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Monash University Faculty of Medicine, Nursing & Health Sciences YEAR 5 MBBS CLINICAL KNOWLEDGE TEST 18 AUGUST, 2006

EXAM DURATION: READING TIME: * PLEASE NOTE:

3 HOURS 10 MINUTES ALL 120 ITEMS MUST BE ATTEMPTED PLEASE USED BOTH SIDES OF THE GENERAL PURPOSE ANSWER SHEET ALL ITEMS HAVE ONE SINGLE CORRECT ANSWER

THIS PAPER IS FOR STUDENTS SITTING AT: (tick where applicable)


Clayton Mildura Bendigo

During an exam, you must not have in your possession, a book, notes, paper, calculator, pencil case, mobile phone or other material/item which has not been authorised for the exam or specifically permitted as noted below. Any material or item on your desk, chair or person will be deemed to be in your possession. You are reminded that possession of unauthorised materials in an exam is a discipline offence under Monash Statute 4.1.

AUTHORISED MATERIALS CALCULATORS OPEN BOOK SPECIFICALLY PERMITTED ITEMS if yes, items permitted are: NO NO NO

STUDENT NAME____________________________

ID ____________________

Year 5 Clinical Knowledge Test 18 August, 2006 Each question must be attempted. Each question has only 1 correct answer

1.

A 56 year old man presents to the Emergency Department with a 3 day history of central chest discomfort which has been waking him at night. He is currently pain free. He smokes 30 cigarettes per day and has a history of hypertension but compliance with medications has been erratic. He recalls similar symptoms 3 months ago, but only in the first few minutes of walking after meals. If he slowed down, the pain would disappear and allow him to complete his walk without any further symptoms. Which one of the following is the most appropriate management? A. B. C. D. E. Admit to the Coronary Care Unit for urgent thrombolysis Advise the patient on how to use anginine and antacids, then arrange exercise stress ECG Test and upper GIT endoscopy Arrange exercise stress ECG test as soon as possible Patient should be referred for upper GIT endoscopy Perform a 12-lead ECG and check cardiac enzymes

2.

A 75 year old woman is on no medication and has had nine episodes of syncope over the past three weeks. Examination shows a heart rate of 40bpm, blood pressure 180/100mmHg with a soft ejection systolic murmur over the aortic region, not radiating to the carotids. The most likely explanation of her syncope is: A. B. C. D. E. aortic valve stenosis complete heart block recurrent systemic emboli systemic hypertension vasovagal attack

3.

Individuals in population X have a 10% chance of developing ischaemic heart disease in the next 10 years. Your local pharmaceutical representative correctly indicates that randomised, placebocontrolled trials show that treatment with drug Y reduces the relative risk of ischaemic heart disease by 30%. The reduction in absolute risk of ischaemic heart disease in the next 10 years associated with treatment with drug Y (ie. the chance of an individual benefiting from treatment with drug Y) in population X is approximately: A. B. C. D. E. 1% 3% 7% 10% 30%

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Year 5 Clinical Knowledge Test 18 August, 2006 Each question must be attempted. Each question has only 1 correct answer

4.

Please review the following ECG. Which one of the following statements is true? A. B. C. D. E. Digoxin is contraindicated Early management should include an artificial pacemaker implant There is impaired conduction in the left bundle branch There is likely to be an obstructed dominant coronary artery This condition is more common in younger patients

5.

An elderly hypertensive, smoker with claudication is treated with an ACE inhibitor and there is an unexpected deterioration in renal function. A secondary form of hypertension is suspected. What is the most likely cause? A. B. C. D. E. Coarctation of the aorta Cushings syndrome Phaeochromocytoma Renal artery stenosis Hydronephrosis

6.

In the management of a patient presenting with severe diabetic ketoacidosis, which one of the following is the most urgent priority? A. B. C. D. E. Intravenous 5% dextrose infusion Intravenous bicarbonate administration Intravenous isotonic sodium chloride infusion Intravenous potassium chloride Subcutaneous injection of rapidly acting insulin

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Year 5 Clinical Knowledge Test 18 August, 2006 Each question must be attempted. Each question has only 1 correct answer

7.

A 25 year old patient with insulin-dependent diabetes is found unconscious and hypoventilating. There are no other abnormal physical signs. From the following options, which is the most appropriate initial management? A. B. C. D. E. Administration of 10 units of short acting insulin IV Administration of 50ml of 50% IV dextrose Encourage the patient swallow a glass of orange juice Insert a urinary catheter to look for glucose and ketones Obtain blood glucose sample and await laboratory results before initiating treatment

8.

A 26 year old married woman presents with secondary amenorrhoea; she has previously been well, however is on antidepressant medication. Her LH and FSH levels are normal and a prolactin level is twice the upper limit of normal. A repeat prolactin estimation, performed after the patient has relaxed for 20 minutes is similarly elevated. The next most appropriate step is to: A. B. C. D. E. administer bromocriptine therapy cease her antidepressant medication order a pregnancy test order an MRI scan of the pituitary organize a vaginal ultrasound

9.

A 20 year old woman with acute thyrotoxicosis is commenced on Carbimazole. After two weeks she develops a persistent and worsening sore throat with fever and mouth ulceration. What is the first and most appropriate test that is required? A. B. C. D. E. Blood culture Paul Bunnell test Serum immunoglobulins Throat swab White blood cell count

10.

A patient who has previously been treated with long term prednisolone collapses on returning to the ward following elective surgery. He is peripherally shut down with pulse 104bpm and blood pressure 82/50mmHg. Which one of the following would suggest a cause other than an Addisonian crisis (acute adrenal failure)? A. B. C. D. E. High arterial hydrogen ion concentration Hypercalcaemia Hyperkalaemia Hypernatraemia Hypoglycaemia

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Year 5 Clinical Knowledge Test 18 August, 2006 Each question must be attempted. Each question has only 1 correct answer

11.

A 45 year old man presents with a painful lesion on his left forearm. He states that the lesion has increased in size over the past two months. He had a cadaveric renal transplant 10 years before for chronic renal failure of unknown cause, and remains on triple immunosuppression with azathioprine, prednisolone and cyclosporin. On examination he has a 2x2 cm erythematous nodule with a central keratinous area. The most likely diagnosis is: A. B. C. D. E. fungal infection guttate psoriasis impetigo lichen planus pityriasis rosea

12.

A 52 year old man with active ulcerative colitis develops painful skin nodules on his legs. On examination there are five lesions in total, each being approximately 4cm in diameter, erythematous, firm and tender. The most likely diagnosis is: A. B. C. D. E. erythema multiforme erythema nodosum furunculosis insect bites multiple haemangiomata

13.

In a patient with degenerative disc disease in the lumbar spine, a limitation of straight leg raising with the production of sciatica: A. B. C. D. E. indicates nerve root irritation is a common presenting feature is a manifestation of a nerve root conduction defect is an indication for surgery usually indicates a central disc prolapse

14.

A 65 year old woman with long standing rheumatoid arthritis presents for her routine check-up. She now reports concern with mid to low back pain, however all is well with her joint disease. She is on disease modifying drugs including methotrexate and prednisolone. Which one of the following is the most likely cause of her back pain? A. B. C. D. E. Ankylosing spondylitis Psychogenic Rheumatoid arthritis of the axial spine Sacro-iliitis Vertebral collapse secondary to osteoporosis

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Year 5 Clinical Knowledge Test 18 August, 2006 Each question must be attempted. Each question has only 1 correct answer

15.

A 56 year old man presents with a two day history of a sudden onset painful swollen left knee joint. Aspiration of the joint reveals cloudy fluid. Microscopy shows large number of neutrophils containing a few negatively birefringent crystals. No organisms are seen and culture remains negative after several days. The most likely diagnosis is: A. B. C. D. E. gout pseudo-gout Reiters disease septic arthritis traumatic knee injury

16.

Which one of the following side-effects has been ascribed to calcium entry blocking drugs (calcium antagonists)? A. B. C. D. E. Deafness Early cataract formation Hyperglycaemia Hyperuricaemia Peripheral oedema

17.

A 66 year old man with severe psoriasis, hypertension and depression is admitted and found to have abnormal liver function tests with raised serum transaminases. Which one of his medications listed below, is most likely to have caused his hepatic toxicity? A. B. C. D. E. Amlodipine Aspirin Fluoxetine Lisinopril Methotrexate

18.

Tim is a 25 year-old previously well man who presents with a one week history of nausea, vomiting, and mild right-sided abdominal pain. He is mildly icteric and has a temperature of 37.8C. He has right upper quadrant tenderness. Results of his initial investigation include: Aspartate amino transferase (AST) Alanine amino transferase (ALT) Alkaline Phosphatase (ALP) Gamma Glutaryl transferase The most likely diagnosis is: A. B. C. D. E. acute cholecystitis extrahepatic biliary obstruction with cholangitis liver abscess undisclosed paracetamol overdose viral hepatitis 400 U/L 500 U/L 200 U/L 100 U/L (<35) (7 56) (30 120) (10 75)

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Year 5 Clinical Knowledge Test 18 August, 2006 Each question must be attempted. Each question has only 1 correct answer

19.

Hepatic encephalopathy may be precipitated in a cirrhotic patient by each of the following, except: A. B. C. D. E. infection constipation gastrointestinal bleed oral neomycin surgery

20.

A patient with poorly controlled ulcerative colitis develops abdominal distension a few days after a barium enema and is critically ill. Paradoxically, his stool frequency has decreased. An abdominal radiograph shows a colonic diameter of twice normal size. He is admitted to a high dependency unit and given intravenous fluids and corticosteroids. Daily plain abdominal x-rays are performed. The most likely diagnosis is: A. B. C. D. E. faecal impaction from inspissated barium non malignant stricture of the ascending colon pseudopolyposis toxic megacolon volvulus

21.

A 54 year old woman with a past history of primary biliary cirrhosis presents to the Emergency Department following an episode of large volume, painless haematemesis. On general inspection, she has spider naevi and palmar erythema. On examination, the splenic tip is palpable. The most likely diagnosis is: A. B. C. D. E. duodenal ulcer gastric angiodysplasia gastric ulcer Mallory-Weiss tear variceal haemorrhage

22.

A 56 year old man presents with a six month history of epigastric discomfort that is relieved by antacids. Over the past two months he has lost some weight. He smokes 20 cigarettes per day and drinks 32 units of alcohol per week. The most appropriate management plan is to: A. B. C. D. E. commence treatment with a H2 receptor antagonist for six weeks and review organise an ultrasound scan of abdomen provide life-style advice, continue with antacid and review in six weeks request a gastroscopy test for Helicobacter pylori and treat if positive

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Year 5 Clinical Knowledge Test 18 August, 2006 Each question must be attempted. Each question has only 1 correct answer

23.

A 70 year old woman presents with a six month history of lethargy and left upper quadrant abdominal discomfort. On examination, generalised small lymphadenopathy and moderate splenomegaly is detected. Full blood examination reveals haemoglobin WCC platelets neutrophils lymphocytes The most likely diagnosis is: A. B. C. D. E. acute lymphoblastic leukaemia acute myeloid leukaemia chronic lymphocytic leukaemia Hodgkins Disease infectious mononucleosis 9.0g/dL 19.0 x 109/L 145 x 109/L 5.0 x 109/L 30.0 x 109/L (12.5 17.5) (4 11) (140 - 450) (2.0 8.0) (2.0 8.0)

24.

A 75 year old woman on low dose warfarin therapy for chronic atrial fibrillation is admitted to hospital with an acute abdomen requiring urgent surgery within four hours. Her International Normalised Ratio (INR) is 2.5 (normal 1). The surgeon requests your advice and therapeutic intervention to prepare this patient for surgery. Which one of the following would be the single best advice? A. B. C. D. E. If patient is on low dose warfarin therapy, she has minimal risk of bleeding Patient will require fresh frozen plasma to rapidly correct the INR as well as vitamin K intravenously. When INR is less than 1.5, surgery can safely go ahead Surgery should be delayed for 24 hours to allow withdrawal of warfarin and minimise the bleeding risk The most appropriate therapy for rapid reversal of warfarin is intravenous recombinant factor 8 concentrate The patient should receive vitamin K therapy intramuscular, which should reverse the warfarin effect and allow surgery within four hours

25.

Spontaneous petechial haemorrhages are characteristically associated with which one of the following: A. B. C. D. E. haemophilia heparin therapy platelet count less than 20,000x109/L von Willebrands disease warfarin therapy

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Year 5 Clinical Knowledge Test 18 August, 2006 Each question must be attempted. Each question has only 1 correct answer

26.

In a patient presenting with pleuritic chest pain, all of the following support a diagnosis of pulmonary embolus, except: A. B. C. D. E. an unmatched perfusion defect on a ventilation/perfusion lung scan hypoxaemia normal D-dimer level presence of a pleural rub on auscultation of the chest sinus tachycardia

27.

A 71 year old woman presents with increasing low back pain over six weeks. X-rays show a wedge compression fracture of L4 together with multiple lytic lesions in the pelvis. Full blood count shows a mild pancytopaenia. Liver function tests show an increase in the serum concentration of total protein and a normal albumin. Calcium is elevated at 3.1mmol/L (2.1 2.6) and renal function is impaired with a creatinine of 210mol/L (< 120). The most likely diagnosis is: A. B. C. D. E. acute myeloid leukaemia metastatic cancer of unknown primary origin multiple myeloma osteoporosis primary hyperparathyroidism

28.

A 69 year old man presents with a four week history of weight loss, and night sweats. He has no significant past medical history. Examination reveals the presence of significant lymphadenopathy in the cervical and axillary regions. The nodes are firm and measure up to 3cm in diameter. His spleen is easily palpable 16cm beneath the left costal margin. Appropriate management of this man would include all of the following, except: A. B. C. D. E. biopsy of the spleen bone marrow examination CT examination of his neck, chest, abdomen and pelvis examination of the blood film measurement of serum LDH level

29.

Which one of the following is correct regarding a positive HIV antibody test? A. B. C. D. E. The patient can transmit the virus through saliva The patient has AIDS The patient has lifelong infection and infectivity The patient should immediately commence combination anti-retroviral chemotherapy The patient should commence Pneumocystis carinii prophylaxis

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Year 5 Clinical Knowledge Test 18 August, 2006 Each question must be attempted. Each question has only 1 correct answer

30.

A medical student has been in Australia for four years and decides to return home to Africa for a holiday. On his return to Australia he has flu-like symptoms with chills, jaundice, muscle aches and is mildly anaemic. After two days of illness he feels increasingly under the weather and is taken to the Emergency Department. What condition should be uppermost in the thoughts of the examining doctor? A. B. C. D. E. Falciparum malaria Hepatitis type A HIV infection Type A influenza Typhoid or paratyphoid fever

31.

A 29 year old woman had an attack of pleurisy six months ago. She has had recurrent mouth ulcers for the past two years and more recently she has had night sweats, arthralgia and alopecia. Her hands and wrists are stiff in the morning but improve during the day or after active movements. Which one of the following investigations is most likely to support your clinical diagnosis? A. B. C. D. E. Antinuclear antibodies Chest x-ray Erythrocyte sedimentation rate Full blood examination Rheumatoid factor

32.

A man aged 40 comes to the Emergency Department complaining of a hot red, swollen, painful knee joint and inability to walk. The diagnosis to exclude first should be: A. B. C. D. E. coagulation disorder crystal arthritis monoarticular rheumatoid arthritis septic arthritis sustained trauma

33.

A 45 year old smoker presents with a one month history of increasing shortness of breath and haemoptysis. On examination he has dullness to percussion in the right base to mid zone, absent breath sounds and decreased vocal resonance. This clinical picture is most consistent with: A. B. C. D. E. lung fibrosis pleural effusion pneumothorax pulmonary abscess pulmonary consolidation

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Year 5 Clinical Knowledge Test 18 August, 2006 Each question must be attempted. Each question has only 1 correct answer

34.

A 28 year old mechanic presents with a 24 hour history of upper respiratory tract infection followed by sudden onset of chills, rigors and cough. Chest x-ray demonstrates right lower lobe pneumonia. Which one of the following statements is most applicable? A. B. C. D. E. Chest x-ray findings makes mycoplasma likely Klebsiella pneumoniae commonly presents with lobar pneumonia and the patient should receive vancomycin The most likely causative organism is Streptococcus pneumoniae and the patient should receive intravenous penicillin The most likely organism is Haemophilus influenzae and the patient should be treated with intravenous ampicillin The patient should receive metronidazole

35.

A 19 year old woman presents to the Emergency Department with asthma. She is unable to tell you her history due to severe breathlessness but her friend tells you she has had asthma all her life, but recently her regular puffers are not controlling it well. On examination her HR is 126bpm, RR 36bpm, BP 150/70mmHg and her peak flow is 100L/min. She has an oxygen saturation of 98% whilst on oxygen. Her chest is surprisingly quiet on auscultation. You prescribe nebulised salbutamol. Your next action should be to: A. B. C. D. E. arrange a chest x-ray and ECG call for senior help immediately repeat her peak flow revisit her in half an hour to assess her reversibility with nebulised salbutamol wait for result of arterial blood gases

36.

A 25 year old man, who has been previously well, presents with acute onset of dyspnoea. On examination he has tracheal deviation to the right with reduced expansion, percussion hyper-resonant reduced breath sounds and reduced tactile vocal fremitus on the left side of the chest. His oxygen saturation is 88% breathing air. You commence oxygen therapy. Which one of the following options is the most appropriate next step in management? A. B. C. D. E. Commence antibiotics Commence increased inspired oxygen via nasal prongs Order a spiral CT scan of the chest Perform left sided needle thoracostomy Treat with non-invasive positive pressure ventilation via face mask while awaiting chest x-ray

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Year 5 Clinical Knowledge Test 18 August, 2006 Each question must be attempted. Each question has only 1 correct answer

37.

A 50 year old man who smokes 20 cigarettes per day gives a history of two months weight loss and persistent cough. There are no abnormal physical signs other than a persistent, fixed wheeze in the right upper chest anteriorly. A chest radiograph shows a centrally placed perihilar opacity with radiating streaks. No sputum is available. Which one of the following investigations is most likely to guide your future management of this patient? A. B. C. D. E. Bone scan Bronchoscopy and biopsy Computed tomography scan Isotopic ventilation-perfusion scan Pulmonary function studies

38.

A 45 year old woman presents with a 6 day history of increasing muscular weakness and paresthesia of hands and feet. On examination there is moderately severe ascending symmetrical weakness of limb and trunk muscles. There is no wasting. Reflexes are all absent. Initial investigations include a normal serum CK level and the following CSF findings: cells nil protein 0.95 g/L (< 0.4) glucose 3.5 mmol/L (2.5 - 4.5) The most likely diagnosis is: A. B. C. D. E. amyotrophic lateral sclerosis Guillain-Barr syndrome multiple sclerosis poliomyelitis polymyositis

39.

A 70 year-old man, who normally lives alone in a very small apartment, is brought into the Emergency Department in a drowsy state. He is known to drink alcohol. Although he can give some account of his past life, he is unclear of the events of the last few weeks. On examination, he has nystagmus on looking to either side and mild bilateral sixth nerve palsies. The most likely cause for his current state is: A. B. C. D. E. acute alcohol intoxication central pontine myelinolysis extradural haematoma overdose of amitriptyline Wernickes encephalopathy

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Year 5 Clinical Knowledge Test 18 August, 2006 Each question must be attempted. Each question has only 1 correct answer

40.

A 23 year old woman is brought into the Emergency Department by her boyfriend. She appears drowsy. Her boyfriend says she developed a cold last week. She then developed a headache and earlier today complained of photophobia. He came home early to find her in bed. Lumbar puncture shows: WBC 15 x 106/L (<5) 80% lymphocytes gram stain negative protein 0.45 g/L (0.15-0.45) CSF glucose normal RBC < 3 x 106/L The most likely diagnosis is: A. B. C. D. E. bacterial meningitis Guillain-Barre syndrome polio tuberculous meningitis viral meningitis

41.

A 75 year old man complains of a left frontal headache increasing in severity over the past two weeks. A few days ago he also noted some tenderness in his jaw which was brought on at meal times. He has not felt well for the past month and has lost 2kg in weight. Which one of the following is the most likely diagnosis? A. B. C. D. E. Cerebral tumour Depression Late onset migraine Pagets disease Temporal arteritis

42.

Nephrotoxicity may be caused by each of the following, except: A. B. C. D. E. cyclosporin A digoxin gentamicin intravenous contrast myoglobin

43.

Angiotensin converting enzyme inhibitors are routinely used in each of the following, except: A. B. C. D. E. congestive cardiac failure first line treatment of essential hypertension following anterior myocardial infarction severe aortic stenosis treatment of hypertension in diabetic patients

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Year 5 Clinical Knowledge Test 18 August, 2006 Each question must be attempted. Each question has only 1 correct answer

44.

A girl aged 13 has had a fight with her boyfriend and ingested 6 of her mothers diazepam 5mg tablets. Three hours post ingestion she is drowsy with a Glasgow coma score of 12 and has a pulse rate of 80bpm and blood pressure 110/50mmHg. Her oxygen saturation is 98% on room air. Which one of the following is the most appropriate treatment for this patient? A. B. C. D. E. Activated charcoal Close observation Gastric lavage Intravenous fluids Intravenous flumazenil

45.

Which one of the following is the single best investigation when assessing renal function? A. B. C. D. E. Creatinine clearance Creatinine excretion Serum creatinine Serum potassium Serum urea

46.

A patient has had a subtotal thyroidectomy. Three hours after surgery she develops severe respiratory distress and an increasingly swollen neck. After calling for more senior help, the correct treatment is to: A. B. C. D. E. administer an anaesthetic and explore the wound administer morphine to allay distress arrange for intubation of the patient in the ward setting high flow humidified oxygen via mask therapy open the wound in the ward and divide sutures in the deep fascia

47.

Which one of the following techniques is most effective in controlling anterior nasal bleeding from Littles area? A. B. C. D. E. Adrenaline and cocaine paste Digital compression of the nares Digital compression over the nasal bones Ice pack to the forehead Insertion of a Foleys catheter

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Year 5 Clinical Knowledge Test 18 August, 2006 Each question must be attempted. Each question has only 1 correct answer

48.

Two days after a total thyroidectomy a 54 year old woman complains of tingling around her mouth and in her hands. The most appropriate initial investigation to guide immediate management of this patient is: A. B. C. D. E. arterial blood gases serum calcium serum parathyroid hormone levels serum urea and electrolytes thyroid hormone levels

49.

A 25 year old woman presents with full thickness burns to both entire upper limbs and one half of the posterior aspect of her trunk. What percentage burns has she suffered? A. B. C. D. E. 5% 9% 12% 27% 50%

50.

A 22 year old motorcyclist has been brought into the Emergency Department following a collision. The ambulance staff report a Glasgow coma score of 9, pulse rate 110bpm and blood pressure 100/60mmHg. He has a wound of the right lower limb, which is bleeding. What is your first line of management in this patient? A. B. C. D. E. Apply tourniquet to the lower limb Assess his airway Compression to the bleeding point CT scan of the brain Insert 2 large bore intravenous cannulae

51.

The most appropriate suture for a laceration on the cheek is: A. B. C. D. E. Cat gut 2/0 Nylon 3/0 Nylon 6/0 Nylon 9/0 Silk 3/0

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Year 5 Clinical Knowledge Test 18 August, 2006 Each question must be attempted. Each question has only 1 correct answer

52.

A 48 year old heavy drinker and smoker has a laparotomy with oversewing of a perforated duodenal ulcer. Seventy two hours after surgery he is confused, disorientated and tacypnoeic. Which one of the following is the most important initial investigation? A. B. C. D. E. Blood alcohol concentration Blood gases Blood screen for disseminated intravascular coagulation Liver function tests X-ray of abdomen

53.

A patient presents to the Emergency Department complaining of colicky abdominal pain and vomiting for six hours. Plain radiographs of his abdomen show distended loops of small bowel with fluid levels. If laparotomy is indicated, which one of the following intravenous regimens would you prescribe? A. B. C. D. E. Balanced electrolyte solution (Hartmanns) 2000ml prior to surgery Balanced electrolyte solution (Hartmanns) 500ml during operation 4% dextrose in N/5 saline 2000ml during operation 4% dextrose in N/5 saline 500ml prior to surgery 5% dextrose 2000 ml before surgery

54.

Four days after a laparotomy for a perforated peptic ulcer, your patients abdominal dressing is noted to be heavily saturated with clear, non purulent fluid. What is the most appropriate management? A. B. C. D. E. Commence IV flucloxacillin Commence IV penicillin Return to theatre to oversew reperforated ulcer Return to theatre to repair dehiscence of the muscle layers Swab the wound for microscopy and culture

55.

The effects of heparin can be reversed by treatment with which one of the following: A. B. C. D. E. prostaglandins prostigmine protamine sulphate thiamine Vitamin K

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Year 5 Clinical Knowledge Test 18 August, 2006 Each question must be attempted. Each question has only 1 correct answer

56.

A 72 year old man presents to his GP with a one day history of sudden onset of a painful right eye. The pain is severe and he has vomited twice. The right eye is red with a cloudy cornea. It has an acuity of hand movements only; acuity in the left eye is 6/12. The pupil in the right eye is fixed and semi-dilated. The most likely diagnosis is: A. B. C. D. E. conjunctivitis (acute) glaucoma (acute) iritis (acute) optic neuritis retinal detachment

57.

In hospital surgical patients the most common cause of acute oliguric renal failure is: A. B. C. D. E. hypovolaemia medication reaction pre-existing renal disease uncontrolled infection urinary obstruction

58.

Which one of the following statements is true in planning elective surgery in a patient with type 1 diabetes? A. B. C. D. E. Diabetes medication should be ceased 24 hours prior to surgery Insulin and saline should be infused continuously during surgery Patients normally treated with diet alone should be given sulphonylurea The patient should ideally be put first on the operating list There is no need for pre-op fasting

59.

A 30 year old man is freed from a car involved in a head on collision. He clearly has extensive facial fractures. The first priority in his care is to: A. B. C. D. E. check for a tension pneumothorax ensure adequate pain relief measure and monitor Glasgow coma scale secure adequate large bore IV access secure airway and stabilise cervical spine

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Year 5 Clinical Knowledge Test 18 August, 2006 Each question must be attempted. Each question has only 1 correct answer

60.

A patient presents with intermittent loose bowel actions for six months associated with episodes of colicky central abdominal pain. Physical examination reveals tenderness in the right iliac fossa and an anal fissure. Which one of the following is the most likely diagnosis? A. B. C. D. E. Carcinoma of the colon Crohns disease Diverticular disease Irritable bowel syndrome Ulcerative colitis

61.

An elderly man has been immobile for 3 weeks after a stroke. For one week he has been restless and has increasing thin, watery, highly offensive stools leaking continually into the bed. His abdomen feels lumpy and an abdominal x-ray shows a ground glass homogeneous appearance in the pelvis. Spurious diarrhoea is suspected. What is the most probable cause? A. B. C. D. E. Fistula in-ano Intestinal hurry from a high osmolar diet Pseudomembranous colitis Rectal faecal impaction Volvulus of the colon

62.

A 26 year old man is the driver involved in a high speed head on car crash. His blood pressure is 80/50mmHg, HR 130bpm and he has a raised JVP. Which one of the following is correct? A. B. C. D. E. A chest x-ray is necessary to diagnose a tension pneumothorax A CT scan is not necessary A widened superior mediastinum on an AP supine CXR does not confirm aortic transection He does not require a cervical spine x-ray Pericardial drainage is required if his heart sounds are muffled

63.

A man in his thirties has a heavy meal with alcohol and vomits shortly afterwards. He has severe thoracic and epigastric pain. He becomes breathless and hypotensive. When you see him in the Emergency Department he is noted to have subcutaneous emphysema in the root of the neck on both sides and a left sided pleural effusion. What intrathoracic event has occurred? A. B. C. D. E. Aneurysmal dissection Lower oesophageal rupture Massive pulmonary infarct Myocardial infarction with rupture of left ventricular wall Tension pneumothorax

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Year 5 Clinical Knowledge Test 18 August, 2006 Each question must be attempted. Each question has only 1 correct answer

64.

A patient returns 48 hours after application of a long leg cast for a fractured tibia, complaining of severe pain in the leg with loss of feeling in the foot and inability to dorsiflex the great toe. Your next step in managing this patient is to: A. B. C. reassure the patient, explaining the degree of pain associated with the fracture with advice to go home and elevate the limb split the cast from top to bottom, including the entire thickness of the webbing or velband lining so the skin is visible and arrange for admission and leg elevation split the cast from top to bottom, including the entire thickness of the webbing or velband lining so the skin is visible and then wrap cast in crepe bandage to support it and arrange outpatient appointment split the cast partially to relieve swelling split the plaster cast but not the webbing or the velband lining

D. E.

65.

A patient presents after sustaining a fall. He has pain in the wrist and a tender anatomical snuff box. Initial management should be: A. B. C. D. E. apply ice and bandage firmly immediate bone scan if x-ray is normal and treat according to result mobilise the limb fully, assuming a sprain x-ray and immobilise for 10 days prior to repeat x-ray x-ray and mobilise fully, if no fracture is found

66.

A 25 year old motorcyclist admitted to hospital for a fractured femur is noted to be confused and short of breath six hours after internal fixation of the fracture. His oxygen saturation is 100% on high flow oxygen. He had no loss of consciousness at the scene and the fracture is his only injury. The most probable diagnosis is: A. B. C. D. E. a fat embolism acute pulmonary embolism atelectasis pneumonia due to aspiration pneumothorax

67.

An 80 year old woman sustains a fall in the ward while walking to the toilet. On examination her leg and foot are externally rotated compared with the opposite limb and there is some shortening. Which one of the following is the most likely diagnosis? A. B. C. D. E. Ankle fracture Dislocation of hip Fractured neck of femur Rami of the pelvis fracture Shaft of the femur fracture

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Year 5 Clinical Knowledge Test 18 August, 2006 Each question must be attempted. Each question has only 1 correct answer

68.

Which one of the following is least predictive of a life threatening attack of acute pancreatitis? A. B. C. D. E. Hypocalcaemia Increased amylase Metabolic acidosis Raised white cell count Reduced arterial oxygen tension

69.

A 45 year old woman presents with sudden onset of severe abdominal pain. Plain abdominal x-rays show multiple air fluid levels and distended bowel loops. There is no free gas under the diaphragm. The most likely diagnosis is: A. B. C. D. E. abdominal aortic aneurysm rupture cholelithiasis Meckels diverticulum perforated peptic ulcer strangulated internal hernia

70.

Which one of the following combinations is most likely to indicate that a patient has acute appendicitis? A. B. C. D. E. Pain in the right iliac fossa associated with vomiting Peri-umbilical pain associated with several episodes of vomiting Right iliac fossa pain associated with a fever of 39.5oC Right iliac fossa pain associated with local tenderness and guarding Right iliac fossa pain associated with profuse diarrhoea and a fever of 37.8oC

71.

Which one of the following indicates complete transection of the cord immediately after spinal cord injury? A. B. C. D. E. Flaccid paralysis and loss of all sensory modalities and reflexes below the involved segments Loss of motor power below the involved segments but not of sensation Loss of sensation and power below the involved segments but not of leg reflexes Loss of sensation below the involved segments but not of motor power Spasticity and hyper-reflexia below the involved segments

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Year 5 Clinical Knowledge Test 18 August, 2006 Each question must be attempted. Each question has only 1 correct answer

72.

The most important clinical observation following head injury is: A. B. C. D. E. Babinski reflex fundoscopic examination level of consciousness pulse rate state of the pupils

73.

A man aged 70 years falls off his bicycle and grazes his face, cheek and forehead. He is temporarily stunned but recovers and has no further problems. Three weeks later he notices that his left foot is dragging. Within hours his left arm is weak and he becomes progressively drowsy. He is taken to hospital and following treatment makes a complete recovery. The most likely diagnosis is: A. B. C. D. E. a subdural haematoma cerebral embolus cervical spinal cord trauma haemorrhage into cerebral tumour subarachnoid haemorrhage

74.

An 18 year old woman presents with a traumatic tension pneumothorax. Which one of the following statements is most applicable? A. B. C. D. E. A catheter should be inserted in the 2nd intercostal space mid-axillary line A plain chest x-ray is necessary before insertion of any tube or cannula An open wide bore IV cannula should be inserted into the 2nd intercostal space mid-axillary line An open wide bore IV cannula should be inserted into the 2nd intercostal space mid clavicular line If a wide bore cannula is inserted it must be connected to underwater seal

75.

Which one of the following is true of fractured ribs? A. B. C. D. E. They are more common following penetrating trauma rather than blunt trauma They frequently require some form of internal fixation They occur more often in children than adults subjected to similar injurious forces They rarely involve 1st and 2nd ribs They usually result in a flail chest

76.

Which one of the following is true regarding mammography? A. B. C. D. E. It causes excessive radiation exposure It is able to differentiate cystic from solid lesions It is more accurate in premenopausal women It is more likely than self examination to detect early cancers It is most useful in women who have a palpable breast lump

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Year 5 Clinical Knowledge Test 18 August, 2006 Each question must be attempted. Each question has only 1 correct answer

77.

A 65 year old man presents with a six month history of passing blood stained stools. Proctoscopy reveals 2nd degree haemorrhoids and sigmoidoscopy shows no other anorectal pathology. The next step in management for this patient should be to: A. B. C. D. E. advise high fibre diet and avoid straining at stool arrange faecal occult blood tests on three stool samples arrange for a colonoscopy refer to a surgeon for a haemorrhoidectomy treat the haemorrhoids with rubber hand ligation

78.

You diagnose a 1cm diameter malignant melanoma on clinical examination of the right calf of a 25 year old woman. The next step in managing this patient would be: A. B. C. D. E. excisional biopsy of the lesion fine needle aspiration cytology incisional biopsy of the lesion pelvic CT scan (with contrast) looking for malignant node involvement prescribe a steroid based cream

79.

The most important treatment modality in gas gangrene of the lower limb is: A. B. C. D. E. hyperbaric oxygen therapy intravenous high dose penicillin lower limb amputation regular saline dressings urgent surgical debridement

80.

A 16 year old boy presents complaining of acute pain in the left testicle. Which one of the following is true? A. B. C. D. E. A normal duplex study excludes torsion of the testicle A normal urine test excludes epididymo-orchitis If it is normal on examination, the diagnosis is idiopathic scrotal oedema It requires urgent surgical exploration to prevent infarction of the testicle The testicle is rotated in a lateral direction to see if this relieves the pain

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Year 5 Clinical Knowledge Test 18 August, 2006 Each question must be attempted. Each question has only 1 correct answer

81.

A 77 year old woman has undergone a total knee joint replacement for severe osteoarthritis. After two weeks the knee is noted to be red, swollen, hot to touch and more painful than in the few days immediately after the operation. She is unable to participate in ongoing rehabilitation due to pain. On examination there is evidence of minor wound dehiscence and a purulent discharge which grows methicillin resistant Staphylococcus aureus (MRSA). She looks well, and her blood pressure is 145/85mmHg, pulse rate of 100bpm, and she is febrile at 38.2C. Which one of the following represents the best management for this patient? A. B. C. D. E. Empirically commence intravenous vancomycin Organise a CT scan of the knee to exclude an abscess Organise a return to theatre for joint washout and direct examination Organise an ultrasound to exclude a fluid collection Take a deeper wound swab and commence intravenous Vancomycin

82.

Which one of the following is true regarding paracetamol? A. B. C. D. E. It does not cause hepatotoxicity It is a non-steroidal anti inflammatory drug It is not antipyretic It is usually given in a dose of 200mg to adults It may be given rectally

83.

Which one of the following changes would you expect to find in an otherwise fit 25 year old man who has had a loss of one litre of blood over a period of one hour? A. B. C. D. E. A drop in supine systolic blood pressure of 15mmHg A drop in supine systolic blood pressure of 30mmHg A pulse rate rise from 70 to 120 on standing Confusion Restlessness and agitation

84.

Which one of the following is correct. Wound healing is likely to be impaired by: A. B. C. D. E. administration of prophylactic antibodies closure with absorbable sutures debridement of necrotic tissue inversion of skin edges use of an occlusive dressing

85.

Which one of the following is correct. A sebaceous cyst (epidermoid cyst): A. B. C. D. E. is attached to skin is common intraorally is fluctuant is transilluminable occurs at sites of fusion of dermatomes

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Year 5 Clinical Knowledge Test 18 August, 2006 Each question must be attempted. Each question has only 1 correct answer

86.

A patient with a prosthetic mechanical mitral heart valve and who is on warfarin, is scheduled to have a prostatectomy. The correct management is to: A. B. C. D. E. add concurrent low molecular weight heparin to the warfarin regime continue the warfarin until just before surgery discontinue the warfarin at least 5 days prior to surgery and maintain anticoagulation with low molecular weight heparin un 24 hours prior to surgery discontinue the warfarin two days prior to surgery maintain the warfarin therapy, however check the International Normalized Ratio (INR) frequently

87.

Each of the following are recognised long term side effects of chronic steroid use, except: A. B. C. D. E. cataracts glucose tolerance impairment hypercholesterolemia osteoporosis proximal myopathy

88.

Mrs Wales, aged 65 years, has had multiple infective exacerbations of COPD over the past 10 years. She is short of breath on minimal exertion, with evidence of right heart failure, and still smokes occasionally. Each of the following options should be included in her overall management plan, except: A. B. C. D. E. consideration of home oxygen flu vaccine annually optimisation of bronchodilator therapy organise Council home help pulmonary rehabilitation

89.

Emma is a 14 year old girl who has insulin dependent diabetes mellitus. She monitors her blood glucose levels 23 times a day at home. Her record book shows blood glucose values between 59mmol/L for the past three months. The concentration of glycosylated haemoglobin (HbA1C) is found to be 15% (normal < 6.4%). Which one of the following statements is most correct? A. B. C. D. E. HbA1C level is inconsistent with the glucose levels reported HbA1C level suggests beta thalassaemia She has a high dietary fat intake She has optimal control of her diabetes She is taking an inappropriately high insulin dose

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Year 5 Clinical Knowledge Test 18 August, 2006 Each question must be attempted. Each question has only 1 correct answer

90.

An 80 year old man with degenerative back disease has worsening chronic pain. Pain was initially controlled with paracetamol 1g QID. The most appropriate next step in management is to: A. B. C. D. E. add meloxicam (Mobic) 7.5mg BD add neurontin (Gabapentin) 300mg BD change to codeine 30mg QID change to liquid morphine 20mg QID change to piroxicam (Feldene) 20mg

91.

Considering terminal restlessness (ie. agitated delirium within a few hours of death), which one of the following statements is true? A. B. C. D. E. First line treatment is benzodiazepine given by subcutaneous or sublingual route. Intravenous or intramuscular are the routes of choice for appropriate treatment. It is always easy to differentiate from pain. It is an uncommon problem in a palliative care ward. Urinary retention or faecal impaction are not factors which need to be considered.

92.

An 85 year old woman has been admitted via the Emergency Department with worsening back pain and confusion over the last 7 days. She has previously had severe osteoarthritis, spinal canal stenosis with severe back pain and she sustained a fall approximately 10 days ago. Since the fall she has not been mobile and has been confined to bed, has not been able to prepare meals and has been restricted in toileting due to limitation of movement due to pain. Management of her delerium includes all of the following, except: A. B. C. D. E. assessment of fluid status discussion with the GP about recently commenced drugs exclusion of UTI family meeting to determine how she has been coping at home measurement of serum electrolytes

93.

A 75 year old woman complains of pain mainly around the shoulders and hips associated with stiffness, particularly on waking. Examination is normal apart from mild tenderness and stiffness around the shoulder and hip joints. Your provisional diagnosis will be most likely confirmed by: A. B. C. D. E. ESR >100mm muscle biopsy rheumatoid factor serum Ca/P04/alkaline phosphatase x-ray of shoulder and pelvis girdle

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Year 5 Clinical Knowledge Test 18 August, 2006 Each question must be attempted. Each question has only 1 correct answer

94.

A 78 year old man attends your surgery with symptoms of chronic constipation. He has been self medicating with camomile tea, avocado, Nulax and bran. You take a medication history and find he is on Norvasc for hypertension as well as Panadeine and Celebrex for arthritis. What is your first step in managing this patient? A. B. C. D. E. Cease the Panadeine Check faecal occult bloods Fluid increase Prescribe Movicol X-ray of the abdomen

95.

In a patient who has suffered a stroke, which one of the factors listed below gives the best prognosis for rehabilitation? A. B. C. D. E. Denial of paralysed side Incontinence Motor paresis strength 3/5 Neglect Premorbid cognitive impairment

96.

A 20 year old male medical student collapses in the autopsy room from the nauseating smell that fills the room as the pathologist slits open the abdomen of an elderly man who recently died with peritonitis. At the time of the collapse, one of his colleagues noticed a pulse rate of 30bpm. What is the most likely cause of his collapse? A. B. C. D. E. Epileptic fit Panic attack Postural hypotension Second degree heart block Vasovagal episode

97.

Michael is a 35 year old man who has been working in his shed today. He presents to his GP because he thinks something may have entered his right eye when he was hammering some metal, but he cant feel it there now. On examination, the right eye appears slightly inflamed and visual acuity is (L) 6/6, (R) 6/12. He has an irregular shaped pupil. There is no foreign body to be found, even with eversion of the lids. What is the most appropriate next step in management? A. B. C. D. E. Prescribe topical antibiotics and eye pad, and review the next day Prescribe topical antibiotics and review if it doesnt settle within a few days Provide reassurance and explanation Refer for orbital x-ray and urgent follow up by ophthalmologist Refer to ophthalmologist within days to weeks

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Year 5 Clinical Knowledge Test 18 August, 2006 Each question must be attempted. Each question has only 1 correct answer

98.

A 56 year old woman presents with recent onset of changes to her right nipple that appear eczematous. On examination, she has no obvious lump in either breast. What is the most appropriate next step in management? A. B. C. D. E. Advise against using soap when washing herself Antibiotic treatment and review Arrange mammography Review for repeat examination in a month Steroid cream treatment and review

99.

Bruce is a 35 year old man with a known history of excess alcohol use. He presents with a 4 hour history of severe epigastric pain which came on quite suddenly. He feels nauseated and has vomited twice. On examination, he is pale and sweaty, has temperature of 37.8C, a pulse rate of 110bpm, and extreme tenderness in the epigastrium. He finds that the pain is slightly relieved by sitting forward. What is the most likely diagnosis? A. B. C. D. E. Acute pancreatitis Cholecystitis Gastro-oesophageal reflux Peptic ulcer Pericarditis

100.

Mrs Shand, a 44 year old woman, presents to your clinic on Monday morning. She describes an episode of severe abdominal pain and vomiting last Saturday night which woke her at about 1.00am. She called a locum, and has brought a letter from him. The letter states that during the episode of pain Mrs Shand was afebrile and had abdominal tenderness maximal in the right upper quadrant. She was given an injection of pethidine and fell asleep soon afterwards. When she woke several hours later, the pain was gone. What is the most likely diagnosis? A. B. C. D. E. Biliary colic Cholecystitis Irritable bowel syndrome Peptic ulcer Renal colic

101.

Mr Tyler, aged 29, presents with tiredness and lethargy for six weeks. He also reports pins and needles in his hands and feet. He has no significant past medical history. He eats a strictly vegan diet, which includes no animal products at all. What is the most appropriate investigation that will assist you in this scenario? A. B. C. D. E. Fasting glucose HIV serology Iron studies Thyroid stimulating hormone (TSH) Vitamin B12 and folate

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Year 5 Clinical Knowledge Test 18 August, 2006 Each question must be attempted. Each question has only 1 correct answer

102.

Mrs Mahoney is aged 65 and has multiple myeloma. She presents with three days of severe left sided chest pain which radiates under her left breast. She developed a rash in this area 24 hours ago. She has been taking slow-release oral morphine 10mg bd and naproxen 250mg bd for bony aches and pains with good relief but these have had no effect on this new pain. What is the most likely cause of her pain? A. B. C. D. E. Acute herpes zoster Osteoporotic crush fracture Paraneoplastic syndrome Rib metastases T4 nerve root compression

103.

You are asked to see a 2 year old girl at your practice. She has a purulent unilateral nasal discharge. This has been present for six weeks despite two courses of oral cotrimoxazole. Which one of the following is the most appropriate next step in management of this child? A. B. C. D. E. A course of oral flucloxacillin Nasal examination under general anaesthesia Nasal swab for microscopy and culture Tobramycin nasal drops t.d.s. X-ray of paranasal sinuses

104.

A 30 year old woman presents with a history of three days of dysuria. There is no blood, nitrates or white cells detected in the urine. What is the most appropriate next step in management? A. B. C. D. E. Perform an examination of the genitalia Prescribe a urinary alkalinizer (Ural) Prescribe an antibiotic, according to Antibiotic Guidelines Prescribe an antifungal cream Prescribe paracetamol

105.

Brad is a 6 year old boy on chemotherapy for acute myeloid leukaemia. He presents to the Emergency Department with a temperature of 39.4C. Which one of the following is the most appropriate management? A. B. C. D. E. Administer intravenous gamma globulin Administer paracetamol and review in 24 hours Perform septic workup and commence broad spectrum antibiotic Perform septic workup and monitor his temperature Refer to outpatient clinic with an oral cephalosporin

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Year 5 Clinical Knowledge Test 18 August, 2006 Each question must be attempted. Each question has only 1 correct answer

106.

Sarah is a 16 year old girl who presents with a history of sore throat, fever and enlarged cervical lymph nodes. Examination reveals exudative tonsillitis, generalised adenopathy and a palpable spleen. Which one of the following is the most likely diagnosis? A. B. C. D. E. Acute Streptococcal infection Diphtheria Hodgkins disease Infectious mononucleosis Leukaemia

107.

A child aged 2 years presents with a 12 week history of a recurrent nocturnal cough which is occasionally associated with a wheeze and vomiting. Her cough improves transiently after inhaled bronchodilator. Which one of the following would be the most appropriate method to treat her with a bronchodilator? A. B. C. D. E. Dry powder inhaler MDI (metered dose inhaler) and spacer MDI alone MDI and spacer with face mask Nebuliser alone

108.

Rachel, aged 15, presents with a history of weight loss of 10kg over a three month period, poor concentration and mood swings. On examination, her BMI is 19, she has postural hypotension, cool peripheries and a soft faecal mass is palpable in the left iliac fossa. Which one of the following is the most likely cause of her symptoms? A. B. C. D. E. Anorexia nervosa Hypothalamic tumour Inflammatory bowel disease Severe depression Thyrotoxicosis

109.

A 7 year old boy with atopic eczema is brought to the Emergency Department after having eaten food containing peanut. On examination, there is swelling of his tongue and face. He has a spreading urticarial rash, an audible stridor, rhonchi in his chest and a blood pressure of 60/35mmHg supine. Which one of the following is the most appropriate initial treatment? A. B. C. D. E. IM adrenaline IV fluids IV hydrocortisone Oral dexamethasone Oral Phenergan

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Year 5 Clinical Knowledge Test 18 August, 2006 Each question must be attempted. Each question has only 1 correct answer

110.

A 6 month old male infant is brought to the Emergency Department with a troublesome cough. He has received all of his immunisations including the DTPa vaccine. The cough occurs day and night and is very distressing, being associated with facial suffusion and not uncommonly vomiting at the end of the coughing episode. He has not been cyanosed. What is the most likely cause of his symptoms? A. B. C. D. E. Adenovirus Bordetella pertussis Haemophilus influenzae type b Mycoplasma pneumoniae Streptococcus pneumoniae

111.

Gary is a 48 year old salesman who presents because he is finding it difficult leaving his house. He is worried that he may be contaminated by germs and frequently washes his hands and showers several times a day to prevent this. When he leaves his house he needs to count all the bricks of the fences that he passes. He says it is easier to just stay at home. Which one of the following is the most likely cause of his presentation? A. B. C. D. E. Bipolar disorder Obsessive Compulsive Disorder Schizophrenia Social anxiety disorder Specific phobia

112.

Amanda is a 23 year old woman who was involved in a car accident where two of her friends died. Whenever she drives she cannot stop thinking about the accident, and cannot bear the thought of being in traffic. Amanda has found it increasingly difficult to leave her house. Which one of the following is the most likely cause of her presentation? A. B. C. D. E. Dysthymic disorder Major depressive disorder Post traumatic stress disorder Separation anxiety disorder Specific phobia

113.

Matt is a 20 year old man with five convictions for petty theft. He feels no remorse after stealing the life savings of an 80 year old woman, saying that life is about looking after number one. Matt has a history of truancy at school and a series of unskilled jobs. He left home at age 13 after his mother moved in with her fourth de-facto partner. Given this pattern of behaviour, what is the most likely diagnosis? A. B. C. D. E. Antisocial personality Borderline personality Histrionic personality Narcissistic personality Passive aggressive personality

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Year 5 Clinical Knowledge Test 18 August, 2006 Each question must be attempted. Each question has only 1 correct answer

114.

Jenny is a 32 year old mother of two children, aged 5 and 7. She reports a two month history of broken sleep, tearfulness, feeling down, and over-eating. She states that sometimes she wishes she was dead and has recently thought about ending her life. Which one of the following is the most likely cause of her presentation? A. B. C. D. E. Binge eating disorder Cyclothymic disorder Histrionic personality disorder Major depressive disorder Post-natal depression

115.

Sam is aged 26 and has a past history of depression. He has quit his job as a plumbers apprentice to spend more time developing his real estate portfolio. He is staying up all night documenting his plans, which are becoming increasingly disorganised. Which one of the following is the most likely cause of Sams behaviour? A. B. C. D. E. Bipolar disorder Cyclothymic disorder Histrionic personality disorder Schizoid personality disorder Schizophrenia

116.

Each of the following are side effects of iron tablets, except: A. B. C. D. E. constipation diarrhoea flatus nausea pale coloured stools

117.

Osteoporosis risk factors include each of the following, except: A. B. C. D. E. malabsorption syndromes premature menopause prolonged use of steroids tobacco smoking use of marijuana

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Year 5 Clinical Knowledge Test 18 August, 2006 Each question must be attempted. Each question has only 1 correct answer

118.

The benefits of breast feeding include each of the following, except: A. B. C. D. E. aids involution meets all the infants nutritional needs for first 12 months of life protects against infection reduces risk of breast cancer reduces risk of some forms of ovarian cancer

119.

Which one of the following organisms is the most common cause of mastitis? A. B. C. D. E. Aerobic streptococcus Bacteroides fragilis Escherichia coli Staphylococcus aureus Streptococcus viridans

120.

Pre-pregnancy investigations should include each of the following, except: A. B. C. D. E. CMV immunoglobulin titre full blood count Pap smear if not performed in last 18 months rubella immunoglobulin titre varicella immunoglobulin titre

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