Mrcp part 2 july 2012 discussion

[mahim]

pyogenic liver abscess- strepto. milleri?
cns side effects of antimalarial: mefloquine?
which was the drug causing seizure?
cancer patient, pain scale 9/10- drug to start: controlled released morphine/fentanyl patch?
arrythmogenic RV?
fast idiopathic rythm?
oversensing of ventricles/atrium etc
nonsustained vt- verapamil?
what was the answer for a PO2/CO2/PH chart?
what was the answer to- urine Na/Chloride/Ph chart?
sevelamer/cinacalcet: hemodialysis pt?

[mahak]

definite indicator for upper GI bleed?
inc creat/alb ratio, inc ALP, dec mcv, dec plt
repaeat: usg thorax /decubitus xray/ ct for pt developing bullas on chest/torso etc

a patient with chest pain, stridor develpoed chest pain twice. second time ECG inferior STEMI, CXR- left pleural effusion. - investigation- echo/ ct with contrast/ laryngoscopy/ PCI??

[mahak]

yesterday ecg: RBBB with Loud P2, RAD: ASD or EBSTEINS>50% EBSTEINS also has ASD (Pls elaborate..)
cause of jaundice: simvastatin/chorpromazine
2 Vertibro-basilar artery stroke
epileptic attacks
paroxysmal hemicrania
reactional neurosis? factatious amnesia
side effects of few drugs (pls recall)
copd
hocm-icd?
hemochromatosis-genetics

[mahak]

Paper 3:
Old lady with hypona, diarrhoea, vomiting, serum osm low, urine osm high, but urine na 5, siadh????

Gbs - campy?

Asian lady with ct scan brain - meningioma/tuberculoma?

MRI of brain - ? Normal pressure hydro?

Pelvis X-ray - pagets

Chest X-ray sailor - chagas?

Blood film - ? Any idea?

Neck pain with horners - vertebral artery dissection / carotid?

Neuralgic amyotrophy?

Abdo pain amylase 800 - ac pancreatitis?

High igf1 - gigantism?

Ataxia in old lady? Paraneoplastic breast or ovarian

[mahak]

Questions with images:
Epidural abscess
Cryptogenic organizing pneumonia
Ecg pacemaker: atrial hypersensing/ventricular hypersensing/lost control on ventriles/atria
Ecg : widespread ST elevations : pericarditis/MI
Ecg: idioventricular rhythm/ventricular bigeminy
Painless Visual field inferior defect: AOIN
Ecg showing hyperkalemia- calcium gluconate
Mri posterior cerebral infarction/cerebral abscess
Ecg v fib: defibrillate/cpr ot precordial thump
Ecg : broad complex tachycardia: adenosine or flecanide
CT:ca head of pancreas
Squamous cell carcinoma skin/basal cell ca/seborrhic keratosis
Deviated tongue:brainstem haemmorrhage
Contact dermatitis/pstulopalmo plantaris
Xray ards/allergic bronchopulmonary aspergillosis/
X ray pulmonary hypertension: mitral stenosis
Karyotype: androgen insensitivity syndrome

[mahak]

other questions for paper 1 and 2
Atlantoaxial subluxation –loss of power in all four limbs
Diabetic amyotrophy
Lewy body dementia
Compensation neurosis/factitious/
Dyspepsia: reassure and discharge
Dyspepsia:h pylori stool antigen
Iv drug abuser with dvt and chest signs: next investigations CT chest /echo
Ca terminal patient agitated: haloperidol
Ca terminal patient for pain relief: immediate acting morphine
Pt started on bupropion: seizures cause- bupropion,nicorandil
Erectile dysfunction: improved by dm control/smoking dysfunction
Aplastic anemia cause: prednisolone
Renal transplant- recurring- focal segmental glomerulosclerosis
Wegeners on renal biopsy: crescentric
Pcos: cyproterone acetate
Hypogonadotrophic hypogonadism: kallmans
Increased neck swelling in known case of multnodular goiter-tender neck swelling- tsh low-subacute thyroiditis,thyroid abscess/thyroid haemorrhage
Small cell ca: chemotherapy
Non small cell ca: surgery
Family and personal history of nephrolithiasis: what should be avoided in diet:calcium/oxalate/phosphate
Patient with atrial flutter: b blocker
Pseudohyperparathyroidism (wrong)
Snoring with large uvula- uvuloplasty
Multiple abscesss in liver- gram positive cocci- strep pyogenes/bovis/agalatiae
Colon cancer- hyponatremia- increased urine osmolality
Excess water consumption: both osmolalities decreased
Addissons disease: short synacthen test
Paroxysmal hemicranias/migraine without aura
Headache due to analgesic abuse
Less than 4% plasma cells on biopsy with parethesia: monitoring/mulphan?
Primary polycythemia
Pyogenic liver abscess: streptococcus milleri is the right answer.
Pt with stage 5 kidney disease on amlodipine.diuretic and ramipril . what else to lower high bp-dialysis
Cutaneous sarcoidosis/granuloma annulare
Heart failure: already on carvidelol,ace inhib. Stopped spironolactone due to gynecomastia: what next with good prognosis: eplerenone

[mahak]

Paper 3:
Old lady with hypona, diarrhoea, vomiting, serum osm low, urine osm high, but urine na 5, siadh???? yes SIADH because plasma osmlarity was low which cannot be low in dehydration

Gbs - campy? yes campylobacter

Asian lady with ct scan brain - meningioma/tuberculoma?

MRI of brain - ? Normal pressure hydro? i think it was alzhiemer's with cerebral atrophy

Pelvis X-ray - pagets
. i also wrote pagets as there were areas of osteopenia and sclerosis.

Chest X-ray sailor - chagas? ?

Blood film - ? Any idea?

Neck pain with horners - vertebral artery dissection / carotid? ? i wrote vertebral artery dissection

Neuralgic amyotrophy?

Abdo pain amylase 800 - ac pancreatitis?

High igf1 - gigantism? i also wrote gigantism

[mahak]

paper 3:
rash on back: corticosteroid induced striae/dermatitis artefacta/striae distansae/cushings
pt with breathlessness--CT showing pericardial effusion/rupture of aortic aneurysm
blood film : african with weakness and diarrhea: haemoglobin SC disease/malaria/iron def/celiac/autoimmune hemolytic anemia
CXR showing cardiomegaly: organism: trypanosoma cruzi
cough for 4 weeks,CXR showing pnemonic patch on rt lower zone: amox + clarithromycin/erythromycin/

[mahak]

b/l hydronephrosis,hematuria,renal impairment--cause? renal ca/bladder tumor/urolithiasis/prostatic enlargement

*MRSA +ve, fusidic acid and vancomycin given...second cultures showed coliforms and staph aureus--change fusidic acid to ciprofloxacin

*necrotizing fascitis
* 20 yrs history of UC--primary sclerosing colangitis
* alcoholic with raised liver enzymes,alk phos and amylase---alcoholic hep/ac pancreatitis/gall stone ileus
*life threatening asthma" mgso4 /non invasive positive pressure vent

[mahak]

*pt with apistaxis ,headaches---check plasma viscosity
*k/c/o epilepsy with steven johnson syndrome:next step: stop antiepileptic /high dose steroids
*biopsy: chronic granulomatous inflammation with fibrosis: TB/sarcoidosis
*playing with baby ,throwing him in air whille lying down presented with chest pain and parehtheiia in hands bilaterally....ecg showing t wave inversions in v1 to v4,mild epigastric tenderness----cause of chest pain: gerd/pulmonary embolism/cervical disc prolapse/
* pt with history graves--thyroiectomy done ..started with 100 ug thyroxine now increated to 250 ug still tsh high ----erratic compliance/resistance to thyroid hormone/malabsorption of levothyroxine/tsh assaying error (question repeated in 2 papers)

* pt with dilated cardiomyopathy,AFib on digoxin---stroke thromboprophylaxis--warfarin
*pt with history of chemo and radiotherapy develops dilated cardiomyopathy--cause: chemotherapy induced or radiation induced