Wentwest SGPe 2: Mock Written Exam

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. It may be seen as a sexually transmitted infection

• B. Secondary infection may cause lesions to become pustular

• C. It should always be treated

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

• E. Typically it resolves spontaneously over 3 – 18 months

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. It may be caused by cat scratch disease

• B. Patients should have a CXR as routine investigation

• C. NSAIDs may provide symptomatic relief

• D. It may be caused by the oral contraceptive pill

• E. It is usually a sign of underlying malignancy

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. Lipoma

• B. Neurofibromatosis

• C. Dercum’s disease

• D. Gouty tophi

• E. Rheumatoid nodule

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. Nephrotic syndrome

• B. Angio-oedema

• C. Wilm’s tumour

• D. Urinary tract infection

• E. Haemolytic uraemic syndrome

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

• A. Hammer toe

• B. Morton’s neuroma

• C. Gout

• D. Bunion

• E. Plantar fasciitis

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. Pupil on the affected side reacts normally to light

• B. Retina appears engorged on fundoscopy

• C. Visual field loss always affects the entire visual field

• D. Fundoscopy reveals a bright red spot at the macula

• E. Acuity is usually well preserved initially

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. It seldom persists for more than 72 hours

• B. It may cause septicaemia

• C. It should be treated with loperamide

• D. It is usually acquired through eating chicken

• E. It is a normal commensal in the human bowel

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

• A. Dizziness

• B. Otorrhoea

• C. Deafness

• D. Facial nerve Palsy

• E. Rhinorrhoea

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. The most likely diagnosis is septic arthritis

• B. The patient is suffering from pseudogout

• C. This condition may be a result of warfarin therapy

• D. XR of the knee is essential in diagnosis

• E. Gout is the likely diagnosis

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. Rosacea

• B. Pityriasis rosea

• C. Pityriasis versicolor

• D. Pityriasis alba

• E. Seborrhoeic dermatitis

• F. Eczema

• G. Guttate psoriasis

• H. Secondary syphilis

• I. Erythema multiforme

• J. Erythema nodosum

• K. Folliculitis

• L. Acne

• M. Psoriasis

• N. Discoid eczema

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

• A. Rosacea

• B. Pityriasis rosea

• C. Pityriasis versicolor

• D. Pityriasis alba

• E. Seborrhoeic dermatitis

• F. Eczema

• G. Guttate psoriasis

• H. Secondary syphilis

• I. Erythema multiforme

• J. Erythema nodosum

• K. Folliculitis

• L. Acne

• M. Psoriasis

• N. Discoid eczema

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. Rosacea

• B. Pityriasis rosea

• C. Pityriasis versicolor

• D. Pityriasis alba

• E. Seborrhoeic dermatitis

• F. Eczema

• G. Guttate psoriasis

• H. Secondary syphilis

• I. Erythema multiforme

• J. Erythema nodosum

• K. Folliculitis

• L. Acne

• M. Psoriasis

• N. Discoid eczema

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. Acute pericarditis

• B. Angina

• C. Aortic dissection

• D. Costochondritis

• E. Gastrooesophageal reflux

• F. Myocardial infarction

• G. Panic attack

• H. Pleurisy

• I. Pneumothorax

• J. Pulmonary embolus

• K. Pancreatitis

• L. Thoracic facet joint dysfunction

• M. Cardiac failure

• N. Oesophageal spasm

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. Acute pericarditis

• B. Angina

• C. Aortic dissection

• D. Costochondritis

• E. Gastrooesophageal reflux

• F. Myocardial infarction

• G. Panic attack

• H. Pleurisy

• I. Pneumothorax

• J. Pulmonary embolus

• K. Pancreatitis

• L. Thoracic facet joint dysfunction

• M. Cardiac failure

• N. Oesophageal spasm

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.

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.

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.

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.

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.

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.

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.

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.

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.

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?

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.

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.

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?

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.

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.

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.

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.

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.

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.

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.