Wentwest Sgpe 2: Mock Written Exam

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Wentwest Sgpe 2: Mock Written Exam - Quiz


In this mock examination for the Wentwest SGPE, we’ll be covering such medical topics and scenarios like epiglottis, lesions, tonsillitis, loss of vision, diarrhoea, cholesteatoma and many more. What can you tell us about these conditions?


Questions and Answers
  • 1. 

    Which of the following are NOT features of epiglottitis?

    • A.

      A. The patient is usually aged 2 – 6 years

    • B.

      B. The patient is unwell and looks septic

    • C.

      C. The voice is muffled

    • D.

      D. There is drooling

    • E.

      E. It is exclusively seen in children

    Correct Answer
    E. E. It is exclusively seen in children
    Explanation
    Epiglottitis is a condition characterized by inflammation of the epiglottis, a flap of tissue that prevents food from entering the airway during swallowing. It is commonly seen in children aged 2-6 years, as mentioned in option a. The patient with epiglottitis appears unwell and septic, as stated in option b. The voice becomes muffled due to the swelling of the epiglottis, as mentioned in option c. Drooling is also a common symptom of epiglottitis, as stated in option d. However, epiglottitis can also occur in adults, so it is not exclusively seen in children, as mentioned in option e.

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  • 2. 

    5 year old Tamara presents with warts on her eyelids.  On examination, she has firm umbilicated papules on her face and eyelids.  Which of the following statements about molluscum contagiosum is NOT true?

    • A.

      A. It may be seen as a sexually transmitted infection

    • B.

      B. Secondary infection may cause lesions to become pustular

    • C.

      C. It should always be treated

    • D.

      D. Those infected should use separate towels to prevent spread to other family members

    • E.

      E. Typically it resolves spontaneously over 3 – 18 months

    Correct Answer
    C. C. It should always be treated
    Explanation
    Molluscum contagiosum is a viral infection that commonly affects children. It is usually spread through direct skin-to-skin contact or contact with contaminated objects. While treatment may be recommended to prevent the spread of the infection or to alleviate symptoms, it is not always necessary. In many cases, molluscum contagiosum resolves on its own within 3 to 18 months. Therefore, the statement that it should always be treated is not true.

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  • 3. 

    21 year old Michael presents with a 1 week history of tender lumps on his shins (see picture).  He is otherwise fit and well and takes no regular medication.  Which of the following is NOT true of this condition?

    • A.

      A. It may be caused by cat scratch disease

    • B.

      B. Patients should have a CXR as routine investigation

    • C.

      C. NSAIDs may provide symptomatic relief

    • D.

      D. It may be caused by the oral contraceptive pill

    • E.

      E. It is usually a sign of underlying malignancy

    Correct Answer
    E. E. It is usually a sign of underlying malignancy
    Explanation
    The correct answer is e. It is usually a sign of underlying malignancy. This means that tender lumps on the shins, as seen in the picture, are not typically associated with underlying malignancy.

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  • 4. 

    33 year old Jack has had the following lesion since childhood.  He has multiple simple lesions elsewhere in the body as well as macular patches on his arms and legs.  What is the diagnosis?

    • A.

      A. Lipoma

    • B.

      B. Neurofibromatosis

    • C.

      C. Dercum’s disease

    • D.

      D. Gouty tophi

    • E.

      E. Rheumatoid nodule

    Correct Answer
    B. B. Neurofibromatosis
    Explanation
    Jack's presentation of multiple simple lesions elsewhere in the body, as well as macular patches on his arms and legs, is consistent with the diagnosis of neurofibromatosis. Neurofibromatosis is a genetic disorder that causes tumors to form on nerve tissue, leading to the development of multiple skin lesions and macular patches. Lipoma, Dercum's disease, gouty tophi, and rheumatoid nodule do not typically present with these specific characteristics.

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  • 5. 

    3 year old Tom was diagnosed and treated 5 days ago with tonsillitis.  He is brought in today by his mother with puffiness around the eyes over the last 3 days.  He seems well in himself and his mother is concerned that he may have hayfever.  Examination reveals ankle oedema but he is otherwise well.  Dipstick urine shows protein 4+ and blood 1+.  What is the most likely diagnosis?

    • A.

      A. Nephrotic syndrome

    • B.

      B. Angio-oedema

    • C.

      C. Wilm’s tumour

    • D.

      D. Urinary tract infection

    • E.

      E. Haemolytic uraemic syndrome

    Correct Answer
    A. A. Nephrotic syndrome
    Explanation
    The most likely diagnosis in this case is nephrotic syndrome. The presence of puffiness around the eyes, ankle edema, and significant proteinuria (4+) on the urine dipstick are all suggestive of nephrotic syndrome. Nephrotic syndrome is a kidney disorder characterized by increased permeability of the glomerular filtration barrier, leading to excessive loss of protein in the urine. This can result in edema, particularly around the eyes and ankles. The presence of blood (1+) on the urine dipstick may be indicative of glomerular damage. This condition is more common in children and is often associated with infections, such as tonsillitis.

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  • 6. 

    40 year old Jo presents with a 2 week history of sharp pain radiating into the toes with walking.  Examination reveals tenderness between the 3rd and 4th metatarsals.  What is the most likely diagnosis?

    • A.

      A. Hammer toe

    • B.

      B. Morton’s neuroma

    • C.

      C. Gout

    • D.

      D. Bunion

    • E.

      E. Plantar fasciitis

    Correct Answer
    B. B. Morton’s neuroma
    Explanation
    The most likely diagnosis for Jo's symptoms is Morton's neuroma. Morton's neuroma is a condition characterized by sharp pain radiating into the toes, typically between the 3rd and 4th metatarsals. This condition is caused by a thickening of the tissue around the nerves leading to the toes, often due to repetitive stress or compression. The tenderness between the 3rd and 4th metatarsals seen on examination further supports this diagnosis. Hammer toe, gout, bunion, and plantar fasciitis do not typically present with the same symptoms or tenderness in this specific location.

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  • 7. 

    65 year Sue presents with a sudden painless loss of vision in one eye.  Which of the following would be consistent with a diagnosis of central retinal artery occlusion?

    • A.

      A. Pupil on the affected side reacts normally to light

    • B.

      B. Retina appears engorged on fundoscopy

    • C.

      C. Visual field loss always affects the entire visual field

    • D.

      D. Fundoscopy reveals a bright red spot at the macula

    • E.

      E. Acuity is usually well preserved initially

    Correct Answer
    D. D. Fundoscopy reveals a bright red spot at the macula
    Explanation
    Central retinal artery occlusion is a condition where there is a blockage in the main artery that supplies blood to the retina. This sudden loss of blood flow can lead to ischemia and damage to the retina. Fundoscopy, which involves examining the back of the eye, reveals a bright red spot at the macula in central retinal artery occlusion. This is known as a cherry red spot and is caused by the contrast between the pale retina and the red choroid. The other options are not consistent with a diagnosis of central retinal artery occlusion.

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  • 8. 

    25 year old Joe works as a carer for the disabled.  He presents with a 3 day history of profuse diarrhoea, fever and abdominal cramps.  Stool culture reveals campylobacter infection.  Which of the following is true?

    • A.

      A. It seldom persists for more than 72 hours

    • B.

      B. It may cause septicaemia

    • C.

      C. It should be treated with loperamide

    • D.

      D. It is usually acquired through eating chicken

    • E.

      E. It is a normal commensal in the human bowel

    Correct Answer
    D. D. It is usually acquired through eating chicken
    Explanation
    Campylobacter infection is usually acquired through eating contaminated poultry, particularly chicken. This is because poultry, such as chicken, can carry the bacteria without showing any signs of illness. Therefore, consuming undercooked or contaminated chicken can lead to Campylobacter infection. The other options are not true based on the given information.

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  • 9. 

    43 year old Geoffrey has been diagnosed with a cholesteatoma.  Which of the following is not a typical symptom?

    • A.

      A. Dizziness

    • B.

      B. Otorrhoea

    • C.

      C. Deafness

    • D.

      D. Facial nerve Palsy

    • E.

      E. Rhinorrhoea

    Correct Answer
    E. E. Rhinorrhoea
    Explanation
    Rhinorrhoea, or a runny nose, is not a typical symptom of cholesteatoma. Cholesteatoma is a noncancerous growth of skin cells in the middle ear behind the eardrum. Typical symptoms include dizziness, otorrhoea (ear discharge), deafness, and facial nerve palsy (weakness or paralysis of the facial muscles). Rhinorrhoea is more commonly associated with conditions affecting the nose and sinuses, rather than the middle ear.

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  • 10. 

    63 year Neville is normally well with no significant past history.  He presents with a 24 hour history of an acutely swollen, red and painful left knee.  On examination, he is afebrile and aspiration of the knee effusion reveals slightly turbid fluid.  On microscopy calcium pyrophosphate crystals are seen.  Which of the following is true of this condition?

    • A.

      A. The most likely diagnosis is septic arthritis

    • B.

      B. The patient is suffering from pseudogout

    • C.

      C. This condition may be a result of warfarin therapy

    • D.

      D. XR of the knee is essential in diagnosis

    • E.

      E. Gout is the likely diagnosis

    Correct Answer
    B. B. The patient is suffering from pseudogout
    Explanation
    The patient's presentation of an acutely swollen, red, and painful knee, along with the presence of calcium pyrophosphate crystals on microscopy, is consistent with pseudogout. Pseudogout is a form of arthritis caused by the deposition of calcium pyrophosphate crystals in the joints. The absence of fever and the slightly turbid fluid on aspiration suggest that the condition is not septic arthritis. There is no mention of warfarin therapy or gout in the patient's history or presentation. Therefore, the most likely diagnosis in this case is pseudogout.

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  • 11. 

    20 year Elisa presents with a history of a rash for 2 weeks. It initially started with a singular lesion on the torso and has now spread to also involve the upper limbs. It is mildly itchy but she is otherwise well.

    • A.

      A. Rosacea

    • B.

      B. Pityriasis rosea

    • C.

      C. Pityriasis versicolor

    • D.

      D. Pityriasis alba

    • E.

      E. Seborrhoeic dermatitis

    • F.

      F. Eczema

    • G.

      G. Guttate psoriasis

    • H.

      H. Secondary syphilis

    • I.

      I. Erythema multiforme

    • J.

      J. Erythema nodosum

    • K.

      K. Folliculitis

    • L.

      L. Acne

    • M.

      M. Psoriasis

    • N.

      N. Discoid eczema

    Correct Answer
    B. B. Pityriasis rosea
    Explanation
    The patient's presentation of a rash that started with a singular lesion and spread to involve the upper limbs, along with mild itchiness and overall well-being, is consistent with the diagnosis of pityriasis rosea. Pityriasis rosea is a common skin condition characterized by a herald patch, which is a single larger lesion that appears first, followed by smaller lesions that spread in a Christmas tree pattern. The rash is typically mildly itchy and resolves on its own within a few weeks to months.

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  • 12. 

    18 year old Carey presents with an acute eruption on his hands and palms over the last 72 hours.

    • A.

      A. Rosacea

    • B.

      B. Pityriasis rosea

    • C.

      C. Pityriasis versicolor

    • D.

      D. Pityriasis alba

    • E.

      E. Seborrhoeic dermatitis

    • F.

      F. Eczema

    • G.

      G. Guttate psoriasis

    • H.

      H. Secondary syphilis

    • I.

      I. Erythema multiforme

    • J.

      J. Erythema nodosum

    • K.

      K. Folliculitis

    • L.

      L. Acne

    • M.

      M. Psoriasis

    • N.

      N. Discoid eczema

    Correct Answer
    I. I. Erythema multiforme
    Explanation
    Carey's acute eruption on his hands and palms over the last 72 hours suggests a possible diagnosis of erythema multiforme. Erythema multiforme is a skin condition characterized by the sudden onset of red, target-like lesions on the skin, typically affecting the hands and extremities. It can be triggered by various factors such as infections, medications, or allergic reactions. The timing and presentation of Carey's symptoms align with erythema multiforme, making it the most likely diagnosis.

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  • 13. 

    24 year old Kumar presents with an acute eruption on his torso, neck and upper arms.  He seems to remember getting it the same time last year during summer.

    • A.

      A. Rosacea

    • B.

      B. Pityriasis rosea

    • C.

      C. Pityriasis versicolor

    • D.

      D. Pityriasis alba

    • E.

      E. Seborrhoeic dermatitis

    • F.

      F. Eczema

    • G.

      G. Guttate psoriasis

    • H.

      H. Secondary syphilis

    • I.

      I. Erythema multiforme

    • J.

      J. Erythema nodosum

    • K.

      K. Folliculitis

    • L.

      L. Acne

    • M.

      M. Psoriasis

    • N.

      N. Discoid eczema

    Correct Answer
    C. C. Pityriasis versicolor
    Explanation
    The correct answer is c. Pityriasis versicolor. Pityriasis versicolor is a common fungal infection of the skin caused by the yeast Malassezia. It typically presents as small, scaly patches that can be lighter or darker than the surrounding skin. The eruption tends to occur during the summer months and is more common in young adults. This matches the patient's presentation of an acute eruption on the torso, neck, and upper arms, with a history of getting it at the same time last year during summer.

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  • 14. 

    44 year old Murray presents with a 2 day history of sharp pleuritic chest pain which is relieved by leaning forwards.  He has no cardiac risk factors.  ECG shows ST elevation across all leads.

    • A.

      A. Acute pericarditis

    • B.

      B. Angina

    • C.

      C. Aortic dissection

    • D.

      D. Costochondritis

    • E.

      E. Gastrooesophageal reflux

    • F.

      F. Myocardial infarction

    • G.

      G. Panic attack

    • H.

      H. Pleurisy

    • I.

      I. Pneumothorax

    • J.

      J. Pulmonary embolus

    • K.

      K. Pancreatitis

    • L.

      L. Thoracic facet joint dysfunction

    • M.

      M. Cardiac failure

    • N.

      N. Oesophageal spasm

    Correct Answer
    A. A. Acute pericarditis
    Explanation
    Murray's presentation of sharp pleuritic chest pain that is relieved by leaning forwards suggests acute pericarditis. This condition is characterized by inflammation of the pericardium, the membrane surrounding the heart. The sharp chest pain is typically worsened by deep breathing or lying flat and is relieved by sitting up or leaning forwards. The absence of cardiac risk factors and the presence of ST elevation across all leads on the ECG further support the diagnosis of acute pericarditis.

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  • 15. 

    70 year old Marius presents with a sudden onset of tearing central chest pain through to the back.  On examination he is hypotensive with weak asymmetrical radial pulses.

    • A.

      A. Acute pericarditis

    • B.

      B. Angina

    • C.

      C. Aortic dissection

    • D.

      D. Costochondritis

    • E.

      E. Gastrooesophageal reflux

    • F.

      F. Myocardial infarction

    • G.

      G. Panic attack

    • H.

      H. Pleurisy

    • I.

      I. Pneumothorax

    • J.

      J. Pulmonary embolus

    • K.

      K. Pancreatitis

    • L.

      L. Thoracic facet joint dysfunction

    • M.

      M. Cardiac failure

    • N.

      N. Oesophageal spasm

    Correct Answer
    C. C. Aortic dissection
    Explanation
    The sudden onset of tearing central chest pain through to the back, along with hypotension and weak asymmetrical radial pulses, is highly suggestive of aortic dissection. Aortic dissection occurs when there is a tear in the inner layer of the aorta, causing blood to flow between the layers and potentially leading to life-threatening complications. This presentation requires immediate medical attention and intervention.

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  • 16. 

    KEY FEATURE PROBLEM 1 You receive a phone call from the funeral director stating that your patient Mary Brown aged 82, has died at home.  The funeral director requests that you complete the death certificate. Question 1:  List 4 circumstances when you need to notify the coroner and cannot fill out a death certificate for one of your patients who has died.

  • 17. 

    KEY FEATURE PROBLEM 1 You receive a phone call from the funeral director stating that your patient Mary Brown aged 82, has died at home.  The funeral director requests that you complete the death certificate. Question 2: What devices must be documented on a cremation certificate as not being present with the body, else cremation may be refused by the crematorium?  List 2.

  • 18. 

    KEY FEATURE PROBLEM 1 You receive a phone call from the funeral director stating that your patient Mary Brown aged 82, has died at home.  The funeral director requests that you complete the death certificate. Question 3:  Mary’s husband Robert 86 years presents 1 week following Mary’s death.  List 4 aspects that should be assessed to determine if Bob is safe to remain living alone at home.

  • 19. 

    KEY FEATURE PROBLEM 1 You receive a phone call from the funeral director stating that your patient Mary Brown aged 82, has died at home.  The funeral director requests that you complete the death certificate. Question 4:  Name 1 service that may help you perform an assessment of Robert’s needs.

  • 20. 

    KEY FEATURE PROBLEM 2 Mary 57 years old presents to your practice following a dog bite on her L calf.  The wound is shallow and after cleaning and dressing the wound you offer her a tetanus injection. Question 1: Apart from a bite, what are the indications for an ADT?  List 3.

  • 21. 

    KEY FEATURE PROBLEM 2 Mary 57 years old presents to your practice following a dog bite on her L calf.  The wound is shallow and after cleaning and dressing the wound you offer her a tetanus injection. Question 2:  List one contraindication to the ADT vaccine.

  • 22. 

    KEY FEATURE PROBLEM 2 Mary 57 years old presents to your practice following a dog bite on her L calf.  The wound is shallow and after cleaning and dressing the wound you offer her a tetanus injection. Question 3: What adverse effects of an ADT vaccination would you advise Mary?  List 3.

  • 23. 

    KEY FEATURE PROBLEM 3 56 year old Roger presents to you as an emergency with 2 hours of epigastric pain.  It is constant, severe and associated with nausea.  Roger states that he had eaten hot chips 30 minutes prior the onset of the pain and the pain is usually triggered by food.  On examination, Roger is afebrile and tender to palpation in the epigastrium but has no guarding or rigidity. Question 1:  What other questions would you want to elicit on history?  List 4.

  • 24. 

    KEY FEATURE PROBLEM 3 56 year old Roger presents to you as an emergency with 2 hours of epigastric pain.  It is constant, severe and associated with nausea.  Roger states that he had eaten hot chips 30 minutes prior the onset of the pain and the pain is usually triggered by food.  On examination, Roger is afebrile and tender to palpation in the epigastrium but has no guarding or rigidity. Question 2:  List your 4 main differential diagnoses.

  • 25. 

    KEY FEATURE PROBLEM 3 56 year old Roger presents to you as an emergency with 2 hours of epigastric pain.  It is constant, severe and associated with nausea.  Roger states that he had eaten hot chips 30 minutes prior the onset of the pain and the pain is usually triggered by food.  On examination, Roger is afebrile and tender to palpation in the epigastrium but has no guarding or rigidity. Question 3:  What first line investigations would you order to determine your diagnosis?

  • 26. 

    KEY FEATURE PROBLEM 4 30 year old Sarah presents with a history of bilateral diffuse breast discomfort 2 days preceding her menstrual period.  She states that this has occurred at the same time during the last 3 cycles and resolves with the onset of her period.  She is in the middle of her cycle at present and is painfree. Question 1: What other aspects of history would you cover with Sarah?  List 4.

  • 27. 

    KEY FEATURE PROBLEM 4 30 year old Sarah presents with a history of bilateral diffuse breast discomfort 2 days preceding her menstrual period.  She states that this has occurred at the same time during the last 3 cycles and resolves with the onset of her period.  She is in the middle of her cycle at present and is painfree. Question 2: What specific features on physical examination would you look for?  List 4.

  • 28. 

    KEY FEATURE PROBLEM 4 30 year old Sarah presents with a history of bilateral diffuse breast discomfort 2 days preceding her menstrual period.  She states that this has occurred at the same time during the last 3 cycles and resolves with the onset of her period.  She is in the middle of her cycle at present and is painfree. Question 3:  Further history is insignificant and examination is normal.  What is your most likely diagnosis?

  • 29. 

    KEY FEATURE PROBLEM 4 30 year old Sarah presents with a history of bilateral diffuse breast discomfort 2 days preceding her menstrual period.  She states that this has occurred at the same time during the last 3 cycles and resolves with the onset of her period.  She is in the middle of her cycle at present and is painfree. Question 4: What management would you advise Sarah?  List 4 management options.

  • 30. 

    KEY FEATURE PROBLEM 5 6 year old Jonathan presents with his mother who is concerned about a midline neck lump that appears to be enlarging over the last few months.  Question 1: What is your differential diagnosis?  List 3.

  • 31. 

    KEY FEATURE PROBLEM 5 6 year old Jonathan presents with his mother who is concerned about a midline neck lump that appears to be enlarging over the last few months.  Question 2:  What further questions on history would you want to ascertain?  List 4.

  • 32. 

    KEY FEATURE PROBLEM 5 6 year old Jonathan presents with his mother who is concerned about a midline neck lump that appears to be enlarging over the last few months.  Question 3: What features on examination would you elicit?  List 4.

  • 33. 

    KEY FEATURE PROBLEM 5 6 year old Jonathan presents with his mother who is concerned about a midline neck lump that appears to be enlarging over the last few months.  Question 4: Name the investigation that is most likely to assist you in reaching a diagnosis.

  • 34. 

    KEY FEATURE PROBLEM 6 52 year old Neville is a regular patient of yours.  You diagnosed him with hypertension 18 months ago and started him on an ACEI (Coversyl ) as lifestyle modification had not made any difference.  Neville had obtained reasonable control of his hypertension with this medication, with his last BP readings being 120/80 and 125/75 over the last 6 months.  He presents to you concerned that his blood pressure readings at home have been much higher than usual in the last week with readings of 150/100 and 145/95.  Neville is otherwise well with some mild osteoarthritis which he manages with OTC medications from the pharmacist.  Question 1:  List 5 aspects of history that you would ascertain to determine the cause of his BP rise.

  • 35. 

    KEY FEATURE PROBLEM 6 52 year old Neville is a regular patient of yours.  You diagnosed him with hypertension 18 months ago and started him on an ACEI (Coversyl ) as lifestyle modification had not made any difference.  Neville had obtained reasonable control of his hypertension with this medication, with his last BP readings being 120/80 and 125/75 over the last 6 months.  He presents to you concerned that his blood pressure readings at home have been much higher than usual in the last week with readings of 150/100 and 145/95.  Neville is otherwise well with some mild osteoarthritis which he manages with OTC medications from the pharmacist.  Question 2:  You notice that Neville’s creatinine on a blood test done last week has increased from 0.07mmol/ L six months ago to 0.13 mmol/ L (normal limit 0.06 – 0.12mmol/L).  List 2 possible causes for this.

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