‫بسم هللا الرحمن الرحيم‬

Recall of mrcp ireland part 2

MARCH 2022 diet

1. Picture of 2 small colored lesion asking about diagnosis is it melanoma? Or Navie?

2. Picture of necrobiosis lipodica diabetcorum in leg
3. A scenario of pt has investigation typical for Cushing asking for next step there was high dose
Dexa suppression test result in failure of cortisol suppression mri pituitary?? inferior petrosal
sinus sampling??
4. A scenario typical for sub-acute combined degeneration of the cord asking for diagnosis actually
he may be need you to choose between celiac as underlying cause or the diagnosis itself which
is subacute degeneration???
5. Scenario of elderly patient admitted with pneumonia and given antibiotic co-amoxiclav after
that suddenly deteriorate developing again fever only with high wbcs count he asking about
treatment this is clostridial difficele treatment oral metronidazole note this question from on
examination q bank!
6. Scenario as we remember of pt feeling tired weak numbness per Orum I think no family history
with result of investigation showing low serum ca high po4 low urinary ca asking for diagnosis:
secondary hypothyroidism? Pseudohypothyrodism? Vitamin d deficiency??
7. Patient complain of back pain limping aggravated by standing relieved by rest regarding this
condition which is true: vascular? Cord trauma? Paraneoplastic actually it looks like spinal canal
stenosis which can be managed surgically
8. Recurrent attack of urticarial rash in patient diagnosis: chronic urticaria? Angioedema? Food
allergy?
9. Scenario from on examination q bank of foster Kenedy syndrome (sub frontal meningioma)
10. Patient presenting with bloody diarrhea colonoscopy done there is inflammation continuous
from rectum up to transverse colon involving mucosa only diagnosis: Crohn's? Ulcerative?
11. Which HIV drug can cause renal impairment? Tenofovir
12. Scenario of patient with high bp and low serum k+ investigation? renin aldosterone
13. Patient with high blood pressure von- Hipple feature asking about next investigation as pt fail to
control his bp: CT brain? Catechol amine in urine?
14. Typical scenario of Kallman with anosmia key feature
15. In which condition you will find normal alkaline phosphatase? Hepatic Mets from melanoma?
Hepatic Mets from renal cell cancer? Primary biliary cirrhosis? Melanoma Mets to spine?
Prostate cancer with bone Mets?
16. Scenario of celiac with dermatitis herpetiform.
17. Young patient came from Spain have diarrhea with all investigation came negative even anti
endomysia anti body asking for what further investigation to do?
18. Scenario of pt have celiac on gluten free diet but despite this still anti ttg positive what
investigation to do? Dudeonalbiopsy by endoscopy
19. Diabetic pt develop change to response for hypoglycemia becoming confuse explain what
happen? Loss of glucagon response?catechole amine response? Normal for dm?pregnancy?
20. Pt have CLL wbcs leucocyte raise from 50 to 75 no symptoms? Observe
21. Scenario of MguS WHAT NEXT STEP? Repeat electrophoresis after 3 months? Do cytometry?
22. Result of pt have high ca+ high renal profile anemia asking for diagnosis mostly myeloma
23. Typical scenario of TTP confusion raise renal profile post-transplant
24. Patient has ecchymosis Malena low hb normal wbc platelet v low diagnosis? Aplastic anemia?
ITP?
25. POST TRANSPLANT ACUTE GRAFT VERSUS HOST DISEASE WHAT NEXT STEP?
METHYLPREDINSOLONEWITH CYCLOSPORIN
26. HYPERKERATOSIS OF HAND IN PATIENT WITH DYSPHAGIA(TYLOSIS) FOR SOLID? ESOPHAGEAL
WEB? ESOPHAGEAL CANCER? BARRET?
27. FATIGUE XANTHALSMA HIGH ALKALINEPHOSPHATASE? PRIMARY BILLIARY CIRHOSIS
28. SEVERE HYPONATREMIA S.NA+116 WITH SEZIURE TRATMENT? 0.9 SODIUM CHLORIDE?
3%SALINE?
29. DIABETIC HIGH HBA1C WITH LEG WEAKNESS ATROPHY (DIABETIC AMYOTROPHY) TREATMENT?
TIGHT GLYCEMIC CONTROL OTHER CHOICE B12 PREGABLIN
30. PATIENT DIAGNOSED AS HYPOTHYRODISM UPON RESULT OF TFT SHOWING NORMAL TSH LOW
T4 THEN TAKEN THYROXINE CAME COLLAPSED IN ER TREATMENT? IV HYDROCORTISONE
31. DIABETIC OBESE HTN HEPATOMEGALLY SMOOTH LIVER SURFACE DERANGED LIVER PROFILE
ALT/AST HIGH DIAGNOSIS? NASH
32. SECONDARY AMENORRHA FOR 4MONTHS HAS 2KIDS INVESTIGATION LOW ESTRADIOL LOW LH
LOW FSH LOW TESTERONE NEXT INVESTIGATION? PITUATRY MRI? US PELVIC?
33. RECURRENT PNEUMONIA WITH LOW IMMUNOGLOBULIN TREATMENT? IMMUNOGLOBULIN IV?
PLASMA EXCHANGE?
34. QUESTION ABOUT FACT REGARDING MACULAR DEGENERATION IN PT VISUAL ACQUTY IS 6/18
IN BOTH EYE? CAN'T DRIVE INFORM DEVLA?90%ARE DRY? HE CAN DRIVE TILL BLINDNESS? IF
DETRIORATE CONTACT DOCTOR?
35. DIABETIC WITH PROTEIN UREA TREATMENT? ACEI? TIGHT GLYCEMIC CONTROL
36. WHICH SCREENING HIV PT NEED TO DO? CERVICAL SMEAR EVERY 3YEARS? MAMOGRAPHY?
37. RETURN FROM SOUTH AFRICA HAVE JAUNDICE WITH ALT 2000 WEAKE FATIGUE WHICH
INVESTIGATION MOSTLY WILL BE SIGNIFICANT? HCV AB? HBAIGG? HBAIGM? HB CORE AB?
38. TRAVELLING PT CAME WITH MACULOPAPULAR RASH ARTHRALGIA SORE THROAT? DENGUE
FEVER? MALARIA? HIV SEROCONVERSION?
39. TRAVELLING HISTORY MACULOPAPULAR RASH SEVERE ARTHRALGIA? CHIKENGUNIA? DENGUE?
40. ELDERLY PATIENT HAS NEW MURMUR WITH CULTURE POSITIVE ENTEROCOCCUS FECCALIS? FOR
ECHO? COLONSCOPY?
41. WHICH PARKINSON TREATMENT WOULD CAUSE COOL EXTERMITY?
BROMOCREPTIN?SELEGLINE? LEVODOPA?
42. SCENARIO OF DEQUARVIAN THYRODITIS ASKING ABOUT INVESTIGATION? RADIOACTIVE IODINE
43. SCENARIO OF PT DEVELOPING POST PARTUM THYRODITIS
44. SCENARIO OF PT WITH AMIDIARONE INDUCED THYRODITIS LOW ESR ASKING FOR TREATMENT?
STOP AMIADARONE
45. SCENARIO OF PT WITH THYROTOXOSIS AND HIGH ESR NEXT INVESTIGATION? THYROID AUTO
ANTIBODY? US ?RADIOIODINE UPTAKE?
46. UBNORMAL FLINGING MOVEMENT? HEMIBALISMUSWHAT
47. TYPE OF CELL AFFECTED IN PERNICIOUS ANEMIA? PARIETAL? CHIEF?
48. SITE OF HEMIBALISMUS LESION? SUBTHALAMIC NUCLEUS
49. PT WITH FATIGUE WT LOSS INVESTIGATION SHOW HIGH RENAL PROFILE HIGH CALCIUM HIGH
CK ITHINK HIGH ESR DIAGNOSIS? MM? POLYTHYCEMIA? POLYMYALGIA RHEUMATICA?
50. ANEMIA FRAGMENTED RBCS NEXT INVESTIGATION? DIRECT COOMBS TEST? HEPATOGLOBIN?
LDH?
51. CT ABDOMIN (PICTURE) WITH ASCITIS SCENARIO MALENA DIAGNOSIS? HEPATITIS? ALCOHOLIC
LIVER DISEASE? PORTAL VEIN THROMBOSIS? ITHINK ITS LIVER FIBROSIS DUE TO ALCOHOL
52. BOY WITH DIARHEA FLOATE NORMAL /HB LOW/MCV HIGH DIAGNOSIS? BLIND LOOP? CELIAC?
TERMINAL ILLIETIS?
53. Pt work in shop has abnormal neck movement painful his neck spontously shift to rt side and
can return back by touching his rt side of the face sternocleidomastoid is hyper active diagnosis?
Cervical dystonia
54. Pt heavy drunker how to diagnose alcohol dependency syndrome? Mcv? Ggt? serum alcohol?
55. Pt diagnosed as tb her sister contact her how to treat sister? rifampicin for 6months
56. Pt has history of varicose vein with ulcer developed not healed despite daily dressing but before
this there was small lesion on same site which then ulcerate what diagnosis? Venous ulcer?
Squamous cell cancer?
57. Adrenalin dose in anaphylaxis 1:1000im
58. Breast cancer with para neoplastic syndrome what treatment?? Chemotherapy? mastectomy?
59. Anti hu positive diagnosis
60. Pt on warfarin has ecchymosis INR 8.8 treatment? STOP WARFARIN AND RESTART WHEN INR
BELOW 5? GIVE VITAMIN K 5MG IV ONLY?
61. PT ON RIVORAXBAN DEVELOPED MASSIVE VOMITING OF BLOOD WHAT TO GIVE?
CRYOPERCIPITATE
62. MRSA POSITIVE GIVEN BEFORE VANCOMYCIN AND DEVELOPED REACTION NOW AGAIN HAS
SAME +VE MRSA WHAT TO GIVE? VANCOMYCIN? DAPTOMYCIN?
63. MICROSCOPIC COLITIS HE GIVE RESULT OF COLONOSCOPY WITH LYMPHOCYTIC INFILTERATION?
TREATMENT BUDESONIDE
64. PHSIOLOGICL RESPONCE TO STATUS EPILIPTICUS? LOW RBS?
65. PT WITH DISABLING PLANTAR PAIN FOUND TO HAVE ON XRAY CALCENIAL SPUR TREATMENT?
INTRALESIONAL CORTICOSTEROID INJECTION? ORAL CORTICO STERIOD? REST?
66. SCENARIO OF RENAL VEIN THROMBOSIS?
67. SCENARIO OF PT WITH LOW C4 NORMAL C3 NORMAL ANA/ANTIDSDNA AND +VE HCV?
CRYOGLOBULINEMIA

68. PT WORKING IN NURCERY HAVE ARTHRALGIA FATIGUE FEVER RASH CONTACT WITH SICK KIDS'
DIAGNOSIS? PARVO VIRUS
69. PT ELDERLY VIVID DREAM KICKING HIS WIFE IN BED MMS 27/30 TREATMENT?
DONEPZIL?QUETAPINE? LEVODOPA?
70. PT WITH +VE ANTI BASMENT MEMBRANE AB? RAPIDLY PROGRESSIVE GN?
71. ESINOPHILIA WITH HAEMATOURIA I CAN'T REMEMBER THE SCENARIO BUT THERE WAS GOOD
PASTURE AND WEGNER AS CHOISE
72. RHEUMATOID PT WITH NEPHROTIC SYNDROME? AL AMYLOID? MGGN ?MINIMAL CHANGE
DISEASE?
73. PT COMMENCE ON CAPTOPRIL RENAL PROFILE DETRIORATE WHAT INVESTIGATION NEEDED?
RENAL ANGIOGRAPHY
74. CHEST XRAY WITH INCREASE PULMONARY VASCULATURE LVH? ASD VSD?
75. PT OLD AGE DETRIORATE WITH DEMENTIA BECOMING SEVERE AND DEVELOPED MASSIVE
HEMPTYSIS WIFE CAME WITH PAPER SINGED BY THE PT SINCE 4 YRS AGO IN CAESE HE LOST
ATORNY SHE IS RESPONCIBLE SHE ASK YOU NOT TO GIVE HIM ANY INTERVENTION WHAT WILL
BE YOUR RESPONCE?
76. PT HAS CHRONIC DIARHIA GP ADVISE FOR COLONOSCOPY BUT PT NOT MAKE HE HAVE ALDO
PIGMINTED LESION UNDER AXILLA PROTIN URIA WHAT IS NEXT INVESTIGATION? RENAL BIOPSY
77. LIST OF DRUGS ASKING WHICH ONE DOSE NOT AFFECTED BY RENAL IMPAIRMENT?
OMEPRAZOLE
78. WHICH TYPE OF RASH LAMOTRIGINE SUPPOSE TO MAKE AS SIDE EFFECT?
ACNIFORM?TARGETOID? MORBILLIFORM? PLAQUE?
79. PT POST MI RECIEVING NITROGLYCERINE SUDDNLY DETERIORATE HYPOTENSIVE SWEATY?
RETURN OF ISCHEMIA? ANAPHLYXIX TO NITROGLYCERINE?
80. ROUTE OF ADMINISTRATION OF ADRENALIN IN ANAPHYLAXIS? IM
81. FOOT BALL PLAYER TRAVELLING HISTORY TO CANARY ISLENDS CAME WITH ACUTE CHEST PAIN
FEVER 38 BP112/60 PR 90 O2 SAT <90 WHAT FEATURE SUPPOSE TO LET YOU ADMIT HIM TO
HOSPITAL? WBCS 14? HCT <28%? O2 SAT <90??
82. WIFE AND HUSBANDS CAME ASKING FOR INVESTIGATION REGARDING INFERTILITY THE
HUSBAND HAS RECURRENT CHEST INFECTION SWEAT TEST CAME –VE DIAGNOSIS? CILLIARY
DYSKINESIA? CYSTIC FIBROSIS? BRONCHIATASIS?
83. PT PRESENTING WITH CHEST INFECTION FOUND TO HAVE +VE PSEUDOMANCE AND
HINFLUENZA IN SPUTUM CULTURE CT SCAN IS COMING IN EXAM I THINK SHOWING TRAM LINE
DIAGNOSIS? CYSTIC FIBROSIS
84. IS THERE ANY INTERACTION BETWEEN ACEI AND ASPRIN?? LOOK FOR THAT!
85. PT PRESENTING WITH MURMUR INCREASED BY VALSALVA NEXT INVESTIGATION TO ASSES
CARDIAC FUNCTION? ECHO? CATHETER?
86. PT WITH CHRONIC GOUT HIGH S. URATE WHAT DRUG TO GIVE NOTE PT HAS RENAL
IMPAIRMENT? ALLOPURINOL? PROPENOCID?
87. PT PRESENTING WITH HIP PAIN BUT NORMAL ALK PHOSPHATASE CALCIUM IN SERUM?
TREATMENT? BISPHOSPHANATE?
88. SKULL XRAY, I THINK THERE IS METS IN PT WITH WT LOSS? MM?
89. CAUSE OF DEATH IN ORGANOPHOSPHATE TOXICITY? RESPAIRATORY FAILURE? HTN? GI
BLEEDING?
90. TYPICAL RESULTS OF TUMOUR LYSIS SYNDROME
91. HOW TO CONFIRM? SCENARIO OF PT WITH TYPICAL RHEUMATOID ARTHRITIS? ANTI CCP WITH
RHEUMATOID FACTOR
92. 20 YRS OLD WITH WEAKNESS AND ATAXIA OPTIC ATROPHY DIAGNOSIS? FREDRIC ATAXIA?
HERIDETRY SPASTIC PARAPLEGIA? SCDC OF THE CORD?
93. COUGH FEVER FOR 6WEEKS? ABPA? ESINOPHILIC PNEUMONIA?
94. PT WITH SOB CLUPPING FINE RESPAIRATORY CREPITATION? PULMONARY FIBROSIS?
95. PICTURE CT CHEST MAY BE AORTIC DISECTION? HAS SOB FOR 2DAYS? CAD? AORTIC DISECTION?
96. PNEUMONIA ABG WITH ACIDOSIS AND HIGH ANION GAP DIAGNOSIS? METHANOL POISONING?
LACTIC ACIDOSIS? DKA BUT NOTE RBS IS 12 ONLY?
97. SCENARIO OF PT ON MANY ANTI PSYCHOTIC DRUG OLANZAPINE IS ONE OF THEM DEVELOPED
NEUROLEPTIC MALIGNANT SYNDROME TREATMENT? STOP OLANZAPINE
98. PT WITH PACE MAKER HAS HYPOTENSION? PACED AT 70? HAS TWITCHING SENSATION AT THE
SITE OF PACE MAKER?
99. PT PLANNED FOR HIP REPLACEMENT BUT THEY FOUND ON ECHO EF45% AORTIC VALVE
GRADIENT 55 WHAT TO DO REGARDING OPERATION? DONOT ATTEMPT? REFER FOR AORTIC
REPLACEMENT THEN HIP REPLACEMENT? PROCEED WITH HIP REPLACEMENT WITH INOTROPIC
DRUG?
100. PNEUMONIA WITH LOW SODIUM IN SERUM? LEGIONELLA? MYCOPLASMA?
101. PT HAS PET SHOP OWNER DEVELOP COUGH FEVER SPLENOMEGALLY? PSITACOSIS?
102. HTN WITH HYPOKALAMIA LOW RENIN? CONNS SYNDROME?
103. WHICH DRUG HAS GOOD PROGNOSIS IN HT FAILURE? ACEI? BBLOCKER?
104. PT STARTED DETOXIFICATION PROGRAM FOR ALCOHOL START CHLORODIAZOPEXIDE
SUDDNLY COLLAPSE? FLUMAZENIL? NALOXONE?
105. ELDERLY PATIENT WITH CONFUSION ALL INVESTIGATION NORMAL? WHAT TO DO NEXT?
LP? EEG?
106. HIV WITH HIGH CHOLESTEROL TREATMENT? PRAVSTATIN
107. RHEUMATOID ARTHRITIS ON METHOTREAXAT AND UTINSKUMAB? PT HAS HIGH LIVER
ENZYME ITHINK ANSWER IS METHOTREXATE
108. PT ON INFLIXIMAB CAME WITH FEVER PLEURICY? TB
109. AGAIN, SAME ASPECT INFLIXIMAB CAUSING TB
110. WOMEN WITH CHEST PAIN WT LOSS SOB HUSBAND WAS PLUMPER DIE OF LUNG
PATHOLOGY =METHOSOLIOMA
111. C-XRAY WITH CAVITY =ASPERGILLOMA
112. HAEMOLYTIC UREMIC SYNDROME?
113. PT ON CYCLOPHOSPHENAMIDE ASKING ABOUT INFERTILITY HE IS MALE?
114. WHICH CLINICAL FINDING GOING WITH FUCTIONAL DISORDER?
115. PELVIC MASS WITH PSAMOMA BODY IN BIOPSY HOW TO MONITOR TUMOUR? C125
116. ELDERLY? FENTNYL MISSED SCENARIO
117. ELDERLY WITH CONFUSION?
118. THEOPHYLIN TOXICITY
119. CHEST XRAY WITH BILATERAL EFFUSION WHAT TO DO?
120. ONE QUESTION I THINK ABOUT C1 ESTERASE DEFICIENCY?
121. PNEUMONIA CURB SCORE IS 3 FOR HDU+CO-AMOXICLAVE+CLARYTHROMYCIN
122. PT WITH GLYCOSURIA HAS NORMAL OGTT WHAT TO DO NEXT?
123. OBESE WITH LATAREAL THIGH NUMNESS NOT CROSSING MIDLINE MOTHER DIE OF MS
WHAT TO DO? MRI LUMBAR? REASSURE? ADVISE ABOUT RAPID WT LOSS
124. ANEMIA BASOPHILIC STIBBLING WORKING IN NEW HOUSE RENOVATION? LEAD
POISOINING?
125. ALLOPURINOL INDUCED TEN
126. AMARUOSIS FUGAX WITH INTERNAL CAROTID ARERY STENOSIS NOT MATCHING IT FOR
ASPIRIN?
127. PT CKD LOW TRANSRERRIN FOR IV IRON AS FAIL TO RESPOND TO ORAL
128. PRURITUS IN LIVER FAILURE?
129. VT NOT REMEBER SCENARIO
130. PT HAS TESTICULAR MASS WITH BOTH ALPHA FETO PROTEIN AND HCG HIGH? SEMINOMA
VS NON-SEMINOMA?
131. QUESTION FROM ONEXAMINATION ABOUT ANTIPHOSHOLIPID SYNDROME
132. PRIMARY HYPERPARATHYRODISM
133. IV PAMIDORNATE BUT NOT REMEMBER SCENARIO
134. ???CJD SCENARIO
135. PT IN SHOCK ACUTE MI =PCI
136.