Clinical Sciences
Cell/molecular and membrane
(72)
biology
Clinical anatomy (67)
Clinical biochemistry and metabolism (118)
Clinical physiology (92)
Genetics (107)
Immunology (118)
Statistics (158)
Passing mark range between 63-66%
Year No. of Q
MRCP 1 May 19 100
MRCP 1 Jan 19 100
MRCP 1 Sept 18 100
MRCP 1 May 18 100
MRCP 1 Jan 18 100
MRCP 1 Sept 17 100
MRCP 1 May 17 100
MRCP 1 Jan 17 100
MRCP 1 Sept 16 100
MRCP 1 May 16 100
MRCP 1 Jan 2016 100
MRCP 1 Sept 2015 100
MRCP 1 May 2015 100
MRCP 1 Jan 2015 100
A. H. Murad
ﻻ ﺗﻨﺴﻮﻧﺎ ﻣﻦ ﺻﺎﻟﺢ دﻋﺎﺋﻜﻢ
ﺗﻢ ﺑﺤﻤﺪ ﷲ وﺗﻮﻓﯿﻘﮫ وﻣﻨﮫ
ﺟﻌﻞ ﷲ ﻋﻤﻠﻨﺎ ﻣﺘﻘﺒﻼ ﺧﺎﻟﺼﺎ ﻟﻮﺟﮭﮫ اﻟﻜﺮﯾﻢ
,A 54-year-old woman presents with severe tiredness and lethargy. She also reports having
joint pains and dry, gritty eyes. You arrange an antibody screen, which reveals positive anti-
Ro antibodies and positive antinuclear antibodies
A Systemic lupus erythematosus (SLE)
B Rheumatoid arthritis
C Polymyositis
D Myasthenia gravis
E Sjögren’s syndrome
Explanation
E Sjögren’s syndrome
Clinically and serologically this lady has Sjögren’s.
Anti-Ro antibodies are anti-extractable nuclear antigen (ENA) antibodies. Subtypes of ENA
antibodies can be distinguished by their fluorescence pattern, as seen on enzyme-linked
immunosorbent assay (ELISA) testing. Anti-Ro antibodies are particularly associated with
SLE and Sjögren syndrome. Other ENA antibodies include anti-La antibodies (associated with
Sjögren’s alone), anti-Sm (associated with SLE alone) and anti-U1-RNP (associated with a
range of diseases including SLE and overlap syndrome).
A Systemic lupus erythematosus (SLE)
Systemic lupus erythematosus (SLE) is incorrect. Antinuclear antibodies are found in around
95% of cases of systemic lupus erythematosus (SLE), but are non-specific and are found in
many other autoimmune conditions. They have low specificity, but a high negative predictive
value, ie if someone is ANA negative they are extremely unlikely to have SLE. This lady does
not have any clinical features to suggest that she has primary SLE with secondary Sjogrens
(such as malar rash) nor any laboratory features (such as low complement or anti-dsDNA).
B Rheumatoid arthritis
Rheumatoid arthritis is incorrect. The patient does not have synovitis or antibodies such as
rheumatoid factor or anti-CCP. N.B. rheumatoid factor can occur in Sjögren’s syndrome
, C Polymyositis
Polymyositis is incorrect. She has no signs of proximal myopathy. 40-80% of patients with
polymyositis are ANA positive.
D Myasthenia gravis
Myasthenia gravis is incorrect. There are no signs such as fatiguability, ptosis etc to suggest
myasthenia gravis, or the anti-acetylcholinesterase receptor autoantibody
5231
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, A 70-year-old woman presents with pain over her left hip, which occurred suddenly with no
history of trauma. Past history of note includes severe chronic obstructive pulmonary disease
(COPD), for which she is managed with multiple medications, including combination steroid
and long-acting ß-agonist inhaler and chronically prescribed oral corticosteroids.
On examination she looks cushingoid in appearance, there is pain over the hip and clicking on
movement. Flexion, abduction and internal rotation are limited and she walks with a marked
limp. An X-ray has excluded a fracture. Blood tests including inflammatory markers are
normal.
A MRI
B Ultrasound
C X-ray
D CT scan
E Bone scan
Explanation
A MRI
This patient is cushingoid and has sudden onset pain over her left hip. Without a history of
trauma this raises the possibility of avascular necrosis (AVN) of the hip. MRI is the
investigation of choice,with sensitivity that exceeds 90%.
B Ultrasound
Ultrasound is incorrect. Ultrasound scan of the hip would not be sensitive enough to detect
early AVN.
C X-ray
X-ray is incorrect. An X-ray of the hip during the early stages of avascular necrosis would not
have sufficient detailing to image signs of avascular necrosis. The X-ray would appear normal
in the early stages of disease.
D CT scan
Cell/molecular and membrane
(72)
biology
Clinical anatomy (67)
Clinical biochemistry and metabolism (118)
Clinical physiology (92)
Genetics (107)
Immunology (118)
Statistics (158)
Passing mark range between 63-66%
Year No. of Q
MRCP 1 May 19 100
MRCP 1 Jan 19 100
MRCP 1 Sept 18 100
MRCP 1 May 18 100
MRCP 1 Jan 18 100
MRCP 1 Sept 17 100
MRCP 1 May 17 100
MRCP 1 Jan 17 100
MRCP 1 Sept 16 100
MRCP 1 May 16 100
MRCP 1 Jan 2016 100
MRCP 1 Sept 2015 100
MRCP 1 May 2015 100
MRCP 1 Jan 2015 100
A. H. Murad
ﻻ ﺗﻨﺴﻮﻧﺎ ﻣﻦ ﺻﺎﻟﺢ دﻋﺎﺋﻜﻢ
ﺗﻢ ﺑﺤﻤﺪ ﷲ وﺗﻮﻓﯿﻘﮫ وﻣﻨﮫ
ﺟﻌﻞ ﷲ ﻋﻤﻠﻨﺎ ﻣﺘﻘﺒﻼ ﺧﺎﻟﺼﺎ ﻟﻮﺟﮭﮫ اﻟﻜﺮﯾﻢ
,A 54-year-old woman presents with severe tiredness and lethargy. She also reports having
joint pains and dry, gritty eyes. You arrange an antibody screen, which reveals positive anti-
Ro antibodies and positive antinuclear antibodies
A Systemic lupus erythematosus (SLE)
B Rheumatoid arthritis
C Polymyositis
D Myasthenia gravis
E Sjögren’s syndrome
Explanation
E Sjögren’s syndrome
Clinically and serologically this lady has Sjögren’s.
Anti-Ro antibodies are anti-extractable nuclear antigen (ENA) antibodies. Subtypes of ENA
antibodies can be distinguished by their fluorescence pattern, as seen on enzyme-linked
immunosorbent assay (ELISA) testing. Anti-Ro antibodies are particularly associated with
SLE and Sjögren syndrome. Other ENA antibodies include anti-La antibodies (associated with
Sjögren’s alone), anti-Sm (associated with SLE alone) and anti-U1-RNP (associated with a
range of diseases including SLE and overlap syndrome).
A Systemic lupus erythematosus (SLE)
Systemic lupus erythematosus (SLE) is incorrect. Antinuclear antibodies are found in around
95% of cases of systemic lupus erythematosus (SLE), but are non-specific and are found in
many other autoimmune conditions. They have low specificity, but a high negative predictive
value, ie if someone is ANA negative they are extremely unlikely to have SLE. This lady does
not have any clinical features to suggest that she has primary SLE with secondary Sjogrens
(such as malar rash) nor any laboratory features (such as low complement or anti-dsDNA).
B Rheumatoid arthritis
Rheumatoid arthritis is incorrect. The patient does not have synovitis or antibodies such as
rheumatoid factor or anti-CCP. N.B. rheumatoid factor can occur in Sjögren’s syndrome
, C Polymyositis
Polymyositis is incorrect. She has no signs of proximal myopathy. 40-80% of patients with
polymyositis are ANA positive.
D Myasthenia gravis
Myasthenia gravis is incorrect. There are no signs such as fatiguability, ptosis etc to suggest
myasthenia gravis, or the anti-acetylcholinesterase receptor autoantibody
5231
Rate this question:
Next Question
Tag Question
Feedback End Session
Difficulty: Easy
Peer Responses %
Session Progress
Responses Correct: 0
Responses Incorrect: 1
Responses Total: 1
Responses - % Correct: 0%
, A 70-year-old woman presents with pain over her left hip, which occurred suddenly with no
history of trauma. Past history of note includes severe chronic obstructive pulmonary disease
(COPD), for which she is managed with multiple medications, including combination steroid
and long-acting ß-agonist inhaler and chronically prescribed oral corticosteroids.
On examination she looks cushingoid in appearance, there is pain over the hip and clicking on
movement. Flexion, abduction and internal rotation are limited and she walks with a marked
limp. An X-ray has excluded a fracture. Blood tests including inflammatory markers are
normal.
A MRI
B Ultrasound
C X-ray
D CT scan
E Bone scan
Explanation
A MRI
This patient is cushingoid and has sudden onset pain over her left hip. Without a history of
trauma this raises the possibility of avascular necrosis (AVN) of the hip. MRI is the
investigation of choice,with sensitivity that exceeds 90%.
B Ultrasound
Ultrasound is incorrect. Ultrasound scan of the hip would not be sensitive enough to detect
early AVN.
C X-ray
X-ray is incorrect. An X-ray of the hip during the early stages of avascular necrosis would not
have sufficient detailing to image signs of avascular necrosis. The X-ray would appear normal
in the early stages of disease.
D CT scan
