*MRCP 2. Paper. Qs . 27 oct 2020 * (DR. SAIFEE ) ​

1) Treatment of intermittent psychosis in dementia 2) Treatment of alcoholic fatty liver disease other than vit and diazepoxide 3) Viral thyroiditis 4) Isotope scan thyroid thyroid adenoma (nodule) 5) Phenytoin toxicity although (normal phenytoin level) 6) methHB----- dapsone 7) Treatment for dermatitis herpetiformis other than gluetin free diet dapsone 8) Treatment of polymorphic v tach 9) Treatment of v.tach in unstable pt 10) Treatment IIH other than acetazolamide - wt loss 11) Treatment of heart failure... add Eplerenone 12) Infliximab reaction vitally stable pt what to do 13) Gentamicin pre dose high what to do next 14) Liver abscess echinococcosis investigation 15) HUS what investigations to do Blood film 16) OA takes paracetamol what next treatment 17) Hep C 18) Radiation fibrosis 19) Most common complications of TIPSS 20) ECG pt with pacemaker problems in atrial 21) Female pt with CA breast receiving radio chemotherapy 10 years ago presents again with CA what’s the cause 22) Many questions in dermatology pictures (melanoma, squamous cell CA, reactive arthritis, I think cutaneous anthrax, lichen planus? 23) DKA although not so high blood sugar pt on gliflozin 24) Question on ischemic colitis 25) Autoimmune hepatitis 26) Cholestasis of pregnancy 27) Poor prognosis in CLL--- p53 deletion 28)I think hepatocellular CA due to haemochromatosis 29) Investigations in jaundice pt with stone in gallbladder and CBC NORMAL 30) Asbestosis 31) ABPA 32) --- post procedure 33) Turner’s syndrome primary Amenorrhea 34) Secondary amenorrhea 35) pt with proteinuria improved after ACE inhibitors what’s cause he’s diabetic and hypertensive 36) Investigations for severe left iliac fossa pain pt has ulcerative colitis 37) Picture CA lung adenocarcinoma 38) X-ray very wide mediastinum 38) takayasu different in BP in both arm 39)I think RA 40) Systemic sclerosis 41) Picture SAH 42) TB constrictive pericarditis 43) Scenario of Mitral 44) Acute hepatitis D 45) Neutropenic sepsis treatment 46) Typhoid 47) OSA syndrome 48) Next treatment for autoimmune hepatitis after steroid 49) Carotid 50) Immediate treatment scenario of acute glaucoma I think acetazolamide iv

------1) Acromegaly+ microprolactinoma - Tran sphenoidal surgery 2) Dysphagia, anti Scl70 - systemic sclerosis 3) AF and heart failure - Digoxin 4) AF and RAD - Mitral stenosis 5) Amenorrhea - Hypothyroidism vs premature ovarian failure 6) CT chest - bronchiectasis 7) Ig A case scenario 8. Skin rash? Fungal? Sarcoid - treatment 9) INR 4.7 on , impending rupture aortic - needs Emergency laprotomy - prothrombin concentrate PCC 10) Ba swallows - ? ca esophagus 11) CXR looks clear? Pectus excavatum 12) BiPaP settings - ABG improved on the given setting- further action 13) Deterioration after extubation, Type 1 respiratory failure - CXR opacity in whole lungs bilaterally- ?pulmonary haemorrhage 14) CXR - right mid zone opacification, left lower zone opacification - ? Pul adeno Ca 15) Myocarditis clinical scenario 16) Pregnant, post-viral, tender thyroid, high T3- ? Riedel’s / ? Post-partum 17) HF treatment - Ivabradine 18) Pemphigus vulgaris - biopsy features 19) Anaphylaxis shock - IM adrenaline 20) Ischemic hepatitis scenario 21) Anterior spinal artery occlusion scenario 22) Myasthenia gravis scenario- pyridostigmine 23) Autoimmune hepatitis Scenario 24) ABPA scenario 25) Radiation fibrosis CXR 26) Acute tubular / acute tubulointerstitial nephritis 27) Hepatorenal syndrome scenario 28) Leg swelling after hip surgery, more pain in thigh, swab positive for MRSA - ? Remove hip screw /? Vancomycin 29) After trip to Singapore, Bloody diarrhea, tender LIF after 4 days of amoxicillin and clarithro- ? Shigella/? Entamoeba 30) Most priority for negative pressure isolation- MRSA cavitating pneumonia 31) Study to minimize the bias - double blind 32) TEN Scenario 33) Hereditary angioedema treatment- immunoglobulin 34) Mental capacity 35) Berthel’s index 36) Low glucose, low cortisol - SST

37) UC flare up - next investigation- XRay abdomen 38) Gonococcal arthritis (necrotic rash on toe) 39) Echo- myxoma - myomectomy 40) Bilateral hydronephrosis in T2 DM, urinary incontinence -?chronic reflux nephropathy 41) Acute brachial neuritis 42) Ongoing dialysis, dark red vomiting, normal endo/colonoscopy - ? Angiodysplasia/?Dieufloy’s leision 43) high PT, high APTT, normal fibrinogen, very high ALT, in patient with advanced CA -? pcm od 44) Chest pain, followed by - CT aortography 45) Lower normal Ca, high PTH, high ALP osteomalacia vs Paget 46) Neuroleptic malignant vs serotonin 47) Multiple embolic in MRI, IE scenario- investigation -? Blood cultures

48) Eye - macular leision- ? Visual field defect -? Central 49) Depressive psychosis 50) PTSD 51) Heparin induced TCP - argatroban 52) Cholesterol embolism 53) Ketosis, high lactate, acidosis, recently started empagliflozin, normal BM - DKA 54) Screening before rituximab- Hep B (No TB in answer) 55) Methanol poisoning 56) Restless leg syndrome 57) Bile acid diarrhea- treatment 58) Asymptotic hypercalcemia- next treatment 59) HHS - IV 0.9% saline 60) Primary biliary cholangitis 61) Hereditary angioedema allergic reaction to infliximab 62) Maltoma.. Pylori eradication Raised hb - renal ultrasound vs jak 2 mutation Anaphylaxis shock- hydrocortisone Question about tender hepatomegaly - budd Chiari syndrome Question on lung ca with neurological features - Anti Hu antibodies Question with auer rods and DIC - Promyelocytic leukemia CT scan with vertebral lesion- brucella Thyroid uptakes scan picture- toxic adenoma CT with dilated ventricles- Normal pressure hydrocephalus, do LP CT head with intracranial bleed Skin lesions pictures, lichen planus Foot ulcer picture with ABPA readings- , compression bandaging Fundus picture- ? Central scotoma Malignant melanoma picture Radiation induced fibrosis on chest x ray CT scan with mets from renal CA ?spinal canal stenosis Poor prog factor for CLL Do pleaural fluid aspiration for empyemma first Coxiella infection/Q fever Add LAMA in copd therapy Torsades de pointes ecg - iv mgso4 Bechet’s Reactive arthritis Polymyalgia rheumatica Hepatorebal syndrome Hemochromatosis Stop erythropoetin for TCA poisoning- iv fluids HHG- 0.45 percent saline Distal RTA Cardiac amyloidosis with RA Calcium and vitamin D supplementation Ectopic cause of cushings ABPA E coli Autoimmune hepatitis Tubulointerstitial nephritis Do peripheral film Anti VG calcium channel Ab for Lambert eaton syndrome Botulinum toxicity Post prosthetic hip join gram positive cocci infection ? Strept species vs staph? HPOA on bone scan vs mets? Methemoglonemia Reduce EPAPand increase IPAP Reduce oxygen in CO2 retention

Female patient with breast carcinoma. Treated with surgery and radiotherapy.and tamoxifen for 5 yrs.developed lung carcinoma. Cause?? 1.radiotherapy 2.tamoxifen 3.chemotherapy 4.BRCA germ line

Patient is on maintenance dialysis. Was on erythropoietin. Developed increase BP. Mild leg . what to do 1. Amlodipine 2. Frusemide 3. Stop erythropoietin 4. Increase fluid removal by dialysis A young man developed Jerking movement of his limbs associated with tongue biting and urinary incontinence. There was post ictal confusion and . He describes occasional Jerking movement of his hand and body.Dx? 1. Juvenile myoclonic epilepsy 2. Non epileptiform attack ????

75 yrs old lady with proximal femur fracture. She gave power of attorney for her health and welfare to her son. Does not wants to be treated. What you will do? 1.let her go home 2.assess her mental capacity 3.ask family members 4.solicitor opinion shouted

A case of COPD.chronic sputum production.patient is on SABA ,LAMA+ICS .no oedema or raised jvp.cbc-no polycythemia.po2-8kpa ph-7.39 Further treatment?? 1.carbocysteine 2.azithromycin 3.O2 therapy

Patient developed renal impairment and lower limb rash 48 hrs after LAD stenting.no was mentioned. Cause?? 1.cholesterol embolism 2.contrast nephropathy

Systemic sclerosis patient developed breathlessness.ECHO demonstrated pulmonary arterial pressure of 54mm Lung clear.what further investigation?? 1. Right heart catheter 2.cardiopulmonary exercise test 3.transoesophageal echo

Old man with right upper quadrant pain.usg showed gall stone common bile duct was not dilated.alk phos 340,ALT-85 Invest to confirm the diagnosis?? 1.MRCP 2.ERCP 3.LIVER BIOPSY

A CT scan showed rt sided hypodense lesion with surrounding hyperdense area in the parietal lobe.Lesion was lense like adjacent to bony skull 1.abscess 2.hge in 3.EDH

Ongoing dialysis. Developed dark red vomiting. Cause? 1.dieulafoy lesion 2.small bowel angiodysplasia

Most priority of negative pressure room 1.MRSA 2.PVL producing cavitating pneumonia 3.chicken pox 4.herpes zoster ophthalmicus

Patient was on OCP.developed ,hepatomegaly.which investigation to be done? 1.abdominal doppler USG 2.CT scan etc

Low normal calcium Increase PTH Increase ALP 1.osteomalacia 2.primary hyperparathyroidism 3.pagets

Patient was taking phenytoin.developed nystagmus, coarse tremor Phenytoin level was normal. Cause?

A patient with HIV developed cardio myopathy. Cause? 1.CMV 2.HIV 3.HTLV 4.EBV

34 weeks pregnant Increase alkphos No symptoms i think

Dx-normal pregnancy Cholestasis of pregnancy??

Developed rash after infliximab.BP-100/70,tachycardia No chest tightness or SOB.transfusion stopped. What to do next? 1. Adrenaline 2. Chlorpheniramine iv 3. Hydrocortisone

Symptoms of NPH CT scan enlarged ventricle. What investigation next? 1.LP 2.SPECT 3.MRI

46 yrs old lady secondary amenorrhea. Estrogen -low. FSH,LH -high Dx- menopause?

Sensory level, Para paresis, retention, spared vibration and position Dx - Ant. Spinal artery syndrome?

A patient with flu like symptoms developed tachycardia. There was gallop rhythm. Cause? 1. Influenza 2. Myocarditis

A case of heart failure with AF Is on bisoprolol,ramipril,frusemide.having oedema,heart rate 120.K5.5 AF,What treatment next? 1. Increase dose of frusemide 2. Spironolactone 3. Digoxin

A patient describes severe headache that started in her eye spreads to back and neck .there was no neck stiffness but laterl flexion of neck was painful has developed Horner’s syndrome of left eye.dx?? 1. Cluster headache 2.migraine 3.carotid artery dissection

A patient with cough, .on exam lung clear,heart sound inaudible, ECG-low voltage,tachycardia Cause? 1.tubercular pericarditis 2.consrtictive pericarditis

Quadriparesis,ptosis,facial palsy,areflexia in a iv drug user on ventilator.cause?history of flu like illness 4 wks back 1.GBS 2.Botulism

A lady has skin lesion on her back (picture).that was blackish somewhat elevated like stuck on appearance. There were brown mole surrounding it.she does not know for how long it was there Dx??

Patient is on ventilator.developed pneumonia.which organism??

Patient of parkinsonism. Violent movement at night during sleep.his wife when wake him up he becomes alright Dx? 1.REM sleep behaviour disorder 2.restless leg syndrome 3.epilepsy

Patient with sickle cell anemia There is vasoocclusive vs hepatic sequestration

75 yrs old lady with proximal femur fracture.she gave power of attorney for her health and welfare to her son.does not want to be treated. What you will do? 1.let her go home 2.assess her mental capacity 3.ask family members 4.solicitor opinion shouted

One skin picture ulcerative lesion on leg. 1.basal cell carcinoma 2.squamous cell ca 3.pyogenic granuloma

One dermatology picture Intermittent pain in leg for 5 yrs. Brown pigmentation was there in the leg 1.lipodermatosclerosis 2.pretibial myxoedema 3.necrobiosis lipoidica

Bone scan in NSCLC 1.bone metastases 2.pagets disease 3.multiple myeloma 4.HPOA the one who think that his food is always is contaminated with influenza virus ?? what did you pic I remember Obsession adjustment ..... the venous ulcer case with ABI in the right was 0.89 [N 0.9-1.2]... in the image it was the leg with big venous ulcer in the left it was 0.9 [in the image it has a smaller ulcer] bandage dressing [I don't remember which dressing was there] but the value was boarder one Case autoimmune Hepatitis and started on prednisolone additional ttt azithio hyperlipidemia in pregnancy conservative vs cholestyramine

Relieve chest pain from a cancer [the CXR with a lesion behind the hear[ ??? By nerve block radiotherapy Chemotherapy

History of frequent fall,vertical upper gaze palsy,parkinsonism Dx?

Patient returned from Spain presented with fever , arthralgia and renal failure with proteinuria Urinary antigen for legionella ?

Patient extubated then coarse crepitation over the lung ARDS Or negative pressure pulmonary edema

Screening before R-CHOP therapy? Hepatitis B CMV MRSA

ECHO picture ?Myxoma

IgA vasculitis.on ramipril.still PCR-270 BP-148/85 what treatment? 1.amlodoipine 2.diuretic 3.prednisolone

Multiple sclerosis patient Incontinence Residual volume 30 ml Rx? self catheterisation Suprapubic catheterisation Oxybutynin

A young patient with myotonic dystrophy develop light headedness.pulse_60/min What is the cause of light headedness? 1.conduction defect 2.diastolic dysfunction 3.mvp

Quadriparesis,ptosis,facial palsy,areflexia in a iv drug user on ventilator.cause?history of flu like illness 4 wks back 1.GBS 2.Botulism

A case of heart failure with AF Is on bisoprolol,ramipril,frusemide.having oedema,heart rate 120.K5.5 AF,What treatment next? 1.increase dose of frusemide 2.spironolactone 3.digoxin

A patient with long standing rheumatoid arthritis developed breathlessness and swelling of leg.ecg -poor R wave progression V1-V3 Echo-systolic dysfunction, rt and it atrial enlargement urine protein + Dx?

A patient treated for pneumonia with antibiotics for 5 days but fever does not subsides.USG showed -loculated pleural effusion. What management next? 1.pleural aspiration 2.chest drain. 3. CT chest

Dementia with psychosis in parkinsonism Rx of psychosis ? Rivastigmin Amantadine Memantine??

Poor short term prognosis in liver disease 1.high PT 2.Raised SGPT 3.low albumin

What investigation should be done after starting azathioprine? TPMT -Normal Cbc cbc n lft tmpt level U and c

Cholangitis-most common organism?? Staph aureus psedumonas E.coli

A vet developed lumber pain,fever MRI -Discitis Which Organism? Staph.aureus Mycobacterium bovis

46yo women BMI slight high amenorrhoea high FSH high LH TSH -

hypothyroid menopause?

2 drugs To avoid in pregnancy? and acei

Rt foot xray with dm1 with reduced sensation with crp mildly raised & uric acid mildly raised?

Charcot joint

Vasculitis on Azathioprine, deranged LFT, bright liver? HIV patient with cervical and inguinal lymphadenopathy with biventricular failure . Ebv htlv

Guy with pigeon breeder in past come with respiratory symptoms, honeycombing on cxr avian precipitins negative RA slightly high - hypersensitivity pnemonitis Idiopathic pulmonary fibrosis?

NPH scenario investigation to confirm?

LP mri ct scan Idiopathic intracranial Hypertension given

acetazolamide - appropriate management weight loss? Serial LP Thyroid scan uptake: solitary toxic adenoma?

Multiple psychiatric drugs with fever and super high CK - diagnosis? mydriasis rhabdo neuroleptic malignant syndrome? serotonin synd

IgA on thiazides and ramiopril previously stable now come with proteinuria

Echo: (Picture) mass in systole and diastole - management surgical evacuation? Atrial myxoma - so surgical intervention?

CLL poor prognosis 1.TP 53 deletion 2.raised lymphocytes 3.??high LDH

A lady complaining of food contaminated with influenza virus.she is obtunded in low mood.expressing her anxiety about finances. Dx? 1.anxiety disorder 2.adjustment disorder 3.depressive psychosis 4.schizophrenia 5.obsessive disorder

A young patient with palpitation and he was hyper ventilating.pulse-119/min Resp-28/ min.he has tinling in his fingers and mouth .what should you do next?? ionized calcium was 1.02