Qs RECALL / MRCP PART 1- MAY 2019 ---------DR.

SAIFEE
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1-Pregnant lady with early diastolic murmur increased on expiration? Pulmonary HTN as
there is loud S2,

2-Painful inguinal lymph nodes - ? LGV

3-Painful vaginal ulcers, girl not drinking anything due to painful micturition - ? Herpes
simplex virus

4-Confusion, temporal changes on CT - ? Herpes simplex encephalitis

5-Hemophilia A , odds to fetus being effected - ? i guessed in 4 , what was the answer ? X
linked reccecive1:4

6-Old lady with uti , how to reduce risk of fall - ? Physical restraint-- I think the question
asked for treatment of her confusion.. So I think it will be haloperidol as first line of
treatment,

7-Definition of sensitivity - something like "those with the disease ..."

8-Lady with small joint arthritis of the hands with the options being anti Citrulline, anti sm
- I Chose anti CCP antibodies

9-Chances of kid being affected in a genetic condition, answers in percentage given , I put
50 percent

10-Fragile x male with few symptoms with fsmily history of the disease
His sons wud b affected how much %

11-Dementia = MSME <24 in q. was 25 , Not Lewy body / Alzheimer

Man driving behind horses – schizrophrenia

student thinks professor evil ,hears voices - paranoid schizophrenia

Drugs that's cause long Qt:dilatizim.. Or that uses for alzhaimer??

Prosthetic metallic valve replacement with endocarditis ..asking antibiotics ? vancomycin

Long QT mechanism - blockage of K channels

 A lady with ck 3000 and difficulty in raising from chair.... anti ach antibodies.. or ct chest ?
Muscle biopsy *Ck is NL in MG

Inc creatinine .... trimethoprim

Restless leg syndrome ... ropinirole

RA case.. addedd adlimumab .. moa ..anti tnf

 pt treated for pnemonia , has LTC with suspision of uti , what do u do with the amoxicillin ,
- ? Change to co amox, pt have resistance to amoxicillin, so Cipro

Meningitis case..Allergic to amoxicillin.. give chloramafenicol

Meningitis-- prophylaxis for family -- Cipro

uy with uti with E Coli of 100,000- was was the investigation

Case of chalamydia trichomatics .. rx doxy 

Case of pnemonia .. lab shows low Na.. i did legionella

Case of otitis media with discharge then half face paralysis (bells)?... where is lesion .. trunk
of facial nerve
Female with tenderness on lat side of thigh, no problem in movement in any direction ...
tronchentor bursitis?

Case of low back pain tenderness ..on upper back too .. multiple tender points
...fibromyalgia?

Case of late diastolic murmur ... MS ?

Female treated with anythrcyline now developed sob ..cardioxicity? she has kaussamul sign
so malignant pericardial effusion…Cardiac tamponade.....sudden onset Kaussam. Sign

Case of thyroid cancer.. treated.. now check thyroglobulin to followup.?

Female with thyrotoxicosis. pt has increase uptake in rt upper lobe, .propranolol given..one
nodule radio uptake .. Rx.. carbimazole.. PTU..radioiodine therapy .near total thyroidectomy
?

psychiatry qs.. i did ..

Cannabis induced psychisis?
..
Psychotropic drugs usage ?
..
Drug induced psychosis?

Qs asking tacrolimus toixcity. Pt on fluconazole too...i did dec renal clearance nt sure

Fluconazole = p450 inh. =toxicity

 Female with urine incontinence memory loss.. with falls ..NPH

Female with Bitemporal hamianopia ..bp 80/50..i did pituitary adenoma?

 lady with upper limb symptoms and loss over sensation over the thumb and index finder -
C6

One qs of simvastatin drug interaction.. it was clarithromycin

Rash on legs after throat infection.. guttate psoriasis?

Iv drug abuser. Site abscess.. and endocarditis? Rx  fluclox 

 Forearm pain on wrist extension? Lateral epicondylitis? Radial tunnel syndrome?

A case of LFT deranged.. Gamma gt raised.. i did alcoholic hepatitis?

There was a q on deranged LFTs with hep A , B , C as the options , what was the answer

A case of surgery. On warfarin already.. what to give.. i did prothrombin complex?

Qs of severe diarrhea ..chinese restaurant .. i did b.cerus

Qs of liver cirrhosis .. peritonitis,(SBP) peritoneal dialysis...Staph Epidermis , E.coli

Qs of one month diarrhea .. multiple joint pain .. i did Whipple's

Qs of gastric cancer .. eradicate h.pylori , Family history as the most imp factor,

Qs of foot injury.. got tetanus infection.. moa of tetanospamin ?? Endocytosis..exocytosis..

inc dna protein synthesis etc

 Qs about NG tube placement in Parkinson pt.. first thing to confirn.. ask to speak..auscultate
air on steth .. cxr..?

man with lung functions tests , had changed 3 jobs , - was the answer hypersensitivity
pneumonitis

Drug implicated in c diff infection - ? Omeprazole, simvastatin, aspirin

Qs with Hb A2 was 4... i did beta thalesemia trait ?

pt with SVT settled with vagal massage - ?now on ECG there is preexcitation vt… reassure
and discharge

Most common finding in PE - ? Tachycardia, S1Q1T3 on ecg

Anaemia with sidroblasts on film , splenomegaly, mom had spleen removed - Sidroblastic
anaemia
Pancytopenia with mention of teardrop cells - answer something like mylodysplasia or
myelofibrosis

 target of imatinib - tyrosine kinase

CML as the anser to one of the questions , i think the pt has spleemomegaly , is this the
same question where there is raised WCC ..

heart block in the baby - anti Ro

migraine prophtylaxis – propranolol

pt with diplopia, ptosis , poximal limb weakness- myesthenia gravis

nephritic picture , ACR normal , ? investigation - ? biopsy

80 yr old lady with painless visual derterioration from last 4 days , hypertensive, cotton
wool spots , options being hypertensive something , CRAO , CRVO - what was the answer ?

hyperthyroid patent , very low tsh , raised t4 , thyrotoxic nodule picute , iodine uptake on
scan asking for MX with the options being carbimazole, radiodine - what was the answer ? (
i put radio ioidine )

 acts on a membrane channel – furosemide

highest glycemic index ? choclate

pt with toxoplasmosis - pyrimethamine ( i got it wrong :( )

t1dm pt claiming he had ingested something , anion gap was normal - diabetic ketoacidosis

 pt vomitting with gatric something , what would u expect -hypokalmic alkolasis

anorexia female .. which drug she is taking ..frucimide..thiazide ..?

apkd most likely association - spleemomagaly , MVP

One case of electrolyte imbalance ..u gave calcium.. why .. i did membrane stability

One case of SAH ..did clipping.. now what to do initial investigation .. CT..MR brain..
venogram brain

pagets disease rx a bisphosphonate

One case female got HRT.. main indication .. menopausal symptoms

 papillary carcimona , monitor with Thyroglobulin 

squamous cell carcinoma with confusion and polyuria --primary hyperthyroidism 

Oral n genital ulcers .. which HLA ? I did HLA B51

sorethroat and multiple oral ulcers of hard palate and tongue , options being some king of
fungus , HSV, - I chose HSV

 FFP given .. what’s risk . Anaphylaxis. Ascetic meningitis? Other options were too

angioedema .. what will b increase .. bradykinin ..histamine ..?

how u transfer the stuff.. keep on ice..keep at 37c.. keep in freezer ..??

gastro question old man with micro anemia picture , asking for inv , - colonoscopy,
endoscopy with duodenal biopsy.

Female with skin rash papules on face chin around nose cheeks.. what u give
..isoterntoin..doxy ..amox.

pt takes cocaine .. bloody diarrhea ... i did ischaemic colitis

 wt loss ..rt lower quadrant palpable mass .. i thought it could b cecal tb ..?

 pt having lympadenopathy .. night swts .. etc.. i did lymph node biopsy

 Teratoma cancer .. afp raised .. what to do followup.. b.hcg.. LDH.. ?

Short girl with prob with sexual characteristics primary amenorrhea  - I put turner
syndrome

vomiting ..suction splash. Pyloric stenosis.. what electrlyte imbalance .. hypokalemic

alkalosis

Diarrhea for one month.. hx of travel .. Now bloody diarrhea .. rt upper quadrant pain.. dx..
ameobiasis.. salmonella entritis ?
Cryoglubinemia sample handing, send to lab in 10 min -- keep on ice , keep in 37.c, keep in
freezer, keep under sunshine

Young guy with asymptomatic hyperbilirubinemia.... gilbert syndrome

Medullary sponge kidney .. What will have pt in the end .. large kidneys.. HTN.. end stage
renal disease.. acute kidney injury ?, nephrolithiasis.

Most sensitive investigation for pleural tb - ? pleural biopsy with fluid something, pleural
fluid microscopy n culture,

Pt on Dialysis .wrist pain.. what will be deposition.. beta 2 microglobulin ?

Myoclonic seizures..... rx.. Sodium valproate

Thrombocytopenia.... i did autoimmunity

Function of C3 , - --- t lymphocytes, opsonisation,

Black spots in mouth ..peutz jeghers ? Asking colon ca ?

Stroke, hypertensive patient, site of lesion..

Bone pain... taking morphine.. Now buprenorphine added .. why .. Relieve pain.. Add
anesthesia. Respiratory depression.

 CCBs mode of action.. on arterioles ..on venules.. on capillaries . elastic arteries .?

Anaphylaxis.. Angioedema.. rx .. --- IM adrenaline

Young diabetic , strong family hx of diabetes = sulphonylureas, young with a positive family
hx pointing towards MODY, for which Gliclazide is first choice

MOA Gliflazolin ====== glycosuriac

Resistance to penicillins ....asking mechanism.. beta lactamase enzyme, efflux pump, influx

Drug-Ambreastein MOA = Endothelin receptor antagonist

Hx of exposure to tobacco, upper lobe changes = ext allergic alveolitis

Guy have fast driving on narrow road.. said i cant have any accident as some angles guiding
me .. he had ecstsy taken previously too.. ? I did drug induced psychosis

pt had worsened creatine , asking for cause - limb chopped off

advantage of humanisation of monoclonal antibodies -Reduce immunogenicity, reduce

antigenicity

lady cant concentrate , feels low , asking for diagnosis - ? generalised anxiety disorder

patient on some parkinsons meds , cant tolerate co caroldopa , what would you add
,options being MOA , selegeline , - amantadine, selegiline , 

Gastric bypass surgery bariatric surgery, ? most common deficiency—zinc, folate, iron

 Lady with prev breast cancer , now hypercalcemia , bone scan normal , ? next investigaion -
? electrophoresis

pt goes flacid , kind of falls down , options being epilepsy , cataplexy --- ? cataplexy

.female having pubic hair louse ...permethrin, hair cutting cleaning option

Hpeatitis A ---for guy came from India or something like that

Fast acetylator took Inh = hepatitis ( exam Q )

Slow acetylator took Inh = peripheral neuropathy

Ptyriasis rosae = HHV7 homonis bovis

Separate proteins by which Molecular technology---elisa, western, southern

Paget's--zoledronic acid and aldronate sodium

Dissociation curve: o2 more released to tissue always to right ie, ans: raised pco2.

Acromegaly.cause of sweating?ans: BMR,Sympathetic activity?? hypertrophy of sweet

glands
Squamous cell ca of lung- surgery contraindicated when with vocal cord paralysis*

Duloxetin ----GABA , SSRI, SNRI,

Hyponatremia + bilateral basal consolidation is mycoplasa , legionella

Recent bleed in the brain , now presents with stroke like symptoms , NEXT inv -- ? CT head

iron over load , ? rx, deferixamine..

pt on SABA + Inh steroid, asthma add on drug = monteleukast

The anorexic female significant hypokalemia and hyponatremia, more of a feature of loop
and thiazide