MRCP & MRCS free exam questions

For those who are preparing for the MRCP or MRCS, there are some free resources developed by doctors to help others to pass the exams.

MRCP free questions :

MRCP.org provides an exam guide on how to revise for and pass MRCP and
free MCQs and BOFs for MRCP 1 & 2 - "the biggest and best selection of MCQs and BOFs"

Neurology4mrcp group provides free MCQs & BOFs in PDF format and are free to download, updated at regular intervals. Also check the useful links on "what to read for MRCP".

PassPACES.com is independent and privately funded website with the aim of helping fellow doctors to pass their MRCP PACES examination. It provides free MRCP PACES tutorial and other useful information.

AIPPG provides free MRCP mock tests

There are also commercial websites that offer online courses by personal subscriptions.
Onexamination.com

PasTest Online

123Doc

Medexam.net - the first 200 questions are free for all users


MRCS free questions :

mrcs.org provides tips for MRCS part 1 and 2 training

Clinical Tutor - provides interactive MCQs and a MCQ question database etc. , registration is required.

Surgical-tutor.org.uk - provides a bank of resources from journal club, MCQs, revision notes etc.

Webhealthcentre.com - the Student Centre has a large bank of MCQs free to all registered users.

Fleshandbones.com - this site provides study tips and an image bank, also MCQ database in many subjects with answers ( located in the Revision Center). Need to register to gain access to the free resources.

Surgeons.org.uk - a free educational website with MCQs and surgical turorials etc. Need registration to gain access the material

Tips and advices from BMJ Careers :

Is it mandatory to complete 3 parts of the MRCP exam in order to be able to apply for an SHO post in dermatology or would MRCP part 1 be enough

How to pass MRCP

Preparing for MRCP part 1

Comments on the usefulness of these resources would be helpful to other users.

Health News

A leading health economist has proposed 2% cut of GPs' or consultants' annual salary.

NHS surgeons to get war training for gun crime victims

Taking low or moderate doses of aspirin could reduce women's risk of dying early, but UK experts warned aspirin could cause bleeding.

Cutting junior doctors' working hours will not reduce fatigue and the risk of errors on its own.

Supermarkets and other private business and GPs to bid for contracts to host health services

BZP drugs, said to offer legal alternative to hard drugs, may cause health problem

Doctors must involve in budget decisions

Children with congenital heart failure may be at risk from discrepancies in doses of captopril tablets

The government has failed on out-of-hours care, only GPs had benefited from the new arrangements.

Weight loss surgery could lead to memory loss.

Bodies needed for undergraduate medical training.

Palliative Medicine articles address the misconception that morphine is a lethal drug and a common cause of death when used to control symptoms in the dying.

If you are authors or readers of the Lancet....

The J of Royal Society of Medicine (JRSM) published an editorial "Reed-Elsevier's hypocrisy in selling arms and health" on its website calling authors and readers work together to take the lead in preventing the sales of arms.

The Lancet, a leading medical journal, is owned by Reed Elsevier, the world's largest publisher of scientific and medical journals, that also publishes 2000 other medical and scientific journals. One of its subsidiary runs international arms fairs, the same subsidiary also runs Lancet conferences.

The Lancet published a letter in 2005 saying that Reed Elsevier's connection with the arms trade was "incompatible with The Lancet's guiding principles……, and the ethics of many of its contributors, readers, editors and reviewers." The editors and the advisory board asked the publisher to "divest itself of all business interests that threaten ...., health and well-being." Unfortunately Reed Elsevier said that it is legal to sell arms and they are needed in a dangerous world. ( J of R Soc Med 2007;100:114-115 ).

BMJ also published an editorial, "Reed Elsevier's arms trade" in the March issue, 2007;334:547-548 ( subscription required) joining JRSM in calling for action against Reed Elsevier. The editors said that the "scientific and health communities have the power to influence corporate strategy" and suggested ways they can end their support for the company's links with arms trade".

Recently, the publisher's arms trade was condemned by a group of prominent academics and an online petition has collected more than a 1000 signatures.

UK junior doctors medical training

The new recruitment system for junior doctors has turned into a disaster with hundreds of the most capable doctor failed to win an interview and without job prospect causing "deep distress to both trainees and those tasked with their selection".

Many senior surgeons threatened to boycott the interview process because they said the new system was flawed and unfair. Doctors of all ages and levels have written to the media voicing their strongest concerns over the implementation of the new recruitment system for PG speciality training. Staff at two major hospitals in London also sent a letter to Prof Elizabeth Paice, chair of the PG Medical Deans demanding "major changes".

DoH had previously said that they would not cancel the new system but would keep it under review but later backdown on the new recruitment system after protests from the medical profession and junior doctors. An independent review ordered by the DoH said the process has "shortcomings" and the system should be modified. Health minister Lord Hunt has apologised to those affected and the DoH said there will be "significant" changes to the second round of interviews in April.

This will include allowing applicants to submit full CVs and portfolios to support their applications. There will be changes to the application form and the scoring system, as well as better support and feedback for candidates. Those who have been rejected by the computerised system in the first round will be able to have their applications reconsidered.

Read the protest letter sent to the Daily Telegraph from 136 consultants

Beta-blocker should not be first-line therapy for hypertension

A systematic review published in the latest issue of the Cochrane Library, 2007, Issue 1, found that evidence does not support the use of beta-blockers as first-line drugs in the treatment of hypertension.

Patients who use beta-blocker have a slightly higher risk of death and cardiovascular disease than patients who use calcium channel blockers.

This conclusion is based on 13 RCTs that have found the "relatively weak effect of beta-blockers to reduce stroke and the absence of an effect on coronary heart disease when compared to placebo or no treatment. More importantly, it is based on the trend towards worse outcomes in comparison with calcium-channel blockers, renin-angiotensin system inhibitors, and thiazide diuretics."

Health News

BMA calls for delay to the new junior doctors recruitment system.

Vitamins appeared to raise the risk of death but an expert in the industry said the JAMA study was fatally flawed.

Eating ice cream can help women make babies?

Dementia sufferers in Britain is forecast to rise sharply incurring huge costs.

Violent attacks on NHS staff have reached unprecedented levels.

A treatment centre run by a private company for the NHS patients has been launched by the First Minister.

New guidelines for preventing heart disease in women was published by AHA in the journal Circulation.

BMA warns the risks of medical regulation proposals

Pseudoevidence-Based Medicine (PBM)

There is an interesting article on Emerald's "This month's journal highlights". "Pseudoevidence-based medicine:what it is and what to do about it". Clinical Governance, 2007, 12(1), p.42-52. Wally R. Smith, Virginia Commonwealth University, USA.

The author says that "PBM can be defined as the practice of medicine based on falsehoods that are disseminated as true evidence, then adopted by unwitting and well-intentioned practitioners of EBM" and needs to be discovered, opposed and prevented. Physicians need to be more critical and vigilant in using research evidence.

The full text article is available via the HILO website if you have an Athens acount.

Health News

Viagra to be sold over the counter at Boots in the UK.

NHS doctors treat elderly patients differently.

Ketek - warning that it carries a risk of liver damage.

Switching from tamoxifen to the new drug, exemestane ( Aromasin), after two or three years resulted in reduced death rates.

The symptoms of Rett Syndrome (RS), the most disabling autism spectrum disorder could be reversed.

Coronary artery bypass surgery performed on a beating heart is safe with fewer negative side effects for bypass patients.

A low dose of naltrexone, a drug used to ease symptoms of alcohol and drug addiction, may also bring relief to people with Crohn's disease.

The drug levetiracetam gives hope to epilepsy patients.

Patients need to act to protect themselves from medical errors.

Pediatricians face challenges in reporting medical errors.

A new treatment for psoriasis that targets its key inflammatory mediators (IL-12 and IL-23) is highly effective.

Patients with a history of heart failure, Lipitor (atorvastatin calcium) 80 mg tablets reduced significally the risk of hospitalizations.

Loss of the activity of the human gene, DDAH, leads to reduced nitric oxide production and may cause heart and circulatory disease.

Recent increase in reported autism diagnoses may be part of a broader pattern in childhood mental illness.

A poll showed that many PGs had private health care.

A significant proportion of doctors do not feel they have an obligation to inform patients about all options on moral or religious grounds.

A commonly used anaesthetic, isoflurane, could cause changes in the brain linked to Alzheimer's.

MRI can provide a more sensitive diagnosis than CT scan for acute stroke.

Safety concern of Aprotinin

An article "Mortality Associated With Aprotinin During 5 Years Following Coronary Artery Bypass Graft Surgery" published in the Feb 7 issue of JAMA has questioned the safety of the continued use of Aprotinin.

Trasylol, the brand name for Aprotinin, a drug commonly used to limit blood loss during cardiac surgery, is found associated with an increased risk of long-term mortality following CABG surgery. The US researchers conclude that "continued use of aprotinin in this population does not appear prudent, given that safer alternatives ... are available."

Cardiac surgeon T. Bruce Ferguson Jr., M.D., writes in an editorial in the same issue of JAMA, "Aprotinin – Are There Lessons Learned?" saying that the study "highlights the need for better ways to assess drug safety.

Aprotinin is made by Bayer, approved for use in patients undergoing cardiac surgery in the US in 1993. The drug was used on more than four million people worldwide since 1985 mainly for heart surgery. This study has raised a larger issue of drug safety evaluation in the current medical environment.

Redundant publications are widespread

Redundant publications have been a cause of concern for many journal editors.

"A redundant publication is one which duplicates previous, simultaneous, or future publications by the same author or group or, alternatively, could have been combined with the latter into one paper." Surgery. 2001 Jun;129(6):655-61. "Redundant surgical publications: tip of the iceberg?"

The article concluded that "Almost 1 in every 6 original articles published in leading surgical journals represents some form of redundancy…. . Redundancies …. is widespread, and it cuts across the entire spectrum of surgeons in the United States and abroad. Redundant publications must be recognized ........... as a real threat to the quality and intellectual impact of surgical publishing."

Redundant orthopedics publications

There is an interesting article in Orthopedics. 2007 Jan;30(1):60-2. "Redundant publications in the orthopedic literature". Eck JC, Nachtigall D, Hodges SD, Humphreys SC. Department of Orthopedic Surgery, Memorial Hospital, 325 S Belmont, Box 129, York, PA 17403, USA.

The article states that the "rates of redundant publications in the general surgery literature are approximately 14%" and the rate of redundant publications in the orthopedic literature is 2.75%, relatively low when compared to other fields.

The authors call for a concensus to define acceptable criteria to discourage redundant publications that have damaged the ethical standard that the scientific community strives to uphold. You can read the full text article if you have an Athens password at the HILO website.

Health News - 31 January 2007

A "virtual" model of all the biochemical reactions that occur in human cells has been created.

Some NHS operations may need to be paid for in the future.

Women who take folic acid supplements early in their pregnancy can substantially reduce their baby's risk of cleft lip.

Saturday surgery disappeared from GP new contract for 6% pay cut.

Drug company cover up evidence about the safety of the anti-depressant drug, Seroxat.

A website is to be set up by the Government in July to give patients more surgery choice.

Alzheimer's vaccine delivered through a patch has been shown to be safe and effective.

Cynicism can increase the risk of heart disease.

Women could halve their risk of breast cancer by eating high fibre diet.

Switching off the gene involved in cell division can prevent cancer growth.

NHS Consultation on private clinics to carry out diagnostics and minor treatment.

The Government is creating a website for patients to rate doctors and hopsitals.

Get a dog if you want to live a healthier life.

Better training for GPs, practice nurses and dieticians to tackle the problem of food allergy.

Proposal - GPs' high earning to be capped.

A new strain of MRSA is spreading rapidly in Britain.

Folic acid supplements can improve cognitive function in older adults.

The lavatory is the winner of the BMJ poll

In the BMJ poll, readers have voted sanitation (15.8%), put forward by Professor Johan Mackenbach, Erasmus University Medical Centre in Rotterdam , the greatest medical breakthrough since 1840, followed by antibiotics ( 14.5% ) and anaesthesia ( 13.9%).

Some doctors disputed the result of the poll but the BBC presenter of the series "What the Victorians did for us" said that the "sanitation was a deserving winner."

The biggest group of voters were doctors ( 28.6% ) and the public ( 21.8% ).

See the full ballot results.

Health News - 15 january 2007

Bilingualism can delay onset of dementia.

Is Statins linked to Parkinson's ?

A mutated gene, SORL1, is linked to Alzheimer's.

GM hens' eggs could help fight cancer.

Common cold virus could destroy cancer tumors.

Blood test has proved highly effective in predicting the risk of heart attack or stroke in patients with coronary heart disease - JAMA.

Men who have had gonorrhoea are twice as likely to develop bladder cancer- British J Cancer.

Spicy foods such as pepper can kill cancer cells.

Using your instincts is better than thinking too hard.

Drinking tea without milk could have more health benefits - European Heart J.

Artificial skin that is germ-resistant and could save the lives of severe burns victims.

New stem cells have been extracted successfully from amniotic fluid surrounding the developing foetus - Nature.

IPPR report - "a better NHS will be one with fewer hospital beds overall" and shortening hospital stay could save £1bn.

There should be better testing of anti-obesity drugs as the long-term impact of the drugs was not clearly known - Lancet.

Hercceptin reduced death rates among women with early HER2-positive breast cancer but with some serious side effects - Lancet.

Shortage of GPs and nurses in 4 years due to job cuts in the NHS across England

Hospital told to dealy operations to ease debts

Diathermy raises substantially the risk of giving birth early, doctors should consider using alternatives - BJOG.

GPs are being forced to use referral management centres to refer patients to hospital.

A potentially cheaper version of an existing Hepatitis C drug by altering the molecular structure .

UK PubMed Central is live

UK PubMed Central (UKPMC) is now live and freely available, the database holds over 620,000 full-text articles.

Based on PubMed Central (PMC) , the U.S. National Institutes of Health free digital archive of biomedical and life sciences journal literature, UKPMC provides a stable, permanent, and free-to-access online digital archive of full-text, peer-reviewed research publications.

GP surgery put health education videos on YouTube

A GP surgery in Wales has launched a series of health education films on YouTube to help educate patients. YouTube is a free online video service that allows users to view and share videos that have been uploaded by its members.

United Press International said "the visual element of YouTube makes it easier to explain treatments and interventions that are difficult to describe in other Web-based formats such as discussion groups..... medical experts warn against using YouTube as a replacement for professional guidance."

To view the health education videos at YouTube, you may need to install a newer version of Flash. Contact your IT Department if you have difficulty in installing the free sotftware.

How Web 2.0 is changing medicine

There is an interesting editorial in the BMJ Christmas issue, BMJ 2006;333:1283-1284 (23 December) about the development of Web 2.0 and its impact in medical content.

"Web 2.0 brings people together in a more dynamic, interactive space ....... The new environment features a highly connected digital network of practitioners where knowledge is not limited or controlled by private interests."

Many medical schools, medical journals as well as physicians have embraced the opportunity the emerging technologies offer in sharing, creating and disseminating medical knowledge as well as exhanging opinions in real time. Some popular examples of Web 2.0 include blogs, wikis, RSS feeds, podcasts etc.

Many quick responses to the editorial are in favour of the Web 2.0 : the interactivity of Web 2.0 will help doctors make better decisions and empowered patients, medical information and updates can be pushed far more effectively. A few warn that using these creative tools requires responsibility and the collaboration of medical information needs verifying and certifying so that users can trust and rely on it.

What is the greatest medical breakthrough?

BMJ is launching a competition to decide the greatest medical breakthrough to mark the relaunch of the BMJ.

100 nominations by readers have been received and 15 shortlisted including :

anaesthesia, antibiotics, chlorpromazine, computers, DNA, EBM, germ theroy, imaging, immunology, oral rehydration therapy, the pill, risks of smoking, sanitation, tissue culture and vaccines.

What do you think is the greatest medical milestone? Read the shortlisted milestones and vote for the winner.

"Health care information matters"

Adam Bosworth, Google's Vice President of Engineering, talked about his interests in the issues of health care and health information. When helping care for his mother who battled with cancer for four years and eventually died, he saw firsthand how challenging the health care system was in supporting caregivers and communicating between different medical organisations.

He found it incredibly challenging to get the right information that could help his mother make the right decisions in very difficult times. He felt strongly that patients need easy acess to medical information and be able to organize their own health information so that they can control their own health information.

In his speech " Connecting Americans to their health care : empowered consumers, personal health records and emerging technologies" at a national conference in Washington, D. C., he said that the lack of easily accessible, comprehensive medical records results in people suffering and dying unnecessarily. An efficient system would improve the standard of care by giving patients control over their health and medical information, patients would be able to easily retrieve and share their information in its totality and use it to ensure that they get the best possible quality of care. He is confident that increased and more trageted use of technology will help improve healthcare for all. Read more ….

Health News Bulletin - 15 December 2006

Drop in new breast cancer cases in the US could be linked to millions of women gave up HRT following reports questioning its safety.

Journal "Heart" study -the number of deaths caused by SADS is 8 times higher than estimate, average age of death was 32 and 63% were men.

BMJ study - people with higher IQ were healthier as a vegetarian diet was linked to lower heart disease and obesity rates.

BMJ study - proposals to improve patient safety as many incidents were found unreported, with doctors being the worst culprits.

BMJ report - 1 in 5 adults are obese in the UK, if left unchecked, could bankcrupt the NHS.

NICE guidelines on obesity incuding helpline numbers attached to oversize clothes.

Journal "Archives of Internal Medicine" - Height loss in old age is associated with increased risk of heart attacks and death.

Fat scan could reveal hidden fat and the precise location of fat has more of a bearing on health than simply being overweight.

Women who have epidurals during childbirth have more breastfeeding difficulties.

Clinical trials for a new type of dissolving stents to unblock diseased arteries and to perform further surgery on the artery.

The government is to tell the NHS England to balance the books as its first target.

The American Journal of Epidemiology - taking aspirin and other NSAIDs may halve the risk of developing an enlarged prostate but with possible side effects.

A new study found the prescription painkiller, dihydrocodeine, cheaper and safer than methadone, but as effective at treating heroin addicts.

Pfizer, the US drug manufacturer dropped heart and cholesterol drug torcetrapib after tests linked it to increased deaths and heart disease among trial patients

Excess weight increases the risk of developing several types of cancer.

Journal "Clinical Cancer Research" - extra genes, FGFR1, found in lobular breast cancer cells suggesting that blocking FGFR1 activity may slow, stop or reverse tumour growth.

Doctors' dilemmas and the need for medical ethics training.