few points from 22nd Jan MRCP 1 exam

Discussion in 'MRCP Forum' started by melosqueak, Jan 23, 2008.

  1. melosqueak

    melosqueak Guest

    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

    :D
  2. Guest

    Guest Guest

    marfans was fibrillin-1
  3. LJY

    LJY Guest

    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

    - Central scotoma - Optic neuritis

    - 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
  4. Guest

    Guest Guest

    Hello dear doctor.
    Salam.
    At last exam is over.lets try to recollect the questions.i hope every one should post the question in chapter basis.

    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.
  5. Guest

    Guest Guest

    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
  6. Guest

    Guest Guest

    The posterior surface (facies posterior) is devoid of peritoneum, and is in contact with the aorta, the lienal vein, the left kidney and its vessels, the left suprarenal gland, the origin of the superior mesenteric artery, and the crura of the diaphragm.
  7. workhard

    workhard Guest

    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
  8. workhard

    workhard Guest

    Statistics

    Question regarding specificity answer was D 93.2
  9. nancy.

    nancy. Guest

    hi,
    just sat for the exam yesterday.i found the 1st paper difficult,but the 2 nd paper was easy.50-70 percent questions from the 2np paper were from on examination.
    so i am keeping my fingers cross to pass the exam.i hope and pray that HE will answer my prayers.
    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
    3)Vit d rich source-cod liver oil,dairy products?
    4)stastics-wat is power of study
    5)how to calculate-sensitivity,positive predictive value
    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
  10. valli

    valli Guest

    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
  11. zax.

    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

    clear crest choosed anticentromere then changed it to antio RNP but al7amdollah i went back to the anticentromere

    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

    patint with 2 cavitries on CXR renal symptoms with +ve canca negative panca >>>wagners

    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

    question on adult onset stills diz

    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
  12. workhard

    workhard Guest

    Obese lady with infertility and type II diabetes treatment options i answered metformin
    Question with absent corneal reflex i selected acoustic neuroma
    question of minimal change glomerulonephritis answer was prednisolon
    one answer was staphylococcal infection
    question of glomerulonephritis after 3 days of urti was IgA nephropathy
    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
    One condition was latex allergy the reaction pt developed with dental procedures etc
    The interpretation of blood sugars and GTT normal person
    one answer was renal glycosuria not diabetes
    One question with retinal vein or artery thrombosis macroglobilunuria
    Atrial fibrillation rate control answer was Digoxin
  13. MRCP 2008

    MRCP 2008 Guest

    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 violent relations and parasuicidal--Borderline personality disorder
    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
  14. LJY

    LJY Guest

    Defidiency of Any factor needed in Intrinsic pathway causes prolongation of APTT.....so the answer was Xl...
  15. Guest

    Guest Guest

    i want to know the general impression about mrcp 1exam of yesterday ..was it bad or good...
  16. Guest

    Guest Guest

    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.
  17. docahmer

    docahmer Guest

    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)

    3.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,

    MICROANGIOPATHIC HEMOLYTIC ANEMIA

    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)

    27.DEMYELINATION-decreased motor conduction velocity

    28.CONNS SYNDROME_ diag by hypokalemia, difficult to treat htn...test is ARR ratio

    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)

    39.SCOTOMA CENTRAL- optic neuritis

    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 use- minimum 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

    58.GUY ON IMMUNOSUPRESSION DEVELOPS PAINFUL SWALLOWING- candidiasis

    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

    75.ADH WORKS ON COLLECTING DUCT

    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

    96. hypopigmented..scaly lesion in a tanned young man---- scraping for mycology ,TAENIA versicolor

    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......

    HOPE U FIND MY EXPLANATIONS USEFUL...JUST TRYING TO GIVE BACK TO RXPGIANS WHT THEY GAVE TO ME.....ANY CONSTRUCTIVE CRITISCISM

    APPRECIATED...
  18. part one

    8)
    what about mitrochondrial disorders transmission :
    a) anticipation b) genetic imprinting c) hetroplasmy
    d) recessive
  19. a a asif

    a a asif Guest

    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.
  20. Guest

    Guest Guest

  21. dd

    dd Guest

    hii.. anyone knows which the ques mentioned the monopost test and what was the answer....theopylline ....
  22. My turn

    My turn Guest

    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

    14)Amaurosis Fugax is caused by
    a)Middle miningeal Artery
    b) Internal Carotid Artery
    c) External Carotid Artery

    15) Skin lesion in relation with ERYTHEMA AB IGNE may develop
    a) Sq Cell CA
    b) Basal Cell CA
    c) Malignant Melanoma

    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
  23. Guest

    Guest Guest

    i think the woman 's test will be for PBC NOT sjorens synd i.e U SHOULD CHEEK THE AMA NOT RO\LA ABS
  24. a a asif

    a a asif Guest

    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
  25. marie

    marie Guest

    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
  26. Dr. Adeel

    Dr. Adeel Guest

    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
    7. Demyelination dec. velocity
    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 crohn’s 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)
    25. RA episcleritis
    26. HLAB27 (Reiter’s)
    27. CKMB after 3 days to check 4 reinfarction
    28. Minimal change dis. Give prednisolone
    29. Boy with one kidney absent & nephrotic proteinuria give steroid trial( BP 126/66)so I didn’t 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 & sjogren’s)
    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)
    53. Anti-centromere in crest dis.
    54. IgA nephropathy
    55. Affinity=potency(comparison of OP1 with OP2)
    56. Benign essential tremors
    57. Fragmented RBC’s 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
    69. Haemochromatosis
    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
    78. Scotoma-optic neuritis
    79. Pulsus paradoxus physiology( dec. Lt. atrial filling)
    80. Anti smith Ab in lupus nephritis (or C3-4???????)
    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. Still’s 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
    108. Wegner granulomatosis
    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 raynaud’s
    119. NNT(100/18-8)
    120. Specificity(890/900)
    121. OCD(pt thinks there is someone in his basement and checks repetitively but to no avail!!!!) (I hate psychiatry)
    122. Behcet disease( genitor-oral ulcers with neurological signs)
    123. Pt. with pleural effusion on CXR; can’t 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?????)
    5) Amaurosis fugax; wats source of embolism( ICA???????????)
    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)
    9) Girl with 1 episode of DVT now planning for air travel wat to advise( I opted for LMW heparin)?????
    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(takayasu’s 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 crohn’s 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!!
    VIII. Myesthenia gravis(25 yrs pt. with diplopia & prox. Muscles weakness)
    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 Devil’s 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. Cushing’s dis. Causes Met. Alkalosis
    XII. A Q of factor 11 def. (I wrote factor 10)
    XIII. A case of NASH
    XIV. A case of Ca pancreas ( I wrote haemochromatosis)
    XV. PEFR both at work and home 4 occupational asthma.
    XVI. Extrinsic allergic alveolitis(upper lobe infiltrates/antibodies)?????
    XVII. Who’z 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 didn’t 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 “SEQUENCINGâ€) [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)
  27. marie

    marie Guest

    NOW IJUST REMEMBERD THE THE STRANGEST Q IN MRCP1 JAUN 2008 DRUG CAUSES RUPTURE TENDON ACHILIS???????????????????????????????????????????????????????????????????? DOES ANY BODY REMEMBER THAT Q?
  28. Guest

    Guest Guest

    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.
  29. Dr. Adeel

    Dr. Adeel Guest

    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!!!!!
  30. LJY

    LJY Guest

    Fluroquinolone causes Achilles tendon rupture
  31. shaheen.

    shaheen. Guest

    Criteria for Terminating Resuscitative Efforts
    In the hospital the decision to terminate resuscitative
    efforts rests with the treating physician. Healthcare professionals must understand the patient, the arrest features, and the system factors that have prognostic importance for resuscitation. These include time to CPR, time to defibrillation, comorbid disease, prearrest state, and initial arrest rhythm. None of these factors alone or in combination is clearly predictive of outcome.11 The most important factor associated with poor outcome is time of resuscitative efforts.12 13 14 15 16 The chance of discharge from the hospital alive and neurologically intact diminishes as resuscitation time increases.17 18 19 20 Clinicians must constantly reassess patient status. The responsible clinician should stop the resuscitative effort when he or she determines with a high degree of certainty that the arrest victim will not respond to further ACLS efforts. (See below for further discussion.) No reliable criteria are available to determine neurological outcome during cardiac arrest.

    Available scientific studies have shown that, in the absence of mitigating factors, prolonged resuscitative efforts for adults and children are unlikely to be successful and can be discontinued if there is no return of spontaneous circulation at any time during 30 minutes of cumulative ACLS. If return of spontaneous circulation of any duration occurs at any time, however, it may be appropriate to consider extending the resuscitative effort. Other issues, such as drug overdose and severe prearrest hypothermia (eg, near-drowning in icy water), should be considered when determining whether to extend resuscitative efforts.

    For the newly born infant, discontinuation of resuscitative efforts may be appropriate if spontaneous circulation has not returned after 15 minutes. Lack of response to intensive resuscitation for >10 minutes carries an extremely poor prognosis for survival or survival without disability.21 22 23 24

    DNAR Orders
    Unlike other medical interventions, CPR is initiated without a physician’s order under the theory of implied consent for emergency treatment. In the United States a physician’s order is necessary to withhold CPR, but this may not apply in other countries in specific circumstances. For example, since physician-staffed ambulances are much more common in Europe, those physicians are able to make such decisions themselves, without having to place a telephone call to a separate medical control person. Many patients will discuss resuscitative options, but physicians often hesitate to initiate discussion because of inappropriate concern about provoking severe anxiety or undermining a patient’s hope. There is good evidence that this is not the case.

    The commonly used term do not resuscitate (DNR) may be misleading. It suggests that resuscitation would be successful if undertaken. The term do not attempt resuscitation (DNAR) may more clearly indicate that success at resuscitation often is not achieved. The terms DNR, DNAR, and no CPR are currently in use, and local custom determines the preferred term. The term DNAR is used throughout the remainder of this chapter.

    In the United States, legal precedent has defined very specific requirements before an advance directive can be used to withhold CPR. DNAR orders written in the hospital are not advance directives, and these legal requirements do not apply. The scope of a DNAR order may be ambiguous. A DNAR order does not preclude interventions such as administration of parenteral fluids, nutrition, oxygen, analgesia, sedation, antiarrhythmic agents, or vasopressors. Some patients may choose to accept defibrillation and chest compressions but not intubation and artificial ventilation. The DNAR order can be written for an individual in specific clinical circumstances and should be reviewed at regular intervals.

    Some physicians discuss CPR when patients are thought to be at risk of cardiopulmonary arrest. Typically the possibility of cardiopulmonary arrest becomes clear as a patient’s condition worsens. Then the patient may no longer be capable of decision making. Targeting sicker patients also reinforces the belief that discussion of DNAR orders signifies a bleak prognosis. Selective discussions may also be inequitable. Physicians discuss DNAR orders more frequently with patients who have AIDS or cancer than with patients who have coronary artery disease, cirrhosis, or other diseases with a similarly poor prognosis.8 Physicians must, within reason, consider initiating CPR discussions with all adults admitted for medical and surgical care or with their surrogates.

    Terminally ill patients may fear abandonment and pain more than death. In discussions with such patients, physicians need to emphasize their plans to control pain and provide comfort and general overall care even if resuscitation is withheld.

    All decision making begins with the physician making a recommendation based on sound medical judgment to the patient. Patients and their surrogates have a right to choose from medically appropriate options on the basis of their assessment of the relative benefits, risks, and burdens of the proposed intervention. This does not imply the right to demand care beyond options based on appropriate medical judgment and accepted standards of care. Physicians also are not required to provide care that violates their own ethical principles. In such cases they may choose to transfer care to other healthcare providers.

    Conflicts of interest may lead parents to make decisions that are not in the best interest of their child. Outside consultation should be obtained if patients, surrogates, or parents cannot agree with physicians on a course of action. In such an instance the physician may seek the assistance of another consultant, the family physician, the hospital ethics committee, or—as a last resort in pediatric cases—a governmental child protection agency. A growing number of children with chronic and potentially life-threatening conditions are living in foster care under state jurisdiction. Ambiguities about the scope of decision-making authority vested in custodial guardians, especially decisions about CPR and prolonged life support, must be resolved.

    Decisions to limit resuscitative efforts should be communicated to all professionals involved in the care of the patient. Such interactions provide a wider information base, ensure that staff is fully informed, and offer an opportunity for discussion and resolution of conflicts. DNAR orders carry no inherent implications for limiting other forms of treatment. Other aspects of the treatment plan should be documented separately and communicated. Admitting a patient with a DNAR order to an intensive care unit is consistent with the attitude that all patients deserve the best available care, regardless of the existence of a DNAR order.

    DNAR orders should be reviewed before surgery by the anesthesiologist, attending surgeon, and patient or surrogate to determine their applicability in the operating room and postoperative recovery room.
  32. shaheen.

    shaheen. Guest

    Once, according to clinical variables, an intermediate to high risk of perioperative events is recognized for the individual patient it will be necessary to establish the presence, extent and severity of inducible myocardial ischemia, parameters which correlate with short and long-term prognosis in patients undergoing major vascular non cardiac surgery. Risk stratification with exercise electrocardiography has been performed [8-16], but this type of testing is not suitable for patients with peripheral vascular disease due to their inability to reach an ischemic threshold. Cutler et al. [9] demonstrated that patient who achieved >75% of maximum predicted heart rate and no ischemic electrocardiographic modifications did not develop postoperative cardiac complications, whereas there were 10 postoperative cardiac events, including 7 myocardial infarctions (25%), in the high risk group.

    Other authors [15] have confirmed these data by showing that the failure to achieve 85% of maximum predicted heart rate or 5 metabolic equivalents is a predictor of poor outcome in vascular surgery patients. These data, consistently with the AHA/ACC guidelines stress the need for an adequate functional capacity to select high risk patients. Pharmacologic stress testing with perfusion scintigraphy or ultrasound, alternative to exercise is more suitable in this set of patients due to the aforementioned physical limitations. Myocardial perfusion imaging with dipyridamole has been used widely for the preoperative evaluation of patients before vascular surgery [17-24]. The positive predictive value of thallium redistribution ranged from 4% to 20% in reports that included >100 patients, but more recent studies have further reduced the positive predictive value of this method, likely due to the selection of high risk patients for whom an alternative approach is followed (coronary revascularization before peripheral surgery, optimization of medical regimen etc.). The negative predictive value of a normal scan remains high at 99% for myocardial infarction and/or cardiac death. Some studies have demonstrated that not only the presence but the magnitude and severity of the perfusion abnormalities correlated with a worse outcome, suggesting that more severe defects have a greater cardiac risk [22,23,25]. The meta-analysis by Shaw et al. [26] analyzed the results of 10 articles describing the use of dipyridamole-thallium in vascular surgery candidates over a 9-year period (1985–1994). Cardiac death or nonfatal myocardial infarction occurred in 1, 7, and 9% of patients with normal results, fixed defects, and reversible defects on thallium scans, respectively. Moreover, 3 out of the 10 studies analyzed have used a semi-quantitative scoring demonstrating a higher incidence of cardiac events in patients with two or more reversible defects [26]. Recently Baron et al [27], raised the need for caution in routine screening with dipyridamole thallium stress test of all patients before vascular surgery. In this review of 457 patients undergoing elective abdominal aortic surgery, the presence of definite coronary artery disease and age greater than 65 years were better predictors of cardiac complications than perfusion imaging. In line with this evidence, Mangano [24] reassessing the use of perfusion scintigraphy, has shown its poor specificity mostly when applied to consecutive and unselected patients. In consideration of these data, some authors have stressed the need to select patients on clinical grounds first to obtain a better power of stratification when imaging techniques are used [7,17,28].

    Many reports have demonstrated that pharmacological stress echocardiographic imaging techniques predict perioperative ischemic events in patients undergoing noncardiac vascular surgery [29-36]. The experience of several groups with either dobutamine or dipyridamole indicates, in univocal terms, that these tests have a very high negative predictive value (between 90 and 100%): a negative test is associated with a very low incidence of cardiac events and allows a safe surgical procedure. Much lower is the positive predictive value (between 25 and 45%). In the series by Poldermans et al. [32] the presence of a new wall motion abnormality was a powerful determinant of an increased risk for perioperative events after multivariate adjustment for different clinical and echocardiographic variables. In an update of the EPIC (Echo Persantine International Cooperative) Study – subproject risk stratification in major noncardiac vascular surgery, in a patient population of 509 [37] it has been demonstrated that test positivity identified as the variation between rest and stress wall motion score index (delta peak wall motion score) was the best predictor of peri-operative in-hospital cardiac death. When the data were analyzed according to an interactive procedure, considering the variables in clinical order: historical parameters first, preoperative risk assessed on clinical grounds and stress echo parameters; still stress echocardiographic parameters added significant prediction to the model compared with historical and clinical variables. Published data, although less numerous than for perfusion scintigraphy, show that pharmacologic stress echocardiography is safe and effective in the risk stratification of this set of patients. In a meta-analysis of 15 studies [26] comparing intravenous dipyridamole-Thallium-201 imaging and dobutamine echocardiography for risk stratification before vascular surgery it has been demonstrated that the prognostic value of noninvasive stress imaging abnormalities for perioperative ischemic events is comparable between available techniques but that the accuracy varies with coronary artery disease prevalence (fig. 2). One study compares dipyridamole perfusion scintigraphy with dipyridamole stress echocardiography for the prediction of perioperative cardiac events [38]. Sensitivity of the two techniques is not significantly different (scintigraphy vs. stress echo, 90% vs.68%, p = ns), while specificity as well as diagnostic accuracy are significantly better for stress echocardiography (88% vs. 68%, p < 0.001 and 84% vs. 72%, p = 0.02, respectively).

    In a recent meta-analysis Kertai et al. [39] showed that pharmacologic stress echocardiography with dobutamine or dipyridamole is significantly better than perfusion scintigraphy in the prediction of perioperative events OR 37.1 (95% CI, 8.1 – 170.1) vs. 9.6 (95% CI 4.9 – 18.4, P = 0.12, dipyridamole vs. dobutamine) vs scintigraphy (OR 1.95 (95% CI, 1.2 – 3.2). On the basis of these data stress echocardiography has a prognostic profile comparable to perfusion scintigraphy, if not better. But these considerations should be put into a wider framework in the clinical decision making. In fact, medical imaging with nuclear techniques represents the main manmade source of radiations and its environmental impact should be considered along with the individual risk of each single patient of experiencing a fatal or non-fatal cancer" [40]. On this issue a European Law states that a nuclear examination can be performed only when "it cannot be replaced by other techniques which do not employ ionizing radiations. This is one of those cases in which the nuclear technique can be clearly replaced without loss of critical information
  33. shaheen.

    shaheen. Guest

    Hypomagnesemia may inhibit parathyroid hormone secretion, causing hypocalcemia and hyperphosphatemia


    frabmented RBcs is the right answer as per emedicine

    http://www.emedicine.com/EMERG/topic238.htm#section~workup

    HUS produces a microangiopathic hemolytic anemia (hemoglobin typically less than 8 g/dL). This is the hallmark finding and is necessary to establish the diagnosis.
    The hallmark of HUS in the peripheral smear is the presence of schistocytes. These consist of fragmented, deformed, irregular, or helmet-shaped RBCs (see Image 1). They reflect the fragmentation of RBCs that occurs as the RBCs traverse vessels partially occluded by platelet and hyaline microthrombi. The peripheral smear may also contain giant platelets. This is a reflection of the reduced platelet survival time resulting from the peripheral consumption/destruction of platelets


    http://www.emedicine.com/med/topic589.htm#section~treatment

    as per emedicine
    treatment for dumping have nothing about changing the feeding habbits
    2 drugs ( acarbose or octeriotides) then surgery

    .
    Parameters that are useful in monitoring lupus activity and flare-ups in patients with SLE include new clinical manifestations (number and type of skin lesions, arthritis, serositis, neurologic manifestations), laboratory tests (complete blood cell count), immunologic tests (serum C3/C4, anti-C1q, anti-dsDNA), and validated global activity indices.

    http://www.medscape.com/viewarticle/559745
  34. shaheen.

    shaheen. Guest

    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 crohn’s 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!!
    VIII. Myesthenia gravis(25 yrs pt. with diplopia & prox. Muscles weakness)
    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 Devil’s 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. Cushing’s dis. Causes Met. Alkalosis
    XII. A Q of factor 11 def. (I wrote factor 10)
    XIII. A case of NASH
    XIV. A case of Ca pancreas ( I wrote haemochromatosis)
    XV. PEFR both at work and home 4 occupational asthma.
    XVI. Extrinsic allergic alveolitis(upper lobe infiltrates/antibodies)?????
    XVII. Who’z 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 didn’t 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 “SEQUENCINGâ€) [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) .
  35. boss

    boss Guest

    i think ans is IGT not renal glycosuria.
    in reynauds use inoprost=prostacyclin
  36. Guest

    Guest Guest

    Am I only the one who simply assumed the Hb of 0.1 was a typing error and should have been 10.1? :?
  37. boss

    boss Guest

    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)
  38. guest12345

    guest12345 Guest

    some recalls from 2008 jan MRCP1

    1.Azathioprine MOA ,TPMT
    2.Torticollis -metoclopramide
    3.hemolytic anemia?howell jolly bodies
    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
    10.nurse with flexural rash-latex allergy
    11.treatment of toxoplasmosis,fansidar :D 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 :D
  39. marie

    marie Guest

    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
  40. Musa.

    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

    clear crest choosed anticentromere then changed it to antio RNP but al7amdollah i went back to the anticentromere

    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

    patint with 2 cavitries on CXR renal symptoms with +ve canca negative panca >>>wagners

    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
  41. zax.

    zax. Guest

    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

    question on adult onset stills diz

    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


    the word in that question were exactly whats written in here so i changed the right answer by my hand ,my IQ is my problem,

    i think i already failed ,i changed half of my correct answers to the worng answers at the last minute anyway i didnt deserve to pass from the start i studied for one months about 10 weeks ago & thats it
  42. Guest 123.

    Guest 123. Guest

    result is expected on12th or 13th of feb 2008

    result is expected on12th or 13th of feb 2008 on MRCP (uk) official website.U 'll need Ur RCP-code .Best of luck.
    We all make blunders, I've made errors which even 1st year student may not make.But thats the way it is. U make right guesses 10 times & then U also make 2-3 silly blunders at the same time, so dont get dishearted!
  43. Guest 123.

    Guest 123. Guest

    Parameters that are useful in monitoring lupus activity and flare-ups in patients with SLE include new clinical manifestations (number and type of skin lesions, arthritis, serositis, neurologic manifestations), laboratory tests (complete blood cell count), immunologic tests (serum C3/C4, anti-C1q, anti-dsDNA), and validated global activity indices.

    http://www.medscape.com/viewarticle/559745


    Howell-Jolly Bodies
    Howell-Jolly bodies are spherical blue-black inclusions of red blood cells seen on Wright-stained smears. They are nuclear fragments of condensed DNA, 1 to 2m in diameter, normally removed by the spleen.

    They are seen in severe hemolytic anemias, in patients with dysfunctional spleens or after splenectomy .
  44. Guest

    Guest Guest

    What do you think about the passmark???
  45. Guest

    Guest Guest

    Thre was a Q about the absolut contraindication of regnancy.
    The answer was pulmonary hypertension i think.
  46. Guest

    Guest Guest

    this time will be around 70%
  47. ammarmohy77

    ammarmohy77 Guest

    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??
  48. ammarmohy77

    ammarmohy77 Guest

    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?
  49. marie

    marie Guest

    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:
  50. drvik

    drvik Guest

    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.

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