Discussion in 'MRCP Forum' started by OREOLUWA, Nov 24, 2006.
8-NSIADS are more prone to cause interstitial nephritis than nephrotic syndrome
it's HPO notice the typical periosteal lining, though not typical place
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another q I remeber was picture of cord compression- what will you arrange- ? radiotherapy ? dexamethasone?
dear all----I have checked the slide.the imp thing was history,fever and diarrhoea and came back from africa-following can be the posibilities
1------usually the blood slide of malaria has very very significant paracytaemia.in this slide there were very few cells which showed a black spots.
2------it can be coeliac due to the pictures like howell jolly bodies which we come across in coeliac and sickle due to hyposplenism
3-hemolysis shows either sperocytes or schistocytes.the history if we talk of hemolysis should shoe schistocytes--cos that we come across in intravascular hemolysis.there were definitely no scistocytes.
I put is as coelic but my justification is unsure.
what i did that i went to the onexamination.com and did the 75 qs of haematology again and printed out three blood films and this made me to convince that the slide was most likely hyposplenism.that is coeliac------please comment,thanks
1.Coeliac disease causes FE,FOLIC ACID AND VIT B12 DEF and not Haemolysis.In the data there was Anemia with reticulocytosis.This with the histiory of fever and the patient being from Africa makes it MALARIA.You can also see DOTS/RINGS on the blood film.
2.The case you say was HPOA.In HPOA,there is triad of
ARTHROPATHY,CLUBBING AND GYNAECOLOMASTIA.The x-ray is typical of a CONTINUOUS SUBPERIOSTEAL EROSION/RESORPTION usually on the TIBIA/FIBULA.CAUSES - Respiratory,CVS AND GIT Conditions.These were all absent.The lesion was just on the UPPER REGION OF THE FEMUR.
3.The QS about Spinal Cord Compression - First line will be Dexamethasone/Steroid and later radiotherapy has the best treatment.
OTHER QS TO DISCUSS ARE AS FOLLOWS
1.CHEMORADIATION - Patient with malignancy and some spread to the LYMPH NODES.
2.OMEPRAZOLE - Patient with Upper GI Bleeding.
3.TB - Patient with high Pleural PROTEIN AND PLEURAL-SERUM LDH indicating EXUDATE.Patient had a history of RA.
4.ENTERAL ROUTE WITH NGT - Patient with a history of Infection,surgery and weight loss.There were other options like ORAL ROUTE,IV,HIGH PROTIEN DIET AND PERCUTANEOUS GASTROSTOMY.VERY TRICKY??
5.Heparin with Thrombolysis - For massive PE.Patient was HAEMODYNAMICALLY INSTABLE(HYPOTENSIVE) So you give Thrombolytics following Heparin.
1-the patient had the haemoglobin of 8.7,this is anaemia.USUALLY .malaria doen't cause anaemia.qs.was about film,not the pathogenesis.there were no schistocytes and there were no spherocytes.therefore it was not cassical hemolysis as someone has written that it was not coeliac.to me the closet answer was coeliac.please keep on commenting---thanks
1-the qs showing X-ray tibia is HPO there was priostitis that is bilatral asymetrical and the long bones are common site of involvement
2-the Shoulder Xray is SUPRASPINATUS TENDINITIS there were visibe calcification and the history is typiacal with limited painfull abduction in frozen shoulder adhesive capsulitis there is restriction of movement in the shoulder in all directions
3-in the blood film
MALARIA- not possibel:no visible parasite or ring forms +no schistocytes to explain a Hb of 8 (which is extremely rare) to indicate hemolysis of intravascular type
CELIAC - not possible:the lady is AFRRICAN + no HJ bodies+no target cells (no apparent hyposplenic features)
Iron deficieny -not possible simply there were no hypochromasia instead there is polychromasia which is Defective hemoglobinization not a state of deficiency+also there were no pencil cells
Sickle -not possible because simply there is no SICKLE
The remained answer is the true answer AUTOIMMUNE HEMOLYSIS (Polychromasia+MARKED spherocytosis+red cells agglutination)
i think it should be clear now
there was an Xray pelvis i dont remember the history but i remember that it was pagets disease(trabeculation+osteosclerosis+osteolytic lesion) can any one recall the answer
urr hypomagnesaemia occurs in bartter's as well
was age then the only clue to diagnosing gitelman's?
very HONOURS only type of question
probably only for medal winners
:lol: MORE QS
1.CELLULITIS HAND - RX BENZYL PEN
2.TESTOSTERONE RX - Patient with hypogonadism and Osteopporosis
3.PID - Patient was using IUCD and had dysmenorrhea and dyspaurenia.
4VAGINAL OSTROGEN - Patient with vaginal dryness due to postmenopausal symptoms.
5.LEWY BODY DEMENTIA
8.NORMAL PRESSURE HYDRCEPHALUS
9.SYRINGOBULBA - patient with Tongue deviation
10.ARNOLD CHIARI MAL - patient with Down beat nystagmus
11.SYRINGOBULBA - Patient with a CT scan showing fluid in the Pons,Medulla and Midbrain with enlargement.The spinal cord was quite alright,no syrinx present.He also had tongue fasiculation which is more common in Syringobulba(Brainstem involvement) than Syringomyelia(Central Spinal Cord involvement)
:lol: MORE QS
1.RODENT ULCER - Lesion nodular,pearly and crusted.
2.HIGH DOSE PREDNISOLONE - For Bullous Pemphigoid
3.SC MORPHINE CONTINUOUS - Patient with infection and bone pain due to malignancy.RX?
4.CONTROLLED RELEASE MORPHINE - Patient not responding to Codeine/Paracetamol.
5.SERUM FERRITIN - Patient with Haemachromatosis and hypogonadic hypogonadism
6.FIBROMYALGIA - Patient with musculoskeletal pain with TENDER SPOTS ON THE BODY.
7.3RD NERVE PALSY - Patient with Diabetes,ptosis.Cover test done.DM affects 3RD AND 6TH nerve.
8.SERUM GLUCOSE - Patient with Paracetamol toxicity and impaired LFT/INR.
9.LANGERHAN'S CELL HISTIOCYTOSIS - Patient with cranial diabetes insipidus.
10.PYODERMA GANGRENOSUM - History of UC and surgery.Lesion on the surgery site.
music from another room
ur answer are like muzak to my ears
i think i concur 80% wif u
can u recall anymore questions in more details?
my brain is fried right now
if we're both correct then i hope u pass!!!!
:lol: THANKS FOR THE RESPONSE.I HOPE SO.MORE QS
1.REPAGLINIDE - Patient with DM TYPE11 and had got renal and liver impairement.What is the RX? Meformin,Sulphonylurea and Glitazoles are contraindicated in patients with renal and liner impairement.So the best option is Repaglinide,which is contraindicated in severe liver impairement and not just in liver impairement.
2.Prolactinoma - Patient with a prolactin level 6,000 and features of hypogonadism.Another possible option is Craniopharyngioma because of the age of the patient in the history(young lad).But it causes more of Growth failure,headache and visual problems.
3.LABETALOL -Pregnant woman with hypertension and liver impairement.So methyldopa is contraindicated.The only possible option was Labetalol.
4.Ursodoxycholic acid - Patient with Cholestasis of pregnancy(3rd trimester) and abnormal LFT.QS - RX?
5.CONGENITAL ADRENAL HYPERPLASIA - Patient with raised Androgen/Testosterone,normal LH/FSH and riased 17 OH PROGESTERONE.It was not PCOS where you should have raised LH,LH:FSH ratio(>3) and testosterone with normal 17 OH PROGESTERONE.
6.TRIAL OF ANTI-TB DRUG - Patient with fever,weight loss and night sweat.Heaf test stage 2 with normal sputum test.QS - NEXT STEP? Try ANTI-TB RX.
7.ISCHAEMIC NEPHROPATHY - Patient with no history of diabetes but had Diabetic retinopathy,proteinuria( prt very high in urine).It was not diabetic nephropathy which is mainly characteristic of microalbuminuria(30 -300 mg/day or 20-200micromol/l).The value given was far above this.So it is not typical of DN but of Ischaemic type.Very tricky????
8.CORONARY ARTERY DISEASE - Patient with heart failure and atrial fibrillation and ECG with INFEROLATERAL MI features.QS - CAUSE OF HF/AF?
9.SALT RESTRICTION - Patient with heart failure and was not responding to diuretics.It is not I.V frusemide because we are talking about ACUTE HEART FAILURE.
10.ECHO - Patient with breathlessness and a history of premature heart disease.Echo to find out the cause.Vague QS??
11.ECHO - Patient with a history of ASD and murmur.Do echo to rule out EBSTEIN ANOMALY OR EISENMENGER' SYNDROME.
:lol: MORE QS
1.GRAVITATIONAL ECZEMA - Also known as Venous Eczema.Patient had pigmentation with haemosiderin deposition on the skin.
1.SICK SINUS SYNDROME - Patient with an ECG showing Bradycardia,AF and Sinus pause :lol:
2.HEPATITIS C/CRYOGLOBINAEMIA - Patient with arthralgia,purpuric rash with other systemic features.
In brugada syndrome, tyhe ECG shows rsr pattern - Was it shown in the exam
In brugada syndrome the ECG shows rsr pattern in V1 and V2 - was it shown in the ECG given in the exam
:lol: IN BRUGADA YOU HAVE ST ELEVATION AND RBBB(RSR PATTERN).This was present in the ECG and there was a family history of sudden death.Brugada Syndrome can be familial and predisposes patient to VT/VF,which is responsible for sudden death.
1RENAL TB -Patient with fever,night sweat,weight loss and renal iimpairement.There was also a negative urine culture.
:lol: MORE QS
1.HISTORY OF CVA - Patient with a history of Carotid artery stenosis and is fit for Endarterectomy.What factor to look for before surgery? ANSWER - HISTORY OF CVA BECAUSE SURGERY PREDISPOSES PATIENT TO STROKE.Surgery is a risk factor so you need to check if there is any history of CVA.
2.I.V MAGNESIUM - Patient with Acute Severe Asthma.O2,NEBULISED SALBUTAMOL,PREDNISOLONE AND IPRATOTROPIUM GIVEN BUT TO NO AVAIL.It is I.V MAGNESIUM AS OPPOSED TO I.V AMINOPHYLLINE WHICH CAN CAUSE HYPOKALAEMIA.TREMOR AND CARDIAC ARRTHYMIA.
WAT'S UP??Are people tired of contributing?? Is the exam easy or what??
in burgada u have persistenet ST elevation in V1 V2 V3 + or - RBBB wich was shown in the
I agree with u in the IV MAGN qs as well the Previous history of TIA as the pt. was admitted with acute coronary syndrome and for bypass graft and it was DISCOVERED that he has carotid stenosis of 75% so wheather to operate or not you need to know if there was a previious history of TIA as carotid endarterectomy is a method of SECONDARY PREVENTION of TIA ..
Regarding the Renal TB mentioned i dont remember i really but i remember a 75 years old male with fever ,night sweats,loin pain ,renal impairment with Hb of 18 and the answer was RENAL CELL CARCINOMA
i think there was a qs about an asian with TB adrenalitis
could u please give more details ......
MY OPINION RE:CARDIOLOGY QS.
WHEN SOMEBODY GET CARDIAC BYPASS,IT IS THE RISK OF CARDIAC ARREST AND STROKE HAS TO BE ASERTAINED BEFORE SURGERY.IN ABOVE QS,ALTHOUGH THERE WAS 75%STENOSIS---STENOSIS WOULD NOT DETERMINE THE RISK OF THE STROKE.PT.NEED TO HAVE ECHO.TO SEE ANY THROMBUS OR ANY CLOT SITTING IN THE HEART OR ALSO ANUEURYSM,WHICH WILL FURTHER INCREASE THE CHANCES OF STROKE.
SO TO ME THE ANS.WAS TO DO ECHO.-----PLEASE COMMENT,I AM NOT EXPERT,JUST LIKE U,,,,THAKS
the patient with hypogonadism and osteoporosis was 70 plus yrs , i would rather give him alendronate at this age not testosterone
i chose also to do echo for the risk of stroke in carotid stenosis
1.RCC - If my memory serves me right i didnot remenber any case like TB ADRENALITIS.There was a case of Addison's disease with treatment(hydrocortisone).I think RCC came only once and that was the one on the CT SCAN ABDOMEN.There was one RENAL TB as i have describe before.
2.Testosterone - Please note that the primary cause of the Osteoporosis was Hypogonadism( with low testosterone).Therefore,the first line rx will be testosterone to correct the hypogonadism and later alendronate for the osteoporosis.
1.DRUG INDUCED DYSTONIA/TARDIVE DYSTONIA - RX is Anticholinergic drug or bromocriptine (Dopamine agonist).I think the patient took Metoclopramide (Dopamine antagonist).I donot remember which one i chose.
1.CAROTID ARTERY STENOSIS - Answer - History of CVA.Check Kumar and Clark on the Surgical approaches.It states that the mortality rate is 3% and has got a similar risk as stroke.Please note that they are not asking about the cause of the stenosis but the prognosis/risk/complication associated with Endarterectomy.
armed and dangerous
i remember that question
it was an elderly man with 5 weeks of fever and night sweat
did not improve with antibiotics
sr urate 0.6
sr psa 21
ur feme leucocte 1+,blood 2+
what is ur diagnosis?
2) urate nephropathy
3) renal cell carcinoma
4) renal tuberculosis
i wish it was renal tuberculosis but i think tarekdeema was spot on with renal cell carcinoma the only real explanation for a raised HB of 18
RENAL TB - Please be aware that HB ranges from 13.5 - 17.50 or 18g/dl.So 18 is not all that high to cause seconadry polycythaemia.
1.STRONTIUM - Patient with Osteoporosis and a history of achalasia. Bisphosphonates are contraindicated in Achalasia.So the best rx will be Strontoium.
2 COMMENTS PLEASE:
1-PSA WAS 21 BUT THE NORMAL WAS LESS THAN 4---IT WAS FIVE TIMES HIGHER
2-BISPHOSHPNATES ARE NOT STRICLY CONTRAINDICATED----FIRST WE HAVE TO GIVE A TRIAL OF BISPHOSPHONATES AND THEN TRY SOMETHING ELSE.
1.PSA - There was no qestion about BPH OR PROSTATIC CARCINOMA.NO PSA WAS ABOVE 10 TO INDICATE PROSTATIC CA.
2.STROMTIUM - CHECK YOUR BNF.BISPHO - C/I IN GI UPSET OR ACHALASIA.
:lol: MORE QS
1.VASOVAGAL ATTACK OR SYNCOPE - Patient with a history of syncope especially when standing in a crowd waiting for a bus.It lasts for 2 minutes.You will be tempted to go for PANIC ATTACK.VVA has a classic history of it lasting for about 2 minutes and occurs when waiting for a bus or as a result of an emotional situation.Other features can be papitation,sweating,pallor and even urinary/faecal incontinence(DD will be epilepsy).
2.Viral Thyroiditis - Patient with painful and tender neck gland.The isotopic scan showed reduced uptake.
3.POST-PARTUM THYROIDITIS - Patient with a history of Hyperthyroidism two months following delivery.
These are some of the images i could recall from the 3 papers2 weeks ago. The answers are what i thought was correct at the time of exam.
1. Picture of gums. Elderly vagrant with gingivitis and poor oral hygiene.
Ans- Scurvy (malnutrition)
2. X-ray femur/humerus- well circumscribed mass proximally
Ans- Osteoid osteoma
Ans- Mitral Valve Prolapse
4. Blood film - Howell-jolly bodies. African lady with anaemia, diarhoea 2 weeks. no rash/lymphadenopathy
Ans- AIHA ( but i think its coeliac disease) Malaria was also an option given
5.ECG - abnormalities at V1-V3 Young dude with family history of sudden death presents with palpitations.
Ans- Brugada Syndrome
6. ECG - Q waves in anterior chest leads.
Ans - Anterior MI
7. Scalp photo of elderly man
Ans - Actinic Keratosis
8. Skin lesion
Ans - Basal Cell Carcinoma
9. CT Abdo - Huge right sided mass
Ans - Pancreatic pseudocyst ( But thinks its RCC)
10. IVP/KUB ? stones in bladder, fibromuscular dysplasia ?
Ans - Excessive Vit D, Calcium intake ( other options were methysergide)
Ans - Benign Lentigo ( could also be Lentigo Maligna)
12. Hand picture of young boy
Ans - Scabies
13. Face of teenager
Ans - Acne Vulgaris
14. Fragile skin with breakage and photosensitivity
Ans - PCT
15. Histology small bowel - ? PAS macrophages
Ans - Whipples Disease
16. CXR with cardiomegaly, symptoms of heart failure
Ans - T. Cruzi
Ans - Diabetic maculopathy
18. CT Brain
Ans - Subdural Haematoma ( Think it should've been EDH)
19. MRI Brain
Ans - Syringobulbia ( ? Arnold Chiari Malformation)
20. Hand picture with swelling of PIP joint
Ans - RA ( ? OA)
21. Face picture
Ans - Molluscum Contagiosum
22. AXR - lead pipe colon
Ans - UC
1Diabetic Maculopathy - There was no QS about Diabetic Maculopathy which is xterised by macular oedema,reduced visual acuity,hard exudate.The only ones i could remember as CRA EMBOLISM,CRV OCCLUSION,DEMYELINATION(PATIENT WITH SUSPECTED MS - OPTIC NERVE WAS SWOLLEN AND PALE) AND ANTERIOR OPTIC ISCHAEMIC NEUROPATHY.
1.ANAPHYLACTIC SHOCK - Patient with a history of shock following intake of food(cannot remember which food).Best treatment from the options was IM ADRENALINE 500MICROGRAMS(0.5MG/0.5ML) - this is the treatment for anphylactic shock.SC is ineffective and I.V is reserve for severe forms.
2.Pheocromocytoma - Patient with a history of palpitation,hypertension,sweating,anxiety with i think mid-systolic click.
Dear Friends - Who appeared recenlty the MRCP2 exam.
Could you plz guide the freshers how to prepare for Part 2 I mean -what are the books and sites to be studied.
Hi - guys when is the result of MRCP2 expected.
Last time DEC 2005 - the result was released on 13th Jan 2006 exactly after over 5 weeks , may be because of CHRISTMAS and NEW YEAR holidays for RCP.
This time we do not know .
The questions discussed by different MRCPians really quite encouraging answers and almost the whole Q bank of DEC 2006 has been discussed.
1. The Answer for Metachlorpropamide toxicity is BENZTROPINE IM.
2. The answer for Xray SLIDE is OSTEOID OSTEOMA.
3.CA oespphagus - yes the answer is CHEMORADIATION -clearly given in OHCM
4. RADIOTHERAPY IS THE answer for pain management .
5.There was nothing like LICHEN PLANUS SLIDE.
6.THERE was also another option in the Qs Brugada syndrome where in there is family H/O sudden death -ARYTHMOGENIC CARDIOMYOPATHY.
7.YES the answer for TB is trial of treatment.
8.BRONCHIAL ASTHMA. 1. I.V. MAGNESIUM 2. ADMISSION FOR PEFR LESS THAN 40%.
9. There was Q of FIBROMUSCULAR DYSPLASIA - where a 30 year old lady with hpokaleimia and HIGH RENIN AND HIGH ALDOSTERONE.
10.PSYCHIATRY- SCHIZOPHRENIA IS THE RT ANSWER.
11. ANOTHER - DEPRESSIVE DISORDER.
Any way friends - we all have done whatever the best we could do.
Now let's pray that May Allahusubhanahuta'ala give a great success to all of us.
Amen Amen Amen
:lol: MORE QS
1.TOXOPLASMOSIS -Patient with HIV and CT SCAN showed ENHANCEMENT ON THE TEMORAL REGION.It is Toxoplasmosis and not HSV ENCEPHALITIS which will show abnormal signals/features on the temporal region and not ENHANCEMENT.
2.PREDNISOLONE - Patient with ABPA.Itraconazole should be given as an adjunct to Prednisolone.
are the results out?
RESULTS INSHALLAHTA'ALA WILL BE IN THE WEEK COMMENCING FROM 8TH JANUARY.
RESULTS INSHALLAHTA'ALA WILL BE IN THE WEEK COMMENCING FROM 8TH JANUARY.
MAY ALLAH GIVE US ALL A GREAT SUCCESS IN THIS EXAM - AMEN AMEN AMEN OH ALLAH AMEN
RESULTS COULD BE PUT ON THE WEBSITE INSHALLAHUSUBHANAHTA'ALA TOMORROW.
MAY ALLAH GIVE US ALL A GREAT SUCCESS -AMEN AMEN AMEN
YA ALLAH AMEN
why r u saying that it can be out tomorrow??? it clearly states the week begining 8th..............I think the earliest they will give would probably 6th the friday when they will upload the results on the website and go home and then post the result the following week...........anyways best of luck
i have more passion than you know wot to do it
hey guys lets keep the questions going
last count there wuz like only 150 - 170 questions discussed
there's at least 70 more
let me start the ball rolling again
1) young diabetic lady severe pneumonia intubated and developed pulseless limb which was amputated
2 weeks later extubated c/o unable to take orally and dizziness when lying down
bp 124/74 lying bp 114/54 sitting
wot is your dx?
2) autonomic neuropathy
AUTONOMIC NEUROPATHY - Patient is diabetic and the change in systolic pressure was more than 20mmHG in the exam (POSTURAL HYPOTENSION) which is part of Automonic Neuropathy.Diabetes causing it.
:lol: MORE QS
1.RENOVASCULAR DISEASE/FIBROMUSCULAR DYSPLASIA - Patient who was on Captopril and had some renal impairement and Femoral Bruit.The Kidney size on the ultrasould was not significant for it to be RENAL ARTERY STENOSIS - WHICH IS MORE PROXIMAL WITH KIDNEY SIZE DIFFERENCE OF AT LEAST 1.5CM.FMD IS DISTAL WITH MULTIPLE STENOSES.IVP WILL SHOW BEAD ON STRING PATTERN FOR FMD.
dermato pict questions
1) The one with a lesion for 6/12 squamous cell ca/ solar keratosis?
2) Old lady found using hot bottle for back pain, pict showing blisters over back ? Shingles or Burnt lesions, question asked, what antibiotics to give.
3) Acne vulgaris or herpetic lesion?
Pls discuss. Thanks
1- for the 6/12 lesion on the elderly man i wrote basal cell carcinoma -because it didnt look like all others ,i think it looks typical (a slowly growing nodule in an old man is BCC till proved otherwise ..
2-the women with back pain and using hot bottel ,this is SHINGLES typically(unilateral,distributing over one dermatome,the PAIN which usually appears over the area before the skin lesion and the women usese the hot bottele in an attempt to alliavate the pain and 2-3 scanty blistres where obvious
3-the young boy skin rash who has a history of exzema i wrote exzema herpiticum as the pictures didnot show comedones with either black or white tops to say acne vulgaris ,for me there were nodules,papules,pustules ..
1-could anyone remember the qs about the Chest xray with miliary shadow (mottiling)
2-scabies -MELATHIONE TT
3-CT brain photos?
one is HSV encephalitis and other was extradural hematoma what are the others
could u describe more on te miliary question? can't really recall
was there any questions on teraparatide?
Separate names with a comma.