Drug induced CS with proximal myopathy with Underlying SLE, APS?

UK MRCP
#1

Day 4 first round YGN diet 3: 11/10/2018
BCC1
MG with IHD, xanthelesma
BCC 2
Drug induced CS with proximal myopathy with Underlying SLE, APS ??
St1:
Respiration… Rt Ca lung ( I am not sure :thinking:)
Abd… ADPCKD
St3:
CVS… AS, AR ( AR dorminant)
Neuro… difficulty in walking found out to be Lt hemiplegia due to CVA
History…
had sinusitis and seemed to relieved with bug killers and since then having constitutional symptoms and GP found impaired renal function with haematuria and proteinuria … on history rash appeared on arm and leg one month back… seemed to have haemoptysis but I didn’t explore it :frowning: pt concern ( is it serious?? Is it UTI? )… pt doesn’t have neurological symptoms
Wegener’s G… DDx CSS, SLE

Communication…
75 year female with unintentional wt loss 20kg presented with deep jaundice… apart from distended gall bladder there is no other abnl on CT scan… possibilities are Ca pancreas or Cholangiocarcinoma… stent was inserted and task is to explain to pt’s daughter bcos pt couldn’t remember details of her medical conditions… diagnosis of uncertainty… concern is don’t want to let mom know if cancer sure… and was it operable???
Examiners question about ethical principle and further Mx for pt

diagnosis of uncertainty (possible cholangiocarcinoma and Ca pancreas ) explain to pt’s daughter
Concern… don’t want to tell mom if found out to be Ca

Another experience:=
Yangon 11-10-2018
Day 4 Round 1
Station 1:
Right upper lobe fibrosis with dullness at RLZ
I gave differential
Old TB + DDx of dullness at lung base
Abd - J +clubbing+splenomegaly
COL with portal hypertension, DDX CML, chronic malaria
Station 2 :

  • sinusitis+ fever+jt pain+rash+ impaired renal function
    Wegner’s
    DDx APSGN, AB induced interstial nephritis
    St3:
    CNS :
    Rt third cranial nerve palsy,pupil dilated
    I gave surgical cases first
    Examiners also want medical causes
    Other candidate- Left hemiplegia
    CVS:
  • AR AF with peripheral signs, other candidate says AS also +

St 5: BCC1:
outside 30 yr old lady Chest pain off and on 1mth, inside pain was typical cardiac pain, occular MG with known DM 1 yr
On pyridostigmine and OHA, DM control poor
Dx Angina, ACS
BCC2:
weight gain and difficulty in climbing stair
Inside Cushingoid face with past history of SLE
regular taking of prednisolone +
Drug induced Cushing
Consern want to stop steroid and want to have baby