MRCP 1 JAN2010 Qs

[CT 1]

Hi all of you
Just back from exam Happy after paper 1 , devastated after paper 2
I think same topics but with variety of questions , may be I need more practice
Here are some questions which i remember , answers might be wrong but please discuss and add if remember more



1 . Alcoholic , weight loss , chest signs and symptoms , CXR shows pleural effusion aspiration attmepted but failed whats the NEXT investigation
its clearly mention next not best investigation

bronch
ct chest
us chest
thoraco


2. carbamazemine autoinduction


3. valporate hair loss

4. cyclosporin excessive hair

5.patient suffered peripheral neuropathy , had chemo whic medication to stop ? vincristine

6. mismatch blood transfusion what test to confirm ? direct coombs test

7. Ring enhancing lesion on CT aids patient ( toxo )

8. 10 days after chemo patient neutrophil 1.2 ( Neutropenic sepsis )? prophylactic cipro

9. patient with variety of symptoms and sign anaemia . renal failure . neuropathy ? Polyarteritis nodosa

10. Mild headache in elderly which investigation ? ESR

11. Patient having unequal pupil and Ptosis ( Horner) which investigation to confirm ? cxr

12. CSF showing 100 lympho plus high protien ? TB

13. Ankylosing spondylosis what will present in Lumbar xray ? sclerosis / osteophyste / sydem/ wedge shape

14. patient with hip pain and lateral tenderness ? Osteoarthritis

15. 2/52 renal transplant dont remember the exact question but indicating cyclosporin toxicity

16 . patient on cyclosporin LFT become derange what investigation next to find the cause renal ultrasound / urea creatinine / cyclosporin levels

17. Alcoholic with deranged LFT pointing towards NASH

18. Contraindication to liver biopsy PT / obesity / platelets / ultrasound appearance of intra dilation of biliary tree

19 . patient on 5 HTN medications develops ankle edema amlodipine/ doxazocin / monoxidine

20 . Preg HTN methyldopa

21. 19 yr old patient having heavy protien urea but no heamturia most common cause membranous / minimal /FG / Ig A

22. routine medcial check showing iron deficiency with basophilic stripling , patient asymptomatic lead poisonng / sideroblastic dont remember other options

23. elderly feeling lethatgic investigation showing Iron defeciency but no altered bowel symptoms which investigation first ( gaasto / colonoscopy )

24. patient having blood diarrhoea / recent antibiotics for chest infection history of MI / diabetes ( c .diff / ischaemic colitis / diverticulits )

25. patient having blood diarrhoea not respond to 5 days of metro ? campylo

26. IV drug abuser sign and symtoms of tetanus which antibiotcs ? metro ? doxy

27 . Endocarditis blood culture alpha hemolytic which combination ? ben + rifa / benpen + genta

28 . GB syndrome patient asking for Vital capacity i think

29 . 37 yr old patient with Upper and lower motor sign father had similar problem at 78 yr of age ? amyotrophic lat sclerosis

30 . Bronchiectasis whic organism common ? Kleb / Moraxella / H influenza

31. Pulmonary HTN best investigation ? Echo / ctpa / vq scan

32 . caviating lesion with RF ? Wegners

33. weight loss / hemoptysis / hyponatremia which lung ca ? small cell

34 . patient heavy smoker and asbestos exposure diagnose lung cancer which account more i think smoking mainly

35 . testicular feminisation how will patient look like male with female genitals / male with inguinal testis / femal with clitromegaly etc

36 . Type 2 dm obese which medication first metformin

37. thyroid mass with normal TFT which investigation next ? FNAC ? radioisotope scan

38 . Man 30s pain behind eye and problem with colours examination showis central scotoma ? optic neutris

39 . question asking about absent ciliary reflex

40 . cocaine abuser ischaemic chest pain

41 . elder with fast AF but unstable hypotensive sys less then 80 ? cardiovert ? iv amiodarone / iv betablocker

42 . VSD want to become pregant which will be make it difficult ? Pulmonary HTN / aortic regurg cant remember all

43 . patient why playing dead HOCM

44. RTA which will be present renal stones

45 . Cushing meatbolic alkalosis

46 . Patient investigated for palpitation all normal last yr think he had cancer ? Hypochondriasis

47 . Mother stressed with disobeyed child suddenly unable to speak ? akinetic mutism ? dpreseeion


48 . pastient with left hemiplegia and h/o of CABG 15 yrs , unable to find right brachial and radial pulse . having head neck and back pain
? brachia site stenosis / dissection / GCA

49 . Nurse from southern india experiencing wight loss and diarrhea facal elastase less then normal ? tropical sprue ? coeliac

50 . lady with linear erythema and exfoliative margins on the shoulder prv h/o of overdose ? factitious / psoraisis

51 . lady taking carbimazole develops hypopig around eyes ? vitiligo

52 . Discoid lupus not responding to normal treatment what next

53 . MMSE 18 medication donezepil

54 . qusetion about drug induced Diabetes inspidus

55 . idiopathic PD ? symmetrical bradykinesia

56 . Acromegaly invest OGGT and growth harmone

57 . copd with PE which invetigation ? CTPA ? V/Q scan

58 . patient blood gas showing mixed metabolic and resp acidosis

59 . patient blood gas showing type 2 resp failure diagnosis copd / Asthma

60 . RA anti ccp positve

61 . RA treatment metho / pred

62 . patient ABPA admitted with exacerbation what to give first ? steroids ? itraconazole / neb saline / neb steroids


63 . patient with Hypokalemia what will ECG shows

64 . patient with Pericardial rub What will ECG shows ? small complex

65 . Ramipiril most common side effect cough

66 . pateint with facial edema ? which medication ramipirl

67 . Patient on lithium HTN medication made levels high ? ACE

68 . Cholestrol emboli what will in the blood ? eosinophilia ? thrombopcytopia


69 Patient with features of DIC what investigation ? coagultion ? d dimers

70. ITP treatment prednisolone

71.another question with neutropnia what to give GCFactor

72 . question about reactive arthirtis affectiong knees ankle and sole rash

73 . 2 questions of Herpes patient ? iv acyclovir

74 . myxoma where left atra / right atria / ventricles

75 . clusture headache question

76 , Perxisome straight forward question

77 . Hypercalcemia patient recieving fluids 4 hrs qhat next pamidranate

78 . Hypercalemia but low PO which is increasing ca reabsorbtion ? PTH / 1 , 25 / Hypophostemia

79 . 2 questions of Primary Hyperparathyroid

80 . Question about prolactinoma

81 . patient with renal failure and high total protien ? Multiple myeloma

82. Recent major surgery now 3 days later major MI after aspirin and clopidogrel what next ? primary angio / thrmobolysis / LMWH / unfrac heaprin

83 . patient on clopidogrel and aspirin awaiting surgery ? stop clopi and start LMWH

84 . SLE want to ask about developing neonatal Lupus which antibody present ? Anti Double Ds ? Anti Ro ? Anti sm

85 . question about PBC

86 question of Autoimmune Hepatis

87 cystic fibosis what chance of sister being carrier or effected cant remember the exact qyuestion ? 1:4 ? 2:3

88 . tubeorus scleosis two question asking association polycystic kidney

89 . diabetic patient with B/L small kidneys and protienuria and mild renal derangement ? Amylodosis ? diabetic nehropathy ? renavascular both kidneys

90 . ALL poor prognosis Ph chromosome

91 . CML treatment Imatinib

92 . question of grave disease

93 . megaobastic anaemia ileal resection

94 . another question with high MCV cause ? b12 def ? folate def

95 . parietal lobe infarction patient unable to read ? agraphia

96. patient with glucose in urine fasting and 2 hr normal feeling tired and lethargic ? Renal glucosuria

97 . medical student think he is dean of the university

98 . hemibalissmus wher is lesion ? subthalamic ? substania nigra ? caudate nucleus

99 . separate RNA from DNA ? northern blotting ? hybri

100 . whome to isolate patient with MRSA septicaemia / pneumonia and MRSA in sputum / perotenal TB 1 day treatment / pulm TB 16 day treatment


These are some , if some one has good memory fill the rest of the parts
Thanks

[saadi10]

parietal lobe infarction i wrote hemianopia as there is diffciulty reading

isolation of patient i wrote TB in sputum

[saadi10]

cholecystitis awaiting sugery post stent insertion is on aspirin and clopidogrel ?? i wrote delay for 6 months as stents need antiplatlets Clopidogrel for 6 months ,LMWH is not antiplatlet its anticoagulant

[Guest]

but it was a drug eluting stent?? so why cant we stop the clopidogrel?

[guest3232]

paper 1 was OK though made silly mistakes but overall was alright
paper 2 was Baaaaaaad
how this is evaluated both papers or each separately?

[fidu]

hiya every1...here r da Q's i cud muster out ov ma short term memory...
wish u all da best ...

1. wasting and fasiculation in UL and spasticity in LL - AML
2.Cyclosporin long term adverse effect- nephrotoxicity
3.RTA 1 - nephrocalcinosis
4. Contact Dermatitis to latex- delayed hypersensivity
5. Carbamazepine- p450- auto induction
6.Angioedema- bradykinin release
7.Pt taking throxine with low T4, low free T4, normal T3 , normal TSH-
appropiate thyroxine dose.
8.Afib on digoxin and warfarin uncontrolled with left ventricular dys-Amiadarone
9.Pneumothorax in 35 yr old with 1 cm rim and now assymtomatic-discharge with out patient CXR
10.Pt with some harmless PVC on ECG and was worried about cancer when all tests were normal-hypochondriac
11.Student low mood, suspects teacher is conspiring against him-paranoid pshsophrenia.
12-multiple symptoms but all normal normal-somatisation d/o
13.sudden death-hocm
14.35 y/o with IHD or DM has TC 5.2 and LDL 3.2-simva 40mg
15.left hemiplegia with absent right brachial artery and radial pulse , BP 160/80 -COA
16.DM first line-metformin
17.PPV- 50%
18.Chance of breast problem in population-404/10000
19.Cfibrosis carrier in kids-1:2
20.HIV (CD count-80) with SINGLE ring enhancing lession-TB
21. Androgen insensitivity0- female phenotype with external female features
22.MI after colectomy on asprin+clopidrogrel-PCI
23.FEV 70% , FEV1/FVC 50% KCO2 50%- empysema
24.pt 19 yr old with proteinuria +4, Protein in urine 4 g/dl-minimal change
25.purpura on legs in young-henosh scholein purpura
26.pt with alcoholic neuropathy needs chemo- avoid vincristine
27.terlipressin-splanchnic vasoconstriciton
28.Asbetosis+smoking +hyponatremia-small/mesothelioma
29.asbestosi+smoking-smoking caused increased chance of CA
30.muslim T2DM who wants to fast is on metformin 500 mg tds-take 500 in morning and 1000 mg in evening
31.lady finds difficult to read scan shows parietal lobe infact-heminopia
32.herpes ,later develops eruption-Erythema marginatum
33.hiker develops ring lession with central clearing-lyme disease
34.foot drop,absent ankle reflex,lat loss of sensation, after hip surgery-common peroneal nerve
35. CML-Imatinib
36.ALL poor prognosis-Philadelphia chromosome
37.Parkinson disease-assymetrical bradykinesia
38.pt with APTT 30, platelets 30-ITP
39.ITP - steroids pred
40. Inferior MI- RCA
41.Haemochormotosis screening in family-Transferin saturation
42.Infective endocarditis with prostethic valve ,culture grew strep-b pencilin +gent
43.19 yr old develops edema and proteinuria-minimal GN
44. Pt has arthritis in MCP,MT,writst with negtive RF but positive CCP-RA
45. A spondolyis - Sclerosing of vertebra
46.ABGs-Mixed respiratory metabloic acidosis
47.Cushing-met Alkalosis
48.LH:FSH ratio raised - PCOD
49.Wheeze, Breathless, Stridor- Loop flow
50.GB syndrome-FVC
51.Bleeding PR - icolonoscopy
52. painfull intermittent bleeding in young- anal fissure
53.sideroblastic anemia,hypochromic picture - lead /basophilic
54.poikilocytosis + lethargy-myelofibrosis
55. bipolar develops hyponatremia-drug induced
56.pt on frusemide develops rash-drug induced/bullous pemhigus
57.prenicious anemia on endoscopy finding in- gastric antrum
58.malaria how plasmodium exits red cells-effverce
59.seborrhic dermatitis- ketokonazole
60.JAK2 -poly cythemia ruba
61. 70 yr old headache 3 weeks sudden loss of vision with papillodema-ESR
62.chickepox rash for 5 days-acyclovir
63.pupil slow reacting to light and concesullay, assymetrical-adie/RAPD
64.P/C poisioing -anorexia nervosa
65.alcoholic,ataxic, opthalmoplegia, -wernick korsakoff syndrome
66.glucose fasting raised, OGTT fasting 5.6 2 hr 7.2 BP 150/80 glycosuria-reanal glycosuria/cushing
67.pericardial rub-diffuse ST /low voltage
68.normal Ca, low Phosphate, raised ALP-PTH
69.Subungual fibroma,hypopigmentation,epilepsy, cysitc kidney dz-Tuberous sclerosis
70.post partum 3 months with exopthalmos and TSH 0.01, raised T3 T4-Grave disease
71. pt with CA confusion and Na 120 - SIADH
72. pul HTN-echo
73.pleural fluid on cxr but can aspirate-USG
74.pt had hickmann for parenteral feed develops weakness-hyposphatemia
75.scotoma- optic neuritis
76.hyponatremia w/o renal pathology- addison
77.raised PTH, raised Ca, low Phosphate - primary hyperparathyroidism
78.CXR b/l consolidation with hypotension after flue - S.aureus/mycoplasma
79.Crest patient with b/l basal creps and cxr show basal shadowing-ILD
80.statin , develops myopathy after Ab - erythromycin
81. lithum + HTN started develops toxicity-ACE
82.african kid returns has arthritis in knee, ankle , wrist - gonococcal
83.young 25 yr old labile mood , choreathethoid movement, other neuropsychiatric problems- wilson
84.young 16 yr old with lymphadenopathy, fever, WBC 17 ,lympho 11 and atypical lymphocytes-glandular fever
85.All picture on full blood count with LN enlarged-Immunophenotyping
86.student has insomnia and pressured speech -mania
87.break downs protiens-proteosomes
88.appendicetomy, fever, hypotenstion- CRP (sepsis+MOF , prognostic value)
89.young low GCS, pin point pupil-opiod oxy codine
90.back pain in elderly with raised ESR - M Myeloma
91. Myeloma - AL amyloid
92. mitrochondrial disease- optic atrophy
93.RNA using DNA probe- northern blotting
94.Unable to move on sleeping and waking up with hallucination-sleep paralysis
95. acromegally- GH+ GTT
96. acoustic neuroma- absent corneal reflexes
97.hypokalemia on ecg- u waves
98.hocm prognosis - septal wall > 3 cm
99. Malignant melanoma- thickness
100.addison disease- short synacten test

phewwwwwwwwwwww.... da rest later muaz out for now .....

[saadi10]

I am quoting this from up to date
pleasae read last paragragh
main reason is to prevent late thrombosis

The ability of prolonged clopidogrel therapy to prevent major adverse cardiac events after bare metal stenting was shown in both PCI-CURE (patients with ACS), in which clopidogrel plus aspirin for a mean of nine months was compared to aspirin alone, and in the CREDO trial, in which dual therapy was given for three months and clopidogrel was either continued or switched to placebo for nine more months [9,10]. In both trials, the benefit of clopidogrel therapy increased over time, with no evidence of a plateau at one year (graph 1 and graph 2).

Although neither trial assessed the specific outcome of stent thrombosis, both provide evidence in favor of clopidogrel therapy for at least one year in patients with BMS. PCI-CURE and CREDO did not evaluate DES. However, given the findings cited below about the increased risk of late stent thrombosis after clopidogrel is withdrawn prematurely in DES, these observations provide further support for at least one year of dual antiplatelet therapy in patients not at risk for bleeding. (See "Coronary artery stent thrombosis: General issues", section on 'Long-term comparison of DES and BMS'