mrcp july 07 part 2 recollect questions /share experience

[dk]

ok guys lets start remembering questions

dresslers syndrome
question about bird flu

[glad]

Posted: Thu Jul 26, 2007 10:07 pm Post subject: MRCP PART 2 JULY 2007

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tHE EXAM WAS SOMEWHAT TOUGH, VAGUE QUESTIONS, BUT WAS MANGEABLE.

ANYONE WANNA SHARE EXPERIENCE FROM THE EXAM?

BYE




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guest apo
Guest






Posted: Fri Jul 27, 2007 5:30 am Post subject:

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2 ethics questions -
one about a main on 2 years of dialysis, symptomatic and waiting for cadaveric transplant who wants advice re getting a new kidney.
Should you
a) convince him to take his willing 16 year old son's kidney
b) tell him to wait his turn on the cadaveric list
c) persuade his wife to donate hers
d) urgently refer for cadaveric transplant
e) contact an overseas company about dodgy kidney deals

what influences your decision to make a mentally competent patient for or not for resuscitation?
a)age
b)co-morbidities
c)patient's wishes
d)family's wishes
e) can't remember e but it wasn't right

_________________
Help others to help yourself, in the end faith only matters

[drshereenahmed]

was dressler's or was it pericarditis
was the eye imaage licsh or holmes aidie
thr only retina was it a cmv or a candida

[ahmed almokadem]

answers
1\ ask him to wait for cadav. list
2\ pt wishes

[ahmed almokadem]

halmos eye
cmv
dermatomyositis
dressler s
verapamin constipation
clopdigrol
iv hydrocortizon
hperventilation
flail chest

[glad]

Posted: Fri Jul 27, 2007 6:15 am Post subject: mrcp2

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it was no joke


i really had the worst time of my lif

the exam was pretty hard and i think the time is hardly enough


i dont what the others have to say about the exam

i m waiting for your experience and feedback




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bonzy
Guest






Posted: Fri Jul 27, 2007 7:10 am Post subject:

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hi, i found it difficult.. no easy answers whatsoever.... every single question is a conundrum... a real nightmare...

some questions look easy, but there wasn't any straightforward answers, there is always something not fitting well with your chosen answer...

for example a patient with a quite typical history for cluster headache

2 month history of once daily 45 min episode of pain around eye and temple, with nose congestion and lid drooping... but then they say the pain happens in the early hours of the morning which is not typical of cluster headachce (happens in the night), besides 2 months is not sufficient time to make your mind about whether the pain comes in clusters or not.... other options were migraine, trigeminal neuralgia and i dont remeber the rest...

i was startled by how many HIV questions there were!!! many obstetrics questions which i hate!!!!

i initialy thought that 3 hours is so much for only 90 questions, but i was surprised to find myself barely finishing at time... 2 minutes only is NOT enough to answer a long and tricky question..

i'll try to post some questions i remember, but it seems nobody is interested at this stage in discussing anything about mrcp2...

yours.

_________________
Help others to help yourself, in the end faith only matters

[bonzy]

i think the guy with the renal transplant, the best advice is to encourage him to take his son's kidney, as his son is 16 which is a legal age to make independent decisions, and he would be the best HLA match..

as for the dnacpr, i chose the patient's wishes given he's competent..

as for the recurrent chest pain, pleuritic in nature i think it's pericarditis as it's more common than dressler's but i chose dressler..

HIV with bacterial looking pneumonia with solitary consolidation in lower lobe? strep pneumonia?
prostitute and drug user with botulinism
an old lady with syncope, ecg bradycardia and atrial fibrillation, how to manage, i was so confused between 24 hour ecg, or pacemaker given the severe bradycaria and the syncope!!
juvenile myoclonic epilepsy, sodium valproate...
lung function tests showing restrictive pattern but KCO increased i think the answer was obesity..
another obstructive pattern and KCO increased, asthma... but chest xray equivocal??
a man who gets dark burgundi urine on exercise, raised ck and myoglobinuria... ?polymyositis. alkaptonuria.
amyodarone causing thyroid disturbance, what to do, stop amiodarone or give carbimazole...
best approach to preserve renal function in young diabetic type1 with no hypertension nor proteinuria, Strict glycaemic control, ACEI, others..
a picture of irritant dermatitis i think....
a lady who has been to some countries (she might have been a prostitue or HIV positive, icant remember)... and has a picture of acute hepatitis, hepC, or mushroom (aflatoxin)..
cough variant asthma how to best diagnose... i forgot all the choices.


write later.

[Guest]

hi guys ,i think mrcp is never easy,it lookes easy ,but tricky.
same more questions
-lady husband died 1 yr back ,came with abdompnal pain many time, every thing norma... hypochondriosis,somatisatioon,adjestmant.i chose somatization
- pt with polyurea and polydipsia low plasma osmolality,low urine osmolality.... polygenic.
another

[Guest]

another q PT had accident was admited, withhight plasma osmolality low urine osmolality....SIADH....DI...DEHYDRATION......
-PICTURE OF PREGNANT LADY WITH ERYTHEMA AND BLISTRING ON UPPER THIGHT AND ABDOMEN .WHAT YOU WILL GIVE ..PREDNISOLONE, ACYCLOVIR.........
-ANOTHER PICTURE PT HAD SAME LESIONNS ON FOREHEAD AND DORSUM OF HAND.....SEDECIOUS CYST...MALGNANT MELANOMA......
-OLD MAN WITH PALE STOOL AND DARK URINE...CA PANCREASE
-PT WITH UC, DISTURBED LFT ...CAH..SCLOROSING CHOLINGITIS ...IT WAS NOT STREAT FORWARD
-

[HALIT2007]

one question was about heterchromia (there was a picture) i think the answer is congenital horner's syndrome.

[HALIT2007]

cough variant asthma how to diagnose, i think the answer was histamin challange as both histamin and methacholine challenge tests can be used to diagnose cough variant asthma

[HALIT2007]

2 ethics questions -
one about a main on 2 years of dialysis, symptomatic and waiting for cadaveric transplant who wants advice re getting a new kidney.
Should you
a) convince him to take his willing 16 year old son's kidney
b) tell him to wait his turn on the cadaveric list
c) persuade his wife to donate hers
d) urgently refer for cadaveric transplant
e) contact an overseas company about dodgy kidney deals

The answer is to convince him to take kidney from the son as the same question in in pastest practice papers book

[HALIT2007]

the ECGs i tihnk the brought it from the space, very difficult

[Guest]

Qs---ethics---1-autonomy of the patient is more important is patient is mentalyy compesmentous---
2---He has the choice to accept his son's Kidney.

Guys I have dissected about 180 qs.If U wanna have serious discussion please start by topic.I am starting one from cardiology---thanks

[Guest]

Case Report: Cough variant asthma

Anthony D’Urzo, MD, MSC, CCFP Pieter Jugovic, MD, MSC

Chronic cough is the fifth most common complaint seen by primary care physicians,1 and for many it is a diagnostic challenge. In a few patients with documented airway hyperresponsiveness (AHR), cough can be the sole presenting symptom of asthma. This uncommon clinical condition is known as cough variant asthma.2 Despite underlying AHR, it is difficult to diagnose cough variant asthma because these patients typically have normal lung function that does not change in response to bronchodilator challenge.

Case description

A 32-year-old woman initially presented with an intermittent nonproductive hacking cough that had lasted several days. She denied having other respiratory, cardiovascular, or constitutional symptoms. Review of systems was unremarkable. Her medical history was negative for atopy, gastroesophageal reflux disease, cancer, tuberculosis, or cardiopulmonary diseases. She was a non-smoker and did not have a history of occupational exposure to respiratory toxins. Results of physical examination were normal. For symptom relief, she had used antitussives including codeine syrup.

Despite periods of remission, her cough persisted. Results of physical examination and chest radiograph were normal. Spirometry revealed normal pulmonary function with no reversibility after bronchodilator challenge with a 2-agonist. Her pulmonary function was further evaluated using a methacholine challenge test. Results showed severe airway hyperreactivity: provocative concentration for a 20% fall in forced expiratory volume in 1 second (PC20) was 0.398 µmol/L (normal PC20 > 1.4 mmol/L). Cough variant asthma was diagnosed, and treatment was started with a bronchodilator and an inhaled corticosteroid. After initiation of asthma therapy, the patient’s chronic cough resolved and her pulmonary function remained normal.

Discussion

MEDLINE was searched for articles related to diagnosis of cough variant asthma. Articles were found using the key words asthma, variant asthma, chronic cough, prevalence, diagnosis, and natural history. The search was limited to investigations completed between 1960 and 2000 of human beings, written in English, and conducted on both sexes. A total of 67 articles were found. Only articles that focused on cough variant asthma and its epidemiology, natural history, diagnosis, and treatment, were used.

The prevalence of adults with cough variant asthma in the general population and more specifically among asthmatic patients is unknown. Studies have not compared the prevalence of cough variant asthma to the symptoms and signs typically associated with classic asthma, namely wheezing, dyspnea, cough, and variable airflow obstruction. One Canadian study has shown that persistent cough and wheezing affect only 6% and 13% of asthmatic children, respectively,3 supporting the notion that isolated cough is less common than other clinical manifestations of asthma. Since cough variant asthma almost always presents as chronic cough (duration more than 8 weeks4), family physicians are faced with the challenge of differentiating it from classic asthma and from other very common causes of chronic cough.

Chronic cough has a lengthy differential diagnosis. Yet asthma, postnasal drip syndrome, gastroesophageal reflux disease, postinfectious cough, or some combination of these are most often responsible.1,4-6 A comprehensive approach to diagnosing chronic cough is discussed in another paper in this issue.

Cough variant asthma is elusive because history, physical examination, and laboratory results are often completely normal, as they were in this case. Among patients with chronic cough, underlying AHR can be the sole manifestation of cough variant asthma. While AHR is not specific for asthma, its absence makes a diagnosis of asthma very unlikely.4 Consequently, AHR is the key to detecting this occult form of asthma. Both exercise7 and methacholine challenge4-6 tests can evaluate AHR, but methacholine testing is better established.8 Ultimately, diagnosis of cough variant asthma depends on a positive response to a methacholine challenge test in concert with a favourable response to a brief trial of conventional asthma therapy.5,9

Briefly, methacholine is a cholinergic agent. It can enhance bronchoconstriction and artificially exacerbate potential airway hypersensitivity in healthy people, and to a markedly greater extent in asthmatic patients. A positive test is defined as a 20% reduction in forced expiratory volume in 1 second (FEV1) with a PC20 of methacholine less than 1.4 µmol/L. A methacholine challenge test is indicated when asthma is a possibility but when spirometry before and after bronchodilator use is not diagnostic.8 For this reason, methacholine tests are essential for detecting cough variant asthma. Absolute contraindications for methacholine testing include severe airflow limitation (FEV1 < 50% predicted), recent (within past 3 months) myocardial infarction or stroke, uncontrolled hypertension (systolic blood pressure above 200 mm Hg), and aortic aneurysm.

Methacholine testing has a positive predictive value up to 88% and a negative predictive value of 100% for cough variant asthma.4-6 Thus, negative results from a methacholine test preclude a diagnosis of cough variant asthma. A small portion of patients with positive results from a methacholine test have false-positive results (more likely among those with bronchitis, allergic rhinitis, chronic obstructive pulmonary disease, congestive heart failure, and cystic fibrosis).8 Cough variant asthma is more likely, however, when results of chest x-ray examination are normal and response to a brief trial of asthma therapy is positive.

Most often, patients with cough variant asthma respond well to bronchodilators and corticosteroid drugs.2 The few patients who are refractory to inhaled therapy often do well with oral corticosteroids.2 Diagnosis of cough variant asthma is confirmed only with demonstrated AHR during a challenge test when chronic cough responds well to asthma therapy. Current treatment recommendations stress the need for early diagnosis and control of asthma.10 The natural history of cough variant asthma underscores the importance of early detection and appropriate treatment, as many patients with cough variant asthma lose lung function and develop additional asthma symptoms.

Conclusion

Cough variant asthma is a diagnostic challenge because history, physical findings, and simple spirometry results often fail to uncover abnormalities in lung mechanics and AHR. Physicians should consider referring patients with undiagnosed chronic cough, normal lung function, and normal results from chest radiographs for methacholine challenge tests. Early introduction of inhaled bronchodilator and anti-inflammatory therapy should prove useful in alleviating cough and slowing the clinical progression of this type of asthma.

[guest apo]

there was a question about someone who'd been in Thailand and got bird flu and there was the option to give Oseltamivir amongst other things - I chose that one anyway.

[guest apo]

another rubbish question was one about rapid reversal of warfarin and the options were
FFP
PCC (prothrombin concentrate)
IV Vit K
Protamine sulphate

the thing is both the first two answers are correct - I hope this is one of the questions they take out for monitoring purposes.

[guest apo]

worst of all was having to queue for 25 mins for a bagel that cost £4 at OiBagel. I wouldn't cry too much if the Excel Centre accidentally burned down anytime soon.

I think the chap in the eye picture had Lisch nodules.

[rajeev aya]

OK guys How much ever I could remember I have written.

MRCP part 2
Slides

1.Pyoderma Gangrenosum answer steroids
2.CT head Young teenager with hx of convulsions from west indies travelled to south asia.
Ans= ? Tuberculoma(Caseating granuloma single lesion)/ Neurocysticercosis (multiple normally)
3 ECG atrial tachycardia with irregular conduction
4 Complete heart block
5 Holmes adie pupil
6 Gottrons papules Dermatomyositis
7 N CT head treatment aspirin
8CT basilar artery thrombosis
9Blistering Rash on pregnant lady ans ?steroids /?acyclovir
10. Chest X Ray Osteum Secundum ASD Commonest
11. CMV retinitis in an HIV patient. PIZZA fundus.
12. ECG reperfusion arrhythmia. Ans Do nothing
13 Acute promyelocytic leukaemia ans t (15,17)
14 Lady with hx of diarrhoea for 7 days No hx of Sickle cell disease ---(Pic) Osteomyelitis of lumbar spine cause ? Brucella or ? Salmonella.
15 ECG ? Pericarditis ? Stemi Infero lateral including 1 and avl. Patient has chest pain for 1hour.
Background of IHD answer Thrombolyse as pericarditis will not kill him ( I.e if you give pain relief)
16. CXR Fibrosing alveolus’s 2e to RA
17 CT chest Pleural effusion 2e to breast cancer
18 CT chest thymoma ans ??
19 Foot rash with nails Answer ?? Toe nail clippings for mycology or serum epidermal antibodies

Questions
1 suspected clinical Endocarditis started on ben pen and fluclox blood culture coag -ve stap. Contaminant Ans Do nothing continue same abx.
2 Muscle aches and pains.Burgundi urine on exercise answer was Mc Cardles disease.
3 Another Mccardles disease forget the question.
4 KC increased asthma
5 KCO increased obesity
6 Cough cause with normal Lung function answer Pharyngeal pouch therefore Barium swallow.
7. Lady with jaundice with low HB and platelets Auto immune hepatitis.
8 Spinal meningioma
9 20% pneumothorax answer observe . 50% pneumothorax corresponds with 2cms of air in the chest X ray. Surprisng but that s the truth. I got it wrong went for chest drain.
10 Don’t know the answer to this but pot thrombolysis --- gastro bleed of 450 ml or so what would you do--if you give FFP it will be fluid overload and increase clotting tendency and worsen his condition//? Tranexamic acid don’t know
11 Renal transplant --- Sons kidney
12 CML fluid overloaded ans Plasma exchange
13 Pregnant lady with hypertension --- methyl dopa
14 preg lady with type 1 diabetes with proteinuria ans ---? Methyl dopa again as amlodipine reduces blood flow to the fetus and ACE and b blockers contraindicated.
15. Pictuatory tumor leading to emergency Diabetes insipidus ans DDAVP not steroids ref OHCM emergency of DI
16. Cluster headache
17. HIV patient with Pneumococcal pneumonia
18 Legionella Answer Quinolone only one was Cipro
19 Amyloidosis with renal involvement Answer test to confirm echo
20 Painless burn on finger with small muscle wasting answer Charcot marie tooth The one with the palpable nerve in the hand Only other condition Lepromatous leprosy. I wrote syringomyelia
21. Myasthenia gravis Patient wanting a drug which does not give lung fibrosis and does not have dopaminergic dyskinesias Answer ?? Encaptone as it has on and off properties. Don’t know myself
22 Alopecia atreata 2e to renal failure an transplant
23 Methotrexate induced lung fibrosis with eosinophilia ans was not chronic eosinophilic pneumonia
24 Mentally competent patient Ans Patients WISH is supreme
25 Calcium channel blocker induced constipation
26 Mechanism of Obesity induced breathlesness ans Central chemo receptors
27 Haemoptysis Aspergillosis
28 TB diagnosis Bronchoscopy
29 Biopsy of Renal calcified kidney granuloma no caseation ans Sarcoidosis
30 Sarcoidosis confirm ans test Biopsy

[Guest]

9 20% pneumothorax answer observe . 50% pneumothorax corresponds with 2cms of air in the chest X ray. Surprisng but that s the truth. I got it wrong went for chest drain.

The right answer is chest tube as the patient's age was more than 50 and he was dyspneic, so as also he had secondary pneumothorax the treatment of choice in such case is drain