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Recall Sept 2016 2
Recall Sept 2016 2
MRCP part 1
MRCP 1, 6 September 2016 recall
Correct me if I'm wrong
1: vertebral artery is a branch of? Subclavian artery
2 relationof Subclavian vein? I marked lie anterior and inferior to Subclavian artery
3: alcoholic man, felt nausea before flight, and when flight took off he felt aural fulness and lost consciousness for
45sec, there were some jerky movements of his limbs what is the cause?
Vasovagal,Cardiogenic, alcohol associated syncope
3: splicing? Removal of introns
4: scenario of antiphospholipid syndrome, what does echo will show? Normal echo
5: CD4 =MHC class ll
CD 8 = MHC class l
6: concain abuser feels insects crawling on his skin what's this called? Hallucination?
7: a female with Breast cancer believes that she has got this cancer due to and affair many years ago (
something like that) this is known as?
Overvalued idea and other options
8: male age 67, hypertensive, not controlled by life style modification what to add next? Calcium channel blocker
9: sign and symptoms of angiodema, list of medication, which one to stop? ACE inhibitors
10:H/O CABG, complicated by pericardial effusion, which required re intervention few years ago, Pt now
presented with SOB, with raised JVP, hepatomegaly
echo showed, dilated IVC, with some spetal wall motion abnormality what's the cause?
constrictive pericarditis/ restrictive cardiomyopathy/ pulmonary embolism
11: egg protien allergy, which vaccination should be avoided? Influenza?
12: prosthetic valve endocarditis
Culture: G+ diplicocci
T/M: flucloxacillin and rifampicin
13: patient taking glifozin
Urine shows glycosurea, what is the mechanism of action?
SGLT2 inhibitor
14:umblicated vesicles with Pruritis, case of moluscum contagiosam
T/M?no treatment
Steroids
Antihistamine
15: mother brought her 19 years old daughter, having history of 2 episodes of generalized seizures, she has
problem during early morning having breakfast things fall from her hand, there was no other past history
Diagnosis?
Juvenile myoclonic epilepsy
16: x ray shows chondrocalcinosis
Next investigation?
Serum ferritin
17: an alcoholic man, with hypokalemia and hypocalcaemia
What's the cause of his hypocalcaemia?
Hypomagnesaemia
18: person with BP 190/110 there was slightl difference in BP in both arms( which was a distraction)
In his Labs there was hypokalemia, serum potassium: 2.5
What's the diagnosis?
Con's syndrome
19: a case of insulinoma? What's the test to confirm?
72 hours supervised fasting
20: A man with h/O PR bleed, on PR examination there was fresh blood
What's the next investigation?
Colonoscopy
Mesenteric angiography
CT angiography
21: A women with C/O Pruritis, LFT's shows cholestatic picture, anti mitochondrial Ab: +ive
Next investigation?
ERCP
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9/28/2016 (3) MRCP part 1
CT abdomen
No investigation
22: 57 yrs old man, who donates blood regularly
Was deffered donation
His CBC shows, microcytic anemia
He is otherwise healthy, no active complaint
What's the likely cause?
Colon Cancer
Gastric cancer
Angiodysplasia
Diverticulitis
23: young female with c/O fatigue, she says her mother had spleenectomy
CBC: Hb: decreased
MCV: increased
Peripheral blood shows: megaloblasts
What's the best treatment?
Give vitamin B12
Folic acid
No treatment
24: contraindication of bisphosphonate therapy
Patient had undergone dental surgery, it increases the risk if osteoporosis of jaw, so I did that
25: Symptoms of gout, with history of moderate LVF
What's the initial treatment?
Colchicine
NSAIDS
Allopurinol
26: 12 week pregnant lady, she didn't have MMR vaccination, when to give MMR?
Now
After delivery at 24 weeks
27: Pt with h/O Rheumatoid arthritis and asthma, she had an exacerbation of asthma, she was taking Ibuprofen
400mg TDS for RA, which was stopped during exacerbation. She has improved now
But her Joint pain has worsen
How to treat her?
Give same dose if NSAIDS
Give half the dose of NSAIDS
And other options
28: a case of squamous cell lung CA, with HPOA what's the treatment?
Bisphosphonates
29: non small cell CA, neoplastic syndrome?
Hypercalcemia
30: man with c/O SOB, on examination decreased breath sounds on right side
CXR: right pneumothorax
What's the treatment?
Wide bore chest drain
Small bore chest drain
31: elderly lady with fracture, serum corrected calcium:2.2
Serum phosphate: 0.8
Serum ALP: increased
Parathyroid increased
Next investigation?
Check vitamin D?
32: A patient with h/O Parkinson disease, having symptoms of psychosis what's the treatment?
Benzodiazepine
Resperidone
Qtiepine
33: female taking antisychotics, presented with galactorrihea
Serum prolactin > 2000
Diagnosis?
Prolactinoma
Antisychotics
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34: man working in tobacco factory presented with SOB
Transfer factor: decreased
Spirometry: restrive defect
Diagnosis?
Extrinsic allergic alveollitis
IPF
Asthma
COPD
35: Lithium toxicity causing DI
postural BP drop
serum sodium: increased
T/M?
0.9 % N/S
Desmopressin
Dextrose water
36: polucythemia: COPD
37: c/O diarrhea and arthralgia
PAS positive macrophages on histology
Diagnosis?
Whipples diseases
38: young female with abdominal discomfort,diarrhea, mucous in stools ,abdominal pain relieved on defecation,
she is taking regular, NSAIDS for headache
What's the diagnosis?
NSAIDS enteropathy
IBS
Chrohns
38: man presented with lion pain, he's taking NSAIDS from 6 days for knee injury, on examination he has knee
effusion
Urine shows: protien +
Wbcs +
RFTs: derranged
Diagnosis?
AIN
ATN
UTI
39: SLE antibody association with fetal heart block
AntiRo
40: peripheral neuropathy symptoms?
Vincristine
41: Pt with H/O rheumatoid arthritis presented with c/O red eye, gritty sensation, hypopyon
Diagnosis?
Keratitis
Scleritis
Episcleritis
Sicca syndrome
42: case of acne rosacea with symptoms of anterior blephritis
43: Ataxia with opthalmoplegia, reflexes brisk
Diagnosis?
Spinocerebeller syndrome
MS
Miller Fisher
Cavernous sinus thrombosis
44: PICA syndrome, it was easy scenario
45: travel his, black spot at the site of tick bite, now diffuse maculopapular rash.
Diagnosis?
46: IV drug abuser, with shortness of breath
Exam: Normal
CXR: bilateral infiltrate
Next investigation?
BAL( case of PCP pneumonia secondary to HIV in IV drug abuser
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47: raised IgM what will patient likely to develop?
Huperviscosity syndrome
48: Pt with thrombosytosis and raised Wbcs: 16,000
Neutrophelia
Diagnosis?
Essential thrombocythemia
CML
AML
49: pt taking cyclosporin, developed a nodule on temple
Diagnosis?
Sq cell CA
Basal CA
T cell lymphoma
b cell lymphoma
50: cyclosporin = hypertrichosis
51: pericarditis, Shape of ST elevation, concave
52: troutte syndrome
53: biscodyl mode of action: stimulant laxative
54: familial hyperchlolesterolemia mode of inheritance: autosomal dominant
55:H/O abdominal surgery, presented with diarrhea, something like that
Options were
Blind loop
Diverticulitis and others
56: clindamycin MOA: inhibits protien synthesis
57:Mechanism of diarrhea D/t short bowel surgery for chrons
Due to Mal absorption of bile salts?
58:dysphagia for soild and liquid from start?
achalasia
59: peripartum cardiomyopathy
60:low ca and low phosphate,raised ALP
Diagnosis?
osteomalacia
61:exmple mitochondrial disorder?
optic atrophy
62: glucose +fructose?
sucrose
63:left heminomus hemianopia
Occipital lobe
64:LVEDP( left ventricular end diastolic pressure)?
70
65:Pt with chest pain, under went coronary angiography, during the procedure she had an episode of Vfib, which
was treated successfully
Coronary angiography: Normal
Next step in management?
ICD
Amiodarone
Do nothing
66:suspicion of Giardiasis,Stool negative
How to confirm?
duodenal biopsy
Giardia antibody IgM
Trial of metronidazole
67: LVF what medication to be added, he's already taking aspirin, stating,ACEI, betablocker
spironolactone.
68:Boggy wrists + chrondrocalcinosis
pseudogout
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69:egg shell calcification in CXR
Diagnosis?
silicosis
70:causes of shift of the oxygen curve to the right?
If value is more than 2 SD from the mean, how much % of population??
5%
2.5
95
71:need for surgery in a pt. with aortic stenosis
Gradient = 50, how to determine the need for surgery?
Pt's symptomtology
Gradient
72:infarction of colon splenic flexure artery involved?
Superior mesenteric
Inferior mesenteric
83: O2 disos to the right...acidosis
84:Middle aged right handed female presented with reading difficulty, CT head shows right parietal lobe ischemia.
How to explain her reading difficulty?
agraphia
amnesia
visual inattention
84:Mechanism of action of metformin
increases insulin sensitivity
85:M echanism of action of montelukast
leukotriene receptor antagonist
86:Mechanism of action of ivabradine
blocking I(f) current
87:Mechanism of action of verenicline
nicotinic receptor partial agonist
88:42 year old man collapsed at work. He died before the ambulance could arrive. What is the most common
cause of sudden death in this age group?
Long QT
HOCM
Coronary artery disease
89:A boy is being tested for adrenal leucodustrophy, his brother is having the same condition, he is using
intranasal steroids for sinusitis
Short synactan test performed
Before the test cortisol level were low
After the test cortisol increased
What's the likely condition?
Steroid induced
Addisons
Adrenal leucodustrophy
Cushing
Diurnal variation
90:Pt with tensed ascites and neutrophil count greater than 500..management..?
Ciprofloxacin
91:One question was many blisters and two big blisters options were impetigo and pemphigus vulgaris
92:a question also wife complaining husband changed in behaviour and was tearful emotionally labile..what was
the problem ?
93: had a shagreen patch but was asking about lesion in the face .. neurofibroma was an option
94:another one is how to prevent falling in elderly man with UTI
95:Also one about source of haematuria ? From bladder , kidney or ureter
96:old diabetic patient with pain in feet while walking pulses present…the answer is neurogenic claudication
97:poor prognosis in Rheumatoid disease
joint erosion?
98:cause of false positive rheumatoid factor
Age?
99:some question about pain in the thumb with de quervain tenosynovitis as an option
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100:Multiple sclerosis pathology…. Phagocytosis/switching/anergy/mimicry??
101:BPPV pt with nystagmus,worsen when move to right side, periphral cause
Right vestibular lesion
102:antidepressant for type 1 diabetic young man
Fluoxitine
103:Investigation for sleep apnea syndrome ?
Polysomnography
104:Pt with hepatic encephalopathy have itching how to treat
citrizine ( it's non sedative)
Chlorpheneramine
Chlorpromazine
105:Pt with needle stick injury, tetanus immunoglobulin given, best next action as she brought the needle
Give hep B immunoglobulin
Check needle for HIV,Hep B,Hep C
Check patient for HIV, Hep B and Hep C
106:Pt with heridetery spherocytosis.. what to give first .. options had folate b 12
107:Yes stem told about some features of MEN 2
HOCM/ Long QT/ coronary artery disease
108:athletic girl what do u expect to find low in her hormonal profile
LH
Prolactin
Growth hormone
ACTH
Cortisol
109:predictor of death in 42 yrs old patient with strong family history of HOCM is septal wall thickness more than
3.3
111:patient with erythema multiform
Cause?
Herpes simplex
110:genetics father had pKD brother had berry aneurysm .. chance of him getting disease
111:Pt with seminoma asking about tumor marker
Beta Hcg
Alpha feto protien
112:Pt taking many hypertensive and furosemide what to add .. still hypertensive. . alpha blocker or
spironolactone
113:site of action of spironolactone
DCT
114:Pt with pneumonia .. CURB 65 score=2
and decide about admission or out pt
Discharge patient on oral antibiotics
Admit to medical ward
Admit to ICU
115:young female with multiple unexplained symp ..... answer is somatization
116: pt with CP presented with fracture ?
Osteomalacia
Osteoporosis
Osteogenesis imperfecta
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