MRCP Mock Exam (2)

MRCP Mock Exam (2)

More questions......

Question 1:

A 45-year-old man presented with diplopia, dysarthria and difficulty with swallowing. Over the next few days he developed weakness of the upper and lower limbs. On day 4 he was unable to walk unaided. He denied any sensory symptoms or bladder disturbances. His previous medical history is unremarkable. He is a non-smoker, does not drink alcohol excessively. He does not take any drugs .

On examination he was apyrexial. His general medical examination was normal. His higher mental function was unremarkable. There were no signs of meningism. Cranial nerve examination showed bilateral dilated and fixed pupils. He had binocular diplopia but
no obvious ophthalmoplegia. He was dysarthric with weak cough. His vital capacity was 3.15 standing and 2.00 lying flat. He had lower motor neuron tetraparesis of power 3/5. He was hyporeflexic with normal sensation. He was unable to walk unaided.

Blood tests including FBC, U+Es, LFTs, TFTs, Ca, Autoantibody screen, ESR,
CRP were normal. ECG and CXR were unremarkable. CT brain was normal. Nerve conduction studies and EMG were normal.

What is the most likely diagnosis?
1 ) Guillain Barre Syndrome
2 ) Lyme disease
3 ) Myasthenia gravis
4 ) Botulism
5 ) Vasculitis

Question 2:

A 75 year-old woman presents with a two month history of episodic loss of vision in her right eye. Her ECG was normal and carotid ultrasound reveal a 50% stenosis of the right internal carotid artery What is the most appropriate treatment for this patient?

1 ) Aspirin
2 ) Carotid endarterectomy
3 ) Dipyridamole
4 ) Prednisolone
5 ) Warfarin

Question 3:

A 70 year old woman presented with a history of pancreatitis and persistent diarrhoea. She also gave a history of osteoporosis and had had a deep vein thrombosis. Which one of the following drugs will become less effective after she starts taking Cholestyramine to relieve intolerable itching?

1 ) Aspirin
2 ) Folic Acid
3 ) Thiamine
4 ) Vitamin D
5 ) Warfarin

Question 4:

A 55 year old female presents with episodic sweats and tremors which are are relieved by glucose. She has gained approximately 6 kg in weight of late and drinks approximately 10 units of alcohol weekly. Her investigations show normal Full Blood Count, Normal Urea and electrolytes and a fasting plasma glucose concetration of 4 mmol/l (3-6). What is the most appropriate investigation for this patient?

1 ) 72 hour fast
2 ) CT scan of pancreas
3 ) EEG
4 ) Insulin and C-peptide concentration
5 ) Oral glucose tolerance test

Question 5:

A 33 year old female is admitted with erythema multiforme and erythematous lesions of the mouth and eyes.
Which one of the following drugs may account for her presentation?

1) Diazepam
2 ) Fluoxetine
3 ) Mebeverine
4 ) Oral contraceptive
5 ) Sulphasalazine

Answers to the above questions: 4,1,4,1,5. Got 100%?

MRCP Mock Examination (1)

MRCP Mock Examination (1)

Hi, sorry for the long absence from this blog, these MRCP questions are the questions provided by Ahmed Hakim in his site.

Question 1:

60-year-old woman presented with 3 months history of diplopia and blurred vision of left eye. She denied any pain or other neurological symptoms. Her previous medical history is unremarkable. She smokes 20 cigarettes per day and drinks alcohol in moderation. Her general medical examination is normal. Her visual acuity on the right is 6/6 and on the left 6/36.
There is left partial ptosis and mild proptosis with conjunctival injection. The left pupil is smaller than the right but reacting normally to light. There is some limitation of abduction of the left eye. Fundoscopy showed a pale left optic disk. The left corneal reflex is reduced.

The remaining of the neurological examination is normal. Routine blood tests including FBC, U+Es, LFTs, TFTs, Ca, Creatine kinase, autoantibody screen were normal. ECG, CXR were unremarkable. Slit lamp examination was normal. Intra-ocular pressures were within normal range.

Where is the most likely cause of her symptoms?

1 ) Cavernous sinus
2 ) Superior orbital fissure
3 ) Orbital apex syndrome
4 ) Optic chiasm
5 ) Brain stem

Question 2:

A 72 year old male is being treated for hypertension, gout, Gastro-oesophageal reflux and has a three year history of type 2 diabetes. He takes a variety of medications. His general practitioner is concerned after requesting U+Es on this patient which reveal:

Serum Sodium 138 mmol/l
Serum Potassium 4.4 mmol/l
Serum Urea 12.8 mmol/l
Serum Creatinine 162 micromol/l
Of the following drugs that he takes, which one's dose does NOT need to be reduced for this patient?

1 ) Allopurinol
2 ) Gliclazide
3 ) Lansoprazole
4 ) Lisinopril
5 ) Metformin

Question 3:

A 16 year old girl is seen in clinic as she is concerned due to areas of hair loss on the scalp. Past medical history includes atopic eczema and she has a number of depigmented areas on her hands. What is the most likely diagnosis?

1 ) Alopecia areata
2 ) Hypothyroidism
3 ) Seborrhoeic dermatitis
4 ) SLE
5 ) Trichotillomania

Question 4:

A 17 year old male with glucose-6-phosphate dehydrogenase deficiency presents with tiredness and is noticed to be jaundiced. These features have developed since he developed a mild chest infection one week ago. Which one of the following is the most likely haematological finding?

1 ) Haemoglobinuria
2 ) low mean cell volume
3 ) Positive direct antiglobulin test
4 ) Reduced reticulocyte count
5 ) Spherocytes present on blood film

Question 5:

A 32 year-old man presented to hospital with a four week history of progressively worsening dyspnoea on exertion. He also complained of a non-productive cough. Over the two days preceeding admission the patient had become breathless at rest and was started on oral co-amoxiclav by his general practitioner.

On examination he was febrile 38°C and looked unwell. Candida was noted on the tonsilar pillars. No wheeze or crackles were heard in his chest. His chest radiograph is shown. Oxygen saturation was 95% on room air, but fell to 85% following about of coughing. Arterial blood gases show pO2 of 59 mmHg.

What treatment shold be given?

1 ) Co-amoxiclav + clarithromycin
2 ) Co-trimoxazole + prednisolone
3 ) Vancomycin + ceftazidime
4 ) Cefuroxime + metronidazole
5 ) Benzylpenicillin + flucloxacillin

Question 6:

A 52 year old female presents with blistering of the hands and arms which deteriorates during the summer. She was otherwise well and drinks approximately 20 units of alcohol weekly. Examination of her skin revealed erosions and scarring on the backs of her hands and forearms and some mild hirsutes.

Which one of the following is the most likely diagnosis?

1 ) Acute intermittent porphyria
2 ) Erythropoietic protoporphyria
3 ) Pemphigoid
4 ) Porphyria cutanea tarda
5 ) Subacute lupus erythematous

OK, now mark your marks, the answers to above questions are 3,3,1,1,2,4.

I will try to upload more questions soon.
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