mrcp july 07 part 2 recollect questions /share experience

Discussion in 'MRCP Forum' started by dk, Jul 27, 2007.

  1. dk

    dk Guest

    ok guys lets start remembering questions

    dresslers syndrome
    question about bird flu
  2. Guest

    Guest Guest

    Posted: Thu Jul 26, 2007 10:07 pm Post subject: MRCP PART 2 JULY 2007

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    tHE EXAM WAS SOMEWHAT TOUGH, VAGUE QUESTIONS, BUT WAS MANGEABLE.

    ANYONE WANNA SHARE EXPERIENCE FROM THE EXAM?

    BYE




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    guest apo
    Guest






    Posted: Fri Jul 27, 2007 5:30 am Post subject:

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    2 ethics questions -
    one about a main on 2 years of dialysis, symptomatic and waiting for cadaveric transplant who wants advice re getting a new kidney.
    Should you
    a) convince him to take his willing 16 year old son's kidney
    b) tell him to wait his turn on the cadaveric list
    c) persuade his wife to donate hers
    d) urgently refer for cadaveric transplant
    e) contact an overseas company about dodgy kidney deals

    what influences your decision to make a mentally competent patient for or not for resuscitation?
    a)age
    b)co-morbidities
    c)patient's wishes
    d)family's wishes
    e) can't remember e but it wasn't right
  3. Guest

    Guest Guest

    mrcp2

    was dressler's or was it pericarditis
    was the eye imaage licsh or holmes aidie
    thr only retina was it a cmv or a candida
  4. mrcp 2 july 2007

    answers
    1\ ask him to wait for cadav. list
    2\ pt wishes
  5. halmos eye
    cmv
    dermatomyositis
    dressler s
    verapamin constipation
    clopdigrol
    iv hydrocortizon
    hperventilation
    flail chest
  6. Guest

    Guest Guest

    Posted: Fri Jul 27, 2007 6:15 am Post subject: mrcp2

    --------------------------------------------------------------------------------

    it was no joke


    i really had the worst time of my lif

    the exam was pretty hard and i think the time is hardly enough


    i dont what the others have to say about the exam

    i m waiting for your experience and feedback




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    bonzy
    Guest






    Posted: Fri Jul 27, 2007 7:10 am Post subject:

    --------------------------------------------------------------------------------

    hi, i found it difficult.. no easy answers whatsoever.... every single question is a conundrum... a real nightmare...

    some questions look easy, but there wasn't any straightforward answers, there is always something not fitting well with your chosen answer...

    for example a patient with a quite typical history for cluster headache

    2 month history of once daily 45 min episode of pain around eye and temple, with nose congestion and lid drooping... but then they say the pain happens in the early hours of the morning which is not typical of cluster headachce (happens in the night), besides 2 months is not sufficient time to make your mind about whether the pain comes in clusters or not.... other options were migraine, trigeminal neuralgia and i dont remeber the rest...

    i was startled by how many HIV questions there were!!! many obstetrics questions which i hate!!!!

    i initialy thought that 3 hours is so much for only 90 questions, but i was surprised to find myself barely finishing at time... 2 minutes only is NOT enough to answer a long and tricky question..

    i'll try to post some questions i remember, but it seems nobody is interested at this stage in discussing anything about mrcp2...

    yours.
  7. bonzy

    bonzy Guest

    i think the guy with the renal transplant, the best advice is to encourage him to take his son's kidney, as his son is 16 which is a legal age to make independent decisions, and he would be the best HLA match..

    as for the dnacpr, i chose the patient's wishes given he's competent..

    as for the recurrent chest pain, pleuritic in nature i think it's pericarditis as it's more common than dressler's but i chose dressler..

    HIV with bacterial looking pneumonia with solitary consolidation in lower lobe? strep pneumonia?
    prostitute and drug user with botulinism
    an old lady with syncope, ecg bradycardia and atrial fibrillation, how to manage, i was so confused between 24 hour ecg, or pacemaker given the severe bradycaria and the syncope!!
    juvenile myoclonic epilepsy, sodium valproate...
    lung function tests showing restrictive pattern but KCO increased i think the answer was obesity..
    another obstructive pattern and KCO increased, asthma... but chest xray equivocal??
    a man who gets dark burgundi urine on exercise, raised ck and myoglobinuria... ?polymyositis. alkaptonuria.
    amyodarone causing thyroid disturbance, what to do, stop amiodarone or give carbimazole...
    best approach to preserve renal function in young diabetic type1 with no hypertension nor proteinuria, Strict glycaemic control, ACEI, others..
    a picture of irritant dermatitis i think....
    a lady who has been to some countries (she might have been a prostitue or HIV positive, icant remember)... and has a picture of acute hepatitis, hepC, or mushroom (aflatoxin)..
    cough variant asthma how to best diagnose... i forgot all the choices.


    write later.
  8. Guest

    Guest Guest

    hi guys ,i think mrcp is never easy,it lookes easy ,but tricky.
    same more questions
    -lady husband died 1 yr back ,came with abdompnal pain many time, every thing norma... hypochondriosis,somatisatioon,adjestmant.i chose somatization
    - pt with polyurea and polydipsia low plasma osmolality,low urine osmolality.... polygenic.
    another
  9. Guest

    Guest Guest

    another q PT had accident was admited, withhight plasma osmolality low urine osmolality....SIADH....DI...DEHYDRATION......
    -PICTURE OF PREGNANT LADY WITH ERYTHEMA AND BLISTRING ON UPPER THIGHT AND ABDOMEN .WHAT YOU WILL GIVE ..PREDNISOLONE, ACYCLOVIR.........
    -ANOTHER PICTURE PT HAD SAME LESIONNS ON FOREHEAD AND DORSUM OF HAND.....SEDECIOUS CYST...MALGNANT MELANOMA......
    -OLD MAN WITH PALE STOOL AND DARK URINE...CA PANCREASE
    -PT WITH UC, DISTURBED LFT ...CAH..SCLOROSING CHOLINGITIS ...IT WAS NOT STREAT FORWARD
    -
  10. HALIT2007

    HALIT2007 Guest

    mrcp july part 2007

    one question was about heterchromia (there was a picture) i think the answer is congenital horner's syndrome.
  11. HALIT2007

    HALIT2007 Guest

    mrcp2 july 2007

    cough variant asthma how to diagnose, i think the answer was histamin challange as both histamin and methacholine challenge tests can be used to diagnose cough variant asthma
  12. HALIT2007

    HALIT2007 Guest

    july 2007 mrcp2

    2 ethics questions -
    one about a main on 2 years of dialysis, symptomatic and waiting for cadaveric transplant who wants advice re getting a new kidney.
    Should you
    a) convince him to take his willing 16 year old son's kidney
    b) tell him to wait his turn on the cadaveric list
    c) persuade his wife to donate hers
    d) urgently refer for cadaveric transplant
    e) contact an overseas company about dodgy kidney deals

    The answer is to convince him to take kidney from the son as the same question in in pastest practice papers book
  13. HALIT2007

    HALIT2007 Guest

    mrcp 2 july 07

    the ECGs i tihnk the brought it from the space, very difficult
  14. Guest

    Guest Guest

    Qs---ethics---1-autonomy of the patient is more important is patient is mentalyy compesmentous---
    2---He has the choice to accept his son's Kidney.

    Guys I have dissected about 180 qs.If U wanna have serious discussion please start by topic.I am starting one from cardiology---thanks
  15. Guest

    Guest Guest

    Case Report: Cough variant asthma

    Anthony D’Urzo, MD, MSC, CCFP Pieter Jugovic, MD, MSC

    Chronic cough is the fifth most common complaint seen by primary care physicians,1 and for many it is a diagnostic challenge. In a few patients with documented airway hyperresponsiveness (AHR), cough can be the sole presenting symptom of asthma. This uncommon clinical condition is known as cough variant asthma.2 Despite underlying AHR, it is difficult to diagnose cough variant asthma because these patients typically have normal lung function that does not change in response to bronchodilator challenge.

    Case description

    A 32-year-old woman initially presented with an intermittent nonproductive hacking cough that had lasted several days. She denied having other respiratory, cardiovascular, or constitutional symptoms. Review of systems was unremarkable. Her medical history was negative for atopy, gastroesophageal reflux disease, cancer, tuberculosis, or cardiopulmonary diseases. She was a non-smoker and did not have a history of occupational exposure to respiratory toxins. Results of physical examination were normal. For symptom relief, she had used antitussives including codeine syrup.

    Despite periods of remission, her cough persisted. Results of physical examination and chest radiograph were normal. Spirometry revealed normal pulmonary function with no reversibility after bronchodilator challenge with a 2-agonist. Her pulmonary function was further evaluated using a methacholine challenge test. Results showed severe airway hyperreactivity: provocative concentration for a 20% fall in forced expiratory volume in 1 second (PC20) was 0.398 µmol/L (normal PC20 > 1.4 mmol/L). Cough variant asthma was diagnosed, and treatment was started with a bronchodilator and an inhaled corticosteroid. After initiation of asthma therapy, the patient’s chronic cough resolved and her pulmonary function remained normal.

    Discussion

    MEDLINE was searched for articles related to diagnosis of cough variant asthma. Articles were found using the key words asthma, variant asthma, chronic cough, prevalence, diagnosis, and natural history. The search was limited to investigations completed between 1960 and 2000 of human beings, written in English, and conducted on both sexes. A total of 67 articles were found. Only articles that focused on cough variant asthma and its epidemiology, natural history, diagnosis, and treatment, were used.

    The prevalence of adults with cough variant asthma in the general population and more specifically among asthmatic patients is unknown. Studies have not compared the prevalence of cough variant asthma to the symptoms and signs typically associated with classic asthma, namely wheezing, dyspnea, cough, and variable airflow obstruction. One Canadian study has shown that persistent cough and wheezing affect only 6% and 13% of asthmatic children, respectively,3 supporting the notion that isolated cough is less common than other clinical manifestations of asthma. Since cough variant asthma almost always presents as chronic cough (duration more than 8 weeks4), family physicians are faced with the challenge of differentiating it from classic asthma and from other very common causes of chronic cough.

    Chronic cough has a lengthy differential diagnosis. Yet asthma, postnasal drip syndrome, gastroesophageal reflux disease, postinfectious cough, or some combination of these are most often responsible.1,4-6 A comprehensive approach to diagnosing chronic cough is discussed in another paper in this issue.

    Cough variant asthma is elusive because history, physical examination, and laboratory results are often completely normal, as they were in this case. Among patients with chronic cough, underlying AHR can be the sole manifestation of cough variant asthma. While AHR is not specific for asthma, its absence makes a diagnosis of asthma very unlikely.4 Consequently, AHR is the key to detecting this occult form of asthma. Both exercise7 and methacholine challenge4-6 tests can evaluate AHR, but methacholine testing is better established.8 Ultimately, diagnosis of cough variant asthma depends on a positive response to a methacholine challenge test in concert with a favourable response to a brief trial of conventional asthma therapy.5,9

    Briefly, methacholine is a cholinergic agent. It can enhance bronchoconstriction and artificially exacerbate potential airway hypersensitivity in healthy people, and to a markedly greater extent in asthmatic patients. A positive test is defined as a 20% reduction in forced expiratory volume in 1 second (FEV1) with a PC20 of methacholine less than 1.4 µmol/L. A methacholine challenge test is indicated when asthma is a possibility but when spirometry before and after bronchodilator use is not diagnostic.8 For this reason, methacholine tests are essential for detecting cough variant asthma. Absolute contraindications for methacholine testing include severe airflow limitation (FEV1 < 50% predicted), recent (within past 3 months) myocardial infarction or stroke, uncontrolled hypertension (systolic blood pressure above 200 mm Hg), and aortic aneurysm.

    Methacholine testing has a positive predictive value up to 88% and a negative predictive value of 100% for cough variant asthma.4-6 Thus, negative results from a methacholine test preclude a diagnosis of cough variant asthma. A small portion of patients with positive results from a methacholine test have false-positive results (more likely among those with bronchitis, allergic rhinitis, chronic obstructive pulmonary disease, congestive heart failure, and cystic fibrosis).8 Cough variant asthma is more likely, however, when results of chest x-ray examination are normal and response to a brief trial of asthma therapy is positive.

    Most often, patients with cough variant asthma respond well to bronchodilators and corticosteroid drugs.2 The few patients who are refractory to inhaled therapy often do well with oral corticosteroids.2 Diagnosis of cough variant asthma is confirmed only with demonstrated AHR during a challenge test when chronic cough responds well to asthma therapy. Current treatment recommendations stress the need for early diagnosis and control of asthma.10 The natural history of cough variant asthma underscores the importance of early detection and appropriate treatment, as many patients with cough variant asthma lose lung function and develop additional asthma symptoms.

    Conclusion

    Cough variant asthma is a diagnostic challenge because history, physical findings, and simple spirometry results often fail to uncover abnormalities in lung mechanics and AHR. Physicians should consider referring patients with undiagnosed chronic cough, normal lung function, and normal results from chest radiographs for methacholine challenge tests. Early introduction of inhaled bronchodilator and anti-inflammatory therapy should prove useful in alleviating cough and slowing the clinical progression of this type of asthma.
  16. guest apo

    guest apo Guest

    there was a question about someone who'd been in Thailand and got bird flu and there was the option to give Oseltamivir amongst other things - I chose that one anyway.
  17. guest apo

    guest apo Guest

    another rubbish question was one about rapid reversal of warfarin and the options were
    FFP
    PCC (prothrombin concentrate)
    IV Vit K
    Protamine sulphate

    the thing is both the first two answers are correct - I hope this is one of the questions they take out for monitoring purposes.
  18. guest apo

    guest apo Guest

    worst of all was having to queue for 25 mins for a bagel that cost £4 at OiBagel. I wouldn't cry too much if the Excel Centre accidentally burned down anytime soon.

    I think the chap in the eye picture had Lisch nodules.
  19. rajeev aya

    rajeev aya Guest

    Questions

    OK guys How much ever I could remember I have written.

    MRCP part 2
    Slides

    1.Pyoderma Gangrenosum answer steroids
    2.CT head Young teenager with hx of convulsions from west indies travelled to south asia.
    Ans= ? Tuberculoma(Caseating granuloma single lesion)/ Neurocysticercosis (multiple normally)
    3 ECG atrial tachycardia with irregular conduction
    4 Complete heart block
    5 Holmes adie pupil
    6 Gottrons papules Dermatomyositis
    7 N CT head treatment aspirin
    8CT basilar artery thrombosis
    9Blistering Rash on pregnant lady ans ?steroids /?acyclovir
    10. Chest X Ray Osteum Secundum ASD Commonest
    11. CMV retinitis in an HIV patient. PIZZA fundus.
    12. ECG reperfusion arrhythmia. Ans Do nothing
    13 Acute promyelocytic leukaemia ans t (15,17)
    14 Lady with hx of diarrhoea for 7 days No hx of Sickle cell disease ---(Pic) Osteomyelitis of lumbar spine cause ? Brucella or ? Salmonella.
    15 ECG ? Pericarditis ? Stemi Infero lateral including 1 and avl. Patient has chest pain for 1hour.
    Background of IHD answer Thrombolyse as pericarditis will not kill him ( I.e if you give pain relief)
    16. CXR Fibrosing alveolus’s 2e to RA
    17 CT chest Pleural effusion 2e to breast cancer
    18 CT chest thymoma ans ??
    19 Foot rash with nails Answer ?? Toe nail clippings for mycology or serum epidermal antibodies

    Questions
    1 suspected clinical Endocarditis started on ben pen and fluclox blood culture coag -ve stap. Contaminant Ans Do nothing continue same abx.
    2 Muscle aches and pains.Burgundi urine on exercise answer was Mc Cardles disease.
    3 Another Mccardles disease forget the question.
    4 KC increased asthma
    5 KCO increased obesity
    6 Cough cause with normal Lung function answer Pharyngeal pouch therefore Barium swallow.
    7. Lady with jaundice with low HB and platelets Auto immune hepatitis.
    8 Spinal meningioma
    9 20% pneumothorax answer observe . 50% pneumothorax corresponds with 2cms of air in the chest X ray. Surprisng but that s the truth. I got it wrong went for chest drain.
    10 Don’t know the answer to this but pot thrombolysis --- gastro bleed of 450 ml or so what would you do--if you give FFP it will be fluid overload and increase clotting tendency and worsen his condition//? Tranexamic acid don’t know
    11 Renal transplant --- Sons kidney
    12 CML fluid overloaded ans Plasma exchange
    13 Pregnant lady with hypertension --- methyl dopa
    14 preg lady with type 1 diabetes with proteinuria ans ---? Methyl dopa again as amlodipine reduces blood flow to the fetus and ACE and b blockers contraindicated.
    15. Pictuatory tumor leading to emergency Diabetes insipidus ans DDAVP not steroids ref OHCM emergency of DI
    16. Cluster headache
    17. HIV patient with Pneumococcal pneumonia
    18 Legionella Answer Quinolone only one was Cipro
    19 Amyloidosis with renal involvement Answer test to confirm echo
    20 Painless burn on finger with small muscle wasting answer Charcot marie tooth The one with the palpable nerve in the hand Only other condition Lepromatous leprosy. I wrote syringomyelia
    21. Myasthenia gravis Patient wanting a drug which does not give lung fibrosis and does not have dopaminergic dyskinesias Answer ?? Encaptone as it has on and off properties. Don’t know myself
    22 Alopecia atreata 2e to renal failure an transplant
    23 Methotrexate induced lung fibrosis with eosinophilia ans was not chronic eosinophilic pneumonia
    24 Mentally competent patient Ans Patients WISH is supreme
    25 Calcium channel blocker induced constipation
    26 Mechanism of Obesity induced breathlesness ans Central chemo receptors
    27 Haemoptysis Aspergillosis
    28 TB diagnosis Bronchoscopy
    29 Biopsy of Renal calcified kidney granuloma no caseation ans Sarcoidosis
    30 Sarcoidosis confirm ans test Biopsy



    :D :D
  20. Guest

    Guest Guest

    9 20% pneumothorax answer observe . 50% pneumothorax corresponds with 2cms of air in the chest X ray. Surprisng but that s the truth. I got it wrong went for chest drain.

    The right answer is chest tube as the patient's age was more than 50 and he was dyspneic, so as also he had secondary pneumothorax the treatment of choice in such case is drain
  21. halit2007

    halit2007 Guest

    mrcp uk july 207

    9 20% pneumothorax answer observe . 50% pneumothorax corresponds with 2cms of air in the chest X ray. Surprisng but that s the truth. I got it wrong went for chest drain.

    The right answer is chest tube as the patient's age was more than 50 and he was dyspneic, so as also he had secondary pneumothorax the treatment of choice in such case is drain
  22. halit2007

    halit2007 Guest

    mrcp uk july 207

    19 Amyloidosis with renal involvement Answer test to confirm echo
    the correct answer is biopsy from the invloved site, in this question biopsy from the rectum is the safest with good yield

    bye
    khaled mat
  23. Guest

    Guest Guest

    ANS IS RECTAL BIOPSY---fOR AMYLOID
  24. halit2007

    halit2007 Guest

    mrcp part 2 july 2007

    a question was that a patient with picture consistent with Pure Red Cell Aplasia and chest x-ray showing anterior mediastinal mass(slide), I think the answer was that thymoectomy vs IVIG, but choosed thymoectomy
  25. Resident

    Resident Guest

    5 Holmes adie pupil <-- not Lisch nodules?
    18 CT chest thymoma <-- thymectomy

    9 20% pneumothorax answer observe . 50% pneumothorax corresponds with 2cms of air in the chest X ray. Surprisng but that s the truth. I got it wrong went for chest drain. --> secondary pneumothorax so need chest drain!
    10 thrombolysis --- gastro bleed of 450 ml --> Tranexamic
    19 Amyloidosis with renal involvement --> rectal biopsy

    Questions
    - Parkinson's disease patient wanting a drug which does not give lung fibrosis and not want levodopa -> Ropinirole
    - old lady slow AF with syncope -> VVI pacemaker
    - severe idiopathic aplastic anemia -> transplant
    - retinal pigment + sural bx onion bulb nerve -> Refsm disease (HSMN IV)
    - UTI in pregnancy -> Cefalexin
    - Worsening SOB in lung fibrosis lady -> deterioration due to pul HT
    - asthma, hemoptysis, worsening wheeze, clubbing -> additional Dx: bronchiectasis
    - Factor V Leiden heterozygotes, post-partum D7 DVT-> no more warfarin need
    - Hemochromatosis -> monitor ferritin
    - Antiemetic to use in pregnancy -> Domperidone vs Promethazine
    - Crohn's flare during pregnancy -> steriod?
    - Fentanyl overdose -> naloxone infusion
    - Neurofibromatosis -> renal artery stenosis vs conductive deafness
    - PTH resistance
    - toxic thyroid nodule -> surgery
    - thin young lady + lymphadenopathy + fever + mildly elevated fT4-> viral thyroiditis
    - amiodarone induced thyroiditis -> stop amiodarone
    - young man chest pain with ECG -> HOCM
    - ECG during reperfusion stage -> idioventricular rhythm
    - man out of nightclub, headache, vomiting, normal CT, LP no blood or xanthochromia, pyramidal weakness -> venous sinus thrombosis
    - ICU case, type 2 RF -> intubation
    - Dapsone, polychromasia, reticulocytosis -> stop Dapsone
    - man with LFT derangement and hypogonadotrophic hypogonadism, normal testes on exam -> check ferritin
    - nephrotic syndrome, Lt lung mass, hemoptysis -> bronchial CA x 2
    - Wegener's granulomatosis
    - Leptospirosis
    - nephrectomy + pneumothorax Hx -> alpha1 antitrypsin deficiency
    - hemarthrosis + correct aPTT with mixing + normal FVIII -> Hemophilia B
    - liver bx patient, normal PT, Plt 94, aPTT slightly prolonged (not correct with mixing), normal fibrinogen -> go on with bx
    - HIV on HARRT with urine protein/blood + -> crystal nephropathy
    - tender transplant kidney case -> CMV
    - HIV with hepatosplenomegaly, no lymphadenopathy -> EBV
    - Barrett's oesophagus with high grade dysplastic leasion -> ablation
    - >10yrs UC with high grade dysplastic lesion -> panprotocolectomy
    - mixed metabolic acidosis and metabolic alkalosis
    - severe high AG metabolic acidosis, dehydrated 48yo man -> DKA
    - overdose, urine with calcium oxalate -> ethylene glycol
    - anemia, increase PT, low calcium, low albumin -> duodenal biopsy
    - patient on immunosuppressant, clear lung, SOB -> P. carinii
    - unsteady young patient with LFT derangement -> Wilson's disease
    - S/S of Still's disease -> check RF
    - oesteoporosis with #, not for alendronate -> Raloxifene
    - normal 17-0H sex steroid, suppressed LDDST -> PCOS
    - reduce hirsuitism for PCOS, BMI 29 and hyperinsulinemia -> diet and metformin
    - MEN 2a -> hyperparathyorid
    - VDRL 1/2, long term lesion on legs -> Yaws
    - Paper 1 last Q, with decreased sensation -> cryoglobulin
    - TCA overdose -> give sodium bicarbonate
    - low calcium, high phosphate, low PTH, low Mg -> give Mg
    - collapsed patient, very high CK, renal failure -> Rhambdomyolysis
    - patient with laparotomy done, malignancy gastric ulcer with perforation, post-op abdominal distension, renal failure, high K, urine Na 6 -> pre-renal failure
    - macroprolactinoma -> medical therapy first

    Pictures
    - SAH (blood in basal cistern)
    - pineal gland tumor
    - EAA (contact with bird, bil. basal hazziness, normal eosinophil)
    - slow Junctional rhythm, patient with syncope -> transient pacing?
    - spine X-ray -> TB?

    8)
  26. Guest

    Guest Guest

    Author Message
    guest20
    Guest






    Posted: Sat Jul 28, 2007 3:38 am Post subject: hard exam indeed

    --------------------------------------------------------------------------------

    other nightmares answers
    1.persistent vegetative state
    2.irretable bowel syndrome -another ibs for reassurance
    3.confounding factor in epidemiology
    4.entameba histolytica
    5.pseudom colitis
    6.nitrofurantoin for uti in quinolone sensitive pt
    7.mitral incompetence in catheter with v waves tracing
    8.c7 root lesion
    9. c5 root lesion
    10.blood film in ttp
    11.hemolytic uremic syndrome
    12.duodenal biopsy for giardiasis
    13.nsaid ileocecal ulcer
    14.theophylline toxicity
    15.quinine toxicity
    16.malignancy induced glomerulonephritis
    17.membranous gn in lung cancer pt
    18.mallory weiss tear-reassurance
    19.hydration for hyercalcemia in multiple myeloma pt
    20.zoster encephalitis




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  27. Guest

    Guest Guest

    PHARMACOLOGY


    A female patient with ‘fit like’ symptoms after taking medication for vomiting (?oculogyric crisis); she presents with vomiting again. What to give? Choices include: promethazine, chlorperazine, domperidone


    CARDIOLOGY

    A man was referred to the cardiologist for systolic murmur on routine medical check up. Echocardiogram showed aortic stenosis with gradient >90mmHg. Patient is asymptomatic. What is the next step in management? Choices include: aspirin, valve surgery, repeat echo in 6 months time


    Cardiac catheter question: a man with inferior AMI, hemodynamically quite stable; what is the expected cardiac catheterization data? Answers include PWCP, RA pressure etc.

    A patient with valvular heart disease underwent bladder instrumentation without antibiotic prophylaxis subsequently developed endocarditis. What is the likely bacteria?
    Choices include: strep viridans, staph aureus, proteus mirabilis


    A man was diagnosed with infective endocarditis subsequently treated with iv antibiotics, which included iv gentamicin, however noted progressive worsening creatinine. Cr 200+, genta level 1.8, C3 and C4 low. What is the diagnosis? Choices include: glomerulonephritis, septic emboli, gentamicin toxicity

    A man with cardiovascular risk factors on beta blocker and aspirin had a near fainting spell whilst defecating. Postural drop in BP. PR brown stools, smooth enlarged prostate. Cr slightly raised. Hb normal What is the diagnosis? Choices include: micturition syncope, complete heart block, GI loss, ruptured aortic aneurysm


    NEUROLOGY


    A man with features of Parkinsonism, also developed high pitched voices, wakes up with vivid dreams, erectile dysfunction. What is the diagnosis? Choices include: multi system atrophy, idiopathic Parkinson’s disease, frontal meningioma. Answer is MSA


    A man with recent severe head injury. Presented with headache, urinary incontinence, unable to walk. What is the diagnosis? Choices include post traumatic hydrocephalus, subarachnoid haemorrhage


    A young man c/o episodes of weakness of which his limbs goes floppy, but there was no loss of consciousness, felt well after each episode. What is the diagnosis?
    Choices include: cataplexy, akinetic seizures



    GASTROENTEROLOGY


    a young patient with abdominal bloatedness with bloody diarrhea and tenesmus. Recently returned from Tanzania. What is the likely diagnosis? Choices include: Campylobacter jejuni, Entamoeba histolytica, Shigella


    A patient had perforated duodenal ulcer, laporotomised, treated with triple therapy for +ve H pylori. Reviewed 6 weeks later and was well. What is the next step in management? Choices include: repeat urease test, repeat OGD, reassurance and discharge



    ACID BASE

    An unkempt patient presents with drowsiness and dehydration. Na 167. Blood glucose 12. metabolic acidosis picture. What is the diagnosis? Choices include: DKA, alcoholic ketoacidosis, Gram negative septicemia

    INFECTIOUS DISEASES


    A nursing home patient presented with vomiting and diarrhea. A few nursing home patient have it as well. Recently treated with co-amoxiclav for UTI. What is the diagnosis? Choices include: pseudomembranous colitis, infectious diarrhea


    A patient recently had anterior resection for CA rectum as well as had MRSA decolonization therapy. Came for fever, and urinary symptoms. What is the choice of antibiotics? Choices include: vancomycin, meropenem, co-amoxiclav








    GENITOURINARY MEDICINE


    A patient with polycystic kidney disease presents with right loin pain and 1 day of hematuria. Urine microscopy negative. What is the next step in management? Choices include: cystoscopy, IVU, renal angiography


    Picture of renal arteriography that shows spiraling of renal vessels. Choices include: fibromuscular dysplasia, right renal artery aneurysm
  28. Guest

    Guest Guest

    hi mrcp is never easy :evil:
    same more questions
    --pt ,husband died 1y back,came many time with abdominal --pain...somatisation,hypochondiac..adjestmend disorder...
    -pt had accidennt,had hight plasma osmolality,low urine osmolality......SIAHD,DI,DEHYDRATION....
    -pt with polyurea,polydipsia,with low plasma and urine osmolality...polygenic....
    -pregnant lady with hight BP.what will be best treatment,,m.dopa,labetalool,acei.verapamil.......m.popa
    -another simillar question,i think had protenurea what to give,m dopa,verapamil,labetalool,acei
    -pregnant lady,had extensive erythamatus rash with blisters on thigt and upper abdomin,picture...what treatment ...prednisolon,,acyclovir...reasure...
    -pt with chickenpox had miningitis..what is the cause...varicella zoster,herpes simplix......
    -pt had suden headech,i gont remmember the rest senario.....subarachnoid hge........
    -pt had accident had same fracture came with........ bacterial meningitis...subdural heamatoma..ct brain picture
    ---ECG..dorsadepo..what is likely case..sotalol
    pt had vomiting,last time had some movment afer that......what was the question ,what to give now or what was the medication.....we where confused after the exame ..i thought they are asking waht was the madication...i chose metachlopromide...
    -pt with INO what is the case...cerebellar infarction..........
  29. guest20

    guest20 Guest

    rely

    yes GUIST the answer is metoclopramide as the q asked about what drug the pt. used ?
  30. guest20

    guest20 Guest

    sory GLAD for inconveniane

    some more nightmares
    1.stop dapsone for hemolytic anemia side effect
    2.stop fluoxetine for siads
    3.stop methotrexate for pneumonitis or pulmonary fibrosis side effect
    4.vvir pacemaker for sinus pause of 9 second with hr 60/min
    5.cardiovertor def implant for resuscitated vf
    6.ecf chb with af
    7.ecg of pericarditis-ttt analgesia
    8.pemphigus v
    9.toxic epidermal necrolysis
    10.penicillin as a cause of erythema nodsum-asot normal-cxr normal
    11.alendronate therapy in MM hypercalcemia pt
    12.local radiotherapy for severe bone pain with bone scan osteosclerotic seconderies in cancer prostate pt
    13.ca 19-9 estimation in cancer pancreas pt
    14.cavitated rt lung lesion in overian cancer pt with raised ca125
    15.add lithium for pt with depresion,insomnia,loss of concentration who is currently on valproate for a psychiatric illness
  31. guest20

    guest20 Guest

    another set of nightmares please comment because i personall

    1.churg straus syndrome
    2.budesonide for chron pt with stricture and ulceratition in the ileocecal area bowel enema pictured
    3.mushroom poisoning???
    4.tight glycemic control in typi 1 dm with no microalb and normal bp -hight hba1c
    5.bisoprolol added to heart failure pt on thiazide and acei with heart rate 120/min and dyspneic
    6.digoxin added to another hf pt on thiazide and acei with tachycardia and the ecg showen with intraventriculer block picture
    7.carbimazole for amiodarone induced thyrotoxicosis
    8. rewarming in pt with hypothermia ecg showed J wave and low voltage
    9.another case of hypothyroidism
    10.tuberculoid leprosy in patient with thick ulner n and burns on the hand
  32. guest20

    guest20 Guest

    comment

    the sun of renal failure pt was 15 years old not 16 so he can not decide for himself to donate and I THINK THE ANSWER IS TO WAIT AS HIS PROBLEMS IN DIALYSIS CAN BE MANAGED CONSERVATIVELY-
    PATIENT OF 20% PNEUMOTHORAX WAS COPD PT SO CHEST DRAIN IS THE CORRECT ANSWER
  33. HALIT2007

    HALIT2007 Guest

    mrcp 2 july 2007

    Treatment

    Radioiodine ablation is usually the treatment of choice. Because normal thyroid function is suppressed, 131I is concentrated in the hyperfunctioning nodule with minimal uptake and damage to normal thyroid tissue. Relatively large radioiodine doses [e.g., 370 to 1110 MBq (10 to 29.9 mCi)131I] have been shown to correct thyrotoxicosis in about 75% of patients within 3 months. Hypothyroidism occurs in <10% of patients over the next 5 years. Surgical resection is also effective and is usually limited to enucleation of the adenoma or lobectomy, thereby preserving thyroid function and minimizing risk of hypoparathyroidism or damage to the recurrent laryngeal nerves. Medical therapy using antithyroid drugs and beta blockers can normalize thyroid function but is not an optimal long-term treatment. Ethanol injection under ultrasound guidance has been used successfully in some centers to ablate hyperfunctioning nodules. Repeated injections (often more than 5 sessions) are required to reduce nodule size. Normal thyroid function can be achieved in most patients using this technique.
  34. Guest

    Guest Guest

    - toxic thyroid nodule ->
    A patient presents with symptoms of hyperthyroidism. Confirmed hyperthyroid on blood tests; thyroid scan showed high uptake in right sided thyroid nodule with suppression of the rest of the glands. What is the treatment of choice? surgery; other choices include radioactive iodine, carbimazole for 8 weeks



    - young man chest pain with ECG
    A young man presents with non specific chest pain for one hour. Father had AMI at aged 60. patient’s cholesterol is 11.2. ECG showed T inversions in V2-6. What is the diagnosis? Choices include HOCM, NSTEMI, anterior MI
  35. Guest

    Guest Guest

    RHEUMATOLOGY

    A patient has ankylosing spondylitis currently on corticosteroids presents with dyspnoea. Clinically patient has anasarca – bilateral pleural effusion, ascites and nephritic syndrome. What is the next investigation to reach the diagnosis? Choices include: pleural tap, CT abdomen


    RESPIRATORY MEDICINE

    A middle aged heavy smoker presents with cough lethargy and loss of weight. Also c/o arthralgia of the small joints of the hand. Clinically there was clubbing and synovitis affecting the small joints of the hands. X-ray showed periosteal reaction of the bones. What investigation to do next to reach a diagnosis? Choices include: CXR, bone scan, CT abdomen


    A patient was found collapsed in the shopping complex. Clinically drowsy, hypotensive, hypoxic and hyperventilation on ABG, ECG showed sinus tachycardia with LBBB. What is the treatment of choice? Choices include: iv teneplase, iv heparin, aspirin


    NEUROLOGY


    A patient was diagnosed with advanced glioblastoma multiforme. Started on oral valproate due to recurrent seizures. GCS worsened over the next few days. Noted to have myoclonic jerks occasionally. What is the treatment of choice? Choices include: fentanyl patch, iv diamorphine, dihydrocodeine


    GASTEROENTEROLOGY


    A young lady presents with symptoms of abdominal pain and watery diarrhea. Investigations were normal. She felt that her symptoms improved after abstaining from milk products, nuts etc. what is the next investigation of choice? Choices include: RAST, skin test
  36. HALIT2007

    HALIT2007 Guest

    mrcp part 2 july 2007

    Therapy for Nodules (Table 18-3,18-4) (Figure 18-13)


    Figure 18-13.Diagnostic sequence and therapeutic decisions in managing a patient with an apparent single nodule of the thyroid.


    Toxic Nodules
    Three therapeutic options are available for toxic nodules: surgery, 131-I therapy and ethanol injection. Radioiodine is a very effective therapy and is becoming the treatment of choice in many patients over 25 years of age and particularly in older patients and those with coincident serious illness, because of its ease and convenience, slightly lower expense, avoidance of a scar, and avoidance of hospitalization. The activity of 131-I to be administered will depend on the size of the nodule and usually ranges between 185 and 740 MBq (5-20 mCi). Euthyroidism and a variable shrinkage of the nodule are obtained in most patients. When one single dose is ineffective, the procedure may be repeated. With time, hypothyroidism may develop in up to 30-40% of the patients, since the remainder of the gland receives 1,000-8,000 rads (64). Hypothyroidism is more frequent in patients with positive anti-thyroid autoantibodies prior to therapy 59a. Although, in theory, this radiation could induce tumor formation, this has not been reported. Further, the patient receives 30-60 rads of whole body irradiation (65).

    Surgery is indicated for large nodules, particularly when they have a large cystic component, in very young patients (although rare) and in those refusing radioiodine therapy. Surgery consists of a total lobectomy and must be performed after restoration of a normal thyroid function by antithyroid drugs. Also after surgery, late hypothyroidism is common (30-40% in our experience), while the occurrence of surgical complications is nearly absent in the hands of experienced surgeons.

    The third option for the treatment of toxic or pre-toxic nodules, ethanol injections, has been proposed by Italian authors (66, 67). The procedure consists in percutaneous intra-nodular ethanol injection, which induces cellular dehydration followed by coagulative necrosis and vascular thrombosis and occlusion. Volumes of .4 - 2 ml are injected, and patients may receive up to 9 or more treatments at intervals of several days. The technique requires a well-trained staff. Transient, sometimes severe, local pain is the most frequent side effect, followed by transient fever, and occasionally transient dysphonia. Long term follow-up studies have shown that the rate of recurrence is limited to a few patients, and almost no patient developed hypothyroidism (68). However, in our opinion, this therapeutic option should be limited to highly selected cases, such as small nodules, well accessible to palpation, in patients at surgical risk or refusing radioiodine.Small autonomous functioning thyroid nodules, without thyrotoxicosis, can be left untreated and followed. Nearly 30-40% will eventually evolve into toxic nodules (69), but many may stay as they are or even undergo spontaneous cystic degeneration.
  37. Adel 71

    Adel 71 Guest

    36 year old man knonw HIV, is admitted with increasing shortness of breath. He is on antiretroviral medications. On examination he has raised JVP, bilateral lower limb oedema and crackles on both bases. Echocardiogram showes severe biventricular dysfunction.
    What is the most likely cause of his prolbem:
    a) cytomegalovirus
    b) toxoplasmosis
    c) HIV
    d) Zidovudine
    e) Ritonavir

    I choose HIV as it is a known cause of dilated cardiomyopathy but I know that some antiretrovial drugs can also cause DC. I was not sure which.
  38. HALIT2007

    HALIT2007 Guest

    mrcp 2 july 2007

    Zidovudine

    Adverse Reactions
    >10%:
    Central nervous system: Severe headache (42%), fever (16%)
    Dermatologic: Rash (17%)
    Gastrointestinal: Nausea (46% to 61%), anorexia (11%), diarrhea (17%), pain (20%), vomiting (6% to 25%)
    Hematologic: Anemia (23% in children), leukopenia, granulocytopenia (39% in children)
    Neuromuscular & skeletal: Weakness (19%)
    1% to 10%:
    Central nervous system: Malaise (8%), dizziness (6%), insomnia (5%), somnolence (8%)
    Dermatologic: Hyperpigmentation of nails (bluish-brown)
    Gastrointestinal: Dyspepsia (5%)
    Hematologic: Changes in platelet count
    Neuromuscular & skeletal: Paresthesia (6%)
    <1%, postmarketing and/or case reports: Anaphylaxis, angioedema, aplastic anemia, bone marrow suppression, cardiomyopathy, cholestatic jaundice, confusion, granulocytopenia, gynecomastia, hepatomegaly with steatosis, hepatotoxicity, mania, myopathy, neurotoxicity, oral pigmentation changes, pancreatitis, pancytopenia, seizures, Stevens-Johnson syndrome, tenderness, thrombocytopenia, toxic dermal necrolysis, vasculitis
  39. HALIT2007

    HALIT2007 Guest

    Medication Safety Issues

    Sound-alike/look-alike issues:

    Azidothymidine may be confused with azathioprine, aztreonam

    Retrovir® may be confused with ritonavir

    AZT is an error-prone abbreviation (mistaken as azathioprine, aztreonam)

    Pronunciation

    (zye DOE vyoo deen)

    U.S. Brand Names

    Retrovir®
    Index Terms

    Azidothymidine
    AZT (error-prone abbreviation)
    Compound S
    ZDV
    Generic Available

    Yes: Tablet

    Canadian Brand Names

    Apo-Zidovudine®
    AZTâ„¢
    Retrovir®
    Pharmacologic Category

    Antiretroviral Agent, Reverse Transcriptase Inhibitor (Nucleoside)
    Pharmacologic Category Synonyms

    NRTI
    Nucleoside Reverse Transcriptase Inhibitor
    Retroviral Therapy, Reverse Transcriptase Inhibitor (Nucleoside)
    Reverse Transcriptase Inhibitor, Nucleoside
    RTI, Nucleoside
    Use

    Treatment of HIV infection in combination with at least two other antiretroviral agents; prevention of maternal/fetal HIV transmission as monotherapy

    Use: Unlabeled/Investigational

    Postexposure prophylaxis for HIV exposure as part of a multidrug regimen

    Pregnancy Risk Factor

    C

    Pregnancy Implications

    Zidovudine crosses the placenta. No increased risk of overall birth defects has been observed following 1st trimester exposure according to data collected by the antiretroviral pregnancy registry. The use of zidovudine reduces the maternal-fetal transmission of HIV by ∼70% and should be considered for antenatal and intrapartum therapy whenever possible. The Perinatal HIV Guidelines Working Group considers zidovudine the preferred NRTI for use in combination regimens during pregnancy. In HIV-infected mothers not previously on antiretroviral therapy, treatment may be delayed until after 10-12 weeks gestation. Cases of lactic acidosis/hepatic steatosis syndrome have been reported in pregnant women receiving nucleoside analogues. It is not known if pregnancy itself potentiates this known side effect; however, pregnant women may be at increased risk of lactic acidosis and liver damage. Hepatic enzymes and electrolytes should be monitored frequently during the 3rd trimester of pregnancy in women receiving nucleoside analogues. Health professionals are encouraged to contact the antiretroviral pregnancy registry to monitor outcomes of pregnant women exposed to antiretroviral medications (1-800-258-4263 or www.APRegistry.com).

    Lactation

    Enters breast milk/contraindicated

    Breast-Feeding Considerations

    HIV-infected mothers are discouraged from breast-feeding to decrease potential transmission of HIV.

    Contraindications

    Life-threatening hypersensitivity to zidovudine or any component of the formulation

    Warnings/Precautions

    Box warnings:

    • Hematologic toxicity: See “Concerns related to adverse effects†below.

    • Lactic acidosis/hepatomegaly: See “Concerns related to adverse effects†below.

    • Myopathy: See “Concerns related to adverse effects†below.

    Concerns related to adverse effects:

    • Fat redistribution: May cause redistribution of fat (eg, buffalo hump, peripheral wasting with increased abdominal girth, cushingoid appearance).

    • Hematologic toxicity: [U.S. Boxed Warning]: Often associated with hematologic toxicity including granulocytopenia, severe anemia requiring transfusions, or (rarely) pancytopenia. Use with caution in patients with bone marrow compromise (granulocytes <1000 cells/mm3 or hemoglobin <9.5 mg/dL); dosage adjustment may be required in patients who develop anemia or neutropenia.

    • Immune reconstitution syndrome: Patients may develop immune reconstitution syndrome resulting in the occurrence of an inflammatory response to an indolent or residual opportunistic infection; further evaluation and treatment may be required.

    • Lactic acidosis/hepatomegaly: [U.S Boxed Warning]: Lactic acidosis and severe hepatomegaly with steatosis have been reported with nucleoside analogues, including fatal cases; use with caution in patients with risk factors for liver disease (risk may be increased with female gender, obesity, pregnancy or prolonged exposure) and suspend treatment in any patient who develops clinical or laboratory findings suggestive of lactic acidosis or hepatotoxicity (transaminase elevation may/may not accompany hepatomegaly and steatosis).

    • Myopathy: [U.S. Boxed Warning]: Prolonged use has been associated with symptomatic myopathy and myositis.

    Disease-related concerns:

    • Renal impairment: Use with caution in patients with severe renal impairment; dosage adjustment recommended.

    Concurrent drug therapy issues:

    • Interferon alfa: Use with caution in combination with interferon alfa with or without ribavirin in HIV/HBV coinfected patients; monitor closely for hepatic decompensation, anemia, or neutropenia; dose reduction or discontinuation of interferon and/or ribavirin may be required if toxicity evident.

    Adverse Reactions

    As reported in adult patients with asymptomatic HIV infection. Frequency and severity may increase with advanced disease.

    >10%:

    Central nervous system: Headache (63%), malaise (53%)

    Gastrointestinal: Nausea (51%), anorexia (20%), vomiting (17%)

    1% to 10%:

    Gastrointestinal: Constipation (6%)

    Hematologic: Granulocytopenia (2%; onset 6-8 weeks), anemia (1%; onset 2-4 weeks)

    Hepatic: Transaminases increased (1% to 3%)

    Neuromuscular & skeletal: Weakness (9%)

    Frequency not defined:

    Cardiovascular: Cardiomyopathy, chest pain, syncope, vasculitis

    Central nervous system: Anxiety, chills, confusion, depression, dizziness, fatigue, insomnia, loss of mental acuity, mania, seizure, somnolence, vertigo

    Dermatologic: Pruritus, rash, skin/nail pigmentation changes, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria

    Endocrine & metabolic: Body fat redistribution, gynecomastia

    Gastrointestinal: Abdominal cramps, abdominal pain, dyspepsia, dysphagia, flatulence, mouth ulcer, oral mucosa pigmentation, pancreatitis, taste perversion

    Genitourinary: Urinary frequency, urinary hesitancy

    Hematologic: Aplastic anemia, hemolytic anemia, leukopenia, lymphadenopathy, pancytopenia with marrow hypoplasia, pure red cell aplasia

    Hepatic: Hepatitis, hepatomegaly with steatosis, hyperbilirubinemia, jaundice, lactic acidosis

    Neuromuscular & skeletal: Arthralgia, back pain, CPK increased, LDH increased, musculoskeletal pain, myalgia, neuropathy, muscle spasm, myopathy, myositis, paresthesia, rhabdomyolysis, tremor

    Ocular: Amblyopia, macular edema, photophobia

    Otic: Hearing loss

    Respiratory: Cough, dyspnea, rhinitis, sinusitis

    Miscellaneous: Allergic reactions, anaphylaxis, angioedema, diaphoresis, flu-like syndrome, immune reconstitution syndrome
  40. guest20

    guest20 Guest

    1.methotrexate for psoriatic arhropathy and extensive skin lesions
    2.motor neuron disease -prgressive musculer trophy type
    3.hroni inflammatory demyelinatig poyradiculopathy
    4.subcutanous midazolAm infusion for status epleptius in a patient with advanced glioblastoma
    5.IV THIAMINE FOR WERNICKE,S ENCEPHAOPATHY IN ALCOHOLC PT
    6.DESMOPRESSIN FOR DI IN HYPOPITUITARY PT
    7.ADDISON S DISEASE
    8.ADRENAL FAILURE IN ANOTHR PT
    9.ERYTHROPIOTIN RESISTANCE DE TO HYPERPARATHYOIDISM IN CRF T
    10.REPAGLINIDE AS A CAUSE OF YPOGYCEMI IN AN OD LADY
    11.FASTING GLUCOSE AND INSULIN ESTIMATION IN A PT RPRESENTD BY HYPOGLYCEMIA
    12.PULMONARY HYPERTENSIN IN SCLERODERMA PT
    13.PLASMAPHORESIS FOR PT WITH HYPERVISCOSITY
    14.CONN SYNDROME IN HYPOKALEMIC HYPERTENSIVE PATIENT
    15.CRUDE TAR FOR LOCALISED PSORIASIS IN THE UMBILICUS PICTURED
  41. THEBUSIEST

    THEBUSIEST Guest

    MCQs ;
    *YOUNG MALE WITH POSTEXECISE THIGH STIFFNESS , NO WT LOSS OR FEVER CK SLIGHTLY HIGH -----------> McARDLE SY.
    * PATIENT POST-MI TWO DAYS DEVELOPED FEVER TOO EARLY FOR DRESSLERS SYN (BUT I CHOSE IT )
    * 50 Y PATIENT WITH DERANGED LFT , HYPOGONADOTROPHIC HYPOGONADISM ----------> CHECK FERRITIN LEVEL
    * THE ECG WITH BRADY-AF PACEMEKER WILL NOT HELP NEEDS BIVENTRICULAR PACING
    * ACUTE HEMIPARESIS WITH AF CT-BRAIN NORMAL WILL YOU START ANTICOAGULATION WITH HEPARIN OR ONLY ASPIRIN .
    * RECURRENT TIA WHICH DRUG WILL ADD TO ASPIRIN---------> DIPYRIDAMOLE NOT CLOPEDIGROL ( STUDY WISE)
    * PATIENT WITH SEPSIS IN ICU ON TAZOCIN NOT RESPONDING CULTURES NEGATIVE WHAT TO ADD ( ADD TEICOPLANIN NOT FLUCONAZOLE)
    * HIV PATIENT WITH 3 WEEKS H/O MALAISE AND HEADACHE CSF SHOWS LYMPHOCYTOSIS WITH SLIGHTLY RAISED PROTEIN CT NORMAL ---> i put cryptoccocosis
    * ANOTHER PATIENT WITH SEPSIS ON TEICOPLANIN AND VANCO NOT RESPONDING WHAT TO ADD ( FLUCONAZOLE)
    * CT WITH UPPER MEDISTINAL MASS LDH HIGH , NEGATIVE AFP AND B-HCG ---------> LYMPHOMA (I PUT THYMOMA AS THE MASS DOESNT LOOK LIKE MULTIPLE LN )
    * PATIENT WITH TCA OVER DOSE PRESENTATION DEVELOPED I BELEIVE VT WHAT TO GIVE ----------> NAHCO3
    * PATIENT WITH HEART FAILURE AND AF, PR 116 HE IS DYSPENIC CHEST IS CLEAR WHAT TO ADD ----------> BISOPROLOL
    * PATIENT WITH ACUTE ST ELEVATION MI WHAT BEST MANAGEMNT APPROACH ------->PTCA NOT THROMBOLYSIS
    * PATIENT WITH PRESENTATION OF P.S CHOLANGITIS COAGULATION DERANGED --------> MRCP NOT PCA
  42. HALIT2007

    HALIT2007 Guest

    mrcp 2 july 2007

    PATIENT WITH ACUTE ST ELEVATION MI WHAT BEST MANAGEMNT APPROACH ------->PTCA NOT THROMBOLYSIS

    He was asking about the immediate drug, I thnk it was aspirin.

    Another question was about one patient with possible prostatic ca, and cord compression, whats the immediate drug, I think it was dexamethasone.
  43. guest20

    guest20 Guest

    nice exam

    1.non selective betablocker in varicose vein grade 1 prophylaxis
    2.lumber puncture for diagnosis of BIH
    3.TRAUMATIC HYDROCEPHALUS
    4.ZIEHL NEELSEN FOR DIAGNOSIS OF TB AFTER INFLIXIMAB FOR CROHN
    5.DUODENAL BIOPSY FOR DIAGNOSIS OF CYSTIC FIBROSIS
    6.ACUTE INTERMITTENT PORPHYRIA
    7.CHARCOT MARIE TOOTH NEUROPATHY
    8.ERCP FOR PT WITH GALL STONES AND THICK WALLED GB AND DILATED CBD PRESNTED WITH FEVER AND JAUNDICE
    9.PANCREATIC SUPPLIMENT FOR MALABSORPTION IN DIABETIC PT PRESENTED WITH LOSS OF WT AND LOW B12 AND NORMAL FOLIC ACID?CHRONIC PANCREATITIS
    10.DATA OF 15 YEARS OLD GIRL WITH RAISED TOTAL T3 AND T4 BUT NORMAL FREE T3 AND T4???PREGNANCY
  44. guest20

    guest20 Guest

    WHERE ARE YOU GUYS?

    ANY COMMENT! THERE IS NO RESPONSE -EVERYONE OF YOU TALKS ABOUT DIFFERENT THINGS WE WANT ACTIVE PARTICIPATION-GOODLUCK FOR ALL OF YOU
  45. Guest

    Guest Guest

    DERMATOLOGY

    An elderly lady c/o rash and itch over the right breast. It has been refractory to emollients and corticosteroids. Clinically the lesion was well demarcated and it involved the areola. The contralateral breast was normal and there was no breast lumps. What is the likely diagnosis? Choices include: eczema, Paget’s disease



    PHARMACOLOGY


    A man presented with a nodule in his right palm. He has known history of renal transplant 10 years ago and he was treated with ciclosporin. Clinically there was a keratotic nodule that was slightly tender. What is the diagnosis? Choices include: Bowen’s disease, basal cell carcinoma, melanoma



    CARDIOLOGY


    A patient presented with symptoms of heart failure. He was on ACE inhibitor, aspirin and frusemide. Clinically he was in fluid overload. His frusemide dose was doubled and there was significant improvement in the symptoms. However, he c/o slight light headedness 2 days later. There was no significant postural drop. No significant impairment in renal failure. What is next step in management? Choices include: stop frusemide and monitor postural drop, restart when patient is asymptomatic, reduce the dose of frusemide, stop ACE inhibitor and monitor postural drop, restart when patient is asymptomatic
  46. guest20

    guest20 Guest

    three difficult questions

    1.I HOPE IT IS PAGET DISEASE OF THE NIPPLE
    2.IT MAY BE SQUAMOUS CELL CARCINOMA
    3.I PERSONALLY STOPPED PIRENDOPRIL AND INTRODUCED IT IN SMALL DOSE
  47. Guest

    Guest Guest

    1-steroid psychosis
    2-lead poisoning
    3-hirsutism-spironolactone
    4-PCOD
    5-viral myocarditis
    6-Stent occlusion
    7-Cholesterol Emboli
    8-Bisphosphonates-dysphgia-strontium
    9-Parkinson's disease--Fibrosing alveolitis
    10-HIV,Increased SOB---PE

    MORE TO COME---PLEASE COMMENT,THANKS
  48. guest20

    guest20 Guest

    EXTRA

    1.RALOXIFEN FOR OSTEOPOROTIC PT NOT TOLERATING PAMIDRONATE
    2.RADIO IODINE FOR SOLITARY TOXIC THYROID ADENOMA
    3.HIV AS A CAUSE OF DILATED CARDIOMYOPATHY
    4.DIASTOLIC DYSFUNCTION AS A CAUSE OF HF IN HYPERTENSIVE PATIENT
    5.TOE IN APATIENT PRESENTED WITH SBE VEGITATIONS NOT SEEN ON TRANSTHORACIC ECHO
    6.TB SPINE IN PATIENT WITH SCA PICTURED
    7.A CASE OF ISCHEMIC COLITIS
    8.??? A CASE OF ISCHEMIC HEPATITIS
    9.???FLAIL CHEST IN TYPE ONE INSULIN PT RBS 30MMOL/L PRESENTED WITH METABOLC ACIDOSIS AND VERY HIGH PCO2
    10.METABOLIC ACDOSIS AND METABOLIC ALKALOSIS MIXED IN UREMIC PT PRESENTED WITH SEVERE VOMITING
  49. Guest

    Guest Guest

    Interesting Qs.please comment

    62 years old barister-unsteady,headache,TIA like symptoms before-O/E carotid bruit.What would be the most appropriate investigation?
    1-Carotid doppler
    2-MRI
    3-Angiogram
    4-TOE
    5-24 hours tape

    MY ANSWER WAS ---MRI---please comment
  50. guest20

    guest20 Guest

    HELLO GUEST

    1. I DON NOT KNOW THIS Q
    2.LEAD POISONING OK
    3. HIRSUTISM IT MAY BE THE LADY WITH PCOS
    4.PCOD ANOTHER ONE OK
    5.IT MAY BE MYOPERICARDITIS AS CK AND TROPONIN ARE HIGH
    6.STENT OCCLUSION MAY BE SUBACUTE THROMBOSIS
    7.IF YOU MEAN THE FUNDUS PICTURE IT WAS CMV RETINITIS
    8.RALOXIFEN IS AN ALTERNATIVE IF PAMIDRONATE NOT TOLERATED
    9.PARKINSON DISEASE THERE WAS ONE DESCRIBED
    10.I DID NOT REMEMBER THIS Q
    THANKS

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