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 herniaB. Inguinal herniaC. PhimosisD. HydroceleE. Balanitis

• Answer: B inguinal hernia

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

A. OculomotorB. Trochlear C. AbducentD. FacialE. hypoglossal

• Answer: A third nerve

5. RosaceaA. Has an insidious onset and courseB. Can sometimes spontaneously remitC. With rhinophyma more common in femalesD. Cannot be differentiated confidently from acne i

n the absence of rhinophymaE. Can be treated with topical steroids of mild to m

oderate potency

• Answer: A

6. Predisposing factors to heat stroke include the following except

A. Salt and water depletionB. FatigueC. Body mass index below 20D. Febrile illnessE. 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 coitus2. Within 6 weeks of cervical biopsy3. Vaginal bleeding4. 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 factorOther 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