MRCP

Question 1

What is a patient with severe malnutrition (anorexia, ETOH Hx) at risk of when re-feeding is commenced?

Answer 1

hypophosphataemia
- from reactive hyperinsulinaemia on starting feed –> phosphate move to intercellular space, hyperglycemia

Question 2

what are the electrolyte imbalances associated with re-feeding?

Answer 2

hypophos, hypoMg, hypoK

• dietitian input, caloric loading at a lower rate, supplementation of electrolytes

Question 3

causes hypoNa

Answer 3

fluid retention (HF)
Nephrotic synd
SIADH
addison’s
use of diuretics

Question 4

causes hyperCa

Answer 4

hyperparathyroidism
malignancies
vit D disorders
paget’s
kidney failure

Question 5

causes hypoCl

Answer 5

severe vomiting
chronic Respiratory failure

Question 6

XY genotype with complete androgen insensitivity, whats the phenotype?

Answer 6

female external genitalia + cryptorchidism (testes present as hernias as infants)

Question 7

phenotype of Klinefelter’s syndrome

Answer 7

male genitalia
small testes and scanty secondary sexual hair

Question 8

large penile ulcer / donovanosis progressively getting larger after visit to tropics

Answer 8

klebsiella granulomatis
- painless spreading ulcer with friable edges (chancre)
- won’t heal without meds
- can be infected / locally destructive –> SCC

Question 9

Syphilis causative agent

Answer 9

treponema pallidum

Question 10

difference b/w treponema pallidum and klebsiella granulomatis re: ulcer

Answer 10

primary ulcer in trep pallidum - single painless ulcer, heal without Tx

K. granuulomatis ulcer - slowly enlarging

Question 11

differentials for causative agents for inguinal / penile ulcers

Answer 11

1. Klebsiella granulomatis : painless ulcer, only responds to meds, infected / spread –> SCC
2. treponema pallidum: single painless ulcer, heal without Tx
3. Chlamydis trachomatis: D-K no ulceration (only uretheritis + urethral discharge), L13 (lymphogranuloma venerum LGV - homosex men - painless genital ulcer –> tender inguinal lymphadenopathy –> ulceration + local destruction
4. haemophilus ducreyi: tropical, painful ulcers
5. HSV 1: crops of small painful ulcers

Question 12

HLA antigen associations

Answer 12

Question 13

HLA-B51

Answer 13

Behcet disease

Question 14

HLA-B27

Answer 14

seronegative arthritides
psoriasis
IBD

Question 15

HLA-DR2

Answer 15

rheumatic fever (protective against rheumatoid arthritis)

Question 16

HLA-DR3

Answer 16

anti-CCP negative Rheumatoid arthritis
T1DM

Question 17

HLA-DR4

Answer 17

T1DM
rheumatoid arthritis

Question 18

cauda equina clinical presentation

Answer 18

due to nerve root compression
- lower back pain
- saddle anaesthesia + bowel & bladder disturbances
- diminished reflexes (ankle and knee jerks)
- unilateral

Ix: MRI or CT lower spine

Question 19

cauda equina vs conus medullaris

Answer 19

Question 20

spinal meningioma

Answer 20

female
middle aged
long Sx duration (1-2 years)

Question 21

how to distinguish B/W MMN vs MND on basis of nerve conduction studies

Answer 21

MMN (multifocal motor neuropathy): normal sensory conduction
- inflammatory neuropathy –> multifocal demyelination with conduction block

MND (motor neurone disease): abnormal sensory conduction
- axonal degeneration

Question 22

Tx for MMN (multifocal motor neuropathy)

Answer 22

immunomodulatory Tx (IV immunoglobulins)

Question 23

Antibodies in MMN

Answer 23

GM-1 anti-ganglioside Ab (50% cases)

Question 24

JVP uses

Answer 24

reflects patient fluid status –> for appropriate fluid management

Question 25

what does JVP detect

Answer 25

right atrial pressure

Question 26

how does JVP normally change with inspiration?

Answer 26

falls (inspiration --> increased intrathroracic pressure + suction of venous blood to heart)

Question 27

normal JVP waveform

Answer 27