Best Of Five Questions For MRCP UK And Ireland Examinations"
Dr. Osama Amin MBChB, MRCPUK part I,MRCPI part I ,MRCPI part II written Senior House Officer and 4th year student of the…..Board of Neurology. ....... Teaching Hospital /Department of Neurology Q1 Digoxin toxicity is enhanced by all of the followings except : 1-cardiac amyloidosis 2-hypomagnesemia 3-hypothyrosidsm 4-concomitent treatment with amiodarone 5-hyperkalemia
Answer 5 Digoxin toxicity is enhanced by HYPOkalemia and its self causes hyperkalemia at toxicity ……other factors that enhances its toxicity are hypocalcaemia, renal impairment, ischemic cardiopmyopathy, chronic lung disease and acidosis
Q2 Tricyclic antidepressants overdose, all ARE TRUE except ; 1-cardiac and CNS toxicities are responsible for most of the fatalities 2-skin blisters may be seen but they are unusual 3-siezures and hyperreflexia are documented 4-rhabdomyolysis indicates severe poisoning 5-sodium bicarbonate infusion is indicated when the ECG shows short QT interval
Answer 5 Indication of bicarbonate infusion : long QT interval, severe hypotension , severe acidosis, life threatening cardiac dysrrhytmias and signs of severer CNS toxicity like seizures .the objective to raise the blood PH between 7.45-7.55 with serum K being in the upper range of normal reference
Q3 Lead poisoning, all are true except: 1-red cell ALA dehydratase activity is decreased 2-glycosuria and aminoaciduria are seen 3-blue lines on gums indicates acute poisoning 4-urinary ALA and coproporphyrin are increased 5-enbcephalopathy mainly seen in children
Answer 3 1- But the red cell free protoporphyrins are increased 2- Chronic interstitial nephritis ….. 3-indicates chronic exposure, mainly due to deposition of sulphides and irritation of the near by gum 4-but the PBG is normal ……differentiating it from acute intermittent porphyria which is one of the differential diagnosis 5-and peripheral motor neuropathy is manily seen in adults with chronic exposure
Q3 Ethylene Glycol poisoning, all are true except: 1-both, anionic gap and osmolal gap are increased 2-renal failure is usually reversible 3-hypocalcemia is seen 4-hemodialysis is the best option in treating severe cases 5-activated charcoal is used if the poisoning occurs with in 2 hours
Answer 5 1-true…and acidosis may very severe 2-true……..but it is irreversible if there was a late presentation with delayed treatment 3-manily seen in the early phase between 30minutes -12 hours of poisoning 4-true……peritoneal dialysis also may be used 5-false, does not combine with it
Q4 Ecstasy poisoning, all are true except: 1-DIC may be seen 2-CPK may be increased 3-hyponatremia is common 4-hypotension may be due to myocardial infarction 5-intracranial hemorrhage is not seen
Answer 5 1-check PT, PTT, fibrinogen 2-in rhabdomyolysis or prolonged seizures 3-true……drinking too much water and SIADH 4-also, shock, malignant ventricular dysrrhythmia, aortic dissection. Hypertension is common and when hypotension is seen, thinks of these complications 5-of of the causes of unexplained ICH in young people
Q5 Carbon monoxide poisoning, all are true except : 1-The most specific investigation is by measuring the blood carboxyhemoglobin level 2-despite of severe intoxication the pulse oxymetery is usually normal 3-the earliest features are headache, nausea and vomiting 4-when seizures occur, try to avoid phenobarbitone as it may further impair the release of oxygen to tissues 5-Hyperbaric O2 is used when the level of Carboxyhemoglobin is more than 5%
Answer 5 1-true, when ever the clinical setting is suggestive, like a patient found unconscious in his closed garage behind the car 2-and there is low PaO2 ……..so this discrepancy may be a clue 3- The rose pink color of the skin is rare antemortem…….cyanosis is much more common 4-true…use diazepam 5-false, remember in smokers the level of carboxy Hb may be up to 15% Indication of hyperbaric O2: pregnancy, severe neurological impairment, coma at any time, carboxyHB above 40% (some centers gives it when it is above 20%)
Q6 Phenytoin toxicity ……….all are true except 1-siezures are rare 2-fatality is fortunately uncommon and mainly due to cardiac toxicity 3-may be enhanced in renal and hepatic failures 4-hemodialysis is of great benefit in the treatment 5-gingival hypertrophy indicates a chronic exposure and hence superadded toxicity rather than accidental poisoning
Answer 4 1-true……but diplopia, ataxia and coarse tremor are common 2-true……usually caused rapid IV infusion causing asystole 3-also any drug that competes with pheytoin albumin binding sites 4-false…………..of no use at all 5-true…….look for any precipitating cause and measure serum phenytoin
Q7 Lithium toxicity, all are true except; 1-enhanced by concomitant thiazide diuretic therapy 2-there may be raised TSH with low T4 blood levels 3-siezures and hyperreflexia are seen 4-fine tremor supports the diagnosis 5-hemodialysis is the treatmnent of choice in severe toxicity
Answer 4 1-Also by NSAIDS, renal failure, ACE inhibitors, diarrhea 2- causing hypothyroidism. Also may cause hyperparathyroidism with high PTH level (i.e. like primary hyperparathyroidism) 3-coma, up going planters 4-false, fine tremor is commonly found in therapeutic level but coarse irregular one indicates poisoning 5-above 3-3.5 mmol /L
