MRCP PART 2 WRITTEN APRIL 2010

Discussion in 'MRCP Forum' started by mint_girl, Apr 8, 2010.

  1. mint_girl

    mint_girl Guest

    Hello all!

    What did you think of the exam? I'm too tired to even relax! And I really want to know the result now! Let's discuss some questions in the meantime..!

    The one that comes to my mind at the moment is the pregnant woman at 36 weeks who has low TSH and high T4 levels and has symptoms of tremor. Was the answer propanalol or carbimazole? I know that carbimazole is contraindicated in pregnancy and i've been doing some searching on the net. Some articles say that if no choice then give carbimazole and another article said, if no choice then resort to SURGERY!! Now what does the royal college want us to answer?!:)
  2. Guest

    Guest Guest

  3. MRCPaspirant

    MRCPaspirant Guest

    FYB

    I felt that all the 3 papers were tough..and i was a bit underprepared!but then when can one be prepared fully with medicine as such...

    I sat the exam in Chennai/India...

    They asked 90questions x 3papers(probably keeping in mind that 100 might be too many,given the lengthy case scenarios).

    A lot of questions from Nephrology - abnormal urinalysis, many nephritic/nephrotic syndromes!!

    Other RCP favorite topics - MIs, Diarrheas, skin spotters, etc,.!!

    A few straight-forward questions too....

    One can never be sure how well the exam went..cause there will always be debate as to what the right answers are..!
  4. Najlaa

    Najlaa Guest

    to mint_girl: is that Q was accompany with photo of thyroid gland isotope scan? :shock:
  5. pebble

    pebble Guest

    It was a question with the values - low TSH, high fT4. No thyroid scan given. I read somewhere to avoid use of propranolol in pregnancy. Chose carbimazole.
  6. MRCPaspirant

    MRCPaspirant Guest

    Treatment of Hyperthyroidism in Pregnancy

    • Radioiodine therapy for pregnant women with hyperthyroidism is absolutely contraindicated. And use of Iodine is not recommended as well.

    • Assuming there are no contraindications to its use, we suggest using a beta blocker for pregnant women with moderate-to-severe hyperthyroidism and hyperadrenergic symptoms. However, toward the end of pregnancy, they should be given only to women who have many symptoms because occasional cases of neonatal growth restriction, hypoglycemia, respiratory depression, and bradycardia have been reported after maternal administration.

    • For women with moderate to severe hyperthyroidism complicating pregnancy, we suggest a thionamide as our first choice of treatment
    We suggest using PTU rather than methimazole in the first trimester, and switching to methimazole at the start of the second trimester

    •We only suggest thyroidectomy in hyperthyroid women during pregnancy who cannot tolerate thionamides because of allergy or agranulocytosis.

    Source: Uptodate
  7. Najlaa

    Najlaa Guest

    :wink: i remebered this Q and and answers were:
    1- thyroidectomy
    2- carbimazole
    3- propronalol
    4- radioidonine
    5- carbimazole+levothyroxine

    i choose number 5
  8. ab1385

    ab1385 Guest

    The answer is either carbimazole or propranolol.

    It's not radioiodine - permanent damage to the fetus. It's not block and replace with carbimazole and thyroxine because if using carbimazole you'd be aiming to use the smallest dose possible to minimize risk to the fetus. I'm fairly sure it's not surgery - for a start you can't really have a GA at 36 weeks pregnant.

    So it's either propranolol or carbimazole. I personally chose carbimazole as this was reasonably severe hyperthyroidism, TSH < 0.1 - though her symptoms were only mild and maybe you could get away with propranolol until birth.

    The main thing that makes me think I was probably wrong was that if you were going to give anti-thyroid drugs it would be PTU rather than carbimazole, so I think it probably is supposed to be propranolol, but I'm not sure.
  9. Najlaa

    Najlaa Guest

    the Q mentioned is consider new so better discuss these type Q AND no need to mention repeated Q from previos exams or which mentioned at some websites :?
  10. MRCP wannabe

    MRCP wannabe Guest

    I thought the answer was carbomazole for that question. Lets discuss some other questions...did everyone put McArdles disease for the patient with myoglobinurea?
    Was the answer to the 1st question from paper 3 atrial flutter? They showed us an ECG. For the temporal lesion did people put BCC or SCC? I put BCC as i thought it had a pearly edge to it with telangectasia (paper 3).
  11. giroop2003

    giroop2003 Guest

    Hi All,
    I also would have made mist take in exam under stress

    as per my knowledge both Carbimazole and PTU can cross placenta on have effect on fetus, Earlier they thought PTU is more safer but later studies showed that both are equally having simillar effects.

    In preganancy unless it is transient hyperthyroidism, we have to start antithyroid drugs like PTU or carbimazole.

    But in case of inflamatory thyroiditis or transient hyperthyroidism we can treat only with proponol,

    Surgery only option if patient is tollerating antithyroid meds and getting worse then under risk also we can do it, more safely in the early pregancy,

    Both carbimazole and Levo thyroxin- Block and replace is not indicated in pregnancy since it need higher dose of Antithyroid drugs that can cause fetal hypothyroidism

    Radioidoine Rx is contraindicated in pregnancy
  12. THAP

    THAP Guest

    Hyperthyroidism in Pregnancy

    As an obstetrician:

    Carbimazole only

    Not block and replace, and propanalol is associated with neonatal hypoglycaemia.
  13. giroop2003

    giroop2003 Guest

    Hi Guys common,

    I know most of them are tired,

    it will great help and little relax to you if bring out your doubt and discuss with all
  14. guest10

    guest10 Guest

    carbimazole was the answer

    what about the image of lady who had rash on face for 2 years, better in summer.
    recently treated with doxycyline and back from holiday
    image showed rash on nose

    ans= dermomyositis
    DLE
    roseacea
    ?
    ?
  15. Guest

    Guest Guest

    I found it all impossible....what about photo of pathological specimen yesterday (?lung) and the inheritence of the disease process.....I had no idea...put all female carriers will pass it onto their son (??X linked histiocytosis X???)

    Also the inheritance/genetics chart today where a rare disease passes down. I put it has skipped a generation
  16. Guest

    Guest Guest

    hi for alll
    congratulation for all just who can take adesicion to enter the exam it,s realy hard
    for me it was realy hard realy horrible realy catastrophic
    i think i wasn,t prebared enough
    anyway


    i chose carbimazole cause onexamination said before it,s not bacame ci
    now it,s same as thyouracil

    also pt is thyrotoxic and it,s harm for baby to leave without treatment with just aprobranlol

    and also thyroxine is dangerous for baby
  17. Guest

    Guest Guest

    i did the folow and not sure
    the inheritance pattern was in penetration
    the picure of yesterday face of female i did discoid lupus
  18. Guest

    Guest Guest

    what about chest pain man with xray wide mediastinum
    the choices was heparin, nitroprusside ,nitroglycerin,,,,,,,????????
  19. Guest

    Guest Guest

    what about the specimen of lung i chose
    high residual volume and low co
  20. Guest

    Guest Guest

    cystis fibrosis i did it 25% chance to have ason with the disease
  21. Guest

    Guest Guest

    What about alternate drug for pt with breast Ca and DVT on tamoxifen

    Also things to do before giving pamidronate as treatment for blny mets??

    I had no idea and cannot even find answers in texts books now!!
  22. Guest

    Guest Guest

    What about alternate drug for pt with breast Ca and DVT on tamoxifen

    Also things to do before giving pamidronate as treatment for blny mets??

    I had no idea and cannot even find answers in texts books now!!
  23. giroop2003

    giroop2003 Guest

    Hi,
    i think chest pain with wide mediastinum may be Aortic dissection or Aneurism, and need to have control BP, may be with nitropruside
  24. ab1385

    ab1385 Guest

    Chest pain and widened mediastinum had to be nitoprusside - risk of dissection and IIRC the BP way around 160/95.

    The cystic fibrosis one, I'm fairly sure, was 1 in 8. The mother's siblings were both carriers, implying that her at least one of her parents were carriers. So she has a 1 in 2 chance of being a carrier. Her partner we know is a carrier. So she has a 1/2 chance of being a carrier, and if she is a further 1/2 chance of passing on that gene. the father we knowis a carrier so he has a 1 in 2 chance of passing on his gene, so the total chance is 1/2 * 1/2 * 1/2 =1/8.

    There was a picture of a kidney post mortem - polycystic - was it a question on inheritance? Can't remember, but if it was it would be autosomal dominant.
  25. ab1385

    ab1385 Guest

    Oh, and the pamidronate one - I think you needed a dental review as she had been taking ibuprofen for toothache, and if she had any abscess etc then she would be at risk of osteonecrosis of the jaw.
  26. giroop2003

    giroop2003 Guest

    alternate drug for pt with breast Ca and DVT on tamoxifen , I think aromatase inhibitor with statins
  27. ab1385

    ab1385 Guest

    I agree with the aromatase inhibitor - can anyone remember what the 5 options were? I can't remember if I put the aromatase inhibitor or something else!
  28. mrcp doctr

    mrcp doctr Guest

    hi all the best for u r results

    is medical master class helpful

    or pastest

    plz advice
  29. Guest

    Guest Guest

    wonder how many Qs can get wrong and still pass cause i ahve got loads wrong (new equating marks sytem)
  30. giroop2003

    giroop2003 Guest

    Hi Guys please remind all the Qs and Post here, it will be very much helpful to most
  31. Guest

    Guest Guest

    this is crazy.....why is noone posting any Qs that came up?????????????
  32. Guest

    Guest Guest

    my freinds let us revise our experiance no problem what will be the result just let us know the true answers


    as i read before
    wide mediastinum na nitroprusside i choose this answer
    cancer breast dvt so aromatase i didn,t remeber what i did
    picture lung specimen was like emphysema so i chose residual volume high and low co
    ecg vt i choose dc cause pt is chest pain and bp 85/60
    ecg irregular tachycardia with p wave so i choose multible atrial tachy
    ecg with bbb and prolonge pr i choose deffect in sinus node and av node and burkinjie fibre wich was in the last choice
    last pic in 3rd paper ct chest was lung fibrosis i chose sarcoidosis
    cystic fibrosis chance of get son with the disease i did 25%
    diagram of mode of inheritance i did incomplete penetrance
    fundus exam pic i did staph embolus
    there was aquestion i chose hus in third paper bloody diarhea and now film schistocutes and ldh high and low plt

    yesterday the was cxr look like thymus enlarged is it was thymectomy any way i didn,t chose it i chose like lymphoma or somthing like that

    there was cxr today was metastasis i chose renal cell carcinome
    yesterday pic of poly cystic kidney i chose will inherit half of sons cos it,s AD

    pls any one remember any try to share us
  33. Guest

    Guest Guest

    fundus pic i put CMV...thought it was pizza appearance
  34. ab1385

    ab1385 Guest

    Lung specimen looked like bullous emphysema to me, so as others have said, high residual volume, low transfer.

    ECG with RBBB showed Wenchebach, so the problem is AV node (type 2 block) and His-Purkinjie system (RBBB).

    There was another ECG at some point which I think showed atrial flutter with 3:1 block.

    The CT at the end of paper 3 I think showed a mass in the posterior of the left lung, so lung cancer.

    There was a question on asthma in a pregnant lady and a question with pre-eclampsia and HELLP, both of whicg I have magnesium, for.

    There was a question on chronic hepatitis C, with a choice of interferon and ribavirin or peginteferon and ribavirin. I think the answer is supposed to be peginteferon and ribavirin but I put inteferon. :(

    I put to DC shock the person with broad complex tachycardia and BP 85/40 but not wholly convinced as he was feeling well and was well perfused. Can't remember the other options, but perhaps try flecainide first?

    Anyone remember any other questions?
  35. MRCPaspirant

    MRCPaspirant Guest

    Think i'll start with the ones i can recollect...

    1. Pregnant lady - GA 8th week - on Valproate - what next?
    2. Pregnant lady - Pneumonia - allergic to penicillins - DOC?
    3. Pregnant lady - high BP,Abd pain,anaemia,low platelets,renal failure,high LDH - Rx??
    4. Long standing Bronchiectasis with nephrotic syndrome - Systemic amyloid?
    5. Prolactinoma with suprasellar/cavernous sinus extension - Rx?
    6. lady - Galactorrhea/amenorrhea - high PRL levels,remote history of metoclopromaide use - diagnosis?
    7. IHD patient on cardiac drugs - erectile dysfunction - what Rx??
    8. Old asthma/rec sinusitis,mild eosinophilia,elevated S.IgE,new onset foot drop - Dx?Churg-strauss
    9. RA patient on Infliximab - Fever/sweats/cough/weight loss/CXR-alveola shadows - ?TB
    10. Peptic ulcer patient - active GI bleed - what helps in reducing mortality in next 48hrs?PPI/Omeprazole infusion
    11. Chronic alcoholic/massive hemetemesis - what next?Octreotide
    12. New onset RUQ pain/abdominal distension/ascites/INv - High Hb,high Platelets, elevated liver enzymes - Dx?Hepatic vein thrombosis
    13. Sleep paralysis asso.?hallucinations
    14. Antimalarial - hallucinations?mefloquine
    15. Patinet with tetany/hypocalcemia?hypoparathyroidism
    16. Macrocytic anemia in post-ilectomy CROHNs - unresponsive to B12 - what next?
    17. head injury - polyuria?Cranial DI
    18. Bipolar pt on Lithium - thinking suicide - what next?
    19. Pneumothorax of less than 1cm,but more than a day old - what next?

    Pictures:
    1.Skin lesions on forehead - BCC/SCC/SebKeratosis?
    2.Extensive verruca vulgaris on hands - Rx?
    3.Nose lesion?DLE
    4.recent onset severe anaemia with low platelets - CXR showing Ant med mass - Thymoma?Rx
    5.CT thorax - honey combing/pleuralbased bronchiectasis - IPF/CFA?
    6.CT Thorax - ?hilar adenopathy/high Cacium - Diagnosis?
    7.Blueish toes- postMI-renal failure-mild eosinophilia-CHOLESTEROL EMBOLI?
    8.DIP joint arthritis+Onychodystrophy- Psoriasis?
    9.APML pic - Translocaton?t15:17
    10.Red/blue pinna,dyspnea&wheeze - Relapsing polychondritis?
    11.Skin lesion on Dorsum of hand/first web space- Discoid eczema?
    12.CXR-Canon ball mets in lungs?source - GI/Renal

    OK pretty tired now.....
    its your turn to put up some questions and active discussion wanted please!
    Not that it will help immediately - but it would eventually!
    cheers
  36. Guest

    Guest Guest

    bibolar these days with depression and suicide
    i don,t know the right but i choose lithium with fluxitine
  37. Guest

    Guest Guest

    has anyone sat this exam before, cause last time i failed by 0.3%.

    I found this one much harder and dont think i will come close to passing. How does anyone else think this compares to past papers
  38. Najlaa

    Najlaa Guest

    Young lady with galactorrhea, amenorrhea, ^ prolactin, ^TSH, T4 NORMAL, FSH+LH low, use one month back metochlopromid for vomiting only 3 days
    so i think case is pregnancy so i choose answer stress
    other answers are: non functioning pituitary tumor, metochlopromide
  39. Najlaa

    Najlaa Guest

    :shock: that Q puzzled me
    bipolar on Lithium and was stable longtime but now increasing depression so action:
    1- continue Li+start fluxitine(i choose)
    2- = =+ = sodium valproate
    3- = = + = amytriptyline
    4- stop Li + = sodium valproate
    5- stop Li + start ......
  40. ab1385

    ab1385 Guest

    My thoughts on the ones posted above which I can remember - what do others think?

    2. Pregnant lady - Pneumonia - allergic to penicillins - I think this is eryhtromycin, judging by BTS guidelines, but they are 9 years old so don't know if doxycylcine has overtaken this.

    3. Pregnant lady - high BP,Abd pain,anaemia,lo
    w platelets,renal failure,high LDH - HELLP and pre-eclampsia - there was also hypertension, increased LFTs and proteinuria. Rx with Magnesium.

    4. Long standing Bronchiectasis with nephrotic syndrome - Systemic amyloid? Can't remember this one either :(

    5. Prolactinoma with suprasellar/cavernous sinus extension - Cabergoline/bromocriptine. can't remember which of the two it was, but either would do.

    7. IHD patient on cardiac drugs - erectile dysfunction - what Rx?? Wasn't sure on this one - I think that the fact that he still had morning erections meant that he was probably having psychological issues but not sure at all.

    8. Old asthma/rec sinusitis,mild eosinophilia,elevated S.IgE,new onset foot drop - Dx?Churg-strauss - I put Churgg-Strauss too.

    9. RA patient on Infliximab - Fever/sweats/cough/weight loss/CXR-alveola shadows - ?TB - Can't remember - what were the options?

    10. Peptic ulcer patient - active GI bleed - what helps in reducing mortality in next 48hrs?PPI/Omeprazole infusion - seems sensible :)

    11. Chronic alcoholic/massive hemetemesis - what next?Octreotide - Probably terlipressin due to the risk of this being a large variceal bleed.

    12. New onset RUQ pain/abdominal distension/ascites/INv - High Hb,high Platelets, elevated liver enzymes - Dx? I put portal vein thrombosis but now, looking at it - you're right it is hepatic vein thrombosis (Budd-Chiari syndrome)

    13. Sleep paralysis asso.?hallucinations - again, I didn't know so guessed (wrongly I think as looking it up, cataplexy is associated with hypnogogic hallucinations).

    17. head injury - polyuria?Cranial DI - Yeah, think so.

    18. Bipolar pt on Lithium - thinking suicide - what next? Lithium and fluoxetine? A guess really.

    19. Pneumothorax of less than 1cm,but more than a day old - what next? I said send home with early review - not SOB and sats OK ..

    Pictures:

    1.Skin lesions on forehead - BCC/SCC/SebKeratosis? - I thought this was a seborrheic keratosis.

    7.Blueish toes- postMI-renal failure-mild eosinophilia-CHOLESTEROL EMBOLI? Definitely.

    8.DIP joint arthritis+Onychodystrophy- Psoriasis? I put psoriasis too on the basis of the nail changes.

    12.CXR-Canon ball mets in lungs?source - GI/Renal - I think I put GI as IIRC there was an anaemia with low MCV, but I haven't really come across GI malignancy metastasising to lung.

    Those are the only ones I can remember - I'm fairly sure I got most of the others you posted wrong but can't really remember much of what I put. A lot of that was a blur!
  41. Najlaa

    Najlaa Guest

    :evil: can any one remember this Q which come first day which is lady with secondary amenorrhea, past history menorrhagia...........................
    answers:
    1- transvaginal u/s
    2- CT abdomen
  42. ab1385

    ab1385 Guest

    There was another one on cryptococcal meningitis - I put Rx with amphoterocin and caspofungin - I think the correct answer is amphoteracin and fluconazole. :(
  43. ab1385

    ab1385 Guest

    The secondary amenorrhea one - transvaginal U/S to rule out PCOS?
  44. Najlaa

    Najlaa Guest

    To ab1385:
    -agree correct answer is amphotiricinB+fluconazole
    -i dont think case is PCO as they usually have oligomenorrhea
  45. Najlaa

    Najlaa Guest

    another Q which i couldnt reach to its idea
    one month back cholecystectomy complicated by MRSA infection but received Tx...recovered and was well but now chest infection so what to give?
    1- vancomycin
    2- emeperinum
    3-....
  46. ab1385

    ab1385 Guest

    I'm probably missing something on that one but vancomycin is fairly standard Rx for MRSA...?
  47. Guest

    Guest Guest

    Re Pregnant lady - Pneumonia - allergic to penicillins - I think this is eryhtromycin, judging by BTS guidelines, but they are 9 years old so don't know if doxycylcine has overtaken this.

    I wouldnt rush into giving a preg lady doxy....unless her kid deosnt mind having grey/crumbly teeth later on!!
  48. Najlaa

    Najlaa Guest

    :lol: that lady pregnant with allergy to penicillin so sure give erythromycin
  49. Najlaa

    Najlaa Guest

    what was answer for Q cross match blood? :shock:
  50. AG

    AG Guest

    -PKD with irrigular liver edje- infected hepatic cyst?
    -question on Coeliaq- another on ethylene glycol
    -pituitary apoplxy with erectile dysfunction- hydrocortisone
    -bleeding p/r with multiple focal lesions in liver- CA colon with metastasis/diverticulitis with abcess
    -diarrhea with -- Ca - chronic pancreatitis
    - drug needing no adjustement with renal faliure ?lansoprazole/trimithoprine
    - dressing on granulation tissue-???? antibiotic dressing
    -question with TTP
    -question on HELLP -delivery
    - H. pylori eradicatio for gastric ulcer- reassurane

Share This Page