6- Elzohry MRCP Questions - Previous examinations.pdf

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Unformatted text preview: Part 1 (18351 Questions) MRCPass OnExamination PassMedicine PasTest ReviseMRCP MRCPstudy (3437 Questions) Khalid Yusuf El-Zohry Sohag Teaching Hospital - Egypt [email protected] Elzohry MRCP Questions Bank (Part 1) – 2013 (For my personal Use) Contents ‫ مقدمة‬........................................................................................... 8 Reference ranges ....................................................................... 11 [ Q: 4183 ] PasTest Exam - 2 exam....................................................................................... 13 [ Q: 4282 ] PasTest Exam - 2 Mock exam ............................................................................. 56 [ Q: 4383 ] PasTest Exam - 2006 January ............................................................................. 99 [ Q: 4589 ] PasTest Exam - 2006 May ................................................................................ 171 [ Q: 4790 ] PasTest Exam - 2007 September ..................................................................... 260 [ Q: 4891 ] PasTest Exam - 2008 January ........................................................................... 305 [ Q: 4992 ] PasTest Exam - 2008 September ..................................................................... 353 [ Q: 5093 ] PasTest Exam - 2009 January ........................................................................... 397 [ Q: 5295 ] PasTest Exam - 2009 May ................................................................................ 491 [ Q: 1777 ] MRCPass - 2010 January .................................................................................. 539 [ Q: 1876 ] MRCPass - 2010 May ....................................................................................... 581 [ Q: 1976 ] MRCPass - 2010 September ............................................................................. 619 [ Q: 2331 ] ReviseMRCP - 2010 September ....................................................................... 661 [ Q: 2076 ] MRCPass - 2011 January .................................................................................. 703 [ Q: 2515 ] ReviseMRCP - 2011 January ............................................................................. 745 [ Q: 2176 ] MRCPass - 2011 May ....................................................................................... 787 [ Q: 2702 ] ReviseMRCP - 2011 May .................................................................................. 833 [ Q: 2275 ] MRCPass - 2011 September ............................................................................. 873 [ Q: 2886 ] ReviseMRCP - 2011 September ....................................................................... 915 [ Q: 2375 ] MRCPass - 2012 January .................................................................................. 957 [ Q: 3064 ] ReviseMRCP - 2012 January ............................................................................. 999 [ Q: 3255 ] ReviseMRCP - 2012 May ................................................................................ 1043 [ Q: 3455 ] ReviseMRCP - 2012 September ..................................................................... 1087 [ Q: 3656 ] ReviseMRCP - 2013 January .......................................................................... 1133 Dr. Khalid Yusuf El-Zohry – Sohag Teaching Hospital (01118391123) Ref MRCPass OE OE 2012 PasTest 2009 PassMedicine 2009 PasTest Exam ReviseMRCP 3 Elzohry MRCP Questions Bank (Part 1) – 2013 (For my personal Use) Dedications To my father, my mother, my wife, my sons: Abd El-Rahman, Muhammed, and Amr To president Muhammad Mursi Dr. Khalid Yusuf El-Zohry – Sohag Teaching Hospital (01118391123) Ref MRCPass OE OE 2012 PasTest 2009 PassMedicine 2009 PasTest Exam ReviseMRCP 5 Elzohry MRCP Questions Bank (Part 1) – 2013 (For my personal Use) Dr. Khalid Yusuf El-Zohry – Sohag Teaching Hospital (01118391123) Ref MRCPass OE OE 2012 PasTest 2009 PassMedicine 2009 PasTest Exam ReviseMRCP 6 Elzohry MRCP Questions Bank (Part 1) – 2013 (For my personal Use) Take the first step, and your mind will mobilize all its forces to your aid. But The first essential is that you begin Once the battle is startled, all that is within and without you will come to your assistance Dr. Khalid Yusuf El-Zohry – Sohag Teaching Hospital (01118391123) Ref MRCPass OE OE 2012 PasTest 2009 PassMedicine 2009 PasTest Exam ReviseMRCP 7 ‫‪Elzohry MRCP Questions Bank (Part 1) – 2013‬‬ ‫)‪(For my personal Use‬‬ ‫مقدمة‬ ‫الحمدددد لحددد ثمددددل أندددقل حدددج هذ‬ ‫العمددد ‪ ،‬هتم دددج هذ فيدددنهند م ددد‬ ‫لودددد ل‬ ‫فجعحدددد‬ ‫ق ددد‬ ‫ددد‬ ‫دددقا‬ ‫لددد‬ ‫دددد تعدددد لج‪ ،‬مددددا ي دددد ن‬ ‫ادددقت‬ ‫فيدددنهند م ددد ء لدددد ت لددد‬ ‫ددد ا‬ ‫هذ‬ ‫حددد ‪،‬‬ ‫ل دددد مدددد‬ ‫ليددد نق الميدددحمن‬ ‫ءظ ق الغن ‪.‬‬ ‫لقدددد اادددنهدًا أندددقل مددد‬ ‫تجددد ير ال أندددق ال أندددق مدددد‬ ‫ا صدددد‪ ،‬ت‪ ،‬ءدددد ذ ددد نه مددد‬ ‫الوددد ي ‪ ،‬لددد ا ءدددد هذ ه‬ ‫دددق‬ ‫ددد لهددد‬ ‫ددد ا العمددد ءهددد‬ ‫ددد ال ددد ق اله ددد‬ ‫ا العم ‪.‬‬ ‫ث لدددي ددد‬ ‫ددد ا المحدددن هذ هادددنهند مددد‬ ‫مددد الدددوملت‪،‬‬ ‫ددد مجهددد جم ددد ذ ددد‬ ‫الن يدددنأ‪ ،‬هتم دددج هذ ف ددد ذ ددد‬ ‫يدددقاًا ال أندددق‬ ‫الجمدددا النقتنددد‬ ‫مندددواذ ثيددد ت‬ ‫فددد‬ ‫القن مة‪.‬‬ ‫ج‪/‬‬ ‫مين هج ا‬ ‫لد ف ان الو قم‬ ‫النعحنم‬ ‫–ا‬ ‫‪ -‬موق‬ ‫‪ ‬‬ ‫)‪Dr. Khalid Yusuf El-Zohry – Sohag Teaching Hospital (01118391123‬‬ ‫‪8‬‬ ‫‪ReviseMRCP‬‬ ‫‪PasTest Exam‬‬ ‫‪PassMedicine 2009‬‬ ‫‪PasTest 2009‬‬ ‫‪OE 2012‬‬ ‫‪OE‬‬ ‫‪MRCPass‬‬ ‫‪Ref‬‬ Elzohry MRCP Questions Bank (Part 1) – 2013 (For my personal Use) ‫زمالئي وأساتذتي والذين تعلمت واستفدت منهم كثيرا‬ ‫ بشير حلمي‬.‫د‬ ‫ رياض السيد‬.‫د‬ ‫رياض‬ Riyadh Shalabi Inas .‫د‬ Mohamed Alassar ‫ بالك هاوس‬.‫د‬ Black House Ayman .‫د‬ Shahin ‫ مجدي أحمد‬.‫د‬ Ahmed .‫د‬ Gabr Heba .‫د‬ Mohammed Ậquắ .‫د‬ Ḿariŋê Amira .‫د‬ Hefney Faisal .‫د‬ Hemeda Reem Ali .‫د‬ Shiny .‫د‬ Moon Aburas .‫د‬ Ab Dr. Khalid Yusuf El-Zohry – Sohag Teaching Hospital (01118391123) Ref MRCPass OE OE 2012 PasTest 2009 PassMedicine 2009 PasTest Exam ReviseMRCP 9 Elzohry MRCP Questions Bank (Part 1) – 2013 (For my personal Use) Reference ranges Reference ranges vary according to individual labs. All values are for adults unless otherwise stated Full blood count Vitamin B12 200-900 ng/l Haemoglobin Men: 13.5-18 g/dl Folate 3.0 nmol/l Women: 11.5-16 g/dl Mean cell volume 82-100 fl Reticulocytes 0.5-1.5% Other biochemistry Platelets 150-400 x 109/l Calcium 2.1-2.6 mmol/l White blood cells 4-11 x 109/l| Phosphate 0.8-1.4 mmol/l Urea and electrolytes CRP < 10 mg/l Sodium 135-145 mmol/l Thyroid stimulating hormone (TSH) 0.5-5.5 mu/l Potassium 3.5 - 5.0 mmol/l Free thyroxine (T4) 9-18 pmol/l Urea 2.0-7 mmol/l Total thyroxine (T4) 70-140 nmol/l Creatinine 55-120 umol/l Amylase 70-300 u/l Bicarbonate 22-28 mmol/l Uric acid 0.18-0.48 mmol/l Liver function tests Arterial blood gases Bilirubin 3-17 umol/l Alanine transferase (ALT) 3-40 iu/l Aspartate transaminase (AST) 3-30 iu/l Alkaline phosphatase (ALP) 30-100 umol/l Gamma glutamyl transferase (yGT) 8-60 u/l Albumin 35-50 g/l pH 7.35 - 7.45 pCO2 4.5 - 6.0 kPa pO2 10 - 14 kPa Lipids Total protein 60-80 g/l Desirable lipid values depend on other risk factors for cardiovascular disease, below is just a guide: Other haematology Total cholesterol < 5 mmol/l Erythrocyte sedimentation rate (ESR) Triglycerides < 2 mmol/l Men: < (age / 2) mm/hr HDL cholesterol > 1 mmol/l Women: < ((age + 10) / 2) mm/hr LDL cholesterol < 3 mmol/l Prothrombin time (PT) 10-14 secs Activated partial thromboplastin time (APTT) 25-35 secs Ferritin 20-230 ng/ml Dr. Khalid Yusuf El-Zohry – Sohag Teaching Hospital (01118391123) Ref MRCPass OE OE 2012 PasTest 2009 PassMedicine 2009 PasTest Exam ReviseMRCP 11 Elzohry MRCP Questions Bank (Part 1) – 2013 [ Q: 4183 ] PasTest Exam - 2 exam Water excretion in the kidneys is influenced by: 1- Proximal tubule 2- Vasopressin 3- Distal tubule 4- Ascending limb of loop of Henle 5- Integrity of collecting ducts Answer & Comments (For my personal use) syndrome) are usually tall, whereas individuals with achondroplasia are usually very short; neither condition has an increased incidence of hypothyroidism or menstrual irregularities. The other typical features of Turner's syndrome are cardiac defects (eg coarctation of the aorta), congenital lymphoedema, neck webbing, widely spaced nipples and cubitus valgus. Noonan's syndrome is an autosomaldominant condition (so it affects both sexes), and other typical features include pulmonary stenosis, neck webbing and low-set posteriorly rotated ears. Answer: 2- Vasopressin Regulation of water secretion is by the distal tubule and the collecting ducts under the influence of vasopressin. The relative hyperosmolality of the medulla is maintained by a counter-current mechanism and is responsible for the flux of water across the renal tubule. [ Q: 4185 ] PasTest Exam - 2 exam You are reviewing a 54-year-old man with a phaeochromocytoma. Which of the following is a suitable aadrenoreceptor antagonist for the presurgical management of his hypertension? 1- Phenoxybenzamine [ Q: 4184 ] PasTest Exam - 2 exam A 20-year-old woman presents with hypothyroidism. On further questioning it transpires she has primary amenorrhoea. She is also of relatively short stature compared to her sisters. 2- Atenolol 3- Propanolol 4- Nebivolol 5- Salbutamol Answer & Comments What is the most likely diagnosis? Answer: 1- Phenoxybenzamine 1- Turner's syndrome 2- Down's syndrome 3- Noonan's syndrome 4- XXX syndrome 5- Achondroplasia Answer & Comments Answer: 1- Turner's syndrome Although Turner's syndrome (XO) and Down's and Noonan's syndromes can be associated with short stature and hypothyroidism, Down's syndrome and Noonan's syndrome are not associated with menstrual irregularities. Females with an extra X chromosome (XXX Phenoxybenzamine is a powerful a -receptor antagonist used in the presurgical management of phaeochromocytoma. Atenolol is a cardioselective b-receptor antagonist, but still has some b2-antagonism and is therefore contraindicated in asthma. Nebivolol has a vasodilating action in addition to b-blocking effects and may be associated with a lower incidence of erectile dysfunction compared with other b-blocking agents. Salbutamol is a b2-agonist used in the treatment of asthma. Agonists potentiate the physiological effects of certain receptors, whereas antagonists block those effects. Another example of antagonism Dr. Khalid Yusuf El-Zohry – Sohag Teaching Hospital (01118391123) Ref MRCPass OE OE 2012 PasTest 2009 PassMedicine 2009 PasTest Exam ReviseMRCP 13 Elzohry MRCP Questions Bank (Part 1) – 2013 is the leukotriene-receptor antagonists which block the bronchoconstrictor response to inhaled leukotrienes. Competitive antagonists bind to the site of action for the endogenous receptor ligand and can be displaced, (eg prazosin), whereas non-competitive antagonists (eg phenoxybenzamine) cannot be displaced or have their effects diminished by an endogenous receptor ligand. A partial agonist (eg acebutolol) may exhibit strong receptor-binding activity, but a limited physiological response. [ Q: 4186 ] PasTest Exam - 2 exam A 52-year-old black woman comes to you for another opinion regarding a history of anaemia that has been unresponsive to oral iron supplementation. She sought your opinion because her other physician was recommending iron supplementation iv. She has been on nearly continuous iron supplementation therapy ever since her second child was born 23 years ago. Over the years she says her doctors have prescribed her to take anywhere from one to three pills daily, sometimes with vitamin C concomitantly. Although she has never needed a transfusion, she says she has been told that her RBC count has never completely normalized. She is otherwise healthy and has no unusual dietary habits. Her menstrual history reveals relatively normal menstrual periods until about 3 years ago, when she attained menopause. The patient believes that her mother was also iron deficient. Your physical exam is normal. Laboratory values show a haemoglobin of 10.6 g/dl; haematocrit, 33%; MCV, 70 fl; normal white blood cell (WBC) with differential; normal platelet count; serum iron, 70 mg/l; iron-binding capacity, 255 mg/dl; and ferritin, 158 m g/l. (For my personal use) 4- Homozygous alpha-thalassaemia 5- Acquired alpha-thalassaemia myelodysplastic syndrome Answer & Comments Answer: 4- Homozygous alpha-thalassaemia This history is suspicious of homozygous athalassaemia. Deletion of two a-genes results in mild to moderate microcytosis and mild anaemia, rarely with any progression or development of other signs or symptoms. Alpha-thalassaemia is probably the most common haemoglobinopathy in the world and the combination of one-gene or two-gene athalassemia has an incidence of 20% or more among blacks. It is often mistaken for iron deficiency anaemia and menstruating women with the condition are often treated for prolonged periods with iron supplementation because it is presumed that the mild microcytic anaemia is due to iron deficiency. A haemoglobin electrophoresis is a useful test for b-thalassemia wherein one looks for increased levels of haemoglobin A2 and haemoglobin F. However, haemoglobin electrophoresis is generally not helpful for the diagnosis of an athalassemia disorder. Haemoglobin C disease has an autosomal recessive inheritance and is one of the "benign" haemoglobinopathies, presenting as haemolytic anaemia. Sickle cell disease presents as chronic haemolytic anaemia and vaso-occlusive crisis. [ Q: 4187 ] PasTest Exam - 2 exam Which of the following antiarrhythmic agents works primarily by its action on SA and AV nodes? 1- Amiodarone 2- Atenolol Which is the most likely diagnosis? 3- Flecainide 1- Sickle cell disease 4- Sotalol 2- Haemoglobin C disease 5- Verapamil 3- Beta-thalassaemia major Dr. Khalid Yusuf El-Zohry – Sohag Teaching Hospital (01118391123) Ref MRCPass OE OE 2012 PasTest 2009 PassMedicine 2009 PasTest Exam ReviseMRCP 14 Elzohry MRCP Questions Bank (Part 1) – 2013 (For my personal use) Answer & Comments Answer: 5- Verapamil Calcium-channel blockers act mainly on the sinoatrial and atrioventricular nodes (direct membrane effect), as these structures are almost exclusively depolarised by the slow calcium channels. Flecainide binds to the sodium channel and decreases the speed of depolarisation (in other words, decreases conduction velocity). Atenolol decreases sympathetic tone. Amiodarone and sotalol increase the action-potential duration and therefore the refractory periods. They have little effect on conduction velocity. [ Q: 4189 ] PasTest Exam - 2 exam A nurse has a needlestick injury after taking blood from a patient known to be HIV positive. What is the most appropriate immediate management after hand washing for 10 minutes? 1- Continue hand washing for a further 20 minutes 2- Antiretroviral therapy 3- Test for hepatitis B and C 4- Blood cultures 5- Broad spectrum antibiotics [ Q: 4188 ] PasTest Exam - 2 exam A 57-year old woman who has just had a renal transplant is being given azathioprine. Which of the following statements best describes the main mechanism of action of this drug? 1- It blocks antibody formation 2- It reduces the production of cytokines 3- It suppresses lymphocyte numbers and function 4- It interferes with T cell-macrophage cooperation 5- It interferes with T-cell activation mechanisms at an intracellular level Answer & Comments Answer: 3- It suppresses lymphocyte numbers and function Azathioprine acts to inhibit purine synthesis necessary for the proliferation of cells, especially leukocytes and lymphocytes. Corticosteroids interfere with T cellmacrophage cooperation and impair macrophage responses to cytokines. Ciclosporin and tacrolimus interfere with T-cell activation mechanisms at an intracellular level. Answer & Comments Answer: 2- Antiretroviral therapy Based on data from more than 3000 occupational exposures to HIV, the average risk of HIV infection after needlestick injury or other percutaneous exposure was calculated to be 0.3% (about 1 in 325). The risk following mucous membrane exposure has been estimated to be around 0.1%. The risk of transmission is greatest for deep injuries; if there is visible blood on the device; during procedures involving direct cannulation of blood vessels; or if the source patient has advanced HIV disease. A small retrospective case-control study demonstrated an 80% reduction in the likelihood of seroconversion in healthcare workers who took zidovudine soon after percutaneous exposure to HIV. In view of the greater activity of antiretroviral drug combinations but without direct evidence, it is currently recommended that high-risk occupational exposures to HIV are treated as soon as possible with two nucleoside inhibitors and a protease inhibitor (such as zidovudine, lamivudine, and nelfinavir) for 1 month. Nevirapine is not currently recommended in postexposure prophylaxis regimens because of a relatively high rate of adverse reactions. In the management of occupational exposure to Dr. Khalid Yusuf El-Zohry – Sohag Teaching Hospital (01118391123) Ref MRCPass OE OE 2012 PasTest 2009 PassMedicine 2009 PasTest Exam ReviseMRCP 15 Elzohry MRCP Questions Bank (Part 1) – 2013 HIV, a careful risk assessment should be done and information provided. [ Q: 4190 ] PasTest Exam - 2 exam A 72-year-old man is admitted unconscious. He has a history of type-2 diabetes and is taking 10 mg of glibenclamide. Blood testing reveals a serum creatinine level of 195 mmol/l and a blood glucose of 1.5 mmol/l. Which treatment regime would be a suitable alternative therapy for his diabetes? (For my personal use) [ Q: 4191 ] PasTest Exam - 2 exam A 25-year-old woman presents to a reproductive endocrinology clinic with a history of being unable to conceive after 2 years of using no contraception. It is thought she may have polycystic ovarian syndrome. Which of the following is most likely to be associated with this condition? 1- A 28 day menstrual cycle 2- Elevated LH/FSH ratio 3- Normal free-androgen index 1- Metformin 4- Low levels of circulating insulin 2- Chlorpropamide 5- Normal BMI (body mass index) 3- Pioglitazone Answer & Comments 4- Metformin and insulin combination therapy 5- Pioglitazone and insulin combination therapy Answer & Comments Answer: 3- Pioglitazone Chlorpropamide and glibenclamide are longacting sulphonylureas, and as such are contraindicated in the elderly and in those with renal impairment because of the risk of hypoglycaemia. Metformin is contraindicated in patients with renal impairment, discontinuation is recommended when creatinine levels are above 130 mmol/l in women and 150 mmol/l in men. For this reason metformin and insulin combination therapy could equally not be a treatment option. Pioglitazone and insulin combination therapy is currently contraindicated due to the risk of oedema. This leaves pioglitazone as the most logical treatment option. Glitazones reduce wholebody insulin resistance by increasing glucose uptake into muscle and fat. They are associated with a low incidence of hypoglycaemia. Answer: 2- Elevated LH/FSH ratio Polycystic ovarian syndrome is one of the commonest causes of anovulatory infertility. Patients can have a normal menstrual cycle but are more likely to have oligomenorrhoea. It is associated with a number of biochemical abnormalities, including raised LH levels, normal or elevated testosterone but with a low SHBG (sex-hormone-binding globulin) resulting in a high free-androgen index. Androstenedione levels can either be normal or raised. The underlying biochemical defect in patients with PCOS is recognised to be insulin resistance. This causes high circulating insulin levels due to peripheral insulin resistance: therefore hyperinsulinaemia, and not low insulin levels, is characteristic of the condition. The insulin resistance has ...
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