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January 2014
(MRCP 1)
BY
Dr. Sherif Badrawy
BADRAWY notes MRCP
A very common SE of
Ciclosporin Rx ? ( and all
Calcineurin inhibitors)
1a
BADRAWY notes MRCP
Tremor
a better choice than
thrombocytopenia
1b
BADRAWY notes MRCP
Infertile woman with
proliferative endometrium
indicates ?
2a
BADRAWY notes MRCP
Anovulation
secretory endometrium is the
hallmark of ovulation.
2b
BADRAWY notes MRCP
Drugs commonly cause
extrapyramidal SEs ?
3a
BADRAWY notes MRCP
Conventional
antipsychotics
Not Atypical antipsychotics,
Not TCA
3b
BADRAWY notes MRCP
On standing for ≥ 1 minute,
physiological change ?
4a
BADRAWY notes MRCP
Decreased UOP
↓ SBP is immediately after standing
& only transient
COP , HR , Peripheral vascular
resistance all increase....
64 y ♀ Osteoporosis lumbar
spine (T score - 2.6,long term
inhaled CST), Rx ?
5a
BADRAWY notes MRCP
Alendronate ➜ 1st line Rx
a better choice than Denosumab ( a
rank ligand inhibitor given for 6
months SC injection, limite...
A pt é Ankylosing Spondylitis
(sacroiliac & back pain 8
months,limited lat. flexion & chest
expansion, sacroilitis in x ra...
Etanrecept
Anti -TNF recommended
after failed 2 NSAIDS , ( a
better choice than
Methotrexate)
6b
BADRAWY notes MRCP
A pt é Porphyrea Cutanea Tarda
(hyperpigmentation ,hypertrichosis,
blistering scarring eruptions in
dorsum of hand,worsen ...
Check urine é UV light
pink fluorescence under Wood's
lamp
for the CLINIC sitting this is a better
choice than urine porph...
A pt é truncal obesity, insulin
resistance, dyslipidemia ,
what do you expect more to
see ?
8a
BADRAWY notes MRCP
HTN
to complete the Dx of
Meabolic syndrome.
8b
BADRAWY notes MRCP
A helminth é a symptomatic
travel through the lung & the
adult worm resides in the
intestine ?
9a
BADRAWY notes MRCP
Ascaris lumbricoids
9b
BADRAWY notes MRCP
A pt é Essential Tremors (low
amplitude tremors, FH of
father affection , head
nodding, no bradykinesia, no
rigidity) , Rx...
Propranolol
Primidone also may be used.
1 b
BADRAWY notes MRCP
A 30 ♂ pt é psychological instability
(fired from job,custody dispute for
his children, Hx of episodes of
breathlessness w...
Conversion Disorder
neurological symptoms ( ex.
Blindness, Deafness, loss of feelings
& physical immobility) with normal
e...
A pt é Dermatitis
Herpitiformis with skin
biopsy, Igs to be found ?
12a
BADRAWY notes MRCP
IgA
present in dermal papillae ,
revealed on immunostaining.
Rx by Dapsone & Gluten free
diet
12b
BADRAWY notes MRCP
Buspirone acts on which
receptors ?
13a
BADRAWY notes MRCP
Serotonin receptors
5HT1A receptors, Short term Rx of
anxiety, effect may be delayed up to
2 wks , no dependance or abuse
...
a ♀ not affected by cystic fibrosis (
normal CXR) with a sister died by
the disease wants to calculate her
risk of having ...
1 in 150
this ♀ risk is 2 in 3 to be a carrier (as she's not
affected) + the partner from the population with
the risk of ...
A pt é Primary biliary cirrhosis (
♀,middle
age,jaundice,hepatosplenomegaly,FH),
Dx Abs ?
15a
BADRAWY notes MRCP
Anti-Mitochondrial Abs
against the components of pyruvate
dehydrogenase complex (E2 binding
protein & E3 binding protein)
...
Autosomal Dominant +
Severe mental retardation in
50% + benign growths in
various body parts ?
16a
BADRAWY notes MRCP
Tuberous Sclerosis
16b
BADRAWY notes MRCP
a young ♀ pt é depression ,
Chronic liver disease Ss,
Golden yellow ring at iris
periphery both eyes + low
serum copper, D...
Wilson's Disease
defect in incorporating copper into
ceruloplasmin / Kayser Fleischer
ring almost always present / Rx by
P...
A pt é HOCM (arrested during a
rugby match & died + postmortem
biopsy ➜ LV & asymmetric septal
hypertrophy) , underlying p...
Beta myosin heavy chain
mutation
a better choice than troponin
mutation (also occur in
HOCM)
18b
BADRAWY notes MRCP
Chronic Hepatitis B , ↑ risk
of ?
19a
BADRAWY notes MRCP
HCC
≅ 100 fold ↑ risk
19b
BADRAWY notes MRCP
Hypoglossal nerve paralysis
Lt side, outcome ?
2 a
BADRAWY notes MRCP
All intrinsic muscles of the Lt side
tongue are paralysed
supplies all ms of the tongue , none
of the palate / only motor,...
Primary Sclerosing
Cholangitis, correct statment
?
21a
BADRAWY notes MRCP
Cholangiocarcinoma occurs in ≅
20% of pts
(75 % associated with IBD / Age of
onset is 40 y / Men 70 % /
associated with HL...
A 79 y pt é dull abdominal pain
radiating to back, Anorexia,
cachexia, normo normo Anemia,
mild ↑ LFTs, ↑↑↑ bilirubin & AL...
Pancreatic Carcinoma
back pain partially relieved by sitting
fwd / jaundice late & presenting
Symptom /± associated with
t...
Causative factor for obesity in
the majority of pts ?
23a
BADRAWY notes MRCP
Energy intake in excess
of expenditure
Not genetic predisposition (
may be in some pts but not
the majority)
23b
BADRAWY n...
A pt é AIDS seroconversion (living
in Thailand, FEW WEEKS of night
sweat , diarrhea, lymphadenopathy
é -ve stool for cysts...
mycobacterium avium
intracellulare
Not CMV ( > acute onset of
presentation), Not cryptosporidium
( no ova or cysts in the ...
A 32 y pt é paroxysmal SVT
,failed valsalva & carotid
sinus massage , Rx ?
25a
BADRAWY notes MRCP
IV Adenosine
a better option than
verapamil dt > rapid onset &
shorter duration of action.
25b
BADRAWY notes MRCP
The greatest absolute risk
reduction from the choices ?
26a
BADRAWY notes MRCP
15 % relative risk reduction vs a
placebo event rate of 3.5 %
absolute risk reduction = 3.5 x 0.15
= 0.525 % (other option...
A pt é LQT1 syndrome
collapsed dt VT & improved
after cardioversion, most
important initial intervention
to prevent recurr...
Atenolol
Not permenant pacemaker
if no response ➜ stellate
ganglionectomy.
ICD is 1st choices in LQT2 & LQT3
dt > incidenc...
A 79 y pt é dyspnea, facial
swelling , ? bronchial
neoplasm.. suspect SVC
obstruction, look for ?
28a
BADRAWY notes MRCP
Venous dilatation over the
anterior chest wall
SVC obst. is 70 % dt lung cancer,
oncological emmergency ➜ rapid Rx
é CST.
...
A correct statment regarding
ppt factors of DKA ?
29a
BADRAWY notes MRCP
Non compliance to Rx is the cause
in 25 % of cases
other ppt factors ➜ Infection 30-40
%,Chge insulin dose 13 %,Newly Dx
D...
What suggests Graves'
disease as the cause of
hyperthyroidism ?
3 a
BADRAWY notes MRCP
Pretibial myxoedema
a better choice than lid lag &
goitre.
3 b
BADRAWY notes MRCP
Should be considered in Rx
of Hemophilia A ?
31a
BADRAWY notes MRCP
Desmopressin may be useful
mild to moderate hemophilia
respond to desmopressin to cover
minor procedures such as tooth
ext...
a young ♀ pt é Sx of
hypothyroidism postpartum,
Dx ?
32a
BADRAWY notes MRCP
Postpartum thyroiditis
Transient,self limiting, may
be associated é
hyperthyroidism.
Iodine deficiency is no rare.
32b
BAD...
Aquaporin 2 gene mutation
causes ?
33a
BADRAWY notes MRCP
Nephrogenic DI
33b
BADRAWY notes MRCP
A pt é RA diffusely red eye,
gritty, painful + preserved
visual acuity,Normal
schirmer test, Dx ?
34a
BADRAWY notes MRCP
Episcleritis
Not Scleritis. preserved visual acuity
points towards episcleritis + scleritis
associated é ≫ severe eye pain...
Associated with
Hyperkalemia ?
35a
BADRAWY notes MRCP
Ciclosporin
35b
BADRAWY notes MRCP
Adisonian Crisis é random
BS 3.4 mmol/l ,1st priority
Rx ?
36a
BADRAWY notes MRCP
Resuscitation é IV NS +
Hydrocortisone
Given simultaneously é immediate
priority to fluid resuscitation.
Not IV Hydrocorti...
AIDS pt on HAART ➜
improved CD4 from 50 to
800 ,c/o reduced vision +
slight eye discomfort, Dx ?
37a
BADRAWY notes MRCP
Immune reconstitution
Uveitis
Not CMV retinitis,not
Toxoplasma (associated é
very low CD4 count)
37b
BADRAWY notes MRCP
Tamoxifen, a correct
statment ?
38a
BADRAWY notes MRCP
functions as a SERM
no need for PAP smear (no risk of
Cx canecr) / ↓ risk of IHD dt ↓ LDL
cholesterol / much ↓ effect on
e...
Recurrent Pneumonia +
pleural effusion,Quieckest
way to decide the need for
drainage ?
39a
BADRAWY notes MRCP
Pleural fluid pH
< 7.2 suggests parapneumonic
effusion requiring drainage
Not pleural fluid culture ➜ takes
sometime for a...
HLA associated é RA ?
4 a
BADRAWY notes MRCP
HLA DR4
4 b
BADRAWY notes MRCP
A 24 y immigrant pt é several
months fever,wt loss,night
sweats,chronic cough ±
hemoptysis,calcified hilar LNs,
normo norm...
Active pulmonary TB
41b
BADRAWY notes MRCP
Hepatorenal
Syndrome,mechanism of
craetinine deterioration ?
42a
BADRAWY notes MRCP
Renal vasoconstriction
definitive Rx is
transplantation.
42b
BADRAWY notes MRCP
A COPD pt é recurrent
exacerbations & hospital
admissions é FEV1 < 50 %,
Rx ?
43a
BADRAWY notes MRCP
Combination high dose
inhaled CST + LABA
43b
BADRAWY notes MRCP
A 24 y pt é dusky blue nodular rash
over shin, intermittent diarrhea ±
blood,proctoscopy ➜ moderate
rectal inflammation + ...
Ulcerative Colitis
a better choice than Crohn's disease
as predominant lower GI Sx é
proctitis are > suggestive of
ulcerat...
A 45 y pt contact tracing program
referral dt sitting beside a man later
found to be +ve in a flight to
pakistan,no Hx of ...
Mantoux test
a very useful initial screening tool.
Not Chest X-ray (next step after
mantoux), Not prophylactic Anti-TB
Rx....
A 48 y pt blurring Lt eye, Angioid
streaks,macular edema,skin folds é
yellow striations & puckering in the
neck & flexor a...
Pseudoxanthoma
elasticum
Not Marfan's syndrome.
46b
BADRAWY notes MRCP
A 61 y pt DM, COPD on ↑ dose seretide
inhaler + multiple toe nail fungal
infections, Rx ?
47a
BADRAWY notes MRCP
Oral Terbinafine
Topical is ineffective in fungal nail
infection, oral Terbinafine is better
than oral Itraconazole esp. i...
Acquired lipodystrophy
(young ♀ pt, loss of fat
around the face & upper
body, creatinine 110), which
complement deficiency...
C3
Acquired lipodystrophy ➜ no
metabolic abnormalities
Congenital lipodystrophy ➜
metabolic abnormalities.
48b
BADRAWY not...
A 12 y boy é gradually progressive
plaque on his buttock for 3 years
with crusting and induration at the
periphery and sca...
Lupus vulgaris
Not Tinea corporis
A lesion with central scarring is suggestive
of lupus vulgaris
commonest manifestation o...
A pt é cirrhosis secondary to
hepatitis C, progressive
deterioration over 6 months, Hx of
IV heroin abuse & alcoholism,
we...
HCC
definitive Dx by U/S folloed
by CT guided biopsy, Rx usu
palliative.
5 b
BADRAWY notes MRCP
a young ♀ é Sx of pulmonary
HTN (Exertional dyspnea,LL
oedema),best Ix to exclude
2ndry pulmonary HTN ?
51a
BADRAWY notes ...
CT pulmonary Angio
a better choice than ECHO &
V/Q scan
51b
BADRAWY notes MRCP
clinical phase-ll study in oncology,
testing a new chemotherapy in
patients with a malignant tumour
Which statistical test...
Log-rank test
52b
BADRAWY notes MRCP
a young pt é aplastic anemia
(BM biopsy ↓ hematopoeitic
cells, fatty BM), most
effective long term Rx ?
53a
BADRAWY notes ...
Hematopoeitic stem cell
transplantation
a better choice than chemotherapy
Children & young adults ➜ BM
transplantation is ...
Anti-epileptic drug causing
SIADH (hyponatremia & ↓
plasma osmolality) ?
54a
BADRAWY notes MRCP
Carbamazepine
Dose related hyponatremia
54b
BADRAWY notes MRCP
an old pt not DM é Lt lateral
hip pain, ↑ é abduction
against resistance, Dx ?
55a
BADRAWY notes MRCP
Trochanteric bursitis
Not Osteoarthritis ( limitation with
the full range of movement + deeper
pain within the joint) / no...
a elderly DM pt é Hx of extensive
psoriasis, hot swollen Lt knee joint,
limited mobility, ↑ESR, WBCs,
Creatinine, knee x r...
Orthopedic referral for aspiration
& washout.
a better choice than IV
Flucloxacilline ➜ Abiotics without
aspiration & wash...
a middle age ♂ with wt loss,
night sweats,mild asthma,
Dyspnea,cough, nosebleed,
↑ESR, ↑Creatinine,cANCA
+ve, Dx ?
57a
BAD...
Wegener's
granulomatosis
Not churg strauss syndrome.
57b
BADRAWY notes MRCP
a 16 y ♀ é B/L renal cortical
scarring,Hx of recurrent UTIs with
antibiotis in childhood but no UTIs
since 5 y., HTN (180/...
ACE Inhibitors
a better choice than Surgical re-insertion
of ureters
imaging + Hx of recurrent UTIs in
childhood ➜ Chronic...
An elderly pt é Polymyositis (
proximal ms weakness +
shoulder pain + ↑↑ CK) ,
initial Rx of choice ?
59a
BADRAWY notes MR...
Prednisolone
screen for underlying
malignancy
59b
BADRAWY notes MRCP
Organism seen in the sputum
of HIV infected pt ?
6 a
BADRAWY notes MRCP
Cryptococcus
Not Cryptosporidium (causes
Diarrhea not pneumonia)
Dx of Cryptococcus by India Ink
stain, in Meningitis do A...
Hemophilia B mode of
inheritance ?
61a
BADRAWY notes MRCP
X-linked recessive
Also Hemophilia A.
61b
BADRAWY notes MRCP
trials a new drug for lowering lipid
levels.2 groups, one receiving the
drug and the other placebo. What is
the best stati...
Unpaired T test
62b
BADRAWY notes MRCP
For what metabolic process
Riboflavin is required ?
63a
BADRAWY notes MRCP
Hydrogen-transfer chain
in the mitochondria
63b
BADRAWY notes MRCP
An 58 pt Uncontrolled DM1 é 5
units bloot transfusion 2 wks earlier,
you want to do Hb A1c to assess
him,how long to wait ...
6 months
Not 3 months
Lifespan of RBCs about 4 months & the
transfusion is large amount (5 units)
➜ wait 6 months before m...
An elderly pt é large stroke ( Lt
hemiparesis, homonymous
hemianopia, left sided neglect,
receptive dysphasia, and poor le...
Receptive dysphasia
dt difficulties complying with
rehabilitation Rx
recovery from neglect is excellent +
function of the ...
a pt é Porphyria Cutanea tarda
(hyperpigmentation ,hypertrichosis,
blistering scarring eruptions in
dorsum of hand,worsen ...
Avoidance of Alcohol
Not avoidance of smoking
66b
BADRAWY notes MRCP
a pt é CAP + reactivation of
Cold sore, Causative
Organism ?
67a
BADRAWY notes MRCP
Streptococcus
pneumoniae
67b
BADRAWY notes MRCP
a 43 y pt é frequent
Headaches worse in the
morning,HTN ,K 3.1,Normal
BMI, Creatinine 112, Test will
get the Dx ?
68a
BADR...
Renin Aldosterone ratio
Not Urinary metanephrines , Not 24
urinary free cortisol
Hypokalemia + HTN + Normal BMI
+ no Cushi...
a 30 y pt é jaundice, anemia
& splenomegaly,
reticulocytosis + osmotic
fragility, Dx ?
69a
BADRAWY notes MRCP
Heriditary spherocytosis
Autosomal Dominant
69b
BADRAWY notes MRCP
Muscle control PIP joint
flexion ?
7 a
BADRAWY notes MRCP
Flexor Digitorum superficialis
Not Flexor Digitorum profundus ➜
flexion at wrist, metacarpophalangeal
& interphalangeal jo...
most important physiologic
mechanism that prevents
reflux ?
71a
BADRAWY notes MRCP
parasympathetic
stimulation of the lower
circular smooth ms fibers of
the oesophagus
No true anatomical sphincter
71b
BADR...
MOA of Allopurinol ?
72a
BADRAWY notes MRCP
Inhibits xanthine oxidase
Colchicine Inhibits microtubule
polymerization ➜ ↓ inflammatory
activity. Rasburicase is a recom...
a pt é GBS + desatting on
lying flat + unable to perform
spirometry ?
73a
BADRAWY notes MRCP
ITU review for
consideration of
ventilation
73b
BADRAWY notes MRCP
HF despite maximal medical
Rx, a decision for pacemaker
,type ?
74a
BADRAWY notes MRCP
biventricular pacemaker
Not Dual chamber
pacemaker
74b
BADRAWY notes MRCP
a 17 y ♀ é Collapse after
strenuous exercise,felt weak
and faint afterwards, father
died suddenly at a young age
,normal e...
Cardiac syncope
Not Seizures
MCC is HOCM but lack of physical
signs is against that.
Long QT syndrome & Brugada
syndrome a...
Which is most consistent
with a diagnosis of Bell's
palsy?
76a
BADRAWY notes MRCP
Hyperacusis
Not Loss of sensation
loss of lacrimation in lesions before
the geniculate ganglion.
Loss of taste to the ante...
a pt é Headache + 3rd nerve
palsy ,Dx ?
77a
BADRAWY notes MRCP
Posterior communicating
Artery aneurysm
77b
BADRAWY notes MRCP
a pt é CAP, most useful in
predicting outcome ?
78a
BADRAWY notes MRCP
Urea
( CURB 65)
78b
BADRAWY notes MRCP
CLL pt é recurrent infections
,Etiology ?
79a
BADRAWY notes MRCP
Immunoglobulin
deficiency
Not T cell dysfunction
79b
BADRAWY notes MRCP
DOCH to control BP in
pheochromocytoma ?
8 a
BADRAWY notes MRCP
Phenoxybenzamine
if going for surgery start it 7-
10 days before
8 b
BADRAWY notes MRCP
Long term prognosis of HSP
?
81a
BADRAWY notes MRCP
Complete recovery with no
long term sequelae
81b
BADRAWY notes MRCP
Route of Adrenaline
adminestration in
anaphylactic shock ?
82a
BADRAWY notes MRCP
Intramuscular
Not IV as Intramuscular is
the most predictable profile
on absorption & clinical
effect.
82b
BADRAWY notes M...
Post-needle stick injury from
a pt with known hepatitis C
+ve ?
83a
BADRAWY notes MRCP
Monthly hepatitis C PCR
83b
BADRAWY notes MRCP
Bullous impetigo with
systemic Sx (fever, ↑ WBCs,
↑CRP) , Rx ?
84a
BADRAWY notes MRCP
IV Co-Amoxiclav
a better choice than oral
flucloxacillin dt > range of
action.
84b
BADRAWY notes MRCP
Chronic alcoholic,Generalized weakness
+ tremors + hypokalemia +
hypocalcemia, Etiology ?
85a
BADRAWY notes MRCP
Hypomagnesemia
dt malnutrition and alcohol
related diuresis
85b
BADRAWY notes MRCP
the strongest pointer towards
a diagnosis of Type 1
diabetes?
86a
BADRAWY notes MRCP
Ketonuria
Not Anti-GAD antibodies
Single autoantibody +ve is not indicative
of a diagnosis of DM1
2 or 3 antibody positivi...
VF in a controlled
enviroment (CCU), Rx of
choice ?
87a
BADRAWY notes MRCP
Defibrillate
Not precordial thumb (only
give if defibrillator is
unavailable)
87b
BADRAWY notes MRCP
HIT, most common
complication ? (IgG Abs
against PF4- heparin coplex)
88a
BADRAWY notes MRCP
DVT
Not arterial thrombosis
88b
BADRAWY notes MRCP
Tirofiban, MOA ?
89a
BADRAWY notes MRCP
2b3a inhibitor
Platelet function returns to baseline
within eight hours after
discontinuation.
contraindicated in hepatic
...
Peanut allergy,correct
statment ?
9 a
BADRAWY notes MRCP
The wheal size resulting from the skin
prick test is an excellent predictor of a
positive food challenge to peanuts
The se...
Wernicke's encephalopathy
(thiamine deficiency in
Alcoholic),what do you
expect to see ?
91a
BADRAWY notes MRCP
Nystagmus
a better choice than coma
Nystagmus is the commonest
eye sign in wernicke's
91b
BADRAWY notes MRCP
Pain in Rt Knee ,Sx of
Reactive Arthritis,Rt Knee
aspirate showed no
organisms, Rx ?
92a
BADRAWY notes MRCP
Intra-articular CST injection
a better choice than Diclofenac or
Doxycycline
Systemic NSAIDS are the mainstay of
Rx but in...
a 23 ♂ pt é anal discharge +
dysuria + urethral smear ➜
intracellular diplococci, Dx ?
93a
BADRAWY notes MRCP
Neisseria Gonorrhea
93b
BADRAWY notes MRCP
Central Chest pain ECG
reveals Twave inversion in V5
and V6 finding on
angiography?
94a
BADRAWY notes MRCP
Critical stenosis of the left
circumOex artery
94b
BADRAWY notes MRCP
Acute Pericareditis, ECG
finding ?
95a
BADRAWY notes MRCP
PR depression
95b
BADRAWY notes MRCP
A 34-y ♀ non-smoker moderate
hypoxaemia,Lung function tests
normal lung volumes but a reduced
Tlco at 45%
PCO2 of 7.9 kPa ...
Pulmonary arteriovenous
malformation
right-to-left shunts, so reducing Tlco
values and provoking
hypoxaemia.Emphysema can ...
A 72-y ♀ left total hip
replacement ,Routine Ix
(WBC 22.5, Lymphocytes 19)
most appropriate Rx ?
97a
BADRAWY notes MRCP
Go ahead with the surgery
but keep her under
haematology follow-up
Mostly CLL & doesn't require
Rx now
97b
BADRAWY notes M...
Lyme disease (tick bite 3
months ago + rash) with
sudden collapse,cause ?
98a
BADRAWY notes MRCP
AV heart block
98b
BADRAWY notes MRCP
Wegner's Granulomatosis,
findings in renal Biopsy ?
99a
BADRAWY notes MRCP
Necrotizing GN without
complement or Ig
deposition
99b
BADRAWY notes MRCP
A 16-y ♂ abdominal pain and
vomiting , ↓Power distally
ankle and knee reOexes
absent,sister has similar condition
+basophi...
Lead poisoning
Not Acute intermittent
porphyria (dt basophilic
stippling isn't in AIP)
1 b
BADRAWY notes MRCP
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January 2014 MRCP1

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Transcript of "January 2014 MRCP1"

  1. 1. January 2014 (MRCP 1) BY Dr. Sherif Badrawy BADRAWY notes MRCP
  2. 2. A very common SE of Ciclosporin Rx ? ( and all Calcineurin inhibitors) 1a BADRAWY notes MRCP
  3. 3. Tremor a better choice than thrombocytopenia 1b BADRAWY notes MRCP
  4. 4. Infertile woman with proliferative endometrium indicates ? 2a BADRAWY notes MRCP
  5. 5. Anovulation secretory endometrium is the hallmark of ovulation. 2b BADRAWY notes MRCP
  6. 6. Drugs commonly cause extrapyramidal SEs ? 3a BADRAWY notes MRCP
  7. 7. Conventional antipsychotics Not Atypical antipsychotics, Not TCA 3b BADRAWY notes MRCP
  8. 8. On standing for ≥ 1 minute, physiological change ? 4a BADRAWY notes MRCP
  9. 9. Decreased UOP ↓ SBP is immediately after standing & only transient COP , HR , Peripheral vascular resistance all increase. 4b BADRAWY notes MRCP
  10. 10. 64 y ♀ Osteoporosis lumbar spine (T score - 2.6,long term inhaled CST), Rx ? 5a BADRAWY notes MRCP
  11. 11. Alendronate ➜ 1st line Rx a better choice than Denosumab ( a rank ligand inhibitor given for 6 months SC injection, limited use dt cost) 5b BADRAWY notes MRCP
  12. 12. A pt é Ankylosing Spondylitis (sacroiliac & back pain 8 months,limited lat. flexion & chest expansion, sacroilitis in x ray, ↑ ESR) + failed Rx é 2 NSAIDS, Rx ? 6a BADRAWY notes MRCP
  13. 13. Etanrecept Anti -TNF recommended after failed 2 NSAIDS , ( a better choice than Methotrexate) 6b BADRAWY notes MRCP
  14. 14. A pt é Porphyrea Cutanea Tarda (hyperpigmentation ,hypertrichosis, blistering scarring eruptions in dorsum of hand,worsen in summer, alcoholic pt) , Dx (IN THE CLINIC) by ? 7a BADRAWY notes MRCP
  15. 15. Check urine é UV light pink fluorescence under Wood's lamp for the CLINIC sitting this is a better choice than urine porphyrins & serum porphyrins. 7b BADRAWY notes MRCP
  16. 16. A pt é truncal obesity, insulin resistance, dyslipidemia , what do you expect more to see ? 8a BADRAWY notes MRCP
  17. 17. HTN to complete the Dx of Meabolic syndrome. 8b BADRAWY notes MRCP
  18. 18. A helminth é a symptomatic travel through the lung & the adult worm resides in the intestine ? 9a BADRAWY notes MRCP
  19. 19. Ascaris lumbricoids 9b BADRAWY notes MRCP
  20. 20. A pt é Essential Tremors (low amplitude tremors, FH of father affection , head nodding, no bradykinesia, no rigidity) , Rx ? 1 a BADRAWY notes MRCP
  21. 21. Propranolol Primidone also may be used. 1 b BADRAWY notes MRCP
  22. 22. A 30 ♂ pt é psychological instability (fired from job,custody dispute for his children, Hx of episodes of breathlessness when adolescent) c/o of blindness inspite of normal medical & neuro. examination, what psychiatric Dx ? 11a BADRAWY notes MRCP
  23. 23. Conversion Disorder neurological symptoms ( ex. Blindness, Deafness, loss of feelings & physical immobility) with normal examination Rx by CBT (Cognitive Behavioral Therapy). 11b BADRAWY notes MRCP
  24. 24. A pt é Dermatitis Herpitiformis with skin biopsy, Igs to be found ? 12a BADRAWY notes MRCP
  25. 25. IgA present in dermal papillae , revealed on immunostaining. Rx by Dapsone & Gluten free diet 12b BADRAWY notes MRCP
  26. 26. Buspirone acts on which receptors ? 13a BADRAWY notes MRCP
  27. 27. Serotonin receptors 5HT1A receptors, Short term Rx of anxiety, effect may be delayed up to 2 wks , no dependance or abuse potential. 13b BADRAWY notes MRCP
  28. 28. a ♀ not affected by cystic fibrosis ( normal CXR) with a sister died by the disease wants to calculate her risk of having a child with cystic fibrosis ( the carrier frequency in population is 1 in 25) ? 14a BADRAWY notes MRCP
  29. 29. 1 in 150 this ♀ risk is 2 in 3 to be a carrier (as she's not affected) + the partner from the population with the risk of 1 in 23 + the chance of having affected child if both are carriers is 1 in 4 ➜ overall chance is 2/3 x 1/25 x 1/4 = 1/150. the key to answer this is that in AR conditions the risk of being a carrier is 2/3 not 2/4 (i.e 1/2) as she's not affected. 14b BADRAWY notes MRCP
  30. 30. A pt é Primary biliary cirrhosis ( ♀,middle age,jaundice,hepatosplenomegaly,FH), Dx Abs ? 15a BADRAWY notes MRCP
  31. 31. Anti-Mitochondrial Abs against the components of pyruvate dehydrogenase complex (E2 binding protein & E3 binding protein) appears long before Sx & before liver function abnormalities. 15b BADRAWY notes MRCP
  32. 32. Autosomal Dominant + Severe mental retardation in 50% + benign growths in various body parts ? 16a BADRAWY notes MRCP
  33. 33. Tuberous Sclerosis 16b BADRAWY notes MRCP
  34. 34. a young ♀ pt é depression , Chronic liver disease Ss, Golden yellow ring at iris periphery both eyes + low serum copper, Dx ? 17a BADRAWY notes MRCP
  35. 35. Wilson's Disease defect in incorporating copper into ceruloplasmin / Kayser Fleischer ring almost always present / Rx by Penicillamine 17b BADRAWY notes MRCP
  36. 36. A pt é HOCM (arrested during a rugby match & died + postmortem biopsy ➜ LV & asymmetric septal hypertrophy) , underlying pathology ? 18a BADRAWY notes MRCP
  37. 37. Beta myosin heavy chain mutation a better choice than troponin mutation (also occur in HOCM) 18b BADRAWY notes MRCP
  38. 38. Chronic Hepatitis B , ↑ risk of ? 19a BADRAWY notes MRCP
  39. 39. HCC ≅ 100 fold ↑ risk 19b BADRAWY notes MRCP
  40. 40. Hypoglossal nerve paralysis Lt side, outcome ? 2 a BADRAWY notes MRCP
  41. 41. All intrinsic muscles of the Lt side tongue are paralysed supplies all ms of the tongue , none of the palate / only motor, no sensory. 2 b BADRAWY notes MRCP
  42. 42. Primary Sclerosing Cholangitis, correct statment ? 21a BADRAWY notes MRCP
  43. 43. Cholangiocarcinoma occurs in ≅ 20% of pts (75 % associated with IBD / Age of onset is 40 y / Men 70 % / associated with HLA A1-B8- DR3) 21b BADRAWY notes MRCP
  44. 44. A 79 y pt é dull abdominal pain radiating to back, Anorexia, cachexia, normo normo Anemia, mild ↑ LFTs, ↑↑↑ bilirubin & ALP, U/S abdomen ➜ bile duct obstruction & epigastric mass , Dx ? 22a BADRAWY notes MRCP
  45. 45. Pancreatic Carcinoma back pain partially relieved by sitting fwd / jaundice late & presenting Symptom /± associated with thrombophlebitis migrans / ± thromboembolic phenomena / CA 19- 9 22b BADRAWY notes MRCP
  46. 46. Causative factor for obesity in the majority of pts ? 23a BADRAWY notes MRCP
  47. 47. Energy intake in excess of expenditure Not genetic predisposition ( may be in some pts but not the majority) 23b BADRAWY notes MRCP
  48. 48. A pt é AIDS seroconversion (living in Thailand, FEW WEEKS of night sweat , diarrhea, lymphadenopathy é -ve stool for cysts & ova), Dx ? 24a BADRAWY notes MRCP
  49. 49. mycobacterium avium intracellulare Not CMV ( > acute onset of presentation), Not cryptosporidium ( no ova or cysts in the stool) 24b BADRAWY notes MRCP
  50. 50. A 32 y pt é paroxysmal SVT ,failed valsalva & carotid sinus massage , Rx ? 25a BADRAWY notes MRCP
  51. 51. IV Adenosine a better option than verapamil dt > rapid onset & shorter duration of action. 25b BADRAWY notes MRCP
  52. 52. The greatest absolute risk reduction from the choices ? 26a BADRAWY notes MRCP
  53. 53. 15 % relative risk reduction vs a placebo event rate of 3.5 % absolute risk reduction = 3.5 x 0.15 = 0.525 % (other options are less) 26b BADRAWY notes MRCP
  54. 54. A pt é LQT1 syndrome collapsed dt VT & improved after cardioversion, most important initial intervention to prevent recurrence ? 27a BADRAWY notes MRCP
  55. 55. Atenolol Not permenant pacemaker if no response ➜ stellate ganglionectomy. ICD is 1st choices in LQT2 & LQT3 dt > incidence é sudden death. 27b BADRAWY notes MRCP
  56. 56. A 79 y pt é dyspnea, facial swelling , ? bronchial neoplasm.. suspect SVC obstruction, look for ? 28a BADRAWY notes MRCP
  57. 57. Venous dilatation over the anterior chest wall SVC obst. is 70 % dt lung cancer, oncological emmergency ➜ rapid Rx é CST. 28b BADRAWY notes MRCP
  58. 58. A correct statment regarding ppt factors of DKA ? 29a BADRAWY notes MRCP
  59. 59. Non compliance to Rx is the cause in 25 % of cases other ppt factors ➜ Infection 30-40 %,Chge insulin dose 13 %,Newly Dx DM 10-20 %,MI <1 %. 29b BADRAWY notes MRCP
  60. 60. What suggests Graves' disease as the cause of hyperthyroidism ? 3 a BADRAWY notes MRCP
  61. 61. Pretibial myxoedema a better choice than lid lag & goitre. 3 b BADRAWY notes MRCP
  62. 62. Should be considered in Rx of Hemophilia A ? 31a BADRAWY notes MRCP
  63. 63. Desmopressin may be useful mild to moderate hemophilia respond to desmopressin to cover minor procedures such as tooth extraction. vWF levels are normal in hemophilia A. 31b BADRAWY notes MRCP
  64. 64. a young ♀ pt é Sx of hypothyroidism postpartum, Dx ? 32a BADRAWY notes MRCP
  65. 65. Postpartum thyroiditis Transient,self limiting, may be associated é hyperthyroidism. Iodine deficiency is no rare. 32b BADRAWY notes MRCP
  66. 66. Aquaporin 2 gene mutation causes ? 33a BADRAWY notes MRCP
  67. 67. Nephrogenic DI 33b BADRAWY notes MRCP
  68. 68. A pt é RA diffusely red eye, gritty, painful + preserved visual acuity,Normal schirmer test, Dx ? 34a BADRAWY notes MRCP
  69. 69. Episcleritis Not Scleritis. preserved visual acuity points towards episcleritis + scleritis associated é ≫ severe eye pain worse at night & at moving the eye. 34b BADRAWY notes MRCP
  70. 70. Associated with Hyperkalemia ? 35a BADRAWY notes MRCP
  71. 71. Ciclosporin 35b BADRAWY notes MRCP
  72. 72. Adisonian Crisis é random BS 3.4 mmol/l ,1st priority Rx ? 36a BADRAWY notes MRCP
  73. 73. Resuscitation é IV NS + Hydrocortisone Given simultaneously é immediate priority to fluid resuscitation. Not IV Hydrocortisone alone,not IV glucose. 36b BADRAWY notes MRCP
  74. 74. AIDS pt on HAART ➜ improved CD4 from 50 to 800 ,c/o reduced vision + slight eye discomfort, Dx ? 37a BADRAWY notes MRCP
  75. 75. Immune reconstitution Uveitis Not CMV retinitis,not Toxoplasma (associated é very low CD4 count) 37b BADRAWY notes MRCP
  76. 76. Tamoxifen, a correct statment ? 38a BADRAWY notes MRCP
  77. 77. functions as a SERM no need for PAP smear (no risk of Cx canecr) / ↓ risk of IHD dt ↓ LDL cholesterol / much ↓ effect on estrogen receptor -ve tumors. 38b BADRAWY notes MRCP
  78. 78. Recurrent Pneumonia + pleural effusion,Quieckest way to decide the need for drainage ? 39a BADRAWY notes MRCP
  79. 79. Pleural fluid pH < 7.2 suggests parapneumonic effusion requiring drainage Not pleural fluid culture ➜ takes sometime for a useful result. 39b BADRAWY notes MRCP
  80. 80. HLA associated é RA ? 4 a BADRAWY notes MRCP
  81. 81. HLA DR4 4 b BADRAWY notes MRCP
  82. 82. A 24 y immigrant pt é several months fever,wt loss,night sweats,chronic cough ± hemoptysis,calcified hilar LNs, normo normo anemia, +ve AFB 6 months ago, Dx ? 41a BADRAWY notes MRCP
  83. 83. Active pulmonary TB 41b BADRAWY notes MRCP
  84. 84. Hepatorenal Syndrome,mechanism of craetinine deterioration ? 42a BADRAWY notes MRCP
  85. 85. Renal vasoconstriction definitive Rx is transplantation. 42b BADRAWY notes MRCP
  86. 86. A COPD pt é recurrent exacerbations & hospital admissions é FEV1 < 50 %, Rx ? 43a BADRAWY notes MRCP
  87. 87. Combination high dose inhaled CST + LABA 43b BADRAWY notes MRCP
  88. 88. A 24 y pt é dusky blue nodular rash over shin, intermittent diarrhea ± blood,proctoscopy ➜ moderate rectal inflammation + normo normo anemia + ↑ CRP , Dx ? 44a BADRAWY notes MRCP
  89. 89. Ulcerative Colitis a better choice than Crohn's disease as predominant lower GI Sx é proctitis are > suggestive of ulcerative colitis. 44b BADRAWY notes MRCP
  90. 90. A 45 y pt contact tracing program referral dt sitting beside a man later found to be +ve in a flight to pakistan,no Hx of TB, no BCG vaccine, normal examination, next step ? 45a BADRAWY notes MRCP
  91. 91. Mantoux test a very useful initial screening tool. Not Chest X-ray (next step after mantoux), Not prophylactic Anti-TB Rx. 45b BADRAWY notes MRCP
  92. 92. A 48 y pt blurring Lt eye, Angioid streaks,macular edema,skin folds é yellow striations & puckering in the neck & flexor aspect of joints, Dx ? 46a BADRAWY notes MRCP
  93. 93. Pseudoxanthoma elasticum Not Marfan's syndrome. 46b BADRAWY notes MRCP
  94. 94. A 61 y pt DM, COPD on ↑ dose seretide inhaler + multiple toe nail fungal infections, Rx ? 47a BADRAWY notes MRCP
  95. 95. Oral Terbinafine Topical is ineffective in fungal nail infection, oral Terbinafine is better than oral Itraconazole esp. in a COPD pt é possibility of macrolide Rx for exacerbation ( ↑ risk of QT prolongation in this combination). 47b BADRAWY notes MRCP
  96. 96. Acquired lipodystrophy (young ♀ pt, loss of fat around the face & upper body, creatinine 110), which complement deficiency ? 48a BADRAWY notes MRCP
  97. 97. C3 Acquired lipodystrophy ➜ no metabolic abnormalities Congenital lipodystrophy ➜ metabolic abnormalities. 48b BADRAWY notes MRCP
  98. 98. A 12 y boy é gradually progressive plaque on his buttock for 3 years with crusting and induration at the periphery and scarring at the centre annular, Dx ? 49a BADRAWY notes MRCP
  99. 99. Lupus vulgaris Not Tinea corporis A lesion with central scarring is suggestive of lupus vulgaris commonest manifestation of cutaneous TB, slightly itchy, asymmetrical scaly Tinea corporis has central clearing and an advanced scaly raised edge 49b BADRAWY notes MRCP
  100. 100. A pt é cirrhosis secondary to hepatitis C, progressive deterioration over 6 months, Hx of IV heroin abuse & alcoholism, weight loss and worsening ascites, ↑ alpha-fetoprotein,Dx ? 5 a BADRAWY notes MRCP
  101. 101. HCC definitive Dx by U/S folloed by CT guided biopsy, Rx usu palliative. 5 b BADRAWY notes MRCP
  102. 102. a young ♀ é Sx of pulmonary HTN (Exertional dyspnea,LL oedema),best Ix to exclude 2ndry pulmonary HTN ? 51a BADRAWY notes MRCP
  103. 103. CT pulmonary Angio a better choice than ECHO & V/Q scan 51b BADRAWY notes MRCP
  104. 104. clinical phase-ll study in oncology, testing a new chemotherapy in patients with a malignant tumour Which statistical test is most appropriate to compare the survival times? 52a BADRAWY notes MRCP
  105. 105. Log-rank test 52b BADRAWY notes MRCP
  106. 106. a young pt é aplastic anemia (BM biopsy ↓ hematopoeitic cells, fatty BM), most effective long term Rx ? 53a BADRAWY notes MRCP
  107. 107. Hematopoeitic stem cell transplantation a better choice than chemotherapy Children & young adults ➜ BM transplantation is 1st choice Rx of severe aplastic anemia. 53b BADRAWY notes MRCP
  108. 108. Anti-epileptic drug causing SIADH (hyponatremia & ↓ plasma osmolality) ? 54a BADRAWY notes MRCP
  109. 109. Carbamazepine Dose related hyponatremia 54b BADRAWY notes MRCP
  110. 110. an old pt not DM é Lt lateral hip pain, ↑ é abduction against resistance, Dx ? 55a BADRAWY notes MRCP
  111. 111. Trochanteric bursitis Not Osteoarthritis ( limitation with the full range of movement + deeper pain within the joint) / not iliopsoas bursitis (medial pain over femoral triangle). 55b BADRAWY notes MRCP
  112. 112. a elderly DM pt é Hx of extensive psoriasis, hot swollen Lt knee joint, limited mobility, ↑ESR, WBCs, Creatinine, knee x ray ➜ osteoarthritis with large effusion, next best step ? 56a BADRAWY notes MRCP
  113. 113. Orthopedic referral for aspiration & washout. a better choice than IV Flucloxacilline ➜ Abiotics without aspiration & washout of the joint can cause permenant joint damage. 56b BADRAWY notes MRCP
  114. 114. a middle age ♂ with wt loss, night sweats,mild asthma, Dyspnea,cough, nosebleed, ↑ESR, ↑Creatinine,cANCA +ve, Dx ? 57a BADRAWY notes MRCP
  115. 115. Wegener's granulomatosis Not churg strauss syndrome. 57b BADRAWY notes MRCP
  116. 116. a 16 y ♀ é B/L renal cortical scarring,Hx of recurrent UTIs with antibiotis in childhood but no UTIs since 5 y., HTN (180/104), Creatinine 186 , how to prevent further kidney damage ? 58a BADRAWY notes MRCP
  117. 117. ACE Inhibitors a better choice than Surgical re-insertion of ureters imaging + Hx of recurrent UTIs in childhood ➜ Chronic reflux nephropathy. ∵ no recent UTIs ➜ recurrent infections are over ➜ little benefit of Surgical re- insertion of ureters. 58b BADRAWY notes MRCP
  118. 118. An elderly pt é Polymyositis ( proximal ms weakness + shoulder pain + ↑↑ CK) , initial Rx of choice ? 59a BADRAWY notes MRCP
  119. 119. Prednisolone screen for underlying malignancy 59b BADRAWY notes MRCP
  120. 120. Organism seen in the sputum of HIV infected pt ? 6 a BADRAWY notes MRCP
  121. 121. Cryptococcus Not Cryptosporidium (causes Diarrhea not pneumonia) Dx of Cryptococcus by India Ink stain, in Meningitis do Ag titre Rx by IV Amphotrecin B or Fluconazole. 6 b BADRAWY notes MRCP
  122. 122. Hemophilia B mode of inheritance ? 61a BADRAWY notes MRCP
  123. 123. X-linked recessive Also Hemophilia A. 61b BADRAWY notes MRCP
  124. 124. trials a new drug for lowering lipid levels.2 groups, one receiving the drug and the other placebo. What is the best statistical test for comparing mean cholesterols between the two groups? 62a BADRAWY notes MRCP
  125. 125. Unpaired T test 62b BADRAWY notes MRCP
  126. 126. For what metabolic process Riboflavin is required ? 63a BADRAWY notes MRCP
  127. 127. Hydrogen-transfer chain in the mitochondria 63b BADRAWY notes MRCP
  128. 128. An 58 pt Uncontrolled DM1 é 5 units bloot transfusion 2 wks earlier, you want to do Hb A1c to assess him,how long to wait to check Hb A1c ? 64a BADRAWY notes MRCP
  129. 129. 6 months Not 3 months Lifespan of RBCs about 4 months & the transfusion is large amount (5 units) ➜ wait 6 months before measuring Hb A1c. 64b BADRAWY notes MRCP
  130. 130. An elderly pt é large stroke ( Lt hemiparesis, homonymous hemianopia, left sided neglect, receptive dysphasia, and poor left sided co-ordination) what is most likely to hinder further progress in rehabilitation? 65a BADRAWY notes MRCP
  131. 131. Receptive dysphasia dt difficulties complying with rehabilitation Rx recovery from neglect is excellent + function of the affected limb usu improve. homonymous hemianopia will affect driving but no effect on daily living. 65b BADRAWY notes MRCP
  132. 132. a pt é Porphyria Cutanea tarda (hyperpigmentation ,hypertrichosis, blistering scarring eruptions in dorsum of hand,worsen in summer, alcoholic & smoker,urine & stool +ve for porphyrins),most successful to ↓ severity ? 66a BADRAWY notes MRCP
  133. 133. Avoidance of Alcohol Not avoidance of smoking 66b BADRAWY notes MRCP
  134. 134. a pt é CAP + reactivation of Cold sore, Causative Organism ? 67a BADRAWY notes MRCP
  135. 135. Streptococcus pneumoniae 67b BADRAWY notes MRCP
  136. 136. a 43 y pt é frequent Headaches worse in the morning,HTN ,K 3.1,Normal BMI, Creatinine 112, Test will get the Dx ? 68a BADRAWY notes MRCP
  137. 137. Renin Aldosterone ratio Not Urinary metanephrines , Not 24 urinary free cortisol Hypokalemia + HTN + Normal BMI + no Cushing's features ➜ Conn's syndrome. 68b BADRAWY notes MRCP
  138. 138. a 30 y pt é jaundice, anemia & splenomegaly, reticulocytosis + osmotic fragility, Dx ? 69a BADRAWY notes MRCP
  139. 139. Heriditary spherocytosis Autosomal Dominant 69b BADRAWY notes MRCP
  140. 140. Muscle control PIP joint flexion ? 7 a BADRAWY notes MRCP
  141. 141. Flexor Digitorum superficialis Not Flexor Digitorum profundus ➜ flexion at wrist, metacarpophalangeal & interphalangeal joints. Lumbricals ➜ flexion at metacarpophalangeal & extension at interphalangeal joints. 7 b BADRAWY notes MRCP
  142. 142. most important physiologic mechanism that prevents reflux ? 71a BADRAWY notes MRCP
  143. 143. parasympathetic stimulation of the lower circular smooth ms fibers of the oesophagus No true anatomical sphincter 71b BADRAWY notes MRCP
  144. 144. MOA of Allopurinol ? 72a BADRAWY notes MRCP
  145. 145. Inhibits xanthine oxidase Colchicine Inhibits microtubule polymerization ➜ ↓ inflammatory activity. Rasburicase is a recombinent urate oxidase inhibitor ➜ ↓ tumor lysis syndrome with chemotherapy. 72b BADRAWY notes MRCP
  146. 146. a pt é GBS + desatting on lying flat + unable to perform spirometry ? 73a BADRAWY notes MRCP
  147. 147. ITU review for consideration of ventilation 73b BADRAWY notes MRCP
  148. 148. HF despite maximal medical Rx, a decision for pacemaker ,type ? 74a BADRAWY notes MRCP
  149. 149. biventricular pacemaker Not Dual chamber pacemaker 74b BADRAWY notes MRCP
  150. 150. a 17 y ♀ é Collapse after strenuous exercise,felt weak and faint afterwards, father died suddenly at a young age ,normal examination, Dx ? 75a BADRAWY notes MRCP
  151. 151. Cardiac syncope Not Seizures MCC is HOCM but lack of physical signs is against that. Long QT syndrome & Brugada syndrome are possibilities 75b BADRAWY notes MRCP
  152. 152. Which is most consistent with a diagnosis of Bell's palsy? 76a BADRAWY notes MRCP
  153. 153. Hyperacusis Not Loss of sensation loss of lacrimation in lesions before the geniculate ganglion. Loss of taste to the anterior 2/3 of the tongue in severe cases. 76b BADRAWY notes MRCP
  154. 154. a pt é Headache + 3rd nerve palsy ,Dx ? 77a BADRAWY notes MRCP
  155. 155. Posterior communicating Artery aneurysm 77b BADRAWY notes MRCP
  156. 156. a pt é CAP, most useful in predicting outcome ? 78a BADRAWY notes MRCP
  157. 157. Urea ( CURB 65) 78b BADRAWY notes MRCP
  158. 158. CLL pt é recurrent infections ,Etiology ? 79a BADRAWY notes MRCP
  159. 159. Immunoglobulin deficiency Not T cell dysfunction 79b BADRAWY notes MRCP
  160. 160. DOCH to control BP in pheochromocytoma ? 8 a BADRAWY notes MRCP
  161. 161. Phenoxybenzamine if going for surgery start it 7- 10 days before 8 b BADRAWY notes MRCP
  162. 162. Long term prognosis of HSP ? 81a BADRAWY notes MRCP
  163. 163. Complete recovery with no long term sequelae 81b BADRAWY notes MRCP
  164. 164. Route of Adrenaline adminestration in anaphylactic shock ? 82a BADRAWY notes MRCP
  165. 165. Intramuscular Not IV as Intramuscular is the most predictable profile on absorption & clinical effect. 82b BADRAWY notes MRCP
  166. 166. Post-needle stick injury from a pt with known hepatitis C +ve ? 83a BADRAWY notes MRCP
  167. 167. Monthly hepatitis C PCR 83b BADRAWY notes MRCP
  168. 168. Bullous impetigo with systemic Sx (fever, ↑ WBCs, ↑CRP) , Rx ? 84a BADRAWY notes MRCP
  169. 169. IV Co-Amoxiclav a better choice than oral flucloxacillin dt > range of action. 84b BADRAWY notes MRCP
  170. 170. Chronic alcoholic,Generalized weakness + tremors + hypokalemia + hypocalcemia, Etiology ? 85a BADRAWY notes MRCP
  171. 171. Hypomagnesemia dt malnutrition and alcohol related diuresis 85b BADRAWY notes MRCP
  172. 172. the strongest pointer towards a diagnosis of Type 1 diabetes? 86a BADRAWY notes MRCP
  173. 173. Ketonuria Not Anti-GAD antibodies Single autoantibody +ve is not indicative of a diagnosis of DM1 2 or 3 antibody positivity being a much stronger pointer towards significant autoimmune beta cell destruction 86b BADRAWY notes MRCP
  174. 174. VF in a controlled enviroment (CCU), Rx of choice ? 87a BADRAWY notes MRCP
  175. 175. Defibrillate Not precordial thumb (only give if defibrillator is unavailable) 87b BADRAWY notes MRCP
  176. 176. HIT, most common complication ? (IgG Abs against PF4- heparin coplex) 88a BADRAWY notes MRCP
  177. 177. DVT Not arterial thrombosis 88b BADRAWY notes MRCP
  178. 178. Tirofiban, MOA ? 89a BADRAWY notes MRCP
  179. 179. 2b3a inhibitor Platelet function returns to baseline within eight hours after discontinuation. contraindicated in hepatic dysfunction 89b BADRAWY notes MRCP
  180. 180. Peanut allergy,correct statment ? 9 a BADRAWY notes MRCP
  181. 181. The wheal size resulting from the skin prick test is an excellent predictor of a positive food challenge to peanuts The severity of the next allergic reaction cannot be predicted by skin prick test or specific lgE,depends on other factors (amount consumed and intercurrent viral infections). 9 b BADRAWY notes MRCP
  182. 182. Wernicke's encephalopathy (thiamine deficiency in Alcoholic),what do you expect to see ? 91a BADRAWY notes MRCP
  183. 183. Nystagmus a better choice than coma Nystagmus is the commonest eye sign in wernicke's 91b BADRAWY notes MRCP
  184. 184. Pain in Rt Knee ,Sx of Reactive Arthritis,Rt Knee aspirate showed no organisms, Rx ? 92a BADRAWY notes MRCP
  185. 185. Intra-articular CST injection a better choice than Diclofenac or Doxycycline Systemic NSAIDS are the mainstay of Rx but in MONOARTHRITIS ➜ Intra-articular CST after ensuring -ve aspirate from the joint is better. 92b BADRAWY notes MRCP
  186. 186. a 23 ♂ pt é anal discharge + dysuria + urethral smear ➜ intracellular diplococci, Dx ? 93a BADRAWY notes MRCP
  187. 187. Neisseria Gonorrhea 93b BADRAWY notes MRCP
  188. 188. Central Chest pain ECG reveals Twave inversion in V5 and V6 finding on angiography? 94a BADRAWY notes MRCP
  189. 189. Critical stenosis of the left circumOex artery 94b BADRAWY notes MRCP
  190. 190. Acute Pericareditis, ECG finding ? 95a BADRAWY notes MRCP
  191. 191. PR depression 95b BADRAWY notes MRCP
  192. 192. A 34-y ♀ non-smoker moderate hypoxaemia,Lung function tests normal lung volumes but a reduced Tlco at 45% PCO2 of 7.9 kPa ? 96a BADRAWY notes MRCP
  193. 193. Pulmonary arteriovenous malformation right-to-left shunts, so reducing Tlco values and provoking hypoxaemia.Emphysema can cause ↓Tlco but is usually associated with ↑residual volume and would be unusual in a young non-smoker. 96b BADRAWY notes MRCP
  194. 194. A 72-y ♀ left total hip replacement ,Routine Ix (WBC 22.5, Lymphocytes 19) most appropriate Rx ? 97a BADRAWY notes MRCP
  195. 195. Go ahead with the surgery but keep her under haematology follow-up Mostly CLL & doesn't require Rx now 97b BADRAWY notes MRCP
  196. 196. Lyme disease (tick bite 3 months ago + rash) with sudden collapse,cause ? 98a BADRAWY notes MRCP
  197. 197. AV heart block 98b BADRAWY notes MRCP
  198. 198. Wegner's Granulomatosis, findings in renal Biopsy ? 99a BADRAWY notes MRCP
  199. 199. Necrotizing GN without complement or Ig deposition 99b BADRAWY notes MRCP
  200. 200. A 16-y ♂ abdominal pain and vomiting , ↓Power distally ankle and knee reOexes absent,sister has similar condition +basophilic stippling +Urinary D- ALA +ve, Dx ? 1 a BADRAWY notes MRCP
  201. 201. Lead poisoning Not Acute intermittent porphyria (dt basophilic stippling isn't in AIP) 1 b BADRAWY notes MRCP
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