MRCP Part 1 Jan 06

[yc]

Hello, I thought I'll contribute some of the questions I remembered from the exam. The answers are what I have written and I am not certain about them.

Cardiovascular
Patient in heart failure. Which beta blocker would you give
Ans : Carvedilol

Young lady - collapse a few times. Father passed away from sudden death. Whats the likely cause.
Ans : Cardiac Syncope (My guess is HOCM)

Prolonged QT --> Torsades. How would you treat
Ans : Magnesium

Prolonget QT --> Which drug is causing them
Ans : ?sotalol

Pharmacology
Rash in sunlight
Ans : Amiodarone

Drugs causing pancreatitis
Ans : Lamotrigine. I think real answer is Carbamazepine

Drugs causing polyuria
Ans : Lithium

Infectious Disease
Young lady, visiting West Africa. Came back with fever, petechial rash. No lymph nodes
Ans : Dengue, ?possibly Malaria

Respiratory
Small cell lung cancer, tumour growing on R main bronchus. How would you treat
Ans : laser therapy (most prob wrong) other options include radiotherapy, chemotherapy, surgical

Neurology
Patient with guillain barre syndrome. Severely breathless, Sats 95%. Unable to measure VC What would you do
Ans : Intubate, ?increase O2 to 100%

Patient with absense ankle reflex
Ans : Common Peroneal Nerve lesion

Basic sciences
Breakdown of peptides
Ans : Peroxisomes, ?proteases

Gastroenterology
Watery diarrhoea, stool chart with weight + showing fasting
Ans : VIPoma (didn't made sense to me)

Long history of alcoholism, abdo pain, weight loss, clay coloured stool. Whats the diagnosis
Ans : Chronic Pancreatitis

Long history of alcoholism, abdo pain, weight loss, clay coloured stool. Best investigation
Ans : CT scan

Acute Medicine
Someone in anaphylactic shock
Ans : 0.5ml 1:1000 adrenaline IM.

Statistics
- Can't remember the questions but they were relatively straightforward
- Question on calculating NNT
- Question on calculating specificity (i think ans was 95+percent)
- Question on understanding p value <0.02

Rheumatology
Patient with asthma develops haematuria ?churg strauss
Ans : antimyeloperoxidase

Patient with Raynauds, which is likely to suggest autoimmune disease
Ans : History of chillbains

Endocrinology
Patient develop polyuria, erectile dysfunction and avascular necrosis
Ans : check blood glucose, ?possibly cortisol

Psychiatry
Patient in uni, became withdrawn, thinks lecturers are against him. Hears auditory hallucination
Ans : ?cannabis induced schizophrenia. Not sure if it was cannabis, could be other drugs

Patient developing dementia, extensor plantar
Ans : ?B12 def.

Renal Medicine
Patient developing diarrhoea + renal failure --> HUS
Ans : Treat with dialysis?

Patient with nephrotic syndrome develops clot. Why?
Ans : dec. antithrombin 3

[yc]

Rheumatology
Lady developing swollen knee, red eye ?cause
Ans : ?reactive arthritis, nongonococcal arthritis

Gastroenterology
Patient develop lesion on the anus
Ans : ?wart

Dermatology
Patient develop smooth lesion on forehead
Ans : sebaceous cyst

Cardiology
Patient with known clotting tendency, on warfarin for DVT. Develop hemiplegia. What will be seen on echo
Ans : normal

Renal
Patient with grey legs, aortic thrill. Develops proteinuria
Ans : ?hepatic vein thrombosis

Psychiatry
Known IV drug abuser, complaining of pain. Yawning, pupils reactive to light
Ans : ?methadone

Neurology
Patient with SAH. Has aneurysm + polycystic kidney. How would you screen relative
Ans : ?to do kidney USS on 1st degree relative. Other option includes MRI relatives

TI lesion, which dermatomes
Ans: dun remember

Haematology
Which virus predisposed to hodgkin's lymphoma
Ans : EBV

Respiratory
pleural effusion - protein 40 glucose 1.5, what is the most likely cause
Ans : ?adenocarcinoma, mesothelioma, rheumatoid arthritis, don't remember the other 2 option

Infectious Disease
Patient with ?gonorrhea or nongonococcal urethritis
Ans : treat with doxycycline

[ahmaddd]

- There was a question regarding the cardiac enzymes to be used for diagnosing MI after 3 days. I dont remember the answer.

- insurance company question..... serum urate level more than normal. which test to do ???

- PCR question....

[Nath]

1. Athelet girl which hormone is suppressed - LH
2. Source of Folic Acid - Liver
3. Gentamycin Half Life - 2 hr
4. Erythromycin action in Gastroparesis - Gastric Emptying ( Made a mistake here- choose inh bac overgrowth )
5. Relative risk - 10%
6. Specificity - 950/970
7.NNT - 100/18-8
8.Statin action - Inh endogenous synth of cholesterol
9.Cranial Nerve Palsy - Jugular Foramen
10.P value 0.01 in a study - 1 in 50 chance of drinking fruit juice helpful in crohns
11. WPW - radiofrequency abl
12. addition of 5th anithypertensive ,adverse effect --- ?
13. pancreatitis in pt with epilepsy and Htn - valproate( Choose nife )
14.Cannabis use with schizophrenic symp - drug induced schizo was not an option,is it paranoid schizo?
15. PCR - DNA Amp
16 - breaking of polypeptide - Protease?
17. Clonig - right ans is Nuclear Transer ( Mistake )
18.Preg lady with PE - V/Q Scan
19. High Calorie - Cheese?
20. Pt with MI with BP 205/115 - ?
21 - Rate conrol in Af - Digoxin
22 - Pt with Patch on Back and rash - P.Rosea
23 - Pt with erisypelas ,which org - Strep.Pyogens
24 - Crest Synd - Anticentromere
25 - Raynouds which is associted - history of Chilblains
26 - Diplopia,6th nerve palsy,contralateral leg weakness ,ext plantar - Brain tsem infarc,pontine lesio,cerebellpontine,cerebellarhemorrhage --- ans ?
27 - treatment of Torsedes - Magnesium
28 - drug cusing torsedes - Sotalol
29 - refractory Asthma treatment - Magnesium
30 - retrosternal goitre - flow volume loop
31 - Asthma,Upperlode Collapse - Churg Staruss
32 - pt with extensive p.versicolor front and back - Ket cream,Tebinafine cream,Oral Itraconazole - Ans ? ( Choose Oral as extensive)
33. Lt knee sweeling in a girl after returning from holiday - Gonococcal
35 - Reiters - HLA B27
36. child with HUS ,treatment - Plasmapheresis
37. Tall guy with hypogonadotrophic hypogonadism - Kallmanns
38. raised calcium,Alp,next investigation - PTH
39. Pt with pagets,next investigation - Calcium
40. epoitin resistance,raised PTH - Hyperparathyroidsm
41. ligh micros of child with Sore throat and haematuria - no change by light microscopy?
42 - pt with s.clerosis,htn,drug - ACE inhibitor
43. pt with recurrent thromboembolism - 6 months warfarin
44. Pt having spinothalamic symp ,dorsal colum spared,acute onset - ant spinal artery aneysm
45. treatment for BEtremor - propanolol
46. pt with intermittent diarrhea and constipation - IBS
47. Pt with occ bloody diarrhea and siggy shows loss of houstr and erythematous friable mucosa - UC?
48.PAS positive ,Diarrhea - Whipples
49.24hr h/o blood diarrhea - ? Sheigella
50.best inv for pancreatic ca - ERCP
51. endocarditis after 6 weeks of valve replacement - Str.epider
52. pt with fever,c3 low - SBE
53. Pt with septic arthritis ,invest - joint aspiration
54. Pt with stump infection,treatment - Fluclox + Penicillin
55. Antibiotic for Gram Neg Diplococci - Cipro
56. Pt with kyphoscoliosis,what Pulmonary f.test - Reduced VC
57.Pt with pul fibrosis ,PFT shows - PEFR of <50%
58.Monitoring of colon ca - CEA
59. malignant melanoma on rt arm,prognsis depends on - Depth of the lesion
60. Pt with symptoms of tamponade,best Inv - Echo
61. Pt received carbimazole,monitoring - TSH
62.Treatment of Hyperthyroidsm in preg - Propylthiouracil
63.pt with small cell ca,treatment - Chemo
64.Pt with headache,lacrimation - cluster
65.Another question on headache with hemiparesis - cerebral venous thrombosis.
66. Pt presenting with ARF and Rash after Coronary angio - Cholesterol embolism
67.T1 root lesion - ? Ans ( I choose Horners)
68. Pt with sore eyes,arthritis - Sjogrens synd
69.Pt with Lymphoma,which virus - EBV
70.Pt admitted with vague symptoms,multiple admissions - Somatisation
71.Pt with Neuroleptic maligant syndrome,which will be the other symptom - ?Fever (other option is Limb tremor)
72. Treatment /Antibiotic for Tetanus - ? Ans (
Choose gentamycin ,is the correct ans Metro?)
73.Young girl with apthous ulcers - Crohns
74. Pt with arthralgia,skin lesions on the shins,diarrhea - Pyoderma gang
75.compression of common peroneal nerve at fubula - ? Ans - weakness of everters,loss of sensation over medial lower leg etc.. no foot drop as an option
76.Pt diarrhea stopped after admission - Laxative abuse
77.Pt with anaphylaxis,raised BP stridor ,treatment - Options were Inhaled adrenaline,S/C adrenaline,IV And IM adrenalline - ? Ans
78.One more question on adrenaline - cant remember exactly
79.Olanzapine blocks Dopamine 2 receptor,which other receptor would enhance it effect - Options were Dopamine 1 ,Seratonin,Alfa 1 etc.
80. pt with cerebral embolism,dvt,what will u see on echo - normal appearence.
81. Outbreak of diarrhea on the ward . patients resolving after 48hr. ?close ward, isolate patient etc.
82. 65yr old lady with Lt hemisphere cerebral infarct, has Lt complete stenosis, and 30% stenosis in Rt Cart. ? no Sugery other otpions arterectomy.+/- angioplasty.
83. 36yr from Zimbabwe with calcification in bladder on X-ray- Schisto.
84. Patient with sarcoidosis what wud lead u to start prednisolone-? Hypercalceamia
85. RTA type 1 common attribute- Renal stones.
86. Post cholecystectomy bile stone is found best Ix- ?ERCP, CT.etc
87.Diabetic patient, notices swelling in knee a week later has calf tenderness and ankle swelling-? backers'cyst #. cellulitis
88. myelofirbrosis likey feature- fatigue etc.
89. 68yr old man with AS what wud reduce pressure gradient across valve.- ?VSD, AR, MR etc.
90. Sciatica with severe pain reqiured immediate symptom relief- ?Physio, Analgesia,intra-epidural steroid, bed rest.
91. COPD with lobar pnemunia treatment. Amoxycillin, Clarythr+Amoxy, Ceftr, etc.

PS. Q1 paper 2. returned from Visit in West Africa , fever, anemia thromboctypaenia, rash etc options, malaria, dangue fever, Lassa, hiv seroconversion

92. asymptomatic hyperuricemia, next investigation - ? lipids profile (increase risk IHD)
93. pt with waldestrom's - cyroglobulinemia, retinal vein thrombosis, etc
94. pt with cholestasis, which medication responsible - co-** ans: augmentin
95. ischemic ATN, long term HD prognosis - 20-30%?
96. solidary thyroid nodule, next step investigation - FNA, radioactive isotope uptake etc
97. pt with high calcium and phosphate and suppressed PTH ? hypercalcemia of malignancy; initial management - IV lasix, IV normal saline, IV biphosphates
98. ataxia, parkinsonism and postural drop in BP - multiple systems atrophy
99. west africa visit with fever, anemia, thrombocytopenia and rash - dengue
100. what clinical signis would suggest Severe aortic stenosis - radiation to carotids, etc
101. Road traffic accident - 2 weeks later developed anxiety symptoms. Evaluated 6 months after RTA. Diagnosis? - anxiety, PTSD, etc
102. h/o splenectomy - give pneumococcal vaccine
103. s/p kidney transplant with worsening renal function. biopsy shows acute rejection. What mediators? - receipient's T cells
104. bloody LP with predominantly lymphocytes (100%). Diagnosis - HSV encephalitis
105. Crytococcus vs toxoplasmosis- CT head with contrast?
106. Chronic alcoholic with visual hallucinations 3 days after admission - DT
107. Hep C treatment. What labs to follow? ALT, HCV RNA titers etc
108. presents with electrolytes imbalance suggestive of DI - medications? lithium
109. Works in the kitchen. Hand rash with fissures on finger pads. Manangement? ellioments, gloves, etc
110. pt with heart failure on many medications. What else to add? carvedilol
111. pt with CRF. What would he most likely die from? AMI/IHD, etc
112. pt with odynophagia to both solids and liquids. next step investigation? esophageal manomotry studies, etc
113. sick euthyroidism - low T3, elevated T4 and normal TSH
114. admitted for AMI, which test would suggest reinfarction? CK, AST, trop I, T
115. pt with intermittent palpitations associated with dyspnea n dizziness. occurs ~1/week. investigation of choice? holter, loop recorder, event recorder, etc
116. Poor prognosis in CAP: BUN > 16
117. heroin addict admitted for pain control. drug of choice for pain control? diclofenac, methadone, tramadol, etc..
118. Young pt out drinking, had a fall. admitted with neck stiffness. CT head normal. investigation of choice: CSF investigation
119. father with VZ, wanted to fly to attend daughter's wedding. What to do? fit to fly, give IVIG and fly, give -cyclovir and fly, not fit to fly, etc
120. features of hypersensitivity pneumonitis: eosinophilia, upper lobe fibrosis, neutrophilia, etc
121. photosensitivity rash. which medication: amiodarone, aspirin, ACEI, etc
122. physical findings of a pt presenting with AN: fine hair on body ie lanugo hair
123. acromegaly seen for increased sweating. reason? sweat gland hypertrophy
124. action of statins: decrease liver production of cholesterol
125. best screen for hemachromatosis: ferritin level
126. pancytopenia and diarrhea: pernicious anemia, celiac disease, etc
127. leukamogenesis of acute promyelocytic leukemia: fusion of 2 genes?
128. recurrent pneumonia, elevated total whites with lymphocytosis. etiology? CLL, CVHG, etc
129. 16 y/o out drinking - developed transient afib. management? lifestyle
130. family h/o PCKD. best screen? u/s all 1st degree relatives
131. microalbuminuria. best management? ACEI
132. action of aldosterone
133. site which remains impermeable to ADH.
134. action of DDAVP in vWD. released stored vWF
135. pt with headache and symptoms of temporal arteritis. next step? esr, prednisolone, analgesics, CT head, etc
136. role of metformin in PCKD. increase peripheral glucose uptake? (decrease insulin resistance)
137. role of NAC in paracet poisoning. replenish glutathione concentration
138. pt with polyuria, decreased libido. What tests to order? ferritin level?
139. HTN on multiple drugs. c/o edema. which drug? nifedipine?
140. htn, depression on multiple drugs and lithium. lithium toxic level - induced by which medication? ACEI?
141. pathology caused by myeloma: activation of osteoclasts.
142. asthmatic on inhaled steroids and b blockers. c/o dysphagia: esophageal candidiasis?
143. absent knee reflexes with extensor plantars: b12 deficiency
144. management of chronic fatigue syndrome
145. gastric adenocarcinoma on biopsy. what histological features: columnar cells, signet ring cells, diminished goblet cells, etc
146. cushing's syndrome. what metabolic disorder? metabolic alkalosis
147. osteoporotic bone pain. on paracetamol. What immediate course of action? add calcitonin? other analgesics
148. acute red eye: closed angle glaucoma
149. suicidal attempt on long acting propanolol. bradycardia unresponsive to atropine. next course of action: glucagon
150. suicidal attempt on TCAs. wide complex tachycardia without p waves. HR 160s. SBP 90. course of action: Dc shock, amiodarone, hco3, MgSO4 etc
151. white nodular exudate on sigmoidoscopy: pseudomembraneous colitis?
152. diabetic with frozen shouder: adhesive capsulitis

[ahmaddd]

gr8 work by NATH. all of us must appreciate

[ahmaddd]

good work by all who have contributed

[Nath]

Thanks Ahmadd,Its a group work and I hope some more friends would contribute to the remaining questions.
Praying for all of us.

[Guest]

Inv of choice for chronic pancreatitis - ERCP

DOC for ctrlling rate in AF- Beta/ Ca channel blockers

Treatment of torsade pointes- Mg

R u sure that the answer for the man who travelled back from africa is Dengue & not HIV

Feature of lat epicondylitis- difficulty in pronation

Treatment of gonococcal urethritis-? 1st choice ceftriaxone not there in the given choices...dont exactly remember the rest

R u sure that the rash on back is P Rosea & not dermatitis herpetiformis....

Thyroid profile in Pneumonia patient: Hypothyroidism seen

Treaatment of chroni fatigue syndrome: antidepressants. Behavioural therapy is the 1st choice whic's not given...decond choice is antidepressants

There was a Q on early morning headache....ans?

Rx of small cell Ca: chemotherapy

Olanzapine : action on D2 & serotonin receptor

Dr. Anoop George Alex

[yc]

Additional info on questions + other questions.

Additional information added in blue

4. Erythromycin action in Gastroparesis - Gastric Emptying, relaxation of pylorus, release of cholecyskinin

14.A young boy with history of depression and suicidal. Has paranoid delusions, Clinical examination mental state is flat, withdrawn, admits to occasional cannabis use with schizophrenic symp - drug induced schizo, psychotic depression

16 - Area where this occurs - breaking of polypeptide - Protease, golgi apparatus, endoplasmic reticulum, mitochondrion, peroxisomes

20. Pt with MI, >2mm ST elevation in V2-6, with BP 205/115, already given morphine and aspirin - the next appropriate management - iv GTN, iv streptokinase, iv tPA,

25 - A patient has a history of Raynaud's syndrome, which other clinical findings would be associated with underlying connective tissue disease - history of Chilblains, recurrent abortions

31 - A man with a history of chronic Asthma presented with breathlessness of 4 weeks duration. CXR showed Upperlode Collapse - Churg Staruss, acute bronchopulmonary aspergillosis

33. Lt knee sweeling in a girl after returning from holiday, also noted to have conjunctivitis, now presents with bilateral ankle swelling - Gonococcal, reactive arthritis

40. A patient with renal failure on hemodialysis for a few years, has been on epoetin before, with baseline Hb of 11-12. Now noted anemia, Hb 8.0, MCV low, with raised Ca, PO4 and raised PTH, what is the cause of epoitin resistance - Hyperparathyroidsm, occult malignant disease, inadequate epoetin dosing

42 - pt with systemic.clerosis, is now hypertensive with cotton wool spots on fundoscopy as well as acute renal failure, what is the next management ,drug - ACE inhibitor, oral atenolol, iv nitruprusside, iv labetalol

43. A lady with a past history of DVT is now on heparin due to a DVT confirmed on doppler. She previously had abortions. What is the next appropriate managment - 6 months warfarin, warfarin indefinitely

53. Pt with a long history of rheumatoid arthritis which is currently quiescent, complained pain of the right knee. Patient is otherwise apyrexial. What is the next immediate investigation that you would do? with septic arthritis - X-Ray of the right knee, joint aspiration, ESR, CRP

65.Another question on headache with hemiparesis that resolves after the attack - cerebral venous thrombosis, migraine

81. Outbreak of diarrhea on the ward . patients resolving after 48hr. ?close ward, isolate patient, stop visitors from coming, use bottled water for drinking

99. A lady who has been to west africa for 6 months returned. 4 weeks after presents with fever, anemia, thrombocytopenia and rash - dengue, lassa fever, falciparum malaria, typhoid, acute HIV seroconversion

100. what clinical signis would suggest Severe calcified aortic stenosis - radiation to carotids, loud second heart sound A2, hyperdynamic apex beat

101. Road traffic accident - 2 weeks later developed anxiety symptoms, headache. Evaluated 6 months after RTA and was found normal. Diagnosis? - anxiety, PTSD, post concussion syndrome

112. A young lady presents with difficulty swallowing solids and liquids. BMI within normal limits. She vomits after taking 3 mouthfuls of food, OGD done, found food residues at the lower part of esophagus. pt with odynophagia to both solids and liquids. next step investigation? esophageal manomotry studies, barium follow through

114. admitted for AMI, which test would suggest reinfarction after 3 days? CK, AST, trop I, T

118. Young lady out drinking the night before, had a fall(?). Had a headache that woke her up and associated with vomiting. has low grade temperature, admitted with neck stiffness. CT head normal. investigation of choice: CSF investigation, MR brain, MR angiography

138. pt with polyuria, decreased libido, right hip pain. What tests to do in order to confirm the diagnosis? ferritin level, cortisol level, blood sugar level

Additional recall questions:

139. An African man has had depressive illness for the past 3 winters. Currently feeling suicidal. Also known to smoke cannabis. What is the diagnosis? Schizophernia, cyclothymic disorder, seasonal related affective disorder

140. 70yo lady has a history of facial rash exacerbated by sunlight and alcohol. Clinically there is an arythematous papular rash with pustules. Weakly positive rheumatological markers. What is the most approriate treatment? prednisolone, flucloxacillin, dapsone

141. 80yo lady c/o fatigue, polyarthralgias and alopecia. She has a history of Raynaud's phenomenon. Clinically joints are normal. Diagnosis? Hypothyroidism, SLE, Sjogren's

142. Patient recently started on carbamazepine for seizures. Came in for breakthrough seizure a few months after and noted subtherapeutic level of anticonvulsants. Pill count showed patient is compliant. What is the explanation? Alcoholic binge, enzyme induction

143. An elderly gentleman was found to be in AF. Pulse 96, BP 124/84. What is the next step in management? DC cardioversion, aspirin, warfarin

144. 48yo lady with type I DM for 2 years, but long history of rheumatoid arthritis. Urinanalysis showed proteinuria. Likely renal pathology? amyloidosis, DM nephropathy, NSAIDS induced nephropathy

155. Young lady with acute leukemia received chemotherapy that consisted of doxoburicin and vincristine. 3 weeks later she complained of abdominal pain with constipation. What is the cause? doxoburicin, vincristine, hypercalcemia

156. Young woman complained transient aphasia and left sided hemiparesis. She just returned to London from Australia. What is the likely echo findings?

157. A patient recently started on oral prednisolone. What is the treatment of choice for steroid induced osteoporosis? Ca/D, bisphosphanates

158. Where is the G protein located ? membrane, mitochondrion, nucleus

159. A pregnant woman with DM has episodes of loss of consciousness without any warning. What is the cause? fetal insulin secretion, tight glycemic control

160. Patient came in for decompensated cardiac failure. JVP raised, oliguric, bilateral pedal edema. What test can identify the cause of deterioration? echocardiogram, CXR, Urea and electrolytes, trop T

161. A patient with compensated type 2 respiratory failure. pH normal. What treatment improves prognosis? Long term O2 therapy, O2 concentrator, pulmonary rehab

162. A young lady admitted for depression. There was history of recent bereavement. She was given some medication that ran out 7 days ago. Clinically, distressed, tachycardic, has a tremor. What is the likely diagnosis? benzo withdrawal, depression

163. A young boy with history of acne on minocycline still has acne with scarring. What is the next appropriate management? tetracyline, topical retinoids, oral isoretinoin

164. drug causing proteinuria - Gold

165. prognostic factor in Pneumonia - Na 130, Urea 11 ?166.Pt with ataxia,demntia and incontinence - Normal pressure hydrocephalus

167.Pt with syncopal attacks,father has the same - Cardiac Syncope

168.Patient with nephrotic syndrome develops clot - ? ans

169.Patient develop lesion on the anus

170.Patient develop smooth lesion on forehead -Ans ?

171.pleural effusion - protein 40 glucose 1.5, what is the most likely cause - Mesothelioma

172.Patient with ?gonorrhea or nongonococcal urethritis,Antibiotic - ? Doxy

[ahmaddd]

Yes man i think the same the person from west africa:::: ans::; aaacute HIV

Outbreak in the ward ::: self limiting :::: use bottle water



any comments

[Guest]

there are 2 versions of the 'west african' scenario i think. my scenario was some guy returned from west africa? zimbabwe? (can't remember exact place) presented with pancytopenia and rash (no mention of lymphadenopathy nor any symptoms/signs of mononucleosis) and dx is likely dengue (a similar question was on onexamination).

those who are interested we have posted questions on aippg as well,

[yc]

HI all, just sat the MRCP part 1 in January, it wasn't as bad as I thought it would be, but I wouldn't say it was easy. ONexamination.com's questions come very very close.


Resp

1. Which respiratory test for enlarged obstructive goitre?

2. Scenario with community acquired pneumonis- you need to memorise the CURB 65 critieria by heart

Cardio

1. Scenario with anterior MI, need to know contraindications to thrombolysis to answer this

2. 68yr old man with AS what wud reduce pressure gradient across valve, i think heart failure is answer

Resp
1. Small cell lung cancer, tumour growing on R main bronchus. How would you treat

2. young man severe guillain barre, FEV1 unrecordable, sats 95%
what is immediate management? choices: high flow oxygen vs intubation

How to manage anaphylactic shock, must choose the right does of adrenaline i.e. 0.5mg of 1:1000

Statistics
quite straight foward
1 was on calculating specificity, 2 were on calculating number to treat
1 was on a trial, with "an intention to treat" vs control, what exactly are they testing?

infectious
36yr from Zimbabwe with calcification in bladder on X-ray- Schisto.

gastro
gastric adenocarcinoma on biopsy. what histological features: columnar cells, signet ring cells, diminished goblet cells, etc

[Guest]

Hi to all of u ,,
and wish u best of luck ,,,,,,,,,,,,,,,IT WASNT AN EASY EXAM
regarding the man who came from africa with fever,rash........etc
i remember that he developed the symptoms 6 weeks after arrival so its not dengue cuz dengue has an incubation period of 3-7 days but from the list which also contained typhoid,brucellosis, hiv ,,,,HIV is the most likely answer cuz it has the longest incubation period among all other options.

[ahmaddd]

Yes i'm also talking abt the same question with incubation period of 6 months.

and i agree with u ppl that this was not easy paper specially part 2 of the paper

[kadhaum ALAMOI]

I WILL SEND SOME OF QESTION WITH ANSWER OF MRCP I 24 -1-2006

1-LEADY PREGNANT 12 W PRESENTED WITH PALPITATION TREMER
TFT REVELD HIGH T3 T4 LOW TSH
ANSWER WAS OBSERVATION NO DRUGS

CROSS REACTIVITY OF TSH RECEPTOR BY HIGH HCG LEVEL IN FIRST
TRIMESTER

2-PATIENT WITH BLOODY DIARRHEA WITH HUS
TREATMENT PLASMA EXCHANGE

3-LEADY WITH MISSCHRAGE BEFORE WITH THROMBO EMBOLISM
TREATMENT WARFARINE INDEPENDTILY

4-OLD AGE WITH AF
TREATMENT WARFARINE

5- PATIENT WITH UREATHRAL DISGHARGE G NEG DIPLO COCCUS
TREAT MENT FIRST THIRD GENERATION CEPHALOSPORINE BUT NOT PRESENT IN OPTIONS. SO TR IS CIPLOX

5 PATIENT TRAVEL FROM USTRALIA TO LONDON BY AIR LINE GET CVA
PATENT FORAMINE OVALE

6-PART OF KIDNEY IMPERMABLE TO WATER ASCENDING LOOP OF HENLE

OLD AGE WITH RECCERENT PNEMONIA HIGH WBC CLL

7-PROMYELOCYTIC LEK (M3) FUSION OF GENE(17-15)

8-patient with headace sign of temporal arteritis (prednosolone)

9-PATIENT WITH OAT CELL CA TREATMENT CHEMOTHERAPY

10 CARDIC PATIENT RECIEVE AMIODARONE GET PHOTOSENSEVITY REACTION

[ahmaddd]

Why not in a pregnant lady... propylthiouracil.....as there are symptooms present i:e palpitations.

Secondaly why is the diagnosis of a person on aeroplane getting CVA is "Patent Foramen Ovale"

[kadhaum ALAMOI]

hello ahmaddd

regarding preqnant lady with tremor and palpitatio


CROSS REACTIVITY OF TSH RECEPTOR BY HIGH HCG LEVEL IN FIRST
TRIMESTER .
because two hormones tsh and hcg have (common alpha unit)
propyl thiouracil is safe and can be use but is often unnecessary.

regarding leady travel from australia to london she was health before
travel get dvt due to long tavel then emboli from vein to rt side of heart
throw patent foramine ovali to lt side to cerebral circulation.this is the senario of this qestion
thank
dr kadhaum

[dibble]

thank you Nath for all your work.
here is what I want to add.

Additional questions I do not think are on the list:

74yr male. drowsy and confused. Normal anion gap acidosis: acetazolamide.
Other answers were causes of raised anion gap acidosis.

Questions on your list which I disagree with your answers. See what you think.

10. P value 0.01 means that there is a less than 1 in 50 cheance that the nul hypothesis is correct. "Fruit juice is helpful in Crohns" implies causation, which a p value cannot tell you.

19. High calorie food- I think butter.

43. Recurrent thromboembolism - lifelong warfarin. (Give 6 months warfarin in 1st embolism, lifelong in subsequent emboli.)

77. Anaphylaxis pt from prawns. I think the answer is do nothing because he was already hypertensive and has normal sats and presented 2hrs after ingestion. Close observation would be the treatment and steroids would be the real treatment, not further adrenaline.

90. Sciatica pain- physio.

My answers to the questions you did not specify the answer:

109. Works in kitchen, skin reaction: Wear gloves.

115. Intermittent palpitations - event recorder.

121. Photosensitivity rash - amiodarone.

135. Temporal arteritis - give prednisolone.

161. Type II resp failure in COPD - I think longterm nebs but I'm not so sure about this one.

162. Young lady, depression. Recent bereavement. Stopped meds 7 dayys ago: I think benzo withdrawal.

163. Young boy with acne - I think isoretinoin.


170 Forehead lesion: I think sebaceous cyst. (Although no punctum, nothing else fitted this description.

So that is my contribution. Feel free to comment.

thank you Nath for all your work. I will continue to try to find out some answers.

God bless.
D.

[sawsan s]

some Answers corrections
breaking of polypeptide: proteasome
rate control in AF: flecainide
Patients with painful, isolated third nerve palsy with pupillary involvement are assumed to have posterior communicating artery aneurysm until proven otherwise.
child with sore thraot and heamaturia: hypercellularity
24 hour h/o bllody diarrhea: I think campylobacter
malignant melanoma: I think the site of lesion is the answer
COPD with lobar pneumonia, Rx: amoxicillin only!

[shabana]

lower right chest pain 15 minutes after liver biopsy?
hemobilia
bilairy peritonitis
pneumothorax
subphrenic hematoms?

what is the answer please?