PART 2 MRCP DEC.2006

Discussion in 'MRCP Forum' started by OREOLUWA, Nov 24, 2006.

  1. OREOLUWA

    OREOLUWA Guest

    Please those that have passed the Part 2 exam .kindly give advice here.Will be writing the Dec.Exam
  2. Guest

    Guest Guest

    Just finishing the the first two papers now.Paper was good but paper two diff.hoping paper 3 will be better will post some questions later.
  3. Guest

    Guest Guest

    please discuss the photographic materials in the 3 papers
  4. Guest

    Guest Guest

    lets discuss the photographic materials what i remember
    ECG anterior MI
    burgada syndrome
    av-bundle of his block (prolong PR+BBB
    SVT+BBB
    pagets
    UC
    erythema chronicum migran
    warts or molluscum
    rash on face
    rach on scalp psoriasis /discoid lupus
    please add yours
  5. guest 2

    guest 2 Guest

    some answers

    1.renal cell ca
    2.CADASIL
    3.GB syndrome
    5.brugada synd
    6.av node disease
    7. hydrocortisone, post surgical adrenal crisis
    8.hyperparathyroidism
    9.blood cultures/echo last question
    10.panic attACK
    11.heparin for PE
    12.SLE
    13.gastric lavage
    14.chemotherapy cardiomyopathy
    15.oral mesalazine
    16.distal RTA
    17.diuretic abuse
    18.ulcerative colitis( xray abd)
    19.acute ischaemic optic neuropathy
    20.oral ferrous sulphat
    23.extradural haematoma
    25.lichen planus
    26.hypothyroidism(high MCV, tiredness, muscle tenderness. not anaemic, muscle biopsy inconclusive)
    27.abg,s ANS.D
    28.iga nephropathy(transplant girl)
    29.membranous nephropathy
    31.sulfasalazine induced nephritis
    32.skin biopsy
    33.immunoglobulins(GBS)
    34.TFT,s(high MCV 16)
    35.esophageal candid( odynophagia)
    36.teriparatide
    37.renal art stenosis
    38.mediastinal LN biopsy
    39.acute pancreatitis
    40.acute ischaemic bowel
    41.low dose dexameth test.
    42.simvast/losartan???
    43.acute HIV
    44.EBV(rash, l nodes)
    45.reidel,s thyroiditid
    46.MV Prolapse on echo
    47.chorda tend rupture
    49.minimal change nephro.
    50.anti thromb 3 def/dehydration???
    51.reassure, continue carbimazole
    52.autosomal dominant with incomplete penetrance
    53.diverticular dis
    54.seborrhic keratosis
    55.lentigo maligna
    56.anti GBM ab
    57.churg strauss synd
    58.long acting B agonists
    60.cefuroxime as empirical therapy
    61.gentamycin toxicity
    62.herceptin for ca breast(taz...)
    63.caeliac disease(biopsy)
    64.crohn,s disease
    65.iron deficiency anaemia ( blood film)
    66.DEC
    67.ecstasy OD
    68.LITHIUM TOXICITY
    69.oral diazepam
    70.schizophrenia/drug induced psychosis
    71.giant cell arteritis/lymphoma..ct abd/chest normal
    72.EAA
  6. Guest

    Guest Guest

    1-the ECG is for av node desease and his bundle cause it showed first degree block and BBB
    2-the thyroiditis is viral De quevarian (tender thyroid high ESR and hyperthyroidism
    3-last question is thrombophilia screen
    4-for pulmonary embolism its MASSIVE so thrombolysis
    5-there is laxative abuse not diueretic
    6-hemodyalisis and Hb 8 blood transfusion
    7-the acute abdomen is budd chiare(actute abdomen+hepatomegaly and tender+high liver enzymes+and even the GT is higher than AMYLASE tricky
    8-the cushing you do first midnight and early morning cortisol to confirm that there is hypercortisolism then you perform the low dose dexa to differentiate between priary and secondary cause then you perfom the high dose dexa to localise the lesion later you do the ACTH .
    in the question you were given the clinical picture but there were no evidance of high coryisol
    9-for the breast carcinoma its Transtuzumab because its HER-2 positive (+3) and both estrogen and progestrone receptor negative
    10-the blood film showed (spherocytosis+polychromasia+agluttination) all compatibe with chronic hemolysis of autoimmune eitiology
    12-COPD pt with PO2 7.8+evidance of HF the management is LTOT for 15 hours daily
    13-the boy with cannabis and paranoid dellusions this is cannabis induce psycosis
    13-women post amputation this is depresive disorder
    14-alchol withdrowal IV benzodiazepin
    15-the one with nephrotic syndrom duo to minimal disease its ANTH3 loss
    16-
  7. optimist

    optimist Guest

    please want detail of question and not only answer :evil:
    Q of polyuria+thirst+some low back pain problem
    was it neurosarcoidosis

    Q old age, 3wks back antibiotic for chest infection, now diarrhea..and bloody(not sure)
    was is it psuedomemb. colitis
  8. Guest

    Guest Guest

    it was histiocytosis x
  9. Guest

    Guest Guest

    where is khk,this time---- :shock:
  10. Guest

    Guest Guest

    chronic mutthu,he is,busy :D
  11. optimist

    optimist Guest

    :? why i have impression that every one who attend exam not care this time.
    is this due to:
    1-depression
    2-exam was easy so sure will pass
    3-loss hope
    4-indifference
    5-tiredness
  12. OREOLUWA

    OREOLUWA Guest

    I WROTE THE EXAM TOO,IT SEEMS FAIR ENOUGH BUT VE STARTED TO READ ALL KINDS OF OPINIONATED ANSWERS I GUESS THE ROYAL COLLEGE WILL DECIDE WHO PASSES.

    I WILL GIVE A LIST OF ALL THE QUESTIONS SHORTLY STILL COMPILING THEM.

    THANKS TO ALL THE PAST EXAMS QUESTIONS POSTED ON THIS SITE SOME OF THE QUESTIONS AT LEAST I COULD COUNT OVER 100 REPEATED BETWEEN DEC.05 AND JULY 06 IN DEC.06 EAXMS.

    KENGLAD HOW WAS IT?

    OREOLUWA.
  13. laxani

    laxani Guest

    difficult exam

    Photographic material:
    1.ECG anterior MI + RV hypertrophy
    2 ECG- burgada syndrome
    3 ECG showed mobitz 2 block + RBBB, hence blockage in AV node + bundle of his
    4 ECG showing SVT but asthmatic, hence give verapamil
    5 XRAY pelvis showing lytic lesion- myeloma- give melphalan + steroids
    6 Xray hand showing ? ruptured brachialis tendon ? not sure about this one
    7 XRAy abd- lead pipe colon of UC
    8 lesion on scalp elderly patient seborrhaic keratitis
    9 lesion on nose lentigo maligna
    10 young boy with rash in flexor of wrist ? scabies - didnt look lile LP-Rx malathion
    11 molluscum contagiosum photo
    12 2 MRI heads- I wrote chiari for both

    13 MRI showing pituitary tumour- treat with surgery
    14 CT brain extradural
    15 MRI one showing contrast enhancement of a SOL- I wrote cefotaxime as treatment
    16 Other MRI ? temporal enhancement? HSV encephalitis
    17CT abdo looked like peritonitis but somebody said there were air shadows in pancreas, hence pancraetitis
    18 Somebody went to sri lanka, had swollen right leg, eosinophilia, CXR showed diffuse air space shadow- I gave treatment of DEC
    19 photo of hand of osteoarthritis with swollen nodes
    20 an ophthalmoscope of ? retroorbital optic nerve compression or something like that- showed papilloedema I thought
    21 blood film of I dont know ? malaria. nothing obvious. there were some spherocytes but the patient ( black ) came back from Ghana.
    22 echo of MVP
    23 CT abdo of renal cell carcinoma
    24 MRI spine showing spinal TB



    please comment. May I also ask you to discuss answers ASAP before we forget them.
  14. laxani

    laxani Guest

    I have taken the liberty to copy the above contributors question list and comment on them. I am happy that quite a few answers were the same.


    1.renal cell ca - CT
    2.CADASIL - obvious question with hereditary disease
    3.GB syndrome - treatment was asked- interferon
    5.brugada synd -ECG
    6.av node disease -ECG
    7. hydrocortisone, post surgical adrenal crisis Na was 105, K6.2
    8.hyperparathyroidism
    9.blood cultures/echo last question was SBE, asking for Ix to find etiology- I said BCX but probably Echo is a better answer
    10.panic attACK - anxiety palpitation etc. sister recently diagnosed with brain tunour
    11.heparin for PE - elderly patient, SOB, sats 83% on O2.BP 63/30. I also wrote S/C heparin. patient came in after a fall. ? will it be thrombolysis?
    12.SLE - multiorgan involvement. cant remember
    13.gastric lavage - cant remember the question but I did not write gastric lavage
    14.chemotherapy cardiomyopathy. Picture of DCM on chemotherapy
    15.oral mesalazine - infalmmed bowel on colonoscopy, diarrhoea for 2-3 weeks. stool normal
    16.distal RTA - normal anion gap acidosis data question
    17.diuretic abuse - I put Gittelmans. low Mg, K 2.7, BP was high. na normal. patient young guy 24 y/o. thin.
    18.ulcerative colitis( xray abd- lead pipe
    19.acute ischaemic optic neuropathy
    20.oral ferrous sulphat . Q was somebody was on dialysis, anaemic? what needs to be done? I said parenteral iron.
    23.extradural haematoma
    25.lichen planus
    26.hypothyroidism(high MCV, tiredness, muscle tenderness. not anaemic, muscle biopsy inconclusive) agree
    27.abg,s ANS.D many ABGS given I think 4 in total. one was DKA. one was ph7.68 HCO3 34, PcO2 3,5 ? lab error ? resp+met alkalosis.
    28.iga nephropathy(transplant girl) - Patient had protein+, nephrotic range proteinuria. I went for FSGN.
    29.membranous nephropathy - I said FSGN. patient had blood+, prtn++
    31.sulfasalazine induced nephritis agree. Another Q was NSAID induces colitis? never heard of it though.
    32.skin biopsy I went for renal biopsy. It was a reno pulmonary syndrome with pANCA. Q was Ix to diagnose pathology.
    33.immunoglobulins(GBS) agree
    34.TFT,s(high MCV 116) - agree.
    35.esophageal candid( odynophagia) specially to hot fluid. 45 y/o smoker. too young for cancer.
    36.teriparatide - it was an indian lady with osteomalacia and osteoporotic vertebral collapse. history of achalasia. ( hence cant give bisphosphonate). I gave strontium.
    37.renal art stenosis - Cr 650 2 weeks after starting ACE
    38.mediastinal LN biopsy I agree, cant remember the Q though I think CT scan showed LN in mediastinum, nothing else. Non specific symptoms. Next Ix.
    39.acute pancreatitis- no I put something else. The anylase was only 650.
    40.acute ischaemic bowel
    41.low dose dexameth test. Disagree, The Q was somebody with likely pseudocushings/ cushingoid. Dont you measure cortisol first to see if high or not? If high, then do low dose to differentiate pseudo/cuhing
    42.simvast/losartan???- IDDM, obese, hypertensive etc, syndromeX. HbAic not too bad. next step to reduce mortality- I put ACE
    43.acute HIV - seroconversion illness. classical in a young female tourist to africa. No condoms!!( joking)
    44.EBV(rash, l nodes) raised lesion over chest.
    45.reidel,s thyroiditid- fever, etc
    46.MV Prolapse on echo
    47.chorda tend rupture - I agree.
    49.minimal change nephro.
    50.anti thromb 3 def/dehydration???- cant remember
    51.reassure, continue carbimazole
    52.autosomal dominant with incomplete penetrance - agree. family tree question
    53.diverticular dis - cant remember
    54.seborrhic keratosis
    55.lentigo maligna
    56.anti GBM ab
    57.churg strauss synd - asthma, arthritis eosinophilia
    58.long acting B agonists
    60.cefuroxime as empirical therapy - I think it was a brain abscess
    61.gentamycin level. Q was somebody on treatment for IE. 1mg/kg genta given tds for 4 days. level high predose but normal 1 hr post dose. next step- 3mg/kg od or 1mg/kg bd. I put 1mg/kg bd
    62.herceptin for ca breast(taz...) agree, HER +
    63.caeliac disease(biopsy) agree.
    64.crohn,s disease
    65.iron deficiency anaemia ( blood film) - I disagree, no target/pencil. hypochromia. it was anisocytosis, spherocytes.
    66.DEC - I agree, photographic Q, Sri lankan tourist.
    67.ecstasy OD - young girl, dialted pupils
    68.LITHIUM TOXICITY - cant remember the question but I think patient looked dry.
    69.oral diazepam - somebody with alcohol withdrawal
    70.schizophrenia/drug induced psychosis . Q was student presented to a/e with odd behaviour demanding position as psychologist. tangential talk, odd theory, much like russel crowe in the beutiful mind. parents said he had drugs 3 months ago. doing poorly in exams. no hallucination. I put schizophrenia.
    71.giant cell arteritis/lymphoma..ct abd/chest normal , middle aged patient. CXR normal, CT abdo chest normal examination normal, bloods generally normal, CRP 120. vague symptoms, weight loss etc. I put GCA. lymphoma unlikely as no nodes found anywhere. CRP 120.
    72.EAA- I think it was afarmers wife having breathlessness. no spiro data given.


    some other Q:

    1. huge oedema on frusemide PO 80 bd, metolazone 2.5 alt days, spiro- but not improving. next step ? IV frusemide
    2. 90 y/o prev independent diagnosed with cancer with liver mets. pain, went home but came back. 2 days later developed pneumonia. what treatment would you discuss with family- ? broadspectrum Abx? I put sc diamorph as liver mets, pain etc. TLC.
    3. strange CT showing ? hemangio in liver??
    4. CT showing cholangiocarcinoma?
  15. laxani

    laxani Guest

    1. for COPD patient with Po2 7.8. Q was what will reduce readmission? I gave steroid inhaler. not LTOT as Po2> 7
    2. Patient with acute drop in GCS ( between noon time and 3 pm ). midbrain localising signs actually given CT normal. Next step at 1900? thrombolysis? I played safe and gave aspirin via NG which is probably wrong.
    3. a question on treatment of tertiary hyperparathyroidism ( a CRF patient) . ? parathyroidectomy . I wrote something else- got it wrong probably.

    4 photosensitive rash- cause ? thiazide ? allopurinol
    5. a question on addisons in a patient who was in south east of USA. CXR normal- TB?
    6. Chagas disease Xray. T cruzi brazilian patient
    7. one answer was neurosarcoidosisI think. cant remember the question.
    8. One answer was serotonin syndrome. patient with sweating etc on citalopram
    9. one NMS question. psychiatry patient.
    10. one CF genetic probability Q. mum and dad both carriers. probability 1/2 X 1/2 X 1/4 = 1/8
    11. one elderly man with pyelonephritis I think it was. rigor, pyrexia WCC high CRP high
    12. painful superficial genital ulcer- Herpes
    13. short term memory loss- alzheimers
    14. one question with IHD, diabetic- cerebrovascular dementia
    15. one question was multisystem atrophy

    cant remember any more topic. If others can post some more questions/answers, some more detail might come back to my mind ( post exam dementia).


    tata
  16. Guest

    Guest Guest

    Dear laxani this was great from u ,nice memory I do have some comments on these answers
    3-GB treatment is immunoglobulins
    9-last qs was thrombophilia screen
    6-it was av node and bundle of his (prolong PR+BBB)
    11-This was MASSIVE PE treatment is thrombolysis(pt developed acute dyspne+RR 44+cyanosis+HF
    17-his qs was laxative abuse (hypokalemic alkalosis with urinary K =23 this was the trick in barter and geitelman the urinary K is high >40
    32-the pulmonary renal syndrome with p ANCA you do LUNG BIOPSY the most diagnostic test because granulomas are present there but a renal biopsy will show u necrotizing vasculitis only which is found in (wegners,chrugg struss , microscopic polyarteritis and PAN
    35-oesophageal candid definitely u will do HIV test
    39-this scenario is typical of BUDD CHIARE SYNDROME the hints are(acute abdomen+tender hepatomegaly 4cm+high liver enzymes gama GT is 750 and alpha amylase is 650 .nice one
    41-you should always perform the 9 am and midnight cortisol level FIRST as to confirm the hypercortisolism and then you proceed
    44-raised PURPLE lesions surrounded by bruising and lymphadenopathy is KAPOSI SARCOMA HSV8
    45-tender thyroid+fever+high ESR is Viral thyroiditis(De quevarien) in reidle you donot get raised ESR
    61-this one I agree with u cuz it’s the only respose that seemed reasonable 1 mg Bd
    62Transzutumab for CA breast HER+
    65-BLOOD FILM showed Marked spherocytosis(small round RBCs) and polychromasia(large gray RBCs duo to defective heamoglobinization when u combine these features it is a hemolytic BF +there was red cells agglutinins which point to AUTOIMMUNE eitiology so this is AUTOIMMUNE HEAMOLYTIC ANAEMIA
    Malaria and celiac and sickle are excluded duo to absence of (paasite,target cells,howell joly bodies and hypochromasia
    72-there was an EAA but I remember the elderly farmes wife was having miliary TB
  17. Guest

    Guest Guest

    thx all need more questions pls............really shaky whether or not I did good enough

    one dispute..........it will be dieruticabuse not laxative....acc 2 sanjay sharma chartof hypok
    thx
  18. Guest2

    Guest2 Guest

    Tough exam with quite a number of ambiguous questions. Thought Paper 3 was the worst of the lot. Some questions don't really recall maybe coz they were research ones different for various centres.

    A comment for one question where an elderly lady is admitted after a fall and noted to have features of massive PE. It was stated that the patient was severely hypoxic and already hypotensive.

    The question asked for the next appropriate step and this should be to intubate and ventilate first (which was an option given). I would agree with thrombolysis once she has been stabilized to some degree.
  19. oye

    oye Guest

    it was laxative abuse as you would expect the urinary sodium and possibly potassium to be elevated in diuretic abuse. the values were normal. it was a close call between the two but that was the difference for me i think.

    does anyone know what was wrong with the chinese chap on dialysis that started fitting?
  20. Guest

    Guest Guest

    Some more themes from MRCP2 Dec 2006

    1.Patient was cystinuria, best treatmentanswer:? Pencillamine
    2.Pneumonia/green sputum answer:? Ciprofloxacin
    3.Respiratory case with systemic involvement,(liver,renal impairment),answer:?Leptospira
    4.Young man with CNS involvemnt on both sides.answer:? Vertebral artery dissection
    5.Warfarin for elective cardioversion, answer:4 weeks before and after cardioversion
    6.Acute asthma, reasons for admission to ICU, answer:pO2 <8
    7.lady with raised AST/ALT, raised immunoglobulins but negative ASM antibodies:? Autoimmune hepatitis
    8.another question? non alcohlic steatohepatitis
    9.Polycystic ovarian syndrome, the answer was between adrenal tumour and PCO, androgens were raised but there was no gross adrogenic features like male type baldness etc, so i went for PCO
    10.Hypopituitary picture in male, what will reduce the risk of fractures, I put androgens
    11.Adult polysystic kidney disease --- advise?
    12.Vitamin D Toxicity?
    13.Pheochromocytoma--- association? Hyperparathyroidim
    14.Watery diarrohea, 12 months , weight loss, hepatomegaly, the answer was either Whipples or Carcinoid, there were no other features of whipples, i put carcinoid
    15.van willebrand levels normal, what was the answer, i dont remember
    16.Immunodifiency, what will modify the future course of disease, ? spleenectomy? immunoglobulins, i put immunoglobulins
    17.Hypertension in renal transplant. answer:? cyclosporin
    18.Acute spinal cord copmression, immidiate treatment? IV Methylpredinisolone
    19.Oesophageal cancer, with lymph node involvement? what is the best course ? palliative??
    20.Young lady with features of pulmonary hypertension, what was the answer?
    21. Unilateral odema of the leg? what was the answer? diethyl....(?filiriasis)
    Some photo questions:
    1 Tongue diviated to one side, i dont remember what they were asking?
    2.GIT SLIDE? answer?? chron`,/abcess/appendicular mass??
    3.Another slide? Renal papillary necrosis?

    All members to please comment on themes and clarify accordingly with their feedback, my answers may be wrong,
    I am trying to rember more and will post further
    Thanks.
  21. laxani

    laxani Guest

    I am just commenting on the ones I remember from the above post:

    3.Respiratory case with systemic involvement,(liver,renal impairment),answer:?Leptospira I agree
    4.Young man with CNS involvemnt on both sides.answer:? Vertebral artery dissection yes, acute onset, was rugby player or something.
    5.Warfarin for elective cardioversion, answer:4 weeks before and after cardioversion yes
    6.Acute asthma, reasons for admission to ICU, answer:pO2 <8 I wrote rising Pco2, this was an option
    9.Polycystic ovarian syndrome, the answer was between adrenal tumour and PCO, androgens were raised but there was no gross adrogenic features like male type baldness etc, so i went for PCO , yes, LH was high. this was obvious PCOS
    10.Hypopituitary picture in male, what will reduce the risk of fractures, I put androgens , I think I put testosterone.
    11.Adult polysystic kidney disease --- advise- I think the answer was likely to be dialysis dependent in 10 yrs
    13.Pheochromocytoma--- association? Hyperparathyroidim . yes. this was a MEN 2
    16.Immunodifiency, what will modify the future course of disease, ? spleenectomy? immunoglobulins, i put immunoglobulins . yes the question was somebody with combined immunodeficiency. levels of Igs low. answer Ig
    19.Oesophageal cancer, with lymph node involvement? what is the best course ? palliative?? Did I put radical radiotherapy?
    21. Unilateral odema of the leg? what was the answer? diethyl....(?filiriasis) yes I agree



    please continue posting guys.
    cheers
  22. Guest

    Guest Guest

    i remember the qs aboout the pt with autoimmune thrombocytopenia who is still having low platelets despite giving him steroids the next option is spleenectomy
    -the psychotic pt was having paranoid dellusions there were no any feature of schizo and he is young and taking cannabis mostt likely a drug induced psychosis
  23. Guest

    Guest Guest

    some cardio qs please add more and comment /


    i remember a case of cardiomyopathy in patient who recived radio and chemo therapy and it was given heart chamber volumes was it cos pericarditis/chemo induced or radioinduced cadiomyopathy

    another one with tricuspic reguirg and wide split of second heart sound was it ebstiens anomaly ?

    another one african lady with mied mitral valve disease Rhematic fever

    the one farmer who developed flue symptoms and then hepatiitis renal failure and endocarditis i think its Q fever

    there was an ECG with options vt/atrial flutter with bbb/atria tach with bbb/?
  24. optimist

    optimist Guest

    there is little misunderstand about tissus plasminogen activator is it means streptokinase or any type of thrombolysis or something else
  25. echo

    echo Guest

    echo

    hi
    anyone has any idea about the echo pic question?
    was it mitral prolapse?

    thanks
  26. kenglad

    kenglad Guest

    hey oreowula ol chap

    hey there oreowula
    i did not fare that well this exam
    i think my chances are 50/50

    good luck to you

    i thot the papers were tough

    the answer is diuretics i think cuz the urinary sodium and potassium was within normal range as stated by sanjay sharma in his book
    when u use diuretics water comes out together with ur salts so that ur urinary salts is within normal ranges
  27. --------------------------------------------------------------------------------

    i will write what i remember of questions
    three papers each paper 90 questions
    with each paper book of pictuers

    1-ecg svt tre verabamil
    2-braganda s
    3-ecg with first degree heart blook +rbbg where is the lesion
    4-picture of echo m prolapse
    5-leady of vascular leg invest echo
    6-ecg rv infarction +rv hyperatropy
    7-picture cardiomegaly
    8-mny q of lung function tests
    9-viral pnemonia
    10-patient with vasculits + rh + (CRYGLOBINEMIA)
    11-patient with marfan his brother get same dis less 1%
    12-patient with recurent chest infection less platelet tre immunoglobuline
    13-picture erythema migrans(lyme d
    14-picture licen planus
    15-scabies
    16-picture r celular carcinoma
    17-hyper parathyrodism
    18-renal t acidosis
    19- pannic attack
    20- schizophrenia
    21-patient with du helc bact + after 4 week reassurance
    22-patient on dialysis with anaemia+ angina treatment blood transfution
    23-acute hiv sero conversion
    14-deqevies thyroditis
    15- post parteam thyroditis
    16-synchycten test
    17-acute pancretitis
    18- acites mild increase afp
    19-minimal g nephropaty
    20-membranous nephropathy
    21-gentamycine toxicty
    22-ciclosporine toxicity due to azithromycine (enzyme inhibitor)
    23-scleroderma picture antri centromere
    24-12 nerve palsy extacranial cause
    24-gullian parre syndrome
    25-ttp
    26-pregnant laeady with diab nephropathy drug for slow progression
    26-picture of barrium follow throw tb or chrons d
    30-ct scan of liver investigation ercp
    31-dm ketoacidosis given fluid+ insuline next give antibiotic - k given after given ns and blood sugar below 300mg and urination
    32-patient given sulphonylurea drug with obesity add methphormine to control bsugar
    33-pacemaker dd site of pacemaker rt atr rt vent
    34-picture of ivp bilateral hydronephrosis retroperitoneal fibrosis(methylsergidine0
    35-PATIENT WITH CHRON COMMON STONE ( URATE STONE)
    36-PATIENT WITH COPD GIVEN ANTIBIOTIC 2 WEEKS LATER GENERALIZED ABDOMEN PAIN TENDERNES CAUSES PSEDOMEMBRANOUS COLITUS TREATMENT IV METRONIDAZOLE
    37-WHIPPLE DISEASE
    38-PATENT GET PULMONARY TB DUE TO INFLIXIMAB TREATMENT
  28. Guest

    Guest Guest

    35-patient with chrons commonly gets OXALATE STONES when they have ileocecal involvement because failure of absorbing free fatty acids leads to retaining the oxalate and then they are secreted in the urine for which the treatment is ca carbonate
  29. Guest

    Guest Guest

    that wa carcinoid syndrome ,watery diarrh, wheeze, hepatomegaly...not whipples dis
  30. echo

    echo Guest

    crohn and stones

    crohn can have either oxalate and urate stones, the later due to dehydration from multiple surgery.

    the clue is xray -> radio opaque/ lucent

    anyone can recall the details?
  31. december 6-7 2006

    35-my apologize oxalate stone not urate stone in chrons d
  32. Guest

    Guest Guest

    some more qs
    NEPHROLOGY
    1-post transplant cyclosporin toxicity
    2-another one about side effects and the drug cyclosporin
    3-sjogren syndrome and RTA
    4-case of sickle and renal papillary necrosis
    5-case of protienurea with biopsy showing focal deposition if IgG and c3 membraneous nephropathy
    6-27 years hemoptosis+hematurea Goodpasture
    7-stones in Chrons post surgery -oxalate
    8-nephrotic sydrome with response to steroids what is diagnosis minimal change disease and developed renal vein thrombosis the cause is-loss of AT3
    9-hypercalcemia of malignancy first thing to do -IV fluids
    10-a case of CRF+angina -Hb 8 what to give -blood transfusion
    11-case of chrug struss syndrome
    12-case of CRF off treatment for 6 months presented with high Ca high PO4 and high ALP what is the treatment-parathyroidectomy as he developed tertiary hyperparathyroidism
    13-case of Iga nephropathy
    14-hypokalemia+alkalosis+HTN and raised renin -renal artery stenosis
    15-another case hypokalemia+alkalosis+normotention+urinary K of 20-Laxative abuse
    16-Ct abdomen with Renal cell carcinoma
    17-70 years old loin pain-fever-high ESR-mass -RCC
    18-HTN starrted ACEI developed raised creatinin -Renal stenosis
    19-ankylosing spondilitis for 50 years on NSAIDS and pencilamin developed frank proteinurea what is most likly renal pathology -secondary amyloidosis
    these r my answers as i remember if you have any additions please comment i will post further inshallah
  33. Guest

    Guest Guest

    more quuestions of hematology
    although were few
    1-a case of TTP
    2-high Hb-high WCC-high rbcs-High platelets :primary polycythemia
    3-african lady Blood film showing(polychromasia+spherocytosis+agglutinins)-Autoimmune hemaloysis
    4-case of methaemoglobinemia O2 sat 82% and normal PO2 what to give-IV mythelen blue
    5-
  34. kenglad

    kenglad Guest

    i had a farm in AFRICA

    hey guys,

    one question that stumped me was

    1)30 plus year old man presented to you with lethargy
    Hb was 9+. MCV and MCHC shows microcytic hypochromic anaemia
    (very suggestive of some minor thalasseamia)

    Iron studies normale
    Sr ferrittin high normale

    Wot should you do?

    a) Do nothing
    b) Blood transfusion
    c) Sc erythropoeitin
    d) Oral ferrous sulphate
    e) Iv Dextran

    wot did you choose guys?
  35. tota

    tota Guest

    mrcp 2

    feso4 ? :?
  36. Guest

    Guest Guest

    in this qs as i remember a young person with anemia low MCV and high serum iron and features compatible with Sideroblastic anemia and one of the options that u didnt mention is PYRIDOXINE Vit B6
  37. kenglad

    kenglad Guest

    ngong hills

    dear tarek,

    i think ur right t'was pyridoxine as an option
    but wot wuz the features that made u suspect sideroblastic anaemia?
    did they give us a blood film report?
    i cannot recall

    also there was a question of a young IV drug abuse lady who came with distal weakness,absence reflexes and bilateral ptosis and cannot swallow
    wot wuz ur answer?

    botulism or GB syndrome?

    and remember that lady with the bizarre loss of sensation over the right cheek and spread to to right upper limb with myoclonus and we were prepping her for ct brain

    wot would u expect to see from the ct brain

    1)infarct
    2) AVM
  38. 6-7 decembermrcp2 written

    pregnant diabetic leady with d nephropathy which drug used to slow progression of nephropathy ! this one of questions
    options

    losartan
    captopril
    another 3 options
  39. kenglad

    kenglad Guest

    denys finch hatten

    the other option wuz labetalol

    there was another pregnant lady with HPT question
    this time labetalol and alpha methyldopa were given as choices

    also wasn't there a question on actinic keratosis as opposed to seborrhoiec keratosis.twas all yellow stuff on a caucasian forehead.looks like actinic keratosis to me
  40. lead?

    lead? Guest

    anyone knows what the hypertrophic gums were? i thought i can see some blue lining too
  41. Guest

    Guest Guest

    :lol: These are my answers :

    1.Gum hypertrophy - phenytoin
    2.Actinic keratosis
    3.CJD
    4.Psoriasis arthritis - uric acid raised with nail changes
    5.Acne vulgaris - face rash
    6.ABPA
    7.CO poisoning - patient drowsy and incoherent with abnormal Sao2 and ABG.Give HYPERBARIC O2.
    8.TABLES - metabolic acidisis,respiratory failures type11
    9.Porphyria cutanea tarda - skin picture with blister,scarring and skin fragility.
    10.ECG - AVN WITH PURKINJE SYTEM INVOLVEMENT
    11.ECG - VT
    12.ECG - POSTERIOR INFARCTION AND BIFASICULAR BLOCK- TWO ANSWERS NEEDED.
    13.PACEMAKER INSERTION - LA AND LV
    14.Anterior MI - Coronary atery involvement - Native LAD ARTERY
    15.Thrombolysis in MI - Streptokinase
    16.Isoprenaline followed by permanent pacing for the patient who under went thrombolysis for Anterior MI.
    17.Normal finding - pateint with Iga Nephropathy with positve urinalysis.No other suitable option.
    18.Skin biopsy for the patient with cutaneous vasculitis
    19.Gitelman' syndrome - low k.high hco3 with low magnesium and hypotension.
    20.Syringobulba - 2 questions
    21.Gout - prednisolone for treatment.Colchicine caused diarrhea.
    22.Weight reduction - patient with NASH.There was alcohol abstainence.
    23.Hyperventilation syndrome- patient who didnot improve despite days off work.
    24.CA 125 - Cause was the ascites.
    25.Heatorenal syndrome - treatment was treplissen
    26.Repeat endoscopy - patient with h.pylori eradication to exclude recurrence and malignancy.
    27.Stop carbimazole - patient with sore throat and leucopenia/ neutropenia.Without leucopenia/neutropneia, reassure.
    28.Hyperkalemia - start calcium gluconate first.
    29.Anticoagulant - patient with DM type 2 and on OLANZAPINE
    30.Eye picture - Demyelination(MS).Patient woman with pale optic disc with swollen.Not Glaucoma.
    31.CRV OCCLUSION - TOMATOSPLASH.
    32.CRA EMBOLISM
    33.Radiotherapy induced cardiomyopathy(restrictive)
    34.ALL - GIVE INTRATHECAL CYTARABINE to prevent CNS INVOLVEMENT.
    35.Malaria - patient from Africa and the blood film shown.You can see the DOT/RING on the film.
    37.Urine culture - Leptospirosis
    38.PCP - patient on immunosuppresive drug with x-ray features.
    39.Obliterative bronchiolitis - Abnormal Lung volumes and a history of surgery.
    40.MRCP - patient with chronic pancreatitis
    41.Culture Aspirate - patient with VIT B12 DEF AND JEJUNAL DIVERTICULAE to rule out BACTERIAL OVERGROWTH
    42.X-LINKED DOMINANCE - FAMILY TREE
  42. Guest

    Guest Guest

    nice work but i have some comments on some answers
    1-i remember that this old juy mouth showed gingivitis and a bleeding gum SCURVY
    4- i remember there was a question with asymetrical oligoathritis and a scaly rash on abdomen for which the answer was Psoriatic arthritis ,,,but the hand photo showed heberdens and bochers nodes of OSTEOARTHRITIS
    26-this pt with duodenal ulcer and recieved PPI+h pylori erad tt and now free of symptoms +there was no risk factor you DISCHARGE AND REASSURE him according to the guidelines u need to repeat endoscopy in any case of Gastric ulcer after 6 weeks of tt.
    270this women was only having very mild leckopenia there is no indication to stop carbimazole unless the WCC goes below 2
    33-this one is really vague because RADIO causes cons pericarditis and CHEMO casues DCM and the figures are misleading
    42-the family tree is AUTOSOMA DOM WITH INCOMPLETE PENETRANCE there was male to male transmition so the x-liked is excluded
  43. Guest

    Guest Guest

    gingivitis/periodental disease

    Facts about Gingivitis and Periodontal Disease

    There is a nice picture exatcly similar to what we got in the exam on google images which I cant unfortunately cut and paste here


    Periodontal disease is a disease of the tissues that support the teeth in the mouth (the gums). It occurs when the body's immune system cannot clear the mouth of the bacteria and toxins, which are constantly forming on the teeth in the form of plaque.

    If plaque is not removed, it will eventually accumulate and harden into dental calculus (or tartar). Calculus can become hard and yellow brownish covering over the crown of the tooth. Calculus can also cover the gum so that the plaque beneath the gum-line cannot be cleaned. The plaque beneath the gum-line is the real cause of periodontal disease.

    As the plaque accumulates and the bacteria multiply, the pockets around each tooth become deeper and more painful for you pet. An early sign of this stage is a swelling and reddening at the gum-line of each tooth. If you touch this area, your pet may shy away and the gum may bleed. This is gingivitis. Gingivitis is a reversible inflammation of the gums. If teeth and gums are cleaned now, the mouth can be "as good as new." However, if the pockets around the teeth are deep enough to infect the bone supporting the teeth and cause the gums to infect the bone supporting the teeth, irreversible changes have occurred in the mouth. This is periodontal disease. Periodontal disease can only be arrested. The damage it has caused cannot be completely reversed.

    Eventually the pockets become deeper, the bone is eroded and lost, and the bacteria and toxins get into the bloodstream and cause widespread systemic disease. Some veterinarians feel that most disease in older animals is directly related to the constant low-grade infection periodontal disease subject to pets. A pet with periodontal disease is circulating bacteria
  44. kenglad

    kenglad Guest

    baroness blixen

    yes there was a picture of a young male with acne vulgaris
    the other misleading options were impetigo,i cannot remember the rest
  45. why isit gitelman's syndrome as opposed to barrter's syndrome

    hypokalaemia,hypomagnesaemia,metabolic alkalosis and normal-ish bp
    can be bartter's
    care to share your thoughts GUEST?

    thanks
  46. turn back the clock

    apparently the only way to tell the difference between gitelman vs bartter
    is thru the urinary excretion of calcium and magnesium
    did anybody remember whether the question contained data re: the amount of magnesium and calcium excreted in urine?

    Guest? Tarekdema?
  47. Guest

    Guest Guest

    :lol: Reply.
    The main difference were the low magnesium and the Age onset.Batter's occurs at an earlier Age than Gitelman's syndrome.The patient was an adult as opposed to a child.
  48. mrcp 2 written 6 -7 dec

    patient with alkalizing spondylitis with multiple myloma with picture show osteolytic lesion in hip joint .pelvis

    treatment with melphelam and dexameth

    but question was for control pain i think radiotheraphy is the right answear
    any suggestion about this question
  49. Guest

    Guest Guest

    :lol: REPLY - I think it is Radiotherapy for bone metastasis in Myeloma.
    OTHER ANSWERS ARE SHOWN BELOW
    1.Malignant Meningitis - Patient with abnormal CSF and cranial nerve palsies
    2.Listeria - Patient with meningitis and abnormal CSF
    3.Gaucher's Disease - Patient with increased ACID PHOSPHATASE
    4.Frozen Shoulder - there was reduction in abduction of the shoulder with a positive x-ray features.
    5.Subdural Haematoma - Patient with head injury and alcohol history with a haematoma below the dura on the CT scan
    6.Cervical radiculopathy - TRICKY ONE.
    7.Adult Onset Still RA
    8.NSAID INDUCED NEPHROTIC SYNDROME
    9.NSAID INDUCED COLITIS - Another name is Microscopic colitis which can be due to NSAID,PPI - ALL PRESENT IN THE HISTORY.
    10.Malignant induced Glomerulopathy
    11.Cluster Headcahe - treatment was SC SUMATRIPTAN
    12.DEXAMETHASONE -For the patient with brain tumour and cerebral oedema shown on the CT SCAN.It was not Cerebral Abscess - NO HALO SEEN.
    13.Osteomyelitis - Shown on the X-ray femur with a history of thigh pain.Another possibility was OSTEOD OSTEOMA??
    14.LUPUS ANTICOAGULANT - TRICKY QS.Platelet low,history of miscarriage,bleeding time prolonged,PT/APTT NORMAL,Factor 8 normal.
  50. Guest

    Guest Guest

    5-extradural haematoma

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