MRCP 2 Dec 2013

Discussion in 'MRCP Forum' started by samuel, Dec 21, 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

    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
  2. samuel

    samuel New Member

    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

    What is it polymyositis or inclusion body myositis.

    The ECG in paper 3 was irregular with no p in the rythem strip . ? atrial fibrillation.

    ? cauda euina syndrome in paper 3

    Cause of endocardtis in prosthetic valve after 3 month staph. Aures.

    checking the PH.

    pt on heparin, low platelet, HIT?

    pregnancy+ hyperthyroidism= propylthiouracil.

    pregnancy + PE= IX = CTPA/ isotope perfusion scan/ CXR.

    Erectile dysfx+ decredease libido+ Pituitary tumour >1cm, not compressing chaesma- treatment- cabergolin/ radiation/ tesyterone replace/ hypophysectomy.

    Urinary incontinence ?

    APML pt, next urgent IX- Clotting/ flow cytometry/ blood film, bone marrow, bone scan.

    pt with SOB- CXR-
    Silicosis/ EAA/....

    RTA, hit face on dashboard- carotid artery dissection/vertebral artery dissection/ orbital fracture/ base of skull fracture.

    rask, muscle wakness, cancer, dx- dermatomyocitis.

    Xray pelvis- erosion of right hip, pubic rami-collapse- Dx- Avascular necrosis of hip, fracture pubic rami, osteosarcoma, pagers disease.

    swallowing difficulty- MNDF/GBS/MS.

    pt with MI 1 month ago, sob, ECG- LBBB, EF 25%, on ACEI, BB, Frusemide. next step= CRT/increase ACEI/BB/Frusemide/ Spironolactone.

    MRI brain - lesion rounded ? what is it? D/D- Arachnoid cyst/ Glioma/cerebral infarct/ hmg/ ...

    Lung cancer, ca removed, had chemotherapy, now increase SOB. D/D- Aspergilloma/ Lung Abcsess/Pneumonia

    Flu like Sx, Holiday to Malaysia, Plat 56. D/D- Chikungunya serology/ Dengu/....

    sore throat, unprotected sex 2 weeks ago, lesion between soft and hard palate, lymphadenopathy, splenomegaly. lymphocytes and neutropenia, ? acute hiv seroconversion or infectious mononucleosis.

    fundoscopy picture- central retinal vein thrombosis.

    skin shin picture- pretibial myxoedema?

    Tuberculous meningitis?

    Pneumothorax <2cm, no pmho lung disease - discharge and cXR in 2/52.

    Pheochromocytoma- labetolol/metoprolol/ phenolazine/...

    digoxin level 3.3. K-normal, tx- digibind.

    rash, renal failure, anca positive - Microscopic p[olyangitis.

    hepatitis C , raynauds, rash, renal fx abn= cryglobulin.

    middle age, Flu, Abn LFTs, ? HIV test.

    Back pain, Mets on MRI, Dexamethasone Tx, next- Radiotherapy/ chemotherapy/surgical removal/increase Dexa dose.

    Endocarditis, Penicillin allergy- Tx- ? Vancomycin and Gentamycin.

    Horners pt??? D/D

    GBS pt - Forced vital capacity.

    boy viral illness, pancytopenia, ? aplastic anaemia


    UC- diarrhoea 10-15 times- tx with hydrocortisone- still abdo pain and diarrhoea 8 times? next step- d/d - colectomy/ metronidazole/azathioprine/methotrexate/ sulphasalazine?

    haloperidol causes acute dystonia

    acute dystonia than acute akathisia

    thrombocythemia question platelet was not not that much high to ? indicate treatment.

    ? h/o thrombosis....then hydroxycarbamide is definitely required??
  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

    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

    18-dystrophic myotonica

    13-ms with urinary incontinence

    8-fredrich ataxia or hsmn

    Non epileptic fit - resist eye opening
    Fit not related to epilepsy. Resisting eye opening

    Smoker with weakness and dry mouth - LEMS

    Temporo parietal leison hsv
    temporoparietal lesions

    an elderly lady hoarding newspapers. Senile squalor syndrome.

    Cluster headache. Verapmil

    Tremor with postural hypotension . Multi system atrophy.
    Autonomic neuropathy with tremor . MSA

    22-leision of pons
    23-cluster headache / migrane
    24-fits not related to epilepsy - cheek bite / duration more than two moin

    26-extradural/ subdural/ contusion - CT scan - Extradural Haematoma (Biconvex lesion.....SDH is crescent shaped)
    27-frontotemporal dementia
    28- idiopathic parkinsonism
    29- sds

    locked in syndrome .leison in pons

    Down beat nystagmus arnold chiari

    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. extradural hematoma presents with a lucid interval.
    pictorial question about ??subdural hematoma

    Mass effect - cerebral contusion

    spinal meningioma MRI

    MRI brain - lesion rounded ? what is it? D/D- Arachnoid cyst/ Glioma/cerebral infarct/ hmg/ ...

    RTA, hit face on dashboard- carotid artery dissection/vertebral artery dissection/ orbital fracture/ base of skull fracture.

    ? cauda euina syndrome in paper 3

    Erectile dysfx+ decredease libido+ Pituitary tumour >1cm, not compressing chaesma- treatment- cabergolin/ radiation/ tesyterone replace/ hypophysectomy.

    swallowing difficulty- MNDF/GBS/MS.

    haloperidol causes acute dystonia

    acute dystonia than acute akathisia.

    GBS pt - Forced vital capacity.

    CARDIOLOGY-

    Ecgs:

    Atrial tachycardia
    Atrial flutter
    CHB
    WPWs Af
    MI/ Pericarditis
    SSS

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

    6- ecg of wpw with vt
    6- ecg- posterior mi or pulmonary embolism

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

    25- after dc shock next step- immediately resume CPR chest compression.

    Low hb in post valve replacement . Valve induced lysis

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

    Sob after icu admission for cardiac failure erta+ vanco

    depression with st elevation pericarditis

    Prolonged pr interval . Rheumatic heart disease.

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

    Pheochromocytoma- labetolol/metoprolol/ phenolazine/...

    digoxin level 3.3. K-normal, tx- digibind.

    The ECG in paper 3 was irregular with no p in the rythem strip . ? atrial fibrillation.

    Cause of endocardtis in prosthetic valve after 3 month staph. Aures.

    pt with MI 1 month ago, sob, ECG- LBBB, EF 25%, on ACEI, BB, Frusemide. next step= CRT/increase ACEI/BB/Frusemide/ Spironolactone.

    Endocarditis, Penicillin allergy- Tx- ? Vancomycin and Gentamycin.

    RESPIRATORY-

    CXR-
    consolidation
    Aspergiloma
    Pleural plaque
    Pulm fibrosis
    Pulm oedema
    NIPPV
    Sleep Apnoea
    pt with SOB- CXR-
    Silicosis/ EAA/....

    pregnancy + PE= IX = CTPA/ isotope perfusion scan/ CXR.

    PATIENT WITH LEFT LUNG MASS STARTED ON STERIOIDS WHAT WOULD BE NEXT STEP?
    ANSWER IS RADIATION

    Lung cancer, ca removed, had chemotherapy, now increase SOB. D/D- Aspergilloma/ Lung Abcsess/Pneumonia

    Pneumothorax <2cm, no pmho lung disease - discharge and cXR in 2/52.
  4. samuel

    samuel New Member

    Skin-

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

    PURPLISH LESION ON FACE OVER 2 YEARS- ?BCC

    32-necrobiosis lipodica
    33-pyoderma gangriosum - Photograph - skin lesion bleeding on minor trauma - Pyogenic Granuloma (?)

    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

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

    Rash , pigmented , reticulated , and TSH 15.

    pyogenic granuloma,

    skin shin picture- pretibial myxoedema?

    Infection-

    Infectious mononucleosus
    HIV
    alcholic , pnumonia

    toxoplasmosis

    aspergolosis

    Deranged lft. High cpk. Muscle pain . Leptospirosis

    19- lymes - doxycycline , Lymes Disease (pt with arthralgia after a tour) - Doxycycline
    20- neisseria gonococcal infection.

    about treatment if gram negative diplococci. ? treatment for gonorrhoea. cedtiz+metro / ceft+doxy.

    Iv drug abuser with weakness botulism.

    Flu like Sx, Holiday to Malaysia, Plat 56. D/D- Chikungunya serology/ Dengu/....

    sore throat, unprotected sex 2 weeks ago, lesion between soft and hard palate, lymphadenopathy, splenomegaly. lymphocytes and neutropenia, ? acute hiv seroconversion or infectious mononucleosis.

    Tuberculous meningitis?

    middle age, Flu, Abn LFTs, ? HIV test.

    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.

    1-pt prolonged with derranged lft ?
    2-alt ast ldh very high
    3-one question alcoholic abuse - lft markedly derranged.

    14-gilbert syndrome?
    15-serum ferritn 750 with liver disease
    16 - intermittent diarrhea, CHOLESTATIC PICTURE diagnosis
    17-autoimmune hepatitis.

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

    Duodenal biopsy slide, Coeliac disease.

    patient with nasogartric tube found to have out NGT.
    QUESTION WAS IN DEC MRCP 2
    ANSWER IS
    ASPIRATE THE FLUID AND CHECK THE PH

    UC- diarrhoea 10-15 times- tx with hydrocortisone- still abdo pain and diarrhoea 8 times? next step- d/d - colectomy/ metronidazole/azathioprine/methotrexate/ sulphasalazine?

    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.

    Hypercalcemia bone scan

    Hyperthyroidism

    Diabetic neuropathy capsacin

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

    10-normal anion gap with metabolic acidosis with hypokalemia
    11- conn syndrome
    12- di

    30-treatement of gout - Chronic kidney disease with raised Uric acid - Febuxostat
    31- treatment of diabetic neuropathy

    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.

    high ca+ normal pth . Primary hyperparathyroidism

    pregnancy+ hyperthyroidism= propylthiouracil.

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

    XRAY RA HAND- PIPJ AND MCPJ INVOLVMENT

    wegener/cs

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

    What is it polymyositis or inclusion body myositis.

    rask, muscle wakness, cancer, dx- dermatomyocitis.

    Xray pelvis- erosion of right hip, pubic rami-collapse- Dx- Avascular necrosis of hip, fracture pubic rami, osteosarcoma, pagers disease.

    rash, renal failure, anca positive - Microscopic p[olyangitis.

    hepatitis C , raynauds, rash, renal fx abn= cryglobulin.

    Pharma-

    Neutropenic sepsis
    Amiodarone thyroid toxi - Tx
    Perianal Ulcer/ ulcer at any other site - Nicorandil

    Haematology-

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

    APML pt, next urgent IX- Clotting/ flow cytometry/ blood film, bone marrow, bone scan.

    thrombocythemia question platelet was not not that much high to ? indicate treatment.

    ? h/o thrombosis....then hydroxycarbamide is definitely required??

    pt on heparin, low platelet, HIT?

    boy viral illness, pancytopenia, ? aplastic anaemia

    Palliative care-

    Back pain, Mets on MRI, Dexamethasone Tx, next- Radiotherapy/ chemotherapy/surgical removal/increase Dexa dose.
  5. samuel

    samuel New Member

    1. ECG wpw vt ...radio frequency ablation
    2. ECG atrial flutter
    3. ECG AVNRT
    4. ECG Complete heart block
    5. ECG t wave invert in lead v1,2,3 arrythogenic RV cardiomyopathy
    6. Echo and prodromal symptoms ..left atrial myxoma
    7. Fundoscopy CRVO
    8. Fundoscopy Retintis pigementosa night blindness
    9. CT scan upper lobe with metastasis to vertebra and given dexthm inj mean SVC obstruction ci for surgery ..radiotherapy
    10. Lung tumor upper lobe after treatment cxr upper lobe cavity with mass inside..aspergilloma
    11.pelvic X-ra for leer lady cannot move rt leg..fracture of rt ranus
    12.upper lobe tumor c X-ra ..non small cell cancer
    13.wrist and hand X-ray ..HPOA..hypertrophic pulmonary osteoarthropathy
    14. C X-ray for pt for check up symptomless ..benign pleural plaque
    15. Collecting old paper with mild low brain ...senile seqular syndrome !
    16. MRI spine.. TB !
    17. Brain CT..Extradural hematoma !
    18. Symptoms of dermatomyocytis ...anti j ab
    19. MRI of bran and Spin..Arnold chari malformation
    20. 5% pneumothorax ??discharge !
    21. Lady with CCF months after delivery ..postpartum cardiomyopathy
    22. Pt with nephrotic syndrome ..sudden increase in renal profile ...renal vein thrombosis
    23. Buddi chari syndrome !
    24. High metabolic gap,osmolarity,high Anionc gap..methanol poisoning
    25. Mild reduce of stool volume post starvation ..vipoma
    26. Dementia,parkinson,hlu...lewy body dementia
    27. Investigation for anemia for lady ..capsule endoscopy
    28. Pt with weakness ...myotonia dystrophy
    29. Description of meningitis symptoms and praital and frontal lobe change...herpes simples virus infection
    30. Pt with ophthalmoplegia,ataxia,lower limb areflexia..muller flisher syndrome
    31. Drugs causes preanal ulcer..nicrondil
    32. Drugs causes cholestasis liver...clavulinic acid
    33. Pic..of back..T. Versicolour
    34. Pic of easy bleeding lesion...Bowen disease !
    35. Pic of face plaque.. Intradermal melanoma !
    36. Ulcerative colitis with skin lesion..pyoderma gangronosum
    37. Overly tumor ..dermatomyocyits
    38. Pic of ivu for aorta and kidney..medullary spongy kidney !
    39. Post sleep paralysis..periodic hypokalemia paralysis
    40. Pic small intestine biopsy..whipples disease
    41. Q about klinfiltter syndrome..mumps if occur after puberty will cause infertility

    42. Parkinson,autonomic neuropathy...multiple system atrophy
    43. Prolong pr interval in child pt..rheumatic fever
    44. Pt paraplegia and sudden developed high bp..first check catheter patency
    45. MS pt wih residual volume 220 ml.. Intermittent self catheter
    46. Pt with folly catheter for week and symptomless nod have growth 100 per HPF of E.coli ...change catheter !
    47. Symptomless lady with high calcium ...hypo auric hypercalcimic
    48. Low HB and fragment red cell and prosthetic valve..valve induced hemolysis
    49. Lockin syndrome ..site of lesion pons
    50. Female pt with painfully genital ulcer and inguinal lymphadenopathy
    51. Investigation of amonerha pt..menopause
  6. samuel

    samuel New Member

    Choice of cytoreductive therapy in ET (grade C recommendation, evidence level IV)
    • Hydroxyurea is the best documented therapy in ET
    • However, due to the concern of possible increased risk of leukemia transformation with
    long-term use it is not recommended as 1st line therapy in younger patients
    • < 60 years (where platelet lowering is the indication for treatment):
    1st line interferon-α or anagrelide, 2nd line hydroxyurea
    • < 60 years (where leukocyte lowering or constitutional symptoms are the indications for
    treatment):

    Grade C and evidence level iv cannot be taken as the preferred management. Infact it goes against evidence based medicine.
    Quote from Harrison's Principle of Internal Medicine (18th ed)
    "Treatment: Essential Thrombocytosis

    Survival of patients with ET is not different than for the general population. An elevated platelet count in an asymptomatic patient without cardiovascular risk factors requires no therapy. Indeed, before any therapy is initiated in a patient with thrombocytosis, the cause of symptoms must be clearly identified as due to the elevated platelet count. When the platelet count rises above 1 x 106/L, a substantial quantity of high-molecular-weight von Willebrand multimers are removed from the circulation and destroyed by the enlarged platelet mass, resulting in an acquired form of von Willebrand's disease. This can be identified by a reduction in ristocetin cofactor activity. In this situation, aspirin could promote hemorrhage. Bleeding in this situation usually responds to -aminocaproic acid, which can be given prophylactically before and after elective surgery. Plateletpheresis is at best a temporary and inefficient remedy that is rarely required. Importantly, ET patients treated with 32P or alkylating agents are at risk of developing acute leukemia without any proof of benefit; combining either therapy with hydroxyurea increases this risk. If platelet reduction is deemed necessary on the basis of symptoms refractory to salicylates alone, IFN-, the quinazoline derivative, anagrelide, or hydroxyurea can be used to reduce the platelet count, but none of these is uniformly effective nor without significant side effects. Hydroxyurea and aspirin are more effective than anagrelide and aspirin for prevention of TIAs but not more effective for the prevention of other types of arterial thrombosis and are actually less effective for venous thrombosis. The effectiveness of hydroxyurea in preventing TIAs is because it is an NO donor. Normalizing the platelet count also does not prevent either arterial or venous thrombosis. The risk of gastrointestinal bleeding is also higher when aspirin is combined with anagrelide.

    As more clinical experience is acquired, ET appears more benign than previously thought. Evolution to acute leukemia is more likely to be a consequence of therapy than of the disease itself. In managing patients with thrombocytosis, the physician's first obligation is to do no harm."

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