Discussion in 'MRCP Forum' started by mint_girl., Nov 25, 2010.

  1. mint_girl.

    mint_girl. Guest

    Hello Everyone,

    Tough 2 days! I have had enough of repeating this exam:( Haven't you all noticed that paper 3 is always scenario based whereas paper 1 and 2 is like problem solving of blood results and ECGs etc? Paper 3 always feels different and I usually cannot recall anything from the first 2 papers!

    1. Pt with numbness and tingling in odd distribution, lost job and mother died recently ?Somatosisation disorder or ?depressive disorder

    2. Tense ascities but patient comfortable (first q on paper 3) what is the treatment for the ascities? ?frusemide ?spironolocatone ? paracentesis?

    3. Patient on amiodarone cos of ischaemic heart disease and recurrent arrythmias, found to have small palpable goitre. What is the treatment of his HIgh T4? ?stop amiodarone ?commence carbimazole

    4. Patient who has history of psoriasis and went gardening then found to have blisters on palms of hands ? guttate psoriasis

    5. Patient with a picture of chronic pancreatitis. What is the next appriopriate investigation? ?Plain abdominal x ray ?CT abdomen ?US abdo

    6. Patient with fracture and HIGH ALP and bowing of legs possible PAGETS what is the treatment?

    7. Patient with celiac disease controlled but still having diarrhoea, what is the next investigation?

    8. Patient with haemochromatosis with jaundice and some LFT abnormality ?hep ca

    9. patient with bilateral tender loins low albumin and had protein and blood in urine, history of minimal change glomerulonephritis ? bilateral renal vein thrombosis

    10. What tells u this is a pleural empyema? ?LDH result or ?pH 7.05

    11. Alcohol admitted camatosed and acidotic ?methanol poisoning

    12. Patient bitten by a dog 4 weeks ago and now presents with locked jaw and back arching etc... what to do next? ?check for rabies antigen

    13. Patient on fluoxetine and took tramadol for wound infection pain in foot. presents with high bp, fever, myoclonic jerks .... ?serotonin syndrome or ?tetanus

    14. Patient had a fall, Z score was -2.8, what is the next treatment? ?Alendronic acid

    15. Patient attended wellbeing clinic, no symptoms... but found to have ?high calcium in serum but low calcium in urine? ??familial hypocaluric syndrome.. question asked what is the treatment!??!

    16. another patient had loin pains and very HIGH calcium in urine but normal calcium in blood... what is the treatment for his stones? ?low protein diet ?low calcium diet ?low oxalate diet

    17. Patient with previous ductal Ca, now has ovarian cancer and tamoxifen was stopped. what is the reason for her deterioration? ?tamoxifen and a bunch of other chemo meds

    18.Picture of eye of homocysteine patient. ?lens dislocation

    19. picture of lady with PRAYER SIGN and had type 1 diabetes ?rhematoid ?cheriarthropathy

    20. 1st photo of patient with red cheeck ?eripsyles

    21. Picture of african lady with vesicles on face. what is the treatment ?oral aciclovir

    22. Patient with persistant inflammatory markers despite 2 different regimens of antibiotics what next? ?flucanazole

    23. Patient who was a miner and plumber and picture of CT CHEST with LFTS showing restrictive lung disease. What is the diagnosis? ?pneumoconosis ?hypersensitive pneumonitis

    24. Asthma patieth with HIGH IGE on leukotriene, salmeterol and beclomethasone inhaler, what next? ?Oral PREdnisolone ?IgE immunomodulator

    25. COPD pt with 2 abgs showing no improvement but no acidosis what next? ?non invasive ventilation

    26. patient with livedo reticularis with normal APTT and PT and lupus anticoagulant negative i think. what investigation to do next ?Factor V lieden ?anticariolipin antibody

    27. MRSA patient with +ve in axilla, groin and nose, what to give ?nasal muciporin or nothing

    28. patient with tender gotire for 3 weeks on amiodarone. diagnosis? ?viral thyroditis ?amiodarone induced

    29. patient with abdo pain and tenderness in lower abdo opening bowels 10 times per day and sometimes doesn't open them and still feels no relief after defecation and feels abdo bloated end of day? ?diverticular disease ?irritable bowel

    30. Another question on irritable bowel disease

    31. Patient had parkinsom disease and then hallucination answer was diffuse lewy body disease

    32. patient wife complainng that he is wondering at night 3 times, and not looking after finances - can't remember the options.

    33. patient with RING ENHANCING lesion on CT and toxoplasmosis treatment was INEFFECTIVE, what is the reason? ? lymphoma ?toxoplasmosis

    34.some patient with abscess that was gram +ve cocci, what treatment to give ?IV coamoxiclav

    35. ECG showing delta waves?? what to give patient ?flecanide ?amiodarone ?adenosine ?verapamil

    36. CPR question, they gave chest compression for 2 mins and DEFIB cos he was in VF, what to do next? ?check carotid pulse ?give adrenaline
  2. mint_girl

    mint_girl Guest

    37. Patient took around 9 g paracetamol cos of tootheache and he is on carbamezapine for epilepsy. when to give n acetylecystine? ?immediately ?when paracetamol level is 100mg at 21 hours ?when paracetamol level 100 at 1 hours? then 2 similar questions with paracetamol level being at 200 instead of 100
  3. dr nn

    dr nn Guest

    great job
  4. dr ABG

    dr ABG Guest

    polycythemia with hypoxia what do next---ABG

    homocystinuria with lens dislocation and minor trauma there is trumatic hythema

    mnt girl i remmbered u from april forum and i came sad when u didnt do it , i am sure u will that one:)
  5. dr nn

    dr nn Guest

    disc dislocation
    paget ...alendronate
    PAN pic
  6. dr nn

    dr nn Guest

    PRAYER SIGN and had type 1 diabetes---------cheriarthropathy
  7. mint_girl_

    mint_girl_ Guest

    dr ABG, I’m glad you remember me. Did you appear for the april exam? And dr nm, which PAN pic?
  8. mint_girl_

    mint_girl_ Guest

    dr ABG, polycythemia with hypoxia in paper 2? I think there was a choice between ABG and do a RED CELL mass? I think i chose Red cell mass cos u want to differentiate between primary and secondary??
  9. mint_girl_

    mint_girl_ Guest

    38. in paper 2. genetic tree with last line having 2 males affected and 1 male unaffected and all females in the tree unaffected. I chose x linked recessive. I decided not to choose the mitochondrial disorder cos that means all males should be affected, am i correct?
  10. mint_girl_

    mint_girl_ Guest

    39. paper 3. pregnant lady, just found out, who is already on warfain, what should she do? switch to low molecular weight heparin until term?
    the other options were to give low weight molecular heparin in 1st trimester then switch to warfain or continue warfarin or give unfractionated heparin throughout the whole pregnancy....

    40. patient with high bp, low k, high supine renin and aldoesterone...?conn's syndrome. other options were barters and gitelmen.....

    41. There was a question which answer was i belive liddle's syndrome in paper 1 or 2.
  11. dr ABG

    dr ABG Guest

    about the genetic tree granmothers(female affected) so i went to A.R but not sure

    LMWH for 1st 13 weeks not tell term

    yes liddle AND second question with high renin and aldost. and high BP so sure not barrter and gitelman having normal BP and conns having low renin so answer is renovascular ds

    old man with tremors and starring look give tetrbenazine /propanolol
    lichen sclerosus??or psoriasis
    another Q rash in forearm spread to trunk?psoriasis or lichen planus
    bit.hemanopia with upper defect --pit tumor
    bit.hemanopia with MRI and prolact. 780 supraselar meningioma or pituitary granulation?????
    sertonin $ with fluxotine and tramadol
    perianal ulcer--------------nicronadil(vaso veno dilator)
    ECG atrium malsense or vent malsense??????????
    alcholic found with normal carboxyhg----i made it hyperbaric O2 olther answers strange
    GIRL IN AF----------ASPRIN
    sroke what to add after asprin and FRUOSMIDE-----------add diprydmole
    patient with abd. man and tend. improve by eating ...barium or gastroscope
    women with trastuzumab side effect with short of breath
    man with snoring and have NO disturb sleep ......weight reduction or cpap or manduible splint
    ECG with delta wave IV adenosine
    dm with laser photocoagulation what to dec. retinopathy ACEI OR ISULIN
    PID Q with adenxal tendreness
  12. dr nn

    dr nn Guest

    renal mri i think or or renography
    it showed microanurysm
    i went for start warfarin
    and the other qs for LMWH
  13. dr nn

    dr nn Guest

    pic of women with erupted lesion all over her face ---went for high dose steroid
    alcoholic liver disease presented with asits and jaundice----hepatocelular cancer?pancreatic ca ?unhodjkin lymphoma
    mri for a young female bmi 17 with low tsh low gonadotropin ----????
    pancrreatitis ----npo or prentral neutrition or iv fluid
  14. dr nn

    dr nn Guest

    calcium stone ---went for thiazid
  15. dr nn

    dr nn Guest

    pt with herpis and psoriasis developed painful erythmatous rash over his hand---???
  16. stuck

    stuck Guest

    how did u ppl find paper 3 was not that lengthy but still i found it worst..i wonder how ppl r saying that it was easy
  17. Dr Ree

    Dr Ree Guest

    Yeah,you are right mint girl.Today's paper was so much different from yesterdays.This is my first time,and God willing,hope to clear it.
    Todays CT chest was confusing,could make nothing out of it.
    The lady with the rash --seemed like Steven Johnson's syndrome - i marked steroids.
    Type 1 DM,prayer sign--diabetic cheiropathy
    Homocystinuria--dislocated lens
    Picture of dermatomyositis
    Yesterday's ECGs were very difficult.
    Terribly exhausted.This drains you completely.
    Praying for all of us to get through.
    All the best
  18. dr ABG

    dr ABG Guest

    this lady has history of atopy and eczema so she become complicated with eczema herpeticum-------oral valaciclovir
  19. NNJ2010

    NNJ2010 Guest

    Paracetamol hepatiis
    Alcoholic hepatitis
    Ischamic nephrpothy
    Fredrichs atxia?/CIDP
    Lithium toxicity – caused by which drug
    Left apical mass with horners syndrome – lung biopsy
    Fundus of wegeners pt – CRVO, Branch CRVO, CRAO?
    Crest syndrome/systemic sclerosis –anti scl
    ESRF Pt prior appendicetomy – mx of high potassium ans Haemodialysis
    Alpha one antitrpsin def?/CVID
    Myotonic dystrophy?
    Becker musc dystrophy?
    Carotid art dissection?vertebral art diss?/PCI stroke
    Pt post cardiac transplant with fever small nodes. CMV?
    SVC obstruction from squamous cell ca – SVC stent?radiotherpay. no improve despite steroids.
    A HIV pt with multiple metastatic like lesions on CXR (photo)
    Next inve? CT chest/B-HCG?
    Lots of meningitis question/CSF analsis.
    Vanc and cef (pt had pen allergy –can’t recall question)
    M.avium complex
    Herpeps simplex?
    Ampicillin ans gent
    Pretibial myxoedema question
  20. mint_girl_

    mint_girl_ Guest

    oh wow, you are making me remember the questions from the first 2 papers, they were terrible! I really WONDER if any of our consultants SIT for the MRCP paper 2 again, would they be able to answer these easily??? MRCP is no longer an EXIT exam in the UK, so why are they making it impossible to answer? Real life is not that complicated! because you have a patient in front of you, a history, and more than one request you can ask for! Sometimes I wonder what is the point of making it sooooo strange like this... there must be more of a reason than financial because people are putting effort into it.
  21. NNJ2010

    NNJ2010 Guest

    Lots of hyponatraemia
    1) Fluid restriction
    2) IV Nacl with pt who was hyponatraemnic and dehydrated
    3) Diabetes Insipidus
    4) TX of craniopharyngioma? Carbegoline or surgery??


    1) Stop ace inhibitor
    2) Cryoglobineamia
    3) Drug induced interstitial nephritis(PAPER2)
    4) interstiital nephritis sec to anti TB medication today
    5) HSP (paper 1)

    3) Photograph of lips/face at end of paper 2 - HHT or peuts jegur- had to rush question as running out of time. question what symP - epistaxis
    4) ECG of trifasic block?
    5) SUbdural haematoma on ct head?
    6) carbon monoxide poisoning in paper 2?
    7) Cardiac cath lab data
    9) ECHO showing LV mass - Atrial MYXoma?
    10) pt with mechanical AV valve replacment - autoimmune haem or valave haemolysis
    11) What organism likly in pt with valve replacment in 4 months.
    Strep, enteroccoi, staph epidermidis.
    12) Pt with gallstones, cholangitis picture - what orgism likly - ecoli?
    13) A scenario with a pt undergoing a procedure who was anamic/ PLT count 0f 25. What next prior to procedure -plt transfusion.
    14) Several observation answers - can't remember question was it CLL question?.
    15) Question on Histusim in paper 2
    16) Whipples disease pas macrophages+ve
  22. NNJ2010

    NNJ2010 Guest

    1) Another pt with seronegative arthritis in paper 1 - can't recall question
    2) Seroposotive rheum arhtrhits -swan neck deformity of hand on pciture/
  23. mint_girl_

    mint_girl_ Guest

    yes lots of hyponatraemia! too much actually and i'm sure i messed them up. anyway one catheter data showed proximal and distal AORTIC saturation, and there was A decrease in saturation of the DISTAL part so i chose PATENT DUCTUS ARTERIOSIS as the cause
  24. dr ABG

    dr ABG Guest

    yes correct PDA

    mint girl were u near to pass in april diet??cause u seem well prepared
  25. mint_girl_

    mint_girl_ Guest

    I dont actually remember my score in april, nor i remember what the pass mark was, but i think i wasn't close, no. i am only well prepared in SOME topics....

    I just wonder where all my effort has gone, this exam did not help me show my true colors..... and if i were to prepare for it again, i'm not sure how to study differently, as the questions are very hmm..... i dont know, it is like u have to know a lot of 'mechanisms' well enough in order to interpret things in a question on the spot?
  26. NNJ2010

    NNJ2010 Guest

    More questions

    1) female pt with whitout on chest xray.
    Dx - TB?

    2) Pt with small bowel bacterial overgwoth on paper 1.
    INV Hydrogen breath test

    3) ECG of a Pacemaker rhythym.
    Ventricle not sensing, atria not sensing???

    4) A pt with sob, raised jvp. echo global 1cm pericardial effsuion.
    next step in mx - pericardiocentesis

    5) A pt with loss of sensation around outer little finger.
    where is lesion - ulnar nerve lesion

    6) Diabetic pt with loss of power, sensation and weakness. Diabetic amyotrophy??- don't know

    7) Several questions on PCP.

    8) Fibrosing alveloitis (IPF) paper 1

    9) Pt with headaches and seziures post partum. cause ?Cortical vein thrombosis.

    10) A question with sob in postpartum woman todat. Peripartum cardiomyopthy.
    11) Addison's type bloods results - short synacthen test. - paper 1?

    12) 2 questions on PE. Ojne in paper one about dx - CTPA and 2nd one about treatment- enoxaparin

    13) Pt with NHL on chemo wiht swollen and painful MCP joint. dx Gout

    14) A pt with Vitamin d defeincy?. Low cholecalciferol level. Tx ergocalferol.
    15)Man with RTA, blunt trauma to chest, resp indices given, can't recall them.
    Dx Flail chest, pul contusion?

    16) Alcohoilic with withdrawal symptoms and agitation. what to give -Diazepam/Haloperidol
    17) IVDU on multiple iv drugs with auditory hullicinations.
    Cause? Coccaine/heroin/amphet/cannibis

    18)eldelrly man with symptoms of dementia (forgetfullnes, lack of cohernace, and also depressive symptoms).

    options-Depression with Dementia

    19) A pt with Headache, neck stiffness and fever. Painful vesicles arounf corner of mouth. Tx -Aciclovir
    20) A pt with lab finding of DKA
    21) Hyperosmolar non ketotic state also.

    Am i making this up!! Did anyone see these questions?
  27. NNJ2010

    NNJ2010 Guest

    there were lots of questions on chronic diarrhoea.

    Can't recall them right now. back later!
  28. Guest

    Guest Guest

    mint girl\

    where did u appear from

    did u do medical master class, any questions from it
  29. nmia2

    nmia2 Guest

    exam is over,but it is still haunting us. To recall some quest,the last in paper 3,post cholecystectomy,low Na,r122, JVP is elevated at 2cm. Management ?iv normal saline 0.9%.
    Cardio v tough
  30. nmia2

    nmia2 Guest

    this was my 1st attepmt,v v tired. Goodnight
  31. guestz

    guestz Guest

    pt with Anaimia with normal ogd and clonoscopy.

    What inve is likly to show cause of anaemia

    1) Capsule endoscopy
    2) CT angio
    3) Push copy
  32. guestz

    guestz Guest

    A pt with calcification of right coronory artery and legt circumflex.

    What next:1)reassurance, maxiumum risk mx, ...
  33. Guest

    Guest Guest

    any questions from MMC
  34. Guest

    Guest Guest

  35. ilearn

    ilearn Guest

    any new questions ?
  36. doctorimmo

    doctorimmo Guest

    Hi all , just posting some more questions using help from others who already post the question

    Feel free to add info or correct the answers in sequence please

    1.ECG left axis deviation / partial RBBB ------------? Trifasicular block
    2.Ecg wolf parkisnson went into VT what will prevent in future radiofrrquency ablation
    3 Ecg ? svt what to give iv adrenaline
    4.Ecg of atrial flutter
    5.Ecg looks like vt but may be atrioventricular tachy with LBBB , young women normally fit and active collapse at work , BP by palpation 60 systolic
    6.Patient with recurrent renal calculi which drug to give? Loop diuretics as I think we avoid giving thiazide in hypercalcemia treatment
    7.Hyponatremia I think 2 or 3 questions I choose fluid restriction in all don’t know the scenarios
    8.Muscle tenderness/ nasal voice / CK raised ------- polymyositis
    9.Seizure 2 days after head injury CT scan showing ? extradural bleed
    10.Sternal # myeloma patient creatinine 167 what to give for pain relieve already taking paracetamol and dihydrocodiene ? diclofenac ? oramorph
    11.RTA chest injury and h/o of poorly controlled DM blood gas showing acidosis and po2 of 22 despite 60% oxygen whats the cause ? flail chest ? DKA
    12.PIC of ? lens dislocation
    13.Hep c , taking methadone and fluxotene want to have treatment what to consider ? depression
    14.Hep c / renal impairment -----? Cryoglobulinaemia
    15. Patient starting to have rash including scalp after starting betablocker for her BP ? psoriaisis
    16. CCF patient taking diuretics / ACE still sympotomatic but acute renal failure what to do ? stop ACEi
    17. 2 days after starting haloperidol abnormal facial movements ? Acute dystonia ? NMS
    18. During TOE patient R/R drop to 8/ min had midazolam ? IV fluemazil
    19. Patient on warfarin unplanned pregnancy ? sc unfrac heparin till birth
    20. ITU patient settled moved to ward , still having catheter in situ , start mobilizing had a mild grade temp 37.1 but urine culture shows extended beta lactamase what to give ? remove the catheter ?
    21. Pic of Lips ? HHT complications she ma y develop epistaxis if diagnosis correct
    22. Echo of the patient experienced pain in her hand and rash looks like clot or left atrial myxoma / ? left atrial thrombus
    23. CXR left upper zone opacity with left hand weakness? pancoast
    24. Pas positive Whipples
    25. Patient with diarrhea / biopsy shows non specific coloits / lymphopenic ? HIV
    26. Pyoderma gangrenosum treatment oral pred
    27. Asthma patient what to add ? salmetrol
    28. Another Asthmatic patient what to add ? oral pred ? sodium cryo
    29. HONK I think 2 questions very high Glucose found collapse at home high sodium as well
    30. Cholecystitis likely organism ? E coli
    31. Xray of sarcoidosis
    32. Patient of Ankylosing spondy for 4 yrs taking etocoxib what next ? metho ? salfasalazine
    33. Question about endocardidits very long pr interval written
    34. Patient with hematuria / murmur had treatment with trimethoprim continue to spike temp , Hb 16 , culture negative ? q fever endocarditis ? renal cell carcinoma
    35. Bacterial overgrowth scenario what test ? urease breath test
    36. Diabetic patient peripheral neuropathy and nocturnal diarrhea ? autonomic
    37. Irritable bowel syndrome all the investigation normal , pain eased after opening her bowels
    38. h/o of preeclampsia , during pregnancy again having same symptoms what to give ? labetalol
    39. ECG showing ischaemia already had Aspirin / GTN / what to give next Enoxaparin
    40. Young patient with pleuritic chest pain ecg showing q waves in led lead what to give ? Enoxaparin
    41. Need to restart the warfarin , changed to LMWH for elective surgery INR 1.2 normally take 3 mg what to do ? normal dose ? loading dose
    42. Staggered accidental od paracetamol I think he took 3 gm 4 times , need to start antidote immediately as we don’t check levels in staggered od
    43. Patient desaturating on exercise African background ? HIV / PCP
    44. Chemo patient SOB ? Transtuzab
    45. Chemo patient painful toe ? Gout
    46. UC patient 32 5 days of IV hydrocortisone still passing 5 stools and tender abdomen what next ? surgery ? elemental diet ? Azathioprine no option of infliximab
    47. Patient coming with abdo pain and bilious vomiting , tender and distended abdomen ehat investigation next ? Plain AXR
    48. Patient accusing staff and stange behavior 2 days in the hospital delirium trem
    49. PD diagnosed starting medication having hallucination ? lewi body dementia
    50. Amiodarone induce thyrotoxicosis ? stop amiodarone
    51. Alcoholic patient found collapse on street / tachypnoic ? Enceph ? Pneumococcal pneumonia cant remember other options
    52. Theophyline toxicity 2 to clarithromycin
    53. PNH question
    54. Creatinine above 150 not to give metformin
    55. Patient think he might have cancer lost 10 kg weight examination and investigation normal ? conversion
    56. Another patient having all symptoms but normal examination and investigation ? Somatization
    57. Ascites what to give first spirnolactone
    58. Cirrhosis 2 to haemochrmatosis admitted with weight loss and unwell ? Hepatocellular ca
    59. Patient having high gastrin level and type 1 dm what investigation? Gastroscopy
    60. Chronic diarrhea h/o of reflux taking Lansprazole , I think investigation were normal ? Drug induced
    61. patient with bilateral tender loins low albumin and had protein and blood in urine, history of minimal change glomerulonephritis ? bilateral renal vein thrombosi
    62. epmpyema confirmation low ph
    63. Physiotherapist referred, no symptoms... but found to have ?high calcium in serum but low calcium in urine? ??familial hypercalemic hypocaluric syndrome they asked the diagnosis not the treatment as far as I remember
    64. Pic of erysipelas
    65. ITU patient had lots of antibiotics still inflammatory markers raised ? add flucazole other option was acyclovir
    66. HIV patient low CD4 count ring enhancing lesion but not improved after treatment? Lymphoma
    67. COPD patient acidotic despite treatment NIV
    68. Severe Asthma what to do next IV magnesium other option was NIV / intubation
    69. patient with livedo reticularis with normal APTT and PT and lupus anticoagulant negative i think. what investigation to do next ?Factor V lieden ?anticariolipin antibody
    70. CPR had compression and then shocked what next ccontinue CPR
    71. Polycythemia what investigation ? Red cell mass
    72. Chart showing all the males affected ? X linked
    73. Hypokalemic HTN ? Conn ? Liddle
    74. Investigation for Cushing overnight desamathasone test
    75. Friedrich ataxia
    76. Renal failure 1 week after starting ATT ? Interstial Nephritis
    77. TIA patient what to add after Aspirin ? Dypyridamole no option of Simva
    78. 44 YR old lady think she might have cardiac risk , husband died at young age father died at age 70 plus her BP normal but raised Cholesterol of 6.2 what advice ? reassure ? prescribe simvastatin ( I don’t think any role of statin in primary prevention )
    79. Right iliac fossa pain and tenderness with cervical excitation and right fornix tenderness ? PID ? appendicitis ( not sure why PV examination in MRCP )
    80. Paroxysmal Charcot Marie tooth disease question
    81. AF with TIA? Aspirin
    82. Anaemia with normal OGD and colonoscopy what next ? capsular endo
    83. Status epilepticus what to give ? phenytoin
    84. Young bright girl with nystagmus father epileptic ? Phenytoin overdose
    85. CJD question young patient with dementia
    86. Another patient aged mid 60s , abnormal behavior wondering unable to manage finances and spend most of his life sub sahara ? cant recall the options
    87. Anti Jo antibodies
    88. Diabetic Inspidus low urine osmolarity
    89. Tender Goitre with slightly raised TPO ? Hashimoto >? Viral
    90. Tricyclic OD 2 questions one asking for diagnosis , 2nd showing all the investigation and vitals stable except ph 7.37 , what to do next ? continue ECG monitoring ? Bicarb
    91. Boy unable to move for about 5 hrs and later after large meal 3 hrs , resolved completely ? periodic paralysis
    92. Xary showing pancreatic calcification don’t remember the question
    93. Nurse admitted with low BM what he took? Glicazide
    94. IV drug abuser admitted with Low BM , had some abdominal surgery also diabetic after that , BM keep droping during admission despite giving dextrose ? Insulin OD ? Insilunoma
    95. Carbamazepine skin rash ? TEN
    96. Pretibial myxedema question
    97. Vanco plus Genta for endocarditis penicillin allergic
    98. Question look like lock jaw what investigation patient for Europe history of IV drug abuse also having groin abcess , also bitten by dog a month ago ? Rabies immune ? culture of abcess drainage
    99. Bisphosphonate for osteoporosis
    100. Heart failure 3 weeks after MI what to add ? spirnolactone
    101. Young girl had a fit with abnormal EEG while yawning what about her driving ? cant drive for 1 yr ? can drive if repeat EEG normal
    102. asymptomatic patient having some new heart scan showing moderately severe calcification of his right coronary artery , no ecg changes on ETT what next ? angio ? reassure
    103. question about syphyillis serology positive after treatment what next
    104. Iranian lady history with hypocalemia and waddling gait suggesting osteomalacia
    105. Addisonian crisis low BP what next IV hydrocortisone
    106. Auditory hallucination h/o of alcohol and drug abuse ? cocaine ? cannabis ? alcohol
    107.22 yr patient B/L ptosis / tired / facial weakness ? Myotonic dystrophy ? MG
    108. 60 plus women collapse 2 times first while eating and later had another collapse with limb jerking all the investigation in hospital normal except pulse of 55 what the cause of first collapse ? cardiac arrhythmia ? vasovagal
    109.Acromegaly what investigation OGTT
    110.Hyperprolactinoa 2 to malignancy what treatment first ? surgery
    111. prison officer ref for derange LFT ? Chronic Hep B
    112. recurrent chest infection ? cystic fibrosis
    113. Poorly controlled asthmatic patient worse in winter splenomegaly and Anaemic , lymph node small on examination ? common immunodefi ? sarcodosis ? lymphoma ? HIV
    114. Metastatic lung cancer observation stable but still SOB despite adequate oxygen ? Diazapam ? Morphine
    115. Prolong ITU admission of alcoholic patient not able to move any limbs but reflexex normal and plantars down going , vertical eye movement ? critical myopathy ? hypoglycemic brain damage
    116.pulmonary vasculitis question
    117.intense itchy rash on feet and ankles ? dermmtits hepetiform
    118.SVC obstruction not relieved with steroids what next ? stent
    119. oesphageal cancer with stent present with sudden onseto of dysphagia ? food impact >? Stent malposition
    120.lady with oral ulcers / h/o of DVT and raynaud asking for treatment I think they were asking treatment for raynaud options were nifedipine / warfarin etc
    121.patient unwell aftr coming from Egypt rash on trunk . lymphopenia and mildly renal and hepatic impairment ? Lepto ? Typhoid
    122. Acid fast test fot TB
    123.Induced sputum for PCP no option for bronchoalvelor lavaga given in paper 3
    124.patient taking lots of Anginal medications develops anal ulcers ? which drug
    125.pic of ? HSP rash around ankle and lower leg
    126.CT ? methotrexate pneumonits
  37. Guest

    Guest Guest

    remembered 156 qs

    1 cpr question--- continue cpr
    2 hand foot syndrome carpoplatin
    3 pancreatitis nasojuj feeding
    4 post op hyponatremia fluid restrict
    5 pict chronic pancreat
    6 pict eryseplas
    7 pict lens dislocation
    8 pict eczema herpiticum
    9 pict sarcoidosis
    10 pict MRI hsv encephalitis
    11 pt with HH ,tense ascitis plt 30 !!,esr 110,inc ALP --?HCC
    12 pt with mesothelioma & dyspnic --?morphine
    13 pt with BR CA + CHF ---trastuzumab
    14 empyme pleural PH 7
    15 alcohol ,dec loc ,met acidosis --methyl
    16 TCA OD
    17 pt on CBZ + APAP od --?start NAC immediatly
    18 hiv + single lesion +not improving on rx of toxo --lymphoma
    19 hiv + non enhancing lesions--csf for JC
    20 ascending cholangitis--ecoli
    21 pict MRI brain brain abcess ---cipro-genta
    22 PD + hallucination --dlb
    23 csf traumatic tab
    24 csf --tb
    25 mrsa carrier --nasal mucoprprion
    26 urinary cath + pnl on UA but pt well--remove cath
    27 critical illness myopathy
    28 myotonic dystrophy
    29 copd not improving ---NIV
    30 pict of fundus in WG --crvo
    31 esrd with high k preop --dialysis
    32 svcO ---???stent -rtx
    33 polymyositis -- anti jo
    34 cresendo stroke -- add dipyridamole
    35 pict cannon ball mets in HIV male ---bhcg
    36 meningitis ---cefotax+vanco
    37 ICU resitant VAP ---fluconazole
    38 pict dermatomyositis
    39 pict gottron pap
    40 pict cheriopathy
    41 CBZ + rash ==TEN
    42 UMNL + small irr pupil --3ry syphiliis
    43 woman with cervical excitation ___PID
    44 PID gonorrhea Cefotax+doxy
    45 calcium stone __thizide
    46 asympt hypercalcemia --FHH
    47 senile sequlaor syndrome
    48 intermediate colitis+seborrhea--HIV
    49 acute HIV serconversion egypt
    50 resitant asthma --antiIGE
    51 inadequate asthma control --formetrol
    52 methylxanthine toxicity -- clarithromycin
    53 post op PE --ctpa
    54 possible PE --LMWH
    55 IVDU with halluciation OFF the drugs--coc
    56 pict pulmo TB?
    57 high AG met acidosis following RTA ,dm ---hypovolrmia
    58 hypok periodic paralysis
    59 renal imp in HCV --cryo
    60 pt started on antiTB devolp ARF with 1+ protein --AIN??
    61 ecg pacemaker will functionin DDD???
    62 ECG rasing in III,AVR depression in else ---?abciximab
    63 ecg svt + inf stemi---adenosine
    64 high calcium score + normal stress--?? reassure
    65 ecg flutter with 2:1
    66 pict HHT --epistaxis
    67 ct brain after HT ---????meningioma
    68 catheter data PDA
    69 pict atrial myxoma
    70 valve hemolysis
    71 late PVE --staph epid ---
    72 LP with platlet 25 --transuse plat
    73 CASE OF ttP
    74 case of whipple
    75 bact OG --h breath
    76 addison short synacthen
    78 how to confirm GH def--OGTT
    79 family tree with x linked
    80 pit non funct adenoma with ON comression --surgery
    81 pict corticocavernous fistula
    82 sertonin syndrome
    83 Li toxicity --thiazide
    84 post op for cholecyst on VKA --start loading with VKA
    85 pt with controlled crohns & persistant diarrhea ---food diary
    86 pt with crohns & normal dud bx & ctabdo---colonoscopy
    87 asthma not improving --hypercabnic --intubation
    88 tense ascitis raised creat --paracent
    89 dvt & pregnant --LMWH
    90 ET --anagerlide or reassure
    91 pcp pneumonia
    92 septic artheritis --fluco
    93 pict of meningiococcemia
    94 pd + tremors ---tetrabenzine got that wrong
    95 NICORADIL anal ulcers
    96 ra + nhl painful mcpj --gout
    97 mcgn + protenuria+loin pain --RVT
    98 feature of depression but voices say she has CRC !!WTF psychotic depression
    99 iranian woman --osteomalcia --ergocal
    100 ivdu bitten by a dog --wound tetanus
    101 pict ct chest in a retired miner that works now as a plumber & keeps birds --WTF --HP
    102 pt with persistnant ida --capsoule enteroscopy
    103 esrd +anaemia --iron
    104 esrd +anaemia---epo
    105 ?hyperosmolar
    106 pemphigoid--dej
    107 acute exacerbation of abpa--cst
    108 asthma pt use SABA EOD--followup
    109 pict --lung abcess looks like cancer---bronchoscopy
    110 post renal tspl + inc lft +anaemia=== CMV
    111 aplasia in pt with ? pcr for erythrovirus
    112 ecg wct + delta ==ablate
    113 hiv + multiple enhancing lesions--toxo
    114 ILF improving after coricosteroids ???????NSIP/UIP
    115 pyoderma in scalp--cst
    116 pict MRI brain in hypopit hypogonadism in crohns pt---weight induced
    117 biochemical profile of bulemia
    118 silly stats questions about amantadine & oseltamivir
    119 itchy erythematous inflammed lesions in lower lig --stasis
    120 lesions in front of both legs ---ab agne
    121 UC + inc ALP==psc
    122 pearly papules ---mullascum vs keratosis pilaris
    123 pacemaker myoinhibition
    124 ecg trifascular block
    125 pt on aza --non melanoma skin cancer
    126 rheumatic fever --abn movement with pr prolongation
    127 ankylosing not responding to NSAIID --sulphasalaz
    128 scaly lesion in scalp + erythema of vulva --ps
    129 case of itchy papule in forearm --lichen planus
    130 old man with history of inability to walk (#neck femur)---xray
    131 old age meningitis ,lympocytic ,low glu--amp+cefotax
    132 htn + hypokalemia -dec both PRA & aldo---liquiorice
    133 htn + hyokalemia -inc both PRA & aldo --RAS
    134 met acidosis + hyokalemia + nephrocalc--distal RTA
    135 hepatic pt with GI bleed & diarrhea & ARF --??ischemic ATN
    136 fever +thromocytopenia+renal imp+ thailand ---most imp inv to be done immediatly --blood film for marlaria
    137 diabtic with diarrhea ,everything normal---AN
    138 pt with MS + weird pains in limbs --PN from nitrofurantoin ??
    139 Pict Pancoast TU
    140 pulm renal syndrome -antigbm -ve--MPA
    141 post splenectomy neutropenic sepsis--tazocin
    142 ligonellas pneumonis
    143 obese + smoker +N fev1+chronic resp acidosis --OSA
    144 OSA normal epworth,normal polysomnigraphy---wt loss
    145 bulbar s/s + nasal tone + fall + inc ck===MG
    146 pseudobulbar ---MND
    147 ecg post MI + lbbb---crt
    148 diab retinopathy which prevent porgression ---acei
    149 c8 lesion vs ulnar
    150 csf inc ptn,dec glu,ct shows basal meningeal thick--tb
    151 diabetic pt with hyponatremia & osmolar gap==pseudohypo
    152 hponatremia + inc urinary na & k & dec serum bun/creat in brain tu pt ==?csw
    153 pt on amio + antiTPO postitive --hashimoto
    154 pt on amio + pict of viral thyroiditis
    155 pt on amio ihd & history of cardiac arrythmia become hyperthyroid---add carbimazole

    156 a man withhemptysis what seems to be pneumonia antigbm neg ,anca weekly pos---pneumococcalpneumonia?????????

    plz try to discuss wrong/controversal answers ,add your own
    best regards
  38. dr nn

    dr nn Guest

    dear nnj2010 wen i was reading qs u post i was really surprised that most of the qs i didnt have it n my paper
    then i read last stem u wrote :lol:
  39. novguest

    novguest Guest

    dr nn

    i think some questions r new to me, which i didnt see in real exam
    i think questions differ from centre to centre or candiate to candiate
    ,ost of the ecgs and pics they r telling not came to me\\

    another imp thing is scoring depends on level of diiffculty of the questions
    if difficult question answered==score rises

    if easy questions unanswered--score goes down

    is it so
    i dont kow
  40. ct

    ct Guest

    at the end of the day you have to correct atleast 160 question to get through
  41. Oldmandoc

    Oldmandoc Guest


    1. CXR showing right paracardiac mass, the patient has hypercalcaemia ? lymphoma/sarcoidosis
    2. CXR showing left apical opacity, the patient has features of C8/T1 involvement ? Pancoast’s
    3. MRI showing bifrontal and medial left temporal enhancement on T2, patient presented with altyered level of consciousness ? H simplex encephalitis
    4. MRI showing ? cystic lesion ? craniopharyngioma in woman with secondary amonorrhoea and features of hypopituitarism
    5. MRI showing ? arachnoid cyst in man with seizures
    6. CT showing left frontal abscess in IVDU with possible aspiration pneumonia, antibiotics ?ceftriaxone + metronidazole
    7. CT of extradural haematoma after trauma
    8. CXR showing features of mitral stenosis, clinical finding expected – loud S1
    9. CXR showing atrial septal defect – ECG features RBBB, right axis deviation
    10. Gottron’s papules in a lady with facial and trunca erythema, proximal myopathy, myalgia, raised CK –dermatomyositis
    11. Hands of diabetic cheiropathy in type 1 diabetes
    12. Legs of a boy with features of Henoch – Schonlein purpura – cause of the leg lesions vasculitis
    13. Face of African lady, possibly HIV-infected as she just returned from her native country, with eczema herpeticum – treatment valacyclovir
    14. Eye of man with homocystinuria who developed sudden blurring of vision following trauma- ?hyphaema/inferior lens location
    15. ECG of LBBB in a man a few months after an anterior myocardial infarction with significant heart failure symptoms on ACEI, beta blocker, diuretic and an LVEF of 20%. The next drug to add is spironolactone
    16. Pre-excited AF – do not remember what they asked
    17. Pre-excited AF – cardioveted – best long-term management is radiofrequency ablation
    18. ECG of AICD lead fracture
    19. ECG of ?ventricular sensing failure
    20. ECG of possible atrial tachycardia – the patient had a tachycardia at 150/mnt and there appeared to be abnormal lokking p waves preceding the narrow QRS complexes. The patient had not responded to adenosine. Or was it atrial flutter?21. Fundus of possible diabetic retinopathy ? maculopathy = asked for the best intervention prognosticall after photocoagulation ?ACEI
    22. Fundus of ?branch retinal vein occlusion23. ECG of trifascicular block (RBBB+FAFB+prolonged PR)
    24. Most likely complication in patient with hereditary haemorrhagic telengiectasia (her tongue was trotruding, showing the telengiectasiae at the tip, confirming it was not Peutz-Jegher's) – epistaxis25. Lady with sudden onset right proptosis, chemosis, total III, V and VI palsy ?carotico-cavernous fistula (non-traumatic)
    26. Lady with acute white righ lung ?tuberculosis
    27. Man coming back from Spain has acne rosacea
    28. Pemphigoid rash –asked for finding on immunoflorescence - IgG deposit in basement membrane
    29. Abdominal x-ray of chronic pancreatitis. The patient has diarrhoea
    30. CT of arachnoid cyst
    31. Vegetation attached to anterior mitral leaflet – the lady had a rash and arthritis of the wrist
    32. Renal arteriogram of polyarteritis nodosa
  42. every body has their own answers
    not sure what is rite what is wrong
  43. dr ABG

    dr ABG Guest

    yes everybody has his own answers i will say my opinion about some questions

    SVC obst.---in pastest begin with dexa and anticoagulant so i went for anticoagulant

    HIV in egypt if u notice he said small erythematious rash ...roth spots for typhoid beside egypt isnt common country to acquire hiv FROM it

    pre opeartive hemodialsis ....he didnt fulfill criteria for haemodialsis so not the answer

    myotonia dystrophy ??how and he said in the Q he is normal mentaly??!

    hallucination after cocaine stopping, may be but i went for LSD common hallucinating drug m,ay be i am wrong

    plz guys some short cut for words like CBZ---TEN i dont understand what is that means
  44. orientglow

    orientglow Guest

    More confusing questions to remember:

    1) A patient with DM heart failure coming for review creatinine> 150 , k: 5.2

    What is the therapeutic intervention? stop metformin ? add furosemide (i
    choosed metformin)

    2) female with muscle pain, weakness, nasal tone of voice at the end of conversation with slightly high ck ? myesthenia ? polymyositis
    I choosed myesthenia as the raised ck is explained by a fall before admission

    ) man was in visit to egypt coming with leucopenia, splenomegaly, rose spots --> typhoid fever
  45. MRCP_UK

    MRCP_UK Guest

    just remembered some more questions
    157 postop hyponat ===restrict fluids
    158 sternal fracture in myloma ---add nsaid
    159 HCV ---depression CI to ifn
    160 abn facial movements after halodol---dystonia
    161 during TOE rr drops on midozolam---flumazenil
    162 microscopic hematuria ,fever ,inc esr --??pan vs rcc
    163 pt with dyspepsia doesnt improve after PPI---urea br test got thet wrong
    164 htn during pregnency --labetalol
    165 abdo pain & cramping --- IBS
    166 refractory UC after 5 dayes of hyrdocortisone IV---MTX vs surgery got thst wrong
    167 acute abdominal pain & tenderness & bilous vmoitus--?CT abdo
    168 creat > 150 --stop metformine
    169 possible zes ---octeriotide scar
    170 pt with celiac dis +controlloed + diarrhea on PPI--?drug induced
    171 case of fredrich ataxia
    172 phenytoid OD
    173 alcoholic with seziures despite alprazolam hypglycemic---glucose
    174 nurse with hypoglydemia c peptide high--SU od
    175 simple syncope + abn EEG---no DVLA restrictions?????
    176 convulsion after which became tearfull origin --- frontal lobe??
    177 stoke adam attack hr 55 looks like cardiac arrythmia
    178 obese man with deranged lft--?nash
    179 oesph cancer & stent become suddently dysphagic & drooly---food bolus umpaction
    180 woman with raynauds & oral ulcers---?nifedipine
    181 pic CXR mitral stenosis ?????
    182 pt have headache ,fatigue,numbness on vague distribution ---CFS vs somatizatio
    183 pt with fall ,inc alp t score -2.7 mx===alendronate

    sorry for using abbreviations
    just had to write the questions down before they are gone forever
    does anyone know approx how many questions have to get right in order to pass
    best regards
  46. nmia2

    nmia2 Guest

    there was a question of CLL, wbc count 26,000,c/o recurrent uti,what to do next,, refer for chemo or give bactrim.
    i marked for trimetho/sulfa as the pt had was systemically well.
    2. ecg of a patient with frequent syncope, was there pause?? failed pacemaker???
    3.CT scan of a patient working as miner,smoker with cough,sob ??asbestosis
    4. history of EAA,exposed to avian birds, x-ray shows nodules in upper loe,what is next inv,1. avian precipitants 2.broncheoalveolar lavage
    5. return traveler from india with diarrhea,no h/o wt loss or blood in stool?giardiasis,
    6. alcoholic cirrhosis with tense ascitis,how to mnage,tap no evidence of infection1.paracentesis 2.fluid restriction
  47. dr ABG

    dr ABG Guest

    the chest x ray show left vent hypertrophy and if u agree with this ,mitral stenosis associated with right vent hypertrophy

    so with the history of dizenes and breathelness it is aortic stenosis so answer is single S2
  48. Guest

    Guest Guest

    Also the one with presence of Auer rods, hgh WCC and low platelets - asking for which immediate investigation - Clotting/Flow cytometry - put clottig because of association of DIC with AML3? Not sure though....

    Difficult exam!
  49. Guest

    Guest Guest

    Also treatment of acute gout - allopurinol, rubicurase, cochicine - put the later!
  50. mint_girl_

    mint_girl_ Guest

    Before I make a list i just wanted to ask cos the same q came up in april too and i still couldn't find the answer! DOES SULPHANYLUREAS cause HIGH c peptide?? or only EXOGENOUS INSULIN??

    am talking about the q regarding the male nurse who still had low glucose despite treatment with glucagon and dextrose

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