past papers for mrcog part 1

mandible wrote:

1- the following substances are freely transferred across the placenta
a-insulin. (false)
b-thyroxine. (false)
c-IgG. (true)
d-warfarin (true).
e-glucose. (true)
Comments:
There are many drugs that freely cross the placenta including the oral hypoglycaemic
agents hence insulin is preferred in pregnancy. Warfarin also ocross the placenta
hence the preferred use of heparin. Glucose a nutrient obviously cross the placenta.
IgG pass but not IgM pass placenta. Thyroxine does not cross the placenta hence the
reason for not using a block and replace regimen for treating thyrotoxicosis as
carbimazole and propyl thiouracil does cross the placenta.
2- in a consanguineous marriage
a- the risk of a serious disease or defect is double that for an unrelated mating. (true)
b-the risk of recurrence for autosomal recessive disorders is 50%.(false)
c-there is an increased risk of producing mentally retarded child. (true)
d-when it is between second cousins, does not carry an increased risk. (true)
e-there is an increased risk of producing a deaf child. (true)
Comments:
Consanguinity (marriage to a blood relative) is associated with an increased risk of
inherited disorders, birth defects as down syndrome and tends to be approximately
double that of unrelated couples but not near 50%. This risk is attenuated as
relationship between partners becomes more distant.
3-Autoimmune addison's disease is associated with
a-premature ovarian failure. (true)
b-hypokalemia.(false)
c-hypothyroidism. (true)
d-vitiligo. (true)
e-Sjogren's syndrome. (true)
Comments:
b- hyperkalemia.
e-in 47% of patients with autoimmune Addison's disease at least one other
autoimmune disorder was present. Primary hypothyroidism has the highest prevalence
(20%) followed by vitiligo(9%), non toxic goiter, premature menopause, grave's
disease, pernicious anaemia, sjogren's disease, hypoparathyroidism,type 1 diabetes
mellitus and celiac disease.
4- the following drugs cause hypokalemia
a- commencement of digoxin for atrial fibrillation.(false)
b-ACE inhibitors.(false)
c-salbutamol for asthma. (true)
d-vitamin B12 for the treatment of pernicious anaemia. (true)
e-cimetidine for duodenal ulcer.(false)
Comments:
a-only toxicity of digoxin cause toxicity.
b-hyperkalaemia.
c-especially high dose in nebulisers for acute asthma.
d-paarticularly at the beginning of the treatment.
5-Regarding the climacteric menopause
a-the average age of the menopause in the united kingdom is about 50 years. (true)
b-demineralization of bones take place after the menopause. (true)
c-the level of prolactin rises after the last period.(false)
d-the severity of flushing has been shown to be related to the level of oestrogen in the
blood.(false)
e-clinical studies have shown that the later the menarche the earlier the
menopause.(false)
Comments:
Average age for menopause is approximately 50 years and is associated with sharp
reduction in bone mineral density and increase in cardiovascular risk
c- it falls.
d-there is no relationship with severity. The presence of sweating is more likely in
women with low oestrogen level
e-no relation between menarche and menopause.
12-hypoparathyroidism is associated with
a-increased incidence of Addison's disease. (true)
b-chronic mucocutaneous candidiasis. (true)
c-basal ganglia calcification commonly causing parkinsonism. (false)
d-short 4th and 5th metacarpals.(false)
e-good response of hypocalcaemia to calcium and vitamin D treatment (true)
Comments:
a-Hypoparathyroidism is associated with Addison,s disease.
c- short 4th and 5th metacarpals is associated with pseudohyperparathyroidism.
d-basal ganglia calcification is common but usually cause chorea.
e- the condition is treated buy vitamin D.
13-Gastrin
a-Stimulates gastric acid secretion in response to meals (true)
b-stimulates the growth of cells in the gastric mucosa. (true)
c-is predominantly produced by G cells located in the pancreas (false)
d-levels are decreased in atrophic gastritis(pernicious anaemia) (false)
e-stimulates insulin secretion particularly after a carbohydrate meal. (false)
Comments:
The main action of gastrin is stimulation of gastric acid and pepsin secretion and
stimulation of growth of mucosa of the stomach and intestine.It is produced by G cells
in the gastric antrum ,duodenum, fetal pancreas and in adults with pancreatic tumors
as gastrinoma .Levels are increased in conditions of low acid production e.g:atrophic
gastritis and proton pump inhibitor therapy due to loss of negative feed back.
Gastrin levels only reach high enough levels following a protein meal to stimulate
insulin secretion.
14-Galactorhoea may be caused by treatment with
a-levodopa. (false)
b-cimetidine. (true)
c-aspirin. (false)
d-spironolactone. (false)
e-haloperidol. (true)
Comments:
Hyperprolactinaemia caused by dopamine antagonism (TCA, major tranquilizers,
haloperidol, high dose SSRI may push up prolactin producing galactorrhoea
a-levodopa does not cause hyperprolactinaemia but methyl dopa does.
d-causes of gynaecomastia but not galactorrhoea (not cause hyperprolactinaemia)
15-Sulphonyl urea therapy:
a-may increase weight.(true)
b-is useful in all type 2 diabetics.(false)
c-enhances glucose stimulated insulin release from the pancreas. (true)
d-stimulates peripheral glucose utilization. (false)
e-has hyponatraemia as a side effect (true)
Comments:
Sulphonylurea therapy stimulate insulin secretion from the beta cells of pancreas
through potassium channel opening . metformin cause increased glucose utilization .
These agents may cause SIADH.
16- drugs which can be given in near normal dosage in severe renal failure include
a- benzyl penicillin. (false)
b-digitoxin. (true)
c-doxycycline. (flase)
d-streptomycin. (false)
e-rifampicin. (true)
Comments:
Drugs whose concentration may accumulate in renal failure include digoxin (digitoxin
metabolized by liver),streptomycin,penicillin,statins,furosomide,doxycycline can
worsen renal failure.
17-Hypercalcaemia is associated with:
a-thyrotoxicosis. (true)
b-secondary hyperpaprathyroidism. (false)
c-excessive absorbable alkali reserve. (true)
d-sarcoidosis. (true)
e-acute adrenal failure. (true)
Comments:
Hypercalcaemia may occur in association with hyperpaprathyroidism, vitaminosis D,
sarcoidosis, Addison's disease, milk alkali syndrome,thyrotoxicosis. Secondary
hyperparathyroidism is associated with hypocalcaemia with chronic renal failure and
impairment of 1 alpha hydroxylation of vitamin D by the kidneys.
18-Testicular feminization syndrome
a-is characterisedby XXY chromosomal pattern. (false)
b-have a female phenotype. (true)
c-is associated with low serum testosterone levels (false)
d-have undetectable serum oestrogen concentrations (false)
e-is an x-linked disorder. (true)
Comments:
a-it is XY.
Testicular feminization syndrome or androgen insensitivity syndrome(AIS) is when a
person has XY genotype but is resistant to androgens. As a result the individual has
some or all of the physical characteristics of a woman, despite having genetic make
up of a man. Its types complete and incomplete. Complete AIS results in someone
who looks as a female. In incomplete AIS the degree of sexual ambiguity varies
widely from individual to other. Testosterone concentrations are in normal male range
but the receptor defect prevents the testosterone from exerting its effects. Oestradiol
concentrations are measurable and produced from the peripheral conversion of
testosterone as well as by the gonads.
19- which of the following predispose to microbial invasion
a-urinary obstruction. (true)
b-ciliary dyskinesia. (true)
c-cystic fibrosis. (true)
d-skin ulceration. (true)
e-neutrophil deficiency. (true)
20-Autosomal dominant inheritance
a-25% of offspring are affected with an affected parent. (false)
b-is the mode of inheritance in multiple neurofibromatosis. (true)
c-afects both sexes equally. (true)
d-shows a pattern of vertical inheritance in a pedigree. (true)
e-always manifests at birth. (false)
Comments:
Autosomal dominant conditions include huntington's chorea, achondroplasia, MEN
type 1. It affects both sexes equally and 50% of offspring are affected with an affected
parent.
21- In the treatment of cushing's disease
a-long term metyrapone may be used. (true)
b-cabergoline is used in patients unfit for surgery. (false)
c-after bilateral adrenalectomy, Nelson's syndrome is prevented by adequate
glucocorticoid replacement . (false)
d-recurrence of cd after transphenoidal surgery is virtually zero. (false)
e-yttrium implantation is indicated in the treatment of pituitary tumors compressing
the optic hiasma. (false)
Comments:
Cushing's disease equates the pituitary dependant disorder while cushing syndrome
include all the other causes as ectopic and adrenal. Cabergoline is used in
prolactinomas not CD. Metyrapone blocks cortisol production. Recurrence after
pituitary surgery is of the order of 20-40%. Yttrium implantation is never used these
days.
22-Polycystic ovary syndrome is characterized by
a-hirsutism .(true)
b-raised serum LH. (true)
c-raised serum testosterone. (true)
d-raised FSH. (false)
e-menorrhagia. (false)
Comments:
PCOS is characterized by hirsutism, oligomenorhoea(usually with normal oestrogen
concentration)and obesity. Insulin resistance is thought to play a major part in
evolution of oligomenorrhoea and contribute to elevated LH with normal FSH and a
slightly elevated testosterone.
23-Polymerase chain reaction(PCR)
a-can amplify RNA but not DNA. (false)
b-it is of no value in prenatal diagnosis. (false)
c-depends on thermostable taq DNA polymerase. (true)
d-requires primer bits either side. (true)
e-use heat to separate 2 strands of DNA. (True)
Comments:
PCR allows amplification of small samples of DNA and through reverse transcriptase
RNA. It can be used for prenatal diagnosis of disease as cystic fibrosis.
d-this is a disadvantage because the primers have to be known.
24-Characteristic finding in anorexia nervosa are
a-a decrease in cortisol levels. (false)
b-increase in LH levels. (false)
c-impaired glucose tolerance. (true)
d-raised androgen levels. (false)
e-hyperkalemia. (false)
Comments:
a-cortisol and growth hormones are elevated.
b-LH and FSH low and LH response to LHRH is impaired when weight loss is severe.
e-hypokalemia, hypoalbuminaemia, anaemia, leukopenuia, raised serum carotene.
25- Acidosis may result in
a-potassium retention. (true)
b-a rise in plasma chloride (true)
c-a low pCO2 . (true)
d-peripheral vasodilatation. (true)
e-tetany. (false)
Comments:
Acidosis is associated with potassium retention and rise in chloride with maintainance
of the anion gap.Peripheral vasodilation occurs to improve oxygenation of
metabolizing tissue. Alkalosis is associated with tetany and reduction of ionized
calcium.in an effort to correct acidosis respiration increase with reduction of pCO2.
26-primary hyperparathyroidism
a-is associated with hypocalcuria due to elevated PTH levels . (false)
b-PTH is secreted in a pulsatile manner from the posterior pituitary and acts through
PTH receptors on parathyroid cell membranes . (false)
c-is usually caused by an adenoma of a single parathyroid gland. (true)
d-progresses to tertiary hyperparathyroidism with time. (false)
e-is associated with bone resorption by PTH to restore depressed serum calcium
levels to normal. (false)
Comment:
Associated with hypercalcaemia, hypophosphataemia and there is usually
hypercalcuria. It is usually a consequence of a single adenoma but may be associate
with hyperplasia and rarely carcinoma where PTH concentrations may be particularly
high
d- secondary progress to tertiary.
27-Recognized features of acromegaly include:
a-hypocalcuria. (false)
b-intestinal polyposis. (true)
c-splenomegaly. (true)
d-Palpable peripheral nerves. (true)
e-proximal myopathy. (true)
Comment:
Features of acromegaly include large hands, feet, macroglossia, organomegaly and
prognathism.
a-hypercalcuria.
b-compression of the optic chiasma may produce a bitemporal hemianopia.proximal
myopathy can occur as well as diabetes mellitus, glucose intolerance and
hypertension. Diagnosis on the basis o non suppression of GH concentrations with the
oral glucose tolerance test.
28-the following are true:
a-an elevated TSH level excludes the diagnosis of hyperthyroidism. (false)
b-free thyroxine levels are elevated in normal pregnancy. (false)
c-most circulating thyroxine s bound to thyroglobulin. (false)
d-phenytoin may reduce total thyroxine levels.(true)
e-amiodarone treatment may cause hyperthyroidism. (true)
comments:
Elevated normal TSH is expected in secondary hyperthyroidism.Total T4
concentrations are usually low or normal in normal pregnancy due to dilutional
effects. Best to regard the TSH concentration. However. Early pregnancy may be
associated with slight rise in T4 associated with elevated HCG which declines as
pregnancy progresses.75% of T4 is bound to thyroid binding globulin not
thyroglobulin.Phenytoin treatment of euthyroid patients results in a 30 to 40%
decrease in serum T4 and free T4 levels and either normal or slightly decreased levels
of T3 and free T3 .Amiodarone may cause hyper as well as hypothyroidism.
29-The following may be associated with hypocalcaemia:
a-convulsions. (true)
b-psychosis. (true)
c-restless legs. (false)
d-Peripheral neuropathy. (false)
e-Papilloedaema. (true)
Comments:
And depression , raised ICP and prolonged QT interval.
30-the following cause multiple painful genital ulcers:
a-circinate balanitis. (false)
b-herpes simplex. (true)
c-chancroid. (true)
d-Primary syphilis. (false)
e-granuloma inguinale. (false)
Comments:
A+d+e usually are painless . Painful ulceration includes herpes simplex/zoster and
genital herpes. Behcet's disease,Reiter's,chancroid and gonocoocal disease.
31-raised aldosterone levels are found in:
a-normal pregnancy. (true)
b-renal artery stenosis. (true)
c-loop diuretics therapy. (true)
d-polycystic ovariansyndrome.(false)
e-Liddle syndrome (false)
Comments:
Aldosterone is elevated in association with reduced circulating
volumes,pregnancy,conn's syndrome,and raised with diuretic therapy (hence good
combination of diuretics and ACEI). Liddle's disease is a renal tubular defect due to
Na/K channels and is associated with hyporenninaemic hypoaldosteronism with
hypokalaemic hypertension.
32-Which of the following are found in multiple endocrine neoplasia type 1
syndrome:
a-phaeochromocytoma. (false)
b-medullary carcinoma of the thyroid. (false)
c-hyperparathyroidism. (true)
d-prolactinoma. (true)
e-insulinoma. (true)
Comments:
MEN type 1 is associated with pituitary, parathyroid, and pancreatic tumours. MEN
type 2 is associated with medullary thyroid carcinoma.
33-Turner syndrome:
a-is seen only in females. (true)
b-may have one chromosome as an isochromosome. (true)
c-is usually associated with severe mental retardation. (false)
d-pateints usually present with primary amenorrhoea. (true)
e-cannot be detected at birth. (false)
Comments:
Turner syndrome XO is associated with a female phenotype with webbed neck,short
stature, cardiac abnormalities and streak gonads. Intelligence is usually unaffected.
34-In diabetic ketoacidosis:
a-leukocytosis is common and does not confirm infection. (true)
b-Amylase levels may be raised in the absence of pancreatitis. (true)
c-urinary stick testing for ketosis may be negative. (true)
d-plasma glucose may be low. (false)
e-a normal plasma potassium level excludes significant potassium defeicienc. (false)
Comments:
DKA is typically associated with increased plasma glucose,leukocytosis,reduced
pH,bicarbonate, pCO2 and pO2. However it is well recognized that DKAmay still be
associated with normal or not so high eg:15mmol/L .Usually ketones are found in
urinebut occasionally are absent for reasons as impaired clearance during DKA. Due
to excess renal losses, total body potassium is typically low even if plasma potassium
is high.
35-Causes of anovulation include:
a-hyperprolactinaemia. (true)
b-weight loss. (true)
c-Obesity (true)
d-polycystic ovary syndrome . (true)
e-propranolol. (false)
Comments:
Anovulation may occur in association with poly cystic ovarian syndrome,
anorexia/marked weight loss but is also associated with obesity.Hyperprolactnaemia
through negative feedback on gonadotrophes in the pituitary produces
hypogonadotrophic hypogonadism and amenorrhoea. Propranolol is not associated
with anovulation.
36-Karyotypic abnormalities are found in the following:
a-Huntington's disease. (true)
b-Burkitts lymphoma. (true)
c-Chronic granulocytic leukemia. (true)
d-phenylketonuria. (false)
e-Acute lymphocytic leukaemia. (true)
Comments:
a-if very large number of triplet repeats.
d-autosomal recessive single gene defect.
37-Abnormal colouration of urine in absence of haematuria may be due to:
a-consumption of beetroot. (true)
b-treatment with codanthramer.( true)
c-phenylketonuria. (false)
d-porphyria cutanea tarda. (true)
e-acute intravascular haemolysis. (true)
Comments:
b-may be pink if rifampicin or isoniazid
c-alkaptonuria.
d-the urine is darker in porphyria cutanea tarda.It has red fluorescence under wood's
light.
e-haemoglobinuria.
38-the following congenital abnormalities are associated with a characteristic
karyotype:
a-Klinefelter's syndrome. (true)
b-cri-du-chat syndrome. (true)
c-Ovarian dysgenesis. (true)
d-Pierre-Robin syndrome. (false)
e-meningomyelocoele. (false)
Comments:
Klinefelter's syndrome-XXY,cri-du-chat deletion chromosome 5p.
Turner /gonadal dysgenesis-XO.
39-Epstein-Barr virus is associated with:
a-Burkitt's lymphoma. (true)
b-Cervical neoplasia. (false)
c-nasopharyngeal carcinoma. (true)
d-pharyngitis. (true)
e-autoimmune haemolytic anaemia. (true)
Comments:
b-No association with cervical neoplasia unlike human papilloma virus.
c-Anaplastic nasopharyngeal carcinoma.common in SE china, virtually all cases have
evidence of EBin the tumour tissue.
d-infectious mononucleosis usually severe pharyngitis.
e-usually resolves after 1-2 months.
40-The following drugs in pharmaceutical doses have been shown to cause a rise in:
a-thiazide diuretics. (true)
b-ethanol. (false)
c-Aspirin. (false)
d-gliclazide. (false)
e-Atenolol. (false)
Comments:
Drugs that may cause hperglycaemia include: corticosteroids, thiazides, glucagon.
Atenolol is associated with hypoglycaemia.
Gliclazide is an oral hypoglycaemic
b-it causes a fall.
c-It causes a fall.
41-Causes of metabolic acidosis include:
a-starvation. (true)
b-thiazide diuretics. (false)
c-uraemia. (true)
d-pyloric stenosis. (false)
e-Sulphonylurea. (false)
Comments:
a-starvation ketoacidosis.
b-can cause metabolic alkalosis.
c-may be caused by diversion of glutamate metabolism to the liver and the consequent
bicarbonate consuming effect of hepatic ureagenesis.
d-an important cause of metabolic alkalosis.
e-biguanides however are associated with lacticacidosis.
Comments:
The primary host response to bacterial infectionsis dependant on mononuclear
phagocytes and neutrophils. T-lymphocytes are involved in cell mediated acquired
immune responses where as B-lymphocytes are involved in humoral immunity and
produce immunoglobulins.
T-lymphocytes compose the majority of circulating lymphocytes in plasma.
Epstein-Barr virus infects B-lymphocytes and squamous epithelial cells of the
oropharynx. The virus can transform B cells and epithelial cells to produce Burkitt's
lymphoma, a subset of hodgkin's lymphoma.Nasopharyngeal carcinoma and oral
hairy leukaemia. T cell lymphoma makes up 10 to 20% of non Hodgkin lymphoma
and has a worse prognosis than B cell lymphoma.
43-The action of noradrenaline released at sympathetic nerve endings is terminated
by:
a-enzymatic decarboxlation. (false)
b-enzymatic inactivation by catechol O methyl transferase. (false)
c-re-uptake of nordrenaline by the axonal terminals. (true)
d-oxidative deamination by monoamine oxidase. (false)
e-it is removed by the circulating blood. (false)
Comments:
Popular pathway to be asked .
44-which of the following conditions are a consequence of chromosomal aberrations:
a-fragile X syndrome. (true)
b-phenylketonuria. (false)
c-Cri du chat syndrome. (true)
d-Osteogenesis imperfect. (false)
e-Down's syndrome. (true)
Comments:
Fragile X syndrome is due to micodeletions on the X chromosom giving the
appearance of fragile notch in this chromosome. Cri du chat is due to a deletion in 5p.
Down's syndrome may be due to trisomy of chromosome 21 or translocation of 14 to
21. OI is autosomal recessive as is phenylketonuria.
45-Side effects of alpha methyl dopa include:
a-pyrexia. (true)
b-visual disturbance. (false)
c-Oedema. (true)
d-nasal congestion. (true)
e-depression. (true)
Comments:
Also haemoytic anaemia, weight gain, GI
disturbance,arthralgia,parkinsonism,nightmares,gyaecomastia,galactorhea, hepatitis.
46-In the normal neonate:
a-the white cell count may be 25x10(9). (true)
b-haemoglobin F is the predominant haemoglobin. (true)
c-The platelet count is in the normal adult range. (true)
d-nucleated red cells are rarely seen in the peripheral blood. (false)
e-the mean cell volume is greater than 100 fl. (true)
47-In mitosis:
a-the number of chromosomes is halved. (false)
b-anaphase lag may produce turner syndrome. (true)
c-the stage of metaphase shows separation of whole chromosome. (false)
d-non disjunction increases with decreasing maternal age. (false)
e-an abnormal plane of division of the chromatids produce isochromosomes. (true)
Comments:
Each time new cells are produced there is a mitotic cycle it must go through. They are
interphase, prophase, metaphase, anaphase, telophase.
48-Which of the following organelles have their own self replicating DNA:
a-lysosymes. (false)
b-golgi bodies.(false)
c-mitochondria.(true)
d-nucleus. (false)
e-rough ER. (false)
Comments:
Mitochondria have DNA and give rise to maternally inherited disease as
mitochondrial myopathies, red ragged fibres, DIDMOAD syndrome, wolfram disease
49-Hypothyroidism:
a-is more common than hyperthyroidism . (false)
b-is associated with low serum carotene. (false)
c-is a cause of pericardial effusion. (true)
d-may present with cerebellar ataxia. (true)
e-is associated with a reduced CSF protein. (false)
Comments:
Hyperthyroidism is 8 times commoner.
b-increased.
e-elevated.
50-Common features of cushing's syndrome due to adrenal carcinoma include:
a-retarded growth in children. (true)
b-Clitoromegaly. (true)
c-subconjunctival oedema. (true)
d-marked hyperpigmentation. (false)
e-supraclavicular fat pads. (true)
Comments:
Adrenal carcinoma and cushing are rare.typically more than 4 cm. Growth retardation
due to increased cortisol is typical in children. Co secretion of androgen may produce
clitoromegaly.Typical features of Cushing include fat pad or buffalo hump,thin skin,
easy bruising and subconjunctival oedema
d-this may be seen in Cushing's syndrome due to ectopic ACTH.

Dr.eman wrote:[b]السلام عليكم ورحمة الله
انا صديقه جديده للمنتدى تبقى لى شهران واخلص الامتياز وعايزه امتحن MRCOG عايزه اعرف تفاصيل اكتر عن كيفية التسجيل والزمان والمكان والمطلوب من الاوراق والشهادات والتكلفه كم ارجو الافاده ولكم جزيل الشكر [/b]

القرشى موسى على wrote:الأخوة القائمون على امر منتدى نجم السودان أ قدم لكم اجزل الشكر بقبولى مشتركأ جديد بهذا المنتدى العامر و اللذى كما سمعت مسبقا كان عونا و بوابة عبور لنجاح الكثيريين لأجتياز امتحانات الرويال كولدج ...
و أنه لشرف لى أن أتعرف عليكم و أن اكون عضوا بهذا المنتدى الاكاديمى المتميز ..
د . القرشى موسى على.