August 08, 2010

West African College of Physicians (WACP) Calender Of Events For The Year 2010

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WACP CALENDER 2010

The West African College of Physicians (WACP) has announced its complete Calender Of Events for the year 2010. All fellows and associate members are to take note and inform their centers. You are encouraged to spread the information far and wide.

August 07, 2010

Deep brain stimulation show promising results for Alzheimer's disease

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Stereotactic apparatus used to insert an elect...
Apparatus for DBS; Image via Wikipedia
In a world first, Dr. Andres M. Lozano and his team at Toronto Western Hospital has shown using Deep Brain Stimulation (DBS) on patients with early signs of Alzheimer‘s disease is safe and may help improve memory.

The phase one safety trial of six Ontario patients took place from 2005 to 2008. All patients left hospital within 2 to 3 days of surgery, and continue to participate in regular follow-up cognitive assessments.

Throughout these assessments, Dr. Lozano says half the patients continue to perform better than predicted - that is - their memory capacity has improved, or deteriorated less than expected.

"While the study was not looking for efficacy, the results suggest that of the six patients, three may have done better than if the Alzheimer‘s disease was allowed to run its course," commented Lozano.

"We showed that not only is this a safe procedure, but that the evidence is there to warrant a bigger trial. Any amount of time that extends quality of life and quality years to someone with Alzheimer‘s may be a benefit."

Dr. Lozano first discovered the potential for DBS to treat Alzheimer‘s disease while treating a patient for obesity using DBS back in 2003.

While signaling areas of the brain, Dr. Lozano and his team triggered memories in the patient. In follow-up testing the patient‘s memory improved and Dr. Lozano set in motion the first ever DBS trial of patients with early signs of Alzheimer‘s disease.

”We‘ve demonstrated this is safe, and that the evidence warrants more study. We‘re now planning a phase two, multi-centred trial - we‘re just waiting on the funding,” says Dr. Lozano.

Interested in more information about participating in the next phase?
Visit: http://www.uhn.on.ca/Focus_of_Care/KNC/Functional_Neurosurgery/research.asp (interested applicants can print and fax in the form).
Contact: Fiona Hill; Fiona.hill@uhn.on.ca; 416-603-5323; University Health Network

August 03, 2010

GMC Acceptable Postgraduate Qualifications

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The General Medical Council (GMC) is the UK's independent body concerned with regulating doctors, and ensuring good medical practice in the UK. Its primary role and purpose is to protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine in the UK.

The Royal College of Physicians (RCP) and West African College of Physicians (WACP) Partnership

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The RCP and WACP

Supporting medical practice and educational opportunities in West Africa

The role of the RCP: strengthening partners
The RCP is supporting the needs of physicians in the region by partnering with the West African College of Physicians (WACP) in a joint effort to improve standards of training in West Africa. The two colleges signed a formal agreement in 2008 to work in partnership towards this objective, which will contribute to the broader aim of the advancement of medicine, and the improvement of patient care in the region.

Our partnership focuses on strengthening the capacity of the WACP to train the physicians of the future in two main areas: medical education and clinical sub-specialty training. This is being done through the WACP/RCP collaboration programme for educational capacity building launched in 2009, a three year project working with the countries with WACP membership: Nigeria, Ghana, The Gambia, Sierra Leone, Liberia, Cote d'Ivoire and Senegal.

Activities include:

Faculty Development
Using the RCP expertise in training physicians as educators, we are training a WACP Faculty to deliver educational workshops for doctors and other healthcare professionals. Through this activity the WACP fellows (with teaching responsibilities) will be trained to further develop their teaching skills, and to structure a new education faculty within their College.

Clinical training
This activity has two main components:

Future clinical leaders
A number of doctors will be trained in sub-specialty areas identified as urgent priorities by the WACP. These doctors, in the formative years of their careers, will receive focused sub-specialty training in the UK for three month periods.

Visiting UK Specialists
Two-week teaching visits by leading clinicians from the UK to West African centres to demonstrate advances in their areas, appropriate for adoption in West Africa.
Both components will open opportunities for clinical training and foster links between centres of excellence in West Africa and the UK.

Learning resources
We are reinforcing the available resources for trainees in academic centres in the region. We are providing the WACP accredited teaching institutions with Medical Masterclass Institutional Premier packages, the main RCP's distance-learning resource.

Joint scientific meeting
A joint conference to bring the officers and staff of the Colleges together, along with Fellows and Members, to share knowledge and expertise, celebrate success and plan future collaboration. The conference will take place in The Gambia in November 2011.

This program is supported by an unrestricted grant from Pfizer Inc.

Source: RCP website

MRCP 2 Question 20

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Mike comes into the office complaining of pain in his chest that comes and goes when he is emotionally distressed. Mike is 55 years old with an intracranial tumor.

Further review of the ECG reveals a 2nd degree heart block.

What is the best treatment for this patient:

a) Nitroglycerin
b) Propranolol
c) Nifedipine
d) Verapamil
e) None of the above







ANSWER
The correct answer is C

Explanation

Mike has a list of problems. First he has an intracranial tumor. Second, he is complaining of chest pains that occurs when emotionally disturbed. This is a typical sign of variant angina, also known as prizemetal angina. He also has a 2nd degree heart block.

Therefore, the list of the problems that Mike has are is as follows: 1. Variant angina; 2. Intracranial tumor; 3. 2nd degree heart block.

When dealing with angina we have to understand the cause of the underlying problem. Basically, angina is pain in the chest which is referred pain from the heart. It is a result of decrease in oxygen supply to the heart.

In exertional angina, the heart is putting in a lot of work and it requires more oxygen than what it's supplied with. When looking at the coronary arteries, one will find atherosclerotic plaques covering the intima of these vessels.

In variant angina, the coronary vessels are spastic. The spasticity is triggered by an emotional stress.
Atherosclerosis is not directly related to variant angina.

To treat each of these two problems we have two different approaches.

To treat variant angina we have to relax the coronary vessels. We can use nitroglycerin, but it would be of no good to Mike. Mike has an intracranial tumor. Nitroglycerin increases intracranial pressure, thus making Mike's life more miserable.

We can also use Beta blockers or verapamil, a calcium channel blocker. This is not true in Mike's situation because he has a 2nd degree heart block. Both will agrevate it.

We can use nifedipine. This is because it has an action on calcium channels of arteries more than on the heart. It has negligible effect on the heart. So it vasodilates Mike's coronary vessels without aggravating any of his existing problems.

Therefore, the correct is answer is choise C.

MRCP 2 Question 19

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A 24 year old following her PhD in chemistry is working in a laboratory when a mercury-containing solvent was accidentally spilled over her desk top. She inhaled the vapour.

She started coughing and soon after was severely nauseated .She was urgently admitted to the emergency department complaining of a tight feeling in her chest, and having difficulty with breathing.

Which is the best drug treatment for mercury poisoning?

a) penicillamine
b) hydrocortisone
c) subcutaneous adrenalin
d) glyceryltrinitrate
e) cephalosporin







ANSWER
The correct answer is A

Explanation

Penicillamine is also indicated for the treatment of copper, arsenic, lead and zinc poisoning, Wilson's disease and cystinuria

Mercury may still be an occupational hazard for people working in medical care facilities. If mercury vapor is inhaled , as much as 80 percent of the inhaled mercury may be absorbed into the bloodstream.

The biological half-life of mercury is 60 days. Thus,the body burden will remain for at least a few months.

Very high exposures to mercury vapor in the air can cause acute poisoning as in this case. An outcome may be pneumonia, which can be fatal.

August 02, 2010

MRCP 2 Question 18

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A comparison of norepinephrine and phenylephrine shows that, when given at therapeutic doses both can:

a) Decrease skin blood flow
b) Stimulate liver gluconeogenesis
c) Cause reflex tachycardia
d) Relax pregnant uterus
e) Increase A-V conduction








ANSWER
The correct answer is A

Explanation

Norepinephrine works on alpha-1 and 2 and beta-1 receptors. Phenylephrine works on alpha-1 only.

Stimulation of liver gluconeogenesis is activated by Beta-2. Reflex tachycardia is elicited by blocking alpha-1. Relaxation of pregnant uterus is achieved by activation of Beta-2. Increase of A-V conduction is accomplished by activation of Beta-1.

As we notice these are functions that are not in common to both drugs.

On the other hand decrease in skin blood flow is an alpha-1 function. This is an action that is done by both drugs.

This makes choice A the correct answer

MRCP 2 Question 17

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Most likely diagnosis:

a) pulmonary embolism
b) early repolarization
c) acute pericarditis
d) acute myocardial infarction
e) Myocarditis






ANSWER
The correct answer is B


Explanation

One must be able to distinguish acute pericarditis from normal early repolarization. This pattern is most common in teenage boys and men in their 20s.

These individuals differ from pericarditis patients in that the clinical syndrome of pain and dyspnea is absent, PR-segment depression is present in some patients but uncommon, and, most important, the ECG does not, over time, evolve a pattern of return of the ST segment to baseline followed by T-wave inversion


Image above shows single electrocardiographic complexes comparing (left) acute pericarditis, (center) early repolarization and (right) injury pattern of acute myocardial infarction. Note the degree of ST-segment elevation is greater in the pericarditis complex than in the early repolarization complex.

Important findings of acute infarction include the presence of Q waves and a more convex upward ST segment, both of which are present in the right complex.

MRCP 2 Question 16

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a) acute extradural hematoma
b) sub-acute acute extradural hematoma
c) acute subarachnoid hematoma
d) subacute subdural hematoma
e) acute subdural hematoma






ANSWER
The correct answer is D


Explanation

Subdural hematomas which become symptomatic between 3 days and 3 weeks after initial injury are considered subacute.

Compared to the normal brain parenchyma, subacute subdural hematomas appear isodense to low density.

These collections may be subtle, especially if they are bilateral.

Medial displacement of the gray-white matter interface is an important finding to identify.