MRCP 2 July 2014 recalls

Discussion in 'MRCP Forum' started by samuel, Aug 20, 2014.

  1. samuel

    samuel New Member

    1. AIH 2 due to amiodarone ---> prednisolone
    2. Aortograph in pics ...Takayasu arteritis?
    3. Invasive ductsl ca risk factors...alcohol (w)
    4. Shoulder xray?? Ruptured tendon?
    5. Familial growth thing
    6. Turner?
    7. Bullous pemphigoid pic
    8.allopecia and nail pitting..psoriasis (w)
    9. Gall bladder empyema?(w)
    10. Farmer xray miliary tb?(w)
    11. Pyoderma gangrenosum on uc patient pic. Prednisolone
    12. Lesion on foot not respondimg to? Antifungal??
    13. Fompizole in alcohol guy?.
    14. Ursodeoxycholic acid in PBC.
    15. Long standing diarrhea fecal elastase?
    16. GCA additiomal drug?(w)
    17. Cardiac cath VSD.
    18. Hiv +ve patient with unilateral visual acuity loss..toxoplasmosis?
    19. Commonest association with celiac disease...hepatic cysts?
    20. Moderate Aortic stenosis and calcification...avr?
    21. Huntington guy with depression...respect his will?
    22. Acute gout attack due to lack of colchicine...stop allopurinol?
    23. Recurrent gout attack...adive low purine diet?
    24. Girl taking grandma's painkillers...buprenorphine??
    25.copd exacerbations...ltot?
    26. Salmon pink rash with joint pains..adult onset stills?
    27. Multiple system atropyhy
    27. African patient with cxr...kaposi sarcoma?
    28. Calcium scan Ct?
    29. Post mastectomy lung infiltration that relapses after stopping prednisolone...lymphangitis carcinomata?
    30. Prolonged diarrhea with low fecal elastase...pancreatic exocrine deficiency
    31. Lady with celiac disease sister having 8 months diarrhea...irritable bowel?
    32. MIBI scan..inferior fixed?
    33. Pneumococcal pneumonia
  2. samuel

    samuel New Member

    1.statistic - inattention to treat analysis, how many pts to include? need to include all pts both treated and discontinued
    2.PCKD - the most frequent accompanying pathology: liver cysts (also berry aneurism, mitral valve prolapse)
    3. after acromegaly treatment, human growth hormone still slightly elevated: what is the most frequent complication: IHD
    4. woman with tattoo and deranged liver enzymes, rash on tattoo. Ix?
    viral hep screen?
    autoantibody
    serum caeroplasmin
    5. Woman had surgery, extubated, sudden pleuritic chest pain in the R side. X ray - r sided opacification, tracheal and mediastinum shift towards the pathology (lung collapse?) treatment : chest drain?
    6. Pt on warfarin: INR 4,6, black stool, low HB. Rx: protrombin concentrate
    FFP
    vit K
    7. thyrotoxicosis with AF
    rx:
    propanolol
    flecainide (stupidly chosen by myself!!!)
    8. question re diabetes insipid us, pt with polydipsia, polyuria. no increase in urine osmolality after water deprivation and DVAPP: nephrogenic DI
    9. pt with proteinuria Rx:
    ACE?
    10. pt after MI with heart failure and LV ejection 35%, which RX additional to B blockers and furosemide improve outcome:
    digoxin (correct?)
    warfarin
    no options for spironolactone or ACE)))
    11. pregnant with deranged liver tests:
    acute fatty liver of pregnancy?
    12. inclusion body myositis: proximal leg weakness, distal muscle weakness of hands
    13. guliian barre with TLC 1.5 litters - classic discretion
    14. drug abuser with paraparesis and diplopia: botulism
    15. X-ray pleural effusion (also option lung collapse there)
    16. dermatomyosis with picture of the rash on hand
    17. bullos pemphigoid in elederly person
    18. lesion on the chin picture: BCC? squamous papilloma?
    19.diabetic on annual review, retina pic. Rx:
    photocoagulation, observation?
    on pic - pre-profilirative retinopathy, is there haemorrhage in the macula region?

    20. diabetic N cholesterol, low HDL, high triglicerides, quite poor diabetic control. How to improve his lipids:
    tight control of diabetes (?)
    fibrates
    statins
    Dermatomyositis
    Seborrheic keratosis
    Prolonged PR
    SVT WITH ABBERANCY
    LIMB LEADS MISPLACED
    CT: Hydronephrosis
    Skull x ray: fracture
    Bullous pemphigoid
    intradermal naevus
    supraspinatus tendinitis
    CT: PE
    CT: left upper lobe collapse

    21. SVC obstruction: most appropriate Rx:
    dexamet
    radiotherapy
    stent

    22. increased Ca
    increased PTH
    normal vit D
    Rx
    cinacalcet
    alfacalcidol
    calcitonin
  3. samuel

    samuel New Member

    1. Girl with Htn, sister also had it - phaeochromocytoma
    2. Guy with s bovis- rt knee aspiration
    3. Aorta gram - ? Takayasu
    4. Question on aortic dissection
    5. Girl with Turners features
    6. Eplerenone to improve mortality in uncontrolled chronic heart failure
    7. Eplerenone to reduce 1 year mortality...
    8. Girl with'fluttering' - ectopic beats
    9. The Huntington guy with VT - give treatment
    10. Foreigner with past history of Scarlett fever - constrictive pericarditis
    11. Guy with mania and hasn't slept for 5 days ? Bipolar - lithium
    12. Next treatment for copd - tiotropium
    13. One question with Sarcoid
    14. Pneumothorax 1cm - discharge
    15. Duodenal biopsy for coeliac
    16. Duodenal biopsy again?
    17. PBC with raised IgM - ursodecolic acid
    18. Inflliximab for uncontrolled crohns
    19. Stop ramipril
    20. Bacterial overgrowth in multiple surgery patient for IBD
    21. Cause of acid base balance in a pregnant lady - lactic acidosis
    22. Boy with recurrent chest, ear infections - CVID
    23. CLL - observe
    24. Middle aged with haematoma - acquired haemophilia
    25. Methanol/ethylene glycol - fomipezole
    26. Non functional macroadenoma
    27. Na valproate for the seizures patient
    28. Hypothyroid myopathy for the lady who couldn't get up
    29. TTP
    30. Convulsing man, septic - cerebral abscess
    31. Severe diarrhoea and renal dysfunction in a returning traveller - cause of renal - ATN
    32. Bulllous pemphigoid
    33. Returning traveller with myalgia and lymphadenopathy - HIV serology
    34. Old man with hypertension - nephrosclerosis
    35. Wound breakdown and pus and sepsis - surgical exploration
    36. Boy with reiters - doxy
    37. Why would you give irradiated platelet to that lady - because awaiting stem cell transplant
    38. Possible bronchial cancer with glomerulonephritis - membranous glo
    39. Asian lady had transfusion 19 yrs ago, now presents with jaundice what serology ?
    40. Copd man, regular ITU, now in severe type 2 RF - intubate!
  4. samuel

    samuel New Member

    Mrcp

    1- temporal arthritis additional treatment - aspirin
    2- alopecia areata
    3- pregnant lady with reflux - alginate
    4- takayasu arthritis
    5- Indian patient with hepatomegaly - leishmania
    6- farmer with tattoos - hypersensitive pnemonitis
    7- copd patient with t2 respiratory failure - niv
    8- pyoderma gangrenosum - prednisolone
    9- old gentleman returned from holiday has pneumonia signs and abdo pain - legionella
    10- young lady with pneumonia symptoms confused - legionella
    11- 25 year old lady come for review f/h of colon cancer at the age 70 - no treatment required
    12- patient with asymptomatic aortic stenosis - outpatient review
    13- primary pneumothorax less than 1 cm - discharge with early review
    14- lady with osteomalacia - treatment calciferol
    15- anaemia with zinc protoporhyrin test - lead toxicity
    16- normal pressure hydrocephalus
    17- multi system atrophy
    18- good pasture
    19- cryoglobulin - hepatitis c
    20- acute hepatitis patient hep b and a negative - hepatitis e
    21- chrons patient severe flare already on azathioprine- infliximab
    22- pagets - skull xr and bone scan was given
    23- ECG with tented to waves - hyperkalemia
    24- still disease
    25- sleep apnea patient snoring at night bmi 27 and not sleepy during the day- mandibular advancement device
    26- epileptic girl on topiramate and phenytoin, comes with movement of her arms and legs - non epileptic seizure
    27- myo epilepsy - valproate
    28- lady depressed, constipation and 3 kg weight lost, lost her husband 6 months ago - reassurance
    29- scleroderma patient with pulmonary hypertension - answer either echo or cardiac catheterisation
    30- patient after admission with MI deteriotes, saturation increases from right atrium to right ventricular - vsd
    31- patient with inferior mi had PCI, has heart block on ECG - continue monitoring
    32- in copd which would decrease the recurrence of attacks - inhaled steroids
    33- small cell carcinoma patient coming with positive Romberg test - lambert eaten
    34- budd chiari - Doppler ultrasound abdomen
    35- amytripline overdose - bicarbonate
    36- patient on lithium, urine and osmolality results were given after water deprivation and desmopressin test, no improvement seen - nephrogenic diabetes ins
    37- sjogren patient with hypokalemia - distal renal tubular acidosis
    38- patient grown strep bovis in blood cultures - colonoscopy
    39- a lady with positive IgM and alp but asymptomatic - ursedeoxycolic acid
    40- patient who has long term catheter, grown 10 over 5 coliform and pseudomonas but patient asymptomatic - no treatment required
    41- idiopathic intracranial hypertension - lumbar puncture
    42- lady with loose teeth and jaw pain - necrosis of jaw
    43- pregnant patient which tablets to stop - ramipril
    44- patient on amiodorone developed hyperthyroidism treated with carbimaxole but still hyperthyroid low intake of iodine - treat with prednisolone
    45- Charcot joint on xr - resting the foot
    46- patient with urethral discharge, conjunctivitis and arthritis, gram stain negative - treat for chlamydia > doxycycline
    47- patient developed breast cancer previous history of radiotherapy - most likely cause is radiotherapy
    48- pheochromacytoma on ct scan - treat with Alpha blocker
    49- subacute combined degeneration symptoms - check b12
    50- patient on methotrexate develops sore throat, initial investigation - check FBC
    51- patient with AF previous stroke asking which one weighs more when you decide warfarin - previous stroke
    52- ITT analysis - add all the patients
    53- CKD patient with low calcium high phosphate and pth - treat with calcidol
    54- primary hyperparathyroidism
    55- bilateral leg swelling, old lady has erythematous lesions in both legs asking initial management - s/c lmwh
    56- suspicious melanoma lesion - excision biopsy
    57- elderly confused, agitated and has hallucinations what to give - haloperidol
    58- lymphocystosis with smear cells - phenotyping
    59- patient with cancer has bleeding problem - acquired heamophilia
    60- TTP - I cannot remember the question but I gave TTP as answer
    61- patient with chrons and previous bowel resection - renal stones
    62- patient with peripheral neuropathy initial treatment - duloxetine
    63- gentamicin, through level is 2, 1hour post dose level is 4 on 60mg TDS dose - don't change the dose repeat the test again
    64- patient on warfarin comes with uppergi bleed - give pcc
    65- patient had syncope when having a shave - carotid hypersensitivity
    66- CLL patient give 0,3,6 monthly bloods WCC increased over the period but not doubled and she is asymptomatic - management is to observe
    67- another CXR with huge pneumothorax on the right side - chest drain
    68- patient comes with syncope on standing, tilt table test produces dizziness and bp drop of 40 - postural hypotension
    69- Turner syndrome
    70- patient has long history of anaemia had ogd colonoscopy and repeat colonoscopy which were normal, asking for next step - capsule endoscopy
    71- patient comes with abdo pain background of several abdo surgeries, colonoscopy was normal - pseudo obstruction
    72- thyrotoxicosis patient on AF what to give - propranolol
    73- CTPA shows pulmonary embolus treatment , this was the first question of first paper I cannot remember the story but it was consistent with pe - treatment lmwh
    74- alopecia areata
    75- paracetamol overdose , ph 7.1, pt > 100, creatinine > 300 asking what would be the life saving intervention, I cannot remember whether the patient had encephalopathy but I think it was iv n acetyl cysteine
    76- tall young guy, gh not suppressed - gigantism
    77- diabetic patient with background retinopathy comes with sudden visual loss, fundoscopy shows large heamorrhage - branch vein occlusion
    78- patient on metformin and gliclizide started on exenitide now lost weight and hba1c improving but has frequent hypo attacks - stop gliclizide
    79- patient with history of childhood scarlet fever had biatrial enlargement raised jvp normal heart size - constrictive pericarditis
    80- coal worker has nodular changes on cxr - asbestosis
    81- locked in syndrome
    82- dextrocardia - ECG
    83- ECG - wpw
    84- ECG - pr prolonged
    85- ECG - avnrt
    86- HSP - patient with diarrhoea now has purpuric rash
    87- HAND PHOTO - dermatomyostosis
    88- bullous pemphigoid
    89- patient on dialysis comes wth temps very high ferritin and rash - adults still disease
    90- lead poisoning - sodium edta
    91- fascioscapulahumeral muscle atrophy - this is the patient who cannot whistle
    92- patient with quadriceps and hand flexor weakness - inclusion myosytosis
    93- patient with chest tenderness, high total protein, low albumin, had anaemia and renal failure - myeloma
    94- skull xr - I thought it was myeloma
    95- eplerone to increase mortality - I gave this answer twice 2x
    96- returning traveler, lady comes with myalgia a month later after returning back - HIV SEROLOGY
    97- inclusion body on histology - ganciclovir
    98- svco - steroids
    99- elderly patient who looks like palliative patient has seizure and becomes unresponsive with twitches - sc midazolam
    100- benign positional vertigo
    101- IV drug user with muscle weakness - botulism
    102- Lewy body dementia
    103- depressive disorder - old lady who was playing piano before she had a stroke
    104 - ear infection - pseudomonas
    105- 18 year old guy with purulent sputum previous infections grown pseudomonas in sputum - CF
    106- lady post mastectomy with lung infiltrates - radiation pneumonitis
    107- patient with previous pulmonary haemorrhage with microscopic polyangitis now has temps high crp and right sided consolidation - pneumococcal pneumonia
    108- farmer diagnosis is leptospirosis - treat with benpen
    109- eosinophilic pneumonitis
    110- pregnant lady with jaundice deranged lfts - acute fatty liver of pregnancy
    111- Tb patient - negative pressure room and masks
    112- retinal detachment
    113- CT - hydronephrosis
    114- girl with hypoglycaemia and high insulin and c peptide - insulinoma
    115- disseminated gonorrhoea
    116- what to do with warfarin before surgery - stop and swap to lmwh before surgery
    117- patient with angioedema who used the adrenaline first time - I gave the adrenalin again as the question repeated the fact that it was her first time using it maybe it was not correct - not sure
    118- Asian lady previously had blood transfusion - hepatitis c serology
    119- hypothyroid myopathy
    120- duedonal biopsy for coeliac
    121- lady with diarrhoea negative coeliac screen, started gluten diet and stopped lansoprozole - lansoprozole induced diarrhoea
    122- patient on ciclosporin started on diltiazem - diltiazem&ciclosporin interaction
    123- diabetic patient wth very high triglyceride - fibrate treatment
    124- bed bound patient with pressure sores, also diabetic - bed arrangement
    125- severe diarrhoea and dehydration in returning traveler asking the cause of renal failure - ATN
    126- lady with painful lesion on her legs, previously given antibiotics for shortness of breath and cough - I thought this is sarcoidosis and question was asking the investigation cxr
    127- young gentleman comes with bloody diarrhoea, normal bowel sounds asking for the investigation - flexisig
    128- patient on dopamine agonist becomes very psychotic - dopamine side effect
    129- HIV positive lady who is psychotic as well, very restless and talks quickly - amphetamine use
    130- narcolepsy - modafanil
    131- and I chose craniopharngioma, non functional pituitary macroadenoma but I cannot remember the stories.
  5. samuel

    samuel New Member

    1) ecg .. Recent MI .. VT like ecg ...> SVT WITH ABBARANT CONDUCTION
    2) ecg .. Dextrocardia?
    3) ecg changes ... Deep a iv v1 ... Pulmonary embolus
    4) patient with chemo .. R lung pneumonia ..pneumococus
    5) rigitity hallucinations,memory ... Levy body dementia
    6) patient with symtoms and tremors .. PARKINSONS
    7) patients with dopamine agonists ...psycotic symtoms. ??side effect of dopamine
    8) 2 patients with MMSE .. Around 25 ?
    Age related cognitive impairment ? Dementia ? Frontal lobe tumor
    9) lambort eton mysthenia .. Ca related abs
    10)patient with weakness and low fev..GB syndrome
    11) another question paper 1... GB Synndrome
    12) i/v drug user .. Botulism
    13) patient eith toxoplasmosis ?? HIV.. Check if medical decision , patient intesrest
    14) pateint with tb .. -ve pressure room ... Mask only in MDR TB
    15) picture with mole ..nodular melanoma ??
    16) patient with gottrons papule rash.. Dermatomyositis
    17) old lady bullous pamphigoid
    18) a girl with rash (e.nodosum ) and sob.. Inv ? CXR
    19 dermatitis herpitiformis radh scenario
    20) HUS .. Paper 1
    21) paper 3 girl with diarhea ..rash .. HUS?? HSP
    22) Aids patient with vision one eye .. CMV ratinitis .. Gancyclovir
    23) lumber puncture .. 400 neutrophills .. Meningiococcal meningitis
    24) another luber puncture with high protient some cells ... Viral
    24) diabetic eye .? Neovascularization. Photocoagulation
    25 ) myopic patient .. Eye shadow .. Ratinal deachment
    26 ) 2 questiins .. Eplerenone
    27) after angio infarcts/lesions on foot ... Cholesterol embolization
    28) ear photo.. Relapsing polychondritis
    29) ear jnfection .. Pseudomonas
    30) vertigo ..BPPV
    31) lady with unsteady walk .. Tatto .. Liver failure hepatomegaly .. Ceruloplasmin
    32) lady with blood transfusion... Hepatitis C
    33) cryoglobinimia... Hepatitis C
    34) CT scan .. Patient with obstrctive sob... Thymoma
    35) CTPA .. Enoxaparin??
    36) haemorage in temporal lobe MRI.. HSV
    37) sholdr x ray .. ??
    38) diabetic with foot xray red hot tender .. Charcoat >> immobilisation
    39) primary progressive multiple sclerosis ?
    40) PKD .. Common .. Hepatic cyst
    41) PKD .. Pain.. Stone?
    42) chest infection treated .. Had catheter MSU..
    Pseudomonas .. Patient well.. Do nothing ?
    43) reactive arthrtis scenario .. Doxy
    44) patient with HOCM ... ICD? Pacemaker?
    45) myocardial scan..?
    46) cardiac cath .. Ventricular septal rupture
    47) m.bovis... Colonoscopy
    48) patient with low 20% ihd risk .?? Investigation.. Exersise tredmill? Myoscan?
    49) APACHE score .. Icu patient .. VBG? Urine output?
    50) skull scan ... Pagets diseaee
    51) girl with angiodema ...?
    52) patient with a gradiant 80... AVR
    53) ischimic cardiomyopathy .. Dilated atria
  6. samuel

    samuel New Member

    PYOGENICGRANULOMA PIC,ECG LEFT ATRIAL HYPER TROPHY,PAGETS XRAY,WPW,AORTIC DISSECTION,NEGATIVE PRESSURE ROOM,OSTEOMALACIA,BASAL CELL CARCINOMA,MANDIBULAR RECONSTRACTION,
  7. samuel

    samuel New Member

    question 1 in paper 3-Vasculitic Pneumonia
    Oncology Questions
    CXR-Lymphangitic carcinomatosis
    CXR-Mets in a young man-BHCG-Possible testicular Ca
    ECGS-Sinus Tachy , WPW , V.T , Proloned PR
    Pyogenic granuloma-Pic with hx of easy bleeding
    Bullous phemphigoid-pic
    pic with rt ear-polycondritis
    few xrays - Rh arthritis , skull # near rt side of the ear on elderly lady with fall and warfarin , padgets disease , raised eosinophils i=on pt who was farmer with cxr changes on lt side-aspergillosis
    LBD
    PT with polydepsia-water deprivation test given-Normal response
    Insulinoma
    M.S
    Rotator cuff tear
    Ischemic colitis
    osteonecrosis to jaw
    2 questions with answer-eprelinone
    aspirin overdose with in 1 hour,mild acidotic,vitals-stable,no organs failure went for oral charcol
    pic with dermatomyositis
    Cinacalcit-for raised phosphate
    alpha calcidol-osteomalacia
    Cystic fibrosis
  8. samuel

    samuel New Member

    1) ecg .. Recent MI .. VT like ecg ...> SVT WITH ABBARANT CONDUCTION
    2) ecg .. Dextrocardia?
    3) ecg changes ... Deep a iv v1 ... Pulmonary embolus
    4) patient with chemo .. R lung pneumonia ..pneumococus
    5) rigitity hallucinations,memory ... Levy body dementia
    6) patient with symtoms and tremors .. PARKINSONS
    7) patients with dopamine agonists ...psycotic symtoms. ??side effect of dopamine
    8) 2 patients with MMSE .. Around 25 ?
    Age related cognitive impairment ? Dementia ? Frontal lobe tumor
    9) lambort eton mysthenia .. Ca related abs
    10)patient with weakness and low fev..GB syndrome
    11) another question paper 1... GB Synndrome
    12) i/v drug user .. Botulism
    13) patient eith toxoplasmosis ?? HIV.. Check if medical decision , patient intesrest
    14) pateint with tb .. -ve pressure room ... Mask only in MDR TB
    15) picture with mole ..nodular melanoma ??
    16) patient with gottrons papule rash.. Dermatomyositis
    17) old lady bullous pamphigoid
    18) a girl with rash (e.nodosum ) and sob.. Inv ? CXR
    19 dermatitis herpitiformis radh scenario
    20) HUS .. Paper 1
    21) paper 3 girl with diarhea ..rash .. HUS?? HSP
    22) Aids patient with vision one eye .. CMV ratinitis .. Gancyclovir
    23) lumber puncture .. 400 neutrophills .. Meningiococcal meningitis
    24) another luber puncture with high protient some cells ... Viral
    24) diabetic eye .? Neovascularization. Photocoagulation
    25 ) myopic patient .. Eye shadow .. Ratinal deachment
    26 ) 2 questiins .. Eplerenone
    27) after angio infarcts/lesions on foot ... Cholesterol embolization
    28) ear photo.. Relapsing polychondritis
    29) ear jnfection .. Pseudomonas
    30) vertigo ..BPPV
    31) lady with unsteady walk .. Tatto .. Liver failure hepatomegaly .. Ceruloplasmin
    32) lady with blood transfusion... Hepatitis C
    33) cryoglobinimia... Hepatitis C
    34) CT scan .. Patient with obstrctive sob... Thymoma
    35) CTPA .. Enoxaparin??
    36) haemorage in temporal lobe MRI.. HSV
    37) sholdr x ray .. ??
    38) diabetic with foot xray red hot tender .. Charcoat >> immobilisation
    39) primary progressive multiple sclerosis ?
    40) PKD .. Common .. Hepatic cyst
    41) PKD .. Pain.. Stone?
    42) chest infection treated .. Had catheter MSU..
    Pseudomonas .. Patient well.. Do nothing ?
    43) reactive arthrtis scenario .. Doxy
    44) patient with HOCM ... ICD? Pacemaker?
    45) myocardial scan..?
    46) cardiac cath .. Ventricular septal rupture
    47) m.bovis... Colonoscopy
    48) patient with low 20% ihd risk .?? Investigation.. Exersise tredmill? Myoscan?
    49) APACHE score .. Icu patient .. VBG? Urine output?
    50) skull scan ... Pagets diseaee
    51) girl with angiodema ...?
    52) patient with a gradiant 80... AVR
    53) ischimic cardiomyopathy .. Dilated atria
  9. samuel

    samuel New Member

    1- Lewy body dementia Scenario.
    2- Multiple system atrophy scenario.
    3- Scenario of Normal pressure hydrocephalus. CT scan given in question.
    4- Guillian Barre Syndrome.
    5- Botulism.
    6- Dermatomyocytis , photo given.
    7- Photo of bullous pimphigoid.
    8- Scenario of Henoch Schonlein purpura.
    9- Cause of retinitis in HIV pt >>> cytomegalo virus.
    10- Cytomegalovirus treatment >>> ganciclovir.
    11- Sarcoid scenario asking for investigation >>> CXR.
    11- CSF analysis (High opening pressure , Neutrophilia+low CSF glucose ) >>> meningococcal meningitis.
    12- CSF analysis ( High opening pressure+lymphocytosis+low CSF glucose) >> TB meningitis.
    13- CSF analysis with temporal lesions >>> Herpes meningitis.
    14- Scenario of retinal dettachment.
    15- Scenario of cholesterol embolization.
    16- Relapsing polychondritis - photo.
    17- Case of benign positional vertigo.
    18- To do HCV in cryoglobulinaemia.
    19- Charcot joint with diabetes >>> immobilization.
    20- A case of PKD with loin pain >>> diagnosis is acute rupture to cyst.
    21- Catheter interpretation >> ventricular septal rupture.
    22- Colonoscopy in S. bovis.
    23- Temporal arteritis - next step to start aspirin.
    24- Pregnant with dyspepsia >> give alginate.
    25- Pyoderma gangrenosum treatment >> steroids.
    26- A case of legionella pneumonia.
    27- A case of mycoplasma pneumonia.
    28- No screening required for a young girl with grandpa having colon cancer.
    29- Simple pneumothorax (1 cm) >> discharge with early review.
    30- Infliximab for uncontrolled Crohn's.
    31- ECG >> hyperkalaemia.
    32- ECG >> VT.
    33- EcG >> WPW syndrome.
    34- ُECG >> prolonged PR.
    35- Epilepsy treatment >> valproate.
    36- Budd chiari syndrome >> To do doppler abd. US.
    37- Na-bicarb for tricyclic overdose.
    38- Ursodeoxy cholic acid for PBC.
    39- Lumbar puncture for benign intracranial hypertension.
    40- A case of Ostenecrosis of the jaw.
    41- Pregnant >>> stop ramipril.
    42- Amyodarone-thyrotoxicosis >> prednisolone.
    43- Which factor in the pt history is associated with increased cancer risk >> radiotherapy.
    44- Which factor in the pt history is associated with increased risk of stroke >> previous stroke.
    45- CKD with 2ndary hyperparathroidism >> give cinacalcet.
    46- A scenario of TTP.
    47- Treatment of diabetic neuropathy >> diluoxetine.
    48- CLL management >> observe.
    49- A case of vasodepressor syncopy.
    50- A case of Stokes Adams attacks.
    51- Treatment of thyrotoxic AF >> propranolol.
    52- A scenario of vegetative state.
    53- EDTA for lead poisoning.
    54- A scenario of myeloma.
    55- A case of lung cancer with SVCO >>> steroid.
    56- Terminally ill pt with seizures and irritable >> SC midazolam.
    57- Elderly pt febrile and confused >> haloperidol.
    58- Cause of ear infection >> pseudomonas.
    59- A case of cystic fibrosis.
    60- Acute fatty liver of pregnancy.
    61- Restrictive PFT with eosinophilia >> esinophilic pneumonia.
    62- CT >> hydronephrosis.
    63- Insulinoma.
    64- Disseminated gonorrhoea.
    65- Hyperthyroid Myopathy.
    66- Duodenal biopsy for celiac.
    67- Diabetic with elevated TG >> fenofibrate.
    68- Treatment of bed sores >> pressure relieving cushions.
    69- AIDS patient with acute psychosis and aggressive >> amphetamine abuse.
    70- Fomepizole for alcohol poisoning.
    71- Tetanus infection >> urgent surgical depridement.
    72- Membranous glomerulonephritis.
    73- A case of Paroxysmal nocturnal haemogobinuria.
    74- Diagnosis of PE >> CTPA.
    75- Lung metastates CXR >> do BCG for testicular cancer.
    76- Antivoltage gated channels for Lambert Eaton.
    77- Diabetic pt with lab features of DKA >> to give 9% NS.
    78- The commonest cause of mortality in acromegaly >> IHD.
    79- A scenario of haemochromatosis.
    80- Lyme disease case.
    81- Flaicanide for WPW.
    82- A case of adhesive capsulitis.
    83- A case of PCOS.
    84- Juvenile myoclonic epilepsy.
    85- Primary hypoadrenalism scenario.
    86- Photo of pyogenic granuloma.
    87- Eplerenone fo heart failure.
    88- Another herat failure case to add epleronone.
    89- Treatment of ITP >> steroid.
    90- A scenario of HUS.
    91- Progressive primary MS.
    92- HCV screening for the Asian lady.
    93- Stable angina - what to do >> exercise stress test.
    94- Unstable angina - what to do >> coronary angigraphy.
    95- Diagnosis for pt with leishmaniasis >> lymph node.
    96- Diagnosis for burkitt's lymphoma >> lymph node biopsy.
    97- Which factor should be corrected in pyelonephritis >> urine output.
    98- ECG inferior MI with heart block >> transvenous pacing.
    99-Turner syndrome.
    100- Capsule endoscopy.
    101- Pt. with abd pain following several abd surgeries >> Intestinal adhesions.
    102- PE pt presented after 48 hours >> LMWH.
    103- Familial tall stature.
    104- Retinal vein occlusion.
    105- Lady with stroke , previous pianist and social activist >> adjustment disorder.
    106- Pt. with acute abdominal pain and bloody diarrhea - urgent investigation >> plain abd. X-ray.
    107- sisters with hypertension and renal bruit >> fibromuscular dysplasia.
    108- Huntigton pt >> respect his will.
    109- Suspected HIV patient >> wait until he regains consciousness and gives consent.
    110- Manic disorder >> give lithium.
    111- CXR >> pulmonary Kaposi sarcoma.
    112- Annular lesions not improved by steroid >> give antifungal.
    113- Cause of erectile dysfunction in diabetic >> autonomic dysfunction.
    114- Spondylarthropathy.
    115- Acute intersitial nephritis scenario.
    116- Patient taking cyclophosphamide and developed frank haematuria >> diagnosis bladder cancer ( haemorrhagic cystitis not mentioned in options).
    117- CXR >> lung metastases.
    118- IV drug user with stahylococcal infection >> flucloxacillin + gentamicin.
    119- Most appropriate treatment for hyperparathyroidism >> parathyroidecomy.
    120- Tumour with inferior quadrantanopia >> craniopharyngioma.
    121- Tumour with superior quadrantanopia >> nonfunctional pituitary adenoma.
    122- Hepatic tumour with coarse outlines on US >> hepatocellular carcinoma.
    123- A girl with diastolic murmur and bounding pulse >> aortic regurg.
    124- Myotonic dystrophy case.
    125- Ca-gluconate for hyperkalaemia.
    126- AIDS pt with uraemic encephalopathy and deranged liver function >> haemodialysis.
    127- Pt with focal segmental glomerulosclerosis >> start ramipril.
    128- Anemic patient with CKD >>> IV iron therapy.
    129- Factor associated with adverse prognosis in breast cancer >> lymph node spread.
    130- Elderly female with urinary incontinence >> pelvic floor exercise.
    131- Female 48 years with psychosis >> menopause.
    131- Pt with primary ovarian failure, tall with hypogonadotropic hypogonadism >> Kallman's syndrome.
    132- Patient with right hypochindrial and epigastric pain with pleural effusion >> pancreatic pseudocyst.
    133- CT >> occipital bleeding following trauma >> give dexamethasone.
    134- Pt with brain metastasis with high ICP>> give dexamethasone.
    135- Patient with chest pain and breathing difficulty , CXR abnormality >> pleural plaques.
    136- Spanish man with huge spleen (10 cm) >> visceral leismaniasis.
    137- Febrile patient with recent travel Hx and hepatosplenomegaly >> salmonellosis.
    138- A girl with painful loss of vision of eyes >> bilateral optic neuritis.
    139- Pt with recent travel presented with pharyngitis and lymphadenopathy >> HIV serology.
    140- Irradiated blood because awaiting bone marrow transplant.
    141- Essential tremor.
    142- APKD , mostly associated with >> hepatic cysts.
    143- Doxycycline for reactive arthritis.
    144- Lansoprazole-induced diarrhoea.
    145- Inclusion body myositis.
    146- Stop warfarin 3 days before surgery and commence LMWH.
    147- Psoriasis case with alopecia and nail pitting.
    148- Varicella pneumonia.
    149- Scabies.
    150- Girl with painful rash and breathing difficulty , diagnosis >> sarcoidosis.
    151- Aspirin overdose presented after 1 hour >> oral activated charcoal.
    152- After DDAVP urine osmolality low and plasma osmolality low >>> primary polydepsia.
    153- Obese diabetic with hypoglycemia >> stop gliclazide.
    154- Pt with alcohol poisoning and deranged liver function , which is life saving >> haemodialysis.
    155- Patient with frequent ashma attacks >> increase the dose of inhaled steroid.
    156- ARDS case.
    157- Paget's disease of breast.
    158- ECG>> Transposition of limb leads.
    159- Paranoid schizophrenia.
    160- Patient with scarring alopecia and joint pains , which autoantibody to do >> Antinuclear antibody.
    161- Another case of hypoadrenalism in the conext of autoimmune polyendocrine syndrome ( patient with hypercalcaemia and thyroid problems).
  10. samuel

    samuel New Member

    Autonomic neuropathy
    Hypochondial syndrom
    Genciclovir
    Hep c with cryoglo
    Psoriasis
    Itracanozole
    Pneumothorax
    Pul thromboembolism with ECG s1 Q3 T3
  11. samuel

    samuel New Member

    Can someone answer these.
    1.HIV pt. With low CD4 count: ?? NHL
    2.Indian with multiple hypopigmented patches with scaling: ?? Itraconazole.
    3. X ray of wrist:?? hypertrophic osteoarthropathy
    4. Itchy rash over the groins, axillae , wrist: ??? Scabies
    5. Abdominal pain in pt using herbal medication: ?? porphyria
    6. Pt with facial wound / swab positive for gram positive cocci: ??? Surgical debridement.
  12. samuel

    samuel New Member

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

    samuel New Member

    166- A case of hypochondrical disorder.
    167- After reviewing and asking many MRCP 2 passers >>> the most likely diagnosis is radiation pneumonitis.
    168- Gout >>> add cholchicine because it would help also for the acute attack.
    169- Patient with hypocalcaemia and hypomagnaesemia having mouth twitching which indicates ongoing hypocalcaemia, what to do >>> increase calcium dose.
    170- Osteomalacia scenario.
    171- Hypocalcaemia in the context of malabsorbtion synd (there was also anaemia, hypoalbuminaemia mentioned in ques) , what is the management : increase calcium intake.
  14. samuel

    samuel New Member

    172- Hypokalaemic periodic paralysis.
    173- Penicillin for farmer with leptospirosis.
    174- Catheter interpretation >>> Mitral regurg, but could be tricuspid regurg too but mitral regurg is suggested more by the high PCWP , need feedback on this question.
  15. samuel

    samuel New Member

    The golden role is when you encounter huge splenomegaly (more than 8 cm) so think of the classical causes as the following:
    1- Chronic myeloid leukaemia.
    2- Tropical malaria splenomegaly syndrome.
    3- Visceral leishmaniasis.
    4- Gaucher's disease.
    So the answer undoubtedly is visceral leishmaniasis.
  16. samuel

    samuel New Member

    175- Cathterized with infective catheter >> change the catheter.
    176- Coagulase -ve staphcocci >>> the reasonable answer is to stop amoxicillin and to start vancomycin but one may argue that the pt responded well to azithromycin which is pharmacologically related to fusidic acid. The bacteria was sensitive to fusidic acid on c/s result so it would be sensitive to azithromycin too . This is proved by the well response of the pt as he became afebrile and asymptomatic. So , continue current treatment could be correct answer. No benifit from repeating culture as I guess.
  17. samuel

    samuel New Member

    1- temporal arthritis additional treatment - aspirin
    2- alopecia areata
    3- pregnant lady with reflux - alginate
    4- takayasu arthritis
    5- Indian patient with hepatomegaly - leishmania
    6- farmer with tattoos - hypersensitive pnemonitis
    7- copd patient with t2 respiratory failure - niv
    8- pyoderma gangrenosum - prednisolone
    9- old gentleman returned from holiday has pneumonia signs and abdo pain - legionella
    10- young lady with pneumonia symptoms confused - legionella
    11- 25 year old lady come for review f/h of colon cancer at the age 70 - no treatment required
    12- patient with asymptomatic aortic stenosis - outpatient review
    13- primary pneumothorax less than 1 cm - discharge with early review
    14- lady with osteomalacia - treatment calciferol
    15- anaemia with zinc protoporhyrin test - lead toxicity
    16- normal pressure hydrocephalus
    17- multi system atrophy
    18- good pasture
    19- cryoglobulin - hepatitis c
    20- acute hepatitis patient hep b and a negative - hepatitis e
    21- chrons patient severe flare already on azathioprine- infliximab
    22- pagets - skull xr and bone scan was given
    23- ECG with tented to waves - hyperkalemia
    24- still disease
    25- sleep apnea patient snoring at night bmi 27 and not sleepy during the day- mandibular advancement device
    26- epileptic girl on topiramate and phenytoin, comes with movement of her arms and legs - non epileptic seizure
    27- myo epilepsy - valproate
    28- lady depressed, constipation and 3 kg weight lost, lost her husband 6 months ago - reassurance
    29- scleroderma patient with pulmonary hypertension - answer either echo or cardiac catheterisation
    30- patient after admission with MI deteriotes, saturation increases from right atrium to right ventricular - vsd
    31- patient with inferior mi had PCI, has heart block on ECG - continue monitoring
    32- in copd which would decrease the recurrence of attacks - inhaled steroids ?LTOT
    33- small cell carcinoma patient coming with positive Romberg test - lambert eaten
    34- budd chiari - Doppler ultrasound abdomen
    35- amytripline overdose - bicarbonate
    36- patient on lithium, urine and osmolality results were given after water deprivation and desmopressin test, no improvement seen - nephrogenic diabetes ins
    37- sjogren patient with hypokalemia - distal renal tubular acidosis
    38- patient grown strep bovis in blood cultures - colonoscopy
    39- a lady with positive IgM and alp but asymptomatic - ursedeoxycolic acid
    40- patient who has long term catheter, grown 10 over 5 coliform and pseudomonas but patient asymptomatic - no treatment required
    41- idiopathic intracranial hypertension - lumbar puncture
    42- lady with loose teeth and jaw pain - necrosis of jaw
    43- pregnant patient which tablets to stop - ramipril
    44- patient on amiodorone developed hyperthyroidism treated with carbimaxole but still hyperthyroid low intake of iodine - treat with prednisolone
    45- Charcot joint on xr - resting the foot
    46- patient with urethral discharge, conjunctivitis and arthritis, gram stain negative - treat for chlamydia > doxycycline
    47- patient developed breast cancer previous history of radiotherapy - most likely cause is radiotherapy
    48- pheochromacytoma on ct scan - treat with Alpha blocker
    49- subacute combined degeneration symptoms - check b12
    50- patient on methotrexate develops sore throat, initial investigation - check FBC
    51- patient with AF previous stroke asking which one weighs more when you decide warfarin - previous stroke
    52- ITT analysis - add all the patients
    53- CKD patient with low calcium high phosphate and pth - treat with calcidol
    54- primary hyperparathyroidism
    55- bilateral leg swelling, old lady has erythematous lesions in both legs asking initial management - s/c lmwh
    56- suspicious looking lesion - ?excision biopsy ?punch biopsy
    57- elderly confused, agitated and has hallucinations what to give - haloperidol
    58- lymphocystosis with smear cells - phenotyping
    59- patient with cancer has bleeding problem - acquired heamophilia
    60- TTP - I cannot remember the question but I gave TTP as answer
    61- patient with chrons and previous bowel resection - renal stones
    62- patient with peripheral neuropathy initial treatment - duloxetine
    63- gentamicin, through level is 2, 1hour post dose level is 4 on 60mg TDS dose – change to once daily dosing
    64- patient on warfarin comes with uppergi bleed - give pcc
    65- patient had syncope when having a shave - carotid hypersensitivity
    66- CLL patient give 0,3,6 monthly bloods WCC increased over the period but not doubled and she is asymptomatic - management is to observe
    67- another CXR with huge pneumothorax on the right side - chest drain
    68- patient comes with syncope on standing, tilt table test produces dizziness and bp drop of 40 - postural hypotension
    69- Turner syndrome
    70- patient has long history of anaemia had ogd colonoscopy and repeat colonoscopy which were normal, asking for next step – meckel’s scan
    71- patient comes with abdo pain background of several abdo surgeries, colonoscopy was normal - pseudo obstruction
    72- thyrotoxicosis patient on AF what to give - propranolol
    73- CTPA shows pulmonary embolus treatment , this was the first question of first paper I cannot remember the story but it was consistent with pe - treatment lmwh
    74- paracetamol overdose , ph 7.1, pt > 100, creatinine > 300 asking what would be the life saving intervention, I cannot remember whether the patient had encephalopathy but I think it was iv n acetyl cysteine
    75- tall young guy, gh not suppressed - gigantism
    76- diabetic patient with background retinopathy comes with sudden visual loss, fundoscopy shows large heamorrhage - branch vein occlusion
    77- patient on metformin and gliclizide started on exenitide now lost weight and hba1c improving but has frequent hypo attacks - stop gliclizide
    78-eplerenone
    79- patient with history of childhood scarlet fever had biatrial enlargement raised jvp normal heart size - constrictive pericarditis
    80- coal worker has nodular changes on cxr - ?pneumoconiosis
    81- locked in syndrome
    82- dextrocardia - ECG
    83- ECG - wpw
    84- ECG - pr prolonged
    85- ECG - avnrt
    86- HSP - patient with diarrhoea now has purpuric rash
    87- HAND PHOTO - dermatomyostosis
    88- bullous pemphigoid
    89- patient on dialysis comes wth temps very high ferritin and rash - adults still disease
    90- lead poisoning - sodium edta
    91- fascioscapulahumeral muscle atrophy - this is the patient who cannot whistle
    92- patient with quadriceps and hand flexor weakness - inclusion myosytosis
    93- patient with chest tenderness, high total protein, low albumin, had anaemia and renal failure - myeloma
    94- skull xr - pagets
    95- eplerone to increase mortality -
    96- returning traveler, lady comes with myalgia a month later after returning back - HIV SEROLOGY
    97- inclusion body on histology - ganciclovir
    98- svco - steroids
    99- elderly patient who looks like palliative patient has seizure and becomes unresponsive with twitches - sc midazolam
    100- benign positional vertigo
    101- IV drug user on methadone, healing scar with muscle weakness - GBS
    102- Lewy body dementia
    103- depressive disorder - old lady who was playing piano before she had a stroke
    104 - ear infection - pseudomonas
    105- 18 year old guy with purulent sputum previous infections grown pseudomonas in sputum - CF
    106- lady post mastectomy with lung infiltrates - radiation pneumonitis
    107- patient with previous pulmonary haemorrhage with microscopic polyangitis now has temps high crp and right sided consolidation - pneumococcal pneumonia
    108- farmer diagnosis is leptospirosis - treat with benpen
    109- eosinophilic pneumonitis
    110- pregnant lady with jaundice deranged lfts - acute fatty liver of pregnancy
    111- Tb patient - negative pressure room and masks
    112- retinal detachment
    113- CT - hydronephrosis
    114- girl with hypoglycaemia and high insulin and c peptide - insulinoma
    115- disseminated gonorrhoea
    116- what to do with warfarin before surgery - stop and swap to lmwh before surgery
    117- patient with angioedema who used the adrenaline first time - FFP
    118- Asian lady previously had blood transfusion - hepatitis c serology
    119- hypothyroid myopathy
    120- duedonal biopsy for coeliac
    121- lady with diarrhoea negative coeliac screen, started gluten diet and stopped lansoprozole - ?IBS
    122- patient on ciclosporin started on diltiazem - diltiazem&ciclosporin interaction
    123- diabetic patient wth very high triglyceride - ?fibrate treatment
    124- bed bound patient with pressure sores, also diabetic - bed arrangement
    125- severe diarrhoea and dehydration in returning traveler asking the cause of renal failure - ATN
    126- lady with painful lesion on her legs, previously given antibiotics for shortness of breath and cough - I thought this is sarcoidosis and question was asking the investigation cxr
    127- young gentleman comes with bloody diarrhoea, normal bowel sounds asking for urgent investigation –AXR to rule out toxic megacolon
    128- patient on dopamine agonist becomes very psychotic - dopamine side effect
    129- HIV positive lady who is psychotic as well, very restless and talks quickly - ? amphetamine ? cannabis
    130- narcolepsy - modafanil
  18. samuel

    samuel New Member

    131- and I chose craniopharngioma
    132. non functional adenoma
    133. Girl with Htn, sister also had it - phaeochromocytoma
    134. Guy with s bovis- rt knee aspiration
    135. Aorta gram - ? Takayasu
    136.Question on aortic dissection
    137.Girl with'fluttering' - ectopic beats
    138.The Huntington guy with VT - give treatment
    139. Guy with mania and hasn't slept for 5 days ? Bipolar - lithium
    140. Next treatment for copd - tiotropium
    141. One question with Sarcoid
    142. Cause of acid base balance in a pregnant lady - lactic acidosis
    143.. Boy with recurrent chest, ear infections - CVID
    144. Methanol/ethylene glycol - fomipezole
    145. Convulsing man, septic - cerebral abscess
    146. Old man with hypertension - nephrosclerosis
    147. Wound breakdown and pus and sepsis - surgical exploration
    148. Boy with reiters - doxy
    149. Why would you give irradiated platelet to that lady - because awaiting stem cell transplant
    150. Possible bronchial cancer with glomerulonephritis - membranous glo
    151. Copd man, regular ITU, now in severe type 2 RF - intubate!
    152.AIH 2 due to amiodarone ---> prednisolone
    153. Invasive ductsl ca risk factors... ?regional lymph nodes
    154. Shoulder xray?? Ruptured tendon
    155. Long standing diarrhea fecal elastase?
    156. GCA additiomal drug - aspirin
    157. Hiv +ve patient with unilateral visual acuity loss..toxoplasmosis? ?CMV
    158. Commonest association with APKD disease...hepatic cysts
    159. Acute gout attack due to lack of colchicine...add colcichine
    160. Girl taking grandma's painkillers... ?tramadol
    161. African patient with cxr...kaposi sarcoma? ?TB
    162.. Prolonged diarrhea with low fecal elastase in a CF px...pancreatic exocrine deficiency
    163. MIBI scan..inferior fixed?
    164.commonest cause of death in persistent acromegaly – IHD
    165. girl with tattoo, phychiatric symptoms and deranged lfts- Serum ceruloplasmin
    166. Lesion on chin pic - ? squamous pappiloma?
    167. Intention to treat -750 px
    168.CT: left upper lobe collapse
    169. pic – seborrhoric keratosis
    170. frontal lobe meningioma
    171. patient eith toxoplasmosis ?? HIV.. Check if medical decision , patient intesrest
    172. lumber puncture .. 400 neutrophills .. Meningiococcal meningitis
    173. another luber puncture with high protient some cells ... Viral
    174. diabetic pic – background retinopathy - observe
    175. myopic patient .. Eye shadow .. Retinal deachment
    176. after angio infarcts/lesions on foot ... Cholesterol embolization
    177. ear photo.. Relapsing polychondritis
    178. haemorage in temporal lobe MRI.. HSV
    179. diabetic with foot xray red hot tender .. Charcoat >> immobilisation
    180. primary progressive multiple sclerosis
    181.patient with HOCM, nodding off while driving - alcohol ablation of septum
    182. cardiac cath .. Ventricular free wall rupture
    183. patient with low 20% ihd risk .?? Investigation.. Exercise tredmill? Myoscan?
    184. APACHE score .. Icu patient .. VBG? Urine output?
    185. Aspirin intoxication – activated charcoal
    186. Girl whose father died at 70 of colon cancer – reassure

    187. scenario with high K 7.5 and creat 1000 with atrophic kidneys , what to do first – calcium gluconate
    188. abnormal blood results Na low, K high – hypoadrenalism
    189. drug abuser with CXR changes , likely lung abscess – Cef + Metronidazole
    190. Old man found at home with high CK – Rhabdo
    191. Suspected Lung cancer – sputum cytology
    192.Girl with back pain and diarrhoea – IBD
    193. ICU patient first cxr pic showed collapse, 2nd one showed resolution, what happened – (chest) physio
    194.Woman with longstanding backpain and ibuprofen use – Interstitial nephritis
    194. Man with fall, high BP CT showed adrenal tumour – alpha blockers
    195. CT head pic of old man ? bleed ? mass - ? Dexamethasone
    196.Asian man with skin changes, wood’s light showed bluelight (leprosy) – dapsone
    197. Woman with cancer treated by chemo and radiotherapy, now developed another cancer, why – Radiotherapy
    198.HIV man CD4 90 with rigors - ? Non hodgkins ? visceral Kaposi
    199.CXR of an ITU px - ?ARDS
    200.Man with chronic chest, fine end inspiration crackles, restrictive on lung fxn – Hypersensitivity Pneumonitis
    201.Lady with high calcium, high PTH, scan shoed adenoma – parathyroidectomy
    202.Man with diarrhoea, CRP 4 – loperamide
    203. Girl with bloody diahroea, AXR showed empty colon - ? UC
    204. Gallstone ileus
    205. Young girl under inv for proteinuria and leg swelling, renal biopsy showed Focal segmental , management - ?Prednisolone
    206. CXR of African farmer - ? miliary TB
    207. Cause of retinitis in HIV pt >>> cytomegalo virus.

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

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

    210- Pregnant with dyspepsia >> give alginate.

    211. A case of lung cancer with SVCO >>> stent. .
    212- A case of Paroxysmal nocturnal haemogobinuria.
    213- Lung metastates CXR >> do BCG for testicular cancer.
    214- Antivoltage gated channels for Lambert Eaton.
    215- A scenario of haemochromatosis.- do HFE gene analysis
    216- Flaicanide for WPW.
    217- Stable angina - what to do >> exercise stress test. .
    218- Diagnosis for pt with leishmaniasis >> lymph node. .
    219- Which factor should be corrected in pyelonephritis >> urine output.
    220- Pt. with abd pain following several abd surgeries >> Intestinal adhesions.
    221- Cause of erectile dysfunction in diabetic >> autonomic dysfunction.
    222- Patient taking cyclophosphamide and developed frank haematuria >> diagnosis bladder cancer ( haemorrhagic cystitis not mentioned in options).
    223- machinery murmur - PDA
    224- Anemic patient with CKD >>> IV iron therapy.
    225- Elderly female with urinary incontinence >> pelvic floor exercise.
    226- Female 48 years with psychosis >> menopause.
    227- Patient with chest pain and breathing difficulty , CXR abnormality >> pleural plaques. .
    228- Febrile patient with recent travel Hx and hepatosplenomegaly >> salmonellosis.
    229- Essential tremor.
    230- Varicella pneumonia.
    231- Patient with frequent ashma attacks >> increase the dose of inhaled steroid.
    232- Patient with scarring alopecia and joint pains , which autoantibody to do >> Antinuclear antibody.
    234. Itraconazole for Aspergilloma
    235. A case of ? Leber’s optics
    236. Old lady with cognitive impairment – Alzheimers
    237. Px convinced he had symptoms which proves he had cancer despite everytest and he was depressed - ? hypochondriac, ? dysmorphophobic
    238. Mycoplasma pneumonia with erythema multiforme.
    239. Hypokalemic periodic paralysis
    240.xray of wrist – HPOA
    241.catheter interpretation with high pressures RA – Tricuspid regurg
    242. Correct hypomangnesemia first
    243. High ALP, low Ca, low phosphate – Osteomalacia
    244. ramipril in deteriorating Renal function – stop the ramipril
    245.Woman with ? post partum thyroiditis ? sick euthyroid
    246. Young girl who took some grandma drugs and is now comatose +convulsion - ? Tramadol toxicity
    247. old man with COPD, chronic retainer now on 60% O2 PCO2 10, PO2 12 ( was Pco2 7.5 ) on discharge after previous admission – what next to do – reduce O2 to 28%
    248. CXR with metastases, what inv - ? Renal USS for renal cell carcinoma ?beta HCG
    249. CXR- plueral plaques
    250. Osteonecrosis of jaw - alendronate
  19. samuel

    samuel New Member

    Quick recall.
    177- Patient with recurrent unexplained proteinuria >> investigation >> renal biopsy.
    178- Long term O2 therapy.
    179- Young pt with ataxia and deranged liver function >>> serum caeruloplasmin. This question is different from the tatoo pt ques which I don't remember my answer to it.
    180- Pt with suspected haemochromatosis >> investigation >> liver biopsy.
  20. samuel

    samuel New Member

    183- Elderly with recent travel and hepatomegaly with supraclavicular lymph node >>> leukaemia.
    184- COPD with type 2 respiratory failure but pt conscious >> NIV.
    185- Pt with SOB and chest pain , blood gas shows respiratory alkalosis >> PE.
    186- Alopecia areata.
    187- Scenario of dermatitis herpetiformis.
    188- Cor pulmonale.
    189- Pt with low K , low HCO3 >>> diuretic abuse.
    190- Young girl with nephrotic syndrome most likely due to minimal change disease , which drug to give, steroid was not mentioned in the options >>> the most reasonable option give is furosemide possible to alleviate oedema, need feedback on this qus.
  21. samuel

    samuel New Member

    Some comments about the recalls...
    1-question of one pt was using methotrexate and devoloped mouth ulcers I know from my practical experience that oral ulcers are side effects of methotrexate so better to do methotrexate level than fbs??

    2-question of girl took her grandma pain killers medications I think it was mentiobed that she had seizures and no pin poibt pupill so as I think hydrocodeine could do this.

    3-question of rhabdomyolisis and arf with very high k best ttt is hemodialysis immediately.

    4-was there any progressive supranuclear palsy question or I did it wrong?

    5-Question of one man with history of scarlet fever and dilated atria and proteinuria...why not amyloidosis not constrictive pericarditis?

    6-the question of high stature guy he had obvious myopathy as mentioned so why not gigantism not familial tall stature?

    7-question of man comming from india and had right hypochondrial tenderness...was it amebic liver abcess.

    Last thing I saw one post recalled 250 questions but many of them repeated already and also many have 2 different answers for the same question. .could u please review and correct them...but really appreciated offer
    Dr Rahmat likes this.
  22. samuel

    samuel New Member

    191- Alcoholic with heart failure >> most probably dilated cardiomyopathy due to alcoholism.
    192- Cholestramine for diarrhoea post ileal resection.
    194- Cause of hypokalaemia >> distal tubular acidosis.
    195- Pt with cognitive decline >> Alzheimer.
    197- Scenario of major depression.
    199- Elderly with AF and IHD developed bloody diarrhoea >> ischaemic colitis.
    200- Pt with breathlessness and there was X ray given asking for the cause of breathlessness.
    200- Sleep apnoea case , his BMI is 27 which is close to high normal level (25), he has only 4 cycles per 24 hours which indicates mild disease>>> most appropriate action is to reduce weight but not sure.
    201- Pic >> nodular melanoma.
  23. samuel

    samuel New Member

    202- Pt with suspected septic arthritis >> investigation >> synovial fluid analysis.
    203- Pt with CAP >> treatment >> co-amoxiclav+azithromycin.
    204- ECG>> AVNRT.
    205- Pic >> basal cell carcinoma or squamous papilloma. For me , it looks more like basal cell carcinoma with rolling edge and necrosis.
    206- Menopausal woman , investigations showed no evidence of osteoporosis >> treatment >> oestrogen replacement.
    207- Major depression >> treatment >> paroxetine.
  24. samuel

    samuel New Member

    69-year-old man was admitted to hospital with a three week history of increasing exertional dyspnoea.There was no history of cough or sputum production, but he complained of sweats at night. He gave a two month history of general malaise and anorexia and reported weight loss of approximately 8 kg. There was no other past history of note. He did not take any regular medications.On examination he appeared pale. His temperature was 37.5°C. Two finger nail-fold infarcts were noted and a small splinter haemorrhage in his left great toe.His pulse was 100 beats per minute and regular with a blood pressure of 110/75 mmHg. His heart sounds were normal with a pansystolic murmur heard loudest at the apex and radiating to the axilla. No diastolic murmur was heard. His chest was clear.The abdomen was soft and slightly tender in the left upper quadrant where the tip of the spleen could be palpated 3 cm below the left costal margin.Investigations showed:Haemoglobin98 g/L(130-180)MCV92 fL(80-96)White blood cells7.9 ×109/L(4-11)Platelets102 ×109/L(150-400)ESR110 mm/1st hour(0-20)Serum sodium138 mmol/L(137-144)Serum potassium4.1 mmol/L(3.5-4.9)Serum urea8.1 mmol/L(2.5-7.5)Serum creatinine150 µmol/L(60-110)UrinalysisBlood++Blood cultures Streptococcus bovis grown in all bottles. A transthoracic echocardiogram showed two vegetations on the mitral valve leaflets. The patient was started on appropriate antibiotic therapy.What additional investigation should be performed?(Please select 1 option)BronchoscopyColonoscopy CorrectCystoscopyProlonged blood culture for fastidious organismsTransoesophageal echocardiogramIdentification of the causative organism is essential for appropriate antibiotic treatment of endocarditis.In native valve endocarditis, the most commonly identified organism is Streptococcus viridans, which accounts for about 50% to 60% of cases.Most cases of endocarditis affect the left heart, though the converse is true in injecting drug users.Staphylococcus aureus is identified in about 20% of cases (but is the commonest causative organism in injecting drug users).Less common organisms to cause native valve endocarditis are Strep. Groups B, C, and G Streptococci,Streptococcus pneumoniae, Streptococcus pyogenes and Enterococci.Coagulase-negative Staphylococci, though a common cause of prosthetic valve endocarditis, account for fewer than 1% of native valve infections. Gram-negative organisms and fungi represent a very small percentage of cases.Endocarditis caused by Streptococcus bovis has a strong association with underlying colonic carcinoma and patients should be promptly investigated by colonoscopy.Blood cultures are negative in up to 20% of cases. This may be due to low organism burden, exposure to antibiotics or may point to the presence of an unusual or fastidious organism that requires longer incubation for detection.Among the latter group are the fastidious, slow-growing, Gram negative bacteria in the HACEK (Haemophilus,Actinobacillus, Cardiobacterium, Eikenella and Kingella). These are normal flora of the upper respiratory tract and constitute 5-10% cases of endocarditis; they require prolonged incubation in enriched media and increased carbon dioxide tension.Other organisms that can cause endocarditis may require specialised diagnostic techniques for diagnosis, for example:Coxiella burnetii from sheep and cattleBartonella henselae from catsChlamydia psittaci from birds.
  25. samuel

    samuel New Member

    60-year-old gentleman presents with a two week history of fever (38.5°C on admission). He describes a two week history of weakness and night sweats.On initial examination he had an early diastolic murmur. Three sets of blood culture grew S. bovis. He successfully completes treatment for infective endocarditis. Transthoracic and transoesophageal echocardiograms had both demonstrated vegetations on the aortic valve but no aortic root abscess.Which of the following investigations would be most appropriate to organise before discharge?(Please select 1 option)Antinuclear antibodyColonoscopy CorrectC reactive proteinNo further investigations are necessaryRepeat transoesophageal echocardiographyThis gentleman requires gastrointestinal (GI) investigations as S. bovis bacteraemia infective endocarditis is strongly associated with GI malignancy. He is most likely to be suffering from infective endocarditis rather than another cause.The portal of entry of S.bovis is the gastrointestinal tract. Rarely, the urinary tract, the hepatobiliary tree or oropharynx have been reported as the source of the bacteraemia.There is a strong association between S. bovis bacteraemia with or without endocarditis and malignancy or premalignancy within the colon.Patients with S. bovis bacteraemia should be investigated for a GI malignancy.
  26. samuel

    samuel New Member

    as S. bovis bacteraemia infective endocarditis is strongly associated with GI malignancy. He is most likely to be suffering from infective endocarditis rather than another cause.The portal of entry of S.bovis is the gastrointestinal tract. Rarely, the urinary tract, the hepatobiliary tree or oropharynx have been reported as the source of the bacteraemia.There is a strong association between S. bovis bacteraemia with or without endocarditis and malignancy or premalignancy within the colon.Patients with S. bovis bacteraemia should be investigated for a GI malignancy.
  27. samuel

    samuel New Member

    A 60-year-old man known to have consumed alcohol excessively for at least thirty years presented to the emergency unit with epigastric and right hypochondrial pain.He was nauseated, and had vomited several times. He described feeling very hot and sweating profusely. He had been consuming alcohol up to the time of admission.In the past history he recalled that a surgeon had previously suggested a gall bladder operation but he was unsure of the details as he had self discharged on that occasion.On examination he was flushed. He was febrile at 38°C. Blood pressure 120/70 mmHg and a of pulse of 100 beats per minute. His sclera were yellow. He had eight spider naevi on his upper torso. Heart sounds were normal and the chest was clear on auscultation. His abdomen was tender in the right upper quadrant but no mass was palpable. There was no detectable ascites and rectal examination was unremarkable.Investigations revealed:Haemoglobin142 g/L(130-180)MCV101 fL(80-96)White cell count17 ×109/L(4-11)Platelets110 ×109/L(150-400)International normalised ratio1.5(<1.4)Serum sodium139 mmol/L(137-144)Serum potassium4.1 mmol/L(3.5-4.9)Serum urea4.7 mmol/L(2.5-7.5)Serum creatinine101 µmol/L(60-110)Serum albumin30 g/L(37-49)Serum total bilirubin70 µmol/L(1-22)Seruma alanine transaminase65 U/L(1-31)Serum aspartate transaminase70 U/L(5-35)Serum alkaline phosphatase600 U/L(45-105)Serum C reactive protein100 mg/L(<10)Serum amylase100 U/L(60-180)What is the likely diagnosis?(Please select 1 option)Acute cholecystitisAcute on chronic pancreatitisAlcoholic hepatitisCholangitis CorrectEmpyema of the gall bladderIn this case it is easy to assume an alcohol-related aetiology.The patient's lifestyle does fit the profile for alcoholic hepatitis. However although the liver function tests may be virtually normal in alcoholic hepatitis an AST to ALT ratio of 2:1 (or greater) is very suggestive and not present here. The degree of hyperbilirubinaemia and coagulopathy in alcohlic hepatitis are variable and are used in assessing the severity of the condition.His low albumin and platelets along with elevated INR point to significant underlying liver disease.Acute on chronic pancreatitis can have normal amylase and this is an important differential.However in this question the triad of fever, jaundice and RUQ pain points to cholangitis and the blood tests support this.Without an USS one cannot be sure about empyema but clinically no mass is felt.Acute cholecytitis may coexist but the obstruction on the bloods points towards common bile duct pathology.
  28. samuel

    samuel New Member

    A 19-year-old woman, with type 1 diabetes, is referred by her general practitioner with chronic diarrhoea and weight loss.She describes passing large volumes of watery stools at least four times a day without mucous, blood or abdominal pain. She reports a good appetite.Other than Lantus and NovoRapid insulins she denies taking any medications or having any other medical problems. On examination she is very slim.Her blood tests demonstrate:HbA1c116 mmol/mol(20-42)Sodium142 mmol/L(137-144)Potassium2.8 mmol/L(3.5-4.9)Urea4.1 mmol/L(2.5-7.5)Creatinine52 µmol/L(60-110)The B12, folate, calcium, erythrocyte sedimentation rate, C-reactive protein and thyroid function tests are all normal.What is the most likely cause of her diarrhoea?(Please select 1 option)Bile salt malabsoprtionCoeliac diseaseDiabetic autonomic neuropathyLaxative abuse CorrectSmall bowel bacterial overgrowthLaxative or purgative abuse is most commonly seen in young female patients complaining of chronic diarrhoea. The diarrhoea is frequently high volume and patients often have low serum potassium. In this case the HbA1c is also particularly high indicating poor diabetic control, this may represent an attempt to control weight by manipulating insulin dosages.Bile salt malabsorption does cause large volume watery diarrhoea but without a history of terminal ileal, biliary or pancreatic disease it is highly unlikely.Diabetic autonomic neuropathy of the gut would be very unusual in the absence of other evidence of diabetic complications (that is, peripheral neuropathy, retinopathy, and nephropathy).Small bowel bacterial overgrowth produces a clinical picture of malabsorption and steatorrhoea in patients with risk factors for its development.Coeliac disease is more common in patients with autoimmune conditions, such as type 1 diabetes; however it causes malabsorption of which there is no evidence in this case. Undiagnosed coeliac disease in adults rarely presents with profuse diarrhoea and metabolic disturbance.
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