MRCP mock exam

Question 1

HTN
low plt
livedo reticularis
R flank pain

which Ab?

Answer 1

anti cardiolipin Ab

Antiphospholipid syndrome

Question 2

HTN 
livedo reticularis
low plt
raised APTT 
thrombosis 
miscarraiges

Answer 2

antiphospholipid syndrome

Question 3

lactose made of

Answer 3

glucose + galactose

Question 4

maltose made of

Answer 4

fructose x2

Question 5

glucose + fructose =

Answer 5

sucrose

Question 6

sugar: aldohexose monomer

Answer 6

mannose

Question 7

glucose + galactose

Answer 7

lactose

Question 8

ST elevation + Q waves
4 weeks post MI
displaced apex

Cause?
Mx?

Answer 8

LV aneurysm

anticoagulation (risk stroke)

Question 9

2 weeks post MI
raised JVP
pulsus paradoxus
quiet HS

Cause?

Answer 9

LV free wall rupture
(HF secondary to tamponade)

Need percardiocentesis and thoracotomy

Question 10

R dilated pupil
no response to light
slow accommodation reflex and remains constricted

Cause?

Answer 10

Adie’s tonic pupil

Question 11

DILATED pupil 
unilateral in 80% 
light reflex absent 
accommodation reflex present
absent knee/ankle reflex

Answer 11

Adie’s tonic pupil

benign condition

Question 12

small, irregular pupils
no response to light
response to accommodate

Answer 12

Argyll-robertson pupil

Question 13

argyll robertson pupil associated with

Answer 13

diabetes

neurosyphilis

Question 14

Recurrent
24-h urinary calcium
8.8 mmol (2.5–7.5)

24-h urinary citrate
0.2 mmol (0.3–3.4)

Rx to reduce stone formation?

Answer 14

Potassium citrate
(makes Ca soluble)

Ca not high enought to warrant thiazide diuretics

Advice on diet is high fluid low salt diet. DON’T ask to reduce Ca in diet (unhelpful)

Question 15

commonest renal stone type

Mx

Answer 15

Calcium oxalate

Opaque on XR

Mx = high fluid, vegetarian, low salt diet.
THIAZIDES
K citrate (if citrate also low)

Question 16

Calcium oxalate stone Mx

Answer 16

cholestyramine reduces urinary oxalate secretion

pyridoxine reduces urinary oxalate secretion

Question 17

Uric acid stone formation

Answer 17

allopurinol
urinary alkalinization e.g. oral bicarbonate

radioLUCENT on XR

May be caused by diseases with extensive tissue breakdown e.g. malignancy
More common in children with inborn errors of metabolism

Question 18

Recurrent renal infections

Stones = Mg + Phos + NH4

Stones from urease producing bacteria

Answer 18

Struvite stones

Radio-opaque

Question 19

RTA type 1 and 3

high urine pH

Which renal stones may form?

Answer 19

Calcium phosphate

Question 20

Outcome of EPO in CKD + anaemia

Answer 20

Improved exercise tolerance

Question 21

SEs of EPO

Answer 21

accelerated HTN
(can ->encephalopathy and seizures

bone aches
flu-like symptoms
skin rashes, urticaria
red cell aplasia (rare)
risk of thrombosis (e.g. Fistula)
IDA 2 to inc. erythropoiesis

Question 22

50M multiple joints swollen and painful.
Satrted on allopurinol 2wk ago for tophaceous gout
temp 37.5 urate high CRP 180

Cause of Sx?

Answer 22

allopurinol therapy

• need to give 2 weeks after 1st gout attack, as can precipitate further attacks

Question 23

Artery causing severe haemoptysis

Answer 23

bronchial artery (90%) pulmonary artery (5%)

need embolization

Question 24

Pt had blood transfusion
1 wk later Hb dropped to 42

Findings a/w delayed transfusion reaction?

Answer 24

positive DAT

Question 25

Transfusion reaction:

occurs 24hr after transfusion
clinical signs 2wk after 
positive DAT 
high unconjugated bilirubin 
jaundice
anaemia
reticulocytosis 
raised LDH 
fever

Answer 25

Delayed transfusion reaction

NB Hburia indicates more significant transfusion reaction

Question 26

TACO vs TRALI

Answer 26

TACO - HTN

TRALI - low O2, hypotension

both get pulmonary oedema

Question 27

2m violaceous pruritic papules on wrist, arm, back. also in line on forearm

associated with?

Answer 27

buccal mucosa involvement

(Lichen Planus)

rash line = Koebner phenomenon