PART 2 MRCP DEC.2006

[OREOLUWA]

Please those that have passed the Part 2 exam .kindly give advice here.Will be writing the Dec.Exam

[Guest]

Just finishing the the first two papers now.Paper was good but paper two diff.hoping paper 3 will be better will post some questions later.

[Guest]

please discuss the photographic materials in the 3 papers

[Guest]

lets discuss the photographic materials what i remember
ECG anterior MI
burgada syndrome
av-bundle of his block (prolong PR+BBB
SVT+BBB
pagets
UC
erythema chronicum migran
warts or molluscum
rash on face
rach on scalp psoriasis /discoid lupus
please add yours

[guest 2]

1.renal cell ca
2.CADASIL
3.GB syndrome
5.brugada synd
6.av node disease
7. hydrocortisone, post surgical adrenal crisis
8.hyperparathyroidism
9.blood cultures/echo last question
10.panic attACK
11.heparin for PE
12.SLE
13.gastric lavage
14.chemotherapy cardiomyopathy
15.oral mesalazine
16.distal RTA
17.diuretic abuse
18.ulcerative colitis( xray abd)
19.acute ischaemic optic neuropathy
20.oral ferrous sulphat
23.extradural haematoma
25.lichen planus
26.hypothyroidism(high MCV, tiredness, muscle tenderness. not anaemic, muscle biopsy inconclusive)
27.abg,s ANS.D
28.iga nephropathy(transplant girl)
29.membranous nephropathy
31.sulfasalazine induced nephritis
32.skin biopsy
33.immunoglobulins(GBS)
34.TFT,s(high MCV 16)
35.esophageal candid( odynophagia)
36.teriparatide
37.renal art stenosis
38.mediastinal LN biopsy
39.acute pancreatitis
40.acute ischaemic bowel
41.low dose dexameth test.
42.simvast/losartan???
43.acute HIV
44.EBV(rash, l nodes)
45.reidel,s thyroiditid
46.MV Prolapse on echo
47.chorda tend rupture
49.minimal change nephro.
50.anti thromb 3 def/dehydration???
51.reassure, continue carbimazole
52.autosomal dominant with incomplete penetrance
53.diverticular dis
54.seborrhic keratosis
55.lentigo maligna
56.anti GBM ab
57.churg strauss synd
58.long acting B agonists
60.cefuroxime as empirical therapy
61.gentamycin toxicity
62.herceptin for ca breast(taz...)
63.caeliac disease(biopsy)
64.crohn,s disease
65.iron deficiency anaemia ( blood film)
66.DEC
67.ecstasy OD
68.LITHIUM TOXICITY
69.oral diazepam
70.schizophrenia/drug induced psychosis
71.giant cell arteritis/lymphoma..ct abd/chest normal
72.EAA

[Guest]

1-the ECG is for av node desease and his bundle cause it showed first degree block and BBB
2-the thyroiditis is viral De quevarian (tender thyroid high ESR and hyperthyroidism
3-last question is thrombophilia screen
4-for pulmonary embolism its MASSIVE so thrombolysis
5-there is laxative abuse not diueretic
6-hemodyalisis and Hb 8 blood transfusion
7-the acute abdomen is budd chiare(actute abdomen+hepatomegaly and tender+high liver enzymes+and even the GT is higher than AMYLASE tricky
8-the cushing you do first midnight and early morning cortisol to confirm that there is hypercortisolism then you perform the low dose dexa to differentiate between priary and secondary cause then you perfom the high dose dexa to localise the lesion later you do the ACTH .
in the question you were given the clinical picture but there were no evidance of high coryisol
9-for the breast carcinoma its Transtuzumab because its HER-2 positive (+3) and both estrogen and progestrone receptor negative
10-the blood film showed (spherocytosis+polychromasia+agluttination) all compatibe with chronic hemolysis of autoimmune eitiology
12-COPD pt with PO2 7.8+evidance of HF the management is LTOT for 15 hours daily
13-the boy with cannabis and paranoid dellusions this is cannabis induce psycosis
13-women post amputation this is depresive disorder
14-alchol withdrowal IV benzodiazepin
15-the one with nephrotic syndrom duo to minimal disease its ANTH3 loss
16-

[optimist]

please want detail of question and not only answer
Q of polyuria+thirst+some low back pain problem
was it neurosarcoidosis

Q old age, 3wks back antibiotic for chest infection, now diarrhea..and bloody(not sure)
was is it psuedomemb. colitis

[Guest]

it was histiocytosis x

[Guest]

where is khk,this time----

[Guest]

chronic mutthu,he is,busy

[optimist]

why i have impression that every one who attend exam not care this time.
is this due to:
1-depression
2-exam was easy so sure will pass
3-loss hope
4-indifference
5-tiredness

[OREOLUWA]

I WROTE THE EXAM TOO,IT SEEMS FAIR ENOUGH BUT VE STARTED TO READ ALL KINDS OF OPINIONATED ANSWERS I GUESS THE ROYAL COLLEGE WILL DECIDE WHO PASSES.

I WILL GIVE A LIST OF ALL THE QUESTIONS SHORTLY STILL COMPILING THEM.

THANKS TO ALL THE PAST EXAMS QUESTIONS POSTED ON THIS SITE SOME OF THE QUESTIONS AT LEAST I COULD COUNT OVER 100 REPEATED BETWEEN DEC.05 AND JULY 06 IN DEC.06 EAXMS.

KENGLAD HOW WAS IT?

OREOLUWA.

[laxani]

Photographic material:
1.ECG anterior MI + RV hypertrophy
2 ECG- burgada syndrome
3 ECG showed mobitz 2 block + RBBB, hence blockage in AV node + bundle of his
4 ECG showing SVT but asthmatic, hence give verapamil
5 XRAY pelvis showing lytic lesion- myeloma- give melphalan + steroids
6 Xray hand showing ? ruptured brachialis tendon ? not sure about this one
7 XRAy abd- lead pipe colon of UC
8 lesion on scalp elderly patient seborrhaic keratitis
9 lesion on nose lentigo maligna
10 young boy with rash in flexor of wrist ? scabies - didnt look lile LP-Rx malathion
11 molluscum contagiosum photo
12 2 MRI heads- I wrote chiari for both

13 MRI showing pituitary tumour- treat with surgery
14 CT brain extradural
15 MRI one showing contrast enhancement of a SOL- I wrote cefotaxime as treatment
16 Other MRI ? temporal enhancement? HSV encephalitis
17CT abdo looked like peritonitis but somebody said there were air shadows in pancreas, hence pancraetitis
18 Somebody went to sri lanka, had swollen right leg, eosinophilia, CXR showed diffuse air space shadow- I gave treatment of DEC
19 photo of hand of osteoarthritis with swollen nodes
20 an ophthalmoscope of ? retroorbital optic nerve compression or something like that- showed papilloedema I thought
21 blood film of I dont know ? malaria. nothing obvious. there were some spherocytes but the patient ( black ) came back from Ghana.
22 echo of MVP
23 CT abdo of renal cell carcinoma
24 MRI spine showing spinal TB



please comment. May I also ask you to discuss answers ASAP before we forget them.

[laxani]

I have taken the liberty to copy the above contributors question list and comment on them. I am happy that quite a few answers were the same.


1.renal cell ca - CT
2.CADASIL - obvious question with hereditary disease
3.GB syndrome - treatment was asked- interferon
5.brugada synd -ECG
6.av node disease -ECG
7. hydrocortisone, post surgical adrenal crisis Na was 105, K6.2
8.hyperparathyroidism
9.blood cultures/echo last question was SBE, asking for Ix to find etiology- I said BCX but probably Echo is a better answer
10.panic attACK - anxiety palpitation etc. sister recently diagnosed with brain tunour
11.heparin for PE - elderly patient, SOB, sats 83% on O2.BP 63/30. I also wrote S/C heparin. patient came in after a fall. ? will it be thrombolysis?
12.SLE - multiorgan involvement. cant remember
13.gastric lavage - cant remember the question but I did not write gastric lavage
14.chemotherapy cardiomyopathy. Picture of DCM on chemotherapy
15.oral mesalazine - infalmmed bowel on colonoscopy, diarrhoea for 2-3 weeks. stool normal
16.distal RTA - normal anion gap acidosis data question
17.diuretic abuse - I put Gittelmans. low Mg, K 2.7, BP was high. na normal. patient young guy 24 y/o. thin.
18.ulcerative colitis( xray abd- lead pipe
19.acute ischaemic optic neuropathy
20.oral ferrous sulphat . Q was somebody was on dialysis, anaemic? what needs to be done? I said parenteral iron.
23.extradural haematoma
25.lichen planus
26.hypothyroidism(high MCV, tiredness, muscle tenderness. not anaemic, muscle biopsy inconclusive) agree
27.abg,s ANS.D many ABGS given I think 4 in total. one was DKA. one was ph7.68 HCO3 34, PcO2 3,5 ? lab error ? resp+met alkalosis.
28.iga nephropathy(transplant girl) - Patient had protein+, nephrotic range proteinuria. I went for FSGN.
29.membranous nephropathy - I said FSGN. patient had blood+, prtn++
31.sulfasalazine induced nephritis agree. Another Q was NSAID induces colitis? never heard of it though.
32.skin biopsy I went for renal biopsy. It was a reno pulmonary syndrome with pANCA. Q was Ix to diagnose pathology.
33.immunoglobulins(GBS) agree
34.TFT,s(high MCV 116) - agree.
35.esophageal candid( odynophagia) specially to hot fluid. 45 y/o smoker. too young for cancer.
36.teriparatide - it was an indian lady with osteomalacia and osteoporotic vertebral collapse. history of achalasia. ( hence cant give bisphosphonate). I gave strontium.
37.renal art stenosis - Cr 650 2 weeks after starting ACE
38.mediastinal LN biopsy I agree, cant remember the Q though I think CT scan showed LN in mediastinum, nothing else. Non specific symptoms. Next Ix.
39.acute pancreatitis- no I put something else. The anylase was only 650.
40.acute ischaemic bowel
41.low dose dexameth test. Disagree, The Q was somebody with likely pseudocushings/ cushingoid. Dont you measure cortisol first to see if high or not? If high, then do low dose to differentiate pseudo/cuhing
42.simvast/losartan???- IDDM, obese, hypertensive etc, syndromeX. HbAic not too bad. next step to reduce mortality- I put ACE
43.acute HIV - seroconversion illness. classical in a young female tourist to africa. No condoms!!( joking)
44.EBV(rash, l nodes) raised lesion over chest.
45.reidel,s thyroiditid- fever, etc
46.MV Prolapse on echo
47.chorda tend rupture - I agree.
49.minimal change nephro.
50.anti thromb 3 def/dehydration???- cant remember
51.reassure, continue carbimazole
52.autosomal dominant with incomplete penetrance - agree. family tree question
53.diverticular dis - cant remember
54.seborrhic keratosis
55.lentigo maligna
56.anti GBM ab
57.churg strauss synd - asthma, arthritis eosinophilia
58.long acting B agonists
60.cefuroxime as empirical therapy - I think it was a brain abscess
61.gentamycin level. Q was somebody on treatment for IE. 1mg/kg genta given tds for 4 days. level high predose but normal 1 hr post dose. next step- 3mg/kg od or 1mg/kg bd. I put 1mg/kg bd
62.herceptin for ca breast(taz...) agree, HER +
63.caeliac disease(biopsy) agree.
64.crohn,s disease
65.iron deficiency anaemia ( blood film) - I disagree, no target/pencil. hypochromia. it was anisocytosis, spherocytes.
66.DEC - I agree, photographic Q, Sri lankan tourist.
67.ecstasy OD - young girl, dialted pupils
68.LITHIUM TOXICITY - cant remember the question but I think patient looked dry.
69.oral diazepam - somebody with alcohol withdrawal
70.schizophrenia/drug induced psychosis . Q was student presented to a/e with odd behaviour demanding position as psychologist. tangential talk, odd theory, much like russel crowe in the beutiful mind. parents said he had drugs 3 months ago. doing poorly in exams. no hallucination. I put schizophrenia.
71.giant cell arteritis/lymphoma..ct abd/chest normal , middle aged patient. CXR normal, CT abdo chest normal examination normal, bloods generally normal, CRP 120. vague symptoms, weight loss etc. I put GCA. lymphoma unlikely as no nodes found anywhere. CRP 120.
72.EAA- I think it was afarmers wife having breathlessness. no spiro data given.


some other Q:

1. huge oedema on frusemide PO 80 bd, metolazone 2.5 alt days, spiro- but not improving. next step ? IV frusemide
2. 90 y/o prev independent diagnosed with cancer with liver mets. pain, went home but came back. 2 days later developed pneumonia. what treatment would you discuss with family- ? broadspectrum Abx? I put sc diamorph as liver mets, pain etc. TLC.
3. strange CT showing ? hemangio in liver??
4. CT showing cholangiocarcinoma?

[laxani]

1. for COPD patient with Po2 7.8. Q was what will reduce readmission? I gave steroid inhaler. not LTOT as Po2> 7
2. Patient with acute drop in GCS ( between noon time and 3 pm ). midbrain localising signs actually given CT normal. Next step at 1900? thrombolysis? I played safe and gave aspirin via NG which is probably wrong.
3. a question on treatment of tertiary hyperparathyroidism ( a CRF patient) . ? parathyroidectomy . I wrote something else- got it wrong probably.

4 photosensitive rash- cause ? thiazide ? allopurinol
5. a question on addisons in a patient who was in south east of USA. CXR normal- TB?
6. Chagas disease Xray. T cruzi brazilian patient
7. one answer was neurosarcoidosisI think. cant remember the question.
8. One answer was serotonin syndrome. patient with sweating etc on citalopram
9. one NMS question. psychiatry patient.
10. one CF genetic probability Q. mum and dad both carriers. probability 1/2 X 1/2 X 1/4 = 1/8
11. one elderly man with pyelonephritis I think it was. rigor, pyrexia WCC high CRP high
12. painful superficial genital ulcer- Herpes
13. short term memory loss- alzheimers
14. one question with IHD, diabetic- cerebrovascular dementia
15. one question was multisystem atrophy

cant remember any more topic. If others can post some more questions/answers, some more detail might come back to my mind ( post exam dementia).


tata

[tarekdeema]

Dear laxani this was great from u ,nice memory I do have some comments on these answers
3-GB treatment is immunoglobulins
9-last qs was thrombophilia screen
6-it was av node and bundle of his (prolong PR+BBB)
11-This was MASSIVE PE treatment is thrombolysis(pt developed acute dyspne+RR 44+cyanosis+HF
17-his qs was laxative abuse (hypokalemic alkalosis with urinary K =23 this was the trick in barter and geitelman the urinary K is high >40
32-the pulmonary renal syndrome with p ANCA you do LUNG BIOPSY the most diagnostic test because granulomas are present there but a renal biopsy will show u necrotizing vasculitis only which is found in (wegners,chrugg struss , microscopic polyarteritis and PAN
35-oesophageal candid definitely u will do HIV test
39-this scenario is typical of BUDD CHIARE SYNDROME the hints are(acute abdomen+tender hepatomegaly 4cm+high liver enzymes gama GT is 750 and alpha amylase is 650 .nice one
41-you should always perform the 9 am and midnight cortisol level FIRST as to confirm the hypercortisolism and then you proceed
44-raised PURPLE lesions surrounded by bruising and lymphadenopathy is KAPOSI SARCOMA HSV8
45-tender thyroid+fever+high ESR is Viral thyroiditis(De quevarien) in reidle you donot get raised ESR
61-this one I agree with u cuz it’s the only respose that seemed reasonable 1 mg Bd
62Transzutumab for CA breast HER+
65-BLOOD FILM showed Marked spherocytosis(small round RBCs) and polychromasia(large gray RBCs duo to defective heamoglobinization when u combine these features it is a hemolytic BF +there was red cells agglutinins which point to AUTOIMMUNE eitiology so this is AUTOIMMUNE HEAMOLYTIC ANAEMIA
Malaria and celiac and sickle are excluded duo to absence of (paasite,target cells,howell joly bodies and hypochromasia
72-there was an EAA but I remember the elderly farmes wife was having miliary TB

[Guest]

thx all need more questions pls............really shaky whether or not I did good enough

one dispute..........it will be dieruticabuse not laxative....acc 2 sanjay sharma chartof hypok
thx

[Guest2]

Tough exam with quite a number of ambiguous questions. Thought Paper 3 was the worst of the lot. Some questions don't really recall maybe coz they were research ones different for various centres.

A comment for one question where an elderly lady is admitted after a fall and noted to have features of massive PE. It was stated that the patient was severely hypoxic and already hypotensive.

The question asked for the next appropriate step and this should be to intubate and ventilate first (which was an option given). I would agree with thrombolysis once she has been stabilized to some degree.

[oye]

it was laxative abuse as you would expect the urinary sodium and possibly potassium to be elevated in diuretic abuse. the values were normal. it was a close call between the two but that was the difference for me i think.

does anyone know what was wrong with the chinese chap on dialysis that started fitting?

[inamhk]

1.Patient was cystinuria, best treatmentanswer:? Pencillamine
2.Pneumonia/green sputum answer:? Ciprofloxacin
3.Respiratory case with systemic involvement,(liver,renal impairment),answer:?Leptospira
4.Young man with CNS involvemnt on both sides.answer:? Vertebral artery dissection
5.Warfarin for elective cardioversion, answer:4 weeks before and after cardioversion
6.Acute asthma, reasons for admission to ICU, answer:PO2 <8
7.lady with raised AST/ALT, raised immunoglobulins but negative ASM antibodies:? Autoimmune hepatitis
8.another question? non alcohlic steatohepatitis
9.Polycystic ovarian syndrome, the answer was between adrenal tumour and PCO, androgens were raised but there was no gross adrogenic features like male type baldness etc, so i went for PCO
10.Hypopituitary picture in male, what will reduce the risk of fractures, I put androgens
11.Adult polysystic kidney disease --- advise?
12.Vitamin D Toxicity?
13.Pheochromocytoma--- association? Hyperparathyroidim
14.Watery diarrohea, 12 months , weight loss, hepatomegaly, the answer was either Whipples or Carcinoid, there were no other features of whipples, i put carcinoid
15.van willebrand levels normal, what was the answer, i dont remember
16.Immunodifiency, what will modify the future course of disease, ? spleenectomy? immunoglobulins, i put immunoglobulins
17.Hypertension in renal transplant. answer:? cyclosporin
18.Acute spinal cord copmression, immidiate treatment? IV Methylpredinisolone
19.Oesophageal cancer, with lymph node involvement? what is the best course ? palliative??
20.Young lady with features of pulmonary hypertension, what was the answer?
21. Unilateral odema of the leg? what was the answer? diethyl....(?filiriasis)
Some photo questions:
1 Tongue diviated to one side, i dont remember what they were asking?
2.GIT SLIDE? answer?? chron`,/abcess/appendicular mass??
3.Another slide? Renal papillary necrosis?

All members to please comment on themes and clarify accordingly with their feedback, my answers may be wrong,
I am trying to rember more and will post further
Thanks.