Organised past papers – GP

General health / palliative care / pain

- Drinking half a bottle of wine every night for years, same as friends → offer/give
advice to stop or reduce alcohol intake vs. refer to rehab counselling
- 30 y/o Macrocyctic anaemia with raised GGT- Alcohol → GI??
- Recurrent episodes of pancreatitis- alcohol history → GI??
- Neurological issues from alcohol- vitamin B1
- Patient on Paracetamol, NSAIDs and Tramadol and is still in pain. What would you
give next? Morphine Sulphate or Amitriptyline; MORPHINE (GOING UP TO STEP 3); IF
STILL IN PAIN, ADD AMITRIPTYLINE – pain
- Obese man tired all the time, no matter how much sleep he gets, recently fell asleep
while driving, wife says he snores very loudly and has to sleep in other room
sometimes. BMI 30, BP 150/95?? (hypertensive anyways) – best next step – options:
lifestyle advice (lose weight, salt restriction), refer for polysonography, start Ramipril
– CVR
- Woman with breast cancer mets in thoracic spine confirmed on imaging. Current
management between palliative care and GP. Highest oral analgesia not adequate,
clearly distressed with the pain. What to do next – options: refer to
physio/psychologist/chemo/radiation/neurosurgeon – MSK/palliative
- Obese women with mild osteoarthritis, doesn’t want to discuss weight loss- Come
back when ready to discuss – MSK
- Female with sleeping difficulties- sleep hygiene
- Insomnia mx: sleep hygiene
- Day time Sleepiness, snoring at night, HBP- advise lifestyle modifications – Cardio???
- Women needs to loose wt - ask to consider discussing in the future
- physio ( palliative)
- Lymph node
- Conservative? Lump in the back

- clinical scenario → Palliative care

o SE to watch for in morphine: constipation or respiratory depression
o Changes to dosage→ Increase dose to 80mg (She was on 60mg and still has
pain)
o Two complications of arm metastasis
o Progressive SOB IX→ D-Dimer
o Ethics: doctrine of double effect
-

Cardiology
- ambulatory bp high what to give -→ Ramipril
- DM and microalbuminuria what to give → ACE inh
- NOAC what measure- eGFR
- Most important parameter to check before starting NOAC – eGFR
- Post MI-which intervention first
- Murmur radiating to carotids- aortic stenosis
- ECG, Valsalva manoeuvre made better - paroxysymal supraventricular tachycardia
- Hyperkalaemia secondary to medication → remove Ramipril
- Post-MI intervention to prioritize → diet vs. smoking vs. alcohol? I think smoking bc
cessation decreases risk of death by 50% over 15y
- Picture: ulcer on medial leg + orange-brown discoloration → venous ulcer
- Incidental finding of BP 158/85 and for two occasions her blood pressure still
remained high→ ABPM (Ambulatory BP) or start ACEI? I would go with ABPM; I
would only start ACEI without ABPM if the BP has severe clinical systolic >/=180 or
diastolic >/=110
- Calf swelling + erythema + tenderness → DVT
- 2 weeks post hemicolectomy, presents with redness and swelling in right calve,
confirm diagnosis by- right leg venous ultrasound
- TN on ACE-I, next drug to add → amlodipine
- Mid-diastolic murmur louder at the apex – mitral stenosis
- Statin most important blood test to monitor after starting – liver function
- Someone on ACEi and you’re adding a diuretic, most important to check? Renal
profile
- 42 y/o female chest and epigastric pain- confirm by ECG x2
- Orthostatic hypotension- BP on standing and supine. HERE?
- ECG: atrial fibrillation
- CHF: spironolactone
- Murmur: mitral stenosis
- IHD she was asymptomatic - Statin
- Guy with collapse, mild asthma - refer for urgent cardiology, give salbutamol
- ECG, valsalval manoeuvre made better - paroxysymal supravetricular tachycardia
- Mid-diastolic murmur, heard best at apex - aortic regurg, mitral stenosis
- Drug that the person should be getting for the ischemic heart disease (was already on ace
inhibitor, aspirin etc) – put on statin (whatever the statin was)
- SVT
- Add simvastatin to woman with ischaemic heart disease
- monitor LFTs on atorvastatin
- Heart murmur mid diastolic

- Clinical scenario → Brother w/ recent heart attack

o Most important CV-RF: smoking
o Drug for primary prevention: simvastatin
o Comment on ECG→ Normal Rate and Regular/Normal Rhythm
o Add medication→ Aspirin

- Clinical scenario → Paroxysmal AF (Atrial Fibrillation)

o 2 medical conditions/complications: stroke/CVA, HF
o 2 reasons for high INR>6 → Alcohol and Grape Fruit Juice
o Manage high INR→ Stop Warfarin (Data Interpretation Lecture)
o Systematic Review→ Selection and Publication Bias
 - Clinical Scenario → Elderly man can’t work more than 200m, gets pains in calves,
which is relieved by rest
o Most likely diagnosis- Peripheral Arterial Disease
o Investigation of choice- Ankle Brachial Pressure Index
o What meds to add (list 2)- aspirin; diuretics
o Not compliant with meds and worse now, what features on clinical
examination (list 4) → oedematous legs; hair loss; ulceration; haemosiderin
deposition
▪ DISAGREE with the hemosiderin deposition (thats venous changes)
▪ hair loss, shiny, pallor (atrophic skin changes), ulceration, absent foot
pulses

Respiratory
- Monophasic wheeze and local area on CXR- lung carcinoma
- Baby with wheeze all over what do you give nebulised salbutamol
- Copd patient what first line SABA
- Acute severe asthma which one is a sign resp rate → 25
- 3 months history of cough in smoker who smokes 15 cigarettes per day, appropriate
investigation
- Pleuritic chest pain + recent trip to Thailand → CXR
- 3 months history of cough in smoker who smokes 15 cigarettes per day, appropriate
investigation → spirometry, PFT, CXR
- Next step in COPD RX after inhaled salbutamol with FEV 60% → LABA
- Man with SOB, left pleuritic chest pain, tachypnoeic and tachycardia, recently taken
up diving as a hobby – pneumothorax
- Man with restrictive pattern on PFTs what will auscultation likely demonstrate?
Coarse crackles? Other options: fine crackles, bronchial breathing, expiratory wheeze
or rhonci
- End of life COPD, manage dyspnoea symptoms- Morphine sulphate
- COPD, cough no other symptoms- Acute bronchitis
- Smoker: COPD
- Pt w/ wheeze: CXR
- Scuba diving, left chest pain - bornholm disease / pneumothorax
- Tibia with breathlessness - PE
- Smoking, one side - lung carcinoma
- PE
- Coarse crackles
- Pneumothorax- diver

- Clinical scenario → Poorly controlled asthma

o Second line treatment after ACE-I for HTN (Amlodipine)
o Control questions
o Next step in RX→ LABA (SABA, then inhaled corticosteroid then LABA)
o Patient who quit smoking for two years and now is considering to go back to
smoke. Which stage of change? Relapse
infections
- pneumonia antibiotics- only amoxicillin – resp
- Baby fever, abdominal pain vomiting- first investigation urine dipstick
- Which one give antibiotics for sure centor>3?
- Guy with sore throat, redness of tonsils what – viral illness
- Acute confusion in elderly → infection/geriatrics
- HFM (Hand Food Mouth) disease → supportive RX
- Hand Foot mouth disease management
- Neutropenia, otherwise well → refer to haem/repeat bloods
- Boy comes in with father, you are rural GP 90+ mins from local hospital. Boy has
petechial rash, high fever – give IM benzylpenicillin
- HIV patient- encourage to discuss with husband
- Scratch on arm, develops fever, tachycardia and arm erythematous and oozing-
sepsis
- Lymphadenopathy, night sweats, weight loss: TB
- Hand, foot and mouth - symptomatic management
- Man from bangladesh, pancytopenia, enlarged spleen - Hodgekins / TB - RESP

- Clinical Scenario
o Diagnosis- acute pharyngitis
o Treat (SBA- choose 2)- oral paracetamol & oral ibuprofen
o Brother has EBV; Management give 2 options- Analgesia; bed rest
o What would you find on bloods, choose 4- EBV antibodies; raised
transaminases; lymphocytic leucocytosis

Gastroenterology
- Anal fissure at 6 o clock what do you do stool softner
- Loose stools exam normal – IBS
- IBS question
- 22 y/o women with abdominal pain and diarrhoea, all tests normal- Irritable bowel
syndrome
- Get pain after eating- peptic ulcer disease
- Abdominal cramps + loose stools, no bleeding, IX → abdominal CT/US/PFA
- High GGT and MCV+ macrocytic anaemia → alcohol liver disease
- Woman in elderly home w/ incontinence x2w + not taking fiber for last 1m →
catheter vs. laxative; I would go with the laxative bc constipation can cause
incontinence due to faecal impaction
- Mass in RUQ, pale w/ attacks → intussusception
- Anemia + pallor + dyspepsia → refer for upper GI endoscopy
- Reason to refer- Frank bleeding PR??
- Pt w/ jaundice: pancreatic ca
 - child with peri-umbilical pain that localised to the right lower abdo- probably
appendicitis
- lady with vomiting and upper abdominal pain with tenderness in the RUQ -probably
acute cholecystitia
- 30 units of alcohol, dyspepsia - gastric cancer
- Hyperglycaemia, pancreatitis - alcohol hx
- Supraclavicular lump, feeling sick, so small intake - gastric cance
- Cut in the perianal lesion - anal fissues - stool softener
- Person with anal fissure at 6 oclock – stool softener
- Man with previous haemorrhoids, DRE normal - iron def tests or colonoscopy?
- Person with blood covered stool, 60 year old man – refer for colonscopy
- Gastric cancer
- Laryngeal cancer

- Clinical Scenario → 20y/o complaining of abdominal pain. Needs to empty bowels

very often. Pain is quite bad, needs to miss school
o DDx- Irritable bowel syndrome; inflammatory bowel disease
o What investigation you would do (choose 2)- colonoscopy; FBC
o On OCP, get headaches, photophobia and tingling sensation in arm; what
features worrying of pathology if present (choose 3)- petechial rash;
o Treatment for headaches (choose 2)- topiramte and sumitriptan

Endocrinology
- Subclinical hypothyroidism bloods – eltroxin (from moodle SBA)
- Lab results showing subclinical hypothyroidism → refer to endocrinology vs measure
after 6 months vs measure after 12 months; if no symptoms, repeat after 3-6 months
then annually
- Chronic steroid use → Cushing’s syndrome
- Tremors, weight loss, palpitations → Elevated T4 and Low TSH
- Women on eltroxin for hypothyroidism, bloods show raised T4 and raised TSH- over
medication
- Poorly controlled diabetes, complication seen on urine dipstick- proteins
- Hyperglycaemia: T2DM
- Subclinical hypothyroidism - TSH 6 and T4 12
- Women with hypothroid on levothyroxine - what now - increase the level
- Tsh elevated, normal thyroid levels – subclinical hypothyroidism
- Continue levothyroxine

- Clinical Scenario → Elderly man with new onset blurred vision and tingling
sensations in hands and legs

o Investigation- OGTT
o Features from history that leads to diagnosis (list 2)- blurred vision; tingling
sensation
o First line therapy- Metformin
 - Clinical Scenario → Came in with mom. 22 y/o very edgy and panicky. Tremor,
weight loss and heart palpitations. Cardiovascular and respiratory examinations
normal.

o Single most important investigation- TFTs (right)

o 2 management options- carbimazole; fluoxetine

Genitourinary / renal
- SA test what do explain risk and benefit then give
- Ph 6 and vaginal discharge – bacterial vaginosis
- Hard swollen testes- USS
- Scrotal lump- reassure and non-urgent ultrasound??
- Swollen and tender mass in the testicles. Diagnosis? Acute Epididymo-orchitis
- Incontinence want do use medication – oxybutin
- Guy having intercourse with men 10 days ago, urethritis and discharge what test –
renal
- Renal flank pain what test to confirm diagnosis urine analysis
- 26yo F w/ loin pain radiating to groin + haematuria → renal colic
- Haematuria, renal angle tenderness, rigors, dipstick blood + nitrates + and White
cells + - what treatment? Ciprofloxacin
- 30 something year old man presents with solid 2cm right testicular mass – best next
step – USS? Other option – CT pelvis, biopsy
- Boy with nocturnal frequency, lost weight, has RTI taking ibuprofen- AKI
- Prostate symptoms- reassure, advise self-help and follow up
- Renal colic- refer for X-ray of kidney ureter and bladder??
- Pt w/ testicular tumour: US
- Blood in urine: refer to urology
- Pyelonephiritis - ciprofloxacin
- Stress incontinence - pelvic floor
- Man with right testicular mass, 2 cm in size – ultrasound?
- Man with the stone – ultrasound?
- Man with pyelonephritis – give ciprofloxacin
- Urinalysis- RENAL STONES

Neurology
- hit head, headache chronic subdural haemorrhage
- fall risk with Doxazosin thingy
- status epilepticus what do you give- IV midazolam
- Symptoms of cauda equine- refer to ED X2
- Slept on arm, decreased sensation over first webspace- which action reduce
- Meningitis → IM penicillin (benzylpenicllin; cefotaxime if anaphylaxis against
penicillin)
- Band headache, worse at work → tension headache
- 4-month headache, HX of fall, 1w HX of paracetamol & codeine → chronic subdural
hemorrhage? I believe so
 - Seizure in waiting room, airway cleared → diazepam/midazolam/loosen clothes/turn
the patient into the recovery position/check glucose
- Vascular dementia + bilateral tingling in LL → ECG/Vitamin B12/electrophoresis
- Woman brought in by her husband hx of fall ~ week ago, forgetful, headaches
resistant to analgesia, most likely dx? – chronic subdural haematoma
- In GP practice you call next patient in you notice she is slow to start walking,
unsteady, wide based gait, nearly falls as she turns the corner – cerebellar disease
other options: parkinsonism
- 23 year old male with back pain, radiates down to his thigh no further than that.
Happened 24 hours ago? Localised pain to L4 with associated muscle spasm. No
neurological impairment. How to treat – advise bed rest for 2 days/MRI lumbar
spine/take analgesia and back to work
- Intension tremor, wide based gait, slurred speech- Cerebellar disease
- Resting tremor, shuffling gait- Lewy body dementia
- 17 y/o with collapse and jerking movements with immediate recovery- reassure as
vasovagal syncope
- Tension type headache- advise relaxation techniques
- 90y/o women with many falls, poorly controlled T2DM, metatarsal ulcer norm
noticed by her, fall caused by- Peripheral neuropathy??
- lady with eye pain that started in the shower -probably MS
- Elderly man with falls - doxizosan - causes postural hypotension
- Women walking with wide based gait - cerebellar
- Women walks in acutely ill and collapses - lie down and call an ambulance – drowsiness
- Women who fell 4 weeks ago - chronic subdural haematoma
- Woman who had a fall one month ago, has had a headache ever since – chronic subdural
haematoma
- Cerebellar disease
- Vasovagal syncope

- Vascular dementia
o Vascular dementia
o Ischemic stroke- change meds (Warfarin)

MSK
- Tennis history of OA painful arc test – impingement
- Shoulder pain: impingement
- Shoulder pain + FHX of OA + painful arc → IA injection/refer to ortho/MRI/X-ray
(PAINFUL ARC= SHOULDER IMPINGEMENT → REST, NSAIDS, THEN PHYSIO THEN
SUBACROMIAL STEROID INJECTION)
- Lower back pain after carrying heavy box + focal tenderness + (+) straight leg raise
- First thing to prescribe for osteoporosis- alendronate
- Guy comes in neck brace says that pain in neck since yesterday- on exam reduced
neck movements what do you do – neuro
- Ankylosing spondylitis → HLA-B27
- Gout secondary to medication → remove thiazide – MSK/renal
- Lower back pain after carrying heavy box + focal tenderness + (+) straight leg raise →
MRI spine/X-ray spine/analgesia/bed rest
- Runner w/ foot pain, unable to run, worse in morning → Achilles vs. plantar fasciitis
 - Pregnant patient with lower abdominal pain radiating to the back. What is the best
next step of management? Lignocaine Patch OR Refer to Physiotherapy OR Refer to
Orthopaedics or Heat Patches ???
- Woman post tibial fracture discharged from hospital 1 week ago – now short of
breath, tachypnoeic and tachycardic – most likely dx PE
- Lower back pain with decreased sensation on shin and dorsum of foot, weakened
dorsiflexion of big toe, knee and ankle reflex intact. What nerve root? L5
- Imingement - lack of sensation on the shin and over the foot, present reflexes in knee and
ankle - L5
- Woman with hx of carpal tunnel, now with bilateral wrist pain worse in morning,
can’t remember other clinical details – question most likely dx – RA
- DEXA Scan -2.6 - Alendronic acid x2
- Sciatica- absent ankle reflex and normal knee reflex?? – neuro???
- Golfers elbowF- wrist pronation
- Man with right thumb and knee pain, worse after activity- Pseudogout??
- Knee and finger pain, raised LFTs and hyperglycaemia- rheumatoid factor??
- Back pain: degenerative lumbar
- Old lady, externally rotated and shortened - right hip fracture
- Rheumatoid arthritis - woke with pain, got better throughout the day with dry eyes
- Carpal tunnel - sensation of the ring finger and baby finger
- Painful arc syndrome - Sub acromial inpingement
- Bilateral wrist swelling, history of dry eyes – rheumatoid arthritis
- Woman who had a fall and hip externally rotated – hip fracture
- Back pain with change in dorsiflexion of big toe and reduce sensation over shin area what
nerve root impingement (L5?)
- Lower back pain what impingeent ?
- Subacromial impingement
- Lower back pain physio
- Carpel tunnel tips?
- carpal tunnel syndrome wasting of hyperthenar eminence ?
- lady with bilateral carpal tunnel worse in morning
- L5

Mental health
- guy inappropriate, delusional, does not want to go for psych (increase lithium or
olanzapine??) increase olanzapine? (dude has schizophrenia)
- Guy on citalopram thinks mood better and thinks med affecting libido what do you
do
- Suicidal tendencies in 14-year-old what do- psych referral
- Women fainted, pinpoint pupils, 6 breaths/minute- Opioid overdose X2
- anxious patient comes again and again what do you do
- Depression 1y ago, complaining of decreased libido → taper/titer the dose of SSRI to
avoid withdrawal symptoms vs. specialist referral
- Known depression + HX of self-harm + wants to drink bleach → refer same
day/immediately for psych review
- Schizophrenic on olanzapine + lithium → increase dose, forced admission, refer to
psych OPD
 - Elderly on multiple medications, fall risk, which to review immediately →
citalopram/aspirin/doxazosin. CITALOPRAM
- 14 y/o overdose- psych referral??
- Panic Attack 3 to 5 times per week- refer for CBT??
- Women started on escitalopram, but complaining of worse mood and increased
anxiety, what do you do- continue with the medication at same dose
- Pregnant lady w/ depression: fluoxetine
- Lady w/ depression: SSRI
- Pt w/ bipolar: involuntary admission
- old lady with sudden onset confusion and agitation worse in the evening. Also seeing
her dead husband- I don’t know. Options were dementia, infection, psychosis and 2
more that I can’t remember; INFECTION → DELIRIUM
- Women with delirium, worried about neighbours - urine dipstick – delirium
- FBC - delirium
- Man separated from wife, with alcoholism and some suicide intent - adjustment disorder
- Woman with the 1 month history of anxiety, hence nausea? Etc – commence anxiety
treatment
- Bb blue/ psychosis (elation after delivery) → Reassure-baby blues
- Anxiety management
- Substance misuse/depression
- Alcohol history

- Clinical scenario → Psych: anxiety symptoms

o Two investigations→ ECG and TFT
o One diagnosis→ Generalized Anxiety Disorder
o One management→ CBT

- Clinical Scenario → 42y/o man depressed. Lost job recently. Drinking more than
usual (30 units a day).
o 2 important depression questions- how is your mood?; loss of appetite?
o 4 management options- start SSRI, refer to CBT; advice on alcohol reduction;
do FBC before prescribing medications
o ECG abnormality- RBBB

OBSGY
- Heavy menses what contraception- IUD levoprogesterone
- Obese, smoker what contraception- POP
- 40+ year old woman new partner, doesn’t want children, smoker, obese, mother had
osteoporosis, what contraception? POP
- Pregnant lady with blood showing low haemoglobin what test next FBC with iron
studies
- IMB + PCB + on OCP → stop pill
- Contraception 6w post-CS → lactational amenorrhea, POP, COCP, IUCD; lactational
amenorrhea up until 21 days (no contraception needed during this time); COCP
 shouldn’t be used if breastfeeding, have increased risk of VTE, or if CS; IUCD only if
CS uncomplicated; POP probably the best option
- PM woman w/ stress incontinence + mild cystocele → ring pessary vs. vaginal
pessary. A ring pessary is a vaginal pessary
- PM woman w/ recurrent dysuria + vaginal dryness → topical estrogen
- Pregnant woman w/ white vaginal discharge after course of amoxicillin → topical
antifungal; I think this is Bacterial vaginosis (treat w/ metronidazole esp in pregnancy
bc there is high risk of preterm delivery)
- Breast cancer with metastasis to thoracic spine, max analgesia → refer to
chemo/radio/psych/physio
- Breast cancer post-palliative radio on 10mg morphine, now drowsy and over sedated
→ increase dose/reduce/lower the dose to 5mg morphine sulphate/same and
monitor/switch to patches/add fentanyl; I would reduce the dose
- Pregnant women + slapped cheek → check parvovirus AB vs. refer for IVIG
- Pregnant woman w/ Hb 11.3, WBC N, platelets 440 → continue routine/refer to
haem/investigate low platelets
- Obese woman with heavy menstrual bleeding (flooding every month), over 35 years,
smoker – mirena coil
- Women - obese, smoking - POP
- Girl with menorrhagia and anaemic on blood test, what is most likely appearance on
blood film? Microcytic hypochromic – GU/haematology
- Breast feeding women with migraine with aura- COCP contraindicated X2
- Nipple hyperpigmentation, breast soreness and urinary frequency- Beta HCG
- Bilateral breast pain starting pre-menstruation and relieved with period- cyclical
breast pain
- Breast cancer, mets to spine - give radiotherapy
- Vaginal discharge and pain after intercourse with new partner- Swab for
chlamydia/gonorrhoea
- Women with PMB (postmenopausal bleeding)- endometrial biopsy
- Heavy menses - intrauterine levonergestrel
- Heavy menses, fatigue and SOB - microcytic, hypochromic and normocytic normochromic
- Pregnant 22 weeks elevated platelets, low Hb - do bloods FBC with iron studies or just
continue because it is physiological
- Woman who was a smoker, aged 43, looking for contraception, had no history of excessive
bleeding etc – progesterone only pill
- Woman who was 43 with the excessive bleeding – intrauterine system
- Woman who comes into GP, not feeling the best, collapses – lie supine and call ambulance
- 70yo banged her head a month ago now unsteady on her feet
- Menorrhagia tx
- Contraception for a smoker (progesterone only)

- Clinical scenario → Antenatal care

o 3-4 health promotion for her current pregnancy
o Treatment of abdominal pain in pregnancy→ Heat patches or Lignocaine
Therapy or Physiotherapy
o 2 symptoms of pre-eclampsia: vomiting, epigastric pain, headache, visual
disturbance, decreased fetal movements, small for gestational age fetus
o Breast engorgement
 - Clinical Scenario → 42 y/o women with vaginal discharge, vulval soreness and
pruritis
o Most likely diagnosis- candida
o Treatment- fluconazole
o Still having discharge after medications; choose 3 investigations- endocervical
swab
o Wants contraception, bloods shows microcytic anaemia- Intrauterine coil

Paediatrics
- Baby wants more feeds, mom feels breast empty, weight from 3.1 to 3.4kg in 2w →
add extra bottle feed and re-weigh or have feeding schedule
- 18 month old child with 24 hours vomiting, diarrhoea, no fever, appears well, good
form, wet nappies, cap refill <2secs → oral rehydration? Other options: oral
domperidone, loperamide, abx
- 10 y/o 38.7 temp, creps- Amoxicillin
- Child with bronchiolitis- symptomatic management
- Child with vomiting and diarrhoea- rotavirus
- child with abdominal distension, constipation and pallor- probably intussusception
- Child with mastoiditis - refer to A+E
- Child with lone playing, repeated words - ASD
- 18 month old with abdominal pain - FBC / Urine dipstick
- Child well, vomiting and diarrhoea - oral rehydration
- Child with lump in the neck, anterior to SCM and after a viral illness - branchial cyst
- Child with purpuric petechiae, GP 70 mins from hospital – im benzylpenicillin
- 18 month old child with the very heavy offensive diarrhea – oral rehydration
- lateral neck mass on three yo

- Clinical scenario → Paediatrics question

o Diagnosis→ Acute otitis media
o Antibiotic→ Amoxicillin
o 2 DX to rule-out in nocturnal enuresis→ UTI and Diabetes Mellitus
o 3 advice/non-pharmacological interventions→ Star Chart, Stop Fluid Intake
before Sleep and Use Bathroom before sleep

Haematology
- Nose bleeding, gum bleeding and bruising- thrombocytopenia
- 64 yr old with iron def anaemia- colonoscop
- 63yo M w/ fatigue + Hb/MCV/MCH/haematocrit low → colonoscopy vs. Vitamin B12
levels
- Elderly man with haemorrhoids, minimal bleeding every time with bowel movement,
normal PR exam- FBC to check for Fe deficiency anaemia??
- Low MCV: iron def
- Hypo microcytic
 - FBC and iron studies?
- Investigate platelet/ go to clinic (high platelet)

Oncology
- 22 yr old with itching mild splenomegaly, night sweats, weight loss, non-tender
lymphadenopathy in axilla and neck – lymphoma
- appropriate management for a 54 year old lady with post-menopausal bleeding-
options were CA125, abdominal US, and endometrial biopsy. I would start with
abdominal US, then do endometrial biopsy. (ddx: cervical cancer; ca125 points
towards ovarian cancer and she doesn’t present those symptoms) – gynae
- Supraclavicular lump, feeling sick so small intake - gastric cance

ENT
- Benign paroxysmal positional vertigo - eppleys maneuver
- BPPH- refer for Epley manuevre
- 60 something year old with hoarsness- refer to ENT
- Opera singer with hoarseness- vocal nodules
- Child with unilateral offensive nose bleed- foreign bod
- 19 y/o with nasal congestion- Intranasal fluticasone
- Mastoiditis with ear pain→ refer to ER
- Hoarseness + HX of smoking → refer to ENT
- Girl with recent ear infection tx with Abx not resolved, now has protruding ear with
bony tender prominence behind the ear, what is best next step – refer to ED
- 19 y/o with nasal congestion- Intranasal fluticasone
o Fluticasone (steroid) nasal spray → used to treat nasal polyps (swelling of the
lining of the nose)
o Should NOT be used to teat symptoms (e.g. sneezing, stuffy, runny, itchy nose)
caused by common cold
- Submandibular swelling: reassure pt
- Hearing loss, previous otitis media, retracted ear drum - with effusion
- Smoking, alcohol, pharynx fine, hoarse 8 weeks - laryngeal cancer
- Obstructive sleep apnoea - lifestyle advise vs. polysonography
- Glue ear
- Refer to ED Mastoiditis

Ophthalmology
- headache, hazy eye, right eye pain, decreased visual acuity what does he have
(options migraine, acute angle closure glaucoma, giant cell arteritis)
- Pic of blood in eyes and high bp- reassure
- Picture: conjunctivitis → warm compresses vs. chloramphenicol
- Picture: haemorrhage with no trauma→ refer to ophthalmology → (I DISAGREE, I
THINK IF THERE IS NOT HISTORY OF TRAUMA, IT WILL CLEAR SPONTANEOUSLY;
REFER IF HX OF TRAUMA) → CHECK
- Red eye, no trauma, young woman - reassure
 - “Curtain coming down on eyes”, fine next day, examination N → refer to
optometrist/neuro/ophthalmology evaluation
- Blepharitis- wash with baby shampoo
- Bitemporal hemianopia- pituitary tumor
- End organ damage for eye- retinal haemorrhage and cotton wool spots??
- Male with joint pains and presenting with sudden vision loss in left eye- prednisone
60mg and refer urgently for temporal artery biopsy
- 6 week check, absent red reflex- urgent referral to ophthalmology x2
- Red eye picture - uveitis
- Photophobia with the red looking conjunctiva – episcleritis
- Other red eye, looked like subconjunctival haemorrhage – reassure the patient
- - bloody eye
- red eye with photophobia and pain

Geriatrics
- Woman in elderly home w/ incontinence x2w + not taking fiber for last 1m- what do
- Elderly woman brought in by her daughter, change in behaviour for last week. Thinks
neighbours stealing food from her fridge and can see them hiding in the garden.
Drowsiness or some clouded consciousness?? What test – options: FBC, random
glucose, urine dipstick, MRI brain
-

Medication related
- Man with ischaemic heart disease, well controlled ACEi, aspirin, beta blocker, what
would be most beneficial to add – simvastatin. Other options: diuretic,
antidepressant
- Medication review: on anti-HTN, thiazide, aspirin, triptan PRN → which to remove? I
would remove Triptan
- Elderly man with polypharmacy, having falls lately, what medication most likely
causing them? Doxazosin. Other options: citalopram
- Diuretic started - what blood test - renal?
- Statin - LFTs
- NOAC - eGFR, APTT, monitor for signs of anaemia?
- Drug causing the mans postural hypotension – doxazosin (or whatever the alpha adrenegric
antagonist was)
- Renal function
- Aptt
- Iv benzylpenicillin?
- Statins- LFTs

Statistics
- NNT 4% and 2%
- Prognosis which study- cohort
Emergency
- Patient came in with anaphylactic shock, treated appropriately, fine now, next step-
send to ED
- Hemmorhage? Refer?

- Clinical Scenario → a patient Came in with angioedema, strider, wheeze can’t

breathe
o Diagnosis- Anaphylactic shock
o Priority (SBA)- call ambulance
o Medication- adrenaline
o Route- IM
o 4 therapeutic indications- antihistamine; corticosteroid; observe for late
phase reaction; recognise trigger
o After, what to prescribe- Epi Pen

Dermatology
- Pic of lesion on mouth and smoker- SCC
- Vesicular rash itching all over- chicken pox
- Child with vesicular rash on hands, feet and mouth. Tx – supportive
- Picture of child with crusty golden lesion around nose and mouth – Impetigo (same
as tutorial)
- Impetigo - child with lesions
- Picture of BCC (same as in tutorial)
- Basal cell ca - red pearly lesion
- Picture- keratoacanthoma??
- Picture- Comedonic acne
- Women with acne rosacea- metronidazole
- Picture: seborrheic keratosis → cryotherapy or refer to dermatology or reassurance
- Picture- scabies
- Scabies - women working in residential care, 2 week history of itching
- Picture: skin tags
- Picture: acne
- Picture: uveitis
- Picture: chicken pox
- Acantinic keratosis - women with sun exposure
- Sebacous cyst - biopsy / reassure
- Woman with rash on the back 2 weeks previously, not pain in the same area - neuropathy
answer???
- Diagnosis of skin lesion on nose – actinic keratosis
- Picture of lesion on mans forhead – basal cell carcinoma
- The other lesion with a blackhead top and was growing in size – biopsy lesion
- Post shingle neuralgia
- Scabies picture
- Management of cyst picture
- Cocksaxki supportive tx
- Impetigo
- Scabies
- Acetenic keratosis
- Basal cell carcinoma

- Pic of sebaceous cyst- conservative treatment

- pic of rosacea- metronidazole

- atopic dermatitis pic of infant

- Skin lesion + recent horse riding→ Tinea cruris

- Picture: molloscum contagiosum