(32 yrs. Nurse presented in ED following a needle stick injury from an HBs Ag positive pt + Lab test: her anti-HBs ab titer <10 following 3 months her last booster dose + Most appropriate important intervention >> Hepatitis B immunoglobulin. (423 yrs man presented with intermittent diarrhea, bloating, and abdominal pain for 3 weeks following a holiday in vietnam + On exam: Wt loss, mild abdominal tenderness + Lab test: Raised CRP + Most likely Dx >> Giardiasis. (418 yrs lady show farm worker presented with nausea, vomiting, and diarrhea for a few days + onLab test: Hb%: 82 g/I (Fragmented red cells on film) + Platelet count: 61x10°9/I + Creatinine: RAISED + most likely dx >> Hemolytic Uremic syndrome.(32 yrs. Nurse presented in ED following a needle stick injury from an HBs Ag positive pt + Lab test: her anti-HBs ab titer <10 following 3 months her last booster dose + Most appropriate important intervention >> Hepatitis B immunoglobulin. (423 yrs man presented with intermittent diarrhea, bloating, and abdominal pain for 3 weeks following a holiday in vietnam + On exam: Wt loss, mild abdominal tenderness + Lab test: Raised CRP + Most likely Dx >> Giardiasis. (418 yrs lady show farm worker presented with nausea, vomiting, and diarrhea for a few days + onLab test: Hb%: 82 g/I (Fragmented red cells on film) + Platelet count: 61x10°9/I + Creatinine: RAISED + most likely dx >> Hemolytic Uremic syndrome.@ 27 yrs lady presented with progressive confusion, drowsiness, and short-term memory loss following flu-like illness + On exam: fever, headache, obvious neck stiffness, GCS: 13/15 + CT head: low-density changes within the anterior and medial areas of both temporal lobes + Most likely cause of pt’s neurologic symptoms >> {) 45 lady presented with worsening renal function + On exam: she has polyarthritis, an erythematous rash on the sun-exposed area of her face and arms + On lab tests: low Hb%, high creatinine, urine( Blood 1+, protein 1+) + Most appropriate intervention for the pt's renal dysfunction >>i) 28 yrs lady with known Factor V Leiden polymorphism brought to ED following a collapse short before landing from a flight + On exam: Lt sided pleuritic chest pain, Bp: 80/60 mmHg, HR: 110 bpm, RR:33 br/min + 02 saturation: 92% on 10-liter oxygen + ECG: S1, Q3, T3 pattern + Most appropriate intervention >> Alteplase IV. *Massive Pul embolism >> IV Alteplase ln i | ey I sy + Ral Ae J ET 1 me A Ct ty A nyt Ly aes if oa | Other findings: 1. Tachycardia (Rate ~ 120/min) 2. Rightward axis 7 3.Incomplete RBBB [sa] 4. Simultaneous T-wave inversions in the inferior and anteroseptal leads } Ahad ee pe VA et +f una hon tern he ; ep fe] ) Es] EET { | ' | ‘ | | | Epomedicine.com RESEND ee eae ee oe{0 45 lady presented with worsening renal function + On exam: she has polyarthritis, an erythematous rash on the sun-exposed area of her face and arms + On lab tests: low Hb%, high creatinine, urine( Blood 1+, protein 1+) + Most appropriate intervention for the pee renal pene >> eno : {§§ 20 yrs lady presented with hirsutism, acne, irregular heavy periods + On exam: mustache and beard line over the chest + on lab test: K+: 4.5 mmol/I, testosterone: 4.2 nmol/l + Most useful investigation >> Adrer{3 75 yr man was brought by his wife with a complaint of a tendency to fall, broad base shuffling gait, and short-term memory loss + MRI brain shows: ventricular enlargement + Other signs would you expect to find >> % Intial tx: carbonic anhydrase inhibitor and repeated lumbar puncture. as a oye eT{) 48 yr lady known advanced breast ca with brain mets presented with worsening headache, nausea, and vomiting + now unable to get out and bilateral papilloedema on fundoscopy + Most effective in managing pt's symptoms >> ) 27 yr pt recently moved to the UK from Indi © WhatsApp olex partial seizure wi ; é , cting his right arm + Cf."{0 64 yrs smoker pt presented with dull Left sided chest pain, wt loss, and lethargy + On exam: dull percussion on Lf side + On CXR: Lt sided homogenous opacity up to mid zone with + Most appropriate next step >> Ultrasonography guided pleural aspiration. ‘ {i 64 yrs pt presented in the nephrology clinic after failing a trial of an Angiotensin-converting enzyme inhibitor + After starting Ramipril for Heart failure his creatinine and K+ levels started to Increase + I fy |Idiopathic Thrombocytopenic purpura. %%* Suspected case of Nodular sclerosing + investigation of choice >> Lymph Node biopsy. »%& * Drug causing wide QRS complex >> Amitriptyline. (TCA group drug) %&* Post MI pansystolic Murmur at apex >> Papillary muscle rupture. 3% Post MI pansystolic Murmur at Lt lower parasternal edge >> Ventricular septal wall perforation ye Hypertensive pt on ACEI + intermittent facial swelling + drug causing this >> Perindopril. 3+ Hypertensive pt on CCB + Lower limb (ankle) swelling, drug causing this >> Amlodipine 3% Mode of transmission of HOCM >> Autosomal Dominant. WhatsApp%x* Drug of choice in aortic Dissection >> Labetalol. + Drug of choice in Hypertension in pregnancy >> Labetalol 3% Patient with headache, blurred vision, absent pulse, carotid Bruit + Likely dx >> Takayasu arteritis. %&* Turner patient with Rib notching on CXR + likely lesion >> Coarctation of aorta. %% Drug of choice in aortic Dissection >> Labetalo! 3% Drug of choice in aortic Dissection >> Labetalo! 3% Treatment of choice for torsa-des De pointes >> IV Mgso4. x Treatment of choice for convulsion in Eclampsia >> IV Mgso4. WhatsApp@ Young lady presented with paracetamol poisoning + H/O self- harm & laceration to her forearm on multiple occasions + always » Ingry, recently broke up with her .lusband + most likely dx >> borderline personality disorder. @& 80 yrs. found collapse in her lounge + a gas fire was turned on + Investigation: pH: 7.2 ;HCO3-: 15mmol/l & Glucose 17 mmol/L + Most likely cause of pt’s collapse >> Carbon Monoxide poisoning. @ Blood supply of the duodenal Cap >> Gastroduodenal artery. @ Pt with a history of egg allergy, which vaccine must be avoided >> Yellow fever vaccine. Omri:February 2022 (NEW ADDITION) > 962 yrs. Known DM & HTN pt presented with the ,2ature of Transient Ischemic attack + ECG: Atrial fibrillation + Most appropriate intervention for his atrial fibrillation >> Apixaban. & Mode of action of Sitagliptin >> Inhibition of dipeptidyl peptidase-4. @ 45 yrs. pt presented with weight gain (15 kg) in last 3 months + BP: 152/90 mm Hg + BMI: 35 kg/m2 + Investigation: Low K+, High Bicarbonate + Most appropriate next investigation >> 3x24- hour urinary free cortisol. (Dx: Cushing syndrome). ( WhatsApp81. Decreased lean body mass >> reduced volume of distribution >> Lead to slow rise in Lithium level. 82. 39 yrs woman presented with rapidly worsening renal function, nosebleed, hemoptysis + CXR: bilateral pulmonary infiltrate and Anti-PR3 auto-antibody is positive >> Granulomatosis and polyangiitis. 83. Long term complications of Schistosoma mansoni infection >> May lead to liver fibrosis. 4% complications of Schistosoma haematobium: Bladder carcinoma Renal stone Hydronephrosis Chronic Kidney disease 84, Pt with biliary sepsis now fever + WBC raised, D-dimer, APTT and PT raised, fibrinogen is low + most likely cause of abnormal clotting result >> DIC 85. 45 yr woman with SOB, painful proximal myopathy, inspiratory crackles + lung function test: Restrictive picture + Autoantibody most likely to be present >> Anti-jo 7 86. Radfolodine is a recognized factor to worsen Grave's Ophthalmopathy.87. Young woman In ED following fall and subsequent scalp injury + exam: Lt pupil is 1 mm larger than the Rt. Both react normally to light and accommodation >> most likely explanation for her pupil size >> Variant of normal. 88. Renal transplanted (6 weeks ago) pt presented with progressive rising if creatinine despite optimal Tx with ciclosporin+ rejection is suspected + factor has the biggest impact on rejection in this pt >> Human Leukocyte antigen Matching. 89. Rugby player presented with numbness over the regimental badge area + nerve most likely to be injured >> Axillary nerve. 90. Young female presented with posterior neck pain during bending forward following a car accident + feel electric shock like pain in her limbs + clumsiness in her hand and weakness in her legs more marked on Lt side. + Cervical X-ray shows normal + likely dx >> Cervical disc prolapse. 91. 23 yr lady presented with the concern that recently her father and uncle died of pancreatic cancer + her elder brother recently diagnoses with pancreatic cancer+ test: she has BRCA 1 gene mutation + she is at risk of >> Ovarian cancer. 92. Pregnant woman is not immune to VZV and recently has had significant exposure + most appropriate next step >> VZV immunoglobulin. 93. Young boy from Traveller's family presented with tired, frustrated, short, intermittent muscle pain + lab text: low Ca++, low PTH, high PO4 and High ALP >> Hypoparathyroidism.37. 42 yr woman with erythematous rash worsens on sun exposure, searing hairloss, area of atrophy, atrophie skin more prominent over the elbow # likely cx >> Discoid lupus. 38. Pt with wt loss, fever + CT chest showed hilar lymphadenopathy, Rt sided pleural thickening + most useful next investigation >> "/eurel biopsy. 39. Pt presented with Lt sided stroke following a long-haul flight + exam: LT lower leg DVT, 02 caturation: 91% + CT brain shows: no sign of hemorrhage + investigation of choice to confirm the cause of. Sttoke >> Bubble contrast echocardiography. 40. Pt started anti-TB medication now complaints [oss of color vision + likely cause of his visual disturbance >> &iembutol 41, Most appropriate way to dx the suspected latex allergy >> Skin patch testing. 42, 40 yrs, man with raised liver enzyme and peak flow mildly reduced + Non-smoker, moderate drinker + suspected ATATD + likely genotype >> M2. 43. Ptwith gonorthea already treated with single dose azithromycin, Nuclele acid amplification test suggested still there is infection + antibiotics should he receive >> Ceftriaxone,February 2022 (NEW ADDITION) Action + Hot opoeeree ntervetion fh eel lriltion >» Apleabon Mode of oction of Sitagliptin 45 yrs. pt presented with weight gain (15 kg) in last 3 months + BP: 152/90 mm Hg « BMI: 35 kg/m2 + Investigation: Low Ke, High Bicarbonate + Most appropriate next investigation 73 elderty pt with known H/O Pancreatic Ca and Parkinson's disease + Joundice, tender epigasirium + Most appropriate choice of anti-emetic for this pe > ansetron (Plz be careful during Following administration of 1 0.9% saline how much fluid is likey to increase in intravascular volume >> (Around 20-25 % fluid remains intravascular space following administration of 1L isotonic fluid)@Causes of Reverse split: As A2 occurs before P2, so in Lt sided (Conductive tissue/heart chamber) pathology or Rt sided over stimulation will cause reverse split KALt sided pathology: ¢ LBBB * Severe AS (@Rt-sided overstimulation: Rt ventricular pacing. @PHeart sound $3: 3rd sound is audible in 3 letter Disease: ¢ DCM (3 letter) e LVF (Gallop rhythm) ¢ C-onstrictive Pericarditis (order of C is 3) @Heart sound: 4: (Caused by Atrial contraction against stiff ventricle. (Cause of 4th heart sound: Mnemonic: 2, 3, 4 letter disease AS, HTN, HOCM5:42 @4aO NEL all 73% > @ Road To MRCP Part-1 (9... < 4 monoarulmamun.com @ Road To MRCP Part-1 (9 months subscription) Toe a ian ————_ 16. Middle age known DM pt presented with abnormal liver function + On exam: he is tanned, | presence of spider naevi, hepatomegaly + Knee X- | ray: Bilateral chondrocalcinosis + Most likely cause of pt's knee pain >>Pyrophosphate arthropathy. (Dx: | » ‘'aemochromatosis) 17. Mode of action of Digoxin >> inhibits the Sodium-potassium exchange pumps. 18. Reason behind transfusing irradiated blood >> Prevent graft vs host disease. 19. 36 ys lady presented with H/O Fourth 2nd trimester miscarriages, intermittent joint pain + Blood test: Low Hb, Low Platelet, ANA antibody (+), | Most appropriate next investigation >> Anti- p holipid antibody. : Next >» ll O <87. Young woman In ED following fall and subsequent scalp injury + exam: Lt pupil is 1 mm larger than the Rt. Both react normally to light and accommodation >> most likely explanation for her pupil size >> Variant of normal. 88. Renal transplanted (6 weeks ago) pt presented with progressive rising if creatinine despite optimal Tx with ciclosporin+ rejection is suspected + factor has the biggest impact on rejection in this pt >> Human Leukocyte antigen Matching. 89. Rugby player presented with numbness over the regimental badge area + nerve most likely to be injured >> Axillary nerve. 90. Young female presented with posterior neck pain during bending forward following car accident + feel electric shock like pain in her limbs + clumsiness in her hand and weakness in her legs more marked on Lt side. + Cervical X-ray shows normal + likely dx >> Cervical disc prolapse. 91. 23 yr lady presented with the concern that recently her father and uncle died of pancreatic cancer + her elder brother recently diagnoses with pancreatic cancer+ test: she has BRCA 1 gene mutation + she is at risk of >> Ovarian cancer. 92. Pregnant woman is not immune to VZV and recently has had significant exposure + most appropriate next step >> VZV immunoglobulin. 93. Young boy from Traveller's family presented with tired, frustrated, short, intermittent muscle pain + lab text: low Ca++, low PTH, high PO4 and High ALP >> Hypoparathyroidism.94. Pt with known Crohn's disease already underwent 3rd time bowel surgery, now presented with diarrhea and wt loss + test shows: blood Ca++ and Albumin level is low; Hb%: 9.8% + likely cause of his diarrhea >> short bowel syndrome. 95. Pt present with 7th CN palsy affecting both upper and lower facial muscle weakness + loss of sensation over anterior 2/3 of the tongue on the affected side. + most likely site of lesion >> Just before it emerges from the stylomastoid foramen. 96. Obese taxi-driver presented with poor controlled DM with metformin and sitagliptin +H/O recent MI and Hear failure + BMI: 34kg/m2 and HbA1c: 68 mmol/mole + most appropriate next step to controlled for glucose >>Empagiiflozin. 97. Elderly pt presented with blood mixed diarrhoea and Lt iliac fossa pain + raised WBC + Abdominal X-ray shows: colon loaded with impacted stool + likely cause >> Diverticulitis 98. Pt presented with recent change in facial appearance, HTN, DM, IGF-1 is significantly raised+ most appropriate way confirmation test for acromegaly >> Glucose tolerance test with growth hormone measurement. 99. Pt with known CLD presented huge abdominal distension, fever, confusion + lab test: WBC count raised, platelet is low + most useful investigation >> Ascitic tap. 100. Most appropriate way to confirm eradication of H. pylori >> Carbon-13 breath testing.55. If the rapid streptococcal antigen test is positive likelihood that the pt has streptococcal pharyngitis >> 91%. 56. Investigation of choice in suspected Pulmonary Embolism >> CTPA. 57. 24 yr young pt presented with Macroscopic haematuria + urinary protein (+) (blood (+), most likely dx >> IgA nephropathy. 58. COPD pt present Severe SOB + pH: 7.30 p(02) 7.1kPA and PCO2:7.6kPa + most appropriate next intervention >> Continuous positive pressure ventilation, 60. 67 yr presented with IDA + Colonoscopy and Endoscopy shows normal, capsule endoscopy shows: small bowel angiodysplasia + GP noted: A systolic Murmur + likely dx >> Aortic stenosis. 61. Pt with Hematological malignancy should receive /rradiated blood. 62. Pt with weakness in his Left leg and foot with associated sensory loss + looks apathetic and is non-communicative + lesion most likely to have occurred >> Distal segment of anterior cerebral artery. (Proximal segment occlusion of anterior cerebral artery is less likely to result in neurological Sequelle because of existence of collateral blood supply)64. Elderly pt from Nursing home presented with projectile vomiting and explosive liarrhea, several resident having same illness for last 24 hours + there is is 20 -mm Hg * lrop in her blood pressure on standing+ most likely underlying cause of her gastro- intestinal symptoms >> Norovirus. 65. A climber presented with Lt lower motor type of facial palsy and noticeable round patch of erythema on his left leg following return from Austrian Alps + most useful next investigation >> Borrelia Burgdorferi serology. 66. 45 yr. man presented with palpitation, sweating, dry mouth and irritable + he felt he is not good enough to do his job, almost fearful to his work >> Generalized Anxiety Disorder. 67. Most appropriate 02 therapy regimen for COPD pt >> 28% 02 via Venturi mask. 68. 48 yrs known RA pt presented with Left foot drop + Likely cause of footdrop >> Entrapment of peroneal nerve at the neck of the fibula. 69. Pt with positive family history of bipolar disorder presented with abnormal thought and behavior + he thought, he is being poisoned and people are trying to steal his money + currently he took mefloquine for malaria prophylaxis >> Mefloguine induced Psychosis.@ Young lady presented with paracetamol poisoning + H/O self- harm & laceration to her forearm on multiple occasions + always » ingry, recently broke up with her sdusband + most likely dx >> borderline personality disorder. @ 80 yrs. found collapse in her lounge + a gas fire was turned on + Investigation: pH: 7.2 ;HCO3- : 15mmol/ & Glucose 17 mmol/l + Most likely cause of pt's collapse >> Carbon Monoxide poisoning. @ Blood supply of the duodenal Cap >> Gastroduodenal artery. & Pt with a history of egg allergy, which vaccine must be avoided >> Yellow fever vaccine.yoke Heart sound: Heart sound S1: Cause: Closure of Mitral valve (Loud in >> Mitral stenosis C-losure of mitral valve >> Correspondswith QRS C- omplex in ECG. Heart sound S2: (Aloud A2 >> Systemic HTN (Arterial HTN) (4dLoud P2 >> Pulmonary HTN (Soft A2 >> Aortic Stenosis (AFix-ED Split >> ASD (ESD-ASD) @Cause of Wide split S2 (Normally A2 before P2): As A2 occurs before P2, so, Rt-sided (Conductive tissue/heart chamber) pathology, will cause widely split. e RBBB e Pul. Stenosis.a FY Road To MRCP Part-1 (9 months subscription) Woe Nn) bg 28. 42 yrs Alcoholic presented with H/O several tooth loose, gum disease + On exam: Araea of petechiall hemmorrhage + Most likely vitamin deficiency >> Vitamin-c. 29. Pt with known NYHA class 2 heart failure started Celecoxib for severe arthritic pain of knee + Most concerned side effect of celecoxib here >> Worsening cardiac failure. 30. Pathophysiology best fit of hemoptysis in bronchiectasis >> Capillary engorgement. 31. Elderly pt came for a follow-up following starting Risedone following a Lt Colle’s fracture + Most important risk factor for osteonecrosis of the jaw as a result of bisphosphonate treatment >> Dental Caries.Road To MRCP Part-1 (9 months subscription) 7 of 94 items [Ss kk kLung Cancer: %* Smoker + hemoptysis + weight loss + Hyper Ca++ >> Squamous cell lung Ca. %* Smoker + hemoptysis + weight loss + Hyponatremia >> Small cell lung Ca. kk kRespiratory cause of Clubbing: %Mnemonic: ABCDEF. e A>> Asbestosis. e B>>Bronchiectasis. e C >> Cystic fibrosis. e D >> Dirty Tumor (Bronchial Ca, Mesothelioma) e E>>Empyema. e F >> Fibrosing Alveolitis.541408 full 49 all 73% 8 > @ Road To MRCP Part-1 (9... < 4 monoarulmamun.com @ Road To MRCP Part-1 (9 months subscription) To eee ants ————— 7. Elderly pt presented with a known case of severe hyponatremia (Na+: 108 mmol/l) and now underwent correction with 1.8% saline + Nurses noticed: that he now appears unable to move his limbs and suspect that pt might be suffering from osmotic emyelination + likely initial cause of osmotic > emyelination >> Astrocyte apoptosis. | 7. Middle-aged lady presented with progressive fatigue and itching + on exam: Xenthelesma, scratch mark, 2 finger breadth hepatomegaly + Autoantibody | most likely to be found in this pt >> Anti- | mitochondrial Ab. (Dx: Primary Biliary cirrhosis) | 10. Known CKD, IHD, Past H/O of recovery from sepsis presented with fever after Haemodialysis episode following hemodialysis + Blood test: WBC raised, CRP: 73 mg/l + Most likely cause of pt’s fever >> Staphylococcus epidermidis. | Next » ll O <et Adult Polycystic Kidney Disease (APKD) Mnemonic: POLYCYSTIC KIDNEY>16 letters * Affected chromosome no in APKD-1: 16 wane NEURO FIBROMATOS!S>I7 letter *Affected chromosome no in type I: 17 weak WILSON DISEASE >> 13 letter *Affected chromosome no: 1311:49 > GA Fe all ull 54% \ @ Road To MRCP Part-1 (1... < 4 monoarulmamun.com Previous Paper Bullets (Previous 6 Years Question In The Form Of Bullet) [May 2022 (New Addition) @ awe 1203 1 August 2022 (New ‘Adaliion) © awe 1208 [November 2022 (New ‘Adation) @ awe 205 Dy January 2021 @ au 1206 [May 2021 (Preview) © aie 1207 Dy August 21 © Quiz 1208 January 2020 © duiz 1200 LD) September,2020, @ Quiz 210 Dy January 2019 © qwiz1201 oe” cee eee [J Mode of action of Sitagliptin >> Inhibition of dipeptidyl Ppeptidase-4. 47/45 yrs. pt presented with weight gain (15 kg) in last 3 months + BP: 152/90 mm Hg + BMI: 35 kg/m2 + Investigation: Low K+, High Bicarbonate + Most appropriate next investigation >> 3x24-hour urinary free cortisol. (Dx: ‘Cushing syndrome). (473 elderly pt with known H/O Pancreatic Ca and Parkinson's disease + Jaundice, tender epigastrium + Most appropriate choice of anti-emetic for this pt >> Ondansetron (Piz be careful during choice of anti-emetic in Parkinson's disease pt) Ef Following administration of 1 L 0.9% saline how much fluid is likely to increase in intravascular volume >> 200 Mi (Around 20-25 % fluid remains intravascular space following administration of 1 L isotonic fluid) Pt with lethargy, night sweat, SOB, Hemoptysis, collapsed ‘nose, sinusitis + BP: 155/90 mm Hg, inspiratory crackles + Investigation: Raised Creatinine + Antibody Is characteristic for her condition >> C-ANCA (Dx: Wegner’s Granulomatosis) Elderly pt at renal clinic with worsening peripheral edema + high BP + investigation: Raised Creatinine, low serum Albumin, Urinary protein: (3+); Renal biopsy: Thickened capillary walls with subepithelial deposits + Most appropriate next step >> Rituximab (Dx: Idiopathic Membranous Nephropathy) (Young pt presented with back pain + difficulty in getting up from bed + Exam shows: Limitation of forward and lateral flexion of the lower back + Raised CRP + Most useful imaging investigation >> MRI OF SACRO-ILIAC JOINT ( Dx Ankylosing Spondylitis) 718 yrs. pt presented with Haemo-arthrosis of the knee following injury and bleeding following tooth extraction + PT and APTT are normal + Most likely dx >> Von-Willebrand disease. {In Haemophilia we expect o have prolonged PT and APTT. Pre Newt + O <yet Adult Polycystic Kidney Disease (APKD) Mnemonic: POLYCYSTIC KIDNEY>I16 letters * Affected chromosome no in APKD-1: 16 wane NEURO FIBROMATOS!S>I7letter “Affected chromosome no in type 1: 17 week WILSON DISEASE >> 13 letter *Affected chromosome no: 1314, Pt with DM, HTN, High BMI + high HCO3~ +Abdominal striae + most useful next investigation >> 24-hour Urinary cortisol. * IGF-I >> best screening test for Acromegaly. * Short synacthen test >> best screening test for Addison's disease. 15. Pt with 3 epidoses of abdominal pain, bloating + upper Gl & Lower Gl all investigation shows normal + unable to work because of worrying about pain + likely underlying DX >> Sematic symptoms disorder. 16. Asthma patient taking beclomethasone 200 mg twice & montelukast daily, salbutamol inhaler as needed + still have night cough wheeze + MANT >> Add salmatero/ 50 mg BD.35. You are going to do a smoking cessation study to compare baseline smoking rates between ethnic group+ best statistical test >> Tukey’s range test. * Measure of the linear correlation between two sets of data >> Pearson's correlation Coefficient. * Compare whether is there any difference in means between two sample populations>> student's t-Test * To analyze direct relationship between two variables >> Spearman’s rank test. 36. Retired Demolition worker with SOB, dry cough, Pedal edema + B/L fine inspiratory crackles up to mid zone + restrictive lung pattern + Likely cause >> Asbestosis. 37. Pt on chemotherapy + now with severe neutropenia (<0.3) + most appropriate intervention >> Filgrastim.23, Cocaine abuser came with Lt lower ab pain, diarrhea and tenderness, bowel sound: quiet + raised serum amylase & Lactate + most likely cause ab pain >> Ischemic Colitis. 24. Young Male with agitated + he covered his windows with black paper to prevent broadcasting his thought + he interprete his Neighbour's red curtain as a Russian spy + likely Dx >> Schizophrenia. 25. Agroup of people of a cruise came with profuse vomiting & diarrhea + fever & generally tender abdomen + likely cause >> Norovirus, * **4 group of people in a ship /nursing care /boarding school with food poisoning > Look for Norovirus infectionEgg Vs MRCP: © © Bgg shell calcification on CXR >> Silicosis. © © Egg Pizza appearance on fundoscopy >> CMV retinitis. © © Fried egg appearance in Peripheral blood film >> Hairy cell leukemia. © © Basket egg appearance on immuno-flourosceince of renal biopsy >> Alport's syndrome. #«k Causes of Gum hypertrophy: ‘Mnemonic PNC + Promyelocytic leukemia + Phenytoin = Pregnancy + Nifedipine. * Ciclosporin.40.18 yr Female with primary amenorrhea, normal height & breast development + virtually ne Pubic & axillary hair + Dx >> Androgen insensitivity syndrome. + No smell sense + low GnRH, low FSH & LH >> Kallmann syndrome. * Male, Tall stature + High FSH & LH >> Klinefelter syndrome. * Secondary amenorrhea + High FSH & LH >> Premature ovarian failure 41. Elderly patient with moderate Aortic stenosis planning to undergo colonoscopy for anemia + Appropriate pretreatment he should take >> No pretreatment is necessary. “Antibiotic prophylaxis is no longer recommended for patient with valve lesion in following condition: * Dental procedure. + Upper& Lower Gi tract procedure. + Upper & lower Genitourinary tract procedure. * Upper & lower respiratory tract procedure.mm Mnemonic tk Myotonia Dystrophica * Mode of transmission: Autosomal dominant * Affected chromosome no: 19 (Mnemonic: MY O TONIA DYSTROPHICAhasT9 letters) Feature: Mnemonic: 6D GD >> Dysarthria EAD >> Dysphagia E9D >> Distal muscle weakness QD >> Dilated cardiomyopathy Gp >> DM (ID >> Dementia.mm Mnemonic tk Myotonia Dystrophica * Mode of transmission: Autosomal dominant * Affected chromosome no: 19 (Mnemonic: MY O TONIA DYSTROPHICAhasT9 letters) Feature: Mnemonic: 6D GD >> Dysarthria EAD >> Dysphagia E9D >> Distal muscle weakness QD >> Dilated cardiomyopathy Gp >> DM (ID >> Dementia.x @ Road To MRCP Part-1 (12 mont... < monoarulmamun.com £29 yrs. lady presented with tiredness, loss of libido, milk leakage on minimal nipple stimulation + Visual field test shows: Loss of peripheral vision + Prolactin: 8900 IU/ | + MRI: Macroadenoma with pressure on optic chiasma + Most appropriate intervention >> Cabergoline. Pt known IgA deficiency pt presented with vesicular rash on buttock, posterior thigh, wt loss, pallor + Anti-TTG is negative + most useful next investigation >> Endoscopy with small bowel biopsy. {@Pt with known Factor V Leiden mutation presented with extensive leg DVT and pulmonary embolism + cause of increased risk of Thrombosis in this pt >> Protein C resistance. (@ Most useful investigation in motor neuron disease >> Electromyography. (Pt with acute severe asthma failed to recover his peak flow to > 50% of predicted despite back-to-back nebulizer + next most useful step >> IV Magnesium. (Best way to manage a pt with anorexia nervosa is >> eating disorder- focused cognitive behavioral therapy. (Mode of action of Rasburicase >> Recombinant urate oxidation. (19 yrs. pt presented with abdominal pain, intermittent diarrhea and constipation + symptoms exacerbated by eating and abdomen is distended + Most appropriate initial advice >> Restrict tea, coffee and alcohol consumption (Dx: Irritable bowel syndrome)$okEgg Vs MRCP: » » Egg shell calcification on CXR >> Silicosis. & & Egg Pizza appearance on fundoseopy >> CMV retinitis. » © Fried egg appearance in Peripheral blood film >> Hairy ceil leukemia. » » Basket egg appearance on immuno-flourosceince of renal biopsy >> Alport’s syndrome. #xCauses of Gum hypertrophy: Mnemonic: PNC + Promyelocytic leukemia + Phenytoin * Pregnancy « Nifedipine. + Ciclosporin.40.18 yr Female with primary amenorrhea, normal height & breast development + virtually ne Pubic & axillary hair + Dx >> Androgen insensitivity syndrome. + No smell sense + low GnRH, low FSH & LH >> Kallmann syndrome. * Male, Tall stature + High FSH & LH >> Klinefelter syndrome. * Secondary amenorrhea + High FSH & LH >> Premature ovarian failure 41. Elderly patient with moderate Aortic stenosis planning to undergo colonoscopy for anemia + Appropriate pretreatment he should take >> No pretreatment is necessary. “Antibiotic prophylaxis is no longer recommended for patient with valve lesion in following condition: * Dental procedure. + Upper& Lower Gi tract procedure. + Upper & lower Genitourinary tract procedure. * Upper & lower respiratory tract procedure.30, Young boy with repeated syncopal attack + family H/O father, brother died in bed during sleep + chest clear, no murmur + likely underlying cause of his syncopal attack >> Brugada syndrome. * Family history, patient has syncopal attack during exertion, Murmur present + Dx will be >> HOCM 31.62 yr male with a thickened pigmented lesion on neck, axilla, palm + has indigestion, wt loss, anaemia + mildly distended abdomen + likely cause of his skin changes >> Gastric carcinoma. 32, Young female with urethral discharge + Microscopy shows; Gram-negative Diplococci + \ikely cause >> Gonorrhea. * Tx of choice >> single dose IM ceftriaxone$okEgg Vs MRCP: » » Egg shell calcification on CXR >> Silicosis. & & Egg Pizza appearance on fundoseopy >> CMV retinitis. » © Fried egg appearance in Peripheral blood film >> Hairy ceil leukemia. » » Basket egg appearance on immuno-flourosceince of renal biopsy >> Alport’s syndrome. #xCauses of Gum hypertrophy: Mnemonic: PNC + Promyelocytic leukemia + Phenytoin * Pregnancy « Nifedipine. + Ciclosporin.64. IVDU with fever, facial grimacing, neck stiffness, involuntary muscle spasm + has a large groin abscess & abdomen is rigid + raised WBC & CRP + Most appropriate next step Tx >> Human tetanus Immunoglobulin. * Suspected tetanus infection >> Administer I HTIG, then Wound debridement. * Suspected tetanus infection + /Respiratory compromise >> Intubation & ventilation 65. Elderly man with socra/ pressure sore with visible bone + grade of pressure sore >> G-4 Grading of pressure sore: * GI >> Non-blanchable erythema. * G2 >>Partial skin loss. * G3 >>Full thickness skin loss.#tkCause Of ling fibrosis: 4+#UPPER ZONE LUNG FIBROSIS CAUSE: Mnemonic: CHARTS (chart always hang on wall >> Up) * C>> Coal dust * H => Hypersensitive alveolitis (Extrinsic allergic alveolitis, Histiocytosis) * A>> Ankylosing spondylitis * R >> Radiation induced fibrosis * T>>TB * S >> Silicosis, Sarcoidosis. *+LOWER ZONE FIBROSIS: Mnemonic:"BASEMeNt (Basement >> Floor >> lower zone) * B >> Bleomycin * A>> Asbestosis, Amiodarone, Autoimmune disease [RA, SLE] * SE >> SLE, Systemic Sclerosis. + Me >> Methotrexate. + N >> Nitrofurantoin. * T >> Tumor treatment drug.'76. Young pt with severe back pain & sacroiliac joint pain + Limited forward & lateral flexion of the lumber spine with raised CRP + Likely Dx >> Ankylosing spondylosis * Tx of choice >> physiotherapy with NSAIDS. 77. Elderly Retired Plumber with dry cough & SOB + Coarse Creps in all lung area + FEVI/FVC: > 0.7 + Likely cause of pt's SOB >> Pulmonary fibrosis 78, Patient came with excessive sweating, recent change in facial feature + prominent mandible with macroglossia + Most useful initial test to Dx >> IGF-1. * Investigation of choice >> OGTT with growth hormone measurement * 9° Tx >> Trans-sphenoidal excision of pituitary adenoma.