MRCP2 july 2009 recall questions

Discussion in 'MRCP Forum' started by Guest, Jul 30, 2009.

  1. Guest

    Guest Guest

    Patients with CVID often have a history of recurrent infections.

    * The recurrent infections commonly affect the upper and lower respiratory tracts. Patients come to medical attention due to infectious diseases at the time of onset, the most common being otitis media, diarrhea, pneumonia, and sinusitis.10 Almost all have acute and recurrent infections.
    * Persistent diarrhea and malabsorption caused by Giardia lamblia infection occur in patients with CVID.
  2. Guest

    Guest Guest

    there were 2 mcqz wid psoriasis one wid oral treatment nd 1 wid topical treatment ! wazza treatment ? I wrote methotrexate nd corticosteroid respectively. please comment
  3. Guest

    Guest Guest

    whn z d result xpected?
  4. mithun 1234

    mithun 1234 Guest

    vit d3 and methotreaxte for psoriasuis
  5. Guest

    Guest Guest

    I wrote steroids fr topical nd methotrexate fr oral treatment
  6. adeljack

    adeljack Guest

    Exam Date

    dear All
    when do you expect result
  7. Guest

    Guest Guest

    wild guess end of next week! daz wut evry1 z saying
  8. Guest

    Guest Guest

    no news frm aippg ! seems evry1 z depressd :( nd lazy ! nd keeping his/her fingers crossd :wink: gud luck 2 evry1!
  9. aaisha khan

    aaisha khan Guest

    whattttt???????

    man i dunno abt anyone else but it sure was not easy..MRCP 1 was a piece of cake infront of it and yeah shanjay and on E was nuthin like the real paper. The images were crazy anyhow lets see..
  10. Guest

    Guest Guest

    hi every one
    regard this examine its not that easy . but really we couldnt consider it diffucult , its not depend on the preparation for the examine only which need much time just to know what to read specially if you dont have much clinical experience.
    the second thing is the way how to answer the questions as many question you can answer it correctly without knowing any thing about the subject of the answer as they try to examine your way of thinking and your self confidence not only the recall of information.

    any way if i passed the examine i will disclose some trick i used in this examine and it help me to answer more the 20 question easly. any way let us wait the result to see if my way is correct. good luck for all

    Dr Nashat halasah
  11. Guest

    Guest Guest

    I'd be interested in hearing your trick Dr Halasah - especially as i may have to resit again :(

    The only "trick" I used was the try to cross off the options that were wrong to leave as few possibilities as I could. For some q's this helped, others not.

    Also I learned that often the paragraph does not have to be read to answer the question (can be completely unrelated), so i would read the q first, then read the intro.

    What were your techniques?
  12. Guest

    Guest Guest

    .
  13. Guest

    Guest Guest

    her some fact which help in the last minute before examine one of the active member in AIPPG write them :

    TOP 50 MRCP facts

    1. Acromegaly – Diagnosis: OGTT followed by GH conc.
    2. Cushings – Diagnosis: 24hr urinary free cortisol. Addisons --> short synacthen
    3. Rash on buttocks – Dermatitis herpetiformis (coeliac dx)
    4. AF with TIA --> Warfarin
    5. Herpes encephalitis --> temporal lobe calicification
    6. Obese woman, papilloedema/headache --> Benign Intercanial Hypertention
    7. Drug induced pneumonitis --> methotrexate or amiodarone
    8. chest discomfort and dysphagia --> achalasia
    9. foreign travel, macpap rash/flu like illnes --> HIV acute
    10. cause of gout --> dec urinary excretion
    11. bullae on hands and fragule skin torn by minor trauma --> porphyria cutanea tarda
    12. Splenectomy --> need pneumococcal vaccine 2 weeks pre-op and for life
    13. primary hrperparathyroidism --> high Ca, normal/low PO4, normal/high PTH (in elderly)
    14. middle aged man with KNEE arthritis --> gonococcal sepsis (older people -> Staph)
    15. sarcoidosis, erythema nodosum, arthropathy --> Loffgrens syndrome benign, no Rx needed
    16. tremor postural,slow progression,titubation, relieved by OH->benign essential tremor AutD
    17. electrolytes disturbance causing confusion – low/high Na
    18. contraindications lung surgery --> FEV <1.5, MALIGNANT effusion, mets outside lung
    19. prevent further renal deterioration/proteinuria--> dec bp 130/90, Ace inhibitors
    20. headache with many analgesics at once -> analgesic induced headache
    21. 1.5 cm difference btwn kidneys -> Renal artery stenosis --> Magnetic resonance angiogram
    22. temporal tenderness--> temporal arteritis -> steroids > 90% ischaemic neuropathy, 10% retinal art occlusion
    23. severe retroorbital, daily headache, lacrimation --> cluster headache
    24. pemigus – involves mouth (mucus membranes), pemphigoid – less serious NOT mucosa
    25. diagnosis of polyuria -> water deprivation test, then DDAVP
    26. insulinoma -> 24 hr supervised fasting hypoglycaemia
    27. Diabetes Random >7 or if >6 OGTT -> >11.1 also seen in HCT
    28. causes of villousd atrophy: coeliac, Whipples, dec Ig, lymphoma, trop sprue (rx tetracycline)
    29. diarrhoea, bronchospasm, flushing, tricuspid stenosis -> gut carcinoid c liver mets
    30. hepatitis B with general deterioration -> hepaocellular carcinoma
    31. albumin normal, total protein high -> myeloma (hypercalcaemia, electrophoresis)
    32. HBSag positive, HB DNA not detectable --> chornic carier
    33. Inf MI, artery invlived -> Right coronary artert
    34. Aut dom conditions: Achondroplasia, Ehler Danlos, FAP, familial hyperchol,Gilbert, Huntington's, Marfans's, NFT I/II, Most porphyrias, tuberous sclerosis, vWD, PeutzJeghers
    35. X linked: Beck/Duch musc dyst, alports, Fragile X, G6PD, Haemophilia A/B
    36. Loud S1: MS, hyperdynamic, short PR. Soft S1: immobile MS, MR
    37. Loud S2: hypertension, AS. Fixed split: ASD. Opening snap: MOBILE MS, severe near S2
    38. HOCM/MVP - inc by standing, dec by squating (inc all others). HOCM inc by valsalva, decs all others. Sudden death athlete, FH, Rx. Amiodarone, ICD
    39. MVP sudden worsening post MI. Harsh systolic murmur radites to axilla.
    40. Dilated Cardiomyopathy: OH, bp, thiamine/selenium deficiency, MD, cocksackie/HIV, preg, doxorubicin, infiltration (HCT, sarcoid), tachycardia
    41 Restrictive Cardiomyopathy: sclerodermma, amyloid, sarcoid, HCT, glycogen storage, Gauchers, fibrosis, hypereosinophilia Lofflers, caracinoid, malignancy, radiotherapy, toxins
    42. Tumor compressing Respiratory tract --> investigation: flow volume loop
    43. Guillan Barre syndrome: check VITAL CAPACITY
    Horners – sweating lost in upper face only – lesion proximal to common carotid artery
    Internuclear opthalmoplegia: medial longitudinal fasciculus connects CN nucleus 3-4. TRIES TO YANK THE ipsilateral BAD EYE ACROSS THE NOSE. Convergence is normal. Causes: MS, SLE, Miller fisher, overdose(barb, phenytoin, TCA), Wernicke
    46.Progressive Supranuclear palsy: Steel Richardson. Absent voluntary downward gaze, normal dolls eye. i.e. Occulomotor nuclei intact, supranuclear pathology
    47 Perinauds syndrome: dorsal midbrain syndrome, damaged midrain and superior colliculus: impaired upgaze (cf PSNP), lid retraction, convergence preserved. Causes: pineal tumor, stroke, hydrocephalus, MS.
    48. demetia, gait abnormaily, urinary incontinence. Absent papilloedema-->Normal pressure hydrocephalus.
    49. acute red eye -> acute closed angle glaucoma >> less common (ant uveitis, scleritis, episcleritis, subconjuntival haemmorrhage)
    50. wheeles, urticaria, drug induced -> aspirin
    51. sweats and weight gain -> insulinoma
    52. diagnostic test for asthma -> morning dip in PEFR >20%
    53. causes of SIADH: Lithium, chlorpropamide, carbamepine
    54. bisphosphonates:inhibit osteoclast activity, prevent steroid incduced osteoperosis (vit Dalso)
    55. returned from airline flight, TIA-> paradoxical embolus do TOE
    55. alcoholic, given glucose develops nystagmus -> B1 deficiency (wernickes). Confabulation->korsakoff
    56. mono-artropathy with thiazide -> gout (neg birefringence). NO ALLOPURINOL for acute

    High Yield Topics
    1. Anorexia Nervosa
    2. Reiters Syndrome – arthritis, uveitis, urethritis – Chlymidia, campylobacter, Yersinia, Salmonella, Shigella. Balanisits.
    3. PKD – aut dom Chr 16/4 assoc berry aneurysm, mitral/aortic regurg
    4. Porphyria – photosensitivity, blisters, scars with millia, hypertrichosis
    5. Heart sounds: Aortic Stenosis s2 paradoxical split, length proportional to severity
    6. Vitiligo – commonest assoctions pernicious anaemia >>> type 1 dm, autoimmune addisons, autoimmune thyoid dx

    ALMOST Pathognomic for the exam
    1.fatiguability -> myasthrnia gravis
    2.fasciculations -> Motor neurone diease
    3.silvery white scale -> psoriasis
    4.hypopigmented -> vitiligo/pityriasis versicolor


    good luck Dr Nashat halasah
  14. Guest

    Guest Guest

    more MRCP FACTS:

    56.returned from airline flight, TIA-> paradoxical embolus do TOE.
    57. alcoholic, given glucose develops nystagmus -> B1 deficiency (wernickes). Confabulation->korsakoff.
    58. mono-artropathy with thiazide -> gout (neg birefringence). NO ALLOPURINOL for acute.
    59. painful 3rd nerve palsy -> posterior communicating artery aneurysm till proven otherwise
    60 late complication of scleroderma --> pumonaryhypertention plus/minus fibrosis.
    61. causes of erythema mutliforme: lamotrigine
    62. vomiting, abdominal pain, hypothyroidism -> Addisonian crisis (TFT typically abnormal in this setting DO NOT give thyroxine).
    63. mouth/genital ulcers and oligarthritis -> behcets (also eye/skin lesions, DVT)
    64. mixed drug overdose most important step -> Nacetylcysteine (time dependent prognosis)
    65. cavernous sinus syndrome - 3rd nerve palsy, proptosis, periorbital swlling, conj injectn
    66. asymetric parkinsons -> likely to be idiopathic
    67. Obese, NIDDM female with abnormal LFT's -> NASH (non-alcoholic steatotic hepatitis)
    68. fluctuating level of conciousness in elderly plus/minus deterioration --> chronic subdural. Can last even longer than 6 months
    69. Sensitivity --> TP/(TP plus FN) e.g. For SLE - ANA highly sens, dsDNA:highly specific
    70. RR is 8%. NNT is ----> 100/8 --> 50/4 --> 25/2 --> 13.5
    71. ipsilateral ataxia, Horners, contralateral loss pain/temp --> PICA stroke (lateral medulary syndrome of Wallenburg)
    72. renal stones (80% calcium, 10% uric acid, 5% ammonium (proteus), 3% other). Uric acid and cyteine stone are radioluscent.
    73. hyperprolactinaemia (allactorrohea, amenorrohea, low FSH/LH) -> Da antags (metoclopramide, chlorpromazine, cimetidine NOT TCA's), pregnancy, PCOS, pit tumor/microadenoma, stress.
    74. Distal, asymetric arthropathy -> psoriasis
    75. episodic headache with tachycardia -> phaeochromocytoma
    76. very raised WCC -> ALWAYS think of leukaemia.
    77. Diagnosis of CLL --> immunophenotyping NOT cytogenetics, NOT bone marrow
    78. Prognostic factors for AML -> bm karyotype (good/poor/standard) >> WCC at diagnosis.
    79. pancytopenia with raised MCV --> check B12/folate first (other causes possble, but do this FIRST). Often associayed with phenytoin use --> decreased folate
    80. miscariage, DVT, stroke --> lupus anticoagulant --> lifelong anticoagulation
    81. Hb elevated, dec ESR -> polycythaemua (2ndry if paO2 low)
    82. anosmia, delayed puberty -> Kallmans syndrome (hypogonadotrophic hypogonadism)
    83. diag of PKD -> renal US even if <30, linkage analysis BUT requires serum from 2 relatives with dx
    84. Young female -> think anorexia nervosa
    85. commonest finding in G6PD hamolysis -> haumoglobinuria
    86. mitral stenosis: loud S1 (soft s1 if severe), opening snap.. Immobile valve -> no snap.
    87. Flank pain, urinalysis:blood, protein -> renal vein thrombosis. Causes: nephrotic syndrome, RCC, amyloid, acute pyelonephritis, SLE (atiphospholipid syndrome which is recurrent thrombosis, fetal loss, dec plt. Usual cause of cns manifestations assoc with lupus ancoagulant, anticardiolipin ab)
    88. anaemia in the elderly assume GI malignancy
    89. hypothermia, acute renal failure -> rhabdomyolysis (collapse assumed)
    90. pain, numbness lateral upper thigh --> meralgia paraesthesia (lat cutaneous nerve compression usally by by ing ligament)
    91. diagnosis of haemochromatosis: screen with Ferritin, confirm by tranferrin saturation, genotyping. If nondiagnostic do liver biopsy 0.3% mortality
    92. 40 mg hidrocortisone divided doses (bd) --> 10 mg prednisolone (ie. Prednislone is x4 stronger)
    93. BTS: TB guidlines – close contacts -> Heaf test -> positive CXR, negative --> repeat Heaf in 6 weeks. Isolation not required.
    94. Diptheria -> exudative pharyngitis, lymphadenopathy, cardio and neuro toxicity.
    95. Indurated plaques on cheeks, scarring alopecia, hyperkeratosis over hair follicles ->>Discoid lupus
    96. wt loss, malabsoption, inc ALP -> pancreatic cancer
    97. foreign travel, tender RUQ, raised ALP --> liver abscess do U/S
    98. wt loss, anaemia (macro/micro), no obvious cause -> coeliac (diarrhoea does NOT have to be present)
    99. haematuria, proteinuria, best investigation --> if glomerulonephritis suspected --> renal biopsy
    100. venous ulcer treatment --> exclude arteriopathy (eg ABPI), control oedema, prevent infection, compression bandaging.
    101. Malaria, incubation within 3/12. can be relapsing /remitting. Vivax and Ovale (West Africa) longer imcubation.
    102. Fever, lymphadenopathy, lymphocytosis, pharygitis --->EBV ---> heterophile antibodies
    103. GI bleed after endovascular AAA surgery --> aortoenteric fistula

    High Yield Topics
    1. Young girl – suspect Anorexia Nervosa – linugo hair, finctional hypogonadotrophic hypogonadism -> amennorhea. LH and FSH both low. All other hormones are usually normal. Ferritin low.
    2. Reiters Syndrome – arthritis, uveitis, urethritis – Chlymidia, campylobacter, Yersinia, Salmonella, Shigella. Balanisits.
    3. PKD – aut dom Chr 16/4 assoc berry aneurysm, mitral/aortic regurg
    4. Porphyria – photosensitivity, blisters, scars with millia, hypertrichosis
    5. Heart sounds: Aortic Stenosis s2 paradoxical split, length proportional to severity
    6. Vitiligo – commonest assoctions pernicious anaemia >>> type 1 dm, autoimmune addisons, autoimmune thyoid dx
    7. Gout – blood urate high/low/normal, joint aspirate pos birif, ppt thiazides, NO allopurinol/aspirin in acute phase
    8. Peripheral neuropathy – a) B12 – rapid, dorsal columns (joint pos, vibration), sensory ataxia, pseudoathetosis of upperlimbs b) diabetic – slow, spinothalamic (pain, temp?) c)alcohol – slow progressive, spinothalamic d) Pb – motor upper limbs
    9. CNS abnormalities in HIV: toxoplaasmosis (ring enhancing), lymphoma (solitary lesion). HIV encephalopathy, progressive multifocal leucoencephalopathy (PML – demylination in advanced HIV, low attenuation lesions)
    10. Travellers diarrohea: chronic (>2 WEEKS) giardia (incidious onset rx. Metronidazole), salmonella (serious systemic illness), E.coli (rx. Ciprofloxacin) , Shigella
    11. Renal syndrome – minimal change disease, membanous, IgA nephropathy, post-streptococcal.
    12. If you see blood on urinalysis forget about RAS
    13. Thyroid Malignancy – tend to be non-functional, anaplastic has worse prognosis, local infiltration -> dysphagia, vocal cord paralysis
  15. Guest

    Guest Guest

    some statistical facts which can be useful for the exam

    **Fibrosing alveolitis is the most common pulmonary manifestation of rheumatoid arthritis.

    **impairment in renal function in Hepatorenal syndrome The hallmark is oliguria and progressive decline in renal function. The urine is typically free of protein or any other sediment.

    **Long-term haemodialysis is associated with carpal tunnel syndrome. is the most common complication

    **the most likely cause of bacterial meningitis in adult patients with neutropenia :
    Listeria monocytogenes.

    **the most frequent cause of a nosocomial wound infection: Insufficient hand disinfection

    **Osteoporosis is the most common cause of fracture of neck of femur and is not associated with any specific abnormality in the standard bone biochemistry profile.

    **Tuberculous arthritis usually affects children aged 2–5 years. The hip is one of the most frequently affected joints.

    **Meningitis due to enterovirus and meningococcus (N. meningitidis) are the most likely in this age group(28 yrs0

    **Tuberculous meningitis is rare in the UK and the CSF typically shows a markedly raised protein (> 1 g/l), a low glucose (< 50% serum) and a lymphocytosis.

    **Streptococcus meningitis is the commonest cause of meningitis in those over 40 years of age; very high neutrophil counts are often seen in the CSF, which has a high protein and low glucose level.

    **Factors predisposing to digitalis toxicity are advanced age, hypoxia, hypokalaemia, hypomagnesaemia, hypercalcaemia, hypothyroidism, amyloidosis and renal failure. The most common precipitating factor is hypokalaemia.

    ** In Hodgkin’s disease Lymphocyte depleted has the worst prognosis. It is the least common variant and typically occurs in older people.

    **The commonest mutation in patients with cystic fibrosis (CF) is the Delta-F508 mutation.

    **in systemic lupus erythematosus Recurrent pleurisy and pleural effusions are the most common manifestations and are often bilateral

    **Cryptosporidium infection in HIV-positive patients along with cytomegalovirus, is the commonest cause of HIV-related diarrhoea and tends to present when the CD4 count is less than 100.

    **Diarrhoea and flushing, occurring separately or together, are the most frequent presenting features of carcinoid syndrome (approximately half of all patients).

    **Focal necrotising glomerulonephritis is the characteristic renal lesion of generalised Wegener’s granulomatosis. Typically, it presents with deteriorating renal function that progresses to renal failure within 3 months,

    **Glomerulonephritis is a common occurrence in chronic Schistosoma mansoni infection in Brazil, especially in patients with hepatosplenic disease

    **Tremor in the legs is a useful sign as it is almost always associated with idiopathic Parkinson’s disease. The tremor is typically a rest tremor unlike benign essential tremor, where actions such as drinking a cup of tea make the tremor worse.

    **Pericardial effusions are more common in patients with rheumatoid arthritis than constrictive pericarditis and acute pericarditis.

    **The earliest lesions to be detected in diabetic retinopathy are usually dot haemorrhages (capillary microaneurysms) and venous dilatation.

    **Hypertrophic cardiomyopathy is the single, most common cause of sudden death in young athletes.

    **the most common cause of paranoid psychosis with visual hallucination :Alcohol withdrawal

    **Basal cell carcinomas are the most common malignant skin tumour and are related to excessive skin exposure. They are common later in life and may present as a slow-growing nodule or papule.

    **The most common type of thyroid cancer is papillary cancer, which accounts for approximately 70% of all thyroid cancers
  16. Guest

    Guest Guest

    more facts
    Neuropeptide Y (enteric nerves)regulates intestinal blood flow.

    Somatostatin (stomach & pancreas) inhibits secretion and action of gut hormones.
    Glucagon(pancreas)reduces GI motility


    **In systemic lupus erythematosus (SLE). Joint involvement is the most common clinical feature (> 90%).

    **Prolactinoma is the commonest pituitary tumour, making up 30% of all adenomas. Microadenomas occur with increasing frequency in women, macroadenomas more commonly in men.

    **ASDs account for about 10-15% of all congenital cardiac anomalies and are the second commonest congenital heart disease seen in adults.

    **VSDs are the commonest adult congenital heart disease.

    **Frontal lobe dementia------>a failure to generate list rapidly is the test of frontal lobe+difficulties with task sequencing and executive skills. EXPRESSIVE aphasia, primitive reflexes, perseveration, anosmia and changes in personality.

    Parietal lobe--------------->Dyscalculia(inability to perform mentalarithmetic) is a manifestation of the dominant parietal lobe
    Sensory inattention, apraxia, neglect, astereognosis(unable to recognise an object by feeling it) and visual field defects( typically homonymous inferior quadrantanopia).

    Temporal lobe-----------> typical homonymous superior quadrantanopia), Wernike's (RECEPTIVE) aphasia, auditory agnosia, and memory impairment

    Occipital lobe---------->cortical blindness(blindness due to damage to the visual cortex and may present as Anton syndrome where there is blindness but the patient is unaware or denies blindness), homonymous hemianopia, and visual agnosia( seeing but not percieving objects - it is diffirent to neglect since in agnosia the objects are seen and followed but cannot be named).

    Homonymous hemianopia----------> occipital lobe
    superior quanranopia---------------->temporal lobe
    inferior quanrtanopia------------------->parietal lobe

    **AUTOIMMUNE ASSOCIATIONS
    Thyroid disease, IDDM, Addison disease, pernicious anaemia, alopecia, vitiligo.

    MULTIPLE ENDOCRINE NEOPLASIA
    Autosomal dominant. The association of a number of endocrine tumours.

    MEN I MEN IIa
    Parathyroid Adrenal (phaeochromocytoma, Cushing)
    Pituitary (prolactin or GH or ACTH) Thyroid (medullary carcinoma)
    Pancreas Parathyroid hyperplasia
    (Thyroid)
    (Adrenal)
    Fasting calcium level (??) Calcitonin level ? (medullary ca. thyroid)
    Look for phaeochromocytoma



    MEN IIb is the same as MEN IIa, with Marfanoid features and multiple neuromas.

    Prophylactic total thyroidectomy is performed if the child is known to carry the gene for MEN II.

    **Adrenergic inhibitors used in hypertension:
    Peripheral neuronal inhibitors: Reserpine, Guanethedine
    Central adrenergic inhibitors: M-dopa, Clonidine, Guananbenz, Guanafacine
    Alpha-receptor blockers:
    o Alpha 1 and 2 receptor blockers: Phenoxybenzamine, phentolamine
    o Alpha 1 blockers: Doxazosin, Terazosin
    Beta blockers
    Alpha and beta blockers: Labetalol

    **Mixed connective tissue disease (MCTD) is an overlap connective tissue disease with features of SLE, polymyositis and progressive systemic sclerosis. The characteristic auto-antibody pattern is of high titre anti-RNP and speckled pattern ANA.

    **The antiphospholipid syndrome is one of the commoner causes of hypoadrenalism and may precipitate adrenal infarction and haemorrage through adrenal vein thrombosis.

    **Biphasic high amplitude sharp waves are characteristic of ceutzfeld-jacob disease.

    **Causes of dilated pupils: Holme's adie(myotonic pupils)
    Third nerve palsy
    drug poisons(atropine, CO, Ethylene glycol)

    Causes of small pupils : horner;s syndrome
    old age
    pontine haemorrhage
    Argyl Robertson pupil
    Drug poisons(opiate, organophosphate)

    **Optic neuropathy------------->central scotoma.
    Optic tract lesion--------------->incongrous homontmous hemianopia.
    Chiasmal lesion---------------->bitemporal hemianopia.
    optic radiation and occipital lobe---------------->congrous hemianopia.

    **Listeria meningitis is typically associated with brain stem signs. CSF shows neutrophilic pleocytosis, low glucose and high protein.

    **Nystagmus is defind as involuntary oscillations of the eyes.
    THis may be
    1-Pendular: when the oscillations are equal in rate and amplitude.
    2-Jerking: when there are quick and slow phases(the quick phase is used to define the direction).
    pendular nystagmus is usually duee to loss of macular vision, but maybe seen in diffuse brain stem lesions.

    jerking nustagmus which is of constant direction regardless of the direction of gaze, suggests a labyrinthine or cerebellar lesion.

    Nystagmus which changes with the direction of gaze suggests a widspread central involvement of vestibular nuclei.

    Jerking nystagmus present only on lateral gaze, and who's fast component is in the direction of gaze, indicates a lesion of brain stem or cerebellum.

    Nystagmus confined to one eye suggests a peripheral lesion of the nerve or mucsle, or a lesion of the mediallongitudinal bundle.

    Nystagmus restricted to the abducting eye on lateral gaze(ataxic nystagmus) is due to a lesion of the medial longitudinal bundle between the ponds and midbrain as in MS.

    Nystagmus occuring on upward gaze with the fast component upwards( upbeat nystagmus) maybe due to a lesion in the mid-brain at the level of the superior colliculus.

    Downbeat nystagmus(fast phase downward) suggests a lesion in the lower part of the medulla. It's therefore, typical of the Arnold Chiari malformation.

    **Causes of absent ankle reflexes and extensor plantars:
    subacute combined degeneration of the cord
    syphilitic taboparesis
    friedreich's ataxia
    motor neuron disease

    **Bicuspid aortic valve is perhaps the most common form of congenital heart disease in adults(1-2% of population).

    **hyporeflexia is a common clinical sign in patients with hypercalceamia. Biphosphanates inhibit bone resorption and are the first line pharmacological treatment of hypercalceamia of malignancy.

    **Premature epiphysial closure is a classical finding of CAH.

    **Flecainide is the drug most likely to restore sinus rhythm in atrial fibrillation.

    **Lithium can produce Diabetes Insipidus and hypercalceamia.

    **Constrictive pericarditis produces an elevated JVP, with prominent x & y descent.Pulsus paradoxus occurs less frequently than in tamponade.

    **Streptococcus bovis is a normal commensal of the GI tract. However, S.bovis bactereamia and endocarditis has a strong association with GI malignancy.

    **Neisseria meningitidis( Gram negative diplococci)
    Streptocuccus pneumonia(gram positive diplococci)

    Rx:
    gram stain unavailable: cefotaxime+- ampicillin
    g +ve cocci: Cefotaxime +vancomycin( S.pneumonia)
    G +ve bacilli:Ampicillin +gentamicin.(listeria)
    G -ve cocci: Benzyl penicillin.(N.meningitidis)
    G -ve bacilli: Cefotaxime + gentamicin(heamophilus influenza)

    **Anaplastic carcinoma carries the worst prognosis in thyroid cancer followed by thyroid medullary carcinoma in MEN 2B.\

    **ANCA ab are of 2 types:

    1- C-ANCA which correlates with antiproteinase 3 antibodies--->most specific for wegener's granulomatosis.
    2- P-ANCA which correlates with anti myeloperoxidase ab. P-ANCA/MPO ab. are highly sensitive and specific for rapidly progressive glomerulonephritis and haemorrhagic alveolar capillaritis.

    AMA ab--------> PBC
    Anticentromere ab.--------> CREST/scleroderma syndrome
    ANA and anticardiolipin ab.----------->SLE.

    **Clozapine is associated with agranulocytosis in app.1-2% of patients

    **Acute pancreatitis with worse prognosis:
    Age>55
    WCC>16,000
    LDH>600
    AST>120
    Glu>10

    **Pendred's syndrome


    Pendred's syndrome is a rare autosomal recessive condition characterised by incomplete oxidation of trapped iodide prior to organification.

    It may be confirmed by a positive perchlorate discharge test.


    **Anti 21 hydroxylase ab. found in about 80% of cases of addison's disease.

    **SSRIs are a recognised cause of SIADH.

    **Astimulatory mutation of thr Gs protein alpha subunit has been noted in approx.30% of GH secreting pituitary tumours.

    **Carcinoid tumours of the foregut unlike tumours of the midgut are not associated with carcinoid syndrome but may secret CRF/ACTH resulting in ectopic cushing's syndrome.Other associated conditions include somatostatinoma, Zollinger -Ellison syndrome and Acromegaly.

    **The antiphospholipid syn. is one of the commoner causes of hypoadrenalism and may precipitate adrenal infarction and haemorrhage through adrenal vein thrombosis.

    **Osteopenia is defined as a T score of between -1 and -2.5 standard deviation below the bone mineral density of a young female.Osteoporosis is defined as <2.5 SD.

    **bcl-2 is an inhibitor of apoptosis.
    fas and caspases promote apoptosis but are nottumour supressor genes
    p53 is a tumour supressor gene that inhibits mitosis and promotes apoptosis.
    ras is oncogene.

    **Congenital adrenal hyperplasia is autosomal recessive disorder.

    **beta blockers are the mainstay of treatment in long QT interval. The most commonly used drugs are propranolol and nadolol.

    **pulmonary complications of reumatoid arthritis"
    Fibrosing alveolitis
    pleural effusions
    empyema
    cryptogenic organising pneumonia
    bronchiectasis
    pulmonary ndules

    **Fetal alcohol syn., Down's syn., and congenital rubella syn. are ass. with an ASD(Loud 2nd sound plus fixed splitting.

    **VIP
    Achlorhydria
    profuse diarrhea
    hypokalaemic acidosis
    hyperglycaemia

    **Cavitations on pulmonary x ray:
    squamous cell carcinoma
    abscess(staph. aureus, Klebsiella, and pseudomonas aeruginosa0
    lymphoma
    rheumatoid nodule
    pulmonary infarction
    wegener's granolumatosis

    **p-ANCA is present in approx. 70% with UC and less than 20% of Crohn.
    85% of untreated subjects with wegener's will have c-ANCA

    **prerenal failure:
    urinary Na<20
    urine osmolality> 500
    urine/plasma ratio>8and
    urine/plasma creatinine >40\

    Renal failure:
    Na>40
    osmolality urine<350
    U/P ratio<3
    U/P creat.<20

    **Vitamin D resistant rickets is x linked dominant.

    **infection is the commonest cause of death in multiple myeloma.

    **Antimicrosomal antibodies------>Hashimoto's thyroiditis

    **Behchet's disease is associated with HLA B5

    **Venous beading, loops and soft exudates(cotton wool spots) are ccharacteristic of preproliferative retinopathy.

    Microaneurysms, Hard exudates and Macular edema suggests background diabetic retinopathy

    New vessels suggests proliferative retinopathy.

    **Hexosaminidase A deficiency is ass. Tay-Sachs disease
    Sphingomyelinase deficiency ->Nieman-Pick disease
    Arylsulphatase-A Def. ass. with metachromic leucodystrophy
    Iduronidase def. ass. with Hurler's syn.
    B-glucosidase def.--->Gaucher's disease.

    **Methotrexate is a well known cause of acute pneumonitisand interstitial lung disease.

    **Clopidegrol prevent platelet aggregation through antagonism of the ADP receptor.

    **Patients with painful, isolated third nerve palsy with pupillary involvement are assumed to have posterior communicating artery aneurysm until proven otherwise.
  17. Guest

    Guest Guest

    my question is the website says results on line on 28 why do u say results on line is 21 can someone please answer
  18. guest Dr A

    guest Dr A Guest

    wat was the passing percentage in the last exam ?
    its a guess that result will be out on 21
  19. DRAWAN

    DRAWAN Guest

    The website said the same last time and the result was declared a week early
  20. DRAWAN

    DRAWAN Guest

    the pass percentage last time was 54.51%
  21. guest Dr A

    guest Dr A Guest

    wat u think wud be the passing marks this time ?same as before or less than that ? if u compare to april exam ???
    yea even in MRCP 1 it was released one wk before the date they gave on website ..so most probably its coming on this wkend !
  22. DRAWAN

    DRAWAN Guest

    it fluctuates, and I dont think it ll be higher than 56-57%. I did not sit the exam this time, so i dont really know how difficult the exam was.
  23. DRAWAN

    DRAWAN Guest

    Good luck to all those on the forum. I hope most of them pass
  24. Guest

    Guest Guest

    I think d score dis time z gonna b around 50 -51% ! not more cuz in 2008 people ve even passed wid 49.7% ! I think dis xam was reeeally tough ! pleease comment !
  25. 33

    33 Guest

    I HAVE PASSED FROM THE FIRST ATTEMPT ALLHUMDOALLAH
    THE PASS MARK IS 53.99%
  26. i have passed el7amdolellah i scored 54.75 i am so happy
  27. Dr -A

    Dr -A Guest

    ALHAMDULLILAH i have passed !
    cant see my detail percentage .. dont knw why .. but i have passed !
    congrats to all those who passed ...
    Dr manoj,dr osler ? dr who ? dr noname ....,hey guys wat abt ur results?

    BEST OF LUCK TO EVERYBODY >>I HOPE ALL OF U PASS
  28. Doctor Who

    Doctor Who Guest

    I'm sorry to say I have failed again - 48.67. Nowhere near.

    I am very disappointed and upset, not sure if I want to sit the exam again.

    Well done to those who have been successful.
  29. Dr --A

    Dr --A Guest

    thats very sad .. i feel bad ...
    i knw its a difficult period but u can do it ...inshALLAH !
  30. depressed

    depressed Guest

    sad

    i have failed
    should i go 4 nov or april 2010
    i m confused
    congrats to those who have passed
    hope dr manoj pass this time
  31. mithun 1234

    mithun 1234 Guest

    i passed at last
  32. mithun 1234

    mithun 1234 Guest

    i passed at last
  33. depressed

    depressed Guest

    hi

    mitium1234 congrats
    at last????? means how many attempts
    anyway be happy
  34. dna

    dna Guest

    I passed MRCP2 in first attempt, Alhamdulillah with score 64.64.The exam was really confusing.I feel onExamination gives plenty of questions with similar themes in the exam.Congratuations to all those who passed this exam.For those,who did not make this time,they are wiser than before.Do not be sad,do a sincere retrospection of weak points/confusions, and be determined and confident to pass in the next attempt.this wesite and forum of MRCP have been doing a great job to give us a clssroom and class-mate feeling.Keep it up.Thanks.
  35. Guest

    Guest Guest

    By god`s grace I passed.
  36. Guest

    Guest Guest

    By god`s grace I passed.
  37. Guest

    Guest Guest

    Thanks To ALLAH, I have passed. :D :D :D
    Score= 69 :lol: :lol: :lol:
  38. dr atif

    dr atif Guest

    i ve passed in first attempt... :D
    i scored 66%
  39. Dr -A

    Dr -A Guest

    HEy congrats :) dr osler,noname ,dr rahul n dr atif :) n all those who passed
    very good percentage dr osler !mabrook
    i passed too :) i have not been able to see my detail marks ! though i go in exam history but no details open yet ! :( ...mrcp 1 n 2 both in first attempts ! so thankfull to Allah Almighty !
    u guys are my mrcp 1 fellows ...
    very happy for all of u :)
    yes the exam was very confusing, and it was nuthing like onexam n passtest . but these two sites do help in preparing the topics but dont rely on them completely, do as many mcq as u can.sanjay sharma is impo but wat is most impo is to be upto dated with the guidlines. n read as much as u can from the internet. from oxford handbook. and search for images,ecgs, ct scans ,mri etc
    they dont come from anybook ! the more u search the better u get !
    n Beleive in ur self n focus and keep praying for Blessings of Allah Almighty ~!
    for those who cudnt make it . i wud say that u guys attempt nov or april diet not later than that and this time focus on the areas u are weak !
    thanku so much to this wonderfull forum and all u guys who disscussed things n always added in my knowledge :)
  40. Guest

    Guest Guest

    Thanks alot Dr A for ur nice post. And Alf Mabrouk Leek. are u egyptian?
    Regarding results, ensure that u had checked ur result to appear on the website, if yes, from ur account, click on exam history, then click on mrcp2 july 2009, if error appeared, try older version of IE or another broswer. Thanks
  41. Dr_ A

    Dr_ A Guest

    no we chat once ... i am a pakistani, n i live in kuwait
  42. Guest

    Guest Guest

    Oh, i m sorry, Dr Tania, I wish u good luck in the PACES
  43. Dr Malaysian

    Dr Malaysian Guest

    I ve passed both my mrcpuk and mrcp ireland written part at 1st attempt in july. Congrats to every1 who ve passed and those who ve failed please don't give up. Must try till u get the victory. I couldn't see my detail result online.think may be i apply exam via paper.
  44. Guest

    Guest Guest

    congrats 2 all those who passed ! I failed ! cud nt c my score online ! did dr.manoj pass ! I prayed a lot fr hm !
  45. Dr -A

    Dr -A Guest

    yes its Dr Tania ..
    Thank u so muchdr Osler.. yes sure we shud start a new forum for paces right away...
    my percentage is 54.58... n passing was 53.85 in my centre
    dose it effect paces in any way ???
  46. Dr -A

    Dr -A Guest

    Dr malaysian .. try from another computer with IP address
    that is how i was able to see my result details .. as dr osler explained,thanks
  47. Guest

    Guest Guest

    Dr A
    start a paces thread immediately so that we can keep the momentum going
  48. guest 420

    guest 420 Guest

    hey dr osler and all others tell ur complete result not just 69% or watever rite down ur complete percentage wid points like 64.63 % so dan we will know if u r telling the truth or lying
  49. dr-Osler

    dr-Osler Guest

    It is 69.2%. Is this enough or do u want me to upload an image of the result?!!!
  50. Guest

    Guest Guest

    i pass the exam
    mohammed abdalla
    sudan
    الحمد لله

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