NUZHET A-ALI

APPLIED KNOWLEDGE TEST FOR THE M

RCGP

3

www.scionpublishing.com

9 781907 904189

ISBN 978-1-907904-18-9

APPLIED KNOWLEDGE TEST FOR THE MRCGP THIRD EDITIONThis new edition now contains nearly 500 questions which comprehensively cover the curriculum and use single best answer, extended matching questions, rank ordering, picture format, and algorithm completion question types. The questions continue to be grounded in everyday practice and new questions have been added which cover the topics the RCGP have identified as causing difficulty for candidates including:• skin lesions• dermatology – safe prescribing• contraception including LARC• screening programmes – antenatal and general management of childhood asthma• developmental milestones and immunisations in children• drug doses and calculations• side-effects of commonly used drugs• controlled drug regulations• osteoporosis• diabetes – interpreting diagnostic test results

Questions and answers have been updated to reflect changes in management of clinical areas such as atrial fibrillation, as well as in administrative areas such as the new fit notes, with references updated throughout. This new edition features even more questions in every format: • 350 extended matching, single best answer questions, rank ordering and free text completion• nearly 80 algorithm completion questions• nearly 50 picture questions, with all photographs presented in full colour

The book has been favourably reviewed by trainees, trainers and programme directors alike and is on the recommended reading lists of a number of VTS schemes. It is essential reading for candidates preparing for the AKT and also for training practices and libraries. It has been used by trainers to plan teaching sessions and tutorials and by established GPs to help them with appraisal and revalidation.

IF YOU WANT TO PASS THE AKT PAPER IN THE MRCGP, THEN YOU NEED THIS BOOK

“Just had my AKT results and they were well above the average… This book is clearly laid out and I feel acts as a good supplement to online revision and fills in

the gaps online revision can leave.”

“This is a good road testing for those who face into the AKT… the questions are clear and easily understood. The picture quality is excellent. The answers are

informative and provide useful revision...”

NUZHET A-ALI

APPLIEDKNOWLEDGETEST MRCGP

FOR THE

QUESTIONS AND ANSWERS FOR THE AKT

THIRDEDITION

P. NAIDOO AND C. MONKLEY

CONSULTATION SKILLS FOR THE MRCGPSECOND EDITION

This book helps readers pull together the knowledge and communication skills required for success in the consultation components of the MRCGP exam, namely Clinical Skills Assessment (CSA) and Clinical Observation Tool (COT). The book does this in three ways:• by demonstrating some of  the required consultation skills on the accompanying DVD, which

features 13 typical consultations• by identifying and teaching these skills in a further 20 case write-ups – these offer readers an

ordered, step-wise approach to data gathering, clinical management and interpersonal skills• by giving candidates 15 ‘practice cases’ (completely new for the second

edition) for use either alone or in small groups – these cases now feature marking schemes

The book and DVD are meant to be interactive, with some of the DVD cases being accompanied by a CSA marking schedule for readers to assess the candidate’s performance. Readers are asked if the doctor on the DVD:• asked the right questions, at the right time, in the right way• performed the right examination correctly• communicated in a precise, understandable and sensitive manner.

REVIEWS OF THE FIRST EDITION:

“This book is really easy to revise from with nice chunks in the form of cases. I did one a night... The DVD was a really nice alternative form of revision. …”

“I think it is a very useful book for many reasons. Most useful is the video consultation which are provided in the DVD which comes with it. Also there are good mock cases.”

“A well written, easy to understand book which helped me to prepare for my CSA by giving me understanding of what was being examined – this was supported excellently by the accompanying DVD.”

“Overall, an essential book for anyone in GP training with a good varied set of patient cases in DVD and mock case format. Makes me feel confident about passing GP training, and does so in a really easy-to-use, interesting format.”

9 781904 842965

ISBN 978-1-904842-96-5

www.scionpublishing.com

CONSULTATION SKILLS FOR THE MRCGP

NAIDOO AND MONKLEY

2

97819048428119781907904189 9781907904172

OTHER GENERAL PRACTICE TITLES FROM SCION:

9781904842941 978190484293497819048425529781907904073

APPLIED KNOWLEDGE TEST MRCGP

FOR THE

THIRDEDITION

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For more details see www.scionpublishing.com

A L S O O F I N T E R E S T

00-AKT 4 MRCGP-3rd ed-ccp Part 1.indd 2 01/10/2013 06:58

NUZHET A-ALIMBBS, MRCGP, DRCOG, DFFP, DCHGP Trainer in Berkshire

APPLIED KNOWLEDGE TEST MRCGP

FOR THE

QUESTIONS AND ANSWERS FOR THE AKT

THIRDEDITION

00-AKT 4 MRCGP-3rd ed-ccp Part 1.indd 3 01/10/2013 06:58

© Scion Publishing Limited, 2014

ISBN 978 1 907904 18 9

Third edition first published 2014

Second edition published 2010, reprinted 2013

All rights reserved. No part of this book may be reproduced or transmitted, in any

form or by any means, without permission.

A CIP catalogue record for this book is available from the British Library.

Scion Publishing Limited

The Old Hayloft, Vantage Business Park, Bloxham Road, Banbury OX16 9UX, UK

www.scionpublishing.com

Important Note from the Publisher

The information contained within this book was obtained by Scion Publishing Ltd

from sources believed by us to be reliable. However, while every effort has been made

to ensure its accuracy, no responsibility for loss or injury whatsoever occasioned to

any person acting or refraining from action as a result of information contained herein

can be accepted by the authors or publishers.

Readers are reminded that medicine is a constantly evolving science and while the

authors and publishers have ensured that all dosages, applications and practices

are based on current indications, there may be specific practices which differ

between communities. You should always follow the guidelines laid down by the

manufacturers of specific products and the relevant authorities in the country in

which you are practising.

Although every effort has been made to ensure that all owners of copyright material

have been acknowledged in this publication, we would be pleased to acknowledge in

subsequent reprints or editions any omissions brought to our attention.

Registered names, trademarks, etc. used in this book, even when not marked as such,

are not to be considered unprotected by law.

Typeset by Phoenix Photosetting, Chatham, Kent, UK

Printed in the UK

00-AKT 4 MRCGP-3rd ed-ccp Part 1.indd 4 01/10/2013 06:58

v

Contents

Preface viiAcknowledgements viiiIntroduction to the applied knowledge test (AKT) ix

Questions 1–50 1Answers to questions 1–50 13

Questions 51–100 21Answers to questions 51–100 31

Questions 101–150 39Answers to questions 101–150 49

Questions 151–200 59Answers to questions 151–200 67

Questions 201–250 73Answers to questions 201–250 83

Questions 251–300 89Answers to questions 251–300 99

Questions 301–350 105Answers to questions 301–350 113

Algorithm questions 1–77 119Medical management of osteoporosis 119Medical management of actinic keratoses 120Medical management of a patient with atrial �brillation 121Medical management of a breast lump 122Symptoms and signs suggestive of chronic heart failure 123Pharmacological management of facial hirsutism 124Choosing drugs for patients newly diagnosed with hypertension 125Management of an unconscious adult 126Coeliac disease care pathway 127Management of primary hypothyroidism in non-pregnant adults 128Patients with suspected ovarian cancer 129

Answers to algorithm questions 1–77 131

Picture questions 1–47 143Answers to picture questions 1–47 165

Appendix: Photograph permissions 173

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143

Picture questions 1–47for answers see pages 165–172

1. Skin rash

With regard to this rash choose one correct answer from the list below:A Typically painlessB Typically seen in �t healthy young menC It is due to herpes simplex virus type 2D Topical lidocaine is not recommended as a �rst-line agent in the treatment of

post rash complicationsE Reduced in terms of duration and severity of pain if systemic antiviral treatment

is started within 4 to 8 days after presentation

2. Skin rash

Which one of the following statements is true?A Early signs of this disease in children include leg pains, cold hands/feet and a

mottled skin colourB Oral penicillin should be given before hospital admission by the GP C �is non-blanching haemorrhagic purple rash is due to chicken pox virusD In children, the classic symptoms of this disease (i.e. rash, headache and

impaired consciousness) always appear within the �rst 2 hours of the illnessE IV penicillin should be given before hospital admission by the GPF �e GP should then personally arrange contact tracing and prophylaxis for the

family and kissing contacts.

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Applied Knowledge Test for the MRCGP

144

3–6. Systematic review and meta analysis

A Horizontal line (there are 14 shown)B Square in middle of each horizontal lineC Width of each horizontal lineD Solid vertical line down middleE Diamond below all horizontal lines (there are two here)

Considering the systematic review and meta analysis data shown above, match the de�nitions to the description given; each de�nition may be used only once, and not all of them are used.

3. �is sign represents pooled data from all trials shown.

4. �is represents the 95% con�dence interval of this estimate.

5. �is is the line of no e�ect and is associated with a relative risk of 1.0.

6. �is corresponds to each trial and shows the relative risk of the condition as a result of the intervention.

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Picture questions 1–47

145

7. Device failure

Which one of the following does not a�ect the failure rate of this device?A Petroleum jellyB VaselineC Baby oilD Clotrimazole cream 1% E KY jelly

8. Ophthalmology

�e mother of a two year old child brings her to see you; she has brought with her a number of recent photos, including the one shown above; the child is well and asymptomatic; on examination with an ophthalmoscope you are unable to elicit a red re�ex in the left eye.

Which one of the following is true?A �e child should be reviewed by yourself in two weeks B It most likely be a problem with the camera which should be replaced and the

child re-photographedC �e child should be referred routinelyD �e condition could be lethalE �e condition is never hereditary

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Applied Knowledge Test for the MRCGP

146

9. Ophthalmology

Which one of the following statements concerning this photograph is correct?A �is is a photo showing panretinal photocoagulation scars in a patient with

diabetic retinopathyB �e white spots are small haemorrhagesC �is picture is typical of wet age-related macular degenerationD �is picture is typical of dry age-related macular degenerationE �e deposits are covering the optic nerve

10. ECG

A 40 year old man collapses with chest pain; his ECG shown above displays which one of the following?A Acute anterior myocardial infarctionB Acute postero–inferior myocardial infarctionC Old anterior myocardial infarctionD Pulmonary embolismE Normal ECG

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