Merry Christmas and Happy New Year!

That time of year again! A chance to wish everyone Merry Christmas and all the best for 2014!

MRCP Part 2 Notes

Three weeks today until Christmas - one week until Part 2! Managed to do some case-based learning sessions this afternoon with the Glasgow medical students up at the university (psoriasis & acne) then have got a further two cases to cover on Friday (melanoma and alopecia). The big news in Glasgow this week was of course the tragic helicopter crash at the Clutha pub in town which left 9 people dead - my thoughts go to all of the emergency workers involved in the aftermath of the crash and condolences to those who lost loved ones.

Some MRCP revison notes - this week taken from sample questions on the MRCP website:

Brugada Syndrome: A 26 year old is referred for assessment after their brother suffers a sudden cardiac death age 32. ECG shows sinus rhythm with a partial RBBB pattern and elevation of the ST segment in V1/V2. This history would be characteristic for Brugada syndrome. There may be no evidence of LVH. The condition is inherited in an autosomal dominant manner and there is an increased risk of cardiac death in these patients due to ventricular arrhythmias. 

Minimal-Change Nephropathy: A 22 year old man presents with leg swelling, chest pain, thrombosis and a right basal perfusion defect. What is the likely renal diagnosis? Minimal-change nephropathy. Treatment of this condition with corticosteroids often leads to a rapid resolution in symptoms. NB. In a patient with visible haematuria the most important investigation is cystoscopy to rule out bladder cancer, other investigations would only be carried out once the result of the cystoscopy was known.

Phenytoin overdose: Classical presentation would be with inco-ordination, slurred speech, reduced GCS and nystagmus. Serotonin Syndrome: Classic presentation is with agitation, hyperthermia, tachycardia and severe hypertension with neurological involvement (malignant hyperthermia is usually associated with anaesthetics whilst neuroleptic malignant syndrome typically presents with a 'lead-pipe' rigidity.

Basilar Migraine: Typical presentation would be an 18 year old woman with transient bilateral blindness, slurred speech, a severe occipital headache and neck stiffness.

 

Rheumatoid vasculitis: A 70 year old woman with a 20 year history of rheumatoid arthritis presents with weakness of the right leg and numbness of the right hand with foot drop and a sensory peripheral neuropathy. Examination reveals nail fold infarcts. This presentation has the appearances of a systemic vasculitis and in a patient with such long-standing RA, rheumatoid vasculitis would be the most likely diagnosis to consider. 

TB Diagnosis: The diagnosis relies on culturing of mycobacterium tuberculosis and bronchoscopy will produce the best specimen for acid-fast staining and mycobacterial culture. Routine sputum microscopy and culture will not isolate mycobacterium tuberculosis.

Blood transfusions in Hodgkin's Lymphoma: There is a risk in these patients of transfusion-associated graft vs. host disease (in immunocompromised individuals). These patients should receive X or gamma-irradiated blood. CMV seronegative products are reserved for CMV sero-negative individuals while HLA-matched platelets are used for patients refractory to platelet transfusions or in those who have developed anti-HLA or anti-platelet antibodies.