MRCP Part 1 - Mock Exam (1)

I have prepared 20 questions for you to answer in 25 minutes, you can

find the answers after you complete the questions below,
1)A 55 year old female undergoes a DEXA scan which reveals a bone
mineral density T score of -2.5 at the hip and lumbar spine.
Which of the following may contribute to such a result?
1 ) Acromegaly 2 ) Delayed menopause 3 ) Hypothyroidism 4 )
Myeloma 5 ) Obesity
2)In a normal heart, the oxygen saturation of a sample of blood taken
from a catheter in the pulmonary capillary wedge position should be
equal to a sample from which of the following?
1 ) coronary sinus 2 ) femoral artery 3 ) pulmonary artery 4 ) right
atrium 5 ) right ventricle
3)Elevation of the jugular venous pressure during inspiration is most
likely to be found in which of the following situations?
1 ) a normal physical exam 2 ) cardiac tamponade 3 ) constrictive
pericarditis 4 ) dilated cardiomyopathy 5 ) myocarditis
4)A 50-year-old plumber presented with a dry nocturnal cough and
increasing exertional breathlessness.
On examination he had early finger clubbing, cyanosis and bilateral
basal crackles. A chest X-ray showed bilateral lower zone shadowing.
Investigations revealed:
PaO2 (breathing air) 8.0 kPa (11.3-12.6) FEV1/FVC ratio 90%
Which of the following investigations is most likely to establish the
diagnosis

1 ) Echocardiography. 2 ) High resolution CT scan of the lung 3 )

Measurement of diffusion capacity
4 ) Serun calcium level 5 ) Transbronchial lung biopsy
5)A 40 year old woman presents with an acute attack of asthma. She
is able to speak in short sentences.
Her respiratory rate is 20 breaths per minute and the peak expiratory
flow rate 320L/min (predicted 480 L/min.
What is the most appropriate treatment for this patient?
1 ) Intravenous aminophylline. 2 ) Intravenous salbutamol 3 )
Nebulized salbutamol
4 ) Oral salbutamol 5 ) Oral theophylline
6)A new diagnostic test for malabsorption has been analysed and the
results have yielded the following 2x2 contingency table.
Disease present
test result yes no
+ve 0.9 0.1
-ve 0.2 0.8
Applying this test to a case of chronic diarrhoea from a patient group
where the prevalence of malabsorption is known to be 20%
(probability = 0.2)
what is the probability of a patient having malabsorption if they have a
positive test?
1 ) 0.16 2 ) 0.24 3 ) 0.48 4 ) 0.64 5 ) 0.8
7)A 53-year-old man presented with hypertension of 150/110 mmHg.
He is generally asymptomatic and has no previous medical history of
note. He is a smoker of 5 cigarettes daily and drinks modest quantities

of alcohol. He takes no prescribed medications. Examination reveals a

BMI of 33.5 kg/2 but nil else.
The following detail his investigations:
Serum sodium 146 mmol/l (NR 133-145)
Serum potassium 3.2 mmol/l (NR 3.5 - 5)
Urinary potassium excretion 42 mmol/l (NR less than 30)
What is the likely diagnosis?
1 ) Adrenocortical adenoma 2 ) Bartter's syndrome 3 ) Liddle's
syndrome 4 ) Liquorice ingestion 5 ) Pheochromocytoma
8)A 74-year-old man presented with acute pain, pallor and absent
pulses in his right leg. Investigations revealed an embolus in his
femoral artery.
What is the most likely source of this embolus?
1 ) marantic endocarditis 2 ) paradoxical emboli 3 ) rheumatic
endocardial vegetations
4 ) right ventricular thrombi 5 ) thrombi from an atheromatous aorta
9)When acclimatised to life at high altitudes
1) the mean corpuscular haemoglobin concentration is increased 2)
respiration becomes periodic
3) cardiac output is increased 4) pulmonary diffusion capacity is
increased 5) airway resistance is decreased
10)Recognised features of acromegaly include EXCEPT
1) hypocalciuria 2) intestinal polyposis 3) splenomegaly 4) palpable
peripheral nerves 5) proximal myopathy
11)Which ONE of the following statements is true of autoimmune

hepatitis:
1 ) It usually presents as an acute hepatitis 2 ) It rarely presents
before 20 years of age
3 ) It may be associated with keratoconjunctivitis sicca 4 ) It is
associated with hypogammaglobulinaemia
5 ) It rarely interferes with menstruation except in later stages
12)A 38 year old female presents with red target lesions confined to
the hands and is diagnosed with erythema multiforme.
Which of the following could be the cause? 1 ) Cytomegalovirus
infection 2 ) Ureaplasma urealyticum
3 ) Group B Streptococci 4 ) Langerhan's cells histiocytosis 5 )
Penicillin V
13)A 50-year-old man presented in the summer complaining of itching
and blistering of his hands and forehead. On examination there were
small areas of excoriation on the backs of his hands.
What is the most likely diagnosis?
1 ) dermatitis herpetiformis 2 ) lupus erythematosus 3 ) pemphigoid
4 ) pemphigus 5 ) porphyria cutanea tarda
14)Which of the following statements concerning the thymus is true?
1 ) The majority of cortical thymocytes express either CD4 or CD8.
2 ) CD4/CD8 double positive cells are eliminated by a process of
negative selection.
3 ) A proportion of alpha/beta+ thymocytes undergo isotype switching
to produce gamma/delta+ T cells.
4 ) Thymocytes whose TcR bind with high affinity to self Ag/MHC
complexes are clonally deleted.
5 ) Mature thymocytes express surface IgM and IgD.
15)Which of the following conditions is most likely to be associated

with thrombocytopenia?
1 ) haemophilia A 2 ) hereditary haemorrhagic telangiectasia 3 )
pernicious anaemia 4 ) porphyria 5 ) uraemia
16)Concerning Neurofibromatosis Type 1 (NF1),
which one of the following statements is true?
1 ) Bilateral acoustic neuromas are common 2 ) Clinical severity in
individuals is similar in a given family
3 ) New mutations occur rarely 4 ) Lisch nodule is a characteristic
feature
5 ) The diagnosis is likely if one caf-au-lait patches are present
17)A 73 year old female is diagnosed with Cushing's disease. Which of
the following is correct?
1 ) Adrenalectomy would be the treatment of choice. 2 ) op-DDD is a
treatment if unfit for surgery 3 ) Ketoconazole may be used as a
treatment if unfit for surgery 4 ) Recurrence of Cushing's disease after
transphenoidal surgery is less than 5%
5 ) yttrium implantation is an effective treatment
18)A 19-year-old male student attends casualty complaining of an
urethral discharge. Gram stain shows numerous neutrophils, some of
which contain gram-negative intracellular diplococci. The patient is
treated with Ceftriaxone, 250 mg as an im injection. Five days later,
the patient re-attends with persisting discharge.
Which of the following is the most likely cause of this discharge?
1 ) Chlamydia trachomatis 2 ) Penicillin-resistant Neisseria
gonorrhoeae 3 ) Re-infection with Neisseria gonorrhoeae
4 ) Ureaplasma urealyticum 5 ) Urethral stricture
19)A randomised double-blind placebo controlled study of a

cholesterol-lowering drug for the primary prevention of coronary heart

disease was conducted. It had a five-year follow up period.
The results showed an absolute risk of myocardial infarction in the
group-receiving placebo during was 10 per cent. The relative risk of
those given the cholesterol lowering medication was 0.8
What number of patients will need to be treated with the drug for five
years to prevent one myocardial infarction?
1 ) 20 2 ) 40 3 ) 50 4 ) 80 5 ) 100
20) This gentleman presents with recurrent per-rectal bleeding.What is
the risk of his children to have the similiar problem?

1) 25%
2) 50%
3) 100%
4) Depending on the children's gender
5) variable
with permission from www.passpaces.com
Find your answers here!
Questions:
1)A 67 year old man presents with sudden onset atrial fibrillation
(ventricular rate of 150/minute). His serum creatinine concentration
was 250 umol/L (70-110).
What is the main factor that determines the choice of loading dose of

digoxin in this patient?

1 ) Absorption 2 ) Apparent volume of distribution 3 ) Lipid solubility
4 ) Plasma half-life 5 ) Renal clearance
ANSWER: 5
2)Serum digoxin concentrations are increased when given
with...EXCEPT
A Amiodarone B Spirolactone C Cholestyramine D Quinine E Verapamil
ANSWER: C
3) A 72 year old man is admitted with fast atrial fibrillation but is
receiving treatment with digoxin. An inadequate dose is suspected. A
sample of blood is drawn six hours after the last dose of digoxin and a
plasma concentration is requested.
Which of the following factors explains the six hour wait before
measuring the digoxin concetration?
1 ) enterohepatic circulation 2 ) the rate of absorption 3 ) the rate of
clearance
4 ) the rate of distribution 5 ) the rate of elimination
ANSWER: 4
4)A 65-year-old was advised to start oral digoxin at a dose of 250 g
daily. His physician explained that the full effect of this treatment
would not be apparent for at least a week.
Which one of the following pharmacokinetic variables did the physician
use to give this explanation?
1 ) bioavailablity 2 ) half-life 3 ) plasma protein binding 4 ) renal
clearance 5 ) volume of distribution
ANSWER: 2

MRCP Part 1-Mock Exam (2)

MRCP Part 1 Questions

Here are some questions for MRCP Part 1, take the test and look at the
answers later!
1)Ostium secundum ASD is associated with
A tricuspid regurgitation
B left bundle branch block
C fixed splitting of the second heart sound
D onset of atrial fibrillation in the second decade
E early onset of heart failure in the second decade
2)A 34 year old male presents with episodes of breathlessness on
exertion. Examination reveals a loud P2 and fixed splitting of the
second sound. Which of the following may be responsible for these
signs?
1 ) Maternal chicken pox infection 2 ) Maternal thalidomide therapy
3 ) 47 XXY karyotype 4 ) Homocystinuria 5 ) Excess maternal alcohol
consumption
3)A 35-year-old healthy woman has a faint systolic murmur on
physical examination. An echocardiogram is performed, and she is
found to have a bicuspid aortic valve. In explaining the meaning of this
finding to her, the most appropriate statement is that?
1 ) An aortic valve replacement is eventually likely to be required.
2 ) Other family members are likely to have the same condition
3 ) She should be treated with a cholesterol-lowering agent
4 ) The problem resulted from past injection drug usage
5 ) This is one manifestation of an underlying autoimmune disease
process
4) A 24-year-old woman develops infective endocarditis involving the
aortic valve. She receives a porcine bioprosthesis because of her desire
to have children and not to take anticoagulantmedication. After ten

years, she must have this prosthetic valve replaced. Which of the
following pathologic findings in the bioprosthesis has most likely led to
the need for replacement?
1 ) Calcification with stenosis
2 ) Dehiscence
3 ) Infective endocarditis
4 ) Strut failure
5 ) Thrombosis
5) The following can cause bradycardia: EXCEPT
A hypothermia B hypothyroidism C severe anaemia D subdural
haematoma E shock
6)The following are recognised causes of reversible dilated
cardiomyopathy:- EXCEPT
A alcohol B Selenium deficiency C Acromegaly D Lead poisoning E
Coxsackie virus
7) Which of the following concerning congenital heart disease is
correct?
1 ) ASD is the commonest malformation at birth
2 ) congenital complete heart block is usually associated with Anti-Ro
antibodies in the mother 3 ) Ebstein's anomaly is associated with
maternal exposure to lithium carbonate
4 ) Hypoplastic left heart syndrome is characterised by a large, dilated
left ventricle
5 ) Osteogenesis imperfecta is associated with aortic stenosis
8) Coarctation of the aorta is: EXCEPT
A usually congenital but may be aquired
B recognised by absent or delayed femoral pulses
C a common cause of heart failure in infancy but an uncommon cause
of hypertension in adults D associated with an increased incidence of

an aortic bicuspid valve

E a cause of left to right shunting of blood
9)A 65-year-old woman, a heavy smoker for many years, has had
worsening dyspnoea for the past 5 years, without a significant cough.
A chest X-ray shows increased lung size along with flattening of the
diaphragms, consistent with emphysema. Over the next several years
she develops worsening peripheral oedema. BP 115/70 mmHg. Which
of the following cardiac findings is most likely to be present?
1 ) Constrictive pericarditis 2 ) Left ventricular aneurysm 3 ) Mitral
valve stenosis
4 ) Non-bacterial thrombotic endocarditis 5 ) Right ventricular
hypertrophy
10)Increased pulmonary vascular markings on chest x-ray are a
recognized feature of:
A Pulmonary stenosis
B Mitral stenosis
C Persistent ductus arteriosus
D Primary pulmonary hypertension
E chronic constrictive pericarditis
11) A 59-year-old man who was active all his life develops sudden
severe anterior chest pain that radiates to his back. Within minutes, he
is unconscious. He has a history of hypertension, but a recent treadmill
test had revealed no evidence for cardiac disease. Which of the
following is the most likely diagnosis?
1 ) Acute myocardial infarction
2 ) Group A streptococcal infection
3 ) Pulmonary embolus
4 ) Right middle cerebral artery embolus
5 ) Tear in the aortic intima

12)Low T waves on an ECG are seen in:

A hyperkalaemia B hypercalcaemia C athletes D pericardial effusion E
myelodysplasia
13)A 56 year old male with left ventricular systolic dysfunction was
dyspnoeic on climbing stairs but not at rest. The patient was
commenced on ramipril and frusemide.
Which one of the following drugs would improve the patient's
prognosis?
1 ) Amiodarone 2 ) Amlodipine 3 ) Bisoprolol 4 ) Digoxin 5 ) Nitrate
therapy
14) A 70-year-old male is referred by his GP for management of
recently diagnosed congestive heart failure. The patient has a history
of poorly controlled hypertension. Over the last three months he has
been aware of deteriorating shortness of breath, fatigue, and
orthopnea. Over the last month he had been commenced on Digoxin
(62.5 micrograms daily), Frusemide (80 mg daily), and amiloride 10
mg.
On examination he has a pulse of 96 bpm regular, a blood pressure of
132/88 mmHg. His JVP was not raised, he had some scattered bibasal
crackles on auscultation with a displaced apex beat in the anterior
axillary line, 6th intercostal space. Auscultation of the heart revealed
no murmurs and he had peripheral oedema to the mid tibia.
Investigations showed: electrolytes normal serum urea concentration
17 mmol/l (NR 2-8 mmol/l) creatinine 175 micromol/l (NR 55-110)
Serum digoxin 0.7 ng/mL {therapeutic: 1.0-2.0}
One month previously his urea had been 11 mmol/l and creatinine 110
micromol/l. An ECG reveals left ventricular hypertrophy and Chest Xray shows cardiomegaly and calcified aorta.
What is the most appropriate next step in management?
1 ) Add an ACE inhibitor to the current regimen
2 ) Add atenolol at a dose of 25mg daily

3 ) Increase digoxin to 0.25 mg daily

4 ) Increase frusemide to 80 mg twice daily
5 ) Maintain on current therapy.
15)A 17-year-old woman loses consciousness while out jogging one
afternoon, as she has done for many years. She is taken to Accident
and Emergency, where a chest X-ray, CT brain scan, FBC, and
biochemistry are all normal. Over the next year, she develops mild
dyspnea and fatigue. There are several episodes of pre-syncope. After
another syncopal episode, she is referred to a cardiologist who orders
and ECG that shows changes of left ventricular hypertrophy and broad
Q waves. An echocardiogram reveals left ventricular and septal
hypertrophy, small left ventricle, and reduced septal excursion. The
septum has a "ground glass" appearance. She then dies suddenly and
unexpectedly. The microscopic appearance of the septum with
trichrome stain reveals myofiber disarray. Which of the following
conditions is she most likely to have had?
1 ) Diabetes mellitus 2 ) Hypertrophic cardiomyopathy 3 ) Rheumatic
heart disease 4 ) Systemic lupus erythematosus 5 ) Viral myocarditis
16) A 78 year old female is referred by her GP with high blood
pressure. Over the last three months her blood pressure is noted to be
around 180/80 mmHg. She has a body mass index of 25.5kg/m2, is a
non-smoker.There are no features to suggest a secondary cause for
her hypertension. Which of the following is the most appropriate
treatment for her blood pressure?
1 ) Alpha-Blocker 2 ) Angiotensin Converting Enzyme (ACE) Inhibitor 3
) Angiotensin Blocker 4 ) Beta-blocker 5 ) Calcium channel blocker
17) Infective endocarditis rarely occurs with:
A mitral valve prolapse B patent ductus arteriosus C bicuspid aortic

valve D atrial septal defect E mitral stenosis

18) A 60-year-old man presents with an inferior MI and receives
thrombolysis. 4 hours following initial presentation he becomes acutely
breathless. His ECG demonstrates sinus tachycardia (rate 108bpm)
with T wave inversion inferiorly. His ST segments are normal. On
examination his JVP is elevated at 5 cm. Chest was clear to
auscultation. Following 80 mg of Frusemide he deteriorates. His BP is
now 80/60 and his urine output over the last 2 hours is 5 mls. What is
the best investigative measure?
1 ) Arterial Blood Gases 2 ) Central Venous Pressure Monitoring 3 )
Chest X-Ray 4 ) Echocardiography 5 ) Pulmonary Capillary Wedge
Pressure Monitoring
19) The following are true regarding mitral stenosis:
A it is not tolerated well in pregnancy
B there is characteristically a low wedge pressure
C in AF, the opening snap disappears
D loud murmurs if valve is high calcified
E Doppler U/S is usually inaccurate in determining severity
20) The following are recognised features of pulmonary embolism:
EXCEPT
A long PR interval on the electrocardiogram
B decreased left atrial pressure
C pulmonary hypertension
D collapse of the affected lung segments
E necrosis of lung tissue
Answers for the questions
1) ANSWER:C

2)ANSWER: 5
3) ANSWER: 1
4) ANSWER: 1
5) ANSWER: C
6) ANSWER: E
7) ANSWER: 3
8 ) ANSWER: E
9) ANSWER: 5
10) ANSWER: C
11) ANSWER: 5
12) ANSWER: D
13) ANSWER: 3
14) ANSWER: 1
15) ANSWER: 2
16)ANSWER: 5
17)ANSWER: D
18)ANSWER: 5
19)ANSWER: A
20)ANSWER: A

BASIC SCIENCES QUESTIONS FOR MRCP

Hope all of you find these questions helpful........ for MRCP PART 1
1)How many carbon atoms does a molecule of Acetyl Co-A contain?
A : Two B : Three
C : Four D : Five E : Six.

ANSWER:A
2)A Mendelian X-linked dominant condition would be transmitted to:
A : All of the sons of an affected woman.
B : All children of an affected man.
C : None of the sons of an affected woman.
D : All of the sons of an affected man.
E : Half of the daughters of an affected woman.

ANSWER:E
3) A 68-year-old woman is admitted because she is 'off her legs'. Her
routine biochemical screen reveals plasma Na 126 mmol/l, K 3.1
mmol/l, urea 3.2 mmol/l, glucose 4.5 mmol/l. Her calculated plasma
osmolality (mosmol/l) is:
A : 271.1 B : 273.6 C : 265.9 D : 136.8 E : 144.5.

ANSWER:C
4)Which of the following are common physiological findings during
pregnancy?
A : Reduced fractional urate clearance B : 10% reduction in cardiac
output
C : Increased peripheral vascular resistance D : A fall in blood pressure
during the first trimester
E : Reduced plasma volume.

ANSWER:D
5) The following are NOT used for the estimation of renal function:
A : Serum creatinine B : Serum cystatin C C : Creatinine clearance
D : Ethylenediaminetetraacetic acid (EDTA) clearance E : Urinary
albumin/creatinine ratio.

ANSWER:E
6)A 78-year-old man is receiving treatment for a deep venous
thrombosis. After five days the pharmacist reminds you to check a full
blood count: why?

A : Because of the possibility of gastrointestinal haemorrhageB :

Because of the possibility of haemolytic anaemia
C : Because of the possibility of leucocytosisD : Because of the
possibility of thrombosis
E : Because of the possibility of thrombocytopenia.

ANSWER: E
7)You are looking after a patient with established long-standing autoimmune haemolytic anaemia. Which one of the following blood film
changes would you most expect to see?
A : Spherocytosis B : Schistocytosis
C : Bite cells D : Burr cells E : Pappenheimer bodies.

ANSWER: A
8)Considering the identification of cells by their surface antigens,
which one of the following statements is true?
A : CD4 indicates cytotoxic T cell function. B : CD19 is a T cell marker.
C : CD3 is a universal T cell marker. D : CD8 indicates T helper cell
function.
E : CD56 is a marker of B cells.

ANSWER:C
9)An 83-year-old woman on carbimazole for thyrotoxicosis:
A : usually takes three to six months to become euthyroid
B : should stop treatment at once if she develops a rash
C : cannot be given propylthiouracil if she has a sensitivity reaction to
carbimazole

D : should have her propranolol discontinued

E : should have her white blood count (WBC) checked if she develops a
sore throat.

ANSWER: E
10)A 16-year-old girl presents because her menstrual periods have not
started. She is in good health, but is the smallest girl in her class at
school and has not yet developed any secondary sexual characteristics.
The most likely diagnosis is:
A : Cystic fibrosis B : Coeliac disease
C : Klinefelter's syndrome D : Turner's syndrome E : Chronic renal
failure.

ANSWER:D

Free BOFs for MRCP!

I went to clean up my study room this morning and found out these
questions. I tool my MRCP Part 1 and 2 in 2003.
1) An 18 year old woman is noted to have persistent polyuria in excess
of 4 litres per day whilst recovering from a head injury she sustained
in a road traffic accident. Investigations reveal: potassium 4.1 mmol/L
(3.5-4.9) calcium 2.4 mmol/L (2.2-2.6) glucose 5.6 mmol/L (3.0-6.0)
Which one of the following is the most effective method of confirming
the diagnosis?
1 ) autoantibodies to vasopressin neurones
2 ) MRI of the hypothalamus and pituitary
3 ) therapeutic trial of low dose DDAVP
4 ) vasopressin concentration

5 ) water deprivation test

ANSWER: 5

2) An 87-year-old woman was referred to clinic with a two-month

history of alternating constipation and diarrhea, night sweats and
fatigue. The patient was not sure if she had lost any weight. On
examination she appeared thin and pale. Pulse 80/minute and regular.
A systolic murmur was audible at the apex, radiating to the axilla. No
diastolic murmurs were heard.
Investigations
Blood cultures: positive Transthoracic echocardiogram revealed a
vegetation on the mitral valve
What is the most likely causative organism in this case?
1 ) Coagulase-negative Staphylococcus
2 ) Staphylococcus aureus
3 ) Streptococcus bovis
4 ) Streptococcus mitis
5 ) Streptococcus viridans

ANSWER: 3
3) Which of the following is least true regarding IgA nephropathy?
1 ) Is the most common glomerulonephritis in the world
2 ) Predominantly affects young men
3 ) Commonly follows a sore throat
4 ) May be associated with a rash and arthritis
5 ) Light chains may be found in the urine

ANSWER:5

4)Which one of the following statements applies to an infant with

undiagnosed congenital hypothyroidism.
1 ) they may be asymptomatic
2 ) haemolytic jaundice occurs
3 ) they may later have early acceleration of bone age and short
stature at maturity
4 ) gastrointestinal disturbances, especially diarrhoea may develop
5 ) Tachyarrhythmias may occur.

ANSWER: 1

5) A 47-year-old woman presents with high fever, rigors and myalgia.

Nasal aspirate is positive for influenza virions. Which of the following is
true of her B-cell response?
1 ) The antibody response to the virus does not require T-cell help
2 ) Her B-cells express immunoglobulin on their surface
3 ) Deficiency of either CD40 or CD40L still allows an IgG response
4 ) Affinity maturation takes place in the blood stream
5 ) Memory cells are not formed as repeated infections with influenza
often occur
ANSWER: 2

6)A patient who is listed for excision of his operable squamous cell
lung cancer, suffers a life threatenting haemoptysis on the ward. Which
of the following is the most appropriate treatment of the following?
1 ) Bronchial embolisation

2 ) Tranexamic acid
3 ) Conservative care
4 ) Antibiotics
5 ) Radiotherapy

ANSWER: 1

7) Which of the following is a feature of hereditary haemorrhagic

telangiectasia? ( check out the photo of a patient with HHT
at www.passpaces.com/MRCP/issue2.html )
1 ) a good response to oestrogen therapy
2 ) cerebral arteriovenous malformations
3 ) GI haemorrhage as the usual presenting feature
4 ) telangiectasia of the mucous membranes, but not the skin
5 ) tendency of lesions to become less obvious with age

ANSWER: 2
8) You are considering starting a patient on Griseofulvin. Which of the
following statements concerning its pharmacology is true?
1 ) It is active against Candida albicans.
2 ) It is active against aspergillus.
3 ) It should not be used in renal failure.
4 ) It used for a maximum of 2 weeks.
5 ) It is associated with drug-induced Stevens Johnson syndrome.

ANSWER: 5

9)A 60 year-old woman attends the Casualty department with a 6

week history of lethargy, neck pain, weakness in the upper limbs and
gait disturbance. She describes occasional episodes of electrical
sensation shooting down her spine on flexing her neck. She has a long
history of lower back pain, primary generalised osteoarthritis, and
vitiligo. She takes voltarol regularly. She neither smokes nor drinks.
She is of Pakistani origin and has been in this country for the past 6
years. There is no history of recent foreign travel. On examination she
is afebrile. General examination is unremarkable except for vitiligo.
Examination of the cranial nerves is normal. There is no wasting of the
limbs but there are a few fasciculations in brachioradialis and biceps on
the right. Tone is mildly increased. Apart from mild weakness of elbow,
wrist and finger flexion and extension, more marked on the right,
power is normal. There is inversion of the right supinator reflex, and
triceps, knee and ankle jerks are brisk bilaterally. Right plantar is
extensor, the left flexor. Sensation and coordination are within normal
limits. Gait is mildly spastic. Investigations: Hb 11.3 g/l WCC 7 x 109/l
Plat 130 x 109/l Clotting normal ESR 67 mm CRP 17 mg/l Na 137
mmol/l K 4.2 mmol/l Urea 5.7 mmol/l Creatinine 87 umol/l Protein 83
g/l Albumin 33 g/l Ca 2.23 mmol/l Phosphate 1.2 mmol/l LFTs normal
CXR: normal X ray cervical spine: Extensive osteophytes. Normal
alignment.
What is the most likely diagnosis?
1 ) Degenerative cervical spondyloarthropathy
2 ) Syringomyelia
3 ) Polymyalgia rheumatica
4 ) Multiple myeloma
5 ) Motor neurone disease

ANSWER: 1

10) Which of the following statements is true of Type 2 Diabetes

Mellitus?
1 ) 20% of patients develop macrovascular complications within 10
years of diagnosis
2 ) B In drug treatment there is a 25% reduction in developing
microvascular complications in comparison to diet control
3 ) Fasting plasma glucose >8 is diagnostic of the disease
4 ) Type 2 diabetes is associated with being underweight
5 ) Metformin is the preferable treatment in the obese patient with
type 2 diabetes

ANSWER: 5

Another set of FREE BOFs for MRCP Part 1!

Hope you find all these questions useful.
1)Transcription RNA (tRNA) has three bases specific for a particular
amino acid with which it binds to messenger RNA (mRNA). This
specific area of tRNA is called the
1 ) anticodon
2 ) codon
3 ) exon
4 ) intron
5 ) transposon

ANSWER: 1
2)The Polymerase Chain Reaction (PCR) is used to amplify small
amounts of DNA for further analysis. First the DNA double helix must
be split into two strands. This is achieved by

1 ) alkali solution
2 ) centrifugation
3 ) DNA polymerase
4 ) heating to nearly 100C
5 )viral reverse transcriptase

ANSWER: 4
3)Two strains of Escherichia coli are isolated and both are resistant to
ampicillin. Strain A retains its resistance to amplicillin when grown
form multiple generations in the absence of ampicillin. However strain
B loses its resistance when grown in the absence of ampicillin. Which
of the following best explains the loss of antibiotic resistance in strain
B?
1 )Changes in the bacterial DNA gyrase
2 )Downregulation of the resistance gene
3 )Loss of a plasmid containing the resistance gene
4 )Mutations in the resistance gene
5 )Transposition of another sequence into the resistance gene

ANSWER: 3
4)A 36 year old male presents with lethargy. He takes no medication
and has generally been otherwise well. Examination reveals that he is
obese with a BMI of 36.4 kg/m2 and a blood pressure of 120/72.
There are no abnormalities of the cardiovascular, respiratory or
abdominal systems. Investigations reveal a sodium of 141 mmol/l, a
potassium of 2.8 mmol/l, a urea of 5.6 mmol/l and a creatinine of 76
mol/l. What is the most likely diagnosis.

1 )Conn's syndrome
2 )Apparent mineralocorticoid excess
3 )Cushing's syndrome
4 )Hypokalaemic periodic paralysis
5 )Bartter's syndrome

ANSWER: 5
5)A 52 year old female presents with tiredness. There are no specific
abnormalities noted on examination, but investigations reveal a T4 of
21.1 (NR 9.8 - 23), a T3 of 5.2 pmol/l (NR 3.3 - 5.5) and a TSH of
0.05 mU/l (NR 0.1 - 5 mU/l). Thyroid autoantibody titres are all
undetectable. These results suggest a diagnosis of
1 )DeQuervain's thyroidits
2 )Sick euthyroid syndrome
3 )Solitary toxic nodule
4 )Graves' disease
5 )Hashimoto's thyroiditis

ANSWER: 3
6)A 32 year old female presents with a 4 month history of
amenorrhoea. She takes no specific therapy. She has two children and
her husband has has a vasectomy. Examination reveals an obese
individual but no other abnormality. Investigations reveal an oestradiol
concentration of 100 pmol/l (NR 130 - 500), an LH of 2.1 mU/l (NR 3.0
- 6.6), an FSH of 2.2 mU/l (NR 3.3 - 10.1), a prolactin concentration of
800 mU/l (NR 50 - 500 mU/l) and a testosterone concentration of 2.1
pmol/l (NR less than 3 pmol/l). Which investigation is the most

appropriate?
1 )Insulin tolerance test
2 )A Pregnancy test
3 )17 hydroxy-progesterone
4 )Urine free cortisol concentration
5 )A MRI of the pituitary

ANSWER: 5

MRCP Part 1 Questions

Hope you find these questions useful........... For MRCP Part 1
1)Which of the following is true regarding diabetic neuropathy?
A : It is best detected by testing for light touch with cotton wool.
B : It is always bilateral.
C : It does not cause vomiting.
D : It does not cause urinary incontinence.
E : It cannot be reversed by good glycaemic control.
ANSWER: E
2) A 76-year-old man presents with an acute confusional state. He was
diagnosed to have lung cancer recently.Investigations review serum
calcium 3.21 mmol/l. Which is the most appropriate initial treatment?
A : Intravenous sodium pamidronate
B : Intravenous 5% dextrose
C : Oral prednisolone (20-60 mg)
D : Intravenous frusemide
E : Intravenous 0.9% sodium chloride.
ANSWER: E

3)The presence of ketoacidosis in a patient without diabetes mellitus

would suggest which one of the following causes?
A : Insulinoma
B : Addisonian crisis
C : Starvation
D : Acute on chronic renal failure
E : Salicylate overdose.
ANSWER: C
To learn more about metabolic acidosis, look at my previous post of
Metabolic Acidosis in MRCP!
4)A 60-year-old man presents with breathlessness. He has had a
history of previous myocardial infarction and peripheral vascular
disease. He has recently been started on PERINDOPRIL for
hypertension. He has been anuric for 2 hour. His serum urea is 35
mmol/l and his potassium is 7 .9 mmol/l. His ECG shows tall tented T
waves. The first most appropriate step in management would be:
A : ten units of soluble insulin with 50g glucose(50%) IV
B : haemodialysis
C : bicarbonate (50 mls of a 4.2% solution) by IVI
D : calcium resonium 30g
E : 10-30 ml calcium gluconate (10%) IVI.
ANSWER: E
5) Which one of these features is typical of dermatomyositis...EXCEPT?
A : Heliotrope rash around the eye
B : Gottron's papules over knuckles of fingers
C : proximal muscle weakness
D : association with malignancy
E : Sclerotic digital skin.

ANSWER: E
6)

Photo source: www.passpaces.com/MRCP/issue2.html

The 25-year-old lady is admitted with ptosis, diplopia and dysphagia.

On examination he is found to have fatigable muscle weakness and
normal deep tendon reflexes. What is the most likely diagnosis?
A : Bells palsy
B : Guillain-Barre syndrome
C : Motor neurone disease
D : Multiple sclerosis
E : Myasthenia gravis.
ANSWER: E

MRCP Part 1 Questions (1)

Hope you find the following questions useful,
1)A 50-year-old male presented with acute respiratory failure during
an episode of fulminant sepsis and was thought to have developed
adult respiratory distress syndrome (ARDS). Which of the following

would support a diagnosis of ARDS?

1 ) High pulmonary capillary wedge pressure
2 ) High protein pulmonary oedema
3 ) Hypercapnia
4 ) Increased lung compliance
5 ) Normal chest X-ray
ANSWER: 2
2)In malignant hyperpyrexia:
1 ) A mortality rate of 10-20% may be expected
2 ) Elevation of serum creatine kinase and myoglobinuria is diagnostic
3 ) Muscle biopsy may be histologically normal
4 ) The only available specific treatment is sodium dantrolene, which
has a neutral pH
5 ) The predisposing gene is thought to be on chromosome 9
ANSWER: 3
3)A 25-year-old female presented with 6 months history of depression,
irritability and painful sensory symptoms in her legs. Over the last 4
weeks she presents a broad base ataxic gait. An MRI brain showed
bilateral posterior thalamic nuclei high signals.
The most likely diagnosis is:
1 ) Sporadic CJD
2 ) New variant CJD
3 ) Wilson disease
4 ) Multiple system atrophy
5 ) Herpes simplex encephalitis

ANSWER: 2
4)A 25-year-old man presents with a two years history of intermittent
tingling sensation involving his left side. It starts in his fingers and
spreads in 10-20 seconds to affect the whole arm and leg on the same
side. The attacks only last for one minute. The most likely diagnosis is:
1 ) Migraine with aura
2 ) Transient ischaemic attacks
3 ) Somatosensory seizures
4 ) Hyperventilation
5 ) Multiple sclerosis
ANSWER: 3
5)Causes of dilated pupils include:
1 ) Argyll Robertson pupil
2 ) Ethylene glycol poisoning
3 ) Myotonic dystrophy
4 ) Organophosphate poisoning
5 ) Pontine haemorrhage
ANSWER: 2
6)Diabetic Microalbuminuria:EXCEPT
A Occurs within 10 years of the diagnosis of diabetes mellitus
B Is most accurately assessed through a timed urine collection during
the day.
C Predicts premature cardiovascular mortality in type 2 diabetes
D Correlates with hypertension
E Is reduced by ACE inhibitor therapy

ANSWER: A
7)A 35-year-old man on regular haemodialysis complained of
weakness and exertional fatigue. On examination, his blood pressure
was 177/105 mmHg (pre-dialysis) and 150/95 mmHg (post-dialysis).
Investigations pre-dialysis revealed:
Haemoglobin 9.0g/dl
serum potassium 6.9
serum creatinine 1250 serum
corrected calcium 2.1 mmol/l
Which intervention is most likely to improve his symptonis:
1 ) increase haemoglobin with epoetin
2 ) increase the length of each dialysis session
3 ) lower the potassium in the dialysate
4 ) improve blood pressure control with ramipril
5 ) correct hypocalcaemia with alfacalcidol
ANSWER: 1
8)A 50-year-old woman on treatment for long-standing rheumatoid
arthritis has recently become dyspnoeic on mild exertion and
developed a dry cough. The oxygen saturation was found to be 89%
on air. The chest x-ray showed a diffuse bilateral interstitial infiltrate.
An extensive infection screen was negative and her symptoms were
felt to be drug-induced.
Which drug is most likely to have caused this adverse effect?
1 ) azathioprine 2 ) cyclosporin 3 ) hydroxychloroquine
4 ) methotrexate 5 ) sulphasalazine

ANSWER: 4
9)A 70 year old female is admitted 12 hours after taking an overdose
of aspirin. Investigations revealed: Serum sodium 138 mmol/L (137144), Serum potassium 5.9 mmol/L (3.5-4.9), Serum bicarbonate 14
mmol/L (20-28), Serum urea 18.1 mmol/L (2.5-7.5), Serum creatinine
238 umol/L (60-110), Serum salicylate 1120 mg/L (8 mmol/L). What
is the most appropriate treatment of this patient?
1 ) Haemodialysis 2 ) Haemofiltration
3 ) Intravenous sodium bicarbonate. 4 ) Peritoneal dialysis. 5 ) Urine
alkalinization.
ANSWER: 1
10)A 62 year old male is noted to have a broad-based ataxic gait.This
is characteristic of which of the following?
1 ) A basal ganglia lesion 2 ) Cerebellar vermis lesion 3 ) Osteomalacia
4 ) phenytoin toxicity 5 ) Right-sided cerebral infarction
ANSWER: 4

MRCP Part 1 Questions (2)

Hope you find these neurology questions useful..........
1) A 26-year-old male presents with 2 days history of diplopia and
unsteadiness. 2 weeks ago he suffered from viral fever. Examination
reviews that there is complete opthalmoplegia, areflexia and gait
ataxia. Which of the following blood tests is the most likely to confirm
the diagnosis?

1 ) Acetylcholine receptors antibodies

2 ) Anti GM1 antibodies
3 ) Anti GQib antibodies
4 ) Anti Topoisomerase antibodies
5 ) Anti purkinje cell antibodies
ANSWER: 3
2) A 40-year-old woman is referred with a two-week history of
difficulty walking . On examination, there was distal limb weakness
and the power is 3/5. Tendon reflexe was absent over ankle and the
plantar responses were flexor.There was no sensory loss. What is the
most likely diagnosis?
1 ) polymyositis
2 ) cervical cord compression
3 ) Guillain-Barr syndrome
4 ) myasthenia gravis
5 ) poliomyelitis
ANSWER: 3
3) A 50 year old female is admitted with progressive weakness
following a flu-like illness. Which of the following would exclude
Guillain-Barre Syndrome as the diagnosis?
1 ) Autonomic dysfunction
2 ) Elevated protein on CSF examination
3 ) Evidence of muscle wasting
4 ) Ophthalmoplegia
5 ) Sensory involvement
ANSWER: 5
4) A 15 year old girl presents with Guillain-Barre syndrome. Her

weakness continues to worsen after admission to hospital and she

complaines of shortness of breath. Which of the following should be
used to monitor her?
1 ) arterial blood gases
2 ) chest expansion size
3 ) FEV1/FVC ratio
4 ) PEFR
5 ) vital capacity
ANSWER: 5
5) Which of the following clinical manifestations suggests Guillain Barr
Syndrome?
1 ) Weakness beginning in the arms
2 ) Asymmetrical involvement of distal muscles
3 ) Bulbar involvement in about 50% of cases
4 ) Brisk tendon reflexes
5 ) Normal CSF protein
ANSWER: 3
6)A 43-year-old woman develops a progressive, ascending motor
weakness over several days. She is hospitalized and requires
intubation with mechanical ventilation. She is afebrile. A lumbar
puncture is performed with normal opening pressure and yields clear,
colorless CSF with normal glucose, increased protein, and cell count of
5/microliter, all lymphocytes. She gradually recovers over the next
month. Which of the following conditions most likely preceded the
onset of her illness?
1 ) Ketoacidosis
2 ) Staphylococcus aureus septicemia
3 ) Systemic lupus erythematosus
4 ) Viral pneumonia

5 ) Vitamin B12 deficiency

ANSWER: 4
7)Common features of normal pressure hydrocephalus are EXCEPT:
A papilloedema
B The opening pressure for lumbar puncture is normal
C gait apraxia
D incontinence
E cognitive impairment
ANSWER: B
8)A 60 year-old man presents with a 2 month history of progressive
confusion, gait disturbance, and urinary incontinence. Examination
reveals gait ataxia. CT brain done is as follow, lumbar puncture reveals
normal CSF pressure and constituents. Which one of the following
managements steps is likely to be most helpful?

1 ) CSF drainage via repeated lumbar puncture

2 ) EEG
3 ) Intracranial pressure monitoring
4 ) MRI brainstem
5 ) Serum B12 and folate levels

ANSWER: 1
9)A 75-year-old man presented with an unsteady gait. He was noted
to be becoming impaired with his memory and agitated at nights. His
GP started an antidepressant. He was incontinent of urine. He was a
heavy smoker and had lost 2 stones in weight over 2 months. His
blood sugar was 10 mmol/l.
Which is the next best investigation?
1 ) CT Head
2 ) CXR
3 ) Arterial Blood gas
4 ) Thyroid function test
5 ) Blood Calcium level
ANSWER: 1