MRCP part 1 sept. 2009

Discussion in 'MRCP Forum' started by zafar_nzr, Sep 22, 2009.

  1. zafar_nzr

    zafar_nzr Guest

    just returned from examination center. Paper 2 was very tough. Few recall questions are as follows ;
    1. a nurse has latex allergy ; develops anaphylaxis after lunch ; which fruit.... banana , orange , apple , pear, grape ? (banana). I selected orange :(
    2. trastuzumab started for a pt. for breast cancer; which factor predisposes to heart failure..... ? don't remember the options; one was ...past anthracycline Rx ;
    3. another question for trastuzumab and heart failure;
    4. a pt. with ischemic stroke and AF with 150/min rate presented after 6 hours ; initial Rx ? ... alteplase , aspirin , clopidogrel , dipyridimole, warfarin?
    5. 18 yrs old male had excessive bleeding after dental extraction , APTT =86 , PT= normal ; deficiency of which clotting factor? II , VII , V , X , XII or XI

    Sorry friends, that's all i remember at this time; my mind is very tired; however, i'll post whenever i remember any question.
  2. Guest2001

    Guest2001 Guest

    What I found out in paper 2 that there are many answers for the same question, its just how you chose to answer it. I think for the atrial fibrillation the answer was Aspirin, as the question was 'whats the next best management'.
  3. M SOLIMAN

    M SOLIMAN Guest

    Very tough 2 paper,
    Aspirin for AF
    echo for tarzmib!! and duboxtine!!
    Factor V
    Pneumo carinii pneumonia
    Prolonged diarrhoea
    Acute Hep A infection
    Anti TB adjovant = CSF
    Prognosis of Rh A Acute onset
    Macrocytic aneamia in Gastrectomy pt= U endosopy
    tear drop= myelofibrosis
    Wagner`s s =Pul hge+renal imp
    Thrombocytopenia= ? Churg straus
    A promylo leukemia
    Transudae Pl eff= ? TB vs SLE not sure wt
    Commonest Thrompophilia

    Please keep posting
    Thank u for opening this topic
  4. dr_mohammed

    dr_mohammed Guest

    splitting of second heart sound: LBBB
    SVC: immediate management, I think stenting as radiotherapy requires 2 weeks
    amlodipine for the elderly on lethium
    ciclosporin nephrotoxicity for the patient with increasing creatinine and on fluconazole
    there was a question about someone with both hypokalemia and hypercalcemia, I picked hypomagnesemia
    the boy with teratoma, follow up by alpha-fetoprotein and hCG
    the female with secondary amenorrhea, i think it was premature ovarian failure
    regular narrow complex tachycardia: AV re-entry tachycardia with accessory pathway
    High levels of IgM: Walendstrom macroglobulinemia
    The patient with SAH are likely to develop hydrocephalus
  5. Immo

    Immo Guest

    r u sure we should give aspirin in AF rather then warfarin ?
  6. Immo

    Immo Guest

    the question with renal failure and patient complaing of hemoptysis , they also gave the option of good pasteur as well as wegners granulomatosis


    another tough question patient with paracetamol od investigations shows
    INR 2.1
    Cewatinine 200 plus
    ph 7.1
    alt 1348
    fasting BM 2.2

    which indicate for possible liver transplant
  7. Guest

    Guest Guest

    banana is a cause of sensitvity in latex allergy
    *the plural effusion is exudate with protein content of 50 that is mean more than 30
    * if the ph less than 7.3 it is sure for liver transplant
    * bad prognostic sign in rhumatoid arthritis is being a female not acute onset * it is not just spiliting of the second heart sound it is a fixed and that mean atrial septal defect ASD which is the first option

    *the patient with tachycardia is eldry around 60 years so AVNRT is more common with strucral heart diseases
    * the question about the immediate action after stroke , so aspirin is first then warfarin which take 72 hours to take full effect
  8. Guest

    Guest Guest

    LBBB causes reversed splitting not a fixed splitting
  9. Immo

    Immo Guest

    Patient 75 yrs age , new onset AF with mild sob , planned to control rate only , no structural or vlave disease cxr clear

    digoxin
    bisoprolol
    dont remember other options
  10. Guest

    Guest Guest

    other options
    amidarone
    flecainide
  11. Guest

    Guest Guest

    latex allergy and food

    Latex allergy and food
    Around half of all people with latex allergy have allergic reactions when eating particular foods including avocado, banana, chestnut, kiwifruit, passionfruit, plum, strawberry and tomato. This is because some of the proteins in latex that cause latex allergy are also present in these fruits. Common symptoms include tingling in the mouth, stuffy nose, itchy eyes and wheezing.

    A person who is allergic to the manufacturing chemicals in latex will not have allergic reactions to these foods.
  12. Immo

    Immo Guest

    still not sure why these type of questions ask by royal college which we experience very rarely
  13. Dark Knight

    Dark Knight Guest

    My opinions!

    -The stroke Pt should be given ASPIRIN.. Warfarin is never started b4 2 weeks even in Ischaemic soke for hear of haemorrage into an infarct
    -The strongest indicator for Liver transp in Paracet o/dose is pH!
    - The described pl effusion was an Exudate, specifically EMPYEMA (bcoz low pH)
    - SVC immediate ttt is Radiotherapy!
    - Cyclosporin (and Tacrolimus too) axn inhibits IL2
    - Both female sex and anti CCP are bad prognostics for Rh arthritis. I don't know which 1 they want but probably female (I wish i chose it :shock: )!!!
  14. Majeed1974

    Majeed1974 Guest

    Regarding the atrial fibrillation for rate control, there was a similar question in onexamination, and the answer is digoxin when there is an evidence of heart failure, otherwise, its a beta blocker. And true, the low PH is an indication for liver transplantation. I believe there was a question on Henoch Schonlein purpura too. Lichen planus was the answer for the skin rash with white mucosal streaks?
  15. Guest

    Guest Guest

    actually there is no anti CCp in the options it is already given in the stem above so being female is the true answer
  16. Majeed1974

    Majeed1974 Guest

    Myoglobulin is the first cardiac marker
    That lady with a facial skin lesion coming from Brazil, was it Discoid lupus?
    In general, how do you all rate this exam, was it tough or reasonable?
    [/b]
  17. Guest

    Guest Guest

    indications of surgey in infective endocarditis
    prolongation of PR interval due to the formation of abscess
  18. Immo

    Immo Guest

    was it not cutanoeus leshmeniasis lady from brazil
  19. Majeed1974

    Majeed1974 Guest

    Mohammed
    it can also be the onset of valvular incompetence, as indicated by the onset of systolic murmur!
    Immo
    I think it is discoid based on the description of the hair follicle plugging, and the age and gender is compatible with discoid lupus.
    [/b]
  20. Immo

    Immo Guest

    question asking for treatment of atopic dermatitis


    patient collapse 5 min after tetanus injection , local erythema and hypotensive which type of hypersensitive reaction
    Type 1 , Type 2 , type 3 ........ type 5
  21. Immo

    Immo Guest

    thanks majeed for discussion
  22. Guest

    Guest Guest

    for atopic dermatitis you have to use a potent steroid as a second line which is clobetasone propionate
    it is type 1 anaphaylaxisis
  23. Guest

    Guest Guest

    was there a qs with an answer "secondary syphilis"? I think it was the chap who had exudative tonsillitis (so SUPPOSEDLY had Penicllin) then developed a scaly rash
  24. M SOLIMAN

    M SOLIMAN Guest

    I chosed type IV delayed as it is the 2nd exposure
  25. Guest

    Guest Guest

    regarding the rate control in atrial fibrilation here is a very informative piece of information
    Atrial fibrillation: rate control and maintenance of sinus rhythm

    The Royal College of Physicians and NICE published guidelines on the management of atrial fibrillation (AF) in 2006. The following is also based on the joint American Heart Association (AHA), American College of Cardiology (ACC) and European Society of Cardiology (ESC) 2002 guidelines

    Agents used to control rate in patients with atrial fibrillation
    • beta-blockers
    • calcium channel blockers
    • digoxin (not considered first-line anymore as they are less effective at controlling the heart rate during exercise. However, they are the preferred choice if the patient has coexistent heart failure
    )

    Agents used to maintain sinus rhythm in patients with a history of atrial fibrillation
    • sotalol
    • amiodarone
    • flecainide
    • others (less commonly used in UK): disopyramide, dofetilide, procainamide, propafenone, quinidine


    Factors favouring rate control•
    * Older than 65 years
    * History of ischaemic heart disease
  26. Immo

    Immo Guest

    patient with bruising and blisters
    Hb stable but platelets only 5
    no neurology

    prednisolone
    platet transfusion


    2 questions of minimal change disease , treatment to prevent further protien loss

    prednisolone
  27. Guest

    Guest Guest

    the patient with exudative tonsillitis the true answer is
    guttate psoriasis which is common after streptococal infection and usally in young people
  28. Immo

    Immo Guest

    10 weeks pregnant lady with pleuritic chest pain and left calf pain
    what investigation

    venogram
    CTPA
    dopplers leg
    V/Q scan
  29. Guest

    Guest Guest

    NOOOOOO platelet transfusion for ITP as antibodies will destruct the new platelets...Give Immunoglobulins
  30. Guest

    Guest Guest

    i agree with you immo it is a predinsolone not platlet trasfusion
  31. Guest

    Guest Guest

    CTPA is the best options
  32. Guest

    Guest Guest

    i think the pregnant lady only needs leg doppler. She has a very suggestive CXR and if leg doppler +ve, no need for further scanning
  33. M SOLIMAN

    M SOLIMAN Guest

    patient with bruising and blisters
    Hb stable but platelets only 5
    no neurology

    prednisolone (ITP) PASSMEDICINE

    0 weeks pregnant lady with pleuritic chest pain and left calf pain
    what investigation

    CTPA (LESS RADIATION)

    thank u Immo
  34. Immo

    Immo Guest

    some surgical questions in mrcp


    elderly patient with left iliac fossa pain with mild temp , no sign of acute abdomen
    ? diverticulitis


    patient with rectal bleeding and brown macules around lips ( pets jeug)

    ? colonic ca
    ? angiodysplasia


    post ERCP patient develops abdo pain with mildly elevated amylase , erect cxr no free air
    next option?
    abx
    surgical opinion
    iv fluids analgesic
    repeat ercp
  35. Guest

    Guest Guest

    Pulmonary embolism is the leading cause of death in pregnancy. Despite the difficulties in clinical diagnosis and the concerns regarding radiation of the fetus, the British Thoracic Society guidelines for imaging pulmonary embolism do not specifically address the issue of imaging for pulmonary embolism in this group. This communication discusses the difficulties of diagnosis and imaging pulmonary embolism in pregnancy and proposes a suitable imaging protocol. Clinical exclusion of patients from further imaging is recommended if the patient has a low pre-test probability of pulmonary embolism and a normal d-dimer. It is advised that all remaining patients undergo bilateral leg Doppler assessment. If this test is positive, the patient should be treated for pulmonary embolism; if negative, all patients should be referred for CT pulmonary angiography. Ideally, informed consent should be obtained prior to CT scanning
  36. Guest

    Guest Guest

    one question about a diabetic patient 35 years old needs more doses of gliclazid and he have a ketones in urine but no wt loss
    options
    dm type 1 or
    late autoimmune DM ( LADA )
  37. Guest

    Guest Guest

    I think its type 1 because the patient had ketones which is exclusive to type 1 DM....what do u think?
  38. Immo

    Immo Guest

    patient investigated for addison , using some steroids nasal drops and work night shifts

    short synachten test 0900 high the normal dont remember the value
    0930 570 ( normal )


    diurnal variation
    ?use of steroids
    addison disease
  39. Guest

    Guest Guest

    no wt loss in this patient , and typically ther is wt loss unless trteted with insulin , ketones also occur in LADA
  40. Guest

    Guest Guest

    elderly patient with left iliac fossa pain with mild temp , no sign of acute abdomen+ constipation so I chosed Volvuls

    patient with rectal bleeding and brown macules around lips:? Crhons

    post ERCP patient develops abdo pain with mildly elevated amylase , erect cxr no free air(pancreatitis so I picked iv fluids analgesic)
  41. Guest

    Guest Guest

    don't forget plexus the patient presented with fever which goes with acute cholangitis and need of antibiotics
  42. Guest

    Guest Guest

    I thought of that during the paper but Abx will be important in all the possibilities.
  43. Immo

    Immo Guest

    patient develops lesion o to his left hand 4 yr after renal transplant
    ? cut lymphoma


    lady with severe right forearm pain during weekdays , extension of wrist cause severe pain , unable to hold pain or cup

    ? radial tunnel syndrome
    lat or medial condyle
    pronator sydrome


    question about T1 dermatome problem


    95 yr old gentleman 4 admission with confusion 1 time chest infection 3 times UTI
    next investigation
    ?cystoscopy


    preg lady with uti which abx
    ? cephalosorin


    mycoplasma pneumonia , patient not toleratind clarithrymycin what to give alternate , no other macrolide was in option


    bronchiectais what abx to prescribe
    ? cipro

    what investigation for bronchiectasis
    HRCT

    young lady with recently diagnosed PHT which will make her condition severe
    fatigue
    wheeze
    syncope
  44. Guest

    Guest Guest

    Anti ccp was poor prognosis
  45. Guest

    Guest Guest

    mycoplasma pneumonia you can use doxycycline
  46. Guest

    Guest Guest

    Drug cause diarrhea..?cyclosporin
    patient talking Doxirubicin..?eccho

    question on probability(p value) ...i think , At least as exterme as 5%

    mouth ulcers, diarrhea, thrPombophelebitis..?Behcet

    Pt felling worms under her skin...?somatoform

    ttt of Strongyloidosis...?Albendazole

    H. Influanza with B-Lactamase...?Vancomycin

    female 30 years with proximal weakness and ++CK....Limb and girdle myopathy

    Pt with ascitis and pain.... ascitic fluid cytology

    Multi-Risistant TB...No idea
  47. Guest

    Guest Guest

    1: Patient with acute renal failure, high K 7.6 what is immediate intial managment: Bicarbonate
    2: SVC obstruction: Radiotherapy
    3: 30 year old with high glycaemia and HbA1c 10.0, Ketone 2: Latent diabets of adult

    4: Stroke with AF: Aspirin
    5: Hashimatois thyroditis : TPO thyroid peroxidase antibody
    6: alpha one antitrepsin deficiency: autosomal ressive
    7: low mood, apathy and gait ataxia, MRI generalised atrophy: Hungtinton disease
    8: a yong lady with recurrent monthly migrain attack not responding to paracetamol and aspirin: Sumitriptan
    9:
  48. Immo

    Immo Guest

    Mode of inheritence of Alport syndrome
    ?x linked dominant

    patient after lap chole , mrsa seticaepia
    ? iv vanco


    nodular sclerosing hodgin lymphoma what will be the bad prognostic features


    people recieving warfarin what will be common effect with all of them requiring adustment of daily dose
  49. zafar_nzr

    zafar_nzr Guest

    An 18 yrs old woman with 2 month h/o sudden altered consciousness in which she remains still for about 20 mins; parents could help her sit; regains consciousness without any post-ictal state; aunt has h/o epilepsy; parents had recently decided to separate.......conversion disorder? complex partial siezure? cataplexy ? don't remember other 2 options. I chose cataplexy.
    In the question for bad prognostic factor for Ra, there was option for anti-CCP .
    In the question with pulm. - renal syndrome, ESR was given normal (10 only) ; so was it Wegner's or Goodpauster??
    A lady with itchy , scaly rash on the foot for 6 months; not improving with topical steroid; now rash has started spreading to the leg with central clearing.... ?Boriella serology ; skin scraping for mycology? skin scraping for gram stain? don't remember other options; I selected Boriella serology suspecting erythema chronicum migrans....don't know if i was right.
    a pt. with long h/o scleroderma presented with diarrhea, abdominal bloating etc. colonoscopy is normal ; best option for Rx? ... gluten free diet? prednisolone? tetracycline? don't remember other options.
    A 6 weeks pregnant pt. with UTI; started on ?macrolide ; culture showed resistance to macrolide. Alternative Abx? doxycycline? ciprofloxacin? , trimethoprim? don't remember other options. I chose trimethoprim.
    Gentamicin started for a pt. Creatinine deteriorated. Dosing interval increased to 12 hourly. What will be affected? Bioavailability ? volume of distribution? half life? protein binding? non-renal clearance?
    Commonest thrombophillia in norhtern europeans? factor V leydin heterozygous? protein C def.? protein S def.? there was one more option with heterozygous state; don't remember .
    25 yrs old woman with raised calcium and raised PTH; maternal uncle had primary hyperparathyroidism at the age of 35 yrs and his son had....don't remember exactly...but pointing to MEN I ; diagnosis for the woman...? ? hyperparathyroidism? MEN 2 ? vitamin D intoxication? don't remember the rest.
    A significant number of questions involving raised calcium levels.
    A pt. with raised Ca and PO4- ; pt. has lethargy; CXR shows basal reticulo-nodular shadows bilaterally. Dx ? fibrosing alveolitis? sarcoidosis? don't remember the other options.
    A 40 yrs old male with painless rectal bleeding. No family h/o carcinoma of colon; pt. has brown macules over lips. Cause of his rectal bleeding? carcinoma of colon? angiodysplasia?
    Imatinib is an inhibitor of? tyrosine kinase
  50. Guest

    Guest Guest

    Important prognostic features in HD is
    _ B symptoms- Fever /night sweats/wt loss
    - Mediastnal mass >10 cm

Share This Page