Part I Conjoint Examination

1. Part I Conjoint Examination Sin Ming Chuen

2. Part I Examination • New Format • 2 Parts • MCQ 50% • KFP ( Key Feature Problem) 50%

3. MCQ • 3 hours • 100 simple completion • 60 multiple completion • 20 extended matching

4. MCQ • Simple Completion Questions • 5 choices, ONE correct answer

5. 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:

6. A. cerebral glioma • B. temporal arteritis • C. gravitational headache • D. benign intracranial hypertension • E. cerebral abscess

7. Answer: D benign intracranial hypertension

8. Simple Completion 2. Which of the following is/are true of dementia? • Impaired memory loss is one of the criteria that must be present when diagnosing dementia • Dementia is usually associated with a loss of alertness • Slowing of information processing is typical of dementia • Dementia is associated with a short attention span

9. Answer : A

10. Simple completion 3. Which of the following condition in infant always require surgery? • Umbilical hernia • Inguinal hernia • Phimosis • Hydrocele • Balanitis

11. Answer: B inguinal hernia

12. 4. The commonest cranial nerve affected by diabetic neuropathy is • Oculomotor • Trochlear • Abducent • Facial • hypoglossal

13. Answer: A third nerve

14. 5. Rosacea • Has an insidious onset and course • Can sometimes spontaneously remit • With rhinophyma more common in females • Cannot be differentiated confidently from acne in the absence of rhinophyma • Can be treated with topical steroids of mild to moderate potency

15. Answer: A

16. 6. Predisposing factors to heat stroke include the following except • Salt and water depletion • Fatigue • Body mass index below 20 • Febrile illness • Extremes of life

17. Answer: C BMI below 20

18. Multiple Completion • A. 1,2,3 correct • B. 1,3 correct • C. 2,4 correct • D. 4 correct • E. All correct

19. Multiple Completion • The following is / are contraindications to cervical smear collection • Within 24 hours of coitus • Within 6 weeks of cervical biopsy • Vaginal bleeding • Hormonal therapy

20. Answer: A (1,2,3)

21. 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

22. Answer E (all correct)

23. 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

24. Answer: A

25. 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

26. 1. F depression • 2. D cluster headache • 3. B cervical nerve root irritation

27. 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

28. 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.

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

30. Answer: • Young hypertensive • Recent onset • Reproducibility • Lack of risk factor Other correct answer: • Not on OCP

31. 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

32. 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 )

33. 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

34. Answer: • Essential HT (1) • Nephritis (1) • Reflux nephropathy (1)

35. 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.

36. 1. List 2 most possible differential diagnosis.

37. Answer: RA (1) + • Viral arthritis / SLE /OA

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

39. Answer: panadol / NSAID / aspirin • rest • review investigation results

40. What initial investigations would you perform? Choose up to 4. CBP lipid profile ESR MSU for C/ST CRP CXR Uric acid ECG Spot glucose XR hands TFT C3, C4 ANA joint aspiration RF serum viral titre

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

42. END