MRCP PART 2 : FREE Questions!
1) A 78 year old woman is admitted to hospital with acute coronary syndrome and is discharged on day 6 after making a good recovery. She continues to be under investigation of the cardiologists and is discharged on atenolol 50 mg daily, enalapril 10 mg daily, isosorbide mononitrate 30 mg daily,Atorvastatin 20 mg daily and aspirin 75 mg daily. Her investigations at admission revealed a serum urea concentration of 12.4 mmol/l with a serum creatinine of 250 micromol/l. She is re-admitted one week after discharge with deteriorating dyspnoea. Investigations reveal a serum urea of 28.9 mmol/l, a serum creatinine of 600 micromol/l, a serum bicarbonate of 18mmol/L and a potassium concentration of 6.0 mmol/l with T wave inversion in leads II, III and V5-V6. What is the best course of management if the patient is clinically fluid overload?
1 )Dialysis
2 )Frusemide infusion
3 )Oral frusemide
4 )Salbutamol nebulisers
5 )Stop ACEI
ANSWER :A
2) A 19-year-old woman presented to her General
Practitioner with a history of general malaise,
lethargy and fatigue. She was unsure when the
symptoms first started, but felt that they had
been developing slowly over a period of several
months. On examination, a murmur was audible.
She was referred to a Cardiologist on the basis
of the physical findings.
The data obtained from cardiac catheterisation
are shown below:
Anatomical site Oxygen saturation (%) Pressure
(mmHg) End systolic/End diastolic
Superior vena cava 77 -
Right atrium (mean) 79 7
Right ventricle 78 -
Pulmonary artery 87 52/17
Pulmonary capillary wedge pressure - 16
Left ventricle 96 120/11
Aorta 97 130/60
Which of the following best describes the murmur
that can be heard on auscultating this lady's
chest?
Available marks are shown in brackets
1 )A coarse pan-systolic murmur heard all over
the praecordium
2 )A continuous 'machinery' murmur at the left
upper sternal edge with late systolic
accentuation
3 )A low-pitched apical mid-diastolic murmur
that is reduced in pitch during the Valsalva
manoeuvre
4 )A pansystolic murmur, heard loudest at the
apex and radiating to the axilla
5 )No murmur will be heard
ANSWER:2
3) Examine the cardiac catheter data given below.
Anatomical site Oxygen saturation (%) Pressure
(mmHg) End systolic/End diastolic
Superior vena cava 74 -
Inferior vena cava 72 -
Right atrium 73 5
Right ventricle 74 20/4
Pulmonary artery 74 20/5
Pulmonary capillary wedge pressure - 15
Left ventricle 98 210/15
Aorta 99 125/75
Which of the following clinical scenarios is
most compatible with the catheter data presented
above?
Available marks are shown in brackets
1 )A 16-year-old with finger clubbing and
central cyanosis
2 )A 17-year-old boy who presents after an
episode of exercise-induced syncope
3 )A 54-year-old woman who becomes acutely
breathless seven days after an inferior
myocardial infarction
4 )A 65-year-old woman with a 2-year history of
increasing exertional dyspnoea who presents
following a singe episode of haemoptysis
5 )A 77-year-old man who presents with dyspnoea
ten years after a porcine mitral valve
replacement
ANSWER : 2
4) A 17-year-old boy presents to his General
Practitioner complaining of dyspnoea on
exertion. His mother, who is also in attendance,
says that his exercise tolerance has been
diminishing gradually and that he is no longer
able to play football on a Saturday morning.
After examining the patient, the General
Practitioner refers him to a Cardiologist.
Cardiac catheterisation was performed. The
pressure and oxygen saturation data obtained are
shown below:
Anatomical site Oxygen saturation (%) Pressure
(mmHg) End systolic/End diastolic
Superior vena cava 74 -
Right atrium (mean) 75 7
Right ventricle 87 50/12
Pulmonary capillary wedge pressure - 16
Left ventricle 96 95/12
Aorta 97 110/60
What is the diagnosis?
Available marks are shown in brackets
1 )Coarctation of the aorta
2 )Mitral stenosis and pulmonary hypertension
3 )Pulmonary stenosis
4 )Septum secundum atrial septal defect
5 )Ventricular septal defect
ANSWER : 5
5) A 75 year-old man was admitted to hospital when
he became acutely breathless at 3am. He gave a
history of increasing dyspnoea over a period of
at least three months. In recent weeks he
reported that his breathing was usually better
when sleeping in a chair.
Anatomical site Oxygen saturation (%) Pressure
(mmHg) End systolic/End diastolic
Superior vena cava 76 -
Inferior vena cava 72 -
Right atrium (mean) 74 9
Right ventricle 75 60/8
Pulmonary artery 74 58/26
Pulmonary capillary wedge pressure - 30
Left ventricle 98 150/25
Aorta 97 150/44
What is the most likely diagnosis?
1 )Aortic incompetence
2 )Coarctation of the aorta
3 )Hypertrophic obstructive cardiomyopathy
4 )Patent ductus arteriosus
5 )Pulmonary stenosis
ANSWER : 1
6) A previously fit 60 year-old man is admitted
with a middle cerebral artery occlusion
confirmed on brain imaging.
What is the current recommended cut-off
time-point for thromboytic treatment from the
onset of stroke symptoms?
1 )3 hours
2 )6 hour
3 )8 hours
4 )12 hours
5 )24 hours
ANSWER :1
7) An 18-year-old female presented with bilateral
ptosis and tiredness towards afternoons. She had
a short tensilon (edrophonium test which was
positive). A diagnosis of myasthenia Gravis was
made and she was stated on pyridostigmine. She
now relapses and is given edrophonium
intravenously. However her condition
deteriorates and her forced expiratory volume
falls to 1.0. She is transferred to the high
dependency units. An initial CT scan and chest
x-ray were normal.
What should be the next management step?
1 )Azathioprine
2 )Emergency thymectomy
3 )Intravenous methylprednisolone
4 )Neostigmine
5 )Plasmaphoresis
ANSWER : 5
8)A 17-year-old girl presented with a 2-day
history of severe back pain. A plain x-ray film
of her spine is normal. Two days later, she
complained of tingling in her fingers and toes.
The next day she became generally weak. She
presented in A/E.
On examination, she has bilateral lower motor
neurone facial weakness, tetraparesis with
weakness in all limbs (4/5), areflexia, flexor
plantars and normal sensation.
A lumbar puncture was performed and the CSF
analysis showed: Protein1.4 g/l (<0.4)
GlucoseNormal
Cells0
What is the most likely diagnosis?
1 )Botulism
2 )Guillain-Barre syndrome
3 )Acute poliomyelitis
4 )Myasthenia gravis
5 )Hysteria
ANSWER : 2
9) A 38 year-old man presents with an episode of
right-sided weakness affecting his right arm and
leg. The weakness occurred while he was eating
breakfast and resolved completely in 30 minutes.
Three months earlier he has an episode of
slurred speech lasting a few minutes and had
being investigated extensively in hospital.
Aspirin 75 mg had been started as treatment.
On examination, he is overweight with a BMI of
38, pulse 88 beats/min regular and BP 140/85
mmHg. Heart sounds are normal and no carotid
bruits are detectable.
The neurological examination is unremarkable
except for an upgoing plantar response on the
right side.
A Doppler ultrasound of the carotid arteries
reveal 50% stenosis in the proximal carotid
arteries bilaterally.
What evidence-based intervention is most likely
to prevent further episodes of the patient’s
condition?
1 )Add clopidogrel to aspirin
2 )Add dipyridamole to aspirin
3 )Increase the dose of aspirin to 150mg daily
4 )Stop aspirin and start clopidogrel alone
5 )Stop aspirin and start dipyridamole alone
ANSWER : 2
10) A 50 year-old man with learning difficulties is
referred because of urinary incontinence. He
lives alone. Over the last two months, he has
been finding it increasingly difficult to manage
simple household tasks like making meals and
cleaning. He claims his ‘concentration is not as
good as before.?He had a son who died from
complications of multiple sclerosis.
On examination, he is orientated in time, place
and person. On memory testing, he was able to
register information but was only able to recall
not more than three items out of six after five
minutes. Long-term memory was patchy. On testing
serial 3s, he reached 25 after 30 seconds. His
thought content was normal, but affect was
labile. He was unable to interpret the true
meaning of a proverb. Cranial nerve examination
was unremarkable, except for horizontal
nystagmus on lateral gaze bilaterally.
Examination of the limbs revealed past-pointing
in the upper limbs, difficulty with heel-to-toe
walking in the lower limbs, brisk deep tendon
reflexes and extensor plantar responses.
Palmomental reflexes were present bilaterally.
What is the likely diagnosis?
1 )Alzheimer’s disease
2 )Creutzfeldt-Jakob disease
3 )Depression
4 )Korsakoff’s amnestic syndrome
5 )Lewy body dementia
ANSWER : 4
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