This article contains Sample questions for updated MRCPCH Exam paper (revised in January 2004 - details available in rxpg site)
From the first examination in 2004, to be held Wednesday 21st January, the MRCPCH Part I examination will consist of two papers.
Paper One A (Basic Child Health) will focus on the areas of child health that are relevant to those who will be working with children in their medical careers, not just those entering mainstream hospital-based paediatrics. The areas to be tested will be those conditions likely to be seen in 6 to 12 months of hospital, community or primary care practice.
Paper One B (Extended Paediatrics) will focus on the more complex paediatric problem-solving skills not tested in Paper One A, and on the scientific knowledge underpinning paediatrics. This is equivalent to the current MRCPCH Part I paper.
The regulations for entry have been relaxed to allow candidates to enter the examination upon completion of their primary medical degree. The previous regulation asking for a period of at least eighteen months since the date of graduation has been discontinued.
Both papers will be held on the same day, Paper One A in the morning and One B in the afternoon. 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.
Examination Questions and Assessment
Both written papers will be 2½ hours in duration and consist of between:
40-45 Multiple true-false questions worth 5 marks each (1 per item)
17-20 Best of five questions worth 4 marks each
7-9 Extended matching questions (EMQ) worth 9 marks each (3 per item)
Multiple true-false questions are most useful when testing knowledge when there is an absolute Yes/No answer.
They can cover several aspects of a topic, including pathogenesis, clinical signs, genetics and treatment.
e.g. "The following statements about X condition are true"
Alternatively they might test whether a candidate has true knowledge of a fact or thinks that something similar (but wrong) sounds vaguely familiar.
e.g. " Characteristic features of X condition include"
Best of Five questions are used to test judgement and experience. 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:
" The most likely diagnosis is"
" The most useful investigation would be"
"The next best step would be"
" The best advice to give to the parent is"
" The pathogenesis of this condition is best described as"
" The commonest cause of this condition is"
Extended matching questions (EMQs) are used in much the same way as Best of Five questions. 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:
"For each of the following case scenarios select the most likely diagnosis from the list above"
"For each of the following case scenarios select the investigation most likely to give a definitive diagnosis from the list above"
"For each of the following scenarios select the most appropriate action from the list above"
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Multiple True False Questions
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A previously well 10-year-old girl has been overtaken in height by her 9-year-old sister in the last two years. She has also been suffering from aphthous ulcers. Her Hb concentration is 9.8 g/dl with microcytic indices. She should be investigated for
A acquired hypothyroidism
B Turners syndrome
C coeliac disease
D Crohns disease
E chronic renal failure
Key: C D
Characteristic features of Crohns disease in childhood include
A delayed puberty
B sideroblastic anaemis
C aphthous mouth ulcers
D relatively painless anal fissure
E increased risk of diabetes mellitus
Key: BCD
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Best of Five questions
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Gastrointestinal disease is the most likely diagnosis in a 10-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 10-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: Na 137 mmol/l K 3.2 mmol/l Cl 90 mmol/l HCO3 29 mmol/l Urea 3.1 mmol/l Your next course of action would be:
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. The feature most likely to be recognised by the programme as particularly characteristic of Williams syndrome is
A systolic murmur at left upper sternal edge radiating to the back
B systolic murmur at left lower sternal edge with thrill
C low set ears
D poor feeding with food refusal
E normal appearance at birth
Answer key A
A mother has contracted rubella during the last trimester of pregnancy. She is very worried that her baby will be abnormal. You advise her that the most likely risk to the baby in these circumstances is that he will have
A microcephaly and learning difficulties
B attention deficit hyperactivity disorder
C hepatomegaly with need for prolonged liver function monitoring
D impaired hearing which will require him to be me monitored for at least 2 years
E visual impairment due to cataracts
Answer key D
In a 10-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
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Extended matching questions
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Options
A acquired hypothyroidism
B Turners syndrome
C coeliac disease
D Crohns disease
E chronic renal failure
F alpha thalassaemia trait
G beta thalassaemia trait
H sideroblastic anaemia
I chronic fatigue syndrome
J cystic fibrosis
For each of the following case scenarios select the most likely diagnosis from the list above
1 A previously well 10-year old girl has been overtaken in height by her 9-year-old sister in the last two years. She suffers from aphthous ulcers, is irritable and feels tired all the time. Investigations show Bone age equivalent to 8 years. Hb 9.2 g/dl (10.5 12.5) Serum Ferritin 32 ng/ml L (10 140) C reactive protein 2.6 mg/l Hb electrophoresis, No abnormal bands Serum Ca 2.2 mmol/l (2.1 2.6) Serum Phosphate 0.9 mmol/l (0.8 1.8) Alkaline phosphatase 320 U/L (145 420) Serum creatinine 60 micromoles/l (20-80) Serum Thyroxine 135 mmol/l (85-180) Serum TSH 3.2 mU/mol (0.5 6.0)
Key: D
2 A previously well 10-year-old girl has been having recurrent abdominal pain and finds schoolwork difficult. She is irritable and feels tired all the time. She has had an adverse school report. Investigations show Bone age equivalent to 10 years. Hb 11.2 g/dl (10.5 12.5) Serum Ferritin 12 ng/ml L (10 140) C reactive protein 2.6 mg/l Hb electrophoresis, No abnormal bands Serum Ca 2.2 mmol/l (2.1 2.6) Serum Phosphate 0.9 mmol/l (0.8 1.8) Alkaline phosphatase 320 U/L (145 420) Serum creatinine 60 micromoles/l (20-80) Serum Thyroxine 135 mmol/l (85-180) Serum TSH 3.2 mU/mol (0.5 6.0)
Key: I
3 A previously well 10-year-old girl has been overtaken in height by her 9-year-old sister in the last two years. Previously she had had an adverse school report but has now been commended for being quiet and well behaved in class. Investigations show Bone age equivalent to 8 years. Hb 11.2 g/dl (10.5 12.5) Serum Ferritin 27 ng/ml L (10 140) C reactive protein 2.6 mg/l Hb electrophoresis, No abnormal bands Serum Ca 2.2 mmol/l (2.1 2.6) Serum Phosphate 0.9 mmol/l (0.8 1.8) Alkaline phosphatase 320 U/L (145 420) Serum creatinine 60 micromoles/l (20-80) Serum Thyroxine 60.5 mmol/l (85-180) Serum TSH 3.2 mU/mol (0.5 6.0)
Key: A
Options
A Serum anti-endomysial antibodies
B Colonoscopy
C Upper gastro-intestinal endoscopy
D Thyroid function tests
E Chromosome analysis
F Renal function tests
G Renal biopsy
H Bone marrow examination
I Serum Vitamen D level
J Sweat test
For each of the following case scenarios select the investigation most likely to give a definitive diagnosis from the list above
1 A previously well 14-year-old girl has been overtaken in height by her 13-year-old sister in the last year. She suffers from aphthous ulcers, is irritable and feels tired all the time. She was not developed any signs of puberty. Investigations include Hb 8.2 g/dl (10.5 12.5) Serum Ferritin 7 ng/ml L (10 140) C reactive protein 2.6 mg/l Hb electrophoresis, No abnormal bands Serum Ca 2.2 mmol/l (2.1 2.6) Serum Phosphate 0.9 mmol/l (0.8 1.8) Alkaline phosphatase 720 U/L (145 420) Serum creatinine 60 micromoles/l (20-80)
Key: C
2 A healthy 14-year-old girl has been overtaken in height by her 13-year-old sister in the last year. She was not developed any signs of puberty. She has mild learning difficulties Investigations include Hb 11.2 g/dl (10.5 12.5) Serum Ferritin 20 ng/ml L (10 140) C reactive protein 2.6 mg/l Hb electrophoresis, No abnormal bands Serum Ca 2.2 mmol/l (2.1 2.6) Serum Phosphate 0.9 mmol/l (0.8 1.8) Alkaline phosphatase 320 U/L (145 420) Serum creatinine 60 micromoles/l (20-80)
Key: E
3 A previously well 14-year-old girl has been overtaken in height by her 13-year-old sister in the last years. Her periods started at the age of 10 years 3 months. Previously she had had an adverse school report but has now been commended for being quiet and well behaved in class. Investigations include Hb 11.2 g/dl (10.5 12.5) Serum Ferritin 27 ng/ml L (10 140) C reactive protein 2.6 mg/l Hb electrophoresis, No abnormal bands Serum Ca 2.2 mmol/l (2.1 2.6) Serum Phosphate 0.9 mmol/l (0.8 1.8) Alkaline phosphatase 320 U/L (145 420) Serum creatinine 60 micromoles/l (20-80) Serum Thyroxine 60.5 mmol/l (85-180) Serum TSH 3.2 mU/mol (0.5 6.0)
Key D
Options:
A Acute lymphatic leukaemia
B Hereditary spherocytosis
C Pyruvate kinase deficiency
D Glucose-6-phosphate dehydrogenase deficiency
E Beta thalassaemia major
F HbE / beta thalassaemia
G Hb H disease (Alpha thalassaemia)
H Malaria
I Visceral Leishmaniasis
J Hepatitis B infection
From the above list choose the most likely diagnosis for each of the following case scenarios.
1 An otherwise well 7 year old boy of Caucasian origin is noted to be slightly jaundiced. His spleen is palpable 3 cm below the left costal margin. His Hb is 9.2 g/dl.
Key B
2 An 7 year old boy of Indian origin, is noted to be slightly jaundiced on arrival in Great Britain. His spleen is palpable 5 cm below the left costal margin. His Hb is 6.2 g/dl.
Key F
3 An otherwise well 7 year old boy of Mediterranean origin is noted to be slightly jaundiced on arrival in Great Britain. His spleen is palpable 3 cm below the left costal margin. His Hb is 7.2 g/dl.
Key G
Options:
A History of neonatal hypoglycaemia
B History of poor feeding in infancy
C History of hypotonia in infancy
D Birth weight 2.1 Kg
E Weight 25th centile
F Abnormal visual fields
G Undescended testes
H Father started shaving at the age of 18
I Mother looks short when standing but not when sitting
J Mother has chronic liver disease A boy is referred for an opinion on his short stature. His height is less than the 3rd centile for his age
From the above list choose the ONE clinical observation most likely to lead to a diagnosis in each of the following cases.
1 A 7-year-old who has developed secondary enureses
Key F
2 A 5-year-old who has soft dysmorphic features and is now experiencing school difficulties
Key J
3 A 4-year-old with a voracious appetite
Key C
Options
A Vitamin A deficiency
B Vitamin B 1 (Thiamine) deficiency
C Vitamin B2 (Riboflavin) deficiency
D Vitamin B12 deficiency
E Vitamin C deficiency
F Vitamin D deficiency
G Vitamin E deficiency
H Folic acid deficiency
I Niacin deficiency
J Pyridoxine deficiency
Choose the nutrient deficiency from the above list which is best described by each of the following statements.
1 It is prevented by oily fish and eggs
Key F
2 It causes hypotonia and poor growth in infancy
Key F
3 It causes macrocytic anaemia and is prevented by eating fresh green vegetables
Key H
A Alloimmune thrombocytopenia
B Candida infection
C Congenital toxoplasmosis
D Congenital cytomegalovirus infection
E Congenital leukaemia
F Factor 12 deficiency
G Glanzmans thrombasthenia
H Gram negative septicaemia
I Placental insufficiency
J Rhesus haemolytic anaemia
Match the above diagnoses with the following clinical scenarios, all of which are associated with thrombocytopenia
1 An infant who is born at 38 weeks gestation develops widespread petechiae at 6 hours of age but is otherwise well.
Key A
2 A preterm infant of 32 weeks gestation who is on intravenous meropenem and teicoplanin for suspected sepsis and who becomes progressively unwell.
Key B
3 An asymptomatic growth retarded infant who is born by caesarean section for maternal hypertension. He is noted to have a low platelet count.
Key I
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