Gp Practice Exam
These are the questions from AFP, answers from them too. Except for getting this journal I'm not affiliated with it otherwise. There are a few double ups, and more questions will be added when I get a chance.
- 1.
Lola Parkes, 6 years of age, is brought into your Sydney clinic by her mother. Lola is suddenly irritable and crying after playing in the garden. You have seen her mainly for eczema. She is hypertensive and appears to have a painful left foot. You consider spider bite as one of your differential diagnoses. Terminology around spider bites can be confusing. Select the correct definition:
- A.
Toxindrome refers to symptoms and signs of a medically significant spider bite
- B.
Neurotoxic effects are typically caused by toxins released by Loxosceles species
- C.
Cytotoxic effects are typically caused by toxins released by Latrodectus species
- D.
Araneism refers to the local clinical signs resulting from a spider bite
- E.
Arachnidism refers to an irrational fear of spiders
Correct Answer
A. Toxindrome refers to symptoms and signs of a medically significant spider biteExplanation
‘Toxindrome’ refer to the symptoms and signs of a medically significant spider bite. Araneism or arachnidism is a term for systemic effect resulting from spider bite. Latrodectus species are known for their neurotoxins whereas Loxosceles have predominantly cytotoxic effects.Rate this question:
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- 2.
Lola Parkes, 6 years of age, is brought into your Sydney clinic by her mother. Lola is suddenly irritable and crying after playing in the garden. You have seen her mainly for eczema. She is hypertensive and appears to have a painful left foot. You consider spider bite as one of your differential diagnoses. If Lola does have red spider bite envenomation when would antivenom be indicated:
- A.
All children require immediate antivenom
- B.
Antivenom is not suitable or approved for use in children
- C.
If Lola’s pain is not controlled by simple analgesia
- D.
If Lola has systemic signs of envenomation that are not adequately managed by IV fluids
- E.
Antivenom is not recommended in atopic people as allergy is very common
Correct Answer
C. If Lola’s pain is not controlled by simple analgesiaExplanation
Antivenom is recommended for patients with pain not controlled with simple analgesia, those who require repeated does of opiates, or have signs of systemic envenomation. Children receive antivenom more commonly as they are considered at greater risk. Allergic reactions in Australia appear to be rare.Rate this question:
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- 3.
Lola Parkes, 6 years of age, is brought into your Sydney clinic by her mother. Lola is suddenly irritable and crying after playing in the garden. You have seen her mainly for eczema. She is hypertensive and appears to have a painful left foot. You consider spider bite as one of your differential diagnoses. Lola becomes agitated, is sweating profusely and drooling, and her mother brought in the spider shown as a suspected culprit. Select the best option about this spider and your management of Lola now:
- A.
Envenomation by this spider is usually mild, although it has 88% homology with venom from a more dangerous spider
- B.
A pressure immobilisation bandage and immediate transfer to hospital is required
- C.
Envenomation by this spider causes similar effects to lacrodectism and should be considered if she fails to respond to red back spider antivenom
- D.
This spider occurs throughout mainland Australia
- E.
Fasciculation are very rate manifestations of envenomation by this spider
Correct Answer
B. A pressure immobilisation bandage and immediate transfer to hospital is requiredExplanation
Funnel web spiders are the most venomous in the world and envenomation should be considered a life threatening emergency. Lola requires immediate transfer to hospital for antivenom with a pressure immobilisation bandage. Funnel web spiders are mainly confined to NSW and Queensland and fasciculation occurs in around half of patients.Rate this question:
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- 4.
Michael Train, 29 years of age, is an accountant who returned from rural Vietnam 7 days ago. He complains of fever, headache and severe myalgia that started 3 days ago. You note a petechial rash and consider dengue fever as a differential diagnosis. Select the most accurate option about the rash:
- A.
Petechiae indicate dengue haemorrhagic fever which requires hospitalisation
- B.
Petechiae indicate significant thrombocytopenia requiring platelet transfusion
- C.
Petechiae may occur in uncomplicated dengue fever
- D.
Thrombocytopenia occurs in around 75% of cases of dengue fever
- E.
Thrombocytopenia occurs mainly in patients with a past history of malaria
Correct Answer
C. Petechiae may occur in uncomplicated dengue feverExplanation
A petechial rash or minor bleeding may occur in uncomplicated dengue fever and thrombocytopenia occurs in around 25 – 50% of cases.Rate this question:
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- 5.
Michael Train, 29 years of age, is an accountant who returned from rural Vietnam 7 days ago. He complains of fever, headache and severe myalgia that started 3 days ago. You arrange investigations for Michael. Select the best option:
- A.
Serum dengue PCR can detect virus between day 7 and 14 of the illness
- B.
Serum IgG becomes positive after 4 – 5 days of infection
- C.
No cross reactivity occurs between other flavivirus IgG
- D.
Three blood films are important investigations for Michael
- E.
Full blood count is not useful as Michael is already at day 4 of his illness
Correct Answer
D. Three blood films are important investigations for MichaelExplanation
Three blood films are indicated to exclude the important differential diagnosis of malaria. Serum dengue PCR is useful in early illness as it may detect virus up to day 10. Serum IgM becomes positive after day 4 – 5, but IgG is delayed until about day 7. There is cross reactivity with other flavivirus infection with IgG and FBE is useful at baseline and again at day 3 – 4Rate this question:
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- 6.
Michael Train, 29 years of age, is an accountant who returned from rural Vietnam 7 days ago. He complains of fever, headache and severe myalgia that started 3 days ago. Michael’s IgG and IgM are both positive for dengue, he has mild thrombocytopenia and other investigations are normal. This indicates Michael:
- A.
Is likely to be currently infected with another flavivirus
- B.
Has dengue haemorrhagic fever
- C.
Is immune to dengue and does not currently have the disease
- D.
Has immunity to all four arbovirus serotypes
- E.
Likely has infection by a second dengue serotype
Correct Answer
E. Likely has infection by a second dengue serotypeExplanation
IgM appears after 4 – 5 days but IgG does not become positive until around day 7. This picture indicates Michael has probably been exposed to another serotype of dengue, which increases his risk of haemorrhagic fever. Other flavivirus infection typically causes reduced IgM response.Rate this question:
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- 7.
Michael Train, 29 years of age, is an accountant who returned from rural Vietnam 7 days ago. He complains of fever, headache and severe myalgia that started 3 days ago. Michael’s IgG and IgM are both positive for dengue, he has mild thrombocytopenia and other investigations are normal. Michael’s condition rapidly deteriorates and you arrange transfer to hospital. Which of the following is NOT a ‘red flag’ that indicates more severe disease:
- A.
A drop of haematocrit by > 20% from baseline
- B.
Platelet count < 80 000 cells per cubic mm
- C.
Postural hypotension
- D.
Development of severe abdominal pain
- E.
Development of significant bleeding
Correct Answer
A. A drop of haematocrit by > 20% from baselineExplanation
A rise of haematocrit by > 20% from baseline (or a reduction with rehydration) is a ‘red flag’ not a drop in haematocrit. The other factors listed are red flags for severe disease.Rate this question:
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- 8.
Randy Simpson, 4 years of age, lives on a local farm. He is brought in by his father with an injured left arm and hand, consistent with an animal bite. Select the correct statement about the background and risk factors of dog bite:
- A.
< 25% are unprovoked attacks
- B.
> 75% are unprovoked attacks
- C.
> 75% are by a dog known to the victim
- D.
Female unsterilized dogs are higher risk
- E.
Children less than 5 years of age are at higher risk
Correct Answer
E. Children less than 5 years of age are at higher riskExplanation
Children aged less than 5 years are at greater risk of dog bite and male unsterilized dogs are higher risk. Around 66% are from dogs known to the victim and about 50% are unprovoked.Rate this question:
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- 9.
Randy Simpson, 4 years of age, lives on a local farm. He is brought in by his father with an injured left arm and hand, consistent with an animal bite. Randy reports his 6 year old sister Maddison inflicted the bites. Select the correct statement:
- A.
An intercanine distance of 3 – 5 cm is suggestive of a child bite
- B.
Human bites have high complication and infection rates than animal bites
- C.
HIV prophylaxis should be administered in all human bites
- D.
Hepatitis B immunoglobulin should be administered in all human bites
- E.
Most human bites are complicated by infective endocarditis
Correct Answer
B. Human bites have high complication and infection rates than animal bitesExplanation
Human bites have higher infection rates than animal bites. An intercanine distance of > 3cm indicates a likely adult bite and should raise suspicion of child abuse, particularly for bites on the genitals. HIV prophylaxis should be considered in high risk bites and hepatitis immunoglobulin would be appropriate if Randy is unvaccinated and Maddison is hepatitis B positive. Human bites infected with Eikenella corrodens may cause septic arthritis and is sometimes complicated by infective endocarditis.Rate this question:
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- 10.
Randy Simpson, 4 years of age, lives on a local farm. He is brought in by his father with an injured left arm and hand, consistent with an animal bite. You consider the organisms that cause infection with different animal bites. Select the correct statement about the oral flora of the common animal culprits:
- A.
Staphylococcus aureus are flora of humans and dogs
- B.
Pasturella aerogenes are flora of pigs and cats
- C.
Actinobacillus are flora of cows and rodents
- D.
Clostredium tetani are flora of monkeys
- E.
Streptobacillus moniliformis are flora of dogs
Correct Answer
A. Staphylococcus aureus are flora of humans and dogsExplanation
Staphylococcus aureus can be part of the oral flora of both humans and dogs. The other options are incorrect.Rate this question:
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- 11.
Randy Simpson, 4 years of age, lives on a local farm. He is brought in by his father with an injured left arm and hand, consistent with an animal bite. Certain wounds are at high risk of infection. Which of the following does NOT increase the risk of wound infection:
- A.
Wounds over a prosthetic joint
- B.
Wounds on the trunk
- C.
Wounds with delayed presentation by more than 8 hours
- D.
Puncture and crush wounds
- E.
Wounds to the genitals
Correct Answer
B. Wounds on the trunkExplanation
Wounds to the trunk are not especially high risk. Bites to the hands, feet, face and genitals are high risk, as are all other factors listed and bites to immunocompromised individuals.Rate this question:
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- 12.
Jacinta Quick, 34 years of age, is a receptionist who presents with itchy macular lesions on her arms and shoulders. You consider bed bug bites. Which of the following is a common signs of bed bug infestation:
- A.
Dark spotting on the bed from blood spillage
- B.
Dark spotting on the bed from faecal deposition
- C.
Presence of the small oval, winged insects themselves
- D.
Typical distribution over trunk and feet
- E.
Typical distribution in lattice pattern
Correct Answer
B. Dark spotting on the bed from faecal depositionExplanation
Dark spotting on the bed is typical from bug faecal deposition. The bugs are small and oval, but wingless, and distribution is typically over the arms, shoulders and legs.Rate this question:
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- 13.
Jacinta Quick, 34 years of age, is a receptionist who presents with itchy macular lesions on her arms and shoulders. You consider bed bug bites. Select the correct statement about reactions to bed bug bites
- A.
Reactions always occur within 3 days
- B.
Most bites occur in a linear pattern
- C.
The classic wheal reaction is < 1cm diameter
- D.
Bullous eruptions are very uncommon
- E.
Numerous bites can present as urticaria or an erythematous rash
Correct Answer
E. Numerous bites can present as urticaria or an erythematous rashExplanation
Numerous bites can present as a widespread erythematous rash or urticaria. Reactions can be delayed up to 9 days, the classic wheal is over 1cm and up to 20cm. Bullous eruptions are not uncommon and most bites do not occur in a linear pattern, although this can occur.Rate this question:
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- 14.
Jacinta Quick, 34 years of age, is a receptionist who presents with itchy macular lesions on her arms and shoulders. You consider bed bug bites. Jacinta worries about the secondary effects on her and her family. You explain:
- A.
Anaphylaxis is a common reaction
- B.
Secondary infection is very uncommon
- C.
Although itchy, ulceration from scratching does not occur
- D.
Fever and malaise may occur in some individuals
- E.
Infections such as malaria and HIV are common sequelae
Correct Answer
D. Fever and malaise may occur in some individualsExplanation
Fever and malaise can occur, particularly with the bullous forms. Anaphylaxis is a rare occurrence but ulceration and infection secondary to scratching is relatively common. There have been no proven cases of transition of infectious disease by bed bug bites.Rate this question:
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- 15.
Jacinta Quick, 34 years of age, is a receptionist who presents with itchy macular lesions on her arms and shoulders. You consider bed bug bites. Jacinta asks about treatment options. You explain:
- A.
There are no treatments available
- B.
Bed bugs are easily killed with simple home insect sprays
- C.
Symptomatic treatment with antihistamines and topical steroids is useful
- D.
Bed bugs infestations cannot be treated, necessitating all new furnishings
- E.
Commercial personal lice treatment is sufficient in the majority of cases
Correct Answer
C. Symptomatic treatment with antihistamines and topical steroids is usefulExplanation
Symptomatic treatment with antihistamines and topical or systemic corticosteroids can be useful. Bed bugs have high resistance levels and infestations should be handled by an experienced pest manager.Rate this question:
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- 16.
Janelle Philips, 46 years of age, is a housewife. She underwent laprascopic adjustable gastric banding (LAGB) 6 months ago and has lost 12kg since the procedure. Over 12 months following LABG, patients such as Janelle can expect:
- A.
To lose 30% of their excess weight
- B.
To lose 50 - 60% of their excess weight
- C.
To lose 50 - 60% of their weight
- D.
To lose 70 - 90% of their excess weight
- E.
To lose 70 - 90% of their weight
Correct Answer
B. To lose 50 - 60% of their excess weight -
- 17.
Janelle Philips, 46 years of age, is a housewife. She underwent laprascopic adjustable gastric banding (LAGB) 6 months ago and has lost 12kg since the procedure. Janelle was very happy with the procedure but has recently noticed reflux, especially at night, epigastric pain and difficulty eating solids. The most likely explanation is:
- A.
A port complication
- B.
Erosion of the band into the stomach cavity
- C.
Acute food bolus obstruction
- D.
Acute slip with obstruction and ischaemia
- E.
Symmetrical pouch dilatation
Correct Answer
E. Symmetrical pouch dilatation -
- 18.
Janelle Philips, 46 years of age, is a housewife. She underwent laprascopic adjustable gastric banding (LAGB) 6 months ago and has lost 12kg since the procedure. Janelle was very happy with the procedure but has recently noticed reflux, especially at night, epigastric pain and difficulty eating solids. Regarding appropriate investigation or management for Janelle’s symptoms, which of the following is true:
- A.
Barium swallow is indicated
- B.
Gastroscopy is indicated
- C.
The volume of fluid within the system should be checked repeatedly
- D.
A carbonated beverage may provide relief
- E.
No investigation is indicated
Correct Answer
A. Barium swallow is indicated -
- 19.
Janelle Philips, 46 years of age, is a housewife. She underwent laprascopic adjustable gastric banding (LAGB) 6 months ago and has lost 12kg since the procedure. Janelle was very happy with the procedure but has recently noticed reflux, especially at night, epigastric pain and difficulty eating solids. You appropriately investigate and manage Janelle’s situation but decide to learn about taking fluid out of the LABG system in case you need to do this in the future. Regarding the process of removing fluid from the system, which of the following is true:
- A.
A normal 19 gauge needle can be used
- B.
You enter at 45 degrees to the skin to access the port
- C.
A Huber tipped needle is preferred
- D.
You feel the upper border of the port with the needle
- E.
The port must never be accessed except by the managing surgeon
Correct Answer
C. A Huber tipped needle is preferred -
- 20.
Vince Chinotto, 37 years of age, is a plumber who presents unwell, with bloody diarrhoea and abdominal pain. You suspect inflammatory bowel disease (IBD) and arrange emergency review. Select the best option in regard to diagnostic tests for IBD:
- A.
Anti-saccharomyces cerevisiae antibody (ASCA) is specific to Crohn disease (CD)
- B.
Atypical perinuclear antineutrophil cytoplasmic antibody (p-ANCA) is specific to ulcerative colitis (UC)
- C.
ASCA and p-ANCA cannot differentiate CD from UC
- D.
Calprotectin is a faecal marker specific to CD
- E.
Lactoferrin is a faecal marker specific to UC
Correct Answer
C. ASCA and p-ANCA cannot differentiate CD from UC -
- 21.
Vince Chinotto, 37 years of age, is a plumber who presents unwell, with bloody diarrhoea and abdominal pain. You suspect inflammatory bowel disease (IBD) and arrange emergency review. Vince is diagnosed with UC and is later commenced on a 5-amino salicylic acid drug (5-ASA). Select the best option about this group of medications:
- A.
5-ASA drugs are poorly tolerated
- B.
5-ASA drugs have low compliance rates
- C.
5-ASA drugs have a high incidence of adverse effects
- D.
5-ASA drugs are more effective orally than rectally for UC proctitis
- E.
The use of 5-ASA drugs is best established in CD
Correct Answer
B. 5-ASA drugs have low compliance rates -
- 22.
Vince Chinotto, 37 years of age, is a plumber who presents unwell, with bloody diarrhoea and abdominal pain. You suspect inflammatory bowel disease (IBD) and arrange emergency review. Vince is diagnosed with UC and is later commenced on a 5-amino salicylic acid drug (5-ASA). You see Vince 2 months later with a possible flare up of UC. Select the best option about the use of C-reactive protein (CRP) levels in this setting:
- A.
CRP does not correlate to disease activity
- B.
Persistently elevated CRP correlates to a lower relapse rate
- C.
Persistently elevated CRP correlates to a lower response to infliximab
- D.
Some patients do not mount a CRP response to intestinal inflammation
- E.
CRP is a useful indicator if it is in the normal range
Correct Answer
D. Some patients do not mount a CRP response to intestinal inflammation -
- 23.
Vince Chinotto, 37 years of age, is a plumber who presents unwell, with bloody diarrhoea and abdominal pain. You suspect inflammatory bowel disease (IBD) and arrange emergency review. Vince is diagnosed with UC and is later commenced on a 5-amino salicylic acid drug (5-ASA). You see Vince 2 months later with a possible flare up of UC. Several years later Vince’s UC becomes difficulty to control and you refer him back to his gastroenterologist. Select the correct option about infliximab in this setting:
- A.
Infliximab has no efficacy for UC
- B.
Infliximab is funded by the PBS for use in UC
- C.
Infliximab must be given by subcutaneous injection
- D.
Infliximab is used monthly for maintenance treatment
- E.
Infliximab binds tumour necrosis factor alpha
Correct Answer
E. Infliximab binds tumour necrosis factor alpha -
- 24.
Angelica Garcia Lopez, 29 years of age, is a police officer who returns to you after a thorough assessment for advice about managing her irritable bowel syndrome. Angelica has heard conflicting stories about the aetiology of IBS. Which of the following has NOT been implicated as a possible aetiological factor in IBS:
- A.
Abnormalities of central pain processing
- B.
Postsurgical changes
- C.
Genetic factors
- D.
Sensory dysfunction
- E.
Postinflammatory changes
Correct Answer
B. Postsurgical changes -
- 25.
Angelica Garcia Lopez, 29 years of age, is a police officer who returns to you after a thorough assessment for advice about managing her irritable bowel syndrome. Angelica tried 1 month of probiotics but found no improvement in her symptoms. You explain:
- A.
Different strains of probiotics appear to target different dominant symptoms
- B.
The probiotic species are now part of her permanent bowel flora
- C.
There is no evidence that probiotics are useful for abdominal pain
- D.
There is no evidence that probiotics are useful for global IBS symptoms
- E.
There is no evidence that probiotics are useful for abdominal bloating
Correct Answer
A. Different strains of probiotics appear to target different dominant symptoms -
- 26.
Angelica Garcia Lopez, 29 years of age, is a police officer who returns to you after a thorough assessment for advice about managing her irritable bowel syndrome. You discuss peppermint oil as a possible treatment and Angelica asks about the side effects and contraindications. Select the best option:
- A.
Perianal staining from the oil is a common side effect
- B.
Peppermint oil is known to be safe during pregnancy
- C.
Reflux may occur due to oesophageal sphincter relaxation
- D.
Peppermint oil is contraindicated in people with asymptomatic gallstones
- E.
Peppermint oil is contraindicated in all forms of liver disease
Correct Answer
C. Reflux may occur due to oesophageal sphincter relaxation -
- 27.
Angelica Garcia Lopez, 29 years of age, is a police officer who returns to you after a thorough assessment for advice about managing her irritable bowel syndrome. Angelica’s main complaints are of pain and constipation. She wants to discuss the use of soluble fibre in her diet. Select the best option about the use of soluble fibre in IBS:
- A.
There is no evidence the soluble fibre improves IBS related abdominal pain
- B.
There is no evidence that soluble fibre improves IBS related constipation
- C.
There is no evidence that soluble fibre improves global IBS symptoms
- D.
Soluble fibre is not fermented or digested in the gut
- E.
Soluble fire acts by retaining water thereby increasing stool bulk
Correct Answer
A. There is no evidence the soluble fibre improves IBS related abdominal pain -
- 28.
Joseph Deng, 23 years of age, is a kitchen hand and student who you suspect has IBS.You consider food intolerance as a contributing factor. Select the correct statement about the processing of carbohydrate:
- A.
Fructose requires fructase in the brush border for digestion
- B.
Fructose absorption is impaired by luminal glucose
- C.
Fructose is absorbed via a low capacity carrier mediated facilitated diffusion
- D.
Lactose absorption is increased by luminal glucose
- E.
Some individuals have no lactase present and therefore cannot digest lactose
Correct Answer
C. Fructose is absorbed via a low capacity carrier mediated facilitated diffusion -
- 29.
Joseph Deng, 23 years of age, is a kitchen hand and student who you suspect has IBS.Which of the following foods has the highest lactose load:
- A.
100mL regular milk
- B.
50g swiss cheese
- C.
200g cottage cheese
- D.
100g yoghurt
- E.
50g ice-cream
Correct Answer
A. 100mL regular milk -
- 30.
Joseph Deng, 23 years of age, is a kitchen hand and student who you suspect has IBS.Joseph asks about other potential food intolerances. Select the best option about the content of different food:
- A.
Sorbitol is a synthetic sweetener added to many foods
- B.
Sorbitol rarely occurs in fructose containing foods
- C.
Fructans are storage carbohydrates in Graminaceae plant species, such as wheat
- D.
Fructans are in high concentrations in corn and rice
- E.
Fructans are storage carbohydrates in Compsitae plant species, such as asparagus
Correct Answer
C. Fructans are storage carbohydrates in Graminaceae plant species, such as wheat -
- 31.
Joseph Deng, 23 years of age, is a kitchen hand and student who you suspect has IBS.You ask Joseph about the presence of alarm symptoms. Which of the following is not considered an alarm symptom:
- A.
Alternating bowel habit
- B.
Rectal bleeding
- C.
Anaemia
- D.
Weight loss
- E.
None of the above
Correct Answer
A. Alternating bowel habit -
- 32.
Talay Ozan, 52 years of age, is a librarian with newly diagnosed type 2 diabetes. Talay immigrated from Turkey 8 years ago. Together you plan how to monitor and protect her vision.Select the correct NHMRC recommendation about retinal screening for diabetic retinopathy (DR0 for different groups of people with diabetes:
- A.
Women with gestational diabetes require yearly screening
- B.
Women with diabetes who become pregnant require screening each trimester
- C.
Those with renal disease require yearly screening
- D.
Those with proliferative DR require ophthalmology review within 1 week
- E.
Those with nonproliferative DR require review within 4 weeks
Correct Answer
C. Those with renal disease require yearly screeningExplanation
Diabetics with renal disease are among several groups who require yearly screening. Women with gestational diabetes only require monitoring if diabetes persists, while pregnant women with pre-existing diabetes require screening during the first trimester. Patients with proliferative disease DR should be reviewed by an ophthalmologist within 4 weeks, non-proliferative within 3 – 6 months.Rate this question:
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- 33.
Talay Ozan, 52 years of age, is a librarian with newly diagnosed type 2 diabetes. Talay immigrated from Turkey 8 years ago. Together you plan how to monitor and protect her vision.Talay asks about how visual loss occurs and how common it is. You tell her:
- A.
The commonest mechanism is proliferative DR
- B.
The commonest mechanism is macular oedema
- C.
She has approximately a 25% chance of having DR now
- D.
50% of people in her position will require treatment to prevent visual loss
- E.
None of the above
Correct Answer
B. The commonest mechanism is macular oedemaExplanation
The commonest mechanism for visual loss in DR is diabetic macular oedema, proliferative disease is less common. Around 6% of patients with type 2 diabetes have DR at the time of diagnosis, around 25% have it overall and 30% ultimately need treatment.Rate this question:
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- 34.
Talay Ozan, 52 years of age, is a librarian with newly diagnosed type 2 diabetes. Talay immigrated from Turkey 8 years ago. Together you plan how to monitor and protect her vision.Talay wants to reduce her likelihood of developing DR. You explain that:
- A.
The duration of diabetes is the strongest predictor of DR
- B.
Co-existent hypertension is the strongest predictor of DR
- C.
Diabetic control is the strongest predictor of DR
- D.
Blood pressure control has not been found to reduce DR
- E.
Tight diabetic control has been found to reduce DR
Correct Answer
A. The duration of diabetes is the strongest predictor of DRExplanation
Duration of diabetes is the strongest predictor of DR. DR is also associated with glycaemic control and systolic blood pressure (BP) although trials have only demonstrated a reduction in DR with BP reduction.Rate this question:
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- 35.
Talay Ozan, 52 years of age, is a librarian with newly diagnosed type 2 diabetes. Talay immigrated from Turkey 8 years ago. Together you plan how to monitor and protect her vision.When Talay presents for diabetes review 6 months later, her blood pressure is 150/95. You recheck this a week later and it is 145/95. Mild hypertensive retinopathy:
- A.
Is characterised by optic disc swelling
- B.
Is characterised by early neovascularisation
- C.
Is characterised by cottonwool spots
- D.
Must be screened for yearly in patients with hypertension
- E.
Is predictive of adverse cardiovascular outcomes
Correct Answer
E. Is predictive of adverse cardiovascular outcomesExplanation
Hypertensive retinopathy predicts cardiovascular outcomes. Mild forms are characterised by silver wiring and AV nipping. Moderate forms are characterised by cottonwool spots, while severe forms can cause optic disc swelling. Although common there is no evidence for regular retinal screening for hypertensive retinopathy.Rate this question:
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- 36.
Alphons Wieczorek, 58 years of age, is a teacher who presents with sudden unilateral visual loss.Alphons suffers from migraines. Select the best statement about visual loss from migraine:
- A.
Visual loss is commonly associated with classic migraine
- B.
Occipitobasal headaches with visual loss are typical of migraine
- C.
Tunnel vision may occur
- D.
Aura classically beings temporally
- E.
Typical negative scotoma includes zigzag lights
Correct Answer
C. Tunnel vision may occurExplanation
Visual loss is rarely associated with classic migraine but can cause blurred or tunnel vision. Positive scotoma (such as zigzag lights) is more common, beginning paracentrally and progressing temporally. Atypical cases such as those with occiptobasal headaches warrant further assessment.Rate this question:
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- 37.
Alphons Wieczorek, 58 years of age, is a teacher who presents with sudden unilateral visual loss. Which of the following features on history is most suggestive of giant cell arteritis (GCA):
- A.
Onset of visual loss over several hours
- B.
Visual loss preceded by flashing lights
- C.
Visual loss progresses like a 'curtain' from the periphery
- D.
Unexplained weight loss
- E.
Recent ophthalmic surgery
Correct Answer
D. Unexplained weight lossExplanation
Giant cell arteritis (GCA) may present with systemic symptoms such as unexplained weight loss. It typically causes rapid visual loss with onset over seconds. Visual loss preceded by flashing lights and progressing from the periphery is suggestive of retinal detachment.Rate this question:
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- 38.
Alphons Wieczorek, 58 years of age, is a teacher who presents with sudden unilateral visual loss.Alphons suffers from migraines.You consider nonmigraine causes.Alphons has some concerning features suggestive of GCA. Select the most accurate statement about appropriate investigation:
- A.
Thrombocytopenia increases the probability of GCA 6-fold
- B.
Temporal artery biopsy must be performed before commencement of therapy
- C.
ESR is the most sensitive diagnostic test for GCA
- D.
An ESR of < 29 would be considered normal for Alphons
- E.
A normal ESR excludes GCA in Alphons' case
Correct Answer
D. An ESR of < 29 would be considered normal for AlphonsExplanation
A rule of thumb for the upper limit of ESR in men is half their age. ESR, although useful, is less sensitive than CRP and does not exclude GCA in patients with high clinical suspicion. Thrombocytosis is associated with GCA. Temporal artery biopsy findings are not affected by treatment if performed within 4 – 7 days of commencing steroids.Rate this question:
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- 39.
Alphons Wieczorek, 58 years of age, is a teacher who presents with sudden unilateral visual loss.Alphons suffers from migraines.You consider nonmigraine causes.Alphons has some concerning features suggestive of GCA.Alphons asks if he requires a CT scan. Which of the following examination features is not a commonly agreed indication for a CT brain and orbits:
- A.
Temporal artery tenderness
- B.
Proptosis
- C.
Papilloedema
- D.
Homonymous field defect
- E.
Eye movement disorders
Correct Answer
A. Temporal artery tendernessExplanation
Temporal artery tenderness is suggestive of GCA but is not an indication for a CT brain and orbits. The other examination features are considered indications for CT.Rate this question:
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- 40.
Sydney Bligh, 63 years of age, is a furniture importer with type 2 diabetes. He presents with sudden visual loss.You make a thorough assessment. Select the most accurate statement about fundoscopy:
- A.
Retinal pallor may indicate retinal detachment
- B.
Dilated vessels may indicate retinal artery occlusion
- C.
A cherry red macular is a normal finding
- D.
A cherry red macular may indicate papilloedema
- E.
Widespread nerve fibre layer haemorrhages may indicate retinal artery occlusion
Correct Answer
A. Retinal pallor may indicate retinal detachmentExplanation
Retinal pallor may indicate retinal detachment. Dilated vessels and widespread nerve fibre layer haemorrhages are typical of retinal vein occlusion. A cherry red macula indicated ischaemia.Rate this question:
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- 41.
Sydney Bligh, 63 years of age, is a furniture importer with type 2 diabetes. He presents with sudden visual loss.Haemorrhage is unlikely given that Sydney has no known proliferative retinopathy. However, it is an important differential diagnosis of sudden visual loss. Which of the following is true:
- A.
Vitreous haemorrhage typically produces a discrete black scotoma
- B.
Subhyaloid haemorrhage typically presents as a 'shower of black dots'
- C.
Subretinal haemorrhage typically presents as a discrete brown scotoma
- D.
Vitreous haemorrhage is typically painful
- E.
Subhyaloid haemorrhage typically produces a mobile scotoma
Correct Answer
C. Subretinal haemorrhage typically presents as a discrete brown scotomaExplanation
Subretinal, subhyaloid and retinal haemorrhage typically present as discrete, relatively fixed, red, brown or black scotoma. By contrast vitreous haemorrhage tends to be mobile and is often described as a ‘shower of black dots’. Haemorrhage is a painless cause of visual loss.Rate this question:
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- 42.
Sydney Bligh, 63 years of age, is a furniture importer with type 2 diabetes. He presents with sudden visual loss.If you diagnosed retinal artery occlusion, what investigation would be the first line for Sydney:
- A.
Transoesophageal echocardiogram
- B.
CT angiography
- C.
Fundus fluorscein angiography
- D.
CT brain and orbits
- E.
ESR and CRP
Correct Answer
E. ESR and CRPExplanation
In retinal artery occlusion it is essential to exclude GCA as an underlying cause. Transthoracic echo, vasculitis screen, fasting bloods and a BP reading would also be important. The other tests may be indicated but aren’t first line.Rate this question:
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- 43.
Sydney Bligh, 63 years of age, is a furniture importer with type 2 diabetes. He presents with sudden visual loss.You consider that retinal detachment is the most likely diagnosis in Sydney. Which of the following is true:
- A.
A 'curtain' descending over the visual field is typical
- B.
Central vision preservation requires especially urgent referral
- C.
The pupil must not be dilated as this will exacerbate the detachment
- D.
Urgent ultrasound imaging is essential for all patients
- E.
Detachment can be treated in the ophthalmology clinic with laser
Correct Answer
B. Central vision preservation requires especially urgent referralExplanation
Central vision indicates the macular is uninvolved so referral and repair is particularly urgent. Retinal detachment is often described as a curtain progressing from the side and requires urgent assessment and referral. Ultrasound is useful if there are media opacities such as cataract obscuring the view of the posterior segment. Retinal tears may be treated in ophthalmology clinic but detachment requires surgical repair.Rate this question:
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- 44.
Tony Romano, 70 years of age, is a retired taxi driver who presents for a renewal of his standard licence. During the assessment you find concerning visual impairment.Visual impairment is defined as:
- A.
Visual acuity worse than 6/12
- B.
Visual field of < 10 degrees or less in the better eye
- C.
Visual field of < 20 degrees or less in the better eye
- D.
A and B are correct
- E.
A and C are correct
Correct Answer
E. A and C are correctExplanation
Visual impairment is defined as visual acuity of worse than 6/12 and/or a visual field in the better eye of < 20 degrees or a homonymous hemianopia.Rate this question:
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- 45.
Tony Romano, 70 years of age, is a retired taxi driver who presents for a renewal of his standard licence. During the assessment you find concerning visual impairment.You consider cataract as a differential diagnosis for Tony's visual impairment. Which factors may be associated with cataract formation:
- A.
UV exposure is strongly associated with subcapsular cataract
- B.
UV exposure is strongly associated with cortical cataract
- C.
Corticosteroid use is strongly associated with cortical cataract
- D.
There is a strong association between smoking and nuclear sclreos
- E.
Diabetes is strongly associated with cortical cataract
Correct Answer
B. UV exposure is strongly associated with cortical cataractExplanation
There is a strong association between UV exposure and cortical cataract. There is an association between corticosteroid use, diabetes and trauma with subcapsular formation and only a weak association between smoking and nuclear sclerosis.Rate this question:
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- 46.
Tony Romano, 70 years of age, is a retired taxi driver who presents for a renewal of his standard licence. During the assessment you find concerning visual impairment.You also consider age related macular degeneration (ARMD). Select the best response:
- A.
Approximately 2% convert from dry to wet forms per year
- B.
Dry ARMD involves a choroidal neovascular membrane
- C.
Early ARMD causes distortion or scotoma of central vision
- D.
Wet ARMD involves gradual deterioration of the retinal pigment epithelium
- E.
Wet ARMD involves predominantly peripheral visual loss
Correct Answer
A. Approximately 2% convert from dry to wet forms per yearExplanation
Approximately 2% of ARMD convert from dry to wet forms per year. Early ARMD is asymptomatic and peripheral vision is typically preserved. Dry ARMD involves gradual deterioration of the retinal pigment epithelium with wet forms involving a choroidal neovascular membrane.Rate this question:
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- 47.
Tony Romano, 70 years of age, is a retired taxi driver who presents for a renewal of his standard licence. During the assessment you find concerning visual impairment.You confirm ARMD. Tony asks what his family could do to reduce their chances of this condition. You explain:
- A.
The Amsler grid helps to identify disease onset
- B.
Smoking increases the risk of ARMD 2 - 3 times
- C.
Dietary antioxidants have been shown to reduce risk
- D.
Zinc supplements have been shown to delay onset of ARMD
- E.
UV protection significantly reduces the risk of wet ARMD
Correct Answer
B. Smoking increases the risk of ARMD 2 - 3 timesExplanation
This question is about primary prevention and smoking is the only accepted risk factor increasing risk 2 – 3 fold. UV protection and omega-3 fatty acids may reduce risk. The Amsler grid may be useful for secondary monitoring of disease progression. Vitamins, zinc and pigment supplements may have a role in tertiary prevention.Rate this question:
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- 48.
Phillip Block, 19 years of age, is a football player who presents embarrassed about his sweaty, smelly feet.You consider a diagnosis of primary palmoplantar hyperhidrosis. Which of the following statements is a common diagnostic criteria:
- A.
Asymmetrical presentation - dominant side usually more affected
- B.
Persistence of sweating even during sleep
- C.
Persistence of sweating beyond 6 months
- D.
Onset typically after the age of 25 years
- E.
Does not impair daily activities
Correct Answer
C. Persistence of sweating beyond 6 monthsExplanation
In primary palmoplantar hyperhidrosis sweating is typically symmetrical, impairs daily activities, has onset before 25 years of age, and can occur for 6 months without apparent cause.Rate this question:
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- 49.
Phillip Block, 19 years of age, is a football player who presents embarrassed about his sweaty, smelly feet.You consider a diagnosis of primary palmoplantar hyperhidrosis.You consider investigation in Phillip's case. Which of the following is true about appropriate investigations:
- A.
No investigations are necessary in typical cases
- B.
Thyroid functions tests are required in all cases
- C.
Full blood count and examination is required in all cases
- D.
Chest x-ray is required in all cases
- E.
B and C are both correct
Correct Answer
A. No investigations are necessary in typical casesExplanation
In typical cases, history and examination is sufficient. If features are suggestive of secondary hyperhidrosis or atypical features are present, targeted investigation is required, including relevant imaging, FBE and TFTs.Rate this question:
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- 50.
Phillip Block, 19 years of age, is a football player who presents embarrassed about his sweaty, smelly feet.You consider a diagnosis of primary palmoplantar hyperhidrosis.You also consider a diagnosis of pitted keratosis. Select the appropriate statement about this condition:
- A.
Small pits are often present on the nails beds
- B.
There is often a characteristic 'cheesy' smell
- C.
It is due to a fungal infection of the stratum corneum
- D.
It is due to infection with Mycobacterium sedentarius
- E.
It is unrelated to the diagnosis of palmoplantar hyperhidrosis
Correct Answer
B. There is often a characteristic 'cheesy' smellExplanation
Pitted keratolysis can be an associated condition. It is due to bacterial infection of the stratum by Micrococcus sedentarius and is characterised by a cheesy smell and small pits over the web spaces and plantar surfaces.Rate this question:
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Quiz Review Timeline +
Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.
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Current Version
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Sep 13, 2016Quiz Edited by
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Jan 06, 2010Quiz Created by
Cjack
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