1

 MRCP 2 –Diet JULY 2021 RECALL QS

 By ( dr.waqas Abbasi )
 Compiled by : Dr.Saifee Abro

 Wegener like picture   - asks for investigation – ANCA

 Spherocytes on film, anemic, splenomegaly - hereditary spherocytosis

 Eschar on skin ... doxycycline

 Pt with GBS scenario, respiratory compromise.. Next step - ? Intubate

 Short child and short parents -?? Noonan syndrome

 Multiple brain  lesions on CT - asking for rx ---- was it Rx for toxoplasmosis?

 CT brain  - lesion in the periphery, options Extradural, subdural etc

 CT brain homogeneous single lesion , asked for dx

 Ct head, frontal lobe lesion, asked for organism implicated - ? Staphylococcus

 CT chest given, golfer, sob ---- IPF

 Cause of renal failure, pt with abdominal pain joint pain taking NSAIDs , ? Tubulointerstitial
nephritis

 Pt with SOB , sounded like flash pulmonary edema , had 1 kidney , --- renal a stenosis

 Bilateral hydronephrosis on US and post prime time bleeding - cervical cancer

 Amenorrhea in pt around 40 , high LH , FSH, i guessed primary ovarian failure , not sure

 Young girl recent marathon, paired osmolalities given , had high s osmolality and and
inappropriately low u osmolality , marked diuretics , other options were dehydration ..etc

 Paired osmolality given, answer being diabetes insipidus

 Eosinophil of oesophageal biopsy - i marked the option implying mep something

(monoclonal antibody)

 Pt with few weeks of diarrhea alternating with constipation, ---- ascaries lumbricoides

 Bloody diarrhoea, hepatomegaly --- Amoebiasis

 P2 last q - ? DIC or TTP

2

 Pic of hemochromatosis, asked for ix for cause of high glucose, i mark HFe gene, other
option was ct pancreas

 CJD i marked once, I had had 2 months hx

 Familial amyotrophic lateral sclerosis

 x ray of deformed foot, swelling of finder tips .. i gussed Lupus i think

 Young girl who had facial redness, long vignette, I marked SLE as the answer

 Clinical pic of adrenal insufficiency --- give hydrocortisone CAME TWICE i think

 Synacthen test--------------

 Abnormal gas, 4 day hx of diarrhoea, what would you give, i guessed--- fluids

 Marked NIV --- Once some where

 3 cm lung node, red flags present - do pet scan


 Pt has parapneumonic pleural effusion, what would you do, chest drain, aspirate.. i marked
aspirate

 Secondary pneumothorax not resolved day 5 - refer to thoracic surgeons

 Old lady to be sent some where ---- asses capacity

 Anxious hyperventilating cancer pt, what would you give, lorazepam, haloperidol, i marked
lorazepam

 Sterile urine, 2 recent uti's , weight loss , check urine for tb

 pt with IBS like symptoms , had symptom free intervals - I Marked IBS as the ans , other
option was celiac i think

 Atrophic looking brain on CT , what would make if worse, i put alcohol, other options were
being poor which were all are

 42 male, hypertensive, somewhat high sodium and low potassium, asks for cause of htn, i
marked primary hyperaldosteronism

 Adrenal mass noted on CT, long biochem given , i marked check in 2 yrs

 Lower oesophageal metaplasia but not dysplasia, i marked follow up

 Pt treated for H. pylori, now asymptomatic, - i marked do nothing 

3

 Pt treated to c diff for 10 days , i marked discharge after checking for c diff one , not sure ..

 Rectal thickening on CT, asking for diagnosis, i marked C. difficle .

 Pic of retina, ? Age related macular degeneration

 Dementia with Lewy body as diagnosis, i marked it twice i think

 Drug induced Parkinsonism; don't remember the name of the drug

 qs of drug interaction

 Jugular foramen --- (associated neurology given)

 IV drug user, weakness upper and lower limbs, i marked botulism

 Funny looking cxr , circular mass , cancer pt 

 Jaw necrosis ( pt of steroids, known Wegeners case )

 Elderly, proximal limb girdle weakness, 4/5 , ESR 35 , was it PMR ?

 SIADH--- once i think

 ECG with wide complexes, pt had a block out, was it complete heart block

 ECG on WPW

 Preceding angiography, pain in groin and bruit, ----femoral dissection

 Pic of major PE , BP 80 systolic , i marked alteplase, thrombectomy was also an there

 Air travel, female, sob, ----- PE

 DVT in PE, asking for treatment --- was it tinzaparin

 Cholesterol embolism---- once

 Piperacillin ... (Tazocin) once i think (neutropenic sepsis)

 Pic of eosinophilic pneumonia - give steroids

 CSF given, low glucose, high protein, ---- tb meningitis

 Alcoholic cardiomyopathy, pt had murmur, alcoholic

 Signs of right heart failure, asking for cause - i marked primary pulmonary htn..
4

 Post fun STI , pt seeks vengence from the girl , inform police naming both

 Give acyclovir (pic of genital herpes in a girl, ulcers .. )

 VDRL remains pos post rx in syphilis , DO NOTHING

 Drug implicated in worsening renal function

 19 yr old boy, nephrotic synd case , ? Membranous or minimal change

 Bilateral leg swelling, clinical pic of nephrotic syndrome - nephrotic syndrome

 Boy with unilateral neurology, upper and lower limb, what was the fun scenario ?

 Clinical pic of BPV , rx Epley

 Young pt, arthritis, rash ----- ? Still disease

 Hypertensive lady wants to make a baby - labetalol

 Magnesium was answer to of the questions (torsade’s )

 Tumor lysis syndrome (recent chemo , hyperkalemic , blood count was also low )

 Acute rx of gout in pt is renal failure - ? Prednisolone

 Cardiac arrest, what would you add? amiodarone

 X-ray shoulder, cannot lift the arm, ? Supraspinatus tendinitis

 Unilateral retro-orbital headache, ptosis, -- cluster headache?

 Lady with headache relieved on lying flat - low csf headache

 Skin grows MRSA, another infection (chest infection with an image), likely organism -
MRSA

 Headache and neck pain while running - ? Carotid dissection

 Marked vasovagal once, pt goes blue and all that after some instrumentation i think...

 What drug causes hyperphagia, million dollar q---Ropinirole???

 Some guy comes back from a trip to Africa, deranged LFTs, is unwell - ? HIV
seroconversion

 Farmer, deranged LFT’s, i think jaundiced – leptospirosis

5

 X-ray pelvis, looked white on the left - marked Paget’s disease

 X-ray with what looked like OA of left hip -- ? OA

 Image of spine - longitudinal lesion along vertebral bodies? Malignancy

 Altered TFTs a few weeks after delivery the baby - marked post-partum thyroiditis

 Pt had some surgical procedure, abnormal thyroid tests - marked sick thyroid something

 Pt on amiodarone --- deranged thyroid function.

 11 weeks pregnancy, hyperthyroid, - marked PTU

 Clinical pic of Graves’ disease, next- TSH

 Marked carbimazole once.

 Marked Parkinson disease once

 Marked drug related Parkinsonism once

 Chronic diarrhoea.. Pic of chronic pancreatitis.. Asked for ix – Elastase

 SOB after vomiting.. - marked oesophageal rupture


 Clinical pic of allergic reaction of penicillin - give adrenaline

 Pain anterolateral aspect of thigh, weakness of hip, ---- marked meralgia

 Advantage basal insulin in Type-1 DM, was not sure at all, and marked to avoid rebound
hyperglycemia something

 Gent levels given, the level was low, post dose, what would you do with gent, went for the
last option down the list

 Pt with heart failure, asked which next drug would help, marked spironolactone.. Not sure

 Alcoholic pt presenting with some other problem, gave some signs of withdrawal like tremor
- give chlordiazepoxide

 Alcoholic pt with some complication, asked which drug would help long term

 Wilson’s -- young guy with some neurology..

 Pt loses his job, shops recklessly, marked mania 

6

 Lesion on leg, pic given - pyoderma gangrenosum

 Clinical pic of sarcoidosis (erythema nodosum, hypercalcemia) --- do CXR

 Infectious disease with rash - was it chikungunya (since it sounds fancy)

 Lesions of trunk, i think pt had HIV, not sure. Marked HHV 8 (Kaposi sarcoma)

 Some tumor in head and neck? Craniopharyngioma, asked for association – EBV

 Pic of lesion on nose - ? Actinic keratosis? Versicolor something

 Lesion on forehead with differentiation including SCC, Actinic keratosis not sure ..

 Skin lesion with options lintigo melagna

 Marked IgA nephropathy

 HELLP ( biochem pic )

 Pt with Cushing, biochemistry give , ACTH raised , ---- was the ans ectopic ACTH

 Abnormal gas , asked for cause ..

 B19 infection -- as cause of low blood count, not sure..

 Symptoms of NPH given in elderly pt - Normal pressure hydrocephalus

 asked for addition sign of pic of NHP--- urinary incontinence

 pt had brain Mets and was on tapering dose of dexamethasone , presents with headache ,
options were increase dose of dexa or give mannitol , tough call , marked increase dexa .

 Vitamin deficiency, alcoholic, sounded like pellagra ----- marked niacin

 pt with off gas , marked ethylene glycol ( raised anion gap )

 Antidote of some kind of poisoning?

 Codeine for back pain? I chose IV fluids

 very depressed pt with previous 6 months hx of hospitalisation - options were CBT,ECT

amitriptyline, marked CBT , anyone sure about the ans ?

 Multiple myeloma case?


 Raised IGM, as for management, i marked where they filter out .. what is it called ?
7

 Patient with symptoms of angina - CT coronary angiography

 Pt has had MI, What would you do next ---- invasive coronary angiography

 Dobutamine stress test images given, asked for defect -- only God knows

 Pt with very high troponin - myocarditis

 Drug side effects,? Rifampicin and pyrazinamide as options

 pt with IBS like symptoms, asked for rx , ans was one of new fancy sounds drug for ibs ..
eluxadoline i think

 q asking which medication you would stop ,, list of gypolycemics, i guessed glitazone , .. not
sure what the q intended

 Pioglitazone is associated with sq cell ca bladder. Question stated haematuria.

 Chickenpox, advantage of treatment

 Shingles vaccine. They can cause chicken pox i think

 Pt with RA who was taking Rituximab… what would be the consequences if is given
Varicella zoster vaccine….? 1. Disseminated V infection 2.Multi dermatomal shingles

 RF and antiphospholipid value was given,

 Pt has diarrhoea and abdominal pain not responding to loperamide, what would you give ---
marked codeine.. Octreotide?

 Pregnant patient, list of medications given for some condition, asking which one would you
give , i marked prednisolone .. not sure if correct

 Ophthalmology q, some afferent pupillary defect, .. Options glioma something...........

 Demyelinating optic nerve---- MS

 Imatinib ( rx for some haem malignancy ).. That was CML.

 Abnormal mass on cxr , afp raised ----- ? Germ cell tumor

 Renal vein thrombosis somewhere, if not wrong the pt had some leg swelling , prothrombotic
tendency etc..

 Girl with pic of pyelonephritis - what would you expect of US , Ans being normal US

 What is used to treat kidney stones - Thiazides ( t for treat )

8

 Which medication causes haematuria? List was given..

 Respiratory investigation options being send sputum, lavage etc, i guessed lavage..

 Visual hallucinations with insight, cataract ---- Charles bonnet

 Nose pic --- of lentils maligna or basal cell ca, nose classic site of bcc

 Pt in warfarin, INR give, what who you do..

 Girl with pic of pyelonephritis - what would you expect of US , ---normal US

 Pregnant pt, list of medications given for some condition, i marked prednisolone..

 Lesions of trunk, i think pt had hiv, not sure. Marked HHV 8 (Kaposi sarcoma)

 Pt wanted to be preg and the advice would be don't !

 Ascitic fluid biochemistry given, albumin 28, asked for cause, think i marked ovarian tumor,
not sure..

 What is used to treat kidney stones - Thiazides ( t for treat )

 Renal vein thrombosis, pt had some leg swelling, prothrombotic tendency etc..

 Abnormal mass on cxr, AFP raised -----? Germ cell tumor

 Ophthalmology q, some afferent pupillary defect, .. Options glioma something.

 fine needle aspiration of neck lump

 pt with very high troponin – myocarditis

 Patient with symptoms of angina - CT coronary angiography

 Additional sign of pic of NHP--- urinary incontinence

 pt with Cushing , biochemistry give , ACTH rasied , ---- ectopic ACTH

 BL hydronephrosis on US and post prime time bleeding - cervical cancer

 Pt with Sob, sounded like flash pulmonary edema, had 1 kidney, --- renal a stenosis.

 SOB after vomiting.. - marked oesophageal rupture

 Chronic diarrhoea.. Pic of chronic pancreatitis.. Asked for ix – Elastase

9

 Clinical pic of BPV , rx Epley

 Ct brain homogeneous single lesion, asked for dx

 Some tumor in head and neck? Craniopharyngioma, asked for association – EBV

 Pt loses his job , shops recklessly , mania 

 Clinical pic of allergic reaction of penicillin - adrenaline

 Image of spine - longitudinal lesion along vertebral bodies? Malignancy

 x ray pelvis , looked white on the left - marked Paget’s disease

 Marked vasovagal once, pt goes blue and all that after some instrumentation i think.

 Headache and neck pain while running - ? Carotid dissection

 Unilateral retro-orbital headache, ptosis,-- cluster headache

 Acute rx of gout in pt is renal failure - ? Prednisolone

 Boy with unilateral neurology, upper and lower limb , what was the fun scenario ?

 Drug implicated in worsening renal function

 Marked alcoholic cardiomyopathy once , pt had murmur , alcoholic

 Pic of eosinophilic pneumonia - give steroids

 ECG with wide complexes , pt had a block out , was it complete heart block

 Elderly, proximal limb girdle weakness, 4/5 , ESR 35 , was it PMR?

 Funny looking cxr , circular mass , cancer pt ,

 IV drug user, weakness upper and lower limbs , i marked botulism

 Jugular foramen?? (Associated neurology given )

 Atrophic looking brain on CT , what would make if worse, i put alcohol, other options were
being poor which were all are

 Sterile urine, 2 recent UTI's , weight loss , check urine for tb

 Pt treated for h pylori, now asymptomatic, - i marked do nothing,

 Pt treated to c diff for 10 days-- discharge after checking for c diff one , not sure .
10

 Pic of retina,? Age related macular degeneration

 Adrenal mass noted on CT , long biochem given , i marked check in 2 yrs

 Anxious hyperventilating cancer pt , what would you give, options were lorazepam ,
haloperidol, i marked lorazepam

 3 cm lung node, red flags present - do PET scan

 Abnormal gas , 4 day hx of diarrhoea , what would you give, i guessed fluids

 Pt started on hydrocortisone for diarrhoea, what would you add cyclosporine or influx

 Young girl who had facial redness, long vignette, I marked SLE as the answer

 X-ray of deformed foot, swelling of finder tips .. i guessed Lupus i think

 Picture of nail ---? Dermatophytes nail infection

 Bloody diarrhoea, hepatomegaly --- Amoebiasis