Succeeding in the NMRCGP AKT

Succeeding in the NMRCGP AKT

Paperback(Second Edition)

$31.99

Overview

Succeeding in the MRCGP Applied Knowledge Test is an essential part of progressing through general practice training. This comprehensive revision guide is the most up to date available and covers the entire syllabus through practice SBAs, EMQs and picture MCQs. Written by doctors who have successfully passed the MRCGP AKT, this book is packed with advice and tips, including guidance on topics that candidates consistently struggle with. This clear and time-saving MRCGP revision guide provides practical tips and advice on exam technique and how to best approach the test and maximise your score. Covers all possible question types that will be encountered and offers detailed explanations of the answers with advice from doctors who have successfully passed the exam. Includes 300 practice SBAs, EMQs and picture MCQs and provides a full mock test, comprising a further 200 questions, that can be completed under timed conditions. This easy to use guide will provide you with everything you need to know to fully prepare for all aspects of the MRCGP AKT, and is an essential book for anyone serious in excelling in this exam.

Product Details

ISBN-13: 9781445381558
Publisher: Bpp Learning Media Ltd (Medical)
Publication date: 11/11/2011
Series: Medipass Series
Edition description: Second Edition
Pages: 276
Product dimensions: 6.00(w) x 1.25(h) x 9.00(d)

Read an Excerpt

Succeeding in the MRCGP Applied Knowledge Test (AKT)

500 SBAs, EMQs and Picture MCQs with a Full Mock Test


By Chirag Mehta, Mark Williams, Milan Mehta

BPP Learning Media

Copyright © 2015 Chirag Mehta Mark Williams Milan Mehta
All rights reserved.
ISBN: 978-1-4453-8155-8



CHAPTER 1

Single Best Answer(SBA)

Question Bank

Cardiovascular problems — hypertension

1. A 60-year-old Afro-Caribbean male with known hypertension is already taking both amlodipine 10 mg and bendroflumethiazide 2.5 mg daily. His blood pressure still remains elevated at 165/105 mmHg.

According to NICE hypertension guidelines, which is the SINGLE MOST appropriate next step in management? Select ONE option only.

A. Add in a beta-blocker

B. Add in an alpha-blocker

C. Add in furosemide

D. Add in ramipril

E. Add in an angiotensin-II receptor antagonist


Cardiovascular problems — heart failure

2. According to NICE guidelines, choose from the following list of beta-blockers the only one that is licensed for use in heart failure. Select ONE option only.

A. Atenolol

B. Bisoprolol

C. Propranolol

D. Metoprolol

E. Sotalol


Cardiovascular problems — secondary prevention of myocardial infarction

3. A 58-year-old man has been recently discharged from hospital following a myocardial infarction.

Which of the following medications is NOT considered as essential secondary prevention to reduce mortality? Select ONE option only.

A. Aspirin

B. Amlodipine

C. Simvastatin

D. Ramipril

E. Atenolol


Cardiovascular problems — atrial fibrillation

4. Which of the following is NOT a cause of atrial fibrillation? Select ONE option only.

A. Hypothyroidism

B. Mitral stenosis

C. Ischaemic heart disease

D. Caffeine

E. Haemochromatosis


Metabolic problems — lipid management

5. A 49-year-old man has a fasting lipid profile checked as part of his annual occupational health check-up. Taking his smoking status and blood pressure into account, his 10-year risk of cardiovascular disease is calculated to be 28%. After full discussion, he decides to start simvastatin 40 mg at night.

What should his target cholesterol level be in accordance with NICE guidance? Select ONE option only.

A. Total cholesterol <4 mmol/L

B. Total cholesterol <5 mmol/L

C. Total cholesterol: HDL ratio of <4.5

D. Total cholesterol: HDL ratio of <5.5

E. A target cholesterol level is not appropriate in this case


Cardiovascular problems — atrial fibrillation

6. A 45-year-old man sees you with a 36-hour history of palpitations. There is no associated chest pain or shortness of breath and he has no past medical history of note. Cardiovascular examination is normal, apart from a fast irregular pulse. Electrocardiogram confirms atrial fibrillation with a rate of 120 beats per minute only.

Which is the SINGLE MOST appropriate next step of management? Select ONE option only.

A. Add aspirin + beta-blocker

B. Add aspirin + warfarin

C. Add digoxin + aspirin

D. Add digoxin + warfarin

E. Admit patient to hospital


Cardiovascular problems — heart failure

7. An 80-year-old man has known chronic heart failure secondary to left ventricular systolic dysfunction. He is already on aspirin, simvastatin, bisoprolol, furosemide and ramipril. He says he is still getting short of breath on minimal exertion (eg walking 20 metres). On examination, his chest sounds clear and he has minimal pedal oedema.

Which is the SINGLE MOST appropriate next step of management? Select ONE option only.

A. Change bisoprolol to atenolol

B. Refer to cardiologist

C. Stop aspirin

D. Add angiotensin-II receptor antagonist

E. Add spironolactone


Neurological problems — TIA/stroke

8. For a person who has had a TIA, what is the recommended NICE guidance to prevent further vascular occlusive events?

Which is the SINGLE MOST appropriate option from the list below? Select ONE option only.

A. Start clopidogrel

B. Lifelong aspirin and take dipyridamole modified-release for 1 year only

C. Lifelong aspirin and take dipyridamole modified-release for 2 years only

D. Take both aspirin and dipyridamole modified-release lifelong

E. Initiate warfarin therapy


Neurological problems — dementia

9. According to NICE guidance, which of the following standard instruments should NOT be used in formal cognitive testing to help diagnose dementia? Select ONE option only.

A. Mini Mental State Examination (MMSE)

B. 7-minute screen

C. General Practitioner Assessment of Cognition (GPCOG)

D. Mental Aptitude Test (MAT)

E. 6-item Cognitive Impairment Test (6-CIT)


Neurological problems — Alzheimer's disease

10. Which of the following, according to NICE guidance, should NOT be used for cognitive symptoms and maintenance of function in Alzheimer's disease? Select ONE option only.

A. Donepezil

B. Aripiprazole

C. Galantamine

D. Rivastigmine

E. Memantine


Neurological problems — transient ischaemic attack

11. An 82-year-old woman with known hypertension comes to see you for review. Yesterday, she had a 3 hour episode of weakness in both her left arm and left leg. This is her first ever episode and there were no associated symptoms. Neurological examination is normal when she sees you. Her blood pressure is 160/105 and her only regular medication is bendroflumethiazide.

Which is the SINGLE MOST appropriate next step in management? Select ONE option only.

A. Start aspirin 300 mg od + specialist review within 24 hours

B. Start aspirin 300 mg od + specialist review within 1 week

C. Start aspirin 300 mg od + specialist review within 2 weeks

D. Specialist review within 24 hours

E. Start aspirin 75 mg od + request outpatient CT brain scan


Care of older adults — falls

12. According to NICE guidance of assessment and prevention of falls, which of the following is NOT part of a multifactorial falls assessment? Select ONE option only.

A. Identification of falls history

B. Assessment of urinary incontinence

C. Assessment of cognitive impairment and neurological examination

D. Cardiovascular examination and medication review.

E.Assessment of hearing


Care of people with learning difficulties — autism

13. Which of the following is NOT associated with autism? Select ONE option only.

A. Self-harm

B. Hallucinations and delusions

C. Few friends of the same age

D. Repetitive behaviours

E. Poor verbal communication is usually not supported with non-verbal communication


Genetics in primary care — Trisomy 21

14. A patient has Trisomy 21. Which of the following features is NOT associated with this condition? Select ONE option only.

A. Epicanthic folds on lateral aspects of eyes.

B. Mental retardation

C. Alzheimer's disease

D. Transverse tongue fissures

E. Brushfield spots on the iris


Skin problems — rash

15.A 40-year-old man presents with a very itchy, widespread, papular rash for the last few days. His partner also has a similar rash. He has not used anything new recently. On examination, he has papules all over his body including his penis. A few odd burrows can be seen in his finger-web spaces.

Which is the SINGLE MOST appropriate next step of management? Select ONE option only.

A. Treat with oral antihistamines for 1 week and review if no better

B. Patient should apply permethrin 5% cream

C. Patient and any close contacts should apply permethrin 5% cream

D. Prescribe hydrocortisone 1% cream to apply to papules twice daily for 1 week

E. Suggest the patient should also get tested for syphilis and HIV


Skin problems — impetigo

16. Which of the following statements is TRUE about impetigo? Select ONE option only.

A. It is caused by Staphylococcus aureus

B. Oral flucloxacillin is the treatment of choice

C. It is not very contagious

D. It is sexually transmitted

E. It is caused by Candida albicans


Skin problems — atopic eczema in children

17. According to NICE guidance on atopic eczema in children, which of the following statements is NOT an indication for referral to dermatology? Select ONE option only.

A. If you suspect eczema herpeticum

B. Atopic eczema is severe and has not responded to 1 week of topical therapy

C. The diagnosis is uncertain

D. If you suspect contact allergic dermatitis

E. All children with atopic eczema should be referred to dermatology


Skin problems — itchy feet

18. A 17-year-old boy who plays lots of football and athletics at school complains of an itchy rash on both feet for the last one week. On examination, he has flaking and maceration in the toe web spaces of both feet and on the borders of his feet.

Which is the SINGLE MOST likely diagnosis? Select ONE option only.

A. Eczema

B. Psoriasis

C. Tinea pedis

D. Tinea manuum

E. Tinea unguium


Digestive problems — Irritable Bowel Syndrome (IBS)

19. Which one of the following treatments have NICE guidelines said should NOT be recommended for somebody with IBS? Select ONE option only.

A. Sterculia

B. Lactulose

C. Ispaghula husk

D. Methylcellulose

E. Senna


Digestive problems — chronic diarrhoea

20. A 24-year-old man presents with a 6-month history of diarrhoea and weight loss. He has also noticed an itchy rash has developed on his elbows recently.

Which is the SINGLE MOST appropriate next step in management? Select ONE option only.

A. Refer for colonoscopy

B. Refer for upper GI endoscopy and duodenal biopsies

C. Check anti-tissue transglutaminase (tTG) antibodies

D. Refer to a dermatologist

E. Tell patient to start a gluten-free diet immediately


Digestive problems — epigastric mass

21.A 62-year-old woman presents with a gradually worsening 'feeling of fullness' in the top part of her abdomen and loss of appetite for the last 6 months. She has also noticed that her trousers have become slightly looser around her waist recently. On examination, she has a large, firm, smooth epigastric mass and an enlarged, left supraclavicular lymph node.

Which is the SINGLE MOST appropriate next step of management? Select ONE option only.

A. Request routine abdominal ultrasound scan

B. Refer urgently to gastroenterologist under 14-day referral

C. Request urgent abdominal ultrasound scan

D. Refer routinely to a gastroenterologist

E. Trial of peppermint oil


Digestive problems — Inflammatory Bowel Disease (IBD)

22. Which one of the following conditions is NOT associated with IBD? Select ONE option only.

A. Aphthous ulcers

B. Pyoderma gangrenosum

C. Dermatitis herpetiformis

D. Erythema nodusum

E. Sacroiliitis


Digestive problems — itchy bottom

23. A mother brings in her 4-year-old son who complains of having an itchy bottom for the last week. The itchiness is worst at night. He is otherwise well in himself and examination of the perianal area reveals no abnormality.

Which is the SINGLE MOST appropriate next step of management? Select ONE option only.

A. Call the duty child protection officer

B. Hygiene measures only

C. Hygiene measures + single-dose mebendazole for patient

D. Hygiene measures + single-dose mebendazole for the whole family

E. Hygiene measures + single-dose mebendazole repeated after 2 weeks for the whole family


Digestive problems — gastrointestinal symptoms

24. A patient presents with some gastrointestinal symptoms. Which one of the following symptoms from the history would be least consistent with a diagnosis of irritable bowel syndrome? Select ONE option only.

A. Abdominal bloating

B. 71-year-old male

C. Past medical history of migraines

D. Passing mucous with stool

E. Symptoms worse on eating


Digestive problems — diarrhoea

25. A 22-year-old final year medical student returned from her elective in Kenya a week ago. For the last week, she has had watery stools with lots of flatus and describes the diarrhoea as being 'explosive'. She has no fever, no vomiting, there is no blood in her stools and she is otherwise well. Stool culture is negative.

Which is the SINGLE MOST appropriate next step of management? Select ONE option only.

A. Repeat another stool culture before starting any treatment

B. Trial of loperamide

C. Treat with course of ciprofloxacin 500 mg bd for 7 days

D. Treat with metronidazole 2 g daily for 3 days

E. Treat with mebendazole 100 mg as a single dose


Information management and technology — NHS initiatives

26. Which of the following is NOT one of the National Health Service's initiatives in information management and technology? Select ONE option only.

A. Choose and Book

B. Book and Treat

C. Electronic Care Record

D. GP-to-GP records transfer

E. Electronic prescribing


Information management and technology — Read codes

27. NHS Coding for Health has brought in a new coding system to replace Read codes.

What is the name of this new coding system? Select ONE option only.

A. NHSRC

B. DVOOD

C. READIT

D. SNOWMED CT

E. SNOWFLAKE


Neurological problems — tremor

28. A 68-year-old man complains of finding it increasingly difficult to fasten the buttons on his shirts. His wife has noticed he is salivating and dribbling a lot and that his handwriting has become smaller. On examination, he has a resting tremor and his limbs have cog-wheel rigidity.

Which is the SINGLE MOST appropriate next step in management? Select ONE option only.

A. Trial of levodopa and see if symptoms improve

B. Trial of selegiline

C. Start a beta-blocker

D. Refer to a neurologist

E. Request a computerised tomography brain scan


Rheumatology/musculoskeletal system — chronic fatigue syndrome

29.Which of the following is NOT a feature of chronic fatigue syndrome (CFS)? Select ONE option only.

A. Painful lymph nodes without pathological enlargement

B. Post-exertional fatigue (usually delayed for 24 hours post- activity and slow recovery)

C. Generalised muscle/joint pains without any evidence of inflammation

D. Sore throat

E. Symptoms must be present for at least 4 weeks for diagnosis of CFS


Neurological problems — meningism

30. In suspected meningitis, one test of meningism is pain on straightening the knee when the hip is flexed.

What is the name of this sign called? Select ONE option only.

A. Brudzinski's sign

B. Babinski's sign

C. Kernig's sign

D. Lhermitte's sign

E. Uthoff's sign


Neurological problems — peripheral nerve lesion

31. A 24-year-old woman fell off her horse and landed on her left elbow. She now has clawing of her left ring finger and little fingers with numbness and tingling in these two fingers also.

Which nerve correlates to these signs and symptoms? Select ONE option only.

A. Radial nerve

B. Median nerve

C. Ulnar nerve

D. Sciatic nerve

E. Femoral nerve


Neurological problems — paraesthesia

32. A 22-year-old woman who is 6 months pregnant has recently noticed she been getting painful pins and needles in her right thumb, index and middle fingers and also in the lateral half of her ring finger. Symptoms are worst at night and relieved by shaking her arm.

Which nerve correlates to these signs and symptoms? Select ONE option only.

A. Median nerve B. Ulnar nerve C. Radial nerve D. Sciatic nerve E. Femoral nerve


Neurological problems — peripheral nerve lesion

33. A 55-year-old woman was recently diagnosed with a large, left-sided ovarian cancer which is not surgically treatable. She now finds it very difficult to bend her left knee. On examination, her left hamstrings are weak and she has a left foot-drop.

Which nerve correlates to these signs and symptoms? Select ONE option only.

A. Tibial nerve

B. Common peroneal nerve

C. Sciatic nerve

D. Femoral nerve

E. Ulnar nerve


Neurological problems — peripheral nerve lesion

34. A 17-year-old boy recently fractured his right tibia and fibula after being tackled during football. On examination, he has a right foot-drop and cannot evert his foot or extend the toes. He also has sensory loss over the dorsum of his foot.

Which nerve correlates to these signs and symptoms? Select ONE option only.

A. Tibial nerve

B. Common peroneal nerve

C. Sciatic nerve

D. Femoral nerve

E. Ulnar nerve


Rheumatology/musculoskeletal system — weakness

35. A 30-year-old woman, with known hypothyroidism, presents with weakness in her upper arms for the last four months, especially when she brushes her long hair. She also complains of blurred vision which is worse towards the end of the day. On a recent visit to the optician she was told her vision was fine.

Which is the SINGLE MOST likely diagnosis? Select ONE option only.

A. Multiple sclerosis

B. Myaesthenia gravis

C. Chronic fatigue syndrome

D. Polymyalgia rheumatica

E. Polymyositis


Neurological problems — seizure

36. A 21-year-old postman recently had his first ever seizure a month ago and is currently being investigated by the neurologists. He asks you how long it will be before he can drive again.

Which is the SINGLE MOST appropriate answer? Select ONE option only.

A. 18 months off driving since seizure, with medical review before restarting driving

B. 6 months off driving since seizure, with medical review before restarting driving

C. 24 months off driving since seizure, with medical review before restarting driving

D. 12 months off driving since seizure, without medical review before restarting driving

E. He can start driving immediately if his planned CT brain scan is reported as normal


(Continues...)

Excerpted from Succeeding in the MRCGP Applied Knowledge Test (AKT) by Chirag Mehta, Mark Williams, Milan Mehta. Copyright © 2015 Chirag Mehta Mark Williams Milan Mehta. Excerpted by permission of BPP Learning Media.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Table of Contents

Contents

About the Publisher,
About the Authors,
Acknowledgements,
Copyright permissions list,
Foreword,
Preface,
About the exam and tips on passing it,
Single Best Answer (SBA) Question Bank Answers,
Extended Matching Question (EMQ) Question Bank Answers,
Picture Questions Question Bank Answers,
Mock Paper Question Bank Answers,
Subject Index,

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