MRCP PART 2 Exam on 26th and 27th JULY 06, share exp. here

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  1. Dr. Shareef

    Dr. Shareef Guest

    Good Luck to all appearing this Part 2 , July 26thand 27th 2006 exam.

    Plz share your experience and the Qs asked in the exam.

    Dr. Shareef.
  2. S Hari

    S Hari Guest

    Lots of images in today's paper, these are what I remember...

    1 Intravenous urogram of papillary necrosis? Ring shadows seen?

    2 ECG: Sinus tachycardia with multiple atrial premature beats... D/D MAT and wandering atrial pacemaker

    3 ECG: bifascicular block/ trifascicular? I was not sure... management was PPM for trifasc... and induction loop if u thought it was bifascicular?

    4 CXR... Radiation pneumonitis?... very bizarre!

    5 CT abdo in an alcoholic not feeling well... hepatoma?

    6 MRI Spine coronal showing destruction of a disc space only. what is the next test to do... tuberculin test? Blood culture?

    7 old woman with dypnea on exertion and normal chest X Ray... consider multiple emboli... looked a bit like mitralization but she was too old for MS

    8 ECG with IWMI and 3:1 2nd degree heart block

    9 butterfly rash of SLE... (the way they mixed the most difficult pics with a simple one of a butterfly rash... I dont know how they choose their questions...)

    10 photosensitive rash on the face of a young woman preswnting with arthralgias and malaise,,, they asked which drug could have caused it, I chose minocycline

    11 slapped cheek rash on the face of a 16 yr old presenting with arthraliga... erythrovirus infection.

    12 old woman afer collapse at home... ECG shoed sinus brady. Q was what do you do. Since her BP was OK, I chose the option of close monitering only. NExt q was, what is the best inv to rule out caridac cause of her syncope, I chose ambulatory ECG

    13 a Pathology specimen on coal worker's lung... I chose that it showed 13bronciectasis... bit it showed progressive massive fibrosis? This was not in the choices though

    14 a girl who bit her nail... fingers had lesion which I thought were warts...

    15 bone scan with many many hot nodules including one in the skull. I chose pagets.

    16 bone scan with uniform uptake in tibia and fibula. I chose osteomalacia

    17 fundoscopy slide with sentral retinal artery occlusion with cherry red spot, which I maked as AION becasue the periphery seemed OK, but I think it was CRA occlusion...







    1 Intravenous urogram of papillary necrosis?retro peritoneal fibrosis. too selected retro peritoneal fibrosis as the ureter were kinked whcih happen in that case

    2 ECG: Sinus tachycardia with multiple atrial premature beats... D/D MAT and wandering atrial pacemaker. i forget whiich option i ticked for it

    3 ECG: bifascicular block/ trifascicular? I was not sure... management was PPM for trifasc... and induction loop if u thought it was bifascicular?

    4 CXR... Radiation pneumonitis?... very clear borders. I am not sure abt this answer

    5 CT abdo in an alcoholic not feeling well... hepatoma me too. if it was pancertic mass then i shluld be retro peritonela which was not in this case

    6 MRI Spine coronal showing destruction of a disc space only. what is the next test to do... tuberculin test? Blood culture?chest x ray search for primery?....was biopsy in that option. i think i selected it ....

    7 old woman with dypnea on exertion and normal chest X Ray, I selsected MS as i thought the starigntening of the left heart border and there was calification of the mitral valve

    8 ECG with IWMI and 3:1 2nd degree heart block..correct

    9 butterfly rash of SLE... (the way they mixed the most difficult pics with a simple one of a butterfly rash... I dont know how they choose their questions...) I didnt get this question at all. May i forgot the questions

    10 photosensitive rash on the face of a young woman preswnting with arthralgias and malaise,,, they asked which drug could have caused it, I chose minocycline ...same here too. as the phots showed the area of increased hair growth due to minocycline.

    11 slapped cheek rash on the face of a 16 yr old presenting with arthraliga... erythrovirus infection. I also had put the same choice

    12 old woman afer collapse at home... ECG shoed sinus brady. Q was what do you do. Since her BP was OK, I chose the option of close monitering only. NExt q was, what is the best inv to rule out caridac cause of her syncope, I chose ambulatory ECG .. I also marked the same choice as urs

    13 a Pathology specimen on coal worker's lung... I choose silicosis as it has lot of blackish dicolourisation and also emphyematous blebs also. Progresibe massive fibrosis also occurs in silicosis. Is it so.

    14 a girl who bit her nail... fingers had lesion which I thought were warts... viral wart. I really didnt what was the answer to this question

    15 bone scan with many many hot nodules including one in the skull. I chose pagets. i also choose multiple bone metastases becaouse if it was pagets and myeloma then the skull will be predominats affected which was in this case as it showed only one upatke and predominatly affected the back and scapula


    16 bone scan with uniform uptake in tibia and fibula. I chose HPOA. i though increased uptake meand new bone formation. i think they said she has finger clubbing also.

    17 fundoscopy slide with sentral retinal artery occlusion with cherry red spot, which I maked as AION becasue the periphery seemed OK, but I think it was CRA occlusion... u mean the lady with sudden onset loss of vision? I choose Optic neuritis since they said thar she had afferent pupillary defect.
    I felt it was very tough and no very scared abt the results in 4 weeks time.

    I think mostly i will re take the exam again next time.

    I took the course in 123doc.com for a month. it was ok.

    doctors who took the exam this time pls tell me abt what are the books and online courses u took and give us the feed back at the couser. was it exact reflective of the type of questions in the exam.
  3. Dr. Shareef

    Dr. Shareef Guest

    S.Hari,

    Thanks a lot for posting the Qs for 26-27July.

    Could you plz let us know, What helped you a lot in the exam among the following,

    1. ONEXAMINATION.COM,
    2. PASTEST ONLINE
    3. 123DOC.COM
    4.SANJAY SHARMA CLINICAL CASES.

    OR SOMETHING ELSE.

    PLZ GIVE A BRIEFING.

    THANKS A LOT AND I LOOK FORWARD FOR A GREAT SUCCESS FOR YOU.

    DR.SHAREEF.
  4. sohaib

    sohaib Guest

    1. cannon ball mets in lung: seminoma me too ,
    2 sclerotic right hip in patient with pain in hip: paget's i went wrong in this what was the other choice?

    3 x ray hand with resorbtion of terminal digits: systemic sclerosis me too

    4 third degree heart block me too , me too

    5 traumatic syringomyelia me too did we have 2 questions with traumatic syrnix and syringomyelia

    6 LLL collapse with triangular shadow behing heart: mucus plug. me too

    7 middle cerebral aneurysm in patient with temp lobe epilepsy . this i am not sure int carotid dissection??????????????/

    8 herpetic eczema on face of african woman. i chose the same answer as urs

    9 cervican lymph node TB in Morrocon farmer. I went wrong in this questions iam not sure about this question!

    10 pus over tonsil;;; next test should be Monospot or ASOT? this was not in my question this one was pus or candida it was extended to the hard palate???????????????????

    11 transverse section of a vertebral body with a tumour of some sort... meningioma?.....i chose neurofibrma

    12 MRI humerus head in renal failure head... osteitis fibroasa cystica?? i chose primary hyperparathyroidism , renal osteodystrophy????

    13 toxic megacolon management in UC patient... immediate step steroids or TPN?. i chose steriods i got this one wrong !!!


    14 barium enema of diverticulitis. s me toooooooooo

    15 vertically ridged nails with onycholysis: PSORIASIS .

    16 malignant pustule/ eschar managment;;; isolate first. this was not in my paper anthrax ..........antibiotic

    17 malignant CBD stricture managemnt... PTC/stent/balloon dilatation/surgery or what? \\ ....i chose PTC

    18 multiple SOLs in brain ... i chose mets not lymphoma because I thought lymphoma is unifocal but am not sure. even i chose mets

    19 altitudinal defect in perimetry answer for pale macula in a strip across upper retina on fundoscopy

    20 TOXOPLASMOSIS on fundoscopy

    21 dermatitis herpetiformis i-on forearms.....i am not sure abt this answer

    22 cutaneous larva migrans on foot



    Other questoins...23 what did the boxer with horners and eye pain have... pontine lesion/ caroticocavernous fistula/spinal lesion/ dont remember other choices. other choices were lateral medullary syn....i selected lateral medulary. cartoid desccetsion ia acute condition and BP was normal. Cartocavernous fistula will have pulasite eye ball.

    24 woman living with natives in Tanzania getting a fever and urticarial rash... tick typhus or sshistosoma i choose schistosomiaisis for the high esionophilic count what do u think about this?
  5. Guest

    Guest Guest

    fundoscopy slide with sentral retinal artery occlusion with cherry red spot, which I maked as AION becasue the periphery seemed OK, but I think it was CRA occlusion... u mean the lady with sudden onset loss of vision? I choose Optic neuritis since they said thar she had afferent pupillary defect it was painless loss of vision

    what about this lady with infective endocardits on antibiotic tt and daily ecg monitoring for what PRor QT interval and why?

    there was one ecg with tall t waves what was the mangement?
  6. anjalee

    anjalee Guest

    inf endocarditis with aortic root involvement cqan affect the AB node/ conducting system and cause blocks... so the answer could be QRS duration or pr interval??? not sure. and the one with the tall t waves... hyperkalemia on ECG means immediate managment with calcium gluconate... I think?

    lead poisoning... sodium edetate?

    genotype 3 response to ifn peg plus ribavarin 75%?

    did anyone else think that primary biliry cirrhosos was asked too too much??? the lady suspected of a hematological disorder with abn LFT and alot of IgM... I chose PBC as I could not see her having anything more suitable.

    And the one with retinal changes secondary to hyperviscosity and serum protein greater than 100.... I chose plasma exchange as answer

    what do u think..
  7. Nath

    Nath Guest

    1. barber presenting with multiple - Viral warts
    2. lady on amiodarone and presenting with fever and spreading malar rash - Erisepelas ( very tricky question, tend to choose SLE)
    3. CXR - Mitral Stenosis
    4. CT scan of abdomen - Lt lode heptocellular carcinoma
    5. IVU - Clubbing of Calyces - ?Chronic Pyelonephritis
    6. young lady with facial rash - ?Minocycline ,? OCP
    7. pt with recurrent eistaxis in the past - wegeners
    8. Hep c pt with renal imp - Cryoglobulinemia
    9. pt taking many medicines and proteinuria - Interstitial Nephritis
    10. Young boy with heam + Prot,his maternal grand father was effected - Alports
    11. fundoscopic view of cherry red spot,painless visual loss,afferent puillary defect -? CRA occlusion
    12. ECG of Hyperkalemia - Insulin
    13. ECG - Sinus Brady cardia with dizziness but stable - ?Observe patient
    14 ECG - Sinus Brady - Monitered Cardiac Massage
    15 Treatment for SLeep opnea - Cont pos pressure
    16 ECG showing SVT with vent ectopics
    17 ECG with CHB
    18 Bone scan with mulitple hot spots - Bony mets
    19 Pt having joint pains in the evening,no other abn - Osteoarthirits
    20 Young pt with upper lobe fibrosis - Ank.Spon
    21 HIVpt with night sweats,CD4< 50 - MAI
    22 Autopsy specimen of Lung -?Bullous Emphysema
    23 pt with rhabdomyoslysis ,teatment - IV normal saline
    24 CT scan of brain showing multiple ring enhancing lesions - Cerebral Lymphoma
    25 Pt with restrictive lung with dec KCo - Neuromuscular disease
    26 - ABG after Cardiac Arrest - Difficult -there are 3 options sugg of met +Resp Acidosis
    27- Pt presenting with chestpain radiating to back - def invest - TOE
    28 - fundoscopic view with retinal lesion - is it Retinoblastoma?
    29 - pt with diarrhea and hypokalemia - Villous Adenoma
    30 - asian lady presenting with headaches fever - tuberculoma
    31 - Asian LAdy with Anasarca - Beri Beri
    32 - student found drowsy in room - Carbon monoxide pois -
    33 - Pneumo Pnuemonia and pt rcvd dapsone and trimethoprim presenting with Pso2 of 97% and So2 of 86% , What investigation will u do imme - ?Repeat ABG
    34 - pt with itchy legs,hemosiderin pigment - treatment - ?LMWH ( Venous thromosis), I think its topical steroid.
    35 - CT scan Abdo - Pancreatic Pseudo Cyst
    36 - Young man returned from turkey with fulminant hepatic failure - Hepatitis A
    39 - young man with H/O lithium presenting with Abnormal LFT Paracetamol level on the first sample negligible - Paracetamol overdose
    40 - lady presenting with Obsessive compulsive disorder best treatment - Cognitive behavioural therapy
    41 - pt with diarrhea and rash,renal impairment - HUS , investigation - Stool Culture
    42 - Pt was withdrawn all medications presented 3 days after with sweatings,palpitations ,which drug caused this - Paroxetine
    43 - Pt heard voices saying he has some serious medical condition - Paranoid Schizophrenia or ? Psychotic depression
    44 - pt with dyslipidaemia predominantly triglycerides which drug - fibrate
    44 - pt with stable heart failure ,which drug will reduce the risk of cardiac arryhtmias- Bisoprolol
    45- diabetic nephropathy - irbesartan
    46 - MRI of spine, pt presenting with fever , which inves next - Blood Cultures or Tuberculin - choose Bl cultures
    47 - another MRI, with scoliatic spine - is it disc prolapse
    48 - pt presenting with sudden paraplegia - Sinal artery infarction
    49 - MRI brain - Multiple Sclerosis
    50 - bone sacn showing tibia and fibula - Ostemalacia or Multifocal Osteomyelitis
    50 - pt presenting with lead poisoning - ?sodium edetate
    All these answers are the one I choose and they might be wrong, Please try to recollect questions and post it here so we can discuss and it would be helpful for others as well.

    Thanks
  8. Nath

    Nath Guest

    51. pt presenting with SAH,Lumbar puncture showed blood staind CSF,whats the next invest - Cerebral Angio
    52 - pt receving infliximab for RA - Tuberculosis
    53 - X ray of rt Hip with sclerosis - Pagets
    54 - african girl with rash - Eczema Herpeticum
    55 - young boy with repeated proteinuria/Nephrotic syndrome,what invest next - estimate selectivity of proteinuria to guide treatment
    56 - common bile duct stricture ,what would you do - Percutaneus colang
    57 - X ray with bone resorption in a renal pt - - renal osteodystrophy
    58 - pt with temp 26 after 26 min of CPR ,unconscious arrived by helicopter,what will you do next - Stop CPR
    59 - pt with hyperviscosity - plasmapheresis
    60 - pt with raised Ig M and renal failure - ?Wladenstroms hypregammaglobulineamia
    61 - pt with normal ca normal po4 and raised alp - osteomalacia
    62 - pt with repeated epistaxis - wegeners
    63 - pt with barrets and confirmation of invasion of the abnormal cells ,what will you do - ? Omeprazole or ? Fundoplication
    64 - pt with repeated gastritis,what next - H.Pylori
    65 - treatment of pregannt lady with symptomatic AS - Biological valve rep
  9. gust

    gust Guest

    hand with viral wart
    cxr of mitral stenosis
    lady in tanzania shistomiasis
    man from sudan hiv
    man return from egypt hepatitis a
    lady on minocylin develop sle
    elderly with meningitis listeria monocytogen
    elderly with ca colon develop ie st bovis
    lady with malaise tb adrenalitis
    lady asian develop wt gain and depression hypothyroidism`
    pregnant femal 32 with a v disease metalic valve replacement
    elderly man with symptomatic a v stenosis metalic valve replacement
    man travel from calumengaro develop pulm embolism
    man with deranged lft repeat paracetamol level
    lady with pruritis pbc give chlystyramin
    lady with hypertensive crisis of scleroderma give acei oral
    patient with mailg hpt give iv niprid
    high tg give fibrate
    lady from holiday develop ligonela with hyponatremia
    severe asthma give mg sulfate
    ecg with tall t wave give ca cloride
    chest pain and ecg change mi give altaplas
    pulm embolism do ct pulm angio
    patient with sclerosing choleangitis do ercp
    patient with paraplegia develop syrinx
    ovoid intra cranial extradural hematoma
    xr hand tufted idstal phalanx sc
    patient with rynaulds give nivedipine
    patient dm to decrease renal function deteroration give ravsartan
    bizar shape tyriod function amiodaroin effect
    ecg 2nd degree hb
    ecg chb
    ecg aflutter with avn block
    lady face butterfly rash crossing the nose bridge sle
    16 y old boy with 3rd time nephrotic s give steroid
    patient develop sle nephrotic give steroid
    patient with sle biopsy memberanous
    xr shoulder ofcystica
    candida esophagitis give oral conazol for 7-14 days
    pcp patient on dapson develop methhb stop dapson
    drowsy femal co toxcicty
    neutropenic patient give meronem and ceftazidem
    pulm func with restrictive patern and high coeffecient pleural restriction
    copd excerbation need ventilation not available give doxpram
    status epileptus receive lorazepam not responding give iv fosephynetoyn
    asperliloma with recurent hymoptysis surgical removal
    patient with history of nasal polype wegners
  10. gust

    gust Guest

    patient develop renal failure with fh alport
    patient with isolated increase in bilirubin do unconjucated bilirubin
    patient develop impotence 4y back with dm and arthritis haemochromatosis
    3 cm pneumothx in diseased lung insert chest drain
    lung post mortom with emphysematous bulla
    young femal face with erythrovirus
    man foot with cut larva migran
    acut spinal artery s
    vertebral tb
    bone scan in ll increase uptake bilat osteomalacia
    bone scan with skull paget disease
    patient with hypophosphatemic rik give phosphate pluse cacetriol
    patient with high alk po and low ca oseomalcia
    xry abdomed with uc
    ivp with papilary necrosis
    patient with inerstitail nephritis
  11. gust

    gust Guest

    patient with high ieg and pulm hge ex all aspergilosis
    hus to diagnose do stool culture
    pateint with high aptt his serum could not be corected byy plasma it is antiphospholipid s
    patient with hemolysis do fragility test
    elderly patienn malase fbc showed wbc of 27000 cll
    patient with dysness and syncope do 24h ambulatory ecg
    post mi develop 5 ectope over a day not affected hemodynamecally observe
    csf with picture of cryptocosis meningitis
    suden painless los of vision rvein oclusion
    young spotive man develop in carotid a disectin
    chest pain to the back ao disection do tee
    asian lady develop hypothyroidism
    pregnant femal epileptic on na valoperate to continue
    young lady with acne vulgaris to start isoretonin to do hc gonadotrophin to exclude pregnancy
    man with orcodopexy develop mass teratoma
    man with holly jewel body will catch str pneumonia
    man develop methb do spectophotometry
  12. Guest

    Guest Guest

    for the guest who post the answers above i think u will pass easily
    pray for me tooooo
  13. US

    US Guest

    GUEST - THANKS A LOT FOR POSTING THE QS .

    PLZ TRY TO RECALL MORE QS AND POST THEM.

    WHAT HELPED YOU IN PREPARING THE EXAM.

    1. ONEXAMINATION.COM.
    2. PASTEST ON LINE
    3. 123DOC.COM
    4. MEDICAL MASTER CLASS.
    5. SANJAY SHARMA BOOK OR CD
    6. HANS ULRICH LASH MRCP 2 PRACTICE PAPERS

    PLZ RESPOND .
  14. OREOLUWA

    OREOLUWA Guest

    Thanks so much for all the efforts well appreciated.Wishing all good success.
  15. kenglad

    kenglad Guest

    excellent

    hey thanks for all the recalls
    u chaps are great
    all the best
    would onexamination be a good revision course for part 2 prep?
    :lol:
  16. khk

    khk Guest

    cardiology recalls

    Cardiology

    1) Infectious endocarditis---monitor PR interval
    2) 30year old pregnant lady with AS---bioprosthetic valve replacement
    3) AS with symptoms---mechanical valve replacement
    4) 48yr old gentleman with tropT0.22 and T-wave inversion v1-v6---Angiography
    5) pt with focal neurology, mid-diastolic murmur---Atrial myxoma
    6) pt with aortic aneurysm and pain radiating to back, ECHO unremarkable, next investigation---TOE
    7) CXR shows calcified aortic vavle, associated signs---kassmauls, femoral delay
    8) heart failure---bisoprolol
    9) ECG---Third degree heart block
    10) another ECG---CHB/idioventricular rhythm
    11) 53 yr old with HTN, on ramipril and B-blocker, BP of 142/87 etc and heavy alcohol consumption---cut down alcohol
    12) ECG---preventricular excitation
    13) ECG with sinus brady cardia---Observe
    14) same pt, what to do next---24hr monitoring
    15) post-MI, VF----amiadrone, flecanide
    16) cardiovert VF---Flecanide
    17) 3mins of CPR in pt with asystole
    18) AF with TIA---immediate management---Aspirin, warfarin
    19) BP 230/130--- sodium nitroprusside
    20) scleroderma and BP 230/120---oral captopril
    21) CXR--- MS
    22) HOCM with collapse--- DDDpacemaker, DDD with implantable cardioverter
    23) Alteplase for MI
    24) potassium 6.5---cacl2
    25 Man with typical history of MI, presents 6hrs later---troponinI
  17. cute doctor

    cute doctor Guest

    Q15-flecainide is CI at heart diease
  18. cute doctor

    cute doctor Guest

    Q 17-what were other options beside 3 minutes?as the rule change at 2005 but before that it was 3 min :roll:
  19. Guest

    Guest Guest

    kengland

    onexamination is great for mrcp part 2 - go for it!
  20. khk

    khk Guest

    more q's

    yes flecanide is not the right ans but v cant stop them from giving the wrong options.....lol



    GIT

    1) PBC---lady with pruritis and raised IgM
    2) Another pt with raised ALP and picture consistent with PBC---investigation of choice Liver biopsy
    3) Paracetamol overdose with deranged LFT’s and INR
    4) Man with anaemia and symptoms of UC, deranged LFT’s---primary sclerosing cholangitis
    5) Non-alcoholic steatohosis
    6) Man with deranged LFT’s and raised immunoglobulins---autoimmune hepatitis
    7) Man who went to Egypt and had raised transaminases---HepA
    8) Treatment of deranged LFT’s with PBC---ursodeoxychoilic acid,prednisolone,cholestyramine
    9) Old man with wt. loss and raised ALP---pancreatic carcinoma
    10) Another case of pancreatic carcinoma
    11) AXR showing lead pipe rigidity of UC
    12) Another picture showing toxic megacolon and exacerbation of UC---iv hydrocortisone
    13) Scurvy
    14) GORD and Barretts---H2receptors,fundoplication
    15) 39 yr old with dyspepsia and PPI,again with exacerbation of symptoms---C-breath test,serology,endoscopy
    16) CD---elemental diet, parenteral nutrition
    17) Oral ulceration and previous stroke---bachets
    18) HCC---liver CT
    19) Serum ferritin in hypogonadotrophic hypogonadim
    20) SBP---cefuroxime

    Respiratory Medicine

    1) man with clear sputum production---alveolar cell carcinoma
    2) type2 resp failure with mechanical weakness---NIPPV, intubation and ventilation
    3) autopsy lung---bullae
    4) aspergillosis with FEV1 2.6---surgery
    5) man came from libia with strange appearance on CXR---TR,TB,Pneumocytis
    6) asthmatic---MgSo4
    7) progressive increase in SOB and restrictive defect with normal KCO---intersitial lung disease
    8) bilateral pleural thickening in pt with raised KCO
    9) cavitating pneumonia---klbesiella
    10) COPD with pneumothorax--- chest drain
    11) COPD in an old man, how to d/f from Asthma---reversibility criteria
    12) COPD---stop smoking
    13) Low Po2 and Pco2---PE
    14) Pt with wedge fracture of T7,whats next, life long smoker and wt.loss---CXR
    15) Obs sleep apnea syndrome---uvuloplasty,CPAP,Wt.loss
    16) Pt on infliximab---TB
    17) CXR---healing rib fractures, radiation pneumonitis
    18) CXR---cannon ball metastases---seminoma
    19) LLL collapse with triangular shadow behind in asthmatic---mucus plugging,pneumonia
    20) Leigonella pneumonia with low Na
    21) Bone scan---HPOA
    22) Adult with repeated chest infections in childhood---pseudomonas,streptococus
  21. khk

    khk Guest

    endo/haem/onc

    DM AND ENDO

    1) post MI---continue insulin for 3/12
    2) diabetic---decrease insulin in night
    3) increased insulin and low C-peptide---insulin overdose
    4) pt on calcitriol---give Mg
    5) increased calcium, already had fluids---palmidronate
    6) SIAD---fluid restriction is the first thing to do
    7) Rhabdomyolysis---normal saline
    8) Hypothyroidism and low BP---hydrocortisone first
    9) 61 yr old lady with wrinkiled skin etc---check TFT’s,serum cortisol
    10) decreased sodium and osmolarity---psychogenic drinking
    11) micro pituitary adenoma---dopamine agonist
    12) pt with high mid cortisol, not suppressed by low dose dex---high dose dex test
    13) another q, with no suppression by high dose dex---ACTH secreting tumour
    14) osteomalacia---decreased Ca and PO4
    15) pagest disease---investigation---isotope bone scan
    16) hot spots on bone scan---pagests,bony mets
    17) poor compliance with thyroxine
    18) increased TSH,T3,T4, on amiodrone---TSH secreting tumour
    19) raised ESR,acute thyrpoiditis---inv of choice---isotope bone scan
    20) diabetic lady with venous ulcer---hydrocortisone cream
    21) anti-diabetic effecting absorption---acarbose
    22) diabetic nephropathy---drug of choice---ibersartan
    23) asian lady with hypoadrenalism---autoimmune adrenalitis,TB
    24) lady with wt gain and depression---hypothyroid
    25) pt with impotence and weakness---GH deficiency
    26) how to reduce diabetic retinopathy---sugar control,diabetic nurse referral,BP control

    HAEMATOLOGY/ONCOLOGY

    1) 2hr post-transfusion, temp38.6---give paracetamol and keep an eye on pt
    2) man 61,WCC23,splenomegaly 4cm---CML,CLL
    3) IDA,not helped by oral iron---im iron,iv iron,tranusion
    4) Pt on hemodialysis and low Hb,on erythropoietin and deranged U&E’s---increase dialysis
    5) 17yr old with low Hb and high retic and splenomegaly---osmotic fragility test
    6) pt started on quinine---G6PD deficiency
    7) pt with suspected leukaemia, CML---karypotyping,ALP score
    8) prostate carcinoma with IHD/CABG,79 yr old,no secondaries---radical XRT,Surgery,radical chemo,goseralin
    9) pt with SCLC---chemo
    10) role of cyperoterone acetate---decrease the chance of recurrence
    11) SVCO---dexamethasone
    12) Neutropenic sepsis---cef and piperacillin
  22. khk

    khk Guest

    200 q's

    Cardiology

    1) Infectious endocarditis---monitor PR interval
    2) 30year old pregnant lady with AS---bioprosthetic valve replacement
    3) AS with symptoms---mechanical valve replacement
    4) 48yr old gentleman with tropT0.22 and T-wave inversion v1-v6---Angiography
    5) pt with focal neurology, mid-diastolic murmur---Atrial myxoma
    6) pt with aortic aneurysm and pain radiating to back, ECHO unremarkable, next investigation---TOE
    7) CXR shows calcified aortic vavle, associated signs---kassmauls, femoral delay
    8) heart failure---bisoprolol
    9) ECG---Third degree heart block
    10) another ECG---CHB/idioventricular rhythm
    11) 53 yr old with HTN, on ramipril and B-blocker, BP of 142/87 etc and heavy alcohol consumption---cut down alcohol
    12) ECG---preventricular excitation
    13) ECG with sinus brady cardia---Observe
    14) same pt, what to do next---24hr monitoring
    15) post-MI, VF----amiadrone, flecanide
    16) cardiovert VF---Flecanide
    17) 3mins of CPR in pt with asystole
    18) AF with TIA---immediate management---Aspirin, warfarin
    19) BP 230/130--- sodium nitroprusside
    20) scleroderma and BP 230/120---oral captopril
    21) CXR--- MS
    22) HOCM with collapse--- DDDpacemaker, DDD with implantable cardioverter
    23) Alteplase for MI
    24) potassium 6.5---cacl2
    25 Man with typical history of MI, presents 6hrs later---troponinI
    26) pt with moderate AS going for surgery70 yr old---what would be indication for not attempting surgery---5ectopics per minute
    27) pt on treadmeal, complains of chest pain---stop treadmeal

    GIT

    1) PBC---lady with pruritis and raised IgM
    2) Another pt with raised ALP and picture consistent with PBC---investigation of choice Liver biopsy
    3) Paracetamol overdose with deranged LFT’s and INR
    4) Man with anaemia and symptoms of UC, deranged LFT’s---primary sclerosing cholangitis
    5) Non-alcoholic steatohosis
    6) Man with deranged LFT’s and raised immunoglobulins---autoimmune hepatitis
    7) Man who went to Egypt and had raised transaminases---HepA
    8) Treatment of deranged LFT’s with PBC---ursodeoxychoilic acid,prednisolone,cholestyramine
    9) Old man with wt. loss and raised ALP---pancreatic carcinoma
    10) Another case of pancreatic carcinoma
    11) AXR showing lead pipe rigidity of UC
    12) Another picture showing toxic megacolon and exacerbation of UC---iv hydrocortisone
    13) Scurvy
    14) GORD and Barretts---H2receptors,fundoplication
    15) 39 yr old with dyspepsia and PPI,again with exacerbation of symptoms---C-breath test,serology,endoscopy
    16) CD---elemental diet, parenteral nutrition
    17) Oral ulceration and previous stroke---bachets
    18) HCC---liver CT
    19) Serum ferritin in hypogonadotrophic hypogonadim
    20) SBP---cefuroxime
    21) Picture of gilberts syndrome---do unconjugated biluribin next
    22) Question on celiac disese

    Respiratory Medicine

    1) man with clear sputum production---alveolar cell carcinoma
    2) type2 resp failure with mechanical weakness---NIPPV, intubation and ventilation
    3) autopsy lung---bullae
    4) aspergillosis with FEV1 2.6---surgery
    5) man came from libia with strange appearance on CXR---TR,TB,Pneumocytis
    6) asthmatic---MgSo4
    7) progressive increase in SOB and restrictive defect with normal KCO---intersitial lung disease
    8) bilateral pleural thickening in pt with raised KCO
    9) cavitating pneumonia---klbesiella
    10) COPD with pneumothorax--- chest drain
    11) COPD in an old man, how to d/f from Asthma---reversibility criteria
    12) COPD---stop smoking
    13) Low Po2 and Pco2---PE
    14) Pt with wedge fracture of T7,whats next, life long smoker and wt.loss---CXR
    15) Obs sleep apnea syndrome---uvuloplasty,CPAP,Wt.loss
    16) Pt on infliximab---TB
    17) CXR---healing rib fractures, radiation pneumonitis
    18) CXR---cannon ball metastases---seminoma
    19) LLL collapse with triangular shadow behind in asthmatic---mucus plugging,pneumonia
    20) Leigonella pneumonia with low Na
    21) Bone scan---HPOA
    22) Adult with repeated chest infections in childhood---pseudomonas,streptococcus

    DM AND ENDO

    1) post MI---continue insulin for 3/12
    2) diabetic---decrease insulin in night
    3) increased insulin and low C-peptide---insulin overdose
    4) pt on calcitriol---give Mg
    5) increased calcium, already had fluids---palmidronate
    6) SIAD---fluid restriction is the first thing to do
    7) Rhabdomyolysis---normal saline
    8) Hypothyroidism and low BP---hydrocortisone first
    9) 61 yr old lady with wrinkiled skin etc---check TFT’s,serum cortisol
    10) decreased sodium and osmolarity---psychogenic drinking
    11) micro pituitary adenoma---dopamine agonist
    12) pt with high mid cortisol, not suppressed by low dose dex---high dose dex test
    13) another q, with no suppression by high dose dex---ACTH secreting tumour
    14) osteomalacia---decreased Ca and PO4
    15) pagest disease---investigation---isotope bone scan
    16) hot spots on bone scan---pagests,bony mets
    17) poor compliance with thyroxine
    18) increased TSH,T3,T4, on amiodrone---TSH secreting tumour
    19) raised ESR,acute thyrpoiditis---inv of choice---isotope bone scan
    20) diabetic lady with venous ulcer---hydrocortisone cream
    21) anti-diabetic effecting absorption---acarbose
    22) diabetic nephropathy---drug of choice---ibersartan
    23) asian lady with hypoadrenalism---autoimmune adrenalitis,TB
    24) lady with wt gain and depression---hypothyroid
    25) pt with impotence and weakness---GH deficiency
    26) how to reduce diabetic retinopathy---sugar control,diabetic nurse referral,BP control

    HAEMATOLOGY/ONCOLOGY

    1) 2hr post-transfusion, temp38.6---give paracetamol and keep an eye on pt
    2) man 61,WCC23,splenomegaly 4cm---CML,CLL
    3) IDA,not helped by oral iron---im iron,iv iron,tranusion
    4) Pt on hemodialysis and low Hb,on erythropoietin and deranged U&E’s---increase dialysis
    5) 17yr old with low Hb and high retic and splenomegaly---osmotic fragility test
    6) pt started on quinine---G6PD deficiency
    7) pt with suspected leukaemia, CML---karypotyping,ALP score
    8) prostate carcinoma with IHD/CABG,79 yr old,no secondaries---radical XRT,Surgery,radical chemo,goseralin
    9) pt with SCLC---chemo
    10) role of cyperoterone acetate---decrease the chance of recurrence
    11) SVCO---dexamethasone
    12) Neutropenic sepsis---cef and piperacillin

    NEUROLOGY

    1) lady with nasal congestion and now high tremperature and focal neurology---cerebral abscess
    2) CIDP
    3) Cervical spondylosis
    4) Gram positive bacillus on CSF with low glucose---listeria/TB
    5) Man coming from Africa with mengitis;6wcc but all neutrophils---malaria
    6) Pt with SAH,LP shows blood,CT withour contrast normal---cerebal angiography
    7) Pt with ataxia and cerebellar signs---phenytoin toxicity
    8) Carotid artery dissection in a boxer
    9) Tramautic syringomyelia
    10) Another case of syringomyelia
    11) MRI scan of asian lady---tuberculoma,meningioma
    12) Pt with sudden paraplegia, features consistent with spinal artery obstruction
    13) Status eplilepticus---i/v phosphophenytoin
    14) Pt with self-limiting epilepsy---observe
    15) Progressive dementia in 72yr old with odd behaviour over 3/52---Subdural,AD
    16) Girl with tingling sensation in the arm and funny behaviour with a murmur---do EEG for CJD,ECG,ECHO etc
    17) Pregnant lady on sodium valproate---continue
    18) A case of CJD
    19) Another lady on anti-epileptics,seizure free for 7yrs---continue
    20) HIV pt with Cryptococcus meningitis
    21) Young man with dizzy spells related to posture---benign postural vertigo
    22) A case of acoustic neuroma
    23) Rt shoulder pain after some injection etc---neuralgic amyotrophy
    24) L4lesion

    NEPHROLOGY

    1) a typical case of interstitial nephritris---pt on diclofenac
    2) pt with renal stones,previous surgery for renal stones---check urinary cysteine,po4,ca
    3) MRI---bilateral kinking---retroperitoneal fibrosis
    4) Pt with hemodilysis and carpel tunnel syndrome---amyloidosis
    5) Pt on cyclophosphamide with painless haemeturia---bladder ca
    6) Renal failure with raised myoglobulin---iv fluids
    7) Pt with HUS---stool cultures
    8) Alports syndrome
    9) Genetics od alports syndrome---father would effect less than 5%o males and all females
    10) Pt on ACE-I, raises U&E---do creatinine clearance
    11) Pt with previous nephritic syndrome responded well to steroids---steroids,steroids with cyclophosphamide

    RHEUMATOLOGY

    1) SLE flare-up of joints---hydrochloriquine
    2) Nasal problems with LRTI and renal failure---wegners
    3) Picture of septic arthritis---joint aspiration
    4) Pt with carpel tunnel syndrome,wants no surgery---corticosteroid injection,splint
    5) Man with SLE features and rasied APTT,not helped by 50:50---APL syndrome
    6) Rash on legs and renal failure and hepC---cryoglobuinaemia
    7) SLE,with proteinuria---membranous nepthropathy

    DERMA/EYE

    1) Gorton papules photograph
    2) Tense blisters in 82yr old with oral involvement---pemphigoid,pemphigus
    3) African girl with rash on face---erythema herpeticum
    4) Lady with erypiselas
    5) Fascial SLE---secondary to minocycline
    6) Lady with isoterention---do B-HCG
    7) Oral fluconazole 50mg OD for 2/52 in pt with oral candidiasis
    8) Do HIV test in the above pt
    9) Girl with bitting finger nails---warts,psoriasis
    10) Painful eye with afferent defect---optic neuritis
    11) Another similar q in next paper---optic neuritis
    12) 2 q’s on Central retinal artery occlusion
    13) fundus---toxoplasmosis,retinitis pigmentosa
    14) fundus---central lesions
    15) fundus—eccentric lesions
    16) cutaneous larva migrans

    INFECTIOUS DISEASES/PSY

    1) painful groin ulcer with inguinal lymphadenopathy---do Viral serology and start femciclovir,do bacterial
    2) guy with raised eosinophils---schistomiasis
    3) lady on diving course---leptospirosis
    4) slapped cheek syndrome---erthrovirus
    5) picture of throat---do monospot test
    6) ABG---psychotic hyperventilation
    7) Obsessive-complusive disorder---cognitive behavioural therapy
    8) Lady who hears voices that she has cancer---schizophrenia
    9) HIV with CD4 less than 50---MAI
    10) Acute mania---lithium,olanzapine,clozapine
    11) Pt with withdrawl syndrome---methadone
    12) Painful penile ulcer---H.duceryi
    13) Pt with sepsis,increased pulse and low BP---staph aureus
    14) Pt with IE, bowel cancer---St.Bovis
    15) Chap in ward with C.Diff,different sensitivities given, whats best oral---fusidic acid with minocycline
    16) Lesion on the forearm with high temperature---benzyl penicillin,tetracycline
    17) Farmer with brucellosis

    MISCELLANEOUS/PHARMA

    1) lead poisnoning---sodium ecetate
    2) pt with reynauds---nifedapine
    3) pt with high triglycerides---atrovastatin
    4) pt with high cholesterol and triglycerides---familial hypercholestermia,familial trygylceredemia
    5) pt with prolonged CPR, temp26---bladder irrigation,stop CPR
    6) adult alcoholic with hemocysteine low---due to folate def,cysteine reductase def
    7) pt with dapsone and trimethoprim---check serum levels, hb spectroscopy
    8) CO poisoning---chap with 100%sats but low Po2
    9) LSD poisoning with dilated pupils and sympathetic signs
    10) SIADH---fluoxetine
    11) Digoxin toxicity---digiband
    12) Lithium toxicity
    13) Man with orchidopexy---teratoma
    14) Heparin induced thrombocytopenia
  23. khk

    khk Guest

    results and cut off

    Results would be out in the week commencing 28th aug....I beleive cut off would be around 58%
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