MORE MRCP QUESTIONS!

Here are some questions for MRCP Part 2.

1) A 63-year-old lady has painful, tender, weak muscles to the extent that she has difficulty on rising from a chair. She also complains of polyarthralgia and Raynaud's syndrome. Examination demonstrates sclerodactyly.
Investigations: ESR 71 mm in the first hour
CRP 34 g/lANA >1/640 speckled pattern
RF 1/160
anti-dsDNA negative
anti-Sm negative
SS-A positive
SS-B negative
anti-RNP >1/640
What is the most likely diagnosis?
A. Mixed connective tissue disease (MCTD)
B. CREST (limited scleroderma)
C. Progressive systemic sclerosis
D. Systemic lupus erythematosus
E. Rheumatoid arthritis


ANSWER: A


2)A 75-year-old woman with metastatic carcinoma of the colon is admitted semi-conscious and dying. Her symptoms had been previously well controlled on oxycodone SR 80mg bd.
What would you do about analgesia?
A.Nothing at present as she is semi-conscious and not obviously in pain.
B.Chart prn oxycodone orally
C.Change to im morphine
D.Chart prn paracetamol pr
E.Start a syringe driver with diamorphine.


ANSWER: E

3) A 30-year-old patient presents with episodes of muscle pain after several minutes of exercise and poor exercise tolerance. However, he describes a 'second wind' phenomenon if he exercises through the initial barrier.
Which two of the following are the most likely diagnoses?
A : Acid maltase deficiency B : Becker's muscular dystrophy
C : Carnitine palmitoyl transferase deficiency D : Inclusion body myositis
E : Lambert-Eaton syndrome F : Motor neurone disease
G : Myasthenia gravis H : Myophosphorylase deficiency
I : Myotonic dystrophy J : Phosphorylase b kinase deficiency.


ANSWER:H AND J

4) A 79-year old female with known aortic stenosis (aortic valve gradient 60 mmHg 2 years previously), presents with uncontrolled atrial fibrillation (140 bpm). She is dyspnoiec on exertion and on examination has an elevated jugular venous pressure and basal crepitations.
Which two of the following are indicated as part of the initial treatment regimen?
A : Angiotensin-converting-enzyme inhibitors B : Amiodarone
C : Beta-blockers D : Digoxin
E : Flecainide F : Intravenous diuretics
G : Intravenous nitrates H : Valvuloplasty
I : Verapamil J : Warfarin.


ANSWER:B AND F

5)A 23 year old man gives a history of dysarthria, clumsiness, unsteadiness on his feet and irritability. He has no history of drug abuse. Bilirubin 44 mmol/l ALT 65 U/lAlk. Phos 450 U/l Albumin 34 g/l
Name 1 investigation to confirm your suspicions
A. Serum and urinary copper and caeruloplasmin
B. Liver Ultrasound
C. Ferritin
D. Urinary toxicology screen
E. CT scan of the head


ANSWER: A

6)You are asked to see a 24-year-old woman who presents after possible exposure to sexually transmitted infection.
Which of the following genital infections (when acquired in the UK) requires combination antimicrobial therapy with two agents or more to ensure complete resolution of all symptoms and the prevention of long-term complications?
A : Pelvic inflammatory disease (PID)B : CandidiasisC : Lymphogranuloma venereum
D : Chlamydial cervicitisE : Bacterial vaginosisF : Syphilis
G : GonorrhoeaH : ChancroidI : ScabiesJ : Human papilloma virus infection.


ANSWER:A AND G

7)A man wakes up noticing a generalized rash over his body. A week previously he had developed a 'flu -like' illness. His complete blood count was Hb 12.4g/dl, WBC 8 x 10^9/l and platelets 2 x10^9/l. A bone marrow showed no atypical cells but adequate megakaryocytes and confirmed peripheral consumption.
Which of these treatments are options in an actively bleeding patient with Immune thrombocytopenic purpura (ITP)?
A : Peripheral vasoconstrictors B : Corticosteroids C : Fresh frozen plasma (FFP) infusions
D : Low molecular weight Heparin E : Intravenous immunoglobulin infusion F : Cautery and laser diathermy of bleeding point G : Single platelet transfusion H : Topical fibrin glueI : Hydroxyurea J : Leucocyte infusions.


ANSWER:B AND E

8)A 61-year-old lady presents with a 4-year history of hypertension and an incidental finding of massive hepatomegaly. There is a family history of renal failure. A CT scan confirms multiple large thin walled hepatic cysts and multiple cysts in the kidney. Which of the two pieces of information have been correctly given to the patient?
A : It is an autosomal recessive condition.B : There is a risk of subarachnoid haemorrhage.
C : She is likely to develop liver failure with jaundice and coagulopathy.D : Liver transplantation is contraindicated.
E : Abdominal discomfort from the cysts can be treated surgically.
F : Aspiration of liver cysts successfully relieves abdominal discomfort. G : The condition precludes renal transplantation.
H : Cirrhosis occurs in the non cystic liver. I : Angiotensin-converting enzyme (ACE)-inhibitors should not be used to treat the hypertension. J : Pancreatic cysts do not occur.


ANSWER: B AND E

9)A 30-year-old woman with arthritis presents with a painful, rapidly enlarging ulcer on the lower leg.
What is the most likely diagnosis?
A : A venous leg ulcer B : Pyoderma gangrenosum C : Necrobiosis lipoidica
D : Cutaneous vasculitis E : Squamous cell carcinoma.


ANSWER:B

10)A 38-year-old woman presents with severe headache. Your house physician tells you that her 'right eye is not normal', and you suggest that the patient might have a third nerve palsy. The houseman asks you what signs he should look for to confirm this diagnosis. You reply:
A : there is ptosis, a small pupil, and the eye is positioned 'down and out'
B : there is a small pupil and the eye cannot abduct
C : there is ptosis, a dilated pupil, and the eye is positioned 'down and out', but will rotate inwards if the patient attempts to look down
D : there is a small pupil and the eye is positioned 'down and out'
E : there is ptosis, a dilated pupil, and the eye is positioned 'down and in', and will not move in any direction.


ANSWER: C