MRCP PART 2 WRITTEN APRIL 2010

[mint_girl]

Hello all!

What did you think of the exam? I'm too tired to even relax! And I really want to know the result now! Let's discuss some questions in the meantime..!

The one that comes to my mind at the moment is the pregnant woman at 36 weeks who has low TSH and high T4 levels and has symptoms of tremor. Was the answer propanalol or carbimazole? I know that carbimazole is contraindicated in pregnancy and i've been doing some searching on the net. Some articles say that if no choice then give carbimazole and another article said, if no choice then resort to SURGERY!! Now what does the royal college want us to answer?!

[Guest]

[MRCPaspirant]

I felt that all the 3 papers were tough..and i was a bit underprepared!but then when can one be prepared fully with medicine as such...

I sat the exam in Chennai/India...

They asked 90questions x 3papers(probably keeping in mind that 100 might be too many,given the lengthy case scenarios).

A lot of questions from Nephrology - abnormal urinalysis, many nephritic/nephrotic syndromes!!

Other RCP favorite topics - MIs, Diarrheas, skin spotters, etc,.!!

A few straight-forward questions too....

One can never be sure how well the exam went..cause there will always be debate as to what the right answers are..!

[Najlaa]

to mint_girl: is that Q was accompany with photo of thyroid gland isotope scan?

[pebble]

It was a question with the values - low TSH, high fT4. No thyroid scan given. I read somewhere to avoid use of propranolol in pregnancy. Chose carbimazole.

[MRCPaspirant]

• Radioiodine therapy for pregnant women with hyperthyroidism is absolutely contraindicated. And use of Iodine is not recommended as well.

• Assuming there are no contraindications to its use, we suggest using a beta blocker for pregnant women with moderate-to-severe hyperthyroidism and hyperadrenergic symptoms. However, toward the end of pregnancy, they should be given only to women who have many symptoms because occasional cases of neonatal growth restriction, hypoglycemia, respiratory depression, and bradycardia have been reported after maternal administration.

• For women with moderate to severe hyperthyroidism complicating pregnancy, we suggest a thionamide as our first choice of treatment
We suggest using PTU rather than methimazole in the first trimester, and switching to methimazole at the start of the second trimester

•We only suggest thyroidectomy in hyperthyroid women during pregnancy who cannot tolerate thionamides because of allergy or agranulocytosis.

Source: Uptodate

[Najlaa]

i remebered this Q and and answers were:
1- thyroidectomy
2- carbimazole
3- propronalol
4- radioidonine
5- carbimazole+levothyroxine

i choose number 5

[ab1385]

The answer is either carbimazole or propranolol.

It's not radioiodine - permanent damage to the fetus. It's not block and replace with carbimazole and thyroxine because if using carbimazole you'd be aiming to use the smallest dose possible to minimize risk to the fetus. I'm fairly sure it's not surgery - for a start you can't really have a GA at 36 weeks pregnant.

So it's either propranolol or carbimazole. I personally chose carbimazole as this was reasonably severe hyperthyroidism, TSH < 0.1 - though her symptoms were only mild and maybe you could get away with propranolol until birth.

The main thing that makes me think I was probably wrong was that if you were going to give anti-thyroid drugs it would be PTU rather than carbimazole, so I think it probably is supposed to be propranolol, but I'm not sure.

[Najlaa]

the Q mentioned is consider new so better discuss these type Q AND no need to mention repeated Q from previos exams or which mentioned at some websites

[MRCP wannabe]

I thought the answer was carbomazole for that question. Lets discuss some other questions...did everyone put McArdles disease for the patient with myoglobinurea?
Was the answer to the 1st question from paper 3 atrial flutter? They showed us an ECG. For the temporal lesion did people put BCC or SCC? I put BCC as i thought it had a pearly edge to it with telangectasia (paper 3).

[giroop2003]

Hi All,
I also would have made mist take in exam under stress

as per my knowledge both Carbimazole and PTU can cross placenta on have effect on fetus, Earlier they thought PTU is more safer but later studies showed that both are equally having simillar effects.

In preganancy unless it is transient hyperthyroidism, we have to start antithyroid drugs like PTU or carbimazole.

But in case of inflamatory thyroiditis or transient hyperthyroidism we can treat only with proponol,

Surgery only option if patient is tollerating antithyroid meds and getting worse then under risk also we can do it, more safely in the early pregancy,

Both carbimazole and Levo thyroxin- Block and replace is not indicated in pregnancy since it need higher dose of Antithyroid drugs that can cause fetal hypothyroidism

Radioidoine Rx is contraindicated in pregnancy

[THAP]

As an obstetrician:

Carbimazole only

Not block and replace, and propanalol is associated with neonatal hypoglycaemia.

[giroop2003]

Hi Guys common,

I know most of them are tired,

it will great help and little relax to you if bring out your doubt and discuss with all

[guest10]

carbimazole was the answer

what about the image of lady who had rash on face for 2 years, better in summer.
recently treated with doxycyline and back from holiday
image showed rash on nose

ans= dermomyositis
DLE
roseacea
?
?

[Guest]

I found it all impossible....what about photo of pathological specimen yesterday (?lung) and the inheritence of the disease process.....I had no idea...put all female carriers will pass it onto their son (??X linked histiocytosis X???)

Also the inheritance/genetics chart today where a rare disease passes down. I put it has skipped a generation

[drsammorgan]

hi for alll
congratulation for all just who can take adesicion to enter the exam it,s realy hard
for me it was realy hard realy horrible realy catastrophic
i think i wasn,t prebared enough
anyway


i chose carbimazole cause onexamination said before it,s not bacame ci
now it,s same as thyouracil

also pt is thyrotoxic and it,s harm for baby to leave without treatment with just aprobranlol

and also thyroxine is dangerous for baby

[drsammorgan]

i did the folow and not sure
the inheritance pattern was in penetration
the picure of yesterday face of female i did discoid lupus

[drsammorgan]

what about chest pain man with xray wide mediastinum
the choices was heparin, nitroprusside ,nitroglycerin,,,,,,,????????

[drsammorgan]

what about the specimen of lung i chose
high residual volume and low co

[drsammorgan]

cystis fibrosis i did it 25% chance to have ason with the disease