Self-Assessment: BOFs for MRCP(UK) and MRCP(I) Part I, Third Edition

This is the third edition of my book, “Self-Assessment for MRCP(UK) part 1”, which was published in 2009. The second edition, entitled “Self-Assessment: 650 BOFs for MRCP(UK) and MRCP(I) Part I” was published in late 2016. It has been six years! The third edition has undergone several changes and updates. COVID-19 strikes every chapter. In authoring this book, I tried my best to include the most common examination themes. You may encounter negative or positive stems. The questions’ objective is to teach, i.e., a rapid review of every subject and theme. This book differs from my book “Get Through MRCP part I; BOFs,” which was published in the year 2008 by the Royal Society of Medicine Press in London, and my book “MRCP(UK) and MRCP(I) Part I Best of Fives, Volume I”, which was published in 2022. The former concentrates mainly on the diagnosis and management, i.e., what is the diagnosis, what is the next best step, what feature is consistent with your preliminary diagnosis, and so on. The latter concentrates on several updates in the management of many diseases, addresses some novel diseases and topics, and focuses on COVID-19. Undoubtedly, if you are well-prepared, you will pass the examination very easily. No need to panic when you hear about your colleagues’ experiences. Lack of preparation is the single most common reason for failure. Remember, practice makes perfect. Read and self-assess; that’s it! Good luck with your career and exams!

2. Self-Assessment: BOFs for
MRCP(UK) and MRCP(I) Part I



Third Edition

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4. Third Edition





Self-Assessment: BOFs for
MRCP(UK) and MRCP(I) Part I









Osama Shukir Muhammed Amin
MBChB, MD, MRCP, FRCP(Edin), FRCP(Glasg), FRCP(Ire),
FRCP(Lond), FACP, FAHA, FCCP, FRSA

Senior Consultant Neurologist
Formerly, Director of the Kurdistan Board of Neurology, Sulaymaniyah
Formerly, Clinical Associate Professor
School of Medicine, International Medical University
Kuala Lumpur, Malaysia









Copyright © 2023. Osama Shukir Muhammed Amin.

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Copyright © 2023. Osama Shukir Muhammed Amin.

Copyright Notice:
All rights reserved. No part of this publication may be reproduced
or transmitted in any form or by any means, electronic,
mechanical, photocopying, recording, or otherwise, without the
prior permission of the copyright owner in writing:

Email: [email protected]

First Edition: 2009
Second Edition: 2016
Third Edition: 2023

ISBN: 978-1-4478-5829-4

Disclaimer:
This book was written depending on reliable sources. However,
while every effort has been made to ensure its accuracy, no
responsibility for loss, damage, or injury occasioned on any person
acting or refraining from action as a result of information
contained herein can be accepted by the author or publisher.

Distributed by Lulu Press, Inc. Northern Carolina, USA.

6. Dedication



To my lovely family:

Sarah, Awan, and Naz

7. vi
Acknowledgments


I would like to sincerely thank my patients; their real clinical scenarios
were used to generate these questions.

Special gratitude goes to my wife Sarah for her endless support and
encouragement and her extreme patience.


Osama

8. Preface

“
No human being is constituted to know the truth, the whole truth,
and nothing but the truth; and even the best of men must be content
with fragments, with partial glimpses, never the full fruition
”, Sir
William Osler (1849-1919).
This is the third edition of my book, “Self-Assessment for MRCP(UK) part
1”, which was published in 2009. The second edition, entitled “Self-
Assessment: 650 BOFs for MRCP(UK) and MRCP(I) Part I” got published in
late 2016. It has been six years! The third edition has undergone several
changes and updates. COVID-19 strikes every chapter.
In authoring this book, I tried my best to include the most common
examination themes. You may encounter negative or positive stems. The
questions’ objective is to teach, i.e., a rapid review of every subject and
theme. This book differs from my book “Get Through MRCP part I; BOFs,”
which was published in the year 2008 by the Royal Society of Medicine
Press in London, and my book “MRCP(UK) and MRCP(I) Part I Best of
Fives, Volume I”, which was published in 2022. The former concentrates
mainly on the diagnosis and management, i.e., what is the diagnosis, what
is the next best step, what feature is consistent with your preliminary
diagnosis, and so on. The latter concentrates on several updates in the
management of many diseases, addresses some novel diseases and topics,
and focuses on COVID-19.
Undoubtedly, if you are well-prepared, you will pass the examination very
easily. No need to panic when you hear about your colleagues’
experiences. Lack of preparation is the single most common reason for
failure. Remember, practice makes perfect. Read and self-assess; that’s it!
Good luck with your career and exams!

OsamaAmin
Osama Shukir Muhammed Amin
February 1, 2023

9. viii
Recommended Reading

1. Penmen et al. Davidson's Principles and Practice of Medicine, 24
th edition.
London: Churchill Livingstone; 2022.

2. Feather et al. Kumar and Clark's Clinical Medicine, 10
th edition.
Philadelphia: Saunders Ltd.; 2020.

3. Loscalzo et al. Harrison’s Principles of Internal Medicine, 21
st edition. New
York: McGraw-Hill Professional, 2022.

4. Goldman et al. Goldman-Cecil Medicine, 2-Volume Set (Cecil Textbook of
Medicine), 26
th Edition. New York: Elsevier; 2019.

5. Barrett et al. Ganong’s Review of Medical Physiology, 26
th edition. New York:
McGraw-Hill Education/Medical; 2019.

6. Lang TA, Secic M (eds.). How to Report Statistics in Medicine, Annotated
Guidelines for Authors, Editors, and Reviewers, 2
nd edition. Philadelphia: The
American College of Physicians; 2006.

10. Table of Contents

Chapter 1: Cardiology ................................................................................................. 1
Q
UESTIONS .................................................................................................................................. 2
Answers ................................................................................................................................. 21
Chapter 2: Clinical Hematology and Oncology ............................................................ 43
Q
UESTIONS ................................................................................................................................ 44
Answers ................................................................................................................................. 61
Chapter 3: Clinical Pharmacology, Therapeutics, and Toxicology ................................. 81
Q
UESTIONS ................................................................................................................................ 82
Answers ................................................................................................................................. 93
Chapter 4: Clinical Sciences ....................................................................................... 103
Q
UESTIONS .............................................................................................................................. 104
Answers ............................................................................................................................... 119
Chapter 5: Dermatology ........................................................................................... 137
Q
UESTIONS .............................................................................................................................. 138
Answers ............................................................................................................................... 149
Chapter 6: Endocrinology, Diabetes, and Metabolic Diseases ..................................... 157
Q
UESTIONS .............................................................................................................................. 158
Answers ............................................................................................................................... 181
Chapter 7: Gastroenterology and Hepatology ............................................................ 201
Q
UESTIONS .............................................................................................................................. 202
Answers ............................................................................................................................... 229
Chapter 8: Infectious Diseases and Genitourinary Medicine ...................................... 249
Q
UESTIONS .............................................................................................................................. 250
Answers ............................................................................................................................... 263
Chapter 9: Neurology, Psychiatry, and Ophthalmology ............................................. 277
Q
UESTIONS .............................................................................................................................. 278
Answers ............................................................................................................................... 297
Chapter 10: Nephrology ............................................................................................. 319
Q
UESTIONS .............................................................................................................................. 320
Answers ............................................................................................................................... 343
Chapter 11: Respiratory Medicine ............................................................................. 359
Q
UESTIONS .............................................................................................................................. 360
Answers ............................................................................................................................... 379
Chapter 12: Rheumatology and Diseases of the Bones ................................................. 401
Q
UESTIONS .............................................................................................................................. 402
Answers ............................................................................................................................... 419

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12. 435
More Books by the Author:

MRCP(UK) and MRCP(I) Part II 200 Cases: Case Histories, Data Interpretation,
& Photographic Materials (2022 and 2023):

I have tried to focus on some important updates in medicine that
have been emerging during the past decade; novel diseases, novel
investigations, and newly approved medications. COVID-19 (and its
SARS-CoV-2) and women’s health will be encountered many times.
Remember, the goal is to find and fill in the gaps in your knowledge.
Undoubtedly, if you are well-prepared, you will pass the examination very
easily. No need to panic when you hear about your colleagues’ past [bad]
experiences. Lack of preparation is the single most common reason for
failure. Remember, practice makes perfect. Read, practice, and self-assess;
that’s it! Good luck with your career and exams!

MRCP(UK) and MRCP(I) Part I Best of Fives, Volume I (2022 and 2023):

In writing this book, I have tried to focus on the most important
updates in medicine that have been emerging during the past decade;
novel diseases, novel investigations, and newly approved medications.
Needless to say, COVID-19 and its SARS-CoV-2 will be encountered in
each chapter, in addition to occupying a unique position in the chapter on
infectious diseases. The other aspect that I think is very crucial to tackle
is women’s health and pregnancy. Once again, such a topic has been
addressed in each and every chapter. There are no separate chapters for
geriatrics, clinical sciences, and pharmacology (including therapeutics and
toxicology); their questions have been distributed throughout the book’s
chapters. Each answer is followed by an explanation and a reference
(source) and/or additional (further) reading. In this way, you can go there;
skim the whole subject if you are interested to get more information. I did
my best to avoid regurgitated subjects and themes (which have been
encompassed by many books, including mine, during the past 20 years).
Although many questions appear to be difficult and may fit part II
examinations, I believe these questions (and their explanation) will
strengthen your background and help you prepare well for part II.
Remember, the goal is to find and fill in the gaps in your knowledge.

13. 436
Self-Assessment: 650 BOFs for MRCP(UK) and MRCP(I) Part I (2017):

This is the 2
nd
edition of my previous book, “Self-Assessment for
MRCP(UK) part 1”, which was published in 2009. The book has
undergone several changes and updates. The best initial step is to read
accredited textbooks. After then, self-assess yourself. Read this book,
chapter after chapter, try to find out your mistakes and gaps in knowledge,
and then re-read what you have missed. In writing this book, I tried my
best to include the commonest examination themes.

Neurology: Self-Assessment for MRCP(UK) and MRCP(I) (2016):
You will find 792 questions of different formats, distributed into 3
chapters. The 215 multiple choice questions of chapter one will surf you
onto a rapid review of information to consolidate your background
knowledge of neuro-anatomy, neuro-physiology, neuro-pharmacology,
neuro-pathology,…etc. In addition, testing the clinical aspects of various
diseases is also included. Chapter two will self-assess you in terms of how
to make a provisional diagnosis, what features refute or confirm your
preliminary diagnosis, how to investigate, what to do next, the best
treatment option, and the prognosis of various diseases. The
photographic materials are found in chapter three. You will encounter
various neurological complications/manifestations/signs of system
diseases as well. Brain CT scans, MRI, MRV, and EEG images,…etc of
common diseases will test your ability to interpret/read/analyze their
diagnosis and management. About 490 pages, full-color, on white.

Mock Papers for MRCPI Part I, 2nd edition (2016):

In this second edition, you will find 3 mock papers. Each one
contains 100 questions in a Best of Five (BOF) format. Self-assess, try to
complete each paper within 3 hours, check out your answers, read the
explanation, and re-read accredited medicine textbooks to fill in the gap
in your knowledge. Each question has an “objective”; try to review what
the objective is about. This is the only self-assessment book specifically
written to imitate the MRCPI Part I examination. Each mock paper in the
first edition of this book contained 50 BOFs and 50 MCQ formats.

14. 437
Get Through MRCP Part I: BOFs (2008)

Get Through MRCP Part 1: BOFs provides over 600 questions and
answers, allowing the reader to test their knowledge in preparation for the
MRCP Part 1 examination. Questions are presented in the style used in
the real examination, and answers are supplemented with useful additional
explanatory material to help the reader understand why their answer was
right, or wrong. The book offers a useful review of all elements of the
syllabus, so the reader can feel fully prepared when they enter the
examination room.

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About the Author:

Osama Shukir Muhammed Amin

r. Amin graduated from
Baghdad University, College
of Medicine, and was a
valedictorian student in internal medicine.
He got membership diplomas from the
Royal Colleges of Physicians of Ireland
and the UK and then became Board-
certified in neurology. He is a Fellow of the
American College of Physicians (FACP),
Fellow of the Royal College of Physicians
and Surgeons of Glasgow (FRCP Glasg),
Fellow of the Royal College of Physicians of Edinburgh (FRCP Edin),
Fellow of the Royal College of Physicians of Ireland (FRCPI), Fellow of
the Royal College of Physicians of London (FRCP Lond), and Fellow of
the American Heart Association/American Stroke Association (FAHA).
In recognition of his contribution to ancient history and archaeology, he
was elected a Fellow of the Royal Society of Arts (FRSA) in London. Dr.
Amin is an associate professor of neurology and senior consultant
neurologist, and former director of the Kurdistan Board of Neurology,
Sulaymaniyah. Formerly, he was a clinical associate professor at the
International Medical University, Malaysia. He published 67 articles in
international peer-reviewed neurology and internal medicine journals and
7 self-assessment books for the membership diploma of the Royal
Colleges of Physicians of the United Kingdom and Ireland. In addition,
he published more than 40,000 archaeological illustrations and more than
40 articles in archaeology/history. He was an associate editor, guest editor,
reviewer in several international peer-reviewed internal medicine and
neurology journals, and former Editor-in-Chief. He is a contributor/team
member of “Medical MasterClass,” the MRCP(UK)’s educational arm of
the Royal College of Physicians of London, UK. Dr. Amin is an
international juror for Wiki Science Competition 2017 and 2019,
representing the Pan-Arab World, Iran, and Africa. He has contributed
quite a lot to Wikipedia.

D