Free GPST Stage 2 Questions

By Hannah Brown in GPST on Friday, September 25, 2009 @ 14:43

PRE-REVISION EXAM

Paper One Questions

1. A 75-year-old man is found to have an irregular heartbeat.  His electrocardiogram (ECG) shows repeating sequences of increasing PR interval followed by a dropped ventricular complex.

 Choose the single most likely diagnosis from the options below.

 A First-degree heart block
 B Mobitz type I second-degree heart block
 C Mobitz type II second-degree heart block
 D Third-degree heart block
 E Sick sinus syndrome

2. A five-year-old girl was taken to see her GP as her mother had noticed that she had developed a slight squint in her left eye.  On examination, the red reflex is absent.

 Which one of the following statements best describes this child’s condition?

 A It has a very high mortality rate
 B Most cases present after the age of 3 years
 C The gene associated with this condition is located on chromosome 16
 D The pattern of inheritance is recessive
 E There is a significant risk of secondary malignancy in the survivors

3. Regarding haemophilia A, which one of the following is the most appropriate?

A The disease is inherited in an autosomal dominant manner
B A family history is usually present
C The disease is X-linked
D Women are never affected
E Treatment remains associated with viral hepatitis C transmission

Theme: Endocrinology

A Addison disease
B Conn syndrome
C Cushing syndrome
D Diabetes insipidus
E Graves disease
F Multiple endocrine neoplasia
G Phaeochromocytoma
H Syndrome of inappropriate antidiuretic hormone secretion

For each of the following clinical scenarios, choose the single most likely diagnosis from the list of options above.  Each option may be used once, more than once or not at all.

4. A 56-year-old woman presents to the accident and emergency department with syncope.  You notice she has a significant postural drop in blood pressure and also pigmentation in a recent scar on her neck.

5. A 48-year-old woman has developed striae on her abdomen and is hypertensive.

6. A 31-year-old woman has severe hypertension and is found to have a potassium level of 3.1 mmol/l.

7. A 32-year-old woman has a history of episodes of severe headache and anxiety with flushing.  On examination she is very hypertensive and has a tachycardia.

8. A 56-year-old man, who attends surgery infrequently, presents with a 5-week history of heartburn and acid reflux.  He returns to see you after a 2-week trial of a proton pump inhibitor (PPI) with partial improvement.  His body mass index is 25 kg/m2

 Which one of the following is the most appropriate next step in his management?

 A Add and alginate preparation
 B Continue the PPI and review in 2 weeks
 C Helicobacter pylori testing
 D Refer for urgent endoscopy
 E Refer to a dietician for advice including weight loss measures

9. A 38-year-old accountant is referred to hospital complaining of very severe headache. It started suddenly 12 hours previously, and now persists as “an ache all over”.  She gives no previous history of neurological problems and her only medication is the oral contraceptive pill.  Examination reveals GCS 14/15 (E3 V5 M6). Temp is 37.0C. She has neck stiffness and photophobia, but NO focal neurology.

 Which one of the following diagnoses is most likely?

A Cerebral venous sinus thrombosis
B Migraine
C Subarachnoid haemorrhage
D Meningitis
E Sinusitis

Theme: Vaccinations and Traveller Advice

 A All of E and yellow fever also
 B All of A and meningitis (types A and C) also
 C Hepatitis A vaccine only
 D Hepatitis A, typhoid and polio vaccines
 E Hepatitis A and B, typhoid, polio, diphtheria and rabies vaccines
 F No precautions required
 G Rabies vaccine only
 H Typhoid and polio vaccines only
 I Typhoid vaccine only
 
For each of the traveller descriptions given below, choose the most appropriate advice from the above list of options.  Each option may be used once, more than once or not at all.  Assume each patient is currently resident in the UK.

10. A doctor is travelling to Somalia to work for the International Red Cross.

11. A businessman going to a conference in Thailand.

12. A 40-year-old man intending to travel to Barbados for a holiday.  He had hepatitis A four years ago and received polio vaccine as a child.
13. A 12-year-old girl travelling to rural France with her parents.

14. Which of the following statements regarding investigation of a first seizure is true?

A CT with contrast is the best modality for neuro- imaging
B A normal EEG excludes epilepsy
C The first test should be a blood glucose
D All patients should have lumbar puncture

15. A 24-year-old woman has had an itchy red rash on her left wrist for 1 month.  She also has red scaly areas on her ear lobes.

Which is the single most likely diagnosis from the list below?

A Allergic urticaria
B Atopic eczema
C Chrome dermatitis
D Nickel dermatitis
E Seborrhoeic eczema

16. Which of the following statements regarding investigation / management of suspected TIA is true?

A Carotid dopplers should only be performed if bruits are heard
B Normal CT head excludes TIA
C All patients should have a thrombophilia screen
D Warfarin should be started
E Aspirin should be started

17. Which of the following is true in the management of acute severe asthma:

A Nebulising bronchodilators with oxygen is contra-indicated
B A chest radiograph will reliably exclude pulmonary embolism
C A raised PaCO2 is indicative of near-fatal asthma
D Magnesium Sulphate is contra-indicated
E Hydrocortisone is more potent than oral prednisolone

18. Regarding this rhythm, which statement is true?

A The rhythm originates in the atria
B This rhythm is a stable rhythm
C Amiodarone should be initiated
D So long as he is well he can stay on the general ward
E Electrical cardioversion is immediately indicated

19. A four-year-old boy complains that the end of his penis ‘balloons’ when he passes urine.  His parents tell you the flow of urine is quite poor when this happens, and that it is happening more often as time goes by.  They ask if he needs circumcision.  On gentle examination his foreskin is easily retracted and replaced.

 From the following list of options, choose the single most likely diagnosis.

 A Balanitis
 B Non-retractile foreskin
 C Paraphimosis
 D Peyronie disease
 E Phimosis

20. Howell Jolly bodies suggest which one of the following?

A Splenomegaly
B Folate deficiency
C Vitamin A excess
D Hyposplenism
E Sickle cell anaemia

21. A 26-year-old woman, who is 28 weeks pregnant, complains of breathlessness during a routine antenatal check-up.  On clinical examination everything is normal except she is slightly hyperventilating.

 Which one of the following findings would you be surprised to encounter during a normal pregnancy?

 A Decrease in the serum ferritin level
 B Increase in cardiac output
 C Increase in glomerular filtration rate (GFR)
 D Increase in the levels of clotting factors VII, VIII and IX
 E Increase in total lung capacity

22. What is the most appropriate, recommended anti-tuberculous therapy regimen?

A Isoniazid, Rifampicin, ethambutol, pyrazinamide: for 6 months
B Isoniazid, Rifampicin, ethambutol for 9 months
C Isoniazid, Rifampicin ethambutol, pyrazinamide for 2 months and Isoniazid, Rifampicin for a further 4 months 
D Ethambutol, pyrazinamide for 2 months and Isoniazid, Rifampicin for 4 months
E Isoniazid, streptomycin, rifampicin, ethambutol for 3 months followed by rifampicin/isoniazid for a further 3 months

23. A 3-year-old child presents with a 3-month history of recurrent episodes of cough and wheeze.  The cough is worse at night.  Chest examination is normal between periods of wheeze, but there is prolonged expiratory wheeze during an episode.

 Which one of the following is the most appropriate management?
 
 A Arrange chest X-ray
 B Full blood count
 C Treat with a course of antibiotics
 D Trial of antihistaminics
 E Trial of bronchodilators

Theme: Hypertension

 A Amlodipine
 B Atenolol
 C Bendroflumethiazide
 D Doxazosin
 E Lisinopril
 F Losartan
 G Methyl dopa
 H Moxonidine

 For each of the hypertensive patients below, choose the single most likely antihypertensive medication from the list of options above.  Each option can be used once, more than once or not at all.

24. A 60-year-old man with diabetes who is already taking an angiotensin-converting enzyme (ACE) inhibitor.

25. A 42-year-old African Caribbean woman with hypertension which is not controlled by bendroflumethiazide.

26. A 72-year-old man with poorly controlled hypertension who has recently developed angina.

27. A 41-year-old woman with chronic obstructive pulmonary disease who is taking rampiril and bendroflumethiazide but has developed a persistent dry cough which does not seem to be related to her airways disease.

28. A 35-year-old pregnant woman whose blood pressure is 170/110 mmHg in the mid-trimester

29. A 55-year-old diabetic man with a history of ischaemic heart disease presents to A and E one morning with acute dyspnoea without chest pain.  The most likely diagnosis is:

A Acute right heart failure
B Myocardial infarction
C Acute left ventricular failure
D Diabetic amyotrophy
E Critical aortic stenosis

30. Which one of the following is consistent with a diagnosis of asthma?

A Increased compliance and increased peak flow
B Reduced vital capacity by 30% on lying supine
C Reduced FEV1 and FVC
D Diminished gas transfer
E Reduced FEV1/FVC ratio and normal or increased gas transfer
31. Which of the following blood test results would support a diagnosis of primary osteoporosis:

A Corrected calcium 2.96, Phosphate 1.29, alkaline phosphatase 130
B cCa 2.36, PO4 0.95, ALP 165
C cCa 2.36, PO4 0.89, ALP 1236
D cCa 2.03, PO4 1.35., ALP 233
E cCa 2.86, PO4 0.39, ALP 559

32. A 76-year-old man presents with central chest pain, radiating down the left arm and into the jaw, shortness of breath, nausea and sweating.  On examination he is cold and clammy.  His BP is 120/85 and his pulse 90 bpm.  His respiratory rate is 30 and his saturations are SaO2 97% on 2 litres/min of oxygen.

 

 What is the most likely diagnosis?
 
A Posterior STEMI
B Posterior NSTEMI
C Anterior NSTEMI
D Lateral NSTEMI
E Inferior NSTEMI

Theme: Dermatology

A Erythema multiforme
B Necrobiosis lipoidica
C Pyoderma gangrenosum
D Lupus pernio
E Acanthosis nigricans

For each statement below choose the most appropriate dermatological diagnosis from the list above.

34. Pigmented rough thickening of skin in axillae/inguinal regions, associated with malignancy.

35. Shiny area on shin with yellowish tinge and telangectasia, associated with diabetes mellitus.

36. Recurring pustulo-nodular ulcers, with tender red-blue overhanging edge.  Associated with Crohns disease, vasculitis, rheumatoid arthritis.

 

37. What is the most common cause of hyperthyroidism?

A Hashimoto’s thyroiditis
B De Quervain’s thyroiditis
C Toxic multinodular goitre
D Thyroid carcinoma
E Graves’ disease

38. A 65-year-old Caucasian woman presents with tiredness and exertional breathlessness
Her baseline bloods show:
– Hb 8g/dl
– MCV 65
– Ferritin 5 (Normal >50)
– Blood film: Howell-Jolly bodies; microcytic

Her anaemia is most likely to be:

A Due to B12 deficiency
B Due to thalassaemia
C Due to acquired iron deficiency
D Due to acute upper GI haemorrhage
E Due to menorrhagia

Paper Two Questions

39. During the final week of your foundation attachment in general practice a patient you have been looking after gives you a thank you card.  Inside, you find a cheque for £200.

 Rank the possible responses below in the most suitable order.

 A Happily accept the gift as a reward for your efforts
 B Identify your feeling of embarrassment at receiving the gift and refuse
 C Offer to use the money to buy some equipment for the surgery
 D Politely talk to the patient to ascertain the reason for the gift

40. You are working in a general practice as a foundation 2 doctor.  Your practice manager tells you that she has had a written letter of complaint about you from a patient who states that you missed her diagnosis of lung cancer.  The patient is a 65-year-old lady who you saw four weeks ago with a cough.  You diagnosed a chest infection, gave her amoxicillin and told her to come back in four days if she was no better.  She subsequently presented to the accident and emergency department and had a chest X-ray that led to the diagnosis.  You feel that you managed her case appropriately but are obviously upset by the complaint.

Select from the list below the 3 most suitable responses to the situation:

A Discuss the case with your GP supervisor
B Forward the complaint letter onto your medical indemnity provider
C Ring the patient and explain your management decisions
D Invite the patient in to see you and explain your management decisions
E Write to the patient and explain that you can no longer provide medical care for her

 

41. You are a year 1 Specialist Trainee in general surgery.  You notice on the rota that you are due to be on-call on the same day that you are due to be attending your niece’s birthday party.  The on-call team consists of yourself, a Foundation year 1 trainee, a year 3 Specialist Trainee and the consultant on call.

Rank the possible responses below in the most appropriate order.

A Ask the Foundation year 1 trainee to cover your pager for the shift
B Arrange to swap the shift with a colleague so that you can attend the event.  If you are unable to do this then send your apologies to your niece
C Phone the team on the morning of the shift and tell them you are sick and unable to work
D Inform your niece you are unable to attend

42. Nursing staff tell you that the 19-year-old son of one of your patients is waiting to talk to you about his mother’s condition.  She has just been told she has breast cancer and is about to undergo further investigations to determine the management.

Rank the possible responses below in the most suitable order.

A Offer to discuss things with his mother present
B Read the patient’s notes, and take them with you to fully provide any information the son needs about his mother
C See the son, listen to his concerns and explain about any procedures he is worried about without revealing any confidential information
D Ask the nursing staff to tell the son to discuss it with his mother

43. You are a working in a GP practice. A patient you have never met before requests diazepam, saying they lost their prescription. Rank the following in the most suitable order:

A Offer to give them another prescription and document they lost the last prescription clearly in the notes
B Review their notes before making a decision
C Politely refuse suggesting they should look after their prescriptions
D Discuss the case with your trainer before you issue an prescription