MRCGP Preparation Course MCQ’s Part 2

MRCGP Preparation CourseMCQ’s Part 2 Dr Kashaf Aziz

Format of the exam Paper 1 • MCQs 200 • Which is the SINGLE MOST likely diagnosis? Select ONE option only. • Which is the SINGLE MOST appropriate treatment, according to the current edition of the BNF? Select ONE option only. • Which is the SINGLE MOST appropriate investigation? Select ONE option only.

Example 1 A 65 year old lady falls onto an out stretched arm. You suspect a Colles fracture. Which is the SINGLE MOST appropriate investigation,? Select ONE option only. • CT • MRI • US • X-ray AP • X-ray AP & lateral

Example 2 Your 42 year old patient attends for a 3rd BP check and is consistently found to have a reading of 155/ 96 with grade I hypertensive retinopathy. Which is the SINGLE MOST appropriate treatment, according to the NICE guidelines? Select ONE option only. • Bendroflumethiazide • Doxazosin • Lisnopril • Nifedipine • Propranalol

Example 3 Your patient patient has a chronic paronychia despite several courses of augmentin. Which is the SINGLE MOST appropriate next investigation? Select ONE option only. • Check ESR • Check CP • Check urinalysis for protein • Serum fungal screen • Take a swab for microscopy and culture

Question Time

1. Regarding seborrhoeic dermatitis in infants, which TWO of the following statements are correct? Select TWO answers only. a. It usually affects the flexures of the elbow and at the back of the knees. b. It usually disappears by three months. c. If medical treatment is required, ketoconazole 2% cream is a suitable treatment. d. A rare complication requiring urgent admission is Leiner's disease.

Regarding seborrhoeic dermatitis in infants, which TWO of the following statements are correct? Select TWO answers only.a. It usually affects the flexures of the elbow and at the back of the knees.b. It usually disappears by three months.c. If medical treatment is required, ketoconazole 2% cream is a suitable treatment.d. A rare complication requiring urgent admission is Leiner's disease. The correct answers are C and D.In infants, seborrhoeic dermatitis usually affects the scalp (hence it is sometimes called 'cradle cap'). It can affect the face and body. It usually clears spontaneously within a few weeks or months (most cases clear by six to 12 months of age). If medical treatment is required, 2% ketoconazole cream or shampoo can be effective. Leiner's disease is a rare complication requiring urgent admission. It presents with a sudden confluence of lesions leading to universal scaling redness of the skin. The infant is severely ill with anaemia, diarrhoea, and vomiting.

Regarding childhood febrile convulsions, which ONE of the following statements are correct? Select ONE answer only. a. The incidence is 2% to 4%. b. The peak incidence is at 12 months. c. Usually focal seizures are observed. d. Seizures usually last 20+ minutes.

Regarding childhood febrile convulsions, which ONE of the following statements are correct? Select ONE answer only. a. The incidence is 2% to 4%. b. The peak incidence is at 12 months. c. Usually focal seizures are observed. d. Seizures usually last 20+ minutes. The correct answer is A. A childhood febrile convulsion is a seizure occurring in a child aged six months to five years, associated with fever arising from infection or inflammation outside the central nervous system in a child who is otherwise neurologically normal. The peak incidence is at 18 months, and seizures are usually focal and last three to six minutes.

Regarding febrile convulsions in children, which THREE of the following are the MOST common causes of the fever? Select THREE answers only. a. Urinary tract infection (UTI) b. Post immunisation fever c. Viral infection d. Otitis media e. Lower respiratory tract infection (LRTI) f. Meningitis

Regarding febrile convulsions in children, which THREE of the following are the MOST common causes of the fever? Select THREE answers only. a. Urinary tract infection (UTI) b. Post immunisation fever c. Viral infection d. Otitis media e. Lower respiratory tract infection (LRTI) f. Meningitis g. Tonsillitis The correct answers are: C, D, and G. All of the options above were found to be causes of the fever in febrile convulsions, but the most common are viral infections and otitis media. Serious bacterial infections are an uncommon but potentially life threatening cause.

Regarding nappy rash in infants, which of the following is the most important causative microorganism? Select ONE answer only. a. Staphylococcus aureus b. Methicillin resistant S. aueus (MRSA) c. Escherichia coli d. Candida albicans e. Pseudomonas f. Streptococcus g. Proteus

Regarding nappy rash in infants, which of the following is the most important causative microorganism? Select ONE answer only. a. Staphylococcus aureus b. Methicillin resistant S. aueus (MRSA) c. Escherichia coli d. Candida albicans e. Pseudomonas f. Streptococcus g. Proteus The correct answer is D. Nappy rash is a dermatitis confined to the area covered by the nappy. It is not one distinct diagnosis, but a multifactorial problem with many possible causative factors including infrequent nappy changes, contact with faeces or urine, use of broad spectrum antibiotics and chemical irritants. Candida albicans is the most important causative microorganism.

Which of the following is NOT a risk factor for development and progression of diabetic retinopathy? Select ONE answer only a. Poor glycaemic control b. Raised blood pressure (BP) c. Raised triglyceride levels d. Raised cholesterol levels e. Presence of microalbuminuria and proteinuria

Which of the following is NOT a risk factor for development and progression of diabetic retinopathy? Select ONE answer only a. Poor glycaemic control b. Raised blood pressure (BP) c. Raised triglyceride levels d. Raised cholesterol levels e. Presence of microalbuminuria and proteinuria The correct answer is D. Other risk factors include pregnancy and duration of diabetes. The progression of retinopathy can be minimized by early, rigorous control of blood glucose and BP.

Regarding acute angle closure glaucoma, which TWO of the following statements are correct? Select TWO answers only. a. Patients present more commonly in the winter, and symptoms often present in the evening. b. Pupils become constricted, with a pin prick appearance. c. The eye is typically red and very painful. d. Patients should be referred to an ophthalmologist for an outpatient appointment within two weeks of presentation. e. The eye is typically red and painless.

Regarding acute angle closure glaucoma, which TWO of the following statements are correct? Select TWO answers only. a. Patients present more commonly in the winter, and symptoms often present in the evening. b. Pupils become constricted, with a pin prick appearance. c. The eye is typically red and very painful. d. Patients should be referred to an ophthalmologist for an outpatient appointment within two weeks of presentation. e. The eye is typically red and painless. The correct answers are A and C. Acute angle-closure glaucoma is a rapid and severe rise in intra ocular pressure caused by physical obstruction of the anterior chamber drainage angle. It often presents in the evening when reduced light causes mydriasis (thus it is more common in the winter), and presents with a red, painful eye. It requires URGENT admission (same day) as delay can cause blindness.

Regarding acute angle closure glaucoma, which THREE of the following are risk factors? Select THREE answers only. a) Hypermetropia b) Myopia c) Amblyopia d) Caucasian descent e) Asian descent f) Afro-Caribbean descent g) Previous attack in the other eye

Regarding acute angle closure glaucoma, which THREE of the following are risk factors? Select THREE answers only. a) Hypermetropia b) Myopia c) Amblyopia d) Caucasian descent e) Asian descent f) Afro-Caribbean descent g) Previous attack in the other eye The correct answers are A, E and G. Acute angle closure glaucoma is rare, affecting 1 in 1,000 people over the age of 40. Other risk factors include increasing age, having shallow anterior chambers, and family history.

Regarding the following infectious organisms... a. Staphylococcus aureus b. Chlamydia trachomatis c. Trichomonasvaginalis d. Candida albicans e. Pseudomonas f. Streptococcus pneumonie g. Proteus species h. Dermatophytes i. Enterobiusvermicularis For each of the following presentations, which is the MOST likely causative organism? You may use each option ONCE, MORE than ONCE, or not at all. A four year-old girl presents with intense perianal itching. This is much worse at night, and has caused poor sleep and uncharacteristic irritability. The symptoms have been present for two weeks. Her older sister (aged six) has had similar symptoms.

The correct answer is I. Enterobius vermicularis (threadworm) is the most common helminth infection in the UK. It can be asymptomatic, or present with intense perianal itching worse at night (when the eggs are laid). Adult threadworms live for upto six weeks. Good attention to hygiene is an essential part of treatment. Drug treatment of choice is Mebendazole, and all members of the household should be treated if possible.

Regarding the following infectious organisms... a. Staphylococcus aureus b. Chlamydia trachomatis c. Trichomonas vaginalis d. Candida albicans e. Pseudomonas f. Streptococcus pneumonie g. Proteus species h. Dermatophytes i. Enterobius vermicularis For each of the following presentations, which is the MOST likely causative organism? You may use each option ONCE, MORE than ONCE, or not at all. A 15 year-old girl presents with vulval itching and a white odourless vaginal discharge. She also complains of dysuria. She was last seen in the surgery a week before and treated for an acute sinusitis. She is not sexually active.

The correct answer is D. These symptoms are common in vulvovaginal candidiasis. The most common causative agent is Candida albicans. It is often precipitated by another illness, or by the use of broad spectrum antibiotics. Chlamydia can also present with vaginal discharge and dysuria, but rarely causes itch.

Regarding the following infectious organisms... a. Staphylococcus aureus b. Chlamydia trachomatis c. Trichomonas vaginalis d. Candida albicans e. Pseudomonas f. Streptococcus pneumonie g. Proteus species h. Dermatophytes i. Enterobius vermicularis For each of the following presentations, which is the MOST likely causative organism? You may use each option ONCE, MORE than ONCE, or not at all. A 20 year-old woman presents with vulval itching, dysuria and an offensive discharge. On examination there is a frothy yellow-green discharge. Her only regular medication is the oral contraceptive pill (OCP).

The correct answer is C. Trichomonas vaginalis is a flagellated protozoan which is usually transmitted sexually. Upto 50% of infected women may be asymptomatic. Symptoms include vulval itch, dysuria and a coloured, offensive discharge.

Regarding the known side effects of the following drugs... a. Simvastatin b. Ramipril c. Prednisolone d. Celecoxib e. Methotrexate f. Isotretinoin g. Dermovate h. Minocycline i. Indometacin For each of the following patients, select the drug most likely to be causing the side effects mentioned. You may use each option ONCE, MORE than ONCE, or not at all. A 19 year-old girl with severe acne presents to accident and emergency after taking an overdose of alcohol. She says she does not want to live and had been feeling this way for the last two weeks.

Isotretinoin, which is used for treating severe acne. Patients who develop suicidal tendencies on Isotretinoin may need follow up even after the medication is stopped.

Regarding the known side effects of the following drugs... a. Simvastatin b. Ramipril c. Prednisolone d. Celecoxib e. Methotrexate f. Isotretinoin g. Dermovate h. Minocycline i. Indometacin For each of the following patients, select the drug most likely to be causing the side effects mentioned. You may use each option ONCE, MORE than ONCE, or not at all. A 55 year-old man with known heart disease presents with severe muscle pains. He reports feeling "weak". Creatine kinase (CK) is 1,000 U/L.

The correct answer is A. Rhabdomyolysis/myositis is a well known potentially serious side effect of most statins. Many patients are started on a statin after a myocardial infarction (MI) or if at risk of heart disease. Patients often improve once the drug is stopped, and this can be monitored using CK levels.

Regarding the known side effects of the following drugs... a. Simvastatin b. Ramipril c. Prednisolone d. Celecoxib e. Methotrexate f. Isotretinoin g. Dermovate h. Minocycline i. Indometacin For each of the following patients, select the drug most likely to be causing the side effects mentioned. You may use each option ONCE, MORE than ONCE, or not at all. A 40 year-old patient with systemic lupus erythematosus (SLE) presents with severe upper abdominal pain radiating to the back. Her medication was recently increased after a flare up of her SLE.

The correct answer is C. This presentation is in keeping with acute pancreatitis, which can be caused by steroid treatment. Prednisolone is a commonly used treatment for SLE.

Regarding megaloblastic anaemias, which ONE of the following statements is correct? Select ONE answer only. a. Vitamin B12 deficiency due to pernicious anaemia accounts for 50% of megaloblastic anaemias. b. Vitamin B12 deficiency due to pernicious anaemia accounts for 60% of megaloblastic anaemias. c. Vitamin B12 deficiency due to pernicious anaemia accounts for 70% of megaloblastic anaemias. d. Vitamin B12 deficiency due to pernicious anaemia accounts for 80% of megaloblastic anaemias. e. Vitamin B12 deficiency due to pernicious anaemia accounts for 90% of megaloblastic anaemias.

The correct answer is D. Pernicious anaemia is caused by an autoimmune process causing gastritis resulting in reduced acid production and an absence of intrinsic factor, which is essential for the absorption of vitamin B12.

Which one of the following is the target BP for non diabetic patients recommended by the Joint British Society Guidelines (2005)? Select one answer only. a. <140/85 mm Hg b. <150/90 mm Hg c. <145/85 mm Hg d. <145/90 mm Hg e. <150/85 mm Hg

The correct answer is A: <140/85. The maximum acceptable level according to the guidelines (the audit standard) is 150/90. This is the target adopted for gaining QOF points in the new GMS contract. For diabetics, the target is much lower: 130/80.

Which ONE of the following drugs is associated with the highest increased risk of suicide in adolescents AND adults? a. Fluoxetine b. Citalopram c. Venlafaxine d. Paroxetine e. Duloxetine

The correct answer is D: Paroxetine. A recent report confirmed that there is a significantly increased risk of suicide in adults taking Paroxetine compared to placebo. There have already been many reports about an increased risk in adolescents.

Regarding statistics in screening, which TWO of the following statements are correct? Choose TWO answers only. a. The sensitivity is the same as the false positive rate. b. The specificity is the same as the false negative rate. c. The specificity is the same as the true negative rate. d. The sensitivity is the same as the true negative rate. e. The predictive value negative is the probability that a person does not have the disease given a negative test.

The correct answers are C and E. Sensitivity is the probability that the screening test is positive given that the person actually has the disease. It is the same as the true positive rate. The specificity is the probability that the screening test is negative given that the person does NOT have the disease. It is the same as the true negative rate. The ideal screening tool would be 100% sensitive and 100% specific.

Developmental milestones in children include the following. a. Startled by loud sounds b. 20 words in the vocabulary (monolingual child) c. Responds to name and mimics environmental sounds d. First meaningful words e. Follows commands and performs simple tasks f. Localises sounds Match each of the following age groups to the correct developmental milestones. You can use each option once, more than once, or not at all. Six months 12 months 18 months

Developmental milestones in children include the following. a. Startled by loud sounds b. 20 words in the vocabulary (monolingual child) c. Responds to name and mimics environmental sounds d. First meaningful words e. Follows commands and performs simple tasks f. Localises sounds Match each of the following age groups to the correct developmental milestones. You can use each option once, more than once, or not at all. Six months F 12 months D 18 months E Important developmental milestones in childhood include: • <3 months Startled by loud sounds • 6 months Localises sounds • 9 months Responds to name and mimics environmental sounds • 12 months First meaningful words • 18 months Follows commands and performs simple tasks • 24 months 20 words in the vocabulary (monolingual child)

Regarding 'frozen shoulder', which THREE of the following are correct? Choose THREE answers only. a. Diagnosis requires abnormal clinical and x-ray findings. b. It is characterized by insidious shoulder stiffness; severe pain, even at night; and severe loss of passive and active external rotation of the shoulder. c. It is common in athletes aged 20 to 30. d. Steroid injections offer no benefit over physiotherapy. e. Difficult cases may need arthroscopic release. f. It is associated with diabetes mellitus. The correct answers are B, E, and F. Frozen shoulder is a clinical diagnosis. It is characterised by insidious shoulder stiffness; severe pain, even at night; and severe loss of passive and active external rotation of the shoulder. X-ray is often normal or may show periarticular osteopenia as a result of disuse. It is rare in patients under 40, and slightly more common in women than men. Physiotherapy alone is of little benefit, although it is useful in combination with steroid injection of the joint (which is the mainstay of treatment).

The correct answers are B, E, and F. Frozen shoulder is a clinical diagnosis. It is characterised by insidious shoulder stiffness; severe pain, even at night; and severe loss of passive and active external rotation of the shoulder. X-ray is often normal or may show periarticular osteopenia as a result of disuse. It is rare in patients under 40, and slightly more common in women than men. Physiotherapy alone is of little benefit, although it is useful in combination with steroid injection of the joint (which is the mainstay of treatment).

Which THREE of the following have a strong association with HLA-B27 (positive in at least 50% of cases)? Choose THREE answers only. a. Ankylosing spondylitis b. Juvenile rheumatoid arthritis c. Psoriasis d. Reactive arthritis e. Systemic sclerosis f. Myasthenia gravis

Which THREE of the following have a strong association with HLA-B27 (positive in at least 50% of cases)? Choose THREE answers only. a. Ankylosing spondylitis b. Juvenile rheumatoid arthritis c. Psoriasis d. Reactive arthritis e. Systemic sclerosis f. Myasthenia gravis The correct answers are A, B, and D. HLA-B27 is associated with over 100 diseases. The strongest associations are with Ankylosing spondylitis, JRA, and reactive arthritis. It is weakly associated with psoriasis, but has a strong association in a subgroup of psoriatic patients who also have spondylitis.

Regarding the following women's health issues. a. Vaginosis b. Vaginismus c. Ectopic pregnancy d. Pelvic inflammatory disease (PID) e. Bartholin's cyst f. Polycystic ovarian syndrome (PCOS) g. Endometriosis h. Urinary tract infection (UTI) For each of the following presentations, select the MOST likely diagnosis from the list. You can use each question once, more than once, or not at all. A 33 year-old woman presents with a history of painful periods. This has been present for many years but is getting worse. She also complains of painful intercourse and spotting for several days before her periods. Clinical examination is unremarkable. She is married with an adopted child.

G. Endometriosis. This is common disorder which is characterized by the presence of endometrial glands and tissue outside the endometrial cavity. It is more common in women in their 30s and 40s, and often presents with deep dyspareunia, spotting before or after periods and worsening dysmenorrhea. It is associated with infertility in up to 40% of cases.

Regarding the following women's health issues. a. Vaginosis b. Vaginismus c. Ectopic pregnancy d. Pelvic inflammatory disease (PID) e. Bartholin's cyst f. Polycystic ovarian syndrome (PCOS) g. Endometriosis h. Urinary tract infection (UTI) For each of the following presentations, select the MOST likely diagnosis from the list. You can use each question once, more than once, or not at all. A 27 year-old woman presents for her first cervical smear. She has not responded to several previous reminders to attend. She is very anxious. You are unable to perform the examination as she screams in pain when you try to introduce the speculum. The patient tells you that she has delayed coming for fear of the examination. She has not been sexually active for a long time because she finds it very painful.

MRCGP Preparation Course MCQ’s Part 2