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GMC|Specimenquestionsandstation

Specimenquestionsandstation
Contents
1.Part1samplequestions
2.Part1answers
3.Part2samplestation

Part1Samplequestions
1.A22yearoldmanhashadanacute,painful,redrighteyewithblurringofvisionforoneday.He
hadasimilarepisodeoneyearagoandhashadepisodicbackpainandstiffnessrelievedby
exerciseanddiclofenacforfouryears.
WhatistheSINGLEmostlikelycauseofhisredeye?
AChorioretinitis
BConjunctivitis
CEpiscleritis
DIritis
EKeratitis
2.A40yearolddivorcedmanwithbipolaraffectivedisorderattendshospitalfollowingan
overdoseof30tricyclicantidepressanttablets.Hisnewpartnerhaslefthimandhehasstopped
takinghismedicineandbegundrinkingheavily.Heappearsdepressed,feelshopelessandis
ambivalentaboutbeingalive.Heisnowfitfordischargefromthemedicalwardandacknowledges
thebenefitsofprevioustreatment.
WhatistheSINGLEmostappropriatenextmanagement?
AAdmissiontothepsychiatryward
BArrangepsychiatricoutpatientfollowup
CDischargetothecareofthegeneralpractitioner
DReferraltolocalalcoholtreatmentteam
EReferraltoclinicalpsychologist
3.AhealthybabyboyisbornattermtoawomanwhowasunwellwithconfirmedacutehepatitisB
duringpregnancy.Themotherisveryconcernedthatshemayhaveinfectedthebabywith
hepatitisB.
WhatSINGLEpreventativeinterventionshouldbegiventothebaby?
AFullcourseofhepatitisBvaccine
BHepatitisBimmunoglobulinalone
CHepatitisBvaccineandhepatitisBimmunoglobulin
DHepatitisBvaccineassingledose
ENoneuntilhepatitisBstatusconfirmed
4.Apreviouslywell15yearoldgirlhadanacuteonsetoffever,sweating,bruisingandpetechiae.
Abloodcountshowed:
Haemoglobin63g/L
Whitecellcount1.1x109/L
Neutrophils0.1x109/L
Platelets14x109/L.
Noabnormalwhitecellswereseenonthebloodfilm.Shewastransfusedandgivenintravenous
antibioticsandherconditionimproved.Threeweekslaterherbloodcounthasreturnedtoa
similarpicture.
WhatistheSINGLEmostlikelyunderlyingdiagnosis?
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AAcutelymphoblasticleukaemia
BAcutemyeloidleukaemia
CAplasticanaemia
DChronicmyeloidleukaemia
EPerniciousanaemia
5.A25yearoldwomanhasabloodpressureof160/90mmHgatweek10ofherfirstpregnancy.
Shehadrecurrenturinaryinfectionsinchildhood.Herurinalysisshowsproteinbutnoblood.Her
bloodtestsshow:
Haemoglobin109g/L
Serumurea7.5mmol/L
Serumcreatinine125mol/L.
WhatistheSINGLEmostlikelycauseofherhypertension?
AChronicglomerulonephritis
BChronicpyelonephritis
CEssentialhypertension
DPreeclampsia
ERenalarterystenosis
6.An83yearoldwomanadmittedwithachestinfectionbecomesconfusedwithimpaired
attentionandpoorconcentration.Sheisrestlessandfrightened.Sheisverballyabusiveandhas
perceptualabnormalities.Thereisnosignificantpreviouspsychiatrichistory.
WhatistheSINGLEmostlikelydiagnosis?
ADelirium
BDruginducedpsychosis
CLewybodydementia
DMultiinfarctdementia
EPsychoticdepression
7.Atownhasapopulationof500,000.Inafiveyearperiodthereare1250casesofbladdercancer
diagnosedattheonlyhospital.Duringthesameperiodtheoccupationalhealthdepartment
diagnosedafurther500cases.
Whatistheannualincidencepermillionofbladdercancerinthispopulation?
A2100
B1750
C1400
D700
E350
8.A28yearoldwomanwhohashadapreviouspulmonaryembolisminpregnancywishesto
discusscontraception.Shehasmenorrhagiabutisotherwisewell.
WhatistheSINGLEmostsuitablecontraceptivemethodforthispatient?
ACombinedoralcontraceptivepill
BCopperintrauterinecontraceptivedevice
CLevonorgestrelintrauterinesystem
DProgestogenimplant
EProgestogenonlypill
9.Aneightyearoldgirlhashadleftearachefortwodays.Theearachesubsidedabouttwohours
agowiththeonsetofapurulentdischargewhichrelievedthepain.Hertemperatureis39.2oC.
WhatistheSINGLEmostappropriateantibiotic?
AAmoxicillin
BCiprofloxacin
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CClindamycin
DErythromycin
EFlucloxacillin
10.A38yearoldmanhasdisturbingthoughtsabouthishousebeinginfectedbygerms.Heis
anxiousaboutsafetyandchecksthelocksofhisdoorsrepeatedlybeforegoingtobed.Forthelast
eightweekshehasbeenwashinghishandseverytimehetouchesthelock,2030timesaday.
WhatistheSINGLEmostappropriatemanagement?
AAntidepressant
BAntipsychotic
CAnxiolytic
DCognitivebehaviourtherapy
EPsychodynamicpsychotherapy
11.Atwoyearoldboyfelloffhistricycle,hurtinghisarm.Hegotupandstartedtocrybutbefore
therewasanysoundhewentpale,unconsciousandrigid.Herecoveredafter12minutesbut
remainedpale.Afteranhourhewasbacktonormal.Hismothersaysshewasafraidhewasgoing
todieandthathehadasimilarepisodethreemonthspreviouslyafterhefelldownsomesteps.
WhatSINGLEinvestigationisindicated?
AComputedtomographyscanofthehead
BElectroencephalogram
CFullbloodcount
DNone
ESkeletalsurvey
12.Atlaparoscopicsurgeryforgallstones,atrocarisinsertedthroughthemidlineoftheanterior
abdominalwalljustbelowtheumbilicus.
WhichSINGLEstructure(s)wouldbepierced?
AConjointtendon
BExternalandinternalobliquemuscles
CExternalobliqueaponeurosisandinternalobliquemuscle
DLineaalba
ERectusabdominusmuscle
13.A65yearoldmanhadclosureofcolostomyperformedfivedaysago.Heisnotsystemically
unwell.Thereisatender,localisedfluctuantswelling4cmindiameterinthewound.
WhatistheSINGLEmostappropriatemanagement?
AAbdominalsupport
BAntibiotics
CLaparotomyandresuturewound
DLocalexplorationofwound
EObservation
14.A32yearoldwomanhashadafebrileillnessandswellingofthesmalljointsofherhands,
feet,wristsandkneesfortwodays.Shehasamaculopapularrashandafewpalpable,small
cervicallymphnodes.Shewaspreviouslywell.Thereisnohistoryofrelevanttraveloutsidethe
UK.Shehastwoyoungchildren.
WhatistheSINGLEmostlikelydiagnosis?
APsoriasis
BReactivearthritis
CRheumatoidarthritis
DSarcoidosis
ESystemiclupuserythematosus
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15.A16yearoldgirlhashadanenlargingmassintherightsideofherneckforthelastsixweeks.
Shehashadnoothersymptoms.Shehasa2x2cmenlargedlymphnodeintheanteriortriangle
oftheneckwithseveralsmallerassociatedlymphnodespalpable.Oropharyngealexamination
showstonsillarmembranes.
WhatistheSINGLEmostlikelydiagnosis?
AInfectiousmononucleosis
BLeukaemia
CLymphoma
DSarcoidosis
ETuberculosis
16.A19yearoldmanhasbeenbroughtbyhismotherforassessment.Shesayshehasalways
beenaloofanddistant.Hehasnofriends,preferringsolitaryactivities.Helikestocollectmodel
carsandnowhas2,000.Heappearstobeindifferenttoeitherpraiseorcriticismbyhismother.
WhatistheSINGLEmostlikelydiagnosis?
AAutisticspectrumdisorder
BBipolaraffectivedisorder
CBorderlinepersonalitydisorder
DDissocialpersonalitydisorder
EObsessivecompulsivedisorder
17.A60yearoldmanhashadincreasingpaininbothbuttocks,thighsandcalvesonwalkingfor
threemonths.Hehasalsorecentlydevelopedimpotence.Femoralanddistalpulsesareabsentin
bothlimbs.
WhatistheSINGLEmostlikelysiteofarterialobstruction?
AAortoiliac
BExternaliliac
CFemoropopliteal
DInternaliliac
ETibial
18.A72yearoldwomanhasbeentakingloopdiureticsforleftventricularfailure.Shenowhas
palpitationsandmuscleweakness.
WhatistheSINGLEmostlikelyserumelectrolytepatterntobefound?
ASodium130mmol/L,potassium2.5mmol/L
BSodium130mmol/L,potassium5.0mmol/L
CSodium140mmol/L,potassium4.5mmol/L
DSodium150mmol/L,potassium2.5mmol/L
ESodium150mmol/L,potassium3.5mmol/L
19.A78yearoldmanhascollapsed.Hehashadasevereheadachefor12hoursandhadanupper
respiratorytractinfectionthreedaysago.Hehasatemperatureof39.2oC,apulseof122
beats/minute,abloodpressureof84/60mmHgandarespiratoryrateof34breaths/minutebut
hischestisclear.HehasaGlasgowComaScalescoreof10andsomeneckstiffness.Hehasbeen
startedonhighflowoxygen.
WhatistheSINGLEmostappropriateimmediatemanagement?
AIntravenousantibioticcomputedtomographybrainscan
BIntravenousantibioticlumbarpuncture
CIntravenousfluidscomputedtomographybrainscan
DIntravenousfluidsintravenousantibiotic
EIntravenousfluidslumbarpuncture
20.A16yearoldboywasbroughttohospitalinacomatosestatehavingtakenmethadone
belongingtohissister.Hewasgivennaloxoneandrapidlybecamealert.Somehourslater,he
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graduallybecomessemiconsciousagain.
WhatistheSINGLEmostlikelyreasonforthispatientbecomingsemiconsciousagaininhospital?
AMethadonehepatotoxicityhascausedacuteliverfailure
BMethadoneiseliminatedfromthebodymoreslowlythannaloxone
CNaloxoneisapartialagonistatthecentralnervoussystemopioidreceptor
DThepatienthasmisusedanothersubstancethathascausedanintracranialbleed
EThepatienthasmisusedanothersubstancethatisabsorbedmoreslowlythanmethadone
21.A27yearoldwomanwhotakesthecombinedoralcontraceptivepillhashadpainlessvaginal
spottinganddischargeforthreedays.Herlastmenstrualperiod,whichlastedfourdays,finished
10daysago.Herlastcervicalsmeartwoyearsagowasnormal.Abdominalandvaginal
examinationsarenormalapartfromamildectropionwithcontactbleeding.
WhatistheSINGLEmostappropriateinitialinvestigation?
ACervicalsmear
BColposcopy
CEndocervicalswab
DEndometrialbiopsy
EPelvicultrasoundscan
22.A72yearoldmanbeinginvestigatedforanaemiaisbookedforacolonoscopyin24hours.
WhatistheSINGLEmostappropriatemanagementthenightbeforetheprocedure?
ABisacodyltablets
BGlycerinesuppository
CLactulosesyrup
DMagnesiumcitrate(orally)
ESennatablets
23.A19yearoldwomanhashadprogressivebilateraliliacfossapainanddyspareuniaforthree
days.Shehasanoffensivevaginaldischargeandfeelsunwellandfeverish.Hertemperatureis39o
C.Aninitialantimicrobialregimeniscommenced.
WhatSINGLEsetoforganismsarethemostappropriatefortheantimicrobialregimentocover?
ANeisseriagonorrhoeaeandCandidaalbicans
BNeisseriagonorrhoeaeandCandidaalbicansandGardnerellavaginalis
CNeisseriagonorrhoeaeandChlamydiatrachomatis
DNeisseriagonorrhoeaeandChlamydiatrachomatisandCandidaalbicans
ENeisseriagonorrhoeaeandChlamydiatrachomatisandGardnerellavaginalis
24.A48yearoldmanwithrenalcancerhadradiotherapyformetastaticspinalcordcompression
atthe11ththoracicvertebrafourweeksago.Hehasretainedsensationbutisunabletostand.He
haspaininabandaroundhislowertrunkcontrolledbyregularoralmorphine.Heisdistressedby
increasinglyfrequentepisodesofpainfulmusclespasmsinhisrightleg.
WhatistheSINGLEmostappropriatemanagementofhissymptoms?
AAmitriptyline
BBaclofen
CFentanylpatch
DGabapentin
EIncreasemorphinedose
25.An18yearoldwomanthinkssheisoverweightandhasamildlydepressedmood.Forthelast
18monthsshehasreducedherfoodintakeandhasbeenexercisingfortwohourseachday.She
hasamenorrhoea.Herbodymassindexis15.5kg/m2andherbloodpressureis90/60mmHg.
WhatistheSINGLEmostappropriatemanagement?
APrescribeantidepressants
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BReferforpsychodynamictherapy
CRefertoacutemedicalservices
DRefertodietician
ERefertoeatingdisorderservice
26.Afouryearoldgirlhashadatemperatureof38.5oCfortwodaysandhasnotwantedtoeat
herfood.Yesterdayshedevelopedasorethroatandsmall,painfululcersinsidehermouth.Today
shehassmallblistersonthepalmsofherhandsandsolesofherfeetwhicharepainfulbutnot
itchy.
WhatistheSINGLEmostlikelyunderlyingcause?
ACoxsackievirus
BHerpessimplexvirus
CStaphylococcusaureus
DStreptococcuspneumoniae
EVaricellazostervirus
27.A32yearoldwomanhashadthreeepisodesofslurredspeechandtwoepisodesoftransient
weaknessofbothlegsinthepastfiveyears.Eachepisodehasresolvedwithinthreemonths.
WhatistheSINGLEmostlikelydiagnosis?
AMeningioma
BMigraine
CMultiplesclerosis
DStroke
ETransientischaemicattack
28.A38yearoldmanwithlongstandingalcoholdependencehasvertigoandatremorevery
morning.
WhatistheSINGLEmostlikelydiagnosis?
AAnxiety
BBenignpositionalvertigo
CCerebellardegeneration
DOpticneuritis
ETemporallobeepilepsy
29.An84yearoldwomanwithAlzheimer'sdementiahasrecentlybecomeincontinentandmore
confusedthanusual.
WhatistheSINGLEmostlikelydiagnosis?
ADetrusoroveractivity
BNeuropathicbladder
CNocturnalenuresis
DUrinarytractinfection
EUterineprolapse
30.A14yearoldgirlcomesrequestingtheoralcontraceptivepill(OCP).Shesayssheissexually
active.Herboyfriendisintheyearaboveheratschool.
WhatistheSINGLEmostappropriateaction?
AAdviseheraboutsafesexandprescribeOCP
BContactherparents
CContactthelocalsafeguardingofficer
DContactthepolice
EExplainitisillegaltoprescribethepillforher

Part1answers
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Question

Answer

D(1Mark)Iritis

A(1Mark)Admissiontothepsychiatryward

C(1Mark)HepatitisBvaccineandhepatitisBimmunoglobulin

C(1Mark)Aplasticanaemia

B(1Mark)Chronicpyelonephritis

A(1Mark)Delirium

D(1Mark)700

C(1Mark)Levonorgestrelintrauterinesystem

A(1Mark)Amoxicillin

10

D(1Mark)Cognitivebehaviourtherapy

11

D(1Mark)None

12

D(1Mark)Lineaalba

13

D(1Mark)Localexplorationofwound

14

B(1Mark)Reactivearthritis

15

A(1Mark)Infectiousmononucleosis

16

A(1Mark)Autisticspectrumdisorder

17

A(1Mark)Aortoiliac

18

A(1Mark)Sodium130mmol/L,potassium2.5mmol/L

19

D(1Mark)Intravenousfluidsintravenousantibiotic

20

B(1Mark)Methadoneiseliminatedfromthebodymoreslowlythannaloxone

21

C(1Mark)Endocervicalswab

22

D(1Mark)Magnesiumcitrate(orally)

23

C(1Mark)NeisseriagonorrhoeaeandChlamydiatrachomatis

24

B(1Mark)Baclofen

25

E(1Mark)Refertoeatingdisorderservice

26

A(1Mark)Coxsackievirus

27

C(1Mark)Multiplesclerosis

28

C(1Mark)Cerebellardegeneration

29

D(1Mark)Urinarytractinfection

30

A(1Mark)AdviseheraboutsafesexandprescribeOCP

Part2Samplestation
Thescenario:
Youareinamockconsultationwithapatientplayedbyaroleplayerwhohasbeenbriefedabouttheir
condition.YouareaFoundationYear2doctorinaRheumatologyUnit.Youaretoldthatyourpatient
JamesHorton,aged45,hasbeenreferredbyhisGPwithpaininhisrightbigtoe.Youarenotgivenany
otherinformation.Youmustassessandmanagethepatient.Youhaveeightminutes.
Whattheexaminerwillbelookingfor:
TheexaminerwantstoseeyoudemonstratingthebehaviourstheGMCexpectsofadoctor.Theywill
markyouagainstthethreedomainsDatagatheringskills,technicalandassessmentskills,Clinical
managementskillsandInterpersonalskills.Topassthisscenariotheexaminerwouldexpectyoutodo
someofthefollowingorsimilar:
Findahistoryofacuterecurrentmonoarthritiswhichrespondstononsteroidalantiinflammatory
drugs(NSAIDS).
Findamedicalhistoryofanymedication,psoriasisortrauma.
Findoutappropriatelifestylehistory(egalcohol,diet,sex).
Makeadiagnosisofpossiblegout.
Recommendappropriatemanagement.
Identifypatientconcerns,listenappropriatelyanddisplayempathy.
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Conducttheconsultationfluentlyandprofessionally.
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