MRCP 1: Recalled Questions of May 2011

Discussion in 'MRCP Forum' started by anisa, May 30, 2011.

  1. anisa

    anisa Guest

    optic neuritis--------central scotoma
    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

    banana-----allergy
    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
    dr4help likes this.
  2. 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
    8.Acute onset- Anterior spinal artery syndrome
    9.Abductor poliicis brevis-median nerve- Carpal tunnel syndrome
    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
    18.ADH- cortical collecting duct
    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+ 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.lichen planus
    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- ?????
    48.elderly with bullous lesions peripherally- Bullous pemphigoid
    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
    63.Insulinoma-72 hr fast
    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
    79.Haemochromatosis- Transferrin saturation

    PSYCHIATRY
    80.Hypochondriac
    81.OCD
    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
    117.CREST syndrome- anti-centromeric Ab
    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.Streptococcus bovis- colonoscopy
    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
    129.Latex allergy-banana
    130.High calorie-cheese
    131FactorV mutation- activated protein C.MINE WRONG.
    132.IV-IG

    OPHTHALMOLOGY
    133.Pain and central scotoma-optic neuritis
    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
    172.Pyridoxine for homocystinuria-mine wrong
    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.Achalasia cardia-esophageal manometry
    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.
  3. anisa

    anisa Guest

    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
  4. anisa

    anisa Guest

    Pernicious Anaemia and B12 Deficiency

    Pathophysiology
    Pernicious anaemia accounts for 80% of cases of megaloblastic anaemia due to impaired absorption of vitamin B12.1

    Vitamin B12 is present in meat and animal protein foods. Absorption occurs in the terminal ileum and requires intrinsic factor, a secretion of gastric mucosal (parietal) cells, for transport across the intestinal mucosa. In pernicious anaemia, intrinsic factor production is deficient. It is believed to be an autoimmune disease.

    Parietal-cell antibody and antibodies to intrinsic factor are found in nearly all cases. 90% of patients have antibodies to parietal cells and their components, including antibodies to intrinsic factor and the proton pump H+/K+-ATPase.2 50% of patients have thyroid antibodies.1

    Pernicious anaemia may be associated with simple gastric atrophy in 15% of people aged 40-60 years and 20-30% of the older population. Pathology shows gastritis with all layers of the body and fundus atrophied. The antrum is spared in >80% of patients (type A gastritis).3

    Helicobacter pylori infection has been mooted to be an initiating factor, with subsequent autoimmune changes affecting the gastric mucosa. Genetic susceptibility to this process has been suspected.4

    .
    .
    Epidemiology1
    The incidence of the disease is 1:10,000 in northern Europe. The disease occurs in all races. The peak age is 60, although it is starting to be recognised in younger age groups. 5 The condition is more common in those with blue eyes, early greying, a positive family history and blood group A. The condition has a female:male ratio of 1.6:1.0..
    .
    Presentation1,3,6•The onset is usually insidious as B12 stores in the liver are depleted, and starts with symptoms of anaemia, i.e. lethargy and breathlessness. The anaemia may be more severe than symptoms suggest, due to physiological adaptation.
    •Other symptoms may include anorexia, weight loss, diarrhoea and dyspepsia. Glossitis may be an early symptom.
    •Pernicious anaemia may first present as an incidental finding during the investigation of (reversible) diarrhoea.7
    •Neurological involvement may be present even in the absence of anaemia. This is particularly common in patients over the age of 60. The peripheral nerves are most commonly involved, followed by the spinal cord (subacute degeneration of the cord).
    •Peripheral loss of vibratory sense and position are early indications of central nervous system (CNS) involvement, accompanied by reflex loss and mild-to-moderate weakness. Later stages may be characterised by spasticity, Babinski's responses and ataxia.
    •Other uncommon neurological symptoms include impairment of pain, temperature and touch sensations. The legs and feet are involved earlier and more consistently than the hands.
    •Yellow-blue blindness may occur.
    •Psychiatric symptoms (usually more prominent in advanced cases) may include depression, paranoia (megaloblastic madness), delirium, confusion and dementia.3
    •Signs may include anaemia and jaundice.
    •Severely anaemic patients may present with heart failure, often triggered by an infection. Hepatomegaly and splenomegaly8 may be present..
    Differential diagnosis1,3.


    Causes of vitamin B12 deficiency
    •Poor-quality diet, vegetarian diet.
    •Gastric causes - gastrectomy, congenital intrinsic factor deficiency.
    •Intestinal causes - stagnant loop, congenital selective malabsorption, ileal resection, inflammatory bowel disease.
    •Infestation - fish-tapeworm.
    •Metabolic causes - transcobalamin II deficiency, nitrous oxide anaesthesia.
    •Drugs causing decreased B12 levels - oral calcium-chelating agents,3 aminosalicylic acid,3 biguanides.
    .

    Causes of megaloblastic anaemia
    •Folate deficiency - poor diet, goat's milk,9 gluten-induced enteropathy, tropical sprue, pregnancy, prematurity, chronic haemolytic anaemias (e.g. sickle cell anaemia), malignant disease, increased renal loss (congestive cardiac failure, dialysis), drugs (anticonvulsants, sulfasalazine).
    .

    Causes of macrocytosis1,6
    •Alcohol excess - the most common cause of macrocytosis in the UK;10 may co-exist with folate deficiency in spirit drinkers11 (not seen in beer drinkers due to high folic acid content in beer12).
    •Liver disease.
    •Severe hypothyroidism.
    •Reticulocytosis (e.g. post acute blood loss or haemolytic anaemia).13
    •Other blood disorders - red-cell aplasia, aplastic anaemia, myeloid leukaemia, myelodysplastic disorders.
    •Changes in plasma proteins (e.g. increased paraprotein secondary to multiple myeloma) may cause a spurious rise in mean cell volume (MCV) without the presence of macrocytes.14
    •Drugs that affect DNA synthesis, e.g. azathioprine, hydroxyurea.
    .
    Investigations1,6.


    Tests commonly performed in primary care


    Full blood count:.
    •This may show low haemoglobin and increased MCV, although macrocytosis can precede the development of anaemia. Severe cases may show a pancytopenia.
    •The reticulocyte count may be low for the degree of anaemia (1-3% only).
    •The MCV may be normal if there is associated iron deficiency.
    .
    The blood film:.
    •This may show macrocytic red cells, neutrophils with hypersegmented nuclei and Howell-Jolly bodies (residual fragments of the nucleus causing spherical blue-black inclusions on red blood cells seen on Wright-stained smears.15
    •Associated iron deficiency may result in the MCV being normal, in which case two types or red blood cells may be seen (a dimorphic blood film).16
    •The ferritin level should be checked if such a picture is seen.
    .
    Biochemistry:.
    •There may be an increase in plasma unconjugated bilirubin due to increased destruction of red-cell precursors in the marrow. Liver and thyroid function tests and protein electrophoresis may help in the differential diagnosis of macrocytosis.
    •Serum vitamin B12 is the most commonly used method of establishing B12 deficiency. In general, levels <111 pmol/mL reliably indicate deficiency. Neurological deficiency or anaemia is usually evident in patients with levels <89 pmol/mL. False positives (low levels in the absence of deficiency) can occur with pregnancy, folate deficiency, myeloma,17 and excessive vitamin C intake.
    •False negatives (normal levels in the presence of deficiency) may occur in true deficiency, liver disease, lymphoma, autoimmune disease and myeloproliferative disorders. In borderline cases or where B12 deficiency is clinically suspected, other tests must be carried out. Tissue deficiency of B12 results in raised levels of serum methylmalonic acid and this is a useful test where false positive of negative values are suspected. Other tests include transcobalamin II B12 content and plasma total homocysteine.18
    •Folic acid levels should be measured to exclude deficiency, which may co-exist with B12 deficiency. Red-cell folate is a better guide to deficiency than serum folate.1 B12 deficiency may result in increased serum folate levels but reduced red-cell folate levels, because of the effect on intracellular folate metabolism.19 Combined deficiency usually results in both reduced serum folate and vitamin B12 levels.
    .
    Autoantibody screen: intrinsic factor antibodies, if present, are virtually diagnostic of pernicious anaemia. However, they are absent in 50% of patients with pernicious anaemia. Gastric parietal-cell antibodies are present in 85% of people with pernicious anaemia but are also found in 3-10% of people who do not have pernicious anaemia..
    .

    Tests which may be performed in secondary care
  5. anisa

    anisa Guest

    The Schilling test:

    The purpose of this test is to differentiate between patients whose B12 deficiency is due to pernicious anaemia and those who have an intestinal lesion causing malabsorption. It measures the absorption of B12 with and without intrinsic factor..
    •The patient must not take B12 for five days prior to the test.
    •Radioactive B12 is given orally, followed in one to six hours by a parental B12 'flushing' dose (1,000 micrograms) to avoid liver storage of radioactive B12.
    •The percentage or radiolabelled material in a 24-hour urine collection is then measured (normally >9% of the dose given).
    •Reduced urinary excretion (<5%) in the presence of normal kidney function supports the diagnosis of decreased absorption of vitamin B12.
    •Repeating the first test (Schilling I) using radiolabelled cobalt attached to intrinsic factor from a hog (Schilling II) will confirm if absorption is increased, thus supporting the diagnosis of pernicious anaemia.3

    The Schilling test has its limitations:.
    •Radiolabelled vitamin B12 is difficult to obtain, it is complicated to perform and test results can be difficult to interpret in (often elderly) patients with renal insufficiency.20
    •Because the Schilling test does not measure absorption of food-bound B12, the test will not detect defective liberation of food-bound B12 in the elderly patient.21 Furthermore, the test result often does not contribute much to the ultimate management of the patient.

    If a Schilling test is felt inappropriate, in elderly patients with a low vitamin B12 level and negative intrinsic factor antibodies, response to vitamin B12 may be adequate to confirm a diagnosis of pernicious anaemia if:.
    •The person feels better in 1-2 days.
    •The reticulocyte count increases in 2-3 days and peaks in 5-8 days.
    •The red blood cell count increases within 1 week and normalizes in 4-8 weeks.
    •The MCV increases for 3-4 days (due to the increased reticulocyte count), then decreases, reaching the normal range in 25-78 days.
    •Haemoglobin level increases by 2-3 g/dL every 2 weeks.
    •White blood cell and platelet counts normalise in 7-10 days.
    .
    Bone-marrow aspiration: this may be necessary to narrow the differential diagnosis, especially if myelodysplasia, aplastic anaemia, myeloma, or other marrow disorders are suspected. In B12 and folate deficiency, megaloblasts and giant metamyelocytes (early granulocyte precursors) are seen.22

    Gastric secretions: total gastric secretions are reduced to approximately 10% of the reference range; most patients have achlorhydria and absent intrinsic factor.

    Gastroscopy: this is appropriate on diagnosis to confirm gastric atrophy and exclude gastric cancer and polyps.23 Gastric cancer is two to three times more common in patients with pernicious anaemia than in matched controls.14.
    .
    Associated diseases1•Vitiligo
    •Myxoedema
    •Hashimoto's disease
    •Addison's disease
    •Giant cell myocarditis
    •Hypoparathyroidism
    •Diabetes mellitus
    .
    Management1•For patients with no neurological involvement, treatment is with six injections of hydroxocobalamin, 1 mg in 1 mL at intervals of between 2-4 days.
    •Subsequently, 1 mg is usually given at intervals of three months. There is as yet no evidence-based guidance as to the optimum regime but the National Institute for Health and Clinical Excellence (NICE) is considering releasing guidance in due course. It should be remembered that serum B12 is not always an accurate reflection of deficiency at a cellular level.24 It is perhaps for this reason that some patients become symptomatic if the frequency of their injections is reduced, despite having normal serum B12 levels.
    •For patients with neurological involvement, referral to a haematologist is recommended. Initial treatment is with hydroxocobalamin 1 mg on alternate days until there is no further improvement, after which 1 mg should be given every 2 months for life.1
    •Care should be taken not to give folic acid (instead of B12) to any patient who is B12-deprived, as this may result in fulminant neurological deficit.3
    •Oral iron therapy should be given before B12 if iron deficiency is diagnosed by an absence of stainable Fe in the bone marrow or other parameters (e.g. serum ferritin <449 pmol/mL).3
    .

    When to refer1

    Referral to a gastroenterologist should be considered for any patient with pernicious anaemia who has gastric symptoms and/or co-existent iron deficiency. Patients with pernicious anaemia have a 2-3 times increased incidence of gastric carcinoma and gastric polyps compared with matched controls..
    .
    Complications1•Heart failure - this may be secondary to anaemia, or rarely, myocarditis.
    •Angina.
    •Neuropathy - subacute combined degeneration of the cord, optic atrophy, neurosis, depression and dementia.
    •Gastric carcinoma.
    •Infertility (rare).6
    •Iron deficiency anaemia - secondary to the achlorhydria which results from gastric mucosa atrophy.6
    .
    Prognosis6
    Before the advent of treatment with B12, the disease was fatal, hence the name 'pernicious'. However, pernicious anaemia responds rapidly to replacement therapy and most patients have a normal lifespan with little morbidity. If the deficiency has been severe and prolonged, any neurological complications may be irreversible.
  6. MMR

    MMR Guest

    I think, Moderator should stick this thread.
  7. Dr.A.Y

    Dr.A.Y Guest

    Hi Guys
    What will be the cut off around.????
  8. anisa

    anisa Guest

    ++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
    8.Acute onset- Anterior spinal artery syndrome
    9.Abductor poliicis brevis-median nerve- Carpal tunnel syndrome
    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.ADH- cortical collecting duct
    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+ 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.lichen planus
    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
    48.elderly with bullous lesions peripherally- Bullous pemphigoid
    49.diplopia with cranila nerve- 6th cranial nerve palpsy -----correct is IOP
    50.Dermatits Herpitiformis- IGA
    51.smooth lesion over temple- basal cell ca

    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
    63.Insulinoma-72 hr fast
    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
    79.Haemochromatosis- Transferrin saturation

    PSYCHIATRY
    80.Hypochondriac
    81.OCD
    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
    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
    117.CREST syndrome- anti-centromeric Ab
    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.Streptococcus bovis- colonoscopy
    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
    129.Latex allergy-banana
    130.High calorie-cheese
    131FactorV mutation- activated protein C.MINE WRONG.
    132.IV-IG

    OPHTHALMOLOGY
    133.Pain and central scotoma-optic neuritis
    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.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.Pyridoxine for homocystinuria-mine wrong
    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.Achalasia cardia-esophageal manometry
    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
  9. anisa

    anisa Guest

    Which one of the following antibodies is most specific for limited cutaneous systemic sclerosis?ia

    A.A

    Anti-Jo 1antiobodiesia


    B.A

    Rheumatoid factoria

    C.A

    Anti-Scl-70 antibodiesia



    D.A

    Anti-centromere antibodiesia



    E.A

    Anti-nuclear factoria

    Limited (central) systemic sclerosis = anti-centromere antibodies


    Although ANA is positive in 90% of patients with systemic sclerosis, anti-centromere antibodies are the most specific test for limited cutaneous systemic sclerosis


    Systemic sclerosis

    sqweqwesf erwrewfsdfs adasd dhe
    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 limited systemic sclerosis is CREST syndrome: Calcinosis, Raynaud's phenomenon, oEsophageal 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

    Rate question:

    1

    2

    3

    4

    5
  10. anisa

    anisa Guest

    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.
  11. Dr.A.Y

    Dr.A.Y Guest

    Guys..
    Results tomorrow...

    Hope all of us will pass..

    God pls help us.....
  12. Dr.A.Y

    Dr.A.Y Guest

    Results are out.... I pass..... 667...... God is great.... Passsssssss.... Passed because of god only.......
  13. 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.
  14. 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.
  15. 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.
  16. 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
  17. 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.
  18. upen

    upen Guest

    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.
  19. upen

    upen Guest

    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.
  20. 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
  21. 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.
  22. mahak

    mahak Guest

    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.
  23. nazar ali

    nazar ali Guest

    hi im nazar from sudan iwant to sit for mrcp can yuo advise me what to read examimation or topic
  24. Bilal Shaikh

    Bilal Shaikh Guest

    essential notes by kalra,and on examination questions.

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