Wentwest Sgpe 1: Applied Knowledge Test Paper

40 Questions | Total Attempts: 250

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RACGP Applied Knowledge Test


Questions and Answers
  • 1. 
    A 5 year old boy has been suffering from constipation and soiling for many months.  His mother is concerned that something needs to be done before starting school.  He was born after a normal delivery and had no problems until the age of 2.  On examination he is well with the only finding of note a loaded colon.  Which of the following statements about constipation is true?
    • A. 

      A) Constipation in children may be a sign of systemic disease

    • B. 

      B) The parents can be reassured that he will grow out of his symptoms

    • C. 

      C) Hirshsprung’s disease always presents in the neonatal period

    • D. 

      D) The parents should be trained in the use of enemas to treat any recurrence early

    • E. 

      E) Stimulant laxatives are contraindicated in children

  • 2. 
    A 4 year old girl is brought in by her mother who is concerned that she has stopped growing.  She was born at term after a normal pregnancy and her height and weight were on the 50th centile.  On examination she appears well but her height and weight are both now on the 9th centile.  Which of the following statements about failure to thrive is not true?
    • A. 

      A) It always has an organic basis

    • B. 

      B) If it is caused by coeliac disease, it is usually associated with diarrhoea

    • C. 

      C) It may be caused by hyperthyroidism

    • D. 

      D) It may be caused by a urinary tract infection

    • E. 

      E) If it is caused by growth hormone deficiency, it is usually apparent only from 6 – 12 months

  • 3. 
    Geoff is a 76 year old patient of yours with glaucoma.  Which of the following statements would you advise him?
    • A. 

      A) Glaucoma is usually asymptomatic

    • B. 

      B) If he has raised intraocular pressure but no signs of glaucoma, he may be reassured

    • C. 

      C) It affects approximately 2% of the population

    • D. 

      D) Geoff’s treatment should aim to reduce the intraocular pressure and reverse any loss of visual field

    • E. 

      E) It is a disease of middle aged and elderly individuals

  • 4. 
    37 year old Sarah G2P1, 25 weeks gestation presents to you for a routine antenatal visit.  Which of the following medications is contraindicated in pregnancy?
    • A. 

      A) Penicillin V

    • B. 

      B) Codeine phosphate

    • C. 

      C) Ondansetron

    • D. 

      D) Insulin

    • E. 

      E) Fluconazole

  • 5. 
    35 year old Amanda presents with a 5 year history of increasingly painful periods with a more recent onset of deep dyspareunia.  She and her male partner have been trying to conceive for the last 2 years without success.  Which of the following is the most appropriate advice for her?
    • A. 

      A) She should be treated with a low dose of fluoxetine

    • B. 

      B) She should keep a food diary to try to identify any possible triggers

    • C. 

      C) Non steroidal agents may be effective during exacerbations of pain

    • D. 

      D) Lack of specific signs on examination suggests that her dyspareunia is psychological

    • E. 

      E) Laparoscopy is not indicated

  • 6. 
    24 year old Evangeline presents with a 2 day history of painful vesicular lesions on her labia.  You note that a routine STI screen done 3 months ago was normal for hepatitis B, hepatitis C, HIV, syphilis, Gonorrhoea and Chlamydia.  Which of the following advice would not be appropriate to give her?
    • A. 

      A) The first attack of this condition is usually the most painful

    • B. 

      B) It is unlikely to be an STI in view of her normal screen 3 months ago

    • C. 

      C) She could be treated with Aciclovir to reduce the severity and duration of the attack

    • D. 

      D) Aciclovir will not prevent future recurrence

    • E. 

      E) She should remain abstinent or her male partner should use barrier contraception until the condition has resolved

  • 7. 
    72 year old Mary has been a regular patient of yours for 10 years.  You diagnosed her with metastatic bowel cancer 6 months ago and you have looked after her palliative care since then.  You receive a call from her daughter (who is a nurse) whilst you are in your morning session at the practice saying that she has peacefully passed away 20 minutes ago.  Which of the following is the most appropriate next step in your management?
    • A. 

      A) Organise your registrar to attend and complete the death certificate as you have a fully booked morning session

    • B. 

      B) Organise an immediate ambulance to transfer the body to the morgue

    • C. 

      C) Attend to the body as soon as possible today and complete the death certificate

    • D. 

      D) Advise the daughter to certify the body straight away

    • E. 

      E) Advise the coroner of the death

  • 8. 
    45 year old John has recently started a new relationship and presents with a compliant of low libido.  On further questioning, he admits to feeling lethargic, weak and has noticed that he has less stubble than previously.  He takes no regular medication and is otherwise well.  He does not experience headaches.  Which of the following would be the most appropriate next investigation to order?
    • A. 

      A) MRI Brain

    • B. 

      B) Semen Analysis

    • C. 

      C) Depression screening

    • D. 

      D) Short Synacthen test

    • E. 

      E) FSH and testosterone levels

  • 9. 
    37 year old Corey presents with a lesion on her eyelid (see diagram below).  It is not painful.  What is the diagnosis?
    • A. 

      A) Cellulitis

    • B. 

      B) Conjunctivitis

    • C. 

      C) Chalazion

    • D. 

      D) Sebaceous cyst

    • E. 

      E) Basal cell carcinoma

  • 10. 
    57 year old Mason presents with an acutely swollen knee and difficulty flexing the joint after a fall.  He takes no regular medication and is otherwise well but slightly overweight.  Which of the following is true?
    • A. 

      A) He should be treated for a probable septic arthritis and reviewed in 1 week

    • B. 

      B) He may have an intra-articular fracture with a haemarthrosis

    • C. 

      C) He may have a haemarthrosis in which case he should be screened for haemophilia

    • D. 

      D) The injury is unlikely to cause permanent joint damage

    • E. 

      E) The joint should not be splinted because this prevents mobilisation

  • 11. 
     12 year old Emma presents with her mother.  She is embarrassed that she still has occasional nocturnal enuresis.  This has been going on since she was potty trained and happens on average once or twice a week.  She has tried fluid restriction, frequent waking and the enuresis alarm but to no effect.  Which of the following would you advise?
    • A. 

      A) The condition is more common in girls than boys

    • B. 

      B) Emma may be reassured that no further tests or treatments are necessary and that she will grow out of the condition in time

    • C. 

      C) She should have her urine tested

    • D. 

      D) Desmopressin is an effective long term treatment

    • E. 

      E) It is likely to settle with the onset of menarche

  • 12. 
    17 year old Joel presents with a 2 day history of dysuria and discharge from his penis.  He has no other significant past history.  Results of a urethral swab and MSU show a few pus cells but no growth on either specimen.  What is the most likely diagnosis?
    • A. 

      A) Gonorrhoea

    • B. 

      B) Chronic prostatits

    • C. 

      C) Non specific urethritis

    • D. 

      D) Urinary tract infection

    • E. 

      E) Balanitis xerotica obliterans

  • 13. 
    56 year old Josephine presents with a chronic rash on her face which she tends to cover with heavy applications of makeup.  She also describes recurrent conjunctivitis and itchy eyes.  On examination she has papules and pustules over her cheeks and forehead.  What is the most likely diagnosis?
    • A. 

      A) Systemic lupus erythematosus

    • B. 

      B) Acne vulgaris

    • C. 

      C) Rosacea

    • D. 

      D) Dermatitis herpetiformis

    • E. 

      E) Allergic contact dermatitis

  • 14. 
    61 year old Jacqui complains that her periods have started again after 4 years off HRT.  She has just finished a 5 day period.  She is otherwise well apart from well controlled type II diabetes and asthma.  Abdominal and pelvic examination is normal.  Which of the following is the next most appropriate step in management?
    • A. 

      A) Refer urgently for a gynaecologist review

    • B. 

      B) Advise a pelvic ultrasound after her next period

    • C. 

      C) Refer for a colonoscopy to exclude bowel pathology as a cause of her symptoms

    • D. 

      D) Perform a cervical smear with HPV typing

    • E. 

      E) Perform an urgent FBE

  • 15. 
    41 year old James has a history of gallstones and recurrent episodes of biliary colic.  He is currently on the public hospital waiting list for a cholecystectomy.  He presents with a sudden onset of upper abdominal pain radiating through to the back and associated with vomiting.  He states that the pain is different to his usual biliary colic attacks.  Examination reveals upper abdominal tenderness.  Which of the following is the most likely diagnosis?
    • A. 

      A) Acute pancreatitis

    • B. 

      B) Hiatus hernia

    • C. 

      C) Gastroenteritis

    • D. 

      D) Abdominal aortic aneurysm

    • E. 

      E) Coeliac disease

  • 16. 
    A 33 year old patient presents with a rash on her arms and trunk.  She is otherwise well and has no other symptoms.  She takes no regular medications.  On examination she has a target like rash with central pallor.  Which of the following is not a cause of this rash?
    • A. 

      A) Aspirin

    • B. 

      B) Vitamin deficiency

    • C. 

      C) Mycoplasma infection

    • D. 

      D) Ulcerative colitis

    • E. 

      E) Herpes zoster

  • 17. 
    You receive a phonecall from a residential care facility which you look after stating that one of your patients 72 year old Max, has been unable to pass urine for the last 12 hours.  On arrival he has a tender bladder palpable to his umbilicus.  The nurse advises that Max was complaining of dysuria yesterday.  Which of the following is true of his diagnosis and management?
    • A. 

      A) He has urinary retention precipitated by a UTI and should have an indwelling catheter inserted

    • B. 

      B) He has urinary retention precipitated by acute prostatic obstruction and should have a suprapubic catheter inserted

    • C. 

      C) He has urinary retention and should have a suprapubic catheter inserted due to the likely presence of a UTI

    • D. 

      D) He has acute urinary retention most likely caused by constipation and should have a fleet enema

    • E. 

      E) He has urinary retention secondary to neurogenic bladder and should have an urgent CT lumbosacral spine

  • 18. 
    23 year old Domengo is a foreign student from Italy who has recently arrived in Australia to pursue a university degree in hospitality.  He presents with a 1 week history of intense itching on fingers, wrists and arms.  He says that this is worse at night and after showering.  On examination he has extensive scratch marks and papules with raised white lines in the skin.  He has no previous history and takes no regular medications.  Which of the following is the most likely diagnosis?
    • A. 

      A) Pemphigus

    • B. 

      B) Pompholyx

    • C. 

      C) Scabies

    • D. 

      D) Dermatitis artefacta

    • E. 

      E) IgE hypersensitivity

  • 19. 
    A 35 year old asylum seeker registers at your practice.  He presents with a 6 month history of weight loss, night sweats and cough with occasional haemoptysis.  On examination he has erythema nodosum and reduced air entry in his R mid zone, with dullness to percussion over this area.  He has no previous history of note and has no risk factors for HIV.  Which of the following is the likely diagnosis?
    • A. 

      A) Tuberculosis

    • B. 

      B) Pneumocystis carinii pneumonia

    • C. 

      C) Bronchopneumonia

    • D. 

      D) Lung cancer

    • E. 

      E) Sarcoidosis

  • 20. 
    A 67 year old woman presents with a lump in front of her neck.  She thinks that this has been present for only a few months.  She has no other symptoms and does not take any regular medications.  Examination reveals a smooth non tender lump that moves on swallowing.  Which of the following is true?
    • A. 

      A) TFTs should be performed. If they are normal no further action is necessary at this time. However TFTs should be repeated on a regular basis to detect hypothyroidism or hyperthyroidism

    • B. 

      B) If TFTs show a raised TSH, she should be started on Thyroxine and have TFTs repeated in 3 months to assess effect

    • C. 

      C) She should be referred for specialist review

    • D. 

      D) She is in the acute phase of Hashimoto’s thyroiditis and can be reassured

    • E. 

      E) If she is clinically euthyroid this is most probably a physiological goitre

  • 21. 
    48 year old Tony has a history of poorly controlled type 2 diabetes with sudden onset of visual loss.  You suspect a vitreous haemorrhage.  Which of the following examination findings would be consistent with this?
    • A. 

      A) Loss of red reflex, reduced visual acuity in the affected eye, blood in the posterior chamber of the affected eye

    • B. 

      B) Loss of pupillary reflex in contralateral eye, reduced visual acuity in the affected eye, blood in the posterior chamber of the affected eye

    • C. 

      C) AV nipping, blot haemorrhages and flame haemorrhages

    • D. 

      D) Reduced visual acuity in the affected eye, blood in the anterior chamber of the affected eye, loss of pupillary reflex in the contralateral eye

    • E. 

      E) Splinter haemorrhages, loss of red reflex and blurring of the optic disc

  • 22. 
    87 year old Richard presents for his 3rd ear syringe this year.  He complains that this is becoming too frequent an occurrence.  Which of the following statements would you advise him?
    • A. 

      A) Repeated wax accumulation suggests local ear disease for which he should be actively investigated

    • B. 

      B) Wax impaction is asymptomatic

    • C. 

      C) Wax impaction may be the result of hearing aid use

    • D. 

      D) Any patient presenting with ear wax should have ear syringing

    • E. 

      E) Ear wax drops should be ceased at least 2 weeks prior to ear syringing

  • 23. 
    74 year old Morton presents for his annual diabetic review.  He mentions that he has been getting increasing pain in his calves on walking over the last 6 months such that he can now only walk 50m without stopping.  Examination reveals poor peripheral pulses and sluggish capillary return.  Which of the following is the most likely diagnosis?
    • A. 

      A) DVTs

    • B. 

      B) Spinal canal stenosis

    • C. 

      C) Multiple myeloma

    • D. 

      D) Peripheral vascular disease

    • E. 

      E) Age related changes

  • 24. 
    You are playing squash with your 55 year old senior partner when he yells out and collapses to the floor clutching his left ankle.  After some minutes he is able to stand but cannot easily move his foot.  Which of the following statements is true about his injury?
    • A. 

      A) Achilles’ tendonitis usually presents in this way

    • B. 

      B) A partial tear will usually show no signs on examination other than tenderness and a swelling in the mid tendon

    • C. 

      C) MRI would be the investigation of 1st choice

    • D. 

      D) Complete ruptures should always be treated surgically

    • E. 

      E) Partial tears should always be treated because of the risk of developing a full tear

  • 25. 
    19 year old Sam presents with a 2 month history of cold fingers and toes.  She tells you that every time she gets this, her fingers go white, then purple and then return to normal.  She is otherwise well and takes no regular medications.  Which of the following is true?
    • A. 

      A) She should be referred immediately to the rheumatologist

    • B. 

      B) It is a contraindication to the COCP

    • C. 

      C) It is more common in men

    • D. 

      D) It may be associated with oesophageal disease

    • E. 

      E) It is caused by nutritional vitamin D deficiency

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