MRCP last minute facts

27/7/2014 LAST MINUTE MRCP CRAMMING FACTS: please add your own too | AIPPG Forum Log in or Sign up Resources Forums Search Forums Forums Members Recent Posts UK Medical Zone MRCP Forum LAST MINUTE MRCP CRAMMING FACTS: please add your own too Thread Status: Not open for further replies This is a list of commonly tested facts, if you have corrections or you have some of your own, please add them TOP 50 MRCP facts Guest Guest Acromegaly – Diagnosis: OGTT followed by GH conc Cushings – Diagnosis: 24hr urinary free cortisol Addisons > short synacthen Rash on buttocks – Dermatitis herpetiformis (coeliac dx) AF with TIA > Warfarin Herpes encephalitis > temporal lobe calicification Obese woman, papilloedema/headache > Benign Intercanial Hypertention Drug induced pneumonitis > methotrexate or amiodarone chest discomfort and dysphagia > achalasia 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 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 AutD 17 electrolytes disturbance causing confusion – low/high Na 18 contraindications lung surgery > FEV dec bp 130/90, Ace inhibitors 20 headache with many analgesics at once -> 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 pemigus – 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 -> >11.1 also seen in HCT 28 causes of villousd atrophy: coeliac, 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,Gilbert, 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 Horners – sweating lost in upper face only – lesion proximal to common carotid artery Internuclear opthalmoplegia: medial longitudinal fasciculus connects CN http://aippg.net/threads/last-minute-mrcp-cramming-facts-please-add-your-own-too.15944/ 2/40 27/7/2014 LAST MINUTE MRCP CRAMMING FACTS: please add your own too | AIPPG Forum nucleus 3-4 TRIES TO Y ANK THE ipsilateral BAD EY E ACROSS THE NOSE Convergence 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: Lithium, chlorpropamide, carbamepine 54 bisphosphonates:inhibit osteoclast activity, prevent steroid incduced osteoperosis (vit Dalso) 55 returned from airline flight, TIA-> paradoxical embolus TOE 55 alcoholic, given glucose develops nystagmus -> B1 deficiency (wernickes) Confabulation->korsakoff 56 mono-artropathy with thiazide -> gout (neg birefringence) NO ALLOPURINOL for acute High Y ield Topics Anorexia Nervosa Reiters Syndrome – arthritis, uveitis, urethritis – Chlymidia, campylobacter, Y ersinia, Salmonella, Shigella Balanisits PKD – aut dom Chr 16/4 assoc berry aneurysm, mitral/aortic regurg Porphyria – photosensitivity, blisters, scars with millia, hypertrichosis Heart sounds: Aortic Stenosis s2 paradoxical split, length proportional to severity Vitiligo – commonest assoctions pernicious anaemia >>> type dm, autoimmune addisons, autoimmune thyoid dx ALMOST Pathognomic for the exam 1.fatiguability -> myasthrnia gravis 2.fasciculations -> Motor neurone diease 3.silvery white scale -> psoriasis 4.hypopigmented -> vitiligo/pityriasis versicolor please ONLY ADD COMMONLY TESTED FACTS THAT Y OU HAVE SEEN http://aippg.net/threads/last-minute-mrcp-cramming-facts-please-add-your-own-too.15944/ 3/40 27/7/2014 LAST MINUTE MRCP CRAMMING FACTS: please add your own too | AIPPG Forum REPEATEDLY IN PAST EXAM QUESTIONS Guest, May 13, 2005 #1 re error Correction to line 53 SORRY ! 53 Causes of SIADH : chest/cerebral/pancreas pathology, porphyria Drugs: carbamazepine, chlorpropamide, clofibrate, atipsychotics, NSAIDs drsujitvasanth Guest Causes of Diabetes Insipidus: Lithium, amphoteracin, prologed hypercalcaemia/hypornatraemia, familial X linked type, pituitary damage drsujitvasanth 2, May 13, 2005 #2 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 -> Convergence should be defective Isn't it? Guest, May 15, 2005 #3 Guest Guest re 47 parinauds from Kalra pg 563 -Parinauds syndrome :Guest Guest impaired upgaze and accomodation retraction of the eyelids loss of light reflex with preserved convergence reflex convergent retraction nystagmus relative midriasis -?presumably convergant retraction nystagmus means when eyes are returning to neutral from convergence when it happens ? Guest, May 15, 2005 http://aippg.net/threads/last-minute-mrcp-cramming-facts-please-add-your-own-too.15944/ #4 4/40 27/7/2014 LAST MINUTE MRCP CRAMMING FACTS: please add your own too | AIPPG Forum re list reposted see the main forum, i reposted the list made correction to nummber 53 (now number 43) Guest, May 15, 2005 #5 Guest Guest query kindly let me know what all books should one study for MRCP part preparation, i would highly greatful Guest, Jun 8, 2005 #6 Guest Guest can anyone guide regarding the online courses for mrcp part is onexamination good Guest, Jun 8, 2005 #7 Guest Guest passed MRCP part 1, now comments and suggestions Thank the Lord! Passed MRCP Part on first attempt Mark not yet available drsujitvasanth10 Guest To all those who did not pass - I think this has nothing to with ability as a doctor - not feel bad, just try again, study differently It is really a very silly exam but a hurdle we must get through this is ho I did it Background: Honours medical student from UK, recently sat USMLe Step and http://aippg.net/threads/last-minute-mrcp-cramming-facts-please-add-your-own-too.15944/ 5/40 27/7/2014 LAST MINUTE MRCP CRAMMING FACTS: please add your own too | AIPPG Forum I read some of Kalra when I was a medical student Exam Preparation: I studied what other people with very high scores did and I did likewise, hoping to pass I only had weeks to prepare and during this time I wasn't working 1) Did all onexamination past questions and made notes on the ones I got wrong 2) Looked up common topics in Kalra 3) Read entire chapters of Kalra, taking brief notes Y OU DO NOT NOT NEED TO READ BIG BOOKS TO PASS THIS EXAM!! Please dont waste time reading Kumar and Clarke and Davidsons I also had the MRCP Masterclass but did not use it - It was too heavy going I had a borderline score on my fist attempt at onexamination My score was in the 70's on the second attempt What got me through? 1) onexamination teaches the common topics and the correct way of thinking 2) I followed the advice of people who did well - so even if I did 50% the same as them, I would probably pass Comment Other candidated during the exam seemed to be very pleased to finish with a lot of time to spare - I think tis reflects the unwholesome culture in the nhs this as everything else is not a race - take your time in the exam- as long as you finish all the questions The english deliberately put barriers in the way - emphasising subtle language in the mcq's - which has nothing to with being a good doctor As far as I can see this is only to keep foreign doctors out Their latest ploy appears to be adding lots basic science questions in e.g genetics to put a bias on their local gradates, Conclusion to pass the exam onexamination (past papers), Kalra PS my 100 commomly tested facts list was very high yield for the exam Please check for factual innacuracies drsujitvasanth10, Jun 15, 2005 http://aippg.net/threads/last-minute-mrcp-cramming-facts-please-add-your-own-too.15944/ #8 6/40 27/7/2014 LAST MINUTE MRCP CRAMMING FACTS: please add your own too | AIPPG Forum passing part i like your tactics and well done on passing 1st time silly question: how did you find out how other high-scoring candidates achieved their success? Guest Guest as a currently-unemployed SHO (locuming in A+E) with no friends who are doctors, i have no contact with other people who're studying for MRCP so can't find out what tactics other people employ Guest, Jun 16, 2005 #9 re high scoring tactics hi there the best way to find successful tactics these days is to scour the nlinw forums This helps no end and has worked for me for USMLE Step and and MRCP part Guest try a few forms and some searches i.e mcqs.com etc Guest what it boils down to for mrcp part is 1) onexamination.com 2) read round commonly tested facts good luck! Guest, Jul 9, 2005 #10 mock test is there any tools or mock test available? Guest, Jul 19, 2005 #11 Guest Guest Hi Shyam,mock tests are available on this very website in the mrcp section http://aippg.net/threads/last-minute-mrcp-cramming-facts-please-add-your-own-too.15944/ 7/40 27/7/2014 LAST MINUTE MRCP CRAMMING FACTS: please add your own too | AIPPG Forum Guest, Sep 3, 2005 #12 Guest Guest reply thanks what a collection of important facts? Guest, Sep 7, 2005 #13 Guest Guest Drug induced SLE (DILE) Guest Guest Antihistone antibodies rare but specific Anti-dsDNA present Complement C3/C4 levels decrease Cutaneous findings in >75% Raynaud phenomenon in 50% Hydralazine-induced DILE has association with HLA-DR4 Antiarrhythmics - Procainamide and quinidine Antibiotics - Minocycline, isoniazid, and griseofulvin Anticonvulsants - Valproate, ethosuximide, carbamazepine, and hydantoins Hormonal therapy - Leuprolide acetate Antihypertensives - Hydralazine, methyldopa, and captopril Anti-inflammatories - D-penicillamine and sulfasalazine Antipsychotics - Chlorpromazine Cholesterol-lowering agents - Lovastatin, simvastatin, and gemfibrozil Guest, Sep 7, 2005 #14 Polyglandular Autoimmune Syndrome http://aippg.net/threads/last-minute-mrcp-cramming-facts-please-add-your-own-too.15944/ 8/40 27/7/2014 LAST MINUTE MRCP CRAMMING FACTS: please add your own too | AIPPG Forum Polyglandular Autoimmune Syndrome PGA syndrome type I (PGA-I), (APECED or Whitaker syndrome) is: candidiasis, hypoparathyroidism, and adrenal failure Guest Guest PGA syndrome type II: Addison disease plus type DM + hypogonadism, pernicious anemia, celiac disease PGA syndrome type III: of the following: thyroid deficiency, pernicious anemia, insulin-requiring diabetes, vitiligo, and alopecia Guest, Sep 7, 2005 #15 MEN MEN affects the parathyroid glands, the pancreatic islets and the anterior pituitary Guest Guest MEN (MEN 2A) medullary thyroid carcinoma (MTC), pheochromocytoma and parathyroid tumours MEN 3(MEN 2B) resembling MEN 2, except that parathyroid hyperplasia is rare Guest, Sep 7, 2005 #16 re mrcp commonly tested facts Thanks everyone for your contributions I think a summary of MEn syndromes should be added to thus list but i dont have time right now and the version I see posted has no mention of mucosal neuromas drsujitvasanth10 OK I UPDATED MY LIST OF 50 AND ADDED CORRECTIONS Guest PLEASE GIVE CORRECTIONS AND ADDITIONS ONLY ONLY INCLUDE FACTS THAT HAVE FREQUENTLY APPEARED ON http://aippg.net/threads/last-minute-mrcp-cramming-facts-please-add-your-own-too.15944/ 9/40 27/7/2014 LAST MINUTE MRCP CRAMMING FACTS: please add your own too | AIPPG Forum OFFICIAL PAST MRCP QUESTIONS Acromegaly – Diagnosis: OGTT followed by GH conc Cushings – Diagnosis: 24hr urinary free cortisol Addisons > short synacthen Rash on buttocks – Dermatitis herpetiformis (coeliac dx) AF with TIA > Warfarin Just TIA's with no AF > Aspirin Herpes encephalitis > temporal lobe calicification OR temporoparietal attentuation – subacute onset i.e Several days Obese woman, papilloedema/headache > Benign Intercanial Hypertention Drug induced pneumonitis > methotrexate or amiodarone chest discomfort and dysphagia > achalasia 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 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, http://aippg.net/threads/last-minute-mrcp-cramming-facts-please-add-your-own-too.15944/ 10/40 27/7/2014 LAST MINUTE MRCP CRAMMING FACTS: please add your own too | AIPPG Forum **Fibrosing alveolitis is the most common pulmonary manifestation of rheumatoid arthritis sawsan s **impairment in renal function in Hepatorenal syndrome The hallmark is oliguria and progressive decline in renal function The urine is typically free of protein or any other sediment Guest **Long-term haemodialysis is associated with carpal tunnel syndrome is the most common complication **the most likely cause of bacterial meningitis in adult patients with neutropenia : Listeria monocytogenes **the most frequent cause of a nosocomial wound infection: Insufficient hand disinfection **Osteoporosis is the most common cause of fracture of neck of femur and is not associated with any specific abnormality in the standard bone biochemistry profile **Tuberculous arthritis usually affects children aged 2–5 years The hip is one of the most frequently affected joints **Meningitis due to enterovirus and meningococcus (N meningitidis) are the most likely in this age group(28 yrs0 **Tuberculous meningitis is rare in the UK and the CSF typically shows a markedly raised protein (> g/l), a low glucose (< 50% serum) and a lymphocytosis **Streptococcus meningitis is the commonest cause of meningitis in those over 40 years of age; very high neutrophil counts are often seen in the CSF, which has a high protein and low glucose level **Factors predisposing to digitalis toxicity are advanced age, hypoxia, hypokalaemia, hypomagnesaemia, hypercalcaemia, hypothyroidism, amyloidosis and renal failure The most common precipitating factor is hypokalaemia ** In Hodgkin’s disease Lymphocyte depleted has the worst prognosis It is the least common variant and typically occurs in older people http://aippg.net/threads/last-minute-mrcp-cramming-facts-please-add-your-own-too.15944/ 26/40 27/7/2014 LAST MINUTE MRCP CRAMMING FACTS: please add your own too | AIPPG Forum **The commonest mutation in patients with cystic fibrosis (CF) is the DeltaF508 mutation **in systemic lupus erythematosus Recurrent pleurisy and pleural effusions are the most common manifestations and are often bilateral **Cryptosporidium infection in HIV-positive patients along with cytomegalovirus, is the commonest cause of HIV-related diarrhoea and tends to present when the CD4 count is less than 100 **Diarrhoea and flushing, occurring separately or together, are the most frequent presenting features of carcinoid syndrome (approximately half of all patients) **Focal necrotising glomerulonephritis is the characteristic renal lesion of generalised Wegener’s granulomatosis Typically, it presents with deteriorating renal function that progresses to renal failure within months, **Glomerulonephritis is a common occurrence in chronic Schistosoma mansoni infection in Brazil, especially in patients with hepatosplenic disease **Tremor in the legs is a useful sign as it is almost always associated with idiopathic Parkinson’s disease The tremor is typically a rest tremor unlike benign essential tremor, where actions such as drinking a cup of tea make the tremor worse **Pericardial effusions are more common in patients with rheumatoid arthritis than constrictive pericarditis and acute pericarditis **The earliest lesions to be detected in diabetic retinopathy are usually dot haemorrhages (capillary microaneurysms) and venous dilatation **Hypertrophic cardiomyopathy is the single, most common cause of sudden death in young athletes **the most common cause of paranoid psychosis with visual hallucination :Alcohol withdrawal **Basal cell carcinomas are the most common malignant skin tumour and are related to excessive skin exposure They are common later in life and may present as a slow-growing nodule or papule http://aippg.net/threads/last-minute-mrcp-cramming-facts-please-add-your-own-too.15944/ 27/40 27/7/2014 LAST MINUTE MRCP CRAMMING FACTS: please add your own too | AIPPG Forum **The most common type of thyroid cancer is papillary cancer, which accounts for approximately 70% of all thyroid cancers ***Open angle glaucoma is 100 times more common than angle closure glaucoma, and is asymptomatic until central visual loss appears at the end stage **a high white cell count with smear cells and mature lymphocytes This is characteristic of chronic lymphocytic leukaemia **Chronic lymphocytic leukaemia · Constitutes 25% of all leukaemias It is chiefly a disease of the elderly · It is characterised by an accumulation of mature lymphocytes in the peripheral blood, bone marrow, spleen, liver and lymph nodes · Clinical findings include painless, symmetrical lymphadenopathy, hepatosplenomegaly, pruritus and symptoms due to bone marrow failure · Blood film will show large numbers of mature lymphocytes and smear or smudge cells Anaemia and thrombocytopenia are common · Hypogammaglobulinaemia is common and monoclonal paraproteins are occasionally seen · Staging is by the Binet or Rai systems and depends on number of areas involved and full blood count results · Median survival is 3–5 years and one-third die of causes other than the leukaemia · In early stages no treatment is required In later stages and in rapidly progressive disease treatment is with oral or intravenous chemotherapy such as chlorambucil or fludarabine Stem cell transplantation is an option in younger patients **IgG is the most common paraprotein in myeloma **Myeloma · Median age of diagnosis is 70 years · Diagnosis is made in the presence of two of monoclonal protein in blood or urine, 10% plasma cells in bone marrow and lytic bone lesions · Other clinical features are bone disease, hypercalcaemia, renal failure, bone marrow failure and immune paresis · year survival is only 25% · Treatment is supportive, chemotherapy (which can be oral or intravenous) and autologous or allogeneic stem cell transplantation · Thalidomide has recently been used in relapsed and refractory disease http://aippg.net/threads/last-minute-mrcp-cramming-facts-please-add-your-own-too.15944/ 28/40 27/7/2014 LAST MINUTE MRCP CRAMMING FACTS: please add your own too | AIPPG Forum ***Adrenergic inhibitors used in hypertension: Peripheral neuronal inhibitors: Reserpine, Guanethedine Central adrenergic inhibitors: M-dopa, Clonidine, Guananbenz, Guanafacine Alpha-receptor blockers: o Alpha and receptor blockers: Phenoxybenzamine, phentolamine o Alpha blockers: Doxazosin, Terazosin Beta blockers Alpha and beta blockers: Labetalol **Polycythaemia rubra vera: · Splenomegaly · Aquagenic pruritus · Bleeding · Gout · Peptic ulcer · Conversion to myelofibrosis or leukaemia in 10% **Causes of Chorea Neurodegenerative: Huntington’s disease Benign hereditary chorea Dentatorubropallidoluysian atrophy Inherited metabolic: Wilson’s disease Lesch-Nyhan disease Neuroacanthosis Hypoxic/ischaemic: Stroke Hypotension Vasculitis Sickle cell disease Polycythaemia Toxic: Copper Mercury Drug induced: Oral contraceptive pill L-Dopa Neuroleptics Anticholinergics Cocaine Amphetamines Infection: Sydenham’s chorea Meningitis Viral encephalitis Mycoplasma pneumoniae Legionella http://aippg.net/threads/last-minute-mrcp-cramming-facts-please-add-your-own-too.15944/ 29/40 27/7/2014 LAST MINUTE MRCP CRAMMING FACTS: please add your own too | AIPPG Forum Toxoplasmosis Creutzfeld-Jacob disease Autoimmune: SLE Primary anti-phospholipid syndrome Vasculitis Behcet’s Hashimoto’s thyroiditis (unrelated to hyperthyroidism) Endocrine: Thyrotoxicosis Chorea gravidarum Addison’s disease Metabolic: Hypocalcaemia Hypomagnesaemia Hyper/hypoglycaemia Hyper/hyponatraemia **Causes of sudden cardiac death · Arrhythmia -Acute myocardial infarction -Long-QT syndromes -Hypertrophic cardiomyopathy -Commotio cardis -Coronary anomalies -Myocarditis · Obstruction -Atrial myxoma -Infective endocarditis -Dissection **In Hypertrohpic Cardiomyopathy · Combination of palpable LVS4 and then double systolic apical impulse due to the mid systolic outflow obstruction · It increases in phase II of the valsalva maneouver (the straining phase) and decreases in phase IV (post release phase) · Severe diastolic dysfunction · Children have a worse prognosis than affected adults because of greater incidence of SCD · As in severe AS (because of greater myocardial oxygen demand) **5 histological stages have been described (WHO Classification) and treatment depends on this There is a lack of clear correlation between clinical manifestations and the severity of renal involvement Biopsy findings guide the http://aippg.net/threads/last-minute-mrcp-cramming-facts-please-add-your-own-too.15944/ 30/40 27/7/2014 LAST MINUTE MRCP CRAMMING FACTS: please add your own too | AIPPG Forum selection of immunosuppressive therapy WHO Classification of Lupus Nephritis Stage I ¡V Lupus nephritis without histological changes Stage II ¡V Mesangial lupus nephritis Stage III ¡V Focal proliferative lupus nephritis Stage IV ¡V Diffuse proliferative lupus nephritis (commonest & most severe form) Stage V ¡V Membranous lupus nephritis Conditions that recur in the transplanted kidney Focal glomerulosclerosis Mesangiocapillary glomerulonephritis Rapidly progressive (Crescentic) glomerulonephritis IgA nephropathy Alport¡¦s syndrome Cystinosis Oxalosis Lupus nephritis Goodpastures syndrome Wegner¡¦s granulomatosis **The most common renal disease in HIV is collapsing FSGS in which there is focal sclerosis associated with collapse down of the glomerulus leaving a space in Bowman’s capsule It has a poor prognosis and usually leads to ESRF **The indications for a native nephrectomy prior to renal transplant are: Uncontrolled hypertension where a differential renin study shows that one or the other kidney is significantly contributing to hypertension Pyonephrosis Recurrent attacks of clinically significant UTI **Budd Chiari classically results in a very high protein ascites but may cause a transudate **Transudates (protein < 30gdl or 75% of the serum albumin) are due to: http://aippg.net/threads/last-minute-mrcp-cramming-facts-please-add-your-own-too.15944/ 31/40 27/7/2014 LAST MINUTE MRCP CRAMMING FACTS: please add your own too | AIPPG Forum - Reduced intravascular oncotic pressure (hypoalbuminaemia) - Increased intravascular hydrostatic pressure (cirrhosis, portal hypertension, CCF) **Teaching Notes for Question 15 Theme: Pancreatic Secretion The roles of individual gut hormones are not completely defined, but cholecystokinin (duodenum & jejunum) increases gall bladder contraction, increases colonic motility Gastrin (gastric antrum & duodenum) increases gastric acid secretion,increases GI mucosal growth Secretin(duodenum & Jejunum) increases pancreatic bicarbonate production VIP(enteric nerves)increased intestinal secretion, splanchnic vasodilation Motilin(whole gut) increases small bowel motility Bombesin (gut & Pancreas)stimulates pancreatic exocrine activity Neuropeptide Y (enteric nerves)regulates intestinal blood flow Somatostatin (stomach & pancreas) inhibits secretion and action of gut hormones Glucagon(pancreas)reduces GI motility **In systemic lupus erythematosus (SLE) Joint involvement is the most common clinical feature (> 90%) **Prolactinoma is the commonest pituitary tumour, making up 30% of all adenomas Microadenomas occur with increasing frequency in women, macroadenomas more commonly in men **ASDs account for about 10-15% of all congenital cardiac anomalies and are the second commonest congenital heart disease seen in adults **VSDs are the commonest adult congenital heart disease **Frontal lobe dementia >a failure to generate list rapidly is the test of frontal lobe+difficulties with task sequencing and executive skills EXPRESSIVE aphasia, primitive reflexes, perseveration, anosmia and changes in personality Parietal lobe ->Dyscalculia(inability to perform mentalarithmetic) is a manifestation of the dominant parietal lobe http://aippg.net/threads/last-minute-mrcp-cramming-facts-please-add-your-own-too.15944/ 32/40 27/7/2014 LAST MINUTE MRCP CRAMMING FACTS: please add your own too | AIPPG Forum Sensory inattention, apraxia, neglect, astereognosis(unable to recognise an object by feeling it) and visual field defects( typically homonymous inferior quadrantanopia) Temporal lobe -> typical homonymous superior quadrantanopia), Wernike's (RECEPTIVE) aphasia, auditory agnosia, and memory impairment Occipital lobe >cortical blindness(blindness due to damage to the visual cortex and may present as Anton syndrome where there is blindness but the patient is unaware or denies blindness), homonymous hemianopia, and visual agnosia( seeing but not percieving objects - it is diffirent to neglect since in agnosia the objects are seen and followed but cannot be named) Homonymous hemianopia > occipital lobe superior quanranopia >temporal lobe inferior quanrtanopia ->parietal lobe **AUTOIMMUNE ASSOCIATIONS Thyroid disease, IDDM, Addison disease, pernicious anaemia, alopecia, vitiligo MULTIPLE ENDOCRINE NEOPLASIA Autosomal dominant The association of a number of endocrine tumours MEN I MEN IIa Parathyroid Adrenal (phaeochromocytoma, Cushing) Pituitary (prolactin or GH or ACTH) Thyroid (medullary carcinoma) Pancreas Parathyroid hyperplasia (Thyroid) (Adrenal) Fasting calcium level (??) Calcitonin level ? (medullary ca thyroid) Look for phaeochromocytoma MEN IIb is the same as MEN IIa, with Marfanoid features and multiple neuromas Prophylactic total thyroidectomy is performed if the child is known to carry the gene for MEN II **Adrenergic inhibitors used in hypertension: Peripheral neuronal inhibitors: Reserpine, Guanethedine Central adrenergic inhibitors: M-dopa, Clonidine, Guananbenz, Guanafacine http://aippg.net/threads/last-minute-mrcp-cramming-facts-please-add-your-own-too.15944/ 33/40 27/7/2014 LAST MINUTE MRCP CRAMMING FACTS: please add your own too | AIPPG Forum Alpha-receptor blockers: o Alpha and receptor blockers: Phenoxybenzamine, phentolamine o Alpha blockers: Doxazosin, Terazosin Beta blockers Alpha and beta blockers: Labetalol **Mixed connective tissue disease (MCTD) is an overlap connective tissue disease with features of SLE, polymyositis and progressive systemic sclerosis The characteristic auto-antibody pattern is of high titre anti-RNP and speckled pattern ANA **The antiphospholipid syndrome is one of the commoner causes of hypoadrenalism and may precipitate adrenal infarction and haemorrage through adrenal vein thrombosis **Biphasic high amplitude sharp waves are characteristic of ceutzfeld-jacob disease **Causes of dilated pupils: Holme's adie(myotonic pupils) Third nerve palsy drug poisons(atropine, CO, Ethylene glycol) Causes of small pupils : horner;s syndrome old age pontine haemorrhage Argyl Robertson pupil Drug poisons(opiate, organophosphate) **Optic neuropathy ->central scotoma Optic tract lesion ->incongrous homontmous hemianopia Chiasmal lesion >bitemporal hemianopia optic radiation and occipital lobe >congrous hemianopia **Listeria meningitis is typically associated with brain stem signs CSF shows neutrophilic pleocytosis, low glucose and high protein **Nystagmus is defind as involuntary oscillations of the eyes THis may be 1-Pendular: when the oscillations are equal in rate and amplitude 2-Jerking: when there are quick and slow phases(the quick phase is used to define the direction) pendular nystagmus is usually duee to loss of macular vision, but maybe seen in diffuse brain stem lesions http://aippg.net/threads/last-minute-mrcp-cramming-facts-please-add-your-own-too.15944/ 34/40 27/7/2014 LAST MINUTE MRCP CRAMMING FACTS: please add your own too | AIPPG Forum jerking nustagmus which is of constant direction regardless of the direction of gaze, suggests a labyrinthine or cerebellar lesion Nystagmus which changes with the direction of gaze suggests a widspread central involvement of vestibular nuclei Jerking nystagmus present only on lateral gaze, and who's fast component is in the direction of gaze, indicates a lesion of brain stem or cerebellum Nystagmus confined to one eye suggests a peripheral lesion of the nerve or mucsle, or a lesion of the mediallongitudinal bundle Nystagmus restricted to the abducting eye on lateral gaze(ataxic nystagmus) is due to a lesion of the medial longitudinal bundle between the ponds and midbrain as in MS Nystagmus occuring on upward gaze with the fast component upwards( upbeat nystagmus) maybe due to a lesion in the mid-brain at the level of the superior colliculus Downbeat nystagmus(fast phase downward) suggests a lesion in the lower part of the medulla It's therefore, typical of the Arnold Chiari malformation **Causes of absent ankle reflexes and extensor plantars: subacute combined degeneration of the cord syphilitic taboparesis friedreich's ataxia motor neuron disease **Bicuspid aortic valve is perhaps the most common form of congenital heart disease in adults(1-2% of population) **hyporeflexia is a common clinical sign in patients with hypercalceamia Biphosphanates inhibit bone resorption and are the first line pharmacological treatment of hypercalceamia of malignancy **Premature epiphysial closure is a classical finding of CAH **Flecainide is the drug most likely to restore sinus rhythm in atrial fibrillation **Lithium can produce Diabetes Insipidus and hypercalceamia http://aippg.net/threads/last-minute-mrcp-cramming-facts-please-add-your-own-too.15944/ 35/40 27/7/2014 LAST MINUTE MRCP CRAMMING FACTS: please add your own too | AIPPG Forum **Constrictive pericarditis produces an elevated JVP, with prominent x & y descent.Pulsus paradoxus occurs less frequently than in tamponade **Streptococcus bovis is a normal commensal of the GI tract However, S.bovis bactereamia and endocarditis has a strong association with GI malignancy **Neisseria meningitidis( Gram negative diplococci) Streptocuccus pneumonia(gram positive diplococci) Rx: gram stain unavailable: cefotaxime+- ampicillin g +ve cocci: Cefotaxime +vancomycin( S.pneumonia) G +ve bacilli:Ampicillin +gentamicin.(listeria) G -ve cocci: Benzyl penicillin.(N.meningitidis) G -ve bacilli: Cefotaxime + gentamicin(heamophilus influenza) **Anaplastic carcinoma carries the worst prognosis in thyroid cancer followed by thyroid medullary carcinoma in MEN 2B.\ **ANCA ab are of types: 1- C-ANCA which correlates with antiproteinase antibodies ->most specific for wegener's granulomatosis 2- P-ANCA which correlates with anti myeloperoxidase ab P-ANCA/MPO ab are highly sensitive and specific for rapidly progressive glomerulonephritis and haemorrhagic alveolar capillaritis AMA ab > PBC Anticentromere ab. > CREST/scleroderma syndrome ANA and anticardiolipin ab. ->SLE **Clozapine is associated with agranulocytosis in app.1-2% of patients **Acute pancreatitis with worse prognosis: Age>55 WCC>16,000 LDH>600 AST>120 Glu>10 **Pendred's syndrome http://aippg.net/threads/last-minute-mrcp-cramming-facts-please-add-your-own-too.15944/ 36/40 27/7/2014 LAST MINUTE MRCP CRAMMING FACTS: please add your own too | AIPPG Forum Pendred's syndrome is a rare autosomal recessive condition characterised by incomplete oxidation of trapped iodide prior to organification It may be confirmed by a positive perchlorate discharge test **Anti 21 hydroxylase ab found in about 80% of cases of addison's disease **SSRIs are a recognised cause of SIADH **Astimulatory mutation of thr Gs protein alpha subunit has been noted in approx.30% of GH secreting pituitary tumours **Carcinoid tumours of the foregut unlike tumours of the midgut are not associated with carcinoid syndrome but may secret CRF/ACTH resulting in ectopic cushing's syndrome.Other associated conditions include somatostatinoma, Zollinger -Ellison syndrome and Acromegaly **The antiphospholipid syn is one of the commoner causes of hypoadrenalism and may precipitate adrenal infarction and haemorrhage through adrenal vein thrombosis **Osteopenia is defined as a T score of between -1 and -2.5 standard deviation below the bone mineral density of a young female.Osteoporosis is defined as