Get Through MRCP Part 1: BOFs

313 Pages·2008·4.42 MB·English

by  Osama S M Amin

Get Through
MRCP Part I: BOFs
© 2008 by Taylor & Francis Group, LLC
Get Through
MRCP Part I: BOFs
Osama S M Amin MRCPI MRCPS(Glasg)
DepartmentofNeurology,BaghdadTeachingHospital,Baghdad,Iraq

© 2008 by Taylor & Francis Group, LLC
CRC Press
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© 2008 by Taylor & Francis Group, LLC
Contents
Foreword vii
Preface ix
List of abbreviations xi
Recommendedreading xiii
Dedication xiv
Acknowledgements xv
1. Cardiology: Questions 1
Cardiology: Answers 16
2. Respiratory medicine: Questions 27
Respiratory medicine: Answers 40
3. Renal medicine: Questions 49
Renal medicine: Answers 64
4. Gastroenterology:Questions 75
Gastroenterology: Answers 89
5. Endocrinology: Questions 101
Endocrinology:Answers 115
6. Clinical haematology and oncology: Questions 128
Clinical haematology and oncology: Answers 142
7. Neurology, psychiatry and ophthalmology: Questions 154
Neurology, psychiatry and ophthalmology: Answers 172
8. Rheumatology and diseases of bones and
collagen: Questions 187
Rheumatology and diseases of bones and
collagen: Answers 200
9. Tropical medicine, infections and sexually
transmitted diseases: Questions 211
Tropical medicine, infections and sexually
transmitted diseases: Answers 224
10. Dermatology: Questions 234
Dermatology:Answers 241
11. Clinical pharmacology, therapeutics and
toxicology:Questions 246
Clinical pharmacology,therapeuticsand
toxicology: Answers 262
12. Clinical sciences:Questions 276
Clinical sciences: Answers 289
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© 2008 by Taylor & Francis Group, LLC
Foreword
F
o
r
e
w
The London MRCP exam began in 1859, so this book arrives one year o
r
short of its 150th anniversary. Yet the relevance of the MRCP lies in its d
placeinatwo-and-a-halfmillennium traditionofHippocraticmedicine.
What distinguishes the Hippocratic tradition? I would suggest it has
threecharacteristics.First,itisascientifictradition,basedonobservation
andevidence,notonauthority–whentraditionsareolditiseasytoforget
theirradicalfoundations.Second,anytraditionthatisbasedonscientific
evidence mustcopewith change–wemust beprepared togowhere new
evidence leads.Progress meanschange, andquite possibly thescienceof
medicine has made more progress in the last 150 years than in the two-
and-a-half millennia before. Candidates sitting the exam now and their
counterpartsin1859wouldnodoubtbothbeequallysurprised,anddis-
comforted, to have their question papers exchanged!
Finally, however, Hippocratic medicine is not just a science, and cer-
tainly not just a job. It is a vocation and a profession. From the Hippo-
cratic tradition we have the driving imperative to act only in the
patients’bestinterest,andtoseektoneverbringthemharm.Itisthistra-
ditionthatmakesthosewhoshareitcolleagues,atadeeplevel,withphys-
icians from othernations and other times.
Any profession must function within specific times and cultures, and
medicine is no exception. Postgraduate medical training in the UK is
going through a time of turbulent change. But I am glad to say that this
book contains no questions about MMC or how to write a good CV.
Thejobmaygothroughgoodtimesorbad,butthevocationremainscon-
stant.Therewillalwaysbepatientswhoneedintelligentandcaringtreat-
mentfromtheirphysicians.InthisOsamaAminservesstunninglywellas
arolemodel.IfIwereworkingattheBaghdadTeachingHospitalinIraq,
wouldIbeconcerningmyselfwithwritingmedicaltextbooks?Wecanbe
thankful for such an example. For the real accolade for this book is not
just that it will help you to pass an exam, but that it will help you to
treat patients.
David Misselbrook
Dean, Royal Societyof Medicine

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© 2008 by Taylor & Francis Group, LLC
Preface
P
r
e
fa
c
‘HowdoIgetstarted?’‘WhichbooksshouldIread?’‘Whicharethebest e
self-assessment books?’ ‘How much time do I need for preparation?’
These are the usual questions asked by the MRCP candidates. Rumours
about the MRCP examination spread like a fire, conveying many wrong
ideas and unhelpful ‘tips’.
Anytypeofexamination,medicalornon-medical,requirespreparation.
With careful reading, an appropriate duration of study and proper self-
assessment,thecandidatecansafelysecureapassinthisexamination.
HowdoIgetstarted?Theanswerissimple;startbyreadingaccredited
textbooks, chapter by chapter to build up a wealth of knowledge. An
efficient physician should be familiar with the well-known medicine
textbooks and their contents.
Which medical books should be read? The market is full of well-
accreditedtextbooks.IwouldsuggeststartingwithDavidson’sPrinciples
andPracticeofMedicine;itissimple,compactandcoversmanyimport-
antaspectsandthemesoftheexamination.Youshouldthenextendyour
horizon byreading specialist textbooks.
How much time do I need for preparation? No one can answer this
question for you; you are the only one who can judge your starting
pointandestimatethetimeneededtoassimilatethenecessaryknowledge
base.However,nolessthan6monthswouldsufficeforthispurpose.The
best tip is to take your time and there will beno need to rush.
Which are the best self-assessment books? This is an embarrassing
question! The market is full of these books and the number is rising.
Self-assessment books should be tackled only after reading textbooks.
The idea is to self-assess, i.e. test your level of knowledge. Do not start
your MRCP preparation journey by doing this step first. Do as many
best of five (BOF) books as you can, identify your weak points and try
to fill these gaps.
My examination is tomorrow! There is no need to panic. On the
day before examination, for your own self-esteem, skim quickly over
BOF questions.
What will happen on the day of examination? Reach the place of the
examination at least 1 hour before the expected start time, and bring a
grade 2B pencil and a rubber with you (some examination centres
supply candidates with these). Each candidate has a dedicated seat
labelled with his/her name (and sometimes code number). The MRCP
UK Part 1 examination has two papers, 100 BOF questions in each,
andeachpaperlasts3hourswitha1hourbreakbetween.Thecandidate
should choose the best possible answer from the five stems.
Verify your name, code number and examination number on the
front page of each paper. Paper 1 is usually easier than paper 2. Read
individual questions carefully and mark the answer sheet with your
choice; if you face any difficult question, skip these and return to them
at the end.
ix
© 2008 by Taylor & Francis Group, LLC
According to the MRCP examination regulations, the composition of
P
r the papers is as follows:
e
fa
c
e Specialty Numberofquestions(cid:2)
Cardiology 15
Clinicalhaematology and oncology 15
Clinicalpharmacology, therapeuticsand toxicology 20
Clinicalsciences(cid:2)(cid:2) 25
Dermatology 8
Endocrinology 15
Gastroenterology 15
Neurology 15
Ophthalmology 4
Psychiatry 8
Renal medicine 15
Respiratorymedicine 15
Rheumatology 15
Tropicalmedicine, infectious and sexually 15
transmitted diseases
(cid:2)Thisshouldbetakenasanindicationofthelikelynumberofquestions;
the actual number may vary bytwo.
(cid:2)(cid:2)Clinical sciences comprise:
Cell, molecular and membrane biology 2
Clinicalanatomy 3
Clinicalbiochemistry and metabolism 4
Clinicalphysiology 4
Genetics 3
Immunology 4
Statistics,epidemiology, and evidence-based medicine 5
AdaptedwithpermissionfromMRCP(UK)RegulationsandInformationforCandidates,
2008 edition. MRCP (UK) Central Office, Royal Colleges of Physicians of the United
Kingdom,London,UK.Copyright2008.Allrightsreserved.
The examination may include pre-test questions (trial questions that

are used for research purposes, and these do not count towards the
candidate’s final score).
In writing this book, I have tried to cover the examination syllabus
and its most important themes, and to provide a rapid review of most
of the subjects that can be encountered.
Good luck!
Osama Amin
x
© 2008 by Taylor & Francis Group, LLC
List of abbreviations
L
is
t
o
ABPI ankle:brachialblood pressure index fa
b
ACE angiotensin-converting enzyme b
r
ADH antidiuretic hormone e
v
AIDS acquired immunedeficiency syndrome ia
t
AIP acute intermittent porphyria io
n
ALT alanine aminotransferase s
ANA antinuclear antibody
ANCA antineutrophil cytoplasm antibody
ARDS acute respiratory distress syndrome
ARMD age-related macular degeneration
ASD atrialseptal defect
AST aspartate transaminase
CABG coronary artery bypass graft
CLI critical limb ischaemia
CLL chronic lymphocyticleukaemia
CML chronic myeloid leukaemia
CMV cytomegalovirus
CNS central nervous system
COPD chronic obstructive pulmonary disease
CPAP continuous positive airway pressure
CRP C-reactive protein
CSF cerebrospinal fluid
DIC disseminated intravascular coagulation
DIP distal interphalangeal
DL carbon monoxide diffusion in the lung
CO
DVT deep vein thrombosis
ECT electroconvulsive therapy
EEG electroencephalogram
EIA enzyme-linked immunoassay
EMG electromyography
EPO erythropoietin
ERCP endoscopic retrograde cholangiopancreatography
FAP familial adenomatous polyposis
FEV1 forced expiratory volume in 1 second
FiO fractional concentration of oxygen in inspired gas
2
FVC forced vitalcapacity
G6PD glucose-6-phosphate deficiency
GBM glomerular basement membrane
GFR glomerular filtration rate
GIT gastrointestinal tract
HAART highlyactive antiretroviral therapy
hCG humanchorionic gonadotrophin
HDL high density lipoprotein
IDL intermediate density lipoprotein
INO internuclear ophthalmoplegia
INR international normalized ratio
ITP idiopathic thrombocytopenic purpura
JVP jugular venous pressure
xi
© 2008 by Taylor & Francis Group, LLC
LDH lactate dehydrogenase
L
is LDL lowdensitylipoprotein
t
LV left ventricle
o
fa MCV meancorpuscularvolume
b
b MDR multidrug resistant
r
e MEN multiple endocrineneoplasia
v
ia MGUS monoclonal gammopathy of undetermined significance
t
io MODY maturity onset diabetes of the young
n
s MRI magnetic resonance imaging
NSAID non-steroid anti-inflammatory drug
PAN polyarteritis nodosa
PCI percutaneous coronary intervention
PCR polymerase chain reaction
PCV packed cell volume
PEM proteinenergy malnutrition
PIP proximal interphalangeal
PPI proton pump inhibitor
PTH parathyroid hormone
RBC red blood cell
RIBA recombinant immunoblot assay
RTA renal tubular acidosis
SBP spontaneous bacterial peritonitis
SIADH syndrome of inappropriate ADH secretion
SLE systemic lupus erythematosus
TB tuberculosis
TIA transient ischaemic attack
TIPPS transjugular intrahepatic portosystemicstent shunt
TSH thyroid stimulating hormone
TTP thrombotic thrombocytopenic purpura
UTI urinary tract infection
VLDL very low density lipoprotein
VSD ventricular septal defect
vWD von Willebrand disease
vWF von Willebrand factor
WPW Wolff–Parkinson–White

xii
© 2008 by Taylor & Francis Group, LLC
Recommended reading
R
e
c
o
m
AbrahamsonM, Aronson M (eds).ACP Diabetes Care Guide, ATeam-
m
Based Practice Manual and Self-Assessment Program. Philadelphia: e
n
American College of Physicians, 2007. d
e
AndreoliT,CarpenterC,GriggsR,BenjaminI.AndreoliandCarpenter’s d
r
Cecil’s Essentials of Medicine, 7th edn. Philadelphia:Elsevier, 2007. e
a
Boon NA, Colledge NR, Walker BR (eds). Davidson’s Principles and d
in
Practice of Medicine, 20th edn. Philadelphia: Elsevier, 2006. g
Fauci AS, Braunwald E, Kasper DL et al. (eds). Harrison’s Principles of
InternalMedicine, 17th ed. New York: McGraw-Hill, 2008.
Goldman L, Ausiello D (eds). Cecil Textbook of Medicine, 22nd edn.
Philadelphia: Elsevier, 2003.
Kanski J. Clinical Ophthalmology: A Systematic Approach, 6th edn.
Philadelphia: Elsevier, 2007.
KlippelJ,CroffordA,StoneJ,WeyandC(eds).PrimerontheRheumatic
Diseases,12th edn. Georgia:Arthritis Foundation, 2001.
Larsen P, Kronenberg H, Melmed S, Polonsky K (eds). William’s
Textbookof Endocrinology, 10th edn. Philadelphia: Elsevier, 2003.
Ropper A, Brown R. Adams and Victor’s Principles of Neurology, 8th
edn. New York: McGraw-Hill, 2005.
WarrelD,CoxT,Firth J,BenzeE(eds).OxfordTextbookofMedicine,
4th edn. New York: Oxford University Press, 2003.

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© 2008 by Taylor & Francis Group, LLC