Basic Anatomy in MRCP (I)

Basic Anatomy in MRCP (I)

Anatomy was a hell for me when I was a medical student. There is no trick to be good in anatomy except you have a good memory. Luckily, there are not so many questions about anatomy being asked in MRCP Part 1. I will try to cover basic anatomy in a few posts and I hope the information provided in this blog will be useful for you to answer your MRCP questions.

OK, today I will try to cover the first 6 cranial nerves today and I will try to give you a few popular questions in MRCP.

Refresh your memory first and remember all 12 cranial nerves ,

Nerve I, Olfactory nerve- just remember that it is for smell

Nerve II ( Optic) and Nerve III ( Occulomotor) are important nerves to remember,

There are a few common questions asked in MRCP about these two nerves,

a) Remember that Optic nerve is for vision and you must always remember the visual fields , it is important in your MRCP Part1,2 as well as in MRCP PACES

b) Remember your afferent fiber for your pupillary reflex is your optic nerve and your efferent fiber is Occulomotor ( therefore occulomotor nerve is a parasympathetic fiber)

c) Remember that other components of Occulomotor nerve ( besides its parasympathetic function in constricting pupil) are motor components supplying all extraocular muscles except lateral rectus and superior oblique. It also supplies levator palpebrae superoris.

Therefore, a complete third nerve palsy gives,
i) Dilated pupil (mydriasis)
ii) Ptosis
iii) Deviation of eye laterally and downward ( due to unopposed actions of lateral rectus and superior oblique)

SO…….., one very,very important formula to remember in eye movement is (LR6SO4)3, lateral rectus is supplied by sixth nerve (abducent nerve) and superior oblique is supplied by fourth nerve (Trochlear nerve) and others are supplied by third nerve ( Occulomotor)

You will be surprised that we have learned 5 nerves out of first six cranial nerves, the fifth cranial nerve is trigeminal nerve, just remember that its sensory component supplying the facial sensory dermatomes ( One popular question in MRCP is they will show a patient with shingles over the face and you are expected to know what sensory component of trigeminal nerve is involved!)

New MRCP Sites

New MRCP Sites

For those who are preparing for MRCP Part 1 and 2, I want to recommend you to visit the following sites which are written by Dr Osama Amin. Although I do not know him personally, I think he has done an excellent job to provide FREE information for those who are sitting for MRCP exams. I think he has similar intention as me----hoping that all of you can pass your MRCP if you really study hard!

1) Neurology for MRCP Mocks
2) Neurology for MRCP Blog

Good luck!

Infective Endocarditis in MRCP

Infective Endocarditis in MRCP

Today I would like to discuss about infective endocarditis which is defined as infection of the endothelial surface of the heart. It is a common condition asked in MRCP!A heart valve is always involved but the infection may develop on a septal defect or on the mural endocardium.

Generally, it is useful to classify endocarditis into these three subtypes,

1) Native valve endocarditis- endocarditis develops in native valves. Patients developing native valve endocarditis usually have valvular heart lesion. Common valvular heart lesions that prone patient to get endocarditis include mitral valve lesions ( incompetence and stenosis), aortic valve lesions ( incompetence and stenosis)

2) Endocarditis in Intravenous Drug Abusers- usually IVDUs develop right heart endocarditis ( Tricuspid Valve) due to direct septic emboli to the right heart from peripheral vein.

3) Prosthetic Valve Endocarditis- Endocarditis develops in prosthetic valves. It is easier for you to remember the causative organisms if you divide Prosthetic valve endocarditis into early or late. For early onset Prosthetic valve endocarditis ( onset of symptoms within 2 months post valve replacement), the causative agent is mainly S.epidermidis. Late onset Prosthetic valve endocarditis usually happens post instrumentation in patients with prosthetic valve.

Signs and Symptoms of Infective Endocarditis

Patients may present with fever, lethargy ( may be due to anemia), unexplained weight loss, chest pain, confusion

Always remember about stigmata of infective endocarditis- Janeway lesion ( non- tender), Osler’s nodes (tender), splinter haemorrhages, Roth Spots and petechiae( due to septic emboli)
Splenomegaly
Murmurs
Clubbing
Fever

(A-splinter haemorrhage, B-Conjunctival petechiae, C-Osler's node, D-Janeway's Lesion)

( There is a criteria for you to diagnose Infective Endocarditis known as Durack’s criteria, you do not need to know about the details, however, remember that the two major criteria are positive isolation of organisms from blood culture and evidence of endocardial involvement on ECHO)

Investigations
Full blood count- raised TWC and anemia ( normocystic, normochromic), raised ESR
Haematuria may be present in 50% of cases
Blood culture ( remember that you may need CO2 culture for fastidious HACEK organisms-Haemophilus, Actinobacillus,Cardiobacterium,Eikenella and Kingella)

Complications
Mainly due to septic emboli- the emboli can go to brain, spleen, liver, lung leading to abscess formation. In the heart, infective endocarditis can cause valvular failure, heart block and prosthesis failure!

Treatment
Prolonged IV antibiotics ( up to 4-6 weeks) , usually combination of IV penicillin + gentamycin.
Surgery is indicated if development of fungal endocarditis, valve dehiscence, heart block, valve ring abscesses, failure of medical treatment!


Tips for MRCP
1) Remember patients with what valvular heart lesions need antibiotics prophylaxis before invasive procedures. Click here to find out more!

2) Remember what do you mean by invasive procedures, click here to learn more!

Happy New Year 2007!

Happy New Year to MRCP Blog Readers !!

Hi, Happy New Year to all and for those who are sitting MRCP soon, good luck! I would like to wish all of you " Happy New Year" and hope that 2007 will be a wonderful year for everyone. I started MRCP Part 1 and 2 blog 6 months ago and I really like to thank all of you for reading this blog.



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Thanks

PassMRCP