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
Psoriasis …. All are true except :
1-the disease may be exacerbated by lithium and propranolol treatment
2-posriatic arthritis should not be treated by chloroquin
3-some areas of involvement may be hidden and we have to carefully examine these areas
4-guttate type is seen predominantly in middle aged people
5-the inheritance is polygenic

Answer 4
1-so these should be avoided and replaced by safer ones
2-true……it will exacerbate the skin disease, if severe try MTX which is effective against both skin and joint disease
3-like the genitals and the natal clefts ……so always examine these areas especially in join disease with out any apparent skin involvement ( so you will think of another diagnosis like rheumatoid factor negative rheumatoid arthritis ) , the patient might be shy from telling you that these areas are involved .
4-false in children and some may develop chronic plaque type upon reaching adulthood
5-true with many HLA associations like HLA DW6

Q2
Treatment of psoriasis, all are true except:
1-dithranol can very effective in psoriatic plaques on the face and genitals
2-topical vitamin D analogues have been shown to be effective
3-flexural psoriasis can be treated with topical steroids combined with topical antifungal preparations
4-topical steroids creams when being withdrawn gradually it is advisable to combine them with topical tar preparations
5-methotrexate has an advantage of targeting both the skin and join disease

Answer 1
1-false, very irritant and should be avoided at these sites
2-true, also oral retinoids
3-true…
4-to prevent relapse upon steroids withdrawal
5-true…..avoid chloroquin in joint disease

Q3
All but one of the followings can induce the appearance of acneform rash:
1-systemic steroids
2-androgenic steroids
3-lithium carbonate
4-phenytoin
5-isotretinoin

Answer 5
Isotretinoin is used in the treatment of severe scaring acne .other agents :chlorinated hydrocarbons, estrogenic steroids, oils and tar

Q4


Rosacea , all are wrong except :
1-usually seen in adolescents
2-prominent white and black comedons
3-undortunately there is a poor response to tetracyclines
4-facial telagiectasias and erythema are rarely seen
5-cinjunctivitis and keratitis are seen

Answer 5
1-false, middle age
2-false, against the diagnosis, they are more suggestive of acne vulgaris
3-false, the treatment of choice, sometimes prolonged for 1 year
4-are prominent part in the clinical picture
5-but with no comedons

Q5
Lichen planus, all are true except
1- can produce a scarring alopecia
2- mouth mucosal involvement is common but frank mucosal ulceration is rare
3- the absence of itching is against the diagnosis
4- the disease is disabling and persists for life with relapse and remissions
5- nail changes are seen

Answer 4
1-true……..by attacking the scalp but it is uncommon, so called lichen planus pillaris
2-true, usually seen as white lace like lesions on the buccal mucosa, but the ulcerative variety is rare and is clinically challenging
3-true……..think of another disease …….but always ask if the patient is taking an antipruritic agent ………!!! The patient may say it is not pruritic .
4-false, self limiting usually within 1-2 years, leaving prominent hyperpigmentation on the involved skin areas
5-true

Q6
Causes or pruritis, all are true except:
1-oral contraceptive pills
2-iron deficiency anemia
3-chronic renal failure
4-pregnancy
5-treatment with rifampicin

Answer 5
Don’t think that pruritis is due to skin diseases only ………..many diseases in medicine can produce disabling pruritis . Rifampicin has been shown to be effective against pruritis in selected patients

Q7
Intense disabling itching is characteristically seen in all but one of the followings
1-scabies
2-lichen planus
3-dermatitis herpetiformis
4-atopic eczema
5-vitiligo

Answer 5
The word " characteristic " means something you have to look for the diagnosis and absence of itching in such cases either means that your diagnosis is wrong or the patient is taking a medication against it ( so always ask about these anti itching medications here )

Q8
Nail examination can be very helpful in providing a clue to many diseases, all are true except:
1-blue nail lunulae may indicate Wilson's disease
2-Beua's lines may indicate a serious disease in the past 2-3 months
3-koilonychia indicates severe long standing iron deficiency anemia
4-diffcuse symmetrical black nails may indicate malignant melanoma
5-half and half nails are seen in chronic renal failure

Answer 4
1-true, useful clue when seeing a patient with rigidity, dystonias and liver impairment
2-true and may not be seen in the fingers because they disappear faster than the toes, so examine the toes after this long period ……
3-true……and may be short also, called brachynychia
4-!!!! Come on………..this is just a part of the "make up" ….i.e. nail painting
5-true, indicating an established uremia, useful sign to differentiate from acute renal failure

Q9
In HIV, the following skin diseases are seen, except
1-seborrhoeic dermatitis is much more common that control subjects
2-drug induced rashes are very common and may limit many medication usage
3-wide spread purple spots and plaques may indicate Kaposi sarcoma
4-impetigo is very commonly seen
5-repeated unexplained oral candidiasis may be the first clue

Answer 4
1-and usually resistant to treatment
2-true …….the HIV patients are very sensitive for many drug reactions, like Septrin rashes
3-so take biopsy and examine the mouth
4-fasle…..a problem with neutrophils .
5-true…..always keep it in mind

Q10
Basal cell carcinoma of the skin, all are true except:
1-mainly seen in old people
2-unfortunatrly metastasizes early to the lungs
3-may be an ulcer with rolled up edges with fine telangiectasia
4-best treated by surgery
5-manily seen on the face

Answer :2
1-true, slowly growing tumor
2-false, distant metastasis are extremely rare , the tumor is invasive and destructive locally
3-true, may also look like malignant melanoma
4-radiotherapy is an acceptable alternative in certain areas
5-true