MRCP Forum

MRCP Forum :: RE: who will enter mrcp2 in november 2009 let,s discuss aplan

h_ahmad77 — Fri, 20 Nov 2009 21:45:15 GMT

Author: h_ahmad77
Posted: Sat Nov 21, 2009 3:15 am (GMT 5.5)

i would be surprised if we dont .. everything comes up and anything..so yea i would expect college staff to through some stat questions as if there is no questions to complete the exam..

MRCP Forum :: RE: who will enter mrcp2 in november 2009 let,s discuss aplan

Anonymous — Fri, 20 Nov 2009 21:35:07 GMT

Author: guest1..
Posted: Sat Nov 21, 2009 3:05 am (GMT 5.5)

Do we get any quest on statistics in part2?

MRCP Forum :: RE: who will enter mrcp2 in november 2009 let,s discuss aplan

h_ahmad77 — Fri, 20 Nov 2009 21:25:32 GMT

Author: h_ahmad77
Posted: Sat Nov 21, 2009 2:55 am (GMT 5.5)

the correct answer is pulmonary vasculature disease..

explaination:

PFTs actually normal values if you take a close look ( which obviously we wont in the exam ) apart from a low KCO and TLCO ..

this is classically seen in pulmonary vasculature disease ..

limited scleroderma is associated with anti-centromere antibody .. and is more likely associated with pulmonary hypertension ( pulonary vascular disease )

diffuse scleroderma is associated with anti-Scl70 antibody.. and is more likely to be associated with pulmonary fibrosis..

MRCP Forum :: RE: who will enter mrcp2 in november 2009 let,s discuss aplan

Anonymous — Fri, 20 Nov 2009 20:28:22 GMT

Author: .. double dot
Posted: Sat Nov 21, 2009 1:58 am (GMT 5.5)

pft indicate a restrictive dsorder and with a low tlco and kco would indicate a parenchymal problem... moreover pulm fibrosis is seen in scleroderma..

MRCP Forum :: RE: who will enter mrcp2 in november 2009 let,s discuss aplan

h_ahmad77 — Fri, 20 Nov 2009 20:02:02 GMT

Author: h_ahmad77
Posted: Sat Nov 21, 2009 1:32 am (GMT 5.5)

a patient diagnosed with limited scleroderma has become increasingly short of breath.. the following are the PFT performed:

FEV1 95% FVC 98% TLC 93% RV 101% TLCO 65% KCO 69%

what is the diagnosis:

pulmonary fibrosis
mild anemia
extrapulmonary restriction
congestive cardiac failure
pulmonary vasculature disease

MRCP Forum :: RE: who will enter mrcp2 in november 2009 let,s discuss aplan

Anonymous — Fri, 20 Nov 2009 19:54:15 GMT

Author: .. double dot
Posted: Sat Nov 21, 2009 1:24 am (GMT 5.5)

easy one.....radiation enteritis,....... radiation causes strictures and nidus for bacterial overgrowth and they consume b12 and produce folate

MRCP Forum :: RE: who will enter mrcp2 in november 2009 let,s discuss aplan

h_ahmad77 — Fri, 20 Nov 2009 19:27:52 GMT

Author: h_ahmad77
Posted: Sat Nov 21, 2009 12:57 am (GMT 5.5)

50 year old female c/o 1 year history of abdo cramps, diarrhea, passing loose stool , foul smelling 3-4/day in association with weight loss..she has a good appetite, she has total abmonial hysterectomy done with radiation.

she has low B12 ..normal Folate .. normal CXR and AXR .. Normal ESR

what is the diagnosis:

ileal TB
small bowel lymphoma
diverticulosis
Crohns disease
radiation enteritis

MRCP Forum :: RE: who will enter mrcp2 in november 2009 let,s discuss aplan

Anonymous — Fri, 20 Nov 2009 19:26:27 GMT

Author: .. double dot
Posted: Sat Nov 21, 2009 12:56 am (GMT 5.5)

this is wht i found

� Duration after first DVT or PE with a reversible risk factor
Most physicians will want to keep a person on warfarin for 3 months if they have developed a clot due to a risk factor that was temporary or reversible (i.e. extended travel). There have been many trials and studies performed that look at the risks and benefits of using warfarin over different time frames.

� Duration after first DVT or PE with no known cause
It is recommended that a person who develops a clot and no reason, disorder, or risk factor can be identified should take warfarin for at least 6 to 12 months. It should be strongly considered to continue warfarin indefinitely because they do not have a risk factor to remove.

MRCP Forum :: RE: who will enter mrcp2 in november 2009 let,s discuss aplan

h_ahmad77 — Fri, 20 Nov 2009 19:11:25 GMT

Author: h_ahmad77
Posted: Sat Nov 21, 2009 12:41 am (GMT 5.5)

for DVT :
If the cause will go away (eg post-op immobility): � At least 6 weeks for below knee DVT.
� At least 3 months for above knee DVT or PE.

� At least 6 months if no cause found.

glomus syndrome : tumours affecting the skul base.. could affect cranial nerves 7 8 9 10 11 and 12..

the first sign of parkinsonism ...hmmm..difficult unless there is a new study or something done on that for early diagnosis..

some would say tremor ...others would say bradykinesia..

may be someone else knows something ..

MRCP Forum :: RE: who will enter mrcp2 in november 2009 let,s discuss aplan

Anonymous — Fri, 20 Nov 2009 19:03:42 GMT

Author: .. double dot
Posted: Sat Nov 21, 2009 12:33 am (GMT 5.5)

as far as i read, if a person diagnosed with dvt, and this was secondary to a known cause like for ex, immobilization then warfarin for 3 months... i really want to know whts the duration if no known cause was found..?? shud try to google it

MRCP Forum :: RE: who will enter mrcp2 in november 2009 let,s discuss aplan

Anonymous — Fri, 20 Nov 2009 18:55:18 GMT

Author: voges
Posted: Sat Nov 21, 2009 12:25 am (GMT 5.5)

what about first episode of DVT( with no clotting problems)? warfarin for 3 months or 6 months?

what is glomus jugular syndrome?

any idea on the first sign of parkinsonism?

MRCP Forum :: RE: who will enter mrcp2 in november 2009 let,s discuss aplan

h_ahmad77 — Fri, 20 Nov 2009 18:50:13 GMT

Author: h_ahmad77
Posted: Sat Nov 21, 2009 12:20 am (GMT 5.5)

some of these questions above by voges missing vital info i guess as they were collected by candidates who sat the exam and it is understandable the stress they went through..

thank you double dot for the answers ..appreciated..
so amantidine is the choice for those not tolerating IFN and ribavirin..

MRCP Forum :: RE: who will enter mrcp2 in november 2009 let,s discuss aplan

Anonymous — Fri, 20 Nov 2009 18:42:21 GMT

Author: .. double dot
Posted: Sat Nov 21, 2009 12:12 am (GMT 5.5)

In the absence of thrombophilia, the recommendation from guidelines for treatment of a second provoked DVT is 6 months of warfarin. The APTT is in the normal range, which reduces the likelihood of her suffering from anti-phospholipid antibody syndrome, although she may of course have an inherited disorder. Recurrence of DVT whilst on warfarin would be an indication for life-long anti-coagulation, as would diagnosis of a thrombophilic condition.

Suicidal ideation is a recognised adverse event associated with combination interferon and ribavirin therapy. Pegylation of interferon is associated with increased treatment effectiveness, and reduced AEs, but switching to unpegylated interferon is not likely to significantly improve his symptoms. Giving him anti-depressents is also unwise as he is likely to use them in an overdose attempt. Lamivudine is an effective agent in the treatment of Hepatitis B. Amantadine has been shown to be an effective agent to switch to in patients who are unable to take interferon and ribavirin due to adverse effects, with response rates of 27% in one study.

MRCP Forum :: RE: who will enter mrcp2 in november 2009 let,s discuss aplan

Anonymous — Fri, 20 Nov 2009 18:39:49 GMT

Author: voges
Posted: Sat Nov 21, 2009 12:09 am (GMT 5.5)

1.A patient with conductive deafness,tongue palsy(Unilateral)nasal regurgitation ,swallowing probs and palatal palsy.........most probably Glomus Jugular syndrome or nasopharyngeal carcinoma?...I answered that wrong.

6.A old patient with parkinsonism...his son wants to know the first sign of parkinsonism....a)Daytime somnolence...b)Insomnia(My answer)

25.A small cell ca of Lung patient came with respiratory distress,suspected LEMS and ectopic ACTH but no sign of cushing....blood pic shows high sodium and low potassium....how to treat.........a) metyrapone(Most person answered)..b)KCL( i cant explain why i chosed this)

these questions were in april 2009..
anyone knows the answers?

what is Glomus Jugular syndrome?

MRCP Forum :: RE: who will enter mrcp2 in november 2009 let,s discuss aplan

h_ahmad77 — Fri, 20 Nov 2009 18:32:28 GMT

Author: h_ahmad77
Posted: Sat Nov 21, 2009 12:02 am (GMT 5.5)

anybody with correct answer for the above 2 questions by double dot?

MRCP Forum :: RE: who will enter mrcp2 in november 2009 let,s discuss aplan

Anonymous — Fri, 20 Nov 2009 18:25:10 GMT

Author: voges
Posted: Fri Nov 20, 2009 11:55 pm (GMT 5.5)

lifelong warfarin
psychiatric consultation and antidepressants

MRCP Forum :: RE: Best qbank for MRCP part 1

Anonymous — Fri, 20 Nov 2009 18:02:21 GMT

Author: Geust 211
Posted: Fri Nov 20, 2009 11:32 pm (GMT 5.5)

for part 1
passmeicine
onexam

for part 2
pastest
ydr

MRCP Forum :: RE: who will enter mrcp2 in november 2009 let,s discuss aplan

h_ahmad77 — Fri, 20 Nov 2009 17:59:56 GMT

Author: h_ahmad77
Posted: Fri Nov 20, 2009 11:29 pm (GMT 5.5)

hey double dot .. was the answer to DVT Question correct? ..

well.. for the HCV patient .. i would consider psychiatric consultation and antidepressants..

MRCP Forum :: RE: who will enter mrcp2 in november 2009 let,s discuss aplan

Anonymous — Fri, 20 Nov 2009 17:45:41 GMT

Author: .. double dot
Posted: Fri Nov 20, 2009 11:15 pm (GMT 5.5)

A 29-year-old patient with chronic hepatitis C infection is being treated with pegylated interferon and ribavirin. He becomes suicidal and is found by his girlfriend having slit his wrists; on a previous attempt he also tried to electrocute himself. So far the therapy for his Hepatitis C has been very successful and you are reluctant to stop treatment.

Which of the following is the most appropriate course of action?

Stop the medication and do not substitute anything else
Change to lamivudine
Change to unpegylated interferon
Psychiatric counseling with anti-depressants
Change to amantadine

MRCP Forum :: RE: who will enter mrcp2 in november 2009 let,s discuss aplan

h_ahmad77 — Fri, 20 Nov 2009 17:37:47 GMT

Author: h_ahmad77
Posted: Fri Nov 20, 2009 11:07 pm (GMT 5.5)

usually between 53 and 55 % depending on the diet

MRCP Forum :: RE: who will enter mrcp2 in november 2009 let,s discuss aplan

Anonymous — Fri, 20 Nov 2009 17:31:35 GMT

Author: guest1..
Posted: Fri Nov 20, 2009 11:01 pm (GMT 5.5)

what is usual passing cutoff percentage for MRCP 2 written??

MRCP Forum :: RE: who will enter mrcp2 in november 2009 let,s discuss aplan

h_ahmad77 — Fri, 20 Nov 2009 17:23:58 GMT

Author: h_ahmad77
Posted: Fri Nov 20, 2009 10:53 pm (GMT 5.5)

the 2 episodes of DVT were precipitated by surgical operations..
so I would choose 6 months..

MRCP Forum :: RE: who will enter mrcp2 in november 2009 let,s discuss aplan

Anonymous — Fri, 20 Nov 2009 17:19:25 GMT

Author: .. double dot
Posted: Fri Nov 20, 2009 10:49 pm (GMT 5.5)

A 35-year-old woman is found to have a right sided calf deep vein thrombosis (DVT) 3 days after an elective cholecystectomy. She had been started on low molecular weight heparin 2 days prior to the surgery. Three years ago, she had also suffered a DVT in the same calf, also following an operation. She had been warfarinised for several months following that incident.

Investigations;

Hb 12.8 g/dl
WCC 7.7 x109/l
PLT 178 x109/l
Na+ 140 mmol/l
K+ 4.5 mmol/l
Creatinine 110 �mol/l
PT 14s
APTT 29s

How long should she be warfarinised for this time?

6 weeks
3 months
6 months
1 year
Lifelong warfarin

MRCP Forum :: RE: who will enter mrcp2 in november 2009 let,s discuss aplan

Anonymous — Fri, 20 Nov 2009 17:12:41 GMT

Author: .. double dot
Posted: Fri Nov 20, 2009 10:42 pm (GMT 5.5)

ok the answer is increase aspirin to 650 mg..... question was in july09...

Early infarct-associated pericarditis usually occurs with large transmural infarctions and is characterised by pleuritic chest pain. Radiation to the trapezius ridge is a feature that is rarely seen with ischaemic pain and is a useful clue to diagnosis. Characteristic electrocardiogram (ECG) changes may not be seen because of changes of myocardial infarction (MI). Patients can usually be managed with aspirin and analgesics such as paracetamol. Corticosteroids and non-steroidal anti-inflammatory agents are best avoided in the first 4 weeks after MI, as they delay myocardial healing.
Anticoagulation can be continued if there is no pericardial effusion, as in such cases the risk of haemorrhagic pericarditis is low. However in the presence of significant effusion or if the effusion is increasing, heparin should be discontinued.

MRCP Forum :: RE: the rcp just changes the paces 2009/3 results till 24th Nov

Anonymous — Fri, 20 Nov 2009 16:29:04 GMT

Author:
Posted: Fri Nov 20, 2009 9:59 pm (GMT 5.5)

omg

i thut results are coming today or monday

so have 2 wait