MRCP Part 2a Dec 2008 questions

Discussion in 'MRCP Forum' started by Guest, Dec 4, 2008.

  1. Guest

    Guest Guest

    Hi guys, trying my best to recall, first sitting, hopefully my last as well Don't flame me if my answers are wrong, comments/discussions to correct them are welcome, thanks!

    Opened another thread so i can add to/edit my entry...

    1) treatment of hypertension in RCC - alpha blockers/beta blockers/RCC
    2) read up on tirofiban, came out 2x
    3) medical therapy on exfoliative psoriasis - vit D analogues/WSP/tar
    4) pt with HIV and HAART develops CMP - cause? drugs vs HIV
    5) mentally retarded 18yo epileptic on CMZ drinks 8L/day presents with hyponatremia with water deprivation tests that does concentrates urine from 280 - 300mmol, then doesn't respond very well to DDAVP - DI/water drinking
    6) pt on warfarin for AF presents with Hb drop of 4g/dL, upper and lower scopes are insignificant except for sigmoid diverticular disease that was not bleeding - colectomy/stop warfarin
    7) dextrocardia ECG
    8) read up on causes of acute renal failure, the AINs
    9) eosinophilic pneumonitis
    10) HHT
    11) Wegener's granulomatosis
    12) PSC
    13) UC lady presenting with very subtle signs/symptoms of PBC, not PSC
    14) Alternative reatment for Raynauds when pt cannot tolerate CCBs
    15) Pt who refuses blood transfusions and dies - autonomy
    16) Cause of diarrhea outbreak in a geriatric ward when staff is not affected - C.jejuni/E.coli/Norovirus
    17) Pt with hypokalemia and hypt on doxozosin and amlodipine, RAS testing shows high renin and aldosterone, next step? - repeat RAS after stopping her meds/renal angiogram
    18) anterior NSTEMI ECG
    19) Management of sacral sacral sore (picture)
    20) Xray of Charcot jt - DM
    21) Bone scan of HPOA
    22) Young guy with left UL weakness, CTscan shows SDH
    23) HIV guy not on HAART, presents with dyspnea, lymph nodes++. CXR shows prominent left hilum - TB/PCP/lyphoma
    24) HIV guy with multiple ring enhancing lesion in brain, Toxo IgM -ve, IgG +ve - lymphoma/toxoplasmosis
    25) 60yo Jamaican man with scars on bilateral shins, denies sexual promicuity, VDRL/TPHA +ve - yaws/pinta/syphilis/HIV
    26) Causes of urinary Bence Jones - not only myeloma!
    27) VZV lesion turning into Nec Fas, cause? - S.pyogenes, Fusobacterium, S.aureus
    28) Inotropic support for patient with TSS (from tampons) - dobutamine/noradrenaline/adrenaline
    29) Liver pt with APTT 47s (not corrected with 50% normal plasma) and plt of 104 going for liver biopsy - do nothing/plt transfusion/FFP
    30) CLL pt with low Ig, plt <100, Hb <11, WCC>50, no constitutional symptoms - Ig transfusion/chemo/do nothing
    31) MRI of patient with HSV encephalitis - acyclovir
    32) Treatment with pt with oculogyric crisis - bromocriptine
    33) Patient with SBP, treatment? - vanco/cipro/3d gen cephalosporin
    34) Celiac disease
    35) Sarcoidosis
    36) Old lady with Ca 2.2, PTH 30+, what to do? - parathyroidecmtomy/Vit D
    37) Patient with osteomalacia biochemistry started on calcitriol, what to give next? - Ca/P043-
    38) PCOS
    39) Addison's
    40) Cushing's
    41) 40+ lady with type 2 DM, renal stones, complains of lethargy, foot pain, myalgia, what to do to confirm diagnosis? - IgF/ferritin
    42) 18yo male with non-stereotyped jerking movements with sniffling that has worsened recently - Tourette's/Huntington's/Sydenham/ADHD
    43) Young lady with wrist slashing - borderline PD
    44) Treatment in an old lady with urge incontinence (urinary) - imipramine/tolterodine
    45) Xray of intestinal obstruction, cause? - gallstone ileus
    46) Xray of left pleural effusion affecting half lung, what next? - CT/pleural tap
    47) Photo of a young lady with irritant contact dermatitis affecting lower abd/wrist/neck.
    48) Photo of gingival hyperplasia - phenytoin
    49) 32yo lady, had hypertension during her first pregnancy 6 yrs ago, but lost to follow up, presents with Cr 600, protein +, blood +, cause? - hypertensive nephroscelrosis
    50) Pt on MTX, has been taking 40mg instead of 10mg per week. Now has ulcers, signs/symptoms of MTX overdose, treatment? - folinic acid
    51) Pt had TURP done for BPH, now has urge incontinence and nocturia, treatment? - amitryptyline/can't remember options
    52) HIV man, who was in contact with his grandma who died of pTB, chemoprophylaxis - RH x 3mths/RH x 6mths/RHE x 6mths
    53) Oral treatment of S.aureus ulcer, with a list of resistance/sensitivities - chlramphenical/vancomycin/ciprofloxacin (to test if you know that certain drugs do not have oral formulations)
    54) Pt with presdumptive TB started on RHE, cultures came back MAI, what to do next? - change treatment (a few options)/wait for sensitivities to return
    55) Pt with cerebral venous thrombosis, filling defect, delta sign, treatment? - alteplase/heparin/aspirin
    56) Pt with hx of amaurosis fugax, on aspirin, returns with another stroke. US carotids 50% stenoses bilaterally, echo shows LVH, akinetic apex - endartectomy, add dipyridamole, stop aspirin start warfarin.
    57) Pt AMI, thromolysis given, 6 days later has epigastric pain, left basal crackles, hypotension, tender abd, amylase 200+, good femoral pulses, no BP difference in ULs - acule cholecystitis/acute pancreatitis/perforated gastric ulcer/aortic dissection
    58) 50yo man with 5wk hx of fever/chills/loin pain, presents with hematuria, PSA 12 - prostatitis, RCC
    59) Lady with papilloma on face, has US kidneys showing a few cysts, also has a mentally retarded brother - tuberous sclerosis
    60) Pt on indwelling catheter with UTI, common cause - B.fragilis/Serratia/other options i can't recall, because i don't know the answer!
    61) Pt with liver failure, has high O2 on lying, low O2 on sitting (platypnea), treatment? - terlipressin
    62) Mild asthmatic, PEFR about 75% of normal - home PEFR & double dose of steroids
    63) Hep C +ve, mononeuritis multiplex - cryoglobulins
    64) Pt with DM, ESRF on HD, has carpal tunnel - dialysis associated carpal tunnel syndrome
    65) 60yo lady with heart failure and low ECG complexes - amyloidosis
    66) Pt with HOCM had 1 episode of syncope - AICD
    67) Pt with chest pain, normal BP, ECG - SVT aberrant conduction (not VT)
    68) Bone scan of old man with back pain, hot spots in lumbar spine - myeloma/bone mets
    69) Treatment for essential thrombocytosis - Anagrelide
    70) Thai lady with meningitis, high CSF pressure, lymphocytosis, invx? - JC virus PCR, cryptococcus latex agglutinin, HSV PCR.
    71) Far East immigrant, hypokalemic periodic paralysis, invx? - TFT
    72) Diarrhea/XRay of IO/empty rectum - overflow diarrhea
    73) Pt with Barrett's, histo shows high grade dysplasia, what next? - double PPI dose/oesophagectomy/surveillance
    74) Pt with head of pancreas CA, hepatomegaly, deep obstructive jaundice, what next? - ERCP with stent/PTC tube/Whipple's/palliative splicing CJ,JJ etc
    75) Pt with locally invasive oesophageal CA, what next? - radical oesophgectomy/chemo/radiotherapy
    76) Pt with UL/face motor stroke, with dyphasia, territory? - MCA/total ACA/partial ACA/PCA/indeterminate
    77) Pt with HIV and meningism, qn came out quite a few times with many differentials - toxo/cryptococcus/EBV/HSV
    78) Wrongly placed limb leads ECG
    79) Old man with back pain, high ESR and high paraproteins - multiple myeloma
    80) Man with history of blood transfusion, presents with mononeuritis multiplex and renal failure - cryoglubinemia
    81) Meningism with Gram +ve bacillus - Listeria monocytogenes
    82) A few qns on pts with arthritis, renal failure, rash - SLE
    83) Pt with Barrett's esophagus low grade dyplasia, treatment? - PPI
    84) Picture of old lady with 2 bald patches, non scarring hair loss - alopeacia areata/kerion/discoid lupus erythematosous
    85) Pt wth smoking, dyslipidemia, has renal failure (Cr 200, K+ 3.1), proteinuria - RAS/Conns/Chronic GN
    86) LIF mass + diastolic murmur - S.bovis
    87) MS with high RU - CISC
    88) multiple lesions in liver - aFP/exp lap/MRI
    89) Lady with LBP, IV user - vertebral OM/hemangioma
    90) Bangladeshi woman with LBP - vertebral OM
    91) Pt with no neck pain, 2 yr history of progressive lower limb weakness/numbness - spinal meningioma/cervical myelopathy 2ndary to disc degneration
    92) Old man with hypercalcemia, high ALP, lowish protein and albumin - myeloma vs carinomatosis
    93) DM with erectile dysfunction same time as diagnosis of DM, biochemistry shows secondary hypogonadism, invx? - prolactin, MRI, ferrittin
    94) 50yo painter with incidental fniding of Hb 11, MCV 60, ferritin normal, Hb electrophoresis normal - alpha thal, beta thal, anaemia of chronic diz, Fe def
    95) Oligomenorrhea, high androstenediones, LH:FSH (15:5), normal estradiol - PCOS
    96) Lady with abd pain, bloody diarrhea and hypotensive, recovered well with IV fluids, 2day ladter, colonoscopyy shows erythema and ulceration over sigmoid and descending colon - UC/CD/collagenous colitis/ischemitis colitis
    97) Lady with episodes of saying "it's starting", held her mother's hand, shallow breathing, closed eyes for 90secs, then recovers and recalls episode well - panic disorder/epilepsy/migraine
    98) 16yo girl, thal major on transfusion, with failure to thrive, biochem shows hypocortisol, hypothyroid, low GH picture, start with? - GH, thyroxine, hydrocortisone
    99) Pt whose parent died suddenly, sibling with renal failure, biopsy of nodules shows angiokeratoma - Fabry's diz
    100) HIV pt with low CD4, with resp distress, monophonic wheeze, ABG shows hypoxia, CXR shows collapse of one lobule - endobronchial Karposi, lymphoma, PCP
    101) Stroke pt, normal swallow, CTHead normal, next step? - admit to stroke unit/MRI
    102) Man with 30yr hx of smoking, PiMZ, COPD picture (not reversible with salbutamol), CXR shows bronchiectasis, cause of his airway obstruction? - cig smoking/anti a1AT/asthma
    103) Pt with peripheral vascular disease complains of left foot burning pain, ABI/TBI of right = normal, left = 0.66, cause of foot pain? - neuropathy/peripheral vasc diz
    104) Pt with AF on amiodarone and developed hyperthyroidism, stopped amiodarone, started carbimazole to no effect, isotope scan shows low uptake, treatment? - prednisolone
    105) Pt treated with heparin and developds thromocytopenia and menorrhagia - heparin induced thrombocytopenia
    106) Pt on warfarin for mechanical heart valve, going for TURP - stop warfarin 1 day before, stop warfarin 3 days before and start heparin, stop warfarin and use aspirin
    107) Pt on citalopram & other drugs develops hyponatremia and confusion, treatment - stop citalopram
    108) Pt with delirium tremens - diazepam, lorazepam, chlorthiamezole
    109) Schizophrenic on olanzepine, becomes agitated, treatment? - IM diazepam, IM lorazepam, phenobarbitol
    110) Drug induced lupus - minocycline
    111) Pt with colon CA, hemicolectomy done, histo shows moderately differentiated adenoCA with local lymph node invasion, treatment? - adjuvant chemo/radio/chemo&radio/portal vein chemo
    112) 35yo man with dad who died at 50+ of AMI, has ST depression on TMX, thallium exercise test was normal, mgmt? - discharge from followup/start on aspirin & beta blocker/coronary angiogram
    113) Pregnant woman with UTI, likely organism? - S.agalactiae
    114) Pt with renal failure on HD complains with wrist pain, biochemistry shows full blown ESRF picture, high Cr, uric acid, phosphate, cause of wrist pain? - amyloidosis, gout
    115) XRay of man with finger pains, on thiazide diuretics, has dyslipidemia and right MCP pain and swelling - gout/rheumatoid arthritis
    116) Pt with chronic diarrhea, relieved when fasting - Coeliac disease
    117) Pt with profuse diarrhea, comes in for testing. 4 days of 1.3-1.4L of diarrhea, including the last day whereby she was fasted - VIPoma
    118) Pt with hypoglycemic attacks, 2.4mmol/L, test? - random insulin and glucose levels
    119) Young man involved in RTA, had femoral fracture fixed 1 mth ago, presents with giddiness worse on movement of head, examination revealed fatiguable nystagmus, cause? - BPPV, post-concussion, CN8 injury
    120) Pt with episodes of upper limb, face numbness and has difficulty findings words - TIA/migraine/epilepsy
    121) HIV pt with MRI showing periventricular enhancement - CMV
    122) 79 yo man with sinus pause, 9 seconds long, no conduction blocks on exercise, pacemaker of choice? - AAI/VVI/VVIR/DDD/DDDR
    123) ECG of 2:1 2nd degree AV block


    A few questions with Familial Mediterranean Fever as an option
    Many questions on UC/CD/IBS, and diarrhea. It will be useful to know how to differentiate the types of diarrhea (blood/mucous/watery), this will handle 10% of the questions, seriously
    HIV and CNS infections, with lumbar puncture results - about another 5%
    Waldenstrom's Marcoglobinemia
    PAN
    Pt from African and Indian continents - AIDS/HIV/TB until proven otherwise
    Thai/Far East - AIDS/HIV/TB, and Hepatitis B until proven otherwise. Male = hypoK periodic paralysis

    Good luck!
    PS: Will add more if i remember...
  2. Guest

    Guest Guest

    122) Pt on dapsone, with methhaemoglobinemia, treatment? - methylene blue
    123) Pt with dyspnea and hypoxia, with pneumothorax, chest tube inserted with underwater seal. A few days later, dyspnea resolved, SpO2 92%, CXR showed improvement but PTX still present, chest tube oscillating and water bubbling, next step? - talc/clamp/insert larger chest tube/apply suction
    124) Lady with asthma and SVT, failed carotid massage, treatment? - verapamil/adenosine
    125) Bartender lady with finger lesions, picture shows - warts
    126) Baseballer/Cricket player with shoulder pain over 2 weeks, worse on movement, not relieved with OTC analgesia, XR shows - osteoid osteoma/chondrosarcoma/bony island/bony infarct
    127) Sickle cell pt on morphine for bone infarction, overdosed, reversed with naloxone, screams in pain, treatment? - IM diclofenac/IM haloperidol/IM pethidine
    128) Xray of hand - enchondroma
    129) DM pt with new vessl over optic disc, mgmt? - refer ophthlamologist
    130) Pregnant lady diagnosed with DM, failed diet management, next? - insulin
    131) Fat 30yo lady with fatty liver biochemistry, and US shows fatty liver, next? - lifestyle advice
    132) DM pt with renal failure, failed gliclazide therapy, terrible HbA1c, next? - insulin, metform, rosiglitazone
  3. fabry

    fabry Guest

    thanks!
    i think paper 1 was the toughest of the three. have no clues to most of the questions.
  4. san

    san Guest

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    rajib
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    Posted: Thu Dec 04, 2008 2:57 am Post subject: Share Dec 2008 questions

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

    Today was again a tough exam as usual.
    Will try to put down questions later. Others are also welcome to fill in.



    _________________
    Dr. R C

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    Guest







    Posted: Thu Dec 04, 2008 10:19 pm Post subject:

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

    Out of the tree papers I found the third one the toughest and full of dilemmas.

    Lets start remembering questions..

    1 Photo of fungal nail infection - Rx - itraconazole
    2 ECG - 2nd degree heart block
    3 ECG - SVT - Rx?
    4 Photo of sacral ulcer of a frail lady in a nursing home - Rx - ?Maggot therapy
    5 Rx of a patient with thrombocytosis, erythrocytosis - ?anagrelide
    6 X ray of a hand - enchondroma
    7 X ray of right shoulder of a man with pain(indian origin) - osteomyelitis, bone infarct, bone tumour
    8 x ray of left shoulder of a female - ? neuropathic pain
    9 MRI abd -- ? polycystic kidney ( patient with proteinuria and haematuria in dipstick)
    10 Diabetic patient, overweight BMI- 38, most of the blood parameters normal except BP 140/90 and HB1Ac- 11, next best treatment -- ? metformin ? BP control
    11 Patient with 3 months unwell, on exam she looks vacant and facial grimacing, subsides within 90 secs, can recollect the events, - Dx- ? epilepsy, ? Migraine


    I would add up later. Please try to add your bits.
    Best of Luck




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    Guest







    Posted: Thu Dec 04, 2008 11:04 pm Post subject:

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

    1. Preganacy -Oedema- BP 140/90; Pre eclampsia
    2. Pergnancy - visual symptoms; one GTCS; normal BP; no protein ; eclampsia or Occipital lobe epilepsy
    3. UTI in pregnancy -S.agalactiae
    4. Young girl who firmly holds her mom's hand during a fit and remembers everything -Panic attack
    5. Insect crawling over body but exmn scratch marks only- psychosis
    6. CRF + Gout - Prednisolone
    7. Alopecia areata - picture
    8. Drug induced SLE - Minocycline
    9. Indian with kinked neck without any symptoms - TB abscess
    10. Indian with back pain - OM
    11. Diabetic foot pic - OM
    12. Cholecystectomy pre-op normal lady asymptomatic - ECG - WPW
    13. Obese + difficult to wake up GCS 7 - IPPV
    14. COPD + pneumothorax - ICD
    15. ECG - Limb lead misplacement
    16. SVT + asthma - Verapamil
    17. SVT (ECG)- re entrant tachy
    18. rt UL palsy, facial palsy and speech disturbance - region of lesion - ? partial antr circulation or indeterminate
    19. akinetic LV apex + 3x small cvas - warfarin
    20. Warfarin - periop conversion - heparin infusion
    21. MI - raised BM - Insulin infusion
    22. X ray - pericardial calcification
    23. Cricket player x ray humeru- osteoid osteoma
    24. MetHB » Tx (16%) - methylene blue
    25. tinea corporis - picture
    26. post rta - high bp - ct showing a mass under lt renal vessels - alpha blocker
    27. SDH (CT)
    28. HIT with dvt Tx - leipurudin
    29. multiple mets in the pic - Ix- psa
    30. 90 year old with cancer - Tx -diamorph infusion
    31. MRI showing temporal lobe emhancemnet Tx - acyclovir
    32. Inferior mi - thrombolysed - repeat chest pain - what to do? - re thrombolyse or platelet inhibitor infusion before revasc
    33. verruca cutis - picture
    34. von recklinghausen cyst - radial cyst with hyper parathyroidism
    35. enchondroma - picture
    36. pericardial effusion- values low ci, high ra pr, high pcwp
    37. hiatus hernia with barrets - anaemia - treatment ( I selected the nissen's)
    38. barrets 1 cm - laser or oesophagectomy
    39. pituitary tumor - big one with symptoms - surgery
    40. pcos - lady with raised LH/FSH ratio and hirsutism
    41. man - shaves less frequently - ferritin?
    42. gum hyperplasia - phenytoin
    43. ms - postural hypo and dry mouth - tizanidine
    44. ms with large residual urine - ?Tx
    45. chap with right sided sensory symptom - sensory seizure
    46. median nerve - amyloidosis
    47. crf - hb 11gm%
    48. blood group - AB
    49. fixed monophonic wheeze - hiv - endobronchial kaposi
    50. lorry driver with hypoglycaemia before lunch? - Ix
    51. migraine - paracetamol+ metoclopramide - dystonia - Tx
    52. schizophrenia - treatment of symptoms acutely - iv chlorpromazine
    53. girl iddm - single new vessel on fundoscopy - HbA1c raised and BP 140/90 - what will you do?
    54. lady with panhypopituitarism - initial management
    55. ct abdo showing multiple cystic lesions everywhere
    56. ct abdo showing multiple lesions in liver - next investigation
    57. watery diarhhoea -? malabsorption of bile salts
    58. diarrhoea in care home - staff not affected - organism
    59. GI bleed - post endoscopy - controlled - now severe arf good uo K 5.9 rx?
    60. Young chap with ST depression on treadmill but no symptoms
    61. ECG with LBBB
    62. right hypo pain, fever, right pleural effusion, foreign travel - amoebic liver abscess
    63. peritoneal dialysis - pleural effusion - hole in the diaphragm
    64. X ray - pleural effusion - mx - chest drain insertion
    65. HOCM - sinus pause + illsustained VT - 2 sec - syncope - tx
    66. ECG with second degree heart block 2:1
    67. Continuous murmur left para-sternal area - ? PDA
    68. EF 20% on all treatment - What next - reduce bisoprolol?
    69. ARF + oedema - UO reduced - initially furosemide - later furosemide and moxonidine - oedema better ? which to stop?
    70. Bloody diarrhoea ongoing - dvt - what treatment
    71. post thrombolysis - abdo pain - amylase 290; left pleural effusion- dx
    72. spider naevi young chap - dx
    73. tender hepatomegaly and ascites - 3 days duration - dx
    74. Amiodarone - thyrotoxic - carbimazole - very less uptake - not on carbimazole now - Tx
    75. blood transfusion - reaction - what next?
    76. female,rash in legs, arthritis, urinary protein + - diagnosis
    77. tender cervix, dysmenorrhoea, dysuria, dyspareunia - Dx
    78. post rta - femur fixed - now positional vertigo - what DX (BPV or labyrinthine leak)
    79. Tx for vertigo - Betahistine, cyclizine, etc were the choices
    80. endocarditis - dx
    81. MRSA - sensitivities given - tx
    82. srilankan with pale patches - leprosy - dx - skin bx
    83. some rash in the back and arm picture??
    84. sacral sore treament (picture again)
    85. car mechanic comes with wallenberg like symptoms - vertebral dissection?
    86. Persistent vegetative state or akinetic mutism?
    87. weakness following diarrhoea - saggital sinus thrombosis - Tx
    88. surgery - pain - morphine - resp depression - naloxone - pain - Tx?
    89. Codeine + diazepam - GCS 7 and Hypoxemia - Tx
    90. elderly meningitis - csf - gram positive rods - Listeria
    91. CSF pressure high - CT periventricular enhancement - HIV + - DX
    92. Septic patient - hypotensive - fluid resusucitated - next tx - norad
    93. rash in the legs, protein + urine, lateral aspect of foot, little finger numbness - Dx
    94. Knee pain - effusion - aspireate - increased Neutriphils and negaatively birefringent crystals - Tx
    95. Medial meniscal calcificatio - Dx
    96. sinus pauses 9 secs but good av conduction - pacemaker type for Tx
    97. Post op - DVT - iliac vein TBx - warfarin started - both legs livido reticularis + renal failure (sudden) - DX
    98. X ray pancreatic calcification - treatment for diarrhoea
    99. Ankylosing spondylosis x ray
    100. ca colon - right hemi - nodal disease - tx ? Ct/rt/etc
    101. Oesophageal ca with nodes - Tx ?
    102. insulation worker - serosanguinous pleural effusion- mesothelial hyperplasia only - Dx
    103. watery diarrhoea- giardiasis
    104. PFT with pleural thickening picture
    105. COPD on all possible treatment + Prn home O2 - 62 yrs old - multiple bullae - Tx?
    106. Indian lady - X ray humerus - ? dx (lipping and erosion of glenoid)
    107. chest infection - gp tx amoxy-diarrhoea - abdo x ray dilated colon- C diff
    108. barium enema showing multiple diverticula - lady presents with abdo pain and distension - Ix of choice
  5. Guest

    Guest Guest

    hi all

    first of all ,, hope all who sat this exam would pass successfuly

    just want to know, how was the difficulty of this exam if compare with previous exams, was it hard, regular or easy or even as usual ??


    thank you all
  6. Mrcp 2008

    Mrcp 2008 Guest

    My advice to all future Part 2 candidate: Read Karla and Oxford Handbook of Medicine - sure pass in Part 2. Many topics from exam covered in OHCM.
  7. Guest

    Guest Guest

    Thanks guest for reminding ohocm and kalra, what do think of pastest as i think it is better than onexamination for part 2 written.
  8. Guest

    Guest Guest

    Guys what about sanjay sharma?
  9. fabry

    fabry Guest

    sanjay sharma is good too - cos it helps u to focus on which are the important topics. bascially, u should read around the topic they asked in the book.

    also review the past years' questions cos there are some repeats (albeit minimal).
  10. Guest

    Guest Guest

    hi fellows, i think it was a tough exam specially the 1st 2 papers, the 3rd was not easy but straightforewards Qs,,,,
    thanks Nerdie, u have a quite good memory, shall we discuss the possible answers????
  11. Mrcp v2

    Mrcp v2 Guest

    My advice is very simple. To pass Part 2 , just stick to OHCM and Kalra , then do as many questions as possible. The questions in exam is straight forward. SS book is extra9not essential).
  12. Guest

    Guest Guest

    lets go thru Nerdie list of Qs:

    4) pt with HIV and HAART develops CMP - cause? i think its HIV CMP

    5) mentally retarded 18yo epileptic on CMZ drinks 8L/day presents with hyponatremia with water deprivation tests that does concentrates urine from 280 - 300mmol, then doesn't respond very well to DDAVP - i think its compulsive water drinking & failure to concentrate is due to medullary washout

    14) Raynauds Rx is Minoxidil (vasodilator)

    16) Cause of diarrhea outbreak in a geriatric ward when staff is not affected - difficult to choose btwn C.jejuni & Norovirus as similar incubation, however Norovirus highly contagious

    19) sacral ulver we used Rx with saline dresing & parafin (from our practice)

    20) Xray of Charcot jt - DM... but what about osteomyelitis? as the pt foot was painful... charcaot usually painless!!!!

    32) occulogyric crisis secondary to Metoclop.. Rx Benzotropine

    33) SBP: most likely cipro as option of Rx given didnt include 3rd generation cephalosporin

    44) many Qs about management of urinary sphincter disturbances, the answer from mastercalss neuro: if residual urine <100 Rx Oxybut,,, if >100 intermittent self-cath

    52) TB latent disease in HIV 6mth course of RINH, unlike non-HIV 3 mths

    55) venous sinus thrombosis with delts sign... Rx heparin

    57) pt MI thrombolysed, abd pain, good perip.pulsations... DX: DU

    61) O2 lying HI, O2 sitting drop: characetristic of hepatopulmonary

    68) Bone scan of old man with back pain, hot spots in lumbar spine - i think bone mets

    69) Treatment for essential thrombocytosis - Hydroxycarbamide (hydroxyuria)


    these are my opinions so far.... do u agree???
  13. Guest

    Guest Guest

    I hate the ambiguity of some of the questions!!

    Which is better for essential thrombocytosis - hydroxycarbamide or anagrelide? :roll:

    I thought Clostridia species more likely as the cause for the diarrhoea outbreak as with Norwalk (norovirus) normally staff affected.

    I am too depressed to talk about exam - very bad. :cry:
  14. Guest

    Guest Guest

    tough exam...................

    need to change strategy ....

    I am here for everybody elses recomendations I did ss and passmedicine but was very confused to see those long and difficult questions. I am not sure
  15. Guest

    Guest Guest

    we need to discuss dear dr , i agree it was tough and v.tricky but what can we do now it is is over......anyway i have few comments about some qs :
    1-the ecg in the last paper was 3rd degree heart block not 2nd ...i did write it 2nd degree but then i realized there are PR difference with each lead THAT is not constant as it it is supposed to be in 2 to 1 block...our boss was always mentioning that to us ...u will see broad qrs ,some of them are bizzare (not on the rythm strip) plus constant r-r interval and dissociated p waves with the qrs....it was .v.tricky qs.....
    2- also the ecg in the 2nd paper about that azthmatic pt , if u focuse on that , u would know that was svt in a wpw pt , i.e this pt could not be treated with verpamil or digoxin bcz it would exggareate the accessory pathway ...then we have adenosine which can abort the wpw but this pt is azthmatic so we can't use adenosine , so we left with amiadrone....there were many small PR intervals in that ecg with ventricular prexciation.....
    3- yes there was a lead with a limb transposition...
    4-regarding the MS pt she would need pelic floor trainning firstly....but there were other 2 qs of incontineces one of them should be treated with oxybutin and the other with self training cather
  16. Guest

    Guest Guest

    I am convinced that it was 2nd degree heart block - I am not quite sure what you are saying.

    Also the asthmatic patient looked like an AVNRT to me - didn't see any evidence of WPW. There were 2 other WPW questions in the exams.
  17. asif75

    asif75 Guest

    as a rule in wpw tachycardia there is broad complex which ws nt the case so i thinkit was svt
  18. Irfankhan6

    Irfankhan6 Guest

    Hi All !

    Tough exam . .

    Paper 2 & 3 were like OK but paper 1 was simply horrible . .

    I didnt read OHCM but found Sanjay Sharma, PasTest (online) & medical-masterclass (online) extremely useful . .

    Textbooks are no good . .

    One need to know about UK guidelines (especialy the stroke, AF, & AMI etc) in detail . .

    Stems were too long . . though there were only 90 Q's in all the three papers but still 3 hours were simply not enough for the lengthy stems . .

    I wish we all get through :D
  19. MM

    MM Guest

    by the way it is not a rule to find a wide qrs in wpw ...i thought it svt in a wpw as well and amidraone....there is such similar qs in onexam......it was silly but trueeeeeeeeeeee
  20. MM

    MM Guest

    but i'm not sure if it was a 2nd or 3rd degree heart block but i chose 2nd defree block....but ur analysis is resonable about the the ecgs
  21. Guest

    Guest Guest

    hi all

    can any one plz summerize for us , ( as i am preparing for april or july 2009) ,, how long does it take to prepare well..

    also what did u read for xray,ct,mri & echo

    thanxxxxxxxxxx
  22. Guest

    Guest Guest

    Lets put our efforts guys to recall more questions and discuss what is best method of prepration and why?
  23. Guest

    Guest Guest

    Code:
    4) pt with HIV and HAART develops CMP - cause? i think its HIV CMP 
    
    5) mentally retarded 18yo epileptic on CMZ drinks 8L/day presents with hyponatremia with water deprivation tests that does concentrates urine from 280 - 300mmol, then doesn't respond very well to DDAVP - i think its compulsive water drinking & failure to concentrate is due to medullary washout 
    
    14) Raynauds Rx is Minoxidil (vasodilator) 
    
    16) Cause of diarrhea outbreak in a geriatric ward when staff is not affected - difficult to choose btwn C.jejuni & Norovirus as similar incubation, however Norovirus highly contagious 
    
    19) sacral ulver we used Rx with saline dresing & parafin (from our practice) 
    
    20) Xray of Charcot jt - DM... but what about osteomyelitis? as the pt foot was painful... charcaot usually painless!!!! 
    
    32) occulogyric crisis secondary to Metoclop.. Rx Benzotropine 
    
    33) SBP: most likely cipro as option of Rx given didnt include 3rd generation cephalosporin 
    
    44) many Qs about management of urinary sphincter disturbances, the answer from mastercalss neuro: if residual urine <100 Rx Oxybut,,, if >100 intermittent self-cath 
    
    52) TB latent disease in HIV 6mth course of RINH, unlike non-HIV 3 mths 
    
    55) venous sinus thrombosis with delts sign... Rx heparin 
    
    57) pt MI thrombolysed, abd pain, good perip.pulsations... DX: DU 
    
    61) O2 lying HI, O2 sitting drop: characetristic of hepatopulmonary 
    
    6 Bone scan of old man with back pain, hot spots in lumbar spine - i think bone mets 
    
    69) Treatment for essential thrombocytosis - Hydroxycarbamide (hydroxyuria) 
    
    Qn4 --> i've no idea, i put it as drug induced
    Qn5 --> I think it's compulsive water drinking, because he was hyponatremic, there was no need to do water deprivation test at all! DI will cause normal or high sodium
    Qn14 --> no idea
    Qn16 --> Norovirus
    Qn19 --> Topical colloid?
    Qn20 --> i put as Charcot, did not notice the 'painful' bit, damn
    Qn32 --> Benztropine
    Qn33 --> cipro
    Qn44 --> CISC
    Qn52 --> 6mths
    Qn55 --> Heparin
    Qn57 --> perf GU
    Qn61 --> terlipressin
    Qn69 -->anagrelide
  24. Guest

    Guest Guest

    Code:
    we need to discuss dear dr , i agree it was tough and v.tricky but what can we do now it is is over......anyway i have few comments about some qs : 
    1-the ecg in the last paper was 3rd degree heart block not 2nd ...i did write it 2nd degree but then i realized there are PR difference with each lead THAT is not constant as it it is supposed to be in 2 to 1 block...our boss was always mentioning that to us ...u will see broad qrs ,some of them are bizzare (not on the rythm strip) plus constant r-r interval and dissociated p waves with the qrs....it was .v.tricky qs..... 
    2- also the ecg in the 2nd paper about that azthmatic pt , if u focuse on that , u would know that was svt in a wpw pt , i.e this pt could not be treated with verpamil or digoxin bcz it would exggareate the accessory pathway ...then we have adenosine which can abort the wpw but this pt is azthmatic so we can't use adenosine , so we left with amiadrone....there were many small PR intervals in that ecg with ventricular prexciation..... 
    3- yes there was a lead with a limb transposition... 
    4-regarding the MS pt she would need pelic floor trainning firstly....but there were other 2 qs of incontineces one of them should be treated with oxybutin and the other with self training cather
    1 - i put as 2nd degree, to me, the PR intervals were constant, and it was 2:1

    2 - i put as verapamil, i did not see the WPW features

    3 - agreed.

    4 - agreed.
  25. Mrcp 2008

    Mrcp 2008 Guest

    1. Lady with MS and urinary retention- Suprapubic catather. This pt has 2nd degree progressive MS which carries poor long term prognosis. So, better to have a long term plan than ISC.

    2. Pt who drinks 8L of water... Nephrogenic DI based on DDVAP results(refer Kalra).

    3. Treatment for thrombocytosis- alpha interferon( the latest treatment).
  26. Mrcp 2008

    Mrcp 2008 Guest

    Picture of a lady with hair loss- total of 2 patches ... Discoic lupus and not alopecia areata.( This is a common picture on internet).

    Pregnant lady with high BP..... Fatty liver disease of pregnancy and not Pre-eclampsia( Both has overlapping clinical pics but FLD has MAHA has this pt PBP shows fragmented cells.

    Spider naevi on young man.... Fat embolism

    Trust me , answer to MANY questions in the exam in OHCM. DO NOT FORGET THAT THE RCP HAS SAID OXFORD MEDICINE IS THEIR GOLD STANDARD TEXT AND NO QUESTIONS IF NO ANSWER FOR IT IN OXFORD MEDICINE
  27. Guest

    Guest Guest

    With regards to question 61 above - there were 2 separate questions - 1 on hepato-renal failure requiring terlipressin and 1 about hepato-pulmonary syndrome (which hopefully you didn't get as that would mean it was a test question and I got it wrong - not that I am clutching at straws. :p )
  28. Guest

    Guest Guest

    i think there was two question about limb lead transposition.
    2 question about wpw.answer to 1q was 24 hr ecg.
    ecg was 3rd degree heart block pp interval equal.
    post mi patient vt or svt
    one question with mcv 60 fl ans b thallasemia trait.
    was it discoid lupus or alopecia areata.
    another question about raynauds answer pantoxyphlline.
    one question about bpppv.
    hydroxy carbamide
    anaother pt with cll observation
    post mi, before ptca gp11b3a inhibitor.
    another pt with concentric hypertrophy.dx by ct scan.
    another about hocm.
    what was it on great toe thickening with surrounding scales.
    please post comment
  29. londonparis

    londonparis Guest

    overall a difficult exam
  30. londonparis

    londonparis Guest

    Sorry MRCP 2008 I know you are very nice bloke, however I have to disagree with you on OHCM, I do not think that all the questions were from Oxford book of clinical medicine not at all. It is right that many questions repeat from past papers and you can find some of them in OHCM, however you can find same number of questions from any other book of medicine including Harrison, Kumar or Davidson so I do not know if OHCM is of particular importance for this exam.
  31. londonparis

    londonparis Guest

    I can not really understand why OHCM and kalra are extremely over emphasized and nobody talks about the equally or even better books for preparation. Even if the guys who recommend that OHCM AND KALRA are right for a tiny bit of second one should think that they are very little bare minimum you need to know to pass with lot of clinical experience and loads of past year papers.


    My recommendation would be try to solve and do as many bof and best of many from as many web sites or books as you can afford.

    Comments very welcome

    Best of luck guys
  32. Guest

    Guest Guest

    There is a stable PP interval in 2nd degree block.

    I still think it's second degree - the QRS had concordance with the p wave and was narrow complex (favouring second degree rather than third).
  33. Mrcp v2

    Mrcp v2 Guest

    To londonparis, read my comments again, RCP has said that Oxford Medicine is the Gold standard text book for MRCP exams. That does not mean that that the exam questions need to be set word by word as the written text in the book. Anyhow, OHCM is just the tiny summary of the thick and huge Oxford Medicine. I only agree with u on 1 point, that is to do as many questions as possible.

    Books like Sanjay Sharma is not exam orientated. P.S I am not a book salesman recommending any particular books to get profit.
  34. Mrcp v2

    Mrcp v2 Guest

    A question abt a lady with pervious h/o of constipation has bowel enema that shows diverticulosis( in the pic). Now, she presented with lower abd pain and vomiting and signs of UTI. What next Ix to do?.

    Ans colonoscope?. Why?. This pt already has complications of diverticulitis, which is a fistula to bladder with recurrent UTI. Does colonoscope can confirm the diagnosis of the existence of colo-vesical fistula?. I think it should be CT scan which can show the location of fistula, size, any collection of pus in abd that can guide the surgeon when he do a laparotomy.
  35. John_rambo

    John_rambo Guest

    me either, i believe that sharma , is not exam orianted ,, for the following reasons

    about 45-50% of the questions are not in BOF format , or ( N out of ),
    as the book focus on the old format , which is ( what ,which , )


    but in the same time the book focus on important point,

    for me , i give sharma 6+ no more ,,,,,,,

    as they need to update the book to make it on BOF format ,,,,

    thanx
  36. Guest

    Guest Guest

    no one use colonoscopy for diverticulosis , as the bowel is inflamed so much making it prone for tear or even rupture
  37. Guest

    Guest Guest

    MRCP

    Hi guys,

    I have attended part 2 in Newcastle. I prepared from OHCM, done 150 questions fro sarma (no time to completed), few chapters from Kalra, and done questions from Onexamination and medical masterclass. I have only completed about 40% of the courses due to lack of time. I liked this exam very very much. I am not sure if I pass. But will not worry a bit if fail.
    I would like to join the questions and discussions.

    I think there were a couple of questions about tuberous sclerosis.
    one question a young chap with renal cysts etc. There was PCOD on the options. But I strongly believe answer was TS. there was another withbcutaneous lesion of TS.

    There was a guy with mathaemoglobinaemia with Dapsone. However, his ABG po2 was normal and pt asymptomatic. Sats were low. thats because interference of Methaemoglobin with sats probe. So, put answer as Observation. (to be honest with you, i did not know the answer if he was symptomatic with low sats)

    There was a guy presenting with one sided weakness. However, he notices after waking up. CT did not show bleed. Answer woould be thrombolysis if Noticed within 3 hrs. But Guidelines(my trust) say if he notices on waking up, it should considered as more than 3 hrs and its contraindication. My answer was admit to Acute stroke ward.

    There was a guy with severe chest pain for 6hrs, showed Inferior STEMI and complete heart block, has been temporarily paced. I put Heparin as answer, as I thought it was too late for thrombolysis and more over there was no mention if he was still in pain.

    wll come up with more discussion on and off. I wellcome your opinions.
  38. Guest

    Guest Guest

    sorry for several typos.
    please correct an young man with PCKD.
  39. Guest

    Guest Guest

    I thought ECG showed 2nd Degree Heart block

    Divertulosis with probable fistula, my answer was CT abdomen.
  40. london paris

    london paris Guest

    Thanks mrcp v2 for what you wrote. I disagreed with you respectfully on ohcm but it is our opinion. I do not doubt your intention for a fraction of second. I perfectly know that you are recomending this just to help others. I am doing so in same sprit. cheers
  41. Guest

    Guest Guest

    If not sanjay shrma then what is recommended ? can somebody tell us who are preparing in net diet.
  42. Guest

    Guest Guest

    can every body write their experience of prepration and what books they found useful as well as web sites please . will be really apriciated. Thanks mrcp v2 and londonparis for nice argument.
  43. Guest

    Guest Guest

    the rcp says that the oxford textbook of medicine is the gold standard
    the ohcm and the oxford textbook are totally different
    the ohcm is a handbook that junior uk doctors carry on the ward
    it is not a reference book nor is it a textbook nor is it a revision book
    the oxford textbook is a massive three volume textbook that can only be used for reference and cannot be used for studying or revising
  44. Guest

    Guest Guest

    hello there can so help with question on a 28 y old lady with skinrash, arthralgia, fatigue and mild sensory deficits, what were answers and which was the right one
  45. Guest

    Guest Guest

    can you remind the question properly. I think it was Haemolytic Uraemic syndrome or TTP. May be helpful if u can post the question properly.
  46. Guest

    Guest Guest

    Code:
    2. Pt who drinks 8L of water... Nephrogenic DI based on DDVAP results(refer Kalra). 
    Er, he was hyponatremic. I still think it's compulosive water drinking. the entire DDAVP was a con job.


    Code:
    With regards to question 61 above - there were 2 separate questions - 1 on hepato-renal failure requiring terlipressin and 1 about hepato-pulmonary syndrome (which hopefully you didn't get as that would mean it was a test question and I got it wrong - not that I am clutching at straws.   )
    Oops!


    Code:
    There is a stable PP interval in 2nd degree block. 
    
    I still think it's second degree - the QRS had concordance with the p wave and was narrow complex (favouring second degree rather than third).
    Yes, i'm very sure it's 2:1 2nd degree AV block. There is a constant PR interval, and no dissociation of P/QRS complexes


    Code:
    A question abt a lady with pervious h/o of constipation has bowel enema that shows diverticulosis( in the pic). Now, she presented with lower abd pain and vomiting and signs of UTI. What next Ix to do?. 
    
    Ans colonoscope?. Why?. This pt already has complications of diverticulitis, which is a fistula to bladder with recurrent UTI. Does colonoscope can confirm the diagnosis of the existence of colo-vesical fistula?. I think it should be CT scan which can show the location of fistula, size, any collection of pus in abd that can guide the surgeon when he do a laparotomy.
    CT scan. You colonocopy a diverticulitis --> risk of perf.


    Code:
     think there were a couple of questions about tuberous sclerosis. 
    one question a young chap with renal cysts etc. There was PCOD on the options. But I strongly believe answer was TS. there was another withbcutaneous lesion of TS. 
    
    There was a guy with mathaemoglobinaemia with Dapsone. However, his ABG po2 was normal and pt asymptomatic. Sats were low. thats because interference of Methaemoglobin with sats probe. So, put answer as Observation. (to be honest with you, i did not know the answer if he was symptomatic with low sats) 
    
    There was a guy presenting with one sided weakness. However, he notices after waking up. CT did not show bleed. Answer woould be thrombolysis if Noticed within 3 hrs. But Guidelines(my trust) say if he notices on waking up, it should considered as more than 3 hrs and its contraindication. My answer was admit to Acute stroke ward. 
    
    There was a guy with severe chest pain for 6hrs, showed Inferior STEMI and complete heart block, has been temporarily paced. I put Heparin as answer, as I thought it was too late for thrombolysis and more over there was no mention if he was still in pain. 
    TS for the young man, not PCKD
    Methylene blue for methaemoglobinaemia
    Admit to Acute Stroke Unit, because if he wakes up with the stroke, you take the onset as the time he fell asleep (ie. the night before, definitely >3hrs)
    Can't remember the 3rd qn




    Code:
    hello there can so help with question on a 28 y old lady with skinrash, arthralgia, fatigue and mild sensory deficits, what were answers and which was the right one
    Sounds like a cryoglobulinaemia or PAN to me... Need more details...
  47. Guest

    Guest Guest

    I used Sanjay and cnexamination

    I'm not too impressed with onexamination really. No feedback, and they removed the 'comments' fun which i felt was really useful as people could argue over the answers.

    My friend was pleased with PASTEST, so maybe someone who used PASTEST will care to comment?

    There are very few repeat questions, if any at all.

    Included were XRays, photos, bone scan, CTliver/brain , MRI spine/brain, ECGs.

    These were not present at all: Flow loop, Hearing test, M-mode, 2DEcho
  48. Guest

    Guest Guest

    thanx fellows for this useful discussion, i feel that everybody was on the track with little differences... which is good sign.....

    i agree with Nerdie with the ECG of 2:1 block....

    that guy who woke up with stroke, i agree with the one who mention the guidlines, its true, onset of stroke should be considered at the time he was last seen OK...

    for Methemoglobinemia,, i agree with answer of Observation as Methem level was 16% (mild) and he was asymptomatic, all what is required is to withdraw the offending cause.....

    that pt with skin abnormality in the face & renal cyst & epileptic brother, the answer was TS

    i recommend u to review master class neurology for MS pts with urine disturbances.. its mentioned that if residual urine <100 Rx Oxybut & if >100 ISC

    one pt with hemiparesis, sensory inextinction, severe dysarthyria (not dysphasia), maintained conciousness & normal visual fields..... answer is lacunar stroke....once again review masterclass neurology for stroke OCSS classification score...

    that ECG showing SVT with no abbernat conduction (nor QRS duration) answer is verapamil as adnosine is CI in asthma....

    one Qs about minimal change relapse, responsive to steroid but pt is refusing steroid.... answer cyclophosphamide

    HIV pt with hemoptysis & lung collapse... answer is endobronchial kaposi

    pt with diastolic HF, symmetrical ventricular hypertrophy suggesting amyloidosis, answer is rectal biopsy

    nigerian lady with joints pain & XR (picture) showing avascular necrosis of humeral head
    (probably sickler)

    from my experience i recommend Masterclass series its puplished from the RCP & contain all what is necessary to pass but its difficult to memorize... so as many as possible of Qs bestof 5 & any of many will be extremely usefu.....
  49. Guest

    Guest Guest

    that boy with 8L water drinking is compulsive water drinking & lack of response to DDVAD is due to medullary washout, hyponatremia augment this choice.......

    that guy with MI thrombolysed, developped re-infarction... answer is heparin to bridge rescue PCI.....

    ya there was a Qs with cyoglobulinemia......

    there were 2 ECG Qs, one in paper 1 answer was dextrocardia, paper 3 answer was limb lead malposition....

    if u r in short of time go to pastest online Qs, if u"ve enough time study both pastest & onexaminations
  50. Guest

    Guest Guest

    i agree with the asthma lady --> verapamil, someone said something about the lady have WPW as well on the ECG (i don't know how you can spot that) resulting in verapamil being a contraindication

    Agree with KS being the cause of the monophonic wheeze

    ECGs: dextrocardia and limb lead transpoition and 2:1 block

    AMI and reinfarction, i put tirofiban as the answer

    Lady with heart failure: rectal biopsy for amyloidosis

    Mental retarded guy --> compulsive water drinking

    As for the rest, i did not put the same answers as you suggested, but i think you're right.


    i don't know anything about neuro masterclass, i'm in Singapore :)

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