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MEQ
A 15 year old girl presents with a 3 day history of fever, sore throat and difficulty swallowing.
Q1. Most likely diagnosis
Q2. List four differentials
Q3. What additional features on hx and/or exam would distinguish the differentials
Q4. What features (if present) would justify prescribing an antibiotic?
Q5. Which antibiotic and why?
EMQ 1
Options:
A. Atrophic Vaginitis
B. Bacterial Vaginosis
C. Cervical Erosion
D. Candidiasis
E. Endometriosis
F. Gonnorhea
G. Physiological
H. Endometrial Cancer
1. 23 yo woman with itching, soreness and mild dyspareunia. On exam, there is a white exudate on an
erythematous background.
2. 34 yo 4 weeks post vaginal delivery with low grade fever, purulent discharge and lower abdominal
pain.
3. 26 yo presents with increased vaginal discharge mid-cycle. There is no odour or itch but it does stain
slightly.
4. 34 yo with vaginal discharge who notes a fishy smell with mild itching.
5. 65 yo with a new partner presents with blood stained discharge associated with dyspareunia.
Otherwise well with no systemic symptoms.
EMQ 2
Options:
Colchicine
Local Steroid Injection
Methotrexate
Oral Steroids
Physiotherapy
Refer to surgery
Rest
Splint
1. De Quervains tenosynovitis not responding to rest and wrist support.
2. Early morning stiffness and shoulder pain with a raised ESR.
3. Acutely swollen erythematous 1st metatarsal joint.
4. Acute onset lumbar pain when lifting with right sided sciatica.
5. Patient with fibromyalgia presents with multiple tender points in shoulder. On exam, there is normal
range of movement with numerous trigger points in the muscles.
Question 1
45 year old female hairdresser with 3 week history of cough, intermittently productive of yellow and white
sputum, worse at night. Non-smoker. History of flu like illness 3 weeks ago, pyrexia, runny nose etc, all
symptoms of which now resolved.
What is your main differential? 5 marks
List 5 other most likely differentials. 10 marks
For each of the 5 list 2 items of history or examination that would make it more likely to be the diagnosis.
10 marks
For each of the 5 above list one investigation you would carry out that would provide evidence for your
diagnosis, what would the findings be?
Question 2
EMQ
Hypothyroid
Depression
Iron deficiency anaemia
76 year old woman, tired all the time, weight gain, alopecia, FBC normal.
42 year old woman, 2 children, husband in the navy, he's never around, has presented for sleeping
tablets because she keeps waking at 4am and is exhaused.
Woman presents tired all the time, on FBC her MCV is low and her haemoglobin is 10.3.
Question 3
Azothioprine
Beta metasone
Ciclosporin
PUVA
Tacrolimus
Dermovate
6 year old girl,severe excema only controlled by betamethasone cream, parents worried about long term
steroid use, she's already had 1 month of treatment.
Mechanic, severe psoriasis for which he's already tried tar and a lot of other meds...what would
you recommend?
Severe eczema flare in a man, he uses emmolients, barrier creams and non-bio washing powder etc.
MEQ:
The first patient in your surgery is a 12 month old girl (Anita) brought to you by her father who has had
vomiting and diarrhoea for 48 hours.
1) What is the main differential diagnosis?
2) What points in the history would you clarify with her father and explain briefly how they help. (there was
the best part of a blank page [no lines] to write this) (didn't specify how many points you should make)
3) What points in examination would you look for, and briefly explain how they help. (there was about half
a blank page to do this) (no mention of how many points you should make)
4) What advice would you give to Anita's father about management of her illness. (half blank page)
EMQs:
OPTIONS:
Give benzodiazepines
CT head
CBT
Endoscopy
Encourage reattribution of symptoms to non-organic cause
Tell the patient that this is definitely not due to an organic cause
Inform the family that the patient is making it up (or something like that, worded a bit better)
1. 72 yr old man with some past psychiatric history (anxiety etc. i think) who has come to surgery with
new onset right hemiplegia and aphasia. what do you do?
2. 45 yr old woman with long standing dyspepsia, who has been previously worked up by cardiology and
gastroenterology, with nothing found, presents with worsening symptoms. her mother recently died of
oesophageal carcinoma aged 75. what do you do?
3. a man in his 40s recently found out that his wife had an affair. she brings him to you because he has
suddenly lost the ability to speak. he does not seem concerned by his symptoms. what do you do?
4. a patient of yours calls you about her sister (28yrs). she has a history of alcohol and drug misuse, and
something else psychiatric i think. her sister is fitting. when you get there the person has stopped fitting
and can tell you all about it. she did not injure herself. no incontinence. no tongue biting. (i think it may
have mentioned that she did not lose consciousness). she says she has had some fits recently. what do
you do?
5. can't remember...sorry
GP Rotation 1 Exam
Many thanks to Janet for providing the details of this paper.
Case 1
66 y/o man presents with increasing S.O.B. over a 3 week period. Long hx of coughing everyday. He is
obese and smokes 40 cigs/day.
Q.1. One most likely differential?
Q.2. 4 other differentials you would need to consider?
Q.3. How would you differentiate between these conditions based on history?
Q.4. How would you differentiate between these conditions based on examination?
Q.5. What diagnostic test would you do to confirm your most likely differential and what would you find?
Q.6. What would you do prophylactically for the future? (3 things)
Case 2
45 y/o shopkeeper with a hx of rheumatoid arthritis. Morning stiffness and pain in the afternoon and
evening. She can still do things around the shop but can't do some other things.
Q.1. List the main drug classes used for rheumatoid arthritis with an example from each.
Q.2. What non-pharmacological management could be used for RA?
Q.3. Which members of the primary care team could help with a pt. with RA? (besides the GP)
Q.4. Assuming she is on the normal treatment for RA, what factors would you need to monitor to optimise
her care?
Q.5.
Q.6. She asks about knee surgery for RA. Tell her about the advantages and disadvantages.
Best of luck with the exams,
Paul
The 2nd rotation exam involved:
Case 1
50 yr old man with chest pain, non smoker, no personal history, intermittent over last 3 days, much more
severe in last 2 hrs.
1.
2.
3.
4.
5.
Main differential
4 possible other causes
Hx and Exam clues that would hint at your primary diagnosis
Hx and exam clues that would hint at your other 4 diagnoses
how would you manage him in the acute setting if you were sending him into hospital?
Case 2
Nurse comes back from an education seminar saying she wants to set up an asthma clinic in your
practise
1.
2.
3.
4.
How would she identify patients suitable for it?
What ways could the asthma clinic help the practise
What measures would you use in the clinic/what would you do?
How would she determine if the clinic was a sucess and briefly discuss this (ie audit)
Think the first exam involved a case on COPD and Rheumatology. I think there was a question on knee
joint replacements in it...
Best of luck in your exam,
Cathal
GP Exam Rotation 3
Case 1
33 y/o female, works as an executive assistant in a government office/department, presents with a 1 year
hx of ongoing headache, described as a feeling of "wearing a hair band when there is none". Headaches
have become more severe in recent times and occur at least twice per week now, and can last for an
hour or more.
Q.1. What is your main differential?
Q.2. List 4 other differential diagnoses you would consider.
Q.3. For each of these diagnoses, state one feature that would be obtained from history-taking that would
make that dx more likely.
Q.4. The GP decides to refer the patient to a hospital specialist Headache Clinic. What might the GP
hope to gain from this referral?
Q.5. What could be the potential downsides/disadvantages to going ahead with this referral?
Case 2
70 y/o male with a hx of Type 2 DM for the last 7 years. Past hx of angina. Recently discharged from
hospital following PTCA (Percutaneous Transluminal Coronary Angiography) with stent insertion.
Q.1. List the main classes of drugs you would expect to be used in the management of this patient. For
each class, explain the rationale behind its use and give an example of a drug in each class.
Q.2. How would you gauge this man's compliance with his medications?
Q.3. List which blood tests you would use to monitor this patient for disease complications and treatment
and explain the rationale for each test.
Q.4. What other steps would you take to ensure prevention of further illness and complications in this
man?
All the best with the exams,
Paul
GP exam 4th group
To: Daithí de Baróid <[email protected]>
I think the second patient was 56! :)
2010/1/10 Daithí de Baróid <[email protected]>
Tried to remember this as best i could, hope it helps! Feel free to correct it everyone else!
Daithi
The first patient you have is a 25 year old young woman works in fast food restuarant. presents
with three day history of profuse watery diarrhoea and crampy abdominal pain. Felt nausea but
did not vomit a few days ago. Can drink fluids but cannot tolerate food.
What is your main differential?
What are three other likely causes?
What advice would you give her about SELF-management?
How would you the GP manage her condition?
If this problem had been on and off over the course of the year give five other conditions you would be
concerned about?
The next patient you meet is a mid-40 (can't remember this), obese gentleman with an elevated BP
(can't remember this figure so please correct me if this is this too far off!- 160/90).
What are the other factors you would need to evaluate 10 year cardiovascular risk?
List the main anti-hypertensive drugs and give one example of each.
In this gentleman's case which agent would you chose to prescribe and why?
What are the non-drug methods used to address hypertension?
If this patient was post-stenting for Myocardial Infarction, what other treatment would you expect him to
be on?
1- a 54 year old Male onset lower back pain 3 days previous while lifting a heavy object at work, walks
into your surgery, does not appear to be in any distress and comments its just uncomfortable when he
sits down.
Q1- Most likely diagnosis
Q2-What symptoms and points in the history would indicate a more serious condition - list the symptom
and the condition
Q3- What signs would you look for on exam which indicated a more serious diagnosis ... as above
Q4- What would you advise him
Q5 - What would you prescribe him
2- A 34(?) year old hairdresser who has been previously worked up and diagnosed in hospital with GORD
presents for a repeat perscription of her PPI (omeprazole i think ). You note she is 4'10 and 11 stone
(BMI=29).
Q1- What questions would you ask her to enquire about complications of her condition? ( It was a poor,
and vague question)
Q2 -What investigations would you perform to investigate any possible complications of her condition.
Q3-What advice would you give her to help her manage her GORD.
Q4- What advice would you giver her to help her lose weight.
Q5- She mentions she has heard of an operation to help her with her condition. What is this operation?