1
Q
Jill Brien, age 20, is a university student. She is a non-smoker who has asthma. She has had infrequent asthma symptoms over the years, and uses her medication once or twice a week. You consider her to have mild asthma.
- What class of medication should be the mainstay of her pharmacological therapy? Be specific.
State ONE.
A
A short-acting beta-agonist
2
Q
Jill Brien, age 20, is a university student. She is a non-smoker who has asthma. She has had infrequent asthma symptoms over the years, and uses her medication once or twice a week. You consider her to have mild asthma.
- Ms. Brien starts a part-time job at a construction site. Over the next few weeks she notices that her asthma symptoms are occurring more frequently, and require her to use the medication in question 1 at least once daily. What is the most likely cause of her asthma exacerbation?
State ONE.
A
Dust/An environmental allergen
3
Q
Jill Brien, age 20, is a university student. She is a non-smoker who has asthma. She has had infrequent asthma symptoms over the years, and uses her medication once or twice a week. You consider her to have mild asthma.
- What class of medication should be the mainstay of Ms. Brien’s pharmacological therapy at this point?
State ONE.
A
An anti-inflammatory/A steroidal metered-dose inhaler (MDI)/A nonsteroidal metered-dose inhaler (MDI)/Long-acting
An inhaled glucocorticoid
An inhaled glucocorticoid combined with a long-acting beta-agonist
4
Q
Jill Brien, age 20, is a university student. She is a non-smoker who has asthma. She has had infrequent asthma symptoms over the years, and uses her medication once or twice a week. You consider her to have mild asthma.
- Ms. Brien would like to be able to manage her own asthma therapy. What device would you recommend she purchase?
State ONE.
A
A peak-flow meter
5
Q
Anne Sullivan, age 29, is a schoolteacher who comes to your office complaining of 10 to 12 loose bowel movements a day for the past three to four weeks. The stools are sometimes bloody and often contain mucus.
Ms. Sullivan feels fatigued and has lost about 3 kg in weight. She has not been febrile. She has no history of previous similar episodes.
You examine Ms. Sullivan. She has a few small, ulcerated lesions on her buccal mucosa; her abdomen is diffusely tender, with no guarding or rebound and no masses. The rectal examination is very painful. She has some small ulcerations just inside the anal canal, and there is fresh blood on your glove.
- What is the most likely diagnosis?
State ONE.
A
Crohn’s disease/Inflammatory bowel disease (IBD)/Ulcerative colitis/Colitis *Do NOT accept “irritable bowel syndrome (IBS)”
6
Q
Anne Sullivan, age 29, is a schoolteacher who comes to your office complaining of 10 to 12 loose bowel movements a day for the past three to four weeks. The stools are sometimes bloody and often contain mucus.
Ms. Sullivan feels fatigued and has lost about 3 kg in weight. She has not been febrile. She has no history of previous similar episodes.
You examine Ms. Sullivan. She has a few small, ulcerated lesions on her buccal mucosa; her abdomen is diffusely tender, with no guarding or rebound and no masses. The rectal examination is very painful. She has some small ulcerations just inside the anal canal, and there is fresh blood on your glove.
- What initial laboratory investigations would you order?
List FOUR.
A
Question 2 – 4 points (1 point each – any 4)
Stool culture testing
Stool testing for ova and parasites (O&P)
Hemoglobin testing/Hematocrit testing
White blood cell count (WBC)
Erythrocyte sedimentation rate (ESR) testing
C-reactive protein (CRP) testing
Albumin testing
7
Q
Anne Sullivan, age 29, is a schoolteacher who comes to your office complaining of 10 to 12 loose bowel movements a day for the past three to four weeks. The stools are sometimes bloody and often contain mucus.
Ms. Sullivan feels fatigued and has lost about 3 kg in weight. She has not been febrile. She has no history of previous similar episodes.
You examine Ms. Sullivan. She has a few small, ulcerated lesions on her buccal mucosa; her abdomen is diffusely tender, with no guarding or rebound and no masses. The rectal examination is very painful. She has some small ulcerations just inside the anal canal, and there is fresh blood on your glove.
- What is the most appropriate diagnostic investigation to do next? Be specific.
State ONE.
A
Question 3 – 1 point (either)
Colonoscopy/Sigmoidoscopy
Endoscopy with biopsy testing
Do NOT accept “barium enema”
8
Q
Anne Sullivan, age 29, is a schoolteacher who comes to your office complaining of 10 to 12 loose bowel movements a day for the past three to four weeks. The stools are sometimes bloody and often contain mucus.
Ms. Sullivan feels fatigued and has lost about 3 kg in weight. She has not been febrile. She has no history of previous similar episodes.
You examine Ms. Sullivan. She has a few small, ulcerated lesions on her buccal mucosa; her abdomen is diffusely tender, with no guarding or rebound and no masses. The rectal examination is very painful. She has some small ulcerations just inside the anal canal, and there is fresh blood on your glove.
- The investigation in question 3 confirms the diagnosis in question 1. What are the possible future gastrointestinal complications of Ms. Sullivan’s condition?
List THREE.
A
QUESTION 4 – 3 points (1 point each – any 3)
Strictures
Abscesses
Fistulae
Bowel obstruction
Toxic megacolon
Malabsorption/Malnutrition
Intestinal malignancy
Bile malabsorption
9
Q
Jamie Buchman, age 35, gave birth to a 4.1-kg girl six weeks ago. Ms. Buchman is here today for her postpartum checkup. You are aware that she was diagnosed with gestational diabetes. Ms. Buchman attended a diabetes education centre and saw a nutritionist after the diagnosis was made, and her blood sugar levels were reasonably controlled with dietary changes.
You have read the Canadian Medical Association guidelines for diabetes management, and you know that Ms. Buchman is at increased risk for subsequently developing diabetes or glucose intolerance.
- When in the postpartum period should you test Ms. Buchman for diabetes or glucose intolerance?
Give ONE answer.
A
Question 1 – 1 point
At six weeks to six months postpartum
*Accept any answer within this range, including “now.” Do NOT accept answers outside this range.
10
Q
Jamie Buchman, age 35, gave birth to a 4.1-kg girl six weeks ago. Ms. Buchman is here today for her postpartum checkup. You are aware that she was diagnosed with gestational diabetes. Ms. Buchman attended a diabetes education centre and saw a nutritionist after the diagnosis was made, and her blood sugar levels were reasonably controlled with dietary changes.
You have read the Canadian Medical Association guidelines for diabetes management, and you know that Ms. Buchman is at increased risk for subsequently developing diabetes or glucose intolerance.
- What test should Ms. Buchman have to confirm diabetes or glucose intolerance?
State ONE.
A
Question 2 – 1 point
An oral glucose tolerance test (OGTT)*
*Award 1 point if the answer specifies plasma glucose (PG) testing two hours after a 75-g glucose load.
11
Q
Jamie Buchman, age 35, gave birth to a 4.1-kg girl six weeks ago. Ms. Buchman is here today for her postpartum checkup. You are aware that she was diagnosed with gestational diabetes. Ms. Buchman attended a diabetes education centre and saw a nutritionist after the diagnosis was made, and her blood sugar levels were reasonably controlled with dietary changes.
You have read the Canadian Medical Association guidelines for diabetes management, and you know that Ms. Buchman is at increased risk for subsequently developing diabetes or glucose intolerance.
- Testing confirms that Ms. Buchman has diabetes. You review the results with her and discuss the implications of having diabetes. In the course of your discussion, you review certain complications. For what microvascular complications of diabetes is Ms. Buchman at risk?
List THREE.
A
Question 3 – 3 points (1 point each – any 3)
Nephropathy
Neuropathy/Foot problems
Retinopathy
*Do NOT accept “renal insufficiency.”
12
Q
Jamie Buchman, age 35, gave birth to a 4.1-kg girl six weeks ago. Ms. Buchman is here today for her postpartum checkup. You are aware that she was diagnosed with gestational diabetes. Ms. Buchman attended a diabetes education centre and saw a nutritionist after the diagnosis was made, and her blood sugar levels were reasonably controlled with dietary changes.
You have read the Canadian Medical Association guidelines for diabetes management, and you know that Ms. Buchman is at increased risk for subsequently developing diabetes or glucose intolerance.
- What are the recommended screening methods/referrals for each of the three complications in question 3?
List THREE. (One for each complication)
A
Question 4 – 3 points (1 point each – any 3)
Urine testing for albumin-to-creatinine ratio (ACR)
Neurological examination/Ankle reflex testing/Vibration testing/Proprioception testing/Sensation testing/Monofilament testing
Ophthalmoscopy/Ophthalmoscopy referral/Optometrist/Optometrist referral/Ophthalmologist/Ophthalmologist referral
Foot examination/Examination/Referral to a podiatrist
13
Q
Rachelle, age 16, presents at the after-hours clinic on Sunday afternoon. She had unprotected intercourse and a friend told her she could prevent pregnancy with a pill. She has no allergies and is taking no medications.
- As you consider prescribing the morning-after pill, what is the most important question to ask Rachelle?
State ONE.
A
Question 1 – 2 points
When did you have intercourse?/How long ago did you have sex?
14
Q
Rachelle, age 16, presents at the after-hours clinic on Sunday afternoon. She had unprotected intercourse and a friend told her she could prevent pregnancy with a pill. She has no allergies and is taking no medications.
- What is the most common side effect of oral post-coital contraception?
State ONE.
A
Question 2 – 1 point (either)
Nausea
Vomiting
15
Q
Rachelle, age 16, presents at the after-hours clinic on Sunday afternoon. She had unprotected intercourse and a friend told her she could prevent pregnancy with a pill. She has no allergies and is taking no medications.
- Excluding allergy, what is an absolute contraindication to treatment with oral post-coital contraception?
State ONE.
A
Question 3 – 1 point
Pregnancy—known
References: SOGC—Guidelines 2003-2004/WHO information
16
Q
Rachelle, age 16, presents at the after-hours clinic on Sunday afternoon. She had unprotected intercourse and a friend told her she could prevent pregnancy with a pill. She has no allergies and is taking no medications.
- Rachelle is concerned about the possible side effects of oral post-coital contraception. What other option exists for morning-after contraception?
State ONE.
A
Question 4 – 1 point
Insertion of a copper intrauterine device (IUD) up to seven days post-coitally
* Do NOT accept “insertion of a progesterone intrauterine device (IUD)” or “insertion of a levonorgestrel-releasing intrauterine system (Mirena).” They are not approved for use in this situation.*
17
Q
Rachelle, age 16, presents at the after-hours clinic on Sunday afternoon. She had unprotected intercourse and a friend told her she could prevent pregnancy with a pill. She has no allergies and is taking no medications.
- What other subjects do you discuss with Rachelle?
List THREE.
A
Question 5 – 3 points (1 point each – any 3)
Contraceptive use/Condoms/The birth control pill (BCP)/Norelgestromin and ethinyl estradiol transdermal system (Evra)/Any contraception
Sexually transmitted infections (STIs)/Human immunodeficiency virus (HIV) infection
Cervical cancer testing/A Pap test
Human papillomavirus (HPV) vaccine
Following up if she has no menses/Doing beta-human chorionic gonadotropin (β-hCG) testing if she has no menses/Possible failure of the morning-after pill
Whether sexual intercourse was consensual
18
Q
- What does the electrocardiogram reveal?
Give ONE answer.
A
Question 1 – 1 point
Sinus tachycardia
19
Q
- Excluding blood tests, what other investigation would you order for Dee so that you can assess her palpitations?
State ONE.
A
Question 2 – 1 point
24-/48-hour Holter monitoring/Holter monitoring
20
Q
- What feature of Dee’s history suggests that she suffers from agoraphobia?
State ONE.
A
Question 3 – 1 point
Her fear of walking through crowds/Her fear of crowds/Avoiding going to work
Do NOT accept “pounding heart/palpitations,” “shaking of her hands/tremors,” “feeling of choking,” “nausea,” or “lightheadedness.”
21
Q
- What specific features of Dee’s presentation suggest that she suffers from panic attacks?
List FIVE.
A
Question 4 – 5 points
Pounding heart/Palpitations/Racing heartbeat
Shaking of her hands/Tremors
Feeling of choking
Nausea
Lightheadedness
22
Q
- What is the hematological abnormality? Be specific.
State ONE.
A
Question 1 – 2 points
Microcytic hypochromic anemia
Do NOT accept “anemia” alone.
23
Q
- What is your next management step? Be specific.
State ONE.
A
Question 2 – 2 points
Transfusion of red blood cells (RBCs)/packed cells
Award only 1 point if “transfusion” alone is stated.
24
Q
- What are the most common causes of Darlene’s condition?
State TWO.
A
Question 3 – 2 points
Menorrhagia
Gastrointestinal (GI) bleeding/Cancer (CA) of the bowel/Peptic ulcer
Do NOT accept “dietary deficiency.”
25
1. What diagnosis must you rule out as a cause of Jonathan’s symptoms?
State ONE.
Question 1 – 2 points
Foreign body aspiration
26
2. What initial diagnostic test would you order to confirm your clinical suspicion?
State ONE.
Question 2 – 1 point
Chest X-ray examination
27
3. Two months later, Jonathan’s five-month-old sister, Betty, is brought to your office by her mom, who is worried about Betty’s cough. Like Jonathan, Betty was born at term after an uncomplicated pregnancy, and has received the appropriate immunizations for an infant her age. Betty has been unwell for three days, with a runny nose, decreased appetite, and worsening cough. On examination, you find that Betty has a rectal temperature of 37.5 degrees C, a heart rate of 160 bpm, and a respiratory rate of 60/min. She seems less active than usual, has subcostal and suprasternal indrawing, and has expiratory wheezes on auscultation.
What diagnosis most likely is responsible for Betty’s symptoms?
State ONE.
Question 3 – 1 point
Bronchiolitis/Respiratory syncytial virus (RSV) infection
*Do NOT accept “respiratory distress” (it is not a diagnosis) or “viral upper respiratory tract infection (URTI).”*
28
Two months later, Jonathan’s five-month-old sister, Betty, is brought to your office by her mom, who is worried about Betty’s cough. Like Jonathan, Betty was born at term after an uncomplicated pregnancy, and has received the appropriate immunizations for an infant her age. Betty has been unwell for three days, with a runny nose, decreased appetite, and worsening cough. On examination, you find that Betty has a rectal temperature of 37.5 degrees C, a heart rate of 160 bpm, and a respiratory rate of 60/min. She seems less active than usual, has subcostal and suprasternal indrawing, and has expiratory wheezes on auscultation.
4. What is the most appropriate next step in managing Betty’s condition?
State ONE.
Question 4 – 1 or 2 points (either)
Transfer to the hospital/Transfer to the emergency department (ED)/emergency room (ER) (2 points)
Giving oxygen (1 point)
29
1. What is the most likely diagnosis?
State ONE.
Question 1 – 2 points
Angioedema
30
2. What is the most likely cause of the diagnosis in question 1?
State ONE.
Question 2 – 1 point
Lisinopril use
31
3. What treatments would you prescribe for Mrs. Smith?
List THREE.
Question 3 – 3 points
Discontinue lisinopril
Use corticosteroids
Use antihistamines
*Do NOT accept “use epinephrine.” (This is a mild case.)*
32
What symptoms would you ask Annie about to verify that she does not have a central cause for vertigo?
List FOUR.
Question 1 - 4 points (any 4)
Diplopia
Dysarthria
Paresthesia/Numbness
Ataxic gait/Imbalance
Focal weakness
33
2. Her answers reassure you that she has no central cause for vertigo. What diagnostic physical examination manoeuvre is appropriate for Annie?
State ONE.
Question 2 - 1 point
Dix-Hallpike manoeuver/Bárány manoeuver/Nylen manoeuvre/Nylen-Bárány manoeuvre/Drop test/Hallpike manoeuvre
Accept a description of how the manoeuvre is performed.
34
3. What physical finding on this examination manoeuvre would suggest vertigo?
State ONE.
Question 3 - 1 point
Nystagmus
35
1. What modifiable risk factors for OM would be helpful to ask Mrs. Stocks about?
List THREE.
Question 1 – 3 points (any 3)
Exposure to second-hand smoke
Bottle-feeding/Not breast-feeding
Crowded living conditions
Daycare
Any type of feeding in a supine/flat position
36
Question 2 – 3 points (any 3)
Persistent effusion
Hearing loss
Speech delay/Speech problems
Atelectasis/Retraction of the tympanic membrane
Recurrent episodes of (acute) otitis media (AOM)
37
1. What important common diagnoses (excluding gastrointestinal problems) must you consider and treat urgently, if they are confirmed in a child with Clara's symptoms?
List THREE.
Question 1 – 3 points
Pneumonia
Diabetic ketoacidosis
Urinary tract infection
38
2. On further history-taking, you discover that Clara has had a "cold" for a few days, with a fever and a cough becoming more intense since yesterday. After completing the physical examination, you decide that a diagnostic test should be carried out. What would be the most useful diagnostic test at this point?
State ONE.
Question 2 – 1 point
Chest X-ray examination
39
3. Clara benefits from your appropriate treatment and recovers uneventfully. A year later, Clara's 18 month-old brother, Gabriel, is brought in by his mother for influenza immunization. Gabriel is healthy except for a suspected egg allergy and has never had a flu shot before. She asks if Gabriel can have the flu shot. What do you suggest?
State ONE.
Question 3 – 1 point
Egg allergy is not a contra-indication to the newer flu shots. (2011)
40
1. What features of Ms. Towedo’s history would make you consider prophylaxis for her headaches?
Name TWO.
Question 1 - 2 points
Severity/Impaired quality of life/Missing work/Emergency department (ED) visits
Frequency/Four migraines a month
41
2. Certain classes of medication have been shown to be effective for migraine prophylaxis.
List FOUR of these classes that would be appropriate for Ms. Towedo.
Question 2 – 4 points (any 4)
Calcium-channel blockers
Tricyclic antidepressants (TCAs)/Tricyclic analgesics
Anticonvulsants/Antiepileptics
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Serotonin-receptor antagonists
42
Basing your answer on the information above, what is the most likely diagnosis?
Question 1
Acute cholecystitis/Cholelithiasis/Biliary colic
43
3. Which imaging test would be best to confirm the diagnosis at this stage?
Question 3
Abdominal ultrasonography
43
2. What are the possible complications of the condition in Question 1? List THREE.
Question 2 (Any 3)
Choledocholithiasis/Jaundice/Biliary obstruction
Hydrops
Empyema
Emphysematous cholecystitis
Duodenal perforation and gallstone ileus
Pancreatitis/Hepatitis
Ascending cholangitis
Peritonitis/Perforation of the gallbladder/Necrosis/Gangrene
Sepsis
44
4. Results of Mrs. de la Haye's investigation indicate dilatation of the right hepatic duct. What procedure
should be considered at this stage?
Question 4
Endoscopic retrograde cholangiopancreatography (ERCP)
45
5. What blood tests would you consider ordering for this patient? List FOUR
Question 5 (Any 4)
White blood cell count (WBC)
Bilirubin testing
Alkaline phosphatase testing
Amylase testing/Lipase testing
International Normalized Ratio (INR)/Prothrombin time (PT) measurement
Partial thromboplastin time (PTT) measurement
Aspartate transaminase (AST) testing
Alanine transaminase (ALT) testing
46
What are Elizabeth's risk factors for developing gestational diabetes? List TWO.
Question 1
Aboriginal race
Obesity
47
What other items of her history would you like to know? List TWO items and explain their
significance.
Question 2
Size of first baby: If this newborn weighed > 4 kg, gestational diabetes mellitus (GDM) may have been
present in the first pregnancy.
Family history of diabetes mellitus (DM)
48
At what point in her pregnancy would you screen Elizabeth for gestational diabetes, given that her
current fasting plasma glucose level is normal?
Question 3
At 24 to 28 weeks of gestation
49
A. What result of the screening test in Question 4 would lead you to diagnose gestational diabetes?
B. What result of the screening test in Question 4 would lead you to do further investigations?
C. Should further investigations be necessary, what test would you order next?
Question 5
A. A plasma glucose level > 10.3
B. A plasma glucose level > 7.8
C. A glucose tolerance test
49
What screening test would you order?
Question 4 (Either 1)
Glucose challenge test
Plasma glucose level measurement one hour after a 50-g oral glucose load
50
What are the most common risks for the infant of a woman with untreated gestational diabetes? List
TWO.
Question 6
Macrosomia (large size can lead to birth trauma)
Neonatal hypoglycemia
51
Elizabeth is diagnosed as having gestational diabetes mellitus.
7. Postpartum, what advice would you give Elizabeth to prevent the development of type II diabetes
mellitus later in life? List ONE goal and the way in which Elizabeth could achieve it.
Question 7
Goal: Weight control
Way to achieve it: Through diet and exercise
52
How often would you screen Elizabeth for diabetes mellitus?
Question 8
Annually
53
What screening test would you order?
Question 9
Fasting plasma glucose testing
54
What result of the screening test in Question 9 would lead you to diagnose diabetes mellitus?
Question 10
A result > 7
55
1. What points of his history would you ask Mr. Makentrokken about? List FIVE.
Question 1 (Any 5)
History of a bleeding disorder/History of bruising
Whether this is the first episode
Quantity (minor or massive bleeding)
History of lung disease (tuberculosis (TB)/bronchiectasis/fungal infection) Whether the coughing is new
Whether there is fever/Whether there are night sweats
Use of medications (acetylsalicylic acid [ASA]/warfarin [Coumadin]) History of trauma (nose picking/epistaxis)
Weight loss
56
2. What are the MOST common causes of hemoptysis? List FOUR.
Question 2 (Any 4)
Bronchitis Tuberculosis (TB) Fungal infection Bronchiectasis Pneumonia
Lung cancer (CA)
57
On examination, Mr. Makentrokken is in no distress, is hemodynamically stable, and has 98% oxygen saturation on room air. You order a chest X-ray examination and some laboratory tests.
3. What are some important laboratory tests for the investigation of hemoptysis? List FOUR.
Question 3 (Any 4)
White blood cell count (WBC)
Typing and screening
Hematocrit testing/Hemoglobin testing Platelet count
IWR/IPTT Urinalysis
58
4. What is the definition of massive hemoptysis?
Question 4
Total volume of blood > 200 to 400/24 hrs or > 100 mL/day for three to four days
59
5. What are the reasons to hospitalize a patient with hemoptysis? List TWO.
Question 5 (Any 2)
Massive hemoptysis
Hypercapnia
Active tuberculosis (TB)
Ongoing bleeding or unstable vital signs Hypoxia requiring supplemental oxygen (O2)
60
1. What other ocular symptoms are important to inquire about? List FOUR.
Question 1 (Any 4)
Blurred vision Photophobia Exudation/Discharge Itching
Colored halos in the visual field Sensation of a foreign body Double vision/Diplopia
61
2. Other than viral, bacterial, allergic, or irritated conjunctivitis, what common conditions may cause a red eye? List FOUR.
Question 2 (Any 4)
Iritis
Keratitis
Acute angle-closure glaucoma Presence of a foreign body Blepharitis
Subconjunctival hemorrhage Pterygium
Abrasions Chalazion/Hordeolum/Stye
62
Mrs. Nguyen admits that she has started using her mother's corticosteroid-based ophthalmic drops.
3. If the patient's condition were caused by certain broad groups of pathogens, corticosteroid drops could
worsen the condition. List TWO broad groups of pathogens.
Question 3
Viral pathogens Fungal pathogens
63
4. What are the potentially serious ocular side effects of prolonged use of topical corticosteroid drops in
the eye? List TWO side effects.
Question 4 (Any 2)
Cataracts
Elevated intraocular pressure Optic nerve damage
64
5. If this patient were elderly, were complaining of acute pain in the eye, and had visual acuity of 20/200,
what ophthalmic diagnosis would you be MOST concerned about?
Question 5
Acute angle-closure glaucoma
65
6. What technique is recognized as the "gold standard" for diagnosing the condition in Question 5?
Question 6
Measurement of intraocular pressure/Tonometry
66
7. What is the DEFINITIVE treatment for the condition in Questions 5 and 6?
Question 7
Surgical peripheral iridectomy/ Laser peripheral iridectomy
67
1. What factors are associated with an increased prevalence of thyroid nodules? List TWO
Question 1 (Any 2)
Exposure to ionizing radiation
Iodine deficiency (rare in North America) A family history of thyroid nodules
68
2. Name TWO benign thyroid nodules and THREE malignant thyroid nodules.
A. Benign nodules:
1. 2.
B. Malignant nodules:
Question 2
A. Benign nodules: (Any 2) Colloid nodule
Follicular adenoma
Thyroid cyst
Hashimoto's thyroiditis Multinodular goiter Thyroglossal duct cyst
B. Malignant nodules: (Any 3)
Papillary nodule Follicular nodule Medullary nodule Anaplastic nodule Metastatic nodule Lymphoma
69
3. Certain clinical features are associated with a higher risk of malignant thyroid nodules. What features would raise suspicion he has malignant nodule? List FOUR features.
Question 3 (Any 4)
Firm nodule/Hard nodule Age younger than 30 years Painless nodule
Hoarse voice
Male sex
Cervical lymphadenopathy
70
You decide to proceed with investigations. Various laboratory and diagnostic imaging procedures are available.
4. What is the ONLY thyroid-function blood test required in the initial evaluation of a thyroid nodule?
Question 4
Thyroid-stimulating hormone (TSH) test
71
5. Assume the result of the test in Question 4 is low.
A. What is the MOST appropriate investigation to order now?
B. The result of the test in Question 5A is benign. What is the appropriate investigation to order now?
Question 5
A. Radionuclide scan of the thyroid (131I scan) B. Free thyroxine (T4) test
72
6. Assume the result of the test in Question 4 is in the NORMAL range. What procedure would be appropriate to confirm jason's diagnosis?
Question 6
Fine-needle aspiration biopsy (FNAB) testing
73
1. What other characteristics of Bart's epistaxis are important to inquire about? List THREE.
Question 1 (Any 3)
Previous incidents of non-nasal bleeding Whether bleeding is from one or two nostrils How much bleeding there is
How long the bleeding lasts
Preceding events/Trauma
74
3. Excluding blood dyscrasias, what are the possible causes of Bart's epistaxis? List SIX.
Question 3 (Any 6)
Trauma
Inflammation/Infection/Upper respiratory tract infection (URTI) Presence of a foreign body
A neoplasm
An aneurysm/Atrioventricular (A-V) malformation Arteriosclerosis
Osler-Weber-Rendu disease
Medication use
Recent surgery
Dry environment
Nose picking
74
4. If Bart presents with acute bleeding from the nose, what are some treatments you could try? List THREE.
Question 4 (Any 3)
Ice and pressure
Cauterization (with silver nitrate)
Local vasoconstriction/Lidocaine plus epinephrine/Anterior packing with cocaine/Balloon vasoconstriction Nasal packing
Rhinorrhaphy
74
2. What is the MOST likely site of Bart's bleeding?
Question 2
Kiesselbach's area/Little's area/The anterior nasal septum
75
1. What items in the history are important to obtain in order to determine Mr. infection? List FIVE items.
Question 1 (Any 5)
Was the dog caught?/Can the dog's owner be identified? The dog's vaccination status
Whether this was a provoked or an unprovoked attack The animal's behavior
The patient's previous rabies immunization status Geographic location/Prevalence of rabies in the area Nature of the bite (i.e., puncture, abrasion, or bite) Whether the dog is wild or a pet
76
# ˜
2. You immediately use soap and water to wash and flush the open area of the wound. After washing, you apply 70% alcohol. The history has not allowed you to rule out the possibility of rabies infection. Your management would include giving THREE agents. List these agents.
Question 2
Rabies vaccine/Human diploid cell vaccine (HDCV)
Rabies immune globulin (RIG)
Tetanus booster/Tetanus-diphtheria toxoid (TD) adult-type booster
77
1. What other items of Anna's history are important to elicit? List FOUR.
Question 1
Vaginal discharge
Date of last menstrual period (LMP) Sexual history
Previous abdominal surgery
78
You perform an abdominal examination, which reveals right lower quadrant tenderness with associated guarding. A bimanual examination reveals tenderness in the right adnexa, with mild cervical excitation. Results of a rectal examination are negative.
2. In addition to an ultrasound examination, what laboratory tests would you order at this point? List
Question 2
White blood cell count (WBC)
Serum beta-human chorionic gonadotropin (HCG) test Endocervical swabs
79
3. What are the important diagnoses to consider in this patient? List FOUR.
Question 3
Ectopic pregnancy
Appendicitis
Pelvic inflammatory disease (PID) Rupture of an ovarian cyst
80
1. What other symptoms of Marianne's present illness would help you assess her problem? List FOUR.
Question 1
Chills
Urinary incontinence Nocturia
Abdominal pain
81
2. Name ONE antibiotic commonly used for the OUTPATIENT treatment of UTI in a child of this age, and the minimum duration of treatment.
1. Antibiotic:
2. Minimum duration of treatment:
Question 2
Antibiotic: Trimethoprim
Minimum duration of treatment: Ten days to two weeks
82
3. Excluding follow-up after urinalysis and culture, what investigations should you recommend if urinalysis and culture results confirm UTI in this patient? List TWO investigations.
Question 3
Abdominal ultrasonography Intravenous pyelography (IVP)
83
4. What underlying abnormalities are most often associated with recurrent UTI in children (both boys and girls) of this age group? List THREE abnormalities.
Question 4
Vesicoureteral reflux Posterior urethral valves Ureterocele
84
5. Long-term suppressive treatment can be used for recurrent UTI without underlying abnormalities. If investigations show no underlying abnormalities, what suppressive treatment will you use for Marianne? List the medication, the minimum duration of treatment, and the follow-up management.
1. Medication:
2. Minimum duration of treatment:
3. Follow-up management:
Question 5
Medication:
Minimum duration of treatment: Follow-up management:
Bactrim
Three months
Culture testing every one, two, or three months
85
Excluding family history, what additional information would be important in this child's history. List SIX.
Question 1
Child's history of atopy
Child's history of asthma
Child's history of allx
Use of medications
Recent infection
History suggestive of foreign body aspiration
86
If you were quite certain that Jamie has asthma, what would be your initial treatment/management steps? List FOUR.
Question 2
Patient education
Removing precipitating factors Inhaled beta-agonist Peak-flow meter
87
Despirte adeqaute initial teatment, Jamie's condition deteriorates and he presents at the emergency department one week later. You determine from the history and examination that he is in status asthmaticus.
3. In point form, give the stepwise management of status asthmaticus in this child. Arterial blood gases and peak expiratory flow. continuously monitored and reassessed. Assume his condition continues to deteriorate throughout treatment.
List EIGHT steps.
Question 3
Supplemental oxygen (O2)
Nebulized salbutamol (Ventolin) Subcutaneous epinephrine
Intravenous (IV) steroids
IV fluids
Admission to the intensive care unit (ICU) IV salbutamol
Intubation
88
1. Other than a past history of depression, what symptoms would help you confirm a diagnosis of clinical depression in Sandra? List SEVEN.
Question 1
A depressed mood
Anhedonia
Weight loss
Insomnia
Fatigue/Poor energy
Feelings of worthlessness
Diminished ability to think or concentrate
89
2. You have concluded that Sandra is indeed depressed, and you are now very concerned about her risk for suicide. What factors would lead you to suspect a high risk for suicide? List FIVE.
Question 2
A preoccupation with death or suicide
A specific plan for suicide
A family history of suicide attempts
The lack of a support system (i.e., friends, family, or spouse) Alcohol or drug abuse
90
After discussion with Sandra, you conclude that she has been significantly depressed for some time. Currently she is NOT at risk for suicide, but you believe medical treatment is warranted. You decide to prescribe a selective serotonin-reuptake inhibitor (SSRI) antidepressant. You want to warn her of possible side effects.
3. What are the common side effects of SSRI antidepressants? List SEVEN side effects.
Question 3
Dizziness
Headache
Sedation
Diarrhea
Tremor
Gastrointestinal (GI) upset Insomnia
91
4. What other classes of antidepressant medication could you use for Sandra? List TWO.
Question 4
Tricyclic antidepressants (TCAs) Serotonin-norepinephrine reuptake inhibitors (SNRIs)
92
1. What items of the patient's history (other than those listed above) are important to elicit at this time? List THREE.
Question 1
History of the first pregnancy
Family history of diabetes
Weight gain during previous pregnancy
93
What fasting AND two-hour postprandial glucose values, in mmol/L, should be the goals of therapy?
Fasting glucose measurement:
Two-hour postprandial glucose measurement:
Question 2
Fasting glucose measurement: 5 to 6 mmol/L
Two-hour postprandial glucose measurement: 6 to 8 mmol/L
94
3. Other than any risks associated with delivery, what risks does gestational diabetes carry for the newborn? List FOUR.
Question 3
Hypocalcemia
Hypoglycemia
Hyperglycemia
Polycythemia
95
Jim Brown, a 40-year-old executive, has come to see you for a periodic health evaluation.
1. List risk factors for cardiovascular disease, which, if present, would lead you to order a total cholesterol assay. Assume that the patient has no specific symptoms. List FIVE risk factors.
Question 1
Smoking
Hypertension
Family history of hypercholesterolemia Diabetes mellitus
Obesity
96
Jim Brown, a 40-year-old executive, has come to see you for a periodic health evaluation.
Based on other risk factors, you decide to order a fasting total cholesterol assay. The result is 7.l mmol/L. 2. What test do you order next?
Question 2
Fasting high-density lipoprotein (HDL)
97
Jim Brown, a 40-year-old executive, has come to see you for a periodic health evaluation.
Further investigahest risk group.
3. Excluding the use of drugs, list therapeutic recommendations you would make now. List TWO.
Question 3
Risk factor reduction Diet
98
Jim Brown, a 40-year-old executive, has come to see you for a periodic health evaluation.
4. List THREE drugs, each in a different class, which may be prescribed to lower serum lipids.
Question 4
Cholestyramine (Questran) Nicotinic acid (niacin) Lovastatin (Mevacor)
99
What are the ABSOLUTE contraindications to the use of Ocs for Elizabeth? List FOUR.
Present or past estrogen-dependent malignancy Undiagnosed vaginal bleeding
Hepatic tumor
Pregnancy
100
What physical examination maneuvers would you do before prescribing OCs? List THREE.
Question 2
A baseline blood pressure measurement Percussion and palpation of the liver
A breast examination
101
Elizabeth is worried about the possible side effects of OCs. What side effects are most likely to be caused by progestin excess? List FOUR.
Question 3
Decreased libido
Depression
Fatigue
Increased appetite
102
Elizabeth has been taking OCs for one and half cycles. She reports that her first "pill" period was normal. She is at day 16 of her second cycle of OC use and says she is spotting. A friend told her she should change to a different OC. You ascertain that she is taking the pill regularly and at the same time every day.
4. What do you advise Elizabeth to do?
Question 4
Continue with the same pill for a full three-month trial period
103
Question 5
What is the minimum time you have to wait after the ingestion before you will be able to assess the
severity of her poisoning adequately? Give ONE answer.
Four hours or longer after the ingestion
104
Question 6
Other than measurement of the acetaminophen plasma level, what laboratory tests are important for
determining whether antidote treatment is effective? List THREE.
Serum glutamic oxaloacetictransaminase (SGOT) testing / Aspartate transaminase (AST) testing
Serum glutamic pyruvic transaminase (SGPT) testing / Alanine transaminase (ALT) testing
Bilirubin testing
Measurement of prothrombin time (PT) / International Normalized Ratio (INR)
105
Question 7
Using the Rumack-Matthew nomogram, you determine that the patient requires administration of an
antidote. What antidote would you use? Give ONE answer.
N-acetylcysteine (Mucomyst)
106
Question 1
Other than demographic information, what important initial pieces of information must you elicit from
the woman over the phone? List FIVE.
Child's weight
Child's past medical history
Time of ingestion
Type of exposure / Name of the product ingested
Amount of exposure
107
You decide to have the daughter transported to the hospital immediately for further evaluation. As you
await her arrival, you ponder your approach. You might want to reduce the amount of poison absorbed.
What technique is available for reducing poison absorption? List ONE.
Charcoal administration / Administration of activated charcoal
108
Question 3
You might want to enhance excretion of the poison. What techniques are available to enhance poison
excretion? List TWO.
Forced diuresis
Hemodialysis
Hemoperfusion (over activated charcoal or resin)
Acidification of the urine / Alkalinization of the urine
109
Question 4
Upon the daughter’s arrival at the ED, you secure life support and her condition is stable. After further
questioning of the caller and laboratory testing, you conclude that she has absorbed an undetermined
amount of acetaminophen in the past 12 hours. What complication are you most concerned about with
this type of poisoning? State ONE.
Hepatotoxicity / Liver failure
110
Question 1
List other symptoms, not mentioned above, that you should specifically enquire about to help rule out
sinister medical causes for her fatigue. List TWO.
Fevers
Chills
Night sweats
Constipation / altered bowel habits
111
Question 2
Given the constellation of history and physical findings provided in the stem, list the FIVE most likely
causes for her fatigue.
Depression
Medication side effect (i.e. Betablocker)
B12 deficiency (with/without anemia)
Iron deficiency (with/without anemia)
Hypothyroidism
112
Question 1
Apart from an eating disorder, what are the most likely causes of her amenorrhea? List THREE.
Pregnancy
Anxiety (stress)
Excessive exercise / cachetic state / loss of weight
113
Question 2
What psychiatric disorders can be associated with her eating disorder? List THREE.
Depression
Anxiety
Personality disorder / Obsessive compulsive disorder
Substance abuse
114
Question 3
She is significantly underweight for her height. She admits to binge eating and purging with laxatives
to prevent herself from gaining weight. Her parents are quite concerned about an eating disorder, as
are you. What type of eating disorder does she have? State ONE.
Anorexia nervosa / Anorexia nervosa: binge-eating/purging type
Do NOT accept "bulimia"; the patient is underweight
115
Question 4
What is the most important blood test to order for this patient? List ONE.
Potassium testing
116
Question 5
What possible complications of her eating disorder would you be concerned about? List FOUR.
Osteoporosis Do NOT accept "amenorrhea"; the real concern is osteoporosis, a complication of amenorrhea
Cardiac arrhythmias
Dental erosions
Gastroesophageal reflux disease (GERD)
A Mallory-Weiss tear
Suicide
117
Question 1
What pieces of information regarding the mother's pregnancy and delivery would you inquire about to
assess the newborn's risk of infection? (Do not use abbreviations). List FOUR.
Gestational age / Prematurity
Whether the mother had a fever at delivery / antibiotic use during labor
The mother's group B Streptococcus status
The mother's history of sexually transmitted diseases (STDs) (infection with herpes simplex virus, gonorrhea,
or Chlamydia)
Prolonged rupture of membranes / preterm premature rupture of membranes / premature rupture of
membranes
118
Question 2
On examination, the newborn's temperature is 38.5oC. Your examination does not localize any source
of infection. What investigations should you order for her? List FIVE.
White blood cell count (WBC)
Urine culture testing / Urine culture and sensitivity (C & S) testing
Lumbar puncture / Cerebrospinal (CBS) fluid culture testing
Blood culture testing
Chest X-ray examination
119
Question 1
How long should a couple of their ages attempt to conceive before they are advised there may be
infertility issues that warrant further investigation/referral? Give ONE answer.
12 months
120
Question 2
If she was 37 years old, what would your answer to question 1 be (how long should a couple attempt to conceive before advised about fertility issues)? Give ONE answer.
6 months
121
Question 3
You learn that she has been experiencing irregular menstrual cycles. You suspect that she is
experiencing anovulatory cycles. What lifestyle factors could cause primary hypothalamic-pituitary
dysfunction and subsequent anovulation? State TWO.
Excessive stress
Excessive exercise
Excessive dieting / an eating disorder
122
Question 4
What hormonal diseases/conditions could be responsible for her anovulatory cycles? State TWO.
Polycystic ovary syndrome (PCOS)
Thyroid disease
Cushing's syndrome
Prolactinemia / hyperprolactinemia
123
Question 5
The couple requests advice about optimizing their lifestyle to maximize their chances of conceiving
naturally. What pieces of advice do you give them? List THREE.
Reduce excessive caffeine intake
Optimize the frequency and timing of coitus (two to three times a week / every 72 hours)
Optimize body mass index (BMI)
Avoid overheating the testicles (e.g., avoid placing a laptop computer on one's lap)
124
Question 1
What investigations would you order to clarify the cause of her seizures? State TWO.
Serum phenytoin level
B-HCG (serum or urine)
125
Question 2
What lifestyle changes could trigger an exacerbation of the patient’s epilepsy? State THREE.
Alcohol intake
Recreational drug use
Stress
Sleep deprivation
126
Question 3
What activity must you inquire about? State ONE.
Driving
127
Question 1
What pattern of liver disease do these results suggest? Give ONE answer.
Hepatocellular / Hepatic / intrahepatic
Do not accept obstructive / cholestatic
128
Question 2
You inquire about his history. He tells you that while he was on shore leave six months ago, he and
some colleagues visited Thailand "for some rest and relaxation." He asks whether he "might have
caught something" there. What historical elements should you inquire about to ascertain his risk of
having contracted viral hepatitis? State FOUR.
Illicit intravenous (IV) drug use / Illicit nasal drug use
Unprotected sexual activity
Piercings / Tattoos / Use of contaminated sharps / Use of contaminated needles
Blood transfusions
Exposure to jaundiced individuals
* Do NOT accept hepatitis A risk factors because exposure was six months ago
129
Question 3
You conclude that during his travels overseas, he did not subject himself to any particular risk factors
for contracting viral hepatitis infection. Apart from viral causes, what are other common causes for his
elevated transaminase levels? State THREE.
Alcohol
Drugs / Medications / Over-the-counter (OTC) drugs / Supplements
Fatty liver / Non-alcoholic steatorrheic hepatosis (NASH)
130
Question 4
Other than laboratory investigations, what investigation would help confirm your suspicion? State
ONE.
Liver ultrasonography / abdominal ultrasound
131
Question 1
What risk factors does she have for osteoporosis? State TWO.
Early menopause
Family history of osteoporosis
Do not accept ethnicity
132
Question 2
What lifestyle issues related to osteoporosis risk would you inquire about? List THREE.
Smoking history
Calcium / Vitamin D intake
Alcohol intake
Weight-bearing exercise
133
Question 3
You conduct a baseline bone mineral density which reveals she has a moderate risk for fracture. After
reviewing her bone density results and making lifestyle suggestions, you discuss drug therapy with
her. She has always refused to take hormone replacement therapy. She is already taking a calcium and
vitamin D supplement. At this time, what first line medications other than bisphosphonates could you
suggest to her for osteoporosis prevention? State TWO.
Teriparatide / **Forteo **/ recombinant parathyroid hormone
Raloxifene / SERM / Evista
**Denosumab / Prolia **/ Rank ligand inhibitor
134
Question 2
After taking appropriate anesthetic measures, you proceed to close the wound with a non-absorbable
6-0 monofilament suture. Where would you begin your repair? Give ONE answer.
At the vermilion border
134
Question 1
How would you proceed to provide anesthesia for this child? List TWO options.
Topical anesthetic administration before/instead of a local anesthetic injection
Regional block
Conscious sedation/ketamine
135
Question 3
The father wants to know when is the soonest they should return to have the sutures removed. What
do you tell him? Give ONE answer.
In three to five days
Do Not accept less than three or more than five days
136
Question 4
What wound care instruction is the most important to discuss? State ONE.
Watch for signs of infection (""signs of infection"" MUST be mentioned)
137
Question 5
What key component of the boy's past medical history will be important in deciding whether any other
interventions are required during this visit? State ONE.
Tetanus immunization date/status
138
Question 1
In terms of safety issues, what are your priorities in assessing the patient at this time? List TWO.
The risk of suicide
Homicidal risk
139
Question 2
Apart from a major depressive episode or disorder, what other psychiatric conditions should you
consider? List TWO.
Bipolar disorder
Schizoaffective disorder
Substance abuse (Accept alcohol abuse, drug abuse, narcotic abuse, etc.)
Do not accept anxiety disorder, personality disorder, grief or adjustment disorder
139
Question 3
A diagnosis of a major depressive disorder is made and you feel that outpatient management is safe.
Apart from pharmacotherapy, what are the components of an appropriate management plan? List
THREE.
Appropriate follow-up management / monitoring response to therapy
Psychotherapy / counselling
Contract for safety / seeking help if suicidal
140
Question 4
Although she is compliant with her medication and adheres to the management plan for two months,
her depression fails to improve. Other than referring to a psychiatrist, what are your next steps in
management? State FOUR.
Consider an alternative diagnosis
Look for co-morbid conditions
Augment medication with second drug
Increase / adjust dosage of present medication / switch to alternate medication / antidepressant
141
Question 1
What are the MOST likely diagnoses? Name TWO.
Claudication / Peripheral vascular disease (PVD)
Lumbar spinal stenosis / Neurogenic claudication
142
Question 2
What recommended tests or investigations would you perform in order to rule out each diagnosis?
Name TWO.
Ankle-brachial index (ABI) / arterial dopplers Angiography or stroke volume (VS)
Magnetic resonance imaging (MRI) / CT L-spine
143
Question 3
What lifestyle changes would likely improve his symptoms, regardless of the diagnosis? Name TWO.
Lose weight
Stop smoking
144
Question 1
Other than her age and sex, what are her risk factors for breast cancer? List FIVE.
History of breast cancer in her mother
Nulliparity / Never Breastfed
Obesity / Body mass index (BMI) >30
Increased alcohol consumption / Drinking two glasses of wine each day
Menopause after age 45 / Menopause at age 55
145
Question 3
What imaging study would you order to classify the lesion as cystic or solid? State ONE.
Ultrasonography (Ultrasonography effectively distinguishes between cystic and solid masses)
145
Question 2
What features of the palpable mass would be more characteristic of an ominous lesion? List THREE.
Hardness
Immobility / Being fixed to surrounding tissues / skin
Poorly defined margins / Irregular margins
146
Question 4
The imaging study indicates the lesion is probably cystic. What is the NEXT step in her management?
State ONE.
Fine-needle aspiration
147
What ADDITIONAL physical examination maneuver could you perform in an attempt to reproduce his
lightheadedness? State ONE.
Postural blood pressure (BP) measurement / Orthostatic BP measurement / Measurement of orthostatic vital
signs / Measurement of orthostatic change in the pulse / Heart rate (HR) measurement
Question 2
Given his history, what blood tests and investigations are MOST important to order immedia
148
Question 2
Given his history, what blood tests and investigations are MOST important to order immediately to
determine the cause of his dizziness? List FIVE.
Blood sugar measurement
Troponin test
Electrocardiography (ECG)
Hemoglobin testing
International Normalized Ratio (INR) testing
149
Question 3
Which medication is the most likely cause for his dizziness? State ONE.
Metoprolol
150
Question 4
If he had described a recent fall, what further investigation would you consider? State ONE.
Computed tomography (CT) of the head
151
Question 1
In an attempt to narrow the differential diagnoses, what OTHER elements of the history of the current
illness should you ask about? List THREE.
Fever / Chills
Bowel habit changes / Constipation / Diarrhea / Change in stools / Mucous in stools
Rectal (PR) bleeding
Passage of flatus
Weight loss
152
Question 3
Excluding findings from the rectal exam and peritoneal signs, what physical signs should you look for
during an abdominal exam, which, if present, would be consistent with a surgical cause for his
symptoms? List THREE.
Abdominal distension / Tympanic percussion
Tinkly or abnormal bowel sounds / High pitched bowel sounds / Absent bowel sounds
Mass / Hernia
Pulsatile mass (i.e., an abdominal aortic aneurysm [AAA])
153
Question 2
Other than diverticulitis, cancer, genitourinary causes, and various types of colitis, what OTHER
diagnoses should you consider? List THREE.
Bowel obstruction / adhesions
Hernia
Aortic aneurysm / Iliac aneurysm / Aortic dissection
Ischemic gut
154
Question 1
What SPECIFIC measurement from her pulmonary function test would allow you to confirm the
diagnosis of COPD?
(Forced expiratory volume in 1 second (FEV1) / forced vital capacity (FVC)) FEV1
155
Question 2
Once you have confirmed a diagnosis of COPD, what is the MOST important intervention you would
suggest to her at this time? State ONE.
Smoking cessation
156
Question 4
Further investigations indicate that her primary symptoms are due to her COPD. Having classified her
lung function impairment as mild (MRC2), what CLASS of medication would you offer INITIALLY? State
ONE.
Short-acting beta-agonist / Short-acting anticholinergic agent / Short-acting bronchodilator
157
Question 5
If her symptoms persist, what OTHER class of medication would you add to the treatment regimen?
State ONE.
Long-acting beta-agonist / Long-acting anticholinergic agent / Long-acting bronchodilator
158
Question 6
Aside from her medical therapy, what NON-PHARMACOLOGIC therapy would help with her symptoms?
State ONE.
Pulmonary rehabilitation
159
Question 7
Apart from smoking cessation, what ADDITIONAL recommendations would you make to help her avoid
future exacerbations of COPD? State TWO.
Receive pneumococcal vaccination
Receive influenza vaccination
160
Question 3
The patient returns to complain that, in the past three months, she has noticed shortness of breath
when she is trying to hurry on level ground or up a slight hill. She denies orthopnea or paroxysmal
nocturnal dyspnea. Last month, her chest X-ray examination was normal. What OTHER investigation
would you consider at this time to evaluate these symptoms? State ONE.
Cardiac exercise treadmill testing / MIBI scanning
161
Question 1
Should you advise his father to have the PSA test for screening? Give ONE answer.
No
162
Question 2
Apart from frequency, urgency, and nocturia, what symptoms might the patient complain about if he
had an enlarged or cancerous prostate? State TWO.
Hesitancy
Post-void dribbling
Weak stream
163
Question 3
The son tells you that for the past week he himself has been experiencing some of the above
symptoms. He adds that he has experienced general malaise and a fever for the past several days. He
denies any testicular complaints or flank pain. What is the son's MOST likely diagnosis? State ONE.
Prostatitis / Acute bacterial prostatitis
164
Question 4
What investigations / examinations should you do next to support the diagnosis? State TWO.
Midstream urine culture testing / Urinalysis
Digital rectal examination (DRE)
165
Question 5
Excluding cancer, what OTHER causes could explain an elevated PSA test result? List THREE.
Benign prostatic hypertrophy (BPH)
Urethral instrumentation / Urethral trauma
Infection / Prostatitis
Digital rectal examination (DRE) / Prostatic massage
Ejaculation
166
Question 1
Other than GERD and cancer, what are the important differential diagnoses for this patient's epigastric
pain? List THREE.
Cardiovascular disease (CVD) / Coronary artery disease (CAD) / Angina
Peptic ulcer disease (PUD) / Ulcer / Gastritis / Esophagitis
Cholelithiasis
Pancreatitis
167
Question 2
In addition to blood tests, what investigations should you order at this time? List THREE.
Electrocardiography (ECG) / Stress testing
Urea breath test / Fecal occult blood testing / Fecal immunochemical testing (FIT)
Abdominal ultrasonography
168
Question 3
The patient is worried about gastric cancer. Excluding constitutional symptoms and the history already
provided, what ADDITIONAL symptoms would you ask about? State TWO.
Dysphagia
Early satiety / Indigestion / Postprandial fullness
Melena
Do NOT accept "hematemesis." (The patient is not vomiting.)
169
Question 1
Based on the ECG in figure 1, what is the most likely rhythm abnormality? List ONE.
Atrial Fibrillation
170
Question 2
Apart from underlying cardiac disease, what diagnoses should you consider as the possible causes of
his condition? List THREE.
Alcohol ingestion
Pulmonary embolus
Hyperthyroidism
171
Question 3
The same patient a few weeks later, presents to the emergency room, not feeling well, worse than last
time. His vital signs are HR irreg at 150/min, BP 90/60. What should you look for or enquire about to
determine the treatment priority for this patient at this time? List TWO.
Angina
CHF
Perfusion status: decreased LOC, skin
172
Question 4
His BP is now 60/not measurable, and heart rate is still 150 irreg irreg. What should be your priority
treatment at this time? List ONE.
Cardioversion / synchronous cardioversion
SAMPs
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