Professional Documents
Culture Documents
Practice Questions
Third Edition
CHAPTER 1 QUESTIONS
CARDIOVASCULAR
CONTENTS
Contributors
vii
Introduction
viii
Cardiovascular
Questions
11
Answers
21
35
Answers
49
65
Answers
75
89
101
115
Answers
127
Musculoskeletal
Questions
143
Answers
155
Paediatrics
Questions
169
Answers
181
193
Answers
203
217
Answers
229
11
Questions
247
Answers
259
Reproductive
Questions
273
Answers
287
12 Respiratory
Questions
301
Answers
311
Mock Exam
13 Clinical Problem Solving Example Test Paper
Questions
327
Answers
359
Professional Dilemmas
Introduction to Professional Dilemma Questions
397
Index
vi
Questions
405
Answers
421
434
CHAPTER 1 QUESTIONS
Clinical Problem
Solving Questions
Example
Chickenpox
Erythema infectiosum
Herpangina
Herpes simplex
Rubella
Scarlet fever
Vincent angina
For each clinical scenario given below, select the single most likely
diagnosis from the list above. Each option may be selected once, more
than once or not at all.
A 5-year-old girl has been unwell for 2 days. She now has
oedematous erythematous plaques on the cheeks.
Answers
1
Scarlet fever
Erythema infectiosum
Herpes simplex
Chickenpox
Example
1
Bacterial conjunctivitis
Episcleritis
Iritis
Keratitis
Viral conjunctivitis
Answer E
Viral conjunctivitis
Occasionally, more than one answer may be required (Multiple Best Answer
Question) so it is important to read each question carefully. Beside clinical
scenarios, results of investigations may also be presented. Photographs or
electrocardiograms may also be included.
Each correct answer is awarded one mark and the total score equals the
number of correct answers. The score required to proceed to Stage 3 varies
from year to year and depends on many factors, not least of which is how
hard the paper is thought to be. This implies that a few hard questions can
be expected. The purpose of the test is to distinguish between high and
low achieving candidates and if all the questions are easy that task will be
much more difficult. A few of the examples in this book are in the difficult
category for the same reason.
There is no negative marking in this test (ie the loss of a mark when an
incorrect answer is given). This removes the fear factor. Candidates should
pace themselves carefully and not run out of time. Where an answer is not
known an intelligent guess should be made. No questions should be left
unanswered as this may artificially lower the mark.
A lot of thought is given to the wording of the questions to try to make
them as unambiguous as possible. All questions should be taken at face
value. The answer is the most likely one from the information given.
However, it is important that candidates understand the meaning of certain
conventional terms which frequently appear in the paper. These will be
provided with the paper and can be found on the National Recruitment
Office website. They are reproduced below and may appear in some of
the questions in this book.
Pathognomonic, diagnostic, characteristic and in the vast majority
imply that a feature would occur in at least 90% of cases.
Typically, frequently, significantly, commonly and in a substantial
majority imply that a feature would occur in at least 60% of cases.
In the majority implies that a feature occurs in greater than 50% of
cases.
In the minority implies that a feature occurs in less than 50% of cases.
Low chance and in a substantial minority imply that a feature may
occur in up to 30% of cases.
Has been shown, recognised and reported all refer to evidence that can
be found in authoritative medical texts. None of these terms make
any implication about the frequency with which the feature occurs.
Candidates who do not already do so should start reading thoroughly.
Review articles and editorials in major journals are useful. Weaknesses in
the minor specialties can be covered by reading books such as the ABC
of Dermatology and the ABC of Eyes (both published by BMJ Publishing
Group). It is useful to be aware of the main conclusions presented in
the different sections of Clinical Evidence (BMJ Publishing Group; www.
clinicalevidence.com). It is useful to study the more important guidelines
Chapter 1
Cardiovascular
CHAPTER 1 QUESTIONS
CARDIOVASCULAR
CHAPTER 1 QUESTIONS
QUESTIONS
THEME: CHEST PAIN
Options
A
Mesothelioma
Oesophageal spasm
Pericarditis
Pneumonia
Pneumothorax
Pulmonary embolism
Tietze disease
Unstable angina
From each of the case scenarios given below, select the single most
appropriate diagnosis from the above list of options. Each option may be
used once, more than once or not at all.
1.1
1.2
1.3
11
CHAPTER 1 QUESTIONS
1.4
1.5
1.6
12
CARDIOVASCULAR
CHAPTER 1 QUESTIONS
Check airway
Check pulse
Leave patient
No action
For each of the patients below, choose the single most appropriate
treatment from the list of options above. Each option may be used once,
more than once or not at all.
1.7
1.8
1.9
1.10
1.11
13
CHAPTER 1 QUESTIONS
Amlodipine
Furosemide
Atenolol
Lisinopril
Atorvastatin
Losartan
Clopidogrel
Spironolactone
Digoxin
Warfarin
Dipyridamole
For each patient described below, choose the single most appropriate
treatment from the above list of options. Each option may be used once,
more than once or not at all.
1.12
1.13
1.14
1.15
1.16
14
CARDIOVASCULAR
CHAPTER 1 QUESTIONS
ACE inhibitor
Fibrate
Aspirin
-blocker
No treatment needed
Statin
Ezetimbe
For each patient below, choose the single most suitable option from the
above list for cardiovascular disease prevention. Each option may be used
once, more than once or not at all.
1.17
1.18
1.19
1.20
1.21
15
CHAPTER 1 QUESTIONS
Mitral stenosis
Aortic incompetence
Aortic sclerosis
Aortic stenosis
Pulmonary stenosis
Hypertrophic cardiomyopathy
Tricuspid regurgitation
M Tricuspid stenosis
Mitral incompetence
For each description of clinical signs below, choose the single most likely
diagnosis from the list of options above. Each option may be used once,
more than once or not at all.
1.22
1.23
1.24
1.25
1.26
16
CARDIOVASCULAR
CHAPTER 1 QUESTIONS
Amlodipine
Atenolol
Bendroflumethiazide
Doxazosin
Lisinopril
Losartan
Methyl dopa
Moxonidine
For each of the hypertensive patients below, choose the single most
suitable antihypertensive medication from the list of options above. Each
option may be used once, more than once or not at all.
1.27
1.28
1.29
1.30
17
1.31
CHAPTER 1 QUESTIONS
1.32
18
Amlodipine
Bisoprolol
Digoxin
Losartan
Ramipril
1.33
Atrial fibrillation
Heart block
Heart failure
Side-effect of carbimazole
Ventricular ectopics
1.34
Aortic stenosis
Heart failure
19
CHAPTER 1 QUESTIONS
CARDIOVASCULAR
1.35
CHAPTER 1 QUESTIONS
Aortic regurgitation
Aortic stenosis
Cardiac tamponade
Takayasus arteritis
1.36
A 6-year-old girl has fever and earache. She looks well but
is febrile and has otitis media. Also she has a quiet systolic
murmur localised to the left sternal edge. Otherwise cardiac
examination is normal.
Select from the list below the single most appropriate
management option.
20
Follow-up appointment
Dissection of the aorta within the chest causes severe central pain, that
usually radiates to the back between the scapulae. Dissection of the aorta
is associated with hypertension and collagen disorders (Marfan syndrome,
pseudoxanthoma elasticum). Late-stage syphilis is also associated with
dissection.
1.3
Pulmonary embolism
A clot has embolised from this ladys leg and her lung is infarcted.
Antiphospholipid antibody syndrome is an autoimmune disorder that
predisposes to recurrent thromboses. The clinical presentation of
pulmonary embolism ranges from mild pleuritic chest pain to cardiac
arrest. Patients are often mildly short of breath and hypoxic on arterial
blood gas testing and D-dimer testing will be positive. Chest X-rays are
often normal. Diagnosis is by ventilation/perfusion scanning or spiral
computed tomographic pulmonary angiography.
1.4
Tietze disease
CHAPTER 1 ANSWERS
ANSWERS
1.5
Mesothelioma
CHAPTER 1 ANSWERS
1.6
This woman has reflux of gastric contents into the oesophagus, the acid
nature of which is irritating the oesophageal mucosa and causing pain.
This is often an indigestion-type pain, which may be relieved by antacids
or proton pump inhibitors. Obesity, fatty foods, alcohol, cigarette smoking
and large meals are associated with symptomatic disease. Complications
include oesophageal stricture and Barrett oesophagus.
Check pulse
22
CARDIOVASCULAR ANSWERS
Leave patient
1.9
1.10
Leave patient
Rescue from drowning is an indication to start CPR rather than leaving the
patient to summon help and a defibrillator. If there has been no response
to initial CPR, leave the patient to get help. In an adult who may have
sustained trauma or whose condition indicates drowning as the cause
of cardiac arrest, the first action is also to give 1 minute of CPR prior to
leaving to summon help.1
1.11
Leave patient
23
CHAPTER 1 ANSWERS
1.8
1.12
Dipyridamole
1.13
Losartan
1.14
Spironolactone
1.15
Atenolol
CARDIOVASCULAR ANSWERS
Amlodipine
1.17
Statin
1.18
ACE inhibitor
Healthy people should receive lifestyle advice and drug therapy if the
blood pressure is sustained at levels of 160/100 or greater regardless of
the absolute level of cardiovascular risk. Treatment targets are to produce
levels of 140/85 or less. An ACE inhibitor is the recommended treatment
for a patient under the age of 55 years.6
1.19
Aspirin
25
CHAPTER 1 ANSWERS
1.16
1.20
ACE inhibitor
CHAPTER 1 ANSWERS
ACE inhibitors are recommended for patients with ischaemic heart disease
particularly if there is reduced left ventricular function. They should also
be considered for patients with normal left ventricular function if the
blood pressure targets have not been achieved (< 130/80 in patients with
ischaemic heart disease). Other risk factors need attention and the statin
dose may need adjustment. Aspirin and a -blocker, both beneficial, are
already being taken.
1.21
26
CARDIOVASCULAR ANSWERS
1.24
Aortic stenosis
1.25
Hypertrophic cardiomyopathy
1.26
Patent ductus arteriosus is now almost always identified and treated in the
neonatal period. The murmur, when heard, is usually characteristic.
27
CHAPTER 1 ANSWERS
1.23
1.27
Amlodipine
1.28
Lisinopril
The National institute for Health and Clinical Excellence (NICE) guidelines6
state that calcium channel blockers or thiazide diuretics should be used
first line for black patients at any age. An ACE inhibitor should be added
to the initial therapy if the blood pressure is not controlled.
1.29
Atenolol
-blockers are still used for coronary heart disease and would be very
suitable for this patient. -blockers are no longer used as first line
treatment as studies have shown that they are less effective at reducing
cardiovascular events. 7
1.30
Methyl dopa
28
CARDIOVASCULAR ANSWERS
1.32
Bisoprolol
1.33
Atrial fibrillation
29
CHAPTER 1 ANSWERS
1.31
1.34
CHAPTER 1 ANSWERS
1.35
This is pulsus alternans and describes a pulse with a regular rhythm but
with alternating weak and strong beats. It is found in patients with severe
heart failure and suggests a poor prognosis, ie prolonged recovery of the
failing heart muscles.
1.36
Follow-up appointment
30
CARDIOVASCULAR ANSWERS
CHAPTER 1 ANSWERS
REFERENCES
1.
2.
3.
4.
5.
6.
7.
8.
Scottish Heart and Arterial Disease Risk Prevention. Brief guidelines for
general practitioners giving thrombolytic therapy. 2001.
31