::MRCGP sample questions:: June 2005 - answers

 

1.  Regarding Section 2 of the Mental Health Act 1983 (England and Wales), “Admission for assessment”, which of the following statements is correct?  Select ONE answer only

 

1. Allows for admission to hospital for assessment for 72 hours
2. Allows for admission to hospital for assessment for 7 days
3. Allows for admission to hospital for assessment for 14 days
4. Allows for admission to hospital for assessment for 28 days

 

The correct answer is D, Section 2 is an admission for assessment, and is valid for 28 days.  The patient can appeal in the first 14 days.

 

Further reading:

http://gpnotebook.co.uk/simplepage.cfm?ID=1611006020

 

2. Regarding Section 2 of the Mental Health Act 1983 (England and Wales), “Admission for assessment”, which TWO of the following statements are correct?  Select TWO answers only

 

1. Application is normally by a social worker or nearest relative
2. The applicant must have seen the patient within 7 days prior to the application
3. Treatment can also be given during the assessment period
4. Requires medical recommendation from 1 doctor (usually the GP).

 

 

The correct answers are A and C

Application for a section 2 is normally by a social worker or nearest relative, who must have seen the patient in the last 14 days.  Medical recommendation from 2 doctors is required, one Section 12 approved (usually psychiatrist), and one who knows the patient (usually the GP).  Although it is an admission for assessment, treatment can also be given.

 

Further reading:

http://gpnotebook.co.uk/simplepage.cfm?ID=1611006020

 

3.  Regarding Section 4 of the Mental Health Act 1983 (England and Wales), “Admission in an emergency”, which TWO of the following statements are correct?  Select TWO answers only

 

1. Requires medical recommendation from 1 doctor.
2. The application is valid for 48 hours
3. The patient should be admitted within 24 hours of the medical recommendation
4. Allows admission for 48 hours only

 

The correct answers are A and C.  Section 4 should only be used in an emergency, when a Section 2 would cause too much delay. Recommendation by 1 doctor is enough, and the application is only valid for 24 hours, with the patient admitted within 24 hours of medical recommendation.  The admission is for upto 72 hours.

 

Further reading:

http://gpnotebook.co.uk/simplepage.cfm?ID=1611006020

 

 

4.  Regarding medical exemptions to prescription charges, which THREE categories of patients are eligible for exemption from prescription charges?  Select THREE answers only

 

1. Patients with Hyperthyroidism
2. Patients with Hypothyroidism
3. Patients with Diabetes controlled with diet
4. Patients with Diabetes requiring oral hypoglycaemics
5. Patients with Myasthenia gravis
6. Patients with Hypertension requiring treatment

 

The correct answers are B, D and E

 

Medical exemptions to prescription charges (FP92A form) are available for patients with epilepsy needing treatment, Diabetes mellitus (unless diet controlled only), Hypothyroidism, hypoparathyroidism, Hypoadrenalism, Myasthenia.  A full list is available on the back of the FP10 form.

 

5.  Regarding Controlled Drugs, which THREE of the following are controlled drugs (marked [CD] in the BNF).  Select THREE answers only

 

1. Dihydrocodeine
2. Temazepam
3. Nitrazepam
4. Buprenorphine
5. Pethidine
6. Ketamine

 

The correct answers are B, D, and E.  Commonly used controlled drugs also include morphine, diamorphine and fentanyl.

 

6.  Regarding controlled drug prescriptions, which TWO of the following statements are true?  Select TWO answers only

 

1. The dose must be written in words and figures
2. All parts of the prescription must be handwritten
3. The total quantity or number of dose units to be supplied must be written in words and figures

d.  Full handwriting rules do not apply to all controlled drugs

 

The correct answers are C and D.  The dose does not need to be written in words and figures, only the total quantity / total number of dose units.  The practice address / GPs name can be printed, but the patient details, drug, does, date and signature must be handwritten.  Handwriting rules do not apply to some controlled drugs – e.g. Temazepam and Phenobarbitone, although the date must still be handwritten.

 

Further reading:

http://gpnotebook.co.uk/simplepage.cfm?ID=-449511362

BNF, page 7, Controlled drugs and drug dependance

 

7.  Regarding controlled drug [CD] prescriptions, which ONE of the following statements is correct?  Select ONE answer only

 

1. [CD] prescriptions are valid for 4 weeks from the date on the script
2. [CD] prescriptions are valid for 8 weeks from the date on the script
3. [CD] prescriptions are valid for 13 weeks from the date on the script
4. [CD] prescriptions are valid for 26 weeks from the date on the script

 

The correct answer is C.  Controlled drug prescriptions are valid for 13 weeks from the date on the script.

 

Further Reading

http://gpnotebook.co.uk/simplepage.cfm?ID=-449511362

BNF, page 7, Controlled drugs and drug dependance

 

8.      Regarding the laboratory diagnosis of UTI in children, which ONE of the following statements is correct?  Select ONE answer only

 

1. A significant positive result is when there are greater than 10² colony forming units per litre present
2. A significant positive result is when there are greater than 10³colony forming units per litre present
3. A significant positive result is when there are greater than 10⁴ colony forming units per litre present
4. A significant positive result is when there are greater than 10⁵ colony forming units per litre present
5. A significant positive result is when there are greater than 10⁶ colony forming units per litre present

 

The correct answer is D.

Diagnosis is made by a combination of history, examination and lab findings.  Ideally a clean catch or midstream urine sample is needed, but this can be difficult in children, so urine pads or urine bags may be used as an alternative.

 

Further reading:

http://kidney.niddk.nih.gov/kudiseases/pubs/utichildren/

 

9.      Children aged 1-5 years old that present with a UTI should have an ultrasound and DMSA scan 3-6 months after infection if risk factors are present at time of presentation.  Risk factors include which TWO of the following?  Select TWO answers only.

 

a)     Lower abdominal pain

b)     Loin pain

c)      Dysuria

d)     Nocturnal enuresis

e)     Fever

 

The correct answers are B and E.  Other risk factors include vomiting and family history of renal scarring.

 

Further reading:

http://kidney.niddk.nih.gov/kudiseases/pubs/utichildren/

 

10. Regarding investigations in primary care,

 

a.      ANCA

b.     Serum urate levels

c.      Rheumatoid Factor

d.     ANA

e.      Anti TTG

f.        Haematinics

g.     ESR

h.     LFTs

 

For each of the following presentations, which laboratory investigation is the MOST useful in aiding diagnosis?  You may use each option ONCE, MORE than ONCE, or not at all

 

10.1  A 45 year old man presents with severe pain and swelling in his left knee.  There is no history of trauma, although he does admit a heavy drinking session on the weekend.  The knee is warm and tender, although flexion is only mildly reduced.

 

The correct answer is B.  This presentation is very suggestive of gout, which can be brought on or exacerbated by heavy drinking, affects men more than women and typically affects one joint.  Serum urate levels are useful in monitoring severity and progress, although definitive diagnosis is by aspirating joint fluid and looking for negatively birefringent crystals.

 

Further reading: http://gpnotebook.co.uk/simplepage.cfm?ID=550502405

 

10.2  A 30 year old woman who is 14 weeks pregnant presents with a three month history of fatigue, intermittent fever and general malaise.  This started soon after she became pregnant.  She complains of occasional joint pains, and a facial rash after sun exposure.

 

The correct answer is D.  Systemic lupus erythematosus is often precipitated or exacerbated during pregnancy.  Symptoms include fever, malaise, fatigue and photosensitivity, with a characteristic “butterfly” rash over the face.  Anti Nuclear Antibodies are present in 95% of cases.

 

Further reading: http://gpnotebook.co.uk/simplepage.cfm?ID=1530200144

 

10.3 A 4 year old boy attends surgery with his mother.  She is worried that he has frequent bouts of diarrhoea lasting days to weeks.  This has been going on for more than two years, but has got worse more recently.  The mother is worried that he is also very small for his age.  He is on the 5^th centile for height, and the 10^th centile for weight. 

 

The correct answer is E.  This presentation may be due to celiac disease, which often presents in young children, and gets worse as their diet changes.  Symptoms include chronic diarrhoea, bloatedness, and a failure to thrive.  Definitive diagnosis used to be by jejunal biopsy, but is now often done by Anti TTG antibodies.

 

Further reading: http://gpnotebook.co.uk/simplepage.cfm?ID=1301938180

 

11.  Regarding diabetic retinopathy, which TWO of the following statements are correct?  Select TWO answers only

 

1. Diabetics are 10 times more likely to become blind than non diabetics
2. Diabetic retinopathy is a rare cause of blindness in patients aged 20 to 65.
3. Good glycaemic control can slow the progression of retinopathy.
4. Diabetics should be screened for retinopathy at diagnosis and every two years thereafter.
5. Diabetics should be screened for retinopathy at diagnosis and every year thereafter.

 

The correct answers are C and E.  Diabetics have 20 times the risk of becoming blind, and diabetic retinopathy is the MOST COMMON cause of blindness in those aged 20 to 65.  NICE guidelines suggest screening every year. 

 

Further reading: http://gpnotebook.co.uk/simplepage.cfm?ID=-1966079998

 

12.  Regarding treatment of UTI in pregnancy, which ONE of the following antibiotics is the most suitable?  Select ONE answer only

 

1. Trimethoprim
2. Nitrofurantoin
3. Ciprofloxacin
4. Augmentin
5. Vancomycin

 

The correct answer is D.  The Penicillins are not known to be harmful in pregnancy.  Trimethoprim is a teratogen, and nitrofurantoin and all quinolones are potentially harmful and it is recommended that they be avoided.

 

Further reading:  BNF, appendix 4: Pregnancy

 

13.  Regarding treatment of infections

a.      oral flucloxacillin

b.     oral erythromycin

c.      oral penicillin V

d.     topical fucidic acid

e.      topical clotrimazole (as a pessary)

f.        oral fluconazole one off treatment

g.     oral itraconazole

 

For each of the following patients, select the MOST suitable treatment.  You may use each option ONCE, MORE than ONCE, or not at all

 

13.1 A 22 year old woman on the progestogen only pill presenting with a purulent tonsillitis with swollen glands and fever.

 

The correct answer is C, Penicillin V is the usual first line treatment in acute tonsillitis.  The use of the POP pill does not alter this, although you should advice patients to take extra precautions for the duration of treatment and 7 days afterwards (more relevant with the OCP).    

 

13.2 A 26 year old mother who is breastfeeding presents with vulvovaginal itching and discharge.  There is no bleeding.  She has not had similar symptoms in the past.

 

The correct answer is E.  Thrush can be treated successfully either topically or orally.  Oral treatments are NOT recommended for pregnant women or women who are breastfeeding.

 

13.3 A 6 year old child presents with a golden coloured, crusting rash made up of several discrete vesicles and bullae on the face.  It is itchy, and has begun to spread.

 

The correct answer is A.  This is a typical presentation of impetigo.  Bullae are more common in Staphylococcal impetigo.  Oral therapy is indicated as the rash is spreading.

 

14. Regarding the diagnosis of pathological amenorrhoea (i.e. in the absence of pregnancy and during normal reproductive life), which ONE of the following statements is correct?  Select ONE answer only

 

1. Pathological amenorrhoea is the failure to menstruate for at least 3 months (or 3 cycles)
2. Pathological amenorrhoea is the failure to menstruate for at least 4 months (or 4 cycles)
3. Pathological amenorrhoea is the failure to menstruate for at least 5 months (or 5 cycles)
4. Pathological amenorrhoea is the failure to menstruate for at least 6 months (or 6 cycles)
5. Pathological amenorrhoea is the failure to menstruate for at least 12 months (or 12 cycles)

 

The correct answer is D.  About 20-30% of women suffer from amenorrhoea during their normal reproductive life.  The cause is usually endocrine, although a small proportion is caused by structural abnormalities.  The most common endocrine disorders causing amenorrhoea are functional disorders of the hypothalamus and hyperprolactinaemia.

 

Further reading: http://gpnotebook.co.uk/simplepage.cfm?ID=-670695424

 

15.  Regarding the causes of pathological amenorrhoea (i.e. in the absence of pregnancy and during normal reproductive life), which THREE of the following can cause amenorrhoea?  Select THREE answers only

 

1. Kallman’s syndrome
2. Klinefelter’s syndrome
3. Lynch I syndrome
4. Lynch II syndrome
5. Sheehan's syndrome
6. Turner's syndrome

 

The correct answers are A, E, and F.  Klinefelter’s syndrome only affects MEN!  Lynch syndromes are linked to an increased risk of carcinogenesis.

About 20-30% of women suffer from amenorrhoea during their normal reproductive life.  The cause is usually endocrine, although a small proportion is caused by structural abnormalities.  The most common endocrine disorders causing amenorrhoea are functional disorders of the hypothalamus and hyperprolactinaemia.  

 

Further reading: http://gpnotebook.co.uk/simplepage.cfm?ID=-670695424 

 

 

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