sept11,2007 exam...share ur experience

Discussion in 'MRCP Forum' started by Guest, Sep 11, 2007.

  1. Guest

    Guest Guest

    hi everybody
    those who sat for 11 sept 2007 exam...........care to share their experience.........
    u r all welcome
    all the best
  2. DocToR-ER

    DocToR-ER Guest

    Hmmmmm....

    I just drove back from Bahrain ( where i sat the MRCP1, Sept 11th 07 exam)...

    Paper one was quite reasonable ..

    Paper 2 ... I started feeling shaky and I was like what the hell !...

    Many questions from onexamination.com words for words...

    Waiting for results anyway :>

    Good luck everyone ..
  3. Guest

    Guest Guest

    all the best doctor-er n to everybody else.....
    share ur experience too
  4. sp_gk79

    sp_gk79 Guest

    what a tough exam??

    hi all..
    as regard paper one it was so easy, unlike paper 2 which was too tough and difficult especially those CNS questions
    any way I remember some questions

    1- man travelled from aAustralia to england, has repeated TIA .
  5. Guest

    Guest Guest

    Author Message
    veeru9
    Guest






    Posted: Thu Sep 13, 2007 4:22 am Post subject: mrcp 1

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

    hi ,
    i would like to share few q i remember

    1) there was a question on erysepelas
    2)one on ocd
    3)hypomania
    4)jugular foramen
    5) internuclear ophthalmoplegia.
    6)posterior inferior cerebellar artery
    7)on heparin anti xa
    8)left ventricular aneurysm obs in ccu
  6. pcv

    pcv Guest

    part 1 questions

    The q about the australian travel, Trans oesophageal echo was not given as an option and there was no evidence of dvt..
  7. dssdsds

    dssdsds Guest

    the choice was given trans thoracic echo~
    and that is the right ans:
  8. pcv

    pcv Guest

    if you re thinkin of PFO,TTE will not give you a diagnosis
  9. Guest

    Guest Guest

    there was NO choice of transesophagel echo
    simply had to oblige by the trans thoracic echo option
  10. Guest

    Guest Guest

    Good Luck All some ?'s

    1. Elderly man, afebrile, with pain of his left foot
    Red, hot, painful
    WBC slightly elevated

    a. Gout
    b. cellulitis

    2. Heart block findings

    a. loud 1st heart sound
    b. varying intensity of 1st heart sound
    c. cannon v waves

    3. Man with IgM high (Waldenstrm's macroglob) what findings possible

    a. hyperviscosity


    post much more later
  11. Guest

    Guest Guest

    dr.nasir

    Author Message
    dr.nasir
    Guest






    Posted: Thu Sep 13, 2007 8:15 pm Post subject: mrcp part 1,11 sept2007

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

    hi all h r u?
    rx of a systolic dysfunction of heart who r not having oedema, both pulm and peripheral ,but worsening breathlessness.
    is it frusemide+ramipril?
  12. Guest

    Guest Guest

    mazi

    mazi
    AIPPG Serious Member


    Joined: 10 Apr 2007
    Posts: 14

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    Posted: Thu Sep 13, 2007 6:41 pm Post subject: Flashback -----September 2007 MRCP Part 1 exam

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

    1) Patient with hair dye done 3 days back now presented with weeping eczema over forhead: Suggestive of contact allergic dermatitis (CAD)

    2) Farmer with paronychia and shocklike state : Staphylococcal toxic sock syndrome.

    3) actin is a present as and active component in cytoskeleton

    4) Tumour necrosis factor alfa derived from macrophages

    5) tetanus: delayed hypersensitivity: type 4 hypersensitivity
  13. DocToR-ER

    DocToR-ER Guest

    Hello everyone.

    Regarding the Q of that paitent who came back from Australia.. I think TTE is the most suitable answer ..since for Patent Foramne Ovale u need to use TEE OR TTE with contrast ! as given by some of the notes by onexamination.com

    there was a Q about the best HLA for patients receiving renal transplants !

    a question about number needeed to treat.. and one about the mean and median ( statistics)

    patient with paronychia recived amoxil and flucolx.. and else would u like to add ? ......clindamycin is the right answer..

    again ... there is no comparison at all between paper 1 and 2 at all !
  14. drmomo

    drmomo Guest

    Man with sudden CP and had high pressure in LV, aorta, and arm with lower pressure in the femoral .......aortic dissection

    Lady with severe paralysis needed intubation, iv drug user before, with SC injection marks in the lower limb.....Botulism
  15. doctorimmo

    doctorimmo Guest

    was it Botulism ? i wrote tetanus instead :cry:
  16. drmomo

    drmomo Guest

    X-linked recessive Haemophilia with son having the disease who else....mothers bother

    Allopurinol action.....xanthine oxidase inhibitor

    finasteride side effect.....gynecomastia

    How to know if patient had autoimmune hemolytic anemia....Agglutinin

    Dilated pupil with poor reaction to light....Adie's
  17. drmomo

    drmomo Guest

    Botulism is an acute neurological disorder with life threatening neuroparalysis caused by Clostridium botulinum toxin...five types
    food-borne
    wound (found with iv drug users)
    infantile
    Inadvertent
    Inhalation

    ?sixth form from deliberate use

    this lady injected botulinum toxin IM in her lower limbs
  18. veeru9

    veeru9 Guest

    it is tetanus bcos pt had lock jaw
  19. drmomo

    drmomo Guest

    can't remember really could be, anyway

    re polarization stage in cardiac cycle.....potassium

    Patient with signs of Henoch Schonlein, what renal picture.....Ig A deposition

    IV drug user with cavitation in the lung and fever.....TV endocarditis

    Man with SOB and with reduced LV function but no Pul edema or lower limbs best Rx......i put ACEi only....pt had no congestion and no need for lasix

    Dual chamber ICD placement of LV lead through the coronary sinus, where is it......Right atrium

    Young boy from Iraq with lower limb weakness and other signs (can't remember)....looked like GB syndrome

    Test for Acromegaly......glucose tolerance test


    please post what u remember everyone
    I will keep posting
  20. veeru9

    veeru9 Guest

    boy from iraq i think it is spinal poliomylitis bcos pt had fever and weakness was rapid onset
  21. veeru9

    veeru9 Guest

    for raised lv and aortic pressure and normal femoral bp answer is coarctation of aorta here pt was young.
  22. drmomo

    drmomo Guest

    he had sudden CP and coarction is not in with causes of CP
  23. drmomo

    drmomo Guest

    RF.....IgM againt Fc portion IgG

    BCR-ABL question....... Tyrosine Kinase Inhibitors

    Asthma patient given neb B-agonist, ipratopium, steroids what next....iv Mg
  24. veeru9

    veeru9 Guest

    people can get chest pain with coarct aorta in dissecting bp difference will be in both arms , in coarct bp will be normal in femoral and bp was very raised in lv and aorta bcos it was trying to overcome the resistence
  25. Assalaamu alaikum all,

    Ramadhan Mubarak.

    Here are a few of the basic science qu's from the exam:

    1) Location/role of actin in muscle cells? Cytoskeleton

    2) Genetics of Charcot-Marie-Tooth disease? Duplication (on Chr 17)

    3) Mode of inheritance of Prader-Willi syndrome? Uniparental disomy

    4) 17yr old boy has haemophilia A. Which one of his family members is likely to express the disease in the same way he does (i.e. haemarthroses/bleeds, etc)? Mother's brother

    5) Location/drainage of coronary sinus (wrt inserting dual chamber pacemaker into left ventricle)? Right atrium

    6) Mechanism of action of ondansetron? 5HT3 antagonist

    7) Mode of inheritance of familial adenomatous polyposis coli? Autosomal dominant

    8) What is rheumatoid factor? IgM vs the Fc portion of IgG

    9) What is the function of the BCR-ABL fusion protein? Tyrosine Kinase

    10) What current is primarily responsible for repolarisation in the cardiac cycle? (Outward) Potassium current

    InshaAllah I'll post more over the next few days. May Allah (SWT) make all of you who took it successful (and me also!)

    Wassalaam,
  26. dregypt

    dregypt Guest

    qqq

    it wasnt paralysis in the qq it was trismus and convultion so its tetenus


    Dermatology
    - itching lesion on wrist with surrounding hyperpigmentation with mouth lesion lichen planus
    - female done hair dye 3 days ago have acute vesicular and eryth. Lesion on face and scalp contact dermatitis
    - empirical Ab for impetigo I chose phenoxymethylpenicilen but I think its flucxacilin
    - Farmer with paronychia come with classic Picture of TTS
    - Also TTS what Ab to be add clindamycine
    - Flaccid bulla which sore and mouth and genitalia involvement pemphigus
    - PUVA cause squamouse cell carcinoma
    - Male with area of hair loss alopecia areata
    Psychology
    - Terminal ill patien with agitation ttt I chose haloperidol
    - Pt with Multiple mylola take Vincrestin ,cyclo and steroid since 4 days have agitation why steroid induced pschycosis or sepsis induce pschycosis I chose sepsis ????
    - Mothr with her son don’t obey her and always struggle with her have sudden aphonia = psychological aphonia
    - Male with idea that there is body under his hous and he say he didn’t know why that idea come to him Obsessive C S
    - Pt with rapid speaking u cant interrupt him = pressured speech
    - Alcoholic come to hospital and take glucose with benzodiazepan suffer from confusion and cant walk = thiamin B1 deficiency
    - 25y male medical student come from Kenya and claim to be medical dean = hypomania
    - Femal with DM suffer from wt loss and anemia hyochromic anemia and norml albumin but No amenorrhea or change of bowel habit and BMI = 18 ( anorexia nervosa or ceiliac or crhons or dietary deficiency) I chose dietary deficiency
    - Pt have accident with concussion and his wife die come to GP after 6 months cant cope with life and cant concentrate in work and have sense that he see his wife ( post stress disorder or post concussion or grief reaction) I chose grief reaction because It seem to me abnormal grief reaction


    Neurology
    - Pt with weakness of extensor hallosus longus and loss of sensation on medial aspect of dorsum of the foot ?L4 or L5 lesion I chose L4 (because medial aspect of dorsum of the foot supplied with L4)
    - Pt with 9,10,11,12 lesion chose between jagular foramen lesion or craniocervical junction I chose craniocervical because jagular foramen lesion spare 12th cranial nerve AS KUMAR SAIED
    - Pt with epsilateral weekness and contralateral sensory loss hemisection of the cord at T4
    - Pt with classice pict of PICA lesion
    - Young Pt with loss of all sensation of one arm and all reflexes without atrophy = malignant infiltration of brachial plexuses
    - Pt from Iraq come with symmetrical lower limb weekness (LMNL) with some los of pinprick sensation = GBS
    - Classic pict of ulnar N lesion
    - Classic pict carpal tunnel syndrome
    - Charcot marrie tooth inheritance
    - Limb girdle dystrophy how to assess espiratory function by vital capacity
    - Lew body dementia most characteristic to it high sensitivity to neuroliptic
    - Parietal lesion
    - Pt with increase LL pain with walking but relief with rest with normal LL pulse and sensation spinal canal stenosis
    - Pt unilateral smell loss and vesion loss and contralateral papillodema frontal lobe menengioma
    - 75 old femal come from Kenya with increasing confusion and urinary incontenet and fever and protinuria 1 + chosing between malaria or listeria I chose listeria because pt with cerebral malaris usually have convulsion and other complication
    - Child with recurrent menengiococcal mennengites which decrease = complement
    - CSF with classic Viral finding
    - 16 y child at dentist have loss of consciousness , incontinence and jerking limb and he recover quickly with vomiting = complicated syncope
    - Young female with epilepsy talking Na valeprate have osteomalicia why chose between drug cause it or decrease Vit D I chose decrease Vit D because that female fear from go outside so decrease sun exposure
    - Axonal neuropathy decrease amplitude in EMG
    - Pt with dental pain and abscess complaint of sudden pain lasting for one minute and gone spontaneously , pain came spontaneously or with chewing trigeminal neuralgia
    - Classic pict of INO
    - Pt with loss of papillary and accommodation reflex in one eye site of the lesion = oclumotor nerve ( efferent of both reflex)
    - Classic pict of Giant arteritis with loss of vesion and TTT pridensilon

    Cardiovascular
    - Coronary sinus where is it in RT atrium but I chose Rt ventricule
    - Pt with MI what is the poor prognostic chose between loss of HR variability or VEF= 35% I chose loss of HR variability because it undicate HB and also we assess Ventricular function after the attack not in the attack
    - HB = variable S1 intensity
    - Pt 75 y with COPD and AF since 2 month was advice to take warfarin . has mild dysnea in exersion . investigation no cardiac failure or valve lesion how to TTT chose () digoxin , bisporol, flecianid, amiodaron I chose flecianid because COPD so not B blocker and no HF so digoxin not indicated , amiodaron have wide side effect
    - HOCM and ICD
    - ECG with wide spread st elevation and t wave inversion and normal BL pr ttt NSAID
    - Pt with headach near the period nd BL pr of 170\105 after 10 minute Bl pr 156\102 how u ttt recheck after 1 week or reassurance and repeat it after 2 mon I chose 2nd option
    - CV risk = total cholesterol and HDL
    - 25 pt with SUDDEN CHST PAIN and pressure in LT v and Assending aorta 200\70 and high pr in arms with pr in RT femoral Artry 160\70 or something like that chose () coarcitation or type B AA I chose 2nd option d2 pain and the diastolic pressured is normal
    - Pt with LT v failure ttt ACEI
    - Pt with long standing RA and smoking have RVF signe and dyspnea with normal LT V systolic function normal and dilatation of both atria. Pt normal BL pr and CHEST auscultation and have AF diagnosis I chose constrictive pericarditis ___>> the most option I feel it rt.
    - Pt with MI and had coloctomy for cancer 3 days ago how to ttt ( thrombolysis, heparin or stander angioplasty) I chose angioplasty
    - Best indicatore of timing of AS I chose pt symptoms
    - Colon cancer with SBIE organism Strep. Bovis
    - IVDA and bilateral chest infiltration , fever =IE

    RESPIRATION
    - Emphysema = dynamic bronchial obstruction
    - COPD exacerbation and signe of RT V failure what will be continue after pt ttt ( rt V ejection fraction decrease or Pul BL pr > 82\**
    - COPD exacerbation and paramedic give hime 60% O2 > confusion and po2 =18 pco2=10 and ph=7.2 what the most appropriate next step : stop O2 ( I chose that) or give him 24% O2 or continue with 60% or NIV .
    - Cystic fibrosis and have infection whats empirical TTT pipracillin and tazobactam
    - 42 y with feve and confusion CXR left mid zone consolidation and WBCs 8*109 \L diagnosis influenza pn or mycoblasma or staph I chose mucoplasma Don’t know why
    - Acute sever asthma take inhaler and steroid don’t improve =IV Mg
    - Pt 20ys of smoking and history of shipyard work with pleural effusion why B. Carcinoma or mesothelioma of course its carcinoma the commonest is commonest
    - Asbestos and asymptomatic pt without any finding whats the lesion calcified pleural plaque
    - Dx of asthma > 15 % change of FEV1
    - Pneumonia with allergic to penicillin ttt erythromycin or quinolon I chose quinolone and its true
    Rheumatology
    - Dermatomyocytis Ab anti jo
    - Pt with SLE and signe of antiphospholipid syn = anticardilipin
    - Pt with 10ys ttt of HTN and past history of 2 attack of gout come with bilateral knee pain and mild effusion 3 mon durraton and nodule in elbow brusa DX I chose gout
    - Liver DM and chondrocalcinosis = heamochomatosis
    - Knee pain with limited hip adduction and OA , normal neuro examination but in examination and XRY knoee is normal what to do Knee MRI or spine MRI or hip Xray I chose hip Xray because hip pain frequently referred to knee
    - RA with periarticular erosion ttt methotrixate
    - Pt with DM type 2 and hot mid foot for 2 mon and mildy increase uric acid and increase WBCs >>> gout or osteomylitis or unacustome fracture or cellulites I chose Gout its long for othe option without advancing of it
    - Classic gonococcus arthritis
    - Pt with classic pict of AS how to confirm spin Xray or HLA B27 of course X ray
    - Pt with pain in catching object and pain in extension of wrist against resistant lateral epicondylitis
    -

    BLOOD

    - TNF alpha from Macrophage
    - CD4 and MHC 2
    - Drug cause aplastic anemia trimethprim or aciclovir I chose trimethoprim ( folat antagonist)
    - Pcv and fatigue with leucoerythblastic = myelofibrosis
    - PCV how to confirm RED CELL MASS
    - MM what the next investigation pl electrophoresis or BM aspiration of course its BM because it’s the diagnostic test which demonstrate plasma cell in BM
    - IgM = hyperviscosity
    - LMWH how to assess by anti Xa
    - Warfarin with INR 3 but decrease to 1.2 why carbamazapin
    - vWD and take 2 blood pack after tooth extraction how to px next by DDAVP or high pure factoe 8 or FFp I chose DDAVP
    - hemophilia who will have desease mother brothers
    - autoimmune anemia what is correct =+ve antiglobuline test
    - old female with CLL
    - BCR-ABL gene code for tyrosin kinase
    - Ondansetron MOA 5HT3 antagonist
    - Brast cancer with pain not relifed with NSAID what to gine oral morphin normal release or oral sustain release or SC of coarse oral normal released to 1st calculate total dialy dose to control the pain
    - MM with hyperCalcemia and dehydration 1st tttt = IV saline
    - Pt with long period of repeated blood donor but then Saied to him u cant donate blood more why CMV +ve or druge induce hepatis or hx of visiting Kenya 2 ys I chose the last he may get HIV
    - Pt with macrocytic anemia and hypothyrodisme what next investigation antrum biobsy or IF ab of course its IF ab

    GIT and liver
    - Pt with bloody diarrhea and deplete goblet cell and crypt absceses = UC
    - Pt with fatige and dry mouth and other autoimmune disease with increase ALP = 1ry billiary cirrhosis
    - HBV with chronic low infectivity in serology
    - Also another serology but I coudnt remember
    - 40y pt with dyspepsia and anemia >>> gastroscopy or trial of PPI or urea breath test I chose gastroscopy as anemia is one of alarming symptom
    - Pt with CD but not actve one as lab ( normal plattlet, CRP ) with watery diarrhea ttt cholystramin
    - Active CD with symptom suggesting obstruction or peritonitis what next investigation US or CT or Xray abd I chose X ray to exclude obstruction 1st ( X ray rapid and available)
    - Pt with bloody diarrhea and travel hx far east Asia entamyba histolytica
    - Femal with bloody diarrhea and hx of contact to child having diarrhea ..>>>cambellopacter jujeni
    - Pt with vomiting and abd pain >> staph or C jujeni I chose staph
    - Pt with GI and dehydration and high Na , low K …>>> saline 0.9 and K or Glucose 5% and K I chose saline and K
    - Pt with MM anemia asymptomatic ,old ..>>> colonoscopy
    - FAP inheritance AD
    - Paracetamol poisoning after 2 day with ph=7.2 and creatinin288 and INR 3.4 whats the best predictore of having transplantation = PH
    - Pt with scleroderma and diarrhea loss of wt and low B12 and folat next investigation H2 breath test or int follow through I chose the 2nd to demonstrate the dilatation of SI , bacteria cause dec b 12 and normal folate

    Infection
    - Lower UTI what is empirical TTT co amoxiclave or gentamicine I chos coamoxiclave
    - Same but with allergy to penicillin chose cipro ( not provided in the previous one)
    - Femal with no past hx come with Pr +1 and BL +1 Us both kidney small and irregular surface , having increase BL pr >>>>> reflux or hypertensive or ischemic neuropathy I chose reflux don’t know why
    - Same as above with orthopnea in old age and peripheral VD and NIDDM chose RAD
    - Transplant pt since 14 day with increase CReatinine and normal kidney shap and blood flow in US, taking steroid,ciclosporin. Having tenderness above the kidney Dx CMV or Acute rejection or ciclosporin toxicicty I chose Acute rejection because its early for CMV and ciclosporin toxicity
    - Pt with hx of classic family hx with APCKD how to confirm abd US
    - Henoch scolin purpura = IGA deposit
    - What is poor prognostic for IgA nephropathy = Increase Bl pr
    - Old pt with nephritic and albumin = 9 mg with edema what is the 1st drug ( albumin or frusimid) I chose Albumine because its soooo low
    - Morphin what increase toxicity liver or renal failure chose renal as its secreted there
    - Gentamicin but pt develop decrease GFR , GP increase the interval () the dos ,what is change to gentamicine ( nonrenal clearance or half life or bioavalability) I don’t remember what I chose but I guess its half life
    - Druge used in idiopathic hypercalciuria =thiazid
    - The same but in another way , pt enter hospital but calcium increase what drug
    - Re-feeding synd =hypophosphate..
    Endocrine
    - Diabetic pt since 2 ys , pregnant with recurrent hypoglycemia but without alarming sy wht the cause ( autonomic neuropathy or tight glycemic control or feteal insulin or ) I chose tight control .. I feel its hopless qq and don’t know wht I chose
    - Pt with DKA and taking 200u insulin what dose to begain with 6 or 12 or 18 or 20 IV
    - PT WITH INCREASE chylomicron and cholesteron with family hx of CVD >>> familial combined hyperlipedemia or dysbetalip( remenant) I chose remenant lipedemia
    - Statin decreas intrinsic cholersterol synth
    - Statine with myopathy why= clarithromycin drug
    - Insulinoma = super. Fasting and glu and insulin measure
    - Prolactinoma and pressure sym on vision ttt cabergolin or surgery I chose cabergoline
    - Hypothyroidism and DM and hyogonadism low FSH and LH = ovarian failure
    - Hyerthyrodism in pregnancy ttt propythiuracil
    - Pt with sever pneumonia thyroid test low total T3 and T4 with normal TSH
    - Pt with high TSH normal T3 ..€>>> check compliance
    - Pt with normal T3 and TSH but low T4>>> normal finding in pt talk thyroxin
    - Solitary nodule and euothyroid >>> FNA
    - SIADH what is correct urin Na > 20mmol\l
    - Pt with increase Ca and normal PTH, old femal …>>>> 1ry hyperparthyrodism
    - Acromegaly Diagnosis glucose tolerance test, alsi Gs mutation
    - What happen after one minute of standing increase COP or increase Preipheral resistance I chose the 2nd one
    - Pt with DM and mild renal falure and hypokalemia and high bl pr with bicarbonate in blood 2 ….>>>> renal tubular acidosis
    - Pt with COPD and high Pco2 low PH and high H+ low bicarbonat Mixed metabolic and respiratory acidosis
    -
    -
    -
    -
  27. dregypt

    dregypt Guest

    qqq

    it wasnt paralysis in the qq it was trismus and convultion so its tetenus


    Dermatology
    - itching lesion on wrist with surrounding hyperpigmentation with mouth lesion lichen planus
    - female done hair dye 3 days ago have acute vesicular and eryth. Lesion on face and scalp contact dermatitis
    - empirical Ab for impetigo I chose phenoxymethylpenicilen but I think its flucxacilin
    - Farmer with paronychia come with classic Picture of TTS
    - Also TTS what Ab to be add clindamycine
    - Flaccid bulla which sore and mouth and genitalia involvement pemphigus
    - PUVA cause squamouse cell carcinoma
    - Male with area of hair loss alopecia areata
    Psychology
    - Terminal ill patien with agitation ttt I chose haloperidol
    - Pt with Multiple mylola take Vincrestin ,cyclo and steroid since 4 days have agitation why steroid induced pschycosis or sepsis induce pschycosis I chose sepsis ????
    - Mothr with her son don’t obey her and always struggle with her have sudden aphonia = psychological aphonia
    - Male with idea that there is body under his hous and he say he didn’t know why that idea come to him Obsessive C S
    - Pt with rapid speaking u cant interrupt him = pressured speech
    - Alcoholic come to hospital and take glucose with benzodiazepan suffer from confusion and cant walk = thiamin B1 deficiency
    - 25y male medical student come from Kenya and claim to be medical dean = hypomania
    - Femal with DM suffer from wt loss and anemia hyochromic anemia and norml albumin but No amenorrhea or change of bowel habit and BMI = 18 ( anorexia nervosa or ceiliac or crhons or dietary deficiency) I chose dietary deficiency
    - Pt have accident with concussion and his wife die come to GP after 6 months cant cope with life and cant concentrate in work and have sense that he see his wife ( post stress disorder or post concussion or grief reaction) I chose grief reaction because It seem to me abnormal grief reaction


    Neurology
    - Pt with weakness of extensor hallosus longus and loss of sensation on medial aspect of dorsum of the foot ?L4 or L5 lesion I chose L4 (because medial aspect of dorsum of the foot supplied with L4)
    - Pt with 9,10,11,12 lesion chose between jagular foramen lesion or craniocervical junction I chose craniocervical because jagular foramen lesion spare 12th cranial nerve AS KUMAR SAIED
    - Pt with epsilateral weekness and contralateral sensory loss hemisection of the cord at T4
    - Pt with classice pict of PICA lesion
    - Young Pt with loss of all sensation of one arm and all reflexes without atrophy = malignant infiltration of brachial plexuses
    - Pt from Iraq come with symmetrical lower limb weekness (LMNL) with some los of pinprick sensation = GBS
    - Classic pict of ulnar N lesion
    - Classic pict carpal tunnel syndrome
    - Charcot marrie tooth inheritance
    - Limb girdle dystrophy how to assess espiratory function by vital capacity
    - Lew body dementia most characteristic to it high sensitivity to neuroliptic
    - Parietal lesion
    - Pt with increase LL pain with walking but relief with rest with normal LL pulse and sensation spinal canal stenosis
    - Pt unilateral smell loss and vesion loss and contralateral papillodema frontal lobe menengioma
    - 75 old femal come from Kenya with increasing confusion and urinary incontenet and fever and protinuria 1 + chosing between malaria or listeria I chose listeria because pt with cerebral malaris usually have convulsion and other complication
    - Child with recurrent menengiococcal mennengites which decrease = complement
    - CSF with classic Viral finding
    - 16 y child at dentist have loss of consciousness , incontinence and jerking limb and he recover quickly with vomiting = complicated syncope
    - Young female with epilepsy talking Na valeprate have osteomalicia why chose between drug cause it or decrease Vit D I chose decrease Vit D because that female fear from go outside so decrease sun exposure
    - Axonal neuropathy decrease amplitude in EMG
    - Pt with dental pain and abscess complaint of sudden pain lasting for one minute and gone spontaneously , pain came spontaneously or with chewing trigeminal neuralgia
    - Classic pict of INO
    - Pt with loss of papillary and accommodation reflex in one eye site of the lesion = oclumotor nerve ( efferent of both reflex)
    - Classic pict of Giant arteritis with loss of vesion and TTT pridensilon

    Cardiovascular
    - Coronary sinus where is it in RT atrium but I chose Rt ventricule
    - Pt with MI what is the poor prognostic chose between loss of HR variability or VEF= 35% I chose loss of HR variability because it undicate HB and also we assess Ventricular function after the attack not in the attack
    - HB = variable S1 intensity
    - Pt 75 y with COPD and AF since 2 month was advice to take warfarin . has mild dysnea in exersion . investigation no cardiac failure or valve lesion how to TTT chose () digoxin , bisporol, flecianid, amiodaron I chose flecianid because COPD so not B blocker and no HF so digoxin not indicated , amiodaron have wide side effect
    - HOCM and ICD
    - ECG with wide spread st elevation and t wave inversion and normal BL pr ttt NSAID
    - Pt with headach near the period nd BL pr of 170\105 after 10 minute Bl pr 156\102 how u ttt recheck after 1 week or reassurance and repeat it after 2 mon I chose 2nd option
    - CV risk = total cholesterol and HDL
    - 25 pt with SUDDEN CHST PAIN and pressure in LT v and Assending aorta 200\70 and high pr in arms with pr in RT femoral Artry 160\70 or something like that chose () coarcitation or type B AA I chose 2nd option d2 pain and the diastolic pressured is normal
    - Pt with LT v failure ttt ACEI
    - Pt with long standing RA and smoking have RVF signe and dyspnea with normal LT V systolic function normal and dilatation of both atria. Pt normal BL pr and CHEST auscultation and have AF diagnosis I chose constrictive pericarditis ___>> the most option I feel it rt.
    - Pt with MI and had coloctomy for cancer 3 days ago how to ttt ( thrombolysis, heparin or stander angioplasty) I chose angioplasty
    - Best indicatore of timing of AS I chose pt symptoms
    - Colon cancer with SBIE organism Strep. Bovis
    - IVDA and bilateral chest infiltration , fever =IE

    RESPIRATION
    - Emphysema = dynamic bronchial obstruction
    - COPD exacerbation and signe of RT V failure what will be continue after pt ttt ( rt V ejection fraction decrease or Pul BL pr > 82\**
    - COPD exacerbation and paramedic give hime 60% O2 > confusion and po2 =18 pco2=10 and ph=7.2 what the most appropriate next step : stop O2 ( I chose that) or give him 24% O2 or continue with 60% or NIV .
    - Cystic fibrosis and have infection whats empirical TTT pipracillin and tazobactam
    - 42 y with feve and confusion CXR left mid zone consolidation and WBCs 8*109 \L diagnosis influenza pn or mycoblasma or staph I chose mucoplasma Don’t know why
    - Acute sever asthma take inhaler and steroid don’t improve =IV Mg
    - Pt 20ys of smoking and history of shipyard work with pleural effusion why B. Carcinoma or mesothelioma of course its carcinoma the commonest is commonest
    - Asbestos and asymptomatic pt without any finding whats the lesion calcified pleural plaque
    - Dx of asthma > 15 % change of FEV1
    - Pneumonia with allergic to penicillin ttt erythromycin or quinolon I chose quinolone and its true
    Rheumatology
    - Dermatomyocytis Ab anti jo
    - Pt with SLE and signe of antiphospholipid syn = anticardilipin
    - Pt with 10ys ttt of HTN and past history of 2 attack of gout come with bilateral knee pain and mild effusion 3 mon durraton and nodule in elbow brusa DX I chose gout
    - Liver DM and chondrocalcinosis = heamochomatosis
    - Knee pain with limited hip adduction and OA , normal neuro examination but in examination and XRY knoee is normal what to do Knee MRI or spine MRI or hip Xray I chose hip Xray because hip pain frequently referred to knee
    - RA with periarticular erosion ttt methotrixate
    - Pt with DM type 2 and hot mid foot for 2 mon and mildy increase uric acid and increase WBCs >>> gout or osteomylitis or unacustome fracture or cellulites I chose Gout its long for othe option without advancing of it
    - Classic gonococcus arthritis
    - Pt with classic pict of AS how to confirm spin Xray or HLA B27 of course X ray
    - Pt with pain in catching object and pain in extension of wrist against resistant lateral epicondylitis
    -

    BLOOD

    - TNF alpha from Macrophage
    - CD4 and MHC 2
    - Drug cause aplastic anemia trimethprim or aciclovir I chose trimethoprim ( folat antagonist)
    - Pcv and fatigue with leucoerythblastic = myelofibrosis
    - PCV how to confirm RED CELL MASS
    - MM what the next investigation pl electrophoresis or BM aspiration of course its BM because it’s the diagnostic test which demonstrate plasma cell in BM
    - IgM = hyperviscosity
    - LMWH how to assess by anti Xa
    - Warfarin with INR 3 but decrease to 1.2 why carbamazapin
    - vWD and take 2 blood pack after tooth extraction how to px next by DDAVP or high pure factoe 8 or FFp I chose DDAVP
    - hemophilia who will have desease mother brothers
    - autoimmune anemia what is correct =+ve antiglobuline test
    - old female with CLL
    - BCR-ABL gene code for tyrosin kinase
    - Ondansetron MOA 5HT3 antagonist
    - Brast cancer with pain not relifed with NSAID what to gine oral morphin normal release or oral sustain release or SC of coarse oral normal released to 1st calculate total dialy dose to control the pain
    - MM with hyperCalcemia and dehydration 1st tttt = IV saline
    - Pt with long period of repeated blood donor but then Saied to him u cant donate blood more why CMV +ve or druge induce hepatis or hx of visiting Kenya 2 ys I chose the last he may get HIV
    - Pt with macrocytic anemia and hypothyrodisme what next investigation antrum biobsy or IF ab of course its IF ab

    GIT and liver
    - Pt with bloody diarrhea and deplete goblet cell and crypt absceses = UC
    - Pt with fatige and dry mouth and other autoimmune disease with increase ALP = 1ry billiary cirrhosis
    - HBV with chronic low infectivity in serology
    - Also another serology but I coudnt remember
    - 40y pt with dyspepsia and anemia >>> gastroscopy or trial of PPI or urea breath test I chose gastroscopy as anemia is one of alarming symptom
    - Pt with CD but not actve one as lab ( normal plattlet, CRP ) with watery diarrhea ttt cholystramin
    - Active CD with symptom suggesting obstruction or peritonitis what next investigation US or CT or Xray abd I chose X ray to exclude obstruction 1st ( X ray rapid and available)
    - Pt with bloody diarrhea and travel hx far east Asia entamyba histolytica
    - Femal with bloody diarrhea and hx of contact to child having diarrhea ..>>>cambellopacter jujeni
    - Pt with vomiting and abd pain >> staph or C jujeni I chose staph
    - Pt with GI and dehydration and high Na , low K …>>> saline 0.9 and K or Glucose 5% and K I chose saline and K
    - Pt with MM anemia asymptomatic ,old ..>>> colonoscopy
    - FAP inheritance AD
    - Paracetamol poisoning after 2 day with ph=7.2 and creatinin288 and INR 3.4 whats the best predictore of having transplantation = PH
    - Pt with scleroderma and diarrhea loss of wt and low B12 and folat next investigation H2 breath test or int follow through I chose the 2nd to demonstrate the dilatation of SI , bacteria cause dec b 12 and normal folate

    Infection
    - Lower UTI what is empirical TTT co amoxiclave or gentamicine I chos coamoxiclave
    - Same but with allergy to penicillin chose cipro ( not provided in the previous one)
    - Femal with no past hx come with Pr +1 and BL +1 Us both kidney small and irregular surface , having increase BL pr >>>>> reflux or hypertensive or ischemic neuropathy I chose reflux don’t know why
    - Same as above with orthopnea in old age and peripheral VD and NIDDM chose RAD
    - Transplant pt since 14 day with increase CReatinine and normal kidney shap and blood flow in US, taking steroid,ciclosporin. Having tenderness above the kidney Dx CMV or Acute rejection or ciclosporin toxicicty I chose Acute rejection because its early for CMV and ciclosporin toxicity
    - Pt with hx of classic family hx with APCKD how to confirm abd US
    - Henoch scolin purpura = IGA deposit
    - What is poor prognostic for IgA nephropathy = Increase Bl pr
    - Old pt with nephritic and albumin = 9 mg with edema what is the 1st drug ( albumin or frusimid) I chose Albumine because its soooo low
    - Morphin what increase toxicity liver or renal failure chose renal as its secreted there
    - Gentamicin but pt develop decrease GFR , GP increase the interval () the dos ,what is change to gentamicine ( nonrenal clearance or half life or bioavalability) I don’t remember what I chose but I guess its half life
    - Druge used in idiopathic hypercalciuria =thiazid
    - The same but in another way , pt enter hospital but calcium increase what drug
    - Re-feeding synd =hypophosphate..
    Endocrine
    - Diabetic pt since 2 ys , pregnant with recurrent hypoglycemia but without alarming sy wht the cause ( autonomic neuropathy or tight glycemic control or feteal insulin or ) I chose tight control .. I feel its hopless qq and don’t know wht I chose
    - Pt with DKA and taking 200u insulin what dose to begain with 6 or 12 or 18 or 20 IV
    - PT WITH INCREASE chylomicron and cholesteron with family hx of CVD >>> familial combined hyperlipedemia or dysbetalip( remenant) I chose remenant lipedemia
    - Statin decreas intrinsic cholersterol synth
    - Statine with myopathy why= clarithromycin drug
    - Insulinoma = super. Fasting and glu and insulin measure
    - Prolactinoma and pressure sym on vision ttt cabergolin or surgery I chose cabergoline
    - Hypothyroidism and DM and hyogonadism low FSH and LH = ovarian failure
    - Hyerthyrodism in pregnancy ttt propythiuracil
    - Pt with sever pneumonia thyroid test low total T3 and T4 with normal TSH
    - Pt with high TSH normal T3 ..€>>> check compliance
    - Pt with normal T3 and TSH but low T4>>> normal finding in pt talk thyroxin
    - Solitary nodule and euothyroid >>> FNA
    - SIADH what is correct urin Na > 20mmol\l
    - Pt with increase Ca and normal PTH, old femal …>>>> 1ry hyperparthyrodism
    - Acromegaly Diagnosis glucose tolerance test, alsi Gs mutation
    - What happen after one minute of standing increase COP or increase Preipheral resistance I chose the 2nd one
    - Pt with DM and mild renal falure and hypokalemia and high bl pr with bicarbonate in blood 2 ….>>>> renal tubular acidosis
    - Pt with COPD and high Pco2 low PH and high H+ low bicarbonat Mixed metabolic and respiratory acidosis
    -
    -
    -
    -
  28. dregypt

    dregypt Guest

    qqq

    this q reflect 5 doctor choices including me and we r talk the exam in gulf country . any comment about the answer ........thanks :evil: :lol:
  29. UK Doc

    UK Doc Guest

    MRCP part 1 11 sept 2007

    You've done well to remember all those questions...I do disagree with several of the answers though:

    Prader-Willi question: several genetic problems produce this syndrome, 70% have microdeletion, 25% maternal disomy, the remaining 5% usually have a translocation. Therefore, most likely abnormality and correct answer is microdeletion.

    Male with chest pain and ECG showing widespread ST elevation and t wave inversion (also with a pyrexia) is a PE. Answer treat with clexane. PE ECG is very non-specific but "widespread ST elevation and t wave changes" in a relatively young man with a pyrexia = PE (textbook description taken from Kalra). Pyrexia could be infection but no answers suitable (e.g antibiotics) were given as a potential answer in the choices.

    The question involving sympathetic chain and cranial nerves VII to XII damage is Villaret's syndrome. Lesions are typically at the jugular foramen (ouside the skull). Jugular foramen is therefore the correct answer.

    The question about osteomalacia was drug-induced osteomalacia. This is a well recognised complication of anti-convulsant therapy, and I can't remember the exact values given, but the clue to picking the correct answer was in the relative values of 25-OHvitD3 and 1,25-OH compounds given in the stem.

    In my opinion the question that has fuelled debate- botulism or tetanus- is tetanus. i have looked at numerous articles and IV drug abuse is consistently mentioned as a major cause of tetanus, whereas botulism is associated with wounds and not IV drug use in particular. Google it for yourselves (just type tetanus and IV drug use).

    If I remember any other questions i'll post again!!!
  30. do da

    do da Guest

    2 more dermatology q's~

    1- hypopigmented, scaly lesions, tanned skin: pityriasis versicolor
    2- nose ulcer, central america: leishmaniasis
  31. do da

    do da Guest

    1- cholesterol levels be4 and after drug: paired t-test
    2- MOA of imatinib: tyrosine kinase inhibitor
    3- what was the answer of the q's qhich had the central scotoma word in it, choices had optic neuritis, was that the ans?
    4-q's about pt having cellulitis, being treated with flucloxacillin, growth shows group A streptococcus, what to add: clindamycin
    5-prader willi syndrome: microdeletion
    6-whats the significant difference b/w placebo and drug, cannot remember the q’s, was the answer 27% one? it was like there was a comparison b/w drug and placebo in two columns with five % values
    7- q's about like it was given, last q's of paper 2, drug A half life 2 hrs, volume of distribution given, pt weight was 50 kg, i answered it volume of distribution, pathetic q's. can anyone recall it?
    8-24. pt given digoxin, doctor said it will take a week for it to have maximal effect, reason: volume of distribution? other choices were half life, etc
  32. dregypt

    dregypt Guest

    qq

    As u said its jagular foramen out side the skull = craniocervical junction and in the exam it was jagular foramen only

    About eidspread ST segment elevation and T inversion and fever and normal BL pr in young male its Pericarditis so NSAID is the TTT, and see that in Kumar

    Also Na valproat NOT cause Vit D deficiency,
  33. dregypt

    dregypt Guest

    qqq

    pt given digoxin, doctor said it will take a week for it to have maximal effect, reason I chose Half life I see that qqq frequently and always answered as Half life
  34. dregypt

    dregypt Guest

    qq

    What is uniparental disomy?
    Normally, we inherit one copy of each chromosome pair from our biological mother, and the other copy of the chromosome pair from our biological father. Uniparental disomy refers to the situation in which two copies of a chromosome come from the same parent, instead of one copy coming from the mother and one copy coming from the father. Angelman syndrome and Prader-Willi syndrome are examples of disorders caused by uniparental disomy.

    ٍsee that link

    http://www.muschealth.com/gs/HealthTopic.aspx?action=showpage&pageid=P02159
  35. do da

    do da Guest

    1- increased KCO: pul hemorrhage
    2- Pt with jaundice, Hep A IgM +ve, Anti Hep C antibody +ve, Hep B sAb +ve: acute hepatitis A
    3- about MM case, the answer is serum electrophoresis, not bone marrow, go for non-invasive test first (onexam q's)
    4- regarding q's - Pt with SLE and signe of antiphospholipid syn = anticardilipin , i would say that there were Sx of sle like myalgia, joint pain, facial rash, but there weren't any Sx which suggested antiphospholipid syndrome, infact there were ANA +ve given, i thought this one is Mixed connective tissue disorder so answered Anti RNP
    5- u have mixed two q's dregypt~ one was like pt developing abd distension, vomiting, i think that had the choice of Barium follow through and..........
    6- second q's was like pt with abd Sx, B.P 90/60, suggestive of crohn's, peritonitis, what to do: i answered that X-ray abdomen, people help us out~
    7- was there a q's about holmie adie pupil? lady with one larger pupil, slow to light and accomodation?
    8- what was the answer of the q's with leg nodule? scab?, i answered that lyme disease? is that the answer? can anyone recall the q's?
    9- q's like which told about asbestos exposure and bi-basal shaowing on xray---i answered that asbestos
  36. veeru9

    veeru9 Guest

    regarding pericarditis and pe i think answer was pericarditis,bcos pt ecg showed st elevation in all lead which is typcal of pericarditis and along with fever and answer is nsaid
  37. Guest

    Guest Guest

    some more questions!!!

    1) Psychiatric patient one who sees wife after her death.......Grief reaction

    2) a picture of sponataneous bacterial peritonitis...>250/cubicmm.: Treatment of choice is iv cefotaxime

    3)Prolactinoma: always medical treatment first: cabergoline

    4) Hyperthyroidism in pregnancy : Propylthiouracil is drug of choice

    5) Penicillin allergic patient: treat with macrolides

    6)Osteoarthritis of knee: xrayknee normal: wat to do next: MRI Knee

    7)Nodules palapable in subacromial bursa,uric acid increased: chronic tophaceous gout

    8) Joint space reduced,chondrocalcinosis: pseudogout

    9) screening for family members,picture of pckd: usg abdomen

    10)Crypt abcesses: Ulcerative colitis

    11) Mangment of agitatin in elderly: haloperidol

    12)Praderwilli syndrome:Microdeletion syndromes

    13) Charcot marie tooth disease: point mutation
  38. Guest

    Guest Guest

    some more!!!!

    1) Finasteride: wat will happen on statrting this drug...the anwer was improvement of symptoms

    Other side effects: decreased libido,impotence,failure of ejaculation ,skin rashes,swelling of lips

    2) Psoriasis patient recieving PUVA: predisposes to squamous cell carcinoma.

    3) Autoimmune haemolytic anaemia: direct antigobulin test
  39. do da

    do da Guest

    side effect of finasteride is : Impotence and NOT gynecomastia
  40. mezz

    mezz Guest

    mrcp1

    cellulitis q. was it clinda ?
  41. do da

    do da Guest

    yes...that cellulitis pt growed group A streptococcus, its Rx is clindamycin
  42. Guest

    Guest Guest

    ss

    fenistrid=Artificially low levels of DHT in the body could cause some unwanted conditions. DHT is an antagonist of estrogen. Men’s bodies also produce the female hormone estrogen in the adrenal glands, although this is just one-tenth of the estrogen that premenopausal women produce in their ovaries. By reducing DHT with drugs, a man’s protection from the effects of estrogen may also be reduced. This could result in gynecomastia.
  43. Guest

    Guest Guest

    ss

    uniparental disomy AS DRegypt give the evidance
  44. Guest

    Guest Guest

    ss

    Asalamo alikom dregyt, I am also from Egypt and I agree with u in many qs.
    I hope we pass and go through MRCP2 together.
    And thanks for that large NO of qs u had remember.
  45. do da

    do da Guest

    1-there was a q's like which said about psoriasis and pt with erythroderma, something like that, i think that erythrodermic crisis, answered that hospital admission
    2- q's giving decreased Na levels, i answered that small cell lung Ca, can anyone recall the complete q's?
    3-slow acetylators: hydralazine
    4-colonic carcinoma: CEA
    5-Rx of hypercalcemia: Normal saline
    6-Site of action of aldosterone: DCT
    7-Spontaneous bacterial peritonitis: I/V cefotaxime
    8-Pt with ascites, what to give: aldosterone
    9-Pt had been admitted for 2 weeks for treatment of cellulites in ward, developed diarrhea, stool showed Clostridium difficle, what to give to treat: I/V Vancomycin “OR” oral metronidazole?
    10-Pt with DM type 2 and hot mid foot for 2 months and mildy increase uric acid and increase WBCs count: was the answer gout??
    11-There was a q's which had the description of right upper quadrant pain, fever, choices were like acute pyelonephritis, etc etc? can anyone recall the q's?
    12-Old lady at I think at some old people’s house, foul smelling urine, allergic to penicillin, what antibiotic to give to treat empirically: ciprofloxacin? am not sure?~
    13-Young girl, fever, headache, CSF glucose normal, lymphocytes 60%, what is it: Viral Meningitis “OR” viral encephalitis “OR” tuberculous meningitis? i answered viral encephalitis
  46. mezz

    mezz Guest

    mrcp 1

    Finasteride. An alternative drug for such prostatic
    symptoms is the type II 5a-reductase inhil finasteride, which inhibits conversion of testcone to its more potent metabolite, dihydrotestosterone. Finasteride does not affect serum testosterone or most nonprostatic responses to testosterone It reduces prostatic volume by about 20% and
    increases urinary flow rates by a similar degree. These changes translate into only modest clinic benefits. Finasteride has a t1\2 of 6 h, and is taken as a
    single 5mg tablet orally each day. The improvemerit in urine flow appears over 6 months (as &- prostate shrinks in size) and in 5—10% of patients may be at the cost of some loss of libido. The serum concentration of prostate-specific antigen is aproximately halved. While this may reflect a real reduction in risk of prostatic cancer, in patients receiving finasteride it is safer to regard as abnormal values of the antigen in the upper half of the usua. range. Lower doses of finasteride have been used successfully to halt the development of baldness. Other antiandrogens, such as the gonadorelin agonists, are used in the treatment of prostatic cancer, but the need for parenteral administration makes them less suitable for BPH.
  47. mezz

    mezz Guest

    mrcp 1

    Pseudomembranous colitis : drug of 1st choice metronidazloe , 2nd choice vancomycin ( Clinical pharma , Laurance )
  48. do da

    do da Guest

    can anyone tell me plz

    was impotence the first choice amongst the choices in the finasteride side effects q's..i am sure the second second choice was gynaecomastia, but was impotence the first one? or was the first choice alopecia?
  49. dregypt

    dregypt Guest

    qq

    there is no impotance in the choise it was alopecia or gyneco or rapid relife of symptom
  50. dr dr

    dr dr Guest

    reg fenist

    there was loss of libido....and tats the ans. it is used for hair growth

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