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02/11/2026

!

Your journey towards clinical excellence just got more affordable! 🩺

Get an exclusive 50% OFF on ALL COURSES at MedMonarchy!

📚 Choose your course:
✅ MRCP Part 1
✅ MRCP Part 2
✅ Road to PACES

🎁 Use Promo Code: NOVEMBER50

⏳ Offer valid until 15th November. Don't miss this opportunity to take your medical career to the next level!

PACE YOUR PACES AT YOUR OWN PACE
📚 A Well-curated Course with a model Template for each scenario

Selection your Flexible Plan_ : 3/6/9/12 months subscription

ROAD TO PACES (All PREVIOUS CLASS DASHBOARD):
https://medmonarchy.com/courses/details/e1e2b18e/

ROAD TO PACES (UK & IRELAND)-COMPLETE COURSE: https://medmonarchy.com/courses/details/a6ed06c3/

COMMUNICATION INTENSIVE COURSE: https://medmonarchy.com/courses/details/e8a4b6b3/

ROAD MAP FOR LCC: https://medmonarchy.com/courses/details/adf63f2a/

RECENT TOP 50 PACES CASES (LCC & COMMUNICATION): https://medmonarchy.com/courses/details/711c1d90/

CLINICAL CORE-4 (All 4 short cases): https://medmonarchy.com/courses/details/3c2c9077/

ROAD TO MRCP PART-1 COURSE (9000 Pearl):
https://medmonarchy.com/courses/details/ad30db9f/

PAST PAPER Q SOLVE CLASS COURSE (PART-1): https://medmonarchy.com/courses/details/fbe3cfdd/

ROAD TO MRCP PART-2 COURSE (7200 Pearls):
https://medmonarchy.com/courses/details/4b0b862c/

🌏 To explore more, visit: https://www.medmonarchy.com/
📲 WhatsApp: +447459416899

Thanks and Regards,
MEDMONARCHY TEAM

02/11/2026

🎉 NOVEMBER FLASH DEAL IS HERE!

Your journey towards clinical excellence just got more affordable! 🩺

Get an exclusive 50% OFF on ALL COURSES at MedMonarchy!

📚 Choose your course:
✅ MRCP Part 1
✅ MRCP Part 2
✅ Road to PACES

🎁 Use Promo Code: NOVEMBER50

⏳ Offer valid until 15th November. Don't miss this opportunity to take your medical career to the next level!

PACE YOUR PACES AT YOUR OWN PACE
📚 A Well-curated Course with a model Template for each scenario

Selection your Flexible Plan_ : 3/6/9/12 months subscription

ROAD TO PACES (All PREVIOUS CLASS DASHBOARD):
https://medmonarchy.com/courses/details/e1e2b18e/

ROAD TO PACES (UK & IRELAND)-COMPLETE COURSE: https://medmonarchy.com/courses/details/a6ed06c3/

COMMUNICATION INTENSIVE COURSE: https://medmonarchy.com/courses/details/e8a4b6b3/

ROAD MAP FOR LCC: https://medmonarchy.com/courses/details/adf63f2a/

RECENT TOP 50 PACES CASES (LCC & COMMUNICATION): https://medmonarchy.com/courses/details/711c1d90/

CLINICAL CORE-4 (All 4 short cases): https://medmonarchy.com/courses/details/3c2c9077/

ROAD TO MRCP PART-1 COURSE (9000 Pearl):
https://medmonarchy.com/courses/details/ad30db9f/

PAST PAPER Q SOLVE CLASS COURSE (PART-1): https://medmonarchy.com/courses/details/fbe3cfdd/

ROAD TO MRCP PART-2 COURSE (7200 Pearls):
https://medmonarchy.com/courses/details/4b0b862c/

🌏 To explore more, visit: https://www.medmonarchy.com/
📲 WhatsApp: +447459416899

Thanks and Regards,
MEDMONARCHY TEAM

31/10/2026

A 34-year-old woman presents to the Rheumatology Clinic for review. She has rheumatoid arthritis (RA) and
plans to become pregnant. In advance of trying for a baby, the plan is to switch her disease-modifying
antirheumatic drug (DMARD) to azathioprine.

What is the most important investigation to conduct in this patient, prior to switching medications?

A. Chest X-ray (CXR)

B. Echocardiogram (ECHO)

C. Lung function tests

D. Thyroid function tests (TFTs)

E. Thiopurine methyltransferase (TPMT) activity

28/10/2026

A 64-year-old man comes to the Cardiology Clinic for review. He complains of shortness of breath on minimal
exertion and can only climb the stairs once a day. He suffered from an anterior myocardial infarction (MI) four
years ago. He is treated with 10 mg bisoprolol, 10 mg ramipril and 40 mg furosemide for his cardiac failure.
On examination, his blood pressure is 135/85 mmHg while his pulse is 72 bpm and regular. His chest is clear
on auscultation and there is minor pitting oedema of both ankles.

Investigations:

1\. Haemoglobin (Hb)

- Result: 112 g/l
- Normal value: 135–175 g/l

2\. White cell count (WCC)

- Result: 7.1 × 10⁹/l
- Normal value: 4.0–11.0 × 10⁹/l

3\. Platelets (PLT)

- Result: 303 × 10⁹/l
- Normal value: 150–400 × 10⁹/l

4\. Sodium (Na⁺)

- Result: 144 mmol/l
- Normal value: 135–145 mmol/l

5\. Potassium (K⁺)

- Result: 5.1 mmol/l
- Normal value: 3.5–5.0 mmol/l

6\. Creatinine (Cr)

- Result: 197 μmol/l
- Normal value: 50–120 μmol/l

7\. Ejection fraction

- Result: 30%
- Normal value: > 55%

What is the most appropriate next step in this patient’s treatment?

A. Commence digoxin

B. Commence ivabradine

C. Commence spironolactone

D. Substitute ramipril with valsartan/sacubitril

E. Substitute bisoprolol with amlodipine

27/10/2026

A 42-year-old woman is referred to the Rheumatology Clinic by her General Practitioner with dysphagia,
reflux oesophagitis, Raynaud's phenomenon and cutaneous ulcers on both of her shins. She has also
experienced a progressive decrease in her exercise tolerance over the last few months.
On examination, her blood pressure is 149/88 mmHg while her pulse is 82 bpm and regular. Examination of
her hands reveals peripheral calcinosis and sclerodactyly. Examination of her face reveals microstomia and
multiple telangiectasias. An autoantibody screen is positive for anti-Scl70 antibodies.

What is the most likely diagnosis?

A. Dermatomyositis (DM)

B. Granulomatosis with polyangiitis (GPA)

C. Mixed connective tissue disease (MCTD)

D. Systemic lupus erythematosus (SLE)

E. Systemic sclerosis (SS)

24/10/2026

A 78-year-old woman presents to the Emergency Department having been unable to stand after a plane
journey home from a holiday in Egypt. She had been unwell for the past three days with diarrhoea and found
it difficult to keep up with her fluids.
On examination, her blood pressure is 135/72 mmHg while her pulse is 72 bpm and regular. Her heart
sounds are normal and her chest is clear. Neurological examination of the upper limbs is unremarkable, as is
cranial nerve examination. Lower limb power is reduced, with 1/5 power bilaterally and reduced tone. Fine
touch, joint position sense and vibration sense are intact, while knee and ankle jerk reflexes are decreased.
Pinprick and temperature sensations are reduced in both lower limbs. A**l tone and sensation are normal.

Investigations:
1. Haemoglobin (Hb)
Result: 112 g/l
Normal value: 115–155 g/l

2. White cell count (WCC)
Result: 9.1 × 10⁹/l
Normal value: 4.0–11.0 × 10⁹/l

3. Platelets (PLT)
Result: 382 × 10⁹/l
Normal value: 150–400 × 10⁹/l

4. Sodium (Na⁺)
Result: 144 mmol/l
Normal value: 135–145 mmol/l

5. Potassium (K⁺)
Result: 3.9 mmol/l
Normal value: 3.5–5.0 mmol/l

6. Creatinine (Cr)
Result: 149 μmol/l
Normal value: 50–120 μmol/l

7. Magnetic resonance imaging (MRI) — cervical and thoracic spine
Result: Short segment of abnormal T2 signal at T7–8, with surrounding oedema. On axial imaging, there is an ‘owl eye’ appearance.

What is the most likely diagnosis?

A. Anterior spinal artery infarction

B. Aortic dissection

C. Epidural haematoma

D. Guillain–Barré syndrome

E. Transverse myelitis

22/10/2026

A 51-year-old man is referred to the Respiratory Clinic after a third episode of left lower lobe pneumonia. He
is a non-smoker and has suffered from recurrent respiratory tract infections on multiple occasions since
childhood. He is married and have two children.
On examination, he is apyrexial. His blood pressure is 123/80 mmHg while his pulse is 78 bpm and regular.
There are crackles at the left base on auscultation.

Investigations:

1. Haemoglobin (Hb)
Result: 141 g/l
Normal value: 135–175 g/l

2. White cell count (WCC)
Result: 7.1 × 10⁹/l
Normal value: 4.0–11.0 × 10⁹/l

3. Platelets (PLT)
Result: 302 × 10⁹/l
Normal value: 150–400 × 10⁹/l

4. Sodium (Na⁺)
Result: 144 mmol/l
Normal value: 135–145 mmol/l

5. Potassium (K⁺)
Result: 4.9 mmol/l
Normal value: 3.5–5.0 mmol/l

6. Creatinine (Cr)
Result: 112 μmol/l
Normal value: 50–120 μmol/l

7. C-reactive protein (CRP)
Result: 28 mg/l
Normal value: < 10 mg/l

What is the most likely diagnosis?

A. Bronchioloalveolar carcinoma of the bronchus

B. Bronchiectasis

C. Bronchial carcinoid

D. Cystic fibrosis

E. Hiatus hernia

18/10/2026

A 45-year-old woman is reviewed in the Endocrinology Clinic prior to surgery to remove a pituitary adenoma.
She presented to her General Practitioner a few weeks ago with hypertension, diabetes mellitus and changes
in her facial appearance, including prognathism and macroglossia.
On examination, her blood pressure in the clinic is 165/102 mmHg while her pulse is 84 bpm and regular. Her
body mass index is 23 kg/m .

Investigations:

1. Haemoglobin (Hb)
- Result: 120 g/l
- Normal value: 115–155 g/l

2. White cell count (WCC)
- Result: 7.2 × 10⁹/l
- Normal value: 4.0–11.0 × 10⁹/l

3. Platelets (PLT)
- Result: 199 × 10⁹/l
- Normal value: 150–400 × 10⁹/l

4. Sodium (Na⁺)
- Result: 142 mmol/l
- Normal value: 135–145 mmol/l

5. Potassium (K⁺)
- Result: 4.1 mmol/l
- Normal value: 3.5–5.0 mmol/l

6. Creatinine (Cr)
- Result: 110 µmol/l
- Normal value: 50–120 µmol/l

7. Glucose
- Result: 13.1 mmol/l
- Normal value: < 7 mmol/l

8. Insulin-like growth factor 1 (IGF-1)
- Result: 205 nmol/l
- Normal value: 11.3–29.1 nmol/l

What is the most appropriate treatment to provide this patient prior to surgery?

A. Cabergoline

B. Domperidone

C. Liraglutide

D. Octreotide

E. Phenoxybenzamine

Address

Gibson House (1st Floor) Northwest Associates Ltd, 800 High Road
Dhaka
N170DH

Telephone

+8801979411927

Website

http://www.Medmonarchy.com/

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