"Best Of Five Questions For MRCP UK And Ireland Examinations" Dr. Osama Amin MBChB, MRCPUK part I,MRCPI part I ,MRCPI part II written Senior House Officer and 4th year student of the…..Board of Neurology. Dedication to The Republic Of Iraq and Iraqi Doctors all over the world.
Q 1 Brucellosis, all are true …...except 1-splenomegally usually indicates a chronic brucellosis or a severe acute infection 2-the gold standard investigation is blood culture 3-neuro-brucellosis may presents like multiple sclerosis 4-spinal tenderness is uncommon 5-usually it is clinically difficult to differentiate a new infection from a relapsing one in a patient who was treated in the past
Answer 4 1-genralized lymphadenopathy may be seen 2-but unfortunately needs long time in special culture media with special environment. Also it is hazardous to the lab workers, so it is NOT used in almost all cases 3-or a BIH like picture. 4-false very common 5-true, especially in highly endemic areas and 2 mercapto ethanol test is used in this situation
Q2 Typhoid fever, all are true except : 1-human being is the only reservoir 2-constipation is seen in the first week but diarrhea in the second week 3-rose spot are seen in a minority 4-blood cultures have the highest yield in the first week 5-bone marrow cultures are useless in those who were partially treated
Answer 5 1-unlike other salmonella species 2-also palpable spleen and rose spots are seen in the 2nd week 3-but are highly suggestive when seen 4-about 90% positivity and then decreases there after 5-false, the main indication is in those who were exposed to antibiotics
Q3 Malaria, all are true except: 1-the thik blood film is mainly used for rapid diagnosis 2-thicn blood film is used to confirm the diagnosis and to sepeciate the organism 3-severe infections should be treated with intravenous Quinin 4-mefloquin is contraindicated in epilepsy and lactation 5-steroids are useful in treating cerebral malaria in falciparum infections
Answer5 1-should be done if suspecting malaria clinically 2-and to count the parasitemia 3-true………may cause hypoglycemia and cardiac toxicity and cinchonism 4-and 3rd trimester of pregnancy 5-false are of no benefit at all, actually it should be avoided
Q4 Leptospirosis, all are true except: 1-the occupation or the hobby of the patient is important 2-the early phase is due to leptospiroemia and hence the blood culture here has high positive results 3-hemorraigc manifestations are common 4-the second phase is an immune mediated one 5-there is peripheral blood lymphocytosis and CSF lymphocytic pleocytosis
Answer 5 1-true…like sewage workers 2-true……urine culture becomes gradually positive in the second phase 3-true…and may cause significant morbidity and mortality 4-true… 5-there is blood neutrophil leukocytosis which is very important in differentiating leptospirosis from severe viral hepatitis infections
Q5 Toxic shock syndrome, all are true except 1-2/3rds of cases are due to infected tampons 2-blood cultures are almost always negative 3-serum CPK is commonly raised 4-the mortality rate is 90% 5-shock is usually resistant to fluid therapy
Answer: 4 1-other sources from skin abscess, conjunctivitis 2-true……….it is not a bactremic infection……..it is exotoxin mediated 3-actually one of the diagnostic criteria 4-false, up to 10% 5-and usually necessitates the use of pressors
Q6 Rabies, all are true except 1-caused by a RNA rhabdoviurs infection 2-transmitted through animal saliva 3-once symptomatic, it is almost virtually fatal 4-may present as an ascending paralysis state 5-the incubation period is unfortunately very short
Answer 5 1-usualy through a bite of an infected animal 2-the virus is present in the saliva, although it infects the CNS 3-true….very few exceptions are documented world wide…yet they are left with severe neurological disability 4-so called the dumb type found in 20 % only; the other 80% is called the furious type with many characteristic PHOBIAs 5-fasle highly variable
Q7 Lassa fever, all are true except: 1-caused by an arena virus transmitted through rat urine 2-usually present with fever, myalgia and pharyngitis 3-renal and hepatic failures are seen 4-the mortality may reach 50% 5-no treatment is effective till now
Answer: 5 1-RNA one 2-true after an incubation period of 1-3 weeks 3-true…and circulatory collapse 4-considered to be high 5-fasle …Ribavirin is effective and may decrease the mortality rate if given with in the 1st week
Q8 Yellow fever, all are wrong except 1-caused by an RNA togavirus infection tranmitted from cows through mosquitoes 2-fortunately has a long incubation period of 3-6 months 3-there may be an intense neutrophil leukocytosis and even a leukemoid reaction 4-the usual presentation is with fever, join pain, muscle pain and headache 5-excellent response to lamivudine
Answer 4 1-from Monkeys through mosquitoes 2-3-6 days 3-leukopenia is seen 4-true 5-fasle ………no specific treatment, only supportive
Q9 Dengue, all true except 1-a mosquito born infection 2-there is fever, lymph node enlargement and skin rash 3-all individuals in endemic areas should be vaccinated 4-intense headache and backache 5-has an incubation period of 5-6 days
Answer: 3 Till now there is no vaccine!!!
Q10 Q fever, all are true except: 1-there may be a history of exposure to animals 2-may present as an atypical pneumonia 3-one of the causes of culture negative infective endocarditis 4-poor response to tetracycline 5-liver dysfunction is seen
Answer 4 1-the disease mainly seen in farmers and vets 2-but usually other features are seen also 3-true……..and its treatment is usually prolonged may be for 1 year 4-the drug of choice 5-true….liver granulomas …..But usually asymptomatic
Q11 Typhus fevers in general, all are true except : 1-are arthropod born infection 2-the rickettsia infect and damage the endothelium of small blood vessels 3-the mortality is variable and depends on the infecting agent 4-all have gastroenteritis as a common feature 5-the treatment of choice is tetracycline
Answer: 4 1-may be mite, flea, tick and louse born 2-in the skin, brain, lung … 3-true…… 4-false …..No such a feature 5-or chloramphenicole
Q12 Lyme disease, all are true except: 1-history of a tick may not always be found 2-the characteristic early skin rash may be not seen 3-cranial nerve palsies especially the facial nerve are seen 4-caused by spirochetes 5-joint involvement usually occurs in the form peripheral symmetrical large joint arthropathy
Answer 5 1-true……actually many patients are not able to recall it 2-true….may disappear before being noticed by the patient 3-may be bilateral 4-Borrelia burgdoferi 5-false, asymmetric oligoarthritis
Q13 Secondary syphilis, all are true except 1-the rash is non itchy and characteristically spares the face 2-lymphocytic meningitis is seen and usually self limiting or asymptomatic 3-VDRL is always positive 4-snail tract mucosal ulcerations are characteristic 5-even if not treated, not all patients will develop tertiary phase in the future
Answer: 3 1- but involves the palms and soles 2- true……..rarely severe 3- false …….FTA absorption and TPHA are much more sensitive and specific 4- also condylomata lata are seen in the genital areas 5- True……….!!!!
Q14 Paratyphoid fever when compared with typhoid fever, all are true except 1-has shorter incubation period 2-usually presents with acute onset of vomiting and diarrhea 3-the skin rash is much more prominent 4-less frequent intestinal complications 5-more carrier state
Answer 5 It is caused by salmonella paratyphi.
Q15 Cholera ……..all are true except 1-may rarely cause death even before the diarrhea appears 2-usually occurs in epidemics 3-the organism is motile 4-tertacycline is used to shorten the duration of shedding of the organism in stool 5-severe abdominal pain that may be confused with acute abdomen
Answer 5 1-cholera SICCA, causing large fluid loss and sequestration in the bowel 2-true…..a common infecting source is usually there 3-can be seen under the microscope (comma shaped) 4-true………it is not invasive disease 5-false, painless diarrhea!!
Q16 Genital ulcers are caused by all but one of the followings 1-certain Chlamydia strains infection 2-secondary syphilis 3-genital herpes infection 4-certain hemophillus strains infections 5-donavania granulomatis infection
Answer 2 1-lymphogranuloma venereum , Chlamydia trachomatis serovars L1,2,3 2-primary not secondary!! 3-usually type 2 viruses 4-chanchroids….. 5-granuloma inguinale
Q17 Gonorrhea, all are true except 1-extreme incubation period of 2-5 days 2-purulent uretheral discharge and dysuria are the main features 3-needs tetracycline therapy for at least 10 days 4-females tend to be more asymptomatic than males 5- Recurrences and re-infections are common
Answer 3 1-true……..if seen in a female child…….think of sexual abuse which his VERY RECENT 2-true……..but may be mild and bothered by many 3-false ….. can be cured by single dose of many antibiotics like oral 500 mg ciprofloxacin once only ………but because Chlamydia infections may be associated so we give tetracycline for 10 days ………always CONTACT SEXUAL PARTNERS 4-true……….the usually source of SPREADING of the infection to males 5-true………do you think that this infection makes them stop sexual contact (usually with STREET WOMEN?)
Q18 Chemoprophylaxis is used in preventing many infectious disease, all are true except: 1-rifampicine is useful in hemophillus infections prophylaxis in close contacts 2-refimpicine is useful in meningococcal infections prophylaxis in close contacts 3-erythromycine is useful in Legionares disease prophylaxis in close contacts 4-erythromycine is useful in diphtheria prophylaxis in close contacts 5-ampicilline is useful in infective endocarditis prophylaxis in high risk group before dental surgery above the gums
Answer 3 Erythromycin is useful in the treatment of Legionares disease but not in the prophylaxis and besides, there is no man to man transmission of infection
Q19 HIV, all are true except: 1-env viral gene encodes for the envelope proteins which are important for the attachment and entry of the virus into cells 2-Tuberculosis chest infection is much more common than pneumocyctis carinii infection in Africans 3-AIDS dementia complex may be a presenting feature 4-cryptosoridium diarrhea can prove fatal in AIDS patients 5-Kaposi sarcoma of the GIT is usually gravely symptomatic
Answer 5 1-like gp 160 and 45 2-unlike the western population in which P carinii is much more common 3-the progression can be slowed by AZT therapy 4-self limiting in healthy persons 5-false, usually asymptomatic, unlike the pulmonary one which portends a very aggressive course
Q20 Anti HIV medications, all are true except : 1-zidovudin can cause ragged red fibers on muscle biopsy 2-zalcitabine can cause esophageal ulceration 3-lipodystrophy is seen with protease inhibitors 4-non nucleoside reverse transcriptase inhibitors can cause severe skin rashes 5-nail pigmentation is characteristically seen with squanavir
Answer 5
1-similar to mitochondrial myopathy 2-and many NRTIs can cause liver dysfunction and lactic acidosis 3-many types of lipodystrophy 4-and some may cause severe allergic reaction that needs drug stoppage for good 5-nail pigmentation is characteristically seen zidovudine
