2016 QUESTIONS

CONTENTS
2016
SAQ............................................................................................................................................................................... 2
2016
MEQ .............................................................................................................................................................................. 5
2016 MCQ 1 &
2 .................................................................................................................................................................... 9
2016
FORMATIVE ...............................................................................................................................................................
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 2016 SAQ 29 questions with multiple parts, 122 marks 19 pages 2 hours given
1. Woman does a mammography; found to have malignant stage 2 invasive ductal carcinoma. What are two
common types of surgical treatments and short term complications for each procedure (4) 2. Explain the central
and peripheral control of BP, as well as explaining the difference in your answer. (5) 3. Based on your
understanding of cerebrovascular anatomy, where would you most likely localize these
lesions to (3):
a. Motor hemiparesis b. Transient sensory deficit c. Broca’s aphasia 4. Hyperkalemia causes cardiac arrhythmias and
skeletal muscle weakness. Explain the physiology (3?). 5. List 5 features of GP that makes it unique from other
healthcare fields. (5?) 6. Someone comes to you to do a pre-employment health check; How do you ensure that you
obtain an
accurate BP reading in this clinical setting? (4) 7. Mr Wang’s absolute CVA/D risk was 10% in the next 5
years:
a. What lifestyle interventions can you employ to reduce his risk? (4) b. How might poor health literacy influence
the prognosis and progression of a disease? c. Discuss how cultural factors can influence health outcomes. 8. List 3
issues that would affect migrant health and 3 community services that can be used to address them.
(6 marks) 9. A man comes in with uncontrolled type 2 diabetes. Besides GP and hospital, what 2 groups of
individuals
or organisations could help manage the disease and what would their contributions be? 10. An abstract is given
providing a background and objective for a study regarding carers and the stressors
they face. The study will be about gaining their perspective (more details given).
a. In one sentence, what type of study is this? b. What features of this study design/population would you address to
assess its relevance to the
GWS? 11. Teenager that doesn’t trust adults in general. How will this affect your clinical relationship?
What would
you do to address it? 12. Young woman with chlamydia detected on PCR due to unprotected sex.
a. How far back do you have to contact trace? (1) b. How would you explain to her the importance of contact
tracing? c. What service(s) could you and the patient use to assist with contact tracing? (2) 13. Mohammed: First
time patient at the GP, you ask about his immunization history as part of routine. What
questions do you ask? 14. 65 year old man, one pack a day, comes to ED: 2 days of cough and SOB.
a. What are 3 differentials? 3) b. What questions would you ask on history to clarify diagnosis? c. On examination,
what clinical signs would suggest he needs to be hospitalized? 15. Normal urine doesn’t contain glucose. Why do
people with diabetes sometimes have glycosuria and why is
it absent in normal people? (4) 16. Guy has a swollen, red, tender knee joint, limited range of movement, fever.
a. Next step in management/investigation is joint aspiration. Why? b. Acute recurrent gout: Explain the
pathogenesis, and rationale of therapy for treating and
preventing episodes. 17. Clinical case: Female with acute pancreatitis (mild).
a. Knowing that the diagnosis is acute pancreatitis, why does the consultant order an ultrasound?
(ESRP!!!) b. Why order an US and not a CT?
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18. Anal fistulas
a. What is a fistula (generic definition that can apply to any fistula)? b. What are the 2 most common etiologies of
anal fistula? c. Presentation of an anal fistula (2) 19. What is an anal fissure?
a. How do anal fissures present? (2) b. Clinical presentation of hemorrhoids? 20. Incarcerated vs strangulated hernia:
What’s the difference? (2 marks) 21. Man with blood in the stools. What signs on DRE would suggest malignancy?
(3) 22. Anal/rectal cancer
a. Which lymph nodes are important to examine in rectal cancer? b. Which lymph nodes would rectal cancer spread
to? (Lower 2/3: Internal iliac, upper 1/3: inferior
mesenteric) c. What would you expect on histopathology for a carcinoma in: (2 marks)
i. Anus ii. Lower rectum d. Why is differentiation between a rectal and anal cancer important in terms of surgical
treatment? 23. 65yo(?) woman noticed a lump in her breast after falling at the gym.
a. Why is this injury relevant to the history? b. What features on examination of the lump would suggest
malignancy? c. What are the lymph nodes you would inspect in a breast lump exam? (Note: 4 markers; Not enough
to limit to axillary LN? 24. Absolute CVA/D risk was 10% in the next 5 years: What lifestyle
interventions can you employ? (4)
The last 4 questions were several images and spot diagnoses taken from ‘lumps and bumps’ lecture, worth 1
mark each
25. What is this? (1)
26. These were found on a man’s chest; what is it? (1)
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27. Picture of a blackened and necrotic finger nail; half of the nail is missing. What is this? [digital infarction?
Subungual acral lengitinous melanoma?] (1)
28. What is this? (1)
29. What is this? (1)
[ANS: Cherry angioma; not in lecture slides]
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 2016 MEQ 149 marks, 2 hours 10 questions with 49 parts 21 pages
1. A woman comes in with her child, Sophie. She has difficulty hearing and speaking and her father was
late to speak also.
a. She presents with this on otoscopy (GP MIC orientation slides). Describe the findings (2).
b. Label this diagram (6)
ANS:
i. Semicircular canals ii. Cochlear iii. Pina iv. Ossicles
v. Tympanic membrane vi. Round window
c. You do a quick search for studies and found this abstract about OME (it is a randomised control trial). Explain
this in plain language summary to the mother (she has year 10 level English) d. You find that in the study the
children are given a ventilator tube in one ear, and another surgical
intervention in the other ear. What is the advantage of comparing outcomes this way? e. What are some allied
health referrals you could make? (2)
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2. A man presents to ED with a headache and a CT is done, showing he has a subarachnoid haemorrhage.
a. Describe clinical features of subarachnoid haemorrhage and its associated symptoms.
b. Describe this ECG
ANS: Raised ICP is associated with certain characteristic ECG changes: Widespread giant T-wave inversions
(“cerebral T waves”). QT prolongation. Bradycardia (the Cushing reflex – indicates imminent brainstem herniation).
c. What is the ECG most likely showing?
ANS: Raised ICP
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3. Lady comes in with left hip pain after a fall. Xray given (similar to the one below)
a. Explain the findings in this X-ray. b. How would you manage this patient’s pain? c. What are some known
complications of calcium channel blockers and ACE-inhibitors? (4)
4. Man on ACE-I, spinoronolactone and diarrhoea and vomiting presents to ED. You are given a table with
electrolytes blood panel showing
Potassium 8.1mmol/L Normal range Sodium Don’t remember Chloride Don’t remember Bicarbonate Creatinine 235
a. The lab calls you about his elevated potassium. Explain the physiology behind why they did this (3) b. What are
the possible causes of hyperkalaemia? Only the first four reasons will be marked. (4) c. What are the causes of
spurious hyperkalaemia (falsely elevated hyperkalaemia) (3) d. Given that spurious hyperkalaemia is not a
diagnosis, how would you manage her hyperkalaemia?
(6?) e. The patient is found to have a creatinine of 90 two weeks before this presentation. How does this
change your diagnosis? (2) f. Given the above information, what other investigations would you do? (6)
5. Patient has autoimmune adrenal insufficiency.
a. Explain the cause of hyperpigmentation in her case. b. She is found to have hypotension and hyperkalaemia. What
is the name of the hormone
responsible for this (1) c. Explain how the hormone causes hypotension and hyperkalaemia. d. What are the
long term and short term consequences of a dose of glucocorticoid that is too high? e. Why does adrenal
insufficiency occur if long term steroid therapy is withdrawn? f. What other investigations would help you diagnose
adrenal insufficiency? (4 or 6)
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6. A long history is given of an obese woman with SOB, cough with clear sputum, peripheral oedema.
Baseline walking distance before SOB is 500m. JVP is difficult to visualise. She is a smoker and has been
smoking pack a day for 20 years.
a. What are four differential diagnoses, in order of likelihood and explain why you believe they are
possible from this history (8). b. Interpret the ABG: O2 = 64, CO2 = 72, pH = 7.2 c. Given this interpretation,
what do you tell the nurses to do? (2) d. Give four well recognised complications of obesity and what are some
initial investigations for each
(6 or 8)
7. A lady comes in with shortness of breath. She is a non-smoker. A 17mm mass is found on chest XR in the
right upper lobe and pleural effusion.
a. What clinical examination findings would you elicit to confirm pleural effusion? (3) b. What other tests would
you order on the pleural fluid? (3) c. She is found to have lesions on her 3rd and 7th ribs. What other tests would
you do?
8. History of a man who comes in with abdominal pain and nausea. The surgical team suspects he has
small bowel obstruction. He is currently not vomiting but he is nauseous. He has never had abdominal
surgery. He has percussion tenderness, and guarding in the RIF and is febrile.
a. What is the significance of the fact that he has never had surgery? (2) b. He needs a nasogastric. Explain to him
the reason for it, even though he has stopped vomiting. c. What is additional management you would undertake? d.
What findings on CT would you expect to find in SBO. e.What features in the history make you concerned?
9. 55 year old man found collapsed in his home. He has poorly controlled diabetes
a. What is the organism responsible for necrotising fasciitis? (1) b. What are the examination findings for someone
with necrotising fasciitis? c. What are two additional clinical findings? d. How would you treat this condition? (3?)
e. What are two criteria that are used to define SIRS? (2) f. Define sepsis (1)
10. A man comes into the GP. He has been having some problems sleeping and wakes up early. He also has
been having some memory issues. His wife passed away recently and his dog also died. His children live 15
minutes away.
a. What are the most important issues here? (5)
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2016 MCQ 1 & 2
Which of the following does not usually accompany a strangulated hernia?
a) Cough impulse b) Redness c) Tenderness d) Pain e) Irreducibility
Which of the following is incorrect about warfarin?
a) Affects prothrombin time b) Dosage is lowered in liver failure c) Effects can be reversed by p---- (cant remember
the name of the drug) d) Works by affecting vitamin K related clotting factors e) Affected by diet
Photo of a Rodent Ulcer. The image depicts a "Rodent Ulcer". These lesions are:
a) Caused by rat bites b) Usually caused by squamous cell carcinoma c) Usually caused by basal cell carcinoma d)
Only found on the face e) Easily metastasised
84 year old woman, 1 week leg pain, 48 hours bilateral swelling and anorexia. Clinical history and a picture of
cellulitis. Which of the vitals below indicates most urgent need for admission and antibiotics?
a) High wcc b) Fever 38.5 c) Systolic BP 85 mmhg d) HR 110 e) Sats 97%
Which is correct about Type 2 Diabetes?
a) Most likely to die form chronic kidney disease b) will develop ESRD? c) 3 times more likely to have a stroke or
MI d) ? e) ? (According to google it is ‘two to four times more likely to have an MI) The other options were pretty
nonsensical and hard to memorise
A previously well 35 year old man, who had been living in Thailand, is flown back to Australia to be treated for
Pulmonary tuberculosis. Which of the following is the MOST likely comorbidity?
a) Acquired Immunity Deficiency Syndrome (Pulmonary TB is an AIDS defining illness) b) Severe, Combined
Immunodeficiency c) Chronic Hepatitis C d) Common Variable Primary Immunodeficiency
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You are a GP in a private practice. Toby, a 53 year old colleague in your practice, comes to see you about chest
pain, most likely musculoskeletal. Which of the following statements is true about Toby, compared to any other
patient in GP practice?
a) More likely to give you relevant information due to clinical knowledge b) Less patient education necessary due to
clinical knowledge c) May be hard for him to take on the role of the patient and for you to take on the role of the
doctor, instead
of normal collegial relationship d) All of the above
Which of the following about TPN is true?
a) Isotonic b) Can be given via peripheral IV cannula c) Causes LFT derangement d) Pt on TPN does not need
vitamin supplements e) Better than parenteral feeding in terms of nutrition
Young person presents with dyspnoea. V/Q scan suggests pulmonary embolus. What is a potential source of
embolus?
a) Deep veins of upper limb b) Deep veins of lower limb c) Superficial veins of upper limb d) Superficial veins of
lower limb e) Right atrial appendage
Which one of these is not a characteristic of Warfarin?
a) Reversible using Vit K b) Used for chronic therapy c) Effective when taken orally d) Decreases hepatic synthesis
of clotting factors e) Used in pregnancy as it does not cross the placental barrier
Which is NOT a sign of splenic rupture? a) Decreased blood pressure b) Increased heart rate c) Haematemesis d)
Left shoulder tip pain e) Abdominal distention
Rotator cuff is least influenced
a) Superiorly b) Anteriorly c) Inferiorly d) Posteriorly e) Medially
Unilateral foot drop post anterior bowel cancer resection
a) thermal nerve damage by diathermy b) nerve damage by pelvic excision c) compression nerve damage by stirrups
d) something conversion syndrome
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Which of the following has no association with gallstones?
a) Hereditary spherocytosis b) Crohn’s disease c) Gastrectomy d) Acute pancreatitis
Gallstones:
a) Are usually radio-opaque b) Are made of bile pigment c) Are made of mostly calium d) Increased in hereditary
spherocytosis e) Both B and C
A man has a deep laceration to his arm due to broken glass. What would you not do?
a) Check tetanus immunisation status b) Check tendon function c) Check median nerve function d) ?
What are signifiers of good long term control of diabetes mellitus
a) Glycosylated haemoglobin 5.9% b) Absence of microvascular complications c) Absence of signs and symptoms
of hyperglycemia and hypoglycaemia
The amount of potassium required for a 70kg man post-operative who is nil by mouth is
a) Nil b) 20-40 c) 60-80 d) 120-140 e) 160-180
41 year old female with hemiplegia onset 1 hour ago. She goes for a non contrast CT. Please choose the best answer:
a) Dont do a CT if it would delay thrombolysis b) A CT will clearly delineate ischaemia c) The main aim of this CT
was to confirm or deny haemorrhage d) A CT would show an acute stroke e) A perfusion CT would be more useful
Male patient with history of hypertension presents with the following bloods: Significant = Hyperkalaemic and low
CO2. What could cause this?
a) Acute tubular necrosis b) Renal artery stenosis c) Mild chronic kidney disease d) Hypertension e) Obesity
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A young post-partum woman who was tired and depressed? Gaining weight? With low T3 and T4 and high TSH.
What was the diagnosis? a) Hashimotos b) Multinodilar goitre c) Graves d) Colloid thyroid??
Neurofibromatosis is associated with?
a) Diabetes Mellitus b) Intracerebral calcification c) Cafe Au Lait spots d) Renal tubular acidosis
A patient presents with a 3 day history of vomiting, abdominal pain and distension. What sign on this x-ray would
show small bowel obstruction?
a) Haestrae signs b) Dilated loops over 55mm c) Air in the large bowel d) ? e) ?
14 year old presents with 3 day history of sore throat and fever. No rhinorrhea or cough. On examination her
temperature is 38.4, bilateral tonsillar exudate and enlarged, tender lymph nodes. What is the MOST LIKELY
diagnosis?
a) Viral URTI b) Glandular fever c) Group A Streptococcus tonsillitis d) Lymphoma e) Influenza
Which of the following is NOT a complication of acromegaly?
a) Hypertension b) Diabetes Mellitus c) Osteoarthritis d) Liver Cirrhosis e) Colonic Polyps
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2016 FORMATIVE
QUESTION 1 An 82 year-old woman presents to the Emergency Department after being found by her daughter on
the bathroom floor in a confused state. She has a background history of Type 2 diabetes mellitus for which she takes
metformin, and hypertension treated with an ACE inhibitor. She is confused and has a left-sided hemiparesis. A
brain CT scan is reported as normal. Her hemiparesis is MOST likely to be due to:
A) A haemorrhagic stroke B) An ischaemic stroke C) Hypoglycaemia D) A subdural haematoma E) A spinal injury
from falling in the bathroom
Answer: B
QUESTION 2 Questions 2a to 2c are part of the same scenario. 25 year old James Parker presents to Mt Druitt
Hospital Emergency Department on a Thursday evening complaining of fevers, rigors, and generalised myalgias for
3 days. He states that he saw his G.P. the day before, who advised him to go home, take paracetamol, and rest,
because he was suffering from “a virus”. James is concerned that a virus couldn’t possibly make him feel as ill as he
does.
Question 2a. a) List 5 items in the history you would address that would help confirm that James is most likely
suffering from a viral infection, and explain why. Your first 5 items only will be considered in your answer. [ 5
lines] 5 marks
Question 2b. b) Outline 5 components of the physical examination that may help you decide that James is suffering
from a viral infection. Explain why. Your first 5 items only will be considered. ( 3 marks, 5 lines ) 5 MARKS
Question 2c. c) Discuss the methods employed by the immune system to prevent and/or eradicate viral infection. (5
marks, 10 lines )
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QUESTION 3 Questions 3a to 3b are part of the same scenario. A 70-year-old man is evaluated for a 2-week history
of a progressive burning sensation in his hands and feet, and constant discomfort and dull pain in his legs. Medical
history is significant for symptomatic multiple myeloma that developed 2 years ago. This was treated with oral
thalidomide and dexamethasone. He recently experienced a relapse of myeloma, and has completed four cycles of
therapy with bortezomib and dexamethasone. He also has type 2 diabetes mellitus that has been well controlled for
10 years with oral hypoglycaemic agents.
On physical examination, he is afebrile; blood pressure is 138/80 mmHg, pulse rate is 70/bpm, and respiration rate is
15 breaths per minute. There is no evidence of retinopathy, organomegaly, lymphadenopathy, or skin changes.
Neurologic examination discloses bilateral loss of ankle-stretch reflexes and hyperaesthesia in a “glove and
stocking” distribution to the ankles and wrists bilaterally. Vibratory and position sensation are intact, and muscle
strength is normal. The remainder of the physical examination is normal.
Question 4a. a) Name the presenting clinical syndrome. 1 Mark] ( 1 line)
Question 4b. b) List 3 (three) possible causes of this syndrome. [3 Marks] (3 lines)
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