2019 summative Flashcards
(88 cards)
22yo M presents w. sores on penis. GF has hx of cold sores- what is most appropriate next step?
swab (of penile sore) for HSV PCR
23 year old female, itchy and burning sensation down below. Stable
partner for 10 years. External genitalia examination normal. Speculum
examination revealed a small amount of white, adherent discharge. What is
the most likely diagnosis
A. Bacterial vaginosis
B. Atrophic vaginitis
C. Candida vaginitis
D. Trichomoniasis
candida vaginitis
- white, adherent d/c “cottage cheese”
6yo M, 6hr hx n, v, abdo pain and scrotal pain
O/E: tender R scrotum, no erythema, skin changes or swelling
Most likely diagnosis?
A. Orchi-Epididymitis
B. Testicular torsion
C. Hydrocele
D. Testicular cancer
E. Appendicitis
testicular torsion
36 yo woman otherwise well complained of intermittent joint pain and
swelling in mcp, mtp, pip joints, for the last 6 months. Bilateral. She has no
erythema, joint swelling, rash or deformity on examination. 5 kg weight
loss.
A. Fibromyalgia
B. Gout
C. Psoriatic arthritis
D. Rheumatoid arthritis
E. Systemic lupeus erythymatosis
rheumatoid artyhritis
65 M with acute gout and settled with NSAID (diclofenac). Has a PMH
of T2DM, hypertension, ?CAD. Returned for review of gout. Current
medications include perindopril, hydrochlorothiazide, allopurinol. Blood test
result showed worsening of kidney function, with eGFR = 26, and also
HbA1C = 10.1%. Gout symptoms have settled but urea still high…
What changes to the medication should you make?
A. Cease Diclofenac and hydrochlorothiazide
B. Cease Diclofenac and increase allopurinol
C. Cease hydrochlorothiazide and start on low purine diet
D. Cease hydrochlorothiazide and start low dose metformin
E. Start metformin and increase allopurinol
cease diclofenac (NSAID) and hydrochlorothiazide
60 something lady with jaw pain when chewing, vision changes,
headache. What would you give to treat?
diagnosis: GCA for which the treatment is prednisolone/ high dose glucocorticoids (no cure but sx.s resolve) e.g. 40-60mg pred/ day
45 y/o male with L retroorbital pain a/w tearing and redness in eye. The
symptoms last for a few seconds /minutes. These episodes have happened
consecutively on most nights of the week for past 3 months.
cluster headache
31yo M, 2dat hx: photopobia, blurry vsision. Otherwise well. Corneal injection as seen in image. Constricted pupil.
most likely diagnosis?
A. Corneal foreign body
B. Dendritic ulcer
C. Anterior uveitis
D. Acute Glaucoma
E. Hemorrhagic conjunctivitis
anterior uveitis
17-year-old girl? presents with wheeze and SOB. FEV1 50% predicted ->
70% predicted post bronchodilator. Minimal change to FVC. What is the
likely pathology?
A. restrictive lung disease
B. anxiety
C. neuromuscular weakness
D. Foreign body
E. Reversible airways disease
reversible lung dx
Lady, thinks she is 12 weeks pregnant.
BP 150/100mmHg, otherwise normal examination. Normal urinalysis.
Most likely diagnosis:
A. Essential hypertension
B. Pregnancy induced hypertension
C. Preeclampsia
essential HTN
Middle aged man, HTN, smoking. On a business trip and when was
walking to lunch had left jaw pain. Has happened before. Comes to GP
what should you do?
A. Dental referral
B. Cardiology referral
C. ECG
D. dental xray
E. Analgesia
ECG
- due to HTN, smoking hx AND the fact that L jaw pain (like L shoulder pain I guess) occurs when walking with previous episodes
2 yo boy with recurrent otitis media treated w abx. Normal FM + GM +
S milestones but babbles/doesn’t speak well. He presents today w parents
suspecting developmental delay. Likely cause of his language delay?
Ans:
a) Serous otitis media
b) Autism
c) Sensorinerual hearing loss
d) Acute otitis media
serous OM
Elderly lady with dementia in nursing home. Recently completed a course
of oral antibiotics. Has recently started refusing food and had some
alterated behaviours, perhaps agitated
What is appropriate management?
a. Nasogastric tube feeding
b. Speech path review
c. Oral glucose tolerance test
d. Do nothing
e. Nystatin + mouth care
nystatin and mouth care
this looks like oral candidiasis (thrush) for which the preferred topical agents include
- clotrimoxazole
-miconazole
-nystatin (best option in this MCQ BUT not preferable; contains sucrose which can !dental carries which this patient has, may be less effective than clotrimoxazole and miconazole)
16 year old female, living on the street and womens shelters, wanting
contraception that didn’t require partner cooperation. Loves to occasionally
sniff solvents?
A. COCP
B. Condoms
C. Depot
D. Subcutaneous progesterone (the bar)
E. Mini pill
subcutaneous progesterone (the bar) because most permanent
-COCP and minipill requires too much remembering especially for this pt
-condoms requires partner cooperation
-depot is expensive and requires coming into GP
5 year old Thai tourist. Presents with fever, macular rash, conjunctivitis.
Now has white spots on buccal and pharyngeal mucosa. Parents have
been advised to not send her to daycare, when is she able to return?
A. 48 hours after penicillin
B. 5 days after onset of rash
C. When rash is gone
D. When rash has completely crusted over
E. When fever is gone
5 days after onset of rash
this is measles
- fever
- macular rash
- Koplick spots: white spots on buccal and pharyngeal mucosa
mx is wait 4-5 days after onset of rash to be in contact w/ ppl again
17 year old with cosmetically unpleasant acne. Currently doing daily
facial cleanses and topical benzyl peroxide. Has recently become sexually
active and uses condoms, but is interested in going on the “pill”.
Papulopustular acne on face, chest, neck, back. What is the most
appropriate next step in management?
A. COCP
B. Doxycycline
C. More intensive cleansing
D. Oral prednisolone
E. Refer to dermatologist for commencement of roaccutane
COCP
- pt requested for it and it can also help with skin, already suing topical for acne and so this will supplement it and aid both her primary health concerns
- 60 y.o male was diagnosed with essential HTN, was already on beta
blocker then had another med added for BP. Presented with SOB? showed
ECG with bradycardia (no discernible p waves? - I thought I saw post-QRS
inverted P-waves (junctional rhythm). what drug is most likely to have
caused this:
A. Verapamil
B. Amlodipine
C. Thiazide diuretic
D. Nifedipine
E. Enalapril
verapamil
30yo M, centrasl and L chest pain (pleuritic), mild fever, no SOB and ECG is shown
What’s the most likely diagnosis?
A. Acute pericarditis
B. Constrictive pericarditis
C. Acute myocardial infarction
D. Pulmonary embolism
E. Pneumonia
acute pericarditis
- 28 year old female presents to GP for first time requesting oxycodone.
Reports congenital spondylolisthesis at L2/L3, normally takes oxycodone
80mg BD but has forgotten script on holiday.
O/E limping, lumbosacral tenderness on palpation. Muscle bulk
symmetrical, normal tone, power, reflexes.
What do you do? (class is unsure)
A. Refer to emergency department
B. Prescribe small quantity of drug until she sees her regular GP
C. Prescribe smaller dose of drug
D. Don’t prescribe drug
E. Report to prescribing authority
B
Person on sertraline seeing lady dressed in white just before going to
sleep. No hallucinations during the day or any other things going on.
a. Hypnagogic hallucination
b. Sertraline side effect
c. Psychotic depression
HYPNAGOGIC HALLUCINATION
Vegan F pregnant, what additonal screening would you do during routine screening to ensure bub grows well?
B12
. Pregnant lady in first trimester, her child has chicken pox, she is IgG
negative for varicella. what do you do?
A. Reassure
B. Zoster immunoglobulin
C. Varicella immunisation
D. MMRV immunisation
E. Aciclovi
B??? WHY
. 70yo man, his wife is about to undergo CRTx for leukaemia. What
advice do you give him on which immunisation he should have to protect
his wife as she will be immunocompromised?
a. Rotavirus
b. zoster/varicella
c. Tetanus toxoid
d. Polio
e. Hepatitis A
zoster/ varicella
WHY
what is most appropriate mx?
Child, see image for rash, was from europe
diagnosis: impetigo
antibacterial cream