Recall Mrcp 1 Jan 2014

MRCP-1 RECALL- JAN-2014

CARDIOLOGY Join us here: 1. https://www.facebook.com/Medicalvideosfordoctor s 2. http://www.medicalbook.org/f53-mrcp 3. http://medicalvideofree.blogspot.com/

1. Drug that decreases mortality post-MI= Valsartan 2. Malignant HTN that is not controlled by oral verapamil and bisoprolol, what next= i/v labetalol 3. Long apical diastolic murmur with pansystolic murmur, atria dilated with permanent AF and crackles in lungs, Dx= mitral stenosis? 4. 75 years man with high B.P has AF, Rx= warfarin 5. Patient with stroke alredy taking aspirin ,what next= add dipyridamole 6. Cardiac anomaly with pulmonary HTN, contraindication for surgery= pulmonary HTN 7. 2nd MI in a week , which test= ckmb

8. Canon waves= complete heart block 9. 25-30% carotid artery stenosis in a patient taking aspirin, what next= continue aspirin? 10. VF, shock at 200, then 360..no improvement , what next=amidarone 11. Diference between cardiogenic edema and ARDS= increase protein in fluid in ARDS 12. Cardiac effusion contain blood, characteristic finding= increase JVP on inspiration 13. Patient taking warfarin presented with DVT, what next= increase INR to 3.5+/-0.5? 14. Test of choice in HOCM= TTE 15. Most common finding in ECG of P.Emboli= Tachycardia Join us here: 1. https://www.facebook.com/Medicalvideosfordoct ors 2. http://www.medicalbook.org/f53-mrcp 3. http://medicalvideofree.blogspot.com/

HEAM/ONC 1. spherocytes in peripheral blood film, what test to do next= DAT 2. bite cells in peripheral blood film after treatment of UTI with ciprofloxacin, cause= G6PD Deficiency 3. menorrhagia with bruises, small rise in apt and small fall in platelets, Dx=Von-willebrands 4. 70 years old with lymphocytosis, Dx=CLL 5. 10cm splenomegaly with neutrophilia, Dx= Myelofibrosis/CML? 6. 56 years active blood donor has now been refused as blood donor, he is assymptomatic and systemically well, blood film shows iron deficiency , likely cause= small intestine dysplasia/colon cancer? 7. Recurrent abortions with Dvt, ECHO findings= normal 8. Patient with a Episode of Haemetemesis presented, now hb=100(130-150) , what

intervention next= terlipressin/transfuse blood/endoscopy? 9. Patient being transfused twice weekly , now develops anaphylactic reaction , cause=GVHD 10. Increase cret, anaemia, thrombocytopenia, fever and confusion, Dx=TTP 11. CD20= Rituximab 12. Non-Hodgkins= EBV 13. Waldenstorms=Hyperviscosity syndrome 14. Factor 5 leiden= activated protein C resistance 15. Dx of Hypercalcemia of Malignancy Join us here: 1. https://www.facebook.com/Medicalvideosfordoct ors 2. http://www.medicalbook.org/f53-mrcp 3. http://medicalvideofree.blogspot.com/ PHARMACOLOGY 1. Digoxin prescribed to old age patient= volume of distribution increases

2. INH acts on liver enzyme= Cyp3A4-p450 3. Patient on lithium treatment , Tfts are normal, when to repeat test= 6 months 4. Clinical presentation of steven-johnsons syndrome was given, and the patient has known epilepsy, cause= limotrigine 5. Contact prophlaxis of meningococcal meningitis= single dose of ciprofloxacin/ 2 days on rifampicin? 6. SIADH cause = bendroflumethiazide 7. Diazepam and dosulpin overdosed, Rx= sodium bicarb 8. Paracetamol overdosed, cause= alcoholic 9. Obese with T2DM, cret is 150, drug of choice= pioglitazone 10. Patient taking morphine 75mg b.d, what to prescribe for breakthrough pains= morphine elixir 11. Patient prescribed allupurinol 1 week ago presented with pain in multiple joints now , cause= allupurinol 12. Patient presented with red eye was started on cholaramphenicol eyedrops, now presents with swelling of lid and erythema, cause= allergy to chloramphenicol

13. Cocaine intoxication presentation= persistant chest pain 14. Dx of amphetamine induced psychosis 15. Patient with rheumatoid arthritis being treated with MTX and Sulfasalazine with no improvemt, what next= etanercept/rituximab? Join us here: 1. https://www.facebook.com/Medicalvideosfordoct ors 2. http://www.medicalbook.org/f53-mrcp 3. http://medicalvideofree.blogspot.com/ CLINICAL/BASIC SCIENCES

1. Cause of increased anion gap= methanol poisoning 2. Respiratory alkalosis with po2=32, dx= psychological hyperventilation 3. CVID association with infections= meningococcal?

4. SIADH feature from scenario= urinary sodium of 60 5. Cystic fibrosis carrier rate?, mother had it and also one other family member had it = 1 in 25? 6. X-linked disease in a child, cause? = maternal grandfather 7. Breast adenoma, size 3cm, not movable!, which stage of cell cycle is this= G1? 8. Centromere covene at the centre in = metaphase 9. Refeeding syndrome= hypophosphatemia 10. Protein=western blot 11. Dx of L4 radiculopathy 12. Negative result when not diseased= specificity 13. Calculate specificity=40% 14. Compare proportions= chi-square test 15. Swaping and cross over in a study , = paired t-test 16. Rheumatoid arthritis= TNF-alpha 17. NF-1= chr.17 18. Use of PCR= cytogenetics/ protein conformation? 19. Liqorice=hypokalemia

20. Rheumatoid arthritis= b-lymphocytes 21. Gastric adenocarcinoma= signet ring cells 22. Index finger flexion= flexor carpi 23. Surfactant= type-2 pneumocytes 24. Forearm pain, worse on extention , can not use the pen= lateral epicondylitis 25. Cd20= rituximab Join us here: 1. https://www.facebook.com/Medicalvideosfordoct ors 2. http://www.medicalbook.org/f53-mrcp 3. http://medicalvideofree.blogspot.com/ DERMATOLOGY

1. Acne with scars, Rx= oral isotrtinoin 2. HIV +ve patient with pink patch on chest= Kaposi`s 3. Velvety lesions on flexures and neck ( dx=acanthosis nigricans), asosiation= gastinoma

4. Ileostomy site ulceration, dx= Pyoderma Gangrenosum 5. There was a question relating recurrent cellulites. 6. Extensive psoriasis, dry scaly skin , ist line treatment= emoliants 7. Dx of hand, foot and mouth disease 8. Dermatitis herpetiformis , test to diagnose= direct immunoflorescence of skin Join us here: 1. https://www.facebook.com/Medicalvideosfordoct ors 2. http://www.medicalbook.org/f53-mrcp 3. http://medicalvideofree.blogspot.com/ ENDOCRINOLOGY 1. characteristic of MODY= Family Hx 2. interpretiton of thyroid hormones, Dx= adequate dosing 3. hypothyroid patient presented with acute flare, Rx= Steroids

4. Cushings , test to Dx= Oral DST 5. Early morn sweating, with one such episode , blood glucose was 4, gets well with sugar diet, Dx= Insulinoma 6. Pancreatic insufficiency, how to control diarrhea= octreotide/pancreatin? 7. Patient taking quitepine has amenorrhea but not galactorhea, cause? 8. Dx of Kallmans ( both FSH AND LH were low) 9. PKD, test ?= U/S abdomen 10. Adrenal mass, it was either pheocromocytoma or primary hyperaldosteronism? They have asked for Test to diagnose= urinary metanephrines/ ald-renin ratio! ( I opted for primary hyperaldosteronism, which may be wrong ) 11. True about thyroxine= increase gluconeogenesis 12. Retoncogene asosiation= medullary throid cancer 13. Dx of acromegally= GTT and GH measurements

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1. Bilirubin got raised after 1 week of starting coamoxiclav, cause= co-amoxiclave/ gilberts? 2. Dx a case of Achalasia ,and they asked for test of choice= oesophageal manometry 3. Dx a case of Hepato-renal syndrome 4. Hepatitis C complication= PCT 5. Hepatitis C case= check for antibody 6. Anti-Tb meds caused hepatitis, now they are stopped , how to monitor response= liver enzymes 7. Best antiviral response to interferons if it shows = HbeAg ( Infective particle) 8. Dx of possible Laxative Abuse

9. Best test to Dx Giardiasis= Small bowel biopsy 10. Hx of bloody diarrhea after 1 week return from travel= entameaba histolytica 11. Dx of Celiac disease ( vit-b12 was normal, Rbc folate was low) 12. Contraindication of liver biopsy= dilatation of bile ducts 13. Damage to liver= prothrombin time 14. Question relating MRCP ( Magnetic Resonance Cholangi-Pancreatography) 15. Dx of pernicious anaema ( there was autoimmune hepatitis, vitiligo and hemolysis). Join us here: 1. https://www.facebook.com/Medicalvideosfordoct ors 2. http://www.medicalbook.org/f53-mrcp 3. http://medicalvideofree.blogspot.com/ INFECTIOUS DISEASES

1. LGV Rx= doxycycline 2. Lyme disease rash in pregnant, previous hx of allergic rash to penicillin, Rx=Cephalosporin 3. Migratory arthritis scenario, Dx= Lyme disease 4. Dx of leishmaniasis 5. Case of Reiters, asosiated eye findings=conjunctivitis 6. Ring enhancing lesion in parietal area , Dx= Toxoplasmosis 7. Black spot on thigh after return from Africa= Tick typhus 8. Immunocompromised old age patient comes in contact with a child having chickenpox= give VZIG 9. Meningococcal meningitis Dx=Culture ( antibiotics have not been given yet) 10. Scenario of PCP, what is suggestive of Dx= exercise desaturation 11. Patient with subarachnoid heamorrhage presented 12 hrs later, what test appropriate= LP 12. Best test to diagnose Mycoplasma= cold agglutinins/ throat swab for serology? 13. Community acquired pneumonia= streptpneumonie

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NEPHROLOGY

1. Nsaid induced ATN 2. Penicillin induced AIN 3. Prevent contrast induced kidney damage in a patient known diabetic= normal saline 4. Colon cancer has been surgically removed in patient, his kidney functions have markedly improved, dx= membranous GN 5. PAN= MPO 6. IgA nephropathy poor prognosis= HTN 7. Comon with type-1 RTA= nephrocalcinosis 8. Recurrent UTI`s= Reflux nephropathy

9. PKD= Ultrasound 10. C4 decreased= SLE 11. Dx of glomerolunephritis= renal biopsy 12. Long standing kidney disease , one kidney has size of 7cm now= amyloidosis? 13. Scenario of pyelonephritis Join us here: 1. https://www.facebook.com/Medicalvideosfordoct ors 2. http://www.medicalbook.org/f53-mrcp 3. http://medicalvideofree.blogspot.com/ NEUROLOGY AND OPHTHALMOLOGY

1. Essential tremor with head titubation Rx= propanolol 2. Dx of multiple system atrophy 3. Parkinsonism characteristic= asymmetry of tremor 4. Dx of cluster headache

5. Status epilepticus Rx= Lorazepam 6. Memory loss, personality and speech affected, area involved= frontal lobe 7. Weber syndrome , site involved=midbrain 8. Possible Dx of perinauds, site of lesion= dorsal midbrain 9. Hemi sensory loss from head to toe, area involved= thalamus 10. Sub acute combined degeneration involves= dorsal column 11. Syringomylia= prick sensation lost in arm 12. Dx of conus-medullaris syndrome 13. Dx of Fascio-scapulo-humeral dystrophy 14. GBS, respiratory monitoring = Vital capacity 15. Schwanoma= corneal reflex lost on same side 16. Dx of poliomyelitis 17. Bulbar palsy= small arteries hyalinosis 18. What is underlying cause of CRVO from the given scenario= Glaucoma ( increased IOP ) 19. Immediate referral= neovascularization on retina 20. Dx of ischemic optic neuritis

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1. Dx of idiopathic pulmonary fibrosis 2. Upper lobe fibrosis with skin findings= sarcoidosis? 3. 3cm mass, suspected small cell cancer, Rx= chemo/surgery? 4. OSA Characteristic feature= excessive daytime sleep 5. Dx of chronic occupational asthma 6. Dx of psychological Hyperventilation 7. PCP scenario, O2 sat was less than 9, Rx= steroids 8. Increased survival in COPD= LTOT 9. Pulmonary edema not responsive to CPAP, Rx= NIV

10. Pleural effusion and thickened pleura (mesothelioma), best test to diagnose= pleural biopsy 11. Pulmonary emboli , most common ecg finding= tachycardia 12. Possible Dx of Emphysema( alpha anti-trypsin deficiency 13. Dx of Ext.Allergic Alveolitis Join us here: 1. https://www.facebook.com/Medicalvideosfordoct ors 2. http://www.medicalbook.org/f53-mrcp 3. http://medicalvideofree.blogspot.com/

PSYCHIATRY 1. Dx of global amnesia 2. Dx of Somatisation syndrome 3. Dx of Panic disorder 4. Dx of Depressive disorder

5. Dx of acute schizophrenia 6. Dx of anorexia bulimia 7. Dx of wernekes encephalopathy 8. Dx of amphetamine induced psychosis Join us here: 1. https://www.facebook.com/Medicalvideosfordoct ors 2. http://www.medicalbook.org/f53-mrcp 3. http://medicalvideofree.blogspot.com/ RHEUMATOLOGY

1. chondrocalcinosis= pseudogout 2. distal joint involved, mild morning stiffness, Dx= osteoarthritis 3. case of osteoarthritis, now same joint inflamed , swollen, Dx= septic arthritis 4. knee joint swollen,temp of 37.5, patellar tap absent, Dx= prepatelar bursitis 5. dermatomyosities= anti-jo

6. Dx of Limited systemic sclerosis 7. Pain in right hip joint , gets better with analgesia , now pain in left hip joint, Dx= Bilateral Hip dysplasia/ reflex neuropathy? 8. Scenario of eosinophillic fasciitis 9. Migratory arthritis= lyme disease 10. Dx of Ankylosing spondylitis Join us here: 4. https://www.facebook.com/Medicalvideosfordoct ors 5. http://www.medicalbook.org/f53-mrcp 6. http://medicalvideofree.blogspot.com/