MRCGP Applied Knowledge Test 1001 Questions and …

1 MRCGPA pplied Knowledge Test1001 Questions andAnswersRob DanielsMA (Cantab), MB BChir, MRCGPG eneral PractitioneriiiContentsAcknowledgementsv iDedicationviiContributors to the previous editionsviiiIntroductionxAbbreviationsxi i1 CardiovascularQuestions1 Answers192 DermatologyQuestions27 Answers443 Ear, nose and throatQuestions51 Answers664 EndocrinologyQuestions71 Answers815 GastroenterologyQuestions87 Answers976 GeneticsQuestions103 Answers1127 HaematologyQuestions119 Answers127 CONTENTSiv8 ImmunologyQuestions131 Answers1379 InfectionQuestions141 Answers15110 Mental health and learning disabilityQuestions157 Answers16511 MusculoskeletalQuestions171 Answers17912 NeurologyQuestions185 Answers19413 OphthalmologyQuestions199 Answers21014 PaediatricsQuestions215 Answers22815 RenalQuestions235 Answers24416 Reproductive: male and femaleQuestions247 Answers25617 RespiratoryQuestions261 Answers27118 Therapeutic indications and adverse reactionsQuestions277 Answers28619 Critical appraisalQuestions291 Answers311 CONTENTSv20 AdministrationQuestions319 Answers325 Practice paper 1 questions329 Practice paper 1 answers385 Practice paper 2 questions417 Practice paper 2 answers471 Index495 CONTENTSxIntroductionThis book is intended predominantly to help candidates prepare for theMembership examination of the Royal College of General Practitioners, which isthe qualifying exam for a career in general practice.

2 It is also hoped that thisbook will be useful for established GPs to identify learning needs as part of theirappraisal process and perhaps prepare them for any future Knowledge -basedtest introduced as part of line with changes in other specialty exams, the MRCGP now consists of awritten exam, a formal clinical skills assessment and workplace-based assess-ment. The written paper encompasses clinical scenarios, hot topics and criticalreading, and is in the form of a 200 question MCQ exam known as the AppliedKnowledge Test (AKT). The subject matter is divided between critical appraisaland evidence-based clinical practice components, which make up approximately10% of the Questions ; 10% will comprise health informatics and administrativequestions, with the remaining 80% clinical Questions . Questions are of thesingle best answer, extended matching Questions and free text forms, and mayrequire interpretation of pictures, results, and experimental or statistical exam aims to test higher problem-solving rather than simple fact recall.

3 Awealth of information about the curriculum and exam format is available onthe Royal College of General Practitioners website ( ).The Applied Knowledge tests take place at the end of January, May andOctober each year, via computer terminals at 152 Pearson Vue professionaltesting centres around the UK ( ). Detailed feedback willbe provided for candidates who are unsuccessful, allowing them to takeremedial action where necessary before the next sitting. Candidates may takethe exam at any point in their general practice specialty training, but it isexpected that most will do so during their third year of specialty training, whenthey will be working in primary care. All Questions will address important issuesrelating to general practice in the UK, and international applicants should notethat the answers will relate to standard clinical practice in the UK, which maydiffer from their own key to successful preparation is twofold. Exam technique is vital in manymedical exams and the AKT is no exception.

4 Two hundred Questions have to becompleted in 3 hours at a rate of just over one question a minute. The questionsare of the single best answer, extending matching question and algorithmcompletion format, and there are many examples of each type in this book. Thesecond component of successful exam performance is an adequate knowledgebase. The content of the Questions in this book is based on the GP curriculum,which is available on the RCGP s website, and the Questions are loosely based onmy clinical experience. This GP curriculum ( ) is anINTRODUCTION xiexcellent resource in planning your revision, especially in less clinical areas ofthe curriculum such as practice management and information RCGP website gives the pass mark and exam feedback for each sitting. In2012 the pass mark was 68% and the pass rate was 75%. It is well worth readingthe examiners reports on previous sittings as these describe areas of weakperformance, which the examiners may concentrate on in future exams.

5 Candi-dates usually perform well in clinical medicine, less well in critical appraisal andworst in administration best way to prepare for clinical Questions is to read up on problems thatyou see in general practice, ideally keeping a list of PUNs and DENs (patient sunmet needs and doctor s educational needs) encountered during each to do as many practice multiple choice Questions as you can; the old-styleMRCGP exam Questions are still mostly valid and there are a number of excellentpractice MCQ books still available in shops and medical libraries. PasTest alsooffer an online revision package specifically for the AKT, which gives instantprogress feedback (www. ). It should be possible to pick up on hottopics just through working in general practice and reading theBritish MedicalJournalandBritish Journal of General Practice, but a Hot topics course justbefore the exam is usually money well spent. In the previous incarnation of theMRCGP exam, editorials from theBritish Journal of General Practicehad anuncanny habit of turning up as hot topic Questions in the next paper.

6 Examquestions are likely to be drawn from several well-known journals, includingthose listed above. The RCGP s website gives useful information on this, so keepyour eyes on management issues is best picked up by spending a session ortwo with a practice manager, attending practice meetings and doing multiple-choice Questions to identify specific learning needs. It often helps to revise thisarea with a textbook, such asNotes for the MRCGP , although this is nowsomewhat out of date. Practising critical appraisal of journal articles with agroup from your GP training scheme is a useful way of learning this skill, and alot more enjoyable than trying to read a statistics textbook. The Bandolierwebsite ( ) is an excellent source of informationabout critical appraisal. I have included several statistics Questions to illustratevarious concepts, but all of the data and graphs are made up, so please do nottake the results too have done my best to ensure that all the Questions and answers are accurateand current.

7 If you find any discrepancies or have any other comments pleaselet me know and I will make the necessary luck!Rob DanielsINTRODUCTION27 Chapter 2 DermatologySINGLE BEST ANSWER UrticariaA 17-year-old boy comes to see you about his recurrent attacks ofurticaria. Over the years he has tried excluding possible triggers but isnow getting regular attacks. These involve itch and rash but he has nosigns of angioedema. He has not tried any prescription medications one of the following would be appropriate as the next step in histreatment?sA Issue an EpiPen with advice on how to use itsB Loratadine tabletssC Montelukast tabletssD Prednisolone to use orally when he develops attackssE Topical steroids to use for short Sweaty palmsA 36-year-old businessman complains that he has suffered from sweaty palmsfor many years, but is now finding this increasingly embarrassing in businessmeetings. He has a friend who has had successful treatment for this but is notsure what this was.

8 He asks your advice. Which one of the followingtreatments is most effective for this condition?sA Botox injectionssB Cervical sympathectomysC Excision of sweat glandssD Topical aluminium hydroxidesE Topical PsoriasisWhich one of the following is the most appropriate initial treatment for apatient presenting with palmar psoriasis?sA Betamethasone valerate ointmentsB Hydrocortisone 1% ointmentsC Oral prednisolonesD Regular emollientssE Tacrolimus PrurigoA medical student has seen a 40-year-old man with prurigo nodularis. Themedical student asks you to explain more about this condition. Which oneof the following pieces of information is correct?sA Hydrocortisone cream often worsens the conditionsB Patients with the condition often suffer with intense itch that lastsfor about 1 daysC The majority of patients have a personal or family history of atopysD The trunk is often the most affected area of the patient s bodysE Young children are more likely to be affected by prurigo nodularisthan Finger lumpA 56-year-old man attends having knocked his finger while working in thegarage.

9 He reports having had a small lump on his finger for some monthsand, since knocking his finger, this has been leaking, as shown is the single most likely diagnosis?sA KeratoacanthomasB Myxoid cystsC Pyogenic granulomasD Sebaceous cystsE Arm lesionA 78-year-old retired farmer shows you the lesion below, which he hasnoticed on his would be the most appropriate management of this lesion?sA CryotherapysB CurettagesC Excision biopsysD Shave biopsysE Watchful Skin lesionA 93-year-old man complains that for the last few weeks he has had ableeding lesion on his chest that seems to be growing rapidly. The lesionis shown is the single most likely diagnosis?sA Basal cell carcinomasB Malignant melanomasC Seborrheic keratosissD Squamous cell carcinomasE Skin diseaseA 59-year-old woman complains that the skin lesion shown below catcheson her clothing. It has been present for several years and is not associatedwith any other is the single most likely diagnosis?

10 Select one option DermatofibromasB Fibroepithelial polypsC KeratoacanthomasD Nodular basal cell carcinomasE Seborrhoeic Skin lesionA 63-year-old man asks if you can get rid of a wart from his back thatcatches on his clothes and bleeds on occasion. He thinks it has been therefor only a couple of months. The lesion is shown one of the following would be the single most appropriatetreatment for this lesion?sA CryotherapysB Excision biopsysC Salicylic acidsD Silver nitrate cauterysE No treatment Rash affecting the handA 23-year-old man complains of an intensely itchy rash on the palms of hishands. This came on without any obvious cause about 2 weeks ago andwas initially painful. It is now very itchy and keeping him awake at hand is shown is the most likely diagnosis?sA Contact dermatitissB EczemasC Hand, foot and mouth diseasesD PompholyxsE ScabiesQUESTIONS42 FREE TEXT Skin conditionsA 45-year-old man complains of an intensely itchy rash on both wrists.