From: Part1@mrcpuk.org To: mak5962@hotmail.

com Date: Wed, 15 May 2013 11:27:36 +0100 Subject: RE: Your mail dated 15th May, 2013

Dear Doctor, That is great to hear you would like to take a Speciality Certificate (SCE) with the Royal College of Physicians. We currently run 12 speciality examinations. There are no prerequisites to take the Neurology SCE so you can apply to take this when you feel you would like to. The Neurology SCE is run once a year and the next date will be 21 May 2014. The SCEs are run through our booking partner Pearson VUE and you are able to take the examination where it is convenient to you. We ask candidates to choose a city that is close to them when making an application, and we then try and accommodate this. We do not have set centres for the SCEs. If you would like further information about our examinations please do get in contact. Kind regards, Shona Lindsay | Exams Administrator Exams Candidate Office | MRCP(UK) Central Office MRCP(UK), 11 St Andrews Place | Regents Park | London NW1 4LE Direct line +44 (0)20 3075 1515 | www.mrcpuk.org | Part1@mrcpuk.org | facebook | twitter | linkedin From: mak khan [mailto:mak5962@hotmail.com] Sent: 15 May 2013 11:08 To: PART1 Subject: RE: Your mail dated 15th May, 2013 Thanks Ms Shona Lindsay for confirming my eligibility for MRCP Part 1,2 & PACES. and also for Speciality Exam . I will like to go for Neorology speciality . I have a Fellowship in Neurology , Resident House physicianship in Psychiatry and Masters Degree in Counseling and Psychotherapy too plus the clinical practice for over 24 years. Hope I shall be able to take up the Speciality in Neurology once I clear MRCP . DO WE HAVE THIS 'NEUROLOGY SPECIALITY' EXAM AVAILABLE IN INDIA ? Regards DR MATIN JAMSHEDPUR JHARKHAND INDIA Phone 91 9431184120 From: Part1@mrcpuk.org To: mak5962@hotmail.com Date: Wed, 15 May 2013 10:26:52 +0100 Subject: RE: Your mail dated 14th May, 2013

Dear Doctor,

Thank you for your email, and for detailing your history. I can confirm that you will be eligible to take all of the MRCP(UK) examinations. I can also confirm that you can also take our Speciality Certificate Examinations if you wish, and we do have one in Infectious Diseases. Unfortunately I cannot give an indication of how many questions are needed to pass as each examination changes and this is where the equating of each question would differ. The composition of the examination is as follows, and this will be spread across the two papers. Specialty Cardiology Clinical pharmacology, therapeutics and toxicology Clinical sciences** Dermatology Endocrinology Gastroenterology Haemotology and oncology Neurology Ophthalmology Psychiatry Renal medicine Respiratory medicine Rheumatology Tropical medicine, infectious and sexually transmitted diseases Number of questions* 15 20 25 8 15 15 15 15 4 8 15 15 15 15

200 * This should be taken as an indication of the likely number of questions - the actual number may vary slightly. I hope that this helps, and please do not hesitate to get in contact if I can be of assistance. Kind regards,

Shona Lindsay | Exams Administrator Exams Candidate Office | MRCP(UK) Central Office MRCP(UK), 11 St Andrews Place | Regents Park | London NW1 4LE Direct line +44 (0)20 3075 1515 | www.mrcpuk.org | Part1@mrcpuk.org | facebook | twitter | linkedin From: mak khan [mailto:mak5962@hotmail.com] Sent: 14 May 2013 20:14 To: PART1 Subject: RE: Your mail dated 14th May, 2013 Dear Ms Shona Lindsay Greetings! Thanks for your kind mail.. At least there is no age bar as I am almost 53 now. I could not think of MRCP earlier because of some very severe financial and geographical constraints, but since now we can take up MRCP in India , so a new hope has emerged that I can complete my dream. Here are few of my observations : .As far as eligibility is concerned , I suppose I posses it Still I am writing to you so that you can confirm my eligibility 1.I am a MBBS from Ranchi University(Jharkhand, India) passing it in 1987 and after completing Compulsory Rotating INTERNSHIP for a year have completed RESIDENT HOUSE PHYSICIANSHIP (Residencies) extending upto 18 months

(6x3=18 --6 months each ) in the Depts of Int MEDICINE. PEDIATRICS and PSYCHIATRY, which included mandatory Emergency duties and critical care. finishing them till late 1990. 2 In Nov, I990 I have joined Bihar/Jharkhand State Health Services as MEDICAL OFFICER (which involves OPD/ER/Indoor) and continued till 2004. 3. In between I worked in Saudi Arabia under MOH as MEDICAL OFFICER in 1999 for one year and passed DMRD (RADIOLOGY) in 1993 from Ranchi University. 4.Since 2005 I am working as Tutor in the Dept of Biochemistry in MGM MEDICAL COLLEGE & HOSPITAL , JAMSHEDPUR , teaching MBBS students.(under Govt of Jharkhand Health services) which involves Hospital duty too. 5. In between in 2003 I have passed PG Diploma in Family Medicine from Post Graduate Institute of Medicine , Colombo, University of Colombo and Fellowship in HIV Medicine from School of Tropical Medicine KOLKATA. 6.I have passed 'American Academy of HIV Medicine Specialist(AAHIVS) Exam thrice (2008, 2010, 2012 to keep the certification valid for 2 years) from American Academy of HIV Medicine , Washington , USA. 7. I am in active clinical practice since 24 years and published 4 papers in International Medical Journals , plus presented many papers in National International Fora 8. and so I gather, I am eligible for not only Part 1 , but Part 2 and PACES as well should I pass Part 1 MRCP 9. The cut off marks is 521,, but may I know as to how many questions out of 200 questions , one has to correct to secure 521 ? Any guess or idea? 10. What is the division of topics for paper 1 and 2 or the two papers contain mixed sort of ALL the TOPICS., given in the syllabus? Expect to hear from you pretty soon. Regards DR MATIN JAMSHEDPUR

From: Part1@mrcpuk.org To: mak5962@hotmail.com; s.ross@rcpe.ac.uk Date: Tue, 14 May 2013 12:35:17 +0100 Subject: RE: What is the cuttoff /pass marks in MRCP UK ? Is there an age bar ? Is the passing score for MRCP part 1 is 521/999 (by equating method) ?how much percentage approximately does this score equate to? Is it around 60-65%? Dear Doctor, Thank you for your email. The MRCP(UK) Part 1 examination is marked using an equating system. The current passing scaled score is 521, and this has been the passing scaled score since the 2008/03 diet. There is no age bar to sit the MRCP(UK) examinations, but candidates do need to meet the eligibility criteria which is as follows: Candidates may apply to sit the MRCP(UK) Part 1 Examination provided they graduated at least 12 months in advance of the examination date. All doctors must have had at least 12 months' experience in medical employment, i.e. have completed Foundation Year 1 or equivalent. This 12 months experience is calculated up to the date of the MRCP(UK) Part 1 Examination and not the application closing date. The relevant experience may be gained from any hospital in the world. The weight of each question is determined using an equating method. The equating system takes into consideration the difficulty of each question, so each weighting would vary. This is conducted by special statistical software. Further details can be found at this link: http://www.mrcpuk.org/SiteCollectionDocuments/MRCPUK_Part1_Equating.pdf As the scores are equated, no percentage is given overall. The passing scaled score for the 2013 MRCP(UK) Part 1 examinations is 521. If you have any questions please do not hesitate to get in contact.

Kind regards,

Shona Lindsay | Exams Administrator Exams Candidate Office | MRCP(UK) Central Office MRCP(UK), 11 St Andrews Place | Regents Park | London NW1 4LE Direct line +44 (0)20 3075 1515 | www.mrcpuk.org | Part1@mrcpuk.org | facebook | twitter | linkedin From: mak khan [mailto:mak5962@hotmail.com] Sent: 14 May 2013 10:41 To: PART1; Sandra Ross Subject: What is the cuttoff /pass marks in MRCP UK ? Is there an age bar ? Is the passing score for MRCP part 1 is 521/999 (by equating method) ?how much percentage approximately does this score equate to? Is it around 60-65%? Dear Sir/Madam Greetings ! I have few queries reg MRCP UK Part 1 , Will you pl reply those ? 1. 2. 3. 4. 5. 6. 7. 8. What is the average cuttoff /pass marks in MRCP UK ? Is there an age bar to sit in this examinations as I am 53 now ? Is the passing score for MRCP part 1 is 521/999 (by equating method) ? If we have 200 questions in 2 papers then how much marks does a single question carry ? If equating is done then how ? How much percentage approximately does this score equate to? Is it around 60-65%? What is cut off in May 2013 MRCP Part 1 Exam ?

Expect to hear from you pretty soon. DR MATIN A KHAN MGM MEDICAL COLLEGE , JAMSHEDPUR, JHARKHAND INDIA Phone = 91 9431184120 --

Date: Tue, 14 May 2013 10:21:31 +0100 From: J.Gibson@rcpe.ac.uk To: mak5962@hotmail.com Subject: Re: What is the cuttoff /pass marks in MRCP UK ? Is there an age bar ? Is the passing score for MRCP part 1 is 521/999 (by equating method) ?how much percentage approximately does this score equate to? Is it around 60-65%? Dear Dr Khan Please refer to the Regulations, FAQ section and general information on the website www.mrcpuk.org If you still have further queries after reading all the information available please direct any questions you feel are not answered to the Part 1 Written Office of any of the Colleges. You can find details on the contact page of the website. I work on the PACES Examination and not the Written. Regards

Jo Gibson Examinations Department Royal College of Physicians of Edinburgh (A charity registered in Scotland, no. SC009465) 9 - 11 Queen Street Edinburgh EH2 1JQ Telephone: 0131-225-7324 e-mail: j.gibson@rcpe.ac.uk Website: http://www.rcpe.ac.uk This email and any files transmitted with it are intended soley for the use of the individual or entity to whom they are addressed On 10/05/2013 at 19:38, mak khan <mak5962@hotmail.com> wrote: Dear Mr Jo Gibson Greetings ! I have few queries reg MRCP UK Part 1 , Will you pl reply those ? 1. 2. 3. 4. 5. 6. 7. 8. What is the average cuttoff /pass marks in MRCP UK ? Is there an age bar to sit in this examinations as I am 53 now ? Is the passing score for MRCP part 1 is 521/999 (by equating method) ? If we have 200 questions in 2 papers then how much marks does a single question carry ? If equating is done then how ? How much percentage approximately does this score equate to? Is it around 60-65%? What is cut off in May 2013 MRCP Part 1 Exam ?

Expect to hear from you pretty soon. DR MATIN A KHAN MGM MEDICAL COLLEGE , JAMSHEDPUR, JHARKHAND INDIA Phone = 91 9431184120 -This email was Anti Virus checked by Astaro Security Gateway. http://www.astaro.com This message may contain confidential information. If you are not the intended recipient please inform the sender that you have received the message in error before deleting it. Please do not disclose, copy or distribute information in this e-mail or take any action in reliance on its contents: to do so is strictly prohibited and may be unlawful. Thank you for your co-operation.

This message may contain confidential information. If you are not the intended recipient please inform the sender that you have received the message in error before deleting it. Please do not disclose, copy or distribute information in this e-mail or take any action in reliance on its contents: to do so is strictly prohibited and may be unlawful. Thank you for your co-operation.

From: Part1@mrcpuk.org To: mak5962@hotmail.com; s.ross@rcpe.ac.uk Date: Tue, 14 May 2013 12:35:17 +0100 Subject: RE: What is the cuttoff /pass marks in MRCP UK ? Is there an age bar ? Is the passing score for MRCP part 1 is 521/999 (by equating method) ?how much percentage approximately does this score equate to? Is it around 60-65%?

Dear Doctor, Thank you for your email. The MRCP(UK) Part 1 examination is marked using an equating system. The current passing scaled score is 521, and this has been the passing scaled score since the 2008/03 diet. There is no age bar to sit the MRCP(UK) examinations, but candidates do need to meet the eligibility criteria which is as follows: Candidates may apply to sit the MRCP(UK) Part 1 Examination provided they graduated at least 12 months in advance of the examination date. All doctors must have had at least 12 months' experience in medical employment, i.e. have completed Foundation Year 1 or equivalent. This 12 months experience is calculated up to the date of the MRCP(UK) Part 1 Examination and not the application closing date. The relevant experience may be gained from any hospital in the world. The weight of each question is determined using an equating method. The equating system takes into consideration the difficulty of each question, so each weighting would vary. This is conducted by special statistical software. Further details can be found at this link: http://www.mrcpuk.org/SiteCollectionDocuments/MRCPUK_Part1_Equating.pdf As the scores are equated, no percentage is given overall. The passing scaled score for the 2013 MRCP(UK) Part 1 examinations is 521. If you have any questions please do not hesitate to get in contact. Kind regards,

Shona Lindsay | Exams Administrator Exams Candidate Office | MRCP(UK) Central Office MRCP(UK), 11 St Andrews Place | Regents Park | London NW1 4LE Direct line +44 (0)20 3075 1515 | www.mrcpuk.org | Part1@mrcpuk.org | facebook | twitter | linkedin From: mak khan [mailto:mak5962@hotmail.com] Sent: 14 May 2013 10:41 To: PART1; Sandra Ross Subject: What is the cuttoff /pass marks in MRCP UK ? Is there an age bar ? Is the passing score for MRCP part 1 is 521/999 (by equating method) ?how much percentage approximately does this score equate to? Is it around 60-65%? Dear Sir/Madam Greetings ! I have few queries reg MRCP UK Part 1 , Will you pl reply those ?

1. 2. 3. 4. 5. 6. 7. 8.

What is the average cuttoff /pass marks in MRCP UK ? Is there an age bar to sit in this examinations as I am 53 now ? Is the passing score for MRCP part 1 is 521/999 (by equating method) ? If we have 200 questions in 2 papers then how much marks does a single question carry ? If equating is done then how ? How much percentage approximately does this score equate to? Is it around 60-65%? What is cut off in May 2013 MRCP Part 1 Exam ?

Expect to hear from you pretty soon. DR MATIN A KHAN MGM MEDICAL COLLEGE , JAMSHEDPUR, JHARKHAND INDIA Phone = 91 9431184120 --

Date: Tue, 14 May 2013 10:21:31 +0100 From: J.Gibson@rcpe.ac.uk To: mak5962@hotmail.com Subject: Re: What is the cuttoff /pass marks in MRCP UK ? Is there an age bar ? Is the passing score for MRCP part 1 is 521/999 (by equating method) ?how much percentage approximately does this score equate to? Is it around 60-65%? Dear Dr Khan Please refer to the Regulations, FAQ section and general information on the website www.mrcpuk.org If you still have further queries after reading all the information available please direct any questions you feel are not answered to the Part 1 Written Office of any of the Colleges. You can find details on the contact page of the website. I work on the PACES Examination and not the Written. Regards

Jo Gibson Examinations Department Royal College of Physicians of Edinburgh (A charity registered in Scotland, no. SC009465) 9 - 11 Queen Street Edinburgh EH2 1JQ Telephone: 0131-225-7324 e-mail: j.gibson@rcpe.ac.uk Website: http://www.rcpe.ac.uk This email and any files transmitted with it are intended soley for the use of the individual or entity to whom they are addressed On 10/05/2013 at 19:38, mak khan <mak5962@hotmail.com> wrote: Dear Mr Jo Gibson Greetings ! I have few queries reg MRCP UK Part 1 , Will you pl reply those ?

1. 2. 3. 4. 5. 6. 7. 8.

What is the average cuttoff /pass marks in MRCP UK ? Is there an age bar to sit in this examinations as I am 53 now ? Is the passing score for MRCP part 1 is 521/999 (by equating method) ? If we have 200 questions in 2 papers then how much marks does a single question carry ? If equating is done then how ? How much percentage approximately does this score equate to? Is it around 60-65%? What is cut off in May 2013 MRCP Part 1 Exam ?

Expect to hear from you pretty soon. DR MATIN A KHAN MGM MEDICAL COLLEGE , JAMSHEDPUR, JHARKHAND INDIA Phone = 91 9431184120 -This email was Anti Virus checked by Astaro Security Gateway. http://www.astaro.com

This message may contain confidential information. If you are not the intended recipient please inform the sender that you have received the message in error before deleting it. Please do not disclose, copy or distribute information in this e-mail or take any action in reliance on its contents: to do so is strictly prohibited and may be unlawful. Thank you for your co-operation.

Date: Mon, 27 Aug 2012 14:11:06 +0100 From: L.Tedford@rcpe.ac.uk To: mak5962@hotmail.com Subject: Re: Books published by Royal College and MRCP Neuro ! Dear Dr Khan MRCP(UK) used to have sample question books published but they have not done this for sometime now as they are out of date so quickly. Any information that is produced about the MRCP exams (including the Specialty Exams) can be found on the MRCP(UK) website at www.mrcpuk.org Hope this helps Yours sincerely Lindy Tedford Mrs Lindy Tedford Head of Examinations Royal College of Physicians of Edinburgh (A charity registered in Scotland, no. SC009465) 9 - 11 Queen Street Edinburgh EH2 1JQ Telephone: 0131-225-7324 Fax: 0131-225-2053

e-mail: l.tedford@rcpe.ac.uk Website: http://www.rcpe.ac.uk This email and any files transmitted with it are intended only for the use of the individual or entity to whom they are addressed >>> mak khan <mak5962@hotmail.com> 27/08/2012 13:30 >>> Dear Mrs Lindy Tedford Head of Examinations Thanks for your information. Now at least I know that my eligibility stands for all parts of MRCP UK including PACES . 1.I have come to know that there used be 3 books published by ROYAL COLLEGE , which used to contain 'actual questions asked in Part 1 & 2 . Are these still available ? 2.Is MRCP Neuro available in India ? Regards DR MA KHAN Jamshedpur INDIA

Date: Mon, 2 Jul 2012 16:46:07 +0100 From: L.Tedford@rcpe.ac.uk To: mak5962@hotmail.com Subject: Re: My eligibility for MRCP PACES ? pl reply . Dear Dr Khan Thank you for your e-mail. Please refer to the MRCP(UK) website www.mrcpuk.org. The following is an extract from the regulations:5.2 MRCP(UK) Part 2 Written Examination and Clinical Examination (PACES) Candidates for the MRCP(UK) Part 2 Written Examination and Clinical Examination (PACES) must have passed the MRCP(UK) Part 1 Examination within the preceding seven years. It is advised that trainees are unlikely to be able to apply their clinical knowledge or demonstrate their clinical skills across the broad range of clinical cases, and thus be successful in the MRCP(UK) PACES examination, before a total of two years experience, including at least four months in medical specialties or medical sub-specialties, following the award of their primary medical degree. We therefore recommend that candidates will normally have completed a twoyear Foundation programme and started Core Medical Training (or an equivalent period of training) before attempting the MRCP(UK) PACES examination. Within these two years, not less than four months should be spent in posts involving the continuing care of emergency medical patients. This experience in the UK should as a minimum be at Foundation Year 1 and 2 level (or equivalent) and in Core Medical Training (or equivalent), but may be gained in any hospital throughout the world. There is no reason why you should not be able to sit MRCP(UK) Part 1. As far as I can see from your e-mail there is no reason why you should not be allowed to sit PACES and MRCP(UK) Part 2. I hope this helps! Yours sincerely

Lindy Tedford Mrs Lindy Tedford Head of Examinations Royal College of Physicians of Edinburgh (A charity registered in Scotland, no. SC009465) 9 - 11 Queen Street Edinburgh EH2 1JQ Telephone: 0131-225-7324 Fax: 0131-225-2053 e-mail: l.tedford@rcpe.ac.uk Website: http://www.rcpe.ac.uk This email and any files transmitted with it are intended only for the use of the individual or entity to whom they are addressed >>> mak khan <mak5962@hotmail.com> 02/07/2012 12:06 >>> Dear Ms Lindy Tedford Greetings from Dr M A Khan from Jamshedpur, Jharkhand India. This is to enquire about the 'eligibility for PACES in my case. I could not plan MRCP earlier in my life , because of geographical barriers and some serious financial constraints , but now since MRCP is available in India, so will you please let me know whether I will be eligible to take PACES if I pass MRCP -Part I , which I plan to take in May 2013. My profile reads as follows : 1.I am aged 52 years and have passed my MBBS in 1988 from Patliputra Medical College , Dhanbad , Jharkhand affiliated with Ranchi University, Ranchi, Jharkhand in 1988. Now it is affiliated with Vinba Bhave University , Hazaribagh , Jharkhand , India . 2. I have completed my mandatory 1 year core training (called ' Rotating Internship ' over here)in 1988-89. 3. After that I have completed ' RESIDENT HOUSE PHYSICIAN SHIPS in the specialties of Int Medicine , Pediatrics and Psychiatry --6 months each (total 18 months) which included Emergency care /OPD/Indoor treatment( during all 18 months )- from 1989 March-1990 October. 4. Then I qualified for Bihar State Govt Health services in Nov, 1990 and have served in Primary Health Centres ( a 6 bedded hospital ) which included OPD, Indoor care and Emergency care till March 2005.--Total 14 years 5 months . 5. I have passed PG Diploma in Radio diagnosis (DMRD )from Rajendra Medical College . Ranchi Jharkhand during May 1992--- June 1993 , affiliated with Ranchi University , Ranchi , Jharkhand with working as Medical officer which included Emergency care/Indoor/OPD care .( 1 year ) 6.In between I have one year International Experience too having worked in Kingdom of Saudi Arabia under Govt (Ministry of Health -MOH) from Jan 1999-Jan 2000(1 year ) 7.Since 2005 March till date , my employer has posted me in the Deptt of Biochemistry , MGM Medical College , Jamshedpur , Jharkhand . 8..In between I have completed PG Diploma in Family Health( 2003) from Post Graduate Institute of Medicine (Colombo) affiliated with Colombo University , Colombo , Srilanka and Fellowship in HIV Medicine (1 year --200607) from School of Tropical Medicine & Medical College , Kolkata , India. 9. I have presented papers on HIV topics in International Conferences and my 4 papers on HIV topics have been published in Indexed International Journals . 10..I have been in active clinical practice all through since I finished my Residency -->22 years

With this much of credentials pl let me know whether I am eligible for MRCP PACES or not. Expecting to hear from you pretty soon.

Regards DR M A KHAN MGM MEDICAL COLLEGE , JAMSHEDPUR JHARKHAND INDIA

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100 Commonly Tested Facts for MRCP Part 1 Exam Author: sujitvasanth, Posted on Wednesday, November 23 @ 19:10:08 IST by RxPG Add to My Pages Printer Friendly Email Story Download Story MRCP Part 1 alerts

Here is a list of commonly tested facts in hte MRCP Part 1 exam. They are listed in order of importance - highest first.

1. Acromegaly Diagnosis: OGTT followed by GH conc. 2. Cushings Diagnosis: 24hr urinary free cortisol. Addisons --> short synacthen. 3. Rash on buttocks Dermatitis herpetiformis (coeliac dx). 4. AF with TIA --> Warfarin. Just TIA's with no AF --> Aspirin 5. Herpes encephalitis --> temporal lobe calicification OR temporoparietal attentuation subacute onset i.e. Several days. 6. Obese woman, papilloedema/headache --> Benign Intercanial Hypertention. 7. Drug induced pneumonitis --> methotrexate or amiodarone. 8. chest discomfort and dysphagia --> achalasia. 9. foreign travel, macpap rash/flu like illnes --> HIV acute. 10. cause of gout --> dec urinary excretion.

11. bullae on hands and fragule SKIN torn by minor trauma --> porphyria cutanea tarda.

12. Splenectomy --> need pneumococcal vaccine AT LEAST 2 weeks pre-op and for life. 13. primary hrperparathyroidism --> high Ca, normal/low PO4, normal/high PTH (in elderly). 14. middle aged man with KNEE arthritis --> gonococcal sepsis (older people -> Staph). 15. sarcoidosis, erythema nodosum, arthropathy --> Loffgrens syndrome benign, no Rx needed. 16. TREMOR postural,slow progression,titubation, relieved by OH->benign essential TREMOR AutDom. (MS titbation, PD no titubation) 17. electrolytes disturbance causing confusion low/high Na. 18. contraindications lung Surgery --> FEV dec bp 130/90, Ace inhibitors (if proteinuria analgesic induced headache. 21. 1.5 cm difference btwn kidneys -> Renal artery stenosis --> Magnetic resonance angiogram. 22. temporal tenderness--> temporal arteritis -> steroids > 90% ischaemic neuropathy, 10% retinal art occlusion. 23. severe retroorbital, daily headache, lacrimation --> cluster headache. 24. pemphigus involves mouth (mucus membranes), pemphigoid less serious NOT mucosa. 25. diagnosis of polyuria -> water deprivation test, then DDAVP. 26. insulinoma -> 24 hr supervised fasting hypoglycaemia. 27. Diabetes Random >7 or if >6 OGTT (75g) -> >11.1 also seen in HCT. 28. causes of villous atrophy: coeliac (lymphocytic infiltrate), Whipples , dec Ig, lymphoma, trop sprue (rx tetracycline). 29. diarrhoea, bronchospasm, flushing, tricuspid stenosis -> gut carcinoid c liver mets. 30. hepatitis B with general deterioration -> hepaocellular carcinoma. 31. albumin normal, total protein high -> myeloma (hypercalcaemia, electrophoresis). 32. HBSag positive, HB DNA not detectable --> chornic carier. 33. Inf MI, artery invlived -> Right coronary artert. 34. Aut dom conditions: Achondroplasia, Ehler Danlos, FAP, FAMILIAL hyperchol,Gilberts, Huntington's, Marfans's, NFT I/II, Most porphyrias, tuberous sclerosis, vWD, PeutzJeghers. 35. X linked: Beck/Duch musc dyst, alports, Fragile X, G6PD, Haemophilia A/B. 36. Loud S1: MS, hyperdynamic, short PR. Soft S1: immobile MS, MR. 37. Loud S2: hypertension, AS. Fixed split: ASD. Opening snap: MOBILE MS, severe near S2. 38. HOCM/MVP - inc by standing, dec by squating (inc all others). HOCM inc by valsalva, decs all others. Sudden death athlete, FH, Rx. Amiodarone, ICD. 39. MVP sudden worsening post MI. Harsh systolic murmur radites to axilla. 40. Dilated Cardiomyopathy: OH, bp, thiamine/selenium deficiency, MD, cocksackie/HIV, preg, doxorubicin, infiltration (HCT, sarcoid), tachycardia. 41. Restrictive Cardiomyopathy: sclerodermma, amyloid, sarcoid, HCT, glycogen storage, Gauchers, fibrosis, hypereosinophilia Lofflers, caracinoid, malignancy, radiotherapy, toxins. 42. Tumor compressing Respiratory tract --> investigation: flow volume loop. 43. Guillan Barre syndrome: check VITAL CAPACITY.

44. Horners sweating lost in upper face only lesion proximal to common carotid artery. 45. Internuclear opthalmoplegia: medial longitudinal fasciculus connects CN nucleus 3-4. Ipsilateral adduction palsy, contralateral nystagmus. Aide memoire (TRIES TO YANK THE ipsilateral BAD eye ACROSS THE nose ). Convergence retraction nystagmus, but convergence reflex is normal. Causes: MS, SLE, Miller fisher, overdose(barb, phenytoin, TCA), Wernicke. 46. Progressive Supranuclear palsy: Steel Richardson. Absent voluntary downward gaze, normal dolls eye . i.e. Occulomotor nuclei intact, supranuclear Pathology . 47. Perinauds syndrome: dorsal midbrain syndrome, damaged midrain and superior colliculus: impaired upgaze (cf PSNP), lid retraction, convergence preserved. Causes: pineal tumor, stroke, hydrocephalus, MS. 48. demetia, gait abnormaily, urinary incontinence. Absent papilloedema-->Normal pressure hydrocephalus. 49. acute red eye -> acute closed angle glaucoma >> less common (ant uveitis, scleritis, episcleritis, subconjuntival haemmorrhage). 50. wheeles, URTICARIA , drug induced -> aspirin. 51. sweats and weight gain -> insulinoma. 52. diagnostic test for asthma -> morning dip in PEFR >20%. 53. Causes of SIADH : chest/cerebral/pancreas Pathology , porphyria, malignancy, Drugs (carbamazepine, chlorpropamide, clofibrate, atipsychotics, NSAIDs, rifampicin, opiates) 54. Causes of Diabetes Insipidus: Cranial: tumor, infiltration, trauma Nephrogenic: Lithium, amphoteracin, domeclocycline, prologed hypercalcaemia/hypornatraemia, FAMILIAL X linked type 55. bisphosphonates:inhibit osteoclast activity, prevent steroid incduced osteoperosis (vitamin D also). 56.returned from airline flight, TIA-> paradoxical embolus do TOE. 57. alcoholic, given glucose develops nystagmus -> B1 deficiency (wernickes). Confabulation->korsakoff. 58. mono-artropathy with thiazide -> gout (neg birefringence). NO ALLOPURINOL for acute. 59. painful 3rd nerve palsy -> posterior communicating artery aneurysm till proven otherwise 60 late complication of scleroderma --> pumonaryhypertention plus/minus fibrosis. 61. causes of erythema mutliforme: lamotrigine 62. vomiting, abdominal pain, hypothyroidism -> Addisonian crisis (TFT typically abnormal in this setting DO NOT give thyroxine). 63. mouth/genital ulcers and oligarthritis -> behcets (also eye /SKIN lesions, DVT) 64. mixed drug overdose most important step -> Nacetylcysteine (time dependent prognosis) 65. cavernous sinus syndrome - 3rd nerve palsy, proptosis, periorbital swlling, conj injectn 66. asymetric parkinsons -> likely to be idiopathic 67. Obese, NIDDM female with abnormal LFT's -> NASH (non-alcoholic steatotic hepatitis) 68. fluctuating level of conciousness in elderly plus/minus deterioration --> chronic subdural. Can last even longer than 6 months

69. Sensitivity --> TP/(TP plus FN) e.g. For SLE - ANA highly sens, dsDNA:highly specific 70. RR is 8%. NNT is ----> 100/8 --> 50/4 --> 25/2 --> 13.5 71. ipsilateral ataxia, Horners, contralateral loss pain/temp --> PICA stroke (lateral medulary syndrome of Wallenburg) 72. renal stones (80% calcium, 10% uric acid, 5% ammonium (proteus), 3% other). Uric acid and cyteine stone are radioluscent. 73. hyperprolactinaemia (allactorrohea, amenorrohea, low FSH/LH) -> Da antags (metoclopramide, chlorpromazine, cimetidine NOT TCA's), pregnancy, PCOS, pit tumor/microadenoma, stress. 74. Distal, asymetric arthropathy -> PSORIASIS 75. episodic headache with tachycardia -> phaeochromocytoma 76. very raised WCC -> ALWAYS think of leukaemia. 77. Diagnosis of CLL --> immunophenotyping NOT cytogenetics, NOT bone marrow 78. Prognostic factors for AML -> bm karyotype (good/poor/standard) >> WCC at diagnosis. 79. pancytopenia with raised MCV --> check B12/folate first (other causes possble, but do this FIRST). Often associayed with phenytoin use --> decreased folate 80. miscariage, DVT, stroke --> LUPUS anticoagulant --> lifelong anticoagulation 81. Hb elevated, dec ESR -> polycythaemua (2ndry if paO2 low) 82. anosmia, delayed puberty -> Kallmans syndrome (hypogonadotrophic hypogonadism) 83. diag of PKD -> renal US even if think anorexia nervosa 85. commonest finding in G6PD hamolysis -> haumoglobinuria 86. mitral stenosis: loud S1 (soft s1 if severe), opening snap.. Immobile valve -> no snap. 87. Flank pain, urinalysis:blood, protein -> renal vein thrombosis. Causes: nephrotic syndrome, RCC, amyloid, acute pyelonephritis, SLE (atiphospholipid syndrome which is recurrent thrombosis, fetal loss, dec plt. Usual cause of cns manifestations assoc with LUPUS ancoagulant, anticardiolipin ab) 88. anaemia in the elderly assume GI malignancy 89. hypothermia, acute renal failure -> rhabdomyolysis (collapse assumed) 90. pain, numbness lateral upper thigh --> meralgia paraesthesia (lat cutaneous nerve compression usally by by ing ligament) 91. diagnosis of haemochromatosis: screen with Ferritin, confirm by tranferrin saturation, genotyping. If nondiagnostic do liver biopsy 0.3% mortality 92. 40 mg hidrocortisone divided doses (bd) --> 10 mg prednisolone (ie. Prednislone is x4 stronger) 93. BTS: TB guidlines close contacts -> Heaf test -> positive CXR, negative --> repeat Heaf in 6 weeks. Isolation not required. 94. Diptheria -> exudative pharyngitis, lymphadenopathy, cardio and neuro toxicity. 95. Indurated plaques on cheeks, scarring alopecia, hyperkeratosis over hair follicles ->>Discoid LUPUS 96. wt loss, malabsoption, inc ALP -> pancreatic cancer

97. foreign travel, tender RUQ, raised ALP --> liver abscess do U/S 98. wt loss, anaemia (macro/micro), no obvious cause -> coeliac (diarrhoea does NOT have to be present) 99. haematuria, proteinuria, best investigation --> if glomerulonephritis suspected --> renal biopsy 100. venous ulcer treatment --> exclude arteriopathy (eg ABPI), control oedema, prevent infection, compression bandaging. 101. Malaria, incubation within 3/12. can be relapsing /remitting. Vivax and Ovale (West Africa) longer imcubation. 102. Fever, lymphadenopathy, lymphocytosis, pharygitis --->EBV ---> heterophile antibodies 103. GI bleed after endovascular AAA Surgery --> aortoenteric fistula List of High Yield Topics for MRCP Part 1 Exam Author: sujitvasanth, Posted on Wednesday, November 23 @ 19:13:36 IST by RxPG Biostatistics: Basics - a must for all exams

For normally distributed data- parametric test Students t-test For skewed continuous data which is paired- non- parametric testWilcoxon rank-sum test For skewed continuous data which is unpaired- non- parametric testMann Whitney Test To test one categorical variable against another Chi-squared test

Categorical variables are qualitative not numerical. Eg. dead or alive

SE(standard Error)= SD(standard Deviation)/n Confidence intervals are calculated from SE Normal Laboratory Values and Ranges For MRCP Question Papers Date: Monday, July 07 @ 04:27:45 CDT Topic: MRCP Part 1

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Haematology

Full blood count

Haemoglobin (males) 13.0 18.0 g/dL

Haemoglobin (females) 11.5 16.5 g/dL

Haematocrit (males) 0.40 0.52

Haematocrit (females) 0.36 0.47

MCV 80 96 fL

MCH 28 32 pg

MCHC 32 35 g/dL

White cell count 4 11 x 109/L

White cell differential:

Neutrophils 1.5 7 x 109/L

Lymphocytes 1.5 4 x 109/L

Monocytes 0 0.8 x 109/L

Eosinophils 0.04 0.4 x 109/L

Basophils 0 0.1 x 109/L

Platelet count 150 400 x 109/L

Reticulocyte count 25 85 x 109/L OR 0.5 2.4%

Erythrocyte sedimentation rate

Westergren

Under 50 years:

Males 0 15 mm/1st hr

Females 0 20 mm/1st hr

Over 50 years:

Males 0 20 mm/1st hr

Females 0 30 mm/1st hr

Plasma viscosity (25C) 1.50 1.72 mPa/s

Coagulation Screen

Prothrombin time 11.5 15.5s

International normalised ratio <1.4

Activated partial thromboplastin time 30 40s

Fibrinogen 1.8 5.4 g/L

Bleeding time 3 8m

Coagulation Factors

Factors II, V, VII, VIII, IX, X, XI, XII 50 150 IU/dL

Factor V Leiden

Von Willebrand factor 45 150 IU/dL

Von Willebrand factor antigen 50 150 IU/dL

Protein C 80 135 IU/dL

Protein S 80 120 IU/dL

Antithrombin III 80 120 IU/dL

Activated protein C resistance 2.12 4.0

Fibrin degradation products < 100 mg/L

D-Dimer screen < 0.5 mg/L

Haematinics

Serum iron 12 30 mol/L

Serum iron-binding capacity 45 75 mol/L

Serum ferritin 15 300 g/L

Serum transferrin 2.0 4.0 g/L

Serum B12 160 760 ng/L

Serum folate 2.0 11.0g/L

Red cell folate 160 640 g/L

Serum haptoglobin 0.13 1.63 g/L

Haemoglobin electrophoresis:

Haemoglobin A > 95%

Haemoglobin A2 2 3%

Haemoglobin F < 2 %

Chemistry

Serum sodium 137 144 mmol/L

Serum potassium 3.5 4.9 mmol/L

Serum chloride 95 107 mmol/L

Serum bicarbonate 20 28 mmol/L

Anion gap 12 16 mmol/L

Serum urea 2.5 7.5 mmol/L

Serum creatinine 60 110 mol/L

Serum corrected calcium 2.2 2.6 mmol/L

Serum phosphate 0.8 1.4 mmol/L

Serum total protein 61 76 g/L

Serum albumin 37 49 g/L

Serum total bilirubin 1 22 mol/L

Serum conjugated bilirubin 0 3.4 mol/L

Serum alanine aminotransferase 5 35 U/L

Serum aspartate aminotransferase 1 31 U/L

Serum alkaline phosphatase 45 105 U/L (over 14 years)

Serum gamma glutamyl transferase 4 35 U/L (< 50 U/L in males)

Serum lactate dehydrogenase 10 250 U/L

Serum creatine kinase (Males) 24 195 U/L

Serum creatine kinase (Females) 24 170 U/L

Creatine kinase MB fraction < 5%

Serum troponin I 0-0.4 g/L

Serum troponin T 0 0.1 g/L

Serum copper 12 26 mol/L

Serum caeruloplasmin 200 350 mg/L

Serum aluminium 0-10 g/L

Serum magnesium 0.75 1.05 mmol/L

Serum zinc 6 25 mol/L

Serum urate (males) 0.23 0.46 mmol/L

Serum urate (females) 0.19 0.36 mmol/L

Plasma lactate 0.6 1.8 mmol/L

Plasma ammonia 12 55 mol/L

Serum angiotensin-converting enzyme 25 82 U/L

Fasting plasma glucose 3.0 6.0 mmol/L

Haemoglobin A1 C 3.8 6.4%

Fructosamine < 285 mo/L

Serum amylase 60 180 U/L

Plasma osmolality 278 305 mosmol/Kg

Urine

Albumin/creatinine ratio (untimed specimen)

<3.5 mg/mmol (males)

<2.5 mg/mmol (females)

Lipids and Lipoproteins

The target levels will vary depending on the patients overall cardiovascular risk assessment.

Serum cholesterol: < 5.2 mmol/L

Serum LDL cholesterol: < 3.36 mmol/L

Serum HDL cholesterol: > 1.55 mmol/L

Fasting serum triglyceride 0.45 1.69 mmol/L

Blood Gases (breathing air at sea level)

Blood H+ 35 45 nmol/L

pH 7.36 7.44

PaO2 11.3 12.6 kPa

PaCO2 4.7 6.0 kPa

Base excess 2 mmol/L

Carboxyhaemoglobin:

Non-smoker < 2%

Smoker 3 15%

Endocrinology

Adrenal steroids

Blood

Serum aldosterone (normal diet)

Upright (4h) 330 830 pmol/L

Supine (30m) 135 400 pmol/L

Serum cortisol:

09.00h 200 700 nmol/L

22.00h 50 250 nmol/L

Overnight dexamethasone suppression test (after 1mg dexamethasone)

Serum cortisol < 50 nmol/l

Low dose dexamethasone suppression test (2 mg/day for 48h)

Serum cortisol < 50 nmol/L

After insulin-induced hypoglycaemia (blood glucose < 2.2 mmol/L)

Serum cortisol > 550 nmol/L and 200 nmol/L greater than baseline

Plasma 11 deoxycortisol 24 46 nmol/L

Serum dehydroepiandrosterone

(09.00) 7 31 nmol/L

Serum dehydroepiandrosterone sulphate:

(Males) 2 10 mol/L

(Females) 3 12 mol/L

Serum androstenedione (adults)

Males 1.6 8.4 nmol/L

Females 0.6 8.8 nmol/L

Post menopausal females 0.9 6.8 nmol/L

Serum 17-hydroxyprogesterone:

Males 1 10 nmol/L

Females

Follicular 1 10 nmol/L

Luteal 10 20 nmol/L

Serum oestradiol

Males < 180 pmol/L

Females

Post-menopausal < 100 pmol/L

Follicular 200 400 pmol/L

Mid-cycle 400 1200 pmol/L

Luteal 400 1000 pmol/L

Serum progesterone

Males < 6 nmol/L

Females

Follicular < 10 nmol/L

Luteal > 30 nmol/L

Serum testosterone

Males 9 35 nmol/L

Females 0.5 3 nmol/L

Serum dihydrotestosterone

Males 1- 2.6 nmol/L

Females 0.3 9.3 nmol/L

Serum sex hormone binding protein

Males 10 62 nmol/L

Females 40 137 nmol/L

Urine

Aldosterone 14 53 nmol/24h

Cortisol 55 250 nmol/24h

Plasma angiotensin II 5 35 pmol/L

Plasma renin activity

Recumbent 1.1 2.7 pmol/ml/h

Erect after 30m 3.0 4.3 pmol/ml/h

Pancreatic and gut hormones

Plasma gastrin < 55 pmol/L

Plasma or serum insulin:

Overnight fasting < 186 pmol/L

After hypoglycaemia

(Blood glucose < 2.2 mmol/L) < 21 pmol/L

Plasma vasoactive intestinal polypeptide < 30 pmol/L

Plasma pancreatic polypeptide < 300 pmol/L

Plasma glucagon < 50 pmol/L

Anterior pituitary hormones

Plasma adrenocorticotrophic hormone

09.00 < 18 pmol/L

Plasma follicle stimulating hormone

Males 1 7 U/L

Females

Follicular 2.5 10 U/L

Midcycle 25 70 U/L

Luteal 0.32 2.1 U/L

Post-menopausal > 30 U/L

Plasma growth hormone

Basal, fasting and between pulses < 1 mU/L

After hypoglycaemia > 40 mU/L

Plasma luteinizing hormone

Males 1 10 U/L

Females

Follicular 2.5 10 U/L

Midcycle 25 70 U/L

Luteal 1 13 U/L

Post-menopausal > 30 U/L

Plasma prolactin < 360 mU/L

Plasma thyroid stimulating hormone 0.4 5 mU/L

Posterior pituitary hormones

Plasma antidiuretic hormone 0.9 4.6 pmol/L

Thyroid hormones

Plasma thyroid binding globulin 13 28 mg/L

Plasma thyroxine (T4) 58 174 nmol/L

Free T4 10 22 pmol/L

Tri-iodothyronine (T3) 1.07 3.18 nmol/L

Free T3 5 10 pmol/L

Serum TSH receptor antibodies < 7 U/L

Serum antithyroid peroxidase < 50 IU/mL

Serum thyroid receptor antibodies < 10 U/L

Catecholamines

(Plasma recumbent with venous catheter in place for 30m prior to collection of sample)

Adrenaline 0.03 1.31 nmol/L

Noradrenaline 0.47 4.14 nmol/L

Urine

Vanillyl mandelic acid 5 35 mol/24h

Dopamine < 3100 nmol/24h

Adrenaline < 144 nmol/24h

Noradrenaline < 570 nmol/24h

Hydroxyindole acetic acid < 70 mol/24h

Others

Plasma parathyroid hormone 0.9 5.4 pmol/L

Plasma calcitonin < 27 pmol/L

Serum cholecalciferol (vitamin D3) 60 105 nmol/L

Serum 25 OH cholecalciferol 45 90 nmol/L

Age-related insulin like growth factor 1

13 15 yrs 9.3 56.0 nmol/L

16 18 yrs 9.3 56.0 nmol/L

20 40 yrs 7.5 37.3 nmol/L

40 60 yrs 5.6 23.3 nmol/L

>60 yrs 3.3 23.3 nmol/L

Immunology / Rheumatology

Complement C3 65 190 mg/dL

Complement C4 15 50 mg/dL

Total haemolytic (CH50) 150 250 U/L

Serum C-reactive protein < 10 mg/L

Serum immunoglobins

IgG 6.0 13.0 g/L

IgA 0.8 3.0 g/L

IgM 0.4 2.5 g/L

IgE <120 kU/L

Serum 2 micro globulin < 3 mg/L

Autoantibodies (all serum)

Adrenal Negative at 1:10 Dil.

Anticentromere antibodies Negative at 1:40 Dil.

Anticardiolipin antibody

IgG 0 23

IgM 0 - 11

Anti double-stranded DNA (ELISA) 0 73 U/mL

Antineutrophil cytoplasmic antibodies

Anti Proteinase 3 Negative

Anti MPO Negative

Antinuclear antibodies Negative at 1:20 Dil.

ENA Negative

Gastric parietal cells Negative at 1:20 Dil.

Interstitial cells of testis Negative at 1:10 Dil.

Jo-1 Negative

La Negative

Mitochondrial Negative at 1:20 Dil.

RNP Negative

Scl-70 Negative

Ro Negative

Skeletal muscle Negative at 1:60 Dil.

Sm Negative

Smooth muscle Negative at 1:20 Dil.

Thyroid colloid and microcosmal antigens Negative at 1:10 Dil.

Rheumatoid factor < 30 k IU/L

Tumour Markers

Serum alpha-fetoprotein <10 kU/L

Serum carcinoembryonic antigen < 10 g/L

Serum neurone specific enolase < 12 g/L

Serum prostate specific antigen

Males over 40 <4 g/L

Males under 40 <2 g/L

Serum human chorionic gonadotrophin < 5 U/L

Serum CA 125 < 35 U/mL

Serum CA 19 9 < 33 U/mL

Therapeutic Drug Levels

Plasma aminophylline 10 20 g/mL

Plasma carbamazepine 34 51 mol/L

Blood ciclosporin 100 150 nmol/L

Plasma digoxin (taken at least 6h post dose) 1 2 nmol/L

Plasma ethosuximide 280 710 mol/L

Blood gentamicin (peak) 5 7 g/ml

Serum lithium 0.5 1.5 mmol/L

Serum phenobarbital 65 172 mol/L

Serum phenytoin 40 80 mol/L

Serum primidone 23 55 mol/L

Plasma theophylline 55 110 mol/L

Cerebro-spinal fluid

Opening pressure 50 180 mm H2O

Total protein 0.15 0.45 g/L

Albumin 0.066 0.442 g/L

Chloride 116 122 mmol/L

Glucose 3.3 4.4 mmol/L

Lactate 1 2 mmol/L

Cell count 5 mL-1

Differential:

Lymphocytes 60 70%

Monocytes 30 50%

Neutrophils None

IgG/ALB 0.26

IgG index 0.88

Urine

Glomerular filtration rate 70 140 mL/min

Total protein < 0.2g/24h

Albumin < 30 mg/24 h

Calcium 2.5 7.5 mmol/24h

Urobilinogen 1.7 5.9 mol/24h

Coproporphyrin < 300 nmol/24h

Uroporphyrin 6 24 nmol/24h

Delta-aminolevulinate 8 53 mol/24h

5-hydroxyindoleacetic acid 10 47 mol/24h

Osmolality 350 1000 mosmol/Kg

Faeces

Nitrogen 70 140 mmol/24h

Urobilinogen 50 500 mol/24h

Coproporphyrin 0.018 1.2 mol/24h

Coproporphyrin 0.46 mmol/g dry weight

Protoporphyrin 0 4 mol/24h

Protoporphyrin 0 220 nmol/g dry weight

Total porphyrin

(ether soluble) 10 200 nmol/g dry weight

(ether insoluble) 0 24 nmol/g dry weight

Fat (on normal diet) < 7g / 24h

Add to My Pages Printer Friendly Email Story Download Story MRCP Part 1 alerts

1. Young girl suspect Anorexia Nervosa linugo hair, finctional hypogonadotrophic hypogonadism -> amennorhea. LH and FSH both low. All other hormones are usually normal. Ferritin low.

2. Reiters Syndrome arthritis, uveitis, urethritis Chlymidia, campylobacter, Yersinia, SALMONELLA , Shigella. Balanisits.

3. PKD aut dom Chr 16/4 assoc berry aneurysm, mitral/aortic regurg

4. Porphyria photosensitivity, blisters, scars with millia, hypertrichosis

5. heart sounds: Aortic Stenosis s2 paradoxical split, length proportional to severity

6. Vitiligo commonest assoctions pernicious anaemia >>> type 1 DM , autoimmune addisons, autoimmune thyoid dx

7. Gout blood urate high/low/normal, joint aspirate pos birif, ppt thiazides, NO allopurinol/aspirin in acute phase

8. Peripheral neuropathy a) B12 rapid, dorsal columns (joint pos, vibration), sensory ataxia, pseudoathetosis of upperlimbs b) diabetic slow, spinothalamic (pain, temp?) c)alcohol slow progressive, spinothalamic d) Pb motor upper limbs

9. CNS abnormalities in HIV: toxoplaasmosis (ring enhancing), lymphoma (solitary lesion). HIV encephalopathy, progressive multifocal leucoencephalopathy (PML demylination in advanced HIV, low attenuation lesions)

10. Travellers diarrohea: chronic (>2 WEEKS) giardia (incidious onset rx. Metronidazole), SALMONELLA (serious systemic illness), E.coli (rx. Ciprofloxacin) , Shigella

11. Renal syndrome minimal change disease, membanous, IgA nephropathy, post-streptococcal.

12. If you see blood on urinalysis forget about RAS

13. Thyroid Malignancy tend to be non-functional, anaplastic has worse prognosis, local infiltration -> dysphagia, vocal cord paralysis

ALMOST Pathognomic for the exam

fatiguability -> myasthenia gravis

fasciculations -> Motor neurone diease

silvery white scale -> PSORIASIS

hypopigmented -> vitiligo/pityriasis versicolor

pretibial myxoedema --> Graves (NOT lid lag, NOT exopthalmus)

MRCP part-1 recall MCQS 07/05/2013

These are some of the MCQS, which I tried to reproduce. Your suggestion and correction will be appreciated. If anyone of u can reproduce more Plz post on this forum.

1. Patient is unable to take his arm beyond or pain wen rising above 140-180 degree. ( Supraspinatus tendinitis). 2.Sensory loss of middle finger and some other features. (C7 involvement). 3. Pt having diarrhea for last one month following passing holidays somewhere and stool microscopy shows Strongolides. (Albendazole). 4. Protien 3D view. (western method) 5.Patient having recurrent chest infection. (Complement levels).. 6. Mechanism of Action of meglitinides. (DPP-4 inhibitor) 7. Mechanism of action of Flecanide. (sodium channel blocker). 8. Herpetic lesion on wrist then after few days macular rash over the body. (Erythema Multiforme). 9. Pt having low calcium, low phosphate, low Vit-D, ALP raised, parathyroid hormone raised. How to manage. (Oral vit-D). 10. Pt having Ankylosing spondilitis. chose feature. (Global Axial decrease mobility) 11. Pt having itchy scales on sternum, eyelids, face, nasal bridge. (Sebohric dermatitis). 12. Pt having lesion on toes, microscopy shows Trychophytum rubrum. (terbinafine) 13. Pt having sever photosensitivity, malar rash and some other findings. (SLE). 14. Piercing pain in the eye. (trigeminal neuroglia) not sure on this. 15. Pt having ischemic colitis, which part of colon is involved. (Spleenic flexure). 16. Continuous bleeding from pt after vena puncture. PT-raised, APPT-

raised, Fibronogen-low, D-dimers-raised. (DIC) 17. Poor prognostic factor in leukemia. 18. Question from statistics about positive predictive value. answer 10% 19. Vit- D Resistant rickets. (X-link Dominant). 20. Hereditary telangictasia (Autosomal Dominant) 21.Pt having dizziness, vertigo and eye examination was normal. (Mieniers disease) 22. Specify the site of lesion that pt is unable to abduct his eye and some other features. (PONS) not sure, 23. There was a question in which a pt is having lower motor neuron lesion in upper limb and upper neuron lesion in lower limbs. (Amytropic lateral sclerosis) 24. PCR...(fromation od DNA from RNA) 25. Where RNA splicing take place. 26. Pat had mastoid surgery for deafness and there was renal involvement showing blood+, Protien+ in urine. (Alport syndrome). 27. PT diabetic and HTN having painless decrease vision in one of the eye. fundoscopy shows cotton wools, haemorrhage. (Not sure) 28. CSF examination. glucose normal, protein normal, Lymphos raised, neutros normal. (Viral infection) 29. Diagnosis of pt on basis of investigation , Von Willbrand antigen low, Von Willbrand activity low, factor VIII low. (Von willbrand disease). 30. Pt having plasmodium Vivax infection. wt is the benefit of giving chloroquine+primaquine. (Decrease resistant) 31. 1 cm rim of pneumothorax. (Discharge and repeat X-ray after 7 days). 32. Pt having small lung carcinoma, having SOB. Increase cortisol level due to ectopic production of ACTH. 33. Pregnant lady increase frequency of SOB and wheeze. she is on salbutamol inhaler. (Add steriods) 34. Pt on long term tx for rheumatoid arthritis. some other features. (Rectal biopsy for amyloidosis). 35. Pt having barret oesophagus on proven following endoscopy. (Acid

suppression and repeat biopsy). 36. Pt having dyspepsia for long time. (endoscopy) 37. Pt having sever chest infection and was admitted in the hospital. IV antibiotics are given. 10 days after that pt feel SOB and x-ray shows large plural Effusion. (Empyema) not sure. 38. Pt had chemotherapy and presented SOB and muffled heart sounds. (Cardiac temponade) 39. MOA of Bivalirudin. ( direct thrombin inhibitor) 40. Pt having numbness on the lateral boarder of foot. (S1 lesion) 41. CREST complication. (Malabsorption) 42. Pt having lytic lesion on radio graphy. (Protien electrophoresis) 43. Rt sided apical lung cancer involving brachial plexus. Mode of tx. Not sure. 44. Which of the following causing upper lobe fibrosis. (Allergic Fibrosing alvelitis) 45. Which of the following cell is raised in Aspergiollus infection. (Eosinophill) 46. Pt having painlees or red urine and SOB. TX not sure 47. Pt going for chemoptherapy which of the measures should taken prior to tx. (Red pack cell transfusion) 48. Pt taking DEMARDS drugs and having oral ulcer. (candidiasis) 49. Tricyclic overdose. (IV NaHCO3) 50. Methnol Over dose. (Dialysis) 51. Pt collapse not breathig, no pulse, next step. ( Call for Help) 52. patient with abdomina lpain and vomitting and acidosis nothing about ketonemia mentioned given insulin in infusion waht nest step. ( Normal Saline) 53. Hypertention and palpitaion thyroin cancer removed in the hx( carcenoma) what is the diagnosis: pheochromocytoma. 54. Which drug will u give wen pt with pheochromocytomo going for surgery. (phenoxybenzamine) 55. ECG show st depression in V5 and V6. (Circumflex artery) 56. Pt with obstructive sleep apnea. CPAP, BIPAP, some instruments use. not sure in this senario.

Will post more in a day or two. your suggestion and correction will be appreciated.

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Back to top TRENDING: MRCP Part-1 Recall MCQS 07/05/2013 Wed May 08, 2013 11:51 pm (2 days ago) #2 thanks allot my friend but about 4. Protien 3D view I think it is by xkhaled_se Newbie ray . Specify the site of lesion that pt is unable to abduct his eye and some other features. (PONS) not sure ( i think it is correct ) Posts: 1 Credits: 105 thanks again and keep going

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Back to top Thu May 09, 2013 12:05 pm (1 day ago) #3 topics asked were . 1. lateral epicondyitis saeedanwar9 Serious Member 2. ischaemia mesenteric 3.ra 4.sle 5.htn treatement in more than55 Posts: 9 Credits: 145 Aim MRCP Part 1 6.malignant htn 7.hf 8.vsd 9.ps or aortic valve bicuspid ?

10.normal aonion gap metabolic acidosis 11.ppv 12.ppv 13.nonparametric test 14.exercise tolerance test 15.ihd location of artey 16.men 2 pheochromocytoma 17.treatment of pheochromocytoma 18.infective endocarditis 19. rf 20.ankylosing spondylosis 21.gout 22. oa 23.septic arthrits 24.septic arthritis 25 psoritic arthritis 26 enteric arthritis 27.metronidazole -ileic involvement in chrons 28.dka 29.addisons disease 30 hypertension with low potasium. 31.mechanism of action of spirinolactone 32 direct thrombin agonist 33.eea 34.iaa 35.telangestasia 36 marfans 37,complement 38.arnold chiari 39. catract 40.retinal vien obstruction 41, carotid artery dissection 42. alzehmars disease 43. clear airways / call for help

44.peritoneal dialyses 45. occupational asthma 46.copd 47 . mg sulphate 48.scleritis 49.mgravis/ 50.s1 lesion 51.radial nerves branch lesion. 52.frozen shoulder 53.bph 54.ceolic disease 55. systemic sclerosis 56.osteomalacia 58.pagets disease. 59 cushings 60. graves 61. subacute thyrotoxicosis 62.unequal blood pressures 63.psedomonas. 64.hypochondriasis. 65.schizophrenia, 66.seizures 67. head tremor 68 .motor neuron disease. 69.pons 70.intrasellar piytutary 71.hypopitutarism 72.smivastativ+clarithromycin 73.meiners disease. 74.tertiray hyperparathriodism 75.acromegaly 76 insulinoma 77.di lithium. 78. siadh.fluxetine 79. fluoxitine in young patient

80.alcohol piosing 81.wegeners 82 alport 83.hsp 84 iga nephropathy. 85.erythrema multiforme 86.bullous pempigoid 87.seboric dermatits 88.psoriasis 89. granuloma annulare 90.ulnar nerve leision 91.dyspepsia. 92.uc 93.ibs 94.yersinia 95.mechanism of inactivity of cortisol. 96.pcos 97.klienfilter 98.hypothriodism 99.myeloma 100.primary hyperparathyriodism 101.diuretic used in calcium stones 102.cml 103.cll 104. 15.17 translocation 105.mylofibrosis 1o6.dic 107.myelofroliferative disorder 108.pnh 109.anaemia of chronic disease 110.vonwilbrand 111.bilirubin mild elevated next test 112. chronic hepatitis c -cryoglobinemia 113.paracetamol poising- pt 114.mitral valve severity.

115.heriditary angieoedema -c4 level 116.alopecia 117.small cell ca. 118. bpaspergilosis. 119.aspiration pneumonia 120.pregnanat treat asthma 121.prophylaxis in previous preeclampsia 122.iv bypass the first order kinectics 123.epiglotitis 124.oral painful ulcers. 125 treatement of toxoplasmosis 126.xlinked dominant rickets 127.tlco reduced in lung fibrosis 128.plural effusion 129.cluster headache 130.tricyclic overdose' bicarbonate 131.adenosine first in svt then give again 132.adenosine mechanism 133.inflixanib 134.risk factor crohons smoking 135-omega 3 use

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Back to top Thu May 09, 2013 1:16 pm (1 day ago) #4 saeedanwar9 wrote: topics asked were . dr_jabed Serious Member 1. lateral epicondyitis 2. ischaemia mesenteric 3.ra Posts: 6 4.sle

Credits: 137 Aim MRCP Part 1

5.htn treatement in more than55 6.malignant htn 7.hf 8.vsd 9.ps or aortic valve bicuspid ? 10.normal aonion gap metabolic acidosis 11.ppv 12.ppv 13.nonparametric test 14.exercise tolerance test 15.ihd location of artey 16.men 2 pheochromocytoma 17.treatment of pheochromocytoma 18.infective endocarditis 19. rf 20.ankylosing spondylosis 21.gout 22. oa 23.septic arthrits 24.septic arthritis 25 psoritic arthritis 26 enteric arthritis 27.metronidazole -ileic involvement in chrons 28.dka 29.addisons disease 30 hypertension with low potasium. 31.mechanism of action of spirinolactone 32 direct thrombin agonist 33.eea 34.iaa 35.telangestasia 36 marfans

37,complement 38.arnold chiari 39. catract 40.retinal vien obstruction 41, carotid artery dissection 42. alzehmars disease 43. clear airways / call for help 44.peritoneal dialyses 45. occupational asthma 46.copd 47 . mg sulphate 48.scleritis 49.mgravis/ 50.s1 lesion 51.radial nerves branch lesion. 52.frozen shoulder 53.bph 54.ceolic disease 55. systemic sclerosis 56.osteomalacia 58.pagets disease. 59 cushings 60. graves 61. subacute thyrotoxicosis 62.unequal blood pressures 63.psedomonas. 64.hypochondriasis. 65.schizophrenia, 66.seizures 67. head tremor 68 .motor neuron disease. 69.pons 70.intrasellar piytutary 71.hypopitutarism 72.smivastativ+clarithromycin

73.meiners disease. 74.tertiray hyperparathriodism 75.acromegaly 76 insulinoma 77.di lithium. 78. siadh.fluxetine 79. fluoxitine in young patient 80.alcohol piosing 81.wegeners 82 alport 83.hsp 84 iga nephropathy. 85.erythrema multiforme 86.bullous pempigoid 87.seboric dermatits 88.psoriasis 89. granuloma annulare 90.ulnar nerve leision 91.dyspepsia. 92.uc 93.ibs 94.yersinia 95.mechanism of inactivity of cortisol. 96.pcos 97.klienfilter 98.hypothriodism 99.myeloma 100.primary hyperparathyriodism 101.diuretic used in calcium stones 102.cml 103.cll 104. 15.17 translocation 105.mylofibrosis 1o6.dic 107.myelofroliferative disorder

108.pnh 109.anaemia of chronic disease 110.vonwilbrand 111.bilirubin mild elevated next test 112. chronic hepatitis c cryoglobinemia 113.paracetamol poising- pt 114.mitral valve severity. 115.heriditary angieoedema -c4 level 116.alopecia 117.small cell ca. 118. bpaspergilosis. 119.aspiration pneumonia 120.pregnanat treat asthma 121.prophylaxis in previous preeclampsia 122.iv bypass the first order kinectics 123.epiglotitis 124.oral painful ulcers. 125 treatement of toxoplasmosis 126.xlinked dominant rickets 127.tlco reduced in lung fibrosis 128.plural effusion 129.cluster headache 130.tricyclic overdose' bicarbonate 131.adenosine first in svt then give again 132.adenosine mechanism 133.inflixanib 134.risk factor crohons smoking 135-omega 3 use *which is correct---cluster or analgesia induced headache *which is correct ---to prevent colon cancer--

w3 or vit -3 or etoricoxib *in preclamsia--treament--salt restriction or nifedipine *occupational asthma---is it correct --do pefr to do work and away from work *following uti with red urine ,mastoid surgery-iga or alport *in plasmodium vivax -primaquine used due to reduce gamate or liver stage *diabetic retinopathy---stop smoking correct or no* *sciatic or s1 nrve compressio* *red urine with howell jolly body-pnh or pch *severe dyspepsia after treatment-do endoscopy or others *in ra ---ig or citrulline

report this post to a moderator +7 Back to top Thu May 09, 2013 1:20 pm (1 day ago) #5 ***arnold chiarri or ms *optic nerve or occiptal lobe-maccunn dr_jabed Serious Member *in severity of ms --which one correct i la size or pul artery pressure *in ulner nerve anatomy-1 st or 2nd lumbrical

Posts: 6 Credits: 137 Aim MRCP Part 1 report this post to a moderator

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Thu May 09, 2013 1:24 pm (1 day ago) #6 *psudomona-tazobactam or cefotaxime *esbl -impenem or other dr_jabed Serious Member *bowens or granloma annulare *gilbert ----iv nicotinamide or fasting 48 hours *in eyes---osmolality change or cataract Posts: 6 Credits: 137 Aim MRCP Part 1 report this post to a moderator *in youge age af ---flecainide or digixoin

Back to top Thu May 09, 2013 1:26 pm (1 day ago) #7 abpa most confirmatory-preciptant or eosinophilia dr_jabed Serious Member

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Back to top Thu May 09, 2013 1:35 pm (1 day ago) #8 *which is correct---cluster or analgesia induced headache dr_jabed Serious Member *which is correct ---to prevent colon cancer-w3 or vit -3 or etoricoxib *in preclamsia--treament--salt restriction or nifedipine Posts: 6 *occupational asthma---is it correct --do pefr

Credits: 137 Aim MRCP Part 1

to do work and away from work *following uti with red urine ,mastoid surgery-iga or alport *in plasmodium vivax -primaquine used due to reduce gamate or liver stage *diabetic retinopathy---stop smoking correct or no* *sciatic or s1 nrve compressio* *red urine with howell jolly body-pnh or pch *severe dyspepsia after treatment-do endoscopy or others *in ra ---ig or citrulline

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Back to top Thu May 09, 2013 1:36 pm (1 day ago) #9 pls notified early

dr_jabed Serious Member

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Back to top Thu May 09, 2013 2:35 pm (1 day ago) #10 which is correct---cluster or analgesia induced headache i think cluster headache. *in preclamsia--treament--salt restriction or

saeedanwar9 Serious Member

nifedipine i think question ws further protection of preeclampsia i wrote lmwh but i can b

Posts: 9 Credits: 145 Aim MRCP Part 1

aspirin*occupational asthma---is it correct -do pefr to do work and away from work correct *following uti with red urine ,mastoid surgery-iga or alport i wrote iga as macroscopic haematuria .24 hrs before urti . abpa most confirmatory-preciptant or (eosinophilia)i think

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Back to top Thu May 09, 2013 2:40 pm (1 day ago) #11 dr_jabed wrote: *which is correct---cluster or analgesia saeedanwar9 Serious Member induced headache *which is correct ---to prevent colon cancer--w3 or vit -3 or etoricoxib Posts: 9 Credits: 145 Aim MRCP Part 1 *in preclamsia--treament--salt restriction or nifedipine *occupational asthma---is it correct -do pefr to do work and away from work *following uti with red urine ,mastoid surgery-iga or alport *in plasmodium vivax -primaquine used due to reduce gamate or liver stage *diabetic retinopathy---stop smoking correct or no*

*sciatic or s1 nrve compressio* *red urine with howell jolly body-pnh or pch *severe dyspepsia after treatment-do endoscopy or others *in ra ---ig or citrulline

clusterheadache - i think correct lmwh occupational asthma - correct iga - macroscopic haematuria urti 24 hrs before i think correct liver stage i think correct s1 nerve compressionrf act on igg. i think correct

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Back to top Thu May 09, 2013 6:48 pm (1 day ago) #12 copd asthma saeedanwar9 Serious Member test to recognize occupatonal asthma aspiration pneumonia osa tlco Posts: 9 Credits: 145 Aim MRCP Part 1 eaa iaa bpaspergiolosis small cell car epiglotitis pleural effusion

pulmonary embolism from respiratory system

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Back to top Thu May 09, 2013 6:52 pm (1 day ago) #13 asthma mg sulphate sarcoidosis completes 15 question from saeedanwar9 Serious Member respiratory

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Back to top Thu May 09, 2013 7:04 pm (1 day ago) #14 retinal vein occlusion cataract saeedanwar9 Serious Member screlitis Arnold Cherie malformation constitutes eye questions

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Back to top Thu May 09, 2013 7:09 pm (1 day ago) #15 seborric dermatitis

fungal nail treatment granuluma annular psoriasis saeedanwar9 Serious Member treatment of severe atopic dermatitis alopecia bullous pepigoid Posts: 9 Credits: 145 Aim MRCP Part 1 report this post to a moderator dermatology

Back to top Thu May 09, 2013 7:11 pm (1 day ago) #16 erythma multiforme

saeedanwar9 Serious Member

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Back to top Thu May 09, 2013 7:46 pm (1 day ago) #17 saeedanwar9 wrote: erythma multiforme DOC_ATH Addicted Member Wht was the question on granuloma Posts: 11 Credits: 175 annulare?.........I dont remember it at all.

Aim DNB Part 2

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Back to top Thu May 09, 2013 7:50 pm (1 day ago) #18 Selected questions *recurren vertigo = BPV = Dix Halpik bobysab Newbie maneuver. * false +ve VDRL = yaws (trponemal species). * collapsed pt & breath or pulse: chest compression ? (before AHA 2010 PPl argued Posts: 4 Credits: 120 abt asking for help). * Howel-Jowel =hyposplenism = Coealiac. * circular lesion on dorsum of the hand = granuloma annulare. * multiple enhance ring in CT = c.toxoplasmoisi =pyrimeth+ sulfazianize.

* resistant hypertension =Conn's syndrome=Rennin-Aldo ration. * on lithium & hypertensive = give amlodipine * contraindication to samll cell caner = infliltration of brachial plexus (or volue < 1.5 not 1.8 in options) *lambert eaton syndrome = antibodies to post synaptic Ca voltage gated channels. * pain in the forearm worst by wrist extension = radial tunnel syndrome ( more distal than tenis elbow). * malingering man asking fir sick report and he drinks alcohol = alcohol dependence. * woman who sees her dead husband = ?readjustment. * a young man diagnosed as crohn and

started treatment =advice = stop smoking. * ibsilateral facial loss + ibsl horner + con.lt weaknes = posterior inferoir cerebellar *red eye with mild tenderness = epislcleritis * digested into glucose and galactose = lactose. * penumia in ICU improved then high fever with p effusions = empyema * gout in CVS problem = cholcicine (others have risk of fluids retention). * weird movements in class = tourret syndome. * asian woman with unequal blood pressur = Takayasu * pt wheneve has flu urine turn dark = IgA nephropathy *cholangitis with 4-fold rise in S.amylase = stone as pancreatic duct? * discritpiton of sata disribution around mean = SD? *pituitary incidentalom prognosis = no progress * insulinoma = supervised 72h hrs fasting.

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Back to top Thu May 09, 2013 8:07 pm (1 day ago) #19 Selected questions *recurren vertigo = BPV = Dix Halpik bobysab Newbie maneuver. * false +ve VDRL = yaws (trponemal species). * collapsed pt & breath or pulse: chest

compression ? (before AHA 2010 PPl argued Posts: 4 Credits: 120 abt asking for help). * Howel-Jowel =hyposplenism = Coealiac. * circular lesion on dorsum of the hand = granuloma annulare. * multiple enhance ring in CT = c.toxoplasmoisi =pyrimeth+ sulfazianize.

* resistant hypertension =Conn's syndrome=Rennin-Aldo ration. * on lithium & hypertensive = give amlodipine * contraindication to samll cell caner = infliltration of brachial plexus (or volue < 1.5 not 1.8 in options) *lambert eaton syndrome = antibodies to post synaptic Ca voltage gated channels. * pain in the forearm worst by wrist extension = radial tunnel syndrome ( more distal than tenis elbow). * malingering man asking fir sick report and he drinks alcohol = alcohol dependence. * woman who sees her dead husband = ?readjustment. * a young man diagnosed as crohn and started treatment =advice = stop smoking. * ibsilateral facial loss + ibsl horner + con.lt weaknes = posterior inferoir cerebellar *red eye with mild tenderness = epislcleritis * digested into glucose and galactose = lactose. * penumia in ICU improved then high fever with p effusions = empyema * gout in CVS problem = cholcicine (others have risk of fluids retention).

* weird movements in class = tourret syndome. * asian woman with unequal blood pressur = Takayasu * pt wheneve has flu urine turn dark = IgA nephropathy *cholangitis with 4-fold rise in S.amylase = stone as pancreatic duct? * discritpiton of sata disribution around mean = SD? *pituitary incidentalom prognosis = no progress * insulinoma = supervised 72h hrs fasting.

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Back to top Fri May 10, 2013 7:07 am (16 hours ago) #20 than you for all

ahmed1mam2 Newbie

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Back to top Fri May 10, 2013 10:18 am (13 hours ago) #21 Wht muscle wasting in ulnar nerve.....,adductor p brevis&

ahmed_kattout Expert Member

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Back to top Fri May 10, 2013 11:26 am (12 hours ago) #22 Adductor pollicis wasnt an option. The answer was 3rd and 4th lumbricals. AYUSMATI Newbie

Posts: 1 Credits: 105 Aim DNB Part 2 report this post to a moderator

Back to top Fri May 10, 2013 3:11 pm (8 hours ago) #23 I want some vague questions if u do not mind the one who is sure about the answer to ahmed_kattout Expert Member tell,thanks in advance 1 dementia decrease the falls....stop haloperidol 2 lat epicondylitis or radial tunnel Posts: 22 Credits: 240 Aim MRCP Part 1 3 ulnar nerve muscle wasting 4 thyroid hard mass ..... FNA 5 DM not control by sufnyurea ....type 1 6 pituitary small tumor ...none 7 CI for lung cancer surgery....brachial plexus involvement 8 child with father with psoraiasis ??

9 CD mesalazine or stop smoking 10 insect bite ...doxycycline 11 gm -ve cocci....false +ve vdrl 12 oral ulcers after chemotherapy 13 pseudomonas treatment 14 girl with syncope after kneeing for 30min....vasovagal 15 confused parkinson... 16 down....ebstein anomaly 17 ES murmer ....ASD 18 girl with menorrghia ....vW 19 non Hodgkin with high ldh what before start? 20 anaemic of chronic disease 21 thrmbocyathemia..bleeding ...start hydroxycarbamide 22 mitral valve severity...calcification 23

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Back to top Fri May 10, 2013 3:57 pm (8 hours ago) #24 Young patient aged 35 yrs with DM not controlled with sulfonylurea DOC_ATH Addicted Member (gliclazide).........should be LADA. Type 1 DM would present at a much younger age and would require Insulin at a younger age. LADA/ Type 1.5 DM fits more with the criteria. Posts: 11 Credits: 175 Aim DNB Part 2 report this post to a moderator

Back to top Fri May 10, 2013 9:28 pm (2 hours ago) #25 have compiled the questions so far:

Ylngoi Newbie

Part 1

1.Adenosine mech of action - G-couple receptors

Posts: 2 Credits: 110

2.Strongloides tx - albendazole 3. Rupturing blisters - bullous pemphigoid 4.Boy with down syndrome and murmur and parasternal heave - VSD? 5.Pregnant lady with worsening asthma beclomethasone 6.Lady known with pallor, diabetic with postural drop - hypopitutarism 7. ischaemic colitis - splenic flexure (watershed) 8. what rhematoid factor target - RF is a IgM/IgA or IgG that is targeted at IgG 9. Boy with hypercalcemia and xray changes sarcoidosis 10. positive predictive value statistics - 10% 11. Paired t test for question on new topical treatment for facial hemangioma 12. another statistics - sensivity 13. Question about pernicious anemia - this one should be red cell folate.. Reason because patient is post gastric surgery for PUD (likely respected Parietal cells and so b12 deficient), and recently had trimethoprim therapy (folate antagonist).. Red cell folate provides reflection of baseline folate levels

14. What causes repolarization - potassium channels 15. What causes prolongation of QT potassium channel blockage 16. CNS- patient with ipsilateral and contralateral signs - where is the lesion - this answer is right pons.. Had CN 6 and CN7 with crossed hemiparesis... Both nerves from mid to lower pons 17 Patient with RAPD - lesion in optic nerve 18 patient with a non secreting pituitary tumor - tumor is small and non functioning.. Likely to be asymptomatic.. 'Incidentaloma' **19. Lady with bleeders on colonoscopy Hb 9.2 - transfuse in view of symptomatic anaemia.. Tranexamic acid contraindicated bladder fibrosis 20. Young man with haematuria and past history of deafness.. This should be IgA in view of presentation. Creatinine reflected only mild impairment.. If alports likely worse creatinine expected.. Also patient went for mastoid surgery for the deafness whereas alports is a sensorineural deafness due to collagen deficit in inner ear.. I don't think surgery corrects this? Possibly has both a conductive hearing loss and IgA nephron arty 21. lady with purpuric rash cryoglobulinemia 22. 9:22 translocation - CML **23 patient with Howell jolly bodies and hyposplenic picture on PBF 24. Tear drops poikilocytes - myelofibrosis 25. CAPD peritonitis - staph epidermidis 26. Lady with increased ALP and GGT what

further test - Anti mitochondrial antibodies for PBC 27. Patient with IBS with non specific presentation. I think this should be celiac disease.. Patient may sound like IBS but red flags are anaemia with both folate and ferritin low - celiac can present this way. 28. Lady with scleroderma now with watery diarrhea - malabsorption syndrome 29. Lady with CREST - may suffer from malabsorption in the future 30. Young man with dyspepsia, no other signs - Urea breath test 31. Young male, pneumothorax 1 cm no SOB outpatient xray . Patient in face presented 24 hours After pain onset which lasted 3 hours. Clearly patient is stable! 32. old man with pagets disease, no fractures - bisphosphonates 33. Barretts oesophagus - Endoscopy surveillance 34. Man with polyuria, loss of libido and back pain - Do transferrin sat for hemochromatosis 35.Villous adenoma - 81 female with mucous stool, hypokalemia and hypochloremia **36. Patient with diarrhoea, chest infection etc - X-linked agammaglobulinemia ( Wiskott Aldrich - i think) - not sure, could be CVID 37. Loss of sensation dorsum of foot etc - S1 root compression 38. Question about patient with shoulder pain, this should be impingement syndrome, qn describes Hawkins and Neers 39. Ulnar nerve impairment- loss of 3/4

lumbricals 40. Lady with recurrent strept bacterial pneumonia - check complement (capsulated bacteria) **41. High fever hypotension severe cellulitis, sounds like nec fasciitis. Strept pyogenes. Give clinda and. Penicillin **42. Most common cause of SBP community acquired should be strept pneumonia, nosocomial is gram negative 43. Ramipril induced angioedema, what cause - Bradykinin 44. Hereditary Haemorrhagic telangiectasia Autosomal dominant 45. What does primaquine do in vivax plasmodium - destroy gametes in liver. - i think 46. Man with insect bite from south africa Rickettsia 47. Anorexia on NG feeding hypophosphatemia 48. DM - Action of Sitalgliptin - DDP-4 inhibitor 49. Before starting on warfarin - P450 50. which cell organelle splices RNA to protein - This is nucleus. mRNA spliced out introns in nucleus before migrating to ribosomes in RER 51. reverse transcriptase - transcribes RNA to DNA **52. CT scan multiple enhancing lesion , what to start after dexa sulfapyridine/pyrimethamine 53. cANCA + symptoms - Wegners 54. Marfan's syndrome - Aut dominant 55. ST changes in V5-V6, what are you likely

to see on coronary angio - Circumflex stenosis 56. SVT , you gave adenosine 6 mg, nothing happens, what next - repeat adenosine 57. Vit D resistant ricketts - X linked dominant 58. Young man , bipolar, with polyuria Lithium 59.Patient on clarithromycin, dont give simvastatin 60. Bivarudin , mech of action - direct thrombin inhibitor 61. Amitriptylline overdose, low GCS - IV bicarb ***62. Methanol overdose, GCS 5 hemodialysis 63. Man who had viral infection, now comes with rash - erythema multiforme **64. Red eye pain - scleritis 65. Intermittent blurred vision - normal on corrected - cataract from osmolality changes **66. First order kinetics - NOt sure what question means... Shouldn't be bioavailability because they described IV administration so bioavailability should be equal amongst all subjects. I chose half life (5 half lives to steady state) 67. LVF, what antihypertensive to add ramipril aids left ventricle remodeling **68. patchy hair loss - only in frontal and temporal regions - no other hair loss.. I put trichotillomania **69. Dementia, loss of inhibition - ?alcoholic dementia vs vascular dementia 70. Dementia recurrent falls - stop

haloperidol 71. Patient with worsening renal fxn - Leave it alone! Cr can rise 15% with ace inhibitor (allowed). Metformin only needs to stop when Cr >150-200 72. Severe atopic dermatitis - tacrolimus 73. Lorazepam - increases GABA activity 74. 70 yr old man with LVF - add bisoprolol 75. Ashtmatic - severely acute, not responding - IV Mg sulphate **76. Patient on pergolidine - organise ECHO **77. Anti HBc positive, HBsAG negative - Do Hep C serology. Patient immune to hep B and hep A. Hep E usually in pregnant women? 78. Man with neck pain and neurology carotid artery dissection 79. Girl with reduced consiousness and jerks only when disturbed.. Sounds like malingering 80. Headache piercing the eyes, history of analgesia - analgesic induced headache 81. Arm and bilateral lower limb involvement, history of neck and back pain - cervical radiculomyelopathy 82. Girl with menorrhagia - VWD. **83. Man with tumour of apex, which condition will you not operate - FVC 1.8 ?? This one is strange.. I thought the criteria was <1.5?? Not sure 84. Which intervention decreases colon cancer - etoricoxib 85. Which intervention decreases risk of pre eclampsia- aspirin 86. leukaemia good prognosis - t(15:17) 87. Woman with sudden onst SOB, just

started chemo for BRCA - Fulfills becks triad for tamponade 88. Man with painful genital ulcers - LGV 89. Woman whose husband died, but she still sees him talking to her - PTSD. 90. Man with low mood, no eye contact, 2nd person auditory hallucination, drinker, suicidal - Psychotic depression 91. man convinced he had cancer despite all negative tests - hypochondriac 92. Man with poor work performance, alcohol - alcohol dependence. Mental status exam was normal so it's not depression **93. man with parkinsons, agitated, abusive -? Lorazepam - all others are antipsychotics that can cause EPSE even if atypicals.. 94. Joint sepsis - staph aureus 95. man with bloody diarrhoea, children's school mates recently had diarrhoea campylobacter.. Rota causes secretory diarrhea 96. lady admitted with sweating and palpitations - Phaeochromocytoma 97. Complete heart block - variable intensity S1 98. Dermatomyositis, initial mgt prednisolone 99. African lady, symptoms suggestive of leprosy - biopsy a skin lesion. 100.Mixed respiratory and metabolic acidosis 101. ETT, strongest indicator to stop - angina **102. Heart murmur in 2nd and 3rd ic space - PS **103. mitral stenosis, indicator of severity Degree of Pulmonary capillary wedge

pressure (pulmonary HTN) 104. infective endocarditis risk highest with previous IE 105. Patient with cardiogenic syncope - SA dysfunction 106. physiologic change after one minute of standing - increased cardiac output **107. maximum absorption of Na in salt and water depleted patient - still proximal tubule and TAL ? **108. pulmonary hypertension diagnosis 2Decho 109.alcholic, camunity acuired pnemonia, treated in icu, again fever, ?empyema **110. idiopathic pulmonary fibrosis, finding on xr - lower zone heart border blurring ***111. extertringic allergic alviolitis, investigation, CXR shows upper zone involvement ***112 Allergic bronchopulmonary aspergilosis, investigation - precipitins - most specific 113 Small cell carcinoma, one of its paraneoplastic syndromes was given 114. lambert eton syndrome, antibodies to VGCC 115. pain in fore arm on resistance of extension of wrist, lateral epicondolyitis *116. Multiple sclesosis, patient with past histery of arm problem, now vision 117. hopital acquired pnemonia... tazosin 118. patient with fever and jaundice, picture of asending cholangitis, - CBD stone 119. patient with ingestion of 20 paracetamol pills, PT

** 120.feature of anemia of chronic disease 121. patient wid ulcerative collitis and now joint pains - enteropathic arthritis 122. dka, iv insulin was given, iv n saline 123. Test of Acromegaly, insulin with oral glucose toleance test ** 124. feature most strongly associated with tb recurrence - ?CXR granulomas indicate previous infection 125. treament startd with acylovir, csf feature most strongly associated wid diagnosis lymphocytosis ** 126 . man with 3 yrs h/o lesion on shin Bowens disease ** 127. diabetic patient, poorly controlled, type of diabetes 128. Patient with pheochoromsytoma, what treatment shoud be started..?phenoxybenzamine 129. flash pulmonary edema.... renal artery stenosis 130. resistant hypertension, hypokalemic alkalosis - renin/aldo ratio 131. patient with early mornign stiffness and uper arms tenderness,, polymylgia rheumatica 132. patient with father with psoriasis, now with inflammatory oligoarthritis but no other systemic features - spondyloarthropathy 133. ankylising spondolyits, clinical feature reduced joint excursion in all directions 134. patient with picture of RA, on nsaid, next treatment option - MTX 135. patient in hospital, got gout, treatment with colchicine

136. patient with hearing loss, tinnitus and vertigo.. ?meniere's disease **137. sudden onset visual loss, retinal hemrges and cotton wool spots - CRVO 138. thyroid swelling, investigation.... FNAC 139. collapsed patient....call for help first early access as per ACLS/BCLS 140. 3d image of protein - electron microscopy. Xray crystallography is for 3d visualisation of crystals 141. seborrhic dermatitis.. scaly lesion on face, nose scalp sternum i think 142. xray osteosclerosis ---osteoarthritis old lady with varus deformity 3 months pain 143. PCOD--- test... high LH/FSH ratio 144. boy with abnormal movements tourette syndrome ** 145. pt on chemotherapy was given ondansatron but vomiting not controlled nabilone 146. Ciclosporin in post renal transplant Tcell function suppressed 147. A subject with urethritis, gram neg intracellular diplococci, VDRL +ve - False positive VDRL 148.Creatinine increased after Trimethoprim decreased tubular secretion (trimethoprim decreases tubular secretion of creat) 149. things move or spin with head position change = BPV = Dix Halpik maneuver. **150 circular lesion on dorsum of the hand = granuloma annulare (thoguht not mentioned diabetic). ?BCC **151. on lithium & hypertensive = give amlodipine (SHOULD BE alpha blocker)

152. a young man diagnosed with IBD (crohns) and started treatment what is the advice = stop smoking 153. Mechanism of action of Flecanide. (sodium channel blocker). 154. Pt having low calcium, low phosphate, low Vit-D, ALP raised, parathyroid hormone raised. How to manage. (Oral vit-D). 155. Pt having lesion on toes, microscopy shows Trychophytum rubrum. (terbinafine) 156. Continuous bleeding from pt after vena puncture. PT-raised, APPT-raised, Fibronogenlow, D-dimers-raised. (DIC) 157.Pt having dizziness, vertigo and eye examination was normal. (Mieniers disease) 158. Pt having lytic lesion on radio graphy. (Protien electrophoresis for myeloma) 159. Patient hiking in west scotland, has a bite on thigh but no other symptoms - observe 160. Tricyclic overdose. (IV NaHCO3) **161. Pt with obstructive sleep apnea. CPAP 162.normal aonion gap metabolic acidosistype II RTA **163. ?Addison's disease 164. location of mechanism of action of spirinolactone 165. Occupational asthma - monitor PEFR on weekdays and weekends **166. Diplopia and proximal myopathy - MG 167. Unequal blood pressures in both arms in asian lady - Takayasu's arteritis **168. which anti depressant to use in young type I DM patient? mirtazapine? others were SSRI/venlafaxine 169. Rash and renal impairment - HSP

** 170. mechanism of inactivation of cortisol ?free excretion 171. klienfilter syndrome - small testes, primary testicular failure ** 172. Patient with hypocalcemic hyper calciuria. How to treat? **173. Red urine, facial swelling amongst symptoms - likely PNH over PCH 174. bilirubin mild elevated and other LFT normal next test - reticulocytes 175. Organism causing epiglottitis - Hib 176. Lung fibrosis finding? - Reduced TLCO ** 177. Patient with newly diagnosed Chron's disase, started on prednisolone, which is next best treatment advice - mesalazine vs quit smoking 178. Type I DM not well controlled on OHGAs, looks like will be insulin requiring - LADA