Question 1 Tom, aged 18 years, presents with a typical first episode of schizophrenia.
Which of the following antipsychotic medications is the treatment of choice for him? a) b) c) d) e) chlorpromazine haloperidol thioridazine olanzapine clozapine Incorrect. The correct answer is (d).
Olanzapine, risperidone and quetiapine are three of the new so-called atypical antipsychotic medications. These are now preferred (over traditional antipsychotic drugs like chlorpromazine, haloperidol and thioridazine) as first line therapy in first episode schizophrenia, because of improved efficacy and reduced incidence of psychomotor retardation, a well-known and troubling side effect of these medications. Clozapine is an atypical antipsychotic drug recommended for schizophrenic patients who prove resistant to other antipsychotic medications. (Murtagh J., (2003), General Practice, McGraw-Hill, Sydney, p 498-500 ) (Harrison's Online Available: www.accessmedicine.com/content.aspx?aID=109485 Question 2 Pete, aged 54 years, has been a heavy smoker for most of his adult life. He complains about coughing up blood first thing in the morning. The MOST IMPORTANT condition to exclude is: a) Bronchiectasis b) Recurrent pulmonary emboli c) Leukaemia Incorrect. The correct answer is (d). d) Bronchogenic carcinoma e) Laryngeal cancer Smokers are prone to develop a range of diseases including: • • • • atherosclerotic cardiovascular disease, various cancers (lung, larynx, oral, oesophagus, bladder, kidney, pancreas, stomach, cervix) chronic obstructive pulmonary disease peptic ulcer.
As bronchogenic carcinoma has a much more aggressive course than the other
options, a bronchoscopy should be performed as soon as possible. (Murtagh J., (2003), General Practice, McGraw-Hill, Sydney, p 453 ) (Harrison's Online Available: www.accessmedicine.com/content.aspx?aID=109485 ) Question 3 Sarah, a 40 year old woman whose husband has a plasma cholesterol of 6.9 mmol/l (normal <5.5mmol/l) wants to know which oil she should use in meal preparation for her spouse. Which of the following would you advise? a) It makes little difference which cooking oil she uses b) She should use either canola or sunflower oil Correct c) Any margarine is suitable d) Choose an oil rich in saturated fat over one rich in unsaturated fats e) None of the above
Epidemiological studies have shown reduced mortality from cardiovascular causes associated with diets containing increased levels of mono- and polyunsaturated fatty acids. Canola oil, like olive oil, has a high concentration of monounsaturated fatty acids, while sunflower oil is rich in n-6 polyunsaturated fatty acids. For lowering of plasma cholesterol levels, the National Heart Foundation of Australia recommends that saturated fat in the diet be replaced with a combination of mono- and polyunsaturated fats. (National Heart Foundation Statement on Dietary Fats 1999 Available: www.heartfoundation.com.au/downloads/Dietary_Fats_1999.pdf ) (Murtagh J., (2003), General Practice, McGraw-Hill, Sydney, p 1301-1304 ) Question 4 The diagnosis of acute gonorrhoea in a male is ideally made by: a) b) c) d) Gonococcal complement fixation test VDRL reaction Dark ground illumination of urethral pus Gram stain and culture of urethral pus Correct e) Prostatic massage
The gonococcal organism is rapidly identified by gram stain and culture of urethral pus. Dark ground illumination is a method for demonstrating the presence of Treponema pallidum. VDRL is used for the diagnosis of syphilis. Prostatic massage is an unreliable method of obtaining a test sample for acute gonorrhoea. (Murtagh J., (2003), General Practice, McGraw-Hill, Sydney, p 1118-1120 )
(Harrison's Online Available: www. olanzapine. has a family history of breast cancer and seeks advice about her risk of developing the disease. Sexual dysfunction can occur through medication with major tranquillisers and selective serotonin reuptake inhibitors (SSRI) antidepressants. All the other options place June at a moderate to high risk.net.5 times higher than population average).accessmedicine.
.amh. Parkinsonism tends to occur with long-term use of major tranquillisers. aged 38 years.aspx?aID=109485 ) Question 6 June. especially phenothiazines and butyrophenones.accessmedicine. (Australian Medicines Handbook Pty Ltd (2004) Australian Medicines Handbook Adelaide AMH Available: www.com/content. c) One 1° or 2° family member with bilateral breast cancer d) One 1° family member diagnosed with breast cancer at 60 years of age e) One 1° and one 2° family member diagnosed with ovarian cancer
Only about 10% of human breast cancers are due to a germline mutation (of genes p53.com/content. over the age of 50 years) places June at average or only slightly increased risk (1. BRCA-1. often of the same genes as are involved in the familial varieties.au/ ) (Harrison's Online Available: www. The other 90% are due to somatic mutations. A family history of one 1° family member diagnosed with breast cancer at 60 years of age (ie. BRCA-2). Neutropaenia is a rare side effect. The correct answer is (d). All of the following are indicative of moderate to high risk EXCEPT: a) Two 2° individuals on the one side of the family affected with breast cancer b) One 1° family member with ovarian cancer diagnosed before the age of 50 years Incorrect.aspx?aID=68374 ) Question 5 A COMMON side effect of the atypical antipsychotic drug. is: a) b) c) d) Neutropenia Hypotension Sexual dysfunction Weight gain Correct e) Parkinsonism
Weight gain of between 4kg and 9kg is a common side effect of treatment with olanzapine.
The correct answer is (d). The optimum time for commencing this is: a) One week before the extraction b) Two days before the extraction c) The day before the extraction Incorrect. Antibiotics need only cover this period of time and therefore are given orally one hour before the extraction. is admitted repeatedly for not taking her prescribed medication. (Prophylactic antibiotics in children. Delusions are beliefs held.htm#Protection ) Question 8 A 40 year old female undergoing treatment for schizophrenia. 4(7):490-494 Available: www. as she does not consider herself to be ill. She has delusional ideas. Doherty GM. Transference is a psychoanalytical term referring to transfer by a patient of
. It describes the situation where the patient lacks a realistic awareness of self and the relationship of self to others. The CORRECT term for the latter phenomenon is: a) b) c) d) e) Therapeutic delusions Side effect of drug Impaired insight Transference Hallucinations Incorrect.com/content.aspx? aID=62433&searchStr=breast+cancer Question 7 A patient with a past history of rheumatic fever requires oral amoxycillin cover for a tooth extraction. Lange Medical Publications.ca/english/statements/ID/id99-05. Hallucinations are abnormal sensory perceptions and are usually auditory in schizophrenia. The correct answer is (c).
Impaired insight is one of the cardinal signs of psychotic illness.cps. (2003) Current Surgical Diagnosis & Treatment.(Way LW.accessmedicine. Canadian Paediatric Society Paediatrics & Child Health 1999. claiming she communicates with angels and. NY. McGraw-Hill. p 319-339 ) (Harrison's Online Available: www. despite proof to the contrary. believes that she should not have to take any medication. d) One hour before the extraction e) Immediately after the extraction
The risk of endocarditis in patients with valvular heart disease stems from the bacteremia introduced by the extraction.
com/mrkshared/CVMHighLight? file=/mrkshared/mmanual/section18/chapter242/242b. (Murtagh J. Singh. McGraw-Hill.subconscious or conscious feelings onto the therapist. Melbourne.jsp%3Fregion %3Dmerckcom&word=intraductal&word=breast&word=cancer&domain=www.S. Sadock VA. causes stimulation of cardiac contraction with LEAST vasoconstrictor effect? a) Adrenaline b) Isoprenaline Correct c) Pitressin d) Ephedrine e) Noradrenaline
. Lippincott William & Wilkins p 287 ) Question 9 The MOST COMMON cause of a blood-stained discharge from the nipple of a 45 year old woman is: a) Gynaecomastia b) Duct papilloma Correct c) Paget's disease of the nipple d) Fibroadenoma e) None of the above
A blood stained discharge from the nipple is commonly caused by an intraductal papilloma. Third edition. Melbourne University Press. (Bloch. Fibroadenoma tends to present with an asymptomatic discrete. S. p 77-78 ) (Sadock BJ. eczematous rash of the nipple. depending on the underlying cause.. eds (2003) Synopsis of Psychiatry. (2003) General Practice.merck. Gynaecomastia is breast enlargement in the male and may be associated with discharge. 9th ed. B. Less common causes are an intraductal carcinoma and mammary dysplasia. Paget's disease of the nipple usually presents with a dry. com#h1_anchor )
Question 10 Which of the following drugs. mobile breast lump. (1998) Foundations of Clinical Psychiatry. Sydney.merck. p 980 ) (Merck Manual of Diagnosis and Treatment Available: www.
Resistance refers to the conscious and informed decision of a patient not to change behaviour or comply with treatment. Sadock VA. a therapist becomes aware that the patient is avoiding discussion of certain topics. (Rang HP. 1333 ) Question 11 While counselling a patient. p 168. Chap 7. Which of the following types of behaviour is the patient exhibiting? a) Resistance b) Suppression Correct c) Regression d) Repression e) Projection
Suppression refers to the conscious or 'semi-conscious' decision of an emotionally mature. Edinburgh. p 789. Regression refers to return to an earlier stage of developmental function. Dale MM. (2003). (Sadock BJ. healthy adult to postpone dealing with conflict. 3rd ed.. General Practice. and is steering away from topics he finds uncomfortable. Lippincott William & Wilkins p 208 ) Question 12 A traumatic perforation of the ear that has occurred in wet conditions such as swimming or waterskiing will often: a) Be associated with a purulent discharge Correct b) Be complicated by a staphylococcal infection c) Require a short course of oral antibiotics d) Not heal spontaneously e) Require surgical repair
. Churchill Livingstone. Sydney. 175 ) (Murtagh J. Repression refers to the mechanism by which ideas. eds (2003) Synopsis of Psychiatry. Ritter JM (1995) Pharmacology. Projection refers to the unconscious attribution to others of one's own unacknowledged feelings. McGraw-Hill.Isoprenaline works almost exclusively on beta receptors causing increased rate and strength of cardiac contractions (B1) and vasodilatation (B2). All the other drugs listed cause significant vasoconstriction. thoughts or characteristics. 9th ed. impulses or emotions which the person finds painful or unacceptable are forced out of consciousness and forgotten.
Third edition. Churchill Livingstone. Sydney.accessmedicine. (Murtagh J. Most traumatic perforations heal spontaneously.. Clinical signs include a continuous murmur and a bounding peripheral pulse with wide pulse pressure due to shunting of blood from the aorta to the pulmonary artery.pdf )
* Question 13 Which of the following statements about patent ductus arteriosus is INCORRECT? a) It occurs frequently as an isolated phenomenon b) Cyanosis is usually present Correct c) It causes a pansystolic 'machinery' murmur at the upper left sternal edge d) There is a wide pulse pressure e) Treatment is by surgical closure
Cyanosis is not usually present unless a right to left shunt develops. (2003) General Practice. 31: 707-710 Available: www. (2002). Eds. Patent ductus arteriosus is usually an isolated problem occurring most commonly in females. McGraw Hill.com/content. Pseudomonas is more likely to be the offending organism than staphylococcus. when heart failure or infectious endocarditis develops. Surgical repair is indicated for the rare failure to heal.racgp. swimming or waterskiing will generally become infected and be associated with purulent discharge.A traumatic perforation of the tympanic membrane (ear drum) that occurs in wet conditions eg. Sydney. There are often no symptoms until later in life. Robertson DM. 5th ed. but may take up to 9 months.aspx? aID=81122&searchStr=patent+ductus+arteriosus ) Question 14 Where both parents have schizophrenia.au/afp/downloads/pdf/august2002/20020801fagan. Australian Family Physician. what is the probability of their child developing schizophrenia? a) More than 90% b) About 70% c) About 40%
. p 549-561 ) (Fagen P.org. p 319-320 ) (Harrison's Online Available: www. as is analgesia. A short course of topical antibiotics is indicated. (2003) Practical Paediatrics. (Robinson MJ. Patel N. A hole in the drum: an overview of tympanic membrane perforations.
Third edition. (Sadock BJ. even if it does not heal. The incidence in the general community is about 1%. Patel N. p 549-561 ) (Fagen P. Marginal perforation carries the same risk. A cholesteatoma is not a neoplasm but a cystic lesion containing amorphous debris (and sometimes spicules of cholesterol).pdf * Question 16 Which one of the following features is UNLIKELY to be due to arterial ischaemia?
. It is formed through chronic infection and perforation of the eardrum with ingrowth of squamous epithelium. if left untreated. Sadock VA. By progressive enlargement a cholesteatoma can erode the ossicles. A hole in the drum: an overview of tympanic membrane perforations. The correct answer is (b). Sydney.
A dry central perforation will not progress to complications. McGraw Hill. is NOT likely to progress to significant complications? a) b) c) d) e) Continuously discharging central perforation Large dry central perforation Marginal perforation with discharge Perforation associated with a cholesteatoma Perforation that is surrounded by granulation tissue Incorrect. (2003) General Practice.com/content. A continuously discharging central perforation indicates granulation and a risk of osteitis and bone destruction. Australian Family Physician.. labyrinth and adjacent bone and carries the risk of cerebral abscess formation and meningitis. eds (2003) Synopsis of Psychiatry. The other types of perforation are not 'safe' and require specialist attention.org. (Murtagh J. forming a nest which becomes cystic.aspx? aID=109494&searchStr=schizophrenia#109494 ) Question 15 Which of the following tympanic membrane perforations.Correct d) About 10% e) Less than 1%
Pooled data from a number of family studies show that the risk of schizophrenia is about 40% for each child of two schizophrenic parents. 9th ed. Surgical repair is therefore elective and not mandatory. Lippincott William & Wilkins p 482 ) (Harrison's Online Available: www. 31: 707-710 Available: www.au/afp/downloads/pdf/august2002/20020801fagan.accessmedicine.racgp. (2002).
com/content. Addictive Behaviours. (1995). NY. Carlo C.accessmedicine.edu/~bhunt/Stages_of_Change_Theory/precontemplation.msstate. Lange Medical Publications. (Diclemente. this means s/he is: a) Resistant to change b) Preparing for change Incorrect. An Empirical Typology of Subjects within Stage of Change. 20 (3).com/Ezine/ezine20011228.html ) (Merberg B. 299-320.html ) Question 18 Epistaxis is UNLIKELY to arise from:
. Characteristically the pain is a cramp-like ache due to the release of pain-inducing metabolites in muscle. weakness and paralysis are all signs of arterial ischaemia. The Health Coach Available: www. as can the shooting pain of nerve irritation. Due to the aetiology. p 815-824 ) (Harrison's Online Available: www. Doherty GM. James O.healthcoach4u.aspx? aID=83436&searchStr=peripheral+vascular+diseases ) Question 17 When someone is referred to as being in the pre-contemplation stage with regard to a change in behaviour. c) Receptive to change d) Looking forward to specific advice e) Has not yet considered change
Pre-contemplation is the first stage in a model of behavioural change that helps the clinician assess the likelihood that a patient will be receptive to an intervention. Available: www2. & Prochaska.a) Pain along the buttock and thigh after exertion b) Weakness of the buttock and thigh c) Shooting pain from buttock along the back of the leg to calf Correct d) Weakness of the leg e) Smooth shiny skin on the leg below the knees
Diffuse pain. McGraw-Hill. (Way LW. (2003) Current Surgical Diagnosis & Treatment. The correct answer is (e). the pain is diffuse and cannot be localised. At the pre-contemplation stage the patient has not yet considered change as an option. The other options all indicate that the patient is aware of the process of change.
Which of the following conditions is the MOST LIKELY diagnosis? a) Mitral stenosis b) Mitral regurgitation Correct c) Aortic stenosis d) Aortic regurgitation e) Tricuspid stenosis
Mitral regurgitation presents as fatigue.au/afp/downloads/pdf/august2002/20020801pashen. What is the FIRST STEP in managing Stephen?
. presents with spontaneous epistaxis. Stevens M. (Murtagh J.a) b) c) d)
Injury to the turbinates Spontaneous bleeding from Little's area Anticoagulation therapy Enlarged adenoids Correct e) Nasal fracture
Enlarged adenoids do not usually cause epistaxis. A grade III pansystolic murmur is heard most prominently at the apex and radiating into the left axilla. It may also be associated with a short mid-diastolic flow murmur following a third heart sound. A fracture commonly causes epistaxis. p 1328 ) (Pashen D. due to the rapid flow of blood into the dilated left ventricle.. (2002) Management of epistaxis in general practice. epistaxis arises from Little's area.org.accessmedicine.pdf ) * Question 19 Harold. (Harrison's Online Available: www.aspx? aID=81307&searchStr=mitral+valve+insufficiency ) Question 20 Stephen. Sydney. aged 18 years. General Practice. In 90% of cases. aged 24 years.com/content. On examination there are signs of moderate left-sided heart failure. the lower anterior portion of the nasal septum. (2003). exertional dyspnoea and orthopnoea. shortness of breath on exercise and orthopnoea. The second heart sound is normal. and responds to first aid. presents with fatigue. Australian Family Physician 31 Available: www. it can be associated with medical conditions. McGraw-Hill. It is associated with a pansystolic murmur loudest at the apex but radiating over the praecordium and into the axilla.racgp. Rarely.
com/mrkshared/CVMHighLight? file=/mrkshared/mmanual/section21/chapter293/293a. Australian Family Physician 31 Available: www. McGraw-Hill.org. (2002) Management of epistaxis in general practice.pdf ) Question 21 What is the cause of the GREATER life expectancy at birth of females than males in Australia'? a) Males exercise more than females b) Genetic and biological differences Correct c) Females seek health care facilities more than males d) Males die more in accidents and violence than the females e) Employment stress is more for males
Genetic and biological factors play a role together with environmental factors in causing the greater life expectancy of females at birth. If this is ineffective. (2003). Position Stephen so that he is sitting and leaning forward Application of topical local anaesthetic Cautery of bleeding vessel Nasal packing with gauze
b) c) d) e)
The initial steps are to position the patient sitting forward to prevent blood dripping down the throat. and to compress the cartilaginous portion of nose (Little's area) for 5-10 minutes without interruption (constant checking is likely to interfere with haemostasis and restart bleeding). Foley's catheter or similar devices. Sydney. Only in extreme cases would surgery be needed.merck. p 1328 ) (Pashen D.racgp.au/afp/downloads/pdf/august2002/20020801pashen. The correct answer is (b). (Merck Manual of Diagnosis and Treatment Available: www.a) Direct pressure to the lower nose for two minute intervals Incorrect. application of local anaesthetic (traditionally cocaine for its vasoconstrictive properties) will facilitate packing of the nose with ribbon gauze.jsp%3Fregion %3Dmerckcom&word=life&word=expectancy&domain=www. (Murtagh J.merck.. Stevens M.com#hl_anchor ) Question 22 Which of the following is CORRECT? Epistaxis is often: a) A sign of underlying nasal disease b) Influenced by environmental conditions
. General Practice.
pdf ) (Murtagh J.Correct c) Attributable to posterior nasal causes d) Associated with congenital causes of bleeding e) Copious unless promptly treated
Epistaxis is very common and is not usually a sign of underlying disease. the irritant effects of some nasal sprays. Management includes all of the following EXCEPT: a) Admission to hospital b) Plasma troponin measurement Incorrect. In 90% of cases bleeding is from Little's area. While systemic causes. (Harrison's Online Available: www. has known ischaemic heart disease. a 36 year old man. (2002) Management of epistaxis in general practice. Sydney. p 1328 ) * Question 23 Victor. If there is no improvement in 24-48 hours. The correct answer is (e). anterior nasal septum.com/content. Stevens M. they are rare. Use of thrombolytics in UAP is not indicated since they are ineffective and may be harmful. General Practice. cardiac catheterisation and angioplasty are indicated.heartfoundation. as does aspirin and antithrombotic agents such as heparin. He complains of a recent increase in frequency of chest pain and presents with a prolonged episode of chest pain. dry.au/index. such as bleeding diatheses and hypertension are important causes of severe haemorrhage. McGraw-Hill.cfm?page=35 ) Question 24
. (Pashen D. as is life threatening bleeding. Management should include continuous ECG monitoring.-admission to hospital and plasma troponin measurement to exclude myocardial infarction.au/afp/downloads/pdf/august2002/20020801pashen.racgp. nose picking and hot.e.. air dessicating the nasal mucosa and rendering it more friable. There are no ECG changes on your initial assessment.org. Australian Family Physician 31 Available: www.aspx? aID=82486&searchStr=unstable+angina#82486 ) (National Heart Foundation Available: www. c) Continuous ECG monitoring d) Commencement of a statin drug e) Begin thrombolytic therapy
Clinically this patient has unstable angina pectoris (UAP).accessmedicine.com. i. (2003). The Heart Foundation guidelines 2000-2002 state that immediate commencement of a statin reduces risk in UAP. Environmental factors predisposing to epistaxis include pollens causing allergic rhinitis.
aspx? aID=53505&searchStr=hemianopia#searchTerm )
. A lesion of the right optic tract causes a left homonymous hemianopia. NY. (Way LW. (2003). Surgical removal of involved nodes is usually curative. Lymphadenoid goitre is due to Hashimoto's thyroiditis. Similarly. p 305-307 ) (Merck Manual of Diagnosis and Treatment Available: www. General Practice. presents with an enlarged lower cervical lymph node. McGraw-Hill.jsp%3Fregion %3Dmerckcom&word=perinephric&word=abscess&domain=www.com/mrkshared/CVMHighLight? file=/mrkshared/mmanual/section13/chapter155/155b. They are sensitive to TSH and so thyroxine can be used to suppress them. (2003) Current Surgical Diagnosis & Treatment. A pituitary tumour causes a bitemporal hemianopia. as in this case. and move when the tongue is protruded. Biopsy shows thyroid glandular tissue. left half of visual field lost in both eyes. d) Metastasis from thyroid carcinoma e) Lymphadenoid goitre
Thyroid cancer typically presents as a nodule in the gland but can present as an enlarged cervical node. Doherty GM. The correct answer is (d).merck. a 21 year old woman.merck.com/content. McGraw-Hill. Sydney. p 849 ) (Harrison's Online Available: www.com#hl_anc hor ) Question 25 Which of the following usually results in a left homonymous hemianopia? a) b) c) d) e) Damage to the left optic nerve A pituitary tumour Damage to the right optic nerve A lesion of the left optic radiation A lesion of the right optic tract Correct
Lesions of the optic tracts cause homonymous hemianopic visual field defects.accessmedicine. i. The cervical nodes lie more lateral in the neck than is usual for ectopic thyroid tissue or an adenoma. thyroglossal cysts lie in the midline between the thyroid gland and the base of the tongue.Moira.. Damage to the optic nerve results in a unilateral blindness while damage to the optic radiation results in a quadrantic field defect. (Murtagh J. The MOST LIKELY diagnosis is: a) Ectopic thyroid b) Adenoma of lateral thyroid c) Thyroglossal cyst Incorrect. especially in young patients. Lange Medical Publications.e.
eds. a 55 year old man. presented with worsening symptoms of gastrooesophageal reflux disorder (GORD) despite following your lifestyle advice. McGraw-Hill. Which of the following is the MOST APPROPRIATE advice? a) b) c) d) Reflux has been excluded as a cause of his symptoms He should see a dietician to review possible food allergies Endoscopy detects the presence of reflux in only 60-80% of patients He should begin a trial of a proton pump inhibitor (PPI) Correct e) He should have a repeat endoscopy in 6 months
About 50% of patients with significant symptoms of GORD have no abnormality on endoscopy. nausea. eg prosthetic heart valves or orthopaedic appliances
(Way LW.Question 26 Which one of the following situations will NOT require prophylactic antibiotics to manage a wound: a) An elderly debilitated patient b) The wound is more than 8 hours old c) The patient has alcoholic liver disease Incorrect. Doherty GM. eg hands patients in whom presence of bacteremia may have serious consequences. Other reactions are non-immune and are called food intolerance or idiosyncrasy. vomiting. p 120-122 )
* Question 27 Malcolm. (2003) Current Surgical Diagnosis & Treatment. The correct answer is (e). debilitated or general ill health wounds in areas where infection may have serious consequences. True food allergies are uncommon (1-2% of adults) and typically cause skin reactions. Antibiotics may be needed if the following risk factors are present: • • • • • delayed presentation contamination compromised patient. NY. You referred him for a gastroscopy which has not revealed any abnormality. 11th ed. d) A deep wound to the hand e) A large superficial abrasion on the thigh of a 22 year old Wounds treated appropriately and early do not need antibiotics. He still complains of bloating and heartburn. A good response to a PPI is as good as 24 hour pH monitoring to confirm the diagnosis.
. Lange Medical Publications. diarrhoea or anaphylaxis.
Sydney. Third ed.jsp%3Fregion %3Dmerckcom&word=perinephric&word=abscess&domain=www. undrained abscess. or development of drug resistance.com/mrkshared/CVMHighLight? file=/mrkshared/mmanual/section13/chapter155/155b.. (Harrison's Online Available: www.aspx?aID=89425 ) Question 28 Sarah is a 28 year old diabetic patient who presents with a recent history of fever and increased urinary frequency. The correct answer is (b). The correct answer is (b). Blood culture reveals motile E. superinfection by another pathogen. However. 'safe'.merck.merck. safe. All of the following are likely to be causes for her symptoms EXCEPT: a) In vivo resistance of the organism Incorrect.(Murtagh J. a week later she is still having fever and the same urinary symptoms. poor host defences. p 849 ) (Harrison's Online Available: www. Urine culture shows E.accessmedicine.com/content. dead tissue. poor penetration to a site of infection. (2003). waterproof ear to which a
. b) Autonomic dysregulation due to her diabetes c) Papillary necrosis d) Inadequate dosage of antibiotic e) Perinephric abscess
Clinical failure of antimicrobial therapy may be due to inadequate dose.accessmedicine. accelerated drug inactivation.coli.aspx? aID=68140&searchStr=perinephric+abscess#68140 ) (Merck Manual of Diagnosis and Treatment Available: www. waterproof ear c) Improve the appearance of the drum d) Prevent further perforation e) Restore Eustachian tube function The aim of myringoplasty is to produce a dry. coli sensitive to ampicillin and gentamycin with which she is treated intravenously.com#hl_anc hor ) Question 29 The aim of surgery in patients with perforation and infection of the tympanic membrane is to: a) Restore hearing Incorrect.com/content. b) Produce a dry. McGraw-Hill. General Practice.
fatigue and loss of weight. (Fagen P. (2003). polyuria. is correct? a) It develops in every person who is affected with the same severe stressful event b) Signs and symptoms usually occur between 1 and 6 months after the stressful event Correct c) Alcohol abuse reduces the likelihood of its development d) It seldom occurs in assaulted spouses in domestic violence e) Debriefing and counselling are insufficient as initial treatment
According to DSM-IV. complains of lack of energy towards the middle of the day. Patel N. but are less likely in the circumstances described. General Practice.org. (2002).. He has to get up twice at night to pass urine and wants a check for prostate cancer.. 'Safe' implies free of risk of cholesteatoma. (Harrison's Online Available: www. The MOST LIKELY cause of his symptoms is: a) Psychogenic polydipsia b) Diabetes insipidus c) Diabetes mellitus Correct d) Hypercalcaemia e) Chronic renal failure
The classical symptoms of type 1 diabetes mellitus are polydipsia.racgp. rather than loss of weight. The other options listed also cause polyuria. such as being part of a
.accessmedicine. Myringoplasty may not restore hearing. Signs and symptoms usually occur between 1 and 6 months of the stressful event. nor will surgery prevent recurrence of perforation. McGraw-Hill. polyphagia.aspx?aID=55698 ) (Murtagh J. 31: 707-710 Available: www.pdf ) Question 30 John. In type 2 diabetes mellitus. p 189-191 ) Question 31 Which of the following statements about post-traumatic stress disorder.com/content. a 58 year old overweight plumber.hearing aid may be fitted. patients have insulin resistance related to obesity. Third ed. Australian Family Physician. and there are some known protective factors. as this also depends on Eustachian tube function. Not every person who suffers the same stressful event will develop post-traumatic stress disorder. The appearance of the drum is obviously unimportant. A hole in the drum: an overview of tympanic membrane perforations. Sydney.au/afp/downloads/pdf/august2002/20020801fagan. the person must have experienced an event outside the range of usual human experience that would be markedly distressing to anyone.
If the cardiac output and blood pressure are very depressed. Some sufferers will also require drug therapy.accessmedicine. Carotid sinus massage is not indicated in this setting because there is a high likelihood of carotid artery disease which makes the procedure dangerous.m. Risk factors include alcohol and drug abuse. Also the arrhythmia is unlikely to be a
.com/cgi/content/full/322/7278/95? maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=posttraumatic+stress+ disorder&andorexactfulltext=and&searchid=1105664191269_1846&stored_search=& FIRSTINDEX=0&sortspec=relevance&resourcetype=1 ) * Question 32 Herman is a 57 year old man who is recovering from a hitherto uncomplicated myocardial infarction. Victims of domestic violence can develop post-traumatic stress disorder. The ECG shows the following rhythm (see figure). medical treatment is indicated as first line approach. The correct answer is (d). DC cardioversion is required if medical therapy is unsuccessful.group involved in a traumatic event. previous history of depression and previous history of sexual abuse.bmjjournals. abnormal QRS complexes. Sadock VA. Lignocaine IV or sotalol IV or amiodarone IV can be used. 322: 95-98 Available: http://bmj. eds (2003) Synopsis of Psychiatry. On the fourth day he complains of sudden onset of palpitations.
This ECG shows ventricular tachycardia with a rate of 150 b. (Sadock BJ. emergency DC cardioversion must be considered. Short term counselling and debriefing are effective treatments.p.aspx?aID=109209 ) (Summerfeld D (2001) BMJ. There is a rapid ventricular rhythm with broad.
The first line treatment for this patient is: a) b) c) d) e) Carotid sinus massage Digoxin IV Verapamil IV Lignocaine IV DC cardioversion Incorrect. Since his blood pressure is well maintained.com/content. Lippincott Williams & Wilkins p 623-632 ) (Harrison's Online Available: www. Initial examination confirms a tachycardia with blood pressure of 140/80.
com/content.accessmedicine.merck.pdf ) (Harrison's Online Available: www. (Harrison's Online Available: www. IMI benzathine penicillin as a single dose followed by procaine penicillin IMI daily with probenecid for 10 days is the first line treatment for syphilis. (Ooi.org.com/mrkshared/CVMHighLight? file=/mrkshared/mmanual/section16/chapter205/205h.com/content. Follow up with serological and clinical review is recommended.accessmedicine. General Practice. L. Syphilis: Diagnosis and management in General Practice.merck. (2002). Australian Family Physician. p 782-790 ) Question 33 Which of the following is INCORRECT with regard to the management of syphilis? a) b) c) d) e) The diagnosis should be confirmed with treponemal tests Intramuscular injection (IMI) of penicillin is the treatment of choice Serological and clinical review should be done at six and 12 months The patient should be tested for other STDs Sexual contacts should be clinically examined for features of syphilis Correct
Syphilis should be confirmed on diagnosis with specific tests such as FTA-Abs. (2003). as is the need to test for other STD's.aspx?aID=73039 ) (Harrison's Online Available: www.supraventricular tachycardia with bundle branch block.racgp.. 31: Available: www.com#hl_ anchor ) (Murtagh J.jsp%3Fregion %3Dmerckcom&word=ventricular&word=tachycardia&domain=www. Recent sexual contacts may not have clinical features of syphilis but should be treated.aspx?aID=73083 ) Question 34 Daryl is a 3 year old boy who presents with lesions at the corner of his mouth and ulcers in the mouth (see image below).au/afp/downloads/pdf/july2002/20020701ooi. Dayan. If untreated the ventricular tachycardia may rapidly progress to a ventricular fibrillation.. C. Third ed. Sydney. McGraw-Hill.com/content.accessmedicine.
.aspx? aID=80287&searchStr=tachycardia%2c+ventricular#80287 ) (Merck Manual of Diagnosis and Treatment Available: www.
(Polano. J. Systemic analgesics and topical anaesthetic agents. M.These have developed rapidly over a few days and he is febrile and not eating. Color Atlas and Synopsis of Clinical Dermatology. valaciclovir or aciclovir should be commenced. eg lignocaine gel can be used and chlorhexidine mouthwashes may prevent secondary infection. Daryl's management should include: a) b) c) d) Commencement of oral metronidazole Commencement of oral flucloxacillin Commencement of famciclovir Application of topical mupirocin Incorrect. McGraw-Hill ) (Murtagh. Topical corticosteroids are contraindicated. who has never been immunised. p 910-911. Third ed. Sydney. to see you. General Practice. 1179-80) (Harrison's Online Available: www. et al (1992). fever. McGraw-Hill. headache and malaise may also be present. 2nd ed. e) Application of topical corticosteroid
This is an example of herpes simplex infection (primary herpetic gingivostomatitis). Where there is difficulty eating or swallowing oral famciclovir. (2003).com/content.aspx? aID=74294&searchStr=herpesviral+gingivostomatitis+and+pharyngotonsillitis#7429 4 Question 35 Maria brings Amy. New York. Which of the following concepts is it important to ensure that Maria understands?
. Maria states that she is using homoeopathic drops. Regional lymphadenopathy.accessmedicine. her 6 month old daughter. The correct answer is (c).
au/immhandbook/ ) (Harrison's Online Available: www. Alzheimer's disease is the most common cause of dementia. (The Alzheimer's Association. 10% of those aged 65 and over were found to have dementia and another 10% were suspected of having it.au/handbook. it affects 1 in 9 people. 8th ed. 31 Available: www.htm Available: http://www1.racgp. (NHMRC (2003).gov. vol. she needs to be made aware that-homeopathic 'immunisation' has not been proven to give protection against infectious diseases-only conventional immunisation produces a measurable immune response. it affects 1 in 4.accessmedicine.org. In people aged 80-85 years.a) b) c) d) e)
Vaccine preventable diseases are still prevalent Side effects of the disease are greater than side effects of the vaccine The acellular form of the pertussis vaccine reduces the incidence of side effects Amy could still be fully immunised with conventional vaccines All the above Correct
Maria needs to appreciate all the concepts listed in the options. In those over 85 years.com/content. Australian Government Publishing Service Available: http://immunise.asp?id=6144 ) (Harrison's Online Available: www.aspx?aID=67321 ) Question 36 Which of the following statements regarding dementia is CORRECT? a) One in nine Australians in the group aged >85 suffers from dementia b) Dementia affects one in four people aged 80-85 c) Family history is a major risk factor for Alzheimer disease Correct d) Vascular disease is the most common cause of dementia e) Dementia is no more common in the indigenous population than in the general community
Age and family history are the two most common risk factors for dementia.health.aspx?aID=105251 )
. Moreover.health. The Australian Immunisation Handbook. Australian Dementia Facts (2002). Canberra. The Australian Immunisation Handbook has a table which clearly shows a comparison of the effects of vaccines versus the much greater morbidity of the diseases against which they protect.au/document.gov.com/content. One in 15 Australians aged 65 and over has dementia.accessmedicine. Australian Family Physician. In the most recent assessment of indigenous Australians.
What is the diagnosis? a) b) c) d) Atrial flutter Atrial fibrillation Atrial premature beats Sinus arrhythmia Incorrect.aspx?aID=80153 ) Question 38 The clinical features of classical migraine include all of the following EXCEPT: a) Unilateral temporofrontal distribution b) Retro-orbital and occipital radiation Incorrect. McGraw-Hill. McGraw-Hill. p 612-616 ) (Harrison's Online Available: www.accessmedicine..accessmedicine. Sydney. (Murtagh J.aspx? aID=51922&searchStr=migraine#51922 )
.com/content. There are no p waves and the rhythm is irregularly irregular which causes the patient to perceive palpitations. but never as long as a week. The correct answer is (b). e) 1st degree AV block
This ECG shows atrial fibrillation. (2003).aspx?aID=105270 ) * Question 37 Edith is a 70 year old woman who presents with palpitations.com/content. (2003).com/content. (Murtagh J.accessmedicine. General Practice. The correct answer is (d). p 785-788 ) (Harrison's Online Available: www. General Practice.(Harrison's Online Available: www.. c) Intense throbbing character d) Duration 4 hours to a week e) Associated with nausea and vomiting
Migraine attacks last 4-72 hours (average 6-8 hours). Her ECG is shown below. Third ed. Third ed. Sydney.
Sydney. It begins as multiple vesicles which ulcerate and can become secondarily infected. Chancroid produces multiple painful exudative nonindurated ulcers.aspx? aID=74298&searchStr=genital+herpes#74298 ) (Harrison's Online Available: www. of different sizes. The rash has been present for one week. McGraw-Hill.. aged 25 years.aspx?aID=68331 ) Question 40 A 24 year old married woman presents with patches of a scaly coppery pink macular rash over the trunk. Which of the following is the MOST APPROPRIATE management? a) b) c) d) e) Application of benzyl benzoate lotion Prescription of antihistamines Reassurance as it is a self limiting condition Pathology test for rubella antibody titre Application of topical steroids Incorrect.
Primary genital herpes is the most likely cause of a painful ulcerative lesion on his penis. The primary lesion of a syphilitic ulcer is painless and usually persists for 4-6 weeks and heals spontaneously. She feels well.com/content. The correct answer is (a).
. The patches are oval.accessmedicine. Calamine lotion can be used if there is an associated itch and topical steroids are only rarely used in the presence of moderately severe itch. and appear to be spreading. There are no other abnormal findings. The correct answer is (c). p 1120-1122 ) (Harrison's Online Available: www.com/content. (Murtagh J. He has tender inguinal lymphadenopathy on examination. The patches are arranged along the skin creases.accessmedicine. General Practice. What is the MOST LIKELY diagnosis? a) b) c) d) e) Primary genital herpes Primary syphilis Secondary syphilis Recurrent genital herpes Chancroid Incorrect.
The description is typical of Pityriasis rosea and management is usually reassurance only as this is a self-limiting condition and disappears in 4-10 weeks. Recurrent genital herpes episodes tend to become milder and less frequent over time. (2003). presents complaining of feeling unwell with a painful ulcer on his penis.Question 39 Malcolm.
McGraw-Hill. T.com/content.A.B.accessmedicine. Johnson.aspx? aID=56798&searchStr=pityriasis+rosea#56798 )
.(Fitzpatrick. p 1172-1173 ) (Harrison's Online Available: www. Sydney. et al (Eds) (1993) Color Atlas and Synopsis of Clinical Dermatology 2nd ed p56 New York McGraw Hill ) (Murtagh J (2003) General Practice. R. Third ed.