:: Cl .: MI:: (:t : MI:: I:;) : Norman Johnson· Chris Bunker further MRCP Part I Spri nger-Verlag London Berlin Heidelberg New York Paris Tokyo Hong Kong Barcelona Budapest NonnanJohnson,~,FRCP The Middlesex Hospital, Mortimer Street, London WIN 8AA, UK Christopher Bunker, ~, MRCP Charing Cross Hospital London W6 8RF, UK Publisher's note: the "Brainscan" logo is reproduced by courtesy of The Editor, Geriatric Medicine, Modem Medicine GB Ltd ISBN-13: 978-3-540-19781-2 DOl: 10.1007/978-1-4471-2005-6 e-ISBN-13: 978-1-4471-2005-6 British library Cataloguing in Publication Data A catalogue record for this book is available from the British LIbrary Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may only be reproduced, stored or transmitted, in any form or by any means, with the prior permission in writing of the publishers, or in the case of reprographic reproduction in accordance with the terms of licences issued by the Copyright Ucensing Agency Enquiries concerning reproduction outside those terms should be sent to the publishers @ Springer-Verlag London limited 1994 The use of registered names, trademarks, etc in the publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore free for general use Product liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book In every individual case the respective user must check its accuracy by consulting other pharmaceutica1literature Typeset by Concept Typesetting Ltd, Salisbury 28/3830-543210 Printed on acid-free paper Contents Introduction to MRCP Part I Bibliography Addresses of Royal Colleges How to Use this Book vii ix x xi The Examination Examination Examination Examination Examination Examination 18 34 50 66 Answers 82 Examination 83 88 Examination 93 Examination 98 Examination [03 Examination Introduction to MRCP Part I Multiple choice questions have been a popular way of setting exams for at least 20 years However fair or unfair they appear to be, they are destined to remain a part of the system The main reason for their popularity is that they provide a compact method of testing the candidate',s knowledge over a very wide field This is an obvious advantage in a subject such as medicine Multiple choice questions allow easy and unbiased marking which can be performed rapidly by computer Computerised marking also facilitates qualitative control of questions and statistical analysis of the exam In order to discourage wild guessing a heavy penalty is introduced in the form of a negative score for an incorrect answer, which usually results in candidates' answer sheets being returned with a proportion of "don't knows" The MRCP Part I examination is held three times a year in many centres in the United Kingdom and abroad A maximum of four attempts at Part I are allowed Re-entry may be deferred if the candidate fails badly No set syllabus is published by the Royal Colleges but recently the emphasis of the exam has been on the basic sciences, which will comprise up to 30% of the exam Sixty multiple choice questions are used from an ever-changing bank of about 4000 questions A breakdown of the relative distribution of questions is given below Topic No of questions asked Anatomy Cardiology Clinical pharmacology Dermatology Endocrinology Gastroenterology Genetics Haematology Immunology or allergy Industrial medicine Infectious diseases Metabolic disease 3 2or3 1 2or3 Musculoskeletal diseases Neurology Ophthalmology Paediabics Physiology Psychiatry Renal disease Respiratory diseases Reticuloendothelial system Statistics Symptoms and signs Toxicology Tropical medicine 4 4 1 lor lor The exam is essentially competitive, with about the top 30% of candidates passing each time, the passmark therefore being variable In simple terms, this means that the successful candidate must perform better than the majority of his or her colleagues Achieving this requires sound knowledge of medicine and basic science, as well as practice in multiple choice question technique There is no doubt that at least 12 weeks' serious preparatory work is needed for this exam A busy clinical job can erode the time spent in the proper preparation which is so necessary for success Stage I: This should be a stage of broadly based general reading (see list below), aimed at acquiring good background knowledge Stage U: This should be one of using subject-based multiple choice questions to guide detailed reading in areas of weakness This helps to highlight the fields in which additional reading is valuable Using multiple choice questions in this way helps the candidate to be guided into those areas on which the College has placed particular emphasis Stage HI: This stage of preparation for the exam is the most difficult Many candidates find it hard to take an overall view, but working through multiple choice question papers is probably the best way to polish technique and pick out any final points requiring extra attention This method also enables one to gain insight into one's own aptitude for multiple choice question exams, which is invaluable when actually sitting the paper The College quite rightly advises against guessing, but one only learns to assess reasonable certainty by practice and experience Bibliography Brain & Bannister (1992) Clinical neurology, 7th edn Oxford University Press, Oxford Burton JL (1990) Aids to postgraduate medicine, 5th edn Churchill Livingstone, Edinburgh Ellis H (1983) Clinical anatomy, 7th edn Blackwell Scientific, Oxford Forfar JO, Amell GC (1984) Textbook of paediatrics, vols & 2, 3rd edn Churchill Livingstone, Edinburgh Ganong WF (1989) Review of medical physiology, 14th edn Lange Medical Publications, Los Altos, California Goodman LS, Gilman A (1990) The pharmacological basis of therapeutics, 8th edn Macmillan, New York Harrison's principles of internal medicine (1991) 12th edn McGrawHill, New York Johnson NMcI (1990) Respiratory medicine pocket consultant, 2nd edn Blackwell Scientific, Oxford Johnson N, Pozniak A (1986) MRCP Part I Springer, Berlin, Heidelberg, Hew York Johnson N, Bunker C (1988) More MRCP Part I Springer, Berlin, Heidelberg, New York Patten J (1978) Neurological differential diagnosis Harold Starke, London Pocock SJ (1983) Clinical trials: a practical approach John Wiley & Sons, Chichester Roitt I et al (1989) Immunology, 2nd edn Churchill Livingstone, Edinburgh Rubenstein D, Wayne D (1991) Lecture notes on clinical medicine, 4th edn Blackwell Scientific, Oxford Souhami RL, Moxham J (1990) Textbook of medicine Churchill Livingstone, Edinburgh Weatherall DJ (1991) The new genetics and clinical practice, 3rd edn Oxford University Press, Oxford Weatherall DJ, Leadingham JGG, Warrell DA (1987) The Oxford textbook of medicine, 2nd edn Oxford University Press, Oxford Zilva JF, Pannall P (1988) Clinical chemistry in diagnosis and treatment, 5th edn Uoyd-Luke, London Examples of Multiple Choice Questions from the Common Part I MRCP (UK) Royal College of Physicians of Edinburgh, Glasgow and London Medicine Internationa11982 onwards Abingdon, Oxon OX14 3BR Journals: British Medical Journal British Journal of Hospital Medicine Hospital Update The Lancet New England Journal of Medicine Addresses of Royal Colleges Royal College of Physicians of Edinburgh Queen Street Edinburgh EH2 IJQ Royal College of Physicians of Glasgow 242 St Vincent Street Glasgow G2 SRJ Royal College of Physicians of London 11 St Andrew's Place Regents Park London NWI 4LE How to Use this Book The passmark given for each paper (with each answer sheet) gives only an arbitrary guide to the performance of previous candidates who have been successful in the membership You should use this book as a set of test examinations to be taken in stage ill of your revision By doing so, not only will you gain experience of performing under the stress of a time limit, but you will also be able to assess your strengths and weaknesses Don't forget to read the questions carefully, check your answers and fill in the answer sheet correctly Do these and other questions in your possession over again, coming back repeatedly to those you get wrong The Examination You are allowed hours to complete the paper, which is answered on a computer card (see below) with a 28 pencil Each initial statement or stem has five possible completions, listed (a) to (e) Each of these has to be answered "true", "false" or "don't know" by filling in the appropriate box on the answer sheet There is no restriction on the number of true or false answers to any question Answers Examination A.3.1 a T A.3.7 b T c T c F d F d F e F A;3.2 e T a F A.3.S b F c F d T e F e T A.3.9 a F b F c F d T e T e F A.3.10 a T b T c F d T e F e F A.3.ll a F b T c T a F b F c T d T e T d T e F A.3.6 a T b F c F d F A.3.5 a T b F c T d T A.3.4 a T b T c T d T A.3.3 a T b T A.3.12 a F b T c T a F b F c F d F d T e T e F 93 Answers A.3.l3 a F b F A.3.20 a F b F c T d F e T A.3.2l a T b F c F d F e T c F d F e F A.3.l4 a F b F c T d T e T A.3.1S a F b F c F d F e T A.3.22 a T b F c T d T e F A.3.l6 a F b F c F d F e F A.3.23 a T b T c T d F e T A.3.l7 a F b T c F d T e T A.3.24 a F b F c F d T e T a F A.3.2S A.3.1S b T c F c T d F d F e T A.3.l9 a T b F e F a F A.3.26 b F a T b F c F c F d T d F e T e T 94 Answers A.3.27 a T A.3.M b F c F d T e T A.3.28 c F d T e F a T A.3.35 b T c T d T e F e T a T A.3.36 b F c T d T e T e F a F A.3.37 b T c T d F e T A.3.3l b F c T e F a T A.3.38 b F c T a F b F c T d F e T e F a F A.3.39 b F c T a T b T c T d F d F e F A.3.33 a T d T d T A.3.32 a T b T c F d F A.3.30 a F b T c F d F A.3.29 a T b T e F a F A.3.40 b T c F a T b T c T d T d T e T e T 95 Answers A.3.41 a F A.3.48 b F c F c F d F d T e F A.3.42 e F a F A.3.49 b T c F d F e T e F a T A.3.SO b T c F d F e F A.3.4S e F a F b F c T d T e F A.3.S1 a F A.3.52 b T c T a T b T d F e F A.3.47 a T b T c T d T e T c T d T A.3.46 a F b F c T d F A.3.44 a T b F c T d T A.3.43 a F b T e T a F b F c F d T e T A.3.S3 a F A.3.M a F b F c F d F e F b F a T b T c T c T d T e T d F e F 96 Answers A.3.55 a F A.3.58 b T c F c F d F d F e T A.3.56 e T a T A.3.59 b T c T a F b F c F d T d T e F A.3.57 a T b T e F a T A.3.60 b F c T a T b F c T d T d T e T e F 97 Answers Examination A.4.1 a F A.4.7 a F b F c T d T e T a F b T c T d T e F A.4.S a T b T c T d T e T a F A.4.9 b F c T d T e F A.4.2 A.4.3 b F c F c T d F d F e F A.4.4 e F a F A.4.10 b F c F d T e F e F a F A.4.11 b T c F a T b F c T d F d F e F A.4.6 a F b F c F d F A.4.S a F b T e T a T A.4.12 b F c F a F b F c T d T d T e T e T 98 Answers A.4.13 a T A.4.20 b T c F c T d T d F e F A.4.14 e T a F A.4.21 b F c F d F e F e T a F A.4.22 b F c F d F e T e T a T A.4.23 b T c F d F e T e F a T A.4.24 b F c F c F e F e F a F A.4.25 b T c F a T b F c F d T d T e T A.4.19 a T b F d T d T A.4.1S a F b T c T d F A.4.17 a F b T c F d T A.4.16 a F b T c T d T A.4.1S a F b F e T a F A.4.26 b F c T a T b T c T d T d F e T e F 99 Answers A.4.27 a F A.4.34 b T c T c F d T d F e T A.4.28 e F a T b T c T A.4.3S d F e T e F a F A.4.36 b T c T d F e F e F a F A.4.37 b F c F d F e T e T a T A.4.38 b F c F d T e T e T a T A.4.39 b F c T a T b F c T d F d T e F A.4.33 a T b T c T d T A.4.32 a T b T c T d F A.4.3l a F b T c T d T A.4.30 a T b F c T d F A.4.29 a T b T e F a F A.4.40 b F c F d T e T 100 a F b T c F d T e T Answers A.4.41 a F A.4.48 b T c F c T d F d T e T A.4.42 e F a T A.4.49 b T c T d T e T e T a F A.4.SO b F c T d F e T e T a F c F a T b F c F e F e F A.4.S1 b F d T A.4.4S d T a F A.4.S2 b T c T d F e T e T a F b F A.4.S3 c T a T b T c T d F d T e T A.4.47 a T b F c F d T A.4.46 a F b F c F d F A.4.44 a T b T c T d T A.4.43 a F b F e T a F A.4.S4 b T c T a T b T c F d F d T e T e F 101 Answers A.4.SS a F A.4.SS b T c T c F d T d F e T A.4.S6 e F a F A.4.S9 b T c T a T b T c T d T d T e T A.4.S7 a F b T e F a T A.4.60 b T c T a F b T c T d T d T e T e F 102 Answers Examination A.S.t a T A.S.7 b T c F c T d T d T e T A.S.2 e T a F A.S.S b T c T d F e T e T a T A.S.9 b F c F d T e T e F a F A.S.tO b F d T d T e T e T a F A.S.ll b T c F a T b F c F d T d T e T A.S.6 a F b T c F c T A.S.S a F b F c T d T A.S.4 a F b T c T d F A.S.3 a F b T e F a F A.S.12 b F a F b T c F c T d F d T e T e F 103 Answers A.S.U a T A.S.20 b F c T c F d T d T e T A.S.14 e T a F A.S.21 b T c F d T e T A.S.IS e F a F A.S.22 b T c T e T a T A.S.23 b T c F a T b T c F d F d F e T e T a T A.S.24 b T c F a T b F c T d F d T e F e F a F A.S.2S b T c T d T e F A.S.19 a T b T d F e F A.S.IS b T c T c T A.S.17 a T d T d F A.S.16 a T b T a T b F c F d F e T a F A.S.26 b T c F d T e F a T b T c T d F e F 104 Answers A.5.27 a F A.5.34 b T c F c F d F d F e T A.5.28 e F a T A.5.35 b T c T d T e T e T a F A.5.36 b T c T d F e F e F a T A.5.37 b F c T d T e T e T a F A.5.38 b T c T d F e F e F a T A.5.39 b T c F a F b T c T d F d F e T A.5.33 a F b F c F d T A.5.32 a T b T c T d F A.5.31 a T b F c T d T A.5.30 a F b F c T d F A.5.29 a T b T e F a T A.5.40 b F c F a F b F c F d T d T e T e F 105 Answers A.S.41 a F A.S.48 b F c T c F d F d T e F A.S.42 e T a F b F c T A.S.49 d T e T e F a F A.S.50 b F c T d F e F A.S.44 F e T a T A.S.S1 b T a T b F c T d F e F e T a F A.S.S2 b F c F a F b T c T d F e F d F e F A.S.47 b T d T c F A.S.46 a F c d T A.S.4S a F b T c T d T A.S.43 a T b T a T b F c T d F e F A.S.S3 a F A.S.54 b T a F b F c F d F e F a F b F c T c T d F d T e T e T 106 Answers A.S.SS a T A.S.58 b T c T c F d T d F e F A.S.S6 e F a T A.S.S9 b F c F a T b F c F d F d T e T A.S.S7 a F b F e T a T A.S.60 b T c T a T b F c F d T d T e T e T 107 ... Examination Examination Examination Examination 18 34 50 66 Answers 82 Examination 83 88 Examination 93 Examination 98 Examination [03 Examination Introduction to MRCP Part I Multiple choice... Deficiencies of which of the following vitamins are correctly paired with their clinical consequences: a b c d e Q.l.23 Thiamine - Beri beri Niacin - Pellagra Riboflavin - Bitot's spots Thiamine... Athletic training Oestrogen therapy Obesity Increased longevity Aortic stenosis Myocardial infarction Hypertrophic obstructive cardiomyopathy Right ventricular failure Mitral stenosis A diagnosis of