MRCP part 2 written examination <ul><li>Total Marks:35 </li></ul><ul><li>Each question carries 1mark </li></ul><ul><li>No negative marks for wrong answer </li></ul><ul><li>Each slide will be shown for 1 minute </li></ul><ul><li>Duration: 35 min </li></ul>
What is the diagnosis? 1. Carcinoid syndrome 2. Dermatomyositis 3. Endocarditis 4. Lichen planus 5. Porphyria Q1:
What term is used to describe this finding? 1. Arc eye 2. Asthenopia 3. Choroideremia 4. Coloboma 5. Corectopia Q2:
What is the diagnosis? 1. Coarctation of the aorta 2. Lung cancer 3. Pneumothorax 4. Rib fracture 5. Substernal goiter Q3:
Which one of the following conditions is the most likely to be responsible for this clinical picture? 1. Excessive fluoride supplementation 2. Hyperbilirubinemia 3. Treatment with tetracycline 4. Trichophyton rubrum infection 5. Pseudomonas aeruginosa infection Q:4
Serum levels of which one of the following laboratory tests would be expected to be most abnormal in this patient? 1. 17-hydroxyprogesterone 2. Angiotensin-converting enzyme 3. Anti-tissue transglutaminase antibody 4. Prolactin 5. Vitamin B6 Q5:
What clinical presentation would be expected in this patient? 1. Asymmetrical mydriasis 2. Ataxic hemiparesis 3. Hypothermia 4. Quadriplegia 5. Upward gaze palsy Q6:
This 22-year-old man presented with a 1-month history of severe pubic itch that was worst at night. What is the most appropriate topical treatment? 1. Hydrocortisone 2. Hydroxyzine 3. Mupirocin 4. Permethrin 5. Selenium sulfide Q7:
What is the diagnosis? 1. Contact dermatitis 2. Discoid lupus erythematosus 3. Melanoma 4. Nummular eczema 5. Tinea corporis Q8:
What is the diagnosis? 1. Epidural hematoma 2. Glioblastoma multiforme 3. Meningioma 4. Subarachnoid hemorrhage 5. Subdural hematoma Q:9
This patient presented following a high-speed motor vehicle crash. Which structure has been disrupted? 1. Aorta 2. Diaphragm 3. Esophagus 4. Myocardium 5. Trachea Q:10
Which one of the following biochemical measures would be most likely to be elevated in this patient? 1. Alkaline phosphatase 2. Calcium 3. Ferritin 4. Phosphorus 5. 25-hydroxy-vitamin D Q:11
What is the diagnosis? 1. Neuropathic arthropathy 2. Rheumatoid arthritis 3. Hemophilia 4. Chondrocalcinosis 5. Rickets Q:12
What endocrine diagnosis is affecting the identical twin on the right side of the image? 1. Acromegaly 2. Addison's disease 3. Cushing's syndrome 4. Hypogonadism 5. Hypothyroidism Q:13
This patient recently returned from Brazil. What is the diagnosis? 1. Dracunculiasis 2. Ingrown toenail 3. Leptospirosis 4. Scabies 5. Tungiasis Q:14
This patient with chronic alcoholism presented with dysarthria and horizontal nystagmus. What is the diagnosis? 1. Brainstem glioma 2. Central pontine myelinolysis 3. Neurosarcoidosis 4. Pontine stroke 5. Tabes dorsalis Q:15
What diagnosis is suggested by this barium swallow? 1. Ingested foreign body 2. Esophageal diverticula 3. Diffuse esophageal spasm 4. Gastric linitis plastica 5. Esophageal carcinoma Q:16
What is the diagnosis? 1. Angioid streaks 2. Glaucoma 3. Macular degeneration 4. Ocular myiasis 5. Pseudoxanthoma elasticum Q:17
This man had cervical adenopathy. What is the most likely diagnosis? 1. Arteriovenous malformation 2. Cellulitis 3. Graves' disease 4. Lymphoma 5. Orbital fracture Q:18
What is the diagnosis? 1. Chronic paronychia 2. Dermatomyositis 3. Selenium deficiency 4. Rheumatoid arthritis 5. Psoriasis Q:19
What diagnosis is suggested by this corneal photograph? 1. Anterior uveitis 2. Chlamydia trachomatis infection 3. Cytomegalovirus retinitis 4. Herpes simplex virus infection 5. Toxocariasis Q:20
What is the diagnosis? 1. Amelanotic melanoma 2. Cicatricial pemphigoid 3. Keratoacanthoma 4. Hidrocystoma 5. Papular mucinosis Q:21
What is the diagnosis? 1. Asbestosis 2. Colonic interposition surgery 3. Suppurative mediastinitis 4. Pneumopericardium 5. Thoracic aortic aneurysm Q:22
What is the diagnosis? 1. Condylomata lata 2. Neurofibromatosis type 1 3. Keloid 4. von Hippel-Lindau disease 5. Tuberous sclerosis Q:23
What is the diagnosis? 1. Aspiration pneumonia 2. Sarcoidosis 3. Silicosis 4. Idiopathic pulmonary fibrosis 5. Lymphangioleiomyomatosis Q:24
What is the most likely diagnosis? 1. Amyloidosis 2. Craniopharyngioma 3. Leukemia 4. Neuroblastoma 5. von Willebrand's disease Q:25
MRCP April 2009 A 20 year old boy whose younger brother died suddenly last year requested for the ECG(shown above).What is the diagnosis 1. HOCM 2. Arrhythmogenic Right ventricular dysplasia 3.Brugadas syndrome 4. Long QT interval syndrome 5. Acute MI Q:26
MRCP April 2009 A 30 year old female presented with proximal muscle weakness. Examination of hands is shown as in picture.What is the definite investigation of choice in this patient ? 1. Skin biopsy 2. Muscle biopsy 3. Creatine kinase 4. Nerve conduction studies 5. CT head Q:27
MRCP April 2009 A 25 year old asthmatic presented with increasing shortness of breath.An chest X-Ray was done as shown in picture.What is the diagnosis? 1. Status Asthmaticus 2. Brochopneumonia 3. Mucus plug 4. pneumothorax 5. Normal chest X-ray Q:28
MRCP April 2009 A 40 year old alcoholic presented with rash on the hands shown in picture which increased on exposure to sunlight.What is the diagnosis? 1. SLE 2. Steven Johnson’s syndrome 3. Porphyria cutanea tarda 4. Lichen planus 5. Superficial pyoderma Q:29
What is the diagnosis? 1. Psoriatic arthropathy 2. Reflex sympathetic dystrophy 3. Osteoarthritis 4. Gout 5. Rheumatoid arthritis Q:30
MRCP April 2009 A caregiver of 30 year old destitute noticed discolouration of nail recently. What is the most likely diagnosis? 1. Subungual hematoma 2. Subungual melanoma 3. onycholysis 4. Thimble pitting 5. Yellow nail syndrome Q:31
This patient had left knee pain. What is the diagnosis? 1. Acanthosis nigricans 2. Erythema ab igne 3. Lymphangitis 4. Mycosis fungoides 5. Livedo reticularis Q:32
What is the most likely diagnosis? 1. Amyloidosis 2. Celiac disease 3. Hypothyroidism 4. Kawasaki disease 5. Type 2 diabetes Q:33
MRCP APRIL 2009 A 40 year old man presented with past history acute severe chest one year back for which he did not take any medical treatment.The ECG done now is shown in the picture.What is the diagnosis? 1. Acute anterior MI 2. HOCM 3. Old inferior wall MI 4. Lateral wall MI 5. Unstable angina Q:34
Which one of the following medications is most likely to be responsible for this finding? 1. Amiodarone 2. Cinacalcet 3. Lithium 4. Palifermin 5. Trastuzumab Q:35
Answer: What is the diagnosis? Q:1 2. Dermatomyositis Dilated and tortuous blood vessels with areas of atrophy, telangiectases, and bushy loop formation along the fingernail bed are most consistent with dermatomyositis. Periungual telangiectases also occur in patients with scleroderma and systemic lupus erythematosus.
Answer: What term is used to describe this finding? Q:2 4. Coloboma Colobomas are the result of abnormal closure of the optic fissure. They may occur anywhere along the optic fissure and can affect the iris, choroid, or macula. Isolated iris colobomas are asymptomatic, but those involving the macula or the optic disk can result in severe visual impairment. Typical iris colobomas occur in the inferonasal quadrant.
Answer: What is the diagnosis? Q:3 5. Substernal goiter The chest radiograph demonstrates tracheal deviation. Ultrasonography of the neck revealed a large goiter with the right lobe extending into the anterior superior mediastinum.
Answer: Which one of the following conditions is the most likely to be responsible for this clinical picture? Q:4 5. Pseudomonas aeruginosa infection Green nails, a form of chromonychia, may be caused by bacterial infection with P. aeruginosa. This syndrome is typically seen in patients with nail disease such as onycholysis, onychotillomania, or paronychia, particularly in those whose abnormal nails have been exposed to moist environments. The green color is caused by the fluorescent siderophore pyoverdin, produced by P. aeruginosa.
Answer: Serum levels of which one of the following laboratory tests would be expected to be most abnormal in this patient? Q:5 2. Angiotensin-converting enzyme Lupus pernio is a manifestation of sarcoidosis that involves the nasal bridge and cheeks. Serum levels of the angiotensin-converting enzyme are elevated in the majority of patients with untreated sarcoidosis.
Answer: What clinical presentation would be expected in this patient? Q:6 4. Quadriplegia The most common presentation of a pontine hemorrhage is quadriplegia. Small, reactive pupils are characteristic of pontine hemorrhages. Hemiparesis would be expected if the hemorrhage were asymmetrical. Hypothermia is unusual. Upward gaze palsy occurs with midbrain involvement.
Answer: This 22-year-old man presented with a 1-month history of severe pubic itch that was worst at night. What is the most appropriate topical treatment? Q:7 4. Permethrin The visible nits are consistent with pubic pediculosis. The recommended treatments include permethrin or pyrethrin lotions. Alternative regimens to treat lice include topical malathion or oral ivermectin. Patients with pediculosis pubis should be evaluated for other sexually transmitted diseases.
Answer: What is the diagnosis? Q:8 4. Nummular eczema The image illustrates discoid (nummular) eczema in an infant. This pattern of eczema is frequently associated with atopic dermatitis and is often confused with ringworm infection.
Answer: What is the diagnosis? Q:9 1. Epidural hematoma Computed tomogram shows a 2.5-cm epidural hematoma in the left parietal region with mass effect, effacement, and left-to-right midline shift. Epidural hematomas have a lens-shaped appearance. Subdural hematomas are typically sickle-shaped.
Answer: This patient presented following a high-speed motor vehicle crash. Which structure has been disrupted? Q:10 2. Diaphragm The elevated right hemidiaphragm suggests traumatic diaphragmatic rupture. The other listed structures appear to be intact. A computed tomographic scan confirmed the diaphragmatic rupture and showed that the dome of the liver had herniated into the right hemithorax.
Answer: Which one of the following biochemical measures would be most likely to be elevated in this patient? Q:11 1. Alkaline phosphatase The patient has genu varum and enlarged wrists consistent with nutritional rickets. Alkaline phosphatase usually is increased markedly over the age-specific reference range in rickets. Serum phosphorus and vitamin D concentrations are usually low; serum calcium concentration is decreased only in hypocalcemic rickets. Ferritin is not usually elevated in these patients.
Answer: What is the diagnosis? Q:12 4. Chondrocalcinosis The radiograph reveals chondrocalcinosis in the knee outlining the articular cartilage and especially the lateral meniscus. Chondrocalcinosis is the presence of linear, stippled calcification in joint cartilage. It is often found in association with pseudogout.
Answer: What endocrine diagnosis is affecting the identical twin on the right side of the image? Q:13 4. Hypogonadism The man on the right has evidence of central adiposity, preservation of scalp hair, loss of body hair, and gynecomastia compared to his identical brother. These findings are most suggestive of hypogonadism. This patient was diagnosed with a pituicytoma.
Answer: This patient recently returned from Brazil. What is the diagnosis? Q:14 5. Tungiasis Tungiasis is an ectoparasitosis in which the fertilized female sand flea (Tunga penetrans) burrows into the skin, with a predilection for periungual regions. The diagnosis is suggested by the appearance of small white eggs on the skin. The dead adult sand flea and additional eggs appeared with the application of lateral pressure and was fully excised. The parasite is endemic in tropical Africa and South America, as well as in subtropical regions of Asia.
Answer: This patient with chronic alcoholism presented with dysarthria and horizontal nystagmus. What is the diagnosis? Q:15 2. Central pontine myelinolysis The brain MRI reveals central pontine myelinolysis with a well-defined lesion in the pons of low T1-signal intensity, with sparing of the ventral lateral and cortical spinal tracts and no space-occupying effect or distortion of the adjacent fourth ventricle. Central pontine myelinolysis is a noninflammatory, demyelinating condition that was originally described in those with chronic alcoholism.
Answer: What diagnosis is suggested by this barium swallow? Q:16 3. Diffuse esophageal spasm Radiographs of the esophagus that were performed with the use of barium contrast material showed a spiral formation of the barium column up to the cervical esophagus, most consistent with diffuse esophageal spasm.
Answer: What is the diagnosis? Q:17 4. Ocular myiasis These linear and arcuate disturbances in the retina, which were most striking in the macula are most consistent with ocular myiasis. Angioid streaks and the retinal changes of pseudoxanthoma elasticum tend to originate near the papilla and radiate in a ringlike fashion.
Answer: This man had cervical adenopathy. What is the most likely diagnosis? Q:18 4. Lymphoma Binocular proptosis with conjunctival injection and chemosis along with multiple enlarged cervical lymph nodes suggests a diagnosis of lymphoma. In this patient, the proptosis resolved following treatment with combination chemotherapy.
Answer: What is the diagnosis? Q:19 5. Psoriasis Nail involvement is frequent in patients with psoriasis, and mild cases are characterized by small pits and yellowish discoloration of the nail plate.
Answer: What diagnosis is suggested by this corneal photograph? Q:20 4. Herpes simplex virus infection A dendritic ulcer is indicative of herpes simplex virus infection.
Answer: What is the diagnosis? Q:21 3. Keratoacanthoma Keratoacanthoma is typically a benign crateriform neoplasm that often involutes spontaneously after a few months of rapid growth. It is important to differentiate keratoacanthoma from squamous-cell carcinoma.
Answer: What is the diagnosis? Q:22 4. Pneumopericardium The chest radiograph shows pneumopericardium without evidence of pneumothorax or pneumomediastinum. This patient had a perforating esophageal ulcer. The radiograph is not consistent with the other listed diagnoses.
Answer: What is the diagnosis? Q:23 5. Tuberous sclerosis Periungual fibromas such as those in the image are typical in adults with tuberous sclerosis. This patient had tuberous sclerosis.
Answer: What is the diagnosis? Q:24 4. Idiopathic pulmonary fibrosis The chest radiograph reveals bilateral reticular infiltrates. There is subpleural and lower-lobe predominance, consistent with idiopathic pulmonary fibrosis.
Answer: What is the most likely diagnosis? Q:25 4. Neuroblastoma The image shows bilateral periorbital ecchymosis with dysconjugate gaze; the sclera appear normal. The "raccoon eyes" appearance is characteristically associated with neuroblastoma metastases to the skull. The appearance is not consistent with the other choices.
Answer: A 20 year old boy whose younger brother died suddenly last year requested for the ECG(shown above).What is the diagnosis Q:26 3.Brugadas syndrome Characterized by a coved-type ST-segment elevation in the right precordial leads
Answer: What is the definite investigation of choice in this patient ? Q:27 2. Muscle biopsy
Answer: What is the most likely diagnosis? Q:28 3. Mucus plug The image shows classical left middle lobe collapse caused by mucus plugging.
Answer: What is the diagnosis? Q:29 3. Porphyria cutanea tarda Typical cutaneous lesions in a patient with porphyria cutanea tarda. Chronic, crusted lesions resulting from blistering due to photosensitivity are on the dorsum of the hand of a PCT patient.
Answer: What is the diagnosis? Q:30 3. Osteoarthritis Examination of this patient's right hand reveals typical changes of osteoarthritis, with both Heberden's and Bouchard's nodes in association with irregular deformities.
Answer: A caregiver of 30 year old destitute noticed discolouration of nail recently. What is the most likely diagnosis? Q:31 1. Subungual hematoma
Answer: This patient had left knee pain. What is the diagnosis? Q:32 2. Erythema ab igne This reticular, reddish-brown, pruritic, nontender, macular, nonblanching discoloration around the medial aspect of the left knee, with a few superficial erosions, is most consistent with erythema ab igne. This patient had repeatedly applied a heating pad to his left knee in the preceding weeks to relieve discomfort from osteoarthritis.
Answer: What is the most likely diagnosis? Q:33 2. Celiac disease Atrophic glossitis is a typical manifestation of celiac disease.
Answer: Which one of the following medications is most likely to be responsible for this finding? Q:34 3. Old inferior wall MI Old inferior wall infarction as evidenced by pathological Q waves in inferior leads (II, III and aVf). .
Answer: Which one of the following medications is most likely to be responsible for this finding? Q:35 4. Palifermin Palifermin, a recombinant keratinocyte growth factor, is used for the prevention of oral mucosal injury induced by cytotoxic therapy in patients undergoing hematopoietic stem-cell transplantation. Palifermin stimulates the proliferation and differentiation of epithelial cells. The white tongue is commonly observed in patients treated with palifermin and most likely reflects transient, protective mucosal thickening.