Download MRCGP Applied Knowledge Test 50 sample questions with ... and more Lecture notes History in PDF only on Docsity!
MRCGP
Applied Knowledge Test
50 sample questions
with answers
The following 50 questions are in single-best-answer, extended matching and free-text formats to demonstrate the formats that are currently used in the AKT.
Some of these questions relate to current best practice. They should be answered in relation to national UK guidance and not according to an individual's local arrangements.
In the live test of three hours and ten minutes duration, all 200 items will be used in calculating your score. Marks will not be deducted for incorrect answers; your total score on the test will be the number of correct answers you give. You are therefore advised to attempt all items.
1. Post-myocardial infarction
A 58-year-old woman had an ST-segment-elevation myocardial infarction two months ago. She has made a good recovery but has low mood and a poor sleep pattern with early morning wakening. She wishes to try medication as her symptoms are affecting her ability to work.
Which is the SINGLE MOST appropriate antidepressant drug? Select ONE option only.
A Amitriptyline
B Fluoxetine
C Lofepramine
D Mirtazapine
E Venlafaxine
Answer: B (Fluoxetine)
SSRIs are safer in ischaemic heart disease than tricyclic antidepressants and fluoxetine is the first line choice.
Content Guide reference: Cardiovascular problems
3. Emergency contraception
A 26-year-old woman had unprotected sexual intercourse 12 hours ago. She is mid-cycle and this is the first occasion in this cycle. She wishes to start the combined oral contraceptive pill today in addition to Levonelle emergency contraception.
Which is the SINGLE MOST appropriate length of time, if any, that she needs extra precautions to prevent pregnancy? Select ONE option only.
A 2 days
B 7 days
C 9 days
D 16 days
E No additional contraceptive precautions necessary
Answer: B (7 days)
The rules for quick start contraception are clearly outlined in the 2010 Faculty of Sexual Health and Reproductive Healthcare guidance, but vary depending on the type of emergency contraception and the subsequent contraceptive choice.
The AKT regularly tests understanding of contraception and this area remains difficult for many candidates. If this is an area of potential weakness, it would be worth addressing this in your training.
Content Guide reference: Women’s health
4. Skin rash
This nine-year-old boy has been unwell for the past few days and developed a rash affecting his trunk and limbs yesterday. He has no underlying medical problems and is feeling better today. His mother has used a cream recommended by the pharmacist.
Which is the SINGLE MOST appropriate management option? Select ONE option only.
A No additional treatment
B Oral aciclovir
C Topical aciclovir
D Topical fusidic acid
E Topical mupirocin
Answer: A (No additional treatment)
The boy has chickenpox and no additional treatment is required as he is recovering and has no underlying medical problems.
Content Guide reference: Infectious diseases
6. Lethargy
A 50-year-old man has become increasingly tired and lethargic over the past six months and has developed erectile dysfunction. His wife comments that he looks tanned even in the winter months. His serum ferritin and transferrin levels are significantly raised, but his haemoglobin is normal.
Which is the SINGLE MOST likely diagnosis? Select ONE option only.
A Addison’s disease
B Chronic active hepatitis
C Diabetes mellitus
D Haemochromatosis
E Hypothyroidism
Answer: D (Haemochromatosis)
Haemochromatosis is an inherited disorder which increases absorption of dietary iron which accumulates gradually in the liver, pancreas, skin, joints, heart or endocrine glands causing serious tissue damage. Ferritin and transferrin are raised.
Content Guide reference: Metabolic and Endocrine
Viruses
A Adenovirus F Herpes simplex virus
B Cytomegalovirus G Human papilloma virus
C Echovirus H Respiratory syncytial virus
D Epstein-Barr virus I Rotavirus
E Hepatitis B virus J Rubella virus
For each clinical condition, select the SINGLE MOST likely causative virus from the list of options.
7. Hepatocellular carcinoma 8. Warts
Answers: 7 E (Hepatitis B) 8 G (Human papilloma virus)
Hepatocellular carcinomas is associated with hepatitis B infection and warts are caused by human papilloma virus.
This is an example of an extended matching question where the same option list is used for two or more consecutive questions, which are presented on sequential screens as Question 1 of 2 and 2 of 2. Each option can be used more than once.
Content Guide reference: Infectious diseases
Risk of hip fracture
A cohort study evaluated the relationship between dietary calcium supplementation and hip fractures in post-menopausal women. 100 women took calcium supplements and 100 women took placebo tablets.
Over the three year period, five women had hip fractures in the calcium group and ten women had hip fractures in the placebo group. The 95% confidence interval is 0.18 to 1.4.
10. What is the RISK of a hip fracture in the TREATED group? Select ONE option only.
A 0.
B 0.
C 0.
D 0.
E 1.
11. What is the RISK RATIO? Select ONE option only.
A 0.
B 0.
C 0.
D 0.
E 1.
Answers: 10 B (0.05) 11 D (0.5)
Five women out of 100 had a hip fracture when taking calcium supplements. 5/100 = 0.
5/100 for the treated group and 10/100 for the placebo group, so the ratio is 0.5.
Any calculations in the AKT are arithmetically very simple and are included so that candidates demonstrate their understanding of different statistical terms and measures.
Content Guide reference: Research, statistics and epidemiology
12. Epidemiological measures
Which is the SINGLE MOST appropriate epidemiological measure to estimate the rate at which the new cases of papilloma virus infection occur among students on a college campus? Select ONE option only.
A Case fatality
B Incidence
C Median survival
D Mortality
E Prevalence
Answer: B (Incidence)
Incidence is the term used to describe the rate of occurrence of new cases. Candidates should be familiar with common statistical terms and definitions, and understand when they should be used.
Content Guide reference: Research, statistics and epidemiology
14. Side effects of rheumatological drugs
MATCH EACH drug to the MOST LIKELY side effect. All four drugs must be correctly matched to score ONE mark.
A. Diclofenac B. Hydroxychloroquine C. Infliximab D. Methotrexate
Side effect Most likely causative drug
Bone marrow suppression
Stroke
Retinopathy
Septicaemia
Answer: A Stroke - diclofenac B Retinopathy - hydroxychloroquine C Septicaemia - infliximab D Bone marrow suppression - methotrexate
The AKT will test knowledge of commonly used drugs and their potential side effects. Diclofenac has an increased stroke risk and methotrexate is associated with bone marrow suppression. Candidates sometimes worry that more than one answer may be correct because other drugs might affect the bone marrow but methotrexate is the MOST LIKELY from the listed options.
Cytokine modulators such as infliximab have been associated with infections, sometimes severe, including tuberculosis, septicaemia and hepatitis B re-activation. Although GPs do not initiate these drugs, you need to be able to recognise potentially life threatening complications which may present in primary care.
Although retinopathy is rare, people taking long-term hydroxychloroquine should have an annual vision check.
Matching questions are presented in a drag and drop format so it is important to be confident of how to use the on-line software. An online tutorial is available on the AKT website and the same tutorial will be delivered at the start of the AKT. All four listed side-effects have to be correctly placed to gain one mark.
Content Guide reference: Pharmaco-therapeutics Content Guide reference: Musculo-skeletal
15. Management of skin lesions
The parents of a six-year-old child are concerned about the multiple skin lesions that have spread on his face over the past 12 weeks.
Which is the SINGLE MOST appropriate management option? Select ONE option only.
A No treatment necessary
B Oral flucloxacillin
C Topical aciclovir
D Topical fusidic acid
E Topical hydrocortisone 1%
Answer: A (No treatment necessary)
This child has molluscum contagiosum, a self-limiting illness, for which the listed alternative options are inappropriate.
Interpretation of clinical photographs is frequently necessary in the AKT. Knowing when treatment is not required is an important element of general practice and will be tested.
Content Guide reference: Skin problems
Disorders of glucose metabolism
A Gestational diabetes B Impaired fasting glycaemia C Impaired glucose tolerance D Maturity Onset Diabetes of the Young (MODY) E Normal F Prediabetes G Type 1 diabetes E Type 2 diabetes
For the patient described, select the SINGLE MOST likely diagnosis from the list of options.
17. A 47-year-old overweight woman had a screening blood test because of her family history of type 2 diabetes. Her result is as follows:
HbA1 (^) c 40 mmol/mol
18. A 15-year-old obese boy has significant glycosuria on more than one occasion. He is well with no symptoms. His father and brother both have diabetes.
Random blood glucose 12 mmol/L Blood ketones negative
Answer: 17 E (Normal)
This woman has an HbA1 (^) c at the upper limit of the WHO normal range. The AKT tests understanding of diagnostic threshold values. NICE and SIGN guidelines, and the RCGP elearning website are frequently used reference sources
Answer: 18 D (Maturity Onset Diabetes of the Young (MODY))
This boy has persistent glycosuria and a strong family history of diabetes. Any child who is unwell presenting with symptoms of diabetes should be admitted. This child is well, blood ketones are negative and the question asks for the MOST LIKELY diagnosis rather than ‘the potentially most serious’.
The most likely diagnosis is MODY which should be discussed with a duty paediatrician as his management will be coordinated by secondary care.
Content Guide reference: Metabolic and Endocrine
19. Child development
Specialist referral is MOST APPROPRIATE for which TWO of the following children? Select TWO options only.
A A four-week-old boy whose mother reports he does not smile
B A four-month-old girl who cannot grasp an object when it is placed in her hand
C A four-month-old boy who cannot sit unsupported
D A two-year-old girl who cannot hop
E A three-year-old boy who cannot combine words into a simple sentence
Answers: B (A four-month-old girl who cannot grasp an object when placed in her hand) E (A 3-year-old boy who cannot combine words into a simple sentence)
This question highlights the need for an understanding of normal and delayed child development.
Although GPs in training may not have much experience of key childhood developmental milestones, awareness of these is an essential part of being a GP.
The exam board have regularly fed back to candidates that this is an area that will continue to be tested.
This is an example of a multiple best answer question, where more than one correct answer has to be correct to score one mark. If you attempt to move on after only marking one answer, there is a screen warning to prompt you to look again.
Content Guide reference: Children and young people
21. Drug dose calculation
A five-year-old girl has an asthma exacerbation which you decide to treat with soluble prednisolone at a dose of 1.5 mg/kg once per day for three days initially.
She weighs 20 kg. . What is the correct daily dose of prednisolone?
Type your answer in the following text box. Use figures NOT words. Percentages, equations and fractions are NOT acceptable.
mg
Answer: 30
A further drug dose calculation has been included to emphasise the importance of this topic.
In this case the girl weighs 20 kg. The dose is 1.5 mg per kilogram so the total daily dose of prednisolone is 1.5 x 20 = 30 mg.
Content Guide reference: Pharmaco-therapeutics
22. Skin infections in children
An eight-year-old child has had a localised rash around the nose for two days.
Which is the SINGLE MOST appropriate MINIMUM number of days that this child be kept away from school once treatment has started?
Select ONE option only.
A. 1
B 2
C 3
D 5
E 7
Answer: B (2 days)
Once treatment starts the earliest a child can return to school is 2 days provided there is a good response to treatment. Practical knowledge of incubation and quarantine periods will be required and is frequently asked by parents.
Content Guide reference: Infectious diseases
