with recurrent jerks = creutzfeldt Jacob disease

Person becoming drowsy 6 hours after confusion and headache = Herniation
A question on pituitary apoplexy
A hypertensive and CAD pt taking too many medicines, presented with nephrotoxicity= Aspirin
induced
Question on cervical myelopathy
samuel, Sep 13, 2014
#3

2.

samuelNew Member

Postitve predictive value

False negative rate
Wilcoxon sign rank question
Wilson's = autosomal recessive
Becker's disease - X linked recessive
Huntigton's disease = incomplete penetrance

jus returned frm cambodia rx for malaria n resolved- hepatitis b

jus returned frm thailand- dengue
HIV pt taking vaccination can cause clinical- rubella
post chemo spiking temp- cmv
ix for invasive aspergillosis- galactomannan
pons-basillar artery
pulmonary fibrosis

post traumatic syringomyelia

phenytoin- zero order kinetics
to prevent VTE- LMWH
amiodarone- K channel blocker
painless hematuria- bladder tumour
acromegaly- GH and OGTT
obese woman with nerve palsy n headache- BIH
nephrocalcinosis next step- urine pH
complicated effusion ph 7.04- put chest tube
peritonitis- high neutrophil count
APS- anticardiolipin
anti yo- paraneoplastic cerebellar
lithium n polydipisa- nephrogenic DI
bloody diarrhea- e coli 0157
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
dilated pupils- adie tonic
ascending weakness n arreflexia- GBS
T1DM girl investigated for ?seizures with hypoK- insulin overdose
cystinuria
IgM paraproteinemia- hyperviscosity
highest calorie food- red meat

LUQ pain- ?splenic infarct

post duodenal artery bleed
NAFLD- fatty infiltration
MDMA overdose- hypoNa
DM shin lesion- necrobiosis lipoidica
Infective exarcebation COPD with deranged TFT- sick euthyroid
Man frm Zambia with chronic diarrhea n confused- cryptococcus neoformans
strongyloides- screen for HIV
samuel, Sep 13, 2014
#5

3.

samuelNew Member

huntingtons- autso: dominant

alcohol + diazepam overdose- rhabdomyolysis
terlipression - mode of action.
nesseria meningitis- c1/c2/?? (c5-c9)
clost: diff:- oral vancomycin
Pons arterial supply
Young woman, mute, one hand over head other behind back
Man outside school says he can protect children
Young boy paranoid about teacher
Cardiogenic syncope
AS - echo

Unsure about answersRt to left shunt ?aa gradient

Bleomycin, lymph node ?fibrosis
Rasburicase ?action
Pneumothorax second presentation ?...
Man with IECOPD cannot tolerate NIV, only abx, unconscious, ?continue abx only
Pleural plaques ?no further investigation
Man with birds, most consistent finding ?upper zone fibrosis
Respiratory presentation ?do spirometry
Pain control scenarios ?...
Psoriasis, aggravated by drugs ?ARB/ beta blocker/ diuretic
Papule over thigh, epidermal dysplasia with no invasion ?radiotherapy/5FU/steroid/...
samuel, Sep 18, 2014
#6

4.

samuelNew Member

Pleural calcification- next investigation

Foot drop and decrease sensation on outer foot border- level
Calories-sugar/ cheese
Kyphoscoliosos- fvc/spirometery
Klinefelters- infertility
Hyper acute rejection - abo
Psiriasis- beta blockers
Ruq pain, ct scan bile stone, hypokalaemia, hypertension- cushings

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

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
L5 Vs Peroneal nerve diff ???
RASBURiCASE mech: of action in tumerlysis syndrome
scenario of sensory and motor neuropathy
ST elevation V1-V4, with resiprocal- RCA involved
Parkinsons scenerio
lupus anticoagulant-2nd time abortion
Neurofibromatosis -50% chance(autos: dominant)

samuel, Sep 18, 2014

#8

5.

samuelNew Member

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???
5.behcet disease-- HLA B
6. scenario on PITUITARY APOPLEXY
7. recurrent first trimester miscarriage --- ANTIPHOPHOLIPID SYNDROME
8. syncope on swimming-- ECHO
9. scenario of CARDIOGENIC SYNCOPE
10. wilson's disease-- AUTOSOMAL RECESSIVE
11.some scenario on genetics of cystic fibrosis
12.pathophysiology of emphysema--DYNAMIC COMPRESSION OF AIRWAY
13.highest calorie value food--CHEESE
14.ECG Findings of LAD OBSTRUCTION
15.patient faking symptoms for morphine-- FACTITIOUS
16.depression-- EARLY MORNING WAKENING
17. tamponade--PULSUS PARADOXUS
19.16 weeks pregnant lady with hypertension, ECG showing LVH-- ESSENTIAL HYPERTION
20.marfans--FIBRILLIN
21. scenario of ethics-- CONTINUE WITH ANTIBIOTICS

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

52. sleep apnea diagnostic test

53. egg shell calcification-- SILICOSIS
54.pulse of PDA- BOUNDING PULSE
55. separation of chromatins occur--TELOPHASE
56. TR, wheezing, flushing-- CARCINOID SYNDROME
57. episodic diarrhea not relived by fasting-- VIPOMA

59. vitiligo and acidity history-- ANTIPARITAL ANTIBODIES

60. pleural effusion analysis showed PH 7.2-- CHEST TUBE
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???
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??
63.HUNGTINTON ---ANTICIPATION
64. test to do prior to prescribing ATT-- LFTs
65. G Protien is present on-- CELL MEMBRANE
66.WPW syndrome with atrial fibrilation- FLECANIDE
67. Stroke with atrial fibrillation-- WARFARIN??
68. surgical contraindication-- SVC obstruction
69. polymyositis

71. exudate on tonsils + cervical lymphadenpathy-- GLANDULAR FEVER

72. one scenario seems BARTONELLA HENSALE???

74. scenario of ITP- PREDNISOLONE

75. C.Difficle---METRONIDAZOLE
76. Scenario of MENS2
77. scenario of APKD
78. immediate treatment of neutropenia-- ANTIBIOTIC PROPHYLAXIS
79.anti-CCP - RA

80. prophylaxis for dental extraction-- none

81. test for ascitic fluid which leads tpo diagnosis-- NEUTROPHIL COUNT
82. VT -- unsynchronized DC
83. DM,Knee joint arthritis -- HEMACHROMATOSIS
84. malignancy- MEMBRANOUS GN
85. rectal bleeding with clonoscopy, gastroscopy and barium normal-- ANGIODYSPLASIA
87. biopsy showed PAS postive macrophages n villous atrophy--- WHIPPLE
88. scenario of creudzfelt syndrome
89. scenario of idiopathic intracarnial hypertension
90. CSF Analysis- enterovirus
91. blood supply of pons-- BASILAR ARTERY
samuel, Sep 19, 2014
1-patient with anorexia nervousa ,what feature ?low LH
2-patient with pain in eye movement and decreased color vission?optic neuritis .
3-urgent referral to opthalmolegist ?macular exudate
4-homosexual man with recal bleeding ?gonococcal proctitis
samuel, Sep 19, 2014
#10

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

to diagnose depression LOW MOOD is a MUST!

and not early morning awakening.. only.

Diagnostic and Statistical Manual Fourth Edition (DSM-IV) classification.[3] To diagnose major
depression, this requires at least one of the core symptoms:

-Persistent sadness or low mood nearly every day.

-Loss of interests or pleasure in most activities.
samuel, Sep 25, 2014
#14

8.

samuelNew Member

MAQ901 sept.2014 marcp 1

1.Cftr mutation only in paternal gene y?
2.Newly d.m nw joint pain liver enlrge..hemocgromotosis
3.cystinuria...recurent stones
4.marfan ..fibrillin
5.muchensn ...wants morphine recurent er admissions
6.depred on fluixetine outside school claiming special powrs...mania
7.anti ccp....R.A
8.epididmytis...ceftri +doxy
9.cisplatin...hypocalcemia
10.rasburicase...M.o.a
11.acute renal failure...aspirin
12.penicillin induced nephritis
13.thiophyline n clarithro reaction
14.tertiary hyperparathroidim with hypercalcemia n hyperphosp. N raised pth
15.primary hyperpara sceniro also
16.pain walking n lyng in dat side...trochentric brusitis
17.painless hematuria...bladder
18.ecg sinus tachy with lbbb....reversed s2 split
19.wpw with af...flecanide
20.amiodarone ...k chnl blkr
21.svt...first step carotid massage
22.tender calf ankle sweling ...celulitis
23.l5 radiculopathy...loss inversion
24.ca prostate with mets showng gagabsnt.tongue that side paralysd n numbnesd....mets to forman
ovale
25.post trauma syrinx
26.dengue rash n fever low plt inc Alt
27.strongloude what else chk HIV ?
28.erythema nodosum

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

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
66.pitutry apoplxy gv hydrocortisone
67.MEN scenario
68.thtroid area sweling bt labs norml mostly no sym...pregnancy induced
69.hogkin lymphoma treatd c.t chest 2 l.nodes small....normal
70.raisd alt creatanine acutly in alcohlic n diazepam overdose with low body temp...i mrkd
hepatoreanal
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....constituational delayd pubrty
75.14 wk pregnat high bp....essential htn
76.painful penile ulcer hx of sex n recurnce...herpes

78.anticardio anbodies in scanario of recurnt miscarges 3 of thm i think

79.alpha thalasemia trait scanario
80.iridated blood y....i markd to lower cmv transmission
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 n pigmntation at lips...colorectal ca
87.varicose vein drainage i marked hepatic
88.supply to pons ...basilar or mCa?

89.scenario of catatonia i gues bt i thought dystonia

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
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, Sep 25, 2014
#15

9.

samuelNew Member

101.meningitis cultur gram pos. Bacilius....listeria

102.mengitis pic in HIV pt...crptococus
103.invasive aspergilosis..test igE precipitant
104.menungococus mengigits .. complemnt out of 5 to 9 only 7 was gvn so i pickd 7
105.daily k requirmnt it was in mmol ..60
106.paget scanario
107.for pcr ....known nucleotide sequnce if to develop diagnostic test

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

121. before start anti TB- check LFT

122. cat scratch- bartonella henslae
123. pre angio drug to stop- metformin
124. retrosternal chest pain- reflux esophagitis
126. wernicke-korsakoff- nystagmus
127. wernicke-korsakoff- IV thiamine
129. Pleural effusion on the left,INC amylase,Left upper quadrant pain auscultation RUB heard n
tenderness on left upper abd..SPLENIC RUPTURE
130. . invasion of surrounding structures - Anaplastic thyroid ca
131. .contraindication to surgery of lung ca - ?superior vena caval obstruction
132. Lung function testing in kyphoscoliosis
check Kco reduced
133. Flat effect,auditory hallucination - schizophrenia
134.scanario on PAN
135.pt. with sob and dec oxy satCTPA

136.reason y pt no improving on oxygen with hx of cardiac defecthypoxemia result of blood

mixing
137. Bipolar disorder RX -Lithium
138. Pheochromocytoma - MEN
139. Bacterial peritonitis - Neutrophil count
140. Terlipressin in hepatorenal syndrome - Splanchnic vasoconstriction

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

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 ..ABO Incompatibility
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--HUPONATREMIA
169. peripheral neuropathy--NITROFURANTOIN
170. depression-- EARLY MORNING WAKENING
171. .highest calorie value foodCHEESE
172. vit B21 def: -hyperseg neutrophil+megaloblast
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

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:

1.5 ml/kg/hr fluid - for a 80kg man around 2-3 litres/day

 70-150mmol sodium
40-70mmol potassium

This is why the typical regime prescribed for patients is

1 litre 5% dextrose with 20mmol potassium over 8 hours

1 litre 0.9% normal saline with 20mmol potassium over 8 hours
1 litre 5% dextrose with 20mmol potassium over 8 hours

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

18.ecg sinus tachy with lbbb....reversed s2 split

19.wpw with af...flecanide
20.amiodarone ...k chnl blkr
21.svt...first step carotid massage
22.tender calf ankle swelling AFTER SWELLING IN KNEE ONE WEEK BACK ... RUPTURE OF
POPLITEAL CYSTS
23.l5-S1...loss inversion AND ANKLE REFLEX ABSENT
24.ca prostate with mets showng gag absnt.tongue that side paralysd n numbnesd....JUGULAR
FORMAENLOSS OF GAG REFLEX9,10,11CN
25.post trauma syrinx
26.dengue rash n fever low plt inc Alt
27.strongyloide what else CHECK HIV AS IT PREDISPOSES TO OPPORTUNISTIC
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

33.echo in colapse for runing for bus IN A PERSON WITH AS

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....INSULIN OVERDOSE
38.paired t test
39.scater graph for data scenario
40.unpaird t test
41.false negative rate CALCULATION
43.scenioro of acromgly test OGTT WITH GRWTH MESURE
44.barter most specific FINDING-- hypokalemia
45. SLIGHTLY LOW FACTOR 8..VON WILEBRANDS

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

101.meningitis cultur gram pos. Bacilius....listeria

102.mengitis pic in HIV pt...crptococcus MENINGITIS
103.invasive aspergilosis..GALACTOAMANNAN
104.menungococus mengigits .. MANNOSE BINDING LECTIN
105.TPN daily k requirmnt it was in mmol ..60
106.paget scanario
107.for pcr ....A THERMOSTABLE DNA POLYMERASE IS REQUIRED
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
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 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

121. before start anti TB- check LFT

122. cat scratch- bartonella henslae
123. pre angio drug to stop- metformin
124. retrosternal chest pain- reflux esophagitis
126. wernicke-korsakoff- nystagmus
127. wernicke-korsakoff- IV thiamine
129. Pleural effusion on the left,INC amylase,Left upper quadrant pain auscultation RUB heard n
tenderness on left upper abd..SPLENIC RUPTURE
130. . invasion of surrounding structures - Anaplastic thyroid ca
131. .contraindication to surgery of lung ca - superior vena caval obstruction
132. Lung function testing in SEVERE kyphoscoliosis
reduced vital capacity
133. Flat effect,auditory hallucination paranoid schizophrenia
134. scanario on PAN
135. pt. with sob and dec oxy satCTPA
136. reason y pt no improving on oxygen with hx of cardiac defecthypoxemia result of blood
mixing

138. Pheochromocytoma - MEN 2

139. Bacterial peritonitis - Neutrophil count
140. Terlipressin in hepatorenal syndrome - Splanchnic vasoconstriction

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
161.pleural effusion ph 7.02 .chest drain
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
samuel, Oct 1, 2014

#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-Ocular disturbances (ophthalmoplegia).

2-Changes in mental state (dementia).
3-Unsteady stance and gait (ataxia).
samuel, Oct 2, 2014
#22
#23
What was the answer of
1) elderly lady with hip arthritis choosing pain killers after paracetamol
2) asthmatic pt on NSAIDs to continue or stop
3) clubbed cynosed pt systolic murmur ? Ps or vsd

1.codeine
2.celecoxib relatively safer than ibuprofen.
3.pul HTN due to central cyanosis,murmur and clubbing.

samuel, Oct 2, 2014

#24

15.

samuelNew Member

confusing case scenarios

PAIN CASES
1.RA patient on taking pcm develop AEBA. wat is the next thing you do?
a,stop all NSAIDS b. give celecoxib
2.post AML therapy develop hip pain due to
a. avascular necrosis b. gout
3. pain on walking and lying on that side. x ray hip =narrow joint space.
a.trochantric bursitis b. OA
4.RA Pt on MTX develop pain in calf with low grade fever .ankle edema. one week before he had knee
joint pain.
a.septic athritis b. om
5.pt on PCM pain not controlled OA
6.chemo//?RA?OA patient codiene pain not controlled with active peptic ulcer.
7.immediate release of pain for crf pts ? a. MR morphine b.oral tramadol
8.qn on dihydromorphine?///
samuel, Oct 2, 2014
#25

16.

samuelNew Member

MRCP SEPT 2014 DIET RECALLS

1.Anti CCP- RA
2.NHL- cd20
3.Cystinuria
4.Marfan-fibrillin
5.Family h/o pancreatic Ca, recurrent admissions to ED- hypochondriasis

7.Epidydimoorchitis- IV ceftraixone and doxycycline

8.Cisplatin- peripheral neuropathy
9. Gentamicin- Acute tubular necrosis
10.Drug-drug interaction- clarythromycin and theophylline
11.CRF-secondary hyperparathyroidism
12.Scenario on primary hyperparathyroidism
14.Painless hematuria- bladder ca
15.LBBB- reversed split s2
16.Amiodarone-K channel blocker
17.SVT stable- carotid sinus massage
18.Knee pain then lower limb edema with low grade temp- ruptured bakers cyst
19.Lateral spinothalamic tract symptoms post RTA-Post traumatic syringomyelia
20.Pt frm Thailand, fever with thrombocytopenia mildly elevated ALT- Dengue
21.Strongyloides stercralis- also screen for HIV

22.Scenario on somatisation disorder

24.Syncope during swimming o/e systolic murmur to carotids- do ECHO

25.Pulseless VT , next step?-unsynchronized DC shock
26.Wilson disease- autosomal recessive
27.Paired t-test
29.Scenario of acromegaly, hw to Ix- OGTT and GH
31.Bleeding post op, slightly low Factor 8, elevated APTT, mixing test normal- von Willebrand disease
32.Thrombocytopenia plt:12, ITP, Rx?- Prednisolone
33.AF, CHADSVASc>2- warfarin
34.Abd discomfort, PAS granules positive- Whipples disease
35.Pernicious anemia, next Ix- anti parietal cell antibodies
36.X-linked recessive Beckers muscular dystrophy
37.Recurrent myoclonic jerks- Creutzfelt-Jakob disease
38.Ascending motor and sensory neuropathy with arreflexia- GBS
39.Cervical myelopathy
40.Rash at scalp, buttocks, extensor surface- dermatitis herpertiformis
41.Huntingtons choreo, age of which son get compared to father- Anticipation
42.DM retinopathy when to refer opthlmologist?- macular exudates
43.Anyphylactic reaction with angioedema- IM adrenalne
44.Scenario of pituitary apoplexy
45.Addisonian crisis what to do next?- IV hydrocortisone
46.Parathyroid , medullary thyroid ca, phaeochromocytoma- MEN2
47.TFT deranged in pregnancy- Pregnancy induced
48.ARF with hematuria and hypothermia- rhabdomyolysis
49.Ankylosing spondylistis- HLA B
50.Young osteoporosis in male check se testosterone
51. Hypertensive pregnant lady < 20 weeks with ECG having LVH- essential HPT
52.Painful genital ulcers and painful lymphadenopathy- Herpes
53.Pseudomembranous colitis- oral metronidazole

54.Recurrent miscarriage with DVT- Anti cardiolipin ab

55.Anemic pregnant , microcytic with raised HbA2- beta thalassemia trait
57.Exudative pharyngitis with lymphadenopathy and h/o travel Eastern Europe- diphtheria
58. Immidiate rx for hyperkalemia- IV insulin
59.Bloating and diarrhea post terminal ileum resection- bile acid diarrhea
60.Recurrent iron deficiency anemia and h/o colon ca in lady- colonoscopy
61.Fresh painless PR bleed- angiodysplasia
62.abnormal posturing young girl- catatonia
63.Bllod supply of pons- basilar artery
64.dilated pupil- Adie Holmes pupil
65.Paraneoplastic cerebellar syndrome- anti Yo
66. Scenario on benzodiazepine withdrawal
67. Wheeze and flushing with pulsatile liver and tricuspid regurg- carcinoid syndrome
68.Pleural plaque in normal patient- do nothing
69.Acute painful knee with calcified ligament- pseudogout
70.Family h/o recurrent stones with hypercalcemia- familial hypocalciuria hypercalcemia
71.Contact dermatitis- skin patch
72.Allergic reaction 1st line drug-cetrizine
74. Gram pos bacilli meningitis- Listeria meningitis
75.Man frm Zambia with headache and CN palsy with neck stiffness- Cryptococcus meningitis
76. High protein , normal glucose meningitis- viral meningitis
77.Invasive aspergillosis investigation- galactomannan
78.Recurrent neisseria infection- C7 deficency
79.Vomitting and headache with papiledema- cerebral herniation
80. Child having rash contact having fever and red cell apalsia- Parvovirus B19
81.Cardiac tamponade-Pulsus paradoxus
95. LUQ pain with rub- splenic infarct
96. Thyroid mass causing obstruction- anaplastic thyroid ca
97.Contra indication to lung surgery- SVC obstruction
100. Peritonitis impt ix- ascitic fluid neutrophil count

101.Fx of terlipressin- splanchnic vasoconstriction

102.Hx of travel to Cambodia now jaundiced with tender hepatomegaly- Hep B
103.EAA- upper lobe fibrosis
104.MODY- HNF gene mutation
107.Rash after amoxicillin for sore throat- EBV
108.NAFLD- fatty liver
109.bloody diarrhea fater visiting farm- Ecoli 0157
110.post EBV- NK cells
111.Waldernstorm macroglobulinemia- Hyperviscosity
112.G protein receptor- plasma membrane
113.Digoxin- rediced creat clearance
114.Phenytoin- zero order kinetics
115.complicated parapneumonic effusion- put chest tube
116.OSA- polysomnography
117.Melanoma- depth of lesion
118. Vomitting and headache with eye signs- Methanol poisoning
119.DI after Lithium ingestion- Nephrogenic DI
120.MDMA hyponatremia
121.Nitrofurantoin- peripheral neuropathy
122.post pacemaker insertion backpain- Staph discitis
123.Pulmonary fibrosis
124.AML post rx got hip pain- AVN hip
125.tumor lysis syndrome
126.Parkinsonism with vertical eye movement restricted- PSP
127.Amyloid neuropathy
128.Valvular HD prior dental procedure- nothing
129.Cardiac failure aim of treatment- reduce preload
130. Renal disease and mother died of ICB- ADPKD
131.BNP- ventricles

133.obese lady with headache and papiloedema- BIH

134.CFTR- paternal homozygosity chromosome 7
135. Case scenario transient global amnesia
1 central cyanosis,clubing,systolic murmur (vsd,pah,pulmonary stenosis,coarctation of aorta)
2 prosthtic valve involment go dental extraction(ceftrixone1gm,amoxillin 3gm)
3 WPW +afib (flecanide,adenosine,verampil,adenosin)
4 M.I -ST ELEVATION V1-V4) LAD COMPLETE occlusion)
5 B-ANP( Ventricles, atria)
6 SVT chest clear chest clear( adenosin carotid masssage)
7 after swimming ,collapse systolic murmur aortic area radiate to neck (echo,eeg, ecg)
8 periphera neuropathy due to nitrofurantoin
9 Ticagrel adp receptor inhibitor
10 clarithromycin and simvastatin avoided
11 PDA collapse pulse
12H.failure 3rd heart sound
13 long arm,chromo 47xxy most commn abnormality(infertlity,aortic root dillation)
14 shortness breth ,tachypnea ,tachycardia(ctpa,chest xray,spiromtry)
15 AMAIDRONE( K OPNER)
16 MARFAN SYNDROME due to fribllin protein
17 pulsless vt unsynchronised shock
18 cardiac tamponade (pulsus paradoxus,
19 recurnt syncope attacks father died at 38 yr cardiogenic syncope
INFECTIOUS DISEASE
1 after pacemaker insertion ,diarhea due to staphy discites
2 lymph node swelling due to bartonlla Hensle
3 Bcg not given in hiv patient
4painful penile swelling ,painful lympadenopathy (l.venerm, syphills hsv,g.ingunale)
5 diarhea 5 for weeks shingle contact shows neck stifness fever hepe encephlits,TBM,Cryptocal
mengitis
6 chalmydia single dose azithromycin

7 lymphadenopthy +membrane at pharyngtis due to pharyngits

8 meningits gram +baciili is lymph.monocstogens
9 cambodia patient went to uk after few month fevr lymphadenopathy due to HIV
10 fevr for 1wek faint rash lft derangd due to dengu fever
11 increase calore in cheeze
12 TO treat pulm tb in uk patient what do ist hiv, lft,uce
13 sore throat fever lymph due to EBV
14 AFTR amoxicillin rash prominent EBV

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

12Ecstasy pois hyponatrmia

13 k neded daily for adult is 60mmole
14terlipresin splanic vasocostiction
15mothr hav ca colan at agr of 55yr daughtr hav iron dif anemia do colonoscopy
16 contact dermatits skin prick test
17dm+ocp tendr leison at shin E.nodosm
18 dysphagia aftr age of 60 yr do endoscopy

RHEUMATOLOGY

1 anky spondilits hla B

2 hodgkin lym cd 20
3painful red knee is septic arthrits
4linear calcificaton due to pseudogout

6R.A anti ccp

7joint pain increse ALP Pagets disease
8fevr arthrits mononurts multiplex due to PAN

10 osteoarthits k/c peptic ulcer giv lanso+nsaids

12 osteoprosis due to testrosterone

13rasburicase convrt uric acid to alantoin
14 IGM ,headache other common symptm hyperviscosity

16 painfl abd of shldr for 2 to 6month (frozn sholdr,deltoid injury)

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)

12 home aide pupil one pupil larger than other

13 decrease na,cortisole,hypotnsion is pitutary apopexy
14 foot drop evrsion loss ,inversion loss
15 pontine bleed due to basilary artery
16 upper motor sign in lower limb and extensor plantor do( MRI,EMG,NCV)
samuel, Oct 4, 2014
#27
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Forums > UK Medical Zone > MRCP Forum >

MRCP 1 sep 05 ques by rsukhon/csngiu,pl. furthur post here

Discussion in 'MRCP Forum' started by Guest, Sep 21, 2005.

Thread Status:

Not open for further replies.

Page 1 of 21 2Next >

1.

GuestGuest

diabetic pt. Gangrene in his big toe. Next investigation

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

following questions were posted by csngiu

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

history among her children days/weeks ago, diagnosis: rubella, IM.......

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

mrcp 1 sept eaxm contd by csngiu

. 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.......

2. RNA splising occurred at : nucleus, peroxisome, golgi, ribosom

3. Sporotic ca colon, the mutation occurred............ can't remember
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
5. none-scarring alopecia............
Guest, Sep 21, 2005
#2

3.

GuestGuest

by enroute

Here are a few:

1. Cause of monooclar Blindness in AIDS patient:
CMV/Toxoplasmosis/Mycobacterium

2. Most important side effect of Amiodarone:

Phototoxicity/QT Interval prolongation/Hypothyroidism/Corneal deposits/
NO lung fibrosis in the choice.

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

1- Hypokalemia with acidosis, Low HC03, Nephrocalcinosis - TYPE 1 RTA.

2 - Splicing of RNA - Nucleus/ Ribosome/ peroxisome/ lysosome/ golgi

3) Postural Hypotension with ataxia with parkinsonism features, recurrent falls -- Multisystem
atrophy/

4) Number needed to treat.

5) Sensitivity

6) Postive predictive value

7) asymptomatic with Essential thrombocytosis - platelet count > 800 - Treatment - Aspirin/
hydroxurea/ Platelet pheresis/ radioactive substance/ observation

Prosthetic valve a month ago - MCC of IE - Stap epidermidis

9) % of DM type 1 developing diabetic nephropathy -

10) Marfan disorder - fibrillin

11) anticipation

12) BIH

13) GBS - Enmg finding

14) Rifampicin and OCPs

15) action of N acetyl cystiene

16) and many more i will type latter

Bye

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

Posted: Wed Sep 21, 05 12:28 am Post subject: mcqs dr_osle

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

Pregnant lady 14 wks found HTN, ECG lt vent. hypertrophy

1. Eclampsia
2. Pre eclampsia
3. essential Hypertension
Guest, Sep 21, 2005
#7

7.

GuestGuest

Patient with facial reddness and itching. Nothing found by doctor

1. Somatoform
2. Hypochondriasis
H/O Chest infection, took clarythromycin, Lt Supraventricular LN. Cold haemaglutinin

1. NHL (non hodgkin lymphoma??)

Patient with heart failure and diabetes

Drug C/I

1. Rosiglitazone
Guest, Sep 21, 2005
#11

Mechanism of action of Amiodarone

1. Potassium chanel blocker

2. Sodium Chanel blocker
3.
Guest, Sep 21, 2005
#12

8.

GuestGuest

How can diagnose Empyema in a fast way

1. Aspirate culture
2. Ph of aspirate
Guest, Sep 21, 2005
#13

9.

GuestGuest

Mutaion, there was P53 and P27

Guest, Sep 21, 2005

#14

10.

GuestGuest

Follow up colon carcinoma

CA 125
CEA
Guest, Sep 21, 2005
#15

11.

GuestGuest

Left PHRENIC NERVE PALSY

1. lt hemidiaphragm paradocical movement

2. Rt. hemidiaphragm paradocical movement
Guest, Sep 21, 2005
#16

12.

GuestGuest

Violaceous color and itching in the left arm (linear) and flexors

2. Scabies???
Guest, Sep 21, 2005
#17

13.

GuestGuest

Marfan -----> fibrillin

Guest, Sep 21, 2005
#18

14.

GuestGuest

CEA is correct (checked)

Guest, Sep 21, 2005
#19

15.

GuestGuest

CEA confirmed (checked)

Guest, Sep 21, 2005
#20

16.

GuestGuest

Pancreatitis. The most sensitive test for pancreatic exocrine

1. lipase
2. amylase
Guest, Sep 21, 2005
#21

17.

GuestGuest

Agitated and confused lady after a party

1.Alcohol
2. Ecstasy
Guest, Sep 21, 2005
#22

18.

GuestGuest

Diabetic with frozen shoulder -----> adhesive capulitis

Guest, Sep 21, 2005
#23

19.

GuestGuest

ECG deta wave asymptomatic treatment

1.B blocker
2. observation
Guest, Sep 21, 2005
#24

20.

GuestGuest

Parasthesia and LN enlarged in axilla and neck is a side effect of:

1 Phenytoin
2. lamotrigine

O2% goes down during a nebuliser. Why?

1.
Guest, Sep 21, 2005
#27

21.

GuestGuest

Normal Alveoli seen in

1. Asthma
Guest, Sep 21, 2005
#28

22.

GuestGuest

How to monitor SBE

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

Pt with dyspepsia, +ve H. Pylori and mild ?? lymphoma of the stomach??

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

my experience of sept part 1 exam

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.

Here is some of the stuff:

1. Where does the RNA splicing take place - nucleus.

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.

A lot of basic stuff, especially pharmacology.

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

Posted: Thu Sep 22, 2005 11:03 pm byDR GMATH,rsukhon

HERE ARE SOME QS FM SEP 20.FOR DR OA AND OTHERS

1.PT ALLERGIC TO PENICILLIN : DONT GIVE : CEPHRADINE <CROSS ALLERGY>

2.ASSOCIATION WITH SYSTEMIC SCLEROSIS: PUL HTN
4..MOST LIKELY ASSOC OF PBC:VITILIGO
5.CAUSE OF CHB AFTER MI: RT CORONARY ARTEY OCCLUSION
6TREATMENT FOR POLYCYTHEMIA: HYDROXYUREA
7.MOST COMMON CAUSE OD DEATH IN ACROMEGALY: LVF
8.P20 PROTEIN IS IMP B/C : CAUSES EXPULSION OF CYTOTOXIC DRUGS

9.MOST IMP SIGN OF IDIO PARKINSONISM: ASSYMET REST TREMOR

10.NONSUSTAINED VT TREATMENT: MG+ I/V
11.PT WITH CCF AND A LARGE BOUT OF P/R BLEEDING.UPPER GI ENDOSC NORMAL DX
ANGIODYSPLASIA
12.MAN WITH MEDIASTINAL LN ENLAGEMENT HAS STRIDOR ANND LN OBST BRONCH
WAT TO DO MEDIASTINOSCOPY.
13MALT RT ERADICATION THERAPY
14 EPO IMPROVES : EXERCISE TOLERANCE
15.FEMALE WITH BULKY STOOLS AND BLOATING IBS
16 ENDOCARDITIS MONITORING : BLOOD CULTURES
17.PT WITH HEART VALVE RX AND SMALL VEG ON ECHO DX:STAPH EPIDERMIDIS
18> FEMALE WITH HYPOGLYCEMIC EPISODE: STOP DRIVING FOR 3 MNTHS..I HOPE
19>ISOLATED SENSORY LOSS IN A PT>LACUNAR INFARCT
20.DETERIORATING CONSC IN A FEMALE WITH AD:SUBDURAL HEAMATOMA
21CHILD UNDERGOING TOOTH EXTRACTON SUFFERS UNCONSC,JERKS AND INCONT OF
URINE: DX TONIC CLONIC SEIZURES
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
23 INC KCO CAUSE ALV HMG
24PT WITH PRGO SOB CAUSE UL THROMBIEMBOLISM
25 Q OS PIT APOPLEXY
26 MANY OPTH QS
1.AC GLAUCOMA PAIN SUDDEN 6/60 VA
2.RA PT WITH SEVERE PAIN NORMAL VA: ANT UVEITIS
27 SCHIZOPHRENIC REFUSES INTUB WAT TO DO..CONSENT FM KITH AND KIN
28 WAT TO DO IN A PT WITH SSRI RESISTANCE NOT RESPONDING TO IT:LITHIUM
ADDITION
29Q OF MESENTERIC ISCHEMIA
30.PT OF HYPOMANIA PRESSURIZZED SPEECH
31.PT OF SCHIZOPHRENIA

32STATS SENSITIVITY WAS 60

33STATS RANDOMIZATION AWFUL ONE
34 STATS PAIRED COMPARSON WITH MEDIAN AS REF/? CHI SQ?
36DERMA SCARRING ALOPECIA DLE
37DERM INCOGNITO
38 RENAL BARTER SYNDROME HYPOKALEMIA WITHOUT HTN Q
39 TYPE 1 RTA NEPHROCALCINOSIS AND ETC
41 METABOLIC ACIDISIS FINDINGS IN A Q
42 RELAXATON RT FOR A PT OF PANIC ATTACK RIGHT?
43 PHARMA NICORANDIL OPENS ANN ION CHANNEL
44.CLIPPING OF NAIL FUNFGAL INFECTION DX
45 SOB WITH NORMAL KCO ASTHMA'
46SINGLE CAVITATING LESION PNEUMONIA : KLEBSIELLA
47.CF ORGANISM: PEUDOMONAS
48.FEMALE WITH GIANT CELL ARTERITIS
40FTN OF FEMORAL N : ADDUCTOR
50ULNAR ENTRAPMENT
51.BOORHAVE DISEASE
52.TENSION HEADACHE
53.KLINEFELTER SYNDROME
54.AIDS PT ORG BURHOLDERIA
55PT OF AIDS WITH BRAIN ATROPHY?AIDS ENCEPHALOPATHY AS ALL OTHERS CAUSED
LESIONS AND NO LESION IN THIS CASE
56 UNILAT VISUAL LOSS IN AIDS PT TOXOCARA
57 PROPHLAXIS OF SPLENECTOMY INFLUENZAE ..ONLY VIRAL ORG
58.SIADH
59.CRANIAL DI
60 POOR PXIC FACTOR I ALL 9:22
61 SAME IN AML?
62.BULIMIA NERVOSA

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

BYE FOR NOE PRAY 4 ME

I THTINK MRCP

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!

ENDOCARDITIS MONITORING : BLOOD CULTURES (I believe CRP is the answer)

MAN WITH MEDIASTINAL LN ENLAGEMENT HAS STRIDOR ANND LN OBST BRONCH

WAT TO DO MEDIASTINOSCOPY (I believe predinisolone is the answer)

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)

21CHILD UNDERGOING TOOTH EXTRACTON SUFFERS UNCONSC,JERKS AND INCONT OF

URINE: DX TONIC CLONIC SEIZURES (no, this is a classic case for vasovagal syncope! and he is
suffering from perhaps a complex symcope)

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)

RA PT WITH SEVERE PAIN NORMAL VA ANT UVEITIS (epscleritis)

SCHIZOPHRENIC REFUSES INTUB WAT TO DO..CONSENT FM KITH AND KIN (there is no

such thing in england as taking consent from next of kin in england...plus by the time they take consent
the patient would have died, so i think the answer was acting on behalf of the patient's best interests)

28 WAT TO DO IN A PT WITH SSRI RESISTANCE NOT RESPONDING TO IT:LITHIUM

ADDITION (personally i think addition of lithium is not an easy thing because it is a dangerous drug
that requires monitoring and he does not suffer from bipolar disorder to require it so i think giving him
a trial on an alternative class like TCA would be the choice - i am not sure if this is the right answer )

PROPHLAXIS OF SPLENECTOMY (encapsulated organisms like strep pneumonia)

anyway, i hope some of my answers have been helpful, i am open for discussion!

pinkfeets!

1.PT ALLERGIC TO PENICILLIN : DONT GIVE : CEPHRADINE <CROSS ALLERGY>

2.ASSOCIATION WITH SYSTEMIC SCLEROSIS: PUL HTN

4..MOST LIKELY ASSOC OF PBC:VITILIGO
5.CAUSE OF CHB AFTER MI: RT CORONARY ARTEY OCCLUSION
6TREATMENT FOR POLYCYTHEMIA: HYDROXYUREA
7.MOST COMMON CAUSE OD DEATH IN ACROMEGALY: LVF
8.P20 PROTEIN IS IMP B/C : CAUSES EXPULSION OF CYTOTOXIC DRUGS
9.MOST IMP SIGN OF IDIO PARKINSONISM: ASSYMET REST TREMOR
10.NONSUSTAINED VT TREATMENT: MG+ I/V
11.PT WITH CCF AND A LARGE BOUT OF P/R BLEEDING.UPPER GI ENDOSC NORMAL DX
ANGIODYSPLASIA
12.MAN WITH MEDIASTINAL LN ENLAGEMENT HAS STRIDOR ANND LN OBST BRONCH
WAT TO DO MEDIASTINOSCOPY. (
13MALT RT ERADICATION THERAPY
14 EPO IMPROVES : EXERCISE TOLERANCE
15.FEMALE WITH BULKY STOOLS AND BLOATING IBS
16 ENDOCARDITIS MONITORING : BLOOD CULTURES
17.PT WITH HEART VALVE RX AND SMALL VEG ON ECHO DX:STAPH EPIDERMIDIS
18> FEMALE WITH HYPOGLYCEMIC EPISODE: STOP DRIVING FOR 3 MNTHS..I HOPE
19>ISOLATED SENSORY LOSS IN A PT>LACUNAR INFARCT
20.DETERIORATING CONSC IN A FEMALE WITH AD:SUBDURAL HEAMATOMA
21CHILD UNDERGOING TOOTH EXTRACTON SUFFERS UNCONSC,JERKS AND INCONT OF
URINE: DX TONIC CLONIC SEIZURES
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
23 INC KCO CAUSE ALV HMG
24PT WITH PRGO SOB CAUSE UL THROMBIEMBOLISM
25 Q OS PIT APOPLEXY
26 MANY OPTH QS
1.AC GLAUCOMA PAIN SUDDEN 6/60 VA
2.RA PT WITH SEVERE PAIN NORMAL VA: ANT UVEITIS

27 SCHIZOPHRENIC REFUSES INTUB WAT TO DO..CONSENT FM KITH AND KIN

28 WAT TO DO IN A PT WITH SSRI RESISTANCE NOT RESPONDING TO IT:LITHIUM
ADDITION
29Q OF MESENTERIC ISCHEMIA
30.PT OF HYPOMANIA PRESSURIZZED SPEECH
31.PT OF SCHIZOPHRENIA
32STATS SENSITIVITY WAS 60
33STATS RANDOMIZATION AWFUL ONE
34 STATS PAIRED COMPARSON WITH MEDIAN AS REF/? CHI SQ?

36DERMA SCARRING ALOPECIA DLE

37DERM INCOGNITO
38 RENAL BARTER SYNDROME HYPOKALEMIA WITHOUT HTN Q
39 TYPE 1 RTA NEPHROCALCINOSIS AND ETC
41 METABOLIC ACIDISIS FINDINGS IN A Q
42 RELAXATON RT FOR A PT OF PANIC ATTACK RIGHT?
43 PHARMA NICORANDIL OPENS ANN ION CHANNEL
44.CLIPPING OF NAIL FUNFGAL INFECTION DX
45 SOB WITH NORMAL KCO ASTHMA'
46SINGLE CAVITATING LESION PNEUMONIA : KLEBSIELLA
47.CF ORGANISM: PEUDOMONAS
48.FEMALE WITH GIANT CELL ARTERITIS
40FTN OF FEMORAL N : ADDUCTOR
50ULNAR ENTRAPMENT
51.BOORHAVE DISEASE
52.TENSION HEADACHE
53.KLINEFELTER SYNDROME
54.AIDS PT ORG BURHOLDERIA
55PT OF AIDS WITH BRAIN ATROPHY?AIDS ENCEPHALOPATHY AS ALL OTHERS CAUSED
LESIONS AND NO LESION IN THIS CASE

56 UNILAT VISUAL LOSS IN AIDS PT TOXOCARA

57 PROPHLAXIS OF SPLENECTOMY INFLUENZAE ..ONLY VIRAL ORG
58.SIADH
59.CRANIAL DI
60 POOR PXIC FACTOR I ALL 9:22
61 SAME IN AML?
62.BULIMIA NERVOSA
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

Regarding Endocarditis my answer was CRP but when I checked it in Harrison's, it is Blood culture

answer is eradication of h pylori

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

I checked it, its H. Pylori eradication

Guest, Sep 23, 2005
#43

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

Start prednisolone - (No. 1)

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

HERE ARE SOME QS FM SEP 20.FOR DR OA AND OTHERS

1.PT ALLERGIC TO PENICILLIN : DONT GIVE : CEPHRADINE <CROSS ALLERGY>

2.ASSOCIATION WITH SYSTEMIC SCLEROSIS: PUL HTN
4..MOST LIKELY ASSOC OF PBC:VITILIGO
5.CAUSE OF CHB AFTER MI: RT CORONARY ARTEY OCCLUSION
6TREATMENT FOR POLYCYTHEMIA: HYDROXYUREA
7.MOST COMMON CAUSE OD DEATH IN ACROMEGALY: LVF
8.P20 PROTEIN IS IMP B/C : CAUSES EXPULSION OF CYTOTOXIC DRUGS
9.MOST IMP SIGN OF IDIO PARKINSONISM: ASSYMET REST TREMOR
10.NONSUSTAINED VT TREATMENT: MG+ I/V
11.PT WITH CCF AND A LARGE BOUT OF P/R BLEEDING.UPPER GI ENDOSC NORMAL DX
ANGIODYSPLASIA
12.MAN WITH MEDIASTINAL LN ENLAGEMENT HAS STRIDOR ANND LN OBST BRONCH
WAT TO DO MEDIASTINOSCOPY.
13MALT RT ERADICATION THERAPY
14 EPO IMPROVES : EXERCISE TOLERANCE
15.FEMALE WITH BULKY STOOLS AND BLOATING IBS
16 ENDOCARDITIS MONITORING : BLOOD CULTURES
17.PT WITH HEART VALVE RX AND SMALL VEG ON ECHO DX:STAPH EPIDERMIDIS
18> FEMALE WITH HYPOGLYCEMIC EPISODE: STOP DRIVING FOR 3 MNTHS..I HOPE
19>ISOLATED SENSORY LOSS IN A PT>LACUNAR INFARCT
20.DETERIORATING CONSC IN A FEMALE WITH AD:SUBDURAL HEAMATOMA

21CHILD UNDERGOING TOOTH EXTRACTON SUFFERS UNCONSC,JERKS AND INCONT OF

URINE: DX TONIC CLONIC SEIZURES
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
23 INC KCO CAUSE ALV HMG
24PT WITH PRGO SOB CAUSE UL THROMBIEMBOLISM
25 Q OS PIT APOPLEXY
26 MANY OPTH QS
1.AC GLAUCOMA PAIN SUDDEN 6/60 VA
2.RA PT WITH SEVERE PAIN NORMAL VA: ANT UVEITIS
27 SCHIZOPHRENIC REFUSES INTUB WAT TO DO..CONSENT FM KITH AND KIN
28 WAT TO DO IN A PT WITH SSRI RESISTANCE NOT RESPONDING TO IT:LITHIUM
ADDITION
29Q OF MESENTERIC ISCHEMIA
30.PT OF HYPOMANIA PRESSURIZZED SPEECH
31.PT OF SCHIZOPHRENIA
32STATS SENSITIVITY WAS 60
33STATS RANDOMIZATION AWFUL ONE
34 STATS PAIRED COMPARSON WITH MEDIAN AS REF/? CHI SQ?
36DERMA SCARRING ALOPECIA DLE
37DERM INCOGNITO
38 RENAL BARTER SYNDROME HYPOKALEMIA WITHOUT HTN Q
39 TYPE 1 RTA NEPHROCALCINOSIS AND ETC
41 METABOLIC ACIDISIS FINDINGS IN A Q
42 RELAXATON RT FOR A PT OF PANIC ATTACK RIGHT?
43 PHARMA NICORANDIL OPENS ANN ION CHANNEL
44.CLIPPING OF NAIL FUNFGAL INFECTION DX
45 SOB WITH NORMAL KCO ASTHMA'
46SINGLE CAVITATING LESION PNEUMONIA : KLEBSIELLA
47.CF ORGANISM: PEUDOMONAS

48.FEMALE WITH GIANT CELL ARTERITIS

40FTN OF FEMORAL N : ADDUCTOR
50ULNAR ENTRAPMENT
51.BOORHAVE DISEASE
52.TENSION HEADACHE
53.KLINEFELTER SYNDROME
54.AIDS PT ORG BURHOLDERIA
55PT OF AIDS WITH BRAIN ATROPHY?AIDS ENCEPHALOPATHY AS ALL OTHERS CAUSED
LESIONS AND NO LESION IN THIS CASE
56 UNILAT VISUAL LOSS IN AIDS PT TOXOCARA
57 PROPHLAXIS OF SPLENECTOMY INFLUENZAE ..ONLY VIRAL ORG
58.SIADH
59.CRANIAL DI
60 POOR PXIC FACTOR I ALL 9:22
61 SAME IN AML?
62.BULIMIA NERVOSA
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
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!

ENDOCARDITIS MONITORING : BLOOD CULTURES (I believe CRP is the answer)

MAN WITH MEDIASTINAL LN ENLAGEMENT HAS STRIDOR ANND LN OBST BRONCH

WAT TO DO MEDIASTINOSCOPY (I believe predinisolone is the answer)

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)

21CHILD UNDERGOING TOOTH EXTRACTON SUFFERS UNCONSC,JERKS AND INCONT OF

URINE: DX TONIC CLONIC SEIZURES (no, this is a classic case for vasovagal syncope! and he is
suffering from perhaps a complex symcope)

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)

RA PT WITH SEVERE PAIN NORMAL VA ANT UVEITIS (epscleritis)

SCHIZOPHRENIC REFUSES INTUB WAT TO DO..CONSENT FM KITH AND KIN (there is no

such thing in england as taking consent from next of kin in england...plus by the time they take consent
the patient would have died, so i think the answer was acting on behalf of the patient's best interests)

28 WAT TO DO IN A PT WITH SSRI RESISTANCE NOT RESPONDING TO IT:LITHIUM

ADDITION (personally i think addition of lithium is not an easy thing because it is a dangerous drug
that requires monitoring and he does not suffer from bipolar disorder to require it so i think giving him
a trial on an alternative class like TCA would be the choice - i am not sure if this is the right answer )

PROPHLAXIS OF SPLENECTOMY (encapsulated organisms like strep pneumonia)

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 .

REGARDING UR COMMENT ON EPISCLERITIS.I AM SURE THERE WAS OPTION OF

SCLERITIS: PAINLESS, GLAUCOMA:VISION LOSS OCCURS.THEY ASKED ABOUT
REDNESS,NORMAL VA AND PAIN RADIATING TO FOREHEAD ..THERE WAS NO OPTION
OF EPISCLERITIS AINFUL SO AS ANT UVEITIS HAS ALL FEATURES AF THE GIVEN PATHO

REGARDING LITHIUM.IT IS GIVEN IN RESISTANT CASES REF TO KALRA

REGARDING O2 : O2 WAS GIVEN CONTINUOSLY TO PT IN THAT CASE ,U KNOW

DILATORS CAUSE INC DILAT OF ALVEOLI SO PUL ART PRESSURE /RESISTANCE FALLS
SO RELATIVE DEF OF O2 WRT SURFACE AREA WILL BE SEEN

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

IE BLOOD CULTURES U CAN C IN ANY BIG TXTBOOK

REGARDING PREDNISOLONE U R RIGHT
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

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

what are cardiac troponin

ans:strutrural proteins

multiple sclerosis

asymptomatic wpw synd-rx of choise

ans-resurance
Guest, Sep 29, 2005
#50
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Forums > UK Medical Zone > MRCP Forum >

After the exam.(MRCP MAY 06 RECALLS)

Discussion in 'MRCP Forum' started by sma, May 17, 2006.

Thread Status:

Not open for further replies.

Page 1 of 21 2Next >

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____>???

I will post more from my memory.

cu
Guest, May 17, 2006
#2

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:

1. Contraindication to Surgery for Lung cancer: Pleural effusion

2. Lung functions shows FEV1/FVC 40% in RA patient: Bronchiltis Obiterans

3. Cisplatin action

4. How to confirm diagnosis of Leigionerre... Urinary antigen?!?!

5. How to confirm Meningococaemia: PCR?!?!

6. erectile dysfunction: Anxiety??

7. Sildenfil and nicorandil

8. Ciclosporin side effect

9. ABG: Respiratory Alkalosis: PE

10. Paroxitene and unstable angina...

11. UC flare up. next step: possibly azathioprine

12. Knee joint question

13. Cervical spondilysis

14. Two question about RA... psoriatic arthropathy

15. A possibly osteomyelitis!!!

16. metformin and the B12 anaemia

17. metformin and renal impairment?!?!?

18. Sarcoidosis: CXR

19. Overdose of paracetamol and anorexia nervose

20. Overdose of Diazepam and Disulopin: ECG??? there was tachycardia of 140

21. Lateral condyle (tennis elbow) pronation of arm

22. Sensitivity
24. NNT what does it mean!

25. phase I.. what happens in it?

26. two question about choosing the right test in statistics

27. Lung functions COPD

28. MI then thrombolysed then got red dusky coloration of feet anf eosinophilia.. I just though it could
be cholestrol embolism

29. Warfarin and factor VII

30. thalassaemia a.. both parents were traits!

31. APTT prolonged... some 50:50 mix up.. which factor??

32. patient with some history of back pain: non-specific back pain

33. common peroneal nerve and dorsiflexion of ankle

34. intermittent loss of consciousness.. you know who I am talking about!

zf

36. optic neuritis or giant cell arteritis??? swollen pale disc + monoocular visual loss!

37. partial left homonymous hametonpia: which lobe??

38. cortical thrombophlebitis?!?!? it was complicated question but the CT was very suggestive

39. I guess there was Dengue fever

40. Which malaria..??? It was 6 month period!

41. hypocalcaemia and LOng QT

42. pregnancy and amiodarone for AF

44. statins caused myalgia.. what not to use with?/ Fibrates

45. Rx for myclonus epilepsy: Valpraote???

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..

49. what contains double stranded circular DNA

50. G6PD and trimethoprim for UTI

51. two questions about autoimmune haemolytic anaemia: one of them was about dirst antiglobulin test

52. IgA nephropathy

53. E coli HUS.. question

54. Rhabdomylasis and low dose dopamine???

55. thiazide action???

56. ADH action.. where??

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!

58. question about tuberous sclerosis

59. there was two question I choose colonscopy for.. I can remember them at all

60. HIV and odynophagia!

the rest is on the way!

Guest, May 17, 2006
#3

3.

GuestGuest

tarekdeema

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Posted: Wed May 17, 2006 6:12 pm Post subject: A funny question from may 2006

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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.

1. melanoma----- change of colour

size of tumor
i did change of color i eas not not sure.

2. painless liver enlargment and jaundice.

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.

1.mech.of action aciclovir--dna polymerase inhibition.

2.IgA Nephropathy

3.Antidote for cyanide poisoning-colbat edetate

4.a question about melanoma and carvenous sinus involvement.

5.cluster headcahe

6.villous adenoma--colonoscopy

7.T3 toxicosis

8.Carbimazole 30mg and persistence T4 elevation--propilthyuracil.

9.a case of PE

10.A case of behcet dx -venous thrombosis.

11.Sidenafil and nicorandil

12.sideroblastic anaemia

13.Gullain-barre and vital capacity

14.myotonic dystrophy with cataract and weakness

16.APKD and polycystin

17.NNT AND reciprocal of ARR.

18.VIT.K and factor VII

19.OSteomalacia and low calcium and low phosphate but high ALP.

20.CONFUSED and aggressive man --Haloperidol.

21.Prolonged QT and hypocalcemia

22.lithium and drug induced DI

23.CHronic pancreatitis in pregnant lady with loose stool and malabsorptive picture

24CI to surgery lung ca. SVC obstruction

25.Generalized anxiety disorder and IMPOTENCE

26.Major depression and relatives death

27.Scabies and pruritus rash sparing the face

28.Polymorphic light eruption in sun exposed areas.

30.Hep.D super infection

31.Thyroid malignancy common in autoimmune thyroiditis--Lyphoma

32.A case of PCOS

33.A case of BIH

35.OESOHAGEAL HSV IN HIV

36.A case of cholera -rx--Doxycycline

37.Dog bite infection and FLUCLOX.AND BENZYLPEN.

MORE TO COME

THANKS

OREOLUWA
Guest, May 17, 2006
#6

6.

GuestGuest

Author Message
afsheensalman
AIPPG Fresher

Joined: 09 May 2006

Posts: 2

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Posted: Thu May 18, 2006 1:07 pm Post subject: may 2006 part1

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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

lump in nose+lump in neck+lung infiltrate

1-lymphoma
2-histocitosis x
3-sarcodosis
4-wegners
Guest, May 18, 2006
#8

8.

kengladGuest

answer

its svco thats contraindicated in ca lung

not pleural effussion cuz it can be reactive unless the choice was malignant pleural effusion

and its nicorandil

kenglad, May 18, 2006
#9

9.

rahba septGuest

many basic even in the 2 paper

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:

1-lateral condylo pain which will increse it -thumb -open fingers....

2-leg loss reflex what the cause diabetic coronary...neurolog

3-posterior comunicate artery-anterior comunicate artery

4-a trait thalasemia -

5-tirdness weakness synaktin short test

6-diabetus insibidus drug indused ..lethium..

7-erythema on shin ..rash polyuria ..sle..sarcoidosis..

8-idiopathic parkinson ..assemetry tremor

9-ondansterion for nausia was taking metochlopromide

10-acute loss of vision ..venous thrombosis..

11-dry eye ..ulcers mouth genital ...sjogren...behcet..

12-smoking ..coal miner....bladder carcinoma..

13-methadon ..

14-lethium toxisity ....thiazide or nomal saline...

this is for now i,ll continue when i remember more

thank u
rahba sept, May 18, 2006
#10

10.

kengladGuest

some answers

paradoxical embolus definitely for transesophageal echo as u can visualise better

oh urinary antigen definitely for legionnaire's

and it has to be cholesterol embolus as bld eosinophil is high

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

6 months indicate ovale malaria as they have a hypnozoite phase

myoclonus best treated with ethosuximide

rosacea best treated with oxytetracycline

nicorandil cannot be given with sildenafil

too much dilatation
too much is not always good hehehe

melanoma definitely size look it up in kumar and clarke

ca lung c/i is svc obstruction

kenglad, May 18, 2006
#11

11.

GuestGuest

SMK Al rifae'ei

SMK Al rifae'ei
Guest

Posted: Thu May 18, 2006 7:48 pm Post subject: 16 may

--------------------------------------------------------------------------------

i will sening the questions ,try to anser it as we go on:

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

A young diagnosed spastic angina best mangement.

-fecanide
-betablocker
-asprine
--Asprine is correct.
Guest, May 18, 2006
#13

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

best indicator for tonsillar abscess - trismus, .....

AC, May 18, 2006
#17

17.

rahba septGuest

best indicater for tonsillitis

another choisis for best indicator for tonsilitis abscess is continious fever

i,ll cotinue questions

1-foramen ovale

2-prick test ...ige .

3- scabis...

4-e coli

5-cholangio carcinoma ..

6-ulcerative cholitis...

7-mody ..

8-liver biopsy...us guided ..mrcp ...ercp..

9-paroxetin...hypertension..

10-spinal ..foot depression..

11-frontal lobe syndrome..parital lesion ..

12-knee replacement ...

13-noctornal dysphasia

14-tachicardia ..diarrhia....anticholinergic...tox..

15-crticosteroid injection ..joint ..

16-c4..c5..c6..c7....{c4}

17-vertebral prolapse....

18-3..6...trigemeni........pons

19-aspirin coronary spasm ...metoprolol...propranolol..

20-genetic...mother brother...father brother..............mother brother...link ressesive

21-hematuria thrombocytopenia..anemia...imunoglobulin..iga..

22-hemophelia..

23- 1/2......1/4....1/6...1/8

24-graves disease ....t3...t4...

25-hematuria....hypervescosity..syndrome

26-chronic subdural hematoma

27-eozinophilia....nephrology....

thanks
rahba sept, May 19, 2006
#18

18.

rahba septGuest

lady with wrist swelling

i think choisis was bone tumor ...

rahba sept, May 19, 2006
#19

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?

2)lowish ca 2.00 normal po4 1.3 and a sky hi alk phos

it's PAGETS innit? cuz excessive bone turnover so hi alk phos and lowish ca from consumption

3)chap on carbamazepine and came to you with agranulocytosis but no fever.free t4 hi

wot shud u do?
- stop carbamazepine and change to PTU
-radioactive iodine
-pennicillin V
-reduce dose of carbamazepine
wots the answer eh?

4)cisplatin goddamit i knew i shud have read it up

wots the mode of action?

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

7)young chap with coronary artery spasm

aspirin

8)pregnant lady with SVT?

metoprolol?

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

b lymphocyte,t lymphocyte,bone marrow suppression?!

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

15)jysus!~human genome project!!!

wots the answer
issit e)not all dna code for a gene?
kenglad, May 19, 2006
#21

21.

kengladGuest

other question i need answers too

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

issit varicella cuz she's the odd man out

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

5-test to cnfirm ABA :Apargiluus precipitins

7-SVT WITH 250 RATE :AMIODRONE

7-pt receiving statin developed myalagia drug that should be avoided is:NICOTINIC ACID as both are
causes of myositis
8-Pt who was moderate drinker hypertesive brought with gouty attack and given allopurinol came back
with an attack the cause is :ALLOPURINOL THERAPY as it was given solely in an alcholic without
being covered by NSAIDS which precipitate an attack of gout
9-vellous adenome removed follow up COLONOSCOPY once a year in the first 2 years and then
everey 3 years
10-Rt sided effusion,high CA125 :OVARIAN FIBROMA (meigs syndrome)
11-opthalmoplegia+impared sensation in foehead+NO proptosis :CAVERNOUS SINUS
THROMBOSIS
12-78 women with acute loss of vision+pale disck:GIANT CELL ARTERITIS
13-lump in nose+lump in neck+pulmonary infiltarte :SARCOIDOSIS the lump in neck is salivary
gland swelling ,the lump in nose is lupus perinio (MICULIZ SYNDROME
14-women with +anti RO ,+anti Sm :SLE
16-Women brought with fatige has +anti smooth muscle antibodies what test to perform (LVT its

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

mrcp 1 may 16 questions

a patient with nocturnal cough, BMI- 22, probable diagnosis - asthma, GERD, obstructive sleep apnoea

best indicator for peritonsillar abscess- trismus??

AC, May 19, 2006
#27

27.

kulbitGuest

MRCP Part 1 May 16 2006

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.

3. In a patient on Warfarin which factor is likely to be reduced

ANs: Factor VII.

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.

7. Test to confirm nickle skin sensitivity producing wheals and urticaria

Ans: Patch test.

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.

13. HIV positive patient with odynophagia.

Ans: Candida albicans. CMV esophagitis is another possibility, but I think candida is the more common
one.

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.

16. Patient with coronary vasospasm. Drug to be avoided.

Ans: Aspirin.

17. The following are true regarding the human genome.

Ans: Only a small amount of DNA codes for genes.

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

21. Patient is on sildenafil. Which drug has to be avoided?

Ans: Nicorandil

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.

23. NNT is calculated as

Ans: NNT =1/RRR but this option was not there. I think it is percentage difference between AR and
RR because RRR= (1-RR) X 100%.

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.

38. Pt receiving statin developed myalagia. Drug that should be avoided is

Ans: Niacin

39. Antibiotic for dog bite

Ans: co-amoxyclav.

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

hi kulbit the answer is syringomyelia and not brachial plexus infiltration

syringomyelia can affect one side first
the symptoms appear typical of syringomyelia

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.

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
difference what is the Dx-- Amylidosis
44- Elderly pt with Iron def anemia, OGD-Gastritis what to do next---colosocopy
45-Pt with bowel adenoma resected how to follow up- Colonoscopy
46- pt with hypothyrodism on replacement presented with normal TSH, low T4, normal T3---adequate Tx
47-pt presented with lasstitude 6 mths low TSH, high T3, Normal T4---- T3 thyrotoxic
48-Pt with UC +hepatic lesion, high Alk p what Dx- Heaptoma, adenoma, Adencarcinoma, hepato Ca,
Cholangiocarcinoma,
49- case with Knee osteoarthritis management --- knee replacement
50- preg lady with Alpha thal trait+ husband trait wants to know the risk to the foetus--- no risk to the
feotus
51-pt with G6PD given AB for UTI presented with jaundice whish drug--- trimethoprim
52- x-linked disease which family member will be affected-- mothers brother
53- which organeel contains circular DNA-- Mito

54- t with paradoxical embolus which Invx--- Transoesophageal ECHO

55- pt post MI 6 weeks presnted with SVT which Invx-- ECHO, Electrophiseological testing,
56- elderly lady with freq. LOC weaks up with help after 1 min Dx- drop attacks
57-young lady with diplopiam recent wieght gain Dx----BIH
58- young pt with chronic nocturnal cough, normal CXR Dx-- chronic sinusitis
59- pt present with neck sweeling+ swelling in the nostril Dx--- Sarcoidosis
60- HSP which renal Pathology --- IgA nephropathy
61-AS X-ray Appearance- Dysmophytes
62- Joint pain Xray shoing Osteopenia Dx--- RA
63- Pt with overdose what will increase the toxicity?-----Anorexia nervosa
64- which Diabetic agent will increase insulin senstivity?--- Rosiglitazone
65-Pt with MODY how to confirm it?----- Strong family history
66-action of ADH?----on collecting tubules
67-Pt with liver cirrohsis and ascites which Tx?--------- Aldosterone antagosist
68- Pt with DM presented with proteinurea, High HbA1C and background retinopathy he is on insulin,
ramipril what to do next?-------better glycemic control
69-pt presents with ptosis myosis 6 hours after cleaning the ceilling Dx-----Carotid Artery Discetion
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

The rest will follow

Regards
Guest, May 23, 2006
#35

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

116-Pt with paradoxical embolus Ivx? transesophagelecho

117- pt with hepatic disesae which Ivx? ERCP
118-PT WITH PROMYELOCYTIC LEUKEMIA Invx? Karyotyping
119- skin lesion, on close inspection there is keratin plaque and skin atrophy Dx? SLE
120- young pt with generalised myoclonus epilepsy Tx? Sodium Valporate
121- a drug in the market pt developed new side effect which study design? case control study
122-pt with joint pain penile lesion Dx? reactive artheritis
123-Pt with HCM+non sustained SVT, HE IS ASYMPTOMATIC Tx? implantabel defibrilator.
124- elderly lady Hx of IHD going for knee surgery how to assess her cardiac Fxn?--- Thallium scan
125-ST elevation in lead 2,3, AVF which artery?--RCA
126-Rhabdomylysis renal failure Tx? Iv normal saline
127-Qs about peritonsiller abscess?
128-indcation for melanoma transformation? change in size
129-sile of melanocyte in the skin? stratum basale
130-which malignancy asoo. with thyroiditis? Lymphoma
131- Pt with intracerebral hemorrhage, CT= hemorrahge extending to the cortex, Hx of High BP Dx?

Polycystic kidney dis.

132-herpes simplex virus which statement is correct? increase risk of infection befroe the menses
133-pt asking the meaning of anticipation? deacreasing age of presentation with subsequent generation
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

please add on and correct my mistakes

regards
Guest, May 24, 2006
#37

31.

GuestGuest

116-Pt with paradoxical embolus Ivx? transesophagelecho

117- pt with hepatic disesae which Ivx? ERCP
118-PT WITH PROMYELOCYTIC LEUKEMIA Invx? Karyotyping
119- skin lesion, on close inspection there is keratin plaque and skin atrophy Dx? SLE
121- a drug in the market pt developed new side effect which study design? case control study
122-pt with joint pain penile lesion Dx? reactive artheritis
123-Pt with HCM+non sustained SVT, HE IS ASYMPTOMATIC Tx? implantabel defibrilator.
124- elderly lady Hx of IHD going for knee surgery how to assess her cardiac Fxn?--- Thallium scan
125-ST elevation in lead 2,3, AVF which artery?--RCA
126-Rhabdomylysis renal failure Tx? Iv normal saline
127-Qs about peritonsiller abscess?
128-indcation for melanoma transformation? change in size
129-sile of melanocyte in the skin? stratum basale
130-which malignancy asoo. with thyroiditis? Lymphoma
131- Pt with intracerebral hemorrhage, CT= hemorrahge extending to the cortex, Hx of High BP Dx?
Polycystic kidney dis.
132-herpes simplex virus which statement is correct? increase risk of infection befroe the menses
133-pt asking the meaning of anticipation? deacreasing age of presentation with subsequent generation

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

please add on and correct my mistakes

regards
Guest, May 24, 2006
#38

32.

EvangelosGuest

MRCP1

Good Luck to everybody!

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

5circular douple strand DNA will be found in

a- mitoconderia
b- nucleus
c- riposome
d- golgi apparatus
isit mitoconderia?? But I know it is single strand any help??

6pt . known case of contact dermatitis what test you will do

aprick test
b- patch test
I put patch test
7pt e medial epocondile trauma what action will not able to do
aflexion of forearm
b- pronation

8pt unable to abduct his arm against resistant what m affected :

ainfra spinatous
bsupra spinatus
cteres minor
dteres major .

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

155-painless jaundice in a diabetic pt which drug is the likely cause -SULPHONYLUREAS

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

Here what I found from the Amercan Journal of Gastroenterology:

"...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. 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?

He is a chronic hepatitis B virus (HBV) carrier with high infectivity.

He is in the incubation period of HBV.
He is a chronic HBV carrier with low infectivity.
He has recovered from HBV infection and is immune to HBV.

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

Significant liver injury usually occurs with doses of more than 10 - 15 g.

Alcoholics are more susceptible to liver injury even with a low dose.
N-acetylcysteine is most effective when administered within 10 hours of ingestion.
Hemodialysis is effective in the management of hepatotoxicity.
Survivors of acetaminophen-induced hepatotoxicity do not experience any progressive or residual liver
damage.

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.

5. Which statement about esophageal cancer is true?

Dysphagia is an early manifestation.

The most common type of esophageal cancer in the United States is adenocarcinoma.
Esophageal cancer is most commonly located in the proximal third of the esophagus.
Most esophageal cancers are not resectable at presentation.
Barrett's syndrome is associated with squamous carcinoma.

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?

Daily use of nonsteroidal anti-inflammatory drugs (NSAIDs)

Gastric infection with H. pylori
Emotional stress
Cigarette smoking
Gastrin-secreting tumors

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?

About 90% of patients with acute hepatitis B will recover completely.

About 1% of patients with acute hepatitis B can experience fulminant hepatic failure.
Chronic hepatitis B carrier state will develop in 10% of patients.
Interferon administration in the acute phase of infection prevents the development of the chronic
hepatitis B carrier state.

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

Pass a Sengstaken-Blakemore tube.

Obtain an upper GI series.
Insert a transjugular intrahepatic portosystemic shunt (TIPS).
Obtain immediate visceral angiography.
Perform upper endoscopy.

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?

Hemolytic transfusion reaction caused by an ABO incompatibility

Delayed hemolytic transfusion reaction
Autoimmune hemolytic anemia of warm antibody type
Autoimmune hemolytic anemia of cold antibody type
Drug-induced immune hemolytic anemia

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.

2. Pregnancy-related microangiopathic hemolytic anemia is caused by all of the following, except

Preeclampsia/eclampsia
Pregnancy-related ITP

HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count)

Postpartum hemolytic-uremic syndrome (HUS)

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)

3. All of the following cause microangiopathic hemolytic anemia, except

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.

4. Which of the following statements is true?

Thalassemias are quantitative disorders of hemoglobin, whereas hemoglobinopathies are qualitative

disorders of hemoglobin.
Thalassemias are qualitative disorders of hemoglobin, whereas hemoglobinopathies are quantitative

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?

Serum EPO level

Arterial blood gas analysis
RBC mass study
Bone marrow aspirate and biopsy
Pulmonary function tests

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

Serum EPO level

Determination of venous P50 (partial pressure of oxygen at which the hemoglobin is 50% saturated)
Arterial oxygen saturation determination
Carbon monoxide determination
Bone marrow aspirate and biopsy

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?

Partial thyroidectomy followed by radioactive iodine (RAI) treatment

Near-total thyroidectomy followed by RAI treatment
Thyroid hormone treatment
A and C
B and C

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

hyperphosphatemia. Hypoparathyroidism can be congenital or acquired; the latter is accounted for by

transient or permanent disorders. Hypomagnesemia causes deficient secretion of PTH and consequent
functional hypoparathyroidism. In vitamin D deficiency, decreased intestinal absorption of calcium
leads to secondary hyperparathyroidism, which increases renal tubular loss of phosphate. Vitamin D
deficiency can result from inadequate dietary intake, lack of sun exposure, and malabsorption. Renal
failure impairs hydroxylation of 25-hydroxyvitamin D, which results in the malabsorption of calcium.
The body compensates by increased secretion of PTH, leading to increased mobilization of calcium
from bone. Renal failure is characterized by an abnormal serum creatinine, whereas renal dysfunction
is not the critical pathogenetic feature of the other forms of hypocalcemia.

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?

Elicit history of head and neck irradiation.

Elicit a family history of thyroid cancer.
Obtain thyroid function tests.
Perform fine-needle aspiration.
All of the above

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?

Testosterone replacement (only if he is deficient)

Physical therapy
Vitamin D replacement (only if his vitamin levels are low)
Calcium supplementation
Hydrochlorothiazide
All of the above

Answer: F

5. Regarding the patient in question 4, which of the following underlies his osteoporosis?

Decreased bone formation

Increased bone loss
Decreased calcium absorption from the GI tract
Increased calcium loss in urine

All of the above

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?

Free triiodothyronine (T3)

Thyroid scan
Thyroid uptake
Pituitary magnetic resonance imaging (MRI)
Antithyroid antibodies

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?

Adrenal computed tomography (CT) scan

Adrenal vein sampling
18-hydroxycorticosterone
Saline loading test
A, B, and C

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

this patient because of heart failure and hypertensive retinopathy.

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.

10. Which of the following statements is/are true regarding PTH?

Secretion is stimulated by hypocalcemia.

Secretion is inhibited by hypercalcemia.
The effect of magnesium on secretion is the same as that of calcium.
Secretion is stimulated by low 1,25-hydroxyvitamin D and inhibited by high levels of 1,25hydroxyvitamin D.
A, B, and D
All of the above

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

characteristics of the synovial fluid would be expected, except

Pale yellow color

Good viscosity
Routine culture negative
WBC count 800/mm3
Glucose 22 mg/dL

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?

Arthrogram of the right knee

Synovial biopsy of the right knee
Ultrasound study of the right knee popliteal fossa
Venogram of right lower extremity
None of the above

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

Blood cultures followed by IV antibiotics

Arthrocentesis for diagnostic/therapeutic purposes
IV colchicine
Allopurinol
Ultrasound study of right knee, including popliteal fossa

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

Deposits of 2-microglobulin AH (amyloidosis associated with hemodialysis) amyloid compressing the

median nerve could produce these findings.
An entrapment neuropathy could explain these findings.
Paresthesias involving the radial side of the thumb, second, third, and fourth fingers suggest
compression of the medial nerve.
Carpal tunnel syndrome could explain these findings.
Deposits of amyloid of the primary type AL (amyloidosis associated with light chains) would be
typical.

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

Secondary Sjgren's syndrome with sicca complex

Scleritis
Episcleritis
Corneal melts

Ischemic optic atrophy

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?

Serum rheumatoid factor

Erythrocyte sedimentation rate

Magnetic resonance imaging (MRI) of the left hip
Arthrogram of the left hip
Blood alcohol level

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

point would be supportive management and

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.

14. Each of the following is characteristic of polymyalgia rheumatica, except

Mild joint inflammation

Stiffness of the shoulder and hip girdles
Weakness of the shoulder and hip girdles
Elevated erythrocyte sedimentation rate
Normochromic normocytic anemia

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

babu145145 Posted: Thu Apr 21, 2005 12:31

Guest, May 17, 2005
#1

1.

drkashGuest

dear friend ;well done & thanks a lot for this great effort
drkash, Jul 29, 2006
#2

mrcp part 1 ,sept 2006

Discussion in 'MRCP Forum' started by asdfg, Sep 18, 2006.

Thread Status:

Not open for further replies.

Page 1 of 21 2Next >

1.

asdfgGuest

Hello all fellows

here is an exclusive list of questions for all of you
who are going to take the exam
I hope it will prove helpful to you
1.malena..... endoscopy shows small 1cm gastric benign chronic ulcer...treatment
2.Meningitis...signs of raised ICP
3.MI....Thrombolysis fails>>> what to do next
4.Status epilepticus...TRatment
6.Renal failure...develops uti...which antibiotic will exacerbate hyperkalemia
7.pt with hypertension .... abondened treatment due to adverse effevt... which anti htn to be given to
avoid adverse effects like lethargy,gum hyperplasia...
8.Copd...rt vent failure with normal left heart...which treatment will improve prognosis
9.Malignant htn....treatment
10.primary pneumothorax...50%....treatment
11.Acyclovir...MOA
12.Bisphosphonates..MOA
13.HRT...most compelling convincing indiacation
14.paracetamol poisonong...MOA of glutathione
15.Bronchial ca.....SVC obstruction...treatment urgent
16.TTP...treatmnet
17.new onset atrial fib......which treatment will decrease risk of stroke in next 48 hrs
18.BNP...from where is secretd
19.H/o some vegetative tea ingestion....Goitre with normal Tfts....diagnosis..

20.Prolactinoma with suprasellar extension+field defects.....

treatment.....
21.which feature is not suggestive of IBS.......wakening due to pain at night
23.Old man with isolate Alk POSPH raised noramal ca po4
diagnosis......pagets???
24.Antibiotic causing cholestataic jaundice.....Amoxicillin..flucloxacillin????
25.Old woman with raised Lymph 16000 on CBC before Hip surgery.....no previus history....what to
do....
26.Dec Hb with DEC MCV+ splenomegaly... diagnosis....
27.which drug causes increase in HDL...Statin,FIbrates,niacin
28.PaO 8.4
Paco2 3.2
Ph 7.51 diagnosis???
29.MAN with dvt after 3 days
INR 2.5
APTT normal
Advised to continue heparin reason?????
30.Investigation for PSC????? ercp???
31.Sodium valproate...Adverse effect?????
32.CRANberry juice which drug is affected...carbamazepine....
33.Malignant melanoma...Breslow thickness .75mm....next management
34.Relapsing multiple sclerosis....What treatment
35.parkinsonism + psychotic symptoms.....got worse after haloperidol....diagnosis
36.Pt in ICU.... got pneumonia...likely organism..MRSA
37.Pt with freckles around mouth.... bleeding per rectum... cause???..angiodysplasia???
38.Pulmonary hypertension for 2 months...heart sound abnormality??????
39.what will cause pulmonary artery DEc pressure..... Endothelin??? prostacyclin...
40.LVH....Which ECG change is most irrelevant.....
asdfg, Sep 18, 2006
#1

2.

GuestGuest

thank you ver much for thses valuable questions

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

choestatic jaundice is caused by fluxacillin and amoxicillin/clavulanic acid

so, i think the answer is fluxa

thanks alot
halit2006, Sep 19, 2006
#3

4.

halit2006.Guest

the most appropriate side effect of valoproate ws in the question is TREMOR

THANKS FOR EVERYONE WHO IS GONNA PARTICIPATE IN 12/09/2006 MRCP1 FORUM

halit2006., Sep 19, 2006
#4

5.

halit2006..Guest

12/9/06 mrcp1

parkinsonism + psychotic symptoms.....got worse after haloperidol....diagnosis

dx; lewy body disease

patients here are too sensitive to theside effects of antipsychotics

halit2006.., Sep 19, 2006
#5

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.

Primary pneumothorax 50%, I chose chest drain

GrMRCP1, Sep 20, 2006
#6

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

Hi papxxx, and hello to all MRCP1 participants.

I downloaded a picture from the British thoracic society guidelines.

Lets discuss more questions

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.

2-SCALY,ATROPHIC LESION OVER FACE LE

3-PREGNANCY LOSSES 3 TIMES:ANTICARDIOLIPIN AB.
4-RECURRENT URTICARIA WHAT iG;Ig
5-HEPIPLEGIA MULTIPLE BRAIN FOCAL LESIONS;toxoplasis
6-gonorrhoeea tt;amoxi
8:ERYTHEMA NODOSUM:IMPROVE
9:INTERFERON TT FOR MS

10;ACITRETIN TT;PREG TEST

11-COLOR BLINDNESS 56 YR:CONGENITAL

12 9 2006 mrcp1

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

mrcp part 1 12 9 2006

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

I THINK THE INTERCATING DRUG WITH CARNBERRY IS WARFARIN

Possible Interaction Between Cranberry Juice and Drug Warfarin

The British Medicines and Healthcare products Regulatory Agency (MHRA) reported five cases that
suggest a food-drug interaction between cranberry juice and warfarin that could cause internal
hemorrhage.

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.

Many women drink cranberry juice to prevent bladder infections.

halit2006, Sep 22, 2006
#18

13.

halit2001..Guest

9 2006 mrcp1

Possible Interaction Between Cranberry Juice and Drug Warfarin

The British Medicines and Healthcare products Regulatory Agency (MHRA) reported five cases that
suggest a food-drug interaction between cranberry juice and warfarin that could cause internal
hemorrhage.

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.

Many women drink cranberry juice to prevent bladder infections.

halit2001.., Sep 23, 2006
#19

14.

rahul79Guest

sept 2007 exam

Exam was tough but counted about 30-40 questions from emrcp.com

Not sure about cranberry juice answer

rahul79, Sep 23, 2006
#20

15.

GuestGuest

Moderately tough,
Guest, Sep 23, 2006
#21

16.

rashdiGuest

information could support you?

this is very good contribution you done v gud job.

wanna share many correct points:
1.malena..... ans: oral omeprazol
4.Status epilepticus...Rx ans: lorazipam
5.ans:epidural hematoma
6. ans gentamycin
7.ans ca channal blocker
8. ans long term O2 therapy
9. ans nitro prusside
11. ans DNA polymarase
13. ans osteoporosis
14. ans glutathione
15. ans radiotherapy
17.ans subcutenous heparin
18. ans left ventrical
20.ans surgery

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

4)PREGNANCY LOSSES 3 TIMES: ans anti RO AB

Hope this information might be useful

rashdi, Sep 23, 2006
#22

17.

saleemasGuest

PLEASE EXPLAIN Q-20,31,37@WHY

saleemas, Sep 23, 2006
#23

18.

saleemasGuest

PREG LOSS @ANTI RO WHY,CBLOCK IN NEWBORN OK

saleemas, Sep 23, 2006
#24

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

mrcp1 2006 december

no more contributions to mrcp 1 12 9 2006?

halit2006, Sep 24, 2006
#26

21.

halit2006Guest

mrcp 1 12 sept 2006?

hello freinds; why not more contributions to mrcp 1 12 sept 2006?

halit2006, Sep 26, 2006
#27

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.

anyone expects the results of mrcp1 12 09 06 to dispatced earlier

thanks all
halit2006, Oct 2, 2006
#29

24.

Dr_Osama77Guest

Hi

I expect the results to be declared on Saturday

I hope earier...

Good luck to all of you

Dr_Osama77, Oct 3, 2006
#30

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

congratulations for those who passed

no records on the website for me, what to do freinds?

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..

You may need to check this:

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.

Wish you all the best

Dr_Osama77
Dr_Osama77, Oct 7, 2006
#34

29.

halit2006Guest

mrcp1 12 09 06

thanks alot dr_osama

actually i havechecked and hope that they will reply

thanks alot and my congratulations again

halit2006, Oct 7, 2006
#35

30.

GuestGuest

PLZ IF SOME ONE CAN TELL WHAT WAS THE PASSING MARKS
Guest, Oct 8, 2006
#36

31.

Dr_Osama77Guest

You are welcome halit2006 and wish you the best,,,

Dr_Osama77, Oct 8, 2006
#37

32.

guest2006Guest

12 09 06 mrcp1

hi friends;

any one knows or expects the pass mark for 12 09 06 mrcp1 exam?

you think that it is similar to the other previous exams or higher?

thanks alot
guest2006, Oct 9, 2006
#38

33.

rubGuest

Dr osama 77,first of all congratulation .and well done

second plz can you tell us,where did you study from,as this exam was diferent from the previous
one's.and what i got the idea is on examination .com is not goining to help....any comment?
plz am apearing in jan ..so help me

rub, Oct 10, 2006

#39

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

the evidence is here:

Possible Interaction Between Cranberry Juice and Drug Warfarin

The British Medicines and Healthcare products Regulatory Agency (MHRA) reported five cases that
suggest a food-drug interaction between cranberry juice and warfarin that could cause internal
hemorrhage.

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.

Many women drink cranberry juice to prevent bladder infections.

halit2006, Sep 23, 2006
#3

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

i would welcom any comment/discussion

[b]1) Valproate s/eTREMORS

2) Pt having recurrent attacks of migraine, WHAT TO DO NOW??...........5HT2 ANTAGONIST

3) Pt taking Li, toxic level increases, cause?........LOOP DIURETICS

4) Elderly male, Parkinson disease..tremors, what to do 4 tremorsANTICHOLOINERGIC,
BENZHEXOL
5) Parkinsons dis, started on levo dopa, worsens, cause.LEWY BODY DEMENTIA
6) s/e of mesalasine
7) HRT, most compelling indication to start..FOR OSTEOPROSIS, INC BMD
8) Female..38yrs showed low BMD, investigation to find the cause? LH, FSH
9) Choloestrol level low, u want 2 inc HDL level, Rx? NICOTINIC ACID
10) Pt of CHF, getting all Rx, EF low on echo, what 2 do to improve sym? DIGOXIN
11) Renal failure, which antibiotic will cause hyperkalemia? AMPHOTERICIN/
AMINOGLYCOSIDE?
12) MOA imatanib.TK INHIBITOR
13) MOA acyclovir.DNA POLYMERASE INH
14) MOA bisphosphonate.OSTEOCLAST INH
15) MOA n-acetyl cystine.INC GLUTATHIONE LEVEL
16) In normal physiological condition wat act as pulm vasodilator? PROSTACYCLINS
17) Pulm HTN, which clinical finding is u most likely to find? LOUD P2
18) Pt of DVT, warfarin given wid target of 3, after 2 days INR 2.1, he was asked to stay in hosp for 2
days n receive heparin. reason? DEC PROTEIN C & S LEVEL
19) Pt wid factor v leden mutation, wat will occur in him? DEC ACTION OF PROTEIN C
20) Pt of HIV wid Kaposi sarcoma, virus? HHV-8
21) Pt of COPD, wat on PFT will confirm diagnosis? FEV1/FVC =50%
22) Pt wid SOB, PFT showing restrictive pattern, dec TLCO inc KCO, cause of SOB? OBESITY
23) Pt suffering from COPD whose oxygen pressure was very low somewhere about 6.3.. which Rx is
going to be of greatest help? . LTOT
24) Pt underwent pneumectomy, wat will be normal on PFT? KCO
25) Pt had spinal cord lesion, which finding do u expect after 2 weeks? CLONUS??
26) Sarcoidosis, erythema nodsomprognosis? IMPROVE WID NO CONSEQUENCES
27) Pt started on methotrexate, took daily for a week instead of weekly dose, wat do u expect in him?
NEUTROPENIA/ HEPATIC DAMAGE ??

28) Gonorrhoea Rx? CIPROFLOXACIN

29) Anti emetic which act thru peripheral receptors? NABILONE
30) Upper lobe cavitating pneumonia? KLEBSIELLA
31) Alchoholic pt wid fever, pneumonia, heavy sputumlung abscess?.. wat imp information in
history will help u find the cause of symptoms? RECENT HISTORY OF ALCOHOL RELATED FITS
32) 1 week after influenza developed chest infection, b/l crackles, cause? STAPH AUREUS
33) 10 days after staying in ICU, in ward chest inf, b/l basal crepts, cause? MRSA
34) s/e cisplatin? HYPOCALCEMIA
35) BRCA-2 gene +ve, daughter is at risk of ? OVARIAN CA
37) Young child wid classical s/s of inf mononucleosis, thrombocytopenia. What 2 do? STEROIDS
38) Transgenic mice used 4 antibody proliferation n used therapeutically, technique known as?
RECOMBINANT DNA TECHNOLOGY
39) Young pt, spontaneous pneumothorax, 50% collapse on CXR, ABGs normal.what 2 do?
NEEDLE ASPIRATION
40) Pt with IgA def, which statement is true? LIKELY TO GET REACTION ON BLOOD
TRANSFUSION
41) Platelet count fail to rise after platelet transfusion, what to do now? HLA-MATCHED PLT
42) Pt getting TPN thru jugular vein. What is the most common complication of this practice?
INF.ENDOCARDITIS/ SEPTICEMIA??
43) F/H of deafness, hematuria n RBC casts, diagnosis? ALPORT SYN
44) Female pt took some weeds? Vegetables, developed goitre, mech? DYSHARMONOGENESIS

46) CARCINOID SYN

47) Hemachromatosis, screening test? TRANSFERRIN SATURATION
48) Ant mediastinal mass? THYMUS
49) HIV CD count 50, taking no med, fever + rt hemiplegia, CT multiple ring enhancing lesions,
fundus normal..diagnosis? TOXOPLASMOSIS
50) AML..test to find bad prognosis? % OF BLAST CELL ON BONE MARROW
51) Lymphoma, nodular sclerosing, bad prognosis? DRENCHING SWEATS
52) Eosinophilia..IL5

53) HBsAg +, HBeAg - LFT normal, PCR <400.what Rx ? DO NOTHING

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

yea i agree wid u

was under time pressure at that time in exam

didnt look for n analysed all options

anyways
screening for hemachromatosis is by

TRANSFERRIN SATURATION for general population

GENETIC ANALYSIS for family member of affected person

thanks
Guest, Sep 28, 2006
#9

6.

halit2006Guest

MRCP 1 12 09 2006

because of ineffective eryhropoesis i think the elevated enzyme is LDH

Bitemporal hemianopia, pituitary tumour with suprasellar extension, definitive Rx? SURGERY

PROLACTINOMA EVEN IF THERE ARE SIGHNS OF VISUAL COMPRESSION A TRIAL OF

DOPAMIN AGONSIT IS WARRANTED ICLUDING CABERGOLINE

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

Fibrate or Nicotinic acid would boost HDL.

ECG against LVH?

Right axis would go against LVH on ECG

Guest, Sep 29, 2006
#15

8.

GuestGuest

for macroprolactinoma, INVASIVE AND COMPROMISED VISUAL LOSS, Rx is surgery

(HARRISON)
Beside que asked for DEFINITIVE RX, not initial RX
Nicotinic acid raises HDL by 25-35%

" 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

while RCP says they will announce result on 9 oct,

i guess that it will be out on 6th oct FRIDAY

lets see [/b]

Guest, Sep 29, 2006
#19

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

What do u think about increased LDH?

It's also a possible answer!!

Dr_Osama77, Oct 1, 2006
#23

13.

GuestGuest

RESULT IS OUT

CHECK IT

I HAVE PASSED
Guest, Oct 6, 2006
#24

14.

GuestGuest

and see my guess above

ITS 6TH OCT, FRIDAY

Guest, Oct 6, 2006
#25

15.

KASHIGuest

TO doc5

congratulations doc5 on urs success.plz give urs advice & tips.

KASHI, Oct 10, 2006
#26

16.

new to mrcpGuest

12 09 2006 mrcp part one

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?

thanks all, hope to get reply asap

new to mrcp, Oct 10, 2006
#27

17.

GuestGuest

Thanks a lot for the questions......

Guest, Oct 29, 2007
#28
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Share This Page

few points from 22nd Jan MRCP 1 exam

Discussion in 'MRCP Forum' started by melosqueak, Jan 23, 2008.

Page 1 of 31 23Next >

1.

melosqueakGuest

Hey guys,

Few things I remember from today's exam. Hope they useful!

1) Few questions on differential diagnoses of sore throat e.g. EBV vrs. Strep. pyogenes

2) Parkinson like syndromes e.g. parkinson's vrs. supranuclear palsy

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

5) pharmacology; p450 enzyme inducers and inhibitors, lung fibrosis

6) Alport's syndrome

7) risk factors for crohn's disease e.g genetic, OCP

8) diagnosis of haemachromatosis vrs. PBC vrs. autoimmune hepatitis

9) hepatitis A vrs. HIV in young man

10) type on collagen affected in Marfans

melosqueak, Jan 23, 2008

#1

2.

GuestGuest

marfans was fibrillin-1

Guest, Jan 23, 2008
#2

3.

LJYGuest

Few more questions from MRCP exam on 22 jan

- Organ directly in contact with left kidney - Pancreas

- Dermatology .. red scaly circular lesions + very itchy...I thought the answer was Discoid eczema

- Acid base imbalance in Cushings - Metabolic alkalosis

- T1 lesion mostly associated with ....Horners syndrome

- Wasting of small muscles of hand - Ulnar nerve

- African lady with Ring enhancing lesions in the brain on scan - what is the Treatment? Pyrimethamine + Sulphadiazine

Respiratory system

A)occupational asthma ans pf messure 2 wks.

b)central chest mass with muscle weakness ans small cell carcinoma.

c)ca lung,contraindication of surgery ans superior vena caval obs.

d)mesothalioma ans niddle sreak seddling.

e)allergic alveolities ans upper lobe fibrosis.

Guest, Jan 23, 2008

#4

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

Question regarding specificity answer was D 93.2

workhard, Jan 23, 2008

#8

here are some of the questions that i can recall:

1)elderly men with visual symptoms and IG M monogammaglobinemia-waldenstrom
2)RA-painless eye-episcleritis (Answered Above)
3)Vit d rich source-cod liver oil,dairy products?
4)stastics-wat is power of study
5)how to calculate-sensitivity,
6)Wernickes dysphasia-meaning,location
7)ciprofloaxacin-liver enzyme inhibitors
8)causes of isolated increase in APTT
9)a man who firmly believes that his ears were large and need plastics surgery-hypochondriasis?
10)treatment of Af in structurally normal heart-flecainamide
11)young male 12 days history of generalized lymphadenopathy,sore throat,oral ulcers,macular papular
rash-acute hiv
12)rx of infective endocarditis
13)most diagnostic test for legionella pneumonia
14)rx of necrotizing fascitis in MRSA
15)erytematous papule-red elevated lesion
16)treatment of tinea rubrum
nancy., Jan 23, 2008
#9

5.

valliGuest

few more questions that I could remember

1. Genetic technique to test for DiGeorge --> FISH

2. What method to use for size specific RNA molecules with DNA probe?

3. Man with swollen and inflammed testis --> Clamydia trachomatis

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

5. Man who can look downwards --> Progressive Supranuclear Palsy

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?

8. T1 nerve root lesion --> Horners

9. Lady with joint pain, gritty eyes --> Sjogren syndrome

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

Num needed to treat

a girl took a handfull of her mother medx presenting with neck spasm>>>metchlopromide

physiological effects of thyroid >>>>>

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

auto induction of carbamzibines

confused elderly female>>>> startt IV normal saline

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 b serology ques

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

2 questions about respiratory function tests

i choosed one with asthma as she had low co factor & all the other answers makes the co raised ,the
other one was an obese lady so i choosed obese

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

alports found on renal biopsy what to expect i chosed sensoneurl defnease

cushings metabolic status >>i choosed hyocholremic acidosis & i am quite sure i am wrong

qustion about hypercholremic hypokalemia i chosed RTA 1

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

v5,v6 t wave inversion which art affected>>>> lad i choosed

cause of death in angio >>>cva or arrythemia

antichoinergic toxicity

how to know that a young girl took extasy >>>hyperthermia

alzhimers what to give>>> donbezil

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

recureent chest infection ,whats deficent >>>complement

some one with recurent hand & facial swelling >>levels of C1 esterase

SLE how ro monitor >>>>ANA

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

lady with lytic lesions in back bone whats the primary>>breast

cancers with RET proto oncogen i chosed calcitonin

men type1 how to mointor >>low IQ made me choosed catecholamines in urine ,i should be shot in
public

increased risk of smoking in a young smoking girls on ocp ,i chosed smoking

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)

granulomas 9in rectal biopsy >>crohns

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

azathioprine mode of action

colpidegrol mode of action

a couple of VWD questions

pt on dialysis for 5 years with back pain>>b2 microglobinemia

side effect more with acei than losartan>>>cough

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

question on malignant mesothelioma

root of sciatica (pt with typical sciatica pain which root is affected)

pt with oro-genital ulcers ,with leg pain>>>>venous thrombosis

HLA type of reactive arthritis

drug used to control AF in an asthamtic patient i choosed Amiodarone ( i think it was MAT multifocal
atrial tachycardia)

i think there was a quest on rate control of af i choosed dig

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

btw found this on gpnotebook

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

fusion of genes in pro myelocytic leukaemia(PML--RAR gene)

one answer was tertiary parathyroidism
two Questions of X- linked condition no son will be affected
Increased aPTT i selected Anti thrombin II(not sure)
one answer was COPD

The interpretation of blood sugars and GTT normal person

one answer was renal glycosuria not diabetes
macroglobilunuria
Atrial fibrillation rate control answer was Digoxin
The question with IGT and glucosuria with HPT - ? Cushing Syndrome
Big ears ,request surgery review--dysmorphophobia
Newscaster telling world matter to a patient--idea of reference
Pt with RA becames worse after treatment--MG

CLL with recurrebt RTI , the answer is deficent Ig G

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

yes ans was XI deficiency becoz i gave same ans

jokin mate u r rite.
Lab Studies:
An aPTT should be performed
according to emedicine.
Guest, Jan 24, 2008
#16

10.

docahmerGuest

jan 22 mrcp q recall

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

do onexam 3 times....and emrcp awsm stuff (thnx for keepin it free)

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....

1.Large ears -dysmorphophobia

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)

5.SMALL MUSCLES OF HAND _ t1 lesion (onexam)

6.RTA -1 coz hypokalemia, loin pain(calculus) and severe acidosis (mnemonic hypo-ren-cal-sev-dis=
hypokalemia, renal calculi, severe acido.sis)

7.V5,V6- lateral wall ischemia..signifies circumflex artery (emrcp)

8.CICLOSPORIN -nephrotoxic drug (1st complication in easterbrooke)

9.SLE MONITORING-think anti sm(most specific-kalra) am not sure

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

carbohydrate and then after 30 mins tk more food.. (refer bailey)

11.ERECTILE DYSFUNCTION -56 yo m pt with hypogonadism, lh fsh decrease, prolactin increase

slight....choices were asking for cause of er dys..vascular, hypogonadism,

hypopit, phychological, prolactin increase..ans: psychological...as erection is a parasympathetic process

(ohcm) further discussion warranted

12.NATURAL SOURCE VIT D- FISH OILS-not milk as milk and mmilk products are fortified with
vitd ...

13.Q ON SSRI WITHDRAWAL ABRUPT

14.PT HAD SINGLE EPISODE AF- WARFARIN FOR---6 months...if repeated then life long- refer

emrcp

15.SELEGELINE -MAO I INHIBITOR

16.T1 ROOT LESION-HORNERS

17.PARKINSONS PLUS CAN LOOK DOWN--supranuclear palsy(refer ohcm -steele olszewski

syndrome)

18.HAEMOPHILUS INFLUENZAE-ACUTE epiglottitis

19.MARFANS CONNECTIVE TISSUE COMPONENT-fibrillin-1

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

22.ORAL GENITAL ULCER - BEHCETS has dvt....

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)

24. VZV IG in unimmunized pregnant woman.

25.FACTOR V LEIDEN-defect seen is activated protien c resistance

26.HAS MILD SYSTOLIC DYSFUNCTION-RAMIPRIL-decreases afterload as dilates arterioles due

to angiotensin 2 antagonism ( onexam)
28
29.CLOPIDOGREL -MECH IS ADP ANTAGONIST (EASTERBROOK- MNEMONIC CaT
CLOPIDOGREL AND TICLOPIDINE HAVE ADP ACTION)

30.VARICEAL PROPHYLAXIS AFTER 2-3 EPISODES BLEED -PROPRANOLOL (actually

propranolol is used when theres no episodes of bleeding and u want to prevent , but

this patient had already undergone banding and other options were spironolactone...which didnt suit)

31.WHO GIVES ORDER TO STOP RESUSCITATION IN 18 YR OLD GUY -fiance, parents,

consultant on call, cheif of emergency (or smth)--think consultant and parents both r

correct

32.ASKED WHICH DECREASES PULM VASC RESISTANCE- NATURALLY- ADENOSINE-PGSMAY ALSO BE RIGHT( DISCUSSION WARRANTED)

33.BLOODY DIARRHOEA- shigella (emrcp) salmonella doesnt cause bloody diarrhoea

34.ECSTASY -HYPERTHERMIA

35.AFTER 3 DAYS REINFARCTION CHECK CKMB (ONEXAM)

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)

45.LITHIUM -HYDROCHLOROTHIAZIDE INTERACTION

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

49.gas used for calculating transfer factor--carbon monoxide

50.THYROXINE-increases insulin sensitivity

51.INSULIN RECEPTOR LOCATION-(-In molecular biology, the insulin receptor is a transmembrane

receptor that is activated by insulin. It belongs to the large class of

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

53.YOUNG LADY WAS CENTRALLY CYANOSED + BREATHLESS-40 yr old lady..presents ansr

is asd with eisenmenger...pulm htn cant b as thers no cyanosis in pulm htn and

cant b vsd either as it presents early( refer op ghai book of paediatrics)

54.complication of angio-ansrs were arrhythmia, coronary artery dissection, mi.....think its

arrhythmia....(discuss)

55.thalidomide mech of action- acts on cd8 lymphocytes

56.guy with symmetric rash on nose chin and cheeks with papules and pustules was rosacea(not simple
acne)

57.aberrant fusion of 2 genes in aml promyelocytic leukemia

59.pcod PT ALREADY DID CLOMIPHENECITRATE. IS OBESE AND FASTING GLUCOSE IS
INCREASED--DOC METFORMIN

60.HAEMOPHILIA--PTS NONE OF SONS WILL HAVE AS daddy contribute only the y

chromosome

61.immunophenotyping in CLL

62.GUY WITH TREMORS ONLY IN CERTAIN HAND POSTURES BILATERAL....BENIGN ESS

TREMOR( DISCUSS)

63CIPRO CAUSE DECREASED SEIZURE THRESHOLD (SEE PHILIPPA EASTERBRROKE)

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)

66.IDIOPATHIC URTICARIA -first treatment would b to try oral antihistamines as CETRIZINE...

(ONEXAM)-

67.two drugs op1 and op2 ,op1 binds with 10 times more affinity to the same receptor then means tht
op1 has more POTENCY

68.THT GIRL WAS TAKING EXOGENOUS INSULIN

69.GUY WITH ACUTE GOUT (ALCOHOLIC) TOOK ALLOPURINOL-acute exacerbation due to

allopurinol therapy (not alcohol binge-refer onexam)

70.mean is for taking average income

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)

72.C1 ESTERASE DEFICIENCY

73FLUOXETINE DEPRESSION NOT CONTROLLED - 2 ANSRS DOUBTFUL CITALOPRAM

AND LOFEPRAMINE-(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

penicillin as pt is havin no active infection

76.UNILATERAL MASTECTOMY FOR MALE PT...NOW PRESNTS WITH THE OTHER

BREAST ENLARGED---LH , FSH NORMAL.....OR INCR...KLINEFELTERS (NOT

KALLMANS AS NO ANOSMIA , and also kallmans is hypogonadotropic hypogonadism and lh fsh

will be decreased along with testosterone)

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

MANY QS U CAN ANSR IF U REMEMBER THIS

79.HYPERINFLATED CHEST WITH REDUCED TLCO AND FEV1/FVC RATIO 55% IS

EMPHYSEMA

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

INCONTINENCE AND NOT HOW TO PREVENT INFECTION--FOR FORMER ITS

OXYBUTININ i.e antichol..but for latter its intermittent cath..

81.pretibial myxedema --graves

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

as no edema why give a diuretic....ramipril decreases afterload therefore preferred (discuss)

85. CI TO LUNG CA SURGERY (SVC OBSTRUCTION)

86. TOXOPLASMOSIS - SULFADOXINE AND PYREMETHAMINE

87. Pulsus paradoxus Physiology ( dec. Lt. atrial filling)

88. Walder. Macroglobinemia --IGM PARAPROTIEN INCREASED AND ...THROMBOTIC

COMPLICATIONS

89. Check prolactin in asymptomatic MEN-1

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

91. VZV IG in unimmunized pregnant woman.

92. PT WITH RECURRENT CHEST INFECTIONS HAD CLL WAS ON PREDNISOLONE AND
ONE CYTOTOXIC I THINK CHLORAMBUCIL......HERE IMMUNOGLOBULIN

DEFICIENCY.....(REFER ONEXAM)

93.erytematous MACULE --FLAT RED LESION

94.pt on dialysis for 5 years with back pain=b2 microglobinemia

95.granulomas in rectal biopsy -------crohns

97.Question with absent corneal reflex i selected acoustic neuroma

98.DONEPEZIL-DRUG IN ALZHEIMERS

99. LEGIONELLA TEST WAS URINARY ANTIGEN

100. RA PAINLESS EYE -EPISCLERITIS...... (Answered Above)

HOPE U FIND MY EXPLANATIONS USEFUL...JUST TRYING TO GIVE BACK TO RXPGIANS

WHT THEY GAVE TO ME.....ANY CONSTRUCTIVE CRITISCISM

APPRECIATED...
docahmer, Jan 24, 2008
#17

11.

doctor for mrcpGuest

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

You only need to use warfarin for 4 weeks after DC Cardioversion :-

http://www.medscape.com/viewarticle/535333_print

(as this paper also says you can in some cases commence flecainide out of hospital)

84 - I agree ramipril only (mrcpass)

Wish I had done as well as you though.

Guest, Jan 24, 2008
#20

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

1) What is the cause of raised PHOSPHATE in CRF?

a)Dec 125 HO Vit D
b)Dec Phosphate Clearence
c) Hyper vitaminosis D

2)RET oncogene is aaassociated with

a) Anaplastic Thyroid CA
B) Folliculer Thyroid CA
c) Pappillary Thyroid CA

3)ECG finding of Hypothermia

a) Long QT Interval
b) Short PR Interval
c) II degree Heart Block

4) Thyorxine Causes
a) Enhance Insulin sensitivity
b) Dec Myocardial Oxgen demand
c) Dec elasticitiy

5) Thrombosis & raised IgM ass with

a)MGUS
b) Antiphospholipid Syndrome
c) M. Myeloma

6)Girl who took overdose of Ectascy

a)Hypernatremia
b)Hyeprthermia
c)Hyperthyroiddism

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

9) Pt with splenectomy, already had Pneumococus vaccine, next to do

a) Annual Pneumococcus Vaccine
b) No Rx for now
c) Regular Peniciilin

10) Acute epiglottitis is caused by

a) H.Influenza
b) Strep Pneumonie
c) EBV

11) Pt with HBVc Antibody & HBVs Antibody +ve with all other -ve
a)Carrier
b)Prevoius Immunization
c)Previously infected , now recovered

12) Acoutic Neuroma may presents with

a)Cerebeller Signs
b)Facial Weakness
c)Dysphonia

13)Which of the following may hamper recovery of RECOVERY of stroke

a)Dysphagia
b)Dysphonia
c)Hemiparesis

16)Chemotherapy results in
a) Necrosis

b)Sensecence
c)Mitosis

17)Rx of pyogenic liver abcess in Penicllin Allergic

a)Clindamycin + Metronidazole
b)Clindamycin + Ciprofloxacin
c) Vancomycin + Meropenem

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

21)Drug that affect on CD 20

a)Infliximab
b)Tratuzumab
c)Rituximab
My turn, Jan 25, 2008
#22

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

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.

Ref:Cancer genetics Web

WWW.cancer-genetics.org
a a asif, Jan 25, 2008
#24

18.

marieGuest

mrcpr jaun 2008

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

Here R the 190 Question of MRCP-1 on 22-01-08!!!

1. VZV IG in unimmunized pregnant woman.

2. Vit. C def( gum bleeding with multiple non-healing wounds on legs)
3. Bulimia nervosa (BMI 23 with dental erosions) other option: purgative absue
4. Alzheimer Rx donepzil
5. Life long penicillin to splenectomy pt.
6. Ret oncogene medullary Ca
8. Clopidogrel MOA
9. Iberstran in systolic dysfunction
10. Cons syndrome rennin:aldosterone
11. Metochlopropamide (torticollis)
12. Peritibial myxedema for graves dis.
13. Rosiglitazone MOA
14. Testicular feminization (female phenotype with normal ext. genitalia)
15. Marfan syndrome fibrillin-1
16. H.influenzae (epiglottitis)
17. Smoking inc. risk of crohns dis.
18. Pul resis. Dec. by epoprostenol
19. Acute inflammation marker (ferritin)
20. Propronol for vericeal prophylaxis
21. Valproate in pregnancy (mom Dx with epilepsy option included no Rx, phenytoin, gabapentin)
22. MS pt with 20 ml post void bladder vol. give anti-cholinergic( or intermittent catheterization)
23. Ecoli Beta lactamase positive, give ciprox
24. Shigella (man from Egypt with dysentery options include salmonella)

27. CKMB after 3 days to check 4 reinfarction

29. Boy with one kidney absent & nephrotic proteinuria give steroid trial( BP 126/66)so I didnt go
4 ace inhibitors
30. Rituximab
31. Emphysema
32. Lofepramine (after flouxetine in depression)

33. Hepc type 2 cryoglobinemia

34. N/saline for inc. Ca++
35. L3/L4 lesion
36. Psoriatic arthritis
37. Hypomagnesemia due to diuretics
38. RTA (normal anion gap acidosis) options include aspirin
39. PBC check AMA( also features of thyroiditis, pernicious anemia & sjogrens)
40. MR cholangiogram for P S Cholangitis( pt has Ul. Colitis)
41. Ecstacy 40deg temp.
42. Inc. po4 reabsorption in CRF
43. Mean 4 average income.
44. Diphtheria
45. C1 esterase def.
46. Cetrizine 4 cholinergic urticaria
47. Cholicalciferol def.(elderly woman unable to stand after squatting)
48. Binge alcohol +allopurinol=gout exacerbation
49. E.nodosum with oro-genital ulcers wats the cuase of legs swelling( recurrent thrombosis)
50. Dexamethasone in pt. with liver mets suffering from anorexia & wt.loss
51. Beclomethasone dec. exacerbations of COPD.
52. Same Q. as above repeated in second paper(here inquiry was regarding long-acting inhales steroids)
55. Affinity=potency(comparison of OP1 with OP2)
56. Benign essential tremors
57. Fragmented RBCs in HUS
58. How to check factor 5 leiden(late respose to protein C)
59. A-dominant pedigree (women with her brother & their mother suffering)
60. Exogenous insulin
61. EBV
62. HIV with atypical lymphos
63. Fansidar 4 toxoplasma
64. Copd(FEV1/fVC=74% with Kco 55%)man on ship-yard. Heavy smoker

65. ADH works on C duct

66. Ciprox causes fits
67. Immunophenotyping in AML
68. Abberant fusion in APML
70. Candida esophagitis in AIDS
71. V5-V6 Lt. circumflex A.
72. Metformin for fertility in PCOD
73. Klinefelter synd.( man with Hx of Mastectomy)
74. Hemophila father (no dis. In sons)
75. Alport syndrome with deafness
76. Contra-indication to surgery( Sup. Vena cava obst.)
77. Lasix-enalapril in LVf
79. Pulsus paradoxus physiology( dec. Lt. atrial filling)
81. Walder. Macroglobinemia
82. Muti-system atrophy
83. Check prolactin in asymptomatic MEN-1
84. Thallium 4 OA pt. with Hx of MI (pre-op assessment)
85. Insulin receptor location
86. Carbamezapine auto-induction
87. T1 lesion with horner
88. Legionella check 4 urinary antigen
89. Pt. with hypothermia (I wrote long QT)
90. Erythema ab igne Sq. cell Ca
91. Tertiary hyperparathyroid
92. Renal glycosuria/impared GTT?????
93. Morphine causes diplopia
94. Brocas area in post. Frontal
95. Family with PKCD how to check( I wrote linkage analysis)
96. Stills dis. Causes inc. ferittin
97. Short synacthen test for pt. with Addison and hypothyroid features

98. Ace inhibitor in memb. Nephropathy

99. Acne-rosacea
100. Abd. Digiti minimi in ulnar nerve palsy
101. EBV with rash given amoxillin
102. Thyroxine inc. insulin sensitivity
103. Plasma electrophroesis in MM
104. Amiodarone for A-fib rate control
105. Lithium-thiazide interaction
106. Flucloxacillin+gentamycin in I-endocarditis
107. Staph aureus in IV abuser with TR murmur
109. E. nodosum with knee arthritis( check CXR 4 sarcoid/TB)
110. R.A
111. Worst prognosis for RA =joint erosion
112. Erythromycin inc. gut motility
113. Mesothelioma with chance of seeding needle track
114. FISH for micro-deletion
115. Azathioprine MOA
116. Pt. with refracrory unstable angina (trop-t raised) give necorandil (or monis)
117. Wat is erythrematous macule? {LOL} red flat
118. Aloprost for raynauds
119. NNT(100/18-8)
120. Specificity(890/900)

122. Behcet disease( genitor-oral ulcers with neurological signs)

123. Pt. with pleural effusion on CXR; cant B tapped so wats next( I opted for bronchoscopy)
124. Pagets disease; wats next management step ( skull X-ray)
125. Parietal lobe lesion 4 astereognosis
126. Resperidone causes galacrorrhea
127. How to check diffusion capacity( CO gas)

128. Selegiline is MAO-B INHIBITOR

129. Dumping syndrome give dietry advice
130. Dietry source of vit.D(milk/fish)

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]

I. How to check RNA?(northern blot/in-situ hybridization)??

II. Wats most contagious organism(VZV/H.influenzae/others)??

III. Pt with crohns dis.(on rectal biopsy)

IV. Warfarin post-defib! Wats minimum duration(4 weeks/6months)??
V. Pancreas in direct contact with Lt. kidney
VI. Tachy/dilatation with atropine poisoning
VII. HbsAb+,HbcAb+(succeful Rx)not immunization!!

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

ACHILIS???????????????????????????????????????????????????????????????????? DOES ANY

BODY REMEMBER THAT Q?
marie, Jan 25, 2008
#27

21.

GuestGuest

ciprofloxacin causes tendon rupture - according to onexamination

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?????????

Last time the cut-off was 63.6% .

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

Fluroquinolone causes Achilles tendon rupture

Some more questions

I. How to check RNA?(northern blot/in-situ hybridization)??

II. Wats most contagious organism(VZV/H.influenzae/others)??
III. Pt with crohns dis.(on rectal biopsy)
IV. Warfarin post-defib! Wats minimum duration(4 weeks/6months)??
V. Pancreas in direct contact with Lt. kidney
VI. Tachy/dilatation with atropine poisoning
VII. HbsAb+,HbcAb+(succeful Rx)not immunization!!
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)

XIV. A case of Ca pancreas

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 [bleep]-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) .
shaheen., Jan 25, 2008
#34

24.

bossGuest

i think ans is IGT not renal glycosuria.

in reynauds use inoprost=prostacyclin
boss, Jan 26, 2008
#35

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

i also thought Hb .1 was an error.

anyway
regarding cons i ans ct abdomen
resistant depressioin should to add lithium i read in a metaanalysis study(though i ans citolopram)
boss, Jan 26, 2008
#37

27.

guest12345Guest

some recalls from 2008 jan MRCP1

1.Azathioprine MOA ,TPMT

2.Torticollis -metoclopramide

4.granulomas- crohns disease

5.decreased TLCO;empysema

6.legionella diagnosis urine antigen

7.acoustic neuroma-absent corneal reflex
8.hemophilia in father. none of sons will be affected
9.CML.Cytogenic karyotyping

11.treatment of toxoplasmosis,fansidar i wrote co trimoxazole,dont know why?

12.V5 V6 on ecg.no territory involved.circumflex involves I,aVL plus,minus V5 V6
13.large ears insisting on surgery, dysmorphia
14.alports- sensorineural deafness
15.post marketing surveillance,for adverse effects profile.
16.ant relation of kidney. pancreas
17.marfans- fibrillin protein
18.transplant rejection. cytomegalovirus
19.influenza fastest test.blood for PCR
20.female anorexic afraid to eat.phobic anxiety
21.acute epiglotittis H. influenza
22.occupational asthma.?skin prick
23.patient with parrots. ch. psittaci
24.ulnar nerve supplies flexor digiti minimi
25.something with absent knee jerk L3 L4
26.female not adjusted to death? adjustment disorder

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

NOW IHAVE 60 Q WHICH IM NOT SURE OF THER ANSWER

CAN ANY BODY TELL ME HOW MUCH THE PASS MARK POSSIPLY TO BE FOR THAT
EXAM ....
COULD BE MOR THAN 65% COULD BE???? PLEAS DONT SAY COULD BE
marie, Jan 26, 2008
#39

29.

Musa.Guest

girl took a handfull of her mother medx presenting with neck spasm>>>metchlopromide

physiological effects of thyroid >>>>>

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

auto induction of carbamzibines

confused elderly female>>>> startt IV normal saline

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 b serology ques

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

2 questions about respiratory function tests

i choosed one with asthma as she had low co factor & all the other answers makes the co raised ,the
other one was an obese lady so i choosed obese

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

alports found on renal biopsy what to expect i chosed sensoneurl defnease

cushings metabolic status >>i choosed hyocholremic acidosis & i am quite sure i am wrong

qustion about hypercholremic hypokalemia i chosed RTA 1

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

v5,v6 t wave inversion which art affected>>>> lad i choosed

cause of death in angio >>>cva or arrythemia

antichoinergic toxicity

how to know that a young girl took extasy >>>hyperthermia

alzhimers what to give>>> donbezil

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

recureent chest infection ,whats deficent >>>complement

some one with recurent hand & facial swelling >>levels of C1 esterase

SLE how ro monitor >>>>ANA

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

lady with lytic lesions in back bone whats the primary>>breast

cancers with RET proto oncogen i chosed calcitonin

men type1 how to mointor >>low IQ made me choosed catecholamines in urine ,i should be shot in
public

increased risk of smoking in a young smoking girls on ocp ,i chosed smoking

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)

granulomas 9in rectal biopsy >>crohns

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

azathioprine mode of action

colpidegrol mode of action

a couple of VWD questions

pt on dialysis for 5 years with back pain>>b2 microglobinemia

side effect more with acei than losartan>>>cough

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

question on malignant mesothelioma

root of sciatica (pt with typical sciatica pain which root is affected)

pt with oro-genital ulcers ,with leg pain>>>>venous thrombosis

HLA type of reactive arthritis

drug used to control AF in an asthamtic patient i choosed Amiodarone ( i think it was MAT multifocal
atrial tachycardia)

i think there was a quest on rate control of af i choosed dig

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

Thre was a Q about the absolut contraindication of regnancy.

The answer was pulmonary hypertension i think.
Guest, Jan 26, 2008
#45

30.

GuestGuest

this time will be around 70%

Guest, Jan 26, 2008
#46

31.

ammarmohy77Guest

jan22 2008 mrcp1

:? q on monitoring of SLE was c3 &c4

-reinfarction=kinases
-insulin receptors= in the cell mem
-ret-gene=medullary
-glycosuria=cushing
-I AM VERY SAD A LOT OF EASY QS I KNOW THE ANSWERS BUT I CHOOSE THE WRONG
ONE!!!! WHAT SHALL I DO??
ammarmohy77, Jan 26, 2008
#47

32.

ammarmohy77Guest

JAN22 2008 MRCP1

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

Found this on WebMD:

Bening essential tremor tends to occur while voluntarily maintaining a fixed posture against gravity
("postural tremor") or while performing certain goal-directed movements ("kinetic intention tremor")

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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Forums > UK Medical Zone > MRCP Forum >

january 2009 mrcp part 1 questions

Discussion in 'MRCP Forum' started by dr A, Jan 20, 2009.

Page 1 of 111 2345611Next >

1.

dr AGuest

im just after the exam

it was really hard for me..

some stuf i remebr,

1.cholesterol embolisation
2.dicrotic notch
3.cipro to avoid in pregnancy
6. diarrhoea, gastric ulcer--do gastrin leverls
7. de quarvains thyroiditis (painful)
8. firm thyroid- hashimotos
9.NsaidS causing ARF mechanism- ATN

10. post splenectomy overwhelming infection -pneumococcus

11- anti ro-heartblock in child

what was the commnest maligancy assoicated with non hodgkin lymphoma

-tonic puiple unreactive to light and slowly reactive to accomodation unilateral

-alzhimer disease uninary incontiance , grasp reflex, mood disorder
-concrete thinking
- basilar artery infaction - crossed hemiplegia 3rd nerve on one side and hemiplegia on the other side

-multiple sclerosis unsteadiness of the gait and sensory loss spastic paraplegia
rasha27, Jan 21, 2009

porasis of the saclp due to hairline affaction which is hyperkeratotic plaque

rasha27, Jan 21, 2009
#6

2.

rasha27Guest

i cant remmeber more

rasha27, Jan 21, 2009
#7

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

antinuclear antibody to confrim the diagnosis of ANA

rasha27, Jan 21, 2009
#9

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

pt with heavy peroid and have mild vwd------- desmopressin

achlaesia of the cardia
vipoma ----- hypkalemia secretory diarrhea
depressive illness ----- loss of interest
acute global amnesia
aysmetrical tremor---- idiopathtic parkinsomism

progressive supranular palsy---- upgaze paralysis, congitive impairment,falls

osteoarthtritis---- pain and swelling in base of the thumb

acute hepatitis A----- after 4 weeks jaudice dark urine

paget disease------- normal ca and p high ALP usually there is no ostelytic lesion in prostatic cancer

HIV diarrhoea not responding to cryptospodimium

implantable pacemaker sugery...diarrhoea-cl.defficile
von vilibrand-DDVAP/or tranxemic acid???
tricyclic toxicity:bicarbonate
MALT..eradication therapy???oral PPI
Cl.Defficile..cause cipro
Long standing RA-impaired renal function--Do rectal biopsy
SLE;membrnous GN
Huntingoton..Penetrance
peutz jehger...ASD
BNP--Decreases renine-aldosteron
QT-sodium blockade
VT-verapamil contra or adenosin
solid liquid-achalasia
megaloblastic anemia after gastric surgery...small bowl bact.overgrowth
pt for cholecystectomy-small percardial effusion..reasurance i ans????
assessment for aortic valve replacemnt---symptomatic pt
pain in the base of the thimb..osteoarthrits
spetic arthritis..joint aspiration..
joint aspiration__WBC-no organism,..intraaurticular steroid
left hip pain after chemotherapy;avascular necrosis????
which thyroid cancer-worst prognosis????papilary with lymh node mets or madulary with bones mets
or anplastic?????????really tough

heamophilia:mother carier..father heamophilic...in theor daughter..0% or 25% ?????

thas wt i remmber at the moment
burningice, Jan 21, 2009
#13

8.

burningiceGuest

nefedipin causes gingival hyperplasia

burningice, Jan 21, 2009
#14

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 ...

7)thumb pain ... ostearthritis

8)pain in the joint and no organism ... give analgesics first then go for intra articular steroids ?? plz give
ur veiws on this one
8)cipro to be avoided in pregnancy
9)side effects of valproate ... pt on OCPs ... wat alternative anti epileptic to choose ?? carbamazepine ??
lamotrigene is used as a second line or as an adjuvant?? no ?? plz comment
10) gal with polyuria of one week ... Na is NOrmal ... osmolality of plasma 300 something and that of
urine is 200 something ... psychogenic polyuria ..cant recal the full question ??
11) a man with transient gluteal itchy rash from africa ... shistosomiasis ??? or dranuclosis ?
12) itchy hyper keratotic leasion on the hair line .. tinea capitis(psoraisis is not itcy)
13)dermatitis herpitiformis ... IgA
14)MALT... H pylori erradication
15)maxalliray N...foraman ovale
16)one sided dilated pupil non responsive to direct n concensual light reflex... 3rd N palsy
there was a ques abt gonoccocus infection and immunoglobins likely to be deficient ... IgA 1 /IaA
2/IgG 1 /IgG2/IgM??? which one isnt ?i guessed IgG1??
17)diarrhea with blunted atrphic villi in small intestine .easinophilic inclusion .. giardiasis?
18)HiV diarrhea not responding to treatment ... crypococal
19)aneamia ... sperocytosis ... osmotic fragility ? or G6PD def ??
dr A, Jan 21, 2009
#16

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

chest x rays were noraml....i think it was emphysema

a-1 antitrypsin..smokers.PiSZ(pastest)
non-smoker--PiZZ
anorexic:refeeding:hypophosaphat
acromegaly:IGf
long qt is due to potassium channel blockade
1)CLL and plan for surgury .. no symptoms .. observation
2)aortic stenosis operate when symptomatic
3)pts is going to have tooth extraction under local anaesthesia .. pt of warfarin with stable INR ....what
to do ? continue warfarin ?or change it with heparin or asprin?
5)carotid angioplasty ...cholestrol embolism
6)chest pain ..ST elevation in V1-V6 and inversion in inferior leads...wat to find on angioplasty ...ant
decending 100 completely stenosed or 70 %? i dont think it was right coronary involved ... plz

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

cefuraxime causes pseudomembranous colitis

newday, Jan 21, 2009
#23

14.

dr AGuest

long QT is becoz of potassion channel blocker ..as caused by amiodarone

dr A, Jan 21, 2009
#24

15.

dr AGuest

1)yeah i think it was emphysema ..

2)anti trypsin levels MM 100%, MZ or SZ arround 50 percent...ZZ (15%)...mrcpass and oxford
dr A, Jan 21, 2009
#25

16.

dr AGuest

1) pt treated for chest infection ..develop pseudo membranous colitis ...

penicilline ...these are the commenest drug use for community acquired peumonia(step pneamococci)
2).

amiodaron is a k blocker,but it also blocks Na,,,,procainamide also causes

long Qt and it is Na blocker..its tricky
burningice, Jan 21, 2009
#27

17.

burningiceGuest

Hep B vaccine-check surface antigen.

MRSA..wash hands

In MI 100 occlusion is necessary have an ST elevation MI

70 % stenosis is a common finding that you could get in any ACS patient
Since it was an ant MI picture therefor the answer was 100% occlusion
patient going for dental treatment- continue warfarin in therapeutic range?
pitutary apoplexy?- in BP low, patient with head, and hemi anopia

rash in gluteal regios- dracunoculosis?

girl with fever and neck stifness and CSF picture-cryptococcus?
80 yr old female with cough ,diarhoea in hopital-legionnaries/listeria pneumonia?
digoxin loading dose- half life?

staph discitis? in pt with back pain follwinf defibrillator insertion?

most prominent feature in aortic dissection? back pain?
most poor prognostic for plantar ulcers in diabetic- previous ulceration or loss of foot arch?
heaturia with normal USS protein 3, next thing cystoscopy?
pt with hip pain aftr chemo- gout or avascular necrosis?
patient with limited internal rotation, knee pain.. but knee is normal-wt to do next?x ray pelvis? (to see
fracture neck of femur?)
pccasion when BNP would not go up?
BNP inhibits renin anldesterone?
imatinib inhibits tyrosin kinase
anti jo antibodies for SJOGREN?
patients with high JVP (6cm)- constrictive pericarditis?
depressive disorder (businessman not enjoyin life thinkin he has money problems)
man inappropriately dressed and shouting saying he can save children- hypomania?
psychotic depression for anothr question?

alcohol- patient sees dog near bed in hospital?

statssensitivity
man whitney u test
chi square test
reduces false positives

oxygen concentration 40%?(had to calculate it)

cipro to avoid in pregnancy?
Guest, Jan 21, 2009
#32

18.

salboyGuest

I would appreciate if some one could answer these questions Please

-Dignostic- of Aortic dissection??
-In Tooth extraction stop warfarin for 2 days only
-?? Pontine haemorrhage
-Fuction of L parietal lobe in a right handed person
A patient with splenomegaly in any leukemia what what other finding will you see ?? hepatomegaly
-L supraclavicular lyphnode ??
Cauda Equina (Answered Above)
- Colostomy site ?? contact dermatitis??pyoderma gangrenosum
-Firm thyroid?? Iodine def?? Atrophic hypothyroid
-Side effects of all the hypertensives what will you use I chose Minoxidil as it was the only one there
seemmed not used
- Any one written Erytheme nodosum some where
-

-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

-Hospital acquired pnemonia -- Gram - organisms

-?? Erythma Multiform in any response of skin
- action of spironolactone on which site
-cause of ARF in chronic analgesic ingestion in Rhumatiod pt
-27 yrs old with 5 cigs daily -2 yrs of haemoptysis intermittently?? bronchial CA?? forign body
- Hamoptysis with aspergillin test positive -B/G of TB - CxR apical solid shadow =arpergillin skin test
+ --- ??ABPA ?? invasive aspergillosis
-Any response like LTOT
- decision about stopk treatment in a Type 2 respiratory failure
salboy, Jan 21, 2009

#34

20.

dr AGuest

1)splenomegaly with leukodystrophic pic ...i wrote lymphadenopathy ....leukodystryphic pic is

associated with conditions which coz bone marrow invasions ..like myeloma,leukemia
,lymphoma....hepatomegaly is also a possibility ..it was difficult
2)gal with alopecia,mouth ulcers,fever arthralgia...ANA antibodies...SLE

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 ...

2)heamturia plus protein ..normal scan ..do renal biopsy

3)sensitivity for stat ques
4)proteinuria in pt with SLE>...membranous
5)flank pain with heamturia ...scan and urine no stone ...renal vein thrombosis ? cant recal the xact ques

8)itchy vesicular rash on trunk legs ...dermatitis herpitiformis

9)crops of vesicle pustule and crust on the body ...i think i wrote varicella
10)yellow crusted lesion on the chin of a young gal ...impetigo
11)pts up for surgury and have a small pericardial effusion ...everything normal ... proceed to the
surgury ??the other were do mamography or aspirate ...wat u guys say was the answer?
12)firm goitre with hypothyroid pic ...hasimoto thyrioditis

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

MRCP PART 1 JAN--09

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

MRCP PART 1 JAN--09

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 ???

dr A, Jan 21, 2009

#43

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

MRCP PART 1 JAN--09

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

thought if complete than it wud have been from V1-V6?\

4-pt wid peptic ulcer surgery had abdominal bloating, diarrhea.,
i wrote... chronic pancreatitis.dunno why
5- pt wid headache, anopia i wrote subarachnoid haemmorhage

6- chronic infl demyelinating -that's what i wrote too

7- rash at the gluteal region000 dracunculis..?
8- dig loading dose depends on volume of distribution
9- pt wid pacemaker insertion presents wid diarhea n lower back pain- staph discits
10- old lady wid confusion , cough , diarrhea - i wrote listeria meningits..legionelaire disease was an
option too?
11- hip pain after chemo since the time period was 6 months or more so it was avascular necrosis of the
hip joint...
12- aortic dissection prominent feature - back pain
13 - poor prognostic factors for planter ulcer in diabets.i wrote loss of vibration sense?
14-pt wid limited internal rotation ..knee pain but on xray knee was normal
options were xray pelvis, xray femur, arthroscopy knee-last one is the one i wrote
15- ulcer at colostomy site...invading the underlying muscle i wrote reactivation of the inflammatory
disease...other options were pyoderma gangrenosum ..?
16- mouth ulcer, alopecia arthropathy. young lady..i wrote ANA
17- accidental injury wid adrenaline. i wrote phentolamine, there was GTN ,b blocker in the options
18=cause of ARF in pt wid rhematoid arthritis using NSAIDS i wrote papillary necrosis...other option
was ATN
19- pt retired of a job loss of interest in everything...thinks he has less money wife states. there is no
money problem. i wrote depressive illness
20- man seemed detached from the surrounding world..disssociative disorder
21- Na valproate alternative is lamotrigine...it was at onexam
nnad, Jan 21, 2009
#45

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...

4-??breast CA on morphine drowsy ... ?????????anyone knoe the answer...

5-conus medullaris not cauda equina ...in e medicine
6-in hypoxia in which organ vasoconstriction occur....cerebral..skeletal....lung ..renal
7-in pt with leukoerythroblastic blood pic and sign aneima and spleenomelgy i think it's more likely
basal cracles as decompensated anemia not LN or hepato...
5555, Jan 21, 2009
#46

30.

GuestGuest

indication for glycoprotein 11B- 111A inhibitors- left ventricular thrombus?

female with limpaired internal rotation and pain in knee- X ray pelvis ( to exclude fracture neck of
femur)
after sodium valporate- lamotrigine?

phenytoin side effect? dequarvains and peripheral neuropathy

listeria pneumonia or legionnaires?
chronic demyelinating neuropathy?
bad prognosis for ALL- age or t (9,22).. the gal ws 20 yrs wchich ws outside the margin of 10 yrs
dracunoculosis?
40 percent for that calculation answer?
spherocytosis pt -next investigation- osmotic fragility?
Guest, Jan 21, 2009
#47

31.

GuestGuest

females rarely have G6PD deficiency(X LINKED) so i wrote spherocytosis.

Guest, Jan 21, 2009
#49

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?

dr A, Jan 21, 2009

#50
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Forums > UK Medical Zone > MRCP Forum >

MRCP Part 1 Jan 06

Discussion in 'MRCP Forum' started by yc, Jan 26, 2006.

Page 1 of 21 2Next >

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

Prolonged QT --> Torsades. How would you treat

Ans : Magnesium

Prolonget QT --> Which drug is causing them

Ans : ?sotalol

Pharmacology
Rash in sunlight
Ans : Amiodarone

Drugs causing pancreatitis

Ans : Lamotrigine. I think real answer is Carbamazepine

pancreatitis in pt with epilepsy and Htn - valproate( Choose nife )
Drugs causing polyuria
Ans : Lithium

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%

Patient with absense ankle reflex

Ans : Common Peroneal Nerve lesion

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

Ans : Chronic Pancreatitis

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

Patient with Raynauds, which is likely to suggest autoimmune disease

Ans : History of chillbains

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

Patient developing dementia, extensor plantar

Ans : ?B12 def.

Renal Medicine
Patient developing diarrhoea + renal failure --> HUS
Ans : Treat with dialysis?

Patient with nephrotic syndrome develops clot. Why?

Ans : dec. antithrombin 3
yc, Jan 26, 2006
#1

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

TI lesion, which dermatomes

Ans: dun remember

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

Patient with ?gonorrhea or nongonococcal urethritis

Ans : treat with doxycycline
yc, Jan 26, 2006
#2

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.

Athelet girl which hormone is suppressed - LH

2. Source of Folic Acid - Liver

3. Gentamycin Half Life - 2 hr

4. Erythromycin action in Gastroparesis - Gastric Emptying ( Made a mistake here- choose inh
bac overgrowth )
5. Relative risk - 10%
6. Specificity - 950/970
7.NNT - 100/18-8
8.Statin action - Inh endogenous synth of cholesterol
9.Cranial Nerve Palsy - Jugular Foramen
10.P value 0.01 in a study - 1 in 50 chance of drinking fruit juice helpful in crohns
11. WPW - radiofrequency abl
12. addition of 5th anithypertensive ,adverse effect --- ?
13. pancreatitis in pt with epilepsy and Htn - valproate( Choose nife )
14.Cannabis use with schizophrenic symp - drug induced schizo was not an option,is it
paranoid schizo?
15. PCR - DNA Amp
16 - breaking of polypeptide - Protease?
17. Clonig - right ans is Nuclear Transer ( Mistake )
18.Preg lady with PE - V/Q Scan
19. High Calorie - Cheese?
20. Pt with MI with BP 205/115 - ?
21 - Rate conrol in Af - Digoxin
22 - Pt with Patch on Back and rash - P.Rosea
23 - Pt with erisypelas ,which org - Strep.Pyogens

25 - Raynouds which is associted - history of Chilblains

26 - Diplopia,6th nerve palsy,contralateral leg weakness ,ext plantar - Brain tsem
infarc,pontine lesio,cerebellpontine,cerebellarhemorrhage --- ans ?
27 - treatment of Torsedes - Magnesium
28 - drug cusing torsedes - Sotalol
29 - refractory Asthma treatment - Magnesium

30 - retrosternal goitre - flow volume loop

31 - Asthma,Upperlode Collapse - Churg Staruss

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

59. malignant melanoma on rt arm,prognsis depends on - Depth of the lesion

60. Pt with symptoms of tamponade,best Inv - Echo
61. Pt received carbimazole,monitoring - TSH
62.Treatment of Hyperthyroidsm in preg - Propylthiouracil
63.pt with small cell ca,treatment - Chemo
64.Pt with headache,lacrimation - cluster
65.Another question on headache with hemiparesis - cerebral venous thrombosis.
66. Answered above Cholesterol embolism
67.T1 root lesion - ? Ans ( I choose Horners)
68. Pt with sore eyes,arthritis - Sjogrens synd
69.Pt with Lymphoma,which virus - EBV
70.Pt admitted with vague symptoms,multiple admissions - Somatisation
71.Pt with Neuroleptic maligant syndrome,which will be the other symptom - ?Fever (other
option is Limb tremor)
72. Treatment /Antibiotic for Tetanus - ? Ans (
Choose gentamycin ,is the correct ans Metro?)
73.Young girl with apthous ulcers - Crohns
74. Pt with arthralgia,skin lesions on the shins,diarrhea - Pyoderma gang
75.compression of common peroneal nerve at fubula - ? Ans - weakness of everters,loss of
sensation over medial lower leg etc.. no foot drop as an option
76.Pt diarrhea stopped after admission - Laxative abuse
77.Pt with anaphylaxis,raised BP stridor ,treatment - Options were Inhaled adrenaline,S/C
adrenaline,IV And IM adrenalline - ? Ans
78.One more question on adrenaline - cant remember exactly
79.Olanzapine blocks Dopamine 2 receptor,which other receptor would enhance it effect Options were Dopamine 1 ,Seratonin,Alfa 1 etc.
80. pt with cerebral embolism,dvt,what will u see on echo - normal appearence.
81. Outbreak of diarrhea on the ward . patients resolving after 48hr. ?close ward, isolate
patient etc.
82. 65yr old lady with Lt hemisphere cerebral infarct, has Lt complete stenosis, and 30%

stenosis in Rt Cart. ? no Sugery other otpions arterectomy.+/- angioplasty.

83. 36yr from Zimbabwe with calcification in bladder on X-ray- Schisto.
84. Patient with sarcoidosis what wud lead u to start prednisolone-? Hypercalceamia
85. RTA type 1 common attribute- Renal stones.
86. Post cholecystectomy bile stone is found best Ix- ?ERCP, CT.etc
87.Diabetic patient, notices swelling in knee a week later has calf tenderness and ankle
swelling-? backers'cyst #. cellulitis
88. myelofirbrosis likey feature- fatigue etc.
89. 68yr old man with AS what wud reduce pressure gradient across valve.- ?VSD, AR, MR
etc.
90. Sciatica with severe pain reqiured immediate symptom relief- ?Physio, Analgesia,intraepidural steroid, bed rest.
91. COPD with lobar pnemunia treatment. Amoxycillin, Clarythr+Amoxy, Ceftr, etc.

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

mediators? - receipient's T cells

104. bloody LP with predominantly lymphocytes (100%). Diagnosis - HSV encephalitis
105. Crytococcus vs toxoplasmosis- CT head with contrast?
106. Chronic alcoholic with visual hallucinations 3 days after admission - DT
107. Hep C treatment. What labs to follow? ALT, HCV RNA titers etc
108. presents with electrolytes imbalance suggestive of DI - medications? lithium
109. Works in the kitchen. Hand rash with fissures on finger pads. Manangement? ellioments,
gloves, etc
110. pt with heart failure on many medications. What else to add? carvedilol
111. pt with CRF. What would he most likely die from? AMI/IHD, etc
112. pt with odynophagia to both solids and liquids. next step investigation? esophageal
manomotry studies, etc
113. sick euthyroidism - low T3, elevated T4 and normal TSH
114. admitted for AMI, which test would suggest reinfarction? CK, AST, trop I, T
115. pt with intermittent palpitations associated with dyspnea n dizziness. occurs ~1/week.
investigation of choice? holter, loop recorder, event recorder, etc
116. Poor prognosis in CAP: BUN > 16
117. heroin addict admitted for pain control. drug of choice for pain control? diclofenac,
methadone, tramadol, etc..
118. Young pt out drinking, had a fall. admitted with neck stiffness. CT head normal.
investigation of choice: CSF investigation
119. father with VZ, wanted to fly to attend daughter's wedding. What to do? fit to fly, give
IVIG and fly, give -cyclovir and fly, not fit to fly, etc
120. features of hypersensitivity pneumonitis: eosinophilia, upper lobe fibrosis, neutrophilia,
etc
121. photosensitivity rash. which medication: amiodarone, aspirin, ACEI, etc
122. physical findings of a pt presenting with AN: fine hair on body ie lanugo hair
123. acromegaly seen for increased sweating. reason? sweat gland hypertrophy
124. action of statins: decrease liver production of cholesterol
125. best screen for hemachromatosis: ferritin level

126. pancytopenia and diarrhea: pernicious anemia, celiac disease, etc

127. leukamogenesis of acute promyelocytic leukemia: fusion of 2 genes?
128. recurrent pneumonia, elevated total whites with lymphocytosis. etiology? CLL, CVHG,
etc
129. 16 y/o out drinking - developed transient afib. management? lifestyle
130. family h/o PCKD. best screen? u/s all 1st degree relatives
131. microalbuminuria. best management? ACEI
132. action of aldosterone
133. site which remains impermeable to ADH.
134. action of DDAVP in vWD. released stored vWF
135. pt with headache and symptoms of temporal arteritis. next step? esr, prednisolone,
analgesics, CT head, etc
136. role of metformin in PCKD. increase peripheral glucose uptake? (decrease insulin
resistance)
137. role of NAC in paracet poisoning. replenish glutathione concentration
138. pt with polyuria, decreased libido. What tests to order? ferritin level?
139. HTN on multiple drugs. c/o edema. which drug? nifedipine?
140. htn, depression on multiple drugs and lithium. lithium toxic level - induced by which
medication? ACEI?
141. pathology caused by myeloma: activation of osteoclasts.
143. absent knee reflexes with extensor plantars: b12 deficiency
144. management of chronic fatigue syndrome
145. gastric adenocarcinoma on biopsy. what histological features: columnar cells, signet ring
cells, diminished goblet cells, etc
146. cushing's syndrome. what metabolic disorder? metabolic alkalosis
147. osteoporotic bone pain. on paracetamol. What immediate course of action? add
calcitonin? other analgesics
148. acute red eye: closed angle glaucoma
149. suicidal attempt on long acting propanolol. bradycardia unresponsive to atropine. next
course of action: glucagon

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

gr8 work by NATH. all of us must appreciate

Guest, Jan 26, 2006
#5

6.

GuestGuest

good work by all who have contributed

Guest, Jan 26, 2006
#6

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

Inv of choice for chronic pancreatitis - ERCP

DOC for ctrlling rate in AF- Beta/ Ca channel blockers

Treatment of torsade pointes- Mg

R u sure that the answer for the man who travelled back from africa is Dengue & not HIV

Feature of lat epicondylitis- difficulty in pronation

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....

Thyroid profile in Pneumonia patient: Hypothyroidism seen

Treaatment of chroni fatigue syndrome: antidepressants. Behavioural therapy is the 1st choice whic's
not given...decond choice is antidepressants

There was a Q on early morning headache....ans?

Rx of small cell Ca: chemotherapy

Olanzapine : action on D2 & serotonin receptor

Dr. Anoop George Alex

Guest, Jan 27, 2006
#8

9.

ycGuest

Additional info on questions + other questions.

Additional information added in blue

4. Erythromycin action in Gastroparesis - Gastric Emptying, relaxation of pylorus, release of

cholecyskinin

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

Additional recall questions:

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

158. Where is the G protein located ? membrane, mitochondrion, nucleus

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

appropriate management? tetracyline, topical retinoids, oral isoretinoin

164. drug causing proteinuria - Gold

165. prognostic factor in Pneumonia - Na 130, Urea 11 ?166

167.Pt with syncopal attacks,father has the same - Cardiac Syncope

168.Patient with nephrotic syndrome develops clot - ? ans

169.Patient develop lesion on the anus

170.Patient develop smooth lesion on forehead -Ans ?

171.pleural effusion - protein 40 glucose 1.5, what is the most likely cause - Mesothelioma

172.Patient with ?gonorrhea or nongonococcal urethritis,Antibiotic - ? Doxy

yc, Jan 27, 2006
#9

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).

those who are interested we have posted questions on mcqs.com as well,

Guest, Jan 27, 2006
#11

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

1. Which respiratory test for enlarged obstructive goitre?

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

2. young man severe guillain barre, FEV1 unrecordable, sats 95%

what is immediate management? choices: high flow oxygen vs intubation

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

I WILL SEND SOME OF QESTION WITH ANSWER OF MRCP I 24 -1-2006

1-LEADY PREGNANT 12 W PRESENTED WITH PALPITATION TREMER

TFT REVELD HIGH T3 T4 LOW TSH
ANSWER WAS OBSERVATION NO DRUGS

CROSS REACTIVITY OF TSH RECEPTOR BY HIGH HCG LEVEL IN FIRST

TRIMESTER

2-PATIENT WITH BLOODY DIARRHEA WITH HUS

TREATMENT PLASMA EXCHANGE

3-LEADY WITH MISSCHRAGE BEFORE WITH THROMBO EMBOLISM

TREATMENT WARFARINE INDEPENDTILY

4-OLD AGE WITH AF

TREATMENT WARFARINE

5- PATIENT WITH UREATHRAL DISGHARGE G NEG DIPLO COCCUS

TREAT MENT FIRST THIRD GENERATION CEPHALOSPORINE BUT NOT PRESENT IN
OPTIONS. SO TR IS CIPLOX

5 PATIENT TRAVEL FROM USTRALIA TO LONDON BY AIR LINE GET CVA

PATENT FORAMINE OVALE

6-PART OF KIDNEY IMPERMABLE TO WATER ASCENDING LOOP OF HENLE

OLD AGE WITH RECCERENT PNEMONIA HIGH WBC CLL

7-PROMYELOCYTIC LEK (M3) FUSION OF GENE(17-15)

8-patient with headace sign of temporal arteritis (prednosolone)

9-PATIENT WITH OAT CELL CA TREATMENT CHEMOTHERAPY

10 CARDIC PATIENT RECIEVE AMIODARONE GET PHOTOSENSEVITY REACTION

kadhaum ALAMOI, Jan 28, 2006
#15

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 preqnant lady with tremor and palpitatio

CROSS REACTIVITY OF TSH RECEPTOR BY HIGH HCG LEVEL IN FIRST

TRIMESTER .
because two hormones tsh and hcg have (common alpha unit)
propyl thiouracil is safe and can be use but is often unnecessary.

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

My contribution to Naths list.

thank you Nath for all your work.

here is what I want to add.

Additional questions I do not think are on the list:

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.

19. High calorie food- I think butter.

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.

90. Sciatica pain- physio.

My answers to the questions you did not specify the answer:

109. Works in kitchen, skin reaction: Wear gloves.

115. Intermittent palpitations - event recorder.

121. Photosensitivity rash - amiodarone.

135. Temporal arteritis - give prednisolone.

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.

163. Young boy with acne - I think isoretinoin.

170 Forehead lesion: I think sebaceous cyst. (Although no punctum, nothing else fitted this description.

So that is my contribution. Feel free to comment.

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

some Answers corrections

breaking of polypeptide: proteasome
rate control in AF: flecainide
child with sore thraot and heamaturia: hypercellularity
24 hour h/o bllody diarrhea: I think campylobacter
malignant melanoma: I think the site of lesion is the answer
COPD with lobar pneumonia, Rx: amoxicillin only!
lower right chest pain 15 minutes after liver biopsy?
hemobilia
bilairy peritonitis
pneumothorax
subphrenic hematoms?

what is the answer please?

shabana, Jan 29, 2006
#20

20.

GuestGuest

investigation for the diagnosis of a secoend mi within 3 days is the ckmb

Guest, Jan 29, 2006
#21

21.

GuestGuest

i think lower chest pain after liver biopsy ----------- subphrenic haematoma.

and thanx to all for ur help and corrections.

Guest, Jan 29, 2006
#22

22.

kadhaum ALAMOIGuest

regarding opthalmologica guestions

1-PATIENT WITH RT EYE PUPIL LARGE THAN LT EYE LOW RESPONCE TO LIGHT AND
ACCOMIDATION

HOLMES AEDI PUPIL

2-PATIENT WITH NEW VESSLE FORMATION IN EYE TREATMENT LASER THERAPY

PATIENT WITH PTB NEED LIVER F T BEFORE GIVEN ANTI TB

PATIENT WITH CHRONIC EXTERNAL ALLERGIC PULMONARY ALVEOLITIS

NOT ESONOPHILIA BECAUSE IT IS TYPE3 HYPER SENSITIVITY REACTION IMMUNE
COMPLEX REACTION
MY ANSWER WAS APICAL PULMONORAY FIBROSIS 2-Regarding rate control in AF its
digoxin(an av blocker) but fleccanide will be for the paroxism of AF
3-High calorie food i think its butter from the list as it has more than 65% fat 1g=9 kcal while cheese
has less that that
4-COPD imropve long prognosis long O2 THERAPY
i will be happy to see ur replys
Best of luck
Guest, Jan 29, 2006
#25

23.

shabanaGuest

diabetic patient with new vessel formation at optic disc. visual acuity in both eyes not affected (6/9).
what is the managment?

a-tight glycemic control

b-BP control
c-repaeat ophthalmoscopy in 3 months
d-aser treatment
e-couldnt remember the last option!!

asymptomatic patient has a brother with hemocromatosis

what is the screening test?
a- HFE gene
b- serum ferritin
c- serum iron
d-serum transferrin saturation
e- TIBC
shabana, Jan 29, 2006
#26

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

-POLYMYALGIA RHEUMATICA/ GIANT CELL ARTERITIS

-COULDNT REMEMBER THE LAST OPTION!!!
S

For Diabetic Retinopathy

Answer:::: Laser THerapy

Guest, Jan 30, 2006
#28

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.

Haemocromatosis - Agree T Saturation

COPD - LTOT
Melanoma - Not sure I choose depth of the lesion

Praying for all of us.

Nath, Jan 30, 2006
#29

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

regarding asympthomatic man . his brother has hemachromatosis

the screening test was

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

-couldnt rememcer the last option!!!!!!

a diabetic patient with microalbuminuria. what is he likey to die from?

hypertensive heart disease or dilated cardiomyopathy?
shabana, Jan 31, 2006
#34

27.

NathGuest

\Hi
I think its Renal failure due to diabetic nephropathy.Any comments.
Nath, Jan 31, 2006
#35

28.

NathGuest

a diabetic patient with microalbuminuria. what is he likey to die from?

hypertensive heart disease or dilated cardiomyopathy

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

regarding cushing s question associated with metabolic alkalosis

but in question put two options
1-hypochloriemic m alkalosis
2- hyperchloriemic m alkalosis

my answer option 1( hypo ch metabolic alkalosis )

kadhaum ALAMOI, Feb 1, 2006
#37

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?

Available marks are shown in brackets

1 ) bronchial carcinoma
[0]
2 ) cardiac failure
[0]
3 ) mesothelioma
[0]
4 ) rheumatoid arthritis

[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

not sure about the answer but I choose amox + clar,,.......anyone

cheers
Nath, Feb 1, 2006
#44

32.

shabanaGuest

what immediately reverses the effect of warfarin?

cryoprecipitate
fresh frozen plasma
oral vit k
parenteral vit k
?
shabana, Feb 2, 2006
#45

33.

kadhaum ALAMOIGuest

fresh frozen plasma

kadhaum ALAMOI, Feb 2, 2006

#46

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?

sawsan s, Feb 2, 2006

#48

35.

shabanaGuest

smoker with expectoration of cupfull of sputum daily

how to diagnose? was the answer spirometry or high resolution CT chest?
shabana, Feb 3, 2006
#49

36.

GuestGuest

spirometry

MRCP part 1 sept. 2009

Discussion in 'MRCP Forum' started by zafar_nzr, Sep 22, 2009.

Page 1 of 141 2345614Next >

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

Very tough 2 paper,

Aspirin for AF
echo for tarzmib!! and duboxtine!!
Factor V
Pneumo carinii pneumonia

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

Please keep posting

Thank u for opening this topic
M SOLIMAN, Sep 23, 2009
#3

4.

dr_mohammedGuest

splitting of second heart sound: LBBB

SVC: immediate management, I think stenting as radiotherapy requires 2 weeks
amlodipine for the elderly on lethium
ciclosporin nephrotoxicity for the patient with increasing creatinine and on fluconazole
there was a question about someone with both hypokalemia and hypercalcemia, I picked
hypomagnesemia

the boy with teratoma, follow up by alpha-fetoprotein and hCG

the female with secondary amenorrhea, i think it was premature ovarian failure
regular narrow complex tachycardia: AV re-entry tachycardia with accessory pathway
High levels of IgM: Walendstrom macroglobulinemia
The patient with SAH are likely to develop hydrocephalus
r u sure we should give aspirin in AF rather then warfarin ?
Immo, Sep 23, 2009
#5

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

another tough question patient with paracetamol od investigations shows

INR 2.1
Cewatinine 200 plus
ph 7.1
alt 1348
fasting BM 2.2

which indicate for possible liver transplant

*the plural effusion is exudate with protein content of 50 that is mean more than 30
* if the ph less than 7.3 it is sure for liver transplant

* 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

LBBB causes reversed splitting not a fixed splitting

Guest, Sep 23, 2009
#8

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

Myoglobulin is the first cardiac marker

That lady with a facial skin lesion coming from Brazil, was it Discoid lupus?
In general, how do you all rate this exam, was it tough or reasonable?[/b]
was it not cutanoeus leshmeniasis lady from brazil
Immo, Sep 23, 2009
#18

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

question asking for treatment of atopic dermatitis

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

thanks majeed for discussion

Immo, Sep 23, 2009
#21

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

I chosed type IV delayed as it is the 2nd exposure

M SOLIMAN, Sep 23, 2009
#24

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 control rate in patients with atrial fibrillation

beta-blockers
calcium channel blockers
digoxin (not considered first-line anymore as they are less effective at controlling the heart rate
during exercise. However, they are the preferred choice if the patient has coexistent heart failure)

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

Factors favouring rate control

* Older than 65 years
* History of ischaemic heart disease
Guest, Sep 23, 2009
#25

17.

ImmoGuest

patient with bruising and blisters

Hb stable but platelets only 5
no neurology

prednisolone
platet transfusion

the patient with exudative tonsillitis the true answer is

guttate psoriasis which is common after streptococal infection and usally in young people
Guest, Sep 23, 2009
#27

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

i agree with you immo it is a predinsolone not platlet trasfusion

Guest, Sep 23, 2009
#30

21.

GuestGuest

CTPA is the best options

Guest, Sep 23, 2009
#31

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

patient with bruising and blisters

Hb stable but platelets only 5
no neurology

prednisolone (ITP) PASSMEDICINE

0 weeks pregnant lady with pleuritic chest pain and left calf pain
what investigation

CTPA (LESS RADIATION)

thank u Immo
M SOLIMAN, Sep 23, 2009
#33

24.

ImmoGuest

some surgical questions in mrcp

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

0930 570 ( normal )

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

patient develops lesion o to his left hand 4 yr after renal transplant

? cut lymphoma

lady with severe right forearm pain during weekdays , extension of wrist cause severe pain , unable to
hold pain or cup

? radial tunnel syndrome

lat or medial condyle
pronator sydrome

question about T1 dermatome problem

95 yr old gentleman 4 admission with confusion 1 time chest infection 3 times UTI
next investigation
?cystoscopy

preg lady with uti which abx

? cephalosorin

mycoplasma pneumonia , patient not toleratind clarithrymycin what to give alternate , no other
macrolide was in option

bronchiectais what abx to prescribe

? cipro

what investigation for bronchiectasis

HRCT

young lady with recently diagnosed PHT which will make her condition severe
fatigue
wheeze
syncope
Immo, Sep 23, 2009
#43

34.

GuestGuest

Anti ccp was poor prognosis

mycoplasma pneumonia you can use doxycycline
Guest, Sep 23, 2009
#45

35.

GuestGuest

Drug cause diarrhea..?cyclosporin

patient talking Doxirubicin..?eccho

question on probability(p value) ...i think , At least as exterme as 5%

mouth ulcers, diarrhea, thrPombophelebitis..?Behcet

Pt felling worms under her skin...?somatoform

ttt of Strongyloidosis...?Albendazole

H. Influanza with B-Lactamase...?Vancomycin

female 30 years with proximal weakness and ++CK....Limb and girdle myopathy

Pt with ascitis and pain.... ascitic fluid cytology

Multi-Risistant TB...No idea

Guest, Sep 23, 2009
#46

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

4: Stroke with AF: Aspirin

5: Hashimatois thyroditis : TPO thyroid peroxidase antibody
6: alpha one antitrepsin deficiency: autosomal ressive
7: low mood, apathy and gait ataxia, MRI generalised atrophy: Hungtinton disease
8: a yong lady with recurrent monthly migrain attack not responding to paracetamol and aspirin:
Sumitriptan
9:
Guest, Sep 23, 2009
#47

37.

ImmoGuest

Mode of inheritence of Alport syndrome

?x linked dominant

patient after lap chole , mrsa seticaepia

? iv vanco

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

Important prognostic features in HD is

_ B symptoms- Fever /night sweats/wt loss
- Mediastnal mass >10 cm
MRCP Forum
>
RECALLS FROM 2010/02 11MAY PART1
Discussion in 'MRCP Forum' started by PHD, May 11, 2010.
Page 1 of 6
123456Next >
PHD
PHD
Guest
Wow...tht was some fun...
I'm jus tryin to rememb the questions as m sure they'll fade frm memory within a week..
So lets jus try to rememb all the questions first..
Along the way the ones who r sure of the ans..plz keep addin ans..

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,

It was really fun ;)

7h/200 q giving me headache.

the first 30 or so qx of 2nd paper were terrible.

I hope all of u done well,

I will try to recall/post some

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

...will update more...mental block, need food!

booster28, May 11, 2010 #4
Immo
Immo
Guest

RESPIRATORY

1. mediastinal lymph node what investigation first ? ct ? mediascopy

2. father has copd , son non smoker but reduced fev1 and looks obstrictive picture ? obliterans
3. non smoker malignancy shadow on cxr but bronc normal ? adeno ? small cell
4. asthma not settling with steroids 800 and prn salbutamol ? add salmeterol
6. pneumonia curb criteria raised urea
7. pregnant lady blood gas showing resp alkalosis ? hyperventilation
8. right upper zone shadow weight loss h/o of tb , aspergillus positive ? ca ? tb ? aspergilloma
9. peripheral neuropahty causung drug patient on hiv and tb drugs
10.inr decrease after starting tb medicine ? rifam
11.patient spray paint worker worse at work but settled laterin week investigation ? serial peak flow
12.siadh causing ?upper lob collapse
13. patient suffering from pulmonary thromboemolic disease what will happen to his lung ? reduced
tlco ? increased compliance etc
Immo, May 12, 2010 #5
Immo
Immo
Guest
CARDIOLOGY

aortic valve with anaemia ? angiodysplasia colonscopy vs angio

pda what pulse ? collpasing
pt collpase h/o of MI ecg showing st elevation without chest pain q waves and no reciprocal changes ?
vt
3. VT cause ? low Magnesium
4. patient on lithium need to start HTN medication
5. patient on bendro still having high bp had side effects of fluid retention / gum bleeding /lehtargy /
with other HTN medication what next ? beta blocker

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

1 Leucoerythroblastic picture causes

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
6. 2 question about hodgkin lymphoma
7 thyroid swelling with lymph node enlargement
8 soon starting chemo patient having agitation / suicidal thoughts ? steroids psychosis
9. burkit lymphoma nmyc gene
10. hs investigation osmotic fragility test
11 .patient anaemic low ferritin low mcv ogd and colonscopy normal ? sideroblastic anaemia
Immo, May 12, 2010 #7
Immo
Immo
Guest
Here are some recollections answers may be wrong ,
add if you remember the full question or correct answer for discussion please

1 Leucoerythroblastic picture causes

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

6. 2 question about hodgkin lymphoma

7 thyroid swelling with lymph node enlargement

8 soon starting chemo patient having agitation / suicidal thoughts ? steroids psychosis

9. burkit lymphoma nmyc gene

10. hs investigation osmotic fragility test

11 .patient anaemic low ferritin low mcv ogd and colonscopy normal ? sideroblastic anaemia

12. aortic valve with anaemia ? angiodysplasia colonscopy vs angio

13 pda what pulse ? collpasing

14 pt collpase h/o of MI ecg showing st elevation without chest pain q waves and no reciprocal changes
? vt

15 VT cause ? low Magnesium

16. patient on lithium need to start HTN medication

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

22.patient had acute now oliguric ? lvf ? rvf ? hypovoumia

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

28. mediastinal lymph node what investigation first ? ct ? mediascopy

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

33. pneumonia curb criteria raised urea

34 pregnant lady blood gas showing resp alkalosis ? hyperventilation

35. right upper zone shadow weight loss h/o of tb , aspergillus positive ?

ca ? tb ? aspergilloma

36. peripheral neuropahty causung drug patient on hiv and tb drugs

37.inr decrease after starting tb medicine ? rifam

38.patient spray paint worker worse at work but settled laterin week investigation ? serial peak flow

39.siadh causing ?upper lob collapse

40. patient suffering from pulmonary thromboemolic disease what will happen to his lung ? reduced
tlco ? increased compliance et

41 . 2b 3a inhibitor 2 patient with trop positive awaiting for angoi

42. clopigogrel adp inhibitor

43. after MI sliding scale what rate of insulin ? rate 6-8

44 . obese lady failed sulphonylurea low gfr what next ? exenatide

45 . high cholesterol with raised tsh what treatment ? thyroxine

46 . od of 80 tab thyroxine 24 hr later treatment ? beta blocker

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

49. raised ALP back pain pagets

50 . question about Diabetes inspidus check aldesterone and renin

51 . question of hypokalemic hypertension

53 ulcer operation symptomatic check gastrin level

54 . terminal ileum surgery bacterial overgrowth , similar question but high mcv i thik asking for
megaloblastic anaemia

55. one small kidney what investigation MR angio / arterio

56. venous ulcer what next ABPI

57 . seizure after normal viaginal delivery ? cortical thrombosis

58 . meningits picture ? listeria not sure the correct answer

59 . acute TRANSPLANT rejection IgG

62 , syringomyelia question

63. parietal lobe acalculia

64 . temporal lobectomy ? agnosia ? aphasia ? quadrantopia

65 . NNT - 1/ EER-CER

66. seminoma cured after chemo asking for physiology ;-(

67 . most common genetic disorder >? chromosomal ? mitochondrial

68. thyroid swelling and lymphnode ? Hashimoto

70 . anti ro crossing placenta to new born

71 . common perineal nerve damage question

72. cellulitis showing MRSA what should be added along with vanco

73. cipro causing tendon damage

74 . diarrhoea after chinese restaurant bacillius

75 .diarrhea outbreak on a ship ? nora ? rota

76 . prolong offensive diaarhea after returning from asia ? Giardiasis

77. anaemic after trip to india ? hook worm

78 .eosinophilia after trip to uganda ? shistosomia

79 . EAA upper zone fibrosis

80. diarrhoea with blood salmonella

81 diarrhoea e coli

82 . prolong bloody diarrhoea raised inflammatory marker what test ? stool microscopy ? rigid
sigmoidoscopy ? colonscopy ? axr

83 . peptic ulcer still symptomatic check gastrin level

84 . acromegaly what investigation fasting growth harmone/ growth harmone supression / MR

pitutiatry

85 . HSP what antibodies IgA

86 . membranous nephropathy what treatment ? prednisolone

87 . vasculitis what treamtment along with pred ? cyclophos

89. recurrent renal calculi / family history as well ? cystinosis

90 . treatment to prevent renal calculi ? diuretics

91 . sle c4 defieciency

92. ? ethanol for methanol poisoing

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 ?

95 . HIV skin lesion ? kaposi ? molluscum contagisum

96. HIV single ring enhancing lesion ? toxo ? TB

97 . wilson low serum copper

98 . tricyclic overdose treatmetn bicarbonate

99. intention to treat

100. sudden painful loss of vision ? glucoma

101. right pupil large not reacting to light but on convergence become smaller then left ? Argyl
robertson ? home Adie

102. 2 questions of restless leg syndrome answers ropinorole i think

103. splenectmoy when to give pneumococcal vaccine 1 week or 1 month before no option of 2 week

104. aortic dissection what else may present HTN

105. ITCHY lesion dissaperaing spontaneously treatment ? pred ? dapsone

107. psoriasis investigation question

108. chronic pancreatis ? faecal elastase ? faecal fat

109. autonomic features with parkinson shydrager (mutisystem atrophy)

111. alzhemer short term memory loss

112. uc deranged LFT ? PSC

113. UC chance of having malignancy ? prolong inflammation

114. peritoneal dialysis infection which organism ? staph epiderm

115. HHT autosomal dominant

116. acute liver injury prognosis ? PT / ? Bilirubin

117 . sign of decompensated liver disease ? ascites

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

121 . noisy scertion palliative patient intracerberal bleed ? transdeermal hyoscine

122. drug ( Alcohol ) induced porphyria , lady partying now abdo pain and agitated
124. wernicke / delerium tremens

125. phenytoin levels not decreaing in renal failure patient why

126. acetylar status which drug hydralazine

127. graves disease what will be present ? myxedema

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

130 . amyloid do rectal biopsy

131. augmentin cholestatic jaundice

132. question about primary hyperparathyroidism

133. patient on bendrofluthiazide having low k whats the mechanism

134. pain in the wrist and forearm while using hammer ? lat epicon ? ulnar neuropathy ? tennis elbow

135. paranoid schizophrenia

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

140. bitempral hemianopia --> optic chiasm

141. after starting gout painful wrist knees and elbows ? allpourinal induced

143. insulin in gestational diabetes

144. TH2 ----------------> IL4

145 . recurrent infection in lymphoma patient ? complent def

146. transient global amnesia

147.acoustic neuroma ? loss of corneal reflex

148. HUS and and anaemia what type of cells showing in microscopy howell / target / cast etc

149 . role of BRCA genes

150 . achalsia ? decrease peristalsis wave

Immo, May 12, 2010 #8
mrrc
mrrc
Guest

thanks alot for typing virtually all the questions out! :D :D

mrrc, May 12, 2010 #9
Guest
Guest
Guest
GREAT Immo
thanx
Guest, May 12, 2010 #10
walkojalko
walkojalko
Guest
Anybody know how many questions in average you cen get wrong and still pass?
walkojalko, May 12, 2010 #11
asya
asya
Guest
hello
hope u all will pass
if any can remmber more Q and the choice for each
what source did u use for the exam??was it enough?
what about the basic Q in exam..it was difficult ,dont u think so???
i sit for exam in ksa and they exculde Q no 85 did it ocur with some one els???how will be the score
mabged???
asya, May 12, 2010 #12
Guest
Guest
Guest
Yes, they excluded q 85 in LONDON too.
Guest, May 12, 2010 #13
Guest

Guest
Guest
Yes, they excluded q 85 in KUWAIT too.

thanks alot IMMO.....

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????????????//////

32.elbow movements affected_compartment syndrome????????///// 33.acute tubular

necrosis???????????????//////////////////// 34.night out agitated with bp 150/100-ectasy
35.pica???????////////////// 36.syringomyleia with c4-t1 lesion?vibration of hands 37.37year old affected
with htn on discontinuing med due to adverse affects as gum bleeding and ankle sweeling now on
bendroflumethiazide and still thn next treatment -perindoprill since ca channel cause gum bleeding
39.60 yr old with back pain and ca inc-hyperparathyroid 40.saturation kinetics-phenytoin 41.acetylator
-hydralazine 42.nitrates-tlolerance 43.htn pt on lithium and antidepresant with raynauds -amlodipine
since both bp and raynauds will b covered 44.renal transplant -a.hla A/B/C/D/G?????????//////////////////
45.CLL-HYPOGAMMAGLOBINAEMIA so low igs ???????? 46.valsalva
manouvre-????????????????????? 47.16 weeks pregnant 2 hr ogtt 12.5 so soluble insulin 48.old man
agitated man with agitation and refusing to go out and does not like his children does not visit himagoraphobia 49.waspbee keeper-drug induced remainig so hope we all pass
Guest, May 13, 2010 #24
guest23
guest23
Guest
exam was hard
guest23, May 13, 2010 #25
DR_MAHMOUD
DR_MAHMOUD
Guest
HERE ARE MY ANSWERS ALSO NOT SURE ABOUT THEM
1 Leucoerythroblastic picture causes >>>DONT REMEMBER

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

6. 2 question about hodgkin lymphoma

7 thyroid swelling with lymph node enlargement >>>LYMPH NODE BIOPSY

8 soon starting chemo patient having agitation / suicidal thoughts ? steroids psychosis
>>>DEPRESSION??

9. burkit lymphoma nmyc gene >>SAME

10. hs investigation osmotic fragility test >>SAME

11 .patient anaemic low ferritin low mcv ogd and colonscopy normal ? sideroblastic anaemia
>>>SAME

12. aortic valve with anaemia ? angiodysplasia colonscopy vs angio >>>COLONOSCOPY

13 pda what pulse ? collpasing >>SAME

14 pt collpase h/o of MI ecg showing st elevation without chest pain q waves and no reciprocal changes
? vt >>>CEREBRAL EMBLOISM

15 VT cause ? low Magnesium >>>SAME

16. patient on lithium need to start HTN medication >>>DOXAZOCIN??

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

22.patient had acute now oliguric ? lvf ? rvf ? hypovoumia >>>RVH

24.angina on ett with st depression which drug shows improve prognosis ISMN / NITARES /
DILTAZEM >>>NITRATES??

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

28. mediastinal lymph node what investigation first ? ct ? mediascopy >>MEDIASTIANOSCOPY

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

33. pneumonia curb criteria raised urea >>SAME

34 pregnant lady blood gas showing resp alkalosis ? hyperventilation

35. right upper zone shadow weight loss h/o of tb , aspergillus positive ?

ca ? tb ? aspergilloma >>ASPERGILLOMA??

36. peripheral neuropahty causung drug patient on hiv and tb drugs

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

39.siadh causing ?upper lob collapse >>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

42. clopigogrel adp inhibitor >>SAME

43. after MI sliding scale what rate of insulin ? rate 6-8 >>SAME

44 . obese lady failed sulphonylurea low gfr what next ? exenatide >>SAME

45 . high cholesterol with raised tsh what treatment ? thyroxine >>SAME

46 . od of 80 tab thyroxine 24 hr later treatment ? beta blocker >>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??

50 . question about Diabetes inspidus check aldesterone and renin

51 . question of hypokalemic hypertension

53 ulcer operation symptomatic check gastrin level >>SAME

54 . terminal ileum surgery bacterial overgrowth>>>I THINK IT IS FAT DIARHEA AN I

REMEMBER
, similar question but high mcv i thik asking for megaloblastic anaemia

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

56. venous ulcer what next ABPI >>SAME

57 . seizure after normal viaginal delivery ? cortical thrombosis >>CANT REMEMBER

58 . meningits picture ? listeria not sure the correct answer >>SAME??

59 . acute TRANSPLANT rejection IgG >>SAME

62 , syringomyelia question >>ANY ANSWERS PLEASE??

63. parietal lobe acalculia >>SAME BUT FOR DISCUSSIONS

64 . temporal lobectomy ? agnosia ? aphasia ? quadrantopia

65 . NNT - 1/ EER-CER >>DONT ASK ME IN STATESTICS!!!!

66. seminoma cured after chemo asking for physiology ;-(>>>ALSO:(

67 . most common genetic disorder >? chromosomal ? mitochondrial

68. thyroid swelling and lymphnode ? Hashimoto >>SAME

70 . anti ro crossing placenta to new born >>SAME

71 . common perineal nerve damage question >>SAME

72. cellulitis showing MRSA what should be added along with vanco>>RIFAMP

73. cipro causing tendon damage >>SAME

74 . diarrhoea after chinese restaurant bacillius >>B CERIUS

75 .diarrhea outbreak on a ship ? nora ? rota >>ROTA

76 . prolong offensive diaarhea after returning from asia ? Giardiasis >>SAME

77. anaemic after trip to india ? hook worm >>SAME

78 .eosinophilia after trip to uganda ? shistosomia >>SAME TTT PRAZIQUANTIL

79 . EAA upper zone fibrosis >>SAME

80. diarrhoea with blood salmonella >>SAME

81 diarrhoea e coli >>SAME

82 . prolong bloody diarrhoea raised inflammatory marker what test ? stool microscopy ? rigid
sigmoidoscopy ? colonscopy ? axr >>ABDOMINA X RAY(DONNU Y?!

83 . peptic ulcer still symptomatic check gastrin level >>SAME

84 . acromegaly what investigation fasting growth harmone/ growth harmone supression / MR

pitutiatry >>MR PIT

85 . HSP what antibodies IgA >>MESANGIAL CELLULARITY??

86 . membranous nephropathy what treatment ? prednisolone >>>ACE ??DISCUSS PLEASE

87 . vasculitis what treamtment along with pred ? cyclophos>>SAME

89. recurrent renal calculi / family history as well ? cystinosis >>CYSINURIA

90 . treatment to prevent renal calculi ? diuretics >>SAME

91 . sle c4 defieciency >>>SAME

92. ? ethanol for methanol poisoing >>SAME

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??

95 . HIV skin lesion ? kaposi ? molluscum contagisum >>>KAPOSI

96. HIV single ring enhancing lesion ? toxo ? TB >>TOXO

97 . wilson low serum copper >>SERUM CERRULOPLASMIN??

98 . tricyclic overdose treatmetn bicarbonate >>sAME

99. intention to treat >>>SAME

100. sudden painful loss of vision ? glucoma >>SAME

101. right pupil large not reacting to light but on convergence become smaller then left ? Argyl
robertson ? home Adie >>HOLME ADDIE

102. 2 questions of restless leg syndrome answers ropinorole i think

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

105. ITCHY lesion dissaperaing spontaneously treatment ? pred ? dapsone >>PREDNISLONE

107. psoriasis investigation question

108. chronic pancreatis ? faecal elastase ? faecal fat >>FECAL ELEASTACE??

109. autonomic features with parkinson shydrager (mutisystem atrophy)>>SAME MULTI SYSTEM
ATROPHY
111. alzhemer short term memory loss CANT REMEMBER

112. uc deranged LFT ? PSC >>SAME

113. UC chance of having malignancy ? prolong inflammation>> CANT REMEMBER

114. peritoneal dialysis infection which organism ? staph epiderm>>STAPH AURIOUS??

115. HHT autosomal dominant >>sAME

116. acute liver injury prognosis ? PT / ? Bilirubin >>PT

117 . sign of decompensated liver disease ? ascites >>CAPUT??

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??

126. acetylar status which drug hydralazine >>SAME

127. graves disease what will be present ? myxedema >>sAME

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

130 . amyloid do rectal biopsy CANT REMEMBER

131. augmentin cholestatic jaundice>> CO AMOXICLAV SAME

132. question about primary hyperparathyroidism >>SAME

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??

135. paranoid schizophrenia >>SAME

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

140. bitempral hemianopia --> optic chiasm

141. after starting gout painful wrist knees and elbows ? allpourinal induced >>SAME

143. insulin in gestational diabetes

144. TH2 ----------------> IL4 >>I DID IT WRON TNF

145 . recurrent infection in lymphoma patient ? complent def >>HYPO IMMUNOGLOBULIN G

146. transient global amnesia >>SAME

147.acoustic neuroma ? loss of corneal reflex >>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

149 . role of BRCA genes>> DONNU

150 . achalsia ? decrease peristalsis wave>>DIDNT C

DR_MAHMOUD, May 13, 2010 #26
loser
loser

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

acute MI goal glycemic control..... 6-8

past asbestos exposure asympotomatic what will show cxr ? pleural plaques
life threating sign of asthma ? low peak flow less 35 %
pseudogout... positively birefringent, rhomboidal
ring emhansing lesion in Aids pat>>.......Toxoplasmosis
dementia+urinary incontinence+gait problems= N pressure hydrocephalus
vancomycin +rifampicin for mrsa (was it skin/soft tissue infxn???)
cipro causing tendon damage
Chinese Restaurant Syndrome" is an intoxication associated with Bacillus cereus
acromegaly Dx.... IGF-1
membranous nephropathy Rx.... ACEI
recurrent lip / throat swelling beekeeper on ace inhibitor for 6 months ? drug induced
splenectmoy when to give pneumococcal vaccine .... 1 month
agitated / mettalic taste after stopping her pshychiatric medications ......benzodiazepine withdrawal
spontaneous pneumothrax aspirated , symptoms improved repeat cxt showing 1.5 cm what next..... O2
acoustic neuroma ? loss of corneal reflex
pap. thryoid
lucid epiduraral
pneumonia curb criteria raised urea
inr decrease after starting tb medicine ? rifam
pda what pulse ? collpasing
burkit lymphoma c-myc gene
intoxication 80 tab thyroxine ,24 hr later asymtomatic ..treatment ?... beta blocker
hiv proph needle stick... 4 weeks (3 or 2 drugs)
restless leg syndrome-ropinirole
kidny tx hla-dr
MRCP 1 May exam

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?????????

Guest, May 14, 2010 #36

loser
loser
Guest
ok maybe the dermatologist can confirm the answer for theses two:
1- lesions appearing & dissaperaing spontaneously on various body parts and are itchy. what treatment
should be given. among the choices was 1 cetrizine 2- dapsone 3-steroids.
i chose cetrizine thinking it was urticaria

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.

....people come forward with more Q's or answers pls.

----there was one Q about test accuracy.... don't remember details...but it's TP+TN/FP+FN

------one q medicine with t1/2 4 hrs...what % is left after 20hrs.....3.125%

-----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.

(or was it the gene frequency that was 1/100????...

YES IT NEEDS ALOT OF READIG ANY ONE REMEBER THE DERMATOLOGY QS??
DR/ MRCP, May 14, 2010 #40
Guest
Guest

Guest
Which drug improves prognosis in pt. with the chest pain? aspirin, nitrates?
Guest, May 14, 2010 #41
mansouooor
mansouooor
Guest
???

paper 1 was so tuff for me , but paper 2 is ok.

can you tell me more about the marking system and how exactely the process be done .

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

2-increased o2 to tissue>>>>>>>>>>>increased pco2

3-global hand muscle weakness+sensory loss little finger what root>>> T1
4-bloody diarrhea+HUS>>>>>> fragmented rbc

5-marked increase ALP normal ca & ph back pain>>>> paget

6-fetus of mother jogron s>>>> anti RO ssa
8-systemic sclerosis Q
9-pseudo gout>>>>>>>>>>> +ve needle shaped
10-alcholic after 4 day in hospital agitated & disorinted>>>>delrium??
11- normal pr hydrocephelus Q
12-alopecia + hypothroid+ hypopigmented area>>> alpcia areata??
13-dermatology Q >>>>> answer>>> mucosal involvement?????
14-itchy tens blister>>>skine biopsy immunflorescence?
15-wide spread pruritus increased nocturnal + lesion around finger>.>>scabies?????????
15-anaemia + worm from anus>>>>>> hook worm
16-ileal resection for crhons then diarrhea 6 times /d>>>>>bile acids D
17-lithium therapy + hypertension>>>> doxazocin or amlodipine????
18-primaquine added for ttt of malaria why?>>>> hepatic forms
19-40 years RA + protinuria>>>>> rectal biopsy
20- 6 years of rheumatoid A. was on gold now she in remission without medication having protinuria
drug induced or amyloidosis>>>> amyloid???
21-parietal lobe lesion>>>>acalculia
22-valsalva manouver initial response>>> i choose decrease venous return but if there was increase
strok volum between answers it is the correct i do not remem
23-loss of all foot movement + loss of ankle reflex>>>>>. my answer lumbo sacral but think it is
wrong answer sciatic correct
24-hemi anasthesia hemiplegia miosis lesion>>>>> pons
25-post par atum woman 36 hours with 2 fits and severe prgressive headache + epidural anasthesia
during delivery>>>> my answer was wrong subarachnoid hge
26-slow acetylators>>..>>>>> hydralazine
27-malignant pericardial effusion>>>>>>>inspiratory increase in JVP
28-syringomeylia c4-t1>>>>>> loss of pain and temp other hand
29-maximum dose of morphine what to add>>>>>> ?????

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>>???

65-sign of sever asthma>>>>>normal pco2

66-beta blocker>>>>> glucagon
67- Q dibetes ispidus
68--platlet transfusion>>>>>malaria
68- q cath related infection in hemodialysis patient>>>staph epdermidis
69- acut ifective endocarditis>>>>>>>>staph aureus
please any one have an answers for Q endad in ?????? for discussion
Guest, May 15, 2010 #45
imad
imad
Guest
plez go ahead ... let us try to remember the whole exam.
imad, May 17, 2010 #46
p1
p1
Guest
can someone compile a list of answers that is double checked
p 1, May 17, 2010 #47
drhrasheed
drhrasheed
Guest
mrcp part1 11 may 2010

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??

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.
drrajib, Jan 20, 2010 #5
saadi10
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
1. Resp Pathogen for CF pt?
3. Footballer with sudden cardiac arrest?
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.
drrajib, Jan 20, 2010 #7

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

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 !

Guest, Jan 20, 2010 #10
Guest
Guest
Guest
1. Subacute IE. treatment? Benpen + gent
2. litium toxicity. precipitant. ?ramipril
3. chronic CML, (?not candodate for imintab). ? a-interferon or ?hydroxycarbamide
4. Discoid lupus on steroids. ?next treatment. ? hydroxychloroquine.
5. Young pt had appendicectomy then went into shock (?sepsis - abscess). investigations ?clotting
screen ?DIC
6. Pt with face swelling (on ACEi, Statins ..) ? precipitant
7. Macrocytic aneamia with antibodies to parietal cells. ?biopsy (?gastric wall)
8. chikenpox developed pneumonia ?treatment
9. ?mediator in anaphylaxis
10. ?test to confirm transfusion haemolytic reaction
11. A student's girlfriend kicked his ass after he came back from USA. He thought he's the Dean (?
delusional syndrome or ? schizophrenia !!!!!!!)
12. Lady with abdo pain and all Ix NAD --> ?factious disorder
13. Pt thinks he's got cancer --? hypochondria disorder
14. intermittent painful defecation with fresh blood in young lad (?polyp ? haemorrhoids ?anal fissure)
15. Jaundiced pt with deranged LFTs (AST 1453) and tender hepatomegaly recently come back from
holiday abroad (?Hep A)
Guest, Jan 20, 2010 #11

Guest
Guest
Guest
EGYPT?? SALMONELA OR SHIGELLA

ANKLE SWELLING----CA CH BLOCKER

BLUE VISION----SILDENFIL

CONTROL HT RATE IN AF ---BISOPROLOL

AF ---HAEMODYNAMIC LOW----DC

BELLS PALSY---- LACRIMATION OR SALIVATION OR HYPERACUSIS OR HYPERATHESIA

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

saadi10, Jan 20, 2010 #13

JAK-2 Mutation
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 ???
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
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
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

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
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
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
JAK-2 Mutation, Jan 20, 2010 #14
saadi10

saadi10
Guest
ammeen

alopecia is casued by valproate

treatment of neuralgia is carbamazepine
pt on digoxin /warfarin still af uncontrolled i wrote bioprolol ??
pt on dialysis i wrote ischeamic heart disease something related
alcoholic patient with ataxia had blurring of vision 2 years ago therefore i wrote MS
respiratory depression i wrote codiene as its a morphine derivative and can cause resp depression and
low gcs
thyroid nodule i agree it can only be FNA
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
atn sec to 10 day use of diclofenac
saadi10, Jan 20, 2010 #15
Guest
Guest
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
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

16. Northern blotting to detect RNA

17. Weight loss for obstructive sleep apnoea
18. Prophylaxis in trigeminal pain --> carbamezipine
19. New AF in compromised pt --> DC shock
20. AF with CCF not respond to digoxin --> give bisoprolol as per NICE
21. Lady with tenderness + pain lateral R hip --> I wrote bruisitis
22. A question on sensitivity
23. Positive predicted value TP/FP+TP
24. Respiratory depression due to overdose --> dihydrocodeine
25. Ring enhancing lesion --> Toxoplasmosis
26. Obese lady with deranged LFTs and USS prognostic --> Nonalcoholic steatahepatits
27. Hypokalemia --> flattened P wave
28. Refeeding syndrome --> low phosphate
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.
31. DLE --> hydroxychloroquine
32. Dandruf --> ketoconazole
33. Fall and loss of pain and temperature and joint sensation preserved --> ?cervical disc prolapse
dr.wesam, Jan 20, 2010 #17
saadi10
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
saadi10, Jan 20, 2010 #18
CT 1
CT 1
Guest
Hi all of you
Just back from exam Happy after paper 1 , devastated after paper 2
I think same topics but with variety of questions may be I need more practice
Here are some questions which i remember , answers might be wrong but please discuss and add if
remember more

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

3. valporate hair loss

4. cyclosporin excessive hair

5.patient suffered peripheral neuropathy , had chemo whic medication to stop ? vincristine

6. mismatch blood transfusion what test to confirm ? direct coombs test

7. Ring enhancing lesion on CT aids patient ( toxo )

10. Mild headache in elderly which investigation ? ESR

11. Patient having unequal pupil and Ptosis ( Horner) which investigation to confirm ? cxr

12. CSF showing 100 lympho plus high protien ? TB

13. Ankylosing spondylosis what will present in Lumbar xray ? sclerosis / osteophyste / sydem/ wedge
shape

14. patient with hip pain and lateral tenderness ? Osteoarthritis

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

19 . patient on 5 HTN medications develops ankle edema amlodipine/ doxazocin / monoxidine

20 . Preg HTN methyldopa

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

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

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
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

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

Stridor, dysphagia (Flow volume loop)

aladdin80, Jan 20, 2010 #20
Guest
Guest
Guest
alot of stastitcs ...MANN whitney U or chie sequard ??
Guest, Jan 20, 2010 #21
Guest
Guest
Guest
hey guys the question about the infective endocardits in prothetic valve we should give
vancomycin+gentamicin+rifampcin
Guest, Jan 20, 2010 #22
drrajib
drrajib
Guest
Ring Enhacing Lesion-Toxoplasmosis
I thought the question said single Ring Enhacing Lesion, which should be CNS lymphoma
drrajib, Jan 20, 2010 #23
Fed up
Fed up
Guest
-Site of action of bendrofluthiazide
- low hb . low MCV ? cause ? ascaris and others
-Alcohol withdrawl with seeing dog next to bed
-X-ray changes in AS
-pregnant lady with raised amylase
-Duch Ms Dystrophy with grand children inheritance
-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 ?

Fed up, Jan 20, 2010 #24

Fed up
Fed up
Guest
which patient can be left in multibed area - Legionell, Varicella etc etc
Fed up, Jan 20, 2010 #25
MRCPaspirant
MRCPaspirant
Guest
The following are most likely TEST questions,(cos I dont recollect seen them in the exam); so
dont worry if youve got them wrong
1.Which patient can be left in multi-bed area
2.Pregnant lady with raised amylase
3.Causative organism for infected peritoneal dialysis patient
4.Intermittent painful defecation with fresh blood in young lad
5.Blue vision is seen in?
6.Huntington chance of son to be carrier
7.Whom to isolate patient with MRSA septicaemia / pneumonia and MRSA in sputum / peritoneal TB
1 day treatment / pulm TB 16 day treatment
8.Hemiballismus where is lesion ?
MRCPaspirant, Jan 20, 2010 #26
MRCPaspirant
MRCPaspirant
Guest
Also, thought Ill give my explanations for some questions with controversial answers
Site of polypeptide degradation Proteosome /wwwproteasomescom/

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/

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.
MRCPaspirant, Jan 20, 2010 #27
Guest
Guest
Guest
Hello friends!

Thanks for posting all these questions.

I forgot to answer a few questions as I wanted to go back to them at the end to think better but later had
no time as latter questions in Part 2 were lengthier and tougher. I don't remeber seeing many of the
questions posted here. I gave the exam from Thiruvanathapuram, India. Please tell me, is it possible
that the College asks different questions in different regions? If I have missed so many questions, it will
be a disaster for me. Please help.

Johny
Guest, Jan 20, 2010 #28
Johny
Johny
Guest
1.

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?
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

Answer is rheumatoid arthritis

can check at google search Anti-citrullinated protein antibody

aldosteron99, Jan 20, 2010 #33
MRCPaspirant
MRCPaspirant
Guest
To aldosteron99,

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

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 findingdiifuse 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.....
relaxed, Jan 20, 2010 #38
relaxed
relaxed
Guest
dear friend
i think type 1 is best by ketosis, as MODY can occur at young age
relaxed, Jan 20, 2010 #39
Guest
Guest
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
site of action of acetazolamide
many pharmacology questions....
treatment of the lady with multiple ST infections isolated candida, gonococci and vaginosis?
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.
Guest, Jan 21, 2010 #46

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

commonet site for Myxoma??/

RA/Rv

Not able to abduct arm Nerve involved??

axillary N

testicular feminisation??
1-mode of action of docetaxel
prevent microtuble (i did it wrong)
i wrote it DNA:(

2-one q about pt admitted on the word and develop diarriha after 48 hr

i wrote it sallmonella

3-q with long hx of dysphagia for 18 month for both liquid and solid
achlasia

4-q about action og gastrin?!

5-q about drug causes of cholastatic picture

flucloxacillin,other option was parcetamol,tramdol

6-q mention chch feature of ejunal biopsy of whipples dis

7-q qbout toxic thyroid nodules

with feature of thyrotoxicosis and neck us shows increase uptake
ttt:radioactive iodine
other option inculde:propranol.predinsolone,carbamezabine

8-q about s/e of progesteron :

option inculde:nausea,breast pain,headache

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

12-drug causes constipation and option were:metformin,glagazid and other???

13-q mention hyop glycemia and hypotension and hyponatremia,which is best to give
hydrocortison

14-pt obese with family hx of DM and found to be Diabetic:

MODY ,other:DM 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

18-drug causes of gynecomastia:eek: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??

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

35-prognostic feature on AML:intial wbc

36-q about polycythemia rubrvera

37-q about waldenstorm`s macroglobulinemia

38-q about TTP

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:post artery,post inf arety,ant inf aretry,middel cerebral artery

49-q about migrane pt already tried simple analgsic and trpitan what is
next:ergometrine,BB(propranol,NA valoprate

50-cluster headache

51-q about hemiballisim

52-q about tt of essential tremor

53-2 or 3 q about numbness of the thumb

54-q about other feature of common peroneal nerve injury:

55-q about abscent ankel jerkwith extensor planter:subacute combined degenration of the cord????

56-q about progressive supranuclear palsy

57-vt what is contra indicating:verapamil

58-what favvour of vt:hr of 180,RBBB,anteriventricular disociation,

59-ecg of pericarditis

60-pt with sub acute bacterial endocarditis what inv:colonscopy

61-pt with MS what els will indicate other valvular lesion:V wave in JVP

62-pt with MS what will indicate co ass with MR??

displaced heaving apex beat???

opning snape

63-long QT syndrom:due to blockge of k channel

64-what is inv for mycordial ischemia:angiography,ct,

65-pt with high k:ca gluconate

asya, Sep 22, 2010 #4
Guest
Guest
Guest
Bosentan
Guest, Sep 22, 2010 #5
Guest
Guest
Guest
Alcohol + pustular facial rash (nonscarring)
Father & son's nursery have diarrhea: campylobacter
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

86-which 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
asya, Sep 22, 2010 #7
asya
asya
Guest
please all to share and add whatever u could remmber from exam
asya, Sep 22, 2010 #8
Guest
Guest
Guest
good good luck for everyone!!!
Guest, Sep 22, 2010 #9
Guest
Guest
Guest
metformin for PCO

TTT of grade II oes. varices

Guest, Sep 22, 2010 #10
asya
asya

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.

I am just thinking any answer anybody?

Guest, Sep 22, 2010 #12
asya
asya
Guest
89-bostan:mode of action

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)

asya, Sep 22, 2010 #13

asya
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
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

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
asya, Sep 22, 2010 #17
asya
asya
Guest
98-what will be a good indicator for disease activity
a-ccp
b-ana
c-c3
asya, Sep 22, 2010 #18
Guest
Guest
Guest
hemochroatosis c282y gene?
deletion
expansion
am not sure of the answer

the prognosis 26 hr after paracetamol poisoning?

Guest, Sep 22, 2010 #19
tatta
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

tatta, Sep 22, 2010 #20
dr.angel05
dr.angel05
Guest
alslm alikm
this is my 1st attempt paper 1 is diffecult but 2 is ok

i will post 1st what i sure about answer after that i recall the other:

1- fomepizole ------ competitve inhibitor

2- imatimb---------- tyrosine kinse

3-ARDS ------------- high protein
4-digoxin ----------- Na-K ATPse
5-allopurial---------Xanthine oxidase
6- bosentan-------- endothelin- receptor blocker
7- high aion gap------- methanol
8- migraine ------------ ergotamine
9-drug C.I in VT ------ verapamil
10-ECG in pericarditis -------- ST elevetion concave
11- picture of PE investigation ----- CT angio
12- ucler at site of ileostomy------- pyoderma gang.
13- organism of pnemonia after influenza------ staph. aureus
14-Q picture of cholesterol embolism
15-Q picture of global transit amnesia
16-MS with MR ------- displaced apex beat
17- IE and bovi------- colonscopy
18-father has hemophillia chance his son------ 0%
19-18 month pt. c/o pysphagia both solid and fluid ----- achelesia
20-ADPOCK------ 50 % affected
21- drug contiue wiht sildenafil------ ACE-I
23-pt with HTN and low k what investgestion------- aldestrone : renin ratio
23-Dx of cushing------ 24hr urine for cortsione
24- pic of toxic nodule goite------- radiate iodine
25- acromegaly investigation------ glucose tolerance test
26-male c/o back pain has vertebral collapse due to osteoprosis------ testosterone level
27-pic of cholestatic ----- flucoxcillin
28- rupure of tenden--- cipro
29-female pain at base of thumb with swelling----- osteoarthritis
30-numbness in thumb and something in biceps---- C6
31- photosenetivity, blister , millia----- prophyria cutanea tarda

32-sing of common pearneal n.--------- weakness of dorsiflexation of foot

33-pic with liver imaired with high IgM----- PPS
dr.angel05, Sep 22, 2010 #21
tatta
tatta
Guest
-man wit ankylosing spondilitis, what test positive? trendelinberg, straight leg test..........

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 ...

mrcp-4, Sep 22, 2010 #25

exam crammer
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
exam crammer, Sep 22, 2010 #26
exam crammer
exam crammer
Guest
sensory loss at T8?

LMN signs at upper limb with loss of temp/sens

ABG of a pt , heroin abuser

ABG of COPD pt

ABG of metabolic acidosis

Which hormone low in prolactinoma

exam crammer, Sep 22, 2010 #27
Shez
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
Shez, Sep 22, 2010 #28
exam crammer
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?

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

pt with fluctuating consciousness and left sided weakness

turkish woman with hepatosplenomegally

SLE associated immunoglobin

SVT recurrent inx of choice

for ABPA i put PFT , can be wrong

migraine --propanolol

I put ant spinal art for T8 level

low Na , i put carbamezepine too

exam crammer, Sep 22, 2010 #33
exam crammer
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
exam crammer, Sep 22, 2010 #34
exam crammer
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 bilateral and papiledmea

exam crammer, Sep 22, 2010 #35
Shez
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?
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.

1) i put non hodgkins lymphoma

2) i put blepharitis
3) i put COPD
4)COPD
5) propanolol

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:

I have put the same ans as u except the last one

exam crammer, Sep 22, 2010 #45
sle
sle
Guest
confused

the one abt gastrin was stimulation of secretion by luminal peptides

paired t test not elgible was non normal distribution

ondanstron for vomiting in chemotherphy add dexamethasone

pancytopenia-trimethoprim

metaanalysis bias-publication

confusing questions on metabolic abnormalities

hypochondrial disorder for cancer assuming patient

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

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

anisa
anisa
Guest
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

10.ropinirole- dopamine agonist

11.U/L tremor and rigidity- Idiopathic PD
12.Young pt with seizures,N glucose, lymphocytosis- HS Encephalitis
13.Rx for Migraine- Sumatriptans
14.Rx for Essential tremor in elderly- Primidone
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- ?????

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
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

82.Paranoid Schizophrenia- auditory halucinations with mild trace of cannabis/amphetamines

83.Depression- anhedonia
84.Dysthymia..one stem
85.one with MANIA-- grandoise delusions.

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

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.Steroid induced avascular necrosis
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
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
124.Aortic valvular disease with bloody diarrhea---?Colonoscopy

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%

171.Patient with fever and loin pain- acute Pyelonephritis

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 elderly- Streptococcus 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.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

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

76.Diarrhea after cholecystectomy- Rx.Cholestramine
77.Diarrhea-HUS--- E.cole 0157
78.IV drug abuser with HCV Ab- Chronic HCV

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.

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.Steroid induced avascular necrosis
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
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

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
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%

171.GOOD PASTURES SYNDROM CASE

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 elderly- Streptococcus 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
196.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
anisa, Jun 1, 2011 #8

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)

A. Fluorescence in situ hybridisation

B. In situ hybridisation

C. Single strand conformation polymorphism (SSCP) analysis

D. Southern blotting

E. Somatic cell hybridisation

technique described is 'in situ hybridisation'.

Southern blotting is a laboratory procedure in which DNA fragments that have been electrophoresed
through a gel are transferred to a solid membrane, such as nitrocellulose. The DNA can then be
hybridised with a labelled probe and exposed to x ray film.
Somatic cell hybridisation is a physical gene mapping technique in which somatic cells from two
different species are fused and allowed to undergo cell division. Chromosomes from one species are
selectively lost, resulting in clones with only one or a few chromosomes from one of the species.
FISH is a molecular cytogenetic technique in which labelled probes are hybridised with chromosomes
and then visualised under a fluorescence microscope.
SSCP is a technique for detecting variation in DNA sequence by running single-stranded DNA
fragments through a non-denaturing gel. Fragments with differing secondary structure (conformation)
caused by sequence variation will migrate at different rates.
anisa, Jun 1, 2011 #10
Dr.A.Y
Dr.A.Y
Guest

Guys..
Results tomorrow...

Hope all of us will pass..

God pls help us.....

Dr.A.Y, Jun 2, 2011 #11
Dr.A.Y
Dr.A.Y
Guest
Results are out.... I pass..... 667...... God is great.... Passsssssss.... Passed because of god only.......
Dr.A.Y, Jun 3, 2011 #12
Oronno Mon
Oronno Mon
Guest
49.diplopia with cranila nerve- 6th cranial nerve palpsy -----correct is IOP
Why this question in Derma?
Anyway many many thx for ur contribution.
Oronno Mon, Jun 15, 2011 #13
anisa
anisa
Guest
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
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

More of a pharmacology question, eliminate the drugs having renal excretion

upen, Jun 26, 2011 #20
upen
upen
Guest
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

Treating hypertension in bilateral RAS requires treating the underlying cause.

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

Congestive cardiac failure secondary to myocardial infarction.

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

10.ropinirole- dopamine agonist

11.U/L tremor and rigidity- Idiopathic PD
12.Young pt with seizures,N glucose, lymphocytosis- HS Encephalitis
13.Rx for Migraine- Sumatriptans
14.Rx for Essential tremor in elderly- Primidone
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
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- ?????

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
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
80.Hypochondriac

82.Paranoid Schizophrenia- auditory halucinations with mild trace of cannabis/amphetamines

83.Depression- anhedonia
84.Dysthymia..one stem
85.one with MANIA-- grandoise delusions.

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

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.Steroid induced avascular necrosis
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

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

124.Aortic valvular disease with bloody diarrhea---?Colonoscopy

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%

171.Patient with fever and loin pain- acute Pyelonephritis

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 elderly- Streptococcus 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.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

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
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

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

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
76.Diarrhea after cholecystectomy- Rx.Cholestramine
77.Diarrhea-HUS--- E.cole 0157
78.IV drug abuser with HCV Ab- Chronic HCV

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.
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.Steroid induced avascular necrosis
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

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

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
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%

171.GOOD PASTURES SYNDROM CASE

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 elderly- Streptococcus 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
184.
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.IGA nephropathy- control of BP for progression

196.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
anisa, Jun 1, 2011

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)

A. Fluorescence in situ hybridisation

B. In situ hybridisation

C. Single strand conformation polymorphism (SSCP) analysis

D. Southern blotting

E. Somatic cell hybridisation

technique described is 'in situ hybridisation'.

Southern blotting is a laboratory procedure in which DNA fragments that have been electrophoresed
through a gel are transferred to a solid membrane, such as nitrocellulose. The DNA can then be
hybridised with a labelled probe and exposed to x ray film.
Somatic cell hybridisation is a physical gene mapping technique in which somatic cells from two
different species are fused and allowed to undergo cell division. Chromosomes from one species are
selectively lost, resulting in clones with only one or a few chromosomes from one of the species.
FISH is a molecular cytogenetic technique in which labelled probes are hybridised with chromosomes
and then visualised under a fluorescence microscope.
SSCP is a technique for detecting variation in DNA sequence by running single-stranded DNA
fragments through a non-denaturing gel. Fragments with differing secondary structure (conformation)
caused by sequence variation will migrate at different rates.
49.diplopia with cranila nerve- 6th cranial nerve palpsy -----correct is IOP
Why this question in Derma?
Anyway many many thx for ur contribution.
Oronno Mon, Jun 15, 2011
#13

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

More of a pharmacology question, eliminate the drugs having renal excretion

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

Treating hypertension in bilateral RAS requires treating the underlying cause.

upen, Jun 26, 2011
#21

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

Congestive cardiac failure secondary to myocardial infarction.

mahak, Jul 1, 2011

After the exam.(MRCP MAY 06 RECALLS)

Discussion in 'MRCP Forum' started by sma, May 17, 2006.

Thread Status:

Not open for further replies.

Page 1 of 21 2Next >

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

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____>???

I will post more from my memory.

cu
Guest, May 17, 2006
#2

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:

1. Contraindication to Surgery for Lung cancer: Pleural effusion

2. Lung functions shows FEV1/FVC 40% in RA patient: Bronchiltis Obiterans

3. Cisplatin action

4. How to confirm diagnosis of Leigionerre... Urinary antigen?!?!

5. How to confirm Meningococaemia: PCR?!?!

6. erectile dysfunction: Anxiety??

7. Sildenfil and nicorandil

8. Ciclosporin side effect

9. ABG: Respiratory Alkalosis: PE

10. Paroxitene and unstable angina...

11. UC flare up. next step: possibly azathioprine

12. Knee joint question

13. Cervical spondilysis

14. Two question about RA... psoriatic arthropathy

15. A possibly osteomyelitis!!!

16. metformin and the B12 anaemia

17. metformin and renal impairment?!?!?

18. Sarcoidosis: CXR

19. Overdose of paracetamol and anorexia nervose

20. Overdose of Diazepam and Disulopin: ECG??? there was tachycardia of 140

21. Lateral condyle (tennis elbow) pronation of arm

22. Sensitivity
24. NNT what does it mean!
25. phase I.. what happens in it?

26. two question about choosing the right test in statistics

27. Lung functions COPD

28. MI then thrombolysed then got red dusky coloration of feet anf eosinophilia.. I just though it could
be cholestrol embolism

29. Warfarin and factor VII

30. thalassaemia a.. both parents were traits!

31. APTT prolonged... some 50:50 mix up.. which factor??

32. patient with some history of back pain: non-specific back pain

33. common peroneal nerve and dorsiflexion of ankle

34. intermittent loss of consciousness.. you know who I am talking about!

36. optic neuritis or giant cell arteritis??? swollen pale disc + monoocular visual loss!

37. partial left homonymous hametonpia: which lobe??

38. cortical thrombophlebitis?!?!? it was complicated question but the CT was very suggestive

39. I guess there was Dengue fever

40. Which malaria..??? It was 6 month period!

41. hypocalcaemia and LOng QT

42. pregnancy and amiodarone for AF

44. statins caused myalgia.. what not to use with?/ Fibrates

45. Rx for myclonus epilepsy: Valpraote???

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..

49. what contains double stranded circular DNA

50. G6PD and trimethoprim for UTI

51. two questions about autoimmune haemolytic anaemia: one of them was about dirst antiglobulin test
53. E coli HUS.. question

54. Rhabdomylasis and low dose dopamine???

55. thiazide action???

56. ADH action.. where??

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!

58. question about tuberous sclerosis

59. there was two question I choose colonscopy for.. I can remember them at all

60. HIV and odynophagia!

the rest is on the way!

Guest, May 17, 2006
#3

3.

GuestGuest

tarekdeema

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tarekdeema
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Joined: 09 Nov 2005

Posts: 11

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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.

1. melanoma----- change of colour

size of tumor
i did change of color i eas not not sure.

2. painless liver enlargment and jaundice.

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.

1.mech.of action aciclovir--dna polymerase inhibition.

3.Antidote for cyanide poisoning-colbat edetate

4.a question about melanoma and carvenous sinus involvement.

5.cluster headcahe

6.villous adenoma--colonoscopy

7.T3 toxicosis

8.Carbimazole 30mg and persistence T4 elevation--propilthyuracil.

9.a case of PE

10.A case of behcet dx -venous thrombosis.

11.Sidenafil and nicorandil

12.sideroblastic anaemia

13.Gullain-barre and vital capacity

14.myotonic dystrophy with cataract and weakness

16.APKD and polycystin

17.NNT AND reciprocal of ARR.

18.VIT.K and factor VII

19.OSteomalacia and low calcium and low phosphate but high ALP.

20.CONFUSED and aggressive man --Haloperidol.

21.Prolonged QT and hypocalcemia

22.lithium and drug induced DI

23.CHronic pancreatitis in pregnant lady with loose stool and malabsorptive picture

24CI to surgery lung ca. SVC obstruction

25.Generalized anxiety disorder and IMPOTENCE

26.Major depression and relatives death

27.Scabies and pruritus rash sparing the face

28.Polymorphic light eruption in sun exposed areas.

30.Hep.D super infection

31.Thyroid malignancy common in autoimmune thyroiditis--Lyphoma

32.A case of PCOS

33.A case of BIH

35.OESOHAGEAL HSV IN HIV

36.A case of cholera -rx--Doxycycline

37.Dog bite infection and FLUCLOX.AND BENZYLPEN.

MORE TO COME

THANKS

OREOLUWA
Guest, May 17, 2006
#6

6.

GuestGuest

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afsheensalman
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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

lump in nose+lump in neck+lung infiltrate

1-lymphoma
2-histocitosis x
3-sarcodosis
4-wegners
Guest, May 18, 2006
#8

8.

kengladGuest

answer

its svco thats contraindicated in ca lung

not pleural effussion cuz it can be reactive unless the choice was malignant pleural effusion

and its nicorandil

kenglad, May 18, 2006
#9

9.

rahba septGuest

many basic even in the 2 paper

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:

1-lateral condylo pain which will increse it -thumb -open fingers....

2-leg loss reflex what the cause diabetic coronary...neurolog

3-posterior comunicate artery-anterior comunicate artery

4-a trait thalasemia -

5-tirdness weakness synaktin short test

6-diabetus insibidus drug indused ..lethium..

7-erythema on shin ..rash polyuria ..sle..sarcoidosis..

8-idiopathic parkinson ..assemetry tremor

9-ondansterion for nausia was taking metochlopromide

10-acute loss of vision ..venous thrombosis..

11-dry eye ..ulcers mouth genital ...sjogren...behcet..

12-smoking ..coal miner....bladder carcinoma..

13-methadon ..

14-lethium toxisity ....thiazide or nomal saline...

this is for now i,ll continue when i remember more

thank u
rahba sept, May 18, 2006
#10

10.

kengladGuest

some answers

paradoxical embolus definitely for transesophageal echo as u can visualise better

oh urinary antigen definitely for legionnaire's

and it has to be cholesterol embolus as bld eosinophil is high

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

6 months indicate ovale malaria as they have a hypnozoite phase

myoclonus best treated with ethosuximide

rosacea best treated with oxytetracycline

nicorandil cannot be given with sildenafil

too much dilatation
too much is not always good hehehe

melanoma definitely size look it up in kumar and clarke

ca lung c/i is svc obstruction

kenglad, May 18, 2006
#11

11.

GuestGuest

SMK Al rifae'ei

SMK Al rifae'ei
Guest

Posted: Thu May 18, 2006 7:48 pm Post subject: 16 may

--------------------------------------------------------------------------------

i will sening the questions ,try to anser it as we go on:

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

A young diagnosed spastic angina best mangement.

-fecanide
-betablocker
-asprine
--Asprine is correct.
Guest, May 18, 2006
#13

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

best indicator for tonsillar abscess - trismus, .....

AC, May 18, 2006

#17

17.

rahba septGuest

best indicater for tonsillitis

another choisis for best indicator for tonsilitis abscess is continious fever

i,ll cotinue questions

1-foramen ovale

2-prick test ...ige .

3- scabis...

4-e coli

5-cholangio carcinoma ..

6-ulcerative cholitis...

7-mody ..

8-liver biopsy...us guided ..mrcp ...ercp..

9-paroxetin...hypertension..

10-spinal ..foot depression..

11-frontal lobe syndrome..parital lesion ..

12-knee replacement ...

13-noctornal dysphasia

14-tachicardia ..diarrhia....anticholinergic...tox..

15-crticosteroid injection ..joint ..

16-c4..c5..c6..c7....{c4}

17-vertebral prolapse....

18-3..6...trigemeni........pons

19-aspirin coronary spasm ...metoprolol...propranolol..

20-genetic...mother brother...father brother..............mother brother...link ressesive

21-hematuria thrombocytopenia..anemia...imunoglobulin..iga..

22-hemophelia..

23- 1/2......1/4....1/6...1/8

24-graves disease ....t3...t4...

25-hematuria....hypervescosity..syndrome

26-chronic subdural hematoma

27-eozinophilia....nephrology....

thanks
rahba sept, May 19, 2006
#18

18.

rahba septGuest

lady with wrist swelling

i think choisis was bone tumor ...

rahba sept, May 19, 2006
#19

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?

2)lowish ca 2.00 normal po4 1.3 and a sky hi alk phos

it's PAGETS innit? cuz excessive bone turnover so hi alk phos and lowish ca from consumption

3)chap on carbamazepine and came to you with agranulocytosis but no fever.free t4 hi

wot shud u do?
- stop carbamazepine and change to PTU
-radioactive iodine
-pennicillin V
-reduce dose of carbamazepine
wots the answer eh?

4)cisplatin goddamit i knew i shud have read it up

wots the mode of action?

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

7)young chap with coronary artery spasm

aspirin

8)pregnant lady with SVT?

metoprolol?

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

b lymphocyte,t lymphocyte,bone marrow suppression?!

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

15)jysus!~human genome project!!!

wots the answer
issit e)not all dna code for a gene?
kenglad, May 19, 2006
#21

21.

kengladGuest

other question i need answers too

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

issit varicella cuz she's the odd man out

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

best indicator for peritonsillar abscess- trismus??

AC, May 19, 2006
#27

26.

kulbitGuest

MRCP Part 1 May 16 2006

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.

3. In a patient on Warfarin which factor is likely to be reduced

ANs: Factor VII.

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.

7. Test to confirm nickle skin sensitivity producing wheals and urticaria

Ans: Patch test.

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.

13. HIV positive patient with odynophagia.

Ans: Candida albicans. CMV esophagitis is another possibility, but I think candida is the more common
one.

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.

16. Patient with coronary vasospasm. Drug to be avoided.

Ans: Aspirin.

17. The following are true regarding the human genome.

Ans: Only a small amount of DNA codes for genes.

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

21. Patient is on sildenafil. Which drug has to be avoided?

Ans: Nicorandil

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.

23. NNT is calculated as

Ans: NNT =1/RRR but this option was not there. I think it is percentage difference between AR and
RR because RRR= (1-RR) X 100%.

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.

38. Pt receiving statin developed myalagia. Drug that should be avoided is

Ans: Niacin

39. Antibiotic for dog bite

Ans: co-amoxyclav.

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

27.

kengladGuest

the answer is

hi kulbit the answer is syringomyelia and not brachial plexus infiltration

syringomyelia can affect one side first
the symptoms appear typical of syringomyelia

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

I do agree with the above post answers

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
Guest, May 22, 2006

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

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

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

difference what is the Dx-- Amylidosis

44- Elderly pt with Iron def anemia, OGD-Gastritis what to do next---colosocopy
45-Pt with bowel adenoma resected how to follow up- Colonoscopy
46- pt with hypothyrodism on replacement presented with normal TSH, low T4, normal T3---adequate Tx
47-pt presented with lasstitude 6 mths low TSH, high T3, Normal T4---- T3 thyrotoxic
48-Pt with UC +hepatic lesion, high Alk p what Dx- Heaptoma, adenoma, Adencarcinoma, hepato Ca,
Cholangiocarcinoma,
49- case with Knee osteoarthritis management --- knee replacement
50- preg lady with Alpha thal trait+ husband trait wants to know the risk to the foetus--- no risk to the
feotus
51-pt with G6PD given AB for UTI presented with jaundice whish drug--- trimethoprim
52- x-linked disease which family member will be affected-- mothers brother
53- which organeel contains circular DNA-- Mito
54- t with paradoxical embolus which Invx--- Transoesophageal ECHO
55- pt post MI 6 weeks presnted with SVT which Invx-- ECHO, Electrophiseological testing,
56- elderly lady with freq. LOC weaks up with help after 1 min Dx- drop attacks
57-young lady with diplopiam recent wieght gain Dx----BIH
58- young pt with chronic nocturnal cough, normal CXR Dx-- chronic sinusitis
59- pt present with neck sweeling+ swelling in the nostril Dx--- Sarcoidosis
61-AS X-ray Appearance- Dysmophytes
62- Joint pain Xray shoing Osteopenia Dx--- RA
63- Pt with overdose what will increase the toxicity?-----Anorexia nervosa
64- which Diabetic agent will increase insulin senstivity?--- Rosiglitazone
65-Pt with MODY how to confirm it?----- Strong family history
66-action of ADH?----on collecting tubules
67-Pt with liver cirrohsis and ascites which Tx?--------- Aldosterone antagosist
68- Pt with DM presented with proteinurea, High HbA1C and background retinopathy he is on insulin,
ramipril what to do next?-------better glycemic control
69-pt presents with ptosis myosis 6 hours after cleaning the ceilling Dx-----Carotid Artery Discetion

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

The rest will follow

Regards
Guest, May 23, 2006
#35

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

116-Pt with paradoxical embolus Ivx? transesophagelecho

117- pt with hepatic disesae which Ivx? ERCP

118-PT WITH PROMYELOCYTIC LEUKEMIA Invx? Karyotyping

119- skin lesion, on close inspection there is keratin plaque and skin atrophy Dx? SLE
121- a drug in the market pt developed new side effect which study design? case control study
122-pt with joint pain penile lesion Dx? reactive artheritis
123-Pt with HCM+non sustained SVT, HE IS ASYMPTOMATIC Tx? implantabel defibrilator.
124- elderly lady Hx of IHD going for knee surgery how to assess her cardiac Fxn?--- Thallium scan
125-ST elevation in lead 2,3, AVF which artery?--RCA
126-Rhabdomylysis renal failure Tx? Iv normal saline
127-Qs about peritonsiller abscess?
128-indcation for melanoma transformation? change in size
129-sile of melanocyte in the skin? stratum basale
130-which malignancy asoo. with thyroiditis? Lymphoma
131- Pt with intracerebral hemorrhage, CT= hemorrahge extending to the cortex, Hx of High BP Dx?
Polycystic kidney dis.
132-herpes simplex virus which statement is correct? increase risk of infection befroe the menses
133-pt asking the meaning of anticipation? deacreasing age of presentation with subsequent generation
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

please add on and correct my mistakes

regards
Guest, May 24, 2006
#37

30.

GuestGuest

116-Pt with paradoxical embolus Ivx? transesophagelecho

117- pt with hepatic disesae which Ivx? ERCP
118-PT WITH PROMYELOCYTIC LEUKEMIA Invx? Karyotyping
119- skin lesion, on close inspection there is keratin plaque and skin atrophy Dx? SLE
121- a drug in the market pt developed new side effect which study design? case control study
122-pt with joint pain penile lesion Dx? reactive artheritis

123-Pt with HCM+non sustained SVT, HE IS ASYMPTOMATIC Tx? implantabel defibrilator.

124- elderly lady Hx of IHD going for knee surgery how to assess her cardiac Fxn?--- Thallium scan
125-ST elevation in lead 2,3, AVF which artery?--RCA
126-Rhabdomylysis renal failure Tx? Iv normal saline
127-Qs about peritonsiller abscess?
128-indcation for melanoma transformation? change in size
129-sile of melanocyte in the skin? stratum basale
130-which malignancy asoo. with thyroiditis? Lymphoma
131- Pt with intracerebral hemorrhage, CT= hemorrahge extending to the cortex, Hx of High BP Dx?
Polycystic kidney dis.
132-herpes simplex virus which statement is correct? increase risk of infection befroe the menses
133-pt asking the meaning of anticipation? deacreasing age of presentation with subsequent generation
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

please add on and correct my mistakes

regards
Guest, May 24, 2006
#38

31.

EvangelosGuest

MRCP1

Good Luck to everybody!

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

5circular douple strand DNA will be found in

a- mitoconderia
b- nucleus
c- riposome

d- golgi apparatus
isit mitoconderia?? But I know it is single strand any help??

6pt . known case of contact dermatitis what test you will do

aprick test
b- patch test
I put patch test
7pt e medial epocondile trauma what action will not able to do
aflexion of forearm
b- pronation

8pt unable to abduct his arm against resistant what m affected :

ainfra spinatous
bsupra spinatus
cteres minor
dteres major .

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

155-painless jaundice in a diabetic pt which drug is the likely cause -SULPHONYLUREAS

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

Here what I found from the Amercan Journal of Gastroenterology:

"...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!!!

After the exam.(MRCP MAY 06 RECALLS)

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

oreoluwa, Jun 4, 2006

#53

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

chronic nocturnal cough

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

oreoluwa, Jun 5, 2006

#57

7.

GuestGuest

i have chronic sinusitis & never nocturnal cough..

i wrote asthma but i think the correct answer is GERD..

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

propranolol or metoprolol are recommended. Intravenous administration of verapamil may be

associated with a greater risk of maternal hypotension and subsequent fetal hypoperfusion."

I also put metoprolol as the correct answer. Will it be sufficient to pass....?

Good luck to all

Evangelos, Jun 5, 2006
#59

9.

OREOLUWAGuest

I QUITE AGREE WITH EVANGELOS.METOPROLOL WAS RECOMMENDED FOLLOWING

FAILURE OF ADENOSINE TO RATE CONTROL.

WHAT ABOUT THE CASE OF AUTOIMMUNE THYROIDITIS AND TYPE OF THYROID

CANCER THEY ARE PREDISPOSE TO.I CHOSE LYMPHOMA ANY OTHER VIEWS.
OREOLUWA, Jun 5, 2006
#60

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.

I totally agree with you arilowa

Evangelos, Jun 5, 2006
#61

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

regarding peritonsilir abcess the answer is " unable to swallow sliva"

rub, Jun 6, 2006
#68

18.

rubGuest

1-LUMPS BISSNESS IS SARCOID MECKLIC SYNDROME

2- HBV WITH ACUTE DETERURATION WE THINK HEPATIC CA
3- OSTEOARTHRITIS IS ECHO AS SHE CAME FOR KNEE REPLASMENT SHE CAN NOT RUN
ON TREDMIL.
4-CATAPLEXY ,AND VASOVEGAL ATTACH BOUT WITH NO LOC AND REGAIN POWER
WITH IN MINETES WE DONT KNOW WHAT EXAMINER WANTS .
5- HYPER ACUTE REJECTION THE ANSWER IS IGG ,SURE OF THE ANSWER
rub, Jun 6, 2006
#69

19.

tidaGuest

do u know the site onexamination.com?

they wrote 9 Q of may/06

pregnant SVT---> VERAPAMIL

achne with small visicles Rx --->doxytetracycline
dog bite Rx ---> augmentine
action of acyclovir-->thymidine kinase
huscy color legs post procedure--->cholesterol emboli
hashimotos thyroiditis ---> lymphoma
to avoid what if statin cueses myalgia--->gemfibrosyl
if clonic adenoma removed well follow pt wih--->annual colonoscopy
drug inc insulin sensitivity ---> poziglitazone

tida, Jun 6, 2006

#70

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?

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
#71

21.

mrcp fighterGuest

can anybody tell the questions of anatomy with answers?

mrcp fighter, Jun 7, 2006
#72

22.

GuestGuest

hey every1 ....

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

mrcp fighter, Jun 9, 2006

#74

24.

GuestGuest

hi every body
i passed
my name came on the net

but whats the pass mark?

any one knows?
Guest, Jun 10, 2006
#75

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.

Thanks once again

OREOLUWA

ANY ADVICE FOR PART 2 WRITTEN

OREOLUWA, Jun 10, 2006
#76

26.

OREOLUWAGuest

I MEANT THANK GOD NOT THANK GOG.

OREOLUWA, Jun 10, 2006
#77

27.

GuestGuest

i passed fellas... shukar alhamdullilah

(am the guest who posted the mssg about being nervous abt the result)...hehe
Guest, Jun 11, 2006
#78

28.

kengladGuest

evangeloos

evangeloos i am so curious did u pass?

so was it gerd or was it asthma
chicken first or egg?
egg or chicken?
kenglad, Jun 12, 2006
#79

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

So did you pass 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

So did you pass 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

sorry am not taunting evangeloos

juz curious cuz evangeloos knew all the little stuff like cipro = precipitate g6pd etc
stuff i did not know
so i hope evangeloos pass
u see when i was a medical student there was a really smart chap from the states and he would alwiz
answer the prof and answer correctly during lectures while the rest of us kept quiet
so in exasperation the prof would cry "u all better sit next to him during your exam!!!!i would if i were
you sorry bunch!"
i guess evangeloos reminded me of him
kenglad, Jun 13, 2006
#82

32.

kengladGuest

continue

so i hope evangeloos pass!

all the best lad!
cheers!
kenglad, Jun 13, 2006
#83

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.

Take care wishing all well.Did you PASS kenglad.??????????????

oreoluwa, Jun 13, 2006
#84

34.

kengladGuest

how true

hey oreolwula old chap

cats have nine lives
8)
yes i did pass
congrats to u and to all who passed!

this is a cool website very useful for exam takers

present and future

just one more question from the may paper for future examinees

22 year old guy goes to gp and claims he has rashes

examination reveals no rashes
2 years ago he has seen a gp and was given oitment and it worked
but now he could not find any propietary medication that works
what is teh diagosis?
10. Male with severe pain behind eye worse in the morning --? ?trigeminal neuralagia

answer - malingering
kenglad, Jun 14, 2006
#85

35.

OREOLUWAGuest

EVEN IF ITS SCHIZOPHRENIA YOU'RE RIGHT.

OREOLUWA, Jun 14, 2006
#86

36.

oreoluwaGuest

PLEASE DOES ANYONE KNOW THE CUT OFF MARK FOR THE MRCP PART 1.
THANKS
oreoluwa, Jun 16, 2006
#87

37.

EvangelosGuest

Hi kenglad and oreolua!

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...

Have a nice weekend

Evangelos, Jun 17, 2006
#90

40.

lordoye1Guest

got my results today. i passed. the passmark was 59.59%.

lordoye1, Jun 17, 2006
#91

41.

oreoluwaGuest

Congrats Lordoye 1 its good to know.

The pass mark was quite achievable.Congrats
oreoluwa, Jun 17, 2006
#92

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

HAS ANYONE RECEIVED THEIR RESULTS YET-MRCP MAY 2OO6?

WONDERED WHY ITS TAKING SO LONG FOR THE RESULTS TO BE POSTED OUT.
oreoluwa, Jun 21, 2006
#94

44.

Cleo_SGuest

i received mine today --- not too happy with my score : 63.73 %
But i passed --- so... yippy !!! (shukar alhamdullilah)

Pass %age was 59.59

how did every1 else do?

Cleo
Cleo_S, Jun 22, 2006
#95
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Forums > UK Medical Zone > MRCP Forum >

MRCP SEP 2008 RECALLED QUESTIONS

Discussion in 'MRCP Forum' started by dr arif, Sep 10, 2008.

Page 1 of 91 234569Next >

1.

dr arifGuest

MRCP SEP 2008 RECALLED QUESTIONS

dr arif, Sep 10, 2008
#1

2.

muttasimGuest

RECALL MRCP1 SEPTEMPER 2008 QUESTIONS

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

is it cluster headache coz there was no watering f eyes

i wrote cavernous sinus
Guest, Sep 10, 2008
#4

4.

DrAbidGuest

MRCP sep 2008

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

DrAbid, Sep 10, 2008

#5

5.

DrAbidGuest

MRCP sep 2008

pneumonia prognosis:CRUB criteria

hep c and HIV antibody positive?????????/
DrAbid, Sep 10, 2008
#6

6.

satiaGuest

recall questions

it was cluster headache

lamorigine for valproate intolerance
was it orbital apex or cavernous sinus

recall questions

where was tick bite?

wasnt sarcoid with facial palsy
tricyclic with glaucome
mycoplasma serology cold agglutinins in 50 percent only
the exam was very tough
i think it was sarcoidosis with facial palsy but i was confused when my friend told me that it wa
typpical lyme dis

Also, it was sarcoid not tick bite (I think)

1.does anyone know what happens on an ECG in Myatonic dystrophy

2.What prophylaxis is tehre for trigeminal neuralgia
3.Was it aortic regurgitation in the one with the diferent gradients on the echo (i.e. ventricle of

200/70something)
4.how do the kidney's prevent dehydration

Also, how many people pass in each sitting?

Thanks
Guest, Sep 10, 2008
#12

7.

HatesRCPGuest

1. Didn't get such a question.

2. Tegretol.
3. I thought it was coarctation.
4. About 33%.
HatesRCP, Sep 10, 2008
#13

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

mrcp1 sept 2008 recalls questions

liver cirrhosis with fever ---spontaneous bacterial peritonitis

antibiotic used in tetanus treatment -- metronidazole

food poisoning in chinese restaurant is ---bacillus cereius
pregnancy with proteinuria &high BP in 12wks --reflux nephropathy

MRCP sep.2008 recall questions

Was not preeclampsia?

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?

* 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?

UNSTA ANGINA PRE CATH -- CLOPODOGREL

STABLE ANG -- BET BLOCK
CAR CATH LV 200/10 -- COARC VS AR
RESIST HTN -- RENO VAS
WPW NON SUS VT -- FLECAINID
BOY E MARFAN -- FIBRILLIN
PE IND FOR THROMBOLYSIS --- PERSIST LOW PRSSU

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

ACTIONN OF RESPIRDONE -- SEROTONIN

LOSS OF SENS IN SCIATIC --- DORSUM OF FOOT
OSTE ARTH , MINI TRAUMA -- PSEUOGOUT
SCLE DACT, RAYNADUS, SOB -- ILD
MUSLIM NEED FASTING OMN METFORMIN --- 500 AM, 1000 PM
GIRL + GYM , WEAKNESS, HEADCHR--- GROWTH H
HTN, CONFUSION , CT LOW ATT CORT AND SUB CORT, HGE , FEVER, PEV SINUSITI--THROMBOPHLEBITIS
BUROPION CON IND -- EPILEPSY
EPLESY INTOLE TO CARBAMAZ AND VALP --- LAMOTIGINE
STEM CELL PROTEC AGAINST --- MUTAGENESIS
MENOPAUSE 40 Y, OPPSED ESTROGEN CP -- OVARIAN CANC
OSTEOPROSIS, 67 Y --- TTT ALENDORNATE
TIMING OF ALENDRONATE --- REDUCE GI SIDE EF
RISK FACTOR FOR DM REITNOP --- SMOKING
RETIN, DM, NEOVASCULAR --- PHOTOCOAGULATION
FACIAL PAIN AWAKING FROM SLEEP, PTOSIS, MIOSIS -- CLUSTER HEADCHE
TIGEM NEURALGIA PROPH --- CARBAMAZIOINE
DRY MOUTH, RAYNADUS, ANTI SM +, ANTI RO+ --- IRY SJOGREN
HY[POPIGME --- WITH PERN ANEMIA
ITCHY LESION SHOULDER, BUTTOCK , ++ ALK --- 1RY BILIARY CIRRHOSIS
ALCOHOLIC, ACITES, ENCEPHALOPATHY ---- BACT PERITIONITIS
CHRON NOT RESPON TO MESALZIN ---- AZAITHIOPRIN
ULC COLIT, ABD PAIN, ALK ++ ---- SCELOSING CHOLANGITIS
CELULLITIS NO RESPOND TO PENC + FLUCLOXA --- GENTAMICIN
IV RUG WITH FEVER, LOW PRES, SPASM, UNABLE TO EXTEND BACK -- VACOMYSIC
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 %
RELATIVE RISK REDUCTION ---- 50 %
IBS.. WHAT NOT MATCHING --- ABD PAIN AWAKING HER FROM SLEEP
PT RT 6TH, PAIN OPTH DIVISON --- ORBITAL APEX

PAIN,PARTIAL 3RD PALSY, PUPILLARY DEFECT --- POST COM ANEURYSM

PAT ANXIOUS WITH SWEATY PALM AND SOLE ---- ANXIETY DISORDER
RT SIDE COMP HEMIPLEGIA, BROCA AREA --- MID CERB ART
PT FEAR OF AVIAN FLU, PREOCUPAIED --- PHOBIC DISORDER
PT SHOUTING, ALCHOLIC, HEAR VOICE --- MANIC SCHIZOPHRENIA
PT WITH PANIC DISORDER
PT INVEST FOR CANCER..FREE, PALPITATION ,, NO IHD --- HYPOCHONDRIACAL
HYPONATREMIA, COUGH, OLD AGE ---- SIADH
FEMALE WITH WEAKNESS, BROTHER AND SON HAVE FREDRIECH'S ATAXIA ---- 45,X
KARYO
PT SEVERE BACK PAIN,NEURO MANFIST LOWER LIMB --- PROTEIN ELECTROPHRESIS
LOST SENSATION ANT LEG --- L4 -------------- 119 --------STARCH DIGESTION --- AMYLASE
PT WITH PICTURE OD ADDISON'S (-- BP, + K, -Na, + CA),, MOST APPROPRIATE ---- IV
CORTICOSTEROID
H.PYLORI F/U FOR SUCCESFUL ERADICATION ---- C13 UREASE TEST VS ? FECAL
ANTIGEN
Guest, Sep 11, 2008
#19

10.

natronboy!!!Guest

what a tough exam !!

assalmu alikom

here are some question I remembered from the exam

Generally it was very tough especially the 2nd paper!! it was very nauseating one ...
the head questions down is linked with my own response >> it may be correct or wrong >> .. I'll
apperciate any one could respond scientifically to my responses ...
last .. the difficulty of this diet was mainly in the language used,,, some questions was not so clear !! I
spend minutes to understand the language they used .. saying "what did he mean ??"
good luck for all >>> wishing to hear best result for all
CARD ==
UNSTA ANGINA PRE CATH -- CLOPODOGREL
STABLE ANG -- BET BLOCK
CAR CATH LV 200/10 -- COARC VS AR
RESIST HTN -- RENO VAS
WPW NON SUS VT -- FLECAINID
BOY E MARFAN -- FIBRILLIN
PE IND FOR THROMBOLYSIS --- PERSIST LOW PRSSU
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
ACTIONN OF RESPIRDONE -- SEROTONIN
LOSS OF SENS IN SCIATIC --- DORSUM OF FOOT
OSTE ARTH , MINI TRAUMA -- PSEUOGOUT
SCLE DACT, RAYNADUS, SOB -- ILD
MUSLIM NEED FASTING OMN METFORMIN --- 500 AM, 1000 PM
GIRL + GYM , WEAKNESS, HEADCHR--- GROWTH H
HTN, CONFUSION , CT LOW ATT CORT AND SUB CORT, HGE , FEVER, PEV SINUSITI--THROMBOPHLEBITIS
BUROPION CON IND -- EPILEPSY
EPLESY INTOLE TO CARBAMAZ AND VALP --- LAMOTIGINE
STEM CELL PROTEC AGAINST --- MUTAGENESIS
MENOPAUSE 40 Y, OPPSED ESTROGEN CP -- OVARIAN CANC
OSTEOPROSIS, 67 Y --- TTT ALENDORNATE
TIMING OF ALENDRONATE --- REDUCE GI SIDE EF
RISK FACTOR FOR DM REITNOP --- SMOKING
RETIN, DM, NEOVASCULAR --- PHOTOCOAGULATION
FACIAL PAIN AWAKING FROM SLEEP, PTOSIS, MIOSIS -- CLUSTER HEADCHE
TIGEM NEURALGIA PROPH --- CARBAMAZIOINE
DRY MOUTH, RAYNADUS, ANTI SM +, ANTI RO+ --- IRY SJOGREN
HY[POPIGME --- WITH PERN ANEMIA
ITCHY LESION SHOULDER, BUTTOCK , ++ ALK --- 1RY BILIARY CIRRHOSIS
ALCOHOLIC, ACITES, ENCEPHALOPATHY ---- BACT PERITIONITIS
CHRON NOT RESPON TO MESALZIN ---- AZAITHIOPRIN
ULC COLIT, ABD PAIN, ALK ++ ---- SCELOSING CHOLANGITIS
CELULLITIS NO RESPOND TO PENC + FLUCLOXA --- GENTAMICIN
IV RUG WITH FEVER, LOW PRES, SPASM, UNABLE TO EXTEND BACK -- VACOMYSIC

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 %

RELATIVE RISK REDUCTION ---- 50 %

IBS.. WHAT NOT MATCHING --- ABD PAIN AWAKING HER FROM SLEEP
PT RT 6TH, PAIN OPTH DIVISON --- ORBITAL APEX
PAIN,PARTIAL 3RD PALSY, PUPILLARY DEFECT --- POST COM ANEURYSM
PAT ANXIOUS WITH SWEATY PALM AND SOLE ---- ANXIETY DISORDER
RT SIDE COMP HEMIPLEGIA, BROCA AREA --- MID CERB ART
PT FEAR OF AVIAN FLU, PREOCUPAIED --- PHOBIC DISORDER
PT SHOUTING, ALCHOLIC, HEAR VOICE --- MANIC SCHIZOPHRENIA
PT WITH PANIC DISORDER
PT INVEST FOR CANCER..FREE, PALPITATION ,, NO IHD --- HYPOCHONDRIACAL
HYPONATREMIA, COUGH, OLD AGE ---- SIADH
FEMALE WITH WEAKNESS, BROTHER AND SON HAVE FREDRIECH'S ATAXIA ---- 45,X
KARYO
PT SEVERE BACK PAIN,NEURO MANFIST LOWER LIMB --- PROTEIN ELECTROPHRESIS
LOST SENSATION ANT LEG --- L4 -------------- 119 --------STARCH DIGESTION --- AMYLASE
PT WITH PICTURE OD ADDISON'S (-- BP, + K, -Na, + CA),, MOST APPROPRIATE ---- IV
CORTICOSTEROID
H.PYLORI F/U FOR SUCCESFUL ERADICATION ---- C13 UREASE TEST VS ? FECAL
ANTIGEN
natronboy!!!, Sep 11, 2008
#20

11.

muttasimGuest

cellulitis resistant to penicillin & fuloxacillin is ----clindamycin

gonorrhoea resistant to cephalosporin is---chlamydia trachomatis

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:

DNA plymerase function:multiply DNA

Rixitumab function: Anti CD20
Cause of Torsade de point (VT with polymorphic QRS along the axis): respiridone
Function of terlipressin: splanchnic vasoconstrictor
management of gestational diabetes
Cause of pneumnia: bilateral shadowing + history of influenza: Mycoplasma or Staph aureus?

investigation for mycoplasma pneumania: serology?

patient with SLE picture, on phenothiasines and anti-Sm positive: SLE?
Weakness of thumb abduction and numbness in hand and forarm: median nerve or T7 :numbness of
forearm?
weakness of ankle reflex and numbness on lateral side of foot: S1
Weakness of knee flexion and weakness on medial leg: L4
Weakness on Toe walking and tenderness behing medial malleolus: extensor digitorum longus tendon
Cocain overdose feature: hyperthermia (eventhough hyponatraemia is also a feature secondary to
polydipsia)
2 questions on Live attenuated vaccine: yellow fever for both

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

natronboy!!!, Sep 11, 2008

#24

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

Pregnant lady - typical charecteristic of nephrotic syndrome: hpoalbuminaemia, increased 24 hr urine

protein excretion & hence it is minimal change nephropathy.

Resistant hypertension: Pheochromocytoma as renovascular hypertension will have deranged Renal

function tests.

Coarctation of Aorta as there was radiofemoral difference in BP

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

MRCP sep 2008

hi guys wt do u think abt exam

in my opinion it was tough especially second one :shock:
wt were the right ans only RCP knows
we can only geus except some((((
burningi_ce, Sep 11, 2008
#28

16.

burningi_ceGuest

HIV antibody HCV antibody -i think ch.hep C?

thiazide acts on distal tubule
burningi_ce, Sep 11, 2008
#30

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?

unable to move before asleep and before walk...it ws tricky

i ans frontal epilepsy i dono am i right
mrcp sep 2008

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

Found it very tough- EAA/Lyme disease

Young woman with erythema marginatum postg HSV

cause of death in dialysis ... i think Coronary HD

reflux is not hereditary disease in the mjority .. also the protinuria is not in nephrotic range...0.8 gm
--organism in cat scratch disease.
--action of mannitol
-- mode of inheritence of heriditary heamorhagic telangitaxia
-- tear drop appearence on blood film ? dignosis
-- AML ?? which translocation has worst prognosis
-- Old/Middle age man with low HB and platelets WBC Ok --- cause ??? essential throbocythemia ( I
am not sure if I am mixing 2 questions -- please complete if some one could recall)
LET ME RECALL SOME MORE PLEASE ANSWER AND ALL VISITORS PLEASE HAVE YOUR
DDITIONS --- MAY BE WE COULD HAVE ALL 200 QUESTIONS ON BOARD --- PAPER OUT

pancytopenia & tearsdrop RBCs shape is -----myelofibrosis

PKD associated with polycythemia
pt on thyroxine therapy & developed low BP ---addison crisis - hydrocortisone is the treatment of
choice
the post chicken pox pneumina treatment is flucoloxacillin
diagnosis of mycoplasma is serologically
muttasim, Sep 11, 2008
#41
cat scratch bacteria is pasteurla motliceda
manitol increase intravascular osmotic pressure

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.

herez some contribution from my side:

cat scratch>>>>> bartonella hansale

q abt primary polycythemia
tactile hallucinations
hemodialysis>>>> drugs with good plasma protien binding
chemo>>>>> granisetron
TCA overdose>>>>> ecg first of all
ANCA
old man e backache>>>>>>protien electrophoresis
deuchene>>>>>>>> female 45xo
pneumonia in old man>>>>>>SIADH
I.B.S>>>>pain awaking the pt from sleep
Achalasia
pt on sildenafil>>>>>>b blocker

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

hello Guest you contributed 130 questions approx.

You are a genious
Can you recall some more mate
I think you can
Cheers
salboy, Sep 11, 2008
#45

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

Here are some comments on previous answers, please correct me if I am wrong:

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

MRCP sep 2008

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

that was heroine withdrawl.

MRCP SEP 2008 RECALLED QUESTIONS
Discussion in 'MRCP Forum' started by dr arif, Sep 10, 2008.

burningi_ceGuestoh no if it was heroin :shock:burningi_ce, Sep 11, 2008#51

GuestGuestit was cat bite not cat scratch organism so it is pasteurella

lyme disease as the rash is clearing center

what mechanism of terlipressin

RAMADAN MUBARAK

HOPE ALL TO PASS :lol: :lol: Guest, Sep 11, 2008#52

salboyGuestGood work every one

Thanks for your contribution

Keep goingsalboy, Sep 11, 2008#53

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

ssssssssGuestits HCV -RNAssssssss, Sep 11, 2008#56

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

EinasGuestA funny skin lesion...........Erythema multiforme ???

Alfa 1 antitrepsin 20% ( MZ) or (ZZ) ??

Kaposi....HV8Einas, Sep 11, 2008#60

GuestGuestSORRY BUT WHIHC BOF WAS ASKING ABOUT KAPOSI SARCOMA??

CAN U REMEMBER THE QUESTION PLEAS//

THANXXXXXXXXGuest, Sep 11, 2008#61

salboyGuestHave we had HCV RNA in the answer well I am not sure but I choose LFT as well

Its ZZ

I think it was the bartonell bc it was cat scratch not bite

For angio genesis I wrote EDGFsalboy, Sep 12, 2008#62

mokhlesGuestthis what i have answered anyt one have comment just help me

cluster headache

supraspinatous

mitochondria

cavernous sinus syndrome

angiodema

cerebellar thrombophlebitis

parietal lobe lesion

sarcoidosis

back to work after 2 wks

diet regieme for the diabetic pregnant

aortic regurgitation

central saddle pulm embolus

systemic lupus

cat

renal biopsy for q size kidney

steroids for lupus nephrits

zm

anti sm sle

hcv rna

dicodeine withdrawal

perirheral vasoconstrictor

fluxotine ssri cause galactorhhea

x ray for pancreatits

c7 for neiseeria

central retinal v thrombosis

lt parietal lobe lesion

thanks and if in remember any i will sentmokhles, Sep 12, 2008#64

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

Guest110908GuestI would like to clarify certain arguments:

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

1) Acts on Dopamine receptors (antagonist)

2) Does not cause torsades- this answer was sotalol

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

GuestGuest- sotalol causing dorsade de pointes

- lyme

- frontal lobe ----perseveration.

- polycythemia vera --- associatd with low plasma volume or O2 affinity

- temporal arteritis and sudden loss of vision---- anterior ishemic arteriopathy not crvtGuest, Sep 12,
2008#68

Kurdish docGuestrecalled questions

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:

1. drug causing cardiac damage.......Doxorubicin

2. ulcerative colitis with jaundice.......sclerosing cholangitis

3. simvastatin.........to be taked just before bed time

4. galucoma.......tricyclic antidepressant

5. tricyclic anti dep poisoning............ECG

7. gestational diabetes................. soluble insulin

8. proteinuria in diabetes............... reflux disease

10. hypopigmented skin patch plus subungual fibroma.....tuberous slerosis

11. heridetary haemorrhg telang inheritance............AD

12. Duchenne Muscl Dystrophy inheritance..............45 XO karyotype

13. Polycythaemia association........... Gout

14. Desmopressin mode of action...........Release stored VIII

15. drug causing galactorrhoea...............metoclopramide

16. drug causing torticolis.....................metoclopramide

17. "a" wave on jugular pulsation........... P wave on ECG

18. AF in pat with WPW.................fleccanide

20. headache and pupilary dilatation......post communicating a aneurysm

21. prognostic factor in pneumonia...............Urea

22. drug to improve survival in HF......... Bisoprolol

23. Trigeminal neuralgia............. carbamazepin

24. profuse diarrhoea.............VIPoma

25. resistant hypertension............. renovascular dis

26. MODY.............. strong family history

28. Gastrin ..................... gastric peptide

29. Terlipressin action in hepatorenal............splanchnic vasoconstriction

30. Starch digestion.............. Amylase

31. Multiple myloma.................. plasma protein electropheresis

32. RA .................. periarticular osteopenia

33. different arterial pressure reading in ascending aorta and femoral artery...............coarctaion aorta

35. drugs for Crohns disease..............Infliximab

37. chest inf after Influenza...............Staph aureus

38. Foodpoisoning after few hours(vomiting).....Bacillus cereus

39. Acute gout in a pt on Warfarin......... Prednisolon

40. site of thiazide action............. Distal tubule

41. hypopigments skins association............... pernicious anaemia

42. cwerebral oedema in a pat with metastasis....... dexamethason

43. hip pain+polydipsia+loss of libido....... Ferritin

44. gonorrhoea association................ Chlamydia

45. feature NOT in IBS..................... pain waking pat from sleep

46. pat recievinf sildinafil.............keep Ramipril

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 we have compiled about 155 altogather uptill now

Please keep going every one

I think the cut of would be 65% this timesalboy, Sep 12, 2008#70

EinasGuest- Idon`t remember the whole question guest,

but i think it was about the most associated viruses with kaposi S

Options were( HHV8, EBV, ....., ..... ,....)

- perseveration in the symptoms>>>>>Frontal lobe lesion

-Myoglobin as a marker of cardiac damage

-right coronary artery infarct

-hormone not raised in stress>>>LH?

-young boy with hypogonadism..............

-prednisolone dose equivalent to body cortison?

-Diabetes HLA,, AB association

-staghorn calculi(Mg, Ammon Phos)

-Alport female mildly affected(x linked dominant) >>> i chosed lyonisation

-oesophagial candidiasis ...... DM???

-hus question ??? was it about the treatment, plasma exchange?

-Low M W Heparine test>>>>>does not need monitering

-TB >>>> IL2?

-pat with lower limit of normal value CA, low PO4, High ALP

-where there any question in which we needed to calculate anion gap?

-CT lesion In both White & gray Matter......

-haemoglobinuria, urin without RBC casts

-hypokalaemia with hypertention

-Haemodialyis pat taking phosphate binders>>>>Blood values ok. no change in treatment?

-GN with infection

- in COPD>>>>lTOT?

-occupational asthma diag>>>PEFR at work & home

-def of the power of studyEinas, Sep 12, 2008#71

ssssssssGuestfew more, that i remember:

pt with deranged RFT'S>>>>>>>fentanyl patch?

pt with iron def anaemia, faecal occult bld+>>> CA caecum

Aluminium phosphate in a CRF pt.

Vit d levels

power of a test.

down's pt>>>>>>>refractoey hypoxemia

diabetic pt with dysphagia>>> fungal oesophagitis

young boy,not working for last 4 months,brother died of SAH 6months back>>>>>>depressive episode

young girl,break up with boy friend>>>>>>>depression

CA stomach>>>>>>signet ring cells?

giant v waves on jvp

vit D resistant profile

pneumococcal infection>>>>IgA2

antigen presenting cells>>>>>>langerhans cells

chemo>>>>>granisetron

copd pt>>>>>>LTOT associated with prognosis

fireman>>>>>>>>>post traumatic stress disorder

inc prolactin>>>>>>>>hypothyroidism

lupus anti-coagulant

acute sarcoidosis>>>>>>>spontaneous remission

renal carcinoma>>>>>>>adenocarcinoma

nucleus DNA is double strand

http://en.wikipedia.org/wiki/DNA

mitochondrial DNA is single strand

http://en.wikipedia.org/wiki/Mitochondrial_DNA

sourse ; wikipediaGuest, Sep 12, 2008#74

GuestGuestregarding that lady with DIC feature ;

the same BOF was avilable on onexamination ,

the answer was Immunoglobuline , not plasma exchange ,

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),

if you focus upon the BOF , his temp was 38 ,

besides that CMV infection is so common ,

so the answere is acyclovir not prednis.Guest, Sep 12, 2008#76

GuestGuestregarding the BOF , that pat. who got 3rd,6th, & oth.div of trigeminal ,

the answer is orbital apex , not cavernous sinus ,

as c.sinus , there must be congestions of the eye,Guest, Sep 12, 2008#77

mmmmmmmmmmmmGuestthrombophilia common in north europeons?heterozygote factor5

dermatitis artefacta

rash was raised mcv and hypothroididm?raised alp too celiacs or PBC

granuloma annulare on hand of 19 year old

supraspinous tendonitismmmmmmmmmmmm, Sep 12, 2008#78

GuestGuestthat lady with iron def. anemia

iron continue for the next 3 months,

kummar & clarks mention continues for coming 6 months to restore iron store,

but she already has been on iron for last 3 months

so the answere 3 months

you can review the answere at page 188 in kumar & clark pocket book .Guest, Sep 12, 2008#79

GuestGuestHba1c to be checked after 3 months not 1 monthGuest, Sep 12, 2008#80

GuestGuestpost stable angina to decrease morbidity BET BLOCK

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 .

2-acute late severe asthma

so the answere is pul.angiography .

as HIV is a distractorGuest, Sep 12, 2008#82

mmmmmmmmmmmmGuestco amixiclav for cholestasis

antiphospholipid for recurrent abortions

siadh

del 5q poor prognosis

pt with increased mcv and urobilinogen?check retics???????

ankyolostoma for carribean holiday serpenginous rash

basal cell on temple

fev1 fvc 70 kyphosis

beckers dystrophy with son n brother lyonization as turners pts subfertile

there was a question like this on ydr with female n g6pd def so it cant be 45x0mmmmmmmmmmmm,

Sep 12, 2008#83

GuestGuestmotion sickness on a cruise

treated my cinnirzine ( stageron)

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

GuestGuestRisperidone is working at 5HT receptor

not dopamine

GuestGuestITCHY LESION SHOULDER, BUTTOCK , ++ ALK

it was coeliac not PBs , as there was dual def. of blood ie iron & mega.anemiaGuest, Sep 12, 2008#88

GuestGuestLOWE RT WEAKNESS, + TONE + REFLEX, UPPER RT DELTOID,

it was AMLS

as mixed UML+ LMNLGuest, Sep 12, 2008#89

GuestGuestBCG T CELL RESPONSE

if you remember that the Th1 is incharge of cell mediated immun.

and the TH1 produces IL2,& gamma interferon

so answere is IL2

check p.kalraGuest, Sep 12, 2008#90

GuestGuestATOPIC ECZEMA, RASH, CRUSTED

the question mentioned in the end , that the lesion is spread all over the body ...

so the answere is oral steroids, as it was so severeGuest, Sep 12, 2008#91

GuestGuestRT SIDE COMP HEMIPLEGIA, BROCA AREA --- + leg weakness

answere is anterior cerebral artery ,

as leg weakness is a specific & diagnostic of frontal lobe ischemia which supplied by ant.cerebral ar.
Guest, Sep 12, 2008#93

GuestGuestlady FEAR OF AVIAN FLU,birds want to hurt her,,, PREOCUPAIED

if you read carefully till the end , it mentioned that , she can escape the birds , by hiding in her husband
socks.

so the answere is acute delusional schiz.Guest, Sep 12, 2008#94

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.

asiaGuestin fact both of us are correct ,

925.

but we can not know how is the RCP thinking

926.
927.
928.

am i right ?????????????????????asia, Sep 12, 2008#101

929.

yosefGuestYes sure. Can u tell me about these questions:

930.
931.

Flumazenil competitive inhibition?

932.

Best way to controll eradication of Helicobacter pylori....breath ureas test?

933.

Haemodialysis not benefit with which situation or drug.....ans water soluble????.

934.
935.

Am I right about these answers or not?

936.

Thanksyosef, Sep 12, 2008#102

937.

GuestGuestFlumazenil competitive inhibition? CORRECT

938.

Best way to controll eradication of Helicobacter pylori....breath ureas test? CORRECT

939.

Haemodialysis not benefit with which situation or drug.....ans water soluble????. NOT RIGHT,,, THE
right answer ; high proetin binding capacity

940.
941.

8)Guest, Sep 12, 2008#103

942.

mmmmmmmmmmmmGuestpoor prognosis in aml 5q delet(i wrote 8 21)

943.

doxorubicin

944.

obliter of heart border in fibrosing alveolitis?

945.

glaucome tca?

946.

latent tb 2wks

947.

ceacal cancer as rt sided

948.

hydroxyurea

949.

signet cell adenocarcinoma stomach

950.

basal cell on temple

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

just PPI's.ssssssss, Sep 12, 2008#105

954.

GuestGuestregarding poor prognosis in aml 5q delet

955.
956.

what is your sourse plzzzzzzzz??????

957.
958.

as i checked p.karla

959.
960.

it mentions that 5q is related to MDS......Guest, Sep 12, 2008#106

961.

GuestGuestregarding fibrosing alvelitis

962.
963.

the right answer is heart borders poorly demarcated .

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.

H.pylori-eradication is breath Urea and feacal detection of H.Pylori

969.

another q Hb1c should b checked twice a year accord wiki

970.

i dono am i rightburningi_ce, Sep 12, 2008#109

971.
972.

burningi_ceGuestwhich symptom says rather than IBS

973.

i think it is feelings of incomplete defecation

974.

wt do u think guysburningi_ce, Sep 12, 2008#111

975.

koshan13Guest1.a case of PSS, H/O progressive SOB, WHAT'S THE CAUSE????----INTERSTIT

LUNG DISEASE / PROG. FIBROSING LUNG DISEASE........i think ---prog. fibrosing lung
disease...CORRECT 2. AN adult with chicken-pox induced pneumonia, what's his treatment???
ACYCLOVIR/ FCLUCLOX./GENTAMYCIN/.......I think... acyclovir...CORRECT. Floor is open for
discus......... thx.koshan13, Sep 12, 2008#112

976.

yosefGuestWhat is HYDROXYURIA? for which question?

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.

salboyGuestGood going every one

983.

Can we please have some more questionssalboy, Sep 12, 2008#118

984.

yosefGuestFor Irritable bowel, it was the pain awake the patient from sleep correct answer.yosef, Sep
12, 2008#119

985.

burningi_ceGuestin IBS pain could be functional

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.

so 2 METOCLOPROMIDE and 2 Doxirubicin am I right?yosef, Sep 12, 2008#122

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.

-The lady fearing Avian Flue.>>>del shizEinas, Sep 12, 2008#126

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.

Here are some questions which needs discussion

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.

Left sided wasting of deltoid /supraspinatous .in U/L

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.

Nerve conduction studies showed Denervation in Deltoids level bilaterly

1016.
1017.

LUmber Puncture protein >1.5 (n: 1.0)

1018.
1019.

WBC 3 (n: 5)

1020.
1021.

What is the cause??

1022.
1023.

1) Amytrophic Lateral sclerosis

1024.

2) chronic demylinating polyneuropathy

1025.

3) hereditary spastic parapresis

1026.

4) Subacute Combined degeneration of spinal cord

1027.

5) transverse myelitisIQTG, Sep 12, 2008#127

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.

Eye Examination revealed bilateral cupping of discs

1035.

which drug is causing that

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.

while BNF clearly stated that prednisolone causes glucoma

1044.

I think the answer is prednisolone not TCAIQTG, Sep 12, 2008#128

1045.

Kurdish docGuestHi guys.....I just want to comment on a questions...

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.

if still u thinkthat it is pain then might be u r right

1050.

but i still think that it is tenesmus))))))burningi_ce, Sep 12, 2008#130

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.

-give metformine 500 mornig and 1000mg in evening-i choose this

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.

-flecanide- i choose (b/c AF withno sign of HFor etc)

1077.

-?

1078.

*treatment for trigeminal neuralgia----carbamezipen

1079.

-chrug struss syndrom

1080.

multiple myloma ----plasma electrophereses

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.

-Amphetamine i choose ( i think it is wrong )

1085.

* double standerd DNA in Nucleuse (i choose B?C double helicle form is buty of DNA in nucleuse ) /
mitochondria?

1086.

glukokinase enzyme......very difficult i dont know the answer

1087.

competative inhibition ....enzyme in fomepazole treatment.

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.

postmenopausal women......treatment is hormone replacement.

1090.

a young lady with sweaty palms and feet and anxiety symptoms......i put pheo

1091.

mode of action of glucophage......decrease hepatic glucose production

1092.

power of study............i choose the last option as they were looking for defination not numbers

1093.

post traumatic stress disorder .....at least two cases.

1094.

inactivation of x chromosome in lady with muscular dystrophy.

1095.

circular single stranded dna.....mitochondria.

1096.

re why infliximab is humanized....to reduce immunogenicity

1097.

a case of carpal tunnel....median nerve.

1098.

lady with oa and painful swollen and tender knee after trauma...hemarthroses...note labs

1099.

doxorubicin ....cardiomyopathy and chf in breast ca survivor.

1100.

catatonia.......lady who was mute....cf catalalepsy....cataplexy.

1101.

pictureyndesmophytes......ankolysing spondylitis.

1102.

c 13 urease test ......h pylori eridication..

1103.

a case of sleep paralysis

1104.

drugs with dialysis.....with protein binding.

1105.

statin to reduce mortality....as patient had elevated lipids and abnormal stress test not mi.

1106.

thiazides acting at distal tibule

1107.

gentleman with htn and dementia.....cerebrovascular disease ..multiinfarct dementia.no signs of

parkinsonism were givn..cf lewybodyvs ad.

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.

elderly with myeloma.....immediate investigation....mri of spine.

1111.

sotalol causing torsade.

1112.

which hormone will become deficient in pat with pit microadenoma..normal visualfields....i chose
cortisol.

1113.

a gymnist lady.....lutenizing hormone deficiency.

1114.

a case of impetigo....correct abx was easy

1115.

a case of non responding cellulitis....add clinda

1116.

a case of anemia in father whose son had fifths dis....parvovirus...pretty classic picture.

1117.

co amoxiclav............ causing ....cholestasis.

1118.

respidone.....dopamine.receptors

1119.

a cases of cardiac-l shunt...i choose o2 not correcting hypoxia

1120.

a case of pe.....hypotension is the best indication for thrombolytics.ref please see algorithm in ohcm.

1121.

hep c monitor hep c pcr rna

1122.

question about pcr....easy.

1123.

familial colon ca....apc gene.

1124.

a acse of acute coronary syndrome what next....i chose glceryl trinitrate.

1125.

a case of hypertensive encephalopathy.

1126.

fever post transpalnt in cmv neg pt rx.....gancilovir

1127.

a lady with recuurrent afib who was diabetic......rx warfarin

1128.

factor 5 leiden heteroygote in europeans,case was a female

1129.

flecanide for....wpw.

1130.

cause of death in hd.....cardiac.

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.

sever asthma not responding.....iv magnesium.

1134.

a lady who cannot tolerate either carbamezepine and valproate.....phenytoin.....remember lamotrigine is

used for refractory eplilepsy.

1135.

ino....medial longitudnal fasiculus.

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.

at least to lyme cases

1139.
1140.
1141.
1142.
1143.

thanks

1144.

i pray everybody passes....aminshaheed., Sep 12, 2008#131

1145.

muttasimGuestmuttasim

1146.

Guest

1147.

1148.
1149.
1150.
1151.
1152.
1153.

Posted: Fri Sep 12, 2008 2:44 pm Post subject:

1154.
1155.

--------------------------------------------------------------------------------

1156.
1157.

chinese resturant----bacillus cereius

1158.

plasma exchange for -- TTP

1159.

protein electropheresis for -- multiple myeloma

1160.

vipoma for painless watery diarrhoea

1161.

clindamycin for esistant cellulitis

1162.

terlipressin increase stored factor VIII secretion

1163.

corticl thrombophelebitis for post sinusitis tratment NEUROLGICAL DEFICIT

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.

let us start thinking of MRCP2.

1172.

let us do research and find out the best sources resources.

1173.
1174.

So far I found that book by sanjay sharma is needed

1175.
1176.

do not know what to choose between Pass Test/Onexamination/Medical Masterclass. Can anyone
please guide?

1177.
1178.

Love

1179.
1180.

Gursharangursuchi, Sep 12, 2008#136

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.

Check the British Guideline of Asthma .Guest, Sep 12, 2008#137

1184.

yosefGuestLady on haemodialysis with high ca, high pth.... ans is parathroidectomy.

1185.

Lady with intermitent A.F warfaren will be continued for indifint time.

1186.

Vit B12 depends on PANCREATIC HCO3 in addition to intrinsic factor.

1187.

ECHO is the next step for 24 hours h.o ant MI.sys.murmur.pap.musc.rupt?

1188.

Simvastatin...... just befor bed time.

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.

old man dancing on the floor. what is the choice

1193.
1194.

very old lady can not come to the hospital, where to treat

1195.
1196.
1197.

khan@Guest, Sep 13, 2008#142

1198.

yosefGuestI hope there will be some comments so that i can know wether i did it correct or not.

1199.

OK there are more here:

1200.
1201.

Lady with very high BMI,Low FEV1,high RV, Low kco...ans COPD.

1202.

alfa-1 antitrypsin deficiency.....ans ZZ.

1203.

Lady with follicular carcinoma and suprresed TSH...ans keep med.as it is.

1204.

Trastuzumab treatment breast ca. action against.....ans HER- RECEPTORS

1205.

Most commen causes of recurrent DVT among all...ans Antithrombin def.

1206.

upper + lower motor neuron lesion + no sensory = ALS/ MND

1207.

In Amyotropic lateral sclerosis mixxed UMN and LMN picture is seen

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.

I was thinking about the heriditery component

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.

I hope will answer ur queries.IQTG, Sep 13, 2008#146

1216.

Guest120908GuestWPW with AF: Treatment of choice would be Diltiazem as Flecainide is indicated

only in rythm control of aTRIAL FIBBRILLATION for pt with no past history of arrythmia. This pt.
had structural heart disase in the form of WPW & therefore rate control is aim with DILTIAZEM......
Guest120908, Sep 13, 2008#147

1217.

mokhlesGuestthanks for all ur answers,let us help each other,here is some what i have answered

1218.

haemodialysis give vit d

1219.

warfarin for indefinite

1220.

echo in cardiac pansystolic post m i

1221.

statin before bedtime

1222.

alendronate bioavailability

1223.

nasal steroid for not improving bec she has nasal pklyps

1224.

amyptrophioc lat sclerosis

1225.

bacillus cerius

1226.

plasma exchange

1227.

prot electrophoresis

1228.

cortical thrombophlebitis not brain metastasis

1229.

1000 and 500 in ramadan

1230.

prgnant lady with p p s is 210 diet regieme not insulin

1231.

af i answered digioxin w is incorrect

1232.

carbamazepione for trigem neralg

1233.

hiv for low vaccine level

1234.

dicodeine withdrawal

1235.

mitochondria double strand dna circular

1236.

antin sm is sle

1237.

tetanus is vancomycin

1238.

postmenopauasal is alendronate u dodnt know since how long she is menopaused

1239.

glucophage is hepatic gluconeogenesis dec

1240.

hypochondrial

1241.

conversion

1242.

Aortic regurge in the cardiac

1243.

lesion in the left parietal lobe

1244.

preservation in frontal

1245.

ant cerebral a

1246.

catatonia

1247.

ammonium in stone

1248.

renal biobsy not renal angio

1249.

steroid

1250.

axillary n for deltoid

1251.

serratus ant but i answered supraspinatous

1252.

dorsum of the foot senesation

1253.

c7 for meningo cocci

1254.

c4 for sle

1255.

competitive inhibition

1256.

splanchnic vaso constriction but i wrote peripheral vc for telepressin

1257.

fluxotine is ssri do galactorhea and metocloprom but she take flucxo more

1258.

anular circular

1259.

pemphigus

1260.

herp acyclovir

1261.

staph for bact endocarditis

1262.

mycoplasma is coldaglutinin

1263.

cryptiogenis is upper lobe fibrosis

1264.

rheumatoid d 4

1265.

churgstruss

1266.

cluster headache

1267.

sarcoidosis

1268.

x ray for pancreatits

1269.

nurse back after 2 wks

1270.

i will continue later some one say do i have a chance to passmokhles, Sep 13, 2008#148

1271.

GuestGuestjust want 2 ask ;

1272.

what the equal dose of prednisole ?

1273.
1274.

is it 20 ????????????????Guest, Sep 13, 2008#149

1275.

asiaGuestregarding EAA .

1276.

1277.

the question was so tricky , and need a concentrated mind.

1278.
1279.

look , the proper answer is NEUTROPHILIA , which is more common than upper zone shadowing .

1280.

besides that the coomon CXR feature of EAA is mid-zone mottling/consoilidation .

1281.

you can check in Oxford hand book page 180.

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.

this system is rather more difficult than the previous one,

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.

this is a link at RCP

163.

http://www.mrcpuk.org/News/Pages/Part1_Equating.aspxGuest, Sep 13, 2008#151

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.

Thank u very much for any explanationsyosef, Sep 13, 2008#152

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.

GuestGuest-need more clarification or example for such equating system ?????

171.
172.

about spastic paraparesis does not affect upper limb by nameGuest, Sep 13, 2008#154

173.

GuestGuestsorry guyz

174.
175.

just want to ask about that case , which seems to marfan ,

176.
177.

i think it is PSEUDO XANTHOMA ELASTUM

178.
179.

as the case talked about some tear in the aorta or some thing like that ..

180.
181.
182.

does any 1 remember the scenerio ???

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.

we were preparing , and it confueses us all ,,

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.

yosefGuestThe equal dose of prednisolone is 7.5 mg.

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.

GuestGuestsorry but it was already 7.5 ???????

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.

thanx to all for reminding me the questions.

204.

can anyone guess....about what percentage of correct answer should be enough to pass...

205.

the RA xray feature ...is periarticular osteopenia,why not juxtra-articular osteoporosis...

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.

Does anyone know what the answer was:

210.
211.

1)commonest cause of maternal death ?miral regurgitation/?VSF/?ASD

212.

2)side effect of ondensterion

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.

ThanksGuest, Sep 14, 2008#164

223.

koshan13Guestprednisolon------h.e.inducer, so will u prefer to give along with warferin??as it will

reduce the action of warferin...............thx,koshan13, Sep 14, 2008#165

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.

Thanksyosef, Sep 14, 2008#166

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.

Thanksyosef, Sep 14, 2008#167

234.

GuestGuestsignet ring in stomach ca

235.
236.

http://en.wikipedia.org/wiki/Signet-ring_cellGuest, Sep 14, 2008#168

237.

GuestGuestregarding the translucnet in temporal area.

238.
239.

it was sebecious cystGuest, Sep 14, 2008#169

240.

mmmmmmmmmmmmGuestshouldnt induced sputum be tried firdt in pneumocstis pneumonia before

bal as its non invasive .i did an mcq on that once cant remember wheremmmmmmmmmmmm, Sep 14,
2008#170

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.

3) prednisolone leading to raised intraocular pressure in a pt of RA

244.
245.

aNYWAYS ANYONE INTERESTED IN STARTING PLANNING FOR PART 2 PREP PL CONTACT

ME. i HAVE ALREADY DONE A BIT of homework.

246.

lets be positive that we will pass and start prep for part 2.

247.

my email is gursuchi at gmail dot comgursuchi, Sep 14, 2008#172

248.

GuestGuestregarding;

249.
250.

prednisolone leading to raised intraocular pressure in a pt of RA

251.
252.

i totally agree with u , as the other drugs can coz eye problem , but not inc IOP.

253.
254.

thanksGuest, Sep 14, 2008#173

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.

thanx to all for ur contribution,,pls help me regarding some confusion.....

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.

I thought may be hypothyroid...as it is an autoimmune disorder related to DM and also causes

hyponatremia and heart failure like picture....totally confused.

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.

But as lymphadenopath is not mentioned...wht shouls be the answer...the options r...

267.
268.

Chance of developing bilar sacroilitis

269.
270.

Chance to develop Ulcerative colitis

271.
272.

Should not be treated..

273.
274.

4.why not sclerosis in AS xray...though i answered syndesmophyte but sclerosis is also a good option.

275.
276.

take care guys.dr.manoj, Sep 14, 2008#176

277.

koshan13Guestdr. manoj/ following r the ans. of ur Qs.----1. RAxay---osteophytosis-CORRECT, not

periart. osteopenia 2.regarding a case of pneumonia---SIADH--CORRECT , not any other opt. 3. Acase
of sarcoidosis---no need for trearment ---CORRECT. 4. AS xay...sclerosis--CORRECT, not other opt. .
by the by,regarding BIH-------PREDNISOLON(STEROID),----CORRECT ans. pl. go through P.
KALRA , page--577 . take care.koshan13, Sep 14, 2008#177

278.

GuestGuestsorry but osteophytosis has nothing direct with RA

279.
280.

http://en.wikipedia.org/wiki/Osteophyte

281.
282.
283.

the right answer was periarticularGuest, Sep 15, 2008#178

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.

as High volume of diarrhea (continues despite fasting

288.
289.

http://www.health.am/encyclopedia/more/vipoma/

290.
291.

read sings & testsGuest, Sep 15, 2008#183

292.

GuestGuestregarding that lady wity TTP

293.
294.

the same question was on onexaination .

295.
296.

and the answer was Ig , not plasma exchange

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.

and the bold phrase if from onexaminationGuest, Sep 15, 2008#184

301.

GuestGuestthe msot common inherited thrombophilia in north europe is V leiden

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.

dr.manojGuestReview of the questions of MRCP PART 1 on September

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.

2.Cholestatic blood picture due to.....Co-Amoxyclav.

315.
316.

3.Action of terlipressin in hepatorenal synd...splancnic vasoconstriction.

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.

6.H.pylori eradication monitored by.....14 C Breath test.

323.
324.

7.A pt with positive faecal occult blood test,perrectal exam normal,most common site...I answered
Sigmoid colon.

325.
326.

8.Which of the following regarding gastrin is correct...Stimulated by gastric peptide.

327.
328.

9.A pt with pancytopenic picture with increased MCV...inv of choice....Vi-B12 conc.

329.
330.

10.Enzyme acting on starch....Amylase.

331.
332.

11.A pt with long standing watery diarrhoea....VIP Oma.

333.
334.

12.A pt with difficulty in swallowing,hallitosis.....Pharyngeal pouch.

335.
336.

13.A pt with cholestatic blood picture,history of ulcerative colitis....Primary Sclerosing Cholangitis.

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.

17.A DM pt with dysphagia....candidiasis.

345.
346.
347.

### HAEMATOLOGY :

348.
349.

18.Cause of hypercalcemia in Multiple Myeloma....Osteoclastic activation.

350.
351.

19.A pt with low back pain,increased calcium and phosphate..inv.to be done...plasma protein
electrophoresis.

352.
353.

20.70 year old man with lymphocytosis and lymphadenopathy,wt loss...inv of

choice(CLL)....Immunophenotyping.

354.
355.

21.Primary polycythemia...which should be present...Hyperuricaemia.

356.
357.

22.Rituximab..which antigen specific....CD20

358.
359.

23.Splectomy pt should receive vaccine....1 month prior surgery.

360.
361.

24.Increased erythropoietin secretion in....ans probably is renal adenocarcinoma though i answered

renal haemangioma.

362.
363.

25.A PBF showing pancytopenia and tear drop cell...Myelofibrosis.

364.

27.A woman with bruishing purpura and decreased Plt...Cause is Auto immunity.

365.

28.European female..most common cause of thrombophillia....Ans is factor v leiden with

heterogygosity though I answered Anti-2 def...the word heterogygosity confused me as i thought factor
v is A.Recessive.

366.

29.Action of DDAVP....Release of factor 8 from endothelial cell.

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.

31.Cause of T-cell leukemia....HTLV-1.

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.

36.A pt with increased BP in arm but gradually decreased BP in Periphery...Coarctation of Aorta.

372.

37.A pt with WPW and AF...Flecainide.

373.

38.A pt with facial pain,horner''s syndrome( No Lacrimation)...I answered Carotid Dissection...but

confused.

374.
375.

39.A post MI pt with increased cholesterol...factors improves prognosis...Statin.

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.

42.A case on indication of thrombolysis...Low BP of 80/60.

379.
380.

43.Drugs causing Prolong QT...Sotalol.

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.

45.A pt with recurrent AF with mild decreased LV Function...should receive Warfarin...Indefinitely.

385.
386.

46.Drugs causing Postural hypotension most....B-Blocker

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.

49.G protein coupled receptor on...Plasma membrane.

395.
396.

50.Galactorrhoea caused by...Metochlorpropamide.

397.
398.

51. A pt with blood pic of decreased RBS ,Decreased Sodium,normal potassium...wht to

give...Hydrocortisone.

399.
400.

52.A woman with microprolactinoma...which hormone deficient...Oestradiol

401.
402.

53.Action of Metformin...I answered increased Peripheral uptake of glucose according to Davidson..but

may be the ans is decreased hepatic glucose production.

403.
404.

54.2.5 mg prednisolone is equivalent to...7.5 mg of glucocorticoids.

405.

56.MODY feature....Strong Family History.

406.

57.Head injury with cranial Diabetes Incipidus....low urine osmolality

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.

59.Gestational DM...Start Insulin.

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.

61.HbA1c measured after Blood transfusion...I chosed 3 month.

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.

63.Frontal lobe feature...Perservation.

421.
422.

64.A pt with recent memory loss,disorientation,personality change...Alzheimer''s disease.

423.
424.

65.Na Valproate and Carbamazepine resistant Epilepsy...Lamotrigine.

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.

69.A pt with facial nerve palsy and annular rash...Lyme dis.

431.
432.

70.A pt with unilateral facial palsy and annular rash...inv...Ab for Borrelia

433.
434.

71.A pt with sensorimotor deficit and aphasia...MCA territory lesion.

435.
436.

72.A pt with foot drop...which area sensory loss...dorsum of foot.

437.
438.

73.Prophylactic Rx for Trigeminal Neuralgia...Carbamazepine

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.

75.Localization of 3rd,6th and opthalmic division of 5th nerve....Cavernous sinus.

443.
444.

76.A pt with weakness and CxR showing Ant.Mediastinal Mass..Anti-Ach ab

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.

80.A pt with Asthma,no improvement on B agonist and steroid...add Mg++

455.
456.

81.Cause of normal FEV1/FVC...Obesity

457.
458.

82.Improve prognosis in COPD pt...LTOT

459.
460.

83.Genotype developing cirrhosis in Alph-1 Deficiency...ZZ

461.
462.

84.A pt with fever,dyspnoea,CxR Bilat.Shadow but H/O influenza outbreak...Staph.Aureus

463.
464.

85.In EAA...wht happens...upper lobe fibrosis

465.
466.

86.Contact TB pt getting Isoniazid....i chosed...should not get out 2 wk.

467.
468.

87.A pt getting amiodarone,Digoxin,ACEI...cause of bilat shadow on CxR...Amiodarone

469.
470.

88.A pt with restrictive defect with normal FEV1/FVC...Spinal prob.

471.
472.

89.A pt with episodic wheeze,resp distress...doesnt improve on steroid inhaler...course of action...i

chosed PEFR monitoring both to diagnose asthma properly and monitoring of treatment.

473.
474.

90.Fibrosing Alveolitis CxR...Obliteration of cardiac angle

475.
476.

91.Pneumonia pt...poor prognosis...urea level

477.
478.

92.CxR showing Hilar mass...finding is Bronchial Breath sound.

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.

94.Mycoplasma Pneumonia...diagnostic test....Complent Fixation Test(Serology)

483.
484.

95.Feature of cardiac Shunting....O2 doesnt correct hypoxia.

485.
486.

97.Number of pt to treat to prevent one attack

487.
488.

98.Wht does power of study 80% mean?????

489.
490.

99.A drug is reported to cause Fulminant hepatic failure...best way to study...case

control...cohort...randomized trial

491.
492.

100.A new analgesic for postsurgical pain control studied on 2 groups....2 sample t test???

493.
494.
495.

### Skin :

496.

101.A pt with depigmented area on leg & arm...association...Per.Anaemia

497.
498.

102.A pt with purple red lesion on leg...Pyoderma gangrenosum

499.
500.

103.A pt with viral infection with blister like rash...E.Multiforme

501.
502.

104.A pt with facial swelling and photosensitivity...Rosacea

503.
504.

105.A pt with rash with raised borderpresent on dorsal aspect of hand...Granuloma annulare.

505.

106.A man with itchy rash on buttock and diarrhoea...Coeliac dis

506.

107.A pt with blister like rash on trunk and mucosa...Pemphigus vulgaris

507.

109.A woman with H/O PC Overdose in the past presents with crusted lesion on upper arm...Dermatitis
Artefacta

508.
509.

110.A pt herpetic Eczema with fever,...Rx is IV Acyclovir

510.
511.

###Rheumatology :

512.
513.

111.Crest syndrome Cxr...Interstitial lung dis.

514.
515.

112.Pt with joint pain,rash,getting phenothiazine and anti Sm positive...SLE

516.
517.

113.A pt with foot dro and haematuria and ARF...ab found ..ANCA

518.
519.

114.A pt with recurrent miscarriage...ab is Lupus anticoagulant

520.
521.

115.Pt with Warfarin and Gout...Rx is Prednisolone

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.

119.Crest syndrome feature...Malabsorption

527.
528.

120.Anti-CCP ab positive...chance of RA.

529.
530.

121.A pt with OA..presents with red,tender,swelled joint after minor trauma....i answered
Haemarthrosis

531.
532.

122.Anti Ds DNA 1:400 means wht???

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.

124.A pt with tall stature,pectus excavatum,Mitral valve defect...Fibrillin

539.
540.

125.Hypopigmentation with renal cyst...Tuberous Sclerosis

541.
542.

126.PCR for...DNA Amplification

543.
544.

127.Duchene mus dystrophy due to..non random x-chrmsome inactivation

545.
546.
547.

128.Hereditary Hgic Telangiectasia...Autosomal Dominant

548.

129.Circular Double stranded DNA...I answered Nucleus..may be mitochon

549.
550.

130.Most commom condition with Von-Hippel Lindau...i ans Retinal angioma...may be cerebellar
angioblastoma

551.
552.

###Metabolic :

553.
554.

131.Pt with poor libido,DM,arthritis...inv...S.Ferritin

555.
556.

132.Treatment of postmenopausat O.Porosis...Alendronate

557.
558.

133.Why Bisphophonate before meal...increases availability

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.

136.A pt with renal biopsy showing podocyte fusion...prednisolone

567.
568.

137.A pt with almost equal kidney & Haematuria,proteinuria,HTN..Biopsy

569.
570.

138.Dialysis pt increased mortality due to...Cardiomiopathy

571.
572.

139.Composition of staghorn calculi...MgNH4PO4

573.
574.
575.

140.Kidney absorp water by...Activation of aquaporin

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.

142.A 12 week pregnant pt with proteinuria and HTN..i Ans Pre-eclampsia

579.

may be reflux nephropath is right answer

580.
581.

143.Resistant HTN...Renovascular dis

582.
583.

144.Alcoholic pt with increased S.Creatinine...Rhabdomyolysis

584.
585.

###Immunology :

586.
587.

145.Repeated meningococcal infection...C7 deficiency

588.

147.MT test related with....ans is IL-2 though i ans TNF-alpha

589.
590.

###Phychiatry :

591.
592.

148.Risperidone acts on...D2 receptor

593.

150.A woman dont go outside due to fear of embarrasment...I ans Personality disorder...i am confused

594.
595.

151.A man with crawling sensation under skin...Hallucination

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.

155.A pt comes with palpitation and H/O thought of having Cancer,..Hypochondriasis

604.
605.

156.A pt restless due to intracranial metastasis of Malignant Melanoma...drug for restless...SC

Midazolam though i ans IM Chlorpromazine

606.
607.

###Infectous Disease :

608.
609.

157.HCV pt getting Ribavirin & Interferon...monitor wth HCV RNA

610.
611.

158.Live attenuated vaccine...Yellow fever

612.
613.

159.Anti staphylococcal drug(Iv drug user,fever)..Vancomycin

614.
615.

160.A pt with urethral discharge with gm neg bacilli,not improved by ceftriaxone....Chlamydia

616.

162.A pt with transplant from a CMV +ve pt...Ganciclovir

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.

165,organism associated with cat scratch..Bartonella

622.
623.

### Pharmacology :

624.
625.

166.Drug of motion sickness...Cinnarizine

626.
627.

167.Antiemetic in cancer...Granisetron

628.

170.A pt of Chron''s dis,resistant to Mesalazine and Steroid...Azathioprine

629.
630.

171.A DM pt wth Metformin in Ramadan...Morn 500 mg and night 1 gm

631.
632.

172.A pt with hypersalivation and nasal discharge...Heroine

633.
634.

173.Fomepizole acts by...Competitive antagonism

635.
636.

174.Lithium taking pt should get anti-HTN...Bisoprolol

637.
638.

175.Sildenafil receiving pt should not take....ACEI

639.
640.

176.Carbamazepine..increasing dose from initial dose...due to auto-induction

641.
642.

177.Thaiazide acts on....DCT

643.
644.

178.Simvastatin should be taken...just before bed

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.

181.Drugs causing dystonia..Metochlorpropamide

648.
649.

182.Haemodialysis resistance...Increase protein bound though i was wrong to give low vol of
distribution/

650.
651.

###Opthalmology :

652.
653.

183.A pt with new vessel formation on fundoscopy...Photocoagulation.

654.

1-Positive FOB , answer is caecum , as colonic ca is more common in right side .

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.

3-regarding metformin , there was no (decrease hepatic glu.production)

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.

6-that case of a drug reported to coz fulminant hep failure,

660.

the right answere , revise previous side effect ,

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.

it was a sebecious cyst

664.

8- double strand DNA , it was nucleus not mitochondrai , which is single strand. ( you can check it on
the web) .

665.

9-Why Bisphophonate before meal??

666.

the answer to decrease the side effects.

667.

10-Risperidone acts on serotinine ( check oxford hand book )

668.

11-A pt restless due to intracranial metastasis of Malignant Melanoma...drug for restless ,, why not
chloropromazine???

669.
670.
671.

and i will add more BOF s

672.
673.

1-tumor used a factor to get Blood supply

674.

answere ANGIOPOETIN

675.

2-ino....medial longitudnal fasiculus

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.

MRCP-PART1GuestThank you Dr Manoj.

679.
680.

I agree with most of your answers.

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.

2. Postural hypotension question why not doxazocin? (main side effect)

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.

4. Gestational diabetes needs insulin BUT AFTER trial of diet control?

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.

7. Sebaceous cyst in scalp

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.

omar elfarsiGuestSalam alaikom

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.

Daily physiological dose of prednisolone is 7.5mg

714.

Bisphosphonate administartion is to reduce GI side effects: again check pharmcology books

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.

Dr. koshankoshan13, Sep 16, 2008#194

722.

MRCP-UK candidateGuestWhy not resistant hypertension cause would be pheochromocytoma? As

there will be deranged renal function tests in Renovascular HTN while question mentioned normal
U&E.

723.
724.

Please reply......MRCP-UK candidate, Sep 16, 2008#195

725.

dr.manojGuestDear doctors...

726.

Thanx to all for ur attention to the questions i provided.

727.

Actually,I also noticed some difference with some other questions which didnt appear in my
paper...like...

728.

A question regarding glucokinase....drugs causing BIH....a wave in JVP caused by....etc.

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.

Why bisphosphonate before food.....etc

735.

GUEST 1GuestFor the PE indication for thrombolysis...i have confusion do we really

736.

thrombolyse at bp of 80/50?GUEST 1, Sep 16, 2008#197

737.

koshan13Guestattent. dr. manoj/ from my shallow knowledge, i would like to clarify some Qs. -------1.

METFORMIN---incres. perip. uptake of glucose( ref.--on exam.) 2. 3. x-ray RA--- periarticular

osteopenia is the CORRECT ans. , as periartic. osteoporosis(actual correct option)-was not there.and
also the qs. asked about the early sign of RA in x-ray. 4. again x-ray AS----sclerosis is the CORRECT
ans. ( ref.--passmedicine.com)5. BISPHOSNT.--- to avoid the G.I. side effects ----is the CORRECT
ans. any commands pl. thanks.
738.
739.

DR. KOSHANkoshan13, Sep 16, 2008#198

740.

tahseen sabzwariGuestsome quaries

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.

tahseen sabzwariGuestsome quaries

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.

thanks. Dr. koshankoshan13, Sep 17, 2008#202

374.

GuestGuestregarding that nurse,

375.

the right answer , as i remember was the first choice .

376.
377.

which is ;

378.
379.

continue work as usual ,.

380.
381.

as the right thing is to repeat the tubercline test after 6 weeks,

382.

which means no treatment at all.

383.
384.

similar scenario on mrcpassGuest, Sep 17, 2008#203

385.

dr.manojGuestDear Dr.Koshan...

386.

Thanx for ur reply regarding those confusing questions which doesnt indicate at all ur shallo
knowledge.

387.

Actually i also answered increased uptake of glucose as function of metformin...but in some

books(pharmacology of Laurence)the first action is showing as decreased hepatic glucose production.

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.

MANOJdr.manoj, Sep 17, 2008#204

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.

DR. KOSHANkoshan13, Sep 17, 2008#205

398.

GuestGuestsome opinion about the new marking system

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.

As he said this; I was almost shocked, I asked surprisingly why???

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.

In the end he said ;

419.

This is a good & clever way for making money ,

420.
421.
422.

Finally I am not happy & so pessimistic

423.
424.
425.

thankssssssssssssssssssssssssGuest, Sep 18, 2008#206

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

relative difficulty ....

430.

I am still confused...but here i just copied few sentences from mrcpuk.org...

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.

than others, and equating is a statistical process that addresses this.

438.
439.
440.
441.

Actually...more clarification is needed.

442.

thanx.dr.manoj, Sep 18, 2008#207

443.

yosefGuestThank u for everybodys comments

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.

GuestGuestabout the requirement

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.

sandstormGuestMany thanks to Dr. Manoj, and best wishes to all to pass..

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.

Anyways let's hope for the best...

464.

:roll:sandstorm, Sep 18, 2008#212

465.

GuestGuestregarding that muslim dm patinet ,

466.

it is unfair to bring such a question ,

467.

as not all the doctors are muslims,neither all the locations all over the world got muslim patinets

468.
469.

plz RCP put this note in ur concernGuest, Sep 19, 2008#213

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.

hope you are right...which questions do you think where different?

480.
481.

Regards,sandstorm, Sep 19, 2008#215

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.

Thanksbadri, Sep 19, 2008#216

489.

mmGuestcpr ratio

490.

hydroxyurea?mech of action

491.

polycythemia and cva

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.

what is the answer of winging scapula ms responsible

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.

thank u very muchmokhles, Sep 22, 2008#231

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.

and u r depressed for the questions u asked???

505.

i made a lot of mistakes...can u imagine i answered pneumonia causing hyponatremia wrong,also

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.

GuestGuestsorry , just want 2 ask ,

508.

is it an anterior ce.a or MCA ????

509.
510.

as leg , was involved , which is so unique for ACA

511.
512.

and this is my evidence

513.
514.

http://en.wikipedia.org/wiki/Anterior_cerebral_artery#Occlusion

515.
516.

while in MCA there is partial sparing in leg ,

517.

and this topic from emedicine ;

518.
519.
520.

http://www.emedicine.com/pmr/topic77.htm

521.
522.

thanxxxxxxxxxxxxxx

523.
524.

p.s. a similar question was at onexaminationGuest, Sep 22, 2008#233

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.

koshan13Guestregarding ACR vS MCR ..occlution...............as in the senerio , there was hemiperesis

with lower leg weakness , along with aphasia ......all R the features of middle cerb. ar. occlution. so the
CORRECT ans . is MCR ............ thx. dr. koshankoshan13, Sep 22, 2008#235

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.

Left sided strokes may develop transcortical motor aphasia

533.

Gait apraxia

534.

Urinary incontinence which usually occurs with bilateral damage in the acute phase

535.
536.

occlusion of MCA , can leads to ;

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.

3-Inferior division infarcts of the dominant hemisphere lead to Wernicke's aphasia.

541.

4- Finally, resultant temporal lobe damage can lead to an agitated and confused state.

542.
543.
544.

hope this is enough ,,

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.

http://www.emedicine.com/pmr/topic77.htm#section~Clinical (MCA)Guest, Sep 22, 2008#236

552.

GuestGuestdecrease mortality in angina is beta blocker

553.
554.

http://en.wikipedia.org/wiki/Angina_pectoris#TreatmentGuest, Sep 22, 2008#237

555.

GuestGuestHi Guest...

556.

Great...its really great to answer questions with referrances...

557.

so i would like some referrances regarding these questions...

558.
559.

1.Xray feature of Ankylosing spondylitis... Syndesmophyte or Sclerosis.

560.
561.

2.Xray of Rheumatoid arthritis.....Juxtra articular resorption or Periarticular osteopenia.

562.
563.

3.Hba1c should be done after how much time of blood tranfusion...

564.
565.

4.contact TB pt with isoniazid...isolation needed or not

566.
567.

5.metformin main function...decrease hepatic glucose or increase peripheral uptake.

568.
569.

6.cellulitis pt resistant to penicillin and fluclox...should treat with...clindamycin or gentamycin....pls

with referrance....as as far i know clindamycin is used to treat of gm positive infection if they develop
toxic shock synd.

570.
571.

thanx in advance.....Guest, Sep 22, 2008#238

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.

plz do not be afraid , we will not cut your golden fingers

578.

:evil: :twisted: :evil: :twisted: :evil: :twisted:

579.
580.

1-ANK.SP. the right answer syndesmpytes,

581.
582.
583.

http://en.wikipedia.org/wiki/Ankylosing_spondylitis#Prognosis

584.

despite i answer it , wever sclerosis .

585.
586.

2-Xray Ra , in the choices ,there was no juxta articular

587.

so the answer is peri-articular

588.
589.

i read same BOF some where.

590.
591.

3-Hba1c, minimum 2-3 months, andi i remember that the possible choice was 3 months,, not 1 month.

592.
593.

oxford hand book page 182 (8 weeks & more)

594.
595.

4- contact of Tb , needs no isolation ,

596.

similar BOf was on mrcpass

597.
598.

5-metformin , increase peripheral uptake ,

599.

infact the word , was not uptake , it was some thing else, i can not remember.

600.
601.

similar BOf came before few exams.

602.
603.

6-cellulitis resistant to pencilline , answer is clindamycine

604.

same BOF came in may 2008 , i found this BOF online .

605.
606.
607.

in the end , welcome , hope we continue discussion about the exam .Guest, Sep 22, 2008#239

608.

SEP 2008Guestdear doctors

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.

thanxxxxxxxxxxxxxxxxxxxxxSEP 2008, Sep 22, 2008#240

616.

GuestGuestMY correct answers r between 145 to 160

617.

InshaAllah.Guest, Sep 22, 2008#241

618.

mokhlesGuestthank u very much dr manouji for ur support i hope all to pass

619.

u will be great dr in the future thx

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.

Thanx for ur answers regarding my question....

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.

Some other confusing question....can u pls clarify....

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.

Best of luck for everyone.Guest, Sep 22, 2008#243

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.

2- u r correct , increease disposal ,,

646.
647.

to be honest with u , both answeres are correct , as

648.

metformin do both

649.
650.

central & peripheral action .

651.
652.

3- it was orbital apex.... as no congestion ,which occures in cav. sinus, plus the eye pain .

653.
654.

4-cecum is the more common site for colonic ca

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.

u can check any new book , of suregery

660.
661.

ok ,,,,,,,,,,

662.
663.

thanxxxxxxxxxxx

664.
665.

hope we can discuss moreGuest, Sep 23, 2008#244

666.

sep 2008Guesthi guyzzz

667.
668.

i noticed some members are focusing on the 140 correct BOF ??

669.
670.

is this passing mark , according to the example in RCP notes about the new marking system ????

671.
672.

or just a guess??? sep 2008, Sep 23, 2008#245

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.

if the result followed the previous system...i could expect to pass...

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.

so dear guest...dont be depressed....

684.
685.

Take careGuest, Sep 23, 2008#249

686.

GuestGuesti think we have to be Optimistic with ny system the college use...

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
(You must log in or sign up to reply here.)

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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.

thanks. Dr. koshankoshan13, Sep 17, 2008#202

235.

GuestGuestregarding that nurse,

236.

the right answer , as i remember was the first choice .

237.
238.

which is ;

239.
240.

continue work as usual ,.

241.
242.

as the right thing is to repeat the tubercline test after 6 weeks,

243.

which means no treatment at all.

244.
245.

similar scenario on mrcpassGuest, Sep 17, 2008#203

246.

dr.manojGuestDear Dr.Koshan...

247.

Thanx for ur reply regarding those confusing questions which doesnt indicate at all ur shallo
knowledge.

248.

Actually i also answered increased uptake of glucose as function of metformin...but in some

books(pharmacology of Laurence)the first action is showing as decreased hepatic glucose production.

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.

As he said this; I was almost shocked, I asked surprisingly why???

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.

In the end he said ;

270.

This is a good & clever way for making money ,

271.
272.
273.

Finally I am not happy & so pessimistic

274.
275.
276.

thankssssssssssssssssssssssssGuest, Sep 18, 2008#206

277.

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.

I am still confused...but here i just copied few sentences from mrcpuk.org...

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.

than others, and equating is a statistical process that addresses this.

289.
290.
291.
292.

Actually...more clarification is needed.

293.

thanx.dr.manoj, Sep 18, 2008#207

294.

yosefGuestThank u for everybodys comments

295.
296.

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.

GuestGuestabout the requirement

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.

sandstormGuestMany thanks to Dr. Manoj, and best wishes to all to pass..

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.
314.

Anyways let's hope for the best...

315.

:roll:sandstorm, Sep 18, 2008#212

316.

GuestGuestregarding that muslim dm patinet ,

317.

it is unfair to bring such a question ,

318.

as not all the doctors are muslims,neither all the locations all over the world got muslim patinets

319.
320.

plz RCP put this note in ur concernGuest, Sep 19, 2008#213

321.

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.

hope you are right...which questions do you think where different?

331.
332.

Regards,sandstorm, Sep 19, 2008#215

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.

Thanksbadri, Sep 19, 2008#216

340.

mmGuestcpr ratio

341.

hydroxyurea?mech of action

342.

polycythemia and cva

343.

hypercholeremic acidosis

344.

transtuzemab

345.

ankyolostoma

346.

what is the answer of winging scapula ms responsible

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.

is it an anterior ce.a or MCA ????

350.
351.

as leg , was involved , which is so unique for ACA

352.
353.

and this is my evidence

354.
355.

http://en.wikipedia.org/wiki/Anterior_cerebral_artery#Occlusion

356.
357.

while in MCA there is partial sparing in leg ,

358.

and this topic from emedicine ;

359.
360.
361.

http://www.emedicine.com/pmr/topic77.htm

362.
363.

thanxxxxxxxxxxxxxx

364.
365.

p.s. a similar question was at onexaminationGuest, Sep 22, 2008#233

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.

koshan13Guestregarding ACR vS MCR ..occlution...............as in the senerio , there was hemiperesis

with lower leg weakness , along with aphasia ......all R the features of middle cerb. ar. occlution. so the

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.

Left sided strokes may develop transcortical motor aphasia

374.

Gait apraxia

375.

Urinary incontinence which usually occurs with bilateral damage in the acute phase

376.
377.

occlusion of MCA , can leads to ;

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.

3-Inferior division infarcts of the dominant hemisphere lead to Wernicke's aphasia.

382.

4- Finally, resultant temporal lobe damage can lead to an agitated and confused state.

383.
384.
385.

hope this is enough ,,

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.

http://www.emedicine.com/pmr/topic77.htm#section~Clinical (MCA)Guest, Sep 22, 2008#236

393.

GuestGuestdecrease mortality in angina is beta blocker

394.
395.

http://en.wikipedia.org/wiki/Angina_pectoris#TreatmentGuest, Sep 22, 2008#237

396.

GuestGuestHi Guest...

397.

Great...its really great to answer questions with referrances...

398.

so i would like some referrances regarding these questions...

399.
400.

1.Xray feature of Ankylosing spondylitis... Syndesmophyte or Sclerosis.

401.
402.

2.Xray of Rheumatoid arthritis.....Juxtra articular resorption or Periarticular osteopenia.

403.
404.

3.Hba1c should be done after how much time of blood tranfusion...

405.
406.

4.contact TB pt with isoniazid...isolation needed or not

407.
408.

5.metformin main function...decrease hepatic glucose or increase peripheral uptake.

409.
410.

6.cellulitis pt resistant to penicillin and fluclox...should treat with...clindamycin or gentamycin....pls

with referrance....as as far i know clindamycin is used to treat of gm positive infection if they develop
toxic shock synd.

411.
412.

thanx in advance.....Guest, Sep 22, 2008#238

413.

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.

plz do not be afraid , we will not cut your golden fingers

419.

:evil: :twisted: :evil: :twisted: :evil: :twisted:

420.
421.

1-ANK.SP. the right answer syndesmpytes,

422.
423.

http://en.wikipedia.org/wiki/Ankylosing_spondylitis#Prognosis

424.
425.

despite i answer it , wever sclerosis .

426.
427.

2-Xray Ra , in the choices ,there was no juxta articular

428.

so the answer is peri-articular

429.
430.

i read same BOF some where.

431.
432.

3-Hba1c, minimum 2-3 months, andi i remember that the possible choice was 3 months,, not 1 month.

433.
434.

oxford hand book page 182 (8 weeks & more)

435.
436.

4- contact of Tb , needs no isolation ,

437.

similar BOf was on mrcpass

438.
439.

5-metformin , increase peripheral uptake ,

440.

infact the word , was not uptake , it was some thing else, i can not remember.

441.
442.

similar BOf came before few exams.

443.
444.

6-cellulitis resistant to pencilline , answer is clindamycine

445.

same BOF came in may 2008 , i found this BOF online .

446.
447.
448.

in the end , welcome , hope we continue discussion about the exam .Guest, Sep 22, 2008#239

449.

SEP 2008Guestdear doctors

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.

thanxxxxxxxxxxxxxxxxxxxxxSEP 2008, Sep 22, 2008#240

457.

GuestGuestMY correct answers r between 145 to 160

458.

InshaAllah.Guest, Sep 22, 2008#241

459.

mokhlesGuestthank u very much dr manouji for ur support i hope all to pass

460.

u will be great dr in the future thx

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.

Thanx for ur answers regarding my question....

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.

Some other confusing question....can u pls clarify....

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.

Best of luck for everyone.Guest, Sep 22, 2008#243

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.

2- u r correct , increease disposal ,,

487.
488.

to be honest with u , both answeres are correct , as

489.

metformin do both

490.
491.

central & peripheral action .

492.
493.

3- it was orbital apex.... as no congestion ,which occures in cav. sinus, plus the eye pain .

494.
495.

4-cecum is the more common site for colonic ca

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.

u can check any new book , of suregery

501.
502.

ok ,,,,,,,,,,

503.
504.

thanxxxxxxxxxxx

505.
506.

hope we can discuss moreGuest, Sep 23, 2008#244

507.

sep 2008Guesthi guyzzz

508.

509.

i noticed some members are focusing on the 140 correct BOF ??

510.
511.

is this passing mark , according to the example in RCP notes about the new marking system ????

512.
513.

or just a guess??? sep 2008, Sep 23, 2008#245

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.

if the result followed the previous system...i could expect to pass...

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.

so dear guest...dont be depressed....

525.
526.

Take careGuest, Sep 23, 2008#249

527.

GuestGuesti think we have to be Optimistic with ny system the college use...

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

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sep 2008Guestdear Dr. Manoj

584.
585.

would you mind plz , to mention ; is there other mrcp 1 forums , else than

586.
587.

RXPGONLINE . COM

588.
589.

as i would like to surf them too .

590.
591.

thanxxxxxxxxxxxxxxxxsep 2008, Sep 23, 2008#251

592.

sep 2008Guestdear Dr. Manoj

593.
594.

would you mind plz , to mention ; is there other mrcp 1 forums , else than

595.
596.

R X P G O N L INE . COM

597.
598.

as i would like to surf them too .

599.
600.

thanxxxxxxxxxxxxxxxxsep 2008, Sep 23, 2008#252

601.

sep 2008Guestdear Dr. Manoj

602.
603.

would you mind plz , to mention ; is there other mrcp 1 forums , else than

604.
605.

R X P G O N L INE . COM

606.
607.

as i would like to surf them too .

608.
609.

thanxxxxxxxxxxxxxxxxsep 2008, Sep 23, 2008#253

610.

GuestGuestI think cutoff for passing would be around 630/999.Guest, Sep 23, 2008#254

611.

MRCP 1Guestwith all my respect to you ,,,,,,,,,,,

612.
613.

no one can predict what would be the passing mark ,

614.

as we are almost blind about the marking system,,

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

good enough to explain about the marking system ..

620.
621.
622.

merci beacoupMRCP 1, Sep 23, 2008#255

623.

GuestGuestit cannot be this high ,it was a tough exam so probably close to 550Guest, Sep 23, 2008
#256

624.

GuestGuestwawwwwwwwwww 630 !!!!!!!!!!!!!!!!!!!!!

625.
626.

this is so high !!!!!!!!!!!!!!!!!!

627.
628.

sorry can u plz clarify from where u made this number??Guest, Sep 23, 2008#257

629.

GuestGuestDear sep 2008...

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.

The other site u mentioned ,...i couldnt find that...obscenea.com....whats this.....

633.
634.

Take care...Guest, Sep 23, 2008#258

635.

mokhlesGuestthe q say frnakly there is no proptosis thats why it is cavernous definitely not orbital apex
mokhles, Sep 23, 2008#259

636.

GuestGuestclinical features of CAVERNOUS SINUS THROMBOSIS

637.
638.

Classic presentations are abrupt onset of unilateral periorbital edema, headache, photophobia, and
proptosis.

639.
640.

Other common signs and symptoms include:

641.

Ptosis, Chemosis, Cranial nerve palsies (III, IV, V, VI)..

642.
643.
644.

http://en.wikipedia.org/wiki/Cavernous_sinus_thrombosis#Clinical_Features

645.
646.

Clinical features of orbital apex ( superior orbital syndrome)

647.
648.

diplopia, paralysis of extraocular motions, exophthalmos, and ptosis,even Blindness

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.

vs the congestion & peri-orbital odema appear rather earlier .

659.
660.

thanks 8)Guest, Sep 23, 2008#261

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.

this trick proved its failure at may 2008 exam

665.
666.
667.

hahahahahahhaGuest, Sep 23, 2008#263

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.

anyway...hope for ythe bestGuest, Sep 23, 2008#264

673.

GuestGuestwhat is investigation of choice for chronic pancreatitis

674.
675.

CT scan or endoscopic ultrasound, and why?Guest, Sep 24, 2008#265

676.

mokhlesGuestabd x ray is the initial and ct abdomen is diagnosticmokhles, Sep 24, 2008#266

677.

GuestGuestno ct abdomen

678.
679.

85% sensitive more than abdominal xr

680.
681.

regarding the orbital apex ,

682.
683.

do you want the patient ,to have BLINDNESS ,till you diagnose him :shock: ????????? !!!!!!

684.
685.

it was orbital apex , Guest, Sep 24, 2008#267

686.

sep 2008Guestfor chronic pancreatitis

687.
688.

check 100 disease for MRCP2sep 2008, Sep 24, 2008#268

689.

sep 2008Guestit was ct abdomensep 2008, Sep 24, 2008#269

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.

Regarding inv of features of chronic pancreatitis...as the presentation is already indicating

chr.pancreatitis...so our next step to be confirm this as we r suspecting pancreatitis...

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.

In a pt of suspected pancreatitis...if u do abd xray...and find it normal(Chance of normal finding in 70%

cases though the pt has pancreatitis)...u hv to do ct abd...so is that necessary to do xray abd initially
though we r already suspecting chr.pancreatitis...

700.
701.

The answer will be CT ABDOMEN....

702.
703.

Thanx a lotGuest, Sep 24, 2008#271

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.

sep 2008Guestdear dr.manoj

707.
708.

first of all , thank you for your nice pdf file ,

709.

it is really so useful .

710.
711.

ok , regarding the orbital apex, syndrome,

712.

you are 100% correct that visual loss is a hallmark of orbital apex,

713.
714.

but

715.
716.

the sequence of the symptoms is different ,

717.
718.

i mean , the patinet usually , present first with diplopia, paralysis of extraocular motions,

exophthalmos, and ptosis,and lately Blindness ,

719.
720.

due to involvment of V1 (opth.)

721.
722.

,hope you got what i mean ,

723.

i.e. visual loss is 100% specific for orbit.apex, but not occure at the first period of presentation .

724.
725.

thankssep 2008, Sep 24, 2008#273

726.

GuestGuestThe recent years have faced a considerable number of

727.

new techniques for diagnosing chronic pancreatitis.

728.

Technical advances include helical CT, magnetic resonance

729.

imaging and endoscopic ultrasound. Until now

730.

ERCP remained the goldstandard for diagnosing morphological

731.

changes in chronic pancreatitis. Endoscopic

732.

ultrasound (EUS) has the advantage to offer a less invasive

733.

technique to the patient without the risk of pancreatitis

734.

and eliminates the exposure to radiation. EUS

735.

allows high-resolution imaging of the pancreatic parenchyma,

736.

pancreatobiliary ducts, and retroperitoneal

737.

structures due to the very close contact between the

738.

transducer and the organs to be investigated. EUS is the

739.

only imaging modality that can examine the pancreatic

740.

parenchyma in fine detail, and therefore morpholocical

741.

changes can be detected by EUS prior to changes on

742.

ERCP.In conclusion, endoscopic ultrasound is a new imaging

743.

modality not only for improving the diagnosis of

744.

chronic pancreatitis, but has also opened the door for

745.

interventional applications.Guest, Sep 24, 2008#274

746.

GuestGuestDear Sep 2008...

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.

Both r the probabilty and rcp will decide further...

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.

Anyway...to me...i am convinced with the answer CT abdomen for chr.pancreatitis....

757.
758.

Take care...Guest, Sep 25, 2008#275

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.

dr_vikasGuestwell.. if this is the case.. then its good for every1..

763.

nobody amongst us wanted to taste a totally new flavour of marking system..

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.

In paraesophageal hiatal hernias the x-ray finding is retrocardiac air/fluid level.

771.
772.

I am comparing my answers to Dr Manoj so I would like his opinion if possible.

773.
774.

ThanksMRCP1-CANDIDATE, Sep 26, 2008#278

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.

In paraesophageal hiatal hernias the x-ray finding is retrocardiac air/fluid level.

779.

I am comparing my answers to Dr Manoj so I would like his opinion if possible.

780.

ThanksMRCP1-CANDIDATE, Sep 26, 2008#279

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.

In paraesophageal hiatal hernias the x-ray finding is retrocardiac air/fluid level.

785.

I am comparing my answers to Dr Manoj so I would like his opinion if possible.

786.

ThanksMRCP1-CANDIDATE, Sep 26, 2008#280

787.

GuestGuestDear MRCP-1 CANDIDATE...

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.

So...i think the ans should be aclasia...ThanxGuest, Sep 26, 2008#281

798.

GuestGuestDear MRCP-1 CANDIDATE...

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.

So...i think the ans should be aclasia...ThanxGuest, Sep 26, 2008#282

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.

Q: Why are my results presented on a three digit scale?

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.

this is best expressed in a 0 to 999 score range.

819.
820.

So here it is clear that each ques will bear different mark....

821.
822.

IF U GOT DIFFERENT INFORMATION.....PLEASE SPECIFY THAT AND IF U DNT MIND SEND

US THE DOCUMENT IN FAVOUR OF UR INFORMATION.....THAT WILL BE TOO MUCH
HELPFUL FOR US AND WE REALLY BE GREATFUL TO U>>>>>THANXGuest, Sep 26, 2008
#283

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.

Dr. koshankoshan13, Sep 26, 2008#284

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.

Dr. koshankoshan13, Sep 26, 2008#285

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.

Dr. koshankoshan13, Sep 26, 2008#286

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.

Dr. koshan :roll:koshan13, Sep 26, 2008#287

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.

Dr. koshan :roll:koshan13, Sep 26, 2008#288

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.

Dr. koshan :roll:koshan13, Sep 26, 2008#289

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.

Dr. koshan :roll:koshan13, Sep 26, 2008#290

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.

Dr. koshan :roll:koshan13, Sep 26, 2008#291

857.

GuestGuestit was achalasiaGuest, Sep 26, 2008#292

858.

muttasimGuestbut the dysphagia is intermittently what ur explanation for this ?muttasim, Sep 26, 2008
#293

859.

GuestGuestlook , if you concentrate well over the question ,

860.

u will found that it said : dysphagia for food & liquid .

861.
862.

i.e. equally ,

863.

beside the intermittently , is not against the achalasia

864.
865.

hope you read this

866.
867.

http://www.whereincity.com/medical/topic/stomach-care/articles/329.htmGuest, Sep 26, 2008#294

868.

GuestGuestthere was a case ,

869.

some said it was sjogrens`s syndrome .

870.
871.

but it was SLE

872.
873.

as anti sm si so so so so so specific for SLE ,

874.
875.

also you can read oxford hand book page 702,

876.

no mentioning of anti-sm at all .

877.
878.

besides these are the serology of sjogren`s sydnrome

879.
880.

http://www.sjogrens.org/syndrome/diagnosis.htmlGuest, Sep 26, 2008#295

881.

GuestGuesttumer need factor to provide blood supply =

882.
883.

angiopoetinGuest, Sep 26, 2008#296

884.

GuestGuestregarding that fireman

885.
886.

it was poor -adjusment disorder ,

887.
888.

not post traumatic stress disorder

889.
890.

similar question on mrcpassGuest, Sep 26, 2008#297

891.

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.

thanxGuest, Sep 26, 2008#298

897.

sep 2008Guestok ,

898.
899.

well , about the fireman case,

900.
901.

there was no such kind of any trauma,

902.
903.

so it is not POST TRAUMATIC STRESS DISORDER,

904.
905.

as i remember that the scenario was a fireman , lost his friend

906.
907.

so i THINK , the dx is poor adjustment disorder,

908.
909.

not post traumatic str.dis ,

910.
911.

regarding that 565 bof on mrcpass , it was not related , to what r we talking about .

912.
913.

any way , this is one of tricky bof , which bears 2 possibilities

914.
915.

thanksssssssssssssssssssssssep 2008, Sep 26, 2008#299

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.

question....the question of mrcpass was...

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.

A. Onset usually about 3 months after the event

923.

B. More common in older men

924.

C. Replaying a tramatic scene in his mind

925.

D. Low incidence in Europe

926.

E. Predisposing mental illness

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.

anyway...i am also not that much sure

933.
934.

question....Guest, Sep 26, 2008#300

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971.MRCP SEP 2008 RECALLED QUESTIONS
972.Discussion in 'MRCP Forum' started by dr arif, Sep 10, 2008.
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985.

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.

THANXGuest, Sep 26, 2008#301

988.

sep 2008Guestdear dr.manoj

989.
990.

you are correct regarding this point ,

991.

it is so obvious that stress means physical & mental .

992.
993.

but there was a case i read somewhere , as follow

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.

( forgive me for bad re-making of the scenario )

998.
999.

the choices as i remember

1000.
1001.

1-post traumatic stress.

1002.

2-abnormal grief .

1003.

3-poor adjustment disorders.

1004.

4-depression

1005.

5-?

1006.
1007.

the answere was POOR ADJUSTMENT DISORDER ,not abnormal grief

1008.
1009.

so this is my idea <<<<< ie fireman case, is rather close to this lady scenario ...

1010.
1011.

what do u think ???sep 2008, Sep 26, 2008#302

1012.

MRCP1-CANDIDATEGuestRE

1013.
1014.

3- LADY FEARING OF BIRDS , it was parnoid schizo ,

1015.

as the scenario mentioned in the end , that she felt safe as she was hiding in her husband socks , :shock:

1016.
1017.

sep 2008, Sep 27, 2008#307

1018.

dr_vikasGuestis it true the results are out??

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.

IS IT RELIABLE?dr_vikas, Sep 27, 2008#308

1024.

dr_vikasGuestis it true the results are out??

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.

IS IT RELIABLE?dr_vikas, Sep 27, 2008#309

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.

i think i have failed

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.

Thanks for the scientific debate and ideas.

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.

Do you recall that?MRCP1-CANDIDATE, Sep 27, 2008#315

1047.

dr_flurestGuestDiabetes in pregnancy

1048.
1049.

Hypoglycaemic therapy

1050.

Consider hypoglycaemic therapy for women with gestational diabetes:

1051.

_ if lifestyle changes do not maintain blood glucose targets over a period of 12 weeks

1052.

_If hypoglycaemic therapy is required:

1053.

_ regular insulin, the rapid acting insulin analogues aspart and lispro, and/or the oral hypoglycaemic
agents metformin3 and glibenclamide4 may be considered.

1054.

Reference: http://www.nice.org.uk/guidance/index.jsp?action=download&o=41321dr_flurest, Sep 28,

2008#316

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.

dr_vikasGuestits getting tougher waiting for the results..

1068.
1069.

MRCP ppl... plz make it fast :evil:dr_vikas, Sep 28, 2008#319

1070.

mokhlesGuestpressing apply overseas give me apply personal details and continue till the end

1071.

am i failedmokhles, Sep 28, 2008#320

1072.

dr_vikasGuestdont worry mokhles..

1073.

i dont think so..

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.

mokhlesGuestthank u very much for all of u

1079.

i hope all to pass

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.

i want to say one point for you .

1085.

do not take this issue as bigger as its deserve.

1086.

it is not the end of the world evev if you did not make it from your 1st try .

1087.
1088.

as you said , hypertension & these stuff,

1089.

this won`t be on your side ever.

1090.
1091.

for me , i tried last may 2008 , i read for 2 months only

1092.

i scored 60.5% and pass mark was 61%.

1093.
1094.

so at the first i was really heart broken ,

1095.

as then i was offered a good job place , if i would pass it ,

1096.
1097.

so i will try again next jan 2009,

1098.

and that`s all

1099.
1100.

as the statsitics says that only third of doctors pass from their 1st try .

1101.

while more than 2/3 pass from their 2nd try

1102.
1103.

merci beacoupGuest, Sep 29, 2008#325

1104.

GuestGuestall what i want to say ,

1105.
1106.

prepare ourselves for good & bad news

1107.
1108.

8)Guest, Sep 29, 2008#326

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.

mokhlesGuestactually this is the second time

1115.

iam waiting for results hoping pass aaaaaaah enough

1116.

too much stress ,praying

1117.

next friday is too far away

1118.

waiting dingmokhles, Sep 29, 2008#329

1119.

sep 2008Guestdear docs.

1120.

1121.

i know all of us , are on fire now , waiting for the results ,

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.

thanks :lol:sep 2008, Sep 30, 2008#330

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.

GuestGuestDear Sep 2008,

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.

what is this all about

1147.

thanksdr mustaqeem, Sep 30, 2008#333

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.

eid mubarak to all.kul o aam wa untum bakhair.

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.

do one exam at least twice

1160.

do all PAST PAPERS from mrcpass.com as questions came word to word.

1161.

basic science from easterbrook,i know its hard but try.

1162.

this is what i will do if i fail.

1163.
1164.

mustaqeemdr mustaqeem, Sep 30, 2008#336

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.

GuestGuestone question in my paper not mentioned here.

1167.

magnet for a patient with pacemaker can:

1168.

1. stop pacing

1169.

2. stop defibrillation

1170.

3. stop both

1171.

4. stop noneGuest, Sep 30, 2008#338

1172.

GuestGuestthank you so much guest

1173.
1174.

yeh , this was one of the non mentioned BOF among the 184

1175.
1176.

1177.
1178.

i think the 5th option was right ;

1179.
1180.

As i could remember ;

1181.
1182.

RESET THE PACEMAKER OR SOME THING ABOUT PREVIOUS PACE MAKER DATA

1183.
1184.

PLZZZZZZZZ CAN ANY 1 REMEMBERGuest, Sep 30, 2008#339

1185.

GuestGuestdear doctors...

1186.

Eid mubarok to u all...

1187.

So...a tough situation we r passing through...

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.

:x :xGuest, Sep 30, 2008#340

1193.

GuestGuestdr .manoj

1194.
1195.

just want to ask , are you saudi ???

1196.
1197.

as i want to ask you , about the salary there for M.O & internal medicine specialist ???Guest, Sep 30,
2008#341

1198.

GuestGuestthe result realeased hope all to pass

1199.
1200.
1201.
1202.

check yours and thanks for great disscusion

1203.
1204.
1205.
1206.
1207.

:lol: :lol: :lol:Guest, Sep 30, 2008#342

1208.

sep 2008Guesti passed

1209.
1210.

thanx god

1211.
1212.

al hamdu lilahsep 2008, Sep 30, 2008#343

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.

dr mustaqeemdr mustaqeem, Sep 30, 2008#345

1217.

ssssssssGuestAlhamdo lillah i've passed)

1218.

happy eid.ssssssss, Sep 30, 2008#346

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.

sep 2008Guestdr .manoj ,

1221.
1222.

i am waiting for u & dr mokles

1223.
1224.

hope all pass

1225.
1226.

i scored 670sep 2008, Sep 30, 2008#348

1227.

dr mustaqeemGuesthappy eid

1228.

i scored687

1229.

mustaqeemdr mustaqeem, Sep 30, 2008#349

1230.

dr_vikasGuestme too passed

1231.

646 marksdr_vikas, Oct 1, 2008#350

1232.

(You must log in or sign up to reply here.)

1233.

Page 7 of 9
1234.
1235.

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1236.

1237.

1238.

1239.

1240.

1241.

1242.

1243.
1244.

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Share This Page

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.

Borderline personality disorder

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.

Lewy body dementia

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.

Lewy body dementia

1290.

Normal pressure hydrocephalus

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.

Acute paranoid schizophrenia

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.

Best prophylaxis against future events of trigeminal neurlalgia

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.

Frontal lobe epilepsy

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.

Minimal change disease

1359.
1360.

14.Theme:

1361.

Molecular Medicine

1362.
1363.

Question:

1364.

In which organelle would you find ds circular DNA?

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.

1 week before operation

1392.

1 month before operation

1393.

2 weeks before operation

1394.

1 month after operation

1395.

postoperatively

1396.
1397.

17.Theme:

1398.

Infectious Diseases

1399.
1400.

Question:

1401.

Kaposi's sarcoma is associated with which virus?

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.

Pregnant lady develops features of TTP. What is your initial treatment?

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.

Mechanism by which multiple myeloma causes hypercalcaemia

1459.
1460.

Responses:

1461.

Osteoclastic activation

1462.

Decreased renal clearance

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

shows lytic lesions. What is the investigation of choice?

1469.
1470.

Responses:

1471.

MR spine

1472.

Serum beta 2 microgloblulin

1473.

Serum protein electrophoresis

1474.
1475.

25.Theme:

1476.

Genetics

1477.
1478.

Question:

1479.

Hereditary haemorrhagic telangiectasia, mode of inheritance?

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.

Non-random X chromosome inactivation

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.

Pain that wakes patient at night

1505.

Mucus in stools

1506.

Feeling of incomplete evacuation

1507.

Alternation of bowel habit

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.

14C breath test

1517.

faecal antigen test

1518.

13C breath test

1519.

Endoscopy

1520.

Endoscopy biopsy and urease

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.

Mechanism of action of terlipressin when used to treat variceal bleed/hepatorenal bleed?

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.

Normal human immunoglobulin

1565.

IV heparin

1566.
1567.

33.Theme:

1568.

Endocrinology

1569.
1570.

Question:

1571.

Which of the following is the strongest factor to confirm MODY?

1572.
1573.

Responses:

1574.

BMI>>

1575.

Strong family history

1576.

episodes of DKA ?? is this the correct answer as mentioned by pastest

1577.

Autosomal recessive trait

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.

Calculation please if possible

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.

Repeat OGTT in 4 weeks

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.

When should simvastatin be taken?

1648.
1649.

Responses:

1650.

After breakfast

1651.

After evening meal

1652.

Last thing in the evening (bedtime)

1653.

First thing in the morning

1654.

Just before evening meal

1655.
1656.

40.Theme:

1657.

Clinical Pharmacology

1658.
1659.

Question:

1660.

Risperidone has a higher affinity for?

1661.

1662.

Responses:

1663.

Dopamine (D2) receptors

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.

Rituximab has monoclonal antibody activity against?

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.

Anterior interosseous nerve

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.

Cryptogenic fibrosing alveolitis, which sign gives most accurate diagnosis?

1783.
1784.

Responses:

1785.

Lack of clear heart border

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.

Upper lobe fibrosis

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.

Bronchial breath sounds

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.

Continue to work as normal

1819.

Stay off work for 2 weeks while she is on the initial prophylactic isoniazid course

1820.

Stay off work and have a repeat CXR in 6 weeks

1821.

Stay off work for 6 weeks

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.

8-adjusment disorder (check wikipedia + mrcpass)

1833.

9-catatonia.

1834.

10-CABZ.

1835.

11-sleep paralysis.

1836.

12-orbital apex.

1837.

13-reflux.

1838.

14-nucleus (mitochondria SS ) check wikipedia

1839.

15-chlamydia

1840.

16-1 month pre op.

1841.

17-HHV8

1842.

18-clindamycine.

1843.

20-parvovirus.

1844.

21-plasma exchage. ???? Ig ????

1845.

22-aml , associated with DIC

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.

32-Ig ??? P.ex????

1856.

33-strong family Hx

1857.

34-????????????

1858.

35-LH

1859.

36-?????????

1860.

37-insuline

1861.

38-heroin

1862.

39-Last thing in the evening (bedtime

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.

50-Lack of clear heart border (OXFORD HAND BOOK)

1874.

51-?????????? Neutrophilia

1875.

52-Bronchial breath sounds

1876.

53-Continue to work as normal

1877.
1878.
1879.

I HOPE , I HALPED YOU A LITTLE BIT ,

1880.
1881.

these answeres could carry right or wrong possibilty ,

1882.

as i answered them just like this in the exam

1883.
1884.

thankssssssssssssssssssGuest, Oct 14, 2008#414

1885.

GuestGuestSO FAR I HAVE DONE ONLY GASTRO N ENDO SO HERE R MY RESPONSE

WHICH DIFFER A BIT FROM GUEST ...PLZ POINT OUT IF I HAV ANS ANYTHNG WRONG

1886.

27-waking at nit() not in nice guidelines

1887.
1888.
1889.

Irritable bowel syndrome: diagnosis

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.

abdominal pain, and/or

1895.

bloating, and/or

1896.

change in bowel habit

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.

altered stool passage (straining, urgency, incomplete evacuation)

1900.

abdominal bloating (more common in women than men), distension, tension or hardness

1901.

symptoms made worse by eating

1902.

passage of mucus

1903.
1904.

Features such as lethargy, nausea, backache and bladder symptoms may also support the diagnosis

1905.
1906.

Red flag features should be enquired about:

1907.

rectal bleeding

1908.

unexplained/unintentional weight loss

1909.

family history of bowel or ovarian cancer

1910.

onset after 60 years of age

1911.

28-serology remain positive upto 6 mnth so ans will b fecal antigen or c13 breath testnot c14

1912.

29- i think ct abdomen(not sure)

1913.

30-splachic vasoconstriction-

1914.

31-surgery-ohcm(SOME SAID AZATHIOPRIN/INFIXIMB)ANY1 KNOW RT ANS?

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.

GuestGuestok , from dr.manoj 184 BOF ,

1919.
1920.

i solved 155 , and i got 671

1921.
1922.

hope this would helps youGuest, Oct 18, 2008#417

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.

NEW GUESTGuestDear Mokhles,

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.

Good luck!NEW GUEST, Oct 18, 2008#420

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.

i will recommend the following

1941.

read kalra and make notes of subspciaties.

1942.

do all past papers from paid sites like mrcpass.com learn them well

1943.

do bofs from one exam.com.

1944.

inshallah you will pass the next sitting.

1945.
1946.

mustaqeemGuest, Oct 19, 2008#422

1947.

mokhlesGuestthank u dr mustaqueem

1948.

i hope next may i can inter the exam

1949.

bec i cant get it at next january

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.

my score was 460

1959.

how much is it equal to, i didnt rcv the letter yet

1960.

am planning to appear in may

1961.

shall we do combine study

1962.

i have started una coales, passmedicine

1963.

kindly replyGuest, Oct 25, 2008#425

1964.

mokhlesGuestyes guest iam planning to appear next may tooo

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.

my email address is nisark@ymail.com, my name is nisar,am working in saudi,where do u work,my

email id is nisark@ymail.com, wud be very happy to see u r mail

1968.

thank uGuest, Oct 26, 2008#427

1969.

GuestGuestNew and previous system

1970.
1971.

Plz.what is the new system of score. :?Guest, Oct 27, 2008#428

1972.

BBGuestMRCP 1st part exm

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.

Thanks.BB, Jan 2, 2009#429

1977.

emeda300Guestcollection of MRCP MCQ

1978.
1979.

This website is useful 4mrcp exams, contains alot of free MRCP questions

1980.
1981.

4mrcp

1982.
1983.

Faresemeda300, Jan 25, 2009#430

1984.

GuestGuestmrcp books and course material for resale

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.

pls contact me at mandar_d79@yahoo.com

1989.

07799552842[uk]

1990.

Log in or Sign up

1991.
1992.
1993.

Forums

1994.

>

1995.

UK Medical Zone

1996.

>

1997.

MRCP Forum

1998.

>

1999.

MRCP 1 >>9 SEP. 2014 EXAM RECALL DISCUSSION

2000.

Discussion in 'MRCP Forum' started by samuel, Sep 13, 2014.

2001.
2002.

samuelNew Memberanti ccp-RA

2003.

NHL-anti cd-20

2004.

pemphigus vulgaris

2005.

bullous pemhigoid

2006.

von willebrand disease

2007.

marfan-fibrillin

2008.

gentamicin-acute tubular necrosis

2009.

CRF- secondary hyperparathyroidism

2010.

addisonian crisis- iv hydrocort

2011.

ITP-prednisolone

2012.

pulseless VT- non synchronised DC shock

2013.

wernicke-korsakoff- nystagmus

2014.

abduction of thumb pain- carpal tunnel

2015.

retrosternal chest pain- reflux esophagitis

2016.

pre angio drug to stop- metformin

2017.

acute knee pain with ligament clcification- pseudogout

2018.

cat scratch- bartonella henslae

2019.

pseudomembranous colitis- metronidazole

2020.

return from eastern europe with dysphagia- diphteria

2021.

before start anti TB- check LFT

2022.

cardiogenic syncope- do ECHO

2023.

angiodedema n anaphylaxis- im adrenaline

2024.

lung ca and GN- membranous GN

2025.

headache and gram pos bacilli- listeria meningitis

2026.

epididimoorchitis-parenteral ceftriaxone n doxycyline

2027.

wilson-autosomal recessive

2028.

tricuspid regurg with flushing n wheeze- carcinoid syndrome

2029.

s3( gallop rhythm)- poor prognosis in LVH

2030.

LVH in pregnant 14 weeker- essential HPTsamuel, Sep 13, 2014#1

2031.

samuelNew MemberQuestion on RCA territory

2032.

Question on anti Cd 20= Lymphoma

2033.

Part of kidney impermeable to water - Distal collecting duct

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.

Question on whipple's disease

2037.

A 16 yr old boy with proteinuria and had similar episode at the age of 7 years= minimal change disease

2038.

Breast carcinoma nd cerebellar symptoms = anti-Yo antibody

2039.

Esophageal varices = azygous vein

2040.

Termonal ileum resection afrter crohns disease and diarrhoea = bacterial overgrowth

2041.

samuelNew MemberConfirmatory for cardiac tamponade = Pulsus paradoxus

2042.

TIA and AF = Warfarin

2043.

WPW and Af = Flecainide

2044.

Chromatin separation = Telophase

2045.

A question on Lyme's disease

2046.

A elderly male with recurrent jerks = creutzfeldt Jacob disease

2047.

Person becoming drowsy 6 hours after confusion and headache = Herniation

2048.

A question on pituitary apoplexy

2049.

A hypertensive and CAD pt taking too many medicines, presented with nephrotoxicity= Aspirin
induced

2050.

Question on cervical myelopathysamuel, Sep 13, 2014#3

2051.

samuelNew MemberPostitve predictive value

2052.

False negative rate

2053.

Wilcoxon sign rank question

2054.

Wilson's = autosomal recessive

2055.

Becker's disease - X linked recessive

2056.

Huntigton's disease = incomplete penetrance

2057.

samuelNew Memberprimary pulmonary hypertesion

2058.

jus returned frm cambodia rx for malaria n resolved- hepatitis b

2059.

jus returned frm thailand- dengue

2060.

HIV pt taking vaccination can cause clinical- rubella

2061.

post chemo spiking temp- cmv

2062.

ix for invasive aspergillosis- galactomannan

2063.

pons-basillar artery

2064.

pulmonary fibrosis

2065.

post traumatic syringomyelia

2066.

phenytoin- zero order kinetics

2067.

to prevent VTE- LMWH

2068.

amiodarone- K channel blocker

2069.

painless hematuria- bladder tumour

2070.

acromegaly- GH and OGTT

2071.

obese woman with nerve palsy n headache- BIH

2072.

nephrocalcinosis next step- urine pH

2073.

complicated effusion ph 7.04- put chest tube

2074.

peritonitis- high neutrophil count

2075.

APS- anticardiolipin

2076.

anti yo- paraneoplastic cerebellar

2077.

lithium n polydipisa- nephrogenic DI

2078.

bloody diarrhea- e coli 0157

2079.

pituitary apoplexy

2080.

hypochondriasis

2081.

somatoform disorder

2082.

OSA- polysomnography

2083.

minimal change disease

2084.

CHADSVASc >2- warfarin

2085.

carotid artery stenosis right 100%- carotid endarterectomy

2086.

inherited kidney disease n mother died of ICB- ADPKD

2087.

drug-drug interaction cause fits- aminophylline n clarythromycin

2088.

melanoma- depth of lesion

2089.

dilated pupils- adie tonic

2090.

ascending weakness n arreflexia- GBS

2091.

T1DM girl investigated for ?seizures with hypoK- insulin overdose

2092.

cystinuria

2093.

IgM paraproteinemia- hyperviscosity

2094.

highest calorie food- red meat

2095.

LUQ pain- ?splenic infarct

2096.

post duodenal artery bleed

2097.

NAFLD- fatty infiltration

2098.

MDMA overdose- hypoNa

2099.

DM shin lesion- necrobiosis lipoidica

2100.

Infective exarcebation COPD with deranged TFT- sick euthyroid

2101.

Man frm Zambia with chronic diarrhea n confused- cryptococcus neoformans

2102.

strongyloides- screen for HIVsamuel, Sep 13, 2014#5

2103.

samuelNew Memberhuntingtons- autso: dominant

2104.

alcohol + diazepam overdose- rhabdomyolysis

2105.

terlipression - mode of action.

2106.

nesseria meningitis- c1/c2/?? (c5-c9)

2107.

clost: diff:- oral vancomycin

2108.

Pons arterial supply

2109.

Young woman, mute, one hand over head other behind back

2110.

Man outside school says he can protect children

2111.

Young boy paranoid about teacher

2112.

Cardiogenic syncope

2113.

AS - echo

2114.

2115.

Unsure about answers-

2116.

Rt to left shunt ?aa gradient

2117.

Bleomycin, lymph node ?fibrosis

2118.

Rasburicase ?action

2119.

Pneumothorax second presentation ?...

2120.

Man with IECOPD cannot tolerate NIV, only abx, unconscious, ?continue abx only

2121.

Pleural plaques ?no further investigation

2122.

Man with birds, most consistent finding ?upper zone fibrosis

2123.

Respiratory presentation ?do spirometry

2124.

Pain control scenarios ?...

2125.

Psoriasis, aggravated by drugs ?ARB/ beta blocker/ diuretic

2126.

Papule over thigh, epidermal dysplasia with no invasion ?radiotherapy/5FU/steroid/...samuel, Sep 18,
2014#6

2127.

samuelNew MemberPleural calcification- next investigation

2128.

Foot drop and decrease sensation on outer foot border- level

2129.

Calories-sugar/ cheese

2130.

Kyphoscoliosos- fvc/spirometery

2131.

Klinefelters- infertility

2132.

Hyper acute rejection - abo

2133.

Psiriasis- beta blockers

2134.

Ruq pain, ct scan bile stone, hypokalaemia, hypertension- cushings

2135.
2136.

BNP_ VENTRICLES.

2137.

PERNICIOUS ANEMIA(ANTIPARITAL CELL ANTIBDY)- VITILGO

2138.

ANDROGENINSENSIVITY-KARYOTYPING

2139.

naproxen - arthritis(prevous peptic ulce)

2140.

opposite side of sternocledomastoid

2141.

discitis- post op

2142.

g protein coupled receptors

2143.

mast cell - release

2144.

daily potassium req-60

2145.

scenrio of catatonia

2146.

post op- early mobilisation

2147.

mafloqune side effect-( hallucination, night mares etc

2148.

arteriovenous dysplasia

2149.

tender hepatomegaly cause- falciparum??

2150.

vent: tech- carotid message

2151.

MEN-1 pheo+meddul ca(inc: calcium)samuel, Sep 18, 2014#7

2152.

samuelNew Memberpsychogenic polydipsia scenario.

2153.

vit B21 def: -hyperseg neutrophil+megaloblast

2154.

tumerlysis syndrome- chemotherapy related

2155.

TICAGRELOR- ADP receptor inhibitor

2156.

L5/S1 - scenerio

2157.

L5 Vs Peroneal nerve diff ???

2158.

RASBURiCASE mech: of action in tumerlysis syndrome

2159.

scenario of sensory and motor neuropathy

2160.

ST elevation V1-V4, with resiprocal- RCA involved

2161.

Parkinsons scenerio

2162.

lupus anticoagulant-2nd time abortion

2163.

Neurofibromatosis -50% chance(autos: dominant)samuel, Sep 18, 2014#8

2164.

samuelNew Member1.monoclonal antibodies used for non-hodgkin's lymphoma --CD20

2165.

2. gram positive bacilli-- LISTERIA

2166.

3.ulcer on dueodenal cap-- GASTRODUDONEAL ARTERY

2167.

4. hepatic vein drain into --- AZYGOUS VEIN???

2168.

5.behcet disease-- HLA B

2169.

6. scenario on PITUITARY APOPLEXY

2170.

7. recurrent first trimester miscarriage --- ANTIPHOPHOLIPID SYNDROME

2171.

8. syncope on swimming-- ECHO

2172.

9. scenario of CARDIOGENIC SYNCOPE

2173.

10. wilson's disease-- AUTOSOMAL RECESSIVE

2174.

11.some scenario on genetics of cystic fibrosis

2175.

12.pathophysiology of emphysema--DYNAMIC COMPRESSION OF AIRWAY

2176.

13.highest calorie value food--CHEESE

2177.

14.ECG Findings of LAD OBSTRUCTION

2178.

15.patient faking symptoms for morphine-- FACTITIOUS

2179.

16.depression-- EARLY MORNING WAKENING

2180.

17. tamponade--PULSUS PARADOXUS

2181.

19.16 weeks pregnant lady with hypertension, ECG showing LVH-- ESSENTIAL HYPERTION

2182.

20.marfans--FIBRILLIN

2183.

21. scenario of ethics-- CONTINUE WITH ANTIBIOTICS

2184.

22.scenario of SOMATIZATION

2185.

23. peripheral neuropathy--NITROFURANTOIN

2186.

24.cisplatin-- SENSORY NEUROPATHY

2187.

25. scenario on asthma treatment--ADD SALMETEROL

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.

28. scenario of NEPHROGENIC DIABETES INSIPIDUS

2191.

29. which drug to stop before angioplasty--METFORMIN

2192.

30. findings of extrinsic allergic alveolitis -- UPPER LOBE FIBROSIS

2193.

31.DM patient with tender erythematous leisons on shin--ERYTHEMA NODOSUM

2194.

32. scenario of BULLOUS PEMPHIGUS

2195.

33. hypertension with hypokalemia--LIDDLE SYNDROME

2196.

34. RTA findings--HYPOKALEMIA

2197.

35. amiodarone mechanism of action-- CALCIUM CHANNEL BLOCKER

2198.

36. psoraisis exacerbation-- BETA BLOCKER

2199.

37.scenario of HOLME ADIE'S

2200.

39. SENSITIVITY

2201.

40.Lithium posioning-- hemodylasis

2202.

41.patient presented with unknown substance posioning with confusion and eye symptoms--

METHANOL
2203.

42. role of terlipressin in hepatorenal syndrome-- VASOCONSTRICTION OF SPLANCHIC

CIRCULATION

2204.

43. IgE is produced by-- PLASMA CELLS

2205.

44. blood test prior to renal transplant--MHC II

2206.

45. vaccination in HIV patient that will cause active disease-- BCG

2207.

46. treatment of epididmytis-- IV CEFTRIAXONE, DOXYCYCLIN

2208.

47. source of BNP secretion-- CARDIAC VENTRICLES

2209.

50. bloody diarrhea on 3rd day-- SALMONELLA ENTERIDIS

2210.

51.prognositic factor for melanoma--DEPTH OF MELANOMA

2211.

52. sleep apnea diagnostic test

2212.

53. egg shell calcification-- SILICOSIS

2213.

54.pulse of PDA- BOUNDING PULSE

2214.

55. separation of chromatins occur--TELOPHASE

2215.

56. TR, wheezing, flushing-- CARCINOID SYNDROME

2216.

57. episodic diarrhea not relived by fasting-- VIPOMA

2217.

59. vitiligo and acidity history-- ANTIPARITAL ANTIBODIES

2218.

60. pleural effusion analysis showed PH 7.2-- CHEST TUBE

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.

64. test to do prior to prescribing ATT-- LFTs

2223.

65. G Protien is present on-- CELL MEMBRANE

2224.

66.WPW syndrome with atrial fibrilation- FLECANIDE

2225.

67. Stroke with atrial fibrillation-- WARFARIN??

2226.

68. surgical contraindication-- SVC obstruction

2227.

69. polymyositis

2228.

71. exudate on tonsils + cervical lymphadenpathy-- GLANDULAR FEVER

2229.

72. one scenario seems BARTONELLA HENSALE???

2230.

75. C.Difficle---METRONIDAZOLE

2231.

76. Scenario of MENS2

2232.

77. scenario of APKD

2233.

78. immediate treatment of neutropenia-- ANTIBIOTIC PROPHYLAXIS

2234.

79.anti-CCP - RA

2235.

80. prophylaxis for dental extraction-- none

2236.

81. test for ascitic fluid which leads tpo diagnosis-- NEUTROPHIL COUNT

2237.

82. VT -- unsynchronized DC

2238.

83. DM,Knee joint arthritis -- HEMACHROMATOSIS

2239.

84. malignancy- MEMBRANOUS GN

2240.

85. rectal bleeding with clonoscopy, gastroscopy and barium normal-- ANGIODYSPLASIA

2241.

86. protinuria in young male-- MINIMAL CHANGE DISEASE

2242.

87. biopsy showed PAS postive macrophages n villous atrophy--- WHIPPLE

2243.

88. scenario of creudzfelt syndrome

2244.

89. scenario of idiopathic intracarnial hypertension

2245.

90. CSF Analysis- enterovirus

2246.

91. blood supply of pons-- BASILAR ARTERYsamuel, Sep 19, 2014#9

2247.

samuelNew Member1-patient with anorexia nervousa ,what feature ?low LH

2248.

2-patient with pain in eye movement and decreased color vission?optic neuritis .

2249.

3-urgent referral to opthalmolegist ?macular exudate

2250.

4-homosexual man with recal bleeding ?gonococcal proctitis

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.

sec hyperparathroidismsamuel, Sep 19, 2014#11

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.

strongyloid and HIVsamuel, Sep 24, 2014#12

2277.

samuelNew MemberDengue

2278.

diphteria

2279.

progressive supra nuclear

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.

low lean body mass

2300.

MDMa hyponatremia

2301.

S3 heart failure

2302.

testosterone

2303.

colchinine pericarditis

2304.

BNP ventricles

2305.

plysomnography

2306.

heamatochromatsis

2307.

psudogout

2308.

giant cell artritis

2309.

rheumatoid ccp

2310.

apoplexy

2311.

herniation

2312.

bladder Casamuel, Sep 24, 2014#13

2313.

samuelNew Memberto diagnose depression LOW MOOD is a MUST!

2314.

and not early morning awakening.. only.

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.

-Persistent sadness or low mood nearly every day.

2319.

-Loss of interests or pleasure in most activities.samuel, Sep 25, 2014#14

2320.

samuelNew MemberMAQ901 sept.2014 marcp 1

2321.

1.Cftr mutation only in paternal gene y?

2322.

2.Newly d.m nw joint pain liver enlrge..hemocgromotosis

2323.

3.cystinuria...recurent stones

2324.

4.marfan ..fibrillin

2325.

5.muchensn ...wants morphine recurent er admissions

2326.

6.depred on fluixetine outside school claiming special powrs...mania

2327.

7.anti ccp....R.A

2328.

8.epididmytis...ceftri +doxy

2329.

9.cisplatin...hypocalcemia

2330.

10.rasburicase...M.o.a

2331.

11.acute renal failure...aspirin

2332.

12.penicillin induced nephritis

2333.

13.thiophyline n clarithro reaction

2334.

14.tertiary hyperparathroidim with hypercalcemia n hyperphosp. N raised pth

2335.

15.primary hyperpara sceniro also

2336.

16.pain walking n lyng in dat side...trochentric brusitis

2337.

17.painless hematuria...bladder

2338.

18.ecg sinus tachy with lbbb....reversed s2 split

2339.

19.wpw with af...flecanide

2340.

20.amiodarone ...k chnl blkr

2341.

21.svt...first step carotid massage

2342.

22.tender calf ankle sweling ...celulitis

2343.

23.l5 radiculopathy...loss inversion

2344.

24.ca prostate with mets showng gagabsnt.tongue that side paralysd n numbnesd....mets to forman
ovale

2345.

25.post trauma syrinx

2346.

26.dengue rash n fever low plt inc Alt

2347.

27.strongloude what else chk HIV ?

2348.

28.erythema nodosum

2349.

29.somatization sceniro

2350.

30.male sex with male nw ulcer in anal area ..gonococal proctitis

2351.

31.ticagrel m..o.a....ADP inhibtors

2352.

32.cardiogenic syncopy

2353.

33.echo in colapse for runing for bus

2354.

34.v.t...synchronizd shock

2355.

35.central cynosis n clubbing....Pulmonry stenosis

2356.

36.wilson...auto recesve

2357.

37.17 yrs old type 1 dm nw abgs low hco3 low k .hyprventilatng....Dka

2358.

38.paired t test

2359.

39.scater graph for data scenario

2360.

40.unpaird t test

2361.

41.false negative rate 495/500

2362.

43.scenioro of acromgly test OGTT WITH GRWTH MESURE

2363.

44.barter most specific hypokalemia

2364.

45.50.50 mixing stdy i mrkd hemoph A

2365.

47.recurent T.i.a....warfarin

2366.

48.pas +ve...whipple

2367.

49.coeliac scenrio test anti ttg

2368.

50.antipareital atibx for pernicious

2369.

51.cystic fibrosis chnce of nxt child scenrio.. to effect 1 in 4

2370.

52n 53.also two othr on this topic for wilson n hemophilia tranmision to child

2371.

54.Cjd ...jrks

2372.

55.gbs

2373.

56.cervical cored compression nt sure

2374.

57.dermatitis herpit.

2375.

58.posiriasis worsng..bisoprolol

2376.

59.anticipation

2377.

60.whn to refer to opthalmolgy .... blot hemorhages seen

2378.

61.painfull eye mov n dec visual acuity....optic neuritis

2379.

62.d quravian tenosynovitis

2380.

63.recurent pericarditis...prednisolone

2381.

64.primry pneumothorax aspiratd n dischrge wt to do nxt ...nothng

2382.

66.pitutry apoplxy gv hydrocortisone

2383.

67.MEN scenario

2384.

68.thtroid area sweling bt labs norml mostly no sym...pregnancy induced

2385.

69.hogkin lymphoma treatd c.t chest 2 l.nodes small....normal

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.

72.klinefeltr scanario wich most ...valvular hrt dis

2389.

73..male with osteoprosis...chk testostrone

2390.

74.male pt with dec pubic n all 2ndry sexual charatr all testo lh fsh tsh low height
162cm....constituational delayd pubrty

2391.

75.14 wk pregnat high bp....essential htn

2392.

76.painful penile ulcer hx of sex n recurnce...herpes

2393.

78.anticardio anbodies in scanario of recurnt miscarges 3 of thm i think

2394.

79.alpha thalasemia trait scanario

2395.

80.iridated blood y....i markd to lower cmv transmission

2396.

81.scanario with abx treat worseng of fever...glandular fever

2397.

82.wt to gv to lower k frm 7....i.v dextrose with insulin

2398.

83.copd with exb n deranged lfts....dont rembr wt i mark

2399.

84.terminal ileum removed now persistant diarhea...i markd biliary reason

2400.

85.excessive watery diarhea...VIPOMA

2401.

86.painless pr bleed family hx of ca colon n pigmntation at lips...colorectal ca

2402.

87.varicose vein drainage i marked hepatic

2403.

88.supply to pons ...basilar or mCa?

2404.

89.scenario of catatonia i gues bt i thought dystonia

2405.

90.neck dystonia to left..RT sternocladomastod

2406.

91.homes adie scanario

2407.

92.anto yo/purkajie antobodies

2408.

93.gymnast preparong for competition hormone supresd....i mrkd prolactin

2409.

94.scanario of withdrwal of benzodiazipne

2410.

95.carcinoid with epidosic diarhea sweating wheeze n rt heart involmnt

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.

100.legs tense itch blisters....bulous pamphigoidsamuel, Sep 25, 2014#15

2416.

samuelNew Member101.meningitis cultur gram pos. Bacilius....listeria

2417.

102.mengitis pic in HIV pt...crptococus

2418.

103.invasive aspergilosis..test igE precipitant

2419.

104.menungococus mengigits .. complemnt out of 5 to 9 only 7 was gvn so i pickd 7

2420.

105.daily k requirmnt it was in mmol ..60

2421.

106.paget scanario

2422.

107.for pcr ....known nucleotide sequnce if to develop diagnostic test

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.

111.chromatids started to move opposite endsanaphase

2427.

112. Confirmatory for cardiac tamponade = Pulsus paradoxus

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.

117. Question on anti Cd 20= Lymphoma

2431.

118. s3( gallop rhythm)- poor prognosis in LVH

2432.

119. .ST elevation in V1-V4,ST depression in inferior leads - ?Complete Occlusion LAD

2433.

120. lung ca and GN- membranous GN

2434.
2435.

121. before start anti TB- check LFT

2436.

122. cat scratch- bartonella henslae

2437.

123. pre angio drug to stop- metformin

2438.

124. retrosternal chest pain- reflux esophagitis

2439.

126. wernicke-korsakoff- nystagmus

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.

130. . invasion of surrounding structures - Anaplastic thyroid ca

2442.

131. .contraindication to surgery of lung ca - ?superior vena caval obstruction

2443.

132. Lung function testing in kyphoscoliosis

2444.

check Kco reduced

2445.

133. Flat effect,auditory hallucination - schizophrenia

2446.

134.scanario on PAN

2447.

135.pt. with sob and dec oxy satCTPA

2448.

136.reason y pt no improving on oxygen with hx of cardiac defecthypoxemia result of blood

mixing

2449.

137. Bipolar disorder RX -Lithium

2450.

138. Pheochromocytoma - MEN

2451.

139. Bacterial peritonitis - Neutrophil count

2452.

140. Terlipressin in hepatorenal syndrome - Splanchnic vasoconstriction

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.

143. Emphysema Pathophysiology - ?Dynamic airflow obstruction

2458.

144. Q on Mechanism of MODY GLUCOKINASE

2459.

146. DVT,Thrombus in arteries if leg - LMWH

2460.

147. Vaccine contraindicated in HIV pt - ?BCG

2461.

148. Fever,sore throat after using amoxycillin - ?EB virus

2462.

149. unable to abduct arm(painful and limited) - ?rotator cuff syndrome

2463.

150. Alcoholic ,ultrasound of liver hyper echogenecity - Fatty filtration

2464.

151. Bloody diarrhea in a child who been to a farm 3 times.ECOLI 0157

2465.

152. Obese female with b/l papilledema - BIH

2466.

153. Cells responsible for producing IgE - Plasma cells

2467.

154. Ig M ,Waldenstrom's - Hyperviscosity

2468.

155. Egg shell calcification hilar nodes - ?Silicosis

2469.

156. G proteins located at - Plasma membrane

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.

161.pleural effusion ph 7.02 .chest drain

2475.

162. sleep apnea diagnostic test .polysmnography

2476.

163. prognositic factor for melanoma--DEPTH OF MELANOMA

2477.

164. source of BNP secretion-- CARDIAC VENTRICLES

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.

167. scenario of NEPHROGENIC DIABETES INSIPIDUS result of lithium pt taking 10 yrs

2481.

168. ecstasy--HUPONATREMIA

2482.

169. peripheral neuropathy--NITROFURANTOIN

2483.

170. depression-- EARLY MORNING WAKENING

2484.

171. .highest calorie value foodCHEESE

2485.

172. vit B21 def: -hyperseg neutrophil+megaloblast

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.

samuelNew MemberFluid therapy

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.

1.5 ml/kg/hr fluid - for a 80kg man around 2-3 litres/day

2492.

70-150mmol sodium

2493.

40-70mmol potassium

2494.
2495.

This is why the typical regime prescribed for patients is

2496.
2497.

1 litre 5% dextrose with 20mmol potassium over 8 hours

2498.

1 litre 0.9% normal saline with 20mmol potassium over 8 hours

2499.

1 litre 5% dextrose with 20mmol potassium over 8 hours

2500.
2501.

The amount of fluid patients require obviously varies according to their recent and past medical history.
samuel, Sep 25, 2014#17

2502.

samuelNew MemberMRCP PART 1 (9TH sept.2014) RECALL WITH CORRECTIONS

2503.

1.Cftr PATIENT ONLY 1 MUTATION FOUND WHYUNIDENTIFIED MUTATION ON CFTR

GENE as there are more than 1500 mutations on cftr GENE

2504.

3.cystinuria...recurent stones

2505.

4.marfan ..fibrillin

2506.

5.HYPOCHONDRIASIS ...wants morphine recurent er admissions THINKS HAS PANCRETIC

CANCER LIKE HIS FATHER WHO DIED BECAUSE OF IT

2507.

6.deprSSed on fluOxetine outside school claiming special powrs..ACUTE SUBSTANCE ABUSE

2508.

7.anti ccp....R.A

2509.

8.epididmytis...ceftri +doxy

2510.

9.cisplatin...PERIPHERAL NEUROPATHY

2511.

10.rasburicase...FORMS ALLANTOIN

2512.

11.acute renal failure...aspirin

2513.

12.penicillin induced nephritis

2514.

13.MACROLIDES DECREASE THE THRESHOLD FOR SEIZURES--CLARITHROMYCIN

2515.

14.tertiary hyperparathroidim with hypercalcemia n hyperphosp. N raised pth

2516.

15.primary hyperparaTHYROID

2517.

16.pain walking n lyng in dat side...trochentric brusitis

2518.

17.painless hematuria...bladder

2519.

18.ecg sinus tachy with lbbb....reversed s2 split

2520.

19.wpw with af...flecanide

2521.

20.amiodarone ...k chnl blkr

2522.

21.svt...first step carotid massage

2523.

22.tender calf ankle swelling AFTER SWELLING IN KNEE ONE WEEK BACK ... RUPTURE OF
POPLITEAL CYSTS

2524.

23.l5-S1...loss inversion AND ANKLE REFLEX ABSENT

2525.

24.ca prostate with mets showng gag absnt.tongue that side paralysd n numbnesd....JUGULAR
FORMAENLOSS OF GAG REFLEX9,10,11CN

2526.

25.post trauma syrinx

2527.

26.dengue rash n fever low plt inc Alt

2528.

27.strongyloide what else CHECK HIV AS IT PREDISPOSES TO OPPORTUNISTIC

INFECTIONS

2529.

28.erythema nodosum IN TYPE 1 DM TAKING OCP

2530.

29.somatization

2531.

30.male sex with male nw ulcer in anal area ..gonococal proctitis

2532.

31.ticagrel m..o.a....ADP inhibtors

2533.

33.echo in colapse for runing for bus IN A PERSON WITH AS

2534.

34.v.t...synchronizd shock

2535.

35.central cynosis n clubbing....Pulmonry stenosis

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.

39.scater graph for data scenario

2540.

40.unpaird t test

2541.

41.false negative rate CALCULATION

2542.

43.scenioro of acromgly test OGTT WITH GRWTH MESURE

2543.

44.barter most specific FINDING-- hypokalemia

2544.

45. SLIGHTLY LOW FACTOR 8..VON WILEBRANDS

2545.

46.itp..prednisolone

2546.

47.recurent T.i.a....warfarin

2547.

48.pas +ve...whipple

2548.

49.coeliac scenrio test anti ttg

2549.

50.antipareital atibx for pernicious

2550.

51.cystic fibrosis chnce of nxt child scenrio.. NO CHANGE AS IT IS AUTOSOMAL RECESSIVE

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.

56.cervical cord compression

2555.

57.EXTENSOR SURFACE RASH UNRESPONSIVE TO STEROIDS--dermatitis herpit.

2556.

58.posiriasis worsng..bisoprolol

2557.

59.anticipation

2558.

60.whn to refer IN DIABETIC NEUROPATHY .... CHANGES IN THE MACULA

2559.

61.painfull eye mov n dec visual acuity....optic neuritis

2560.

62.d quravian tenosynovitis

2561.

63.recurent pericarditis...COLCHICINE

2562.

64. RECURRENT primAry pneumothorax aspiratd n dischrge AND xraY AFTER 2WEEKS AS ITS
RECURRENT

2563.

66.pitutry apoplxy gv hydrocortisone

2564.

67.MEN 2 scenario

2565.

68.thYroid area swelling bt labs normal mostly no sym...pregnancy induced

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.

72.klinefeltr scanario wich most ...valvular hrt dis

2570.

73..male with osteoprosis...chk testostrone

2571.

74.male pt with dec pubic n all 2ndry sexual charatr all testo lh fsh tsh low height
162cm....CRANIOPHARYNGIOMA

2572.

75.14 wk pregnat high bp....essential htn

2573.

76.painful penile ulcer hx of sex n recurnce...herpes

2574.

78.recurnt miscarges 3 IN FIRST TRIMESTER--ANTICARDIOLIPIN

2575.

79.LOW HBA2 AND ANEMIA- BETA THALASSEMIA TRAIT

2576.

80.iridated blood y....TO PREVENT HOST vs GRAFT DX

2577.

81.scanario with abx treat worseng of fever...glandular fever

2578.

82.wt to gv to lower k frm 7....i.v dextrose with insulin

2579.

83.copd with exb n deranged lfts....dont rembr wt i mark

2580.

84.terminal ileum removed now persistant diarhea...i markd biliary reason

2581.

85.excessive watery diarhea...VIPOMA

2582.

86.painless pr bleed family hx of ca colon AND BROWN MACULES ON lips...colorectal ca(PEUZ

JEGHER)

2583.

87.varicose vein drainage AZYGOUS

2584.

88.supply to pons ...BASILAR

2585.

89.CATATONIA

2586.

90.neck dystonia to left..RT sternocladomastod

2587.

91.homes adie scanario

2588.

92.anto yo/purkajie antobodies

2589.

93.gymnast preparong for competition hormone supresd....i mrkd prolactin

2590.

94.scanario of withdrwal of benzodiazipne

2591.

95.carcinoid with epidosic diarhea sweating wheeze n rt heart involmnt

2592.

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

2593.

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.

100.legs tense itch blisters....bulous pamphigoidsamuel, Oct 1, 2014#18

2597.

samuelNew Member101.meningitis cultur gram pos. Bacilius....listeria

2598.

102.mengitis pic in HIV pt...crptococcus MENINGITIS

2599.

103.invasive aspergilosis..GALACTOAMANNAN

2600.

104.menungococus mengigits .. MANNOSE BINDING LECTIN

2601.

105.TPN daily k requirmnt it was in mmol ..60

2602.

107.for pcr ....A THERMOSTABLE DNA POLYMERASE IS REQUIRED

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.

111.chromatids started to move opposite endsanaphase

2607.

112. Confirmatory for cardiac tamponade = Pulsus paradoxus

2608.
2609.

121. before start anti TB- check LFT

2610.

122. cat scratch- bartonella henslae

2611.

123. pre angio drug to stop- metformin

2612.

124. retrosternal chest pain- reflux esophagitis

2613.

126. wernicke-korsakoff- nystagmus

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.

130. . invasion of surrounding structures - Anaplastic thyroid ca

2616.

131. .contraindication to surgery of lung ca - superior vena caval obstruction

2617.

132. Lung function testing in SEVERE kyphoscoliosis

2618.

reduced vital capacity

2619.

133. Flat effect,auditory hallucination paranoid schizophrenia

2620.

134. scanario on PAN

2621.

135. pt. with sob and dec oxy satCTPA

2622.

136. reason y pt no improving on oxygen with hx of cardiac defecthypoxemia result of blood

mixing

2623.

138. Pheochromocytoma - MEN 2

2624.

139. Bacterial peritonitis - Neutrophil count

2625.

140. Terlipressin in hepatorenal syndrome - Splanchnic vasoconstriction

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.

143. Emphysema Pathophysiology - ?Dynamic airflow obstruction

2631.

144. Q on Mechanism of MODY GLUCOKINASE (HNF1APHA WAS NOT GIVEN)

2632.

146. DVT,Thrombus in arteries if leg - LMWH

2633.

147. Vaccine contraindicated in HIV pt - BCG

2634.

148. Fever,sore throat after using amoxycillin - EB virus

2635.

149. unable to abduct arm(painful and limited) adhesive capsulitis

2636.

150. Alcoholic ,ultrasound of liver hyper echogenecity - Fatty filtration

2637.

151. Bloody diarrhea in a child who been to a farm 3 times.ECOLI 0157

2638.

152. Obese female with b/l papilledema - BIH

2639.

153. Cells responsible for producing IgE - Plasma cells

2640.

154. Ig M ,Waldenstrom's - Hyperviscosity

2641.

155. Egg shell calcification hilar nodes - Silicosis

2642.

156. G proteins located at - Plasma membrane

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.

161.pleural effusion ph 7.02 .chest drain

2648.

162. sleep apnea diagnostic test .polysmnography

2649.

163. prognositic factor for melanoma--DEPTH OF MELANOMA

2650.

164. source of BNP secretion-- CARDIAC VENTRICLES

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.

167. scenario of NEPHROGENIC DIABETES INSIPIDUS result of lithium pt taking 10 yrs

2654.

168. ecstasy--HYPONATREMIA

2655.

169. peripheral neuropathy--NITROFURANTOIN

2656.

170. depression-- EARLY MORNING WAKENING

2657.

171. .highest calorie value foodCHEESE

2658.

172. vit B21 def: -hyperseg neutrophil+megaloblast

2659.

173. post op pacemaker insertion severe backache it was PANCREATITISsamuel, Oct 1, 2014#19

2660.

samuelNew Member1-Corticobasa; syndrome

2661.

2-Which part of nephron remains impermeable to water in dehydration.

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

recurrence by guidelines means third episode.

2670.

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.

samuelNew MemberWhat was the answer of

2672.

1) elderly lady with hip arthritis choosing pain killers after paracetamol

2673.

2) asthmatic pt on NSAIDs to continue or stop

2674.

3) clubbed cynosed pt systolic murmur ? Ps or vsd

2675.
2676.
2677.

1.codeine

2678.

2.celecoxib relatively safer than ibuprofen.

2679.

3.pul HTN due to central cyanosis,murmur and clubbing.samuel, Oct 2, 2014#24

2680.

samuelNew Memberconfusing case scenarios

2681.

PAIN CASES

2682.

1.RA patient on taking pcm develop AEBA. wat is the next thing you do?

2683.

a,stop all NSAIDS b. give celecoxib

2684.

2.post AML therapy develop hip pain due to

2685.

a. avascular necrosis b. gout

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.

5.pt on PCM pain not controlled OA

2691.

6.chemo//?RA?OA patient codiene pain not controlled with active peptic ulcer.

2692.

7.immediate release of pain for crf pts ? a. MR morphine b.oral tramadol

2693.

8.qn on dihydromorphine?///samuel, Oct 2, 2014#25

2694.

samuelNew MemberMRCP SEPT 2014 DIET RECALLS

2695.

1.Anti CCP- RA

2696.

2.NHL- cd20

2697.

3.Cystinuria

2698.

4.Marfan-fibrillin

2699.

5.Family h/o pancreatic Ca, recurrent admissions to ED- hypochondriasis

2700.

7.Epidydimoorchitis- IV ceftraixone and doxycycline

2701.

8.Cisplatin- peripheral neuropathy

2702.

9. Gentamicin- Acute tubular necrosis

2703.

10.Drug-drug interaction- clarythromycin and theophylline

2704.

11.CRF-secondary hyperparathyroidism

2705.

12.Scenario on primary hyperparathyroidism

2706.

14.Painless hematuria- bladder ca

2707.

15.LBBB- reversed split s2

2708.

16.Amiodarone-K channel blocker

2709.

17.SVT stable- carotid sinus massage

2710.

18.Knee pain then lower limb edema with low grade temp- ruptured bakers cyst

2711.

19.Lateral spinothalamic tract symptoms post RTA-Post traumatic syringomyelia

2712.

20.Pt frm Thailand, fever with thrombocytopenia mildly elevated ALT- Dengue

2713.

21.Strongyloides stercralis- also screen for HIV

2714.

22.Scenario on somatisation disorder

2715.

24.Syncope during swimming o/e systolic murmur to carotids- do ECHO

2716.

25.Pulseless VT , next step?-unsynchronized DC shock

2717.

26.Wilson disease- autosomal recessive

2718.

27.Paired t-test

2719.

28. 29.Scenario of acromegaly, hw to Ix- OGTT and GH

2720.

31.Bleeding post op, slightly low Factor 8, elevated APTT, mixing test normal- von Willebrand disease

2721.

33.AF, CHADSVASc>2- warfarin

2722.

34.Abd discomfort, PAS granules positive- Whipples disease

2723.

35.Pernicious anemia, next Ix- anti parietal cell antibodies

2724.

36.X-linked recessive Beckers muscular dystrophy

2725.

37.Recurrent myoclonic jerks- Creutzfelt-Jakob disease

2726.

38.Ascending motor and sensory neuropathy with arreflexia- GBS

2727.

39.Cervical myelopathy

2728.

40.Rash at scalp, buttocks, extensor surface- dermatitis herpertiformis

2729.

41.Huntingtons choreo, age of which son get compared to father- Anticipation

2730.

42.DM retinopathy when to refer opthlmologist?- macular exudates

2731.

43.Anyphylactic reaction with angioedema- IM adrenalne

2732.

44.Scenario of pituitary apoplexy

2733.

45.Addisonian crisis what to do next?- IV hydrocortisone

2734.

46.Parathyroid , medullary thyroid ca, phaeochromocytoma- MEN2

2735.

47.TFT deranged in pregnancy- Pregnancy induced

2736.

48.ARF with hematuria and hypothermia- rhabdomyolysis

2737.

49.Ankylosing spondylistis- HLA B

2738.

50.Young osteoporosis in male check se testosterone

2739.

51. Hypertensive pregnant lady < 20 weeks with ECG having LVH- essential HPT

2740.

52.Painful genital ulcers and painful lymphadenopathy- Herpes

2741.

53.Pseudomembranous colitis- oral metronidazole

2742.

54.Recurrent miscarriage with DVT- Anti cardiolipin ab

2743.

55.Anemic pregnant , microcytic with raised HbA2- beta thalassemia trait

2744.

57.Exudative pharyngitis with lymphadenopathy and h/o travel Eastern Europe- diphtheria

2745.

58. Immidiate rx for hyperkalemia- IV insulin

2746.

59.Bloating and diarrhea post terminal ileum resection- bile acid diarrhea

2747.

60.Recurrent iron deficiency anemia and h/o colon ca in lady- colonoscopy

2748.

61.Fresh painless PR bleed- angiodysplasia

2749.

62.abnormal posturing young girl- catatonia

2750.

63.Bllod supply of pons- basilar artery

2751.

64.dilated pupil- Adie Holmes pupil

2752.

65.Paraneoplastic cerebellar syndrome- anti Yo

2753.

66. Scenario on benzodiazepine withdrawal

2754.

67. Wheeze and flushing with pulsatile liver and tricuspid regurg- carcinoid syndrome

2755.

68.Pleural plaque in normal patient- do nothing

2756.

69.Acute painful knee with calcified ligament- pseudogout

2757.

70.Family h/o recurrent stones with hypercalcemia- familial hypocalciuria hypercalcemia

2758.

71.Contact dermatitis- skin patch

2759.

72.Allergic reaction 1st line drug-cetrizine

2760.

74. Gram pos bacilli meningitis- Listeria meningitis

2761.

75.Man frm Zambia with headache and CN palsy with neck stiffness- Cryptococcus meningitis

2762.

76. High protein , normal glucose meningitis- viral meningitis

2763.

77.Invasive aspergillosis investigation- galactomannan

2764.

78.Recurrent neisseria infection- C7 deficency

2765.

79.Vomitting and headache with papiledema- cerebral herniation

2766.

80. Child having rash contact having fever and red cell apalsia- Parvovirus B19

2767.

81.Cardiac tamponade-Pulsus paradoxus

2768.

95. LUQ pain with rub- splenic infarct

2769.

96. Thyroid mass causing obstruction- anaplastic thyroid ca

2770.

97.Contra indication to lung surgery- SVC obstruction

2771.

98.Scenario on paranoid schizophrenia

2772.

100. Peritonitis impt ix- ascitic fluid neutrophil count

2773.

101.Fx of terlipressin- splanchnic vasoconstriction

2774.

102.Hx of travel to Cambodia now jaundiced with tender hepatomegaly- Hep B

2775.

103.EAA- upper lobe fibrosis

2776.

104.MODY- HNF gene mutation

2777.

107.Rash after amoxicillin for sore throat- EBV

2778.

108.NAFLD- fatty liver

2779.

109.bloody diarrhea fater visiting farm- Ecoli 0157

2780.

110.post EBV- NK cells

2781.

111.Waldernstorm macroglobulinemia- Hyperviscosity

2782.

112.G protein receptor- plasma membrane

2783.

113.Digoxin- rediced creat clearance

2784.

114.Phenytoin- zero order kinetics

2785.

116.OSA- polysomnography

2786.

117.Melanoma- depth of lesion

2787.

118. Vomitting and headache with eye signs- Methanol poisoning

2788.

119.DI after Lithium ingestion- Nephrogenic DI

2789.

120.MDMA hyponatremia

2790.

121.Nitrofurantoin- peripheral neuropathy

2791.

122.post pacemaker insertion backpain- Staph discitis

2792.

123.Pulmonary fibrosis

2793.

124.AML post rx got hip pain- AVN hip

2794.

125.tumor lysis syndrome

2795.

126.Parkinsonism with vertical eye movement restricted- PSP

2796.

127.Amyloid neuropathy

2797.

128.Valvular HD prior dental procedure- nothing

2798.

129.Cardiac failure aim of treatment- reduce preload

2799.

130. Renal disease and mother died of ICB- ADPKD

2800.

131.BNP- ventricles

2801.

133.obese lady with headache and papiloedema- BIH

2802.

134.CFTR- paternal homozygosity chromosome 7

2803.

135. Case scenario transient global amnesiasamuel, Oct 4, 2014#26

2804.

samuelNew MemberCVS

2805.

1 central cyanosis,clubing,systolic murmur (vsd,pah,pulmonary stenosis,coarctation of aorta)

2806.

2 prosthtic valve involment go dental extraction(ceftrixone1gm,amoxillin 3gm)

2807.

3 WPW +afib (flecanide,adenosine,verampil,adenosin)

2808.

4 M.I -ST ELEVATION V1-V4) LAD COMPLETE occlusion)

2809.

5 B-ANP( Ventricles, atria)

2810.

6 SVT chest clear chest clear( adenosin carotid masssage)

2811.

7 after swimming ,collapse systolic murmur aortic area radiate to neck (echo,eeg, ecg)

2812.

8 periphera neuropathy due to nitrofurantoin

2813.

9 Ticagrel adp receptor inhibitor

2814.

10 clarithromycin and simvastatin avoided

2815.

11 PDA collapse pulse

2816.

12H.failure 3rd heart sound

2817.

13 long arm,chromo 47xxy most commn abnormality(infertlity,aortic root dillation)

2818.

14 shortness breth ,tachypnea ,tachycardia(ctpa,chest xray,spiromtry)

2819.

15 AMAIDRONE( K OPNER)

2820.

16 MARFAN SYNDROME due to fribllin protein

2821.

17 pulsless vt unsynchronised shock

2822.

18 cardiac tamponade (pulsus paradoxus,

2823.

19 recurnt syncope attacks father died at 38 yr cardiogenic syncope

2824.

INFECTIOUS DISEASE

2825.

1 after pacemaker insertion ,diarhea due to staphy discites

2826.

2 lymph node swelling due to bartonlla Hensle

2827.

3 Bcg not given in hiv patient

2828.

4painful penile swelling ,painful lympadenopathy (l.venerm, syphills hsv,g.ingunale)

2829.

5 diarhea 5 for weeks shingle contact shows neck stifness fever hepe encephlits,TBM,Cryptocal
mengitis

2830.

6 chalmydia single dose azithromycin

2831.

7 lymphadenopthy +membrane at pharyngtis due to pharyngits

2832.

8 meningits gram +baciili is lymph.monocstogens

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.

11 increase calore in cheeze

2836.

12 TO treat pulm tb in uk patient what do ist hiv, lft,uce

2837.

13 sore throat fever lymph due to EBV

2838.

14 AFTR amoxicillin rash prominent EBV

2839.
2840.

GIT

2841.

1 Large amount of diarhea due to vipoma

2842.

2 diarhea wheeze lft derangd ,TR IS CARCINOID synd

2843.

3 perioral pigmentation ,bleeding due to ca colan

2844.

4 abd pain and distention ,fevr wl do neut count

2845.

5variceal bleeding due to gastrodudnal artery

2846.

6 clost dificle ist line oral metronidazle

2847.

7 obesity,ggt in biopsy fat cells

2848.

8 after iliostomy diarhea due to short bowel syndrom,bile salts in colon

2849.

9 pas +lymphad is whipples disease

2850.

10 bloody diarhea after 2 days of visiting farm area due to e.coli

2851.

11

2852.

12Ecstasy pois hyponatrmia

2853.

13 k neded daily for adult is 60mmole

2854.

14terlipresin splanic vasocostiction

2855.

15mothr hav ca colan at agr of 55yr daughtr hav iron dif anemia do colonoscopy

2856.

16 contact dermatits skin prick test

2857.

17dm+ocp tendr leison at shin E.nodosm

2858.

18 dysphagia aftr age of 60 yr do endoscopy

2859.
2860.

RHEUMATOLOGY

2861.

1 anky spondilits hla B

2862.

2 hodgkin lym cd 20

2863.

3painful red knee is septic arthrits

2864.

4linear calcificaton due to pseudogout

2865.

6R.A anti ccp

2866.

7joint pain increse ALP Pagets disease

2867.

8fevr arthrits mononurts multiplex due to PAN

2868.

10 osteoarthits k/c peptic ulcer giv lanso+nsaids

2869.

12 osteoprosis due to testrosterone

2870.

13rasburicase convrt uric acid to alantoin

2871.

14 IGM ,headache other common symptm hyperviscosity

2872.

16 painfl abd of shldr for 2 to 6month (frozn sholdr,deltoid injury)

2873.
2874.

CNS

2875.

1 Headach,6th nerve palsy,palliodema is IIH

2876.

2 Obesty+ocp headache .papliodema is BIH

2877.

3 TIA,afib give warfarin

2878.

4 oldage confusion due to SDH,EDH

2879.

5 ALL limb weakns+hypotnsion due to GBS

2880.

6OPTIC NEURITS painful eye movmnt,blurred vision

2881.

7 lft carotid 100%and ryt carotd 30% no intervention

2882.

8 vertical gaze parkinsonism due to PSP

2883.

9 PROGRSIV MEMORY LOSS due to CJD

2884.

10 AFTR truma few wekd latr toch ,temp loss is syringomylia

2885.

11 upr limb weakness sensory intact one ll weaknes(multifocal radiculopathy, CIDP,HSNM,cervical

neuropathy)

2886.

12 home aide pupil one pupil larger than other

2887.

13 decrease na,cortisole,hypotnsion is pitutary apopexy

2888.

14 foot drop evrsion loss ,inversion loss

2889.

15 pontine bleed due to basilary artery

2890.

16 upper motor sign in lower limb and extensor plantor do( MRI,EMG,NCV)samuel,

2891.

Recall From MRCP part 1 sept /2010

2892.
2893.

asyaGuest1-mode of action of docetaxel

2894.

prevent microtuble (i did it wrong)

2895.

i wrote it DNA

2896.
2897.

2-one q about pt admitted on the word and develop diarriha after 48 hr

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.

4-q about action og gastrin?!

2904.
2905.

5-q about drug causes of cholastatic picture

2906.

flucloxacillin,other option was parcetamol,tramdol

2907.
2908.

6-q mention chch feature of ejunal biopsy of whipples dis

2909.
2910.

7-q qbout toxic thyroid nodules

2911.

with feature of thyrotoxicosis and neck us shows increase uptake

2912.

ttt:radioactive iodine

2913.

other option inculderopranol.predinsolone,carbamezabine

2914.
2915.

8-q about s/e of progesteron :

2916.

option inculde:nausea,breast pain,headache

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.

glucose with growth hormon measuring

2924.
2925.

12-drug causes constipation and option were:metformin,glagazid and other???

2926.
2927.

13-q mention hyop glycemia and hypotension and hyponatremia,which is best to give

2928.

hydrocortison

2929.
2930.

14-pt obese with family hx of DM and found to be Diabetic:

2931.

MODY ,otherM typ1,DM type 2

2932.
2933.

15-diagnosis of cushing:24 hr free cortisol level

2934.
2935.

16-q about pt is not controled on glgazid and has renal impairment

2936.

extenide,other were metformin

2937.
2938.

17-q about hyperparathyrodism

2939.
2940.

18-drug causes of gynecomastiaption amidaron,pheothiazine...?!!!

2941.
2942.

19-pt with hyper prolactinemia and asking about what hormon will be supreeses:growth
hormon,thyroid,estrodiol,ADH???!!!

2943.
2944.

20-q about other feature of MENII :medullary thyroid ca

2945.

other option was inslinoma,.....

2946.
2947.

21-q about pt with gaining wt and intermettied sweating??inslinoma,other option was

cushing,acromegaly??

2948.
2949.

22-pt which have gastric ligation which will be reduce??folate,zinc,iron,vit k???

2950.
2951.

23-excessof cortisol where will it go?

2952.

bind 2 albumin

2953.

bind to fat

2954.

others.....

2955.
2956.

24-healthworker had injured from pt with hiv +ve

2957.

what is the persantge he will get hiv??

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.

osteopenia of hip and osteoprosis of the femure

2967.

osteoprosis in femur and osteopenia of hip

2968.

both osteopenic

2969.

both osteoprosis

2970.
2971.

26-diagnosis of aspirglloma:lung function test,broncoscopy,

2972.
2973.

27-autosomal ressive inhertance

2974.
2975.

28-autosmal domenat inhertance

2976.
2977.

29-q about pneumothorax:

2978.

outpt aspiration,outpt observation,inpt aspiration.inpt observation

2979.
2980.

30-criteria of ARDS:high protein pul odema

2981.
2982.

31-pt with hx of influza develop pneumonia wht is the oragnsim:strep.pnemonia,staph aures.h.influnza

2983.
2984.

32-q about lung function test option:asthma,COPD bronchitis,pul fibrosis

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.

35-prognostic feature on AML:intial wbc

2988.
2989.

plz all share and add the option or the full q if u remmber itasya, Sep 22, 2010#3

2990.

asyaGuest36-q about polycythemia rubrvera

2991.
2992.

37-q about waldenstorm`s macroglobulinemia

2993.
2994.

38-q about TTP

2995.
2996.

39-mechansim of alloprinol

2997.
2998.

40-machansim of imatinib

2999.
3000.

41-vomiting from ca what other you add to ondansetron:dexamethone,metochropromide

3001.
3002.

42-q about ressident to action of protein C:factor V laden

3003.
3004.

43-q with hyper hypo k and high CL and nephrocalcinosis:RTAI

3005.
3006.

44-what kind of IG ass with cryoglobulinemia II??!!!

3007.
3008.

45-q about minmal change GN

3009.
3010.

46-q pt with RA on methotrexate with sob ,

3011.
3012.

47-renal stone with abd xry shows staghorn calculi and proteus infection

3013.

it should be struvite bt it was not in the option ???!!

3014.

option inculde cystine,urate,ca

3015.
3016.

48-rt homnomuys hemonopia

3017.

optionost artery,post inf arety,ant inf aretry,middel cerebral artery

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.

51-q about hemiballisim

3024.
3025.

52-q about tt of essential tremor

3026.
3027.

53-2 or 3 q about numbness of the thumb

3028.
3029.

54-q about other feature of common peroneal nerve injury:

3030.
3031.

55-q about abscent ankel jerkwith extensor planter:subacute combined degenration of the cord????

3032.
3033.

56-q about progressive supranuclear palsy

3034.
3035.

57-vt what is contra indicating:verapamil

3036.
3037.

58-what favvour of vt:hr of 180,RBBB,anteriventricular disociation,

3038.
3039.

59-ecg of pericarditis

3040.
3041.

60-pt with sub acute bacterial endocarditis what inv:colonscopy

3042.
3043.

61-pt with MS what els will indicate other valvular lesion:V wave in JVP

3044.
3045.

62-pt with MS what will indicate co ass with MR??

3046.

displaced heaving apex beat???

3047.

opning snape

3048.
3049.

63-long QT syndrom:due to blockge of k channel

3050.
3051.

64-what is inv for mycordial ischemia:angiography,ct,

3052.
3053.

65-pt with high k:ca gluconateasya, Sep 22, 2010#4

3054.

GuestGuestBosentanGuest, Sep 22, 2010#5

3055.

GuestGuestAlcohol + pustular facial rash (nonscarring)

3056.

Father & son's nursery have diarrhea: campylobacter

3057.

67-q about ankylosing spondyolitis

3058.
3059.

68-young with behaviour change??

3060.
3061.

69-erythema nodusm

3062.
3063.

70-photosensitivity rash???porphyria cutanda tarda???!!!

3064.
3065.

71-pt with alcholic and rash??rossea

3066.
3067.

72-blister with no mucosal involvement

3068.
3069.

73-pt with cloctomy and a rash??pyoderma gangernosum

3070.
3071.

74-orf

3072.
3073.

75-herdietory angioodema with C1 diffecency

3074.
3075.

76-pt with HIV and ct show low attenuatedML

3076.
3077.

77-dog bite: coamoxiclave

3078.

78-dengue fever/lepospriosis??!!

3079.

79-pt with grame -ve diplococci:gonorrhea what is ttt

3080.

80-3 to 4 q about schs,manic psychosis,

3081.

81-pt with sudden loss of vision

3082.

82-???blephritis

3083.

83-pt with s/s of facial n,tangue and plate where is lesion

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.

86-which drug can be givin with finsteride

3088.

doxazin

3089.

nitrate

3090.

nicorandil

3091.

ACEinhibitor

3092.

17. SQ. CELL CARCINOMA scc

3093.

87-drug which cause pancytopenia/aplastic an

3094.

trimethoprin

3095.
3096.

88-drug lead to LN and wt gain??

3097.

phenytoinasya, Sep 22, 2010#7

3098.

asyaGuestplease all to share and add whatever u could remmber from examasya, Sep 22, 2010#8

3099.

GuestGuestgood good luck for everyone!!!Guest, Sep 22, 2010#9

3100.

GuestGuestmetformin for PCO

3101.
3102.

TTT of grade II oes. varicesGuest, Sep 22, 2010#10

3103.

asyaGuestfor the q about ttt of grade 2 oesphagel varices

3104.

option:

3105.

terlipssen

3106.

banding

3107.

propanolasya, Sep 22, 2010#11

3108.

GuestGuestWhat was the question about Gastrin action?

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.

I am just thinking any answer anybody?Guest, Sep 22, 2010#12

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.

a-increase insulin absorbtion

3119.

b-increase insulin insistivity??

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.

a-total oculsion of LAD

3125.

b-total oculssion of RCA

3126.

c-70%oculsion of LAD

3127.

d-70% oculsion of RCA

3128.

e-oculsion of LAD and rcaasya, Sep 22, 2010#14

3129.

asyaGuest95-pt recive blood transfusion and presented after 3 week with j and...

3130.

a-CMV

3131.

b-acute lung injusry

3132.
3133.

if any one can remmber the complete option and q plz shareasya, Sep 22, 2010#15

3134.

GuestGuestDelayed transfusion reaction ?Guest, Sep 22, 2010#16

3135.

96-pt presented with SOB following successfully tt of MI

3136.

mitral valve prolapse

3137.

97-pt presented with rash,femoral bruit,sob following pci

3138.

chlosterol embolismasya, Sep 22, 2010#17

3139.

asyaGuest98-what will be a good indicator for disease activity

3140.

a-ccp

3141.

b-ana

3142.

c-c3asya, Sep 22, 2010#18

3143.

GuestGuesthemochroatosis c282y gene?

3144.

deletion

3145.

expansion

3146.

am not sure of the answer

3147.
3148.

the prognosis 26 hr after paracetamol poisoning?Guest, Sep 22, 2010#19

3149.

tattaGuestgood luck 2 everyone!

3150.

this exam sucked!

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.

-renal transplant, earliest ab produced against what?HLA class 1 Ag i think

3158.
3159.

-most imp HLA 4 renal transplant matching?HLA A, HLA B, HLA DR.........

3160.
3161.

-vague q about some erythematous rash on legs??? cant remember

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.

-confused febrile........invest negative nitrites? leptospirosis, listeria meningitis..... cant recall

3166.
3167.

plz help me wit answers 2 thosetatta, Sep 22, 2010#20

3168.

dr.angel05Guestalslm alikm

3169.

this is my 1st attempt paper 1 is diffecult but 2 is ok

3170.
3171.

i will post 1st what i sure about answer after that i recall the other:

3172.
3173.

1- fomepizole ------ competitve inhibitor

3174.

2- imatimb---------- tyrosine kinse

3175.

3-ARDS ------------- high protein

3176.

4-digoxin ----------- Na-K ATPse

3177.

5-allopurial---------Xanthine oxidase

3178.

6- bosentan-------- endothelin- receptor blocker

3179.

7- high aion gap------- methanol

3180.

8- migraine ------------ ergotamine

3181.

9-drug C.I in VT ------ verapamil

3182.

10-ECG in pericarditis -------- ST elevetion concave

3183.

11- picture of PE investigation ----- CT angio

3184.

12- ucler at site of ileostomy------- pyoderma gang.

3185.

13- organism of pnemonia after influenza------ staph. aureus

3186.

14-Q picture of cholesterol embolism

3187.

15-Q picture of global transit amnesia

3188.

16-MS with MR ------- displaced apex beat

3189.

17- IE and bovi------- colonscopy

3190.

18-father has hemophillia chance his son------ 0%

3191.

19-18 month pt. c/o pysphagia both solid and fluid ----- achelesia

3192.

20-ADPOCK------ 50 % affected

3193.

21- drug contiue wiht sildenafil------ ACE-I

3194.

23-pt with HTN and low k what investgestion------- aldestrone : renin ratio

3195.

23-Dx of cushing------ 24hr urine for cortsione

3196.

24- pic of toxic nodule goite------- radiate iodine

3197.

25- acromegaly investigation------ glucose tolerance test

3198.

26-male c/o back pain has vertebral collapse due to osteoprosis------ testosterone level

3199.

27-pic of cholestatic ----- flucoxcillin

3200.

28- rupure of tenden--- cipro

3201.

29-female pain at base of thumb with swelling----- osteoarthritis

3202.

30-numbness in thumb and something in biceps---- C6

3203.

31- photosenetivity, blister , millia----- prophyria cutanea tarda

3204.

32-sing of common pearneal n.--------- weakness of dorsiflexation of foot

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.

bec theres difference between trendelinberg sign & test

3210.
3211.

think its straight leg>>tests 4 back pain, although its 4 disc prolapse not ankyl.

3212.

help me out! totally confused!!!!!!!!!!!!tatta, Sep 22, 2010#22

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.

exam crammerGuestGlukokise enzyme, different behavior in brain and liver ? affinity

3217.
3218.
3219.

cortisol mech of inactivation

3220.
3221.
3222.

bias reason in meta analysis

3223.
3224.
3225.

abx for pneumonia after influenza infection

3226.
3227.

abx addition apart from amoxyl and claritho?

3228.
3229.

derranged LFT in preg ? cholestatsis

3230.
3231.

way of giving oxygen to COPD pt

3232.
3233.

ABPA diagnosisexam crammer, Sep 22, 2010#26

3234.

exam crammerGuestsensory loss at T8?

3235.
3236.

LMN signs at upper limb with loss of temp/sens

3237.
3238.
3239.

ABG of a pt , heroin abuser

3240.
3241.
3242.

ABG of COPD pt

3243.
3244.

ABG of metabolic acidosis

3245.
3246.

Which hormone low in prolactinomaexam crammer, Sep 22, 2010#27

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.

Inx of choice for low hb, high prt, low alb, RF

3252.
3253.
3254.

sickle pt claiming to be in pain how can u check

3255.
3256.
3257.

odenestrone not helping post chemo , what next?

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.

exam crammerGuestpost splenectomy blood changes

3266.
3267.
3268.
3269.

pt with fluctuating consciousness and left sided weakness

3270.
3271.
3272.

turkish woman with hepatosplenomegally

3273.
3274.

SLE associated immunoglobin

3275.
3276.

angioedema associated complement

3277.
3278.
3279.

SVT recurrent inx of choiceexam crammer, Sep 22, 2010#31

3280.

exam crammerGuesttest to know the structure of prtexam crammer, Sep 22, 2010#32

3281.

exam crammerGuest@ shez

3282.
3283.

for ABPA i put PFT , can be wrong

3284.
3285.

migraine --propanolol

3286.
3287.

I put ant spinal art for T8 level

3288.
3289.

low Na , i put carbamezepine tooexam crammer, Sep 22, 2010#33

3290.

exam crammerGuestthere a Q with weakness and postural hypotention

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.

exam crammerGuestPMH of TA pt coming in with fundal hge, had high BP

3295.
3296.

another pt with visual change, pain ..cant recall well

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

retinal artery but could be wrong?Shez, Sep 22, 2010#36

3301.

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.

Guest, Sep 22, 2010#39

3306.

dr.angel05Guestcontinue...

3307.

34-alpha1-antitrypsin deficiency------ ZZ

3308.

35-Ankylosing Spondylitis------ global immobile vertabera

3309.

36- QT----- K channel

3310.

37-MS other vlave------- v wave

3311.

38-H.ployi--------- duodenal ulcer

3312.

39- diahrea + anaemia+ mouth ulcer----- celiac

3313.

41-macrophages containing periodic acid-Schiff------Whipples disease

3314.

42-pt. neck stifness csf gram +ve bacilli------ listeria

3315.

43-O2 to COPD pt--------- venti mask

3316.

44-staghorn stone--------magnesium ammonium phosphate

3317.

45-pt from india has vivx malaria----- chloroquine

3318.

46-diarrhea, TR, liver impaired------Carcinoid syndrome

3319.

47-Metformin in PCVS----- inc glucose peripheral intake

3320.

48-typical bic of cluster headache

3321.

49-pt. take steroid------ avscular necrosis

3322.

50-blood film after splenectomy----- hollly jolly

3323.
3324.

to be contentious.....dr.angel05, Sep 22, 2010#40

3325.

GuestGuestPleaseGuest, Sep 22, 2010#41

3326.

GuestGuest1. Cryoglobulin - SC Lymph node - bronchial carcinoma?

3327.

2. Q about adenovirus conjuctivitis??

3328.

3. Pt RR 20 perminute, Respiratory Acidosis, clear lung - CO poisoning.

3329.

4. Infective bronchiectasis, Red Cell Mass >> - Primary Proliferative Policythaemia??

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.

1) i put non hodgkins lymphoma

3336.

2) i put blepharitis

3337.

3) i put COPD

3338.

4)COPD

3339.

5) propanolol

3340.

6)same as youShez, Sep 22, 2010#44

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.

the one abt gastrin was stimulation of secretion by luminal peptides

3347.
3348.

paired t test not elgible was non normal distribution

3349.
3350.

ondanstron for vomiting in chemotherphy add dexamethasone

3351.
3352.

pancytopenia-trimethoprim

3353.
3354.

metaanalysis bias-publication

3355.
3356.

confusing questions on metabolic abnormalities

3357.
3358.

hypochondrial disorder for cancer assuming patient

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.

hope all will pass

3364.

this is my 6th attemed,i dont know really what is wrong(

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.

sleGuestprognostic in aml-karyotypesle, Sep 22, 2010#49

3369.

asyaGuestsalam all

3370.

exam crammer,shez

3371.

hope we all pass

3372.

this is my 6th attemeted,i really dont know what is wrong((

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.

(You must log in or sign up to reply here.)

3376.

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3377.

3378.

3379.

3380.

3381.

3382.

3383.

3384.

25

3385.
3386.

Next >

Share This Page

3387.
3388.
3389.
3390.
3391.

Forums

3392.

>

3393.

UK Medical Zone

3394.

>

3395.

MRCP Forum

3396.

>

3397.
3398.
a.

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3399.
3400.
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3405.

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3406.

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3407.

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3408.

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3409.

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3410.

Recall From MRCP part 1 sept /2010

3411.

Discussion in 'MRCP Forum' started by asya, Sep 22, 2010.

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.

hemochroatosis c282y gene?

3427.

deletion

3428.

expansion

3429.

am not sure of the answer

3430.

this q was not in my paper??!!!!

3431.
3432.

99- prognosis after 26 hr of paracetamol

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.

a-squamous cell ca,

3439.

b-basal,

3440.

c-trophic ulcer,

3441.

d-lupus vulgaris

3442.
3443.

101-renal transplant, earliest ab produced against what?

3444.

HLA class 1 Ag

3445.
3446.

102-most imp HLA 4 renal transplant matching?

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.

d- lumber canal stenosis

3455.

e-avascular necrosis

3456.
3457.

104- fomepizole :the mechansim for which it ttt ethanol poising consider: a-competitve inhibitor

3458.
3459.

105-digoxin mode of action:

3460.

a-Na-K ATPse

3461.
3462.

106-picture of PE investigation

3463.

a- CT angio

3464.

b-v/q mismatch

3465.
3466.
3467.

107-Q picture of global transit amnesia

3468.

108-male c/o back pain has vertebral collapse due to osteoprosis------ testosterone level

3469.
3470.

109-rupure of tenden--- cipro

3471.
3472.

110-photosenetivity, blister , millia----- prophyria cutanea tarda

3473.
3474.

111-Glukokise enzyme, different behavior in brain and liver ? affinity

3475.
3476.

112-cortisol mech of inactivation

3477.
3478.

113-bias reason in meta analysis

3479.
3480.

114-way of giving oxygen to COPD pt

3481.

venturi mask

3482.
3483.

115-sickle pt claiming to be in pain how can u check

3484.

a-symptology of pt

3485.

b-HB s concentation on hb electrophoresis

3486.
3487.

117-turkish woman with hepatosplenomegally:

3488.

leshmaniasis

3489.
3490.

118-alpha1-antitrypsin deficiency------

3491.

a-ZZ

3492.

b-MM

3493.

c-MZ

3494.

about the q of:drug causing of DI i did it lithum

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.

i also put procssed with operation in pt incediently find to have pl.effusion

3505.
3506.

h.pylori q its ass with gastric ca(malt)

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.

exam crammerGuesti have put GORD for H pylori

3513.
3514.

another Q pt with erythema nodosum and pl effsion

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.

i did ctpa for the ?PE

3525.
3526.

publication bias in meta analysis

3527.
3528.

venturi for copd

3529.
3530.

pizz for the alpha 1 antitrypsin one

3531.
3532.

dexamethasone for chemo induced vomit

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.

homonomous hemianopia ??posterior cerebral artery

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

be duodenal ulcer I USED GORD BUT I AM

3547.

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.

i did ctpa for the ?PE SAME

3552.
3553.

publication bias in meta analysis IWENT FOR RESEARCHER

3554.
3555.

venturi for copd SAME

3556.
3557.

pizz for the alpha 1 antitrypsin one .THIS WAS ONE MY FOOLISH MISTAKE BUT U R RIGHT

3558.
3559.

dexamethasone for chemo induced vomit I WENT FOR HYOSCINE...AGAIN

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.

homonomous hemianopia ??posterior cerebral artery SAME

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.

exam crammerGuestthere was a question abt anisopoikylocytosis ? myelodysplaisiaexam crammer, Sep

22, 2010#59

3572.

ShezGuesthey exam crammer thanks for ur responses.

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.

ShezGuestthere was a question abt anisopoikylocytosis ? myelodysplaisia

3576.

I PUT THIS TOO BUT I DUNNO IF CORRECTShez, Sep 22, 2010#61

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.

ShezGuestMRCP IS JUST PICTURES, I THINK U NEED ERCP TO REMOVE BLOCKAGE ?

DONT KNOW FOR DEF THOUGH.

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.

God knows how many i did wrong

3590.

cut off is usually 520exam crammer, Sep 22, 2010#65

3591.

exam crammerGuestyour reply of ERCP is right and there goes mine another wrongexam crammer,
Sep 22, 2010#66

3592.

asyaGuestthere is one q i couldnt remmber bt option was

3593.

ERCP

3594.

MRCP

3595.

some one remmber it???asya, Sep 22, 2010#67

3596.

exam crammerGuestintrabiliary and intrahepatic dilationexam crammer, Sep 22, 2010#68

3597.

asyaGuestok guys u already replaied about that ercp q

3598.

so another q with man who has pain with walking and decrease with rest

3599.

stenosis???asya, Sep 22, 2010#69

3600.

exam crammerGuestyes spinal stenosisexam crammer, Sep 22, 2010#70

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.

i didnt have the Q with CSF showing blood

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.

I also put 20 for the number needed to treat. is that right?

3615.

how does dipyridamole work? i was stuck but put phosphodiesterase inhibitor.

3616.
3617.

i said buserelin gave gynaecomastia.

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.

q about mech of action of pyridamol

3625.
3626.

q about risk reductionhatemmakarem, Sep 23, 2010#75

3627.

asyaGuestdid u guys have an absolute risk reduction calculation. i did and i put 3% but i dunno if that
was right?

3628.

mmmm..i cant remmber such q

3629.
3630.

I also put 20 for the number needed to treat. is that right?

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.

-dipridamole is phosphodiest. inhib just looked it up answered it wrong

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.

2.CML,Imatinib- inhibit tyrosine kinase

3653.

3.protein-c deficiency??-factor v leiden mutant??

3654.

4.ABO incompatibility?Transfusion reaction

3655.

6.Multiple myeloma diagnosis-Bone marrow exam As there was no option other correct

3656.

7.Another qs regarding ig g high & Ig m At upeer border of normal,spine x ray-bone scelrotin

lesion,renal funtion normal-?multipla myeloma or Hyper viscocity?

3657.

8.AML prognosi-i think morphology as M3 good prognosis according classification

3658.

9.young women,confusion low platlet-TTP

3659.

10.Sickle anemia pt-i answered Ht

3660.

CVS

3661.

11.Pericarditis-ST elevation concave upwards

3662.

13.ECG- St elevation v1-v4 & reciprocal depression in inf leads-75% block of Lt descending artery?

3663.

14.VT differ frm SVT-Av dissociation

3664.

15.Contraindicate in VT-Verapamil

3665.

16.MR poor prognosis-Displaced apex beat

3666.

17.Another qs MR with another valvular disease?

3667.

18.Sidanfil-contiue with ramipril

3668.

19.Afro-carribean pt ,HTN-Amlodipine

3669.

20.Diagnosis MI after echo normal

3670.

-??Catheterization

3671.

21.SVT-give Adenosine 6 mg?

3672.

22.Prolonged QT cause-k channel block

3673.

23.Qs i dnt remeber but ans-Cardiogenic Shock?

3674.

24.qs of cholesterol embolisation-i srewd it

3675.
3676.

24.ARDS diagnosis-High protein pulmonary odema

3677.

25.O2 to give in COPD-i answerded wrong.correct is venturi musk :cry:

3678.

26.ABPA diag-precipitin test

3679.

27.Pulmonary embolism diag-CT pul angio

3680.

28.Qs about COPD ph 7.3-Non -invasive ventilation

3681.

29.young pt,no syptom,working,cxr-20% pneumothorax,Pneumothorax management-Observe in opd

3682.

30.primary pul HTN?

3683.
3684.

PHARMA

3685.
3686.

31.Morphine- renal failiue correct but i srewed again :cry:

3687.

32.Gynaecomastia cause-?boseralin?

3688.

33.Duptyrns contracture-phenytoin

3689.

34.Digoxin M/A-inhibit Na/K+ ATP ase

3690.

35.Doxacetil-microtubles

3691.

36.Dypyrimadole M/A-inhibt phospdiesterase

3692.

37.Allopurinol -inhibit xanthine oxidase

3693.

38.Bipolar disorder,Na within Upper normal range--Lithium

3694.

39.Cholestasis-flucoxacillin

3695.

40.Paracetamol overdose-- PT

3696.

41.after chemo vomiting nt control by ondensterone--give dexa or metochloropramide?

3697.
3698.
3699.
3700.

RENAL

3701.
3702.

42.Staghorn stone-NH4MGPO4

3703.

43.RTA-1--Renal stone

3704.

44.ADPKD-??50% affected

3705.

45.PAtch shadow on lung,renal failur--do ANCA

3706.

46.Asymetrical kidney==Do Renal angiogram

3707.
3708.
3709.

NEURO

3710.
3711.

47.Brain CT multiple cyst,HIV pt---Cerebral toxoplasmosis

3712.

48.SPAstic tonge,dysphagia---nerve in jugular foramen

3713.

49.Hemisensory loss-middle cerebral artery

3714.

50.Ankle reflex lost,pain radiates through back--L5/S1

3715.

51.Common peroneal n palsy---affect dorsiflexion

3716.

52.Meningitis, Gm + bacilli---listeria

3717.

53.6th nerve palsy,papillodema---BIH

3718.

54.Transient Global A

3719.

55.brady kinesia, cog-whhel rigidity,tremor,impaired veritcal gaze--supraneuclear palsy

3720.

57.Migraine prophylasix--- i did mistake

3721.
3722.

ENDO

3723.
3724.

58.Prolactinoma which other hormone inhibit---Oestradiol?

3725.

59.cushing diag---24 hr urine free cortisol

3726.

60.Cortisol metabolism--free cortisol in urine??

3727.

61.PCOS, Metformin works---increase peripheral uptake of glucose

3728.

63.qs regarding MODY??

3729.

64.THyroid crisis-- iv hydrocortiosne

3730.

65.MEN2--- medullary thyroid Ca

3731.

66.Toxic noduler goiter---RADIO IODINE

3732.

67.acromegaly diag---OGTT

3733.
3734.
3735.

RHEUMA

3736.
3737.

68.T score ---osteoporosis in vertebra & osteopenia in other place

3738.

69.Ankylo Spon---leg stretch

3739.

70.Knee joint effusion---Joint fluid aspiration

3740.

71.avasculer necrosis bone

3741.

74.Female pt. thumb pain--OA

3742.

75.Young pt,buttock pain---Sacroilitis

3743.
3744.
3745.

Derma

3746.

76.erythema increase with alcohol---rosace

3747.

GASTRO

3748.

82.pregnancy,itching --Intrahepatic Chosestasis of pregnancy

3749.

83.Ig M +---PBC

3750.

84.Dysphagia for solid & liquid---Achlasia

3751.

85.wheezing,diarrhoea---Carcinoid synd

3752.

86.PAS +---Whipples disease

3753.

87.??Toxix mega colon,X ray normal---do usg??

3754.

88.Asymp pleural effusin---proceed to operation

3755.

i remmber another q was asking about giving vacine to young female to protect aginst cx canser(or
some thing like that)

3756.

i answer papilodema virus

3757.

any one can remmber such q

3758.

other option was hereps simplxasya, Sep 23, 2010#79

3759.

GuestGuestGuest, Sep 23, 2010#80

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.

2. Primary Pulmonary Hypertension.

3764.

3. ST elevation V1-V4, and ST depression II, III, aVF- Total LAD occlusion.

3765.

4. Mixed Mitral Valves - Diplaced apex beat.

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.

7. Small Posterior Pericardial Effusion - proceed to cholecystectomy.

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.

10. Diastolic dysfunction - decrease myocardial relaxation.

3772.

Pharmaco:

3773.

1. Bosentan - endothelin receptor antagonist.

3774.

2. Dipyridamol - Phosphodiestrase inhibitor.

3775.

3. Digoxin - Na/K/ATPase inhibitor.

3776.

4. Progesteron only pill - commonly irregular bleeding (means irregular menstrual bleeding) - see BNF.

3777.

5. Suicidal ideation - Verenicline (Champix).

3778.

6. Antipsychotic from risperidone - Dopamin 2 receptor.

3779.

7. Gynaecomastia - Buserelin (LHRH analog).

3780.

8. Allopurinol - Xantin oxidase inhibitor.

3781.

9. Parkinson & aortic stenosis - Benhexol.

3782.

10. Benign Essential Tremor - Propanolol.

3783.

11. Migraine not response with triptan - valproate.

3784.

Rheumato:

3785.

1. Cryoglobulinaemia, history of mycoplasma infection 3/12, come with supraclavicular

lymphadenopathy - Bronchial carcinoma.

3786.

2. ANA - Ig.G.

3787.

3. Cryoglobulin - Rheumatoid Factor.

3788.

5. Pulmonary Renal Syndrome - ANCA.

3789.

6. Shoulder pain - Rotator cuff tear.

3790.

7. Patient no contact with TB, got RA on TNF alfa inhibitor - drinking unpasterurized milk (M. Bovis
detected).

3791.

Pulmo:

3792.

1. Cryptogenic Fibrosing Alveolitis - transfer factor.

3793.

2. Decrease transfer factor - Pulmonary Fibrosis.

3794.

3. Q regarding Pulmonary Artery Hypertension.

3795.

4. COPD - ventury mask.

3796.

5. COPD - NIV.

3797.

6. Acute breathlessness & 20% pneumothorax - inpatient needle aspiration.

3798.

Renal:

3799.

1. Nephrocalcinosis - Type I RTA.

3800.

2. Staghorn calculus - Ca oxalate (80%).

3801.

Dermato:

3802.

1. Sore throat + scalling lession - gutate psoriasis (triggered by. Streptococcus).

3803.

Hemato:

3804.

1. Anaemia in CLL - Autoimmune.

3805.

2. Sickle Cell Crisis - must see blood film.

3806.

3. Splenectomy - Howell Jolly.

3807.

4. Transfussion reaction - ABO incompatibility.

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.

3. Q regarding Optic Neuritis.

3812.

Infectious:

3813.

1. ORF.

3814.

2. Parotitis - Mumps.Guest, Sep 23, 2010#82

3815.

Dr_JoseGuestContinuation

3816.
3817.

1. ABPA - precipitin.

3818.

2. EST then HR drop - AV block?Dr_Jose, Sep 23, 2010#83

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.

2. Microadenoma & prolactinoma - GH <.

3823.

3. Uncontrolled Diabetes, Renal Impairment, on T. Gliclazide, BMI > - SC exanatide.

3824.

4. MEN II - Medullary Thyroid Carcinoma.

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.

2. Question regarding severe wheat intolerance.Guess_1, Sep 23, 2010#84

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.

2. Q regarding brainstem demyelinating.

3841.

3. Q regarding HIV with PML.

3842.

4. Homonymous hemianopia - PCA.

3843.

5. Slurred speech < 45 minutes - Rankin Score 2.

3844.

6. Absent biceps reflex - C6 radiculopathy.

3845.

7. CPNL - absent foot dorsiflexion.Dr_Alpha, Sep 23, 2010#85

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.

guessingGuestI quite agree regarding risperidone. It is called ATYPICAL antipsychotic because it is

overlapping with ANTIDEPRESSANT. Antipsychotic property is contributed mainly by its action on
D2, and less by its action on serotonin receptor, to reduce its extrapyramidal effect. Regarding SLE, I
think C3 is only indicator for lupus nephritis, but in general SLE flare up, we need to liaise to ARA and
SLEDAI, in which ANA is one of important criteria for disease activity.guessing, Sep 23, 2010#91

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.

4. Patient with hyperkalemia, the appropriate treatment to REDUCE Hyperkalemia is IV

Dextrose/Insulin. IV Ca-gluconas is FOR protecting heart, not for reduced electrolyte level.

3859.

Neuro:

3860.

1. Question about woman with behavioural abnormality, dementia, and withdraw from working. The
answer is Wilson Disease.

3861.

2. Parkinson Plus abnormal gaze, normal BP: Progressive Supranuclear Palsy.

3862.

3. Patient with knee swelling, absent ankle reflex - Peripheral Neuropathy.

3863.

4. Impaired pain & temperature sensation, but preserved light touch - SYRINGOMYELIA.Dr_Alpha,
Sep 23, 2010#92

3864.

3-gastric bypass def of what? Folate/iron/zink/vit k

3865.

4-bloody diarrhea not respond to steriod sigmdscopy show infl. of anal margin? Colonscopy

3866.

5-pain in buttk ?glutial magnus tendnitis

3867.

6-polymorphia of the gene?

3868.

7-erythemotus nodeuls in intex finger with H/O animal contact? Orf

3869.

8-acute onest of partoid swelling?

3870.

9-breast ca , colon ca , ovarin? P35 mutation

3871.

10-alcholic pt drak urine , renal faliure? Rhabdomyolysis

3872.

11-direct precursor of estroido?l

3873.

12-Infection after transfusion in female postpartum?cmvdr.angel05, Sep 23, 2010#94

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.

1.digoxin MOA --Na-K-ATPase

3878.

2.allopurinole MOA... xanthine oxidase

3879.

3.Bosantan MOA---endothilin1 inhibition

3880.

4.dispyridamole MOA.. phospho diesterase inhibition.

3881.

5.ARDS investigation.... pulmonary artery wedg pressure.

3882.

6.cushings investigation....24 hr urine cortisole

3883.

7.VT drug should not be given .... verapamil.

3884.

8. bitemboral hemi anopia... posterior ceribral artery.

3885.

9.jejunal biopsy with PAS staining.. whipples

3886.

10. Male Haemophelia % transmision to son---0%

3887.

12.septic arthritis treatment.. flucloxacillin

3888.

13. viagra which drug is safe... ace inhibitor .

3889.

14 AML...prognosis---- cyto genetica

3890.

15.SIADH picture (with hyponatremia)--- carbamazepine..

3891.

16. APKD.. transmission.--50%

3892.

17.activated protien C ---factor V laden

3893.

18.ankylosing spondilitis----restricted motion of lumbar vertibra..

3894.

19.glueal pain now and two monts back... sacro illeitis.

3895.

20.loud P2. rghit ventricular heave..progressive SOB..---pimary pulmonary HTN.

3896.

22.nephro calcinosis----type 1 RTA

3897.

23.. pagets diseae like picture with nl Ca and Nl PO4 whith High alk phospatase.... treatment.
---residronate.

3898.

24.tense bullae in arm and trunk no mucosal involvement--- bullous pemphegoid.

3899.

25.dorsiflecton lt foot lost----- peronial nerve.

3900.

26.CKD with high PO4 And low Ca MIld elevated PTH.... treatment---alfacalcidol.

3901.

27.both Ca and PO4 less ... treatment colecalciferol

3902.

28.rhumatoid arthritis with FEV1 and FVC given as Obstructive PIcture..

3903.

--- brochiolitis obliterance

3904.

29.pulmonary embolism like picture ... investigation.. CTPA

3905.

30.old CLL treated..now with spherocytes.lucocytosis and polychromasia

3906.

?? hypersplnism/??marrow suppression

3907.

32.post partum head ache .with csf blood ++ normal opening pressure??? sub arachaniod H"ge

3908.

34.cholystasi like picture which drug---??tramadole.??flucloxacillin

3909.

35.onther question with cholystatic picture investigation----Ercp

3910.

36. 37. rt plueral effusion with erythema nodosum----??? sarcoidosis

3911.

38.iv drug abuser with multipple cavitating lung leisons.. pnemocystis

3912.

39.typical questionof porphyria cutania tarda

3913.

40 SLE monitoring how---- ???ANA/ ????C3/C4

3914.

41.22.year old urin blood + Protien 4+ ---membranoius GN

3915.

42..microscopic hematuria... urin protien nl, creatinine nl.....????FSGS

3916.

43.old man cam with his wife forgetfulness and repeating words---transent global amnesia

3917.

44.flikering movement of hand--- hemiballism

3918.

45.head ach in the morning .. with lacrimation.... cluster head ache.

3919.

46. migain not responding to sumatriptam and paracetamole

3920.

treatment----propranalol

3921.

47.OHA which cause constipation---??metformin

3922.

48.elivate anion gap--methanol poisoning.

3923.

50.fluctuating level of concousness and fall..c/c subdural hematoma

3924.

51.optic disc bulging...optic nueritis

3925.

52. MI trombolised returne back with murmur---pappillary muscle ruprure

3926.

53.mitral steonosis associated another valvular leision---early diatolic murmur left sternal edge

3927.

54.one question about ablation of accessory pathway ---?????which structure????

3928.

55.smoking 40 pach years with thorasic veribral body collapse--next investigation----CXR

3929.

56.pt on c/c steroid -----avascular necrosis

3930.

57.h.pylosi most strongly associated with---- duodinal ulcer

3931.

58.medullary carcinomathyroind -men type 2

3932.

59.hard nodule in the finger who is a farmer and has contact with cattles---orf

3933.

60.risk of Ca cervix ----human papilloma virus

3934.

61. on question with symptoms suggestive of quillon barry syndrome

3935.

62 one question with upperlimbe weakness and syptoms suggestive on siryngomyia

3936.

63 one question with phenitoin toxicity

3937.

64.post partum transfusion with jaundice..???hep B ??? parvovirus

3938.

65.ocp progestron only pill most common side effect -- ?? breast pain

3939.

67.dysphagia to both solid and liquid---achalasia

3940.

68.one question with lt supraclavicular node ---- non hodgkins lymphoma..

3941.

69.blood picture with CKD and K 7.1 --most rapid correction of K ---calcium gluconate

3942.

70.PTH nl Ca increased PO4 dicreased-----primary hyper parathyroidism

3943.

71.thyrotoxicosis picture with no thyroid enlargement- what is the investigation---radio isotope scan...

3944.

72.toxic nodule(with increased uptake in isotope scan)

3945.

treatment-----radio iodine

3946.

73..IgG Icrease IgM and IgD nl ---monogamopathy of unknown significance

3947.

74 Glukokise enzyme, different behavior in brain and liver ? affinity

3948.

75. metaanalysis bias-publication

3949.

76. paired t test not elgible was non normal distribution

3950.
3951.

77. features with weak ness of 9,10,11,and 12 cranial vervs --level of lession---???cerebellopontine
angle

3952.

78. multiple cancers in the family----p53 mutation

3953.

79.imatinib ----tyrosine kinase

3954.

80.metformin in PCOD ---incease peripheral utilisation of glucose

3955.

81.docitaxel--MOA-- micro tubule

3956.

82. MI involving V1-V5 territory---lt anterior dissentingcomplete occlution

3957.

83.pericarditis like picture wih wthat ecg changes--????

3958.

84on question with afferent pupillary deffect??

3959.

85.afrocarebian antihypertensive---amlodipine

3960.

86.rashes in the face around eye and swelling of eylid --wht???blepheritis

3961.

87.passive abduction nl but passive abduction painful supraspinatous tendonitis

3962.

88.progressive waeknessof lowerlimb with pain and temp loss--- dorsal meningoma.

3963.

89.35 year old fasting glucose 10.1 family h/o GDM

3964.

ketone+----??MODY/???type 1 DM

3965.

90. HTN with hypo kalemia---inve --renin/aldosteron ratio

3966.

91.post iliostomy(Chrons sugery) lesion in the site of iliostome--- necrotising fascitis

3967.

92. c/c bloody diarrohea sigmoidoscopy nl wht is next investigaton--???

3968.

93.MI with cholestol embolism

3969.

94.pt with ace for htn bood investigaton nl bp nl ---continue ace

3970.

95.h/o pain during waliking a short distan , pain releaves on taking rest or siting----peripheral artery
disease

3971.

97.ub beat nystagmus-????brain stem leision

3972.

99.staghone calculous----stuvate stone(magnesium ammonium phosphate)

3973.

100pt with h/o travell with spleen 10 cn hepatomagally 4cm -viseral lesmaniasis

3974.

101.diarrohea in hospital.... norovirus

3975.

102nuber needed to treat 85%to 80% ----20

3976.

103 feeling of having cancer--- hyopochondrias

3977.

104.parkinson like picture no tremor--??L body

3978.

105paracetamole poisoning how to monitor----PT

3979.

106.anemia after gastric by pass for obosity----folate defficiency

3980.

107pain in the 1st metacarpophalangeal join in elderly womon---OA

3981.

108LBBB -investigaton ----angeogram

3982.

109.CURB---- confusion

3983.

110flulike illness followed by lower loabe consolidation---step pneumonia.

3984.

111.policythemia with nl plt and nl wbc but hypoxia-----COPD

3985.

112.needle prick in hiv chance of inheritance ???1/300

3986.

113polactinoma (micro adenioma--- hormon defficient-- ??GH

3987.

114.aplastic picture ----trimethiprim

3988.

115.restrictive picture --redused DLCO

3989.

116.pt on thiazide ,,RA slightly elevated.symmetrical arthralgia affecting proximal and distal
interphangial joint-----RA ?? psoedo gout

3990.

117.pulmonary renal syndrom like picture investigation---- renal biopsy

3991.

118.morpine in pt with lever mets and renal faiulure wht is the cause of toxixcity--- treatment with
erthromcin

3992.

119 hematamesis pt treatment--- banding

3993.

120.travel with rashes in leg pt in confusion--- meningo coceamia---

3994.

121.HIV with multi focal leisons in MRI-----multifoca lueco encephalopathy

3995.

122.myositis which drug----simvastatin

3996.

123.COPD not responding to inhaled steroid and sortocosteroid injection ----non invasiv ventilation

3997.

124recurrent chest infection(broncheactasis picture)-----postural drinage.

3998.

125.pneumothorax 20%asymptomatic ---observe out patient

3999.

126 interstetial nephritis

4000.

127.Achilis tendon rupture------cipro

4001.

128.red awellon knee(post travell) sinovial fluid Nuetroplia Gframstain Negative ---Nisseria
(gonococcal)

4002.

129.gastrin

4003.

130. trasfution reaction---ABO

4004.

131.acromagally---GH+glucose tolerance test.

4005.

132.question with dexa Tscore

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.

extenide,other were metformin

4010.

135. drug causes of gynecomastiaption amidaron,pheothiazine...?!!

4011.

136. excessof cortisol where will it go?

4012.

bind 2 albumin

4013.

bind to fat

4014.

others.....

4015.

137. diagnosis of aspirgllomarecipitin

4016.

138. vomiting from ca what other you add to odansetron----aprepitant

4017.

139. 44-what kind of IG ass with cryoglobulinemia II??!!!

4018.

140.long QT syndrom:due to blockge of k channel

4019.

141. -herdietory angioodema with C1 diffecency associated complement

4020.

142. 77-dog bite: coamoxiclave

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.

a-increase insulin absorbtion

4026.

b-increase insulin insistivity??

4027.

146.tranplant regection which HLA cw3

4028.

147.high anion gap -----methanol poisoning

4029.

148. male c/o back pain has vertebral collapse due to osteoprosispsa

4030.

149. 30-numbness in thumb and something in biceps---- c6

4031.

150. first line antibiotics for febrile neutropenia?????? what bug they trying to fight against

4032.

candida

4033.
4034.

151. way of giving oxygen to COPD pt-n=mask and reservoir.

4035.

152. question abt anisopoikylocytosis ? myelodysplaisia

4036.

153. sickle pt claiming to be in pain how can u checkpt symptomatology.

4037.

155. SVT recurrent inx of choiceelectrophysiological

4038.

156. test to know the structure of prtein

4039.

157.alpha 1 antitrpsin-ZZ

4040.

158. 39- diahrea + anaemia+ mouth ulcer----- celiac

4041.

159. 42-pt. neck stifness csf gram +ve bacilli------ listeria

4042.

160. 50-blood film after splenectomy----- hollly jolly

4043.

161. hypothyroidism ---hashimotors thyroiditis.

4044.

162. red swollen joint---- joint aspiration

4045.

163.small pericardial effusion--- procede to surgery

4046.

164.parkinson tremorbenzhexol

4047.

165. Sore throat + scalling lession

4048.

166.parotitis----bacterial parotitis

4049.

167. alcholic pt drak urine , renal faliure? Rhabdomyolysis

4050.

168. -direct precursor of estroido?l----testosteron/dihydro testosterondr_shahi000, Sep 23, 2010#96

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.

Acute confusional migraine (ACM) is a dramatic,rare manifestation of

4059.

migraine described mostly for children and adolescents.There are few

4060.

data on the treatment of an ACM attack. Prochlorperazine has been

4061.

suggested as an effective drug. The authors of some reports have

4062.

suggested that valproic acid may play a role in the prevention of ACM

4063.

and as treatment for acute migraine headache in the adult population.

4064.

However, this medication has not been reported as rst-line, acute

4065.

therapy for ACM. We report here the case of a 12-year-old girl who

4066.

presented with an ACM attack that resolved rapidly after intravenous

4067.

administration of valproic acid. Pediatrics 2010;125:e956e959Guest, Sep 23, 2010#98

4068.

GuestGuestAIPPG

4069.
4070.

Guest, Sep 23, 2010#99

4071.

ShezGuestthanks for your comments guys.

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.

186 recall part1 2010 september

4084.

1-anion increase in methanol

4085.

3-allopurinol inhibit xanthin oxidase

4086.

4-AML KARYOTYPE

4087.

5-MYCOPLASMA PNEMONIA

4088.

6-co-amoxiclave for dog bite

4089.

7-prothrompin tim for paracitamole over dose

4090.

8-dudenal ulcer h-pylore

4091.

9-achilus tend. ciproflaxacine

4092.

11-metphormin

4093.

12-pyoderma gengerosum post crhon operation stoma

4094.

13-imintabe-------tyrosin kinase

4095.

14-computed angiogragraph for PE

4096.

15-LITHIUM

4097.

16-acromegaly---gtt+groth hormone

4098.

17-cushing syn.-----free cortisole in urine

4099.

18-hashimoto thyroditis hpothyroid

4100.

19-propranolol for palpitation and goiter initial managment

4101.

20-postural drinage for bronchictisis copd

4102.

21-gastine from gastric c g cell

4103.

22-wrist arthritis-----joint aspiration

4104.

23-hypochondrial disease-----cancer

4105.

24-somatiform disorder physical symptom

4106.

25halusination---case hear voices

4107.

26-metphormin glucose uptake

4108.

27-case acne rosare

4109.

28-whipple dis.

4110.

29- case wilson dis.

4111.

30-cns progresive leukopaty

4112.

31-non-alcholic hepatitis DMtype 2

4113.

32-v wave

4114.

33-case IGM PARAPROTENIMIA

4115.

34-cluster headach case watery eye+headache

4116.

36-AF-----unstable------cardioversion

4117.

37-proten c- ------v liden

4118.

38-viagra-------ace inhibitor

4119.

39-ventriculal tachcardia-----verapamil contraindicated

4120.

40-ASD -----FIXED SPLIT aortic valve

4121.

41-staghorn calculus-----amonium+phosphate+magnisium

4122.

42-case pnemothorax------discharge outpatient no cynosis rim less than 2 young age

4123.

43-casse hypothyroidism bp 70/40 mmhg------- iv fluid see on examination

4124.

44-increase k calcium glucanate

4125.

45-respiridone serotonine atypical anti psycosis

4126.

46-MENII -----medulary thyroid ca

4127.

47-PSA-----ca prostate case with metastasis

4128.

48-listeria monocytogen case

4129.

49-phynitoin case side efect

4130.

50-belpheritis

4131.

51-afro-caribian -----amlodipine

4132.

52-esonophilia------aspirgilosis

4133.

53-steroid--------avascular necrosis

4134.

54-thiazide--------hyperurecemia--------gout arthritis

4135.

55- blastran like diovan angotensin II inhibitor

4136.

56-injyry by needle of HIV-------------HEPATITIS B

4137.

57-type 1-------renal stone

4138.

59-poor complince to thyroid drugs

4139.

60-campylo bacter jujenale----bloody diarrhea in nursery

4140.

61-para nicotine reseptor----vinncretin

4141.

62-add gentamycine to be triple antibiotic

4142.

63-stronglydosis-------esonophilia

4143.

64-microtubule------doxel chemothrapy

4144.

65-sckile cell crisis------Hb S in blood film

4145.

66-hypersplinisim case

4146.

67-case celioc dis.

4147.

68- case pancytopenia-----acyclovir

4148.

69-case mild effiusion------go to operation

4149.

70-case not benefit from TCYCLIC ANTI depres drug the case is post traumatic srtress syndrom

4150.

71-case tabis dorsalis

4151.

72-vagal actvation------pulse rate from 50---160

4152.

73-case cardiogenic shock

4153.

74-migrane----ergotamine

4154.

75-case global amnesia

4155.

76-Adult poly cystic kidney----50% affected

4156.

77-c6 radiculopathy

4157.

78-ankylosing spondylitis-----global movement of lumber area restricted

4158.

79-case QT K- chanel

4159.

80-proten-----westren blot

4160.

81-case howly-juley body

4161.

82-case renin-aldosteron level

4162.

83-case MODY DM

4163.

85-case ORF

4164.

86-CASE MEMBRANOUS NEPHRITIS

4165.

87-CASE hemophelia---0%

4166.

88-case TTP

4167.

89-case we give adenosin iv

4168.

90-case we give metclopromide as anti vomit

4169.

91-jagular foramina case

4170.

92-case L5-S1

4171.

93-CASE KNEE JOINT ASPIRATION

4172.

94-CASE GIVE benzhexsol

4173.

95-case HLA DR FOR transplantation

4174.

96-SE progestron--------irrigular bleeding

4175.

97-case manic episode

4176.

98-case testosteron metabolite levele

4177.

99-case myelodysplesia

4178.

100-case MRSA

4179.

101-CASE TB

4180.

102-case compitive inhibition

4181.

103-case correct answer drug affinity

4182.

104-rhabdomyosis case

4183.

105-case varicose banding

4184.

106-.dispyridamole MOA.. phospho diesterase inhibition

4185.

107-ARDS investigation.... pulmonary artery wedg pressure

4186.

108-bitemboral hemi anopia... posterior ceribral artery

4187.

109-septic arthritis treatment.. flucloxacillin

4188.

110-pagets diseae like picture with nl Ca and Nl PO4 whith High alk phospatase.... treatment.
---residronate

4189.

112-MI trombolised returne back with murmur---pappillary muscle ruprure

4190.

113-PTH nl Ca increased PO4 dicreased-----primary hyper parathyroidism

4191.

114-progressive waeknessof lowerlimb with pain and temp loss--- dorsal meningoma

4192.

115-diarrohea in hospital.... norovirus

4193.

116-restrictive picture --redused DLCO

4194.

117-pulmonary renal syndrom like picture investigation---- renal biopsy

4195.

118-.myositis which drug----simvastatin

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.

122-case iodine uptake

4201.

123-increase of proten in pulmonary odema

4202.

124-progresive supranuclear pulsy

4203.

125-case apex beat

4204.

126-case porpheria cutina trada

4205.

127-c1 defecency

4206.

128-SLE c3 decrease

4207.

129-tendenitis of buttock

4208.

130-sholder supratendinitis

4209.

131-digoxin action

4210.

132-st elevation concave

4211.

133-influenza flowing pnemonial infection

4212.

134-cholestrol embolization case

4213.

135-comon peroneal n dorsi flexion

4214.

136-cortisole in activation

4215.

137-morphin toxicity

4216.

138-turkish leshmania

4217.

139-rcp or mrcp case

4218.

140-case spinal stenosis

4219.

141-case ulcerstive colitis second step investigation barium enema---sigmoidoscopy

4220.

142-renal angiography----renal stenosis

4221.

143-case ABO incompatibility

4222.

144-.CKD with high PO4 And low Ca MIld elevated PTH.... treatment---alfacalcidol

4223.

145-both Ca and PO4 less ... treatment colecalciferol

4224.

146-rhumatoid arthritis with FEV1 and FVC given as Obstructive PIcture..

4225.

--- brochiolitis obliterance

4226.

147-cholystasi like picture which drug---??tramadole.??flucloxacillin

4227.

148-rt plueral effusion with erythema nodosum----??? sarcoidosis

4228.

149-flikering movement of hand--- hemiballism

4229.

150-.b/l 6th n palsy with head ache and papillodema

4230.

151-smoking 40 pach years with thorasic veribral body collapse--next investigation----CXR

4231.

152-one question with upperlimbe weakness and syptoms suggestive on siryngomyia

4232.

153-post partum transfusion with jaundice..???hep B

4233.

154-PTH nl Ca increased PO4 dicreased-----primary hyper parathyroidism

4234.

155-metaanalysis bias-publication

4235.

156- paired t test not elgible was non normal distribution

4236.

157-multiple cancers in the family----p53 mutation

4237.

158-ub beat nystagmus-????brain stem leision

4238.

159-nuber needed to treat 85%to 80% ----20

4239.

160-parkinson like picture no tremor

4240.

161-anemia after gastric by pass for obosity----folate defficiency

4241.

162-pain in the 1st metacarpophalangeal join in elderly womon---OA

4242.

163-LBBB -investigaton ----angeogram

4243.

164-CURB---- confusion

4244.

165-policythemia with nl plt and nl wbc but hypoxia-----COPD

4245.

166-needle prick in hiv chance of inheritance ???1/300

4246.

167-COPD not responding to inhaled steroid and sortocosteroid injection ----non invasiv ventilation

4247.

168-case interstetial nephritis

4248.

169-case .question with dexa Tscore

4249.

170-case way of giving oxygen to COPD

4250.

171-.alpha 1 anparotitis----titrpsin-ZZ

4251.

172-case parotitis----

4252.

173-about waldenstorm`s macroglobulinemia

4253.

174-ECG of pericarditis

4254.

175-what is inv for mycordial ischemia:angiography

4255.

176-MAN SEE RED CAR OUTSIDE TRY TO SEE HIM DELUSION OF PERCEPTION

4256.

177-CASE PARANOID SHIZO

4257.

178-PAtch shadow on lung,renal failur--do ANCA

4258.

180-Diastolic dysfunction - decrease myocardial relaxation

4259.

181-Patient no contact with TB, got RA on TNF alfa inhibitor - drinking unpasterurized milk (M. Bovis

detected).
4260.

182-Q regarding Optic Neuritis

4261.

183-Slurred speech < 45 minutes - Rankin Score 2.

4262.

184- GBS - IVIg.

4263.

185- Q regarding cataplexy

4264.

186-Patient with knee swelling, absent ankle reflex - Peripheral Neuropathy

4265.
4266.
4267.

Dear college can you remember the remaining 14 question if yes please added it

4268.
4269.

and try to correct if there is a mistake for the above answers

4270.
4271.
4272.

Thank you and hope the sucsees to allllllllllllllllllali weana ali, Sep 24, 2010#116

4273.

dr.angel05Guest187- absolute risk------ 3%

4274.

188- important HLA in renal tranplant

4275.

189- microscopic hematourea with normal renal funection----- thin membarne nephropathy

4276.

190-contipation------ glicalazidedr.angel05, Sep 24, 2010#117

4277.

ali weana aliGuestrecall

4278.
4279.

Dear angel

4280.
4281.

no. 188 same as no. 95

4282.

no. 189 same as no. 86

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.

dr.angel05Guesthoo sorry ali :roll:

4289.
4290.

here anther too

4291.

case PPS

4292.

case gutted psoriasis

4293.
4294.

about wrong answer

4295.

21-gastine from gastric c g cell

4296.
4297.

in q they siad act on G cell not from g cell so the answer is stimulate by peptide

4298.
4299.

40-ASD -----FIXED SPLIT aortic valve

4300.

they said normal split with loud p2 so it is 1ry pul. HTN

4301.
4302.

44-increase k calcium glucanate

4303.

they want how is decrease ca glucanate just for protect heart

4304.
4305.

105-case varicose banding

4306.

terlipressin

4307.
4308.
4309.

by the way most your answer like me

4310.

so good luckdr.angel05, Sep 24, 2010#120

4311.

ali weana aliGuestto mr. guest ward is thing and theory is something else

4312.
4313.

Pneumothorax

4314.

sqweqwesf erwrewfsdfs adasd dhe

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.

otherwise aspiration should be attempted

4323.

if this fails then repeat aspiration should be considered

4324.

if this fails then a chest drain should be inserted

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.

less likelihood of recurrence than spontaneous pneumothorax

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.

12345ali weana ali, Sep 24, 2010#121

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.

ali weana aliGuestca gluconate reduce the potasim

4347.
4348.

Dear angel

4349.
4350.

ca gluconate reduce the potasium

4351.
4352.

read the managment of DKAali weana ali, Sep 24, 2010#123

4353.
4354.

Prophylaxis of variceal haemorrhage

4355.
4356.

propranolol: reduced rebleeding and mortality compared to placebo

4357.

endoscopic variceal band ligation (EVL) is superior to endoscopic sclerotherapy. It should be

performed at two-weekly intervals until all varices have been eradicated. Proton pump inhibitor cover
is given to prevent EVL-induced ulcerationali weana ali, Sep 24, 2010#124

4358.

GuestGuestGuess

4359.
4360.

Recent review about acute migraine attack.

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

future.Guest, Sep 24, 2010#125

4362.

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.

dr_shahi000Guesti go with banding..

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.

dr_shahi000Guesti have got one doubt regarding ARDS quest

4370.

i think its pulmonary artery wedge pressure rather than high protien pul edema.

4371.

becaz.. they want how you rule out other causes..

4372.

any suggession/evidences plse postdr_shahi000, Sep 24, 2010#130

4373.

dr_shahi000Guestplse see this article from wikipedia

4374.
4375.

ARDS is characterized by:[1][3]

4376.
4377.

* Acute onset

4378.

* Bilateral infiltrates on chest radiograph sparing costophrenic angles

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.

dr_shahi000Guesthere is the explanation from passmedicine

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

dr_shahi000, Sep 24, 2010#134

4400.

dr_shahi000Guestfor the migrain question.i think the answer will be propranalol

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.

so i think the question ask about the prophylaxis.

4403.

so propranalol could be the one...dr_shahi000, Sep 24, 2010#135

4404.

ShezGuestthanks dr shahi.

4405.

i agree regarding propanolol.

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.

dr_shahi000GuestWikipedia BRCA1 says

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.

Recall From MRCP part 1 sept /2010

4429.

Discussion in 'MRCP Forum' started by asya, Sep 22, 2010.

4430.
4431.

Page 4 of 25
4432.

< Prev

4433.

4434.

4435.

4436.

4437.

4438.

4439.

4440.

25

4441.

Next >

4442.

ali weana aliGuestthere is a question about prick test of allergy

4443.

antother about 6 cranial nerve and cavernous sinus

4444.
4445.

any one rember the details of itali weana ali, Sep 25, 2010#151

4446.

ali weana aliGuestthere is also a case of subthalmic neucleus-------in hemblisim

4447.

anthor case ivestigate by renal biopsy

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.

GuestGuest- The question of elevation v1-v4 : The answer 70 % occlusion or total

4452.
4453.

occlsion of LAD ?

4454.
4455.

- The question of shoulder movement disorder ( Rotator cuff of adhesive

4456.
4457.

or what ?

4458.
4459.

- I don't think Pass will depend on number of questions because it differs

4460.
4461.

in difficulty and so in evaluation

4462.
4463.
4464.

Good LuckGuest, Sep 25, 2010#155

4465.

GuestGuest1 pt with papule and pustule in the face increase with alchol , roscia

4466.

3 pt with glutal itiching strangulide

4467.

4 pt with difficult in abducting his shoulder tendon rupture , frozen shoulder

4468.

5 pt with loss of pain and temp in the arm and preservation of postion syrngomylia

4469.

6 pt with vf what drug is contra indicted varpamil

4470.

7 pt with parotid swelling after treatment for pneumonia mump , paroditis , sarcodosis

4471.

8 pt with calconiss in the joint space , ephosphate hyperparthyrodism and heamocromtisis

4472.

9 pt with father of heamophilia how much of his childern will get the disease , no one

4473.

10 pt with dermtomyosist rash

4474.

11 pt with small lung cancer what is investigation of choice

4475.

12 pt is sickler what determine if he have sickle crisis ,

4476.

13 pt with rip metastisis what the next step in mangment riotherpy add pethdine

4477.

14 pt iv drug user with lung cavition bilaterally infective endocartitis

4478.

15 pt pregant with jaundice , chostatic jaundice

4479.

16 pt with high igm , and alkiline phosphatase primiry billary cirrosis

4480.

17 pt with dilated pupil not reactive to light but to accomdication holman die pupile

4481.

18 pt with blot heamorrige in the retena , venous heamorraghe

4482.

19 pt with central sctoma and paplodeamia optic nerve compresion , optic neurtits ,

4483.

20 pt with pneumona follow infulinze staph auris

4484.

21 interpessine difficency what mode of inhertance zz

4485.

22 pt on lasanpril found his renal profile dertord what would be regarding his mangment continus
lasopril

4486.

24 what drup cause of SADAH , carbmizol

4487.

25 pt stope fluxtine develop puring sensation in the hand

4488.

26 pt with visual hallusination

4489.

27 pt with history of loss of memory for short time

4490.

28 pt who work alone after one of men leave work with pain in the limb

4491.

29 pt with think he is been watsh by secert servise

4492.

30 pt with tendon rupture , ciprofloxicine

4493.

31 pt with visceral lashmanis with pancetopnia

4494.

33 pt with fever and headache , urinary disturpance , falcirpime malaria

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.

36 pt with food poising in hospital novirsu

4498.

37 pt with rash in the mouth and diarrhea , cilic discease

4499.

38 pt with wrist joint swelling what investigtion joint aspiration

4500.

39 polychromisa , 2 alla found in the same locus

4501.

40 pt with sle what antibodis found in it igg

4502.

i think i have more but iwill try to remmber the other [/code]Guest, Sep 25, 2010#156

4503.

mrcp-4Guesthv u sit in riyadh centr?mrcp-4, Sep 25, 2010#157

4504.

GuestGuestMRCPian

4505.
4506.

Refer to your archimedes calculator regarding ABCD2 Stroke Score and compare that with Rankin
Score.

4507.

Age greater than or equal to 60 - No.

4508.

Blood Pressure greater than or equal to 140/90 - No.

4509.

Clinical Feature - Speech Impairment

4510.

Duration - put 10-59 minutes

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.

GuestGuestAccording to Occlusion question , what makes us choose total or 70% ?

4522.
4523.

is 70% occlusion insignificant ? And other question of the man who died

4524.
4525.

shortly after MI , I choose cardiogenic shock but i think it goes with VF

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.

i didnt have the question about the TIA

4533.
4534.

where is cortisol deactivated in the body btw??? any idea on answer to that question.Shez, Sep 25,
2010#162

4535.

dr_shahi000Guestlislie you are rtight regarding the renal question..

4536.

it could be renal biopsy

4537.

but there was another question with ppulmonary renal syndrome...

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.

hope you the best...

4546.

safroot..dr_shahi000, Sep 25, 2010#164

4547.

dr_shahi000Guestin some other diet they say it was 62%.... god knows...dr_shahi000, Sep 25, 2010
#165

4548.

GuestGuestGuess

4549.
4550.

Dear Third Year,

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.

GuestGuestDear leslie and other colleagues

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.

Folate or iron ? Some sources Folic acid like that

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.

- Cortisol is inactivated in the liver to inactive cortisone.

4567.
4568.

A daily pattern (circadian rhythm) is also seenGuest, Sep 25, 2010#170

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.

if wegeners.. renal biopsy /open lung biopsy is indicated

4573.

if goodpastures.. then renal biopsy is indicated.

4574.

so i think if you have to confirm the dignosis renal biopy (cresenti glomerulo nephritis with study of

the mmune complex deposit is mandatory.

4575.

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.

dr_shahi000Guestthe oclution question

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.

there is no fixed pass percentage to pass.

4585.

it all depends on the difficulty of exam compared to the previous exams...

4586.

if it is an easy exam the pass mark could even go to 70 %for a score of 521

4587.

and if it is a tough exam it could be as low as 55%also for 521

4588.

so its all about the how difficult was the exam.

4589.

so lets hope for the bestdr_shahi000, Sep 25, 2010#176

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.

GuestGuestRegarding the question of animal bite , what antibiotic of choice ?

4598.
4599.

co-emoxclav or metronidazole ?Guest, Sep 26, 2010#178

4600.

asyaGuestim geeting depressed more and more every day

4601.

this is my 6th trial!!!!!!!!!

4602.

and still i dont know what is wrong

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.

+ofcourse the usual stupid mistake i did

4605.

i count around 35 mistake(((

4606.

and im soooo sad

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.

answer is ostradiol or GH?

4622.
4623.

why not oestradiol as in pprolactinoma we have hypogonadotrohic hyogonadism....mrcp-4, Sep 26,

2010#190

4624.

regarding the qs about ankylosing spondy which is the correct answer

4625.

there was similar qs in 123doc where ans was sacroilities

4626.

but i cant remember if in the option there was sacroilities???

4627.
4628.

option was

4629.

a.trendelberg

4630.

b.straight leg rising

4631.

3.femoral stretchmrcp-4, Sep 26, 2010#203

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.

Refer to RJ Epstein, Medicine for examination:

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.

dr_shahi000Guesthiv transmission after needle prick

4640.

here is the answer

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.

Hepatitis C: Infection from HCV following a needle-stick is around 1.8%.

4644.

HIV: Risk of becoming infected with HIV is a mere 0.3%.

4645.
4646.

Of course the chance of transmission occurring is dependent of several factors including:

4647.

The viral load of the source person at the time of transmission.

4648.

The volume of infected blood transferred.

4649.

so the risk is 3 in 1000

4650.

means 1/333 the answer could be 1/300dr_shahi000, Sep 27, 2010#206

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.

another quest abt oestrogen??was answer testosterone???guest007, Sep 27, 2010#208

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.

GuestGuestDear Shahi and other colleagues

4658.
4659.

I don't know how they evaluate the answers and if questions differ

4660.
4661.

in evaluation or not . I hope they all take the same evaluation

4662.
4663.

and hope we all can pass isa .Guest, Sep 27, 2010#210

4664.

mrcp-4Guestregarding the qs of hyperkalemia.it was which 1 to reduce k rapidly.aanswer is

insulin&dextose.as ca gluconate is only cardio protective.it doesnt reduce k.(according kumar&clark)

4665.
4666.

4667.

wht about the qs ankylosing spondy?option was

4668.

1.tredelnberg

4669.

2.femoral stretch

4670.

3.straight leg rising

4671.
4672.

in 123doc answer is sacroilities

4673.
4674.

pls discuss guys!mrcp-4, Sep 27, 2010#211

4675.

GuestGuestNo sir the answer Calcium Gluconate , SureGuest, Sep 27, 2010#212

4676.

shezGuestthe answer i am sure is insulin dextrose.....

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.

about Q of ankylosing spondy:

4689.

1- global immobile vertebrae

4690.

2-tredelnberg test

4691.

3-femoral stretch

4692.

4.straight leg rising

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.

asyaGuestabout Q of ankylosing spondy:

4699.

1- global immobile vertebrae

4700.

2-tredelnberg test

4701.

3-femoral stretch

4702.

4.straight leg rising

4703.

5-? i forget it

4704.

i think 5th choice was sacroilitis

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.

the questio about estrogen was .. the dorect precursor of estrogen

4708.

the answer is testosteron

4709.

my answer was rong as i put dihydro testosteronedr_shahi000, Sep 27, 2010#220

4710.

GuestGuestIAM MRCP HOLDER : SINCE 1999

4711.
4712.

PLEASE ANY DIFFICULT QUESTION S???????

4713.
4714.
4715.

FOR HYPERKALAEMIA: CA GLUCONATE STABLIZED MYOCARDIUM

4716.
4717.

INSULIN K IS THE QERRECT

4718.
4719.
4720.

PULMN EMOBLISM : INVEST OF CHOICE CT ANGIOGuest, Sep 27, 2010#221

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.

1 in 30000shez, Sep 27, 2010#222

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.

its like this

4731.

3% is 3in100

4732.

0.3 is 3in1000

4733.

so 1t is roughly 1 in 333

4734.

so the answer could be 1/300dr_shahi000, Sep 27, 2010#223

4735.

dr_shahi000Guestdear shez

4736.

regarding the eye question

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.

For the rheumatoid immunoglobulins, IGG or IGM?

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.

wat will be the risk???guest007, Sep 27, 2010#239

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

inhibitor (Pi) normally produced by the liver

4761.
4762.

Genetics

4763.
4764.

* located on chromosome 14

4765.

* inherited in an autosomal recessive / co-dominant fashion*

4766.

* alleles classified by their electrophoretic mobility - M for normal, S for slow, and Z for very slow

4767.

* normal = PiMM

4768.

* homozygous PiSS (50% normal A1AT levels)

4769.

* homozygous PiZZ (10% normal A1AT levels)

4770.
4771.
4772.

Features

4773.
4774.

* patients who manifest disease usually have PiZZ genotype

4775.

* lungs: panacinar emphysema, most marked in lower lobes

4776.

* liver: cirrhosis and hepatocellular carcinoma in adults, cholestasis in children

4777.

Investigations

4778.
4779.

* A1AT concentrations

4780.
4781.
4782.

Management

4783.
4784.

* no smoking

4785.

* supportive: bronchodilators, physiotherapy

4786.

* intravenous alpha1-antitrypsin protein concentrates

4787.

* surgery: volume reduction surgery, lung transplantation

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.

Other detection methods include use of enzyme-linked-immuno-sorbent-assays in vitro and radial

immunodiffusion.

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.

* PiMM: 100% (normal)

4806.

* PiMS: 80% of normal serum level of A1AT

4807.

* PiSS: 60% of normal serum level of A1AT

4808.

* PiMZ: 60% of normal serum level of A1AT

4809.

* PiSZ: 40% of normal serum level of A1AT

4810.

* PiZZ: 10-15% (severe alpha 1-antitrypsin deficiency)

4811.
4812.

* PiZ is caused by a glutamate to lysine mutation at position 342

4813.

* PiS is caused by a glutamate to valine mutation at position 264

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.

dr_shahi000Guesti am not sure of the answer

4820.

it could be PiSZ becauz there is 25% activity

4821.

if it was Pizz then there would be only 10-15%

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.

Recall From MRCP part 1 sept /2010

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.

ali weana aliGuestthere is a case cytomegalovirus can

4829.

any one rember itali weana ali, Sep 28, 2010#253

4830.

ali weana aliGuestthere is a case lithiumali weana ali, Sep 28, 2010#254

4831.

GuestGuestThanks Ali

4832.
4833.

but the case of lithium is carbamazepine ! i made it lithium

4834.
4835.

Much of us have long list of error could reach even 70 :shock:

4836.
4837.

Who will pass ?Guest, Sep 28, 2010#255

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.

dr_shahi000Guestthis is the question in passmedicine regarding ulcer after surgey

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.

A.A Munchausen's syndromeia

4844.

B.A Irritant contact dermatitisia

4845.

C.A Pyoderma gangrenosumia

4846.

D.A Dermatitis artefactaia

4847.

E.A Stomal granulomaia

4848.

but in the exam the senario was different

4849.

it was following chrons surgery..(illiostomy)

4850.

with ulcer with violet colour creaping in to the subcutaniou tissue.

4851.

i dont know if my answer is correct but i put necrotising fascitis as answer ..

4852.

because the discription of the ulcer is more in favour of necrotising fascitis

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.

dr_shahi000Guestthis was my previous post reagrding this

4855.
4856.

here is some information from wikipedia

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.

can anybody give a better explanation....pleasedr_shahi000, Sep 28, 2010#259

4865.

tattaGuestdr.shahi, regarding pyoderma gangrenosum q

4866.
4867.
4868.

This is from wikipedia:

4869.

-There are two main types of pyoderma gangrenosum:

4870.
4871.

the 'typical' ulcerative form, which occurs in the legs

4872.

an 'atypical' form that is more superficial and occurs in the hands and other parts of the body

4873.
4874.

-Other variations are:

4875.
4876.

Peristomal pyoderma gangrenosum is 15% of all cases of pyoderma

4877.

Bullous pyoderma gangrenosum

4878.

Pustular pyoderma gangrenosum[3]

4879.

Vegetative pyoderma gangrenosum

4880.
4881.

and its associated wit IBS

4882.
4883.

this is description from passmed:

4884.
4885.

initially small red papule

4886.

later deep, red, necrotic ulcers with a violaceous border

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.

so there is one more to my wrong list...Guest, Sep 28, 2010#261

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.

so there is one more to my wrong list...

4898.

the above post is from me(guest)dr_shahi000, Sep 28, 2010#262

4899.

dr_shahi000Guestmy colleage told me result will be out by 15th of october

4900.

any body has any idea ??dr_shahi000, Sep 28, 2010#263

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.

i got it wrong as i put Ca gluconate as answer

4905.

the answer could be insulin glucose..dr_shahi000, Sep 28, 2010#266

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.

hope success to alllllld.lissan, Sep 28, 2010#268

4914.

Dr albarwariGuesthhDr albarwari, Sep 28, 2010#269

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.

Dr albarwariGuestAn elderly woman with NO splenomegaly and peripheral blood picture of

pancytopenia with elevated MCV with blood picture show anisopoikylocytosis "Megaloblastic anemia
not given in the options" of course here you are confused between hypoplastic anemia OR
myelodysplastic anemia as both cause pancytopenia and high MCV,,,, the Correct answer is
myelodysplastic as anisopoikylocytosis is feature of itDr albarwari, Sep 28, 2010#271

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.

Dr albarwariGuestIn hereditary nonpolyposis colorectal cancer there is mutation inMLH2,,,,,question

was about the function of MLH2,,,,,it is one of four MutL homologs in S.is involved in mismatch repair
during mitosis and meiosis and plays a role in correcting mismatches that arise during the formation of
heteroduplex DNA between two homologous chromosomes during meiotic recombinationDr albarwari,
Sep 28, 2010#273

4919.

ali weana aliGuestDear dr.barwari

4920.
4921.

reegarding q about hemophilia

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.

regarding the q of potasium

4926.
4927.

1-there is ECG changes in the q

4928.

2-the q mention to imediate managment not imediate decrease of k

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.

dr_shahi000Guestdear ali and alberwari

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.

lets hope ... we have put the correct answers ...

4934.

may allah help us to pass...dr_shahi000, Sep 28, 2010#275

4935.

dr_shahi000Guesti think the question about heamophelia said "the father"...

4936.

it did not say "her father" or the "father of the feotus"

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.

so lets hope for the best....dr_shahi000, Sep 28, 2010#276

4940.

dr_shahi000Guestthe hematuria question the correct answer is thin membrane GN

4941.

i got it wrong as i put FSGN as answer..dr_shahi000, Sep 28, 2010#277

4942.

dr_shahi000Guestthe hematuria question the correct answer is thin membrane GN

4943.

i got it wrong as i put FSGN as answer..dr_shahi000, Sep 28, 2010#278

4944.

dr_shahi000Guestthe hematuria question the correct answer is thin membrane GN

4945.

i got it wrong as i put FSGN as answer..dr_shahi000, Sep 28, 2010#279

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.

hope best to alld.lissan, Sep 28, 2010#280

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.

dr_shahi000Guestthe question with micro prolactinom awhich hormon defficient

4955.

the answer is LH..

4956.

again i got it wrong as i put GH as answer

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.

they giv the answer as LH

4959.

but i ma not sure if there was an option LH..

4960.

do any body knows??dr_shahi000, Sep 28, 2010#282

4961.

dr_shahi000Guesti also put colonoscopy shez..

4962.

so again and again th wrong list is increasing....dr_shahi000, Sep 28, 2010#283

4963.

d.lissanGuestdear ,shez and shahi there is chance for colonoscopy to be true we dont know sometimes
wt mrcp people want .

4964.

q about prolacinaemia options

4965.

1 GH

4966.

2CORTISOL

4967.

3THYROXINE

4968.

4ADH

4969.

5 oestrogen??

4970.
4971.

i think there is no option LH

4972.

i put it wrong thyroxined.lissan, Sep 28, 2010#284

4973.

dr_shahi000Guestshez

4974.

i dont know why i put the answer colono scopy...

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.

mrcp-4Guestregarding the macroprolactinoma there was option of esestradiol.macroprolctinama most

are lactotrophs rather thn craniopharyngiomas so i think GH option is nt correct.i found this
information from 'uptodate'mrcp-4, Sep 28, 2010#288

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.

dr_shahi000Guestdear guest 007 there was no question on smoking sessation for me

4988.

may be that is a test questiondr_shahi000, Sep 28, 2010#292

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.

Dr AlbarwaiGuestRegarding a question about Asbestosis what factor increase it with asbestose,,,,,,I

chose smoking????? want reply for thatDr Albarwai, Sep 29, 2010#296

4993.

Dr AlbarwaiGuestquestion about Hemophilia I am sure it was "Her father has hemophilia"Dr Albarwai,
Sep 29, 2010#297

4994.

Dr AlbarwaiGuestThe question about Hyperprolactinemia was,,,,,A lady has hyperprlactinemia with

amenorrhea,,BMI was 23,,,,Normal B/P,,,, MRI show MICROPROLACTINOMA 7mm What hormone
is deficient???? LH was not given,,,,,the confusion was between Oestradiol and GH,,,if it was

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.

(You must log in or sign up to reply here.)

4999.

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Forums

5017.

>

5018.

UK Medical Zone

5019.

>

5020.

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5021.

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5024.
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5031.

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5032.

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5033.

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5035.

Recall From MRCP part 1 sept /2010

5036.

Discussion in 'MRCP Forum' started by asya, Sep 22, 2010.

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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.

Dr AlbarwaiGuestThe question regarding Tuberculosis,,,,was patient with Rheumatoid arithritis to put

on Infliximab....before putting on it as you know we shouid exclude TB,,,,CXR was nornal but gamma
interferone was positive what is the explanation,,,,the answer is Latent Tuberculosis,,,,I am sure of that
because I am DOTS Programm supervisor in my city,,,,,you know DOTS Programm it is Directly
Observed Treatment, Short Course (DOTS) strategy for Tuberculosis therapyDr Albarwai, Sep 29,
2010#303

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.

the following information is from OHCM Page 265,266 ;;

5061.

monitoring of acute attack treatment; daily FBC,ESR,CRP,XRAY

5062.

IF above complicattions occur surgery is indicated.

5063.

wy do u think colonoscoy is the answer ,just for discussion .good luckd.lissan, Sep 29, 2010#305

5064.

GuestGuestThe question regarding Lung injury is exactly on mock exam

5065.
5066.

on examination and answer is Acute Lung injury .

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.

Dr AlbarwariGuestPatient with hypothyroidism on treatment presented with hypotension, low Na , high

normal K, low glucose what IV you will give???? I think it was Hydrocortison because of addison,,,any
commentDr Albarwari, Sep 29, 2010#311

5075.

d.lissanGuestdear Dr Albarwai

5076.

in my paper the quesion was ;

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.

Dr AlbarwariGuestRegarding A symptomatic 60 years patient smoker with LBBB,,,,Family history of

IHD "his brother" here it increase the probability to be a case of IHD But test to be done,,,,,difintely not
Exercise test as LBBB invalidate it also even if there is NO LBBB "YOU should NOT do ECG
Exercise for patients for the first time if has NO history of IHD" this informationns recently present in
NICE Guideline "NICE clinical guideline 95 Chest pain of recent onset" Which state: Do not use
exercise ECG to diagnose or exclude stable angina for people without known CAD.

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

about angiography as it will be done for probability of 60-90%,,,,,,,,,,any comment,,,,otherwise I will

stopDr Albarwari, Sep 29, 2010#318
5086.

shezGuesti actually put TB for the cavitating bilateral CXR in drug user????? might be wrong.

5087.
5088.

non normal distribution for invalidating a students t test

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.

Dr AlbarwariGuestThanks Shez for replyDr Albarwari, Sep 29, 2010#321

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.

shezGuesti put strongloydies.....

5098.
5099.

i also put flucloxacillin

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.

Dr AlbarwariGuestWhat is the meaning of polymorphism in neurofibromatosis???

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.

Dr AlbarwariGuestOh Dear shez,,,,,what about this question,,,,patient on hemodialysis,,,,with hgh

PO4,,,Normal Ca,,,,High parathyroid hormon,,,what to give????? here it is obvious the patient has
tertiary hyperparathyroidism,,,,,so do NOT give any calcium preparation as it will increase risk of
calciphylaxis,,,,,the correct option I put CINACALCET which is "is a drug that acts as a calcimimetic
(i.e. it mimics the action of calcium on tissues) by allosteric activation of the calcium-sensing receptor"
Cinacalcet is indicated for the treatment of secondary hyperparathyroidism in patients with chronic
kidney disease on dialysis ,,,,,NICE Guidline said do NOT give cinacalcet if s Calcium is low as
cinacalcet cause decrease in PTH which will decrease calcium,,,here it was safe to give it as calcium
was normalDr Albarwari, Sep 29, 2010#330

5110.

ali weana aliGuesti chose also cacinate after you remember me one correct answer

5111.

thank youali weana ali, Sep 29, 2010#331

5112.

ali weana aliGuesti chose also calcinate after you remember me one correct answer

5113.

thank youali weana ali, Sep 29, 2010#332

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.

This question is ranked as Hardd.lissan, Sep 29, 2010#336

5133.

abdallahGuesteslam alykum doctors

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.

iam wait for ur kind repaly

5139.

and may allah be with all of usabdallah, Sep 29, 2010#337

5140.

GuestGuesti think the answer is cerebral malaria- history typically fits into it...

5141.

schisosomiasis is correct for the other question.Guest, Sep 29, 2010#338

5142.

GuestGuestone more clarification can anybody help me out..

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.

Dr AlbarwariGuestDear Dr. leslie_tjong nd others GOOD MORNING

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.

Thanks guy. The answer is ORF.Guest, Sep 29, 2010#344

5154.

dr_shahi000GuestDear barawi and others

5155.

I put colonoscopy for the UC questionnot sure of the answer

5156.

The micro prolactinoma my answer is wron it should be esradiol as u said

5157.

Heamophilia is still confusing me as I have spend some time on it..

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.

The latent TB (post infliximab is correct I am sure of the answer)

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.

I didnt have staph sensitivity question..

5170.

The Kenya confusion question I put cerebral malaria as answer(not sure of the answer)

5171.

I didnt have the itching question .. in the gluteal region

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.

I didnt have the question about polymorphism of neurofibromatosis

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.

What are the side effects of the mini-Pill?

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.

The chief known side effects are:

5189.
5190.

periods tend to be irregular, which can be a considerable nuisance

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.

you may get spots on your skin

5194.

you could get tender breasts

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.

(You must log in or sign up to reply here.)

5210.

Page 7 of 25
5211.

< Prev

5212.

5213.

5214.

5215.

5216.

5217.

5218.

5219.

5220.

25

5221.
5222.

Next >

Share This Page

5223.
5224.
5225.
5226.
5227.

Forums

5228.

>

5229.

UK Medical Zone

5230.

>

5231.

MRCP Forum

5232.

>

5233.
5234.
a.

Search Forums

b.

Recent Posts

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5235.
5236.
5237.
5238.
5239.

Resources
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5240.

Forums

5241.

>

5242.

UK Medical Zone

5243.

>

5244.

MRCP Forum

5245.

>

5246.

Recall From MRCP part 1 sept /2010

5247.

Discussion in 'MRCP Forum' started by asya, Sep 22, 2010.

5248.
5249.

Page 8 of 25
5250.

< Prev

5251.

5252.

5253.

5254.

5255.

5256.

5257.

10

5258.

5259.

25

5260.

Next >

5261.

Dr AlbarwariGuestDear shahi and others

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.

Dr AlbarwariGuestDear shahi and others

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.

Dr AlbarwariGuestDear brother ali weana ali

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.

i agree with you regarding the discussions.. lets continue....

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.

honestly i didnt intent to hurt you ....dr_shahi000, Sep 29, 2010#367

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.

d.lissanGuestno option for coamxiclav , flucloxacllin trued.lissan, Sep 29, 2010#373

5286.

shezGuestyes i put middle cerebral artery d.lissan.

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.

GuestGuestFor all dear friends i pray to pass and let us discuss

5294.
5295.

Drugs causing gynecomastia and i chose Amiodarone !

5296.
5297.
5298.

But i think it's not RCP answer :

5299.
5300.
5301.

Drugs

5302.

Drugs that can cause gynecomastia include:

5303.

Amiloride (Moduretic)

5304.
5305.

Amiodarone (Cordarone)

5306.
5307.

Amphetamines

5308.
5309.

Anabolic steroids

5310.
5311.

Antiandrogens (cyproterone)

5312.
5313.

Anticancer drugs (cytotoxic)

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.

VincristineGuest, Sep 30, 2010#375

5360.

d.lissanGuestthanks dr shez for reply .

5361.
5362.

i had a confusing q in my paper but not mentioned by colleagues yet about;

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.

increase dose of steroid to 1000

5367.

revieow by dietician

5368.
5369.

MY ANSWER was increase dose of steroid

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.

ali weana aliGuestdear brother barwari

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.

d.lissanGuestanother strange q in this exam ;

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.

who remember to discuss ?d.lissan, Sep 30, 2010#379

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.

ali weana aliGuestI rember this q

5391.

if the case is stress leg syndrom the correct answer will be

5392.

ropinrole

5393.

othorwise the correct answer is

5394.

cabergolineali weana ali, Sep 30, 2010#382

5395.

ali weana aliGuestthe question of ladys with lymphadenopathy , fever

5396.
5397.

corect answer is cmvali weana ali, Sep 30, 2010#383

5398.

ali weana aliGuestthe q of renal transplant

5399.
5400.

corect answer is HLA DRali weana ali, Sep 30, 2010#384

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.

ali weana aliGuestdear ,

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.

Dr AlbarwariGuestYes Buserelin was correct option,,,,

5408.

Buserelin is a Gonadotropin-releasing hormone agonist (GnRH agonist). By causing constant

stimulation of the pituitary, it decreases pituitary secretion of gonadotropins luteinizing hormone (LH)
and follicle stimulating hormone (FSH). Like other GnRH agonists, buserelin may be used in the
treatment of hormone-responsive cancers such as prostate cancer or breast cancer

5409.

Side-effects of the gonadorelin analogues related to the inhibition of oestrogen production,,,,, A

potentially embarrassing side effect of the drug is gynaecomastia read this:

5410.

www dot ehow dot com/about_5395298_buserelin-side-effects.htmlDr Albarwari, Sep 30, 2010#390

5411.

GuestGuestBuserelin causes gynecomastia not boserlinGuest, Sep 30, 2010#391

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.

Dr AlbarwariGuestFor the Dog bite???what you put the optionDr Albarwari,

5416.

d.lissanGuestcoamoxclav for bite

5417.

amylodosisd.lissan, Sep 30, 2010#395

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.

Dr AlbarwariGuestThanks d.lissan I chose sameDr Albarwari, Sep 30, 2010#397

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.

SLE compelement system C4Guest, Jan 19, 2011#6

5427.

GuestGuest-Tau proein -- Alzahiemer

5428.

- 20 % non small cell carcinoma

5429.

-50 % Cystic fibrosis

5430.

-PeutzJeghers syndrome --AD

5431.

-asymmetrical parkinsonism

5432.

-syringbulbiaGuest, Jan 19, 2011#7

5433.

GuestGuestYes i agree the paper was tricky

5434.

Hope success for AllGuest, Jan 19, 2011#8

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.

mardeyaGuest:muscles affected in ulnar palsy

5437.

:fast acetylators and INH toxicitymardeya, Jan 19, 2011#10

5438.

GuestGuestQ) Mode of action of docetaxel............?

5439.

A)polymerisation of microtubule n inhibit cell divisionGuest, Jan 19, 2011#11

5440.

GuestGuestQ)in fast acetylators a/e of isoniazid..........

5441.

A) HEPATITIS............because in slow acetylators it is sle syndrome n peripheral neuropathyGuest, Jan

19, 2011#12

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.

b.KGuestpleae dear all post the question along with options

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.

thank you !b.K, Jan 19, 2011#14

5448.

GuestGuest-Nerve, 3rd and 4th Lumbricals supplied by deep branch of ulnar nerve ( Extensor carpi
Ulnaris supplies by Radial Nerve !

5449.

-Fast Acetylator ................ Drug resistance

5450.

-Jugular ForamenGuest, Jan 19, 2011#15

5451.

GuestGuest- Sildenafil ... bluish discouloration

5452.

- Limb Girdlw

5453.

-Nitrofurotion

5454.

-Streptoccocus Pneumonie ... Herbes labialis

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.

- Pansystolic lt sternum with hrilGuest, Jan 19, 2011#16

5467.

GuestGuest- Simvastatin .. grapefruit

5468.

- Mode of action of docetaxel. .. Microtubule

5469.

- Splenic flecture

5470.

- Endometrial Carcinoma

5471.

- Breast 15-3

5472.

- Pulsus alternals

5473.

- Stephin Jonson

5474.

-Pemvigus VulgarisGuest, Jan 19, 2011#17

5475.

GuestGuest-SLE c4

5476.

-Amlodipine ... Hypertension in old with Lithium

5477.

- Benzoxamine

5478.

-muscarinic antagonist

5479.

- doxazocin

5480.

- Doputamine ( Stress not due to knee problem )Guest, Jan 19, 2011#18

5481.

batakotaGuestMRCP 2011 part 1

5482.

5483.

statistics?

5484.

the curve?

5485.

the bias of registration?

5486.

the suitable study design?

5487.
5488.

myelodysplasia qustion for fatigue & tear drop.

5489.

amitryptyline--> Nabiacarboante.

5490.

for spleenectom--> strept.

5491.

Dog bite--> coamoxiclav.

5492.

atrial arrhythmia--> CCB

5493.

Schizophrenia.

5494.

Delusional disorder.

5495.

Pseudo psychogenicseziures.

5496.

grief reaction.

5497.

Irradaited blood.

5498.

IL2.

5499.

Laxative over use.

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.

MG--> gentamycin.batakota, Jan 19, 2011#19

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.

lateral medullary syndrom

5518.

temporl lobe

5519.

psudomembranous collitis

5520.

membranous nephritis

5521.

pericarditis

5522.

anti hep antibodiesguest9979, Jan 20, 2011#22

5523.

guest9979Guestsol for dd in meningitis toxoplasmaguest9979, Jan 20, 2011#23

5524.

pingtiaoGuestPatient with severe anterior chest pain

5525.

Tall R and T waves, ST depression V1, V2

5526.
5527.

Which coronary?

5528.
5529.

1. LMS

5530.

2. prox LAD

5531.

3. mid LAD

5532.

4. circumflex

5533.

5. first septal branch LAD

5534.
5535.

ANSWER: 4, circumflex.

5536.

This is a posterior MI.pingtiao, Jan 20, 2011#24

5537.

pingtiaoGuestThe renal question was great- took me ages of puzzling!

5538.
5539.

Man is confused and unwell

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.

-tight glycemic control

5553.

-splenic flexure

5554.

-amlodipine

5555.

-amiodarone

5556.

-propanolol

5557.

-oraltetracycline

5558.

-doxycycline

5559.

-angiodysplasiaGuest, Jan 20, 2011#31

5560.

jkaGuestpeutz jagher - bleeding is due to intusception!jka, Jan 20, 2011#32

5561.

dr-mahmoudGuesttoo much clinical scince and neoro

5562.

lets start with cardio

5563.

1-reversed splitting-----> lbbb

5564.

3-another af rythm control----->amiodarone

5565.

4-acute chest pain increases in breathing,young mildly elvated troponin,-->pericrditis?or mi

5566.

5-mi v1 v2 elevated (not depressed) with r which teritory

5567.

i wrote 1st septal brach of LAD

5568.

-sife effects of coronary angio

5569.

-stroke(wwhich i chose

5570.

-mi?

5571.

6-murmer of vsd--->

5572.

-ejection systolic murmer on lt strenal edge

5573.

-pan systolic-----------

5574.

7-patient e lithiu whic anti htn ttt---->amlodipine

5575.

please remind me of othersdr-mahmoud, Jan 20, 2011#33

5576.

dr-mahmoudGuestneoro

5577.

-patient elderly agiutated---->haloperidol

5578.

-patient dementic urinated!in front of people---temporo frontal dementis

5579.

-honer ,ataxia, sensory loss---->pica

5580.

-pt temporal lesion--->herpes simplex encephalitis

5581.

-one question i cant remember but by exclusion i made it syringo bulbia?

5582.

-assymetrical movement for parkinsonism

5583.

-benzexol for pakinsonismdr-mahmoud, Jan 20, 2011#34

5584.

dr-mahmoudGuestendocrine

5585.

-medullary crcinaoma for pt e thyroid swelling and sever htn (men)

5586.

-pt e hypoglicemia and pregnant----->i made it fetal insulin?

5587.

-pt e cron's and low tsh,ft4 and normal ft3 ----->euthyroid?

5588.

-ttt of pheocromocytoma---->phenoxylamine

5589.

-continues inhibition----->prolactine

5590.

-cuase of decresed libid---->epiandrostendioe,progsterone,eostradiol,cortisole??dr-mahmoud, Jan 20,

2011#35

5591.

jkaGuestthis question puzzled me for a long time

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.

i have remembered maybe 25 more which i will post

5598.
5599.

keep posting stuff then i can remember more questions!

5600.
5601.

------------------------------------------------------------------------------

5602.
5603.

male, aged mid-20s, presents with haemoptysis. CXR reveal left upper lobe collape.

5604.
5605.

what is the diagnosis?

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.

CXR-small nodular shadowing

5615.
5616.

whats the diagnosis?

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.

Immunoglobulins show IgM ++++

5626.
5627.

What is the most likely complication?

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.

What is the next approprate investigation?

5639.
5640.

1. CT Abdomin

5641.

2. Small bowel enema

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.

what bias is this trying to avoid?

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.

what is the most likely diagnosis

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.

What organism is he likely to be infected by?

5671.
5672.

1. Haemophilus influenzae

5673.

2. Streptococcus

5674.
5675.

-----------------------------------------------------------------------------jka, Jan 20, 2011#36

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.

2) warfarin inhibit the factor VII

5679.

4) pulsus alternans in left heart failure

5680.
5681.

5) amiodarone for maintainance of patient synus rythm after successful cardioversion

5682.
5683.

6) ST elevation on the ECG with chest pain but the chest pain relieved on inspiration is pericarditis

5684.
5685.

7) small VSD is pansystolic murmur with thrills

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.

11) hyperkeratotic plague is psoariasis

5692.

13) poor prognosis for hogkin is sweating (pass year)

5693.

14) colon CA a/w endometrial CA

5694.

15) haemoptysis with gromerulonephritis is anti GBM antibody

5695.

16) after angiography the complications is MI

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.

19) holme's Adie pupil a/w absent reflex

5699.

20) patient has history of Mi and noted absent pulse in the left upper limb is thromboembolic disease?

5700.
5701.

21) amlodipin in lithium

5702.
5703.

22) RTA

5704.
5705.
5706.

23) syringo bulbia

5707.

24) herpes labialis a/w streptococcus pneumonia

5708.
5709.

24) pseudogout

5710.
5711.

25) hydroxyurea use to treat essential thrombocytopenia

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.

28) paranoid personality disorder

5718.

31) SLe a/w C4 deficiency

5719.
5720.

32) in patient with blood result showing hypocalcaemia the ECG changes is long Qt

5721.
5722.

33) refeeding syndrome check serum phosphate (pass year)

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.

36) major raised intracranial pressure-bradycardia(cushing reflex?)

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.

39) LBBB a/s reversed splitting 2nd heart sound

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.

45) fronto temporal demential

5745.

5746.
5747.

47) lithium use to treat the patient wf the manic syndrome

5748.
5749.

48) desmopressin release the stored factor VIII

5750.
5751.

49) myelofibrosis in patient with bld film show tear drop

5752.
5753.

50) reduse exposure to sunlight in patient with low serum calcium low serum phosphate and high ALP

5754.
5755.

51) carbimazole inhibit the iodinasation of thyroxin (pass year)

5756.
5757.

52) after splenectomy the most important organism is strep pneumonia

5758.
5759.

53) WATERY DIARRHE A/W e. COLI 0157

5760.
5761.

54) PATIENT ON pyrazinamide may hav the arthralgia

5762.
5763.

55) ulnar nerve supply the 3rd and 4th lumbrical

5764.

57) staph discitis in patient with pace maker implantation who present with low back pain?

5765.
5766.

58) Ct show tempora... herpes simplex encephalitis (pass year)

5767.
5768.

59) penile and anal wart treat wf podophilline

5769.
5770.

60) poster5ior infarction ?ciorcumfles artery?

5771.
5772.

61) amytryptilline toxicity use iv sodium bircarb

5773.
5774.

62) SAH that develop confusion 5 days later in kumar and clark is hydrocephalus

5775.
5776.

63) aiodine deficiency or sick euthyroid syndrome?

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.

65) tau in alzheimer

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.

> unpaired t test i think

5786.

> 50 in 1000 for NNTGuest, Jan 20, 2011#39

5787.

jkaGuestheaven question 20, mi and absent arm pulses, type a dissectionjka, Jan 20, 2011#40

5788.

guest 1Guestmrcp part 1

5789.
5790.

1 One question on which drug should be avoided in long QT syndrome? Sertaline

5791.
5792.

2.Question on how to avoid complication of angiography? 0.9% nacl

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.

6.About complication of angiod streaks? macular hemorrhage

5802.

2) warfarin inhibit the factor VII

5803.

4) pulsus alternans in left heart failure

5804.
5805.

5) amiodarone for maintainance of patient synus rythm after successful cardioversion

5806.
5807.

6) ST elevation on the ECG with chest pain but the chest pain relieved on inspiration is pericarditis

5808.
5809.

7) small VSD is pansystolic murmur with thrills

5810.
5811.

Cool arm, buttock, thigh itchy rashes that is not response to prednisolone and a/w diarrhea are
dermatitis herpatiformis

5812.

13) poor prognosis for hogkin is sweating (pass year)

5813.
5814.

14) colon CA a/w endometrial CA

5815.
5816.

15) haemoptysis with gromerulonephritis is anti GBM antibody

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.

25) hydroxyurea use to treat essential thrombocytopenia

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.

2Cool paranoid personality disorder

5843.

31) SLe a/w C4 deficiency

5844.
5845.

32) in patient with blood result showing hypocalcaemia the ECG changes is long Qt

5846.
5847.

33) refeeding syndrome check serum phosphate (pass year)

5848.
5849.

34) impingement syndrome in patient with pain and stiffness on shoulder ABD and rotation?

5850.
5851.
5852.

36) major raised intracranial pressure-bradycardia(cushing reflex?)

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.

39) LBBB a/s reversed splitting 2nd heart sound

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.

45) fronto temporal demential

5868.
5869.
5870.

47) lithium use to treat the patient wf the manic syndrome

5871.
5872.
5873.
5874.

49) myelofibrosis in patient with bld film show tear drop

5875.
5876.

50) reduse exposure to sunlight in patient with low serum calcium low serum phosphate and high ALP

5877.
5878.

51) carbimazole inhibit the iodinasation of thyroxin (pass year)

5879.
5880.

52) after splenectomy the most important organism is strep pneumonia

5881.
5882.

53) WATERY DIARRHE A/W e. COLI 0157

5883.

57) staph discitis in patient with pace maker implantation who present with low back pain?

5884.

59) penile and anal wart treat wf podophilline

5885.

61) amytryptilline toxicity use iv sodium bircarb

5886.

2) SAH that develop confusion 5 days later in kumar and clark is hydrocephalus

5887.

63) aiodine deficiency or sick euthyroid syndrome?

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.

65) tau in alzheimer

5890.

66)unpaired t test i think

5891.

67)> 50 in 1000 for NNT

5892.

68)-Oral Terbinafine

5893.

69)-tight glycemic control

5894.
5895.

70)-oraltetracycline

5896.
5897.

71)-doxycycline

5898.
5899.

72)-angiodysplasia

5900.
5901.

73)limited scleroderma

5902.
5903.
5904.

74)lateral medullary syndrom

5905.
5906.

75)temporl lobe

5907.
5908.

76)psudomembranous collitis

5909.
5910.

77)membranous nephritis

5911.
5912.

78)-honer ,ataxia, sensory loss---->pica

5913.
5914.

79)-pt temporal lesion--->herpes simplex encephalitis

5915.
5916.

80)assymetrical movement for parkinsonism

5917.
5918.

81)-pt e cron's and low tsh,ft4 and normal ft3 ----->euthyroid?

5919.
5920.
5921.

82)-ttt of pheocromocytoma---->phenoxylamine

5922.

83)-continues inhibition----->prolactine

5923.
5924.

84)Question on how to avoid complication of angiography? 0.9% nacl

5925.
5926.
5927.

85).One question about stroke and pin point pupils? Pontine hemorrhage

5928.
5929.

87)50 % Cystic fibrosis

5930.
5931.

88) Mode of action of docetaxel...

5932.

........

5933.

89)(-PeutzJeghers syndrome --AD

5934.
5935.

90)Sildenafil ... bluish discouloration

5936.
5937.

91)Nitrofurotion

5938.

93)- Urine hesitancy

5939.
5940.

94)-Down .. Intuscception

5941.
5942.

95)amioacide in alkabtunuree

5943.
5944.

96)a1 anti trypsin d

5945.
5946.

97)-Pemvigus Vulgaris

5947.
5948.

98)sbroaic dermatitis

5949.
5950.
5951.

99)Dog bite--> coamoxiclav.

5952.

100)Schizophrenia

5953.
5954.

101)Laxative over use

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.

112)ACE fascial swelling

5977.
5978.

113)reverse transcrptase

5979.
5980.
5981.

114)reduce weight

5982.

115)72h fasting

5983.
5984.

116)lateral epicondylities

5985.
5986.

117)fast acetylators and INH toxicity

5987.
5988.

118)cuase of decresed libid---->epiandrostendioe,progsterone,eostradiol,cortisole??

5989.
5990.

119)VWD

5991.
5992.

120)nephrogenic DI aquaporin2

5993.
5994.

121)ESTACASY T40

5995.
5996.

122)tarcolimus hyperkalemia

5997.
5998.

123)NA valporate side effect

5999.
6000.

124)streptococus pneumonia meaningitis

6001.
6002.

125)ankylosing spondylitis polygenic inhirtance

6003.
6004.

126)lymph granuloma venerium

6005.
6006.

127)promylocytic leukemia(15/17)

6007.
6008.

128)ramipril as tttt of GN

6009.
6010.
6011.

129)adrenal insufficency

6012.

130)avascular necrosis post CML TTTT

6013.
6014.

131)pulmonary heamorage increase kco

6015.
6016.

132)post trumatic stress disorder

6017.
6018.

133)PE

6019.
6020.

134)direcr antiglobulin test

6021.
6022.

135)over night dexamethasone cushing

6023.
6024.

136)pulmonary HTN maternal mortality

6025.
6026.

137)drhamaz, Jan 21, 2011#44

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.

11) hyperkeratotic plague is psoariasis

6030.
6031.

16) after angiography the complications is MI

6032.
6033.

7) vancomycin is use for the chronic renal failure with IJC because the most common organism is the
staph epididimis?

6034.
6035.

19) holme's Adie pupil a/w absent reflex

6036.
6037.
6038.

21) amlodipin in lithium

6039.

23) syringo bulbia

6040.
6041.

24) herpes labialis a/w streptococcus pneumonia

6042.

3Cool patient with pneumothorax are life long prohibited from diving unless patient underwent
pleurecdomy (pass year)

6043.

54) PATIENT ON pyrazinamide may hav the arthralgia

6044.
6045.

55) ulnar nerve supply the 3rd and 4th lumbrical

6046.
6047.

60) poster5ior infarction ?ciorcumfles artery?

6048.
6049.

-splenic flexure

6050.
6051.

patient elderly agiutated---->haloperidol

6052.
6053.

-benzexol for pakinsonism

6054.
6055.

medullary crcinaoma for pt e thyroid swelling and sever htn (men)

6056.

1 One question on which drug should be avoided in long QT syndrome? Sertaline

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.

6.About complication of angiod streaks? macular hemorrhage

6063.
6064.
6065.
6066.

20 % non small cell carcinoma

6067.
6068.

-Jugular Foramen

6069.
6070.

Limb Girdlw

6071.
6072.

-Primaquine .. G6pd

6073.
6074.

- Simvastatin .. grapefruit

6075.
6076.

4Cool desmopressin release the stored factor VIII

6077.
6078.

Breast 15-3

6079.
6080.

periarticular erosion

6081.
6082.

FBS

6083.
6084.

muscarinic antagonist

6085.
6086.

- doxazocin

6087.
6088.

- Doputamine ( Stress not due to knee problem

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.

codondrhamaz, Jan 21, 2011#45

6113.

GuestGuestMost i agree but some i dont :

6114.
6115.

- Co dopa for parkinsonism (sure )

6116.

-I chose diclofenac but it seems nitrofurantoin

6117.

-Thrombophilia ( remeber age of patient ? If older than 60 hydroxyuria

6118.

- Neurofibromatosis ( tricky as some characters needed to diagnose it not all and may be family history
present or absent )

6119.

-Adhesive Capuslitis not Imingment

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.

- not grief ( imade it so but wrong

6122.

- Fast acetylator - Drug resistance ) sure

6123.

- I chose malingering not sychogenic

6124.

- hemophelia A sure

6125.

-not lymph granuloma venerium it was painful

6126.

-Guest, Jan 21, 2011#46

6127.

GuestGuestHemophilia A The diagnosis may be suspected as coagulation testing reveals an increased

PTT in the context of a normal PT and bleeding time. PTT test are the first blood test done when
haemophilia is indicated. However, the diagnosis is made in the presence of very low (<10 IU) levels
of Factor VIIIGuest, Jan 21, 2011#47

6128.

fidoGuestDefinitely Not Hemophilia A as she was a lady & phenotypically normal

6129.

So not Turner's and it can't be Noonan's as well....

6130.

I chose Von-Willebrand but I'm not sure !fido, Jan 21, 2011#48

6131.

2 - posterior mi - circumflex artery.

6132.

3 - a case with sensory loss over dorsum of foot and great toe - common peroneal palsy.

6133.

4 - cxr rt upper lobe collapsee with recurrent hemoptysis - carcinoid syndrome

6134.

5 - abg showing resp alkalosis with hypoxemia - thrombo embolism

6135.

6- some yellowish waxy lesion over lowerlimb - ? DM

6136.

7 - positive predicted value - truepositive / true positive + false positive .

6137.

8 - upper qudrantopia lesion in eye - Temporal lobe

6138.

9 homonoymous hemianopia - ? occipital lobe .

6139.

10 - breathlessness ehler danlos synd - ? vital capacity

6140.

11 - differentiation between toxoplasmosis and crytococcus ct findings - contrast enanched mass lesion

6141.

12 - pt given haloperidol and dihydro codein having ? extrapyramidal reaction -- ? procyclidine

6142.

13 . alcoholic brought unconscious having high urea and creatine - inv to be done - creatinine kinase

6143.

14 . pt having flushing vomiting after eating tuna - scrombotoxin

6144.

15 - palate weakness , absent gag reflex , fasciculations in tongue , tongue deviation to left . -- ? lesion
in jugular foramen .

6145.

16 - firm lesion on forehead <9mm - ? plaque or nodule

6146.

17 - non small cell ca in lung - clinical sign --- ? monophonic rhonchi .

6147.

18 -pt with loose watery diarrhoea loss of weight , inv showing low b12 level - ? coeliac disease

6148.

19 - hypocalcemia ecg finding - QT Prolongation

6149.

20 - allele - ? alternate form of chromosomesdr areef, Jan 21, 2011#51

6150.

CceGuestHow about the statistic question?

6151.

1. To test the strength of association - odds ratio or correlation coefficient?

6152.

2. 2 groups of people randomised into treatment and placebo group

6153.

- unpaired t test?

6154.
6155.

Dermatology

6156.

Hyperketatotic plaque around scale margin - psoriasis?

6157.
6158.

Psy

6159.

Helicopter control pt's atvt

6160.

- paranoid disorder or schizophreniaCce, Jan 21, 2011#52

6161.

drhamazGuestQ Hyperviscosity syndrom or renal failure??????????????drhamaz, Jan 21, 2011#53

6162.

drhamazGuestQ SIGN of increase intracranial preasure???????????????????

6163.

what right answer?drhamaz, Jan 21, 2011#54

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.

-patient iv drug abuser...amyloidosis

6169.

-antimyeloperoxidase

6170.
6171.

-patient with DM has renovascular disease not diabetic nephropathy

6172.

-patient with linear deposition in basement membrane..good pasture(igm disease)Guest, Jan 21, 2011
#56

6173.

CceGuestHow about the statistic question?

6174.

1. To test the strength of association - odds ratio or correlation coefficient?

6175.

2. 2 groups of people randomised into treatment and placebo group

6176.

- unpaired t test?

6177.
6178.

Dermatology

6179.

Hyperketatotic plaque around scale margin - psoriasis?

6180.
6181.

Psy

6182.

Helicopter control pt's atvt

6183.

- paranoid disorder or schizophreniaCce, Jan 21, 2011#57

6184.

GuestGuestwish a those have enter the exam to pass

6185.

i dint actually enter this one but i`m planning to enter next exam

6186.

and this site has added alot for me

6187.

i`m waiting for the discussion and q

6188.

all the best for u allGuest, Jan 21, 2011#58

6189.

drhamazGuestnot paranoid disorder or schizophrenia its dellusiondrhamaz,

6190.

2) warfarin inhibit the factor VII --ssame

6191.

4) pulsus alternans in left heart failure ---same

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.

7) small VSD is pansystolic murmur with thrills--silly mistake from me1

6195.

8- arm, buttock, thigh itchy rashes that is not response to prednisolone and a/w diarrhea are dermatitis
herpatiformis--dont remember2

6196.
6197.

13) poor prognosis for hogkin is sweating (pass year) --same

6198.

14) colon CA a/w endometrial CA--i put it wrong breast ca3

6199.

15) haemoptysis with gromerulonephritis is anti GBM antibody --same

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.

21) RTA --same

6204.

22) pseudogout

6205.

23) hydroxyurea use to treat essential thrombocytopenia--same

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.

26- paranoid personality disorder --same

6212.

31) SLe a/w C4 deficiency --same

6213.
6214.

32) in patient with blood result showing hypocalcaemia the ECG changes is long Qt ---same

6215.
6216.

33) refeeding syndrome check serum phosphate (pass year) --same

6217.
6218.

34) impingement syndrome in patient with pain and stiffness on shoulder ABD and rotation?

6219.
6220.
6221.

36) major raised intracranial pressure-bradycardia(cushing reflex?) i put it vomiting??

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.

39) LBBB a/s reversed splitting 2nd heart sound ---same

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.

45) fronto temporal demential --same

6237.
6238.
6239.

47) lithium use to treat the patient wf the manic syndrome---same

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.

52) after splenectomy the most important organism is strep pneumonia---same

6250.
6251.

53) WATERY DIARRHE A/W e. COLI 0157 ---same

6252.

57) staph discitis in patient with pace maker implantation who present with low back pain?---same

6253.

59) penile and anal wart treat wf podophilline --same

6254.

61) amytryptilline toxicity use iv sodium bircarb ---same

6255.

62) SAH that develop confusion 5 days later in kumar and clark is hydrocephalus ---saem

6256.

63) aiodine deficiency or sick euthyroid syndrome?---- euthyroid?

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.

65) tau in alzheimer ---cant remember

6259.

66)unpaired t test i think ---chi squard wrong5

6260.

67)> 50 in 1000 for NNT---c ant rememberc

6261.

6-Oral Terbinafine ---same

6262.

69)-tight glycemic control ---fetal insulin?

6263.

70)-oraltetracycline ---plaquinil??

6264.

71)-chlamida--doxycycline

6265.
6266.

72)-angiodysplasia

6267.
6268.

73)limited scleroderma ----primary sjog

6269.
6270.
6271.

74)lateral medullary syndrom ---same

6272.
6273.

75)temporl lobe ---same

6274.
6275.

76)psudomembranous collitis ---same

6276.

79)-pt temporal lesion--->herpes simplex encephalitis --same

6277.

80)assymetrical movement for parkinsonism ---same

6278.

81)-pt e cron's and low tsh,ft4 and normal ft3 ----->euthyroid?

6279.

82)-ttt of pheocromocytoma---->phenoxylamine ---same

6280.

83)-continues inhibition----->prolactine --same

6281.

84)Question on how to avoid complication of angiography? 0.9% nacl---same

6282.

85).One question about stroke and pin point pupils? Pontine hemorrhage---cant remember

6283.

87)50 % Cystic fibrosis---same

6284.

8 Mode of action of docetaxel... ---microtubule

6285.

89)(-PeutzJeghers syndrome --AD ---same

6286.

90)Sildenafil ... bluish discouloration ---same

6287.

91)Nitrofurotion ---same

6288.

93)- Urine hesitancy ??

6289.

94)-Down .. Intuscception ---same

6290.
6291.

95)amioacide in alkabtunuree ---??

6292.
6293.

96)a1 anti trypsin d ???

6294.
6295.

97)-Pemvigus Vulgaris ---same

6296.
6297.

98)sbroaic dermatitis ---same

6298.
6299.

99)Dog bite--> coamoxiclav.

6300.
6301.

100)Schizophrenia ---same

6302.
6303.

101)Laxative over use ---same

6304.
6305.

102)Pseudo psychogenicseziures.

6306.
6307.

103)grief reaction ---cant remember

6308.
6309.

104)BNP ---??

6310.
6311.

105)cryoglopulin ---same

6312.
6313.

106)CML ---same

6314.
6315.

107)animyloperoxidase same

6316.
6317.

108)allel ---cant remember

6318.
6319.

109)septic arthritis ---same

6320.
6321.

110)creatine kinase ---same

6322.
6323.

111)ascitic microscopy---abd u/s

6324.
6325.

112)ACE fascial swelling ---silly mistake for me amlodipin

6326.
6327.

113)reverse transcrptase--dna from rna

6328.
6329.

114)reduce weight same

6330.
6331.

115)72h fasting -same

6332.
6333.

116)lateral epicondylities ---same

6334.
6335.

117)fast acetylators and INH toxicity ---hepatitis

6336.
6337.

118)cuase of decresed libid---->epiandrostendioe,progsterone,eostradiol,cortisole??--dunnu

6338.
6339.

119)VWD ---same

6340.
6341.

120)nephrogenic DI aquaporin2 ---vassopressin?

6342.
6343.

121)ESTACASY T40--cant remember

6344.
6345.

122)tarcolimus hyperkalemia

6346.
6347.

123)NA valporate side effect

6348.
6349.

124)streptococus pneumonia meaningitis --same

6350.

125)ankylosing spondylitis polygenic inhirtance --same

6351.
6352.

126)lymph granuloma venerium ---chacroid??

6353.
6354.

127)promylocytic leukemia(15/17)

6355.
6356.

128)ramipril as tttt of GN ---same

6357.
6358.

129)adrenal insufficency ---same

6359.
6360.

130)avascular necrosis post CML TTTT ---same

6361.
6362.

131)pulmonary heamorage increase ksame

6363.
6364.

132)post trumatic stress disorder

6365.
6366.
6367.

133)pe--same

6368.

134)direcr antiglobulin test---same

6369.
6370.

135)over night dexamethasone cushing --ssame

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.

drhamazGuestadhesiv capsulities not impingement syndrome Im suredrhamaz, Jan 22, 2011#62

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.

GuestGuest- It's diclofenac as it commonly causes congestive heart failure and

6380.

exacerbates breathlessness but nitrofurontoin is RARE cause

6381.

of pulmonary fibrosis .

6382.
6383.

- it's adhesive capsulitis not impingment

6384.
6385.

- Thrombophilia if younger than 60 Aspirin

6386.
6387.

older than 60 Hydroxyurea .. Remeber the age ?Guest, Jan 22, 2011#67

6388.

2 - posterior mi - circumflex artery. ---1ST SEPTAL BRACH OF LAD?

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.

5 - abg showing resp alkalosis with hypoxemia - thrombo embolism

6392.

6- some yellowish waxy lesion over lowerlimb - ? DM ---TFT

6393.

7 - positive predicted value - truepositive / true positive + false positive . SAME

6394.

8 - upper qudrantopia lesion in eye - Temporal lobe SAME

6395.

9 homonoymous hemianopia - ? occipital lobe . SAME

6396.

10 - breathlessness ehler danlos synd - ? vital capacity SAME

6397.

11 - differentiation between toxoplasmosis and crytococcus ct findings - contrast enanched mass lesion
SAME

6398.

12 - pt given haloperidol and dihydro codein having ? extrapyramidal reaction -- ? procyclidine

---NALOXONE IM WRONG

6399.

13 . alcoholic brought unconscious having high urea and creatine - inv to be done - creatinine kinase
SAME

6400.

14 . pt having flushing vomiting after eating tuna - scrombotoxin SAME

6401.

15 - palate weakness , absent gag reflex , fasciculations in tongue , tongue deviation to left . -- ? lesion
in jugular foramen . CEREBELLO PONTUINE ANGEL?

6402.

16 - firm lesion on forehead <9mm - ? plaque or nodule NODULE

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.

19 - hypocalcemia ecg finding - QT Prolongation SAME

6406.

20 - allele - ? alternate form of chromosomes---CANT REMEMBER

6407.

21-PT WITH PLEURAL EFFUSION---CLOSED PLEURAL BIOPSY OR PLEURA ASPIRATION

6408.

22-IV DRUG USER--FOCAL SEGMENTAL GN

6409.

23CODON---MSNGER RNA?

6410.

24-DM NEPHROPATHY\

6411.

25-HYPERVISCOSITY IN PT WITH PE AND WALDENSSTOMS

6412.

26-HYPERSINSITIVITY PNEUMONITIS

6413.

27-Guest, Jan 22, 2011#68

6414.

heavenGuesthaha...i also dunno...but the pastest gv the answer of polymyalgia rheumatical...haha...

heaven, Jan 22, 2011#69

6415.
6416.

GuestGuestBasics

6417.

- Codon codes for Amino Acids ( AUG codes for Methionine

6418.

- DHEA for improvement of libido

6419.

- Sildanafil

6420.

-Muscarinic Antagonist

6421.

-Circumflex

6422.

-L5Guest, Jan 22, 2011#70

6423.

dr ali sidigGuestrecall

6424.
6425.

thyroid swelling in pt with pheochromocytoma diagnosis is MEN11dr ali sidig, Jan 22, 2011#71

6426.

dr-mahmoudGuestthere are stillforgotten quistions

6427.

come on guys lets coplete the 200 list

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.

-pt with recurrenty uti ---->reflux uropathy

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.

some other questions you didnt mention guys:

6435.
6436.

Benefit of Beta Blockers>>> Heart rate

6437.

Pleural effusion (pt with asbestosis), dxic tool>>> aspiration?

6438.

traetment for Psudomonas areginosa>>> clarithromycin??Hussein788, Jan 23, 2011#73

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.

- Ascitic microscopy to diagnose SBP ( Me wrong )Guest, Jan 23, 2011#74

6443.

katkootGuesthi guys i have some comments

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.

3-Rubella- not Hep A ,not Measl as distribution of lyphadenopathy(post cervical) is chatactrestic.

6450.
6451.

4-VATS-(Video assisstant thoracoscopy )for pleural effusion and pleural thikining.katkoot, Jan 23, 2011
#75

6452.

katkootGuest

6453.

1-postpartum lady--cortical sinus thrombosis.

6454.
6455.

2-Parkisonism-seleglen -not benzhexol.

6456.
6457.

3-fast actylator--- Hepatitis.

6458.
6459.

4-Obstructive sleep apneoa- not Narcolepsy as BMI 32

6460.
6461.

5-IV fucloxacellin while waiting for culture-patient on CV line.

6462.
6463.

6-Carotid artery dissection as it was preceeded with neck pain and headach.katkoot, Jan 23, 2011#76

6464.

katkootGuest

6465.

1-Adenosine for SVT.

6466.

2-Gabapentin-peripheral neuropathy.

6467.

3-Aminoacide metabolite in alkaptonuria.

6468.

4-Crabocistien--abdominal pain ,nausea.diarheoa.

6469.

5-Reduced exposure to sunlight is the commenest cause of vit D defe in elderly.

6470.

6-Urine hesitancy- in suspect spinal cord compression.

6471.

7-Depression-old man(can not remmener case senario).

6472.

8-Emphysema.

6473.

9-Procyclidine-- acute dystonia folowing haloperidol.

6474.

10-Adhesive capsulitis.

6475.

11-Rheumatoid arthritis-- not polmyalgia

6476.

12-Acute gout --- not septic arthritiskatkoot, Jan 23, 2011#77

6477.

katkootGuest1-Back from Indonesia with low BP---IV Fluids.

6478.

2- tight glycaemic controle.

6479.

5-Bradycardia(cushing reflex)-increase intraracranial pressure.

6480.

7-Ig A nephropathy -frequent episods of macroscopic haematuria.

6481.

8-Bronchial carcenoid--haemoptysis+CXR-collape lt upper lobe.

13-dermatitis herpitiforms.

6482.

14-Phosphate level-refeeding syndrome.

6483.

15-Periarticluar erosion-worse prognosis.katkoot, Jan 23, 2011#78

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.

2-hydrocephalusfor sub arachenoid hg.

6488.

3-Desmopressen--increase factor VIII from liver stores.

6489.

4-hyperviscosity syndrome.

6490.

5-CA 15.3 CA Breast.

6491.

6-prothrombine time--paracetamole over dose.

6492.

7-muscarinic antagonist -tolterodine.

6493.

8-Haloperidol--agitaed old lady with urinary tract infection.

6494.

9-Nephrogenic DI-Aquporin2

6495.

10-hyperkalaemia--Tacolimus.katkoot, Jan 23, 2011#79

6496.

katkootGuest

6497.

1-cystic fibosis--50% carrier

6498.

2-limb girdle

6499.

3-jugular foramen.

6500.

4-pyazinamide--joint pain.

6501.

5-doxycyclin-chlamydia.

6502.

6-lymphogranuloma venerium.

6503.

7-Space occupying lesion for Toxoplasmosis.

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.

1-VSD-Pansystolic murmur+thrill Lt sternal edge.

6508.

2-Pulsus alternans-Lt vent failure

6509.

3-LBBB-Revesed splitting of 2nd heart sound.

6510.

4-Pulmonary HPT-- increades death during pregnancy.

6511.

5-Hypocalcaemia-Long QT interval.

6512.

5-Sertraline-Torsed `s

6513.

6-Amiodarone-maintainance of rhythm after card

6514.

7-Thromboembolism-af with history of MI.

6515.

8-Oval Malaria.

6516.

9-Pontine HG.

6517.

10-homonomus hemianopia-Occipital.

6518.

11-Optic chiasma-Bitemporal hemianopia

6519.

12-Temporal lobe-upper quadrant hemianopia.katkoot, Jan 23, 2011#81

6520.

katkootGuest

6521.

1-Reduced C4-SLE.

6522.

2-Polygenic-Ankylosing.

6523.

3-Sildenafil-blue vision.

6524.

4-Autosomal resessive-alfa 1 antitrypsin.

6525.

5-Autosomal dominant-Putez jehger.

6526.

6- IV bicarbonate-Amitrypteline.

6527.

7-Ascetic fluid microscopy-SBP in alcoho;ic with ascitis.

6528.

8-Addison`s.

6529.

9-Cryogobulinaemia-patient with Hep C.

6530.

10-Gentamycine-mythenia

6531.

11-Sever asthma.

6532.

12-Pulmonary Embolism.

6533.

13-Medullary ca -MEN1katkoot, Jan 23, 2011#82

6534.

katkootGuest

6535.

1-Factor VII-Warfarin.

6536.

2-Dog bite-Co-moxclave.

6537.

3-Nitrofurantoin.

6538.

4-Propranolol--1ry prophylaxsis Osophageay varecis.

6539.

6-Oral terbinafine.

6540.

7-(15:17)-APML.

6541.

8-Ulcerative colitis.

6542.

10-Post-traumatic stress disorder.

6543.

11-Shizophrenia.

6544.

12-Grief.

6545.

13-Ramipril--old man with resistant nephrotic syndrome.katkoot, Jan 23, 2011#83

6546.

katkootGuest

6547.

1-common bile duct.

6548.

2-Avascular necrosis.

6549.

3-0.9%Nacl--preior to angiograhpy for patient with renal impairment.

6550.

4-Neurofibromatosis.

6551.

5-Alveolar Hg--increase Kco.

6552.

6-50 patients need to be treated to prevent 1 stroke.

6553.

7-true +ve/true +ve+false+--+ve predective value.

6554.

8-Monophonic wheez--cxr with large Lt hilar mass.

6555.

9-Chronic laxative use.

6556.

10-Nicornadil-mouth ulcers.

6557.

11-Streptococuus pneumonae--postsplenctomy.

6558.

12-Podophyllin-- anal and penile warts.

6559.

13-Pemphigus vulgaris.

6560.

katkoot, Jan 23, 2011#84

6561.

GuestGuest-Fast acetylator - Drug resistance

6562.

- PICA not brain infarction

6563.

CoDopa not selegilineGuest, Jan 23, 2011#85

6564.

GuestGuestcould it be essential hypertension?silver wiring?Guest, Jan 24, 2011#86

6565.

CceGuestAnyone remember the age for the patient with essential thrombocytopenia?

6566.

Treatment is aspirin or hydroxyurea?Cce, Jan 24, 2011#87

6567.

GuestGuestYounger than 60 Aspirin

6568.

Older than 60 Hydroxyuria

6569.

Patient age in question ?Guest, Jan 24, 2011#88

6570.

GuestGueste.thrombothytosis/age more than 60/sure .

6571.

IgA diff/common variable immun.diff.

6572.

maculpapular rash with ociptal and cervical LNs/arthritis/rubella

6573.

bad mouth smell/pharyngeal puch

6574.

allergy/tuna+olive/anisakiasis(igE insenstive.)

6575.

indications of immunoglob. therapy/C2 diff.Guest, Jan 24, 2011#89

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.

7-Reduced absorption---for Vit B12 def--post colectomy for Crohn`s.

6583.

8-Night sweating---worse prognosis for lymphoma.

6584.

9-staphylococcal discitis.

6585.

10-herpes simplex-temoparietal involvement on CT brain.

6586.

11-vital capacity---assess muscular dystrophy.

6587.

12-FEV1--improved post Bullectomy.

6588.

13-Parkinsonism----seleglen(sure).katkoot, Jan 24, 2011#90

6589.

katkootGuest

6590.

1-ITP----human immunoglobulin.

6591.

2-lat epicondylitis.

6592.

3-coronary spasm--cocaine.

6593.

4-Direct antiglobulin test.

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.

8-Tumour necrosis factor alpha--Rheumatoid.

6598.

9-Amphotersin B--febril cml patient post multipe antibiotics use.

6599.

10-Pulmonary hg+crecent glomerulonepritis---antimyloperoxidase.

6600.

11-myelodysplasia(i think this is the correct answer)-patient on atenlol,asprin and statin

----Pancytopenia on FBC.katkoot, Jan 24, 2011#91

6601.

katkootGuest

6602.

1-phenoxybenzamine-pheochromocytoma with high BP+non sustained VT.

6603.

2-Strept pneumoni-community pnumonia with herpes labialis.

6604.

3-Pericarditis.

6605.

4-frontotemporal dementia.

6606.

6-Atenolol exacerbate COPD.

6607.

7-CT abdomen-iliac fossa swelling+postprandial abdomonal pain +mother has crohn`s--? carcenoid
with mesenteric occlusion--intestinal angina.

6608.

9-3rd,4th lubiricals-ulnar nerve.

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.

15-Prolactine-under continuous inhibition.

6615.

16-fasting blood sugar---necrobiosis lipodicum.katkoot, Jan 24, 2011#92

6616.

GuestGuestWEGNER is C-ANCA =PR3 antimeloperoxidase is P-ANCA.

6617.

PARKINSON'S/ CARLEDOPA .

6618.

LOW BACK PAIN /IMPORTANT H/O TUBERCULOSIS ?

6619.

PSEUDOMONOUS/CIPROFLUXACIN

6620.

DYPHAGIA/ABD PAIN DIARRHEA/ADERONATEGuest, Jan 24, 2011#93

6621.

katkootGuestnot sure

6622.

1-?Allel-i select part on chromosome.

6623.

2-? Cdon-i select on DNA.

6624.

3-?Post MI-i select 1st septal branch of lf descending.

6625.

4-?Post spontaneous pnumothorax---? diving ? travel by Air.

6626.

5-?Reactive arthritis? gonococcal Arthritis-i select gonococcal.

6627.

6-?Pseudo psychogenic seziure?malingering- i select malingering.

6628.

7-?Study about cholesterol-i select P value.

6629.

8-?Metaanalysis-i select histogram.

6630.

9-?Barret`s osophagus- i select fundoplication.

6631.

10-?Essential HPT-i select glomerulonephritis in view of proteinuria-i can not remember it was dip test
or urine microscopy.

6632.

11-?Bleeding per rectum- i select angiodysplasia.

6633.
6634.

1-Anti-MPO(myloperoxidase is present in the majority of patients with idiopathic crescentic

glomerulonephritis.

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.

katkoot, Jan 24, 2011#95

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,

Jan 24, 2011#97

6640.

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.

GuestGuestWAIT RESULT 7 Feb 2011Guest, Jan 25, 2011#100

6645.

(You must log in or sign up to reply here.)

6646.

Page 2 of 8
6647.
6648.

6649.

6650.

6651.

6652.

6653.

6654.

6655.

6656.
6657.
6658.
6659.
6660.

Share This Page

< 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.

Recalls from MRCP 2011/01

6682.

Discussion in 'MRCP Forum' started by dr_rajib, Jan 19, 2011.

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.

doctor123GuestHow You Docs prepared for MRCP ONE

6697.
6698.

How You Docs prepared for MRCP ONE

6699.
6700.

Thanksdoctor123, Jan 25, 2011#102

6701.

CceGuestWhat do guys think is the passing Mark or the correct answer required this time?Cce, Jan 25,
2011#103

6702.

GuestGuest140Guest, Jan 25, 2011#104

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.

GuestGuesthow about 120Guest, Jan 26, 2011#107

6706.

GuestGuestDR KATKOT COLLECTION AND MY REPLY

6707.
6708.

1-?Allel-i select part on chromosome. DUNNO

6709.

2-? Cdon-i select on DNA. DUNNO

6710.

3-?Post MI-i select 1st septal branch of lf descending. SAME(LASTLY FOUND ANOTHER
COLLEGUE ANSWERED LIKE ME

6711.

4-?Post spontaneous pnumothorax---? diving ? travel by Air. DIVING

6712.

5-?Reactive arthritis? gonococcal Arthritis-i select gonococcal. SAME

6713.

6-?Pseudo psychogenic seziure?malingering- i select malingering. SLEEP APNEA?

6714.

7-?Study about cholesterol-i select P value. CANT REMEMBER

6715.

8-?Metaanalysis-i select histogram. CANT REMEMBER

6716.

9-?Barret`s osophagus- i select fundoplication. ACID SUPPRESUION THEN ENDOSCOPY

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.

11-?Bleeding per rectum- i select angiodysplasia. SAME

6719.

13-phenoxybenzamine-pheochromocytoma with high BP+non sustained VT. SAME

6720.

14-Strept pneumoni-community pnumonia with herpes labialis. SAME

6721.

15-Pericarditis. SAME

6722.

16-frontotemporal dementia. SAME

6723.

18-Atenolol exacerbate COPD. FURANTOIN

6724.

18-CT abdomen-iliac fossa swelling+postprandial abdomonal pain +mother has crohn`s--? carcenoid
with mesenteric occlusion--intestinal angina. COLONOSCOPY?

6725.

20-3rd,4th lubiricals-ulnar nerve. CANT REMEMBER

6726.

21-Nodule->0.5 cm. SAME

6727.

22-Varicella-more communicable. SAME

6728.

23-Myelofibrosis--tear drops. SAME

6729.

24-ciclosporin-IL2. SAME

6730.

25-Endometrial CA. CANT REMEMBER BUT DIFFERENT FROM THIS!!

6731.

26-Prolactine-under continuous inhibition. SAME

6732.

27-fasting blood sugar---necrobiosis lipodicum. TFT?

6733.

27-ITP----human immunoglobulin. SAME

6734.

28-lat epicondylitis. SAME

6735.

30-Direct antiglobulin test. SAME

6736.

31-Renovascular disease. DM NEPHROPATHY?

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.

34-Tumour necrosis factor alpha--Rheumatoid. SAME

6739.

35-Amphotersin B--febril cml patient post multipe antibiotics use. SAME

6740.

36-Pulmonary hg+crecent glomerulonepritis---antimyloperoxidase. SAME

6741.

37-myelodysplasia(i think this is the correct answer)-patient on atenlol,asprin and statin

----Pancytopenia on FBC. SAME THANK YOU

6742.

38-scrombotoxin---Tuna. SAME

6743.

39-hepatitis--fast acytelaor(sure). SAME THANK U

6744.

40-Primaquin----G6PD. SAME

6745.

41-grap fruit---statin. AME

6746.

42-CML. SAME

6747.

44-Reduced absorption---for Vit B12 def--post colectomy for Crohn`s.SAME

6748.

45-Night sweating---worse prognosis for lymphoma. SAME

6749.

46-staphylococcal discitis. SAME

6750.

47-herpes simplex-temoparietal involvement on CT brain.SAME

6751.

48-vital capacity---assess muscular dystrophy. SAME

6752.

49-FEV1--improved post Bullectomy. I PUT LIKE U AT 1ST THEN CHANGED TO VC?

6753.

50-Parkinsonism----seleglen(sure). BENZEXHOL MY B IM WRONG

6754.

51-common bile duct.CYSTIC DUCT I DIDNT REMEMBER THE ANATOMY!!

6755.

53-0.9%Nacl--preior to angiograhpy for patient with renal impairment. SAME

6756.

54-Neurofibromatosis. SAME

6757.

55-Alveolar Hg--increase Kco. SAME

6758.

56-50 patients need to be treated to prevent 1 stroke.

6759.

57-true +ve/true +ve+false+--+ve predective value. SAME

6760.

58-Monophonic wheez--cxr with large Lt hilar mass. CANT REMEMBR BUT DIFFERENT

6761.

59-Chronic laxative use. SAME

6762.

60-Nicornadil-mouth ulcers. CANT REMEMBR

6763.

iga nephropathy with cholesterol of 12-best treatment to protect kidneys after

steroids- ? statins/ ramipril

6764.
6765.

61-Streptococuus pneumonae--postsplenctomy. SAME

6766.

62-Podophyllin-- anal and penile warts. SAME

6767.

63-Pemphigus vulgaris.SAME

6768.

64-Factor VII-Warfarin. SAME

6769.

65-Dog bite-Co-moxclave. SAME

6770.

66-Nitrofurantoin. SAME

6771.

67-Propranolol--1ry prophylaxsis Osophageay varecis.

6772.

69-Oral terbinafine. SAME

6773.

70-(15:17)-APML. SAME

6774.

71-Ulcerative colitis. CRONS OFFCOURSE IM WRONG

6775.

73-Post-traumatic stress disorder. SAME

6776.

73-Shizophrenia. SAME THANK U

6777.

74-Grief.

6778.

75-Ramipril--old man with resistant nephrotic syndrome. SAME

6779.

76-Reduced C4-SLE. SAME

6780.

77-Polygenic-Ankylosing. SAME

6781.

78-Sildenafil-blue vision. SAME

6782.

79-Autosomal resessive-alfa 1 antitrypsin.

6783.

80-Autosomal dominant-Putez jehger. SAME

6784.

81- IV bicarbonate-Amitrypteline. SAME

6785.

82-Ascetic fluid microscopy-SBP in alcoho;ic with ascitis. U/S?

6786.

83-Addison`s. SAME

6787.

84-Cryogobulinaemia-patient with Hep C. SAME

6788.

85-Gentamycine-mythenia SAME

6789.

86-Sever asthma. SAME

6790.

87-Pulmonary Embolism.SAME

6791.

88-Medullary ca -MEN1 SAME

6792.

89-VSD-Pansystolic murmur+thrill Lt sternal edge.ESM IM WRONG

6793.

90-Pulsus alternans-Lt vent failure SAME

6794.

91-LBBB-Revesed splitting of 2nd heart 0sound.SAME

6795.

92-Pulmonary HPT-- increades death during pregnancy.PS IM WRONG

6796.

93-Hypocalcaemia-Long QT interval. SAME

6797.

94-Sertraline-Torsed `s SAME

6798.

95-Amiodarone-maintainance of rhythm after card SAME

6799.

96-Thromboembolism-af with history of MI. ??

6800.

97-Oval Malaria. SAME

6801.

98-Pontine HG. PLEASE RECALL

6802.

99-homonomus hemianopia-Occipital. SAME

6803.

100-Optic chiasma-Bitemporal hemianopia SAME

6804.

101-Temporal lobe-upper quadrant hemianopia. SAME

6805.

102-cystic fibosis--50% carrier SAME

6806.

103-limb girdle . DUCHENE?

6807.

104-pyazinamide--joint pain. SAME

6808.

105-doxycyclin-chlamydia. SAME

6809.

106-lymphogranuloma venerium. CHNCROID?

6810.

107-Space occupying lesion for Toxoplasmosis. SAME

6811.

108-Ecoli o157--HUS. SAME

6812.

109-RTA type 1-hypercholaremic acidosis with normal anion gap--renal impairment 2ry to
nephrocalcinosis. SAME

6813.

110-Ciprofoxacine--pseudomonas. CLARITHROMYCIN?

6814.

112-jugular foramenCEREBELLOPONTINE JUNCTION (WY THERE WAS ATTAXIC GATE)

6815.

113-hypersensitivity pneumonitis--paint srayer exposed to diisocyantes-

6816.

b-hypersensitivity pneumonitis with mid+lower zone nodular infilterate as in our case (in acute
phase). . SAME

6817.

114-hyperviscosity syndrome. SAME THANK U

6818.

115-CA 15.3 CA Breast. SAME

6819.

116-prothrombine time--paracetamole over dose. SAME

6820.

117-muscarinic antagonist -tolterodine. CANT EMEMBER

6821.

118-Haloperidol--agitaed old lady with urinary tract infection. SAME

6822.

119-Nephrogenic DI-Aquporin2 IM WRONG

6823.

120-hyperkalaemiaTacolimus SAME

6824.

121-hydrocephalusfor sub arachenoid hg. SAME

6825.

122-Desmopressen--increase factor VIII from liver stores

6826.

SAME

6827.

123-Back from Indonesia with low BP---IV Fluids. SAME

6828.

124- tight glycaemic controle. FETAL INSULIN(DEBATATABLE)

6829.

125-Bradycardia(cushing reflex)-increase intraracranial pressure. VOMITING ITHINK IM WRONG

6830.

127-Ig A nephropathy -frequent episods of macroscopic haematuria. SAME

6831.

128-Bronchial carcenoid--haemoptysis+CXR-collape lt upper lobe. BRONCHIAL CARCINOMA (PT

WAS SMOKER?)

6832.

130-guttate Psoriasis. PLEASE RECALL

6833.

131-psoriasis -not seborheoic dermatitis as tests for fungus was -ve. SD?

6834.

132-dermatitis herpitiforms. SAME

6835.

133-Phosphate level-refeeding syndrome. SAME

6836.

134-Periarticluar erosion-worse prognosis MORNING STIFFNES?

6837.

135-Adenosine for SVT. SAME

6838.

137-Gabapentin-peripheral neuropathy.SAME

6839.

138-Aminoacide metabolite in alkaptonuria. SAME

6840.

139-Crabocistien--abdominal pain ,nausea.diarheoa.ALENDROATE

6841.

140-Reduced exposure to sunlight is the commenest cause of vit D defe in elderly.VEGETERIAN

DIET?

6842.

141-Urine hesitancy- in suspect spinal cord compression. PLEASE RECALL

6843.

142-Depression-old man(can not remmener case senario). SAME

6844.

143-Emphysema. SAME

6845.

145-Procyclidine-- acute dystonia folowing haloperidol. NALOXONE IM WRONG

6846.

146-Adhesive capsulitis.SAME

6847.

147-Rheumatoid arthritis-- not polmyalgia SAME HANK U

6848.

148-Acute gout --- not septic arthritis SEPTIC

6849.
6850.

149-postpartum lady--cortical sinus thrombosis. SAME

6851.
6852.

150-Parkisonism-seleglen -not benzhexol.

6853.
6854.

151-fast actylator--- Hepatitis.

6855.
6856.

152-Obstructive sleep apneoa- not Narcolepsy as BMI 32

6857.
6858.

153-IV fucloxacellin while waiting for culture-patient on CV line. SAME THANK U

6859.
6860.

154-Carotid artery dissection as it was preceeded with neck pain and headach. ? PLEASE RECALL

6861.
6862.
6863.

ANY OTHER RECALLS OR COMMENT DR KATKOOT?THANK YOUGuest, Jan 26, 2011#108

6864.

katkootGuestcomments to last guest

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.

3-moring stiffness is a criteria for diagnosis not for prognosis.

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.

7-quinilones(ciprofloxacine) drug of choice for pseudomonas.

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.

what about in parkinson's wasnt it careldopa

6877.

i read it from onexamination i mite b rong...!!

6878.

and was it adenosine or amiodarone cos yes adenosine 6mg if not responding go for further same dose

adenosine
6879.

but some books opt for amiodarone

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.

1-Dilated pupil--Holmis Adei-- absent planter - i answered wrong.

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.

4-facial swelling- which drug-- i can not remember my answer.

6886.

5-drug potientiating Lithium -can not remember ?i select candesertan.

6887.

6-Down syndrome-i select intusesception? not sure.

6888.

7-abnormal thyoid function+crohn`s--can not remember? was not sure also.

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.

katkootGuestIn facioscapulohumeral dystrophy-muscles of the face+shoulder and pelvis are affected

but in the question no mention about the face.katkoot, Jan 26, 2011#115

6896.

katkootGuestPyrazinaminde induced hyperuraecimia is more common than thiazides.katkoot, Jan 26,

2011#116

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.

caashifGuestthanks for answering

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.

caashifGuestsertraline ssri will prolong qt

6905.

.9% saline for the one going for angiography but WITH GFR < 20 will it b appropriate or dobutamine

6906.

and can some 1 recall question of ecstasycaashif, Jan 26, 2011#119

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.

caashifGuestcan any body recall complete question of cystic fibrosis inheritance

6913.

i guess it was a man whose neice got cystic fibrosis,what are the chances he will get this

6914.

and its autosomal recessive

6915.

it will be 1 out of 4 chances having the diseasecaashif, Jan 27, 2011#123

6916.

GuestGuest50 % sureGuest, Jan 27, 2011#124

6917.

CceGuestThe question asked the chances he will be a carrier.

6918.

I get this wrong though. I put 25%. stupid me.Cce, Jan 27, 2011#125

6919.

GuestGuestpassing marks?Guest, Jan 27, 2011#126

6920.

GuestGuestCalcium channel blocker ( Nonhydropyridine ) :

6921.
6922.

Verapamil increase neurotoxicity of lithium

6923.

but

6924.
6925.

Amlodipine Safe with lithium ..Guest, Jan 28, 2011#127

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.

katkootGuestdrugs increasing lithium levels causing lithium toxicity ---thiazid diurictics,

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.

caashifGuestamplodipine is dihydropyridine i suppose and verapamil is diphenylalkylamine

6939.

can any 1 recall question of na valproate side effects

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.

kindly some 1 recall the ecstasy question

6943.

and with alendronate is it alendronate or nicorandil

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.

i dunn remember them too but i counted the number of questions

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.

- Question about recurrent infection , primary or secondary

6951.
6952.

immunodeficiency or something else , anyone remember ?Guest, Jan 29, 2011#138

6953.

GuestGuestcant wait to see the result.

6954.

passing v bad timeGuest, Jan 29, 2011#139

6955.

GuestGuestsomeone posted it after the test: 18th Janu 2011

6956.

I hope it will be helpfull for other members taken the tes January2011

6957.
6958.
6959.

1) LVF- associated with pulsus alterans

6960.

2) no proximL Wakness , RF positive- polymyositis

6961.

3) amioacid metabolism- alkaptonuria

6962.

4) increased KLCO- alveolar haemorrhage

6963.

5) bitemporal arteritis- optic chaisma

6964.

6) cyclosporin- IL2

6965.

7) statistic q on association with disease- ? p value

6966.

barrets oesophagus- repeat endoscopy in few weeks with high dose ppi

6967.

9) rabies- amoxicillin

6968.

10) infective endocarditis no response to ab- acyclovir

6969.

11) back pain post pacemaker-staphalococal discitis

6970.

12) differentiate coccidio from toxoplasmosis- ?sol in ct

6971.

13) reversed split- LBBB

6972.

14) sildenafil- blue vision

6973.

15) paint worker, car mechanic- ?reactive pneumonitis

6974.

16) q on holmes- adie pupil- ?ptosis/nystagmus

6975.

17) increased igm - hyperviscosity syndrome

6976.

19) immune thrombocythaemia- immunoglobulins

6977.

20) tca poisoning- soda bicorb

6978.

21) peut- jeghers- AD

6979.

22) statistics q on unpaired test

6980.

23) ig in sle c4

6981.

24) q on s5/l1 lesion

6982.

25) ulnar nerve- ? pronator muscles

6983.

26) ankylosing spon- lumbar x- ray

6984.

27) non enhancing lesion on ct- cerebral abscess

6985.

2 alcoholic hepatitis- best inv-?? ct abd

6986.

29) worst prognosis in ra- ?rf negative

6987.

30) spleenomegaly- cml

6988.

32) tear drop cells- myelofibrosis

6989.

34) t(17, 19)- APML

6990.

35) haemolysis in MAHA- DCT +

6991.

36) spleenectomy- s. pneumonniae

6992.

37) alfa 1 antitrypsin- AR

6993.

3 cancer ass with colonic ca- endometrial ca

6994.

39) axillary freckles- neurofibromatosis

6995.

40) scalp ulcer- ?BLL

6996.

41) ERYTHEMA nodosum- sarcoid

6997.

42) decrases TSH and T3, T4-? thyroid harmone resistance

6998.

43) post dc cardoversion- amiodarone

6999.

44) harmone under negative supression????

7000.

45) harmone for libido????

7001.

46) q on positive pred value

7002.

47) q on NNT- 50

7003.

4 necrobiosis lipoidicum- check BM

7004.

50) elderly lady with fall . left side weakness, pupils to right- ?haemorrhage

7005.

51) lymphnodes, clamydia positive- lymphogranuloma venerum

7006.

52) infective endocraditis in iv abuser- ?vancomycin

7007.

53)epistaxix and renal failure- wegeners

7008.

54) PR3 ab- wegeners

7009.

55) goodpastuers renal failure- anti gm ab

7010.

57) renal failure associated with malignacy- membranous

7011.

59) poor prognosis in hodgkins- night sweats

7012.

60) q on mechanism of bnf???/

7013.

61) q on abg's- ??? co poisoning

7014.

62) q on abg's==pulmonary thromoembolism

7015.

63) avoid pregnancy in primary pulmonary htn

7016.

64) epistaxis and essential thrombocythaemia, immediate management-?? hydroxyurea/ aspirin

7017.

65) q on brutons agammaglobulinaemia

7018.

66) post h. pylori treatment- hydrogen breath test

7019.

67) ab in hep b immunisation- hbs antibody

7020.

6 IE- rush to surgery- pr prolongation

7021.

69) bleeding gums- von willibrands

7022.

70) refeeding syndrome- phosphorus

7023.

71) pregnant with trombosis- sinus venous trombosis

7024.

72) confusing and inappropriate urination- frontotemporal dementia

7025.

73) prostate hypertrophy with neuropathic pain- gabapentine

7026.

74) early morning wakefull- depression

7027.

76)q on ptsd

7028.

77) man covering himself in silver foil- scizophrenia

7029.

7 alcoholic with delusions-? delutional behaviour

7030.

79) best treatment for BIH- csf drainage

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.

82) best prophylaxis to avoid variceal bleeding- propronolol

7034.

83) q on generalised maculopapular rash- ?measels

7035.

84) test for cushings- low dose dexamethasone

7036.

85) postural drop in bp with low na and high k- adissons

7037.

86) low b12 following rt hemicolectomy- bacterial overgrowth syndrome

7038.

87) asian female with low vit d- poor exposure to sunlight

7039.

8 men 2a - medullary ca of thyroid

7040.

89) young lady with axillary freckles, no family history-? Neurofibromatosis

7041.

90) rash over the elbows- dermatitis herpitiformis

7042.

91) crypt abscess on histology on a pt with bloody diarrhoea- ulcerative colitis

7043.

92) part of intestine involved in a pt with bloody diarrhoea and abdominal pain, smoker- caecum

7044.

93) ecg changes in pt on amiodarone- qt prolongation

7045.

94) elderly pt with aplastic anaemia picture- myelodysplasia

7046.

95) angioma on fundoscopy with central loss of vision- sub-macular haemorrhage

7047.

96) docetaxel- microtubules

7048.

97) RA- ? tnf alfa

7049.

[98]) diarrhoea with hyperpigmentation- melanosis coli

7050.

99) rash on forehead-?? saeborrhic dermatitis

7051.

100) which parameter of respiration improves after bullectomy????

7052.

101) facial puffiness on hypertensives- amlodipine

7053.

102) reverse transcriptase- rna to dna

7054.

103) statin- grape juice

7055.

104) haemoptysis , rt upper lobe lesion???

7056.

105) g6pd- pyramethamineGuest, Jan 29, 2011#140

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.

8)Guest, Jan 30, 2011#142

7060.

GuestGuestWhy justifying wrong answer ?! it's cerebral venous thrombosis

7061.
7062.

of course !Guest, Jan 30, 2011#143

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.

Coeliac disease is more common in IgA deficiency.Guest, Jan 30, 2011#144

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.

GuestGuestone question from C5(compliment) deficiency: pt had diarrhea

7079.

any one can recallGuest, Jan 30, 2011#147

7080.

GuestGuestpaper1 was very easy bt paper2 was extremely hard.

7081.

Im in dilema. Scared too.... :roll:Guest, Jan 30, 2011#148

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.

had the same papers ..Guest, Jan 30, 2011#149

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.

(You must log in or sign up to reply here.)

7089.

Page 3 of 8
7090.

< Prev

7091.

7092.

7093.

7094.

7095.

7096.

7097.

7098.

7099.
7100.

Next >

Share This Page

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.

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7121.

>

Resources
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7122.

MRCP Forum

7123.

>

7124.

Recalls from MRCP 2011/01

7125.

Discussion in 'MRCP Forum' started by dr_rajib, Jan 19, 2011.

7126.
7127.

Page 4 of 8
7128.

< Prev

7129.

7130.

7131.

7132.

7133.

7134.

7135.

7136.

7137.

Next >

7138.

CceGuestHi samah, which wrong answer did u mean?

7139.

U did MRCP part 1 jan 2011 also?Cce, Jan 31, 2011#151

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.

I have few questions.

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.

GuestGuestDHEAGuest, Feb 1, 2011#156

7149.

GuestGuestDHEA I read in UptoDate that patient with addisson's disease

7150.

and decrease libido should take DHEA to increase libido

7151.
7152.

Patient with essential thrombocytopenia Age ? Tx aspirin or hydroxyure

7153.
7154.

I'm not sure of age i donot remember exactly but sure of the base

7155.

Less than 60 low dose Aspirin

7156.

More than 60 Hydroxyurea

7157.

Any question we can give answer with basisGuest, Feb 1, 2011#157

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.

bestpractice.bmjGuest, Feb 1, 2011#158

7161.

CceGuest10s for the comments. How about these?

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.

3) statistic question - to compare two groups- is it unpaired t test?

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.

2-PT WITH AF POST SUCCESFUL CARDIOVERSION HOW TO RESTORE>>>>AMIODARONE

7179.

3- PULSUS ALTERNANS IN LVF

7180.

4-PT RECEIVED ADENOSINE 6 MG AFTER SVT BUT STILL PERSISTENT THEN WT TO

GIVE>>>ADENOSINE 6 MG?

7181.

5-WT CIMPLICATION AFTER CORONARY ANGIO>>>MI ANOTHER OPTION STROKE

7182.

6-YOUNG PT WITH SEVERE CHEST PAIN INCREASED WITH BREATHING ST AND

TROPONIN MILDLY ELEVATED>>>>PERICARDITIS

7183.

7-PT POST MI WITHSIGN OF STROKE AND ABSENT radial PULSE(TRICKY)>>>STROKE OR

AORTIC DISECTION

7184.

8-REVERSED SPLITTING OF 2ND HEART SOUND>>>>LBBB

7185.

9-When is pregnancy is dangerou>>>PULMONARY HTN

7186.

10-WT S THE BENEFIT FROM BETA BLOKER?>>>DECREASE HEART RATE OR DECREASE

OXYGEN CONSUMPTION TO HEART

7187.

11-PANSYSTOLIC MURMUR IN LT PARASTERNUM FOR VSD

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.

16-QT PROLONGATION IN HYPOCALCEMIAdr-muslim, Feb 1, 2011#160

7191.

dr-muslimGuest2*NEPHROLOGY

7192.

1-YOUNG PATIENT WITH RECURENT UTI AND NOT IMPROVED>>>REFLUX UROPATHY

7193.

2-DM PATIENT WITH PTURIA AND RENAL IMPAIRMENT>>>DM NEPHROPATHY OR

RENOVASCULAR DISEASE?

7194.

3-IV DRUG ABUSER WHICH TYPE OF GN>>>FOCAL SEGMENTAL G.SCLEROSIS?

7195.

(ONE COLLEGEUE SUGGESTED AMYLOIDOSIS?)

7196.

4-PATIENT WITH PERSISTENT NEPHROTIC WHT TO PRESERVE RENAL

FUNCTIONS>>>RAMIPRIL

7197.

6-PATIENT WITH HEMOLYTIC UREMIC SYNDROME WT THE CAUSE>>>E COLI

7198.

7-PATIENT WITH MI AND RENAL IMPAIRMENT WT TO PRESERVE RENAL FUNCTION

BEFORE AND AFTER CORONARY ANDIO>>>NACL IV

7199.

8-GOODPASTURE SYNDROME DEPOSITION OF ANTI GMB

7200.

9-YOUNG PT WITH HEMATURIA>>>IG A NEPHROPATHY

7201.

11-PT E PULMONARY HE AND RENAL IMPAIRMENT AND C ANCA +VE

7202.

12-ANTIMYELOPEROXIDASE IN P ANCA>>>WEGENERS GRANULOMATOSISdr-muslim, Feb

1, 2011#161

7203.

dr-muslimGuest2*NEPHROLOGY(CORRECTION OF PREVIOS POSTE)

7204.

1-YOUNG PATIENT WITH RECURENT UTI AND NOT IMPROVED>>>REFLUX UROPATHY

7205.

2-DM PATIENT WITH PTURIA AND RENAL IMPAIRMENT>>>DM NEPHROPATHY OR

RENOVASCULAR DISEASE?

7206.

3-IV DRUG ABUSER WHICH TYPE OF GN>>>FOCAL SEGMENTAL G.SCLEROSIS?

7207.

(ONE COLLEGEUE SUGGESTED AMYLOIDOSIS?)

7208.

4-PATIENT WITH PERSISTENT NEPHROTIC WHT TO PRESERVE RENAL

FUNCTIONS>>>RAMIPRIL

7209.

6-PATIENT WITH HEMOLYTIC UREMIC SYNDROME WT THE CAUSE>>>E COLI

7210.

7-PATIENT WITH MI AND RENAL IMPAIRMENT WT TO PRESERVE RENAL FUNCTION

BEFORE AND AFTER CORONARY ANDIO>>>NACL IV

7211.

8-GOODPASTURE SYNDROME DEPOSITION OF ANTI GMB

7212.

9-YOUNG PT WITH HEMATURIA>>>IG A NEPHROPATHY

7213.

12-ANTIMYELOPEROXIDASE IN P ANCAdr-muslim, Feb 1, 2011#162

7214.

dr-muslimGuest3*ENDOCRINOLOGY

7215.

1-PT WITH DIARHEA,HYPONATREMIA, HYPERKALEMIA AND

HYPOTENTION>>>ADRENAL INSUFFECIENCY

7216.

2-PT WITH HYPOGLYCEMIA DIAGNOSED AS INSOLINOMA WHICH TEST>>>72 HOURS

FASTIN

7217.

3-PT E CRONS WITH LOW TSH AND FT4 BUT NORMAL FT3 >>>SICK THYROID
(EUTHYROID) OR LOW IODINE INTAKE?,THYROID H RESISTANCE?

7218.

4- PT E PERSISTENT HIGH BP(PHEOCROMOCYTOMA) AND THYROID NODULE AND

NORMAL TFT>>>MEDULLARY CARCINOMA(MEN)

7219.

5-PREGNANT DM MOTHER WITH RECURENT ATTACKS OF

HYPOGLYCEMIA,WHY>>>FETAL INSULIN,TIGHT INSULIN CONTROL?(DEBATABLE)

7220.

6-MECHANISM OF ACTION OF CARBIMAZOLE>>INHIBIT IODIZATION OF THYROXIN

7221.

7-WT TO DECREASE LIBIDO>>>DHEA DEFECIENCY?

7222.

8- WHICH HORMONE UNDER CONTINOUS INHIBITION>>>PROLACTINE

7223.

9- TTT OF PHEOCROMOCYTOMA>>>PHENOXYLAMIN

7224.

10-AQUAPURINE 2 PRESENT IN>>>NEPHROGENIC DIABETES INSIPIDUS

7225.

11- PT WITH CUSHIG(HTN OBESE) HOW TO DIAGNOSE>>>OVER NIGHT

DEXAMETHASONE SUPPRESION TEST

7226.

12 ONE ANSWER WAS >>>REDUCE WEIGHT BUT I COULDNT RECALL THE

QUESTION!!dr-muslim, Feb 1, 2011#163

7227.

dr-muslimGuest4*HEMATOLOGY AND ONCOLOGY

7228.

1-PT E HIGH IG M AND PULMONARY EMBOLISM(WALDENSTROMS)WHT THE

COMPLICATION>>>>HYPERVISCOSITY SYNDROME

7229.

2-PT WITH DRUG INDUCE HEMOLYTIC ANEMIA HOW TO DIAGNOSE>>>DIRECT

ANIGLOBULIN TEST

7230.

3-PT WITH BLEEDING TENDENCY HIGH PTT LOW FACTOR 8>>>VWD(SOME COLLEGUES
SUGGESTED HEMOPHILIA A?)

7231.

4-PT WITH FATIGUE, SPLENOMEGALY AND HIGH WBC>>>CLASSIC CML

7232.

5-T WITH HIP PAIN WITH TTT OF CML >>>AVSCULAR NECROSIS OF HEAD OF FEMUR

7233.

6-PT WITH ANAEMIA ,SKIN RASH AND HEP C>>>CRYOGLUBINEMIA

7234.

7-PT WITH ACUTE PROMYLEOCYTIC LEUKEMIA PROGNOSIS>>>T15-17

7235.

10-ACTION OF DESMOPRESSIN>>EXTRACT STORED FACTOR V

7236.

11-CANCER COLON INCREASE SUSSEPTABILITY OF >>>ENDOMETRIAL CA

7237.

12-PT WITH THROMBOCTHYSEMIA HOW TO TREAT>>>HYDROXYURIA

7238.

13-PT WITH ANAEMIA AND TEAR DROP IN BLOOD FILM>>>MYELOFIBROSIS

7239.

14- WARFARIN ACT ON >>>FACTOR 7

7240.

15-OLD PT WITH PETICHAE AND PERSISTENT PANCYTOPENIA>>>MYELODYSPLASIA

7241.

16-5 YEARS SURVIVAL OF NON SMALL CELL BRNCHOGENIC CA IF GOOD

ELLIMINATED>>>10%OR 20%

7242.

17-DOCXCETEL>>>INHIBITON OF MICROTUBULE

7243.

18-BREAST CA PROGNOSI BY>>>> 15:3

7244.

19-BAD PROGNOSIS IN HODJIGINS LYMPHOMA>>>SWETTINGdr-muslim, Feb 1, 2011#164

7245.

dr-muslimGuest5* INFECTIOUS DISEASES

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.

2-DROG USED IN TTT OF DOG BITE>>> CO AMOXICLAVE

7249.

3-TTT OF GENITAL WARTS>>> PODOPHYYLINE

7250.

4-POST SPLENECTOMY WHICH ORGANISM THE PT IS SUSSEPTIBLE FOR>>>STREPT

PNEOMONAE

7251.

5-PT CAME FROM AFRICA 6 MONTHS BEFORE WITH FEVER AND CHILLS
>>>PLASMODIUM OVALE

7252.

6-PT WITH GENERALIZED RASH ,JOINT PAIN AND POST CERVICAL

LYMPHADENOPATHY>>>MEASLES,RUBELLA OR HEPATITIS A (DEBETABLE)

7253.

7-HERPES LABIALIS ASSOCIATED WITH>>> STREPT PNEUMONAE

7254.

8-TTT OF CLAMIDIA >>>DOXYCYCLINE

7255.

9-PT WITH DIARHEA 2 WEEKS POST OPERATIVE >>>PSEUDOMEMBRANOUS COLITIS

7256.

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??

7257.

11-PT WITH JOINT PAINS AND H/O TRAVELLING ABROAD >>>>GONNOCOCCAL

ARTHRITIS OR REACTIVE ARTHRITIS

7258.

12- PT E BACK PAIN AND FEVER POST PACEMAKER INSERTION DUE TO>>>STAPH
DISCITIS

7259.

13-MOST CONTAGIOUS ORGANISM>>> SVARICELLA ZOSTER

7260.

14 TTT OF PSEUDOMONAS IN BRONCHIECTASIS>>>CIPROFLOXACIN OR

CLARITHROMYCINE

7261.

15 IMMUNOSUPPRESED PT WITH INFECTIVE ENDOCARDITIS(VIRAL OR FUNGAL)WT

TO USE>>> AMPHOTERICIN B OR ACYCLOVIR?dr-muslim, Feb 1, 2011#165

7262.

dr-muslimGuest6*GIT

7263.
7264.

1-PT WITH DYSPHAGIA ,WHEIGHT LOSS , BAD MOUTH ODOUR>>>PHARYNGEAL POUCH

7265.

2-WT CAUSE OF VIT D DEFECIENCY IN PT POST COLECTOMY AND

ILLIECTOMY>>>LACK OF ABSORPTION

7266.

3-PT ALCOHOLIC , ASCITES LIVER CIRROSIS HOW TO DIAGNOSE(POINTS TO SUB ACUTE

BACTERIAL ENDOCARDITIS?)>>>ASCITC FLUID MICROSCOPY

7267.

4-PT WITH LAXATIVE ABUSE(MELANOSIS COLI)

7268.

5-PT DOWN SYNDROME WITH ACUTE ABOMINAL PAIN, DISTENDED ABDOMEN AND
AXR SHOWS DILATED COLON>>>INTUSUCCEPTION

7269.

6- PT WITH RECTAL BLEADIN AND SKIN LESIONS AROUND HIS

LIP>>>>ANGIODYSPLASIA?\

7270.

7-T DIAGNOSED WITH BARRET,S OESPHAGUS HOW TO MANAGE>>>ACID SUPPRESION

THEN ENDOSCOPY?

7271.

9-PT WITH DIARHEA AND CRYPT ABCESS>>ULERATIVE COLLITIS

7272.

11-OBSTRUCTIVE JAUNDICE AND PANCREATITIS WHERE IS THE OBSTRUCTION>>>CBD,

CYSTIC DUCT, HEPATIC DUCT???

7273.

12-T WITH RT ILLIAC FOSSAN PAIN F/H OF COLON CA HOW TO DIAGNOSE>>>CT

ABDOMN AND PELVIS OR COLONOSCOPY

7274.

13-WT IS THE MOST COMMON SITE OF ISCHEMIC COLLITIS>>>>SPLENIC FLECTURE

7275.

14-HOW TO MONITOR PT GIVEN PROPHYLAXIS AGAINST HEP B>>>Hbs antibodiesdr-

muslim, Feb 1, 2011#166

7276.

dr-muslimGuest7*CLINICAL PHARMA AND TOXICOLOGY

7277.
7278.

1-SIDE EFFECT OF SILDENAFIL(VIAGRA)>>>BLUISH VISION

7279.

2-PT ATE FISH THEN DEVELOPED PAIN AND SKIN RASH WT IS THE
CAUSE>>>>>SCROMBOID TOXIN??

7280.

3-PT TOOK MORPHINE AND DIAZEPAM THEN DEVOLOPED EXTRA PYRAMIDAL

MANIFESTATIONS HOW TO TRAT>>>PYROCYCLIDINE OR NALOXONE?

7281.

4- WHICH CAUSE HYPERKALEMIA>>>TACROLIMUS

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.

6-WT CAUSE FACIAL SWELLING>>>AMLODIPINE OR ACE INHIBITOR

7284.

7-PT WITH PICTURE OF ?PULMONARY FIBROSIS OR COPD

7285.

WT IS THE CAUSE>>>NITROFURANTOIN

7286.

8-AMYTRTRYPTALINE OVER DOSE HOW TO TREAT>>>NA BICARB

7287.

9-PT WITH PARACETAMOL OVER DOSE HOW TO MONITOR>>>PT

7288.

10-INTERACTION BETWEEN STATIN AND>>>GRAPE FRUIT

7289.

11- PT WITH DYSPHAGIA,ABDOMINAL PAIN ,DIARHEA WHICH DRUG

RESPONSILE>>>ALENDROIC ACID?

7290.

13-WHICH ANTI HTN DRUG SAVE TO USE WITH PT TAKIN LITHIUM>>>AMLODIPINE?

7291.

14-PT WITH G6PD AND WILL TRAVEL TO AFRICA WHICH DRUG TO

AVOID>>>PRIMAQUINE

7292.

15- PT TAKING ANTI T.B(RIPE)AND BENDROFLUROTHIAZIDE AND HAS JOINT PAIN

WHICH DRUG IS RESPONSIBLE>>>PYRIZINAMIDE OR BENDROFLUROTHIAZIDE?
(DEBATABLE)

7293.

16WHICH DRUG USED FOR MANIA>>>LITHIUM

7294.

17-WHICH DRUG CAUSE MOUTH ULCER>>>>?NICORADINIL

7295.

18 -ONE QUISTION ABOUT NA VALPROATE

7296.

19- ONE QUISION ABOUT ECTASY

7297.

20- ONE DRUG ACTS ON MUSCARINIC RECEPTORS

7298.

(ACTUALLY CANT REMEMBER LAST FOUR QUISTIONS

7299.

BUT I SAW IT IN THE POSTS)dr-muslim, Feb 1, 2011#167

7300.

dr-muslimGuest8*NEUROLOGY

7301.
7302.

1*PT WITH MOTH DEVIATION AND DIFFICULTY OF SWALLOWING,PALATAL DEVIATION

AND ATAXIA WHERE IS THE LESION>>>JAGULAR FORAMEN OR CEREBELLO PONTINE
ANGLE?

7303.

2-PT WITH UPPER QUADRATIC QUADRANTOPIA>>>LESION IN TEMPORAL LOBE

7304.

4-PT WITH PIN POINT PUPIL >>>PONTINE HGE

7305.

5-WHT IS DIAGNOSTIC IN PARKINSONS DISEASE >>>ASSYMITRICAL MOVEMENTS

7306.

6-PT WITH SUB ARACHNOID HGE WHT THE COMPLICATION>>>HYDROCEPHALUS

7307.

7-PT WITH PROGRESSIVE MEMORY IMPAIREMENT

7308.

AND URINATED IN FRONT OF PEOPLE WT THE DIAGNOSIS>>>FRONTO TEMPORAL

DEMENTIA

7309.

8-PT WITH PICTURE OF ENCEPHALITIS AND LESION ON TEMPORAL LESION IN CT

BRAIN>>>HERPES ENCEPHALITIS

7310.

9 OLD PATIENT AGITATED WT TO GIVE>>> HALOPERIDOL

7311.

10-PT IN PURPUERIUM AND HAS HEADACHE AND >>>CAVERNUS SINUS

THROMBOSIS

7312.

11-PT WITH PAINFULL PERIPHERAL NERVE PAIN(PERIPHERAL NEUROPATHY) HOW TO

MANAGE HIS PAIN>>>GABAPENTIN

7313.

12- PT WITH BITEMPORAN HEMIANOPIA>>>LESION IN OPTIC CHIASMA

7314.

13- HOMONYMOUS HEMIANOPIA WHERE IS THE LESION>>>OCCIPITAL LOBE

7315.

14-PT WITH HORNER AND LOSS OF REFLEXES (MOTOR WEAKNESS NOTMENTIONE?)

(LATERAL MEDDULLARY SYNDROME?)

7316.

>>>POSTERIOR INFERIOR CEREBELLAR ARTERY LESION(ONE COLLEGUE SUGGESTED

BRAIN STEM LESION ACTUALLY BOTH CAN B!!)

7317.

16-WT IS MOST RELIABLE SIGNE IN INCRESED INTA CRANIAL HTN?>>>BRADYCARDIA

OR VOMITING?

7318.

17- HOW TO DIAGNOSE HIV PT WHITH TOXOPLASMOSIS>>>MASS OCCUPYING LESION

IN CT BRAIN

7319.

18-ONE QUISTION I CANT REMEMBER BUT BY EXCLUSION >>>SYRINGOBULBIA!!

7320.

19-PT WITH PARKINSONISM DISEAES AND BRADYKINESIA HOW TO

MANAGE>>>BENZHEXOL OR SELEGLINE?dr-muslim, Feb 1, 2011#168

7321.

GuestGuestany one can remember whether any question from Keloid scar?

7322.

Im confused whether any?

7323.

pl reply and good luck :roll:Guest, Feb 1, 2011#169

7324.

GuestGuestThese answers are sure

7325.
7326.

- Jugular foramen

7327.

-WT IS MOST RELIABLE SIGNE IN INCRESED INTA CRANIAL HTN?>>>BRADYCARDIA

7328.

- Amlodipine Allergic Reactions : facial swelling

7329.

7330.

lisinopril facial swelling drug lisinopril drug group lisinopril 7 mg ace

7331.

inhibitors januvia and lisinopril lisinopril versus enalapril ...Guest, Feb 1, 2011#170

7332.

GuestGuest-PT WITH DYSPHAGIA ,WHEIGHT LOSS , BAD MOUTH ODOUR>>>oesaphageal

carcinoma sure

7333.
7334.

-TTT OF PSEUDOMONAS IN BRONCHIECTASIS>>>CIPROFLOXACIN

7335.
7336.

- IMMUNOSUPPRESED PT WITH INFECTIVE ENDOCARDITIS(VIRAL OR FUNGAL)WT

TO USE>>> AMPHOTERICIN B

7337.
7338.

-5 YEARS SURVIVAL OF NON SMALL CELL BRNCHOGENIC CA IF GOOD

ELLIMINATED>>>20%

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.

2.tnf alpha in rheumatoid arthritis

7344.

3.lat epicondylitis

7345.

4.pseudo gout

7346.

5.periarticular erosion

7347.

6.septic arthritis

7348.

7.osteomalacia reduced sun exposure

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.

2. alpha 1 anti trypsin inheritance AR

7355.

3.increased KCO with pulmonary hemorrhage

7356.

4.narcolepsy

7357.

5.carcinoid upper lobe collapse with hemoptysis

7358.

6.vital capacity or flow loop..?

7359.

7.monophonic wheeze

7360.

8.reactive pneumonitis

7361.

9.which improves after bullectomy KCO

7362.

10.pleural biobsy

7363.

Rheumatology(+4 left ones)

7364.

AS polygenic

7365.

sarcoidosis

7366.

alkaptonuria

7367.

Back pain sinister sign URINE hesitancycaashif, Feb 1, 2011#173

7368.

caashifGuestPsychiatry:

7369.

2.schizophrenia

7370.

3.pseudo psycho seizure

7371.

4.PTSD

7372.

5.paranoid personality

7373.

Dermatology

7374.

1. Acne rosacea

7375.

2. irresponsive to topical steroid dermatitis herpitiformis

7376.

3.BCC

7377.

4.nodule

7378.

5.necrobiosis lipodica

7379.

6.SJS

7380.

7. penile /anal warts podophyllin

7381.

8. oral terbinafinecaashif, Feb 1, 2011#174

7382.

caashifGuestMiscellaneous:

7383.

stats:

7384.

1.NNT 50

7385.

3.bias

7386.

5. p value

7387.

6.unpaired t test

7388.

[b]Psychiatry [

7389.

1. early morning wakening depression

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.

9.return from indo nesia i/v fluids

7400.

10.essential HTN

7401.

11.PMR/ Rheumatoid arthritis

7402.

12.Docetaxil( not sure whether already given in pharma)

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.

pelvic x ray mri knee... and y..?

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.

caashifGuestdr mslim plus caashif total 181 questionscaashif, Feb 1, 2011#178

7414.

GuestGuestI agree with nearly all dr.caashif and moslem

7415.
7416.

but why not malingering and why not OSA ?

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.

GuestGuest1. lesion on lip cause of Gi bleed angiodysplasia

7426.
7427.

2.for parkinson treatment carledopa

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.

GuestGuestAngiodysplasia = Vascular malformation on lips + GIT bleedingGuest, Feb 2, 2011#184

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.

PconGuestPlus, according to emedicine:

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.

GuestGuestWhere does Angiodysplasia most often occur?

7439.

Cecum and Right Colon

7440.

What age range is Angiodysplasia most common in?

7441.

> 50 yoa

7442.

What two diseases may Angiodysplasia be associated with?

7443.

Hereditary Hemorrhagic TelangiectasiaGuest, Feb 2, 2011#187

7444.

GuestGuestpass marks?Guest, Feb 2, 2011#188

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.

1-PT WITH DYSPNEA DURING HIS WORK(PAINTING?) AND RESTRECTIVE LUNG

PATTERN>>>HEPERSENSITIVITY PNEUMONITIS?

7450.
7451.

2- PT WITH MESOTHELOMA AND PLEURAL FLUID HOW TO DIAGNOSE>>>CLOSED LUNG

BIOPSY,FINE NEEDLE ASPIRATION,THORACOSCOPY?(DEBATABLE)

7452.
7453.

3-NON SMALL CELL CLINICAL SIGNS>>>>MONOMORHIC RHONCHI?

7454.
7455.

4-PT WITH DYSPNEA , RESP ALKALOSIS AND HYPOXIA FOR ONE

MONTH>>>PULMONARY EMBOLISM?

7456.
7457.

5-YOUNG PT WITH HEMOPTYSIS MILD SMOKER AND UPPER LUNG COLLAPSE

>>>CARCINOID TUMOUR OR BRONCHIAL CARCINOMA?

7458.
7459.

6-PT WITH DYPNEA ,CHEST PAIN AND INCREASED TLCO>>>>PULMONARY HGE

7460.
7461.

7-PT WITH SEVER DYSPNEA,RESPIATORY ALKALOSIS (COULDNT REMEMBER THE

REST OF QUISTION?)BUT WE AGREED THE ANSWER IS B ASHMA(AS PER ON

EXAMINATION)
7462.
7463.

8- PT WITH DYSPNEA , SKIN LESIONS AND BULKY MEDIASTINUM ON CXR>>>

SARCOIDOSIS

7464.
7465.

9- PT WITH PNEUMOTHORAX WHT TO AVOID>>>TRAVEL BY PLANE FOR 3 MONTHS OR

FOREVER OR AVOID DIVING FOR 3 MONTH OR FOREVER

7466.

10-WHT IMPROVE AFTER BULLECTOMY>>>FEV1 OR VITAL CAPACITY?

7467.
7468.

11-LONG STANDING SMOKER PT WITH OBSTRUCTIVE PATTERN AND CXR SIGNS

OF>>>>EMPHYSEMA??

7469.

13- PT OBESE BMI 32 AND DAYTIME SOMNOLENSE AND SUDDEN LOSS OF

CONSIOUSNESS IN FRONT OF TV>>THIS QUISTION IS EXTREMELY VAGUE BUT I THINK
OBSTRUCTIVE SLEEP APNEA IS MORE CORRECT THAN NARCOLEPSYDR-MUSLIM, Feb 2,
2011#191

7470.

DR-MUSLIMGuest10*RHEUMATOLOGY

7471.
7472.

1-ELDERLY ALCOHOLIC PATIENT FOUND COLLAPSED,HYPOTHERMIA

(RHABDOMYOLYSIS)WT TO CHECK>>>CREATININE KINASE

7473.
7474.

2-PT DM,WITH LIMITED MOVEMENT OF SHOULDER JOINT IN ALL

DIRECTION>>>ADHESIVE CAPULITIS?

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.

4-WHICH ONE HAS BAD PROGNOSIS IN RHEUMATOID ARTHRIITIS>>>PERIARTICULAR

EROSIONS,MORE THAN 2HOUR MORNING STIFFNESS

7479.
7480.

5-PT WITH JOINT PAIN ,MORNING STIFFNESS, NO MUSCLE WASTING RH

+VE>>>>RHEMATOID ARHRITIS

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.

8- PT WITH CREST AND ANTICENTOMERE +VE >>>1RY PSJOGREN OR LIMITED

PSJOGREN?(NOT SURE ABOUT THE RECALL

7488.
7489.

9-PT WITH KNEE PAIN AND SWELLING AND X RAY SHOWED

CALCIFICATION>>>PSEUDOGOUT

7490.
7491.

10-PATHOGENESIS OF RHEMATOID ARTHRITIS>>>TNF

7492.
7493.

11-SLE DEFECIENY IN>>>C4

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.

14- PT WITH TENNIS ELBOW(RADIAL NEVRVE INTRAPEMENT)>>>LATERAL

EPICONDYLITISDR-MUSLIM, Feb 2, 2011#192

7500.

DR-MUSLIMGuest10*RHEUMATOLOGY(CORRECTION

7501.
7502.

1-ELDERLY ALCOHOLIC PATIENT FOUND COLLAPSED,HYPOTHERMIA

(RHABDOMYOLYSIS)WT TO CHECK>>>CREATININE KINASE

7503.
7504.

2-PT DM,WITH LIMITED MOVEMENT OF SHOULDER JOINT IN ALL

DIRECTION>>>ADHESIVE CAPULITIS?

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.

4-WHICH ONE HAS BAD PROGNOSIS IN RHEUMATOID ARTHRIITIS>>>PERIARTICULAR

EROSIONS,MORE THAN 2HOUR MORNING STIFFNESS

7509.
7510.

5-PT WITH JOINT PAIN ,MORNING STIFFNESS, NO MUSCLE WASTING RH

+VE>>>>RHEMATOID ARHRITIS

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.

8- PT WITH CREST AND ANTICENTOMERE +VE >>>1RY PSJOGREN OR LIMITED

PSJOGREN?(NOT SURE ABOUT THE RECALL

7518.
7519.

9-PT WITH KNEE PAIN AND SWELLING AND X RAY SHOWED

CALCIFICATION>>>PSEUDOGOUT
7520.
7521.

10-PATHOGENESIS OF RHEMATOID ARTHRITIS>>>TNF

7522.
7523.

11-SLE DEFECIENY IN>>>C4

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.

14- PT WITH TENNIS ELBOW(RADIAL NEVRVE INTRAPEMENT)>>>LATERAL

EPICONDYLITIS

7527.
7528.

15 -PT WITH OSTEOMALICIA AND VIT D DEFECIENCY DUE TO>>>LACK OF SUN

EXPOSURE,VEGITARIAN DIETDR-MUSLIM, Feb 2, 2011#193

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.

GuestGuestpass marks?Guest, Feb 2, 2011#195

7531.

GuestGuestExamination Pass Mark: nearly 521 from score of 999

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.

GuestGuestpass marks out of 200 for jan 2011?Guest, Feb 2, 2011#198

7537.

GuestGuestguys the result is too soon ...

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.

and it feels horrible..

7542.

seriously guys ..how much correct answers we need to pass thru that hell/exam ..

7543.

plz guyz someone say something ..

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.

plz any input in this guyz ..Guest, Feb 3, 2011#199

7546.

GuestGuestWhen ?Guest, Feb 3, 2011#200

7547.

(You must log in or sign up to reply here.)

7548.

Page 4 of 8
7549.
7550.

7551.

7552.

7553.

7554.

7555.

7556.

7557.

7558.
7559.

Share This Page

7560.
7561.
7562.
7563.
7564.

Forums

7565.

>

7566.

UK Medical Zone

7567.

>

< Prev

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7568.

MRCP Forum

7569.

>

7570.
7571.
a.

Search Forums

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Recent Posts

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7572.
7573.

Resources

7574.

Log in or Sign up

7575.
7576.
7577.

Forums

7578.

>

7579.

UK Medical Zone

7580.

>

7581.

MRCP Forum

7582.

>

7583.

Recalls drom MRCP 1 Jan 2010

7584.

Discussion in 'MRCP Forum' started by drrajib, Jan 19, 2010.

7585.
7586.

Page 1 of 13
7587.

7588.

7589.

7590.

7591.

7592.

7593.

7594.

13

7595.

Next >

7596.

drrajibGuestLets start memorizing questions and discuss them....drrajib,

7597.

drrajibGuest1. Skin lesion and lt ankle sweling..prognosis??

7598.

2. Cause of death in a renal pt receiving HD for 5 yrs??

7599.

3. Causative organism for infected peritoneal dialysis patient??

7600.

4. Ant ST seg elevation MI following GI surgery..Rx option besides anti platelets??

7601.

5. What to do in a patient receiving clopidogrel prior to abd surgery??

7602.

6. Empyema inv.??USG/CT?

7603.

7. Primary pneumo with rim of air <2 cm??

7604.

8. Anti TB with decreased visual acity??

7605.

9.drrajib, Jan 20, 2010#5

7606.

saadi10Guestmrcp jan2010

7607.
7608.

1 suspected pe findings on cxr

7609.

2 person has hematuria father and brother had same

7610.

3 herpetic virus 8 virus causes

7611.

4 type amylodosis al /aa in person with myeloma

7612.

5speceked pattern with tight skin ?scl 70

7613.

6baby lupus ? ro antibodies

7614.
7615.

8 restrictive lung function with raised KCO ?pul heamorraghe

7616.

9obstructive fev/fvc ratio with reduced kco emphysema

7617.

10dna probe to identify rna

7618.
7619.

lsaadi10, Jan 20, 2010#6

7620.

drrajibGuest1. Resp Pathogen for CF pt?

7621.

3. Footballer with sudden cardiac arrest?

7622.

4. Inf MI ECG?

7623.

5. Cons pericarditis ECG??

7624.

6. Poor outcome in a VSD pt with pg??

7625.

7. Her angio neurotic oedema cause of plasma leakage?

7626.

8. CxR of PE?

7627.

9. Dx of PE?

7628.

10.drrajib, Jan 20, 2010#7

7629.

drrajibGuest1.APCKD pt brother refused for kidney donation?drrajib, Jan 20, 2010#8

7630.

MRCPaspirantGuest* seizures, hypomelanotic patches, multiple renal cysts, periungua fibromas

-TUBEROUS SCLEROSISMRCPaspirant, Jan 20, 2010#9

7631.

GuestGuestpsychogenic aphonia or mustism in the woman whom here son disobey here

7632.
7633.

ATN OR AIN OR minimal change nephropathy In diclofenac in woman aged 60

7634.
7635.

traces of canaboid ??? canboid abuse or psychotic depression

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.

ANKYLOSING SPONDYLIS WHAT TO SEE IN X RAY OF LUMBO SACRAL

7642.
7643.

XRAY IN PUL . EMBOLISM ???

7644.
7645.

CLOPIDOGREL STOP TO AVOID BLEEDING AFTER 24H OR STOP AND USE LMWH

7646.
7647.

ODD RATIO ?? QUESTION

7648.
7649.

PLEURAL EFFUSION DIDNT GET ASPIRATED ?? I ANSWER LAT CHEST XRAY

7650.
7651.

ANATOMY: SCIATICA AND LONG THORACIC NERVE AND ABDUCTOR POLLICES PREVIS

7652.
7653.

DISSOCIATED SENSORY LOSS ?? CENRAL CANAL !Guest, Jan 20, 2010#10

7654.

GuestGuest1. Subacute IE. treatment? Benpen + gent

7655.

2. litium toxicity. precipitant. ?ramipril

7656.

3. chronic CML, (?not candodate for imintab). ? a-interferon or ?hydroxycarbamide

7657.

4. Discoid lupus on steroids. ?next treatment. ? hydroxychloroquine.

7658.

5. Young pt had appendicectomy then went into shock (?sepsis - abscess). investigations ?clotting
screen ?DIC

7659.

6. Pt with face swelling (on ACEi, Statins ..) ? precipitant

7660.

7. Macrocytic aneamia with antibodies to parietal cells. ?biopsy (?gastric wall)

7661.

8. chikenpox developed pneumonia ?treatment

7662.

9. ?mediator in anaphylaxis

7663.

10. ?test to confirm transfusion haemolytic reaction

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.

13. Pt thinks he's got cancer --? hypochondria disorder

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.

GuestGuestEGYPT?? SALMONELA OR SHIGELLA

7670.
7671.

ANKLE SWELLING----CA CH BLOCKER

7672.
7673.

BLUE VISION----SILDENFIL

7674.
7675.

CONTROL HT RATE IN AF ---BISOPROLOL

7676.
7677.

AF ---HAEMODYNAMIC LOW----DC

7678.
7679.

BELLS PALSY---- LACRIMATION OR SALIVATION OR HYPERACUSIS OR HYPERATHESIA

7680.
7681.

CSF WITH HIGH LYMPOCYTE AND PROTEIN AND GLUCOSE 3.3 ---GUILLAN BARRE OR

POLIOGuest, Jan 20, 2010#12

7682.

saadi10Guestmrcp jan 2010

7683.

2symptoms of unwell diarrohea post terminal illeum removal ? bile salt irritation

7684.

3 lower quadrant visual symptoms what next investigation

7685.

4 dilated pupil slowly reacting to light irregular ?adie pupil

7686.

5 raised cholestrol ,ldl,triglycerides tx atrorva /simvas

7687.

6 hypokalemia ecg shows U waves

7688.

8 smalll ca with siadh

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.

JAK-2 MutationGuestSalaam all

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.

1.JAK 2 mutation --- PRV

7696.

2.Mother upset by her son's disobedience, presented mute but movement ok-- Depression ???

7697.

4. ITP 2 questions

7698.

5. Tuberous Sclerosis (periungual fibroma)

7699.

6. Pt seeing Dog lying in next bed--Alcohol withdrawal

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.

9. Lady with hip pain but all movements normal--Osteoarthritis

7703.

10. Positive predicted value---I screwed that up

7704.

11. Standard deviation

7705.

12. Lady with hypertension, hursutism and weight gain---PCOS or CAH ?

7706.

13. Lyme

7707.

15. Carbamazepine autoinduction

7708.

16. Respiratory depression in an overdose--Diazepam ??

7709.

17.Ring Enhacing Lesion-Toxoplasmosis

7710.

19. Glucose Tolerance test with Plasma growth hormone measurement

7711.

20. Man from india with jaunced picture--Hep A

7712.

21. Bloating, pain, long standing diarrhoea--Giardiasis

7713.

22. Typpical picture of Multiple Myeloma with unmeasured extra Immunoglobulins in blood + Bence
John's Protein

7714.

24. Anti-Ro ----Heart block

7715.

25. Cyclosporin--Nephrotoxicity

7716.

26. FEV1/FVC low -- Emphysema

7717.

27. ABGs given -- Mixed Metabolic acidosis and respiratory acidosis

7718.

28. Alopecia--Phenytoin

7719.

30. Inflamatory infiltrates in lamina propria+Granuloma --- Crohn's

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.

33.Widespread ST elevation in anterior leads -- Constrictive Pericarditis

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.

36.Thyroid Nodule in a totally asymptomatic patient---Fine Needle Biopsy ??

7726.

37. Minimial Change disease

7727.

38. Henoch Schonlien Purpura

7728.

39. Lorry driver with chest x-ray having calcification--TB

7729.

40.Hypokalaemia, what else is found----U wave on ECG

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.

44. Hypertension in Pregnancy -- Methyldopa

7733.

45. Pt with low BP, Hickman Line insterted presents with various electrolyte abnormalities, what else
can be expected -- Hypophosphataemia

7734.

46. Pt with low BP and AF -- DC cardioversion

7735.

49.50.Short Synacthen test

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.

54. Coronary Vasospam--give Calcium Channel Blocker

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.

56. Pt with typical DLE -- give HydroxyCholoquine

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.

61. Patient with SIADH -- Fluoxetine

7747.

62. Prophylaxis for Trigeminal Neuralgia-- I just marked Phenytoin. Please correct me.

7748.

63.Lithium toxicity ---Concomittant use of ACE-Inhibitor

7749.

64. Rheumatooid Arthritis patient alread on Diclofenac Sodium,what should be started next-Methotrexate

7750.
7751.

This is all I can recall by now.

7752.

Please share more to make a complete list. Thanks and good luck to all.

7753.

May Allah pass us all...AmeenJAK-2 Mutation, Jan 20, 2010#14

7754.

saadi10Guestammeen

7755.
7756.

alopecia is casued by valproate

7757.

treatment of neuralgia is carbamazepine

7758.

pt on digoxin /warfarin still af uncontrolled i wrote bioprolol ??

7759.

pt on dialysis i wrote ischeamic heart disease something related

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.

thyroid nodule i agree it can only be FNA

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.

atn sec to 10 day use of diclofenacsaadi10, Jan 20, 2010#15

7765.

GuestGuestSalam 3aleekom

7766.
7767.

i agree with most of ur choices , those i recall

7768.
7769.

1-28 y with DM why type 1 age, bicarb, acetone i chose age

7770.
7771.

2-Melanoma Depth

7772.
7773.

3-18 y f eczema and recent small pustule at face and UL topical steroid

7774.

4- single nucleotide polymorphism i chose predict protein

7775.

5-Huntington chance of sun to be carrier 50%???

7776.
7777.

7778.
7779.
7780.

however, let us discus these

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.

10. Positive predicted value---I screwed that up---------50%

7787.
7788.

11. Standard deviation----------------SEM

7789.
7790.
7791.

12. Lady with hypertension, hursutism and weight gain---PCOS or CAH ? -------PCO there was high
LH:FSH ratio

7792.

16. Respiratory depression in an overdose--Diazepam ?? ------i chose dihydrocodien PLS discus

7793.
7794.

36.Thyroid Nodule in a totally asymptomatic patient---Fine Needle Biopsy ?? i chose scan discus

7795.
7796.

37. Minimial Change disease--- MGN sicus

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.

63.Lithium toxicity ---Concomittant use of ACE-Inhibitor ----------Ca channel ??//increas toxicity

Guest, Jan 20, 2010#16

7814.

dr.wesamGuest1. Heart block after inferior MI. ?RCA occlusion

7815.

2. Guillain-Barre ?monitor respiratory function ?FVC

7816.

3. 13y after valve replacement. anaemic ? haemolysis

7817.

6. Lady with excessive hair --> SE of: ciclosporin

7818.

7. Acoustic neuroma --? absent corneal reflex

7819.

8. Betablocker overdose with bradycardia not respond to atropine. Next managment --> glucagon
(repeat question Jan 2006)

7820.

9. Hypopigmentated areas round the eyes in pt with thyrotoxcitosis ? vititligo

7821.

10. Male with severe pain behind eye worse in the morning --? ?trigeminal neuralagia

7822.

11. Unwell young pt with lymphoadenopathy --> grandular fever (EBV)

7823.

12. JAK2 mutation --> Polycythaemia ruba vera

7824.

13. Idiopathic parkinson --> ?tremor

7825.

15. Pt with polyarthritis and anti-CCP --> ?RA

7826.

16. Northern blotting to detect RNA

7827.

17. Weight loss for obstructive sleep apnoea

7828.

18. Prophylaxis in trigeminal pain --> carbamezipine

7829.

19. New AF in compromised pt --> DC shock

7830.

21. Lady with tenderness + pain lateral R hip --> I wrote bruisitis

7831.

22. A question on sensitivity

7832.

23. Positive predicted value TP/FP+TP

7833.

24. Respiratory depression due to overdose --> dihydrocodeine

7834.

25. Ring enhancing lesion --> Toxoplasmosis

7835.

26. Obese lady with deranged LFTs and USS prognostic --> Nonalcoholic steatahepatits

7836.

27. Hypokalemia --> flattened P wave

7837.

28. Refeeding syndrome --> low phosphate

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.

31. DLE --> hydroxychloroquine

7840.

32. Dandruf --> ketoconazole

7841.

33. Fall and loss of pain and temperature and joint sensation preserved --> ?cervical disc prolapse
dr.wesam, Jan 20, 2010#17

7842.

saadi10Guestfew more that i can barely remember

7843.

plz help give answers

7844.

testicular feminization ? male with female gentalia

7845.

mitochondrial disease shows ?optic atrophy

7846.

polypeptide degradation occurs in ?? endoplasmic reticulum

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.

cause of pnuemonia in a 50 year old ?mycoplasm/h influenza

7850.

a patients cxr showing 2-5mm calcified lesion ???

7851.

recent colonic operation now severe chest pain management ? nitrates

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.

dx of parkinsonism i wrote repeated falls ( signifies ridigidty )

7855.

recently had chemotherapy now has neuropathy ? cause cyclophosphamide /vincristine

7856.

shin lesion with ankle swelling ?resolves

7857.

cause of raised urinary sodium

7858.

treatment of immune thrombocytopeniasaadi10, Jan 20, 2010#18

7859.

2. carbamazemine autoinduction

7860.
7861.
7862.

3. valporate hair loss

7863.
7864.

4. cyclosporin excessive hair

7865.
7866.

5.patient suffered peripheral neuropathy , had chemo whic medication to stop ? vincristine

7867.
7868.

6. mismatch blood transfusion what test to confirm ? direct coombs test

7869.
7870.

7. Ring enhancing lesion on CT aids patient ( toxo )

7871.
7872.

8.

7873.
7874.
7875.

10. Mild headache in elderly which investigation ? ESR

7876.
7877.
7878.

11. Patient having unequal pupil and Ptosis ( Horner) which investigation to confirm ? cxr

7879.

12. CSF showing 100 lympho plus high protien ? TB

7880.
7881.

13. Ankylosing spondylosis what will present in Lumbar xray ? sclerosis / osteophyste / sydem/ wedge
shape

7882.
7883.

14. patient with hip pain and lateral tenderness ? Osteoarthritis

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.

19 . patient on 5 HTN medications develops ankle edema amlodipine/ doxazocin / monoxidine

7891.
7892.

20 . Preg HTN methyldopa

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.

28 . GB syndrome patient asking for Vital capacity i think

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.

31. Pulmonary HTN best investigation ? Echo / ctpa / vq scan

7910.
7911.

32 . caviating lesion with RF ? Wegners

7912.
7913.

33. weight loss / hemoptysis / hyponatremia which lung ca ? small cell

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.

36 . Type 2 dm obese which medication first metformin

7920.
7921.

37. thyroid mass with normal TFT which investigation next ? FNAC ? radioisotope scan

7922.

39 . question asking about absent ciliary reflex

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.

44. RTA which will be present renal stones

7927.
7928.

45 . Cushing meatbolic alkalosis

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.

? brachia site stenosis / dissection / GCA

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.

51 . lady taking carbimazole develops hypopig around eyes ? vitiligo

7943.
7944.

52 . Discoid lupus not responding to normal treatment what next

7945.
7946.

53 . MMSE

7947.
7948.

54 . qusetion about drug induced Diabetes inspidus

7949.
7950.

55 . idiopathic PD ? symmetrical bradykinesia

7951.
7952.

56 . Acromegaly invest OGGT and growth harmone

7953.
7954.

57 . copd with PE which invetigation ? CTPA ? V/Q scan

7955.
7956.

58 . patient blood gas showing mixed metabolic and resp acidosis

7957.
7958.

59 . patient blood gas showing type 2 resp failure diagnosis copd / Asthma

7959.
7960.

60 . RA anti ccp positve

7961.
7962.

61 . RA treatment metho / pred

7963.
7964.

62 . patient ABPA admitted with exacerbation what to give first ? steroids ? itraconazole / neb saline /
neb steroids

7965.
7966.
7967.

63 . patient with Hypokalemia what will ECG shows

7968.
7969.

64 . patient with Pericardial rub What will ECG shows ? small complex

7970.
7971.

65 . Ramipiril most common side effect cough

7972.
7973.

66 . pateint with facial edema ? which medication ramipirl

7974.
7975.

67 . Patient on lithium HTN medication made levels high ? ACE

7976.
7977.

68 . Cholestrol emboli what will in the blood ? eosinophilia ? thrombopcytopia

7978.
7979.
7980.
7981.

69 Patient with features of DIC what investigation ? coagultion ? d dimers

7982.

71.another question with neutropnia what to give GCFactor

7983.
7984.

72 . question about reactive arthirtis affectiong knees ankle and sole rash

7985.
7986.

73 . 2 questions of Herpes patient ? iv acyclovir

7987.
7988.

74 . myxoma where left atra / right atria / ventricles

7989.
7990.

75 . clusture headache question

7991.
7992.

76 , Perxisome straight forward question

7993.
7994.

77 . Hypercalcemia patient recieving fluids 4 hrs qhat next pamidranate

7995.
7996.

78 . Hypercalemia but low PO which is increasing ca reabsorbtion ? PTH / 1 , 25 / Hypophostemia

7997.
7998.

79 . 2 questions of Primary Hyperparathyroid

7999.
8000.

80 . Question about prolactinoma

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.

85 . question about PBC

8008.
8009.
8010.

86 question of Autoimmune Hepatis

8011.

87 cystic fibosis what chance of sister being carrier or effected cant remember the exact qyuestion ? 1:4
? 2:3

8012.
8013.

88 . tubeorus scleosis two question asking association polycystic kidney

8014.
8015.

89 . diabetic patient with B/L small kidneys and protienuria and mild renal derangement ?
Amylodosis ? diabetic nehropathy ? renavascular both kidneys

8016.

91 . CML treatment Imatinib

8017.
8018.

92 . question of grave disease

8019.
8020.

93 . megaobastic anaemia ileal resection

8021.
8022.

94 . another question with high MCV cause ? b12 def ? folate def

8023.
8024.

95 . parietal lobe infarction patient unable to read ? agraphia

8025.
8026.

96. patient with glucose in urine fasting and 2 hr normal feeling tired and lethargic ? Renal glucosuria

8027.
8028.

97 . medical student think he is dean of the university

8029.
8030.

98 . hemibalissmus wher is lesion ? subthalamic ? substania nigra ? caudate nucleus

8031.
8032.

99 . separate RNA from DNA ? northern blotting ? hybri

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.

ThanksCT 1, Jan 20, 2010#19

8039.

aladdin80GuestStridor, dysphagia (Flow volume loop)aladdin80, Jan 20, 2010#20

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.

drrajibGuestRing Enhacing Lesion-Toxoplasmosis

8043.

I thought the question said single Ring Enhacing Lesion, which should be CNS lymphomadrrajib, Jan
20, 2010#23

8044.

Fed upGuest-Site of action of bendrofluthiazide

8045.

- low hb . low MCV ? cause ? ascaris and others

8046.

-Alcohol withdrawl with seeing dog next to bed

8047.

-X-ray changes in AS

8048.

-pregnant lady with raised amylase

8049.

-Duch Ms Dystrophy with grand children inheritance

8050.

-girl with FH of 2 brothers with ?> weakness . mum negative..mode of inheritance?

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.

1.Which patient can be left in multi-bed area

8055.

2.Pregnant lady with raised amylase

8056.

3.Causative organism for infected peritoneal dialysis patient

8057.

4.Intermittent painful defecation with fresh blood in young lad

8058.

5.Blue vision is seen in?

8059.

6.Huntington chance of son to be carrier

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.

8.Hemiballismus where is lesion ?MRCPaspirant, Jan 20, 2010#26

8062.

MRCPaspirantGuestAlso, thought Ill give my explanations for some questions with controversial

answers
8063.

Site of polypeptide degradation Proteosome /wwwproteasomescom/

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.

JohnyGuest, Jan 20, 2010#28

8067.

JohnyGuest1. Causative organism for infected peritoneal dialysis patient??

8068.
8069.

2. Anti TB with decreased visual acity??

8070.
8071.

3. person has hematuria father and brother had same

8072.
8073.

4. Cons pericarditis ECG??

8074.
8075.

5. ANATOMY: SCIATICA AND LONG THORACIC NERVE AND ABDUCTOR POLLICES

PREVIS

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.

10. Lorry driver with chest x-ray having calcificationTB

8087.

11. Huntington chance of sun to be carrier 50%???

8088.
8089.

12. Male with severe pain behind eye worse in the morning --? ?trigeminal neuralagia

8090.
8091.

13. Weight loss for obstructive sleep apnoea

8092.
8093.

14. a patients cxr showing 2-5mm calcified lesion ???

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.

18. caviating lesion with RF ? Wegners

8102.
8103.

19. question asking about absent ciliary reflex

8104.
8105.

20. Ramipiril most common side effect cough

8106.
8107.

21. pateint with facial edema ? which medication ramipirl

8108.
8109.

22. another question with neutropnia what to give GCFactor

8110.
8111.

23. clusture headache question

8112.
8113.
8114.

24. Perxisome straight forward question

8115.

25. Hypercalcemia patient recieving fluids 4 hrs qhat next pamidranate

8116.
8117.

26. Hypercalemia but low PO which is increasing ca reabsorbtion ? PTH / 1 , 25 / Hypophostemia

8118.
8119.

27. hemibalissmus wher is lesion ? subthalamic ? substania nigra ? caudate nucleus

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.

29. MANN whitney U or chie sequard ??

8124.
8125.
8126.

30. Duch Ms Dystrophy with grand children inheritance

8127.
8128.

31. girl with FH of 2 brothers with ?> weakness . mum negative..mode of inheritance?

8129.

- SE of drug being compared on both sides of face, best statistical rest ?

8130.
8131.
8132.

32. which patient can be left in multibed area - Legionell, Varicella etc etc

8133.
8134.

33. Pregnant lady with raised amylase

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.

MRCPaspirantGuest* Mediator for Hereditary angioedema - Bradykinin

8139.

REF - Clinical Immunology,Volume 114, Issue 1, January 2005, Pages 3-9

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.

Answer is rheumatoid arthritis

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.

(ref: quoted earlier) /wwwspringerlinkcom/content/m24q5784428h2m3n/.

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.

relaxedGuestmrcp part one

8164.
8165.

this forum had been very helpful for giving part one , so i am back to post the questions.

8166.

the ones that are not mentioned are-

8167.

1 . earliest sign of acoustic neuroma- absent corneal reflex.

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.

5.case of hameturia in pt, his borother and father- Ig A nephropathy

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.

stop clop and start lmwh

8175.

stop clop and increase asprin

8176.

delay surgery by 6 months

8177.

7. seborrheic dermatitis - treatment ?ketoconazole

8178.

8. 25 year old with hematuria- normal usg, creat- investigation ? cystoscopy

8179.

10. drug induced diabetes insipidus was fluoxetine

8180.

11. young girl with tooth erosion and decreased na, K , ca, ? bullemia nervosa

8181.

13.decreased tlco, fev1, increased tlc-

8182.

emphysema

8183.

14. decreased tlco and kco 150% of predicted? in pt of systemic sclerosis with prog breathlessness : ?
effusion or diaphgrammatic weakness

8184.

16. bloody diarrhea not responded to metro 5 days

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.

ALL,or infectious mononucleosis

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.

21. poisoning with loss of vision after 24 hrs- ? methanol

8198.

22. pt with chest pain ,hemoptysis- PE like pcitre commonest x ray finding-

8199.

normal xray or wedge shaped infarct

8200.

23. ds caused by hhv 8 -kaposi sarcoma

8201.

24. b/l basal cylindircal bronciectasis - likely organism ? staphy

8202.

25. operated 2 days back for colorectal ca, develos AMI- after apsirin clop, best t/t

8203.

: primary angioplasty

8204.

26. chest pain suggested of pericarditis

8205.

ecg finding-

8206.

diifuse st elevation

8207.

27.acromegaly- invgn-

8208.

glucose tolerance with gh measurement

8209.

28. young lady with hypogly- what to measure next- insulin and c peptide or sulphonylurea level

8210.
8211.
8212.
8213.
8214.

will get back with more as i recollect.

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.

GuestGuestthanx relaxed i did it ketosis too

8219.
8220.

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

8221.
8222.

INSULIN AND C PEPTIDE SURE

8223.
8224.

PRIMANRY ANGIOPLASTY SURE IT IS SUPERIOR TO THROMBLYTICS WHENEVER

AVAILABLE WE SHOULD DO ITGuest, Jan 20, 2010#40

8225.

site of action of acetazolamide

8226.

many pharmacology questions....u1320918, Jan 20, 2010#44

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.

man with history of acute MI

8232.

gilbenclamide

8233.

metformin

8234.

1v insulin

8235.

s/c insulin

8236.
8237.

in standard deviation which value doesnt come under 2sd???

8238.
8239.

8240.

5.30

8241.

10

8242.

95

8243.

97.5

8244.
8245.
8246.

ECG changes in Hypokalaemia

8247.

prominent U wave

8248.

commonet site for Myxoma??/

8249.

RA/Rv

8250.
8251.

Not able to abduct arm Nerve involved??

8252.

axillary N

8253.
8254.

Man with slight rise in Urinary proten 2+???

8255.
8256.

minimal change

8257.

glomerular nephritis

8258.
8259.
8260.

testicular feminisation??winner2010, Jan 21, 2010#47

8261.

GuestGuestDoes anyone remember the liver biopsy question ? I answered obesity as contraindication,
any other ideas ?

8262.
8263.

Those are the contraindications from emedicine :

8264.
8265.

Uncooperative patient5

8266.

Inability to identify a suitable biopsy site by either percussion or ultrasonographic guidance

8267.

Prolonged (>1.5) international normalized ratio (INR)6

8268.

Decreased platelet count (<60,000/mm3)

8269.

Bleeding diathesis (eg, hemophilia)

8270.

Recent use (within the last 7 days) of aspirin or nonsteroidal anti-inflammatory drugs (NSAID) or
antiplatelet class of medications

8271.

Unavailability of blood products for transfusion

8272.

Morbid obesity of patient

8273.

Ascites

8274.

No backup support available from surgery or interventional radiology in case of a complication

8275.

Suspected hemangioma or hepatic echinococcal cysts

8276.

Abdominal wall infection over the identified biopsy site

8277.

Infection in the right pleural cavity or below the right hemidiaphragm

8278.

Bowel overlying biopsy site (on ultrasound or other abdominal imaging)Guest,

8279.
8280.

1. wasting and fasiculation in UL and spasticity in LL - AML

8281.

2.Cyclosporin long term adverse effect- nephrotoxicity

8282.

3.RTA 1 - nephrocalcinosis

8283.

5. Carbamazepine- p450- auto induction

8284.

6.Angioedema- bradykinin release

8285.

7.Pt taking throxine with low T4, low free T4, normal T3 , normal TSH-

8286.

appropiate thyroxine dose.

8287.

8.Afib on digoxin and warfarin uncontrolled with left ventricular dys-Amiadarone

8288.

10.Pt with some harmless PVC on ECG and was worried about cancer when all tests were normalhypochondriac

8289.

11.Student low mood, suspects teacher is conspiring against him-paranoid pshsophrenia.

8290.

12-multiple symptoms but all normal normal-somatisation d/o

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.

16.DM first line-metformin

8294.

18.Chance of breast problem in population-404/10000

8295.

19.Cfibrosis carrier in kids-1:2

8296.

20.HIV (CD count-80) with SINGLE ring enhancing lession-TB

8297.

21. Androgen insensitivity0- female phenotype with external female features

8298.

22.MI after colectomy on asprin+clopidrogrel-PCI

8299.

23.FEV 70% , FEV1/FVC 50% KCO2 50%- empysema

8300.

25.purpura on legs in young-henosh scholein purpura

8301.

26.pt with alcoholic neuropathy needs chemo- avoid vincristine

8302.

27.terlipressin-splanchnic vasoconstriciton

8303.

28.Asbetosis+smoking +hyponatremia-small/mesothelioma

8304.

29.asbestosi+smoking-smoking caused increased chance of CA

8305.

30.muslim T2DM who wants to fast is on metformin 500 mg tds-take 500 in morning and 1000 mg in
evening

8306.

31.lady finds difficult to read scan shows parietal lobe infact-heminopia

8307.

32.herpes ,later develops eruption-Erythema marginatum

8308.

33.hiker develops ring lession with central clearing-lyme disease

8309.

34.foot drop,absent ankle reflex,lat loss of sensation, after hip surgery-common peroneal nerve

8310.

35. CML-Imatinib

8311.

7.Parkinson disease-assymetrical bradykinesia

8312.

38.pt with APTT 30, platelets 30-ITP

8313.

40. Inferior MI- RCA

8314.

41.Haemochormotosis screening in family-Transferin saturation

8315.

42.Infective endocarditis with prostethic valve ,culture grew strep-b pencilin +gent

8316.

43.19 yr old develops edema and proteinuria-minimal GN

8317.

44. Pt has arthritis in MCP,MT,writst with negtive RF but positive CCP-RA

8318.

45. A spondolyis - Sclerosing of vertebra

8319.

46.ABGs-Mixed respiratory metabloic acidosis

8320.

47.Cushing-met Alkalosis

8321.

48.LH:FSH ratio raised - PCOD

8322.

49.Wheeze, Breathless, Stridor- Loop flow

8323.

50.GB syndrome-FVC

8324.

51.Bleeding PR - icolonoscopy

8325.

52. painfull intermittent bleeding in young- anal fissure

8326.

53.sideroblastic anemia,hypochromic picture - lead /basophilic

8327.

55. bipolar develops hyponatremia-drug induced

8328.

56.pt on frusemide develops rash-drug induced/bullous pemhigus

8329.

57.prenicious anemia on endoscopy finding in- gastric antrum

8330.

58.malaria how plasmodium exits red cells-effverce

8331.

59.seborrhic dermatitis- ketokonazole

8332.

60.JAK2 -poly cythemia ruba

8333.

61. 70 yr old headache 3 weeks sudden loss of vision with papillodema-ESR

8334.

62.chickepox rash for 5 days-acyclovir

8335.

63.pupil slow reacting to light and concesullay, assymetrical-adie/RAPD

8336.

64.P/C poisioing -anorexia nervosa

8337.

65.alcoholic,ataxic, opthalmoplegia, -wernick korsakoff syndrome

8338.

66.glucose fasting raised, OGTT fasting 5.6 2 hr 7.2 BP 150/80 glycosuria-reanal glycosuria/cushing

8339.

67.pericardial rub-diffuse ST /low voltage

8340.

68.normal Ca, low Phosphate, raised ALP-PTH

8341.

69.Subungual fibroma,hypopigmentation,epilepsy, cysitc kidney dz-Tuberous sclerosis

8342.

70.post partum 3 months with exopthalmos and TSH 0.01, raised T3 T4-Grave disease

8343.

71. pt with CA confusion and Na 120 - SIADH

8344.

72. pul HTN-echo

8345.

73.pleural fluid on cxr but can aspirate-USG

8346.

74.pt had hickmann for parenteral feed develops weakness-hyposphatemia

8347.

76.hyponatremia w/o renal pathology- addison

8348.

77.raised PTH, raised Ca, low Phosphate - primary hyperparathyroidism

8349.

78.CXR b/l consolidation with hypotension after flue - S.aureus/mycoplasma

8350.

79.Crest patient with b/l basal creps and cxr show basal shadowing-ILD

8351.

80.statin , develops myopathy after Ab - erythromycin

8352.

81. lithum + HTN started develops toxicity-ACE

8353.

82.african kid returns has arthritis in knee, ankle , wrist - gonococcal

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.

85.All picture on full blood count with LN enlarged-Immunophenotyping

8357.

86.student has insomnia and pressured speech -mania

8358.

87.break downs protiens-proteosomes

8359.

88.appendicetomy, fever, hypotenstion- CRP (sepsis+MOF , prognostic value)

8360.

89.young low GCS, pin point pupil-opiod oxy codine

8361.

90.back pain in elderly with raised ESR - M Myeloma

8362.

91. Myeloma - AL amyloid

8363.

92. mitrochondrial disease- optic atrophy

8364.

93.RNA using DNA probe- northern blotting

8365.

94.Unable to move on sleeping and waking up with hallucination-sleep paralysis

8366.

95. acromegally- GH+ GTT

8367.

96. acoustic neuroma- absent corneal reflexes

8368.

97.hypokalemia on ecg- u waves

8369.

99. Malignant melanoma- thickness

8370.

100.addison disease- short synacten test

8371.

Guesthey guys i c here common mistake with u plz seacrh for that: prothetic valve with infective
endocardits---------vancomycin+gentamicin+rifampcin

8372.
8373.

2nnd common perineal how ??? it is sciatica

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.

6th simavastatin 40 mg we start with metform in dm especially he obese

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.

plus question about egypt and bloody diarrhea?salm or shigella

8388.

ACEI in black race ? angiodema

8389.

when to isolate i said pneumonai and postive acid fast bacillia culure

8390.

8391.

thats allGuest, Jan 21, 2010#54

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.

1.Mother upset by her son's disobedience, presented mute -

8397.

Depression ??? akinetic mutism

8398.

3.Pt taking throxine with low T4, low free T4, normal T3 , normal TSH-

8399.

appropiate thyroxine dose

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.

ckeck it was clearly given SINGLE RING ENHANCING LESION---which is caused by tb

8405.
8406.

multiple is caused by toxoplasmosisdr_md, Jan 21, 2010#61

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.

giroop2003Guestcyclosporin, If I am not it is Nephrotoxicity is more imp than excessive hair

giroop2003, Jan 21, 2010#63

8409.

giroop2003GuestCan toxoplamsis cause 3cmm lesiongiroop2003, Jan 21, 2010#64

8410.

gir98Guestyes giroop it cangir98, Jan 21, 2010#65

8411.

giroop2003Guestprotein brakedown is lysosome or peroxidase or proteasegiroop2003, Jan 21, 2010#66

8412.

winner2010Guesthi

8413.
8414.

periperal smear...target cells +basophilic stippling

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.

platelet count increased

8423.

MCV decreasedwinner2010, Jan 21, 2010#67

8424.

JohnyGuestSingle ring enhancing lesion may be due to toxoplasmosis, particularly in AIDS.

Tuberculosis is not specific to AIDS. If a single ring enhancing lesion is found on CT, MRI should be
done next. Diagnosis is confirmed by brain biopsy.Johny, Jan 21, 2010#68

8425.

Dr magandiGuesti have question

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.

GuestGuestThe answer for cystic fibrosis question is 2/3

8436.
8437.

The chances for a newborn in AR disease are:

8438.
8439.

1/4 homozygous for the mutation (manifest disease)

8440.

2/4 carrier of the mutation (phenotypically normal)

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.

Hope this helps.Guest, Jan 22, 2010#71

8446.

Dr MOALYGuestQUESTION ABOUT ACTION OF THIAZIDE ON KID. TUBULE? WHEREDr

MOALY, Jan 22, 2010#72

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.

But I chose decompensated resp acidosis in favour of given COPD patient.

8451.

Correct me if I m wrong.mannyl, Jan 22, 2010#75

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.

mannylGuest1) F, genital rash, multiple papules on vulva.. HPV

8457.

2) Symmetrical rash on trunk and lower limbs.. Erythema multiforme

8458.

3) Lower limb motor + sensory at lateral part of foot.. S1 nerve root

8459.

4) Inflammatory cells on lamina propria.. Chron's d/s

8460.

5) Thyrotoxicosis with raised LFT + ALP.. PSC

8461.

6) Poor Px in paracetamol poisoning.. Anorexia nervosa

8462.

7) Young lady, reduced serum Na, K, Ca.. Bulimia

8463.

8) NSAIDs SE.. AIN

8464.

9) Joint swelling with rash in trunk and soles.. Syphillis

8465.

10) IE with bioprosthesis.. Vancomycin + rifampicin

8466.

11) Case report showed drug associated with cancer, to do next.. RCT

8467.

12) Showing relative risk.. Odd ratio

8468.

13) HbA2 .. Beta thalassemia trait

8469.

14) Reduced bilateral kidney with DM.. Renal art stenosis

8470.

15) Single thyroid swelling with normal TFT.. FNAC

8471.

16) Renal transplant blood group O and donor A.. Hyper acute rejection

8472.

17) 18) Dry eye with anti Ro +.. Sjogren $

8473.

19) Pneumonia after viral illness.. Mycoplasma

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.

n why fnac shud be done in thyroid nodule plz

8478.

n many more doubts i have

8479.

n many r giving for answer abg as mixed

8480.

plz tll me what wa bicarbonate reading-- to call it as mixeddr_md, Jan 22, 2010#82

8481.

mannylGuestIE with bioprosthesis.. vancomycin+rifampicin+genta ( Passmedicine)

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.

Other options are not.mannyl, Jan 22, 2010#84

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.

mannylGuestIf it is 4 days , it must be contact dermatitis.

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.

broncectsis ,h.influnzaahmed M, Jan 22, 2010#93

8498.

ahmed MGuestWHAT ABOUT LIVER DISEASE AND IG A? IT IS ALCOHOLICahmed M, Jan 22,

2010#94

8499.

1.size of RNA using DNA ?pcr or northen... Northern (PCR for DNA coding gene)

8500.

2.there is lyme disease in exam?... I didnt see.(may be diff paper)

8501.

3.loss of ankel reflex with weakness of knee?sciatic nerve...I didnt remember( may be diff paper)

8502.

4.loss of abduction of thumb?median nerve.....the same

8503.

5.inferior infarction with heart block? rt coronary.....the same

8504.

7.contact dermatitis ?delayed hypersenstivity....the same

8505.

8.poly peptid degradation? perostosome but i do peroxisome.....Proteosome

8506.

9.bloody diahrea?camplyobacter....the same

8507.

10.kapose?HHV8.....the same

8508.

11.one egyption with picture of meningitis and lymphoccyte in csf?polio....the same

8509.

12.skin rash at hand with nodule at penis?syphalis....didnt remember( may be diff paper)

8510.

13.high lft with tender liver?IG A.....Autoimmune hepatitis

8511.

15.ANTIPARITEAL CELL ANTIBODY ? FUNDS OR BODY.....Fundusmannyl, Jan 22, 2010#97

8512.

ahmed MGuest16.2 QAUESTION one high IG A,one high IG G

8513.

17.JAK 2?POLYCYTHEMIA

8514.

19.ALL adverse prognosis? phladiphia

8515.

20.one female 79 years with one lymph node ,lymphocytosis?immunophenotyping

8516.

21.low iron ?bone marrow most specific

8517.

22.anemia high HBA2 and basophlic stabling?lead poisoning

8518.

23.most common finding in early blood transfusion reaction?HBemia

8519.

24.CML ttt?imitinap

8520.

27.pt with petechia and low plt normal pt .renal function?ITP

8521.

28.PT WITH lymph adnopathy and atypical lymph?IMN

8522.

30.anti ccp normal rf? rhumatoid

8523.

31.rhumatoid activation?methotreaxat

8524.

32.multi pn and HTN AND KIDENY AFFECTION? PAN

8525.

33.SYSTEMIC SCLEROSIS AND DYSPNEA?PROGREESIVE FIBROSIS

8526.

34.ANKLOSING X RAY?CALCIFICATION OF VERTEBRAL JOINT

8527.

35.ASTHMA, STRIDOR ?FLOW CURVE

8528.

36.GULLIAN BS ?FORCED VITAL CAPACITY

8529.

37.HIGH KCO?PULMONARY HEMORRHAGE

8530.

38.LOW FEV1/FVC?EMPHYSEMA

8531.

39.HYPER VENTILATION?LOW H IN BLOOD

8532.

40.CUSHING?METABOLIC ALKALOSIS

8533.

41.CANCER LUNG CONFUSION?HYPERCALCEMIA

8534.

42.PLURAL EFFUSION NOT ASPIRATE?THORACOSCOBY

8535.

43.MESOTHELIOMA?TARC OF MALIGNANCY ON ASPIRATION

8536.

44.ALLERGIC PULMONARY ASPERGILLOSIS?PREDINSOLON

8537.

47.during exercise arrested not responding to CPR ?arrythmogenic cardiomypathy

8538.

48.x ray in pulmonary empolism? normal

8539.

49.pulmonary embolism in COPD?ct angio

8540.

50.ECG IN pricartitis?wid ST elevation

8541.

51.ECG IN hypokalemia?u wave

8542.

52.mi after surgry?PCI

8543.

53.LOSS OF PULSE ON RT HAND AND HORNER?AORTIC DISSECTION

8544.

54.INFECTIVE ENDOCARDITIS IN PROTHETIC AND STREPT VIRDAN?PEN+GEN

8545.

55.VAVE REPLACEMENT AND ANEMIA HIGH BILIRUBIN?HEMOLYSISahmed M, Jan 22, 2010

#98

8546.

ahmed MGuest56.FRIST DRUG IN TYPE 2 DM?METFORMIN

8547.

57.MI+DM?INSULIN

8548.

58.GLUCOSURIA ,NORMAL BLOOD GLUCOSE HIGH BLOOD PRESSURE?CUSHING

8549.

59.SKIN HYPOPIGMENTATION+THYROTOXICOSIS?VITILIGO

8550.

60.LOW FREE T4 NORMAL TSH IN PT TAKING DRUH?ADEQUTE BUT I THINK IT IS

WRONG

8551.

61.OLD FEMAL HIGH CALICUM PLUS LOW PHOS?HYPERPARA

8552.

62.LOW CALCIUM,PHOS.?DONT REMEMBER CHOICE

8553.

63.HYPOGLYCEMIA? INSULIN C PEPTIT

8554.

64.OLD AGE FATIGE BLURING OF VISION?WALDENSTORM

8555.

65.MULITIPELE MYLOMA

8556.

66.ACROMEGALY?GTT

8557.

67.HYPERKALEMIA+HYPOTENSION?SHORT SYNCHT

8558.

68.HYPOADRENALISM,HYPOTHYROID HIGH LH FSH?OVERIAN FALIURE

8559.

69.AMENORHEA +HIGH LH ,TESTOSTERON?PCO

8560.

70.TESTICULAR FEMINAZATION?FEMALE PICTURE+EXTERNAL FEMAL GENITALIA

ahmed M, Jan 22, 2010#99

8561.

ahmed MGuest71.MUSLIM AND ON METFORMIN?1000MG AFTER BREKFAST AND 500 AT

FAJER

8562.

72.CYSTIC FIBROSIS?2/3 CARRIER

8563.

74.DRT ACIDOSIS?NEPHROCALCINOSIS

8564.

75.HIGH PTH IN CKD?LOW CALCIUM

8565.

76.RENAL TRANSPLANT WITH DIARRHEA?CMV

8566.

77.PCKD BLOOD GROUP O HIS FATHER45 YEAR BLOOD GROUP A NOT ACCEPT?STILL
CHANCE TO BE PCKD

8567.

78.DICLOPHENAC?AIN

8568.

79.AMYLODOSIS IN KID?B2 MICROGLO

8569.

80CAUSE OF DEATH IN ESRD?IHDahmed M, Jan 22, 2010#100

8570.

ahmed MGuest71.MUSLIM AND ON METFORMIN?1000MG AFTER BREKFAST AND 500 AT

FAJER

8571.

72.CYSTIC FIBROSIS?2/3 CARRIER

8572.

74.DRT ACIDOSIS?NEPHROCALCINOSIS

8573.

75.HIGH PTH IN CKD?LOW CALCIUM

8574.

76.RENAL TRANSPLANT WITH DIARRHEA?CMV

8575.

77.PCKD BLOOD GROUP O HIS FATHER45 YEAR BLOOD GROUP A NOT ACCEPT?STILL
CHANCE TO BE PCKD

8576.

78.DICLOPHENAC?AIN

8577.

79.AMYLODOSIS IN KID?B2 MICROGLO

8578.

80CAUSE OF DEATH IN ESRD?IHDahmed M, Jan 22, 2010#101

8579.

JAK-2 MutationGuestIn the question of polycystic ovarian syndrome:

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.

mannylGuest16.2 QAUESTION one high IG A,one high IG G... didnt remember

8584.

17.JAK 2?POLYCYTHEMIA....the same

8585.

19.ALL adverse prognosis? phladiphia.....the same

8586.

20.one female 79 years with one lymph node ,lymphocytosis?immunophenotyping.....the same

8587.

21.low iron ?bone marrow most specific......didnt remember

8588.

22.anemia high HBA2 and basophlic stabling?lead poisoning

8589.

23.most common finding in early blood transfusion reaction?HBemia....didnt remember

8590.

24.CML ttt?imitinap

8591.

27.pt with petechia and low plt normal pt .renal function?ITP....the same

8592.

28.PT WITH lymph adnopathy and atypical lymph?IMN....the same

8593.

30.anti ccp normal rf? rhumatoid....the same

8594.

31.rhumatoid activation?methotreaxat....the same

8595.

32.multi pn and HTN AND KIDENY AFFECTION? PAN....the same

8596.

33.SYSTEMIC SCLEROSIS AND DYSPNEA?PROGREESIVE FIBROSIS....not sure

8597.

34.ANKLOSING X RAY?CALCIFICATION OF VERTEBRAL JOINT.....Sclerosis

8598.

35.ASTHMA, STRIDOR ?FLOW CURVE...the same

8599.

36.GULLIAN BS ?FORCED VITAL CAPACITY....the same

8600.

37.HIGH KCO?PULMONARY HEMORRHAGE....the same

8601.

38.LOW FEV1/FVC?EMPHYSEMA....the same

8602.

39.HYPER VENTILATION?LOW H IN BLOOD....Not sure( I went for HCO3)

8603.

40.CUSHING?METABOLIC ALKALOSIS....the same

8604.

41.CANCER LUNG CONFUSION?HYPERCALCEMIA....didnt remember

8605.

42.PLURAL EFFUSION NOT ASPIRATE?THORACOSCOBY.....CT(?)

8606.

43.MESOTHELIOMA?TARC OF MALIGNANCY ON ASPIRATION....the same

8607.

44.ALLERGIC PULMONARY ASPERGILLOSIS?PREDINSOLON....the same

8608.

47.during exercise arrested not responding to CPR ?arrythmogenic cardiomypathy.....didnt remember

8609.

48.x ray in pulmonary empolism? normal...I got wrong

8610.

49.pulmonary embolism in COPD?ct angio....the same

8611.

50.ECG IN pricartitis?wid ST elevation....I got wrong

8612.

51.ECG IN hypokalemia?u wave.....the same

8613.

52.mi after surgry?PCI....the same

8614.

53.LOSS OF PULSE ON RT HAND AND HORNER?AORTIC DISSECTION....the same

8615.

54.INFECTIVE ENDOCARDITIS IN PROTHETIC AND STREPT VIRDAN?

PEN+GEN......vanco+rifam(?)

8616.

55.VAVE REPLACEMENT AND ANEMIA HIGH BILIRUBIN?HEMOLYSIS...the same

8617.

56.FRIST DRUG IN TYPE 2 DM?METFORMIN....the same

8618.

57.MI+DM?INSULIN....the same

8619.

58.GLUCOSURIA ,NORMAL BLOOD GLUCOSE HIGH BLOOD PRESSURE?CUSHING....didnt

remember

8620.

59.SKIN HYPOPIGMENTATION+THYROTOXICOSIS?VITILIGO...

8621.

60.LOW FREE T4 NORMAL TSH IN PT TAKING DRUH?ADEQUTE BUT I THINK IT IS

WRONG.....Adequate

8622.

61.OLD FEMAL HIGH CALICUM PLUS LOW PHOS?HYPERPARA....the same

8623.

62.LOW CALCIUM,PHOS.?DONT REMEMBER CHOICE......didnt remember

8624.

63.HYPOGLYCEMIA? INSULIN C PEPTIT.....the same

8625.

64.OLD AGE FATIGE BLURING OF VISION?WALDENSTORM.....didnt remember

8626.

65.MULITIPELE MYLOMA....the same

8627.

66.ACROMEGALY?GTT......OGTT+GH

8628.

67.HYPERKALEMIA+HYPOTENSION?SHORT SYNCHT......the same

8629.

68.HYPOADRENALISM,HYPOTHYROID HIGH LH FSH?OVERIAN FALIURE.....the same

8630.

69.AMENORHEA +HIGH LH ,TESTOSTERON?PCO....the same

8631.

70.TESTICULAR FEMINAZATION?FEMALE PICTURE+EXTERNAL FEMAL GENITALIA....the

same

8632.

71.MUSLIM AND ON METFORMIN?1000MG AFTER BREKFAST AND 500 AT FAJER.....didnt

see this one

8633.

72.CYSTIC FIBROSIS?2/3 CARRIER.....1/2(might wrong)

8634.

74.DRT ACIDOSIS?NEPHROCALCINOSIS....the same

8635.

75.HIGH PTH IN CKD?LOW CALCIUM......didnt remember

8636.

76.RENAL TRANSPLANT WITH DIARRHEA?CMV.....the same

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.

79.AMYLODOSIS IN KID?B2 MICROGLO.... the same

8640.

80CAUSE OF DEATH IN ESRD?IHD....I got wrong with (DC)mannyl, Jan 22, 2010#104

8641.

ahmed MGuestTHANKES MANNYL FOR YOUR COOPERATIONahmed M, Jan 22, 2010#105

8642.

ahmed MGuest81.PT WITH CKD WHAT IS ONE ACCURATE?ANEMIA

8643.

82.PT RECURRENT UTI HTN .STROKE,SHRINK KIDENY?RASTENOSIS

8644.

83.ERYTHROPITIN ?LOW IMMUNOGINIC

8645.

84.ABDOMINAL PAIN +RASH+JOINT? HCPURPURA

8646.

85.CYSTIC FIBROSIS +DIARRHEA?FECAL ELASTASE

8647.

86.RECTUM AND BIOPSY GRANULOMA? CROHNS

8648.

87.ACTION OF TERPELISERN?SPLANCHANIC VC

8649.

89.CHOREA AND HIGH LIVER ENZYME?WLISON

8650.

90.DRE EYE ITCHING?PRIARRY BILIARRY

8651.

91.OLD AGE WITH ANEMIA?GASTROSCOPY

8652.

92.CONTRANDICATION TO LIVER BIOBSY?INTRAHEPATIC DILATATION

8653.

93.VAGINAL DISCHARGE SCANTY?METRONIDAZOL

8654.

94.PNUMOCYSTIC?COTRIMEXAZOL

8655.

95.RING ENHANCEMENT?TOXOPLASMOSIS

8656.

96.AFTER APPENDICTOMY BLOOD CULTURE TAKEN? CRP ITIS WRONG

8657.

97.DRUG ABUSER AND CHEST INFECTION?VANCOMYCIN

8658.

98.TYPE 1 DM+HIGH CHOLESTROL NO FAMILY HISTROY?NO NEED TTT

8659.

99.FEMALE ON OCP WITH LOW K.CA.DENTAL EROSION?EARLY PREGNANCY DUO TO

HIGH ALKALINE PHOSPHATASE

8660.

100.PARENTAL NUTRION?HYPO PHOS

8661.

101.CEREBRAL HEMORRHGE PIN POINT PUPILE?PON

8662.

102.PARIETAL LOBE?AGRAPHIA---------- (IT IS WRONG)

8663.

104.PNUMOTHORAX? OBSERVE

8664.

105.NEUTROPENIA .8?OBSERVE

8665.

106.PAIN AT LATERAL OF HIP?BRUSITIS

8666.

107ENTECAPRON?TNF ANTAGONIST

8667.

108.OPTIC ATROPH+ATAXIA? M SCLEROSIS

8668.

109.CLUSTER HEADECHE

8669.

110AMYLOD LATERAL SCLEROSIS

8670.

111.ANTERIOR CORD SYNDROME

8671.

112.ACOUSTIC NEUROMA?EARLY LOSS OF CORNEAL REFLEX

8672.

114.BELLS PALSY?HYPERASTHSISAE

8673.

115.ADI PUPILE

8674.

116.PARKINSON?ASYMMETRICAL

8675.

117.EPLIPSY AND SUB ANGEL FIBROMA?TUBEROUS SCLEROSIS

8676.

118.DILATED FIXED PUPIL?3RD CRANIAL NERVE

8677.
8678.

119.CANCER ?HYPOCHONDRISM

8679.

120.MULITIPLE FUNCTIONAL SYMPTOMES AFTER MOTHER DIED?SOMATOFORM

8680.

121.TAKING DRUG AFTER LIFT GIRL FRIEND?PARANOID SCHIZOPHRENIA

8681.

122.MOTHER DONT SPEAK AFTER STRUGGLE WITH SON?PSYCHOGENIC APHASIA

8682.

123.BEFORE SLEEP OR DURING AWAK NOTABLE TO MOVE?SLEEP PARALYSIS

8683.

124.LESION IN LEFT HAND IN PSYCHIC PT?SELF HARM

8684.

125.SEEING SOMETHING IN BED IN ALCOHOLIC?ALCOHOLIC WITHDRAWAL

8685.

126.WRINKES TTT?THIAMIN

8686.

127.STUDENT FEEL HIS TEATCHER----------?SCHIZOPHRENIA

8687.

129ATRIAL MYXOMA?LT ATRIUM

8688.

130.PREGNANA VSD WORET?PULMONARY HTN

8689.

131.AF +DIGOXIN+WARFARIN SINCE 3 WEEK+LV DYSFUNCTION NOT CONTROL RAT ?

BISPROLOL

8690.

132.ATOPIC ECZEMA+PUSTULE IN FACE AND TRUNK?ORAL AMOXACILLIN

8691.

133.HEREPES THEN SKIN LESSION?ERETHYMA MULITIFORMIS

8692.

134.TENDE PAPULE IN SHIN ?RESOLOVED SPONTENOUSE

8693.

135.OLD AGE FEMALE WITH BULOUS?BULLOUS PIMPHYGOID

8694.

136.MALIGNANT MELLANOMA PROGNOSIS?THICKNESS

8695.

137.DISCOID LUPUS TTT?CHOLOROQUIN

8696.

138BUTERFLY RASH IN FACE CROSE NOSE ,WHAT IS IN BLOOD?ESINOPHILIA-------------I

THINK IT IS WRONG

8697.

139.LESSION IN FACE ERYTHEMA AND IN SCALP+SCALING?TTT BY

METRONIDAZOL---------------I THINK ALSO WRONG

8698.

140.UNILATERAL EXOPHOTHALMOSE +ANTIPEROXIDASE?GRAVESE

8699.

141.DKA?KETONURIA

8700.

142.ahmed M, Jan 22, 2010#106

8701.

ahmed MGuest142.SMALL SAMPLE ?SED

8702.

143.AGE HIGHT SEX AND BLOOD PREESURE? REGRRESION

8703.

144.IN CANCER PROSTATE ?ODD RATIO

8704.

145.+PREDICTIVE ?50%

8705.

146.SENSTIVITY

8706.

147.COCAIN ?CHEST PAIN

8707.

148.PLAVIX AN SURGRY ?ONE WEEK

8708.

149.CARBAMAZEPIN AND NEED TO INCRESE DOSE ?AUTOINDUCTION

8709.

150.ICRASR EFFECT OF DRUG? CLARITHROMYCIN

8710.

151.ANTI HTN IN PREGNANCY ?METHYL DOPA

8711.

152.PROTONRIA ?USE RAMIPRIL

8712.

153. ANT HTN AND EDEMA IN MOUTH ?RAMIPRIL

8713.

154. LITHUM TOXICITY ?RAMIPRIL

8714.

155.LL OEDEMA IN HTN ?NIFEDIPIN

8715.

156.THIAZID ?EARLY DCT

8716.

157.PROPRANOLOL AND BRADYCARDIA BP 85/55 AND NO RESPONSE TO ATROPIN ?IV

GLUCAGON

8717.

158.PT WITH BIPOLAR DISORDER AND POLYURIA?DRUG INDUCED DI

8718.

159ALOPECIA ?NA VALOPRATE

8719.

160.TTT OF ALZAHIMER ?DONAZEPIL

8720.

161.CICLOSPORING ?NEPHROTOXICITY

8721.

162.PT WITH PN SHOULD STOPE ? VINCRISTIN

8722.

163.SIADH ?FLUOXTIN

8723.

164.PARAMOLE OVER DOSE RISK IN ?ANOREXIA NERVOSA

8724.

165.PT TTT AFTER DRUG OVER DOSE HAVE BLURRING OF VISSION?METHYL ALCOHOL

8725.

166.PINPOINT PUPILE ?DIHYDROCODIAN

8726.

167.FLUDAAPIN AND CAPI -----------?LOW DISTRIBUTION I THINK IT IS WRONGahmed M,

Jan 22, 2010#107

8727.

ahmed MGuestTHERE IS 167 QUESTION THAT I REMMEBER ,I HOPE TO HELLP MY FRIENDS

,ALSO MY ANSWER DONT ACCURATE .I WROTE HERE TO HELP ,AND SHARING THE
BEST ANSWER .ALSO I HOPE FOR AA MY FREIND TO PASS EXAME AND STURT STUDY
FOR PART 2

8728.
8729.

WAITING TO SHARE WITH ME THE ANSWERahmed M, Jan 22, 2010#108

8730.

ahmed MGuestTHERE IS 167 QUESTION THAT I REMMEBER ,I HOPE TO HELLP MY FRIENDS

,ALSO MY ANSWER DONT ACCURATE .I WROTE HERE TO HELP ,AND SHARING THE
BEST ANSWER .ALSO I HOPE FOR AA MY FREIND TO PASS EXAME AND STURT STUDY
FOR PART 2

8731.
8732.

WAITING TO SHARE WITH ME THE ANSWERahmed M, Jan 22, 2010#109

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.

mannylGuest81.PT WITH CKD WHAT IS ONE ACCURATE?ANEMIA....didnt remember

8735.

82.PT RECURRENT UTI HTN .STROKE,SHRINK KIDENY?RASTENOSIS...the same

8736.

83.ERYTHROPITIN ?LOW IMMUNOGINIC....didnt remember

8737.

84.ABDOMINAL PAIN +RASH+JOINT? HCPURPURA....the same

8738.

85.CYSTIC FIBROSIS +DIARRHEA?FECAL ELASTASE.....didnt remember

8739.

86.RECTUM AND BIOPSY GRANULOMA? CROHNS....the same

8740.

87.ACTION OF TERPELISERN?SPLANCHANIC VC.....the same

8741.

89.CHOREA AND HIGH LIVER ENZYME?WLISON...the same

8742.

90.DRE EYE ITCHING?PRIARRY BILIARRY....didnt remember

8743.

91.OLD AGE WITH ANEMIA?GASTROSCOPY......Colonoscopy

8744.

92.CONTRANDICATION TO LIVER BIOBSY?INTRAHEPATIC DILATATION...I got wrong

8745.

93.VAGINAL DISCHARGE SCANTY?METRONIDAZOL.....didnt remember

8746.

94.PNUMOCYSTIC?COTRIMEXAZOL....the same

8747.

95.RING ENHANCEMENT?TOXOPLASMOSIS....the same

8748.

96.AFTER APPENDICTOMY BLOOD CULTURE TAKEN? CRP ITIS WRONG....didnt remember

8749.

97.DRUG ABUSER AND CHEST INFECTION?VANCOMYCIN......didnt remember

8750.

98.TYPE 1 DM+HIGH CHOLESTROL NO FAMILY HISTROY?NO NEED TTT....didnt remember

8751.

99.FEMALE ON OCP WITH LOW K.CA.DENTAL EROSION?EARLY PREGNANCY DUO TO

HIGH ALKALINE PHOSPHATASE.....didnt remember

8752.

100.PARENTAL NUTRION?HYPO PHOS....the same

8753.

101.CEREBRAL HEMORRHGE PIN POINT PUPILE?PON....the same

8754.

102.PARIETAL LOBE?AGRAPHIA---------- (IT IS WRONG)....inattention

8755.

105.NEUTROPENIA .8?OBSERVE.....GCSFactor

8756.

106.PAIN AT LATERAL OF HIP?BRUSITIS.....OA(?)

8757.

107ENTECAPRON?TNF ANTAGONIST....the same

8758.

108.OPTIC ATROPH+ATAXIA? M SCLEROSIS....didnt remember

8759.

109.CLUSTER HEADECHE.....there is one

8760.

110AMYLOD LATERAL SCLEROSIS....there is one

8761.

111.ANTERIOR CORD SYNDROME....I got wrong

8762.

112.ACOUSTIC NEUROMA?EARLY LOSS OF CORNEAL REFLEX...the same

8763.

114.BELLS PALSY?HYPERASTHSISAE....Not sure

8764.

115.ADI PUPILE...there is one

8765.

116.PARKINSON?ASYMMETRICAL....Asymmetrical of bradykinesia

8766.

117.EPLIPSY AND SUB ANGEL FIBROMA?TUBEROUS SCLEROSIS....the same

8767.

118.DILATED FIXED PUPIL?3RD CRANIAL NERVE....didnt remember

8768.
8769.

119.CANCER ?HYPOCHONDRISM.....the same

8770.

120.MULITIPLE FUNCTIONAL SYMPTOMES AFTER MOTHER DIED?SOMATOFORM.....the

same
8771.

121.TAKING DRUG AFTER LIFT GIRL FRIEND?PARANOID SCHIZOPHRENIA.....the same

8772.

122.MOTHER DONT SPEAK AFTER STRUGGLE WITH SON?PSYCHOGENIC APHASIA.....the

same

8773.

123.BEFORE SLEEP OR DURING AWAK NOTABLE TO MOVE?SLEEP PARALYSIS.....the same

8774.

124.LESION IN LEFT HAND IN PSYCHIC PT?SELF HARM....the same Factitious disorder

8775.

125.SEEING SOMETHING IN BED IN ALCOHOLIC?ALCOHOLIC WITHDRAWAL....the same

8776.

126.WRINKES TTT?THIAMIN.....the same

8777.

127.STUDENT FEEL HIS TEATCHER----------?SCHIZOPHRENIA.....the same

8778.

129ATRIAL MYXOMA?LT ATRIUM......the same

8779.

130.PREGNANA VSD WORET?PULMONARY HTN....the same

8780.

131.AF +DIGOXIN+WARFARIN SINCE 3 WEEK+LV DYSFUNCTION NOT CONTROL RAT ?

BISPROLOL.....Amiodarone( Age is 62 eligible for rhythum control and bblocker not suitable for LV
dysfunction)

8781.

132.ATOPIC ECZEMA+PUSTULE IN FACE AND TRUNK?ORAL AMOXACILLIN.....didnt

remember

8782.

133.HEREPES THEN SKIN LESSION?ERETHYMA MULITIFORMIS....the same

8783.

134.TENDE PAPULE IN SHIN ?RESOLOVED SPONTENOUSE....the same

8784.

135.OLD AGE FEMALE WITH BULOUS?BULLOUS PIMPHYGOID.....the same

8785.

136.MALIGNANT MELLANOMA PROGNOSIS?THICKNESS....the same

8786.

137.DISCOID LUPUS TTT?CHOLOROQUIN.....the same

8787.

138BUTERFLY RASH IN FACE CROSE NOSE ,WHAT IS IN BLOOD?ESINOPHILIA-------------I

THINK IT IS WRONG.....didnt remember well

8788.

139.LESSION IN FACE ERYTHEMA AND IN SCALP+SCALING?TTT BY

METRONIDAZOL---------------I THINK ALSO WRONG.....Ketoconazole

8789.

140.UNILATERAL EXOPHOTHALMOSE +ANTIPEROXIDASE?GRAVESE.....didnt remember

8790.

141.DKA?KETONURIA....Not suremannyl, Jan 22, 2010#111

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.

answers: sensitivity, specivicity, PPV, NPP, SEM (SEM is correct I think)

8798.

1-which cell organelle is responsible for polypeptide degradation:

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.

answers: Agraphia, hemianopia, visual agnosia, ????, inattention.

8803.

I think inattention was the only option caused by non-dominant parietal lobe infarction.

8804.
8805.

3- whom to isolate:

8806.
8807.

a- positive sputum culture for TB

8808.

b- positive CSF culture for TB

8809.

c- positive sputum direct smear for TB (? correct answer)

8810.

d- positive urine culture for TB

8811.

e- positive urine direct smear for TB

8812.
8813.

4- patient with prosthetic valve... Blood culture: alpha-streptococci

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.

GuestGuest1-which cell organelle is responsible for polypeptide degradation:

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.

answers: Agraphia, hemianopia, visual agnosia, ????, inattention.

8822.

I think inattention was the only option caused by non-dominant parietal lobe infarction.

8823.
8824.

3- whom to isolate:

8825.
8826.

a- positive sputum culture for TB

8827.

b- positive CSF culture for TB

8828.

c- positive sputum direct smear for TB (? correct answer)

8829.

d- positive urine culture for TB

8830.

e- positive urine direct smear for TB

8831.
8832.

4- patient with prosthetic valve... Blood culture: alpha-streptococci

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.

mannylGuest142.SMALL SAMPLE ?SED....the same

8838.

143.AGE HIGHT SEX AND BLOOD PREESURE? REGRRESION....didnt see

8839.

144.IN CANCER PROSTATE ?ODD RATIO....the same

8840.

145.+PREDICTIVE ?50%.....the same

8841.

146.SENSTIVITY....the same

8842.

147.COCAIN ?CHEST PAIN.....the same

8843.

148.PLAVIX AN SURGRY ?ONE WEEK....didnt see

8844.

149.CARBAMAZEPIN AND NEED TO INCRESE DOSE ?AUTOINDUCTION....the same

8845.

150.ICRASR EFFECT OF DRUG? CLARITHROMYCIN......Statin Rabdomyelitis increased by

Ciprofloxacin or Clarithromycin...I went for cifran

8846.

151.ANTI HTN IN PREGNANCY ?METHYL DOPA....the same

8847.

152.PROTONRIA ?USE RAMIPRIL....the same

8848.

153. ANT HTN AND EDEMA IN MOUTH ?RAMIPRIL....the same

8849.

154. LITHUM TOXICITY ?RAMIPRIL....the same

8850.

155.LL OEDEMA IN HTN ?NIFEDIPIN....the same

8851.

156.THIAZID ?EARLY DCT....the same

8852.

157.PROPRANOLOL AND BRADYCARDIA BP 85/55 AND NO RESPONSE TO ATROPIN ?IV

GLUCAGON.....the same

8853.

158.PT WITH BIPOLAR DISORDER AND POLYURIA?DRUG INDUCED DI....the same

8854.

159ALOPECIA ?NA VALOPRATE....the same

8855.

160.TTT OF ALZAHIMER ?DONAZEPIL....the same

8856.

161.CICLOSPORING ?NEPHROTOXICITY.....the same

8857.

162.PT WITH PN SHOULD STOPE ? VINCRISTIN.....the same

8858.

163.SIADH ?FLUOXTIN...the same

8859.

164.PARAMOLE OVER DOSE RISK IN ?ANOREXIA NERVOSA....the same

8860.

165.PT TTT AFTER DRUG OVER DOSE HAVE BLURRING OF VISSION?METHYL

ALCOHOL....didnt see

8861.

166.PINPOINT PUPILE ?DIHYDROCODIAN....the same

8862.

167.FLUDAAPIN AND CAPI -----------?LOW DISTRIBUTION I THINK IT IS WRONG.....didnt see

8863.

168. Methaemoglobinaemia Tx.... Methylene blue

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.

GuestGuesthi uzi,do u remember the optionsGuest, Jan 23, 2010#120

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.

GuestGuestI went for pregnancy divismGuest, Jan 23, 2010#123

8870.

JohnyGuestDiabetes

8871.
8872.

1. Initial drug treatment of obese type 2 diabetes metformin

8873.

2. Differentiating type 1 from type 2 diabetes on the basis of initial investigations low serum
bicarbonate

8874.

3. treatment of type 2 diabetes during acute myocardial infarction intravenous insulin

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.

6. Investigation of Addisons syndrome short Synacthen

8880.
8881.

Thyroid

8882.
8883.

7. Lady on thyroid replacement, low free T4 but euthyroid, normal TSH and T3 adequate thyroid
replacement

8884.

8885.

8. Solitary euthyroid thyroid nodule next investigation FNAC

8886.
8887.

9. Postpartum exophthalmic thyrotoxicosis Graves

8888.
8889.

Parathyroid

8890.
8891.

10. Hyperparathyroidism

8892.
8893.

11. Hyperparathyroidism

8894.
8895.

Pituitary

8896.
8897.

12. Hypogonadotropic hypogonadism, modestly elevated prolactin - ? non-functioning pituitary

adenoma

8898.
8899.

POCS

8900.
8901.

13. Infertility etc.

8902.

14. Hirsuitism, high LH etc.

8903.
8904.

SIADH

8905.
8906.

15. Caused by fluoxetine

8907.
8908.

Lithium

8909.
8910.

16. Nephrogenic diabetes insipidus caused by Lithium patient on treatment for bipolar disorder

8911.

17. Lithium toxicity caused by ramipril

8912.
8913.

Buimia Nervosa

8914.
8915.

18. Dental caries, low K etc.

8916.
8917.

Autoimmune hepatitis

8918.
8919.

19. In someone with other autoimmune diseases

8920.
8921.

Primary biliary cirrhosis

8922.
8923.

Malabsorption

8924.
8925.

23. Increased stool elastase in lady returning from India with diarrhea ? giardiasis

8926.

24. Steatorrhoea in cystic fibrosis ? H2 breath test

8927.
8928.

Diarrhoea

8929.
8930.

25. Bloody diarrhoe unresponsive to metronidazole ? Campylobacter

8931.

26. Bloody diarrhea caused by Schigella

8932.
8933.

Chrons

8934.
8935.

26. Typical description with granuloma etc.

8936.
8937.

Carcinoma colon

8938.
8939.

27. Man 51 or so with iron deficiency anaemia which most useful investigation next ?
ccolonoscopy

8940.
8941.
8942.

Bile salt diarrhoe

8943.

27. In someone who underwent ileal resection 6 weeks back

8944.
8945.

Carcinoma oesophagus

8946.
8947.

28. Progressive dysphagia to both solids and liquids, weight loss etc.

8948.
8949.

Pernicious anemia

8950.
8951.

29. Site to take biopsy from ? fundus of the stomach

8952.

30. Nephrotic syndrome in an adolescent

8953.
8954.

Chronic renal failure

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.

33. Site of action of thiazides in the nephron early DCT

8965.
8966.

RTA 1

8967.
8968.

35. Commonest abnormality nephrocalcinosis

8969.
8970.

Interstitial nephritis

8971.
8972.

36. Renal failure, rash etc. in someone on diclofenac

8973.
8974.

Tuberous sclerosis

8975.
8976.

37. Adenoma sabaceum, haematuria, seizures etc.

8977.
8978.

Alpha thalassemia

8979.
8980.

38. South Asian, asymptomatic, mild anaemia, basophilic stippling, elevated HbA2 etc.

8981.
8982.

Immunosuppression NHL

8983.
8984.

39. Intraabdominal lymphadenopathy in someone on methotrexate for long

8985.
8986.

Multiple myeloma

8987.
8988.

40. Amyloid deposited in the kidneys AL (not answered)

8989.

41. Another description of multiple myeloma

8990.
8991.

Atrial natriuretic peptide

8992.
8993.

42. Vasodilator

8994.
8995.

Telipressin

8996.
8997.

43. Mode of action in hepatorenal syndrome splanchnic vasoconstriction

8998.
8999.
9000.

Mitichondrial DNA

9001.

44. Optic atrophy

9002.
9003.

45. Acute haemolytic transfusion reaction investigation Coombs (not answered)

lzheimers

9004.
9005.

47. Donepezil for

9006.
9007.

Lateral medulla

9008.
9009.

48. Wallenberg

9010.
9011.

Spinal cord

9012.
9013.

49. Anterior cord syndrome

9014.
9015.

Poliomyelitis

9016.
9017.

50. Acute polio

9018.
9019.

Non-dominant parietal lobe

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.

53. Tratment of P Jeroveci pneumonia cotrimoxazole

9028.

Transplatation

9029.
9030.

54. Cyclosporin causing hypertrichosis

9031.

55. Cyclosporins commnest toxicity long-term nephrotoxicity

9032.

56. Typical description of GVHD in someone post-allograft some 6 weeks or so

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.

60. Ulnar neuropathy

9036.

61. S1 lesion

9037.
9038.

Motor neurone disease

9039.
9040.

62. Typical description of AML

9041.
9042.

VII nerve

9043.
9044.

63. Hyperaccussis in acute lesion

9045.

64. Corneal reflex loss in acoustic neuroma

9046.
9047.

Posterior communicating artery aneurysm

9048.
9049.

65. Typical description

9050.
9051.

Adies pupil

9052.
9053.

66. Typical description

9054.
9055.
9056.

Temporal arteritis

9057.

67. Headache followed by altitudinal loss next investigation ESR

9058.
9059.

Multiple sclerosis

9060.
9061.

68. Optic neuritis

9062.

69. Optic neuritis followed by ataxia etc.

9063.
9064.

Parkinsonism

9065.
9066.

70. Asymmetry in early disease diagnosis

9067.

73. Standard error of the mean

9068.

74. Meta analysis

9069.

75. Two sample t test

9070.

76. Somatoform disorder

9071.

77. Hypochondriasis/somatoform

9072.

78. Delusional depression

9073.

79. Mutism in depressed mother

9074.

80. Narcolepsy

9075.
9076.
9077.

Pulmonology

9078.
9079.

81. Meothelioma tracking along percutaneous biopsy route

9080.

82. Mesothelioma & smoking

9081.

83. Small cell lung cancer

9082.

84. Lung cancer surger contraindicated by ipsilateral supraclavicular node

9083.

85. Thoracoscopy for empyema not drainable percutaneously

9084.

86. Interstitial lung disease

9085.

88. ABPA acute exacerbation with bilateral infiltrates and lower lobe collapse treatment - ?oral
prednisolone

9086.

89. Staph pneumonia following influenza

9087.
9088.

ABGs

9089.
9090.

90. metabolic alkalosis in Cushings

9091.

91. Decompensated respiratory acidosis in COPD

9092.

92. Emphysema

9093.

93. Pleural effusion

9094.

92. Respiratory acidosis with metabolic alkalosis

9095.
9096.

Connective tissue

9097.
9098.

93. Neutrophilia in acute SLE

9099.

94. PAN

9100.

96. Scl 70 in systemic sclerosis

9101.

97. Hydroxychoroquine for discoid lupus

9102.
9103.

Skin

9104.
9105.

98. Ketoconazole for face

9106.

99. EM due to herpes simplex

9107.
9108.

Cardiology

9109.
9110.

100. Right coronary occlusion causing acute IWMI with complete heart block

9111.

101. Sudden death while playing football HCM

9112.

102. Bad prognostic indicator in HCM septum more than 3.5 cm

9113.

103. AF rate uncontrolled on digoxin LV dysfunction present add bisoprolol

9114.

104. Ascending aortic dissection with left hemiplegia and absent right radial and brachial pulses

9115.

105. Acute internal carotic dissection

9116.

106. Diltiazem causing pedal oedema

9117.

107. AF with hypotension and heart failure synchronized DC cardioversion

9118.
9119.

Pulmonology

9120.
9121.

108. Horners syndrome next investigation CXR

9122.
9123.

Cardiology

9124.
9125.

109. Hypokalemia causing U wave

9126.

110. Diffuse ST elevation in pericarditis

9127.

111. Constrictive pericarditis

9128.

112. Commonest site of myxoma left atrium

9129.

113. LBBB causing reversed split of S2

9130.
9131.

Pharma

9132.
9133.

114. Macrolide causing elevation of cyclosporine level

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.

117. Imatinib in chronic phase CML

9146.

118. Immunophenotyping in CLL

9147.

119. Ph chromosome as bad prognostic indicator in ALL

9148.

120. JAK 2 mutation in PRV

9149.

121. Myelofibrosis

9150.

123. Rubaricase before chemo in Burkitts with cytopenias and hyperuricaemia

9151.

124. Videlbine causing peripheral neuropathy

9152.

125. Drug to be avoided in NHL man with alcoholic peripheral neuropathy vincristine

9153.

126

9154.

127. Post-chemo cytopenias observe

9155.
9156.

Cardiology

9157.
9158.

128. Investigation of PAH echo

9159.
9160.

Immunology

9161.
9162.
9163.

Infection

9164.
9165.

132. Hepatits A in man returning from India

9166.

133. ? HD/Toxoplasmosis 16 year old boy with throat pain, generalized lymphadenopathy &
atypical mononuclears

9167.

134. Indian nrse with genital warts

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.

139. Mountain exposure, erythema chronicum migrans Lyme

9172.

142. Ankylosing spondylitis

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.

145. Drug in RA methotrexate

9176.

147. VSD with bad prognosis in pregnancy with PAH

9177.
9178.

Haematology

9179.
9180.

148. Methylene blue for acquired methaemoglobinaemia

9181.
9182.

Pulmonology

9183.
9184.

149. Primary pneumothorax with less than 2 cm to be discharged

9185.

150. Monitoring GBS forced vital capacity

9186.
9187.

Genetics/Cell

9188.
9189.

151. Risk of occurrence of cystic fibrosis in child 1 in 4

9190.

152. Risk of occurrence of haemophilia in child 1 in 4

9191.

153. Proteasomes degrading polypeptides

9192.

154. Northern blotting for quantitating RNA

9193.
9194.

Pharma

9195.
9196.

154. Alopecia in valproate use

9197.

156. Man with CAD presenting with bloody diarrhoe mesenteric ischaemia

9198.
9199.

Immunology

9200.
9201.

157. Mechanism of patch test delayed hypersensitivity

9202.
9203.

Poisoning

9204.
9205.

158. Codeine poisoning with low GCS, respiratory depression etc.

9206.

159. Smoking as a bad indicator of outcome in paracetamol poisoning

9207.
9208.

Endocrine

9209.
9210.

159. GTT with GH measurement for acromegaly

9211.

160. Renal glycosuria

9212.
9213.

Polyendocrine deficiency

9214.
9215.

161. Ovarian failure in young lady with multiple endocrine deficiencies

9216.
9217.

Pulmonology

9218.
9219.

162. Upper airway obstruction flow loop

9220.

163. PiZZ has 10% protein

9221.
9222.

Poisoning

9223.
9224.

164. Methanol causing blindness

9225.
9226.

Septicaemic shock

9227.
9228.

165. Following appendicectomy d dimer

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.

168. Another NAFLD-like description

9238.
9239.

Oncology

9240.
9241.

169. Prognosis in melanoma thickness

9242.
9243.

171. CTPA for diagnosing PE

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.

173. Hypophosphataemia after refeeding in malnourished

9252.
9253.

Pharma

9254.
9255.

174. Ethambutol causing decreased visual acuity

9256.
9257.

Immunology

9258.
9259.

175. Vitiligo in a lady on carbimazole for thyrotoxicosis

9260.
9261.

Haematology

9262.
9263.

176. Haemolysis in double valve prosthesis

9264.
9265.

177. Henoch-Schonlein purpura

9266.
9267.

Maternal health

9268.
9269.

178. Pregnancy induced hypertension treatment methyldopa

9270.
9271.

Infection

9272.
9273.

179. HHV 8 causing Kaposis

9274.
9275.

Statistics

9276.
9277.

180. Previous exposures odds ratio

9278.
9279.

181. 95% under 2 SDs

9280.
9281.

ABGs

9282.

ahmed MGuestpatient with low k,ca and recieve oral contraceptive with dntal caris

9283.
9284.

early pregnancy duo to alkaline phosphatase high

9285.
9286.

in septcimia ask about prognosis ----------crpahmed M, Jan 24, 2010#126

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.

Does it mean not every question carry equal marks ?

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.

GuestGuestLook to Equating theoryGuest, Jan 24, 2010#132

9297.

ahmed MGuestdntal caries is pressent in early pregnancy

9298.

also patient not malnurished duo to the BMI was normalahmed M, Jan 24, 2010#133

9299.

ahmed MGuestanorexia nervosa is bad prognosis of paracetamol over dose

9300.
9301.

glucosuria with bp 150/90 why not cushingahmed M, Jan 24, 2010#134

9302.

ahmed MGuestanorexia nervosa is bad prognosis of paracetamol over dose

9303.
9304.

glucosuria with bp 150/90 why not cushingahmed M, Jan 24, 2010#135

9305.

ahmed MGuesthorner next investigation carotid duplex duo to aortic dissection

9306.
9307.
9308.
9309.

pt with MI after one week of hospital admission----------psudomembranous colitiesahmed M, Jan 24,

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.

dr.wesamGuestWorse prognosis in paracetamol overdose id anorexia. (Question is repeated and it's in

passmedicine..)dr.wesam, Jan 25, 2010#139

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.

Its difficult to say which questions carry how many marks

9321.
9322.

Just pray we will all pass as passing ratio in part 1 is only 37 %ct, Jan 25, 2010#140

9323.

JAK-2 MutationGuestThats disconcerting.

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.

(You must log in or sign up to reply here.)

9340.

Page 3 of 13
9341.

< Prev

9342.

9343.

9344.

9345.

9346.

9347.

9348.

9349.

13

9350.
9351.

Next >

Share This Page

9352.
9353.
9354.
9355.
9356.

Forums

9357.

>

9358.

UK Medical Zone

9359.

>

9360.

MRCP Forum

9361.

>

9362.
9363.
a.

Search Forums

b.

Recent Posts

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9364.
9365.
9366.
9367.
9368.

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9369.

>

9370.

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9371.

>

ResourcesLog in or Sign up

9372.

MRCP Forum

9373.

>

9374.

Recalls drom MRCP 1 Jan 2010

9375.

Discussion in 'MRCP Forum' started by drrajib, Jan 19, 2010.

9376.
9377.

Page 4 of 13
9378.
9379.

9380.

9381.

9382.

9383.

9384.

9385.

9386.

13

9387.
9388.

< Prev

Next >

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.

AL in multiple myeloma, antiglobulin test in acute haemolytic transfusion reaction

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.

GuestGuesti think its is COOMB testGuest, Jan 27, 2010#174

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.

iam confused in rgard to some Q

9404.

-that anti-ccp positive (was RA or not)

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.

2. Increase dose of Phynytoin by 50mg

9410.

3. Increase dose of Phynytoin by 100mg

9411.

4. Increase dose of Phynytoin by 150mg

9412.

5. Keep the same dose

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.

JAK-2 MutationGuest*PhenytoinJAK-2 Mutation, Jan 28, 2010#179

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.

ahmed MGuestyes my friendes

9426.

the question asked about the best investigation in acute GIT bleeding

9427.

my choice was ureaahmed M, Jan 28, 2010#182

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.

-Q about retinal haemorrhage and which best investigaton( i donot remember)????????????

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.

Total cholesterol 5.3 mmol/l

9466.

HDL cholesterol 1.0 mmol/l

9467.

LDL cholesterol 3.1 mmol/l

9468.

Triglyceride 1.7 mmol/l

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.

A.A Simvastatin 40mg onia

9475.
9476.

B.A Lifestyle advice, repeat lipid profile in 3 monthsia

9477.
9478.

C.A Nicotinic acidia

9479.
9480.

D.A Atorvastatin 40mg onia

9481.
9482.

E.A Increase his metformin slowly to 1g tdsia a

9483.
9484.

Which one of the following is involved in the degradation of polypeptides?ia

9485.
9486.

A.A Peroxisomeia

9487.
9488.

B.A Endoplasmic reticulumia

9489.
9490.
9491.

C.A Proteosomeia

9492.
9493.

D.A Ribosomeia

9494.
9495.

E.A Golgi apparatusia c

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.

A.A Internal haemorrhoidsia

9501.
9502.

B.A Anal carcinomaia

9503.
9504.

C.A Rectal polypia

9505.
9506.

D.A Anogenital herpesia

9507.
9508.
9509.

E.A Anal fissurei e

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.

B.A Atrial fibrillationia

9528.
9529.
9530.

C.A Widespread ST elevationia

9531.
9532.

D.A ST segment depression in the anterior leadsia

9533.
9534.

E.A Hyperacute T wavesia c

9535.
9536.

A 64-year-old man presents with a eight-month history of generalised weakness. On examination he

has fasciculation and weakness in both arms with absent reflexes. Examination of the lower limbs
reveal increased tone and exaggerated reflexes. Sensation was normal and there were no cerebellar
signs. What is the most likely diagnosis?ia

9537.
9538.

A.A Progressive muscular atrophyia

9539.
9540.
9541.

B.A Amyotrophic lateral sclerosisia

9542.
9543.

C.A Vitamin B12 deficiencyia

9544.
9545.

D.A Syringomyeliaia

9546.
9547.
9548.

E.A Multiple sclerosisia b

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.

A.A Stop metformin + continue gliclazide at a higher doseia

9566.
9567.

B.A Subcutaneous insulin: basal-bolus regimeia

9568.
9569.

C.A Continue metformin + gliclazide at same doseia

9570.
9571.
9572.

D.A Intravenous insulinia

9573.
9574.

E.A Subcutaneous insulin: biphasic insulin regimeia d

9575.
9576.

Which of the following is deficient in patients with hereditary angioedema?ia

9577.
9578.
9579.

A.A C1-INHia

9580.
9581.

B.A C3ia

9582.
9583.

C.A Heat shock protein type 1ia

9584.
9585.

D.A C6ia

9586.
9587.

E.A Histamine degradation protein (HDP)ia a

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.

A.A Synovial cystia

9592.
9593.

B.A Haemarthrosisia

9594.
9595.

C.A Septic arthritisia

9596.
9597.

D.A Goutia

9598.
9599.
9600.

E.A Olecranon bursitisia e

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.

E.A Sulfadiazine and pyrimethamineia b

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

ALT of 2,212 iu/lia

Aspirin therapyia
Platelet count of 100 * 109/lia
Body mass index of 33 kg/m^2ia
Bile duct diltationia e

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.

WCC 5.3 * 109/l

9647.
9648.

PT 11 secs

9649.

APTT 30 secs

9650.
9651.

Factor VIIIc

9652.

activity Normal

9653.
9654.

What is the most likely diagnosis?ia

9655.

A.A Drug-induced thrombocytopeniaia

9656.

B.A Henoch-Schonlein purpuraia

9657.

C.A Thrombotic thrombocytopenic purpuraia

9658.

D.A Idiopathic thrombocytopenic purpuraia

9659.

E.A Antiphospholipid syndromeia d

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.

B.A Enterotoxigenic Escherichia coliia

9664.

C.A Staphylococcus aureusia

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.

Platelets 702 * 109/l

9671.

WCC 56.6 * 109/l

9672.

Film Leucocytosis noted. All stages of granulocyte maturation seen

9673.
9674.

Given the likely diagnosis, what is the most appropriate treatment?ia

9675.

A.A Chlorambucilia

9676.

B.A Stem cell transplantationia

9677.

C.A Rituximabia

9678.

D.A Repeat full blood count in 3 monthsia

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.

C.A Dilated cardiomyopathyia

9684.

D.A Dialysis related sepsisia

9685.

E.A Ischaemic heart diseaseia e

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.

C.A Neurokinin Aia

9691.

D.A Bradykininia

9692.

E.A Nitric oxideia d

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.

C.A Expressive aphasiaia

9697.

D.A Akinetic mutismia

9698.

E.A Psychogenic aphoniaia e

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.

B.A IV diamorphine + arrange echocardiogram urgently to exclude pericardial tamponadeia

9703.

C.A IV diamorphine + call the family in to discuss withdrawal of treatmentia

9704.

D.A IV diamorphine + arrange percutaneous coronary interventionia

9705.

E.A IV diamorphine + thrombolysisia d

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.

Platelets 189 * 109/l

9712.

WCC 13.1 * 109/l

9713.

Neut 5.2 * 109/l

9714.

Lymp 6.2 * 109/l

9715.

Film Atypical lymphocytes seen

9716.
9717.

What is the most likely diagnosis?ia

9718.

A.A Acute lymphoblasic leukaemiaia

9719.

B.A Hashimoto's thyroiditisia

9720.

C.A Infectious mononucleosisia

9721.

D.A HIV seroconversionia

9722.

E.A Septicaemia seconadary to streptococcal throat infectionia c

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.

Deep inflammatory infiltrate from the mucose to the lamina propria

9727.

Numerous granulomata noted

9728.
9729.

What is the most likely diagnosis?ia

9730.

A.A Crohn's diseaseia

9731.

B.A Rectal carcinoma-in-situia

9732.

C.A Tuberculosisia

9733.

D.A Laxative abuseia

9734.

E.A Ulcerative colitisi a

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.

What is the most appropriate antibiotic therapy?ia

9742.

A.A IV benzylpenicillin + gentamicinia

9743.

B.A IV ceftriaxone + benzylpenicillinia

9744.

C.A IV flucloxacillin + gentamicinia

9745.

D.A IV vancomycin + rifampicin + gentamicinia

9746.

E.A IV vancomycin + benzylpenicillinia a

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.

A.A Switch digoxin for verapamilia

9750.

B.A Refer for electrical cardioversionia

9751.

C.A Add amiodaroneia

9752.

D.A Add bisoprololia

9753.

E.A Make no change to his regular medication but prescribe flecanide as a 'pill in the pocker'ia d

9754.

Northern blotting is used to:ia

9755.

A.A Detect and quantify proteinsia

9756.

B.A Amplify DNAia

9757.

C.A Detect RNAia

9758.

D.A Detect DNAia

9759.

E.A Amplify RNAia c

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.

A.A Streptococcus pneumoniaeia

9763.

B.A Klebsiella spp.ia

9764.

C.A Haemophilus influenzaeia

9765.

D.A Pneumocystis jiroveciia

9766.

E.A Pseudomonas aeruginosaia c

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.

CT head Single ring-enhancing lesion in the right parietal lobe

9771.
9772.

What is the most likely diagnosis?ia

9773.

A.A Primary CNS lymphomaia

9774.

B.A Tuberculosisia

9775.

C.A Progressive multifocal leukoencephalopathyia

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.

A.A Rheumatoid arthritisia

9783.

B.A Psoriatic arthritisia

9784.

C.A Goutia

9785.

D.A Reactive arthritisia

9786.

E.A Gonococcal arthritisia d

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.

A.A Glucagon stimulation testia

9789.

B.A Oral glucose tolerance test with growth hormone measurementsia

9790.

C.A Insulin + C-peptide levels during a hypoglycaemic episodeia

9791.

D.A Short ACTH testia

9792.

E.A Insulin tolerance testia c

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.

A.A Right heart enlargementia

9796.

B.A Normalia

9797.

C.A Pleural effusionia

9798.

D.A Linear atelectasisia

9799.

E.A Dilatation of the pulmonary vessels proximal to the embolismia b

9800.
9801.

JAK-2 MutationGuestThank you very much for these BOFs.

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.

if possible I like to seek clarification for some of the quetion,

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.

Table V. Indications for treatment.

9813.

Progressive marrow failure: the development or worsening of anaemia

9814.

and/or thrombocytopenia

9815.

Massive (>10 cm) or progressive lymphadenopathy

9816.

Massive (>6 cm) or progressive splenomegaly

9817.

Progressive lymphocytosis

9818.

>50% increase over 2 months

9819.

Lymphocyte doubling time <6 months

9820.

Systemic symptoms*

9821.

Weight loss >10% in previous 6 months

9822.

Fever >38_C for 2 weeks

9823.

Extreme fatigue

9824.

Night sweats

9825.

Autoimmune cytopeniasgiroop2003, Jan 30, 2010#189

9826.

giroop2003GuestRegarding Bronchitis there was choice, Morexella, I have answered that, and it is
given in Passmedicinegiroop2003, Jan 30, 2010#190

9827.

dr_mahmoudGuestthank u....waiting fon more recalls

9828.
9829.

thank u dr mrcpian

9830.

hope to complete the remaing quistions

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.

waiting for urr recalls

9834.

thank udr_mahmoud, Jan 30, 2010#191

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.

wish you all best of luck

9839.

kind regards

9840.

mrcpianmrcpin, Jan 30, 2010#193

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.

,CARDIAC CATHETRIZATION ONLY IN IDIOPATHIC PULMONARY HTNahmed M,

January 2007

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

generation Cephalosporins 9- When to give pneumococcal vaccine in splenectomy a- 1 week prior b- 1

week after c- At the time of surgery d- 1 month prior surgery 10- Statins interactions with which of the
following: a- cranberry juice b- apple juice c - grapefruit juice d- pinepaple e-orange juice 11- Which
nerve/root is affected if there is global wasting of small muscles of hand? a- C7 b- T1 12- Best initial
management of immune thrombocytopenia? a- Steriods 13- Which one is the centrally acting
antihypertensive? a- MINOXIDIL (vasodilators) b- ACE inhibitors c- Calcium antagonists 14- Dose of
prednisolone equivalent to 20 hydrocortisone? 15- Patient presented with anterior chest pain. Definite
ECG indications to give thrombolysis? a- more than 1mm ST elevation in standard lead b- more than
1mm ST elevation in chest lead c- more than 1mm ST depression in chest lead d- more than 1mm ST
depression in standard lead 16- Best initial investigation in a 17 year old getting recurrent meningitis
17- Type & site of immune deposits in pemphigus vulgaris 18- A school teacher gets pneumococcal
meningitis. what will u do for his contacts? a- nothing b- isolate c- rifampicin d- ceftriaxone 19- Type
of cancer at the margin of a chronic venous ulcer? 20- Peutz-Jeghar Syndrome, inheritance? aautosomal dominant 21- Treatment of WPW Sydrome: a- Flecainide b- Digoxin c- Verapamil 22- A
man with polycystic kidney disease was considered for renal transplant his blood type A and rh
negative which was one of his family was the most suitable donor? a- His son who was blood group O
AND RH negative b- NONE OF THE ABOVE 23- A PATIENT WHO CAME WITH SEVERE RT
SIDE FACIAL PAIN WHICH AWAKEN THE PATIENT FROM THE SLEEP THE PATIENT FELT
THE PAIN IN THE BACK OF HIS EYE & lacrimation? a- TRIGEMINAL NEURALGIA bCLUSTER HEADACHE 24- A lady is given balloons to blow in a party, she later develop lip edema.
Symptoms of angioneuritic oedema including lip swelling? a- C1 INHIBITOR DEFICIENCY b- latex
allergy 25- Which of the following cytokines are secreted by T helper 2 (TH2) CELLS a-IFNGAMMA b-INTERLEUKIN 2 c-IL 4 d- IL7 e- tumour necrosis factor 26- What about pt with bipolar
disorder on lithium, had confusion, was started rosiglutazone came with hyponatremia? Drug causes is?
a- Lithum b- Rosigltazone 27- Pt. swimming in the pole had fit with incontenence of urine-with come
jurks a- epilepsy 28- Antibiotic Prophlaxis: a- Pacemaker, b- Isolated Secundum c- ASD d- MVP
without regurgitation 29- In Physiology , whats Troponin T & I? a- structural protein b- contractile
protein c- enzyme 30- Which Pituitary hormone is in constant inhibition? (Asked twice) a- prolactin bTSH c- ACTH 31- Blistering disorders: structure ? a- dermo-epidermal junctions b- dermis epidermis
32- Gastric CA wid which of skin conditions? a- Erythema Migrans b- Erythema gyratum repens 33Action of Gastrin? a- Stimulus for secretion amino acids in antrum b- acts on G cells in antrum creduces pancreatic bicarb secretion 34- Chlamydia with pregnant patient :Contraindication??? aMetronodazole? b - Doxycycline 35- In Statistics question, to find out senstivity, table was given? a80% b- 40% c-93% d- 95% 37- Patient presented with hypomagnesemia, Reason? a- diuretics
treatment 38- Effect of NSAIDs on Kidney? a- Intersitial Nephritis b- Papillary Necrosis 39- Frontal
Lobe Lesion? a- Perservation 40- Mechanism of Action of Selegeline? a- Monoamine Oxidase
Inhibitors 41- Somatoform Disorder 42- 43- Typical history of Bechet's Disease? 44- Male with
gynaecomastia.History suggestive of klinefelters? 45- MOA of Bisphosphonates? 46- Poor prognostic
sign in left ventricular dysfunction? a- 3 heart sound 4 hours b- fixed 2 hs etc 48- Side Effects of fluid
overload (5 liters of Normal Saline to a post-op patient)? a- Metabolic acidosis b- Pulmonary edema chypoglycemia d- hypernatremia 49- Best method to stage carcinoid syndrome? 50- What to do with a
nurse exposed to a TB patient & tuberculin positive? a- continue work b- dont work till culture is
negative c- Patient can go back IF the sputum is already negative" 51- A patient with a bleeding peptic
ulcer given H Pylori eradication regime. But still urease positive. Reason? a- Re-infection b- not totally
eradicated H. Pylori that's why the patient still symptomatic 52- In G6PD deficieny: 1- Heinz bodies
53- What was ? guar gum and acarbose? 54- Pt. has pain in both proximal and distal joints, on diuretics
,xray showing intra articular calcification what could be the cause? a- heamachromatosis b- gout cpsuedo gout 55- X-ray finding of RA? a- Periarticular osteopenia 56- Pt with confusion, on
examination global cognitive impairment,mainly cognitive aprexia diagnosis? a- Herpis encephalitis.
57- What was the answer for determenant of prognosis in aml :t cell typr number of blasts with bcl abr?
58- A 80 year old female with regurgitation of food & dysphagia and wt loss full in the neck? aEsophageal carcinoma. 59- Thyroid scan? a- Toxic solitary nodule. 60- Young boy with weakness and
normal siblings? a- Friedrek's ataxia b- Subacute combined degenration of the cord. 61-. 62- What to
give in a pt with with hypotension and hypoglycaemia? a- IV triidothyronin b- IV hydrocortison. 63- A
post MI patient with respiratory infection. Given broad spectrum antibiotics. After a week there was a
massive effusion? What is the next appropriate or next step? a- Aspirate fluid b- Echocardiogram cECG 64- Pt. received heparin for a DVT? a- Heparin b- t phlebitic syndrome 65- A pt.with raynaud's
phenomenon? a- Scleroderma 66- Pancytopenia and high MCV? a- Folic acid defiency b- Alcohol
anamia 67- In a patient, there is reduced attentuation in CT in HIV pt.? a- neurosyphilis b- alzehiemer's
disease c- lewy body dementia d- PROGRESSIVE MULTI FOCAL LEUCOENCEPHALOPATH 68-

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?

A Absence of extrapyramidal symptoms

B Fluctuating mental state Correct answer
C Poor concentration
D Rapid onset
E Auditory hallucinations
The three cardinal features that help to distinguish Lewy Body dementia from dementia of Alzheimers
type include
fluctuating cognitive function with varying levels of alertness and significant daytime somnolence.
Visual
hallucinations are also more common in Lewy Body dementia, and there is a strong association with
parkinsonian
motor features. The association with loss of dopaminergic neurones means that patients have
significant sensitivity to
neuroleptics. There may be significant improvement in memory loss in response to cholinesterase
inhibitors.
A 70-year-old man became wheezy while walking uphill, and tripped hitting his left eye. He now
complains of pain in
this eye; the cornea is hazy, the globe feels very firm to palpation and there is a hyphaema obscuring
most of the iris.
Which of the following is the most appropriate treatment?
A Examination under anaesthesia
B Topical -blockers
C Intravenous carbonic anhydrase inhibitors Correct answer
D Topical anticholinergics
E Anterior chamber paracentesis
Blunt ocular trauma can have various effects on the eye. These range from subconjunctival
haemorrhage, corneal
abrasion, traumatic pupillary mydriasis, vitreous haemorrhage, commottio retinae and choroidal
rupture. Hyphaema

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

C Take aciclovir as prophylaxis

D Receive varicella-zoster immune globulin (VZIG) urgently
E Consider termination of pregnancy
The mother should be tested for VZV IgG urgently and if negative should receive VZIG. VZIG is
effective in reducing
the incidence of chickenpox up to 710 days post-exposure and probably in reducing the incidence of
congenital
varicella syndrome. Aciclovir is not licensed as prophylaxis, but is occasionally used in severely
immunocompromised
VZV contacts. The incidence of congenital varicella syndrome is about 2% in mothers who develop
primary
chickenpox in the first half of pregnancy.
A 16-year-old boy comes to the clinic with his parents. He complains that he feels lethargic,
particularly at the end of
the day; this manifests by difficulty doing simple tasks like whistling, and he finds it difficult to carry
things for his
parents because of shoulder weakness. He is also embarrassed as he has a bit of a gut because his
tummy
muscles seem a little lax. Other past history of note is high frequency deafness picked up at a previous
hearing
check. On examination he does have mild proximal upper limb weakness and a winged aspect to
both scapulae.
The only other finding of note is weakness of ankle dorsiflexion.Investigations;
Hb 13.1 g/dl
WCC 6.7 x109
/l
PLT 212 x109
/l
Na+
139 mmol/l

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

Which of the following is the most likely diagnosis?

A Narcolepsy
B Sleep apnoea syndrome
C Restless legs syndrome Correct answer
D Nocturnal leg cramps
E Peripheral neuropathy
This clinical picture is typical of restless legs, with the onset of symptoms on going to bed, lasting to
the early hours of
the morning. Secondary causes of restless legs include iron deficiency anaemia, folate deficiency,
magnesium
deficiency, amyloidosis, diabetes mellitus and pregnancy. In this case restless legs syndrome may
respond to
correction of iron deficiency anaemia and avoidance of agents which affect sleep such as alcohol,
caffeine and
nicotine. Other therapies include dopamine agonists and benzodiazepines such as clonazepam.
A 45-year-old man with previously diagnosed Type 2 diabetes presents to the Emergency room with
severe central
chest pain, nausea and sweating. He was riding his bike in an attempt to lose weight when the chest
pain began. He
also smokes 15 cigarettes per day and is hypertensive, managed with ramipril and amlodipine. On
examination his
BP is 155/95 mmHg, he is pale, sweaty and anxious. He has been given 300mg of aspirin by a passerby.
Investigations;
Hb 13.2 g/dl
WCC 5.9 x109
/l
PLT 209 x109
/l
Na+

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

PLT 187 x109

/l
Na+ 142 mmol/l
K+
5.1 mmol/l
Creatinine 148 mol/l
ECG ST elevation in the anterior leads
Which of the following is the most appropriate way to manage him?
A Monitor on the CCU
B Thrombolyse with TPA
C Refer for immediate PCI Your answer
D Arrange an urgent CT head
E Arrange a cardiac MRI Correct answer
Persistent ST elevation in the absence of chest pain in a patient who has a history of previous anterior
myocardial
infarction raises the possibility of left ventricular aneurysm. Cardiac MRI is an effective way to image
the aneurysm
non-invasively, and would be the preferred initial investigation. The presence of multiple TIAs raises
the possibility of
thrombus formation. Hence anti-coagulation may be considered here, with possible referral for surgical
excision of
aneurysm.
A 56-year-old alcoholic is admitted to the Emergency department with a pyrexia and cough productive
of green
sputum. He admits to drinking around 8 pints of cider per day and an unspecified amount of gin. He
has been
admitted on a number of occasions with decreased consciousness and once previously with aspiration
pneumonia.
On examination he is pyrexial 38.2o
C, with a BP of 105/60 mmHg, and has bilateral coarse breath sounds and

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

B Adjacent to the thin myofilaments Correct answer

C Adjacent to the thick myofilaments
D Free within the cytoplasm
E T-tubules
Troponin binds to the actin in thin myofilaments, forming a complex between G-actin and
tropomyosin. Both troponin I
and troponin T are also found in skeletal muscle, cardiac troponin I only differs slightly from that found
in skeletal
muscle, but troponin T has less structural homology. Very specific assays for troponin T in particular
have now almost
completely replaced assessment of CK in myocardial infarction.
A 59-year-old man is admitted with unstable angina. He has a history of Type 2 diabetes and a previous
inferior
myocardial infarction. His ECG shows anterior ST depression and he has ongoing chest pain despite
nitrates. He
goes for angioplasty and is treated with abciximab.Which of the following correctly describes the mode
of action of
abciximab?
A Cycloxygenase inhibitor
B Prostaglandin E inhibitor
C Glycoprotein 2b 3a inhibitor Correct answer
D Phosphodiesterase inhibitor
E Thromboxane A2 inhibitor
Abciximab is an inhibitor of the glycoprotein 2b 3a receptor on the platelet membrane. The receptor
mediates platelet
aggregation, and inhibition by abciximab, a chimeric/human monoclonal antibody leads to decreased
thrombus
formation. Abciximab is indicated both in the management of unstable angina and in prevention of
ischaemic

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

Creatinine 134 mol/l

CT head slight ventricular enlargement
Which of the following is the most appropriate way to confirm the diagnosis of meningococcus?
A Blood culture Your answer
B CSF microscopy and culture
C Skin lesion culture
D PCR for meningococcus Correct answer
E Meningococcal serology
Lumbar puncture to gain a CSF sample is not recommended when there is raised intracranial pressure
or evidence of
a meningococcal skin rash over the area where LP is being considered. Additionally, the yield from
CSF culture is
diminished after antibiotic therapy has been commenced. As such PCR of either biopsy material or
aspirates from
skin lesions is the most appropriate and rapid way of establishing the diagnosis. Treatment is with a
broad spectrum
cephalosporin such as ceftriaxone.
Altitudinal hemianopia is a cardinal feature in a patient who?
A Denies the fact he is blind
B Is 72 years old with macular degeneration
C Is 70 years old with headache, vomiting and swelling of the optic disc Your answer
D Is a 74-year-old man with multiple cholesterol emboli on fundoscopy Correct answer
E Has coarse facial features, large lips and spade like fingers
Branch retinal artery occlusion can lead to altitudinal field defect with visual loss in either the upper or
the lower visual
field. Fundoscopy may demonstrate embolic material within blood vessels. Anterior ischaemic
neuropathy due to
vasculitis of the posterior ciliary arteries usually causes altitudinal visual loss. A patient who denies the
fact that he is

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

C Start low dose gliclazide

D Start low dose glibenclamide
E Start metformin 500mg BD Correct answer
This patient has proven gestational diabetes and obesity. Traditionally management of gestational
diabetes has
centred on dietary management and insulin initiation, however two studies suggested that
glibenclamide and
metformin may be viable alternatives in appropriate patients. One very large trial of metformin +/insulin versus
insulin alone reported similar outcomes with respect to a composite of various measures of fetal
distress. Given the
fact that she is obese, it would therefore seem reasonable to begin with metformin in this case.NEJM
Vol 358 20032015
A 62-year-old woman is admitted with confusion and increased respiratory rate. She has been managed
by her GP
for shortness of breath and is taking ramipril and indapamide for hypertension and has a salbutamol
inhaler. She
came to the Emergency room with her daughter because of concerns that she was getting worse. On
examination
her BP is 112/62 mmHg, she has a pyrexia of 37.4o
C. Pulse is 75/min and regular and heart sounds are normal.
Auscultation of the chest reveals scattered crackles and wheeze.Investigations;
Hb 13.1 g/dl
WCC 9.2 x109
/l
PLT 201 x109
/l
Na+
138 mmol/l

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

arteries. Skin biopsy appears to be helpful in diagnosis.

A 45-year-old woman is seen in the oncology clinic with end-stage carcinoma of the breast. She has
failed various
treatments and you are considering treating her with docetaxel. What is the mode of action of
docetaxel?
A Disrupting DNA
B Binding to microtubules Correct answer
C Inhibiting mitochondrial energy production
D Inhibiting RNA production
E Inhibiting ribosome production Your answer
Docetaxel reversibly binds to microtubules with high affinity. This leads to a decrease in the
availability of free tubulin,
thus preventing mitotic cell activity. Microtubules also accumulate within the cell increasing apoptosis,
and docetaxel
has a further action in blocking bcl-2. Side effects are similar to those seen with other
chemotherapeutic agents.
A 25-year-old woman presents with nausea and lethargy. The GP has been treating her for essential
hypertension
with ramipril and her latest on treatment BP has been recorded at 149/89 mmHg. Other past history of
note includes
a symmetrical polyarthropathy which may be rheumatoid arthritis and a history of urinary tract
infections as a child.
On examination she looks pale and thin, her BP is 165/90 mmHg. There are bibasal crackles on
auscultation of the
chest.Investigations;
Hb 10.4 g/dl
WCC 6.7 x109
/l
PLT 179 x109
/l

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

D Avascular necrosis Correct answer

E Osteoarthritis
This patient has risk factors for osteoporosis (smoking and corticosteroid use), and avascular necrosis
(corticosteroid
use). Early changes in avascular necrosis include joint sclerosis as seen here; however there is no
evidence to
support the alternative diagnoses of pathological fracture, osteoporosis or Pagets disease. MRI is the
most sensitive
modality for detecting bone changes associated with avascular necrosis, plain x-rays taken later in the
process may
show flattening of the femoral head. Unfortunately most patients with advanced disease require
arthroplasty, although
osteotomy / decompression procedures are attempted in some patients with varying degrees of success.
A 36-year-old woman with a symmetrical polyarthritis comes to the clinic for review. She has been
taking regular
paracetamol and diclofenac but is still suffering from significant joint pains. On examination she has
valgus deformity
of both elbows, and evidence of active synovitis affecting her wrists, hands, knees and
ankles.Investigations;
Hb 11.9 g/dl
WCC 8.9 x109
/l
PLT 222 x109
/l
Na+
141 mmol/l
K+
4.3 mmol/l
Creatinine 130 mol/l
Rheumatoid factor +

Which of the following is the most appropriate additional therapy?

A Tramadol
B Methotrexate Correct answer
C Low dose corticosteroids
D Etanercept
E Gold
This woman has rheumatoid arthritis. Given that it is cost-effective and associated with fewer longterm adverse
events than gold, methotrexate is the best second line agent from the options given. It is usually given
as a single
once weekly dose with additional folic acid. Anti-TNF agents have also showed great promise in the
management of
RA, and hence agents like etanercept are a potential option in those patients who fail to respond to
other DMARDs.
A 70-year-old man has been experiencing a right-sided headache and severe temporomandibular joint
pain for the
past week. He now presents with a sudden loss of vision in his right eye.What treatment is required
urgently to avoid
vision loss in the left eye?
A Intraocular steroids
B Intravenous steroids Correct answer
C Pilocarpine
D Timolol
E Sumatriptan
This man has giant-cell arteritis affecting the temporal artery. This is an inflammatory granulomatous
arteritis of large
arteries, which occurs in association with polymyalgia rheumatica. Involvement of the ophthalmic
arteries causes a
sudden painless temporary or permanent visual loss. Corticosteroids are obligatory in this condition
because they

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

PLT 139 x109

/l
Na+
142 mmol/l
K+
6.1 mmol/l
Urea 35.2 mmol/l
Creatinine 720 mol/l
ALT 1024 U/l
Albumin 32 g/l
Alkaline Phosphatase 623 U/l
Urine on suprapubic catheterisation blood++
Which of the following is most likely to be responsible for his impaired conscious level?
A Hepatic failure Your answer
B Renal failure Correct answer
C Cerebral metastases
D Stroke
E Urinary sepsis
It is clear this patient has severe renal failure. Whilst his LFTs are in keeping with hepatic metastases,
the relative
preservation of albumin would indicate that his liver function is reasonably intact. Because many of the
hepatic opiate
metabolites are also biologically active, dose adjustment of opiates is recommended in both renal and
hepatic failure.
Given that he has been stable for a prolonged period of time, and there is no history suggestive of focal
neurological
impairment, cerebral metastases seem less likely.
A patient with a history of angina is being investigated for dyspnoea. Blood tests confirm haemolytic
anaemia and a

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

E Ventricular ectopics on the monitor

Hypertension of greater than 250/115 mmHg is usually considered as a reason to discontinue the test. A
drop of
more than 10mmHg blood pressure in the presence of other evidence of ischaemia is also a reason for
discontinuing
the exercise test. In the presence of an achieved heart rate of 170/min, ST depression of 2mm is an
entirely
appropriate reason for discontinuing the test. Ventricular ectopics, rather than sustained VT are
acceptable, and the
test need not be stopped for these.
A 34-year-old patient with severe post-influenza staphylococcal pneumonia is admitted to the intensive
therapy unit.
Unfortunately he deteriorates with renal failure and low output cardiac failure with hypotension. He
also has evidence
of developing disseminated intravascular coagulation (DIC). His BP is 95/50 mmHg, pulse 105/min, on
inotropic
support.Investigations;
Hb 10.8 g/dl
WCC 15.2 x109
/l
PLT 74 x109
/l
Na+
141 mmol/l
K+
5.8 mmol/l
Creatinine 375 mol/l
He is given activated protein C but then suffers an acute deterioration in his conscious level. When you
see him is

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

other abnormal findings. Investigations;

Hb 10.0 g/dl
WCC 9.2 x109
/l
PLT 191 x109
/l
Na+
139 mmol/l
K+
3.8 mmol/l
Creatinine 125 mol/l
Albumin 24 g/l
ALT 186 U/l
Small bowel biopsy Expanded villi PAS positive macrophages
Which of the following is the most likely diagnosis?
A Intestinal lymphoma
B Whipples disease Correct answer
C Tropical sprue
D Coeliac disease
E Hepatitis
The presence of malabsorption with chronic diarrhoea, joint pains and intermittent fevers, accompanied
by PAS
positive macrophages is typical of the condition. Hypoalbuminaemia fits with this picture as does the
anaemia;
increases in transaminases are also seen. Antibiotic therapy is the mainstay of therapy, with a prolonged
duration of
treatment of up to 1 year recommended. Pencillin V, amoxicillin or co-trimoxazole are typical regimes
used. PCR is
suggested as an effective way to monitor response to therapy, with adequate treatment reflected by
negative PCR for

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

Creatinine 110 mol/l

Skin biopsy subepidermal blister, polymorphous inflammatory infiltrate with a predominance of
eosinophils
Which of the following is the most likely diagnosis?
A Pemphigus
B Bullous pemphigoid Correct answer
C Erythema multiforme
D Epidermolysis bullosa
E Dermatitis herpetiformis
The distribution of blisters and skin biopsy fits with a diagnosis of pemphigoid. Whilst mouth lesions
are common in
pemphigus, they are rarely seen in patients with pemphigoid. Various techniques exist to measure IgG
directed
against the basement membrane, but most, such as immunoelectron microscopy and ELISA have
limited availability.
Furosemide, NSAIDs, ACE inhibitors and penicillamine are all known to be associated with the
development of
pemphigoid.
A 15-year-old boy is being treated with ADH for diabetes insipidus. His plasma glucose level (fasting)
is 6 mmol/l (3
6), sodium 139 mmol/l (137144), potassium 4.5 mmol/l (3.54.9) and calcium 2.9 mmol/l (2.22.6).
He still has
complaints of polyuria, polydipsia and nocturia. What could be the most probable cause?
A Diabetes mellitus
B Nephrogenic diabetes insipidus Correct answer
C Primary polydipsia
D SIADH
E Hypercalcaemia
This boy most probably has nephrogenic diabetes insipidus. In this condition, renal tubules are resistant
to

antidiuretic hormone (ADH), which is due to a receptor defect of vasopressin-2 receptor or a

postreceptor defect in an
ADH-sensitive water channel called aquaporin-2. The findings do not suggest diabetes mellitus, which
is also
associated with these symptoms. In patients with the syndrome of inappropriate secretion of ADH
(SIADH), sodium
levels are usually < 125 mmol/l. Mild hypercalcaemia (< 3 mmol/l) is frequently asymptomatic.
Primary polydipsia is a
psychiatric disturbance characterised by the excessive intake of water. It is unusual at this age. Sodium
levels fall as
a result and the urine produced is appropriately dilute.
A 30-year-old man completed adjuvant chemotherapy for a stage-I testicular teratoma one month ago.
He now
presents with increasing shortness of breath and a dry cough. You suspect an adverse drug reaction
related to one of
his chemotherapeutic agents.What would be the most likely drug responsible?
A Bleomycin Correct answer
B Cisplatin
C Etoposide
D Methotrexate
E Vincristine
Bleomycin can cause pulmonary toxicity, which typically occurs during or shortly after completing
treatment. Classical
symptoms are shortness of breath, dry cough and fever (particularly in the acute setting). It can result in
permanent
damage and pulmonary fibrosis. While methotrexate can cause pulmonary fibrosis, it is rarely seen and
is not used in
the treatment of teratoma. Cisplatin and etoposide are both used to treat testicular teratoma but do not
cause

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

B Co-amoxiclav Correct answer

C Hepatitis B infection
D Hepatitis C infection
E Ibuprofen
Cholestatic jaundice may occur during co-amoxiclav therapy or shortly afterwards. Epidemiological
studies put the
risk of acute liver toxicity at about six times higher with co-amoxiclav compared to amoxicillin therapy
alone.
Cholestatic jaundice occurs more commonly in patients older than 65 years and more commonly in
men; these
reactions are rarer in children. Jaundice is usually self-limiting and rarely fatal. Duration of coamoxiclav therapy
should be appropriate to the indication and not exceed 14 days on the advice of the Committee on
Safety of
Medicines. Other, rarer side-effects of co-amoxiclav include erythema multiforme, toxic epidermal
necrolysis, and
exfoliative dermatitis.
A diagnosis of diabetes mellitus was being considered in 32-year-old woman who was 16 weeks
pregnant. Her body
mass index (BMI) was 22 kg/m2
(18-25). A 75 g oral glucose tolerance test (OGTT) was reported as in the table:
Time Plasma glucose concentration (fasting) (mmol/l)
Normal range 0h < 6.0
Patient 0h 6.0
Normal 2h < 11.1
Patient 2h 12.5
Which of following appropriate next step in management of this patient?
A Glipizide therapy
B Soluble insulin Correct answer
C Low calorie diet

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

Creatinine 149 mol/l

Which of the following is the most likely diagnosis?
A Complete heart block Correct answer
B Mobitz type 2 heart block
C Sinus bradycardia
D Junctional rhythm
E Ventricular bigeminy
Cannon waves occur when the right atrium contracts against a closed tricuspid valve, and these occur
irregularly in
complete heart block. This diagnosis is entirely in accordance with the presentation with bradycardia,
relative
hypotension and syncope. Management in this case would be an ECG to confirm the diagnosis and then
likely
referral for insertion of permanent pacemaker. Cannon waves are also seen in conjunction with
ventricular
tachycardia.
A 29-year-old missionary is admitted to the Emergency Department suffering from a rash and fever
with associated
diarrhoea. She has been working in Bangladesh and has returned to the UK to visit relatives with her 8
week old
baby. You make a diagnosis of Typhoid fever and wish to commence antibiotic therapy. Which of the
following
antibiotics is the best choice, bearing in mind that she wishes to continue breast feeding?
A Olfloxacin
B Co-trimoxazole
C Ceftriaxone Correct answer
D Ciprofloxacin
E Chloramphenicol
Quinolones are not recommended due to effects seen in animal studies on cartilage formation in
growing mammals,

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 IV 12mg adenosine Correct answer

B IV amiodarone loading
C IV atenolol
D IV verapamil
E IV flecainide
It is appropriate to try 12mg IV adenosine before moving on to an alternative therapy. Verapamil or
short acting beta
blockers such as esmolol are both appropriate alternative agents for achieving sinus rhythm. Flecanide
is useful for
chemical cardioversion of paroxysmal atrial fibrillation in patients with no history of underlying
ischaemic heart
disease; IV amiodarone is a reasonable alternative.
A 57-year-old man with ischaemic heart disease, and a recent transient ischaemic attack, is prescribed
clopidogrel.
How would the mechanism of action of this drug be best described?
A Blocks glycoprotein IIb/IIIa receptors
B Blocks thrombin receptors
C Blocks thromboxane production
D Blocks platelet ADP receptors Correct answer
E Potentiates antithrombin-III action
Clopidogrel blocks platelet ADP receptors, while aspirin blocks thromboxane production, hence the
complementary
actions of the two drugs when given together following coronary stenting. The final common pathway
for platelet
aggregation is through the glycoprotein IIb/IIIa receptor. Hence, the most powerful antiplatelet drugs
are the
glycoprotein IIb/IIIa blockers such as abciximab and tirofiban. Hirudins act by blocking thrombin
receptors but have no
current indication in cardiac disease.

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

PLT 130 x109

/l
Na+
131 mmol/l
K+
4.5 mmol/l
Creatinine 145 mol/l
Urine protein +, blood +
PaO2 7.1 kPa
PaCO2 3.8 kPa
Which of the following is the most likely diagnosis?
A Urinary sepsis
B Listeria monocytogenes
C Legionnaires disease Correct answer
D Pneumococcal pneumonia
E Meningococcal meningitis
Outbreaks of Legionnaires occur because of carriage in air conditioning systems and tend to affect
workers in large
air conditioned offices, or hotel clients. SIADH occurs commonly in association with Legionnaires,
hence the low
sodium seen here; CNS symptoms and diarrhoea are also frequently seen. Urinary antigen testing is a
very rapid and
sensitive way to confirm the diagnosis. Macrolides, namely erythromycin, with or without rifampicin,
are the antibiotics
of choice for treatment of Legionnaires.

9. Most common vessel involved in Mesentric infarction Of ileum Superior Mesentric

Artery
10. Hyponatremia- Detailed Pathophysiology- Changes in Intravascular and Extravascular
Compartment

11. S4 Corresponds to Pwave on ECG

12. Digitalis Toxicity PPt by Hypomagnesemia
13. Action Of Parathyroid Hormone on Metabolism of Phosphate and Calcium
14. Cause of Hyperuricemia in Tumor Lysis Syndrome
15. Anti-CCP in Rheumatoid Arthiritis
16. Eternacept Binds with TNF
18. Cystic Fibrosis Clinical scenario mentioned AR

20. Insulin Receptors Membrane Receptors

21. 0 Phase of Depolarisation- associated with Sodium
23. Study Design What phase represents effectiveness of a drug
24. MOA of Doezolamide Carbonic anhydrase inhibitor
25. Porphyria Cutanea Tarda Clinical scenario mentioned Photosensitive rash with bullaes
+ Hypertrichosis Defect in Uroporphyrin Decarboxylase
26. Menniere s Disease Triad Of Dizziness + Tinnitus + SNHL
27. Pneumothorax after Trumpet Usage- Cant do scuba diving for life
28. Wernickes Aphasia Fluent but Word Neologism Comprehension Impaired- Location ON
superior Temporal gyras
30. Hayflick Theory of ageing of cell Involves Telomeres
31. PICA Ipsilateral Ataxia, CN palsy Contralateral limb sensory involvement
32. Syringomyelia Diagnose from Clinical Picture
33. Phenytoin not effective appropriate blood levels not achieved next action ???
34. Hemiballism characteristics mentioned Subthalmic Nucleus in volved
35. Headache + Loss Of Smell
36. Cause of Hematuria in Which anticytotoxi Cyclophosphomide
37. Hereditary Spherocytosis- Dx by Osmotic fragility test
38. Dignosis fro clinical picture PO2 is N, SPO2 is decreased Methaemglobinemia
39. PRV Rx by Hydroxy carbamide
40. Clinical Picture of Bloods indicating Neutropenia in Middle Eastern Person <1.5 Racial
Variation

41. Von willibrands disease Clinical picture- APTT prolonged

42. ITP
43. Sick euthyroid Syndrome

45. Exanetide GLP1 analogue

46. Production Of Ketones in DKA- Lipolysis
47. Pheochromocytoma associated with MEN 2
48. Carcinoid Syndrome Dx by HIAA
49. Travellor coming from India Bloody Diarhoea- Amoebiasis
50. Terlipressin Before doing Endoscopy and banding in UGI Bleed

52. Hypori causing MALToma Rx by Hpylori eradication therapy

54. Diabetes- Long duration- pain after meals- Chronic Pancreatitis
55. Ulcerative Colitis Treatment
56. Fulminant Hepatitis in Pregnant lady Ex is Hepatitis E
57. Streptococus Sanguinis- diagnosis ???
58. C3b nephritic Factor seen in MCGN- Auto antibody
59. FSGN seen in HIV, IVdrug abuser
60. Clinical features given Dx Lateral Epicondylitis

62. Mixed Cryoglobulenimia

65. HTN in pt. < 55yrs DOC ACE Inhibitor
66. Clinical picture indicating Dx of Cardiac Tamponade
67. PET Scan Uses Fluoeodeoxyglucose
68. Mouth Ulcers seen in Nicorandil Usage
69. Long QT syndrome associated with KCNE1 gene involvement
70. Pt. age >70yrs + severe Aortic Stenosis Rx by bioprosthetic valve replacement
71. PAH Dx by Cardiac catheterization
72. Clinical Picture of TOF indicating Ejection Systolic murmur Pulmonary Stenosis
73. Low O2 delivery Low PCO2

74. Bronchial asthma severe Rx by IV MgSO4

75. COPD Rx
76. Pulmonary Embolism Dx by CTPA
77. Pneumonia + clinical Picture Of Erythema Multiformes Mycolplasma Pneumonia
79. Bronchiectasis reason for hempotysis
80. Immunocompromised Pt. C.I vaccine Yellow Fever
81. Reason for Resistance to anti Retroviral Drugs
82. Pan Valintino Leucocidin Gene involved in MRSA Rx ???
83. Lyme Disease Clinical Scenario Given- Pn Allergic Rx by Doxycline
84. Non Falciparum Malaria Rx
85. Rx of Gonorrhoea
86. Painful Genital Ulcers with Painful Inguinal Lymhadenopathy
87. Atypical Lymphocytes seen in IM
88. Anti-HTN in Pregnancy MethylDopa
89. Venous ulceration Mx by Compression Bandaging
90. Impetigo Clinical Picture given Rx
91. Acnae Rosacea Rx by Topical Metronidazole

93. Somatisation Disorder Dx from Clinical Picture

95. Suicide Risk Factor
96. Catract
97. Scleritis Painful RA
98. Inhibition Of P450 by ERythroycin
99. Supraventriculat tachycardia in Asthmatics Rx by Verapamil
100. Emollient usage dont smoke
101. Post Flu Pneumonia Staph Aureus probably
102. Drug that decreases Wound healing- Prednisolone
103. 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 1:200
104: beakers muscular dystrophy..father had the disease.. No investigation required in boy

child coz x linked recessive...father to son transmission is not seen

105: Costochondritis ?... Diagnosis
106: dermatitis herpetiformis :
107: Bed ridden pt. presents with hypothermia due to loss of which reflex? Shivering
108: AF + IHD add digoxin
109: Diabetic pt. modifiable risk factor for CVS ? Lowering TG levels
111: herpes simples encephalitis : clinical presentations + CT findings given
112: cell membrane around the daughter chromosome . Which phase of cell cycle ..telophase
113: MOA of ACE inhibitors
114: Pt with increase prolactin level !!
Investigation ?
MR scan
115: Pt on CAPD..infection due to Staph epidermatides
116: Antigen presenting cells ---> dendritic cell
117: facial pigmentation in pregnancy ... Melasma
118: cryoprecipitate contents : fibrinogen
119: buprenorphine : partial miu agonist
120: central respiration centre is controlled by? ??
121: action of SO muscle : depression & adduction
There 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 confused
2. Differentiating and correctly diagnosing diseases relating to myopathy and arthiritis RA,
Polymyositis, SLE, ANTi phospholipid syndromes, pseudogout
3. Presentation of different types of Lung cancer
4. Primary amnorrhoea very confusing qs for dx of PCOD, CAH, AIS
GOOD LUCK AND PLEASE DO PRAY FOR ME

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.

73. AF> CHADS SCORING> WARFARIN

74. PATIENT IN STATUS EPILEPTICUS, UNCONCIOUS, RR 8/MIN> INTUBATE/
PHENYTOIN?
75. CH. PANCREATITIS> DEFFICIENCY OF FAT SOLUBLE VITAMINS
76. XRAYS> TB/CARCINOMA/FUNGAL?
77. ASCITIC FLUID TAP?
apt develope myalgia after starting azathionprine,alrteady on mesalzine and steroids(what will u
do)..................a snerio of hypochondrial but optn was not there........................prevntation in stroke pt
for dvt............2 scnerio of upper g.i bleed,in 1 scnerio upper g.i bleed treated 6 month before what will
u do now,and in other scnerio what will u transfused before endoscopy........... a scnerio of pt come to u
for renal failure known case of diabetes(DX)..............a scnerio of angiolosty contrast induced
anaphylactic shock wha t will u give i.v............change of color of finger and nose in cold(how will u
investigate).........pt develope cardiomyopathy after beast cancer chemotherapy............ a scnerio of
young female deveope iron deficiency anemia eating red meat and mother has c.a(what will u
advice)..................... a snerio ecg shows junctional bradycardia..........in psychiatry anerio of
delusion,hallucination and phobia........cause of infectios mononucleosis(ebv)......... a smoker pt
develope ascending aorotic dissection treated with surgery how will u prevent............peritoneal dialysis
infective organism....a snerio in which lower motor neuron sign in upper limb and upper motor neuron
sign in lower limb(DX).......best of luck

2004 September:

MRCP1.21st Sep 04 recollected

Discussion in 'MRCP Forum' started by Guest, Oct 7, 2004.

1.
GuestGuest

Please complete/add/ans to make this a complete question paper

I received these from my friends and from different sources
CARDIOLOGY
1) 60yr male, ant MI, BP 205/125, LVF sign+,first actioniv NTG/IV STK/IV TNK/IV Atenolol
2) old mi, recurrent LOC, signs of LV aneurysm-cause of LOCVT
3) severity of AS
-character of carotid pulse/LV apex/Intensity of murmur/Duration of
murmur
4) tirofiban useACS with raised trop T
5) ReMI after 48 hrs , enzynw for Dignosis
Myoglobin/CK/TropI/Trop T/LDH
6) old MI,post CABG, LV dysfunction, on aspirin, ramipril, diuretic,
no sign of heart failurenext drug to add
Carvedilol/Digoxin /clopidogrel
7) sever AS, GI bleeding, upper and lower Gi endoscopy normal-cause
of bleeding
Angiodysplasia/CA colon
8)ECG- dominant R and Tall T in V 1-2, most likely cause
paosterior MI/anterior MI/inferior M|I/lateral MI/pul. Embolism
9)70 female, BP 180/100, after 3 months- BP 170/95 & 170/90 ,drug for
HT
Bendrofluzide/Atenolo/Ramipril/Losartan/Amlodepin
10) 75 f in AF, rate-85, bp 140/85, drug to considerWarfarin/Aspirin/Digoxin/DC cardioversion/Atenolol
11) Pulmonary embolism- dignosis
CT angio/VQ scan/Ddimer
12) long QT syndrome- drug to startAtenolol/digoxin/?
13) after air travel- TIA cause
PFO/ASD/
14) 25 f c/o palpitation once a week lasting for 20 minutesinvestigation of choiceevent recorder/holter/EP study/echo
15) man with known DVT on long term warfarin with a new thrombus in ?
femoral...what action
local thrombolysis / stop heparin/ warfarin/
16) PREGANCY HYPERTENSION-most suitable RXMETHYL DOPA/ diuretic/ enlapril/ atenolol

17) Lady with 2 DVTs and 2 miscarriages, anti cardiolepin antibody

positive . Rx:
warfarin indefinitely / warfarin for 6 months/-aspirin
18. a pt with SLE, risk of cardiovascular is increased with presence
ofanticardiolepin antibody/ anti- ro/ anti la/ ANA/
19. a case of hyper tension with hypokalemia, which investigation for
diagnosis??
Renin:Aldesteron Ratio/USG/ plasma cortisol level/ plama ACTH
20. ????? patient with known congestive heart failure and renal
impairment.
features of worsening heart failure, also mentioned about decreased
urine output. ask the most useful Ix for the current condition
- echo/ ur/cr and electrolyte

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

11. PNEMONIA POOR PROGNOSISUREA >13, RR 20, WBC 13000

12. a patient with COPD- what to do for prevention of further
damage ?
Stop smoking/ steroid/ Beta agonist/ High flow oxygen
. ?????????indication of chest drainph <7.2/high protein

Haematology1) 53 yr f NHL- prognostic factor

LDH/AGE
2) genetic basis for acute promyelocytic leukaemia
- Post translational
modification/ fusion of two gene/- impaired degradation of
protein/- overexpression of oncogene/ Short telomere
3) Polycythemia vera rubra- infection-PBS- 0.4% promyelocyte and
0.47% metamelocte, Reticount increased
Cause of infection
Transformation to AML/?
4) 1-pt on renal dialysis ..on erythropoitnin with low Hb PTH rasied
Ferrtin conc decreased in three months from upper normal to lower
normal , cause of anemia?
fe def /osteitis fibrosa cystica /inadequate
dialysis /inadequate erythro poitin /
5) Lady with pain in LUQ. Hb 16.9 MCH 0.55 MCV 69 Plts 490. Whats
the underlying cause ?
primary polycythaemia, essential thrombocythaemia , renal cell
carcinoma
6). Non hodking Lymphome chemo, suppress what ?
B cell / T cell or?
7) a pt of ALL treated 10 years back with remission- now present with
a soft swelling on the hand and multiple shadows in the lung on CXRwhat is the dignosismultiple leukaemic deposites/
most common presenting feat of myelofibrosis
fatigue/bone pain/bruises/bleeding
9) a pregnant patient with TTP- mamagementplamsa exchange/ steroid/ platelet
10) know case of chronic ITP, platelets go down from 87 to 43, what
will be the next in managementobservation/ steroids/ platelet transfusion
11) a 20 yrs male with infection, prescribes some antibiotics,
following with he developed anemia, PBS- anisopokilocytosis and bite

cells, diagnosisautoimmune haemolytic anemia/ G6PD def/ aplastic anemia#

12) 70yrs male prescribed trimethoprime for urinary infection,
following which he developed anemia, urine shows hemoglobinuris,
dignosisG6PD def/ autoimmune hemolyitc/
13. a patient with clinical picture suggestive of multiple myeloma,
total protein 9gm%, albumin 3 gm%- next investigation of choiceplasma electrophoresis/ urinary protein/ LFT
14. a clinical picture suggestive of Iron def. Anemia, what is the
management???????
Oral iron/ IV iron/ Diet/
15. pat. have been transfused with group specific platelets many
times one time he develop areaction why
graft Vs host reation/ ABO incompat/ malaria/ CMV.
????????? multiple myeloma- next for diagnosis???????? BM biopsy

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

10. a patient present with fever with intermittent rigors after 6

months of travel to a other country, what is diagnosis?
P. malaria/ dengu/ P. falsiparum/
11. female with lyphadenopathy, diarhoe/ oesophageal candidiasis
HIV/ infecsious mononucleosis/
?????????????????-case of herpes simplex encephalitis
?????????Cerebral malaria --------management?????
????????? HIV with oral thrush what is management?
Nystatin/ ketoconazol/
PHARMACOLOGY and TOXICOLOGY
1. man confused and agitated after cocaine abuse, ask the electrolyte
disturbance findinghyperthermia/ hyperkalemia/ hypothermia/ hyokalemia/ hypernatremia
2. Elderly lady with acne with ?bluish pigmentations in her legs.
What drug cause this?
minocyclin,Hydroxychloroquine, amiodarione, / tetracycline/
3. Lady with systemic sclerosis. BP noted to be 180/90. Fundoscopy
showed ?Av nipping .urea and creat increased Give what next ?
stop captopril , oral atenolol, iv nitroprusside ,
etc
.
4. lady with dipression with jaundice , dry mouth, drowsy , acure
urinary retaintion.
Amitriptylin /paroxetin overdose /
5.drug effecting opiod receptor on circular and longitudnal muscles
of the gut
loperamide/ metaclopromide/ ranitidine
6. pat with OA on ?paracetamol. having knee pain what nextdiclofenac / opioid,/? local ibuprofen
7. pt with OA on codeine+/- paracet. 30 qds not having pain relief...
what is the cause not enough codeine /
8. mechanism of action of adertonateosteoclast inhibition/ osteoblast stimulation
9. drug which potentiates hypoglycemia of glibenclamide
Fluconazol/ ranitidine/ phenytoin/
steroid/ aspirin
10. - WARFARIN INR>9.1 BLEEDING- RX
PROTAMINE CONCENTERATE/ CRYO ppt/ factorVII
11. METHHAEMOGLOBINEMIA>70% UNCONCIOUS- definitive management
Methylene blue/HYPERBARIC OXYGEN /

12. a patient found unconscious with smelling alcohol with ?????

ETHYLENE GLYCOL WITH RAISED CK AND RENAL IMPAIRMENTRHABDOMYOLYSIS / alohol intoxication/ tricyclic antidepreesent
13. H/O DIAZEPAM AND DOTHIPEN HR 140- DO what next?
ECG/ Iv flunazil/
14. PARTIAL AGONIST opiodide COMBINE AITH morphin AGONIST causeREDUCED ANALGESIA / ^ resp
depression, ^ sedation
15- AZOSPERMIA caused by
SULFASALAZINE / azathioprine/ meslazine/ ASA
16. A renal transplant recipient on steroid/ azthiptine/ present with
infection- WBC 3000, cause low WBC of itazthioprine/ steroid/ infection
17. a patient with bicarbonate def.- contraindication of oral
bicarbonates ishypercalemia/ hypokalemia/ acidosis
18. mode of action of thyroxineincrease insulin sensitivity/
19. thyrotoxic on carbimazole treatment, what will be the first to
improve?
TSH/ free T3/total t4/ Thyoglobulin
20. a patient has taken 50 tablets of sustained release theophyllin,
what is true?
Activated charcoal will not be effective/ causes res.
Acidosis/ ipeccahuan induced vomiting would be appropriate/causes
hyperkalemia
21. mechanism of action of Haloperidol as an anti emetic???????
D2 receptor antagosit at CTZ/ D2 receptor antagosit at brain
centre/ D2 receptor antagosit at periphery/ GI motility reduced
22. hx of head injury/trauma, put on some medication. became
jaundiced, ask what's the possible drug - oxybutynin/ txxnidazine
23. lady being treated for chest infection in geriatric long-staying
ward on antibiotics, developed features of acute parotiditis, ask u
the most appropirate rx
- NSAID/- augmentin/ - flagyl/ - panadol
24. patient with hypNa, hypoK, increased Ur Ca. ask the most
likely,causative agents - thiazide/ - lasix
25. ??????????????alcoholic found unconcious paracetamol poisoning.
RHEUMATOLOGY & IMMUNOLOGY
1. Pain in wrist when abducting thumb :
De quervain tenosynovitis /radial neuroma/ # base of thumb
2. Meningiococcal susceptibility which complement ?

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??

HRT/ Ca/ Vit .D

19. a lady with # femue, osteoporotic, what will be the treatment to
prevent further #???/
Alendronate/ Alendronate+ Ca/ Alendronate+ Ca+ Vit.D/ Vit.D
20.???? sensory , mild power loss in UL plus loss of triceps and sup
reflex- cervical spondylosis

CNS-----------------1.diagnosis of Alzemhier diseaseNeurofibre tangles

2. Epileptic young man with status epileticus. Give what ?
iv lorazepam/Iv
phenytoin, iv na valproate
3. SADDLE SHAPE LOSS OF SENSATIONCONUS MEDULARIS LESION /cauda eqina
4 a man with extrapyramidal symptoms with chorea , causeHuntington's disease/ Parkinson's/ vCJD/
5. a man with gradually progressive weakness with sensory level at T
10, 4 deteriotion in hospital without recovery, causearterivenous malfunction of spine/ syringomylia/ cervical
spodylosis / CVA
6. a man with gradually progressive weakness with raised protein in
CSF with small rise in lymphocyte- diagnosis
GB syndrome/ multiple sclerosis/ tuberculous meningitis/
7. a patient with migarin, which will be the first drug to use in
attackibuprofen/ methyserzide/ sc suminat/
8. a female had traumatic left side tooth extraction 6 yrs back,
since then she is complaining of facila pain mainly over upper part
of left face with intermittent exacerbation, sometimes pain goes to
rt side of the face too, what is the diagnosisatypical face pain/ trigeminal neuralgia/ tooth socket cyst
9. a clinical situation suggestive of multiple sclerosis- diagnostic
investigation?
MRI/ CT scan/ lumber spine Xray/
10. a pt c/o weakness increasing over evening with diplopia,
diagnosis?
Myasthenia gravis/ GB syndrome/
11. old man with hx of stroke with ?hemi became acutely confused, ask
the most appropriate treatment - haloperidol /- largactil/valium/- dormicum
12. old woman became increasing confused, disorientated behaviour,
ask the feature of alzhimer ds - impair short term

memory/ - paranoid delusion

...
13. a patient with occipital headache, neckpain- CT normal, cervical
Xray- degenerative changes, what is the diagnosis?
Cervical spondylolithiasis / cerebellar bleed/ - temporal
arteritis/- occipital neuralgia/- epidural h'age
12. a patient with head injury, Na 160, K 5.3, which is true?
Suffering from SIADH/ urinary osmolity low/ Na supplement
13. pt with altered sensorium, developed spastic quadriparesis with
pseudobulbar palsy on day 3, sodium on admission 112- & on day 3145mmol/L -what is the cause????
Central Pontine myelenosis/ multiple sclerosis/tubercular
meningitis
14. an elderly lady with unconsciousness, urinary incontinence, mild
pyrexia, dipstick urin test- protein +, no RBC, what is diagnosis?
UTI/
15. young boy with mild learning disability, abnormal movement, what
is the diagnosis???
Wilson's disease/ vCJ disease/ Alzheimer's disease

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

8- incrased u/o to 4-5L/day after adding one drug, plasma Na 141, K

normal, plasma osm normal ~ 29X, urine osm a bit low ~ 28X. LITHIUM /chlorpropamide/ carbamazepine/ Lasix
9) TEST FOR ACROMEGALYOGTT WITH GH
10.CASE OF CUSHING-investigation of choicelow dose Dexamethasone test/
synacthen test/ cortisone level
11. a 20yrs boy, head injury, CT scan pituitary enlarged- prolactin
normal, tsh normal, 9am cortisol normal, GH low normal, FSH and LH
raised , diagnosis of pituitary tumor supported by
raised FSH and LH/ high prolactin/ low GH
12. a lady with fasting blood sugar raised on investigation- 6.8
mmol/L, what is next invest?
GTT/ Random blood sugar/ insulin level
13. yound man with pain and tenderness ?also swelling over medial
aspect of thigh. high spot glucose of > 20, ask the most useful
investigation
USG/ Bone MRI/ Xray
14. sudden thyroid painful enlargement/ euthyroid, what is the
diagnosis?
- haemmorage into cyst/ thyroiditis
15. a lady with symptoms suggestive of hypercalemia, the best initial
teartment - normal saline
NEPHROLOGY
1. Renal transplant pt 4 weaks ago. Pst transplant Creatinine 118.
Now creatinine 127. Febrile. Kidney was CMV and EBV antibodies
positive and HIV positive. . Whats the problem here?
Acute graft vs host disease, CMV, EBV, pneumocystic
carinii?
2. a pt with palpitation and HYPERKALEMIA- initial managementGIVE CALCIUM GLUCONATE / frusomide/
dialysis/ sodabicarbonate
3. CASE OF INFECTIVE ENDOCARDITIS H/O MALAISE ARTHRALGIA with
glomeulonephritis- REDUCED C3
4. 20 male with IDDM for 5 yrs present with leg oedema, investigationurinary protein 5 gm%, serum cholesterol- 8 mmol/l- dxMINIMAL CHANGE DIESEASE / DIABETIC nephropathy/
5. pt with OA takes diclofenac for 6 yrs, penicillamin for 2yrs but
stooped 1 yrs back- urine- albimin +, rbc ve, bilateral small
kidneys- diagnosisanalgesic glomerulonephritis, analgesic interstitial
nephritis, ISCHAEMIC NEPHROPATHY

6. a patient with renal stone- which is true?

Cystine stones radio-opaque/ alkalization of urine in cystine stone
ppt. it/ Urate stone radiolucent/hexagonal crystals
7. a patient with pH 7.2, pCO2 30, pO2 80, HCO3- 14, diagnosis?
Metabolic acidosis/ metabolic alkalosis/ resp acidosis/ resp alkalosis
8. a diabetic on tablets, BMI 17, urea 21, createnin 190, HCO3- 14,
cause of this finding?
Metformin/ CRF/Gastroparesis induced vomiting/ RTA
9. a patient with renal dysfunction, and rash on renal biopsy- IgA
linear deposited in basement membrabe, diagnosis?
HUS/ Good Pasture syndrome/
10. Pt with hematuria/ hypertension/ urinary protein +, what is the
diagnostic investigation?
Renal biopsy/ IVU/ USG
????????? CASE OF ACUTE TRANSPLANT REJECTION
.??????????? middle aged man have proteinuria, ask the most likely
cause
- minimal change GN/- IgA nephropathy

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

10. qs about forced entry of substances due to pressure gradiant in

gut filtration,active transport,
facilitated diffusion.....
????????????? a clinical pictureof mal absorption suggestive of
celiac ds., investigation for diagnosis- Small bowel biopsy, small
bowel enema, breath test/sigmoidoscopy
???????????Analgesic induced colitis?????????
PSYCHIATRY
1- IN DEPRESSION with suicidal thoughtINDICATION OF ECT
2- Differentiation between DEPRESSION DEMENTIA EARLY MORNING AWAKENING?
3- chronic fatigue syndrome- treatmentCOGNITIVE BEHAVIORAL THERAPY / rest/
antidepressent
4. which of the following will indicate diagnosis of anorexia nervosalow cortisone/ raised FSH and LH/
5. a pt with anorexia nervosa with Na 122, K 2.9, Hco3- 12, which
drug?
Frusomide/ thiazide/ acetazolamide/ amiloride
6. a chronic alholic with psychiatris problem- what is diagnostic?
Jealously/ visual hallucinatiom/ persecutory delusion
7,. korsakoff psychosis -inventing recent happenings(confabulations)
????????? Schizophrenia ????????diagnostic symt????????
???????????Suicide risk is increased with?????????
OPHTHALMOLOGY
1. R pupil larger than L, not constricting to light but during
convergence it contricted to smaller then the L pupil. Whats the Dx?
Myotonic pupil, afferent pupilary defect .?
2-ACUTE PAINFUL RED EYE- CAUSEangle closureGLAUCOMA , optic atrophy, optic
neuritis, retinal detachment, vitreous hge
3. a pt with ptosis and pupillary dilation- site of lesionaneurysm of pst. Communicating artery/ 3rd nerve palsy/ myasthenia
gravis/
4-blurring of vision in poor diabetic pt, cause
maculopathy/
cataract/ refractive changes in lens
5. a patient with papillary afferent defect, diagnosis?
Multiple sclerosis/ AR pupil/ optic atrophy

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

5-CHRONIC CARRIER OF HEP B

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?
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

presents with hepatitis(symptoms are 3 days only.what could be the awnser

hep. A,B.OR C.,d,e
36) Cystic Fibrosis with genetic councelling
A-No famly members will be affected.
37) Cystic Fibrosis complication(I think in P-2)
A.- Male infertility.
3 Old Pt. With dry skin etc.Rx of choiceA.-Emolients.
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.
41) .Pt. with DIC with reduced fibrinogen Rx?
A.-Cryoprecipitate.
42) . Pt with G-6-PD characteristics findingsA-haemoglobinuria.
43) .Lower limb nerve lesionA-Sciatic nerve.
49) .Description consistent with Lateral medullary syndrome(Post. Inf. Cerebellar A)
50) .Young Pt with speech problems with jaundice Dx?
A-Wilsons Disease.
51) .Respiratory Pt. With FEV1/FVC ratio was less than.80%(After calculating) Dx?
A-C.O.P.D.
52) .Pt. with Obstructive features normal diffusion capacity Dx?
A-Bronchial Asthma.
53) .C.O.P.D. Pt long term O2 Tharapy indicationsA-PaO2 Less than 7.3
54) .Oral Nitroglycerine vs sublingual nitroglycerine dose variation What mechanism ?
A-1ST Pass metabolism.
55) .Common Variable Immunodeficiency manifestationA-Recurrent pneumonia.

57) a patient diagnosed with chorea, where is the lesion:

a. hippocampus
b. basal ganglia
c. amygdala
d.caudate nucleus
5 which condition is caused by immune complexes formed by antigen antibody...
a. late transfusion reaction
b. extrinsic allergic alveolitis
59) hodgkins lymphoma, wat indicates the worst prognosis:

a. enlarged mediastinal lymph nodes

b. vena caval obstruction
c. pruritis
d. fever
60) contraindication for lung small cell carcinoma surgery:
a. pleural effusion
b. vena caval obstruction
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.
65)to 69)1. number to treat ( 14% to 9%)
2. sensitivity ( there are 2 questions regarding this)
3. 2 questions (again) regarding a drug which developed a rare side effect and the company wanted to
do a researh fast and which test should they preform
70) lewy bodies should avoid which type of drugs
- haloperidol....etc
71) a patient who developed resting tremor of one hand and 2 family members who had similiar
problem
-wilson disease
-idiopathic parkinson disease
72) pt. on warfarin inr decreased _
- carbamazepine
-amiodarone
73) a patient with spleenomegaly, hepatomegaly .....pancytopenia
leshmania
74) amiodarone induced hyperthyroidism, which investigations is best to confirm the disease
- radioisotop etc....can't remember the options as not sure about the answer
75) poor prognosis of rheumatic arthritis
- x ray changes, erosins
negative rheumatic factor
morning stiffness> 3 hrs

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

46.) Patient had a parathyroidectomy on account of symptomatic parathyroid adenoma and

presents 2 weeks after with the following investigations. Ca Low, P04 Low, Mg
marginally Low, PTH elevated and Vit D marginally low. What Is the likely cause of the
hypocalcaemia - Hungry Bone syndrome. Other options included vit D deficiency and
hypomagnesemia (not likely Hypomagnesemia as this will cause a low PTH instead of
elevated PTH)
47.) There was a case of a patient with isolated ALP increase Pagets disease
48.) There was a case of a lady with Generalised Bone Pain options included
Osteomalacia
49.) Androgen Insensitivity phenotype Patient has Normal female appearance with
cliteromegaly
50.) Patient with VHL with hypertension 24hour Metanephrine measurement
1.) MOA of Vit D Increase intestinal absorption of Ca
2.) Patient with features of Growth hormone excess. OGTT and growth Hormone
measurement
3.) 32 year old MALE with hypothyroidism and firm goiter. Likely diagnosis
Hashimotos or Iodine deficiency or Thyroid dysgenesis
4.) Patient is on medication and has galactorrhoea, likely medication Metoclopramide
5.) A case of Cortisol Deficiency and metabolic alkalosis
6.) Patient with alcohol intoxication presents with Hypoglycaemia and was corrected.
However 2hours after patient became hypoglycaemic again, likely reason hepatic
glycogen depeletion
7.) Patient with hypothyroidism on Levothyroxine presents with intermittent sweating. Lab
values showed Markedly elevated Insulin, marginally elevated C-peptide and hypoglycaemia
Covert insulin use other options included Insulinoma
8.) 36 yr old Male with sensorineural deafness since childhood presents with DM. History of
type 2 DM in PATERNAL UNCLE. What type of DIABETES does this patient have?
Mitochondrial Diabetes Popular answer (DIDMOAD, although no mention of other
components of DIDMOAD). Other options were Type 1 DM, Type 2 DM, or MODY
9.) Patient with DM and low EGFR (56) was commenced on ramipril. However presented
2WEEKS later with fall in eGFR of about 12 (44) and elevation of Creatinine of about 20 or
so. Next line of management. D/C ramipril, D/C Metformin , reduce Metformin or Continue
Present medicatons?
10.) Patient with DM and poor clinic attendance presents with a GFR of 14. D/C
metformin
11.) Patient with Type 1 DM and Proteinuria presents with HbA1c of 50mg/ml. Next best line
Add Ramipril or Incrase Insulin
12.) Patient with 3months recurrent headaches. Elevated prolactin (1300 or thereabout) and
elevated Oestrogen. _ Pregnancy
13.) Elderly patient with hyponatraemia and features in keeping with SIADH. Next line of
action Demecleocycline
14.) Patient with Alzheimers Donepezil
15.) Patient with features of Meningitis and CT scan features in keeping with Temporal Lobe
involvement HSV encephalitis
17.) Patient with Anorexia Nervosa Fine hair on the face and neck
18.) Patient with Stroke and poor swallow reflex and being worked up for Long term enteral
feeding percutaneous endoscopic gastrostomy or Percutaneous jejunostomy
19.) Patient Has features of deperession and admits to suicidal thoughts, next line of care
Fluoxetine (less likely toxic in overdose) . Other options included TCA and Electroconvulsive
therapy
20.) Patient with benign essential tremor Propranol
22.) Patient with Weight gain and alopaecia Na Valproate

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

49.) Contraindication to Surgery in CA lungs Vocal cord paralysis . Other options

included FVC less than 1.7L
50.) Drug with transmembrane transporter action Frusemide. Other options included
acetazolamide (carbonic anhydrase inhibitor not a transmembrane transporter inhibitor)
1.) Commonest cause of death in RRT patient Cardiovascular
2.) 75 year old Patient with sudden onset of visual loss on the right with optic disc swelling.
Giant cell arteritis
3.) Patient with classical features of Osteoarthritis
4.) Patient with ankylosing spondylitis presents with reduction of Lordosis and reduced lateral
flexion. Likely xray features in this patient Syndesmophytes
5.) Patient with Pain in the left gluteal region and loss of ankle reflex on the Left. Best
investigation MRI of the lumbar Spine
6.) Patient with tronchateric Bursitis
7.) Patient with family History of Osteoporosis and a T score of -1.0. Next line of
Management Life style changes
8.) Male patient with Pagets presents with pain Risendronate
9.) Patient with discoid Best management hydroxychloroquine
10.) Patient with RA of 20 years presents with Iron deficiency anaemia . Patient had taken
methotrexate for 3months. Patient was commenced on oral Iron therapy however with no
improvement. Likely cause of Iron deficiency Anemia of Chronic Diseases. Other options
included Ranitidine
11.) Patient with Psoriatric Arthritis controlled on sulfasalazine is about to get pregnant and
worried about side effect of sulfasalazine in pregnancy Continue sulfasalazine. Other
options included Reduce sulfasalazine, stop sulfasalazine and reassess
12.) Patient with Dermatomyositis Anti Jo1
14.) Patient with Psoriatric arthritis not controlled with steroids, next line of care
methotrexate
15.) Patient with pains in the PIP and wrist joints and has family history of Psoriasis and anti
rheumatoid factor Negative but anti CCP positive. Likely cause of the joint pains.
Rheumatoid arthritis not psoriasis
16.) Patient admitted to the ICU who recovered well except for inability to flex the fingers.
Likely Nerve Involved Ulnar nerve (Claw hand) not Radial Nerve (usually has wrist
involvement) . other option included Median Nerve
17.) Patient with Tuberous Sclerosis and rash around d nose Adenoma Sebaceum
18.) Patient with Tennis elbow, muscle involved Extensor carpi Radialis
19.) DIABETIC Patient had amputation of a toe and having pain around the amputated toe
MRI of the toe. Other options included ABPI
20.) CLL diagnosis Immunophenotyping
21.) Patient with Isolated low platelet and easy bruising Immune thrombocytopaenia
22.) Patient with Burkitts rasburicase
23.) Patient with features of Myelofibrosis tear drop cells
24.) Lady with easy bruisability and history of Excessive bleeding post partum in mother.
Next investigation vWillibrand assay
25.) Patient with Alteplase overdose FFP or Prothrombin complex
26.) Patient with jaundice in pregnancy. Positive family history of Spherocytosis. PBF showed
pherocytes. Next investigation Reticulocyte Count (right answer) other options included
No further investigatons
27.) Patient with Features of CML (associated Hepatosplenomegaly)
28.) Patient with inferionasal lens deplacement and history of DVT Cystathione B
synthase deficiency
29.) Patient with visual visual hallucianation Charles Bonnet Syndrome
30.) Mechanism Of Action of desmopressin Release of stored factor VIII
31.) Asymptomatic hypothyroid lady presents with violaceous popular over the lower shin and

ankle.Likely diagnosis Lichen Planus or Pretibial Myxeodema

32.) Prognostic factor in Malignant Melanoma Thickness
33.) Patient with annoying rash. Had herpetic whitlow 2 weeks ago. Diagnosis Erythema
Multiforme
34.) Patient with recurrent urticarial with no cause Chronic Idiopathic urticarial
35.) Chances of two couples with Achondroplasia of having a normal child. 25%
36.) Patient with new mutation. Risk of sister having PKDS - <1%
37.) What demonstrates the correlation/effect of age, sex, diet and race on Blood pressure Forest Plot. Other options included Students test and scatter Plot
38.) A scientist wants to Know the number of Patients that tested positive and actually
have the disease Positive Predictive Value. Other options included sensititity and
specificity
39.) Odds ratio calculation 50%
40.) What percentage of a normal distribution curve will lie outside 2SD deviations of the
mean. 5%
41.) Patient with depression and presents with abdominal pain Conversion disorder
42.) Another patient presents for investigation of a medically unexplained symptom.
Examination findings were normal. Patient admits to that symptoms started around the time he
lost his Job. - No further Test
43.) Patient with schizocytes and thrombocytopaenia TTP
44.) Classical CT scan feature of Progressive Multifocal Leucoencephalopathy
45.) Hill walker with rash clearing at the center Lymes disease
46.) Live attenuated Yellow fever
47.) Egg protein associated vaccine Influenza. Other options included Varicella
48.) Patient presents with Fever and intermittent Rigors. Patient returned from West Africa
about 6months ago. Likely diagnosis (That patient went to west Africa supports Ovale
Malaria. However that patient is presenting for the first time 6months after returning to the
UK is against Ovale malaria as incubation period of Ovale is 8-25days)
49.) Patient went to Caribbean and presents with Snail track rash on the buttocks. How did she
encounter this infection? Larva Migrans acquired by patient lying on sandy beach
50.) Patient presents after visit to Thailand with fever and joint pains Dengue
2.)
1.) 24 out of 28 patients in a cruise ship presented with bloody diarrhea Shigella
2.) Patient with clean wound and couldnt recall his tetanus history Booster Dose of
Tetanus
3.) Farmer with new kitten presents with lymphadenopathy Bartonella Hensella
4.) HIV patient with MAC. Normal ward Hygiene will do. As its an opportunistic
infection for immunosuppressed patients.
5.) Patient with Bacterial Vaginosis metronidazole
6.) Patient with pleural plaques on the right and pleural effusion on the left. Effusion revealed
2% mesothelioma and 78% of lymphocytes. Pleural fluid protein was 44g/dl and low glucose.
diagnosis TB
7.) HHV8 Kaposi Sarcoma
8.) Patient came in from Asia with hepatitic lab features Hepatitis A infection
9.) Patient had reaction almost immediately post infection Type 1 Hypersensitivity
Reaction
10.) Risk of developing Bed sore waterloo score
11.) There was a question also on Analysis of Variance
12.) A question on number of genes per cell 30000 genes in all cells. Other options
include - functions of all genes in the human body has been elucidated, and all genes in the
human body encode a protein
13.) Site of Protein degradation Proteasome
14.) MHC 1 CD 8 cells

15.) Senescence has reduced Mitosis

16.) Mode of Action of N acetylCysteine Replenishes Hepatic Gluthathione
17.) A patient has features suggestive of HSP
18.) Elderly woman with History of Recurrent UTI presents with bilaterally shrunken kidneys
with proteinuria and haematuria +- likely cause of the reduced kidney sizes Chronic UTI .
Other Options included Renal artery Stenosis
19.) Patient had bone marrow transplant and presents with palmoplantar rash and bloody
diarhoea. This patient had total body irradiation before the marrow transplant. What is the
cause of this symptom? Irradiation. Other options included ciclosporin and Graft versus
Host(remember patient had total Body irradiation prior to Transplant)
20.) Patient with ground glass appearance on xray Methotrexate
21.) Hormone that causes increase bicarbonate from the pancreas Secretin
22.) Patient with rashes on the face and eyebrows with no alopaecia. Pityriasis vesicolor
ketoconazole
23.) Patient with weakness of Deltoid, supraspinatus, brachialis and lattissimus dorsi on the
right and deltoid and brachialis on the left Cervial radiculopathy
24.) Patient with Ca Breast with pain not controlled on cocodamol. Next line is Morphine
(cant remb the options). Other options include oxycodone
25.) Patient takes carbamazepine for seizures. However presents with low serum
carbamazepine. Likely cause of the low carbamazepine. Carbamazepine auto induction.
Other options included Binge drinking
26.) Patient with inferior quandratanopia parietal lobe lesion
27.) Sign in support Parkinsons disease Unilateral symptoms
28.) Drug for patient with Rigidity and akinesia Co Carbidopa
29.) There was a patient with RA and features in keeping with amyloidosis
30.) Patient with left sided ptosis and Miosis and history of 40 years smoking history.. Next
investigation Chest Xray
31.) Patient who had splenectomy is presidposed to Penumoccocal
32.) There was a patient with essential Thrombocytopaenia
33.) Patient with features of interstitial lung disease which improves with cmoking cessation
Respiratory Bronchiolitis interstitial Lung disease
34.) Cell found in patient with CA stomach Signet Ring cells
35.) Cause of insulin resistance in a DM patient following surgery. Increase cortisol
36.) There was also a patient with Hodgkins Lymphoma.
37.) Patient with SVT and asthma give verapamil.
195 recalls(source 2)
1. 40 year old, sob, jogging, splenomegaly- CML
2. CLL- Immunophenotyping
3. Tear drop poikilocytes- Myelofibrosis
4. Platelets >1600- Essential thrombocythemia
5. Von Willi brand disease- BT
6. Total body irradiation, skin eruptios, jaundice, diarrhoea- CMV Vs radiation therapy/GVHD
7. Knee crepitus- Prepatella bursitis
8. Lateral hip pain only- Trochanteric bursitis
9. Lateral epicondylitis- Muscle attachment
10. Granisetron- Medulla oblongata
11. Bile acid malabsorption- Sehcat teat
12. Reversa Alteplase- FFP
13. Palpable purpura- HSP
14. Crypglobulinaemia- deficient complement level- C3 vs C4
15. Minimal change vs IgA
16. SLE Electron microscopy- Minimal change vs AA
17. Secondary amylodosis- RA (18 years hx)

18. Echo- HOCM- Septal wall thickness >3.3 cm worst prognosis

19. Malignant melanoma- worst prognosis- thickness
20. MRI- Avascular necrosis hip
21. Dengue fever- deranged lft and low platelets
22. Osteomyelitis- MRI
23. Hiking- Lyme disease
24. West Africa-6 months- Ovale
25. Trichomonas vaginalis- Metronidazole
26. AVR- Benzyl penicillin and gentamicin
27. N-acetylcysteine- Conjugation of paracetamol
28. Femlae- HTN AVN Nipping- Pheochromocytoma
29. Monocular loss of vision+pale disc+old age- Giant cell arteritis
30. Optic neuritis
31. HTN- Unequal pupil- MRI vs Carotid Doppler
32. Chronic idiopathic urticaria
33. DLE- Hydoxyxholoquine
34. Kaposi- HHV8
35. V5-V6- Left circumflex artery occlusion
36. Female Rt sever tender RUQ+ temp 38 next investigation CT/colonoscopy/labeled white scan
37. Detrusor instability- Trospium
38. Benign essential tremor- Propanolol
39. Lip smacking- Temporal lobe biopsy
40. HSV encephalitis
41. Parathyroid gland removed low ca and high po4= Secondary hypothyroidism
42. Old female Primary hypothyroidism
43. Simvastatin- Muscle pain
44. No evidence of osteoporosis- normal t and z score- Lifestyle advice
45. Primary pneumothorax+ sob >3.5 cm- Needle Aspiration
46. Drugs worsening MG- Doxycycline
47. Increase prolactin- Metoclopramide or Omeprazole
48. ICD cannot drive- 12 months
49. Recurrent Pneumothorax- Next investigation Echo vs HRCT
50. DM+ HTN- ACE I
51. Increase creatining more than 250 stop Metformin
52. More seizures- Carbamazapine- Auto induction
53. TB- 8-%Lymphocytosis- TB
54. Cushings- Metabolic Alkalosis
55. Acromegaly- diagnostic- OGTT+GH
56. COPD- Hypoxic 9 po2- not in type 2 rf ph 7.38+pco2 7- Continue nebs vs entrail o2 4 lit/min
57. LMWH- Factor X inhibitor
58. Sleep apnoea 40 hrs (5) BMI 28- CPAP
59. Moxonodine- Angiooedema
60. Anaphylaxis Type 1
61. Oedema + sweLling-mediator-Bradykinin
62. Delusion
63. crawling under skin- Hallucination- tactile
64. Depression start Fluoxetine
65. Risk factor- Post hx of self harm
66. Alcholic+hypoglycaemia- BG 2.8 immediate mx glucose vs thiamine (myth no longer used)
67. Long term alcoholic- collapsed- tight glycaemic control- Hypoglycaemia as 45 secs episoded only
68. Wt gain+alopecia+tremor- Sodium valproate
69. Fine hair- Anorexia nervosa
70. Stroke- long term+ PEG
71. SVT in asthmatic- Verapamil
72. AF in old age group= b/l crackles- Digoxin
73. Ascites- Spironolactone
74. Psoriatic Arthropathy- Methotrexate
75. Conns syndrome- hypertensive- ?Spironolactone/ace/doxazosin
76. Forest plot
77. Sensitivity vs PPV best test to detect MI

78. Human genome 30,000 copies

79. Case control studies odds ratio
81. Polymyositis- Anti JO
82. AMA- Do LFTs next
83. In a group age, sex, ht- Mann whitney vs t test
84. Post influenza- muscle wasting- Neuralgic amyotrophy
85. Parkinson disease
86. Lewy body dementia
87. Bradykineasia- Co carledopa vs Amantadine
88. Normal pressure hydrocephalus
89. Adenoma sebaceum
90. Homocystinuria- Beta cystathione
91. Breakdown in relationship- Motor symptoms and past history of somatisation- Conversion disorder
92. Alkaptonuria (percentage)
93. MHC 1- Class 8
94. PE- CXR Normal
95. Aspergilosis- Prednisolone
96. Pagets- Risendronate
98. Large polypeptide- Protesome
99. Low c-peptide/hypoglycemia- Covert insulin use
100. Hepatorenal syndrome- Vasodilation of splanchnic arteries
101. Crypt abscesses- UC
102. HTN/COMA/IC BLEED- ?AVM
103. Seborrheic dermatitis- Ketoconaloze
104. Urinary NA >25- Addison? Cant remember stem
105. Left buttock itchy/snail track lesion- Sunbathing-cutaneous larva
106. Cardiac arrest- prolong qt- methadone
107. Weak hands= muscle
108. Androgen insensitivity- Female+female sexual characteristics
109. Agitation- Haloperidol
110. Confused post uti+ fall ?lorazepam/halo/well lit room/physical straints
111. Hereditary spherocytosis+family hx+mild jaundice blood film spherocytes-Do nothing vs
reticulocyte count
112. AS- Sclerosis of plate
113. Cocaine- Cardiac ischaemia
114. Before chemo- inc urate- Rasburicase
115. Yellow fever- Live vaccine
116. Egg allergy- Influenza/Yellow fever CI
117. Clean wound no previous vaccine hx- Do nothing vs tetanus IGg
118. DM+Sensorineural deafness- Mitochondrial
119. Angiodysplasia- Aortic stenosis
120. Act on membrane transporter- Furosemide
121. Senescense- Arrest of mitosis
122. Upper GI bleed Urea
123. RA- Anemia of chronic disease
124. MAI- Respiratory isolate
125. Hemoptysis/5 cigs /day- Bronchial carcinoid vs Br Ca
126. Gastric ca- Signet ring cells
127. Isolated raised bilirubin- Gilberts
128. ?Pseudomemranous colitis- cant remember stem answer was different
129. Rigidity. Raised temp-Neuroleptic malignant syndrome
130. Raised TLCO Alveolar haemorrhage
131. Chronic Hep B
132. HNPCC GENE- Tumour in female
133. Osteomalacia- low absorption from gut
134. Palpitaions once a week- ILR
135. TIA- frequesnt attacks in 5 months- no headache
136. Uncontrollable diabetes- Increase cortisol level
137. Pt isolation in TB- Sputum test +ve
138. QT interval- from start of Q to end of T

139. Interstitial lung disease- HRCT

140. Cruise ship/bloody diarrhoea- Shigella
141. Generalise weakness-b/l ptosis/limb girlde weakness not associated with passing the dayMyotonia dystropica vs MG
142. Continue ACE as no raise in renal func >30%
143. Stridor- Flow volume loop
144. Post splenectomy- Strep Pneumoniae
145. Hep A from India
146. Pregnant RA- Continue
147. JVP Giant V waves
148. Hashimotos thyroiditis
149. Dec LH FSH, Rasied prolactin, nausea, no periods, Pregnancy
150. Most common AB- ANA
151. Intermittent fever- Sub acute bact endocarditis
152. Dec appetite in elderly- Leptin low levels
153. Business man all inv normal- anxiety- do nothing
154. Parietal inferior
155. Parietal lobe- reading- Hemianopia
156. Insulinoma
157. TTP with neuro signs
158. ITP
159. AR ?50%
160. Sensitivity 20%
161. Endomysial antibodies
162. Colonoscopy/ogd in male ?
163. Alzhiemers- Donepezil
164. Dermatitis herpetiformis- IgA
165. Bed sore- Waterloo score
166. TP 53
167. Desmopressin- Release of vw factor from cells
168. CXR interstitial pneumonitis- Methotrexate
169. Hypercalcaemia- Thiazide diuretics
170. CAHDVASC- 4
171. Beta blocker- Glucagon
172. Kitten+farmer+ increase lymph nodea- Bartonella henslae
173. CI to lung surgery vocal cord paralysis
174. CI to pregnancy- Pulmonary HTN
175. Hypokalemia- U waves
176. ETT- Low BP
177. Liver disease low BP- Give IV fluids
178. Secretin
179. Refeeding syndrome- do phosphate
180. 2 STANDARD Deviation 95%
181. Anti CCP- RA
182. Smoking history- symptoms resolved ?Usual interstitial pneumonia
183. MRSA/Cancer Hypochondriasis
184. Flat violaceous papule- Lichen planus
185. Orthopnea/cough/oedema mild/cardiomegaly/b/l crepts- CCF
186. Binge drinker-agitation- Alcoholic vs Cannabis vs Korsakoff
187. Long term dialysis- Cardiac disease
188. No mass effect AIDS- PML
189. 24 hr metanephrine
190. B/L arm increase BP ?Options
191. Dose co-codamol 30/500 qds- morphine 5 mg prn 4 hrly ?
192. Pulseless cold arm- Thromboembolism
193. Man- eye issues for 3 weeks 2 years back now arm tingling-MS
194. APC gene
195. Pancreatic CA19-9

RECALLS FROM 9TH SEPTEMBER 2014

1.Anti CCP- RA
2.NHL- cd20
3.Cystinuria
4.Marfan-fibrillin
5.Family h/o pancreatic Ca, recurrent admissions to ED- hypochondriasis
6.Stands in front of school and speaks to students- Mania
7.Epidydimoorchitis- IV ceftraixone and doxycycline
8.Cisplatin- peripheral neuropathy
9. Gentamicin- Acute tubular necrosis
10.Drug-drug interaction- clarythromycin and theophylline
11.CRF-secondary hyperparathyroidism
12.Scenario on primary hyperparathyroidism
13.Mildly narrowed joint space and pain on lying on that side-trochanteric bursitis
14.Painless hematuria- bladder ca
15.LBBB- reversed split s2
16.Amiodarone-K channel blocker
17.SVT stable- carotid sinus massage
18.Knee pain then lower limb edema with low grade temp- ruptured bakers cyst
19.Lateral spinothalamic tract symptoms post RTA-Post traumatic syringomyelia
20.Pt frm Thailand, fever with thrombocytopenia mildly elevated ALT- Dengue
21.Strongyloides stercralis- also screen for HIV
22.Scenario on somatisation disorder
23.cardiogenic syncope- family h/o of HOCM
24.Syncope during swimming o/e systolic murmur to carotids- do ECHO
25.Pulseless VT , next step?-unsynchronized DC shock
26.Wilson disease- autosomal recessive
27.Paired t-test
28. Formula for PPV- TP/TP+FP
29.Scenario of acromegaly, hw to Ix- OGTT and GH
30.Bartters syndrome electrolyte abn- hypoK
31.Bleeding post op, slightly low Factor 8, elevated APTT, mixing test normal- von Willebrand disease
32.Thrombocytopenia plt:12, ITP, Rx?- Prednisolone
33.AF, CHADSVASc>2- warfarin
34.Abd discomfort, PAS granules positive- Whipples disease
35.Pernicious anemia, next Ix- anti parietal cell antibodies
36.X-linked recessive Beckers muscular dystrophy
37.Recurrent myoclonic jerks- Creutzfelt-Jakob disease
38.Ascending motor and sensory neuropathy with arreflexia- GBS
39.Cervical myelopathy
40.Rash at scalp, buttocks, extensor surface- dermatitis herpertiformis
41.Huntingtons choreo, age of which son get compared to father- Anticipation
42.DM retinopathy when to refer opthlmologist?- macular exudates
43.Anyphylactic reaction with angioedema- IM adrenalne
44.Scenario of pituitary apoplexy
45.Addisonian crisis what to do next?- IV hydrocortisone
46.Parathyroid , medullary thyroid ca, phaeochromocytoma- MEN2
47.TFT deranged in pregnancy- Pregnancy induced
48.ARF with hematuria and hypothermia- rhabdomyolysis
50.Young osteoporosis in male check se testosterone
51. Hypertensive pregnant lady < 20 weeks with ECG having LVH- essential HPT
52.Painful genital ulcers and painful lymphadenopathy- Herpes
53.Pseudomembranous colitis- oral metronidazole
54.Recurrent miscarriage with DVT- Anti cardiolipin ab
55.Anemic pregnant , microcytic with raised HbA2- beta thalassemia trait
56.Why irradiate blood?- Prevent Transfusion assoc GVHD
57.Exudative pharyngitis with lymphadenopathy and h/o travel Eastern Europe- diphtheria
58. Immidiate rx for hyperkalemia- IV insulin
59.Bloating and diarrhea post terminal ileum resection- bile acid diarrhea
60.Recurrent iron deficiency anemia and h/o colon ca in lady- colonoscopy

61.Fresh painless PR bleed- angiodysplasia

62.abnormal posturing young girl- catatonia
63.Bllod supply of pons- basilar artery
64.dilated pupil- Adie Holmes pupil
65.Paraneoplastic cerebellar syndrome- anti Yo
66. Scenario on benzodiazepine withdrawal
67. Wheeze and flushing with pulsatile liver and tricuspid regurg- carcinoid syndrome
68.Pleural plaque in normal patient- do nothing
69.Acute painful knee with calcified ligament- pseudogout
70.Family h/o recurrent stones with hypercalcemia- familial hypocalciuria hypercalcemia
71.Contact dermatitis- skin patch
72.Allergic reaction 1st line drug-cetrizine
73.Bullous pemphigoid
74. Gram pos bacilli meningitis- Listeria meningitis
75.Man frm Zambia with headache and CN palsy with neck stiffness- Cryptococcus meningitis
76. High protein , normal glucose meningitis- viral meningitis
77.Invasive aspergillosis investigation- galactomannan
78.Recurrent neisseria infection- C7 deficency
79.Vomitting and headache with papiledema- cerebral herniation
80. Child having rash contact having fever and red cell apalsia- Parvovirus B19
81.Cardiac tamponade-Pulsus paradoxus
84.Poor prognosis LVH- S3 ( gallop rhythm)
85.ST elevation V1-V3 with reciprocal changes complete occlusion LAD artery
86. h/o Lung Ca develop GN- membranous GN
87.Ix prior to starting anti TB- LFT
88.Cat scratch diasese-Bartonella henslae
89.retrosternal chest discomfort while swallowing- reflux esophagitis
90.Drug to stop pre angio- metformin
91.CREST scleroderma- anti centromere ab
92. Wernicke encephalopathy signs- nystagmus
93. Wernicke encephalopathy rx- iv thiamine
95. LUQ pain with rub- splenic infarct
96. Thyroid mass causing obstruction- anaplastic thyroid ca
97.Contra indication to lung surgery- SVC obstruction
98.Scenario on paranoid schizophrenia
99.Polyarteritis nodosa
100. Peritonitis impt ix- ascitic fluid neutrophil count
101.Fx of terlipressin- splanchnic vasoconstriction
102.Hx of travel to Cambodia now jaundiced with tender hepatomegaly- Hep B
103.EAA- upper lobe fibrosis
104.MODY- HNF gene mutation
106.Prophylaxis for DVT in man with calf swelling- LMWH
107.Rash after amoxicillin for sore throat- EBV
108.NAFLD- fatty liver
109.bloody diarrhea fater visiting farm- Ecoli 0157
110.post EBV- NK cells
111.Waldernstorm macroglobulinemia- Hyperviscosity
112.G protein receptor- plasma membrane
113.Digoxin- rediced creat clearance
114.Phenytoin- zero order kinetics
115.complicated parapneumonic effusion- put chest tube
116.OSA- polysomnography
117.Melanoma- depth of lesion
118. Vomitting and headache with eye signs- Methanol poisoning
119.DI after Lithium ingestion- Nephrogenic DI
120.MDMA hyponatremia
121.Nitrofurantoin- peripheral neuropathy
122.post pacemaker insertion backpain- Staph discitis
123.Pulmonary fibrosis

124.AML post rx got hip pain- AVN hip

125.tumor lysis syndrome
126.Parkinsonism with vertical eye movement restricted- PSP
127.Amyloid neuropathy
128.Valvular HD prior dental procedure- nothing
129.Cardiac failure aim of treatment- reduce preload
130. Renal disease and mother died of ICB- ADPKD
131.BNP- ventricles
132.Dermatomyositis
133.obese lady with headache and papiloedema- BIH
134.CFTR- paternal homozygosity chromosome 7
135. Case scenario transient global amnesia

RECALLS FROM JANURARY 2014 DIET

1 Prinzimetal Angina with Heart Failure - Drug of Choice? FELODIPINE
2 Old age man 75yrs hypertensive encounters Atrial Fibrillation - Rx? WARFARIN
3* Diagnostic Investigation of Choice in Hypertrophic Obstructive Cardiomyopathy?
TRANS-THORACIC ULTRASOUND
4* Irregular Canon 'A' waves on ECG - COMPLETE HEART BLOCK (Regular Canon 'A'
waves occur in ATRIOVENTRICULAR NODAL REENTRY TACHYCARDIA
5* Cardiac Malformation with Hypertension and Surgery refuses - Condition - IDIOPATHIC
ARTERIAL PULMONARY HYPERTENSION
6* Pateient with DVT, previous episodes occured, now presented again - Management?
INCREASE INR FROM 2.5 to 3.5
7* One patient Post Stroke on regular medication including Aspirin which drug to be added?
DIPYRIDAMOLE
8* Malignant Hypertension not controlled by first line Anti-hypertensive drugs like ACE
inhibitors and Calcium Channels Blockers - Management? IV LABETOLOL
9* Post MI, after few days Re Infarction occurs? Which cardiac marker to be tested? CK-MB
10* Lady with Antiphospholipid Syndrome comes with TIA - Echo will be? NORMAL
11* Niesseria Gonnorhoea - Treatment? IV CEFTRIAXONE
12* Streptococcus Pneumonia - Diagnotic Test? LUMBAR PUNCTURE
13* Pheochromocytoma - Diagnostic Test? 24 HOURS URINARY CATHECHOLAMINES
14* Red Blood Cells with broken edges (bites) - Diagnosis? G6PD DEFICIENCY
15* There was a CXR showing Consolidation - Diagnosis? STREPTOCOCCUS
PNEUMONIA
16* Drug most suitable to prevent the Kidney function in impeding Renal Diseases? ACE
INHIBITORS
17* Mycoplasma - Diagnosis by way of detecting what? COLD AGGLUTININS
18* Hereditary Spherocytosis - Investigation of Choice? DIRECT ANTIGLOBIN
TEST

19* Crescenteric GN - Antibodies found? ANTI MYLEOPEROXIDASE ANTIBODIES

20 Diazepam overdose-flumazenil
21 patient taking lithium--Thyroid function tests every 6 months
22 Surfactants--> Type 2 pneumocytes
23 MODY----> Family history of DM
24 Calculate Sensitivity----> 40 per cent
25 Calculate specificity ----> 97/142
26 Rheumatoid arthritis----> TNF
27 NF1---> Chromosome 17
28 LGV----> Rx Doxycycline
29 Dermatomyositis---> Anti-jo1
30 Optic apraxia and optic ataxia : Bil Parietal lobe lesions
31 Factor V leiden test : act Protein C reistance
32 Weber's syndrome
33 Anterior optic ischemic neuropathy
34 cirrhosis, DM, High Se Transferrin saturation
35 Pericarditis....other ECG finding PR depression
36 Metformin MOA inc insulin sensitivity
37 infective endocarditis...blood culture
38 HOCM....TTE plz confirm?.
39 Recurrent DVT....continue warfarin for next 6 month
40 Small Cell Ca Lung...management Surgery (no mets on CT scan)
41 COPD....LTOT
42 Digoxin in elderly patients.......Inc voume of distribution
43 lateral epiconylitis
44 Sptep pnumonia
45 Neiserria infection-ceftriaxone
46 LP-strep pneumoniae
47 CXR with consolidation-strep pneumoniae
48 Phaeochromocytoma-24hr urine catecholamines

49 Drug Of Choice to preserve renal fx-ramipril

50 hereditary spherocytosis-direct antiglobin test
51 bite cells in pbf- G6PD def
52 mycoplasma diagnosis-cold agglutinins
53 cresenteric glomerulonephritis-anti-MPO ab
54 LP-poliomyelitis
55 post colostomy-enterocutaneous fistula
56 multiple attacks giddiness and weight gain-insulinoma
57 microcytic anemia and hx of using NSAID- NSAID causing anemia
58 hx of hematemesis- endoscopy
59 contrast nepropathy -hydrate with N/saline
60 subacute degeneration of cord-dorsal columm
61 LGV antibiotics- doxycycline