Last Minute Picture Tests for MRCP 2

45 Pages·2006·2.503 MB·English

by  W.Stephen Waring

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PICTURE TESTS
OR MRCP 2
W S Waring
<D2006PASTEST LTD
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All rights reserved No part of this publicationmay be reproduced, storedin a
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the copyright owner.
FirstPublished 2006
ISBN:1904627 781
A catalogue record for this bookis available from the British Library.
The information containedwithin this book was obtainedby theauthor from
reliablesources.However,whileeveryeffort hasbeenmadetoensure its accuracy,
no responsibility for loss,damageor injury occasioned to any person actingor
refraining from action asa result of information contained herein can beaccepted
by thepublishersor author.
PasTest Revision Books and IntensiveCourses
PasTest hasbeen establishedin the field of postgraduate medical education
since1972,providing revision books and intensivestudy courses for doctors
preparingfor their professional examinations.
Books and courses are available for the following specialties:
MRCGP,MRCP Parts1 and 2,MRCFCHParts1 and 2,MRCPsych,MRCS,
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Text typeset and designed byType Study,Scarborough,NorthYorkshire
Printedand boundin the UK by Alden Press,Oxfordshire
CONTENTS
-
5' = r % *- M
Contributors vil
Introduction ix
Questions and Answers" 1
*Answers arelocated onevery fourth page
List of popular examination questions
3, 10, 16, 24, 26, 32, 36, 47, 49, 55,
63, 68, 80, 87, 95, 104, 112, 136,
142, 150
Index 201
This one
- -
LGE0 1ZP 3XCN
Copyrightedmaterial
CONTRIBUTORS
Alice Miller MA MBChB
SeniorHouseOfficer inMedicine,RoyalInfirmary of Edinburgh,Edinburgh
We acknowledge thecontribution given by a colleaguebased at St John'sHospital,
Livingston.
vii
Copyrightedme
INTRODUCTION
TheMRCP(UK)diploma isa recognisedentry qualification for higher specialist
.
traininginmedicineand its related specialties Eligibility for the MRCP(UK)diploma
normallyrequires candidates tosuccessfully complete the MRCP(UK)examination,
which hastwo parts involving three separate assessments;the Parti examination,
the Part 2 writtenexamination,and thePart 2clinicalexamination. Candidates
can undertakethe Part 2 written examination if theyhavesuccessfullycompleted
the Part 1 examination,or if they haveexemption from thePart 1examination.
TheMRCP(UK)Part 2written examination is overseenby administrativeoffices in
Edinburgh,Glasgow and London,andcan be undertakenat anyoneof several
establishedUK centres,or at oneof a growingnumber of overseas centres.
Theformat of the exam is constantly changing to reflect newpatterns of teaching
methods,andadvancesinknowledgeand skills requiredfor current clinical
practice.From December 2005 onwards,theexaminationhasbeen delivered as
three 3-hour writtenpapers.over thecourse of two days:Papers1&2 onone day,
andPaper 3 on the next day Questions involvea'best of five'format(onecorrect
answer selectedfromfive possibleoptions),and an'n of many'format(two or
threecorrect answersselectedfromten to fifteen possible options). ’Negative
,
marking'has been phased out so thatin thecurrent Part 2 written examination a
correct answer willscore +1,whereas noattempt or anincorrect answer will
score0.Thesechanges have beentaken to create a morereliableassessment of
candidate's abilities.
ThePart 2writtenexamination is designed to assess candidates'knowledgeabout
diagnosis, Investigation,management,and prognosisinrelationto important
.
diseases Inclusionof contextual clinical scenarios aims to keep theexam relevant
toeveryday practice.Thequestions may include theresultsof investigations,and
may be accompaniedby illustrativematerial suchas clinical photographs,ECG
.
traces,radiographic images or microscopic appearances Each of the threepapers
in the MRCP(UK) Part 2 written examination contains around100questions.The
,
exam iscriterionreferenced and a pass markis set before each dietby
experienced clinicians responsible for standard setting.Questions arechosen to
represent eachof the main clinical specialties in the followingproportions:
Specialties
Neurology,ophthalmology,psychiatry 11%
Cardiology 10%
Clinical pharmacology & toxicology 10%
Endocrinology & metabolic medicine 10%
Gastroenterology 10%
Renal medicine 10%
Respiratory medicine 10%
Infectious diseases,tropical medicine & STDs 9%
Rheumatology 6%
Clinical haematology & immunology 5%
Oncology fit palliativemedicine S%
Dermatology 4%
ix
Con
Thisbook contains 1SOcolour illustrationsthat cover a wide range ofclinical
conditions. The photographsincluderadiographs, blood films,ECC traces,
.
pathologicalexamplesand other formats They are accompanied by questions that
areIn thesame style asiscommonly encountered in the exam itself, andgive a
certain amountof relevant history to help thecandidatemake the most
appropriate diagnosis.The answers are succinct andshouldaid the candidate in
revision tost Minute Picture Testsfor MRCPgivescandidatesan opportunity to
,
refresh their knowledge overa broadrangeof topics included in theexam
syllabus. The answers are given as an aide memoirrather thananexhaustive
summary of individual topics, toallow candidatestocoverlargenumbers of
questions more quickly.Explanations are given for certain modalities of
investigation that mightbe unfamiliar to some candidates, for example
echocardiography.
Usefulwebsites for further information are:
1. http://www.mrcpuk.org/plaln/mrcppt2.html
further information on the MRCP Part 2 writtenexam regulations and
application process.
2. http://www.pastestonline.co.uk/
Onlinerevisionsource withpractice papers {different questions from those
appearing in thebook range),including a free demo.
Goodluck!
WSW
2006
x Introduction
Copyrightedmaterial
QUESTIONS
1. The following abdominal ultrasound scan with Doppler flow was
_ performed in a 56-year-old patient with established peripheral
vascular disease. What is the most likely diagnosis?
J A Abdominal aortic aneurysm
I I B Aortic dissection
_
-
C Arterio venous malformation
Q| D Polyarteritis nodosa
J E Renal artery stenosis
Answer on p.4 1
ateria
.
2 A 45-year-old woman attends the A&E department complaining of
severe anterior chestwall pain, associated with vomiting.Which of
__ the following diagnosesdoes the ECC appearance most strongly
suggest?
J A Acuteanterior myocardial infarction
[ J B Acute inferolateral myocardial infarction
I C Acute pulmonary embolism
rI
D Dissection of the ascending aorta
Q
E Right ventricular Infarction
- : 4
:i*"* .*^^ '
.
II I» : n ' r
r ; l i f t s
- ..
>«>»iPTHi 7.7*
(cid:127) (cid:127) (cid:127) (cid:127)
I
2 Answer on p. 4
a
This 61-year-old manhas been admitted to hospital due torecurrent
.
falls and poor mobility You areasked to review himbecause heis
complainingof deterioration of his vision.What is the most likely
diagnosis?
| A Central retinal artery occlusion
i
B Central retinalveinocclusion
C CMVretinitis
_| D Grade IV hypertensive retinopathy
I \ E Polyarteritis nodosa
(cid:127) (cid:127)
* * M
.
Answer onp 4 3
m
.
1 B: Aorticdissection
The scan shows a longitudinaltear along the aorta with laminar flow
in the main aortic lumen (shownin blue to red}and turbulent flow
within thedissection (scattered red,blue, yellow). Aortic dissection
involves the ascendingaorta in 70% of cases,descending aorta in
20%and the aortic arch in 10%.Abdominal aortic aneurysm
dissection usually occursat or below therenal arterylevel, and most
commonly in patients with aortic aneurysm.
B; Acute inferelaterat myocardial infarction
Significant ST segment elevationis seen in bothinferior (11, IIIand
aVF)and lateral leads(V4-6).This Is likely to represent occlusionof
theleft anterior descending coronary artery,but there isinsufficient
informationto suggest underlying aortic dissection.
B:Central retina!vein occlusion
There are extensive retinal haemorrhagesand exudates;allsectors of
the retina are involved, Incontrastto the pattern seen in branch
retinalvein occlusion. Central retinalvein occlusion is a thrombotic
disorder (incontrast to central retinal artery occlusion, which is
usually embolic inorigin). Risk factors are glaucoma and raised
intraocular pressure.
4 Answers to Questions 1-3