PART 2 MRCP DEC.2006

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

  1. Guest

    Guest Guest

    :lol: COMMENTS
    1.ACNE VULGARIS - The lesion was papular,nodular,erythromatous,black comedones and even cystic.Therefore, it is a severe ACNE.Eczema Herperticum is xterised by a widespread multiple small blisters - which was not present in the picture.
    2.Toxoplasmosis - Patient with HIV and CT scan showed Enhancement lesions is typical of TOXOPLASMOSIS as opposed to HSV which will show abnormal features/signal on the temporal lobes without enhancement.Enhancement indicates ABSCESS.HSV is viral and will not cause ABSCESS.TOXO is a common complication in HIV patient than HSV.
    3.SUBDURAL HAEMATOMA - CT scan showed haematoma below the dura matter which was continous and irregular.There was also a history of alcohol.Extradura haematoma - haematoma is on the surface of the dura and is LUCID with a regular haematoma.
    4.MILIARY TB - Patient had a history of VARICELLA inf with CALCIFICATION AND MILIARY SHADOWS on the CXR.NOT Varicella inf because it will cause calcification and not miliary shows.Milliary TB can cause both calcification and miliary shadows.
    5.STRONTIUM - For the QS about OSTEOPOROSIS AND its prevention/treatmemt.NOT BISPHOSHONATES OR TERAPATIDES because of the history of Achalasia and GI Symptoms - both are contraindicated.So the only reasonable answer is Strontium - new drug.
  2. Guest

    Guest Guest

    whats up guys seems like eveyone has fead up ,up till now only we have seen 180 still there is more 90 to go,please for those who recall ADD More questions.
  3. Guest

    Guest Guest

    TAREEK,WELL DONE.U HAVE PUT THE QS.ON ANOTHER SIDE ACCORDING TO THE SUBJECT.LET US DO THIS WAY.I WILL CONTRIBUTE ABOUT 40 MORE.
  4. Guest

    Guest Guest

    my memeory is deleting nowadays ,could any one remember a qs about EBSTIEN'S ANOMALY ?
  5. Picture of gums. Elderly vagrant with gingivitis and poor oral hygiene.
    Scurvy (malnutrition) common in alcoholics

    X-ray femur/humerus- well circumscribed mass proximally
    Ans- HPO

    Blood film - Howell-jolly bodies. African lady with anaemia, diarhoea 2 weeks. no rash/lymphadenopathy
    malaria vivax



    Scalp photo of elderly man
    Ans - seborrhoic dermatitis

    Skin lesion
    Ans - SOLAR KERATOSIS notice the keratinized layers?

    CT Abdo - Huge right sided mass
    Ans - RCC

    Lentigo Maligna


    Face of teenager
    Ans - eczema herprticum
  6. Guest

    Guest Guest

    Dear Guest
    nice to hear that u have another 40 qs please identify ur self and let us see and discuss them
  7. Guest

    Guest Guest

    I AM ON CALL AND IT IS VERY VERY BUSY,I WILL POST IT TONIGHT OR TOMORROW,EARLY MORNING,THANKS GOOD TO HEAR THAT PEOPLE HAVE STILL THE ENERGY TO DISCUSS.
  8. Guest

    Guest Guest

    HI,I AM PUTTING QS.1 TO SEE THE RESPONSE AND DEPENDING UPON THIS I WILL PROCEDE:

    ----OLD MAN WITH BACKGROUND OF DEMENTIA AND ACUTE CONFUSION.SEEN BY RHE FAMILY.FOLLOWING U WILL DO TO CALM?
    1-HALOPERIDOL
    2-LIGHTS OFF
    3-MINIMZE THE NO.OF PEOPLE IN THE ROOM
    4-
    5-
    PLEASE COMMENT.MY WORDING MAY NOT BE HUNDRED PERCENT,BUT COMMENT.THANKS
  9. Guest

    Guest Guest

    i do remember such a scenario with an elderly with dementia brought to A/E aggitated and causing trouble to the staff /what to give him HALOPERIDOL
  10. Guest

    Guest Guest

    I THINK THE ANSWER WAS NOT HELOPERIDOL.BECAUSE THE LETTER BY CMO-UK ONLY QUTIAPINE IS RECOMMENDED.I FEEL THAT THE RIGHT ANS.WAS MINIMIZE THE NUMBER OF PEOPLE IN THE ROOM.---OMMENT PLEASE...THANKS
  11. Guest

    Guest Guest

    :lol: COMMENTS
    IF THE PATIENT WAS AGITATED THEN THE ANSWER SHOULD BE TO GIVE BENZODIAZEPINE(DIAZEPAM) TO CALM THE PATIENT DOWN.THE OTHERS OPTION ARE NOT APPROPRIATE.
  12. Guest

    Guest Guest

    THANKS,THERE WAS NO OPTION OF BENZODIAZEPINES.
  13. Guest

    Guest Guest

    ANOTHER QS.37 YRS OLD LADY CAME WITH CNS SYMPTOMS.HAD REPEATED INVESTIGATIONS FOR GIT AND RESPIRATORY PROBLEMS AND CVS DISORDERS.NOW PRESENTS WITH NUMBNESS LOSS OF POWER.O/E--NORMAL

    ANS----FUNCTIONAL DISORDER
  14. Guest

    Guest Guest

    PAPER THREE;
    picture---x-ray pelvis ---paget's disease

    1-pamomidronate
    2-radiation
    3-etidronate
    4-melpelan+steroids
    5-steroids

    I had put pamidronate---please comment,thanks
  15. Guest

    Guest Guest

    i agree in both qs
    lady with non specific signs and a brain image done what will u get-NOTHING
    PAGETS pelvic xray(trabeculations+sclerosis+lytic lesions
    please post all remaining qs to discuss them all
  16. Guest

    Guest Guest

    ANOTHER QS.

    1-39 YRS OLD MAN WITH PURPLISH COLOR RASH ON THE TRUNK.PRESENTED WITH THE JOINT PAINS----PSORIATIC ATHRITIS
  17. Guest

    Guest Guest

    Benzodiazepines are not usually recommended as a first line treatment for confusion in the elderly (unless the confusion is a result of sedative hypnotic or alcohol withdrawal), because benzodiazepines have marked anticholinergic effects and often worsen the confusion. Other measures are often tried some non drug strategies and if necessary failing that sometimes low doses of neuroleptics.
    Benzodiazepines are sometimes indicated if the confusion is the result of GABA antagonistic drugs such as the fluroquinolone antimicrobials or the beta lactam antibiotics eg meropenem.
  18. Guest

    Guest Guest

    :lol: COMMENTS
    THE GUEST SENDING THIS QS CAN YOU PLEASE BE SPECIFIC OR LOGICAL.YOUR QS AND ANSWERS ARE BIZZARE AND INCOMPLETE.I CANNOT EVEN RECALL SOME OF YOUR QS AND ANS.
  19. Guest

    Guest Guest

    SINCE U CAN'T RECALL-TRY.THESE TWO DIFFERENT PEOPLE.
  20. Guest

    Guest Guest

    :lol: QS
    INTERMITTENT SELF CATHETERISATION - Patient with MS and has been having urinary incontinence for a while now.Patient wants a solution to his problem.The best treatment will be ISC.
  21. Guest

    Guest Guest

    :lol: COMMENTS
    WHERE ARE THE 40 QS WE ARE PROMISED BY ONE OF THE GUEST?????
  22. there's this question about hypercholesterolnemia and trigliseraldemia, wat is the next investigation. Is it Hba1c?
  23. Guest

    Guest Guest

    that qs was really hard a patient with high TAG and CHOLESTROL and which investigation will give the diagnosis ,,, strange really please could anyone recall more details about this qs


    Where is the 40 qs we are expecting from the guest i think he is enjoying EID and new year any how congratulation for all and wish u success inshallah
  24. Guest

    Guest Guest

    SORRY TRREEK,I WAS UNABLE 2 PUT HE QS.PLEASE NOT THAT SINCE MY LAST CONTACT I HAD PUT 3...NOW ANOTHER 2.PLEASE COMMENT,FEW MORE TO FOLLOW VERY SOON.I AM TRYING TO CONFIRM THE QS,WHICH HAS NOT BEEN MENTIONED ON THE OTHER SITES AS WELL AND THEN TRYING TO MEMORIZE.IT IS TAKING HARD TO GET THE RESPONSE FROM OTHERS.I HOPE THIS FESTIVE SEASON HAS BEEN A BLESSING FOR ALL THE FAITHS.WAITING FOR REPLY...

    1-SIGNS OF ARM WEEKNESS.WAS A MAN IN 40S.WORDING WAS BRISK SUPINATOR AND BIECP REFLEX BUT LEASS BRISK TRICEP---
    ANS-------NEURALGIC-----PATHY
    2-A 40 YEAR AOLD MAN FOUND UNCONCIOUS ON THE STREET,BMS--24.3
    ABG
    ANS---(1)
    PH---7.09
    BE--- -17.1
  25. Guest

    Guest Guest

    PLEASE COMMENT SO THAT I COULD ADD MORE.THANKS
  26. Guest

    Guest Guest

    : :lol: COMMENTS
    1.CERVICAL SPONDYLYTIC RADICULOPATHY - WAS A BETTER ANSWER THAN NEURALGIC AMYOTROPHY WHICH IS XTERISED BY MUSCLE WASTING OF THE SHOULDER WITH PAIN.It is usually idiopathic but can be due to allergy,infection(viral) and vaccination.This was not present in the history.But in the history there was a history of arthritis and neck pain leaning towards CSR.
    2.SECOND QS WAS INCOMPLETE.CAN YOU PLEASE BE MORE SPECIFIC.
  27. Guest

    Guest Guest

    THANKS FOR UR REPLY---THE CHOICE WAS NEULAGIC RADICULPATH BUT THE WORDING WAS DIFFERENT

    ANOTHERQS----A MALE WITH AF AND IS ON DIURETICS AND DIGOXIN.NO OTHER HISTORY.HAS A K=3.2.WHAT WOULD U DO:
    1-IV POTASSIUM
    2-ORAL POTASIUM
    3-WILL STOP DIURETICS
    4-DIG. LEVELS
    5------------------------

    MY ANS.WAS ORAL K----COMMENT PLEASE
  28. Guest

    Guest Guest

    :lol: COMMENTS
    LOW POTASSIUM QS - You left out one option.Anyway,if observe patient was an option,then i will go for that especially if there are no symtoms.But if it was not an option, then STOP DIURETICS will be the best option.The normal K IS 3.5 -5.So 3.2 should not prompt you to give ORAL K.However,diuretic with digoxin can cause low potassium,so stop it and then give another drug as a substitute.
  29. Guest

    Guest Guest

    VERY SMART STUFF.
    I THINK IF SOME BODY IS ON DIURETIC AND DIGOXIN AND LOW POTASSIUM,IT IS A RECEPIE OF DISASTER AND THE CHANCES OF ARRYTHMIA DUE TO HYPOKALALEMIA WOULD BE VEY HIGH------THE RIGHT ANS---TO GIVE ORAL SUPPLIMENT AND CHECK POTASSIUM NEXT DAY...........PLEASE COMMENT,THANKS
  30. Guest

    Guest Guest

    i think stopping the diuretics would be ideal at this stage and a level of 3.2 is likley to normalize following stopi think if u put the whole qs u have with ur answers and we discuss them all at once would be great because after tommorw the results will be UP ......... :D
  31. Guest

    Guest Guest

    WHEN PATIENTS ARE ON DIG AND DIURETICS,IT IS USUALLY NUHA-4 FAILURE.MORE SENSIBLE THING WOULD BE ORAL REPLACEMENT AND NOT DISTURBING ANTI-FAILURE MEDICIME---COMMENT PLEASE
  32. Guest

    Guest Guest

    TAREEK THANKS.I AM AFRAID THAT I HAVE STILL 33 MORE.BUT THE CHANCES OF PASSING ARE LITTLE.I DON'T WANNA BE FEELING EMBARACED.
  33. Guest

    Guest Guest

    ANOTHER QS;
    A LADY IN LATE THIRTIES.RECEIVED TREATMENT FOR HYPERTHYROIDISM WITH CARBIMAZOLE.NOW HER
    TSH---17(4-15)
    ANTIPEROXIDASE ANTIBODIES---250(RAISED)
    T4---21(9-21)
    T3----18(18-33)

    1---HASHIMOTOTHYROID
    2- THYROID CA
    3- GRAVE'S DISEASE
    4- PRIMARY HYPERTHYROIDISM
    5- ATOPIC THYROID

    MY ANS-WAS THYROID CA WHICH WAS WRONG---IT WAS HASHIMOTO'S




    QS---SOMEBODY WITH THYROID CA ON FNA---TREATMENT

    1-CARBIMAZOLE
    2-PROPYLTHIOURACIL
    3-PROPRANOLOL
    4-NEAR TOTAL THYROIDECTOMY
    5-RADIATION

    ANS---NEAR TOTAL THYROIDECTOMY

    QS-3---I DO NOT REMEMBER FULLY,BUT THE ANSER WAS ASKING ABOUT COMLINCE.

    THERE WERE TWO MORE THYROID QS.---ALRAEDY MENTIONE BY U FOLKS.
    PLEASE COMMENT
  34. Guest

    Guest Guest

    ANOTHER QS-

    A WOMAN COMES TO THE CLINIC WITH PROGRESSIVE SOB ON EXERTION.O/E SHE HAS CYANOSIS WITH MURMMUR IN HER HEART:
    1- PPH
    2-ASD
    3-EISENMENGER'S DISEASE
    4-HOKM
    5-----
    ANS-----PPH----PLEASE COMMENT BEFORE I THROW OTHERS,THANKS
  35. Guest

    Guest Guest

    QS--SOME BOBY WITH PROLONG BLEEDING TIME AND NORMAL VWB FACTOR AND NORMAL PT/APTT/FIBRINOGEN:
    1-VWB DISEASE
    2-TTP
    CONGENITAL PLATELET DISORDER
    4-HAEMOPHILIA
    5-SLE
  36. Guest

    Guest Guest

    ANOTHER QS---SOME BODY WITH DERRANGED LFT AND FERRITIN OF 400.ALSO ARTHRALGIA.WHAT WOULD IMPROVE PROGNOSIS:
    1-PARACENTESIS
    2-I/V ANTIBIOTICS
    3-DECREASE FERRITIN TO BELOW 30
    4-
    5-

    ANS---3
  37. Guest

    Guest Guest

    ANOTHER PATIENT WITH ALL THE HORMONES LOW AND NORMAL PROLACTIN.EST INVESTIGATION:

    ANS--------MRI PITUITARY
  38. Guest

    Guest Guest

    EVERY BODY,PLEASE COMMENT,THANKS
  39. Guest

    Guest Guest

    ANOTHER QUESTION OF EPILEPSY LIKE SYNDROME---

    ANS---VIDEO TELEMETRY
  40. Guest

    Guest Guest

    :lol: COMMENTS
    SOME OF THE QS ARE INCOMPLETE SO IT IS DIFFICULT TO COMMENT ON THEM.I JUST HAVE ONE COMMENT.

    1.EISENMENGER'S SYN - IS A BETTER ANSWER THAN PPH.PPH WILL CAUSE LOUD 2ND HEART SOUND ON THE PULMONARY REGION WITHOUT A MURMUR.EISENMENGER'S SYN IS A REVERSE SHUNT(LEFT TO RIGHT SHUNT BECOMING A RIGHT TO LEFT SHUNT BECAUSE OF PULMONARY HYPERTENSION.IT WILL CAUSE CYANOSIS AND THE MURMUR CAN BE DUE TO VSD,ASD OR PDA.
  41. Guest

    Guest Guest

    ANOTHER QS.

    A MALE IN 70S ON HEAVEY TOPICAL DOSE OF STEROIDS FOR pemphigoid--SHOWS NO RESPONSE---WHAT IS THE NEXT TREATMENT OPTION
    1-ORAL PREDNISOLONE
    2-METHOTREXATE
    4-AZATHIOPRIME
    4-CRYOTHERAPY
    5-INFLIXIMAB

    ANS-----AZATHIOPRIME
  42. Guest

    Guest Guest

    PLEASE COMMENT---I HAVE PUT ON ALOT--I CANNOT REMEBER ALL THE TEXT BUT AT LEAST I HAVE A LITTLE BIT OF QS. NOT MENTIONED BEFORE,THANKS
  43. Guest

    Guest Guest

    in esingmerger a murmur of ASD OR PDA OR VSD needs to be evident for a long time till the syndrome develops where the shunt is reversed and pressure on right and left equalizes at this stage the murmur gets quiter or even DISAPPEAR ,in PPH the mumrmur u might get is pansustolic ove the tricuspic valve duo to functional reguirge ,another possibility is ebstiens anomly where u get a reguirg murmur+cyanosis and wide fixed splitting of the 2nd heart sound ,,,,if my memory was good the question was a lady with wide fixed splitting of S2 +murmur+cyanosis


    so in all these possibilities u may get a murmu and cyanosis
    :D
    confusing isnt it
    i agree with u in azathioprin as a sparing drug
    tarekdeema
  44. Guest

    Guest Guest

    :lol: COMMENTS
    THE GUY WHO SAID PPH CAN CAUSE MURMUR,PLEASE GO BACK AND LOOK AT THE POSSIBLE AND COMMON CAUSES OF MURMUR OR PANSYSTOLIC MURMUR.PPH CAN CAUSE LOUD 2ND HEART SOUND BUT NOT PANSYSTOLIC MURMUR(VERY RARE).I CAN AGREE WITH THE OTHER POSSIBILITY OF EBSTEIN ANOMALY.THE POSSIBLE CAUSE OF A WIDE AND FIXED SPLITTING OF THE 2ND HEART SOUND WILL BE ASD WHICH IN TURN CAN CAUSED EISENMENGER'S SYN.THE OTHER OPTION ARE LESS LIKELY.CHECK KUMAR AND CLARKE.
    FOR THE OTHER QS I AGREE WITH AZATHIOPRINE.
  45. Guest

    Guest Guest

    THANKS,NOW U HAVE STARTED AND MY BRAIN STARTED WORKING AS WELL

    QS---69 YRS FEMALE---SHE HAS POLYMYELGIA RHEUMATICA--ON STEROIDS FROM 9 MONTHS--PREDNISOLONE 10 MG.WHEN U DECREASE TO 5 MG THE SYMPTOM RECCUR---WHAT WILL U DO?


    1-CONTINUE
    2-INCREASE PREDNISOLONE
    3-AZATHIOPRINE
    4-CYCLOSPORIN
    5-INFLIXIMAB


    ANS---CONTINUE---COMMENT AND THEN I WILL GIVE THE REASON.
  46. the right option was
    continue last dose with azathioprim
  47. Guest

    Guest Guest

    IN PMR-THE TREATMENT IS USUSALYY STATED AT THE HIGH DOSE OF STEROIDS.USUALLY IT TKES 12-18 MONTHS FOR REMISSION.IF SOMEBODY IS AT 10 MG OF PREDNISOLONE,IT MEANS THAT HE IS RESPONDING.FURTHER DECRASE MAY TAKE AGES TO RESPOND.AZATHIOPRINE IS GIVEN AS A STEROID SPARING DRUG ALONG WITH STEROIDS FOR 6 WEEKS TO BEGIN WITH AND IS GIVEN FOR ATHE CONDITIONS WHERE WE HAVE TO GIVE IMMUNOSUPPRESSION FOR LIFE LONG.PATIENTS WITH PMR ARE OLD AND U WOULD HARDLY SEE ANYBODY WITH AZATHIOPRINE IN CLINICS---THIS AN INPUT BY A RHEUMATOLOGIST WHO IS GOING TO RETIRE SOON.---PLEASE COMMENT
  48. this qestion come on 2004-december
    options was

    1-contine steroid
    2-contine current dose steroid +start methotrexate
    3-cotenie tapering dose and treatment symptoms with NSAIDS
    4-INCREASE DOSE PREDNOSOLONE ADD BIPHOSPHONATE
    5-STOP PREDNOSOLONE AND ADD AZATHIOPRINE

    THE BEST ANSWER WAS 2(contine current dose steroid +start methotrexate).
  49. Guest

    Guest Guest

    :lol: COMMENTS
    I WILL AGREE WITH CONTINUE WITH PREVIOUS DOSE PLUS AZATHIOPRINE AS BEST OPTION TO THE PRESENT CONDITION.IN PMR THE FIRST LINE SHOULD BE HIGH DOSE 60MG.BUT IN THIS CASE PATIENT WAS OK WITH THE 10MG.SO IF 5MG CAN CAUSE RECURRENCE THEN GO BACK TO PREVIOUS PLUS A STERIOD SPARING DRUG TO MAKE TREATMET MORE EFFECTIVE AND ALSO TO PREVENT RECURRENCE.
  50. Guest

    Guest Guest

    ANOTHER QS-A WOMAN WITH ARTHRALGIA.NORMAL EXAMINATION.CRP43 AND ANTI-dsDNA 37(24-34)--WHAT WOULD U USE FOR THE SYMTOM CONTROL.

    1-METHOTREXAT
    2-IBUPROFEN
    3-CYCLOSPORIN
    4-PREDNISOLONE
    5-SULFASALAZINE


    ANS-------IBUPROFEN

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