Part I Conjoint Examination

Sin Ming Chuen

Part I Examination

• New Format

• 2 Parts– MCQ 50%– KFP ( Key Feature Problem) 50%

MCQ

• 3 hours

• 100 simple completion

• 60 multiple completion

• 20 extended matching

MCQ

• Simple Completion Questions– 5 choices, ONE correct answer

Simple Completion

• 1. A 29 year old woman with a body mass index of 38 presents with a 2 week history of severe headache, blurring of vision and nausea which followed a course of tetracyclines for a lower respiratory infection. The significant abnormality on examination is papilloedema. The most likely diagnosis is:

• A. cerebral glioma

• B. temporal arteritis

• C. gravitational headache

• D. benign intracranial hypertension

• E. cerebral abscess

• Answer: D benign intracranial hypertension

Simple Completion

2. Which of the following is/are true of dementia?A. Impaired memory loss is one of the criteria that

must be present when diagnosing dementiaB. Dementia is usually associated with a loss of

alertness C. Slowing of information processing is typical of

dementiaD. Dementia is associated with a short attention

span

• Answer : A

Simple completion

3. Which of the following condition in infant always require surgery?

A. Umbilical hernia

B. Inguinal hernia

C. Phimosis

D. Hydrocele

E. Balanitis

• Answer: B inguinal hernia

• 4. The commonest cranial nerve affected by diabetic neuropathy is

A. Oculomotor

B. Trochlear

C. Abducent

D. Facial

E. hypoglossal

• Answer: A third nerve

5. Rosacea

A. Has an insidious onset and course

B. Can sometimes spontaneously remit

C. With rhinophyma more common in females

D. Cannot be differentiated confidently from acne in the absence of rhinophyma

E. Can be treated with topical steroids of mild to moderate potency

• Answer: A

6. Predisposing factors to heat stroke include the following except

A. Salt and water depletion

B. Fatigue

C. Body mass index below 20

D. Febrile illness

E. Extremes of life

• Answer: C BMI below 20

Multiple Completion

• A. 1,2,3 correct

• B. 1,3 correct

• C. 2,4 correct

• D. 4 correct

• E. All correct

Multiple Completion

1. The following is / are contraindications to cervical smear collection

1. Within 24 hours of coitus

2. Within 6 weeks of cervical biopsy

3. Vaginal bleeding

4. Hormonal therapy

• Answer: A (1,2,3)

• Adverse reactions of NSAID are more frequent in the elderly and include– 1. GI ulceration– 2. Salt and water retention– 3. Bronchospasm– 4. Skin rash

• Answer E (all correct)

3. Which of the following is/are possible clinical manifestations of hepatitis A virus infection ?

1. Prolonged cholestasis

2. Relapsing hepatitis

3. Triggered autoimmune hepatitis

4. Chronic hepatitis A

• Answer: A

Extended Matching

• A 54 year-old woman with persistent headache, aches and pains, poor appetite

• A 40 year-old man with episodes of one-sided severe headaches and a watery eye

• A 58 year-old woman with patches of tenderness in the scalp during headaches– A. tension headache, B. cervical nerve root irritation, C.

migraine, D. cluster headaches, E. sinusitis, F. depression

• 1. F depression

• 2. D cluster headache

• 3. B cervical nerve root irritation

Key Feature Problem

• 25 questions. 3 hours

• Each question has same weighting

• Choose up to …

• No mark for the question if– 1. Choose more than required– 2. Choose the fatal response

Key Feature Problem

• A 29 year-old lady was referred to your clinic from GOPD for high blood pressure. She visited your clinic 2 weeks ago for URTI with BP checked and was normal. She had documented BP up to 180/110 twice within 2 weeks in the GOPD. You have checked BP for her today, which is 185/100. She is a non-smoker and is not taking OCP. She has no FH of hypertension.

• 1. List 4 points IN THE SCENARIO that you are most concerned with.

• Answer:– Young hypertensive– Recent onset– Reproducibility– Lack of risk factor

Other correct answer: – Not on OCP

2. What initial investigations would you perform ? Choose up to six

– CBP 24 hour urine for VMA IVU

– RFT CXR – Spot glucose ECG– Uric acid AXR– ESR USG abdomen– CRP CT abdomen– Lipid profile renal biopsy– Morning cortisol Serum renin – MSU C/ST CMG

• Answer:• CBP (1)• RFT (1)• Lipid profile (1)• MSU (1)• CXR (1)• ECG (1) • “Dangerous Answer: renal biopsy (no mark for the

part if choose this as an answer )

3. What is the most likely cause of her hypertension ? Choose up to 3.-essential HT -reflux nephropathy

-Cushing syndrome -Sheehan syndrome -stress - renal artery stenosis -coarctation of the aorta -nephritis -pheochromocytoma -diabetes -SLE -excessive Na intake -renal vein thrombosis

• Answer: – Essential HT (1)– Nephritis (1)– Reflux nephropathy (1)

• A 45 year-old lady presents with 3 weeks history of recurrent pain and erythema over left ankle, knee and wrist joint. She also has fatigue.

• 1. List 2 most possible differential diagnosis.

• Answer: RA (1) +

• Viral arthritis / SLE /OA

• 2. What initial management do you have before investigation results are available ? List 2.

• Answer: panadol / NSAID / aspirin

• rest

• review investigation results

• What initial investigations would you perform? Choose up to 4.

CBP lipid profile ESR MSU for C/STCRP CXRUric acid ECGSpot glucose XR handsTFT C3, C4ANA joint aspirationRF serum viral titre

• Answer: CBP (1) , serum viral titre (1), ANA (1), RF (1)

END