MRCGP McQ Course Session 1 MCQ Paper Confidentiality 1 A married man with pri: diagnosed to you to find out about What is most appropriate ‘ext step? A. Refuse to talk on this matter B Explain report only if husband allows you C Tell her only in the ieabaek Presence of D Tell her only in the absence of husband E Ask her to find ‘out from husband herself. 2 A 35 years old m: about it. What is step? A Call his wife and tell the truth B Don’t tell his wife C Advice patient to tell her himself D Ask him to stay at home till his death E Explore why he does not want her to know | A mother brings 9 years old son with deterioration in school performance. You interviewed the child alone and found sexual abuse at school. He asks you not to tell his Parents. What is most appropriate next step? A Maintain confidentiality B_ Give him time to think again C Ask him to tell mother at home D Tell his mother about abuse E Inform school authorities Tania, 23 years old unmarried model was idmitted with vomiting and found out to have Session 1 wo twin pregnancy. The resident on call has to Present this case in morning round. How should he describe her case? A Tania, famous model presented with vomiting B A famous model presented with vomiting C 23 year old woman was admitted D_ 23 years old unmarried model E 23 years old famous woman ic requests you to keep his auditory hallucinations confidential from his parents. What is most appropriate step? A Ask him to tell them himself B Only mention that he has hallucination C Tell the details of hallucination to ts D Don’t tell his hallucination i E Discuss hallucinations in group session A 35 years old man was found to be HIV positive. His confirmatory test is also positive. He does not want to let his wife know about it. What is most appropriate step? A Inform his wife immediately about HIV B Tell his wife about HIV & sexual relationship C Persuade him to tell his wife himself D Does not matter as she might E parents about already be infected Don’t tell his wife about HIV & sexual relationshipAudit tis 7 A general practitioner notices that most of is diabetic patients are uncontrolled: He wan to do audit of the care of diabetic patients. What should be the most appropriate next step? . A Find out the international standar of diabetic care B Start collecting data of diabetic patients C Set a standard that two ! patients should be controlled D Compare his data with international data E Develop Criteria of diabetic care to be measured 8 A general practitioner is facing criticism about long waiting time for his patients. He audits his scheduling procedure and finds that appointments are clustered at a certain time. Staff suggests appointments uniformly through out the day in order to reduce waiting time. What should be the most appropriate step? ‘A Identify scheduling system of neighboring practice B Set new criteria to measure the scheduling system C Compare your scheduling time with other practices D Find out from the patients if the new system is working E_ Set a standard waiting time for each patient. hird of ) A 80 year old diabetic man presents with urinary tract infection. He is advised insulin 18 units, metformin 500 mg once a day and ciprofloxacin 250 mg twice a day. One day later he develops sweating, palpitation and restlessness. What is most likely cause? A. Side effect of Ciprofloxacin B_ Hyper sensitivity to insulin C Urinary tract infection D_ Insulin dose is high for him E. Side effect of Metformin mrcaP Mca cour ‘Session 1 10 45 years old man was prescribe al } 5 mg at bed time, Few days ae ornitted with encephalopathy, What jg likely cause? ‘A. Renal Impairment B Hepatic Impairment C_ Cerebral Impairment D. Cardiac Impairment FE Endocrine Impairment 11 A 25 years old pregnant woman jp fj trimester comes with fever, sore thrg painful swallowing. Mandibular lymph no fare enlarged and tender. Which one jg most appropriate drug for her? A Erythromycin B_ Lincomycin C Cefixime D Ciprofloxacin E Loratidine 12 A doctor in his practice conscientiously judiciously applies the results of randon controlled trials in the management 9 patients. He is practicing which of the following appropriately:- A. Best Evidence based medicine B_ Expert opinion C Personal Experience D_ Usually practice E Practice Guidelines 13 Metaanalysis of randomised controlle: confirms that Aspirin is useful { Secondary prevention of Which level of evidence this stz indicates? A la B Ib Cc Ila D Ib E WlMRGGP MCQ Course Se: on 1 A B c 19% 20% 23% D 27% E 43% 15 In one of the studies, the event rate in the experimental group is 20% and in the control roUp, it is What is the relative risk reduction fie study? A 10% B 20% Cc 30% D 33% E 50% 16 A test result shows high likelihood ratio. It indicates which of the following most appropriately. A. Absence of disease Certain presence of disease High probability of disease Low probability of disease Uncertain probability moow 17 Inan experimental study, a drug was given to a group of 110 patients. The drug has NNT of I It indicates effectiveness of treatment in which of the following number of patients? Al 50. 95 100 110 18 A bias is found in an experimental study done to determine the association between the exposure and disease. In this study, the association of exposure and disease is:- A Confirmed B Less likely C Most likely D unreliable E_ probable 19 In a factory area exposed to smoke, studied separately foi B Cc D E where the people are children and adults are ra period of five years to find the effect of smoke on the development of respiratory diseases in then ‘groups, This type of study is of which of the following categories? A Case series B Cohort study C Cross sectional study D Randomised controlled trials E Retrospective study 20 A researcher whites an article in which | uses explicit methods to comprehensivi analyse and qualitatively synthes information from multiple —_stud ‘This article is which of the follov categories? A. Case report B_ Expert opinion C Meta analysis D Peer review E Systematic review 21 In a study of 100 patients adverse | occur in one patient in the teated NNH in this study is which of the follo’ AO BT crs D 50 E 100 22 In an experimental study, intervention, the odds ratio Tt indicates that adverse eve experimental group are? ‘A. Marginally decreased B Marginally increased C. Significantly decreased D_ Significantly increased E Unchanged 23 In general practice doctors shoul of themselves and get ready for | as a new patient. Which model of consultation des A. Fraser B Neighbor C Pendleton D RCGP EB Stott and Daviscop McQ Course MRC Session 1 wor with Bs Aldiabetic patient comes to the doctor “i. Tall infection. ‘The doctor mansBes fnfection first, then diabetes, tal opportunity to advise exercise an to change the health seeking behavior, Which model of consultation describe: . Fraser . Neighbor '. Pendleton RCGP Stott and Davis 25 A diabetic patient comes to the doctor with il infection. The doctor manages the nail infection, finds out patient's understanding about diabetes and infection. He educates the Patient and encourages the patient to take Tesponsibility of diet, exercise, weight control. He checks patient's understanding and also asks for his agreement Which model of consultation describes this? A Fraser B_ Neighbor C Pendleton D RCGP E Stott and Davis 26 A diabetic patient comes to the doctor with nail infection. The doctor collects all information about infection and diabetes, examines patient, makes a diagnosis, negotiates a management plan, orders test and also advises pneumococcal vaccine as preventive measure. Which model of consultation is he following? A Fraser B Neighbor C Pendleton D RCGP E_ Stott and Davis 27 A diabetic patient comes to the doctor with nail infection, The doctor manages infection, diabetes, and also asks about his ability to cope with diabetes. He also asks about the effect of diabetes on his life and profession. Which model of consultation jy following? A Fraser B Neighbor (C Pendleton D RCGP E_ Stott and Davis vas consultation has 4 potentials and one of, appara heath promotion them Which model of consultation descriggy this? Fraser Neighbor Pendleton RCGP 2 Stott and Davis 29 When patients come to doctors they have g main reason to see the doctor. Which model of consultation describe this? A Fraser B_ Neighbor C Pendleton D RCGP E_ Stott and Davis 30 For successful consultation a doctor needs be competent in history taking, physi examination, diagnosis, manageme communication skills and record keepin Which model of consultation deseri this? vow> m Fraser Neighbor Pendleton RCGP Stott and Davis moaw> Session 14. 2. Ima health care settin; CC MRCGP McQ Course Session 2 MCQ Paper 1, DPT vaccination is doy inely in chi for prevention of disease.” who was recently for a myocardial Cc. D. A. _ Limitation of saturated fat to less than 10 percent of daily caloric intake. B. Antioxidant vitamin supplementation. C. Daily aspirin use. D. Omega-3 fatty acid supplementation. 23 A 45 years old woman, who has migraine and anxiety, develops hypertension. Her initial work up is unremarkable. Which one medicine would you choose for her? A. Thiazide B. Verapamil C. Atenolol D. Lisinopril E. Felodipine Q Course 24 A45 years old of asthma woman, who is Your old 5 hypertension asthe. ser pulse is 100 pet minutes palpitations. eam Hg. Her initial work BP is 150/90 mmarkable. eth one medicine would choose for lagi A Thiazide B. Verapamil Cc. Atenolol D.__ Lisinopril E. Felodipine 25 A 49 years ‘old diabetic patient develops od pressure. On 170 Siffre Oat BP has been 150) 90 mm Hg. investigations for end organ damage normal. He also has asthma since childhood. He ich one medicine would you prescribe to for blood pressure? A. Enalapril B. Metoprolol C._ Hydrochlorthiazide D. Verapamil E. Amlodipine 26 A 65 years old man whose BP was previous) ‘well controlled on Verapamil presents agai ‘with uncontrolled blood pressure. There are n other cardiovascular risk factors. He als complains of difficulty in passing urine. Which one medicine would you like to add | his prescription? A. Thiazide diuretic B. Terazocin Cc. Atenolol D. _ Lisinopril E. Felodipine 27 A59 years old man has been referred to you ‘a neurologist for control of hypertension. had a CVA 3 months ago. He is on opt doses of ACE inhibitor. Which one medicine would you like to add prescription for prevention of recurrent : control of hypertension? PMRCGP Mca Course Session 3 31 Your gynecology colleague has referred « 4% A. Prazocin B. Thiazide diuretic C. Atenolol D. Diltiazem E. Methy! Dopa 28 A 38 years man who is diabetic and hypertensive develops acute _ myocardial infarction which is treated in CCU. He is discharged home on oral medicines. Three months later his blood pressure remains above 140/90 mm Hg. He is taking Losartan, Aspirin, insulin and Simvastatin. Which one medicine would you like to prescribe to him for control of blood pressure? Metoprolol Furosemide Verapamil Alprazocin E. Amlodipine 29 Mr. Malik is your neighbor and has been coming to you home for BP monitoring. He smokes and his family history is also positive for ischemic heart disease. He has normal blood sugar and lipids. What will be the target BP for him in the light of scientific evidence? A. B. & 140/90 mmHg 130/90 mmHg 130/80 mmHg D. 135/85 mmHg E. 120/80 mmHg 30 Mr. Chaudry is a patient of hypertension. On routine check up his blood sugar was also found high. His blood sugar is now well controlled on medicines. What maximum BP target w‘ for him in order to re ° ould you set duce cardiovascular complications? A. 140/90 mmHg B. 130/90 mmHg C. 130/80 mmHg D. 135/85 mmHg E. 120/80 mmHg What maximum her? years old hypertensive patient to you for control of BP. She has had HTN since 15 years, Her creatinine is 25 mg/dl and proteinuria is present. BP target would you like to set for 140/90 mmHg. 130/90 mmHg, 130/80 mmHg D. 135/85 mig E. 120/80 mmHg 32 A 49 years old hypertensive patient visits your ‘clinic with complains of chest heaviness and sweating on climbing to his office on third floor. His symptoms are relieved by taking rest. On examination his blood pressure is 156/90 mmHg and pulse is 88/minutes Which single antihypertensive would prescribe to him? ‘A. Furosemide B. Metoprolol C. Diltiazem D. Amlodipine E. Lisinopril A B. c you 33 A 45 years old diabetic woman comes | ‘annual health check up. Her clini examination is normal. You aivise ur dipstick examination. Which one of the following is not detected urine dipstick? A. Ketones B. Microalbuminuria C. Bile Pigments D. Glucose E. pH of urineMRCGP McQ Course Session 4 MCQ Paper Mrs. Jennet, 55 years old lady suffers an acute myocardial infarction. What advice would you give regarding the maximally permisnble quantity of alcohol, she may take in future: ‘A. One unit per day : B. Two units per day C. Three units per day D. Four units per day E. five units per day Mr. Khan wishes to fly to London from Lahore to see his relatives. He had an acute MI one week ago and was harged from the hospital without any complication. After MI when will you allow him to travel by air? One week Two weeks Four weeks Six weeks Eight weeks moowD> Mr. Jalal is 40 years old and has sustained anteroseptal MI one week back. He asks you when he can resume sexual activity after MI. What is the most appropriate answer? One week Two weeks Four weeks Eight weeks Twelve weeks BoUOwD> A45 years old man is discharged from hospital ‘one week after MI on Aspirin, Lisinopril, Atenolol and Simvastatin. Two months later at follow up he complains of erectile dysfunction. He asks you if he can use Viagra (Sildenafil). When can this patient start Sildenafil after MI? A. Two months B. Four months C. Six months D. Eight months E. Ten months Session 4 5 A 45 years old man is found to have high levels of serum lipids. You plan to start him on Simvastatin, Which baseline investigation is necessary before starting the drug? A. Creatinine B. Blood Sugar C. SGPT D. CPK E. CBC A 55. years old man who is using ‘Simvastatin comes for follow up after three months. His cholesterol level has decreased though not normalized. He is completely asymptomatic. What investigations will you advise on follow up? A. Total bilirubin B. Direct bilirubin . SGPT D. Alkaline phosphatase E. CPK ‘A 55 years old woman who has come to your clinic for routine checkup. Her clinical examination and investigations are normal except Atrial fibrillation on ECG. Her ECG 5 years ago also had Atrial fibrillation. Which of the following significant risk to her? ‘A. Myocardial infarction B. Ventricular tachycardia C. Sudden cardiac death D. Cerebrovascular accident E. Ventricular fibrillation is the most Mrs. Nasir a 49 years old woman with chronic heart failure comes for follow up. She is taking optimal doses of, Hydrochlorothiazide and Enalapril. She still complains of breathlessness. Her pulse is 80 BPM regular and BP is 130/80 mm Hg.Which one of the following drugs should be added to her prescription?mRrcaP McQ Course Session 4 B. Nitrates C. Beta blockers D. Catcium channe! blockers E. Digox: 9. A 65 years old man walks in your clinic with complaint of dyspnoea and nocturnal cough. His pulse is 98/min and BP is 165/95. He has crackles in the chest. Which one of the following investigations will best exclude failure ? A. BUN B. BNP C. CK-MB D. Chest X-ray E. LDH initial heart 10.4 70 years old man with chronic heart failure comes for routine check up. His symptoms are well controlled. Which one of the following vaccines is recommended for him in relation to his heart failure? A. Tetanus B. Hepatitis B C. Hemophilus influenza D. Meningococcal E. Pneumococcal 11. A 50 years old non smoker man comes to you with some blood reports. His Blood Pressure is 138/90 mm of Hg, BMI is 27, fasting blood sugar is 111 mg / dl, triglyceride is 198 mg/dL, total Cholesterol is 190 mg/dl. What is the single best advice for him? A. Screening for metabolic syndrome. B. No treatment is needed at this time C. He should receive fibrate therapy. D. He should receive niacin therapy. E. He should receive statin therapy 12. A 29 year old businessman comes to your clinic with his lipid profile which he got done after sudden death of his relative. His Session 4 15. weight is 68 Kg. He show: cholesterol = 290 mg/dl Total Cholesterol = 290 mg LDL Cholesterol. = 220 mg/dl loves fatty food. His lays mg/dl IDI. Cholesterot = 50 me/ We haleserel | = 540 mpd Total lipids = 1600 mg/dl What could be the single most likely cause of J pid profile? ‘A. Overweight B. Work stress CC. Sedentary life style D. Genetic predisposition B. High fat Mr. Qureshi visits your clinic for treatment of diabetes and hypertension. He complaing of nausea and anorexia for | month, His SGPT is 240 IU Which one of his routine medicines would you like to withhold? ‘A. Aspirin B. Enalapril C. Glimiperide D. Simvastatin E. Metformin Mr. Alamgir is a diabetic, hypertensive patient and his LDL is 150 mg/dl. You started him on Atorvastatin. Six months later he complains of dull pain and weakness in his thighs and buttocks. Which investigation would you order to confirm his problem? A. ESR B. CRP Cc. CPK D. LDH E. HDL Mr. Khalid is a 45 years old sports teacher comes to your clinic with sore throat. He does not smoke and family history is negative for coronary artery disease. His LDL cholesterol is 136 mg/dl. What should be the next appropri management step?MRcGp A. Low dose Statins B. Life styte e C. Repeat LDL after 6 months D. Statins and life style changes E. No intervention required 16.4 65-year-old hypertensive patient has come to your clinic with angina. His blood Pressure is 170/100 mm Hg, Exercice tolerance testing reveals a 2.5-mm ST depression in the lateral chest leads, Echocardiogram reveals apical akinesis and an estimated ejection fraction of 50%, Which of the following isthe antihypertensive of first choice for this patient? A. Hydrochlorthiazide B. Nifedipine C. Lisinopril D. Atenolol E. Verapamil 17. A 58 year old man presents to your cli four weeks after being hospitalized for myocardial infarction. He is complaining of chest pain, fever, and multiple joint pains, Laboratory tests do not show an increase in cardiac enzymes. What is the most likely diagnosis? A. Dressler’s syndrome B. Costochondritis C. Pneumonia D. Recurrent MI E. Post MI angina 18. A 35 years old man has come to your clinic from a far off village. He complains of weakness, skin changes and shortness of breath for one year. He has been a heavy alcoholic. His pulse is 110 bpm, BP 135/60. mm Hg, basal crepitation and ankle edema are present. j What is the most likely cause of his. symptoms? A. Ischemic heart disease B. Beriberi C. Hypothyroidism D. Pericardial disease E. Thyrotoxicosis 19. A. 64-y¢ -old female comes to your ¢linic With an ulcer on the anterior aspect of her leg for one month. The skin of her leg is very thin and shiny. She also has severe eczema on her leg. Yesterday she shopped all day and developed severe lower limb edema. What is the most likely diagnosis? A. Venous insufficiency B. Arterial insufficiency G. Age related changes D. Peripheral neuropathy E. Obesity related changes 20.A 60 year old man has had myocardial infarction, He has symptoms of breathlessness consistent with NYHA class III, Echocardiography shows an LV ejection fraction of 35%. He is taking Metoprolol, Ramipril, Aspirin and Furosemide. According to NICE Guidelines which one of the following medicines would you add to control his shortness of breath? A. Valsartan B. Diltiazem ©. Hydrochlorthiazide D. Spironolactone E. Indapamide 21.40 years old man is found to have Triglyceride level of 550 mg/dl and Cholesterol level of 180 mg/dl. He does not have risk factors for coronary artery disease, What is the drug of choice for him? A. Nicotinic acid B. Gemfibrozil C. Simvastatin D. Atorvastatin E. Ezitimibe 22. A 60 year old patient has cholesterol of 250 mg/dl and triglycerides of 240 mg/dl. His blood pressure is 165/90 mm Hg. He has a previous history of CVA but not myocardial infarction. Which one of the following is most appropriate?mrcar mca course ‘Session 4 died at the age of 39 Years because of cardial infarction. B. Bezafibrate : €. Gemfibrozil her? ee D. Ezetimibe i soar Be comer ve your clinic: br “homed 2 Me ee act infection. His age is 48 Soe Jeazs and. there is no family history of Se ischemic heart disease. His blood prefs" and blood sugar are normal. His 1 erol is 150 mg/dl Sar gould eH classify his cholesterol? A, Optimal B. Near optimal C. Borderline high D. High E. Very high 24. A 56 years old man has come to your clinic for control of blood sugar. He smokes 10 cig/day, walks for 30 minutes every day, his family history is negative for Coronary Artery Disease. His total cholesterol is 175 mg/dl What would be the goal LDL level for him? <100 mg/dl <110 mg/dl < 130 mg/dl << 160 mg/dl E. <180 mg/dl 25.A 60 years old hypertensive brings his reports showing Cholesterol level of 250 mg/dl and Triglyceride of 320 mg/dl. His blood pressure is well controlled on monotherapy. Which one of the following drugs he might be taking? A. Diltiazem B. Lisinopril C. Atenolol D. Nifedipine E. Losartan -Mrs. Durrani, a 51 years old housewife discusses her lipid profile with you. Her total cholesterol is 236 mg/dl and HDL is 62 mg/dl. She does not smoke. Her brother A B. c. D. Session 4 Id Khan is a 48 years ol * eae! iin a bank, He underwent €o, ass surgery last year- Pyar should be his goal LDL level? ‘A. < 100 mg/dl B. <110me/dl C. < 130 mg/dl D. <160 mg/dl E, <180 mg/dl ! : 28, Mrs, Alvi is your old patient of dial ear her routine labs were done. oe eclenersl is 129 mg/dl. What shou be her goal LDL level? A. < 100 mg/dl < 110 mg/dl < 130 mg/dl < 160 mg/dl < 180 mg/dl 29, Mrs. Wazir is a known case of Mitral Stenosis. She does not have history 9 diabetes and hypertension. Her family, history is unremarkable. What should be her goal LDL level? ‘A. <100 mg/dl B. < 110 mg/dl C. < 130 mg/dl D. < 160 mg/dl E. < 180 mg/dl 30.A 65 years old man with diabetes and hypertension complaints of chest pain. H has loud injection systolic murmur. Hi ECG shows (LBBB) what is the me appropriate initial diagnostic test for him‘ A. Angiography B, Transesophageal echocardiogram. C, Stress echocardiogram q D. Exercise ECG (ETT) E. Cardiac Enzyme B. c D. E.MROGP Mi Mc ‘Q Paper % years aioe suwaker pe \ VAROH eBROAIN With vee raonthe History at Naemoptyals and weight ke Wied of the fllowing Is mast appropriate witiat onvestigation? a A: Complete blood eount 1. Chest radiograph € Sputwen (FALL staing BD. Spatuny for eultares ECP sean of chest \ Styearokt paient presente with mild shormess of breath with wheesing twice a mnonth His syn +! ptOMWS ATE WOKE duiring Winter x exercise following medications is indicated in the initial treatment of this case? A. Salmeteral BG, Salbutamol C, Cromoglyeate D, Ipratropium 5. Theophylline season and takil Which ef the A 32 years old asthmatic patient is taking medications for his asthma, He presents with hoarseness of voi Which one of his medicines is m responsible for his hoarseness? A. Montelukast B. Salbutamol C. Beclomethasone D. Ipratropium E. Theophylline st likely : You advise home peak flow meter to an asthmatic patient. Which one of the following statements is incorrect about peak flow meter? ‘A. A good measure of airflow limitation B. Best for monitoring of disease progression S The best of three attempts is recorded . It is @ simple to use and cheap test Bi It tends to overestimate lung function A 56-year-old smoker presents with cough for the last 10 years associated with progressive shortens af breath The mueaid and evgasien fle wh ough | ly purulent talks, Advert lobes, abn sign His ehe wall thickening What is the most likely diagnowls patient? ‘A. Asthma 1, Emphysema G, Cheanie bronehitis D. Sub aoute bronchitis UL, Allergic bronchitis 6 A 22-year-old nom-amoker student pr with cough for eight months which is mostly at night, There ts no fever, weight loss, shortness Of breath. His physical examination and chest Xeray are normal: ‘What is the most likely diagnosis? ‘A, Allergic bronchitis B. Cough variant asthma €, Bronchial asthma D. Loffler's syndrome E. Chronic obstructive pulmonary disease sents 7 A 2A-year-old woman develops wheezing and shortness of breath when exposed to cold air or when exercising, These symptoms are getting worse, What is the most appropriate drug for her before exercise? A. Inhaled beta2 agonist B, Oral aminophylline C. Inhaled anticholinergic . Inhaled sodium cromoglycate E. Inhaled corticosteroids & A 55 years old COPD patient asks you about preventive vaccines for COPD patients as his cousin in UK also has COPD but he received some vaccines. Which vaccine would like to advise to him based on clinical evidence, assuming that all vaccines are available in your town? A. Meningococcal B. Hemophilus influenzae C. Beg Session 5marco Mca CO Session 6 plaster on her leg. She complaints of shoritere of breath, chest heaviness and restlessness) Th has been taking contraceptive pills to dct: | her leg fracture heels. Her ‘ion is unremarkable. st likely diagnosis in her pregnar lini What would be t A. Pulmonary embolism B. Pulmonary hypertension C. Myocardial infarction D. Pneumonia E. Pneumothorax 10 A 19 years old boy has brought by his father to your clinic for evaluation. The boy complains of cough and shortness of breath off and on since 6 months. His father wants you to confirm the diagnosis of asthma as many of his cousins are also suffering from asthma. You advised spirometry which shows FEVI 1 FVC aa FEVI/FVC 0.3 (0.75 t0 0.80) What does the patient have? A. Asthma B. Reactive airway disease C. Interstitial lung disease D. Normal pulmonary functions E, Restrictive lung disease | A principal of a school was diagnosed to have asthma on clinical and spirometry studies 2 months ago. You have prescribed inhaler salbutamol and beclomethasone in optimal doses. His asthma is not yet controlled. What could be the single most likely cause of not controlling his asthma based on your knowledge of asthma treatment? A. Worsening of the disease B. Poor inhaler technique C. Fake inhalers D. Poor concordance E. Wrong choice of medicines 15 ure asthmatic gitl Is on in 15D and inhaled salbutamay A five year old 90 % of normal ’ he most appropriate SEP regarding ma’? ence salmeterol B, Commence C Commence oral steroids D. Increase dose of salbutamol E. Continue current management fic man on 1600 uy 45 year old asthmatic man o 2a beclomethasone daily and BD: salbutamo} ersents with a cough productive of mucoid pretum and shortness of breath on minimal te n spenion. His peak flow is 50 % of the vatient’s best value. 2 management? A. Formoterol B. Prednisolone C. Cromoglycate D. Ipratropium E. Theophylline ‘A 30 years male smoker comes with SOB, non productive cough and wheeze for last 3 months, His initial peak flow is 300 L/minute. You give salbutamol inhaler and measure peak flow again. ‘At which of the following levels of peak flow after salbutamol would you diagnose him as asthmatic patient? i A = 320 Vminute B= 330 L/minute C = 340 L/minute D = 350 Liminute E = 360 Liminute A 30 years male complains of SOB and non productive cough particularly in the morning for the last 1 month and sometime he also wheezes. You advise him to check his PEFR daily at home for | week. [t shows variation in the reading. Session 5MRCGP McQ Course For how n necessary to A. > Ida B. >2 day/week C. >3 day/week D. >4 day/w E. >5 day/iweek 16 Aasthmatic patient comes in emergency with severe attack of asthma, You measure his FR and it is 45% of his best, 20 What is the cut off of peft for life threatening asthma? a A. < 66% B, < 55% C. < 44% D. < 33% E, < 22% 17 A 60 years old man presents with chronic productive cough for last 10 years. He smokes 2 packs/day for last 30 years. His BMI is 34kg/M2. He becomes short of breath when he climbs up the stairs and itis 21 increasing day by day. Which of the following pulmonary function test is most useful in differentiating this condition from asthma? A= fev! B= feyl/fve pefr residual volume fve Cc D E 18 A 50 years chronic smoker patient comes with SOB when he changes his dress. You advise him lung function test for diagnosis. 22 What would be the value of fevl/fve to make diagnosis of copd? A. <30% B. <30% Cc. <70% D. <90% E. <110% A 50 years asthmatic patient presents with poorly controlled asthma & he wants to Session 5 monitor his asthma at home so that he ean adjust his medicine according to your advice Which one of following pulmonary function test is most easily carried out at home ‘A= fev I/fve ration fev D = residual volume fev ‘A 40 years old man came to emergency with breathlessness, wheezing. He is unable to talk in sentences without break. His b.P is 130/96,pulse 120/min , PUR 30/min PEFR<50% best Which of the following stage of asthma characterizes this stage: Mild asthma, Moderate asthma, Severe asthma. Life threatening asthma. Brittle asthma. moop> A. 37yrs old housewife comes to your clinic with mild shortness of breath during exercise You advised PEFR and spirometry which shows variability of 8% in reading and change in FEV1 is 100/min. Her pulse=82/min,bp=1 10/70,t/r=24/min. What will you tell her that she has? ‘A. Asthma, B. No asthma, C. Copd D. Cof E, Viral disease A Lyrs girl visits to your clinic with cough and breathlessness for last one month. Her PEFR decreases 70L after 6min exercise . Her pulse 90/min ,BP=100/70.temp= 98,68. What is your diagnosis. A. Asthma B. Copd C. Fatigue D. NO disease E. Seasonal problemracer mca course Session 6 and well controled on satbutaml PRR ang with sever a oa 23.30 yrs old man comes to clinic witty Korte = a and chest nen” When will you Mi aa yin 120an A. ened hospital C. Two months Three ont Drow month amma va TIME y comes to 308 She ha d wakes up at night due jy fh, She is taking LABA. ang stil ing B agonist inhaler agian shortness of breatt 24 A 20 yrs old medical student comes t0 srerted steroids but control tha clinic .He has severe cough, wheezing and wakes up 2 times/wk due to his mptoms. He is taking salbutamol inhaler 6 times/wk.What is the next step in ‘management. A. Increase short acting b agonist B. Add oral salbutamol C. Add oral steroid D, Add inhaled steroid E. Add long acting B agonist 29 inadequate. What is the next ste} ‘Add montelukast Increase inhaled steroids Increase LABA. Oral salbutamol . Stop long acting beta agonists 1p in management? moae> A pregnant lady of one month ‘known asthmatic well controlled On present treatment comes to clinic. She is worried that a5 Aas tent co¥ i iyrs old patient comes to clinic with Boo asthraastiay harm her baby dl Severe cou i i medicin pay teat ot whether she can breastfeed het baby afler Regardin| c what is deliver; one ee ee (What will you tell her regarding her worry? A. Mildly controlled A. Admit to hospital B. Moderately controlled B. Continue medicine. C. Poorly controlled . Change oral medicines to inhaler D. Good controlled D. Change oral medicines to I'v drugs E. Borderline controlled E. Stop all medicines 26 A GOYRS old teacher comes for routine 30 A yrs old child came with sever cough and check up .He has cough and slight chest wheezing He wakes up at night 3times/wk. tightness. He is taking LABA and salbutamol He is using salbutamol + inhaled steroid He PRN. has no fever. His bp=120/70, pulse=78/min, 1/26. What is next step in management? What will you advise him? A. Add leukotrines A. Continue same treatment B. Add oral steroids B. Add leukoterine C. Increase both C. Increase LABA D. Increase salbutamol D. Inhaler steroids E. Increase inhaled steroid E. Oral steroids 27 A 30yrs old female comes to you for follow up. She is taking regular treatment for asthma Session 5