Important Topics for MRCP Exams
Topic 1: Ankylosing Spondylitis effecting Sacroiliac joints and presents with Stiffness in Spine.
The patient usually complains of early morning stiffness and pain in the back. Ankylosing Spondylitis is a chronic progressive inflammatory disease of the sacroiliac joints and the axial skeleton. It is present in the relatively younger age group with an HLA-B27 genetic marker. It effects Sacroiliac joints, spine, hip, knee and manubrium sterni. The patient usually complains of early morning stiffness and pain in the back. The pain is worse at night and during rest and relieved after some activity. On examination, the patient has a stiff spine with reduced mobility.
Topic 2: Presentation of Inferior Infarction.
Breathlessness with chest pain with ECG showing diffuse ST-segment elevation in leads II, III as well as ST-segment depression in leads I and aVL are the most likely possibility of Infarction of Right Ventricle. ST-segment elevation in leads II, III which indicates Inferior Infarction.
Topic 3: Troponin Elevation in Pulmonary Embolism
Case: A young patient had a sudden episode of Pain in the chest, breathlessness which was followed by Taccycardia and Tachypnea. CXR Reveals Right Ventricular Dilatation. Serum Troponin Levels are elevated. The most likely cause is ………………………
Cardiac Troponins are elevated in MI. This Young Boy has Right Ventricular Dilatation and Breathlessness which is a feature of Pulmonary Embolism rather than MI. Besides it is Serum Troponins which are elevated and not cardiac Specific Troponins.
Topic 4: Barriers Syndrome is characterized by Hypokalemia, Metabolic alkalosis Normal to low blood pressure with Elevated renin levels and Elevated aldosterone levels.
Barrters Syndrome is characterized by muscular weakness, polyuria, cramps and is a rare form in which potassium wasting occurs. Characteristic of Bartter’s syndrome is Hypokalemia, Metabolic alkalosis Normal to low blood pressure with Elevated renin levels and Elevated aldosterone levels. Hyperplasia of JG Apparatus Occurs. This Child has muscular weakness, polyuria Normal Blood Pressure of 110/70 mmHg and Hypokalemia (Pottasium levels 2.3 mmol/L. ) and Increased Urinary Pottasium and Chloride levels with Elevated Renin Levels a full Proof of this Clinical Entity.
Topic 5 : Wide fixed splitting of second heart sound is characteristic of… ASD.
ASD can go unnoticed in life. Many individuals come to know about this problem incidentally. Patients may Present with dyspnea (difficulty breathing), shortness of breath, and palpitations Wide fixed splitting of second heart sound is characteristic of ASD. It is a congenital defect in the septum between the atria. It is due to failure of the foramen primum or secundum to close normally, resulting in a patent foramen ovale.
Topic 6: Gabapentin may provide symptom relief in… Restless Legs Syndrome
Restless Legs Syndrome is a well Established Clinical Entity more common in cases of patients with Renal Failure of Uremia. Restlessness and curious sensory disturbances lead to an irresistible urge to move the limbs, especially during periods of relaxation. Disturbed nocturnal sleep and excessive daytime somnolence may result. Gabapentin may also provide symptom relief.
Topic 7: Pentostatin and its use in…Hairy cell leukemia
Hairy cell leukemia is a rare but distinctive form of chronic B cell leukemia that derives its name from the appearance of fine ‘hair-like projections’ on the leukemic cells (large B cells). It Presents predominantly in the order age group >40 years with Massive splenomegaly (hepatomegaly is less common), Lymphadenopathy, Pancytopenia, and Recurrent infections. The current treatment of choice is with purine analogues. Other drugs used are Pentostotin, Interferon α and cladribine.
Topic 8: Clinical Triad of Tremor, Rigidity, Bradykinesia is a feature of…Parkinsonism
Parkinsonism is a combination of Tremor, Rigidity, Bradykinesia, and disturbance of Gait and Posture. (Festinant Gait with Short Shuffling Steps). Clinical Manifestations are resting tremor (4- to 6-Hz )resting tremor, Rigidity: lead pipe or cog wheel, Bradykinesia/akinesia and Fixity of facial expression.
Topic 9: Ataxia Telangiectasia is associated with …cellular and humoral immunodeficiencies and with increased risk of Malignancies
Ataxia Telangiectasia has features of ataxia, dysarthria, extensor plantar responses, myoclonic jerks, and areflexia, and patients can have recurrent infections and neoplasms and an increased incidence of cancer. Thymic hypoplasia with cellular and humoral (IgA and IgG2) immunodeficiencies with increased risk of Malignancies is seen.
Topic 10: Atypical Lymphocytosis in Infectious mononucleosis is caused by ……EBV
Infectious mononucleosis is a well recognized clinical syndrome characterized by the onset of headache, fever, pharyngitis, pharyngeal lymphatic hyperplasia, lymphadenopathy.
There is atypical lymphocytosis, heterophile antibody, and mild transient hepatitis. This syndrome occurs most commonly in adolescents and young adults. EBV is implicated in causation.