6 Attempts - Dr Osman Academy of Medical Sciences

WELCOME
Looking Bizarre ?
But We Will Get the Light
Eligibility
• 12 months after Graduation certificate
• 6 attempts for Each part
2 Part Exam
• Part 1 – Written
• Part 2- Written and PACES
Part 2 Eligibility
Part 2 Written and PACES
6 Attempts for each
to be completed within 7 Years
Questions Number Distribution-Par1
Specialty
Number of questions*
• Cardiology
15
• Clinical pharmacology, therapeutics and toxicology
16
• Clinical sciences**
25
• Dermatology
8
• Endocrinology
15
• Gastroenterology
15
• Haematology and oncology
15
• Neurology
15
• Geriatrics
4
• Ophthalmology
4
• Psychiatry
8
• Renal medicine
15
• Respiratory medicine
15
• Rheumatology
15
• Tropical medicine, infectious and sexually transmitted diseases
15
200
**Clinical sciences comprise:
• Cell, molecular and membrane biology
• Clinical anatomy
• Clinical biochemistry and metabolism
• Clinical physiology
• Genetics
• Immunology
• Statistics, epidemiology and evidence-based
medicine
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A proportion of the questions will be on adolescent
medicine and medicine for the elderly.
Answer Score Distribution
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0.75
0.50
0.25
• Question Categories
Questions Categories
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Easy/ Medium / Hard
Diagnostic challenge
Management challenge
Both Diagnostic and Management challenge
Some DIRECT Questions
Information type
Histology/Gene/ Prognosis etc. of some
diseases
Part 1 Questions sample
Easy Question
A 63-year-old male is admitted with a 30 minute
history of central chest pain associated with
nausea and sweating. His ECG reveals ST
elevation in leads II, III and aVF.
Which of the following coronary arteries is most
likely to be occluded?
• (Please select 1 option)
A.
B.
C.
D.
E.
Circumflex artery
Left anterior descending artery
Obtuse marginal artery
Posterolateral artery
Right coronary artery
Easy Question and Management Challenge
A 29-year-old female who is 22 weeks pregnant is
noted to have a blood pressure of 150/90 mmHg
on three separate occasions. Urine protein is
negative.
Which of the following would be the first line
treatment?
• (Please select 1 option)
A.
B.
C.
D.
E.
Alpha methyldopa
Atenolol
Magnesium sulphate
Nifedipine
Salbutamol
Medium Question and Management Challenge
A 30-year-old woman who is 24 weeks pregnant presents with
a blood pressure on three separate occasions of
approximately 160/110 mmHg.
Her liver function tests (LFTs) show:
• Aspartate transaminase 150 U/L (5-45) Alkaline
phosphatase 213 U/L (50-120) Bilirubin 31 µmol/L (0-18)
Which antihypertensive is indicated?
• (Please select 1 option)
A.
B.
C.
D.
E.
Atenolol
Irbesartan
Labetalol
Methyldopa
Ramipril
Hard Question and Diagnostic Challenge
A 23-year-old female presents at 16 weeks into her
first pregnancy with a blood pressure of 144/96
mmHg. A 24 hour urine collection reveals a
protein excretion of 0.7 g/d (<0.2)
What is the most likely explanation for these
findings?
• (Please select 1 option)
A.
B.
C.
D.
E.
Essential hypertension
Gestational hypertension
Normal changes of pregnancy
Pre-eclampsia
Secondary hypertension
Hard Question and Information type
Which one of the following is true regarding acute
pulmonary embolism?
• (Please select 1 option)
A. A normal ECG excludes the diagnosis
B. Embolectomy is more effective than thrombolysis in
improving survival
C. Heparin is as effective as thrombolytic therapy
D. The presence of hypoxaemia is an indication for
thrombolysis
E. Thrombolysis administered through a peripheral
vein is as effective as through a pulmonary artery
catheter
Both Diagnostic and Management Challenge Question
A 45-year-old woman is referred to the respiratory clinic with
shortness of breath. She has been unable to work due to a long
term back injury and is therefore on long term sickness benefit.
On examination her BP is 155/85 mmHg, pulse is 85 and regular. Her
BMI is 32, there is bilateral lower limb pitting oedema with varicose
vein formation. Heart sounds are normal, auscultation of the chest
is clear.
Investigations show:
• pH 7.43 (7.35 - 7.45) PCO2 5.8 kPa (4.8 - 6.1) pO2 9.9 kPa (10 13.3)
Which of the following is likely to be the most effective therapy?
• (Please select 1 option)
A.
B.
C.
D.
E.
Furosemide
Salbutamol
Seretide
Tiotropium
Warfarin
Direct Question
Which of the following are centrally acting
antihypertensive therapies?
• (Please select 1 option)
A.
B.
C.
D.
E.
Hydralazine
Minoxidil
Moxonidine
Phenoxybenzamine
Verapamil
MRCP teaches MORE
than it tests
Dr Osman Academy of Medical Sciences
Holistic approach to the patient
Diagnosis / Problems identification of the patient by
– General Observation PLUS History taking
– Physical Examination
– Investigation
Aim of History taking / Examination/ Investigation
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1) To diagnose the disease and to exclude differential diagnoses
2) To identify causes / risk factors of the disease
3) To identify complication of the disease
4) To identify associated co morbidities
5) For a proper management plan
6) For research
`Dr Osman`s RULE of TWO` for diagnosis
(A calculative method)
BREATHLESSNESS may be a feature of Respiratory
OR Cardiovascular OR Renal Disease. To identify
respiratory source of breathlessness there would be
other respiratory core symptom like Hemoptysis or
Cough etc. Again to identify Cardiovascular disease
there would be other cardiovascular core symptom
like Palpitation or central Chest pain. For renal
problem, there would be Anuria or Oliguria etc in
addition to breathlessness.
DOAMS Method of MRCP Part 1 Preparation
• Clinical Scenario based discussion
• Different patterns of MOCK exam
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Pre Test -5Q*56 =280 followed by Discussion
Post Test- Same Questions of Pre Test
System Mock (According to allocated questions System wise) = 200
Block Mock– 50Q*4 =200
Complete Mock -100Q*2 =200
Total = 880
• Covering all the relevant topics in the shortest possible time
• Reflex development of timing of answering
A Marvelous Class Routine
Unique System Suggestions with Short Notes
Audio Visual Supported Class with FREE Wi-Fi facility
Online help : www.doamsbd.com
– FREE Online Education of Medical topics
– FREE Online Daily MRCP Challenge
– FREE Online FORUM of discussion
• Candidate basket
• Marvelous Class Routine
System Suggestion with Short Notes
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DOAMSmrcp_Suggestion_Cardiology, Nutrition •
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1IHD
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1ACS- CF Nausea, Sweat
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2ACS- Dx, Further Mx Asp-Clop-LMWH
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3ACS- Dx, Mx Angioplasty
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4ACS- Dx, Mx Angioplasty
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5ACS- postSurgery Dx, Mx Aspirin300mg
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6Angina- Further Mx CAG
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7CAD Sequelae-Arterial Embolus from Mural
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Thrombus
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8Chest Pain of IHD Character-Radiation
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9IHD, example of nonAtherosclerosis AR
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10LV aneurysm Dx Mx CCU admission
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11LV aneurysm with VT Dx
12MI Cocain Rx Nitrate
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13MI Cocain Rx Nitrate Infusion
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14MI Investigation Tropn-I
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15MI morbidity not helping Drug- Nifedipin
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16MI involving RCA Dx
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17MI with ATN Dx
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18Papillary rupture Dx
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19RV infarct Dx, Mx IV Fluid load
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1ARRHYTHMIA and PACING
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1Adrenaln dose in Cardiac Arrest -10ml 1-10,000 •
2AF Alcoholic, Mx Lifestyle
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3AF Idiopathic, Mx Warfarin
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4AF paroxysmal, Mx Warfarin
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5AF persistent, Mx Anticoagulation
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6AF post DCCV, Mx Amiodaron
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7AF post DCCV Mx,Aamiodar
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8AF post DCCV Mx, Warfarin
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9AF Rate Control Rx Bisoprolol
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10AF RateControlRx Bisoprolol
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11AF Revert to SinusRhythm if ShortHistory
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12AF Rx Fleicanide
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13AF TIA Dx Mx Anticoagulation
14AF TIA Mx Warfarin
15AF TIA Mx Warfarin
16AF, unstable Dx Mx DC shock
17AF, unstable Dx Mx DC shock
18Conducting pathway not include-Sarcomere
19Heart block Mobitz type1 with RBBB Scenario
20Heart block Rx TPM
21ICD Indication, HOCM-nsVT-recurrent Syncop
22ICD Indication, HOCM-VT-VF
23Jervell-Lange-Nielsen syndrome Gene, KCNQ
24Long QT causing b-blocker, Sotalol
25Long QT causing drug, Erythromycin
26Long QT with drowsiness, DxDiphenhydramine
27Long QT cause, Hypocalcemia
28Long QT cause Hypomagnasemia
29long QT Mx b-blocker, Atenolol
30P asystole Mx TPM cutaneous
31PPM complication- Staph discitis Dx
32PPM Indication, acquired 3rd degree block
33Short QT causing drug Digoxin
34SVT in pregnany prevent, Metoprol
35SVT Rx DC shock
36SVT Rx IV adenosin
37Torsade de pointes Mx IV Mg
38VF VT Mx Amiodaron
39VT Mx not include- Verapamil
40VT Post MI Invest- EPS
41WPWSyn Asymptom Mx- Reassure
42WPWSyn Dx Mx Ablate
43WPWSyn Dx Mx Ablate
1CPR
1ALS further Mx IV amiodar300mg
2BLS Mx-Precord Thump
3PrecordThump Info-Better in PulslessVT than VF
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2MYOCARDIAL DIS
1BNP Info- vasodilator
2CM cause-Selenium deficiency
3CM Hypertensive, finding LVH
4Cor pulmonale Dx, Finding RVH
5DCM Alcoholic, Dx
6DCM cause, Trustazumab
7HF Bad Prognostic, HypoNa
8HF Contra Indication drug, Pioglitazone
9HF drug Rx, Spirolacton-Ramipril-Carvidelol
10HF Dx, Investig- BNP
11HF Furth Mx, Ad ACE-I
12HF Furth Mx, Ad ACE-I
13HF Furth Mx, Ad b block
14HF Furth Mx, Ad Spiron
15HF Mx, Bi Ventricular Pacing
16HF good prgnostic drug, ACE-I
17HF Rx b-blocker
18HF Rx b-blocker
19HF Rx b-blocker
20HF Rx b-blocker
21HF Rx b-blocker Bisoprolol
22HF with Megaloblast anemia, Dx Mx- Bld
Transfus
23HOCM Dx
24HOCM Dx
25HOCM Dx
26HOCM Dx
SOME NOTES:
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• Carotid End Arterectomy
• Carotid endarterectomy has been established as an effective treatment for both
symptomatic patients and asymptomatic patients who are shown to have carotid
artery stenosis. It reduces the risk of disabling stroke or death by 48% in a person
with severe symptomatic carotid stenosis (>70%) who has had a TIA. The perioperative risk of disabling stroke or death is approximately 3%.
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Current UK guidelines recommend endarterectomy for symptomatic patients
with greater than 70% stenosis, based on the North American Symptomatic
Carotid Endarterectomy Trial which showed clear benefit. The endarterectomy
should be performed as soon as the patient is fit for surgery, preferably within
two weeks of a TIA.
• The benefit is marginal for symptomatic patients with 50-69% stenosis, but may
be greater in male patients. NICE recommends these patients are also considered
for endarterectomy. There is significantly less benefit for asymptomatic patients,
even those with greater than 60% stenosis. Patients with less than 50% stenosis
should not be considered for carotid surgery.
• Recurrent stenosis can occur in 1-20% of patients following endarterectomy, and
re-operation is needed in 1-3% of cases. Ipsilateral strokes occur in 9% of patients
following endarterectomy, and 26% of those treated with medical management
alone (within 2 years).
Online- Offline Learning
• Education of Medical topics
• Daily MRCP Challenge/ Picture Challenge
• Discussion FORUM
– Facebook page- DOAMS MRCP Preparation
–Wbst- www.doamsbd.com
–http://challenge.doamsbd.com/
Candidate Basket –Soft Copy
• 3,000 systemwise Question Bank
• Guidelines (Latest)
• Medicine and MRCP Books
– Davidson`s Principles & Practice of Medicine
– Kumar and Clark`s Clinical Medicine
– Harrison`s Principles of Internal Medicine
– Oxford Handbook of Clinical Medicine
– Essential Revision Notes for MRCP by Philip A
Kalra
So DOAMS
Method is Unique
How to Study
Average Memory Retention Rate
Learning tips
How to
memorize well
TPI- Best Way of Memorizing
Total Physical Interaction
Use your ALL the Sensory Apparatus
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Eyes
Ears
Nose
Tongue
Skin
–BRAIN
Chief Instructor
Dr M Osman Gani
MRCP(UK) MRCGP(INT)
Asst Professor, Dept of Medicine
Dhaka Central International Medical College
Dhaka
My Role (As a Coach, NOT the Player)
????????????????
Until Death He was a Teacher
- Dr APJ A Kalam
Thank You