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. ....... Teaching Hospital /Department of Neurology Q1 The followings except one are consistent with acute Confusional state rather than dementia in evaluating a patient with abnormal cognition, 1-fluctuated level of consciousness 2-rapid development 3-visual hallucination 4-the presence of fever 5-gradual loss of short term memory
Answer 5 Remember ,dementia patients are liable to be confused for many reasons, like fever per se, infections, electrolyte disturbance, medication side effect…..etc …..so the past history is very important ………on the other hand e.g. chronic subdural hematoma may have fluctuated level of consciousness and gradually ending with dementia …….so it is difficult task to differentiate actually in practice……..EASILY written in the books !!.
Q2 Anorexia nervosa, all are true except: 1-the level of prolactin, serum cholesterol and glucagons are raised 2-bradycardia and hypotension are found 3-prominent sexual and physical retardation 4-amenorrhea is usually present for more than 3 months 5-usually starts around adolescence
Answer 3 1-and TSH, FSH and LH are reduced 2-cold extremities, lanugos hair ………remember in anorexia nervosa there is starvation and stress. 3-false ……….against the diagnosis 4-and loss of libido also. The loss of weight must be more than 25% of the original weight or the current weight is blow 25% of the normal for age and sex 5-true……bulimia usually starts later
Q3 Which one of the followings is true regarding Bulimia Nervosa? 1-weight loss is prominent 2-usually starts around puberty 3-hospital admission is required to treat it 4-loss of self control and binge eating behavior is present 5-grossly disorganized perception of body image and weight
Answer 4 1-flase …..Usually they maintain weight 2-typically post pubertal but later than anorexia nervosa peak 3-false……rarely required 4-true, to be followed by self induced vomiting, diuretic or laxative abuse……or the patient may enter a phase of prolonged dieting after these recurrent binge eating episodes 5-false….suggests anorexia nervosa
Q4 Good prognostic factors in schizophrenia, all are true except 1-acute onset of true disorder 2-good job records 3-the presence of a precipitating event 4-normal premorbid personality 5-absence of affective symptoms
Answer: 5 1-…chronic insidious one has a bad prognosis 2-true …….the presence of poor job records indicates poor prognosis 3-true……..also absence of family history and catatonic variety has good prognosis 4-true..Schizoid one portends a bad prognosis 5-false…….confers a bad prognosis
Q5 In depression, all are true except: 1-the presence of low self esteem is prominent 2-some patients lose weight 3-loss of pleasure and loss of libido 4-presence of irritability is against the diagnosis 5-some patients have early insomnia
Answer 4 1-the patient feels worthless, helpless and hopeless 2-others gain weight 3-anhedonia 4-false ……..some patients it is very prominent so called agitated depression ….remember …..In severe depression, psychotic symptoms may be prominent and must differentiated from schizophrenia with affective symptoms 5-other have late insomnia
Q6 Antipsychotic drugs ……..all are true except 1-the newer generation like olanzapin is more effective on negative symptoms of schizophrenia 2-in general, no one drug is superior in efficacy over the others 3-extrapyramidal features are uncommon in those antipsychotics with prominent anticholenergic side effects like thioridazine 4-may be used in the control of acute mania 5-some may be used in the control of nocturnal enuresis
Answer 5 1-true……..the older generation like chrolpromazine is more effective on the positive symptoms 2-true…….many doctors think that one of them might be superior to others …….they only differ in the cost , availability and side effect profile ……but as an effect ,all are the same 3-true, those with weak anticholenergic side effects have more risk of extrapyramidal features, eg trifluperazine 4-true….especially haloperidol (Haldol ) 5-false, some tricyclic antidepressants may be used here.
Q7 Tricyclic antidepressants, all are true except 1-mainly inhibit the reuptake of noradrenalin and serotonin at receptor sites 2-should be used with caution in elderlies as it may cause cardiac toxicity 3-may cause postural hypotension 4-their effect is usually seen after 2-4 weeks, some times up to 6 weeks 5-first line agents in severe depression with attempted suicide
Answer 5 1-true….many new anti depressants may have varieties of mechanisms 2-true……..and also old men may have occult prostatism or glaucoma, so be careful 3-very important in old people as it may increase the risk of fall 4-true….so be patient 5-false …..In these cases, electro-convulsive therapy should be used immediately
Q8 Alcohol abuse is suspected in all but one of the followings 1-unexpalined atrial fibrillation 2-unexplained hypertension 3-unexplained diarrhea 4-unexplained gout in pre-menopausal female 5-unexplained papulomacular skin rash.
Answer 5 1-and cardiomyopathy 2-always ask about daily alcohol intake, may worsen already present hypertension 3-may cause chronic pancreatits 4-interfers with tubular uric acid excretion 5- Alcohol does not cause a specific skin rash per say …..but repeated unexplained skin bruises may be a clue to repeated falls from intoxication
Q9 The risk of a success after an attempted suicide is increased in the followings except : 1-being a young female rather than a male 2-living alone 3-presence of a malignant disease 4-using a gun rather than self poisoning 5-being divorced rather than happily married
Answer 1 1-although the risk of suicide per se is much more in females but the success in that attempted suicide event is much more in males, especially old ones 2-true…..and when writing a plan for it 3-or other chronic physical disability 4-true……….many females use self poisoning as a parasuicide to have others attention 5-also when separated from the spouse
Q10 All of the followings are indications for electro-convulsive therapy in depression, except: 1-severe depression with a failed suicidal attempt using a gun 2-severe depression interfering with daily eating causing nutritional problems 3-mildly depressed patient intolerant to the oral tricyclics 4-severe depression with prominent psychotic symptoms 5-agitated depression
Answer 5 ECT usually given under general anesthesia twice or thrice / week for 3 weeks .some patients may need maintenance ECT in the long term .ECT has many contraindication like aortic aneurysm,. Recent fractures, recent MI, unstable cervical spine ., brain tumors causing raised intracranial pressure ……..but because of the general anesthesia ,it is nowadays safe .
