May 15th 2021

Question 1

53M ++manual labour, right hand dimple, 2 underlying diseases

Answer 1

diabetes

liver disease

Question 2

53M ++manual labour, right hand dimple, 3 associated factors?

Answer 2

-increase ETOH
-excessive manual hand labour
-DM2
-liver disease
-smoking
age >50

Question 3

53M ++manual labour, right hand dimple, 2 Mx

Answer 3

watchful waiting

physiotherapy hand stretches

Question 4

65M right hip pain, x-ray shows trebeculations, joint space narrowing, osteophytes, 2 ddx?

Answer 4

Paget’s disease right femur

osteoarthritis

Question 5

68F bipolar, stable on lithium with new eGFR drop to 43, BP 160/80, 2 ddx

Answer 5

• hypertensive nephropathy

- renal damage, lithium

Question 6

68F bipolar, stable on lithium with new eGFR drop to 43, BP 160/80, 2Mx

Answer 6

• commence perindopril 2.5mg, PO, mane

- decrease lithium to 750mg, daily

Question 7

3/12M chesty cough, blocked nose past 3 days, bibasal crackles, 2 pathogens?

Answer 7

rhinovirus
respiratory syncytial virus
adenovirus
influenza
parainfluenza

Question 8

3/12M chesty cough, blocked nose past 3 days, bibasal crackles, 3 risk factors for severe disease

Answer 8

• parental smoking
• congenital heart disease
• undergoing chemotherapy
• immune deficiency

Question 9

55F CA-125 slightly elevated at 45 (0-35), fatigue, anorexia, in menopause 5ya, 6 symptoms to ask about?

Answer 9

abdominal bloating
abdominal girth change
abdominal pressure
change bowel habits
dyspareunia
urinary frequency

Question 10

55F CA-125 slightly elevated at 45 (0-35), fatigue, anorexia, in menopause 5ya, 2 signs

Answer 10

bimanual pelvic mass
palpable liver mass
lymphadenopathy

Question 11

55F CA-125 slightly elevated at 45 (0-35), fatigue, anorexia, in menopause 5ya, 6 causes of raised CA-125

Answer 11

ovarian cancer
breast cancer
normal variation
hepatitis
ovarian cyst
pancreatic cancer
bowel cancer

Question 12

52M hemi facial weakness and left eye soreness, 5 hx

Answer 12

• forehead muscle weakness
• change in taste?
• symptoms of stroke, hemiparesis
• vesicular rash near ear?
• eye pain?

Question 13

52M hemi facial weakness and left eye soreness, 3 mx for bell’s palsy

Answer 13

• eye patch for left eye
• prednisolone 1mg/kg up to 75mg daily for 5 days
• eye lubricants

Question 14

26M 5/52 hx of cough, worse ever, little response to amoxycillin, 5hx questions

Answer 14

• exposure to pertussis?
• immunised against pertussis?
• haemoptysis?
• post-tussive vomiting?
• smoking hx?
• sputum?

Question 15

26M 5/52 hx of cough, worse ever, little response to amoxycillin, likely pertussis, 2 investigations

Answer 15

• pertussis serology

- pulmonary function testing

Question 16

4yo, fever, cough, anxious drooling, quiet inspiratory/expiratory wheeze, missed some immunisations, 3 ddx

Answer 16

acute epiglottis
croup
bacterial tracheitis
inhaled foreign body

Question 17

4yo, fever, cough, anxious drooling, quiet inspiratory/expiratory wheeze, missed some immunisations, 4 examination findings

Answer 17

• stridor
• O2 saturations <92%
• accessory muscle use
• decrease consciousness

Question 18

4yo, fever, cough, anxious drooling, quiet inspiratory/expiratory wheeze, missed some immunisations, 3 immediate management

Answer 18

• 4L O2 via facemask maintain saturations >92%
• calm/comfort
• do not examine throat
• emergency urgent ambulance transfer

Question 19

28F intellectual disability, not attending work: 5 sources of information

Answer 19

tess herself
previous GP
residential support worker
next of kin
work colleagues/boss

Question 20

28F intellectual disability, not attending work:6 ddx

Answer 20

UTI
depression
constipation
pregnancy
hypothyroidism
generalised anxiety
physical abuse