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MRCP Part 2 450 Bofs MRCP Part 2 450 BOFs MRCP Part 2 450 BOFs Carolyn Allen MBChB MRCP Consultant Physician, Rotorua Hospital, Rotorua, New Zealand Suzanne Forbes BSc MBChB MRCP Specialist Registrar in Nephrology, Royal London Hospital, UK David Hunt MBBS BSc PhD MRCP Clinical Teaching Fellow, Newham University Hospital, UK Heather Lewis MBChB MRCP Specialist Registrar in Gastroenterology, Newham University Hospital, UK Ravi Menon MBBS MRCP MD Honorary Clinical Lecturer, Newham University Hospital, UK Luke Moore MBChB MRCP(Lond.) FRCPath MSc MPH DTM&H Lecturer, Division of Infectious Diseases & Immunology, Imperial College, London, UK Edited by Aruna Dias BSc MBBS MRCP Consultant Gastroenterologist, Newham University Hospital, UK Eric Beck MBBS FRCP FRCPG FRCPE Former Chairman of MRCP(UK) Part 2 Board and former Member of the MRCP (UK) Part 1 Board University College London, UK London • Philadelphia • Panama City • New Delhi © 2013 JP Medical Ltd. Published by JP Medical Ltd 83 Victoria Street, London SW1H 0HW, UK Tel: +44 (0)20 3170 8910 Fax: +44 (0)20 3008 6180 Email: [email protected] Web: www.jpmedpub.com The rights of Carolyn Allen, Suzanne Forbes, David Hunt, Heather Lewis, Ravi Menon, Luke Moore, Aruna Dias and Eric Beck to be identified as authors of this work have been asserted by them in accordance with the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission in writing of the publishers. Permissions may be sought directly from JP Medical Ltd at the address printed above. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the authors assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book. This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought. Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity. ISBN: 978-1-907816-45-1 British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data A catalog record for this book is available from the Library of Congress JP Medical Ltd is a subsidiary of Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India Publisher: Richard Furn Development Editor: Thomas Fletcher Design: Designers Collective Ltd Indexed, copy-edited, typeset, printed and bound in India. Preface ‘Assessment drives learning’ is a crucial mantra; it emphasises the broad educational value of the best of five (BOF) MCQs in this book. Its value is further enhanced by the inclusion of explanatory answers, making this a valuable source of continuing medical education and continuing profes- sional development. However, the prime readership will, of course, be candidates preparing for the written Part 2 MRCP examination. In this book you will find authentic questions, comprehensively covering the curriculum, devised by ‘battle-hardened’, recently successful examinees who are now teachers. The chapters reflect the specialties covered by the MRCP Part 2 exam. The number of questions per specialty is directly proportional to the weight each specialty area will carry in the exam. Each chapter covers a broad range of topics within the specialty, and questions range in difficulty between relatively easy and very difficult, as in the exam itself. For each answer, there is a section explaining why that answer is the most appropriate and also why the other options are not correct. The emphasis of the Part 2 examination is in testing the application of basic medical science knowledge to more clinical situations. By passing the Part 1 examination, you have already demon- strated your command of this knowledge. This book gives you an opportunity to practise applying it. Apart from practice, there are no special techniques or tricks to be learned to pass the exam because the examiners take considerable care to use plain English and avoid including ambiguities or clues when setting questions. Nevertheless, always remember the general exhortation for all written examinations: ’read the question carefully before answering!’ The final ingredient required for success is what we all wish you – ‘Good Luck’. Eric Beck January 2013 v Contents Preface v Exam revision advice ix Acknowledgements xiii Dedication xv Chapter 1 Cardiology 1 Questions 1 Answers 26 Chapter 2 Dermatology 47 Questions 47 Answers 59 Chapter 3 Endocrinology 69 Questions 69 Answers 89 Chapter 4 Gastroenterology 107 Questions 107 Answers 128 Chapter 5 Haematology and immunology 147 Questions 147 Answers 160 Chapter 6 Infectious diseases and genitourinary medicine 173 Questions 173 Answers 200 Chapter 7 Neurology, ophthalmology and psychiatry 219 Questions 219 Answers 243 vii Contents Chapter 8 Oncology and palliative medicine 265 Questions 265 Answers 274 Chapter 9 Renal medicine 283 Questions 283 Answers 303 Chapter 10 Respiratory medicine 323 Questions 323 Answers 345 Chapter 11 Rheumatology 367 Questions 367 Answers 378 Chapter 12 Therapeutics and toxicology 389 Questions 389 Answers 405 Index 423 viii Exam revision advice Format The MRCP(UK) exam consists of three elements. Part 1 is a written exam, whereas Part 2 is split into a written exam and a clinical exam (PACES). Part 2 can be attempted only by candidates who have passed Part 1 within the previous 7 years. The Part 2 written exam and PACES can be attempted in either order. The MRCP(UK) Part 2 written exam has a three-paper format. Each paper lasts 3 hours and con- sists of 90 multiple choice questions. The examination lasts 2 days, with two of the papers taken on the first day and the remaining paper on the second day. As in the Part 1 exam, questions take a best of five (BOF) approach, where the most appropriate answer must be selected from a choice of five possibilities, with questions covering the full range of medical specialties. However, one major difference between the two exams is that a proportion of Part 2 questions will be illustrated with a medical image (e.g. ECG, radiograph, CT, MRI, blood film, photograph of a clinical finding), interpretation of which is key to correctly answering the question. The composition of the papers is demonstrated in Table 1. There is no specific syllabus for the MRCP(UK) Part 2 examination, but the Royal Colleges recommend that candidates refer to the Specialty Training Curriculum for General Internal Medicine, prepared by the Joint Royal Colleges of Physicians Training Board. Table 1 Composition of the MRCP Part 2 exam Specialty Number of questions per 100* Cardiology 10 Dermatology 5 Endocrinology and metabolic medicine 10 Gastroenterology 10 Haematology, immunology 5 Infectious diseases and genitourinary medicine 10 Neurology, ophthalmology, psychiatry 10 Oncology and palliative medicine 5 Renal medicine 10 Respiratory medicine 10 Rheumatology 5 Therapeutics and toxicology 10 Total 100 *Figures should be taken as an indication of the likely number of questions – the actual number may vary by up to 2%. A proportion of the questions will be on adolescent medicine and medicine for elderly people. ix Exam revision advice The MRCP(UK) Part 2 exam is now marked using a process called equating. Using the equat- ing system means that rather than being given a percentage overall score, candidates will instead be given an ‘overall scaled score’. This score is a number between 0 and 999, which is calculated from the number of questions a candidate has answered correctly (out of the maximum possible) and takes into account the relative difficulty of the exam. Since no two exams contain the same questions, it is inevitable that some papers may be slightly harder (or easier) than others, and equating is a statistical process that addresses this. At present, the equated score required to pass MRCP(UK) Part 2 is 425. Candidates are strongly advised to visit the MRCP(UK) website for further details of the exam. How to prepare for MRCP (UK) Part 2 Here are some general tips to help prepare for the exam: • Start early – it is advisable to start revision at least 3 months before the exam date. • Approach revision specialty by specialty. • Cover all topics, particularly focusing on the topics from which a greater number of questions will be drawn. • Remember to think laterally when revising – for example, a question on vasculitis could appear in the renal, rheumatology, respiratory, neurology or dermatology sections. • Tackle the questions as you would in the exam, by reading the rubric carefully and thinking of what the correct answer might be before reading the A–E options. Next, select which of the options best fits the answer that you were thinking of. • There are no ‘trick’ questions, but there are definitely questions that are not as straightforward as they may initially appear.
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