MCQS for MRCGP BenGreen

MCQs for MRCGP:

MCQs for MRCGP Dr M N Ahmed GP Race View Hospital Nov 2007

MCQs for MRCGP:

MCQs for MRCGP Q 1:Congenital virus infections include: HIV T/F Cytomegalovirus T/F Varicella Zoster T/F Hepatitis B T/F Rubella T/F

MCQS:

MCQS Answer 1: All true

MCQs for MRCGP:

MCQs for MRCGP Q 2: Huntington chorea Is linked to chromosome 5 T/F Is an autosome recessive disorder T/F Can produce a psychosis T/F May involve truncal movements T/F Can occur in childhood T/F

MCQS:

MCQS Answer 2: False. Huntingtons chorea was mapped on the short arm of chromosome 4 False. Autosomal dominant disorder True True True-typically the illness presents in middle adulthood,but an akinetic Parkinsonian-like picture can present in childhood

MCQs for MRCGP:

MCQs for MRCGP Q 3 : Diabetic neuropathies may cause Diarrhoea alternating with severe constipation T/F Gastric paresis T/F Gustatory sweating T/F Diffuse muscle weakness T/F Erectile dysfunction in males T/F

MCQS:

MCQS Answer 3: All true. Gustatory sweating is severe sweating over face & shoulders during meals. The diffuse muscle weakness is caused by a diffuse motor neuropathy. Erectile dysfunction is caused by 3 factors: neurological damage, arterial damage in pudandal vessels and a psychological input. Other neuropathies cause bladder paresis, postural hypotension, CTS (carpal tunnel syndrome) 3 rd cranial nerve palsy, and insidious sensory neuropathy

MCQs for MRCGP:

MCQs for MRCGP Q 4 Criteria for skull X Ray examination after head injury include Neurological symptoms T/F Blood from the nose T/F Scalp bruising T/F Amnesia at anytime T/F Loss of consciousness at any time T/F

MCQS:

MCQS Answers 4 All true. Blood or CSF from the ear or nose are ominous signs. If disorientation follows a head injury, with or without a skull #,then an early CT scan is advisable, for the risk of intracranial haemotoma is greatly increased by this. For instance, risk of haemotoma in head injury without # is 1/5983,but in diorientated individuals rises to 1/121.In oriented patients with a #,the risk of haematoma is 1/32,but in disorientated patients with skull # the risk is ¼ raised to power 18

MCQs for MRCGP:

MCQs for MRCGP Q 5: Well recognised causes of uveitis include Tuberculosis Sarcoidosis Diabetes Mellitus Multiple sclerosis Reiter disease

MCQS:

MCQS Answer 5 True True False False True Uveitis is an inflammation of the uvea, the pigmented part of of the eye-including the iris, ciliary body & choroid

MCQs for MRCGP:

MCQs for MRCGP Q6:In the diagnosis and management of migraines Headaches which occur every day are unlikely to be migraine Females are about 5 times as likely to suffer from migraine than males Numbness or tingling with ergotamine usually stops without stopping the treatment Methysergide may cause pericardial,pleural and retroperitoneal fibrosis Recognised side effects of pizotifen include weight loss

MCQS:

MCQS Answer 6 : False: migrainous headaches may last several days, but there should be pain free intervals in between attacks False : females are more likely to be affected than males, but only in a ratio 3:2 False :ergotamine must be stopped immediately if sensory symptoms developas gangrene may ensue otherwise True False : pizotifen may cause weight gain

MCQs for MRCGP:

MCQs for MRCGP Q7: In alopecia areata Bald areas show scaling hyperkeratotic lesions T/F Males & females are equally affected T/F There may be an underlying autoimmune disease T/F Exclamation mark hairs are characteristic T/F Any regrowth of hair often lacks pigment

MCQS:

MCQS Answer 7: False. In alopecia areata bald areas usually show normal skin True True. It is not an auto immune disease per se but may occur with autoimmune diseases such as thyroid disorders & SLE True True

MCQs for MRCGP:

MCQs for MRCGP Q 8: In gout During attacks serum uric acid levels are invariably elevated T/F Alcohol causes hyperurecaemia by reducing renal urate excretion T/F Attacks usually last 3 to 4 weeks T/F In an acute attack, treatment may include NSAID & a hypouricaemic agent T/F Colchicine is an effective treatment in an acute attack

MCQS:

MCQS Answer 8: False. The serum uric acid level is not necessarily elevated in an attack of gout-indeed a falling level may precipitate an attack True False. Attacks usually last less than 10 days False. A hypouricaemic agent may precipitate a further attack, or prolong the current one, so it is not prescribed for acute attacks True

MCQs for MRCGP:

MCQs for MRCGP Q 9:In Sarcoidosis Elevated levels of serum Angiotensin -Converting enzyme (SACE) are pathognomic T/F The prognosis of acute-onset sarcoidosis is often excellent T/F Erythema nodosum often occurs T/F Steroid therapy can modify the long-term course of chronic disease T/F Uveitis is a common ocular manifestation T/F

MCQs:

MCQs Answer 9 False. Elevated levels of ACE can occur in miliary tuberculosis and silicosis True True False. Steroid therapy has not been shown to affect the long-term outcome True

MCQs for MRCGP:

MCQs for MRCGP Q 10: Nausea & vomiting in palliative care may be Managed with haloperidol T/F Caused by morphine T/F Caused by hypocalcaemia T/F Caused by intracerebral metastasis T/F Managed by rectal metoclopramide T/F

MCQs:

MCQs Answer 10 True. Haloperidol is a dopamine blocker & acts at the chemoreceptor trigger zone True. Nausea caused by morphine may sometimes wear off in 10 days or so, but metoclopramide can be used to control any morphine induced nausea. However, there are risks of extrapyramidal side-effects, including tardive dyskinesia False. Hypercalcaemia , rather than hypocalcaemia can cause nausea True False.Cyclizine & domperidone can be given rectally, not metoclopramide

MCQs for MRCGP:

MCQs for MRCGP Q 11 Acute tonsillitis Peaks at age of 12-14 T/F May be complicated by quincy T/F Is usually caused by an ECHO virus T/F Can be a presenting feature of agranulocytosis T/F Caused by Epstein –Barr virus may be accompanied by respiratory obstruction T/F

MCQs:

MCQs Answer 11 False. Acute tonsillitis occurs in two age related peaks, one at 5 years, and another around 10 years True False. Haemolytic Streptococci cause about 50% of cases whereas ECHO viruses cause only 1% True True

MCQs for MRCGP:

MCQs for MRCGP Q12 :In schizophrenia Delusions occur in the minority of patients There is often a deterioration from a previous level of functioning Visual hallucinations are very rare A delusional perception is a first-rank symptom 40% of first-time patients will require long-term hospitalisation

MCQs:

MCQs Answer 12 False. Delusions occur in the majority of patients True False. Visual hallucinations occur in about 30% of people True False. The recent proportion of first-time patients that eventually require long-term care is 10-20%.50% of first-time admissions for schizophrenia have a good outcome at 5 years

MCQs for MRCGP:

MCQs for MRCGP Q13: In diagnosing & treating Asthma The bronchodilator reversibility test is positive if there is an improvement of 5% in the Peak Flow T/F Only 28% Oxygen should be used in an acute severe asthmatic attack T/F Inhaled steroids &cromoglycate have a synergistic effect T/F Absence of wheeze is always a good sign in an attack of asthma T/F Patients with occupational asthma should be referred to a chest physician T/F

MCQs:

MCQs Answer 13 False. An improvement of 15% on PF is necessary for diagnosing asthma in the bronchodilator reversibility test. False. High flow Oxygen (40-60%)is required in acute severe asthma. Low concentration O2 is reserved for patients with ventilatory failure due to COPD( 24-28% max) to prevent worsening of CO2 retention False False. In severe, life threatening attack, there may be no wheeze. Indeed a silent chest is an ominous sign True

MCQs for MRCGP:

MCQs for MRCGP Q 14: Inguinal hernias: Occur at any age When direct, usually descend into the scrotum If indirect, can be controlled after reduction by pressure over the internal inguinal ring Are less common than femoral hernias in women Appear below & lateral to the pubic tubercle

Anatomy Inguinal, femoral hernias:

Anatomy Inguinal, femoral hernias

MCQs:

MCQs Answer 14 True False. A direct inguinal hernia may cause a sac to appear medial to the inferior epigastric artery and outside the spermatic cord. An indirect inguinal hernia begins at the internal inguinal ring ,is inside the spermatic cord and therefore usually descends into the scrotum True. See explanation above False. Inguinal hernias occur more commonly than femoral hernias in both sexes, but the femoral kind more commonly in women than men False: Femoral hernias appear below & lateral to the tubercle

MCQs for MRCGP:

MCQs for MRCGP Q 15: Kawasaki Syndrome Predominantly affects the elderly T/F Presents with an insidious low grade pyrexia T/F May produce palmar desquamation T/F May be complicated by coronary arteritis & aneurysm formation T/F May be treated with gamma globulins T/F

MCQs:

MCQs Kawasaki disease

Slide 33:

Kawasaki disease rash

MCQs:

MCQs Answer 15 False. Most patients are below the age of 5 & present with an abrupt high fever with injected conjunctivae, reddened mucosae & a strawberry tongue False-abrupt high fever (retrovirus) True. There is erythema and swelling of the hands & feet and subsequent desquamation. There is a morbilliform rash and cervicl lymphadenopathy True. A myocarditis & aneurysms of the coronary arteries may follow True. Human normal immunoglobin (HNIG)

MCQs for MRCGP:

MCQs for MRCGP Q16: Enzyme induction occurs with Phenylbutazone Phenytoin Griseofulvin Barbiturates Rifampicin

MCQs:

MCQs Answer 16 All true. Many drugs are metabolised in the liver.Induction of the hepatic microsomal enzyme system by one drug can gradually increase the rate of metabolism of another->lower plasma concentrations and a reduced effect.On withdrawal of the inducer, plasma concentrations increase, and toxicity may occur. Drugs affected include warfarin and the oral contraceptives

MCQs for MRCGP:

MCQs for MRCGP Q 17:In Psychiatry Thought control occurs in OCD (Obsessive compulsive disorder) T/F OCD is characterised by recurrent obsessive thoughts & compulsive acts T/F The peaks in incidence are in childhood and middle age T/F 50% of cases suffer a deteriorating course T/F As many as 30% of severe depressives present with obssessional symptoms T/F

MCQs:

MCQs Answer 17 False. Thought control, insertion, withdrawal and broadcast are associated with schizophrenia True. Characteristic features False. The peaks in incidence are adolescence & early adulthood. The lifetime prevalence is 2-3% False.15% suffer a deteriorating course,& these patients are more likely to be men with an early age of onset True. Primary depressive disorder is an important differential diagnosis

MCQs for MRCGP:

MCQs for MRCGP Q18:In forensic medicine,” legal auomatisms” include Hypoglycaemia Nightmares Involuntary intoxication Hypnotic trance Epilepsy

MCQs:

MCQs Answer 18 True False True True True Medical automatisms are usually ictal or peri-ictal; legal automatisms essentially form defences based upon impaired consciousness. All medical automatisms are legal ones, but not all “legal automatisms” are medical ones. Others include hysterical dissociation and post-head-injury concussion

MCQs for MRCGP:

MCQs for MRCGP Q 19:In epidemiology Infant mortality relates to deaths under 1 year of age Perinatal mortality includes deaths between 1 week & 1 month of birth Stillbirth is when a fetus is born dead at term Maternal mortality is defined as death while pregnant or within 42 days of termination of pregnancy Higher mortality rates occur in social class V compared with social class I

MCQs:

MCQs Answer 19 True. Infant mortality rate is the no. of deaths per year under 1 year of age per thousand live births,including the neonatal deaths False. Perinatal death is defined as the sum of still births & neonatal deaths within the 1 st week of life False: Legally (In England & Wales) definition of stillbirth is a foetus delivered after the 24 th week of gestation with no sign of life after complete expulsion True. Figures can be represented by a rate per/1000 live births, per1000 total births- or per 1000 pregnancies, which includes abortions & ectopic pregnanacies True

MCQs for MRCGP:

MCQs for MRCGP Q 20: The following cognitive defects deficits can occur in Alzheimer’s dementia Dyscalculia Early long-term memory deficits Word finding difficulties Visual agnosia Receptive dysphasia

MCQs:

MCQs Answer 20: True. Dyscalculia is an inability to calculate False. Early memory deficits tend to be short-term, because of an inability to learn new information. Long-term defects do occur later in the disease True. Tested by showing objects like pen/watch/table True. Visual agnosia is the inability to understand the meaning of visual stimuli, despite apparently normal vision. There is loss of recognition of visual percepts True-characterised by trouble understanding what has been said to them eg 3 sentence command with no non-verbal communication

MCQs for MRCGP:

MCQs for MRCGP Q 21: Features of bulimia nervosa include Binge eating Callouses over knuckles Swollen salivary glands Purgative abuse Characteristically associated with severe weight loss

MCQs:

MCQs Answer 21 True. With associated feelings of loss of control & intense guilt True. From scraping against incisors when inducing vomiting True-particularly the parotids True. Laxative abuse and self induced vomiting ma relieve feelings of guilt False. Weight is usually within normal limits, unlike anorexia nervosa where a BMI is < 17.5

MCQs for MRCGP:

MCQs for MRCGP Q 22:Pityriasis rosea Occurs more in the elderly Is a dermatophytic fungal infection The herald patch is found most on the face Lesions are usually intensely itchy Lesions often have their long axis in alignment

MCQs:

MCQs Pityriasis rosea

Slide 49:

Pityriasis rosea chest

MCQs:

MCQs Answer 22 False. Pityriasis rosea is usually found in young adults False. The exact cause is unknown, though it is thought that this essentially non-contagious condition is set off by a virus False. The herald patch is nearly always on the trunk False. Not commonly itchy True.The rash often sweeps out from the middle of the body, and its shape resembles drooping pine tree branches

MCQs for MRCGP:

MCQs for MRCGP Q 23 In dermatology The rash of hand, foot and mouth disease is usually caused by a parvo virus Viral warts may show the Koebner phenomenon Erythema nodosum may be produced by sulphonamides Lichen simplex lesions demonstrate Wickham’s striae The itch of scabies may persist after the infestation has cleared

MCQs:

MCQs Answer 23: False. The most common cause of this highly contagious disease is Coxsackie virus infection True. Also called the isomorphic response, also occurs in lichen planus, molluscum contagiousum, psoriasis, lichen nitidus, and systemic form of juvenile Rheumatoid arthritis True.Eythema nodosum is a skin inflammation resulting in reddish, painful tender lumps, most commonly on the shins.Other associations IBD, post streptoccocal throat infection, pill,sarcoidosis,infectious mononeucleosis False: Wicham’s striae are white streaks,seen in lesions of lichen planus True.

Slide 53:

Erythema nodosum

Slide 54:

Lichen planus buccal

MCQs for MRCGP:

MCQs for MRCGP Q 24:In the lower limb The Achilles tendon most commonly ruptures at the tendon’s insertion at the calcane Thompson’s test detects Achilles tendon rupture The pain of plantar fasciitis is especially severe on weight bearing after a prolonged rest The 3 rd metatarsal is most commonly involved in a march fracture

MCQs:

MCQs Answer 24 True. The most common site for tendon rupture is about 2-6 cm above where the tendon attaches to the calcaneum True. Thompson’s test is the calf squeeze test, where movement of the forefoot distally on squeezing the calf indicates an intact tendon True False. The 2 nd metatarsal is the most commonly involved in a march #

MCQs:

MCQs Achilles tendon

Slide 58:

Plantar Fasciitis

MCQs for MRCGP:

MCQs for MRCGP Q 25:Which of these causes of intestinal obstruction are likely to occur at the following ages Adult –Crohn disease Birth-intussusception Over 65-inflammatory appendix mass 6 months-sigmoid volvulus 3 weeks-congenital pyloric stenosis

MCQs:

MCQs Answer 25 True False. Intusssception often presents in patients between 6 and 9 months old False.An inflammatory appendix mass is more common in the younger adult than the elderly False. Sigmoid volvulus tends to occur in old age True.Infant with pyloric stenosis usually presents at 3-4 weeks of age

MCQs for MRCGP:

MCQs for MRCGP Q 26:In the examination and diagnosis of hearing problems Rinne negative means that bone conduction is better than air conduction In sensorineural deafness,sound localises to the contralateral ear in he Weber test Otosclerosis initially causes sensorineural deafness Otosclerosis usually occurs unilaterally A loss of acuity for high sounds occurs in presbyacusis

MCQs:

MCQs Answer 26 True. In conductive hearing loss bone conduction is better than air conduction : BC>AC, a negative Rinne True. In sensorineural deafness, bone conduction &air conduction are both equally depreciated. A patient with unilateral sensorineural loss would hear the sound loudest in the unaffected ear False. Otosclerosis is a cause of conductive deafness, although sensorineural deafness may occur later Otosclerosis is usually bilateral and presents in young adults True. Presbycusis refers to sensineural hearing impairment in the elderly. Characteristially,it involves bilateral high frequency hearing loss

MCQs for MRCGP:

MCQs for MRCGP Q 27 Recognised causes for tunnel vision include a) Hysteria Papillodema Pituitary tumour Migraine Tabes dorsalis

MCQs for MRCGP:

MCQs for MRCGP Answer 27 True True False True True

MCQs for MRCGP:

MCQs for MRCGP Q 28 Horner syndrome causes Dilated pupil Ptosis Loss of light reflect Anhidrosis Enopthalmos

MCQs:

MCQs Answer 28 : False True False True True

MCQs for the MRCGP:

MCQs for the MRCGP Q 29:Polyhydramnios Is associated with maternal diabetes Is associated with renal agenesis Can occur as a result of amniocentesis Predisposes to abruptio placenta Is an indication for an NG tube to be passed in the baby after birth

MCQs:

MCQs Answer 29 True False.Renal agenesis is commonly associated with oligohydramnios False.Amniocentesis should not cause an increase in the liquorvolume True.An abruption may be precipitated as a consequence of sudden decompression ofuterus when the membranes are ruptured True.To exclude oesophageal atresia, a common assosciation