1. January 2014 (MRCP 1) BY Dr. Sherif Badrawy BADRAWY notes MRCP

2. A very common SE of Ciclosporin Rx ? ( and all Calcineurin inhibitors) 1a BADRAWY notes MRCP 3. Tremor a better choice than thrombocytopenia 1b BADRAWY notes MRCP 4. Infertile woman with proliferative endometrium indicates ? 2a BADRAWY notes MRCP 5. Anovulation secretory endometrium is the hallmark of ovulation. 2b BADRAWY notes MRCP 6. Drugs commonly cause extrapyramidal SEs ? 3a BADRAWY notes MRCP 7. Conventional antipsychotics Not Atypical antipsychotics, Not TCA 3b BADRAWY notes MRCP 8. On standing for 1 minute, physiological change ? 4a BADRAWY notes MRCP 9. Decreased UOP SBP is immediately after standing & only transient COP , HR , Peripheral vascular resistance all increase. 4b BADRAWY notes MRCP 10. 64 y Osteoporosis lumbar spine (T score - 2.6,long term inhaled CST), Rx ? 5a BADRAWY notes MRCP 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. A pt Ankylosing Spondylitis (sacroiliac & back pain 8 months,limited lat. flexion & chest expansion, sacroilitis in x ray, ESR) + failed Rx 2 NSAIDS, Rx ? 6a BADRAWY notes MRCP 13. Etanrecept Anti -TNF recommended after failed 2 NSAIDS , ( a better choice than Methotrexate) 6b BADRAWY notes MRCP 14. A pt 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. Check urine 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. A pt truncal obesity, insulin resistance, dyslipidemia , what do you expect more to see ? 8a BADRAWY notes MRCP 17. HTN to complete the Dx of Meabolic syndrome. 8b BADRAWY notes MRCP 18. A helminth a symptomatic travel through the lung & the adult worm resides in the intestine ? 9a BADRAWY notes MRCP 19. Ascaris lumbricoids 9b BADRAWY notes MRCP 20. A pt Essential Tremors (low amplitude tremors, FH of father affection , head nodding, no bradykinesia, no rigidity) , Rx ? 1 a BADRAWY notes MRCP 21. Propranolol Primidone also may be used. 1 b BADRAWY notes MRCP 22. A 30 pt 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. 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. A pt Dermatitis Herpitiformis with skin biopsy, Igs to be found ? 12a BADRAWY notes MRCP 25. IgA present in dermal papillae , revealed on immunostaining. Rx by Dapsone & Gluten free diet 12b BADRAWY notes MRCP 26. Buspirone acts on which receptors ? 13a BADRAWY notes MRCP 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. 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. 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. A pt Primary biliary cirrhosis ( ,middle age,jaundice,hepatosplenomegaly,FH), Dx Abs ? 15a BADRAWY notes MRCP 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. Autosomal Dominant + Severe mental retardation in 50% + benign growths in various body parts ? 16a BADRAWY notes MRCP 33. Tuberous Sclerosis 16b BADRAWY notes MRCP 34. a young pt depression , Chronic liver disease Ss, Golden yellow ring at iris periphery both eyes + low serum copper, Dx ? 17a BADRAWY notes MRCP 35. Wilson's Disease defect in incorporating copper into ceruloplasmin / Kayser Fleischer ring almost always present / Rx by Penicillamine 17b BADRAWY notes MRCP 36. A pt HOCM (arrested during a rugby match & died + postmortem biopsy LV & asymmetric septal hypertrophy) , underlying pathology ? 18a BADRAWY notes MRCP 37. Beta myosin heavy chain mutation a better choice than troponin mutation (also occur in HOCM) 18b BADRAWY notes MRCP 38. Chronic Hepatitis B , risk of ? 19a BADRAWY notes MRCP 39. HCC 100 fold risk 19b BADRAWY notes MRCP 40. Hypoglossal nerve paralysis Lt side, outcome ? 2 a BADRAWY notes MRCP 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. Primary Sclerosing Cholangitis, correct statment ? 21a BADRAWY notes MRCP 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. A 79 y pt 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. 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. Causative factor for obesity in the majority of pts ? 23a BADRAWY notes MRCP 47. Energy intake in excess of expenditure Not genetic predisposition ( may be in some pts but not the majority) 23b BADRAWY notes MRCP 48. A pt AIDS seroconversion (living in Thailand, FEW WEEKS of night sweat , diarrhea, lymphadenopathy -ve stool for cysts & ova), Dx ? 24a BADRAWY notes MRCP 49. mycobacterium avium intracellulare Not CMV ( > acute onset of presentation), Not cryptosporidium ( no ova or cysts in the stool) 24b BADRAWY notes MRCP 50. A 32 y pt paroxysmal SVT ,failed valsalva & carotid sinus massage , Rx ? 25a BADRAWY notes MRCP 51. IV Adenosine a better option than verapamil dt > rapid onset & shorter duration of action. 25b BADRAWY notes MRCP 52. The greatest absolute risk reduction from the choices ? 26a BADRAWY notes MRCP 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. A pt LQT1 syndrome collapsed dt VT & improved after cardioversion, most important initial intervention to prevent recurrence ? 27a BADRAWY notes MRCP 55. Atenolol Not permenant pacemaker if no response stellate ganglionectomy. ICD is 1st choices in LQT2 & LQT3 dt > incidence sudden death. 27b BADRAWY notes MRCP 56. A 79 y pt dyspnea, facial swelling , ? bronchial neoplasm.. suspect SVC obstruction, look for ? 28a BADRAWY notes MRCP 57. Venous dilatation over the anterior chest wall SVC obst. is 70 % dt lung cancer, oncological emmergency rapid Rx CST. 28b BADRAWY notes MRCP 58. A correct statment regarding ppt factors of DKA ? 29a BADRAWY notes MRCP 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 suggestive of ulcerative colitis. 44b BADRAWY notes MRCP 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. 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. A 48 y pt blurring Lt eye, Angioid streaks,macular edema,skin folds yellow striations & puckering in the neck & flexor aspect of joints, Dx ? 46a BADRAWY notes MRCP 93. Pseudoxanthoma elasticum Not Marfan's syndrome. 46b BADRAWY notes MRCP 94. A 61 y pt DM, COPD on dose seretide inhaler + multiple toe nail fungal infections, Rx ? 47a BADRAWY notes MRCP 95. Oral Terbinafine Topical is ineffective in fungal nail infection, oral Terbinafine is better than oral Itraconazole esp. in a COPD pt possibility of macrolide Rx for exacerbation ( risk of QT prolongation in this combination). 47b BADRAWY notes MRCP 96. Acquired lipodystrophy (young pt, loss of fat around the face & upper body, creatinine 110), which complement deficiency ? 48a BADRAWY notes MRCP 97. C3 Acquired lipodystrophy no metabolic abnormalities Congenital lipodystrophy metabolic abnormalities. 48b BADRAWY notes MRCP 98. A 12 y boy 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. 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. A pt 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. HCC definitive Dx by U/S folloed by CT guided biopsy, Rx usu palliative. 5 b BADRAWY notes MRCP 102. a young Sx of pulmonary HTN (Exertional dyspnea,LL oedema),best Ix to exclude 2ndry pulmonary HTN ? 51a BADRAWY notes MRCP 103. CT pulmonary Angio a better choice than ECHO & V/Q scan 51b BADRAWY notes MRCP 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. Log-rank test 52b BADRAWY notes MRCP 106. a young pt aplastic anemia (BM biopsy hematopoeitic cells, fatty BM), most effective long term Rx ? 53a BADRAWY notes MRCP 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. Anti-epileptic drug causing SIADH (hyponatremia & plasma osmolality) ? 54a BADRAWY notes MRCP 109. Carbamazepine Dose related hyponatremia 54b BADRAWY notes MRCP 110. an old pt not DM Lt lateral hip pain, abduction against resistance, Dx ? 55a BADRAWY notes MRCP 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. a elderly DM pt 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. 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. a middle age with wt loss, night sweats,mild asthma, Dyspnea,cough, nosebleed, ESR, Creatinine,cANCA +ve, Dx ? 57a BADRAWY notes MRCP 115. Wegener's granulomatosis Not churg strauss syndrome. 57b BADRAWY notes MRCP 116. a 16 y 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. 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. An elderly pt Polymyositis ( proximal ms weakness + shoulder pain + CK) , initial Rx of choice ? 59a BADRAWY notes MRCP 119. Prednisolone screen for underlying malignancy 59b BADRAWY notes MRCP 120. Organism seen in the sputum of HIV infected pt ? 6 a BADRAWY notes MRCP 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. Hemophilia B mode of inheritance ? 61a BADRAWY notes MRCP 123. X-linked recessive Also Hemophilia A. 61b BADRAWY notes MRCP 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. Unpaired T test 62b BADRAWY notes MRCP 126. For what metabolic process Riboflavin is required ? 63a BADRAWY notes MRCP 127. Hydrogen-transfer chain in the mitochondria 63b BADRAWY notes MRCP 128. An 58 pt Uncontrolled DM1 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. 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. An elderly pt 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. 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. a pt 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. Avoidance of Alcohol Not avoidance of smoking 66b BADRAWY notes MRCP 134. a pt CAP + reactivation of Cold sore, Causative Organism ? 67a BADRAWY notes MRCP 135. Streptococcus pneumoniae 67b BADRAWY notes MRCP 136. a 43 y pt frequent Headaches worse in the morning,HTN ,K 3.1,Normal BMI, Creatinine 112, Test will get the Dx ? 68a BADRAWY notes MRCP 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. a 30 y pt jaundice, anemia & splenomegaly, reticulocytosis + osmotic fragility, Dx ? 69a BADRAWY notes MRCP 139. Heriditary spherocytosis Autosomal Dominant 69b BADRAWY notes MRCP 140. Muscle control PIP joint flexion ? 7 a BADRAWY notes MRCP 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. most important physiologic mechanism that prevents reflux ? 71a BADRAWY notes MRCP 143. parasympathetic stimulation of the lower circular smooth ms fibers of the oesophagus No true anatomical sphincter 71b BADRAWY notes MRCP 144. MOA of Allopurinol ? 72a BADRAWY notes MRCP 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. a pt GBS + desatting on lying flat + unable to perform spirometry ? 73a BADRAWY notes MRCP 147. ITU review for consideration of ventilation 73b BADRAWY notes MRCP 148. HF despite maximal medical Rx, a decision for pacemaker ,type ? 74a BADRAWY notes MRCP 149. biventricular pacemaker Not Dual chamber pacemaker 74b BADRAWY notes MRCP 150. a 17 y Collapse after strenuous exercise,felt weak and faint afterwards, father died suddenly at a young age ,normal examination, Dx ? 75a BADRAWY notes MRCP 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. Which is most consistent with a diagnosis of Bell's palsy? 76a BADRAWY notes MRCP 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. a pt Headache + 3rd nerve palsy ,Dx ? 77a BADRAWY notes MRCP 155. Posterior communicating Artery aneurysm 77b BADRAWY notes MRCP 156. a pt CAP, most useful in predicting outcome ? 78a BADRAWY notes MRCP 157. Urea ( CURB 65) 78b BADRAWY notes MRCP 158. CLL pt recurrent infections ,Etiology ? 79a BADRAWY notes MRCP 159. Immunoglobulin deficiency Not T cell dysfunction 79b BADRAWY notes MRCP 160. DOCH to control BP in pheochromocytoma ? 8 a BADRAWY notes MRCP 161. Phenoxybenzamine if going for surgery start it 7- 10 days before 8 b BADRAWY notes MRCP 162. Long term prognosis of HSP ? 81a BADRAWY notes MRCP 163. Complete recovery with no long term sequelae 81b BADRAWY notes MRCP 164. Route of Adrenaline adminestration in anaphylactic shock ? 82a BADRAWY notes MRCP 165. Intramuscular Not IV as Intramuscular is the most predictable profile on absorption & clinical effect. 82b BADRAWY notes MRCP 166. Post-needle stick injury from a pt with known hepatitis C +ve ? 83a BADRAWY notes MRCP 167. Monthly hepatitis C PCR 83b BADRAWY notes MRCP 168. Bullous impetigo with systemic Sx (fever, WBCs, CRP) , Rx ? 84a BADRAWY notes MRCP 169. IV Co-Amoxiclav a better choice than oral flucloxacillin dt > range of action. 84b BADRAWY notes MRCP 170. Chronic alcoholic,Generalized weakness + tremors + hypokalemia + hypocalcemia, Etiology ? 85a BADRAWY notes MRCP 171. Hypomagnesemia dt malnutrition and alcohol related diuresis 85b BADRAWY notes MRCP 172. the strongest pointer towards a diagnosis of Type 1 diabetes? 86a BADRAWY notes MRCP 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. VF in a controlled enviroment (CCU), Rx of choice ? 87a BADRAWY notes MRCP 175. Defibrillate Not precordial thumb (only give if defibrillator is unavailable) 87b BADRAWY notes MRCP 176. HIT, most common complication ? (IgG Abs against PF4- heparin coplex) 88a BADRAWY notes MRCP 177. DVT Not arterial thrombosis 88b BADRAWY notes MRCP 178. Tirofiban, MOA ? 89a BADRAWY notes MRCP 179. 2b3a inhibitor Platelet function returns to baseline within eight hours after discontinuation. contraindicated in hepatic dysfunction 89b BADRAWY notes MRCP 180. Peanut allergy,correct statment ? 9 a BADRAWY notes MRCP 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. Wernicke's encephalopathy (thiamine deficiency in Alcoholic),what do you expect to see ? 91a BADRAWY notes MRCP 183. Nystagmus a better choice than coma Nystagmus is the commonest eye sign in wernicke's 91b BADRAWY notes MRCP 184. Pain in Rt Knee ,Sx of Reactive Arthritis,Rt Knee aspirate showed no organisms, Rx ? 92a BADRAWY notes MRCP 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. a 23 pt anal discharge + dysuria + urethral smear intracellular diplococci, Dx ? 93a BADRAWY notes MRCP 187. Neisseria Gonorrhea 93b BADRAWY notes MRCP 188. Central Chest pain ECG reveals Twave inversion in V5 and V6 finding on angiography? 94a BADRAWY notes MRCP 189. Critical stenosis of the left circumOex artery 94b BADRAWY notes MRCP 190. Acute Pericareditis, ECG finding ? 95a BADRAWY notes MRCP 191. PR depression 95b BADRAWY notes MRCP 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. 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. A 72-y left total hip replacement ,Routine Ix (WBC 22.5, Lymphocytes 19) most appropriate Rx ? 97a BADRAWY notes MRCP 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. Lyme disease (tick bite 3 months ago + rash) with sudden collapse,cause ? 98a BADRAWY notes MRCP 197. AV heart block 98b BADRAWY notes MRCP 198. Wegner's Granulomatosis, findings in renal Biopsy ? 99a BADRAWY notes MRCP 199. Necrotizing GN without complement or Ig deposition 99b BADRAWY notes MRCP 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. Lead poisoning Not Acute intermittent porphyria (dt basophilic stippling isn't in AIP) 1 b BADRAWY notes MRCP