MRCP 2 dec 2013 recall

Discussion in 'MRCP Forum' started by samuel, Dec 13, 2013.

  1. samuel

    samuel New Member

    1. Non epileptic fit - resist eye opening
    Fit not related to epilepsy. Resisting eye opening
    2. Chronic kidney disease with raised Uric acid - Febuxostat
    3. Lymes Disease (pt with arthralgia after a tour) - Doxycycline
    4. Photograph - skin lesion bleeding on minor trauma - Pyogenic Granuloma (?)
    5. CT scan - Extradural Haematoma (Biconvex lesion.....SDH is crescent shaped)
    6. Smoker with weakness and dry mouth - LEMS
    7. Perianal Ulcer/ ulcer at any other site - Nicorandil

    Aortic Stenosis- Severity of as by gradient more than 60 for replacement.
    mi with severe as
    Sick sinus syndrome .ddd

    Temporo parietal leison hsv

    an elderly lady hoarding newspapers. Senile squalor syndrome.

    Treatment of gout in renal failure. Febuxastat

    hypercalcemia bone scan

    alcholic , pnumonia
    temporoparietal lesions
    toxoplasmosis
    nippv
    aspergolosis
    wegener/cs
    sleep apnea

    Cluster headache. Verapmil

    Diabetic neuropathy capsacin

    Women with three months of amenhorea .raised lh.and fsh low estrogen. Menopause

    Tremor with postural hypotension . Multi system atrophy

    1-pt prolonged with derranged lft ?
    2-alt ast ldh very high
    3-one question alcoholic abuse - lft markedly derranged.
    4- kidney transplanted in father
    5- xlinked recessive or autosomal recessive.
    6- ecg of wpw with vt
    6- ecg- posterior mi or pulmonary embolism
    8-fredrich ataxia or hsmn
    9-central retinal vien occlusion
    10-normal anion gap with metabolic acidosis with hypokalemia
    11- conn syndrome
    12- di
    13-ms with urinary incontinence
    14-gilbert syndrome?
    15-serum ferritn 750 with liver disease
    16 - intermittent diarrhea, CHOLESTATIC PICTURE diagnosis
    17-autoimmune hepatitis.
    18-dystrophic myotonica
    19- lymes - doxycycline
    20- neisseria gonococcal infection.
    21- pregnancy
    22-leision of pons
    23-cluster headache / migrane
    24-fits not related to epilepsy - cheek bite / duration more than two moin
    25- after dc shock next step
    26-extradural/ subdural/ contusion
    27-frontotemporal dementia
    28- idiopathic parkinsonism
    29- sds
    30-treatement of gout
    31- treatment of diabetic neuropathy
    32-necrobiosis lipodica
    33-pyoderma gangriosum
    34-sick sinus syndrome

    Investigation of urgency in aml . investigation of urgency in patient with auer rods. Coagulation screen pml high risk for DIC

    for the ecg: ?benign early polarization, becuz of fishhook sign present.

    Diabetic with skin leison necrobiosis lipoidicum
    picture with hypopigmented leison vitiligo
    normal skin got tanned after exposure to sun .hypo pigmented leisons became more obvious. ?ptyriasis versicolor

    Deranged lft. High cpk. Muscle pain . Leptospirosis
    guy with scar in kidney . Reflux nephropathy

    Young boy high alp . Re assurance
    young boy with abdominal pain , resolved spontaneously , abnormal LFT ( raised ALP 180)

    teenager with reduced lateral spine movement. ? Scheuermann's disease.

    Rash , pigmented , reticulated , and TSH 15.

    Nephrotic syndrome .sob after biopsy. DVT.

    Low hb in post valve replacement . Valve induced lysis
    locked in syndrome .leison in pons

    Down beat nystagmus arnold chiari
    high ca+ normal pth . Primary hyperparathyroidism

    Sob after icu admission for cardiac failure erta+ vanco

    depression with st elevation pericarditis

    Iv drug abuser with weakness botulism.

    Prolonged pr interval . Rheumatic heart disease.

    women with cardiac failure with 6 month child . Post partum cardiomyopathy.

    ESBL in urine change catheter

    MS with Post residual volume .clean intermittent catheter

    Autonomic neuropathy with tremor . MSA

    Duodenal biopsy slide, Coeliac disease.

    Testicular failure. One with hypogonadotrophic hypogonadism, another one is for primary hypogonadism. ? pituitary tumor and ? haemochromatosis respectively. But klinfelter could be the answer for the latter.


    Trina versicolor (correct me if I'm wrong). And

    WPW ECG was shown, for which they asked the treatment to prevent future arrythmias.

    epidural hematoma .... young age, h/o trauma.
    extradural hematoma as well because of his age and due to the absence of 'sickle sign' on the ct. However when I checked ohcm, it says extradural hematoma presents with a lucid interval.
    pictorial question about ??subdural hematoma

    there was a mass effect there, it looked more like cerebral contusion

    pyogenic granuloma,
    spinal meningioma MRI,
    renal angio (possible atheromatous RAS?).

    about treatment if gram negative diplococci. I believe they wanted the treatment for gonorrhoea. I got that wrong, which I'm kicking myself about. I gave the answer as cedtiz+metro. Where as the answer as per the ohcm is ceft+doxy.

    Renal-

    CKD PT, BREATHLESS, TREATED 3 MONTHS ORAL IRON, STILL BREATHLESS, HB 7.6, MCV-88, NEXT APPROPRIATE STEP?
    BLOOD TX
    S/C EPOPOITIN
    IV IRON
    ORAL IRON
  2. samuel

    samuel New Member

    OPHTHALMOLOGY-

    YOUNG GIRL, DILATED PUPIL, 10MM, NOT REACTING TO LIGHT, MORE PRONOUNCE IN DARK, OTHER EYE OK, DX?
    ARGYL ROBERTSON PUPIL
    ADIE TONIC PUPIL
    THIRD NERVE PALSY

    FUNDOSCOPY PICTURE- RETINITIS PIGMENTOSA, ASK PT QUESTION IN HISTORY TAKING- PHOTOPHOBIA, NIGHTBLINDNESS, GLARE.



    PSYCHIATRY-

    cataplexy
    delusional disorder
    organic psychotic disorder
    frontal lobe/thalamus/
    progressive supranuclear palsy
    senile …. disorder

    NEUROLOGY-

    MRI brain - shadow- round - what was it? - Glioma/ Arachnoid cyst/ abcess/…

    IMMUNOCOMPROMISED ELDERLY MAN CONFUSION- Herpes simplex encephalitis

    CONFUSION MID 30S IMMUNOCOMPROMISED MAN, CSF- HIGH PROTEIN, LYMPHOVYTE, ORGANISM- HERPES SIMPLEX, LISTERIA, HERPES ZOSTER, MENINGOCOCCAL, STREPTOCOCCUS

    EPILEPSY PT, STATUS EPILEPTICUS, GLUCOSE 3.4, GOT BUCCAL DIAZEPAM, NEXT APPROPRIATE STEP?
    GLUCOSE, INTUBATE AND VENTILATE, IV PHENYTOIN, DIAZEPAM/ IV LORAZEPAM.

    MONONEURITIS MULTIPLEX


    CARDIOLOGY-

    Ecgs:

    Atrial tachycardia
    Atrial flutter
    CHB
    WPWs Af
    MI/ Pericarditis

    RESPIRATORY-

    CXR-
    consolidation
    Aspergiloma
    Pleural plaque
    Pulm fibrosis
    Pulm oedema


    Skin-

    Shin discharging lesion with new lesion coming up- ?BOWENS DISEASE, PYODERMA GANGRENOUM, GAS GANGRENE,

    PURPLISH LESION ON FACE OVER 2 YEARS- ?BCC


    Infection-

    Infectious mononucleosus
    HIV


    GIT-

    UC- featureless colon diarrhoea 8 x - no better with hydro - Tx? Colectomy ? drug- Azathio/ Methotreax/ Metro
    HISTOLOGY - COELIAC, PT DIARRHOEA AND ANAEMIA.

    Crohns
    PBC
    Cholestasis in pregnancy ? Acute fatty / PBC?

    HEP C POSITIVE, WOULD LIKE TO CONSIDER INTERFERON ALPHA AND ....
    WHICH CONSIDER TO TREAT STRONLY WITH ABOVE-
    AGE, JAUNDICE, HIV, GENOTYPE 2.

    ABDO PAIN, USS GALL STONES, CBD NONDILATED, FURTHER IX- CT ABDO, ERCP, MRCP, PTC

    ABDO PAIN, TENDER, VOMITING, DIARRHOEA 8-9 TIMES
    NEXT IX- PLAIN AXR, CT ABDO, MRCP, ERCP, USS.

    ABDO PAIN, ITCHY JAUNDICE, USS GALL STONES, CBD 3MM, NEXT IX- CT ABDO, MRCP, ERCP, PTC.



    Endocrine-

    Tertiary PTH
    DM-1
    DM-2
    Addisons
    Cushing
    Hypokaelemin periodic paralysis- A BOY, PARALYSE, CANT MOVE LIMBS 4-6 HOURS, WHILE EATING OR SLEEP. D/D- FACTITIOUS, EPILEPSY, ABSCENCE, CATAPLEXY.

    Hyperthyroidism

    RHEUMATOLOGY-
    RAYNAUDS, FINGERS TIGHT, SWELLING, SOB, ANTIBODY RELATED-
    ANTICENTROMERE, ANTI JO-1, ANTI SCL-70

    XRAY RA HAND- PIPJ AND MCPJ INVOLVMENT


    Pharma-

    Neutropenic sepsis
    Amiodarone thyroid toxi - Tx
  3. samuel

    samuel New Member

    Renal-

    CKD PT, BREATHLESS, TREATED 3 MONTHS ORAL IRON, STILL BREATHLESS, HB 7.6, MCV-88, NEXT APPROPRIATE STEP?
    BLOOD TX
    S/C EPOPOITIN
    IV IRON
    ORAL IRON

    guy with scar in kidney . Reflux nephropathy

    Nephrotic syndrome .sob after biopsy. DVT.

    4- kidney transplanted in father

    ESBL in urine change catheter

    MS with Post residual volume .clean intermittent catheter

    renal angio (possible atheromatous RAS?).

    Genetics-

    5- xlinked recessive or autosomal recessive. Maternal grandmother +/+, Mother escaped, two sons involved. X linked recessive.

    OPHTHALMOLOGY-

    YOUNG GIRL, DILATED PUPIL, 10MM, NOT REACTING TO LIGHT, MORE PRONOUNCE IN DARK, OTHER EYE OK, DX?
    ARGYL ROBERTSON PUPIL
    ADIE TONIC PUPIL
    THIRD NERVE PALSY

    FUNDOSCOPY PICTURE- RETINITIS PIGMENTOSA, ASK PT QUESTION IN HISTORY TAKING- PHOTOPHOBIA, NIGHTBLINDNESS, GLARE.

    Fundoscopy picture- Central retinal vein occlusion.

    PSYCHIATRY-

    cataplexy
    delusional disorder
    organic psychotic disorder
    frontal lobe/thalamus/
    progressive supranuclear palsy
    senile …. disorder
  4. samuel

    samuel New Member

    Anabolic steroid-induced hypogonadism (ASIH) is the functional incompetence of the testes with subnormal
    or impaired production of testosterone and/or spermatozoa due to administration of androgens or
    anabolic steroids. Anabolic–androgenic steroid (AAS), both prescription and nonprescription, use is a
    cause of ASIH. Current AAS use includes prescribing for wasting associated conditions. Nonprescription
    AAS use is also believed to lead to AAS dependency or addiction. Together these two uses account for
    more than four million males taking AAS in one form or another for a limited duration. While both of
    these uses deal with the effects of AAS administration they do not account for the period after AAS cessation.
    The signs and symptoms of ASIH directly impact the observation of an increase in muscle mass
    and muscle strength from AAS administration and also reflect what is believed to demonstrate AAS
    dependency. More significantly, AAS prescribing after cessation adds the comorbid condition of hypogonadism
    to their already existing chronic illness. ASIH is critical towards any future planned use of AAS or
    similar compound to effect positive changes in muscle mass and muscle strength as well as an understanding
    for what has been termed anabolic steroid dependency. The further understanding and treatments
    that mitigate or prevent ASIH could contribute to androgen therapies for wasting associated
    diseases and stopping nonprescription AAS use. This paper proposes a unified hypothesis that the net
    effects for anabolic steroid administration must necessarily include the period after their cessation or
    ASIH.
  5. samuel

    samuel New Member

    Overview of chikungunya




    Chikungunya fever is a viral illness that resembles dengue fever. It is spread by the bite of infected mosquitoes. Chikungunya virus is a member of the genus Alphavirus, in the family Togaviridae. The fever is characterized by severe, sometimes persistent, joint pain (arthritis), as well as fever and rash.


    Chikungunya virus was first isolated from the blood of a febrile patient in Tanzania in 1953. Since then it has caused several human epidemics in many areas of Africa and Asia and most recently in limited areas of Europe. However, it is not a life threatening disease. But the widespread occurrence of the fever causes substantial morbidity and economic loss.




    Causes of chikungunya

    As said before, Chikungunya disease is transmitted among humans by the bite of infected mosquitoes. The primary transmission agent for Chikungunya Virus (CHIKV) is Aedes aegypti mosquito. This type of mosquito is also known as yellow fever mosquito.

    This species of mosquito is usually found in tropics. For this reason, the spread of Chikungunya is predominantly seen in Asian and African countries.

    Recently, another mosquito species named Aedes albopictus is found to be a carrier of the disease.

    The Aedes mosquito has evolved over the years and has effectively adapted itself for biting humans. While approaching humans, they reduce the humming of wings and attack from below to ensure minimal detection. This species of mosquito are usually seen in the urban areas, however recently they are have also migrated to many rural areas.

    The Aedes mosquito needs only 2ml of water for breeding. After breeding the eggs can lay dormant up to one year. A carrier mosquito is capable of transmitting the virus to the next generation. However, the Chikungunya virus is sensitive to heat. It is a RNA virus and is classified into three major groups, namely, West African, Central African and Asian.

    However, so far there is no evidence to indicate a person-to-person transmission of the disease.

    Advertisement



    Symptoms of chikungunya

    Chikungunya virus infection most often is characterized by
    •Fever
    •Headache
    •Fatigue
    •Nausea, vomiting
    •Muscle pain
    •Rash
    •Joint pain

    The fever can be severe, even reaching up to 104 degree Celsius. However, in some cases, especially in children, no symptoms are observed.

    Usually, the attack is sudden and occurs within one to 12 days of the infection caused by a mosquito bite.

    Some of the common physical symptoms of Chikungunya are:
    •Redness in eye
    •Difficulty in looking at light
    •Severe fever with headache and joint pain
    •Rashes on limbs and trunks
  6. samuel

    samuel New Member

    ANAGRAELIDE

    .
    Anagrelide is used to decrease the number of platelets (a type of blood cell that is needed to control bleeding) in the blood of patients who have a bone marrow disorder, in which the body makes too many of one or more types of blood cells, such as essential thrombocythemia (condition in which the body makes too many platelets) or polycythemia vera (condition in which the body makes too many red blood cells and sometimes too many platelets). Anagrelide is in a class of medications called platelet-reducing agents. It works by slowing the production of platelets in the body.
  7. samuel

    samuel New Member

    Recalls that I think we all agreed upon are supposed to be correct:
    1. Factor V leiden test : act Protein C reistance
    2. Weber's syndrome
    3. cirrhosis, DM, High Se Transferrin saturation
    4. Pericarditis....other ECG finding PR depression
    5. Metformin MOA inc insulin sensitivity
    6. HOCM—tte
    7. Recurrent DVT....continue warfarin for next 6 month
    8. COPD....LTOT
    9. Digoxin in elderly patients.......Inc voume of distribution
    10. lateral epiconylitis
    11. Strep pneumonia
    12. Strep meningitis
    13. Neiserria infection-ceftriaxone that was allergic to penicillin
    14. DOC to preserve renal fx-ramipril
    15. hereditary spherocytosis-direct antiglobin test
    16. mycoplasma diagnosis-cold agglutinins
    17. essential tremors-propranolol
    18. ADPKD- US abdomen
    19. anemia with vitiligo bilirubin high and LDH high- AIHA
    20. adverse prognosis in leukemia- philadelphia chromosome
    21. acute pericarditis-PR depression
    22. ring enhancing lesion in CT-cerebral toxo
    23. cat scratch-bartonella henslae
    24. long term taking NSAID with renal failure- drug induced interstitial nephritis
    25. statistics on MI-positive predictive value
    26. low t4 but t3 normal TSH normal- adequate throxine replacement
    27. CD20- rituximab
    28. Specificity of a test
    29. Pyoderma gangrenosum
    30. Signet cell in Gastric Ca
    31. multiple attacks giddiness and weight gain-insulinoma
    32. LGV antibiotics- doxycycline
    33. Reinfarction enzyme- ckmb
    34. Refeeding syndrome-
    35. Tca and benzodiazepine poisoning- iv/bicarb
    36. Surfactants--> Type 2 pneumocytes
    37. MODY----> Family history of DM
    38. NF1---> Chromosome 17
    39. Dermatomyositis---> Anti-MI 2
    40. Laxative abuse
    41. Obstructive sleep apnea-day time sleepiness
    42. Bendrofluthiazide induced Hyponatremia
    43. Corneal reflex-acoustic neuroma case
    44. cauda equina
    45. widespread rash with scab in ankle-lyme disease
    46. upper zone fibrosis—eaa
    47. anti-centromere antibodies--- limited systemic sclerosis
    48. during work only breathlessness--- occupational asthma
    49. mid day dizziness---- 3.7 fbs---- drug abuse?
    50. N.meningitis--- rifampicin is prophylaxis
    51. breakthrough dose already on SR Morphine-- i choose fentanyl patch
    52. still fever neutropenic-- i think we need to give viral prophylaxis i.e. acyclovior –
    53. barthel scale--- all fits but most imp was hand grip as hand grip is decreased so pt needs assistance in all of these activities like shaving, holding a cup, feeding toilet use, etc.????
    54. avian birds outside home--- schizo
    55. no money ,retired—depression
    56. severe headache, ct normal, after 12 hrs-- do lp ( xanthchromia in subarach hmg after 12 hrs)
    57. loud S1- mitral stenosis with left atrium enlargement
    58. one question with hip pain—sacroileitis???
    59. Kaposi sarcoma
    60. paracetamol overdose—PT
    61. Latex allergy—banana
    62. Metaphase—chromosomes in center
    63. Osmosis
    64. ret oncogene- medullary thyroid ca
    65. S1 damage ----with ankle reflex lost
    66. Horizontal mov lost in eye vertical normal pupils normal with resp depression--- lesion in medulla ob
    67. blood pressure not responding to bioprolol...iv labetalol
    68. Parkinsonism signs urinary incontinence n ataxia---- multisystem atrophy
    69. specific test to diagnose giardiasis-serum level ab
    70. Analgesic nephritis
    71. Status epilepticus treatment-lorazepam
    72. junctional rhythm-- av node
    73. tia--- aspirin
    74. ca normal raised alp—osteomalacia
    75. oral isotretinoin for acne as next step after oral minocycline
    76. pt with confusion, maha, --- ttp
    77. cluster headache
    78. kallman syndrome
    79. gord—manometry
    80. nystagmus pt--- wernicke syndrome
    81. first question in paper 2..myesthenia gravis???
    82. acromegally-- ogtt followed by GH measurement
    83. protein detection test--- western blotting
    84. glaucoma pt with eye pain for 1 month, on atenolol for hypertension-- i put raised intraocular pressure????
    85. rheumatoid pt with conjuctivitis—episcleritis
    86. high lfts and high cr, pt in shock--- hepatorenal syndrome
    87. t9.22 ALL-- poor prognostic factor
    88. pt with acute pancreatitis... most common cause Gall stones (GET SMASHED--)
    89. was there any question with answer red cell cast??????
    90. adult polycystic kidney disease pt--- ultrasound abdomen
    91. rash in neck and chest-- flourescene light
    (shingles)
    92. penicillin allergy--- serum tryptase
    93. dry cough, father died of copd--- alpha 1 anti trypsin
    94. aplastic anemia
    95. lateral geniculate bodies lesion for visual field defect question????
    96. Amyloidosis
    97. pt had ischemic stroke and was started on warfarin age 75, what is most imp risk factor for next stroke?
    ans . previous stroke
    98. ...give immunoglobulin since not immune
    99. paradoxical embolus--- asd
    100. breast cancer with back pain, osteopenia, high ca--- ans???? i wrote hypecalcemia of malig
    101. bulimia nervosa
    102. hyperviscosity syndrome
    103. cushings first investigation-dex suppression test
    104. Mitochondrion double stranded dna
    105. Foreign visit with worsening bloody diarrohea not improving--- E.Histolytica (amebiasis)
    106. CLL rituximab
    107. pt with TIA taking aspirin.. what to do in management... add clopidogrel
    108. cocaine---- MI
    109. coeliac disease... treat --- gluten free diet
    110. microcytic hypchromic anemia--- duodenal ulcer
    111. young female pt with menorrhagia-- what to test? Von villibrand factor
    112. Rash on buttocks and extensor surfaces--- Dermatitis herpetiformis
    113. diabetic retinopathy was urgent referal to ophthalmolosgist--- new vessel formation
    114. patient with hematemesis..treatment terlipressin (as no active bleeding, so no need endoscopy for band ligation)
    115. gilbert syndrome
    116. digoxin...increased volume of distribution
    117. Pt with v fib given 2 shocks, before 3rd shock which medicine to give?
    1.adrenaline
    2.amiodarone
    i wrote adrenaline as amiodarone is to be given after 3rd shock in 2010 UK guidelines for ALS
    118. tanned skin--- hemochromatosis
    119. x chromosome- mother, the only one who for sure has that????
    120. CF- ¼????
    121. Intestinal biopsy---Celiac disease
    122. MI pt aspirin + bisoprolol +.. which drug improves mortality…… ace inhibitor
    123. Liver biopsy contraindication- hepatitis
    124. Syringomyelia –involve anterior horn cells or spinothalmic tract???
    125. Patient with dementia (minimental test < 24) – lowy bodies in the deep white matter
    126. Sever estensor hallusis longus + weak dorsiflexion of foot – common peroneal nerve
    127. Lower homonymous quadrant anopia – parietal lobe lesion
    128. TTT of acute lyme disease in pregnant woman – amoxicillin
    129. HIV with bilateral pneumonia (PCP) – exercise induced hypoxia
    130. PCR- virology
    131. Pheochromocytoma- 24hrs urinary metaneph
    132. Pleural effusion with thickened pleura in CT- to confirm diagnosis I choose aspiration cytology??
    133. Lithium treatment in stable serum lithium for 2 years, lab tests for thyroid normal..when to check next thyroid---- after 1 year… (uptodate.com)
    134. Decrease renal risk of contrast nephropathy in diabetic patient with high sugar- I.V Na-bicarbonate????iv/nss,???
    135. Somatiform disorder
    136. GBS--- VC vs FVC/FEV1???
    137. Rifampicin inducing which type P 450???? Cyp3a
    138. that DM patient with FPG 16 mmol who had creatinine 150 micro mol.
    what Rx is choice? is it insulin or sitagliptin? I choose insulin
    139. Quest for meningitis c5-9
    140. pemphigus with oral mucosa involvement
    141. there was a question with pulmonary fibrosis in paper 2, i think the ans was reduced TLCO
  8. samuel

    samuel New Member

    Regarding the X chromose question:

    X Y
    X XX XY

    X XX XY

    Men only pass the X chromosome to their daughters, never to there sons. So, it can't be from the paternal side.

    The mother of the boy would have been a carrier, so she wouldn't have the disease. Her father however, would show the disease. Therefore, maternal grandfather.

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