Gp Practice Exam

Toxindrome refers to symptoms and signs of a medically significant spider bite

Neurotoxic effects are typically caused by toxins released by Loxosceles species

Cytotoxic effects are typically caused by toxins released by Latrodectus species

Araneism refers to the local clinical signs resulting from a spider bite

Arachnidism refers to an irrational fear of spiders

All children require immediate antivenom

Antivenom is not suitable or approved for use in children

If Lola’s pain is not controlled by simple analgesia

If Lola has systemic signs of envenomation that are not adequately managed by IV fluids

Antivenom is not recommended in atopic people as allergy is very common

Serum dengue PCR can detect virus between day 7 and 14 of the illness

Serum IgG becomes positive after 4 – 5 days of infection

No cross reactivity occurs between other flavivirus IgG

Three blood films are important investigations for Michael

Full blood count is not useful as Michael is already at day 4 of his illness

Petechiae indicate dengue haemorrhagic fever which requires hospitalisation

Petechiae indicate significant thrombocytopenia requiring platelet transfusion

Petechiae may occur in uncomplicated dengue fever

Thrombocytopenia occurs in around 75% of cases of dengue fever

Thrombocytopenia occurs mainly in patients with a past history of malaria

Is likely to be currently infected with another flavivirus

Has dengue haemorrhagic fever

Is immune to dengue and does not currently have the disease

Has immunity to all four arbovirus serotypes

Likely has infection by a second dengue serotype

Envenomation by this spider is usually mild, although it has 88% homology with venom from a more dangerous spider

A pressure immobilisation bandage and immediate transfer to hospital is required

Envenomation by this spider causes similar effects to lacrodectism and should be considered if she fails to respond to red back spider antivenom

This spider occurs throughout mainland Australia

Fasciculation are very rate manifestations of envenomation by this spider

A drop of haematocrit by > 20% from baseline

Platelet count < 80 000 cells per cubic mm

Postural hypotension

Development of severe abdominal pain

Development of significant bleeding

< 25% are unprovoked attacks

> 75% are unprovoked attacks

> 75% are by a dog known to the victim

Female unsterilized dogs are higher risk

Children less than 5 years of age are at higher risk

An intercanine distance of 3 – 5 cm is suggestive of a child bite

Human bites have high complication and infection rates than animal bites

HIV prophylaxis should be administered in all human bites

Hepatitis B immunoglobulin should be administered in all human bites

Most human bites are complicated by infective endocarditis

Staphylococcus aureus are flora of humans and dogs

Pasturella aerogenes are flora of pigs and cats

Actinobacillus are flora of cows and rodents

Clostredium tetani are flora of monkeys

Streptobacillus moniliformis are flora of dogs

Wounds over a prosthetic joint

Wounds on the trunk

Wounds with delayed presentation by more than 8 hours

Puncture and crush wounds

Wounds to the genitals

Dark spotting on the bed from blood spillage

Dark spotting on the bed from faecal deposition

Presence of the small oval, winged insects themselves

Typical distribution over trunk and feet

Typical distribution in lattice pattern

Reactions always occur within 3 days

Most bites occur in a linear pattern

The classic wheal reaction is < 1cm diameter

Bullous eruptions are very uncommon

Numerous bites can present as urticaria or an erythematous rash

Anaphylaxis is a common reaction

Secondary infection is very uncommon

Although itchy, ulceration from scratching does not occur

Fever and malaise may occur in some individuals

Infections such as malaria and HIV are common sequelae

There are no treatments available

Bed bugs are easily killed with simple home insect sprays

Symptomatic treatment with antihistamines and topical steroids is useful

Bed bugs infestations cannot be treated, necessitating all new furnishings

Commercial personal lice treatment is sufficient in the majority of cases

A port complication

Erosion of the band into the stomach cavity

Acute food bolus obstruction

Acute slip with obstruction and ischaemia

Symmetrical pouch dilatation

Barium swallow is indicated

Gastroscopy is indicated

The volume of fluid within the system should be checked repeatedly

A carbonated beverage may provide relief

No investigation is indicated

A normal 19 gauge needle can be used

You enter at 45 degrees to the skin to access the port

A Huber tipped needle is preferred

You feel the upper border of the port with the needle

The port must never be accessed except by the managing surgeon

Anti-saccharomyces cerevisiae antibody (ASCA) is specific to Crohn disease (CD)

Atypical perinuclear antineutrophil cytoplasmic antibody (p-ANCA) is specific to ulcerative colitis (UC)

ASCA and p-ANCA cannot differentiate CD from UC

Calprotectin is a faecal marker specific to CD

Lactoferrin is a faecal marker specific to UC

To lose 30% of their excess weight

To lose 50 - 60% of their excess weight

To lose 50 - 60% of their weight

To lose 70 - 90% of their excess weight

To lose 70 - 90% of their weight

5-ASA drugs are poorly tolerated

5-ASA drugs have low compliance rates

5-ASA drugs have a high incidence of adverse effects

5-ASA drugs are more effective orally than rectally for UC proctitis

The use of 5-ASA drugs is best established in CD

CRP does not correlate to disease activity

Persistently elevated CRP correlates to a lower relapse rate

Persistently elevated CRP correlates to a lower response to infliximab

Some patients do not mount a CRP response to intestinal inflammation

CRP is a useful indicator if it is in the normal range

Infliximab has no efficacy for UC

Infliximab is funded by the PBS for use in UC

Infliximab must be given by subcutaneous injection

Infliximab is used monthly for maintenance treatment

Infliximab binds tumour necrosis factor alpha

Abnormalities of central pain processing

Postsurgical changes

Genetic factors

Sensory dysfunction

Postinflammatory changes

Different strains of probiotics appear to target different dominant symptoms

The probiotic species are now part of her permanent bowel flora

There is no evidence that probiotics are useful for abdominal pain

There is no evidence that probiotics are useful for global IBS symptoms

There is no evidence that probiotics are useful for abdominal bloating

Perianal staining from the oil is a common side effect

Peppermint oil is known to be safe during pregnancy

Reflux may occur due to oesophageal sphincter relaxation

Peppermint oil is contraindicated in people with asymptomatic gallstones

Peppermint oil is contraindicated in all forms of liver disease

There is no evidence the soluble fibre improves IBS related abdominal pain

There is no evidence that soluble fibre improves IBS related constipation

There is no evidence that soluble fibre improves global IBS symptoms

Soluble fibre is not fermented or digested in the gut

Soluble fire acts by retaining water thereby increasing stool bulk

Fructose requires fructase in the brush border for digestion

Fructose absorption is impaired by luminal glucose

Fructose is absorbed via a low capacity carrier mediated facilitated diffusion

Lactose absorption is increased by luminal glucose

Some individuals have no lactase present and therefore cannot digest lactose

100mL regular milk

50g swiss cheese

200g cottage cheese

100g yoghurt

50g ice-cream

Sorbitol is a synthetic sweetener added to many foods

Sorbitol rarely occurs in fructose containing foods

Fructans are storage carbohydrates in Graminaceae plant species, such as wheat

Fructans are in high concentrations in corn and rice

Fructans are storage carbohydrates in Compsitae plant species, such as asparagus

Alternating bowel habit

Rectal bleeding

Anaemia

Weight loss

None of the above

Women with gestational diabetes require yearly screening

Women with diabetes who become pregnant require screening each trimester

Those with renal disease require yearly screening

Those with proliferative DR require ophthalmology review within 1 week

Those with nonproliferative DR require review within 4 weeks

The commonest mechanism is proliferative DR

The commonest mechanism is macular oedema

She has approximately a 25% chance of having DR now

50% of people in her position will require treatment to prevent visual loss

None of the above

The duration of diabetes is the strongest predictor of DR

Co-existent hypertension is the strongest predictor of DR

Diabetic control is the strongest predictor of DR

Blood pressure control has not been found to reduce DR

Tight diabetic control has been found to reduce DR

Is characterised by optic disc swelling

Is characterised by early neovascularisation

Is characterised by cottonwool spots

Must be screened for yearly in patients with hypertension

Is predictive of adverse cardiovascular outcomes

Visual loss is commonly associated with classic migraine

Occipitobasal headaches with visual loss are typical of migraine

Tunnel vision may occur

Aura classically beings temporally

Typical negative scotoma includes zigzag lights

Onset of visual loss over several hours

Visual loss preceded by flashing lights

Visual loss progresses like a 'curtain' from the periphery

Unexplained weight loss

Recent ophthalmic surgery

Thrombocytopenia increases the probability of GCA 6-fold

Temporal artery biopsy must be performed before commencement of therapy

ESR is the most sensitive diagnostic test for GCA

An ESR of < 29 would be considered normal for Alphons

A normal ESR excludes GCA in Alphons' case

Temporal artery tenderness

Proptosis

Papilloedema

Homonymous field defect

Eye movement disorders

Retinal pallor may indicate retinal detachment

Dilated vessels may indicate retinal artery occlusion

A cherry red macular is a normal finding

A cherry red macular may indicate papilloedema

Widespread nerve fibre layer haemorrhages may indicate retinal artery occlusion

Vitreous haemorrhage typically produces a discrete black scotoma

Subhyaloid haemorrhage typically presents as a 'shower of black dots'

Subretinal haemorrhage typically presents as a discrete brown scotoma

Vitreous haemorrhage is typically painful

Subhyaloid haemorrhage typically produces a mobile scotoma

Transoesophageal echocardiogram

CT angiography

Fundus fluorscein angiography

CT brain and orbits

ESR and CRP

A 'curtain' descending over the visual field is typical

Central vision preservation requires especially urgent referral

The pupil must not be dilated as this will exacerbate the detachment

Urgent ultrasound imaging is essential for all patients

Detachment can be treated in the ophthalmology clinic with laser

Visual acuity worse than 6/12

Visual field of < 10 degrees or less in the better eye

Visual field of < 20 degrees or less in the better eye

A and B are correct

A and C are correct

UV exposure is strongly associated with subcapsular cataract

UV exposure is strongly associated with cortical cataract

Corticosteroid use is strongly associated with cortical cataract

There is a strong association between smoking and nuclear sclreos

Diabetes is strongly associated with cortical cataract

No investigations are necessary in typical cases

Thyroid functions tests are required in all cases

Full blood count and examination is required in all cases

Chest x-ray is required in all cases

B and C are both correct

Approximately 2% convert from dry to wet forms per year

Dry ARMD involves a choroidal neovascular membrane

Early ARMD causes distortion or scotoma of central vision

Wet ARMD involves gradual deterioration of the retinal pigment epithelium

Wet ARMD involves predominantly peripheral visual loss

Antibacterial wash is a first line treatment

Antiperspirants are effective in the majority of cases

Iontophoresis provides adequate symptoms control if performed weekly

Botulinum toxin injection is well tolerated

Surgical management may be complicated by compensatory hyperhidrosis

The Amsler grid helps to identify disease onset

Smoking increases the risk of ARMD 2 - 3 times

Dietary antioxidants have been shown to reduce risk

Zinc supplements have been shown to delay onset of ARMD

UV protection significantly reduces the risk of wet ARMD

Asymmetrical presentation - dominant side usually more affected

Persistence of sweating even during sleep

Persistence of sweating beyond 6 months

Onset typically after the age of 25 years

Does not impair daily activities

Essential tremor is usually asymmetrical

Essential tremor can be postural or kinetic

Essential tremor is exacerbated by alcohol

Essential tremor can be caused by propranolol

The incidence of essential tremor reduces with age

Small pits are often present on the nails beds

There is often a characteristic 'cheesy' smell

It is due to a fungal infection of the stratum corneum

It is due to infection with Mycobacterium sedentarius

It is unrelated to the diagnosis of palmoplantar hyperhidrosis

X-ray is often normal and therefore should not be ordered in this case

Sesamoiditis can be readily managed with steroid injection

Internal fixation is required for more forefoot stress fractures

Jones fractures are prone to delayed healing

Bone scan is the first line imaging to delineate the severity of fracture

X-ray is not indicated for Ana

Anti-inflammatory medications are rarely helpful

Strengthening is the mainstay of treatment

Offloading with a Cam walker or cast is a critical part of treatment

Topical glyceryl trinitrate is a first line treatment

'tiptoe' bouncing does not induce pain

Pain is typically worse at night

Palpation is usually clearly diagnostic

'gel pain' typically occurs with first 'foot to floor'

X-ray demonstrating 'heel spur' is not diagnostically significant

It is typically a high frequency rest tremor

It does not involve the head or face

There may be a postural tremor after a latent period

There may be a postural tremor immediately after adopting a new posture

The tremor improves with propranolol

For Joe to successfully claim you must confirm his work is responsible for 50% of his impairment

You should not make any comment about the contribution of Joe's work to his symptoms

CTS is a constitutional condition, hence Joe has no claim for workers' compensation

You can make a judgement about whether Joe's work is a substantial contributing factor to his CTS

Joe's hobbies and lifestyle are of no relevance to his work related claim

Calcaneal traction apophysitis is likely and should soon resolve with apophysial closure

The possibility of osteochrondrosis can be confidently excluded by plain x-ray

An 'accessory navicular' is unlikely as this is typically worse at rest

Tarsal coalition results in limited eversion of the ankle

Immature posture contributes to pain such as Elena's until after hte age of 12 years

Cerebellar tremor is a pure rest tremor with low frequency

Cerebellar tremor is regular in amplitude

Cerebellar tremor is typically unilateral

Cerebellar tremor is always associated with other cerebellar signs

Cerebellar tremor is usually absent at rest

CTS is 4 - 5 times more common in males

CTS involves the dominant

The pain and numbness of CTS will not radiate past the elbow

CTS is most common in the 20 - 40 years of age group

Most cases of CTS are constitutional in origin

Work in hot environments

High range wrist action

Use of hand held vibratory equipment

Extreme wrist extension

Frozen food work

Iron deficiency

Acromegaly

Diabetes mellitus

Obesity

Thyrotoxicosis myxoedema

Caffeine typically produces an intention tremor

Metoclopramide typically produces a postural tremor

Lithium typically produces a tremor at rest

Neuroleptics typically produce a rest tremor

Thyroid hormones typically produce a rest tremor

India

Vietnam

China

Indonesia

Ethiopia

Household contact with TB

Returned traveller from country with high prevavlence

HIV infection

Contact with local migrant community

Residence for > 3 months in country with high prevalence

Cough for > 2 - 3 weeks

Loss of > 5% body weight

Unexplained new onset fever

Acute shortness of breath

Acute chest pain

HIV associated dementia is very common and the most likely cause of her symptoms

Her symptoms may be due to depression

She must cease her medications as they are the likely cause of her symptoms

Her symptoms are most likely due to excessive alcohol intake

Her symptoms are likey to be related to illicit drug use

Evening sputum collection

2 - 3 sputum collections for TST examination

2 - 3 sputum collections for AFB examination

QuantiFERON-TB Gold skin prick testing

QuantiFERON-TB Gold assay

Wearing dark coloured clothing

Using insect repellent

Wearing strong perfume

Extra care during the hottest part of the day

Extra care during the night

Barmah Forest virus has more prominent joint pains than RRV

Japanese encephalitis usually causes severe encephalitis

Dengue fever is not transmitted in Australia currently

Infectious mononucleosis is an unlikely diagnosis

Systemic lupus erythematosus is a possible diagnosis

Joint swelling occurs in around 50% of cases

Joint pain occurs in around 50% of cases

Tiredness occurs in around 50% of cases

Rash occurs in around 20% of cases

Depression occurs in around 20% of cases

It is more common in HIV positive people of African descent

It is only elevated in patients taking protease inhibitors

It is only elevated in patients taking abacavir

Smoking is less common in patients with HIV

HIV itself increases cardiovascular risk

Possums and horses are important hosts in rural areas

Birds and flying foxes are important hosts in rural areas

Human-mosquito-human transmission cannot occur

Kangaroos and wallabies are the main hosts

Cats and dogs are important hosts in urban area

Annual influenza vaccination is recommended at any age

5 yearly pneumococcal vaccines are recommended after 50 years of age

Hepatitis B vaccination is ineffective

Varicella vaccination is not recommended if CD4 count is < 400

Oral polio vaccines are safe if CD4 count is > 400

Organ transplant recipient

Presence of numerous naevi

Previous multiple solar keratoses

History of large sun exposure

Lesion in area of previous skin cancer treatment

Yearly Pap tests

3 monthly fasting glucose

3 monthly cholesterol, LDL, HDL and TGs

Monthly HIV viral load

6 monthly CD4 count

Nonhaem iron is better absorbed by the body

Vitamin C increases the absorpition of nonhaem iron

Phytates in wholegrains increase the absorption of nonhaem iron

Tannins in tea increase the absorption of nonhaem iron

Iron deficiency is more common in vegetarians than meat eaters

Vegetarian diets usually fall below protein requirements

Strict protein combining is necessary to ensure she has a balanced amino acid intake

Soy protein has a protein digestibility corrected amino acid score similar to meat

Eggs are an appropriate source of protein for Skye

Soy products do not contain readily digestible proteins

Mushrooms are reliable source of B12

250mL of fortified soy beverage would provide her daily needs

Animal and dairy products do not provide B12

Supplements of around 2mg may be useful as large doses are required to ensure adequate intake and bioavailability

Doses of 2 microgram supplements can be useful as bioavailability decreases with increasing intake

Thin cords of basaloid cells

Thin cords of fibrotic stroma

Small clusters of fibrotic stroma

Homogenous changes to basaloid cells

Pallisading cords of mixed cells

30g of cheese

250mL of milk or calcium fortified soy beverage

3 tablespoons unhulled tahini

1.5 cups Asian greens

1 cup almonds

Is readily available in any rural centre with a pathologist

Involves vertical 'bread loaf' tissue slicing techniques

Is rapidly performed by most practitioners

Has a better cure rate than standard surgery

Is inappropriate for recurrent skin tumours

Is usually spread over 6 months

Requires up to 20 daily fractions over 1 month

Results in immediate complications but no delayed complications

Offers lower recurrence rates than surgical management

Is mostly used in young patients

Slows sodium current inactivation resulting in exhaustion of neurotransmitters

Causes synaptic vesicle exocytosis resulting in catecholamine release

Causes severe and rapid life threatening systemic envenomation

Lasts a median of 1 week with around one-third of cases lasting over 1 month

Causes noncardiogenic pulmonary oedema in around 70% of children