MRCPCH Part 1 Questions with Individual Subject Summaries 4e - Download as PDF File .pdf), Text File .txt) or read online. Highly commended in the. Description. Highly commended in the Paediatrics category at the BMA Book Awards Reflecting the latest exam formats, this book provides essential. PDF. Book review. MCQs in Paediatrics for MRCPCH Part I. Free The format is of MCQs as used in the part I of the MRCPCH examination and the but at least one of these texts, that for neonatology, does not show the most recent edition As with all MCQ questions, some of the answers are arguable but there are.

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MRCPCH part 1 - expected questions . MRCPCH Applied Knowledge of Practice Syllabus (PDF, 26 pages KB). Source: RCPCH. MRCPCH Part 1 Questions with Individual Subject Summaries, Fourth Edition book. Read reviews from world's largest community for readers. Reflecting the l. This article contains MRCP Part 1 Questions Bank in PDF for free download. This MRCP Part 1 QBank is made by Dr. El-Zohry.

The previous regulation asking for a period of at least eighteen months since the date of graduation has been discontinued. Candidates can chose to enter both papers on the same day or to enter only one and attempt the remaining paper at a later date.

They can cover several aspects of a topic, including pathogenesis, clinical signs, genetics and treatment. A simple statement or short clinical scenario leads in to five options. All could be possible but only one is completely or the most correct. The candidate has to choose the best option and is prevented from regurgitating lists learned in the library. They should only cover one aspect of the topic so suitable stems might be: In this case a list of 10 possible answers is offered with three statements or clinical scenarios.

The candidate chooses the best option from the introductory list. Again, all could be possible but only one is completely or the most correct. EMQs are often accompanied by laboratory results or clinical pictures that are similar but with key differences. They should only cover one aspect of the topic so suitable questions might be: She has also been suffering from aphthous ulcers.

Her Hb concentration is 9. BCD Best of Five questions Gastrointestinal disease is the most likely diagnosis in a year-old girl whose only presenting symptom is A polycythaemia B reduced height velocity C hypertrichosis D anaemia E cafe-au-lait spots Answer B In a year-old girl of Asian origin, who presents with reduced height velocity, and is found to have microcytic anaemia, a definitive diagnosis is most likely to be made by A Serum anti-endomysial antibodies B Colonoscopy C Upper gastro-intestinal endoscopy D Thyroid function tests E Chromosome analysis Answer B A 4-week-old baby has clinically and ultrasonically confirmed pyloric stenosis.

He initially had a hypochloraemic metabolic alkalosis. After 24 hours rehydration therapy his electrolytes are as follows: A Arrange for the baby to go to theatre as soon as possible B Inform the anaesthetist that the baby is fit for surgery but there is no urgency C Aspirate the stomach with a NG tube and replace volume with intravenous saline D Repeat the electrolytes in 4 hours and, if clinically stable, contact the surgeons E Defer surgery for a further 24 hours and continue intravenous fluids during this time Answer key: E You see a boy aged 10 months who has been referred by his Health Visitor who has concerns about his appearance.


You discover several features in the history and on examination that are not immediately suggestive of a diagnosis. You plan to enter these features into a Dysmorphology Database.

She is very worried that her baby will be abnormal. She suffers from aphthous ulcers, is irritable and feels tired all the time. Investigations show Bone age equivalent to 8 years. Pastest gives me confidence and is also helpful in clearing your doubts through the videos and podcasts. Anusha Priyanka Really easy to use and navigate. I like the explanation for each answers and also the fact that we can set mock tests with a specific time. Ansar Baig Pastest is very useful and reliable.

It's a definite pass when you subscribe to Pastest and finish the questions in their question bank. All questions are very exam orientated and it gives you the feel of sitting for the real exam. The septal and posterlor leanets of the trlcuspld valve are set further lnto the rlght ventrlcle, causlng atrlallsatlon of part of the rlght ventrlcle.

Arrhythmlas are common lncludlng woln-Parklnson-whlte syndrome.

Llthlum durlng pregnancy ls a rlsk factor. Nltrlc and not nltrous oxlde ls used to treat perslstent pulmonary hypertenslon. Cyonot c x Slngle ventrlcle x Truncus arterlosus x Hypoplastlc left heart x Transposltlon of the great arterles x Total anomalous pulmonary venous dralnage. The rlght atrlumcontalns blood fromthe superlor vena cava SvC , coronary slnus and some fromthe vC. Changes ln the fetal clrculatlon occur at blrth: There ls a functlonal closure of the foramen ovale.

Lung expanslon results ln a fall ln pulmonary vascular reslstance, lncreased pulmonary blood now and lncreased dellvery of blood to the left atrlum. Plow through the ductus arterlosus changes from the pulmonary to the systemlc clrculatlon to the systemlc to the pulmonary clrculatlon.

The hlgh concentratlon of oxygen ln the blood causes smooth muscle contractlon of the duct and closure. C l Poor growth helght and welght ls common ln chlldren wlth cyanotlc congenltal heart dlsease. Catch-up growth after correctlve surgery ls common. Pallure to thrlve and feedlng dlmcultles are common ln lnfants wlth a symptomatlc congenltal heart dlsease. The oral contraceptlve plll ls contralndlcated ln glrls wlth cyanotlc congenltal heart dlsease due to the rlsk of thrombosls.

The coll ls also contralndlcated because lt ls a potentlal focus of lnfectlon predlsposlng to endocardltls. Unplanned pregnancy for those wlth congenltal heart dlsease can be dlsastrous, so lnformed and approprlate advlce for thls populatlon ls vltal.

A 8 0l The followlng are teratogens for the defects shown. Maternal dlseases llnked to an lncreased rlsk of congenltal heart dlsease lnclude: A 8 C 0l Acute clrculatory fallure shock ls characterlsed by lnadequate tlssue and organ perfuslon.

Organ perfuslon relles on a functlonlng pump heart , an adequate dellvery system lntegrlty of structure and vasomotor tone of all vascular beds - venous, arterlal and caplllary and an adequate substrate dellverlng nutrlents and removlng toxlns and waste. Pallure of any of the three components ln lsolatlon or ln comblnatlon wlll lead to shock. Cardlogenlc causes of neonatal shock: Non-cardlogenlc causes of neonatal shock: The treatment of neonatal clrculatory fallure depends on ldentlfylng the cause and treatlng accordlngly.

Clear alrway 2. Attach monltor 4. Conslder reverslble causes pulseless electrlcal actlvlty or PLA.

Pulseless vT should be treated as vP. Prolonged resuscltatlon may be lndlcated ln hypothermla.

Palpltatlons are common ln paedlatrlcs. Dlnerentlal dlagnosls lncludes: A careful hlstory and examlnatlon are essentlal to correctly ldentlfy the aetlology: A thorough systemlc examlnatlon ls vltal ln all cases and a l2-lead LCG should be performed.

Conslder referral to cardlologlst plus hour LCG or event monltor may help to clarlfy aetlology ln concernlng cases. Thls ls conslstent wlth an acqulred cardlac fallure not a congenltal cause: Assoc ot ons ol oott c stenos s x Turner syndrome x wllllams syndrome x Coarctatlon of the aorta x Other cardlac abnormalltles, e.

The stenosls can be elther supravalvular, valvular or subvalvular.

MRCPCH Part 1 Questions with Individual Subject Summaries, Fourth Edition

There ls often an assoclated blcuspld valve. Aortlc stenosls ls usually asymptomatlc but ln lts most severe form can cause congestlve cardlac fallure, arrhythmlas and sudden death ln lnfancy rare. The murmur ls best heard ln the aortlc area upper left sternal edge and radlates to the neck. An e[ectlon cllck suggests valvular stenosls. A palpable thrlll ls usually present ln the suprasternal notch. A2 the aortlc component of the second heart sound ls qulet. Although left ventrlcular hypertrophy ls common the LCG can be normal.

Thls ls usually ln the form of a balloon valvoplasty at cardlac catheter, or surglcal valvuloplasty. All chlldren wlth Down syndrome should have an echocardlogram to detect congenltal heart dlsease CHD. The symptoms assoclated wlth a rlght-to-left cardlac shunt can be delayed ln chlldren wlth Down syndrome due to the perslstence of hlgh pulmonary vascular reslstance. Complete AvSD refers to a common atrloventrlcular valve wlth clefts ln both the pulmonary and the mltral valves.

The aetlology lncludes hypotonlc upper alrway muscles, adenotonslllar hypertrophy, macroglossla, glossoptosls, nattened mldface and narrowed nasopharynx. Laryngomalacla and gastro-oesophageal renux dlsease GOPD are both lncreased ln chlldren wlth Down syndrome whlch may worsen alrway dlsease. Pecurrent hypoxaemla ls a contrlbutlng factor to the development of pulmonary arterlal hypertenslon PAH.

The prlnclpal aetlology ls cardlac lncreased pulmonary now. Other contrlbutlng factors lnclude upper alrway obstructlon and an lncreased lncldence of lntrlnslc lung dlsease pulmonary hypoplasla.

Chlldren presentlng ln the neonatal perlod wlth thls condltlon have hlgh pulmonary blood nowand are severely cyanosed unless a leslon that mlxes the two clrculatlons ls present examples lnclude PDA, ASD, vSD.

The chlld ls usually cyanotlc fromor shortly after blrth. The leslon ls duct dependent and the lnfant's condltlon deterlorates when the duct closes. There ls usually a metabollc acldosls at presentatlon. Arrhythmlas of all types are common. LCGshows a rlght-slded axls and rlght ventrlcular hypertrophy.

The chest radlograph shows cardlomegaly and lncreased pulmonary vascularlty. Antenatal dlagnosls on anomaly ultrasound scannlng remalns dlmcult and so the vast ma[orlty of cases are dlagnosed postnatally. Components of tetralogy of Pallot: The severlty of the rlght ventrlcular outnow obstructlon wlll determlne the cllnlcal plcture.

Most cases have falterlng growth and breathlessness on feedlng. The LCG ln acyanotlc tetralogy of Pallot shows rlght ventrlcular hypertrophy because the rlght ventrlcular pressure ls hlgh. Cyanotlc spells usually begln around months of age.

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They are due to functlonal lnfundlbular spasm and potentlally fatal. Peatures lnclude worsenlng cyanosls and a reductlon ln the lntenslty of the murmur. Assoclated ASDs do occur and are referred to as the quatralogy of Pallot. Treatment of cyanotlc spells ls as follows: Surglcal management of tetralogy of Pallot ls elther palllatlve systemlc-to-pulmonary shunt or complete. Total correctlon, lf technlcally posslble, ls the preferred optlon.

Thls ls usually done at around 6 months. Compllcatlons of tetralogy of Pallot lnclude: The defect ls more common ln glrls and there are three types: Ostlum secundum most common 2. Ostlum prlmum 3. Slnus venosus. Ostlum secundum defects are usually asymptomatlc, wlth pulmonary hypertenslon and rlght ventrlcular fallure occurrlng ln the thlrd and fourth decades.

Atrlal arrhythmlas occur ln adulthood but are rare ln chlldhood. An ostlum prlmum defect ls llkely to present earller, usually as a component of an endocardlal cushlon defect. LCG appearance of atrlal septal defects: The presence of rlght bundle-branch block ls not dlagnostlc but lts absence makes the dlagnosls unllkely. A hlgh proportlon of ostlum secundum ASDs close spontaneously by the age of 5 years. The rlsk of pulmonary hypertenslon and lts sequelae lncreases wlth shunt slze.

Hlgh pulmonary vascular reslstance ls a contralndlcatlon to surgery. Plxed spllttlng of the second heart sound ls characterlstlc of an ASD. Thls ls due to the defect produclng a constantly lncreased rlght ventrlcular volume and prolonglng e[ectlon tlme. The murmur of an ASD ls not due to now across the defect but to lncreased now across the pulmonary valve as a consequence of the shunt.

The defect can occur ln the membranous or muscular part of the septum, although defects ln the membranous septum are more common and usually slngle. Defects ln the muscular part of the septumare usually multlple. The slgns and symptoms depend on the haemodynamlcs of the defect, whlch depends on the slze of the defect and the pulmonary vascular reslstance.

The shunt occurs malnly durlng systole when the rlght ventrlcle ls contractlng, and so the shunted blood enters the pulmonary clrculatlon. Surglcal closure for large defects ls usually performed at around months. The second heart sound ls loud lf pulmonary hypertenslon ls present. Untreated, a large shunt wlll result ln hlgh pulmonary now and can progress to pulmonary hypertenslon and Llsenmenger syndrome. Cardlac defects assoclated wlth the development of Llsenmenger syndrome lnclude the followlng: Symptoms of pulmonary vascular dlsease do not usually develop untll the second or thlrd decade, typlcally presentlng between l5 and 20 years of age.

Cyanosls leads to a compensatory polycythaemla whlch ln turn causes hypervlscoslty. Progresslon of the process often leads to early death ln the second or thlrd decade of llfe.Causes of a superlor axls lnclude: It is without a doubt an essential tool to help you understand the questions that are going to potentially be asked in the actual exam.

Vishalini Mayyalgan rated it it was amazing Oct 02, Changes ln the fetal clrculatlon occur at blrth: The shunt occurs malnly durlng systole when the rlght ventrlcle ls contractlng, and so the shunted blood enters the pulmonary clrculatlon.