This document contains notes from Dr. Sherif Badrawy's MRCP examination. It includes multiple choice questions on various medical topics, with the correct answer provided for each. The notes cover areas such as rheumatology, endocrinology, hepatology, infectious diseases, cardiology and respiratory medicine. For each question, the rationale for the correct answer over other choices is also included to help explain the clinical reasoning.

1. January 2014
(MRCP 1)
BY
Dr. Sherif Badrawy
BADRAWY notes MRCP

2. A very common SE of
Ciclosporin Rx ? ( and all
Calcineurin inhibitors)
1a
BADRAWY notes MRCP

3. Tremor
a better choice than
thrombocytopenia
1b
BADRAWY notes MRCP

4. Infertile woman with
proliferative endometrium
indicates ?
2a
BADRAWY notes MRCP

5. Anovulation
secretory endometrium is the
hallmark of ovulation.
2b
BADRAWY notes MRCP

6. Drugs commonly cause
extrapyramidal SEs ?
3a
BADRAWY notes MRCP

7. Conventional
antipsychotics
Not Atypical antipsychotics,
Not TCA
3b
BADRAWY notes MRCP

8. On standing for ≥ 1 minute,
physiological change ?
4a
BADRAWY notes MRCP

9. Decreased UOP
↓ SBP is immediately after standing
& only transient
COP , HR , Peripheral vascular
resistance all increase.
4b
BADRAWY notes MRCP

10. 64 y ♀ Osteoporosis lumbar
spine (T score - 2.6,long term
inhaled CST), Rx ?
5a
BADRAWY notes MRCP

11. Alendronate ➜ 1st line Rx
a better choice than Denosumab ( a
rank ligand inhibitor given for 6
months SC injection, limited use dt
cost)
5b
BADRAWY notes MRCP

12. A pt é Ankylosing Spondylitis
(sacroiliac & back pain 8
months,limited lat. flexion & chest
expansion, sacroilitis in x ray, ↑
ESR) + failed Rx é 2 NSAIDS, Rx ?
6a
BADRAWY notes MRCP

13. Etanrecept
Anti -TNF recommended
after failed 2 NSAIDS , ( a
better choice than
Methotrexate)
6b
BADRAWY notes MRCP

14. A pt é Porphyrea Cutanea Tarda
(hyperpigmentation ,hypertrichosis,
blistering scarring eruptions in
dorsum of hand,worsen in summer,
alcoholic pt) , Dx (IN THE CLINIC)
by ?
7a
BADRAWY notes MRCP

15. Check urine é UV light
pink fluorescence under Wood's
lamp
for the CLINIC sitting this is a better
choice than urine porphyrins &
serum porphyrins.
7b
BADRAWY notes MRCP

16. A pt é truncal obesity, insulin
resistance, dyslipidemia ,
what do you expect more to
see ?
8a
BADRAWY notes MRCP

17. HTN
to complete the Dx of
Meabolic syndrome.
8b
BADRAWY notes MRCP

18. A helminth é a symptomatic
travel through the lung & the
adult worm resides in the
intestine ?
9a
BADRAWY notes MRCP

19. Ascaris lumbricoids
9b
BADRAWY notes MRCP

20. A pt é Essential Tremors (low
amplitude tremors, FH of
father affection , head
nodding, no bradykinesia, no
rigidity) , Rx ?
1 a
BADRAWY notes MRCP

21. Propranolol
Primidone also may be used.
1 b
BADRAWY notes MRCP

22. A 30 ♂ pt é psychological instability
(fired from job,custody dispute for
his children, Hx of episodes of
breathlessness when adolescent) c/o
of blindness inspite of normal
medical & neuro. examination, what
psychiatric Dx ?
11a
BADRAWY notes MRCP

23. Conversion Disorder
neurological symptoms ( ex.
Blindness, Deafness, loss of feelings
& physical immobility) with normal
examination
Rx by CBT (Cognitive Behavioral
Therapy).
11b
BADRAWY notes MRCP

24. A pt é Dermatitis
Herpitiformis with skin
biopsy, Igs to be found ?
12a
BADRAWY notes MRCP

25. IgA
present in dermal papillae ,
revealed on immunostaining.
Rx by Dapsone & Gluten free
diet
12b
BADRAWY notes MRCP

26. Buspirone acts on which
receptors ?
13a
BADRAWY notes MRCP

27. Serotonin receptors
5HT1A receptors, Short term Rx of
anxiety, effect may be delayed up to
2 wks , no dependance or abuse
potential.
13b
BADRAWY notes MRCP

28. a ♀ not affected by cystic fibrosis (
normal CXR) with a sister died by
the disease wants to calculate her
risk of having a child with cystic
fibrosis ( the carrier frequency in
population is 1 in 25) ?
14a
BADRAWY notes MRCP

29. 1 in 150
this ♀ risk is 2 in 3 to be a carrier (as she's not
affected) + the partner from the population with
the risk of 1 in 23 + the chance of having affected
child if both are carriers is 1 in 4 ➜ overall
chance is 2/3 x 1/25 x 1/4 = 1/150.
the key to answer this is that in AR conditions the
risk of being a carrier is 2/3 not 2/4 (i.e 1/2) as
she's not affected.
14b
BADRAWY notes MRCP

30. A pt é Primary biliary cirrhosis (
♀,middle
age,jaundice,hepatosplenomegaly,FH),
Dx Abs ?
15a
BADRAWY notes MRCP

31. Anti-Mitochondrial Abs
against the components of pyruvate
dehydrogenase complex (E2 binding
protein & E3 binding protein)
appears long before Sx & before liver
function abnormalities.
15b
BADRAWY notes MRCP

32. Autosomal Dominant +
Severe mental retardation in
50% + benign growths in
various body parts ?
16a
BADRAWY notes MRCP

33. Tuberous Sclerosis
16b
BADRAWY notes MRCP

34. a young ♀ pt é depression ,
Chronic liver disease Ss,
Golden yellow ring at iris
periphery both eyes + low
serum copper, Dx ?
17a
BADRAWY notes MRCP

35. Wilson's Disease
defect in incorporating copper into
ceruloplasmin / Kayser Fleischer
ring almost always present / Rx by
Penicillamine
17b
BADRAWY notes MRCP

36. A pt é HOCM (arrested during a
rugby match & died + postmortem
biopsy ➜ LV & asymmetric septal
hypertrophy) , underlying pathology
?
18a
BADRAWY notes MRCP

37. Beta myosin heavy chain
mutation
a better choice than troponin
mutation (also occur in
HOCM)
18b
BADRAWY notes MRCP

38. Chronic Hepatitis B , ↑ risk
of ?
19a
BADRAWY notes MRCP

39. HCC
≅ 100 fold ↑ risk
19b
BADRAWY notes MRCP

40. Hypoglossal nerve paralysis
Lt side, outcome ?
2 a
BADRAWY notes MRCP

41. All intrinsic muscles of the Lt side
tongue are paralysed
supplies all ms of the tongue , none
of the palate / only motor, no
sensory.
2 b
BADRAWY notes MRCP

42. Primary Sclerosing
Cholangitis, correct statment
?
21a
BADRAWY notes MRCP

43. Cholangiocarcinoma occurs in ≅
20% of pts
(75 % associated with IBD / Age of
onset is 40 y / Men 70 % /
associated with HLA A1-B8- DR3)
21b
BADRAWY notes MRCP

44. A 79 y pt é dull abdominal pain
radiating to back, Anorexia,
cachexia, normo normo Anemia,
mild ↑ LFTs, ↑↑↑ bilirubin & ALP,
U/S abdomen ➜ bile duct
obstruction & epigastric mass , Dx ?
22a
BADRAWY notes MRCP

45. Pancreatic Carcinoma
back pain partially relieved by sitting
fwd / jaundice late & presenting
Symptom /± associated with
thrombophlebitis migrans / ±
thromboembolic phenomena / CA 19-
9
22b
BADRAWY notes MRCP

46. Causative factor for obesity in
the majority of pts ?
23a
BADRAWY notes MRCP

47. Energy intake in excess
of expenditure
Not genetic predisposition (
may be in some pts but not
the majority)
23b
BADRAWY notes MRCP

48. A pt é AIDS seroconversion (living
in Thailand, FEW WEEKS of night
sweat , diarrhea, lymphadenopathy
é -ve stool for cysts & ova), Dx ?
24a
BADRAWY notes MRCP

49. mycobacterium avium
intracellulare
Not CMV ( > acute onset of
presentation), Not cryptosporidium
( no ova or cysts in the stool)
24b
BADRAWY notes MRCP

50. A 32 y pt é paroxysmal SVT
,failed valsalva & carotid
sinus massage , Rx ?
25a
BADRAWY notes MRCP

51. IV Adenosine
a better option than
verapamil dt > rapid onset &
shorter duration of action.
25b
BADRAWY notes MRCP

52. The greatest absolute risk
reduction from the choices ?
26a
BADRAWY notes MRCP

53. 15 % relative risk reduction vs a
placebo event rate of 3.5 %
absolute risk reduction = 3.5 x 0.15
= 0.525 % (other options are less)
26b
BADRAWY notes MRCP

54. A pt é LQT1 syndrome
collapsed dt VT & improved
after cardioversion, most
important initial intervention
to prevent recurrence ?
27a
BADRAWY notes MRCP

55. Atenolol
Not permenant pacemaker
if no response ➜ stellate
ganglionectomy.
ICD is 1st choices in LQT2 & LQT3
dt > incidence é sudden death.
27b
BADRAWY notes MRCP

56. A 79 y pt é dyspnea, facial
swelling , ? bronchial
neoplasm.. suspect SVC
obstruction, look for ?
28a
BADRAWY notes MRCP

57. Venous dilatation over the
anterior chest wall
SVC obst. is 70 % dt lung cancer,
oncological emmergency ➜ rapid Rx
é CST.
28b
BADRAWY notes MRCP

58. A correct statment regarding
ppt factors of DKA ?
29a
BADRAWY notes MRCP

59. Non compliance to Rx is the cause
in 25 % of cases
other ppt factors ➜ Infection 30-40
%,Chge insulin dose 13 %,Newly Dx
DM 10-20 %,MI <1 %.
29b
BADRAWY notes MRCP

60. What suggests Graves'
disease as the cause of
hyperthyroidism ?
3 a
BADRAWY notes MRCP

61. Pretibial myxoedema
a better choice than lid lag &
goitre.
3 b
BADRAWY notes MRCP

62. Should be considered in Rx
of Hemophilia A ?
31a
BADRAWY notes MRCP

63. Desmopressin may be useful
mild to moderate hemophilia
respond to desmopressin to cover
minor procedures such as tooth
extraction.
vWF levels are normal in hemophilia
A.
31b
BADRAWY notes MRCP

64. a young ♀ pt é Sx of
hypothyroidism postpartum,
Dx ?
32a
BADRAWY notes MRCP

65. Postpartum thyroiditis
Transient,self limiting, may
be associated é
hyperthyroidism.
Iodine deficiency is no rare.
32b
BADRAWY notes MRCP

66. Aquaporin 2 gene mutation
causes ?
33a
BADRAWY notes MRCP

67. Nephrogenic DI
33b
BADRAWY notes MRCP

68. A pt é RA diffusely red eye,
gritty, painful + preserved
visual acuity,Normal
schirmer test, Dx ?
34a
BADRAWY notes MRCP

69. Episcleritis
Not Scleritis. preserved visual acuity
points towards episcleritis + scleritis
associated é ≫ severe eye pain
worse at night & at moving the eye.
34b
BADRAWY notes MRCP

70. Associated with
Hyperkalemia ?
35a
BADRAWY notes MRCP

71. Ciclosporin
35b
BADRAWY notes MRCP

72. Adisonian Crisis é random
BS 3.4 mmol/l ,1st priority
Rx ?
36a
BADRAWY notes MRCP

73. Resuscitation é IV NS +
Hydrocortisone
Given simultaneously é immediate
priority to fluid resuscitation.
Not IV Hydrocortisone alone,not IV
glucose.
36b
BADRAWY notes MRCP

74. AIDS pt on HAART ➜
improved CD4 from 50 to
800 ,c/o reduced vision +
slight eye discomfort, Dx ?
37a
BADRAWY notes MRCP

75. Immune reconstitution
Uveitis
Not CMV retinitis,not
Toxoplasma (associated é
very low CD4 count)
37b
BADRAWY notes MRCP

76. Tamoxifen, a correct
statment ?
38a
BADRAWY notes MRCP

77. functions as a SERM
no need for PAP smear (no risk of
Cx canecr) / ↓ risk of IHD dt ↓ LDL
cholesterol / much ↓ effect on
estrogen receptor -ve tumors.
38b
BADRAWY notes MRCP

78. Recurrent Pneumonia +
pleural effusion,Quieckest
way to decide the need for
drainage ?
39a
BADRAWY notes MRCP

79. Pleural fluid pH
< 7.2 suggests parapneumonic
effusion requiring drainage
Not pleural fluid culture ➜ takes
sometime for a useful result.
39b
BADRAWY notes MRCP

80. HLA associated é RA ?
4 a
BADRAWY notes MRCP

81. HLA DR4
4 b
BADRAWY notes MRCP

82. A 24 y immigrant pt é several
months fever,wt loss,night
sweats,chronic cough ±
hemoptysis,calcified hilar LNs,
normo normo anemia, +ve AFB 6
months ago, Dx ?
41a
BADRAWY notes MRCP

83. Active pulmonary TB
41b
BADRAWY notes MRCP

84. Hepatorenal
Syndrome,mechanism of
craetinine deterioration ?
42a
BADRAWY notes MRCP

85. Renal vasoconstriction
definitive Rx is
transplantation.
42b
BADRAWY notes MRCP

86. A COPD pt é recurrent
exacerbations & hospital
admissions é FEV1 < 50 %,
Rx ?
43a
BADRAWY notes MRCP

87. Combination high dose
inhaled CST + LABA
43b
BADRAWY notes MRCP

88. A 24 y pt é dusky blue nodular rash
over shin, intermittent diarrhea ±
blood,proctoscopy ➜ moderate
rectal inflammation + normo normo
anemia + ↑ CRP , Dx ?
44a
BADRAWY notes MRCP

89. Ulcerative Colitis
a better choice than Crohn's disease
as predominant lower GI Sx é
proctitis are > suggestive of
ulcerative colitis.
44b
BADRAWY notes MRCP

90. A 45 y pt contact tracing program
referral dt sitting beside a man later
found to be +ve in a flight to
pakistan,no Hx of TB, no BCG
vaccine, normal examination, next
step ?
45a
BADRAWY notes MRCP

91. Mantoux test
a very useful initial screening tool.
Not Chest X-ray (next step after
mantoux), Not prophylactic Anti-TB
Rx.
45b
BADRAWY notes MRCP

92. A 48 y pt blurring Lt eye, Angioid
streaks,macular edema,skin folds é
yellow striations & puckering in the
neck & flexor aspect of joints, Dx ?
46a
BADRAWY notes MRCP

93. Pseudoxanthoma
elasticum
Not Marfan's syndrome.
46b
BADRAWY notes MRCP

94. A 61 y pt DM, COPD on ↑ dose seretide
inhaler + multiple toe nail fungal
infections, Rx ?
47a
BADRAWY notes MRCP

95. Oral Terbinafine
Topical is ineffective in fungal nail
infection, oral Terbinafine is better
than oral Itraconazole esp. in a COPD
pt é possibility of macrolide Rx for
exacerbation ( ↑ risk of QT
prolongation in this combination).
47b
BADRAWY notes MRCP

96. Acquired lipodystrophy
(young ♀ pt, loss of fat
around the face & upper
body, creatinine 110), which
complement deficiency ?
48a
BADRAWY notes MRCP

97. C3
Acquired lipodystrophy ➜ no
metabolic abnormalities
Congenital lipodystrophy ➜
metabolic abnormalities.
48b
BADRAWY notes MRCP

98. A 12 y boy é gradually progressive
plaque on his buttock for 3 years
with crusting and induration at the
periphery and scarring at the centre
annular, Dx ?
49a
BADRAWY notes MRCP

99. Lupus vulgaris
Not Tinea corporis
A lesion with central scarring is suggestive
of lupus vulgaris
commonest manifestation of cutaneous
TB, slightly itchy, asymmetrical scaly
Tinea corporis has central clearing and an
advanced scaly raised edge
49b
BADRAWY notes MRCP

100. A pt é cirrhosis secondary to
hepatitis C, progressive
deterioration over 6 months, Hx of
IV heroin abuse & alcoholism,
weight loss and worsening ascites, ↑
alpha-fetoprotein,Dx ?
5 a
BADRAWY notes MRCP

101. HCC
definitive Dx by U/S folloed
by CT guided biopsy, Rx usu
palliative.
5 b
BADRAWY notes MRCP

102. a young ♀ é Sx of pulmonary
HTN (Exertional dyspnea,LL
oedema),best Ix to exclude
2ndry pulmonary HTN ?
51a
BADRAWY notes MRCP

103. CT pulmonary Angio
a better choice than ECHO &
V/Q scan
51b
BADRAWY notes MRCP

104. clinical phase-ll study in oncology,
testing a new chemotherapy in
patients with a malignant tumour
Which statistical test is most
appropriate to compare the survival
times?
52a
BADRAWY notes MRCP

105. Log-rank test
52b
BADRAWY notes MRCP

106. a young pt é aplastic anemia
(BM biopsy ↓ hematopoeitic
cells, fatty BM), most
effective long term Rx ?
53a
BADRAWY notes MRCP

107. Hematopoeitic stem cell
transplantation
a better choice than chemotherapy
Children & young adults ➜ BM
transplantation is 1st choice Rx of
severe aplastic anemia.
53b
BADRAWY notes MRCP

108. Anti-epileptic drug causing
SIADH (hyponatremia & ↓
plasma osmolality) ?
54a
BADRAWY notes MRCP

109. Carbamazepine
Dose related hyponatremia
54b
BADRAWY notes MRCP

110. an old pt not DM é Lt lateral
hip pain, ↑ é abduction
against resistance, Dx ?
55a
BADRAWY notes MRCP

111. Trochanteric bursitis
Not Osteoarthritis ( limitation with
the full range of movement + deeper
pain within the joint) / not iliopsoas
bursitis (medial pain over femoral
triangle).
55b
BADRAWY notes MRCP

112. a elderly DM pt é Hx of extensive
psoriasis, hot swollen Lt knee joint,
limited mobility, ↑ESR, WBCs,
Creatinine, knee x ray ➜
osteoarthritis with large effusion,
next best step ?
56a
BADRAWY notes MRCP

113. Orthopedic referral for aspiration
& washout.
a better choice than IV
Flucloxacilline ➜ Abiotics without
aspiration & washout of the joint
can cause permenant joint damage.
56b
BADRAWY notes MRCP

114. a middle age ♂ with wt loss,
night sweats,mild asthma,
Dyspnea,cough, nosebleed,
↑ESR, ↑Creatinine,cANCA
+ve, Dx ?
57a
BADRAWY notes MRCP

115. Wegener's
granulomatosis
Not churg strauss syndrome.
57b
BADRAWY notes MRCP

116. a 16 y ♀ é B/L renal cortical
scarring,Hx of recurrent UTIs with
antibiotis in childhood but no UTIs
since 5 y., HTN (180/104),
Creatinine 186 , how to prevent
further kidney damage ?
58a
BADRAWY notes MRCP

117. ACE Inhibitors
a better choice than Surgical re-insertion
of ureters
imaging + Hx of recurrent UTIs in
childhood ➜ Chronic reflux nephropathy.
∵ no recent UTIs ➜ recurrent infections
are over ➜ little benefit of Surgical re-
insertion of ureters.
58b
BADRAWY notes MRCP

118. An elderly pt é Polymyositis (
proximal ms weakness +
shoulder pain + ↑↑ CK) ,
initial Rx of choice ?
59a
BADRAWY notes MRCP

119. Prednisolone
screen for underlying
malignancy
59b
BADRAWY notes MRCP

120. Organism seen in the sputum
of HIV infected pt ?
6 a
BADRAWY notes MRCP

121. Cryptococcus
Not Cryptosporidium (causes
Diarrhea not pneumonia)
Dx of Cryptococcus by India Ink
stain, in Meningitis do Ag titre
Rx by IV Amphotrecin B or
Fluconazole.
6 b
BADRAWY notes MRCP

122. Hemophilia B mode of
inheritance ?
61a
BADRAWY notes MRCP

123. X-linked recessive
Also Hemophilia A.
61b
BADRAWY notes MRCP

124. trials a new drug for lowering lipid
levels.2 groups, one receiving the
drug and the other placebo. What is
the best statistical test for
comparing mean cholesterols
between the two groups?
62a
BADRAWY notes MRCP

125. Unpaired T test
62b
BADRAWY notes MRCP

126. For what metabolic process
Riboflavin is required ?
63a
BADRAWY notes MRCP

127. Hydrogen-transfer chain
in the mitochondria
63b
BADRAWY notes MRCP

128. An 58 pt Uncontrolled DM1 é 5
units bloot transfusion 2 wks earlier,
you want to do Hb A1c to assess
him,how long to wait to check Hb
A1c ?
64a
BADRAWY notes MRCP

129. 6 months
Not 3 months
Lifespan of RBCs about 4 months & the
transfusion is large amount (5 units)
➜ wait 6 months before measuring
Hb A1c.
64b
BADRAWY notes MRCP

130. An elderly pt é large stroke ( Lt
hemiparesis, homonymous
hemianopia, left sided neglect,
receptive dysphasia, and poor left
sided co-ordination) what is most
likely to hinder further progress in
rehabilitation?
65a
BADRAWY notes MRCP

131. Receptive dysphasia
dt difficulties complying with
rehabilitation Rx
recovery from neglect is excellent +
function of the affected limb usu improve.
homonymous hemianopia will affect
driving but no effect on daily living.
65b
BADRAWY notes MRCP

132. a pt é Porphyria Cutanea tarda
(hyperpigmentation ,hypertrichosis,
blistering scarring eruptions in
dorsum of hand,worsen in summer,
alcoholic & smoker,urine & stool +ve
for porphyrins),most successful to ↓
severity ?
66a
BADRAWY notes MRCP

133. Avoidance of Alcohol
Not avoidance of smoking
66b
BADRAWY notes MRCP

134. a pt é CAP + reactivation of
Cold sore, Causative
Organism ?
67a
BADRAWY notes MRCP

135. Streptococcus
pneumoniae
67b
BADRAWY notes MRCP

136. a 43 y pt é frequent
Headaches worse in the
morning,HTN ,K 3.1,Normal
BMI, Creatinine 112, Test will
get the Dx ?
68a
BADRAWY notes MRCP

137. Renin Aldosterone ratio
Not Urinary metanephrines , Not 24
urinary free cortisol
Hypokalemia + HTN + Normal BMI
+ no Cushing's features ➜ Conn's
syndrome.
68b
BADRAWY notes MRCP

138. a 30 y pt é jaundice, anemia
& splenomegaly,
reticulocytosis + osmotic
fragility, Dx ?
69a
BADRAWY notes MRCP

139. Heriditary spherocytosis
Autosomal Dominant
69b
BADRAWY notes MRCP

140. Muscle control PIP joint
flexion ?
7 a
BADRAWY notes MRCP

141. Flexor Digitorum superficialis
Not Flexor Digitorum profundus ➜
flexion at wrist, metacarpophalangeal
& interphalangeal joints.
Lumbricals ➜ flexion at
metacarpophalangeal & extension at
interphalangeal joints.
7 b
BADRAWY notes MRCP

142. most important physiologic
mechanism that prevents
reflux ?
71a
BADRAWY notes MRCP

143. parasympathetic
stimulation of the lower
circular smooth ms fibers of
the oesophagus
No true anatomical sphincter
71b
BADRAWY notes MRCP

144. MOA of Allopurinol ?
72a
BADRAWY notes MRCP

145. Inhibits xanthine oxidase
Colchicine Inhibits microtubule
polymerization ➜ ↓ inflammatory
activity. Rasburicase is a recombinent
urate oxidase inhibitor ➜ ↓ tumor
lysis syndrome with chemotherapy.
72b
BADRAWY notes MRCP

146. a pt é GBS + desatting on
lying flat + unable to perform
spirometry ?
73a
BADRAWY notes MRCP

147. ITU review for
consideration of
ventilation
73b
BADRAWY notes MRCP

148. HF despite maximal medical
Rx, a decision for pacemaker
,type ?
74a
BADRAWY notes MRCP

149. biventricular pacemaker
Not Dual chamber
pacemaker
74b
BADRAWY notes MRCP

150. a 17 y ♀ é Collapse after
strenuous exercise,felt weak
and faint afterwards, father
died suddenly at a young age
,normal examination, Dx ?
75a
BADRAWY notes MRCP

151. Cardiac syncope
Not Seizures
MCC is HOCM but lack of physical
signs is against that.
Long QT syndrome & Brugada
syndrome are possibilities
75b
BADRAWY notes MRCP

152. Which is most consistent
with a diagnosis of Bell's
palsy?
76a
BADRAWY notes MRCP

153. Hyperacusis
Not Loss of sensation
loss of lacrimation in lesions before
the geniculate ganglion.
Loss of taste to the anterior 2/3 of
the tongue in severe cases.
76b
BADRAWY notes MRCP

154. a pt é Headache + 3rd nerve
palsy ,Dx ?
77a
BADRAWY notes MRCP

155. Posterior communicating
Artery aneurysm
77b
BADRAWY notes MRCP

156. a pt é CAP, most useful in
predicting outcome ?
78a
BADRAWY notes MRCP

157. Urea
( CURB 65)
78b
BADRAWY notes MRCP

158. CLL pt é recurrent infections
,Etiology ?
79a
BADRAWY notes MRCP

159. Immunoglobulin
deficiency
Not T cell dysfunction
79b
BADRAWY notes MRCP

160. DOCH to control BP in
pheochromocytoma ?
8 a
BADRAWY notes MRCP

161. Phenoxybenzamine
if going for surgery start it 7-
10 days before
8 b
BADRAWY notes MRCP

162. Long term prognosis of HSP
?
81a
BADRAWY notes MRCP

163. Complete recovery with no
long term sequelae
81b
BADRAWY notes MRCP

164. Route of Adrenaline
adminestration in
anaphylactic shock ?
82a
BADRAWY notes MRCP

165. Intramuscular
Not IV as Intramuscular is
the most predictable profile
on absorption & clinical
effect.
82b
BADRAWY notes MRCP

166. Post-needle stick injury from
a pt with known hepatitis C
+ve ?
83a
BADRAWY notes MRCP

167. Monthly hepatitis C PCR
83b
BADRAWY notes MRCP

168. Bullous impetigo with
systemic Sx (fever, ↑ WBCs,
↑CRP) , Rx ?
84a
BADRAWY notes MRCP

169. IV Co-Amoxiclav
a better choice than oral
flucloxacillin dt > range of
action.
84b
BADRAWY notes MRCP

170. Chronic alcoholic,Generalized weakness
+ tremors + hypokalemia +
hypocalcemia, Etiology ?
85a
BADRAWY notes MRCP

171. Hypomagnesemia
dt malnutrition and alcohol
related diuresis
85b
BADRAWY notes MRCP

172. the strongest pointer towards
a diagnosis of Type 1
diabetes?
86a
BADRAWY notes MRCP

173. Ketonuria
Not Anti-GAD antibodies
Single autoantibody +ve is not indicative
of a diagnosis of DM1
2 or 3 antibody positivity being a much
stronger pointer towards significant
autoimmune beta cell destruction
86b
BADRAWY notes MRCP

174. VF in a controlled
enviroment (CCU), Rx of
choice ?
87a
BADRAWY notes MRCP

175. Defibrillate
Not precordial thumb (only
give if defibrillator is
unavailable)
87b
BADRAWY notes MRCP

176. HIT, most common
complication ? (IgG Abs
against PF4- heparin coplex)
88a
BADRAWY notes MRCP

177. DVT
Not arterial thrombosis
88b
BADRAWY notes MRCP

178. Tirofiban, MOA ?
89a
BADRAWY notes MRCP

179. 2b3a inhibitor
Platelet function returns to baseline
within eight hours after
discontinuation.
contraindicated in hepatic
dysfunction
89b
BADRAWY notes MRCP

180. Peanut allergy,correct
statment ?
9 a
BADRAWY notes MRCP

181. The wheal size resulting from the skin
prick test is an excellent predictor of a
positive food challenge to peanuts
The severity of the next allergic reaction
cannot be predicted by skin prick test or
specific lgE,depends on other factors
(amount consumed and intercurrent viral
infections).
9 b
BADRAWY notes MRCP

182. Wernicke's encephalopathy
(thiamine deficiency in
Alcoholic),what do you
expect to see ?
91a
BADRAWY notes MRCP

183. Nystagmus
a better choice than coma
Nystagmus is the commonest
eye sign in wernicke's
91b
BADRAWY notes MRCP

184. Pain in Rt Knee ,Sx of
Reactive Arthritis,Rt Knee
aspirate showed no
organisms, Rx ?
92a
BADRAWY notes MRCP

185. Intra-articular CST injection
a better choice than Diclofenac or
Doxycycline
Systemic NSAIDS are the mainstay of
Rx but in MONOARTHRITIS ➜
Intra-articular CST after ensuring -ve
aspirate from the joint is better.
92b
BADRAWY notes MRCP

186. a 23 ♂ pt é anal discharge +
dysuria + urethral smear ➜
intracellular diplococci, Dx ?
93a
BADRAWY notes MRCP

187. Neisseria Gonorrhea
93b
BADRAWY notes MRCP

188. Central Chest pain ECG
reveals Twave inversion in V5
and V6 finding on
angiography?
94a
BADRAWY notes MRCP

189. Critical stenosis of the left
circumOex artery
94b
BADRAWY notes MRCP

190. Acute Pericareditis, ECG
finding ?
95a
BADRAWY notes MRCP

191. PR depression
95b
BADRAWY notes MRCP

192. A 34-y ♀ non-smoker moderate
hypoxaemia,Lung function tests
normal lung volumes but a reduced
Tlco at 45%
PCO2 of 7.9 kPa ?
96a
BADRAWY notes MRCP

193. Pulmonary arteriovenous
malformation
right-to-left shunts, so reducing Tlco
values and provoking
hypoxaemia.Emphysema can cause ↓Tlco
but is usually associated with ↑residual
volume and would be unusual in a young
non-smoker.
96b
BADRAWY notes MRCP

194. A 72-y ♀ left total hip
replacement ,Routine Ix
(WBC 22.5, Lymphocytes 19)
most appropriate Rx ?
97a
BADRAWY notes MRCP

195. Go ahead with the surgery
but keep her under
haematology follow-up
Mostly CLL & doesn't require
Rx now
97b
BADRAWY notes MRCP

196. Lyme disease (tick bite 3
months ago + rash) with
sudden collapse,cause ?
98a
BADRAWY notes MRCP

197. AV heart block
98b
BADRAWY notes MRCP

198. Wegner's Granulomatosis,
findings in renal Biopsy ?
99a
BADRAWY notes MRCP

199. Necrotizing GN without
complement or Ig
deposition
99b
BADRAWY notes MRCP

200. A 16-y ♂ abdominal pain and
vomiting , ↓Power distally
ankle and knee reOexes
absent,sister has similar condition
+basophilic stippling +Urinary D-
ALA +ve, Dx ?
1 a
BADRAWY notes MRCP

201. Lead poisoning
Not Acute intermittent
porphyria (dt basophilic
stippling isn't in AIP)
1 b
BADRAWY notes MRCP