GENERAL PRACTITIONER EXAM MODE
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- Question 1 of 10
1. Question
1 pointsA 24 year old G1P1 female has an uncomplicated delivery of a 10 pound male infant. The patient is seen in the maternity ward 24 hours after vaginal delivery and repair of a fourth degree perineal laceration. She is concerned about her insurance company requirement that she can stay in the hospital no longer than 48 hours postpartum. The most important indication for extending her hospital stay beyond 48 hours post partum is
CorrectIncorrectExplanation:
A common postpartum complication is infection. The presentation of a puerperal infection may be atypical because of the altered physiology of the postpartum period. Abdominal distention (ileus) and lack of appetite may be the first manifestation of abdominopelvic peritonitis. Careful evaluation of the patient is required with respect to the genitourinary tract. Risks for the development of postpartum infection include vaginal trauma (which this patient had), anemia (this patient´s hemoglobin is 10.8), multiple pelvic examinations, internal fetal monitoring, prolonged rupture of the membranes, and indigent status. Continued surveillance is indicated so that the reason for distention and lack of appetite can be identified and treated. The duration of the patient´s labor is not given, but it is likely that she has not eaten solid food in some time. There may not be significant stool in her large intestine available for evacuation. Also, some narcotic medications used for analgesia during labor may contribute to decreased intestinal motility. The mild ileus that follows delivery, together with perineal discomfort and postpartum fluid loss by other routes, predisposes to sluggish bowel evacuation during the puerperium. Strategies to improve postpartum bowel function include initiating a low-residue diet, prescription of a short course of stool softeners, and a mild laxative on the first postpartum night. She should be reassured that normal bowel function can be anticipated. - Question 2 of 10
2. Question
1 pointsA 31-year-old pregnant lady has a blood pressure of 151/89 mmHg. There are no other abnormalities. BMI is 32.9 kg/m2 and urinalysis is normal. ECG reveals left ventricular hypertrophy. What is the most likely etiology?
CorrectIncorrectExplanation:
This woman has hypertension which is discovered in her pregnancy but has evidence of LVH on her ECG suggesting that this is longstanding.
Often, it takes at least two years of sustained hypertension to develop LVH, and although her pregnancy may have contributed to any deterioration, the LVH suggests may have contributed to any deterioration, the LVH suggests that it was pre-existent.
The cause for her hypertension may be secondary but her high BMT is suggestive of it being essential. - Question 3 of 10
3. Question
1 pointsA 21 year old female has a 5 year history of hirsutism with her having noticed coarse dark hair under her chin. Her periods are irregular. She has not yet conceived and has had a coil fitted for contraception. She has coarse, dark hair over her chin, lower back and inner thighs. No galactorrhea or features of cushing´s disease are present. Labs during the follicular phase show serum 17-hydroxyprogesterone 18.6pmol/L(1-10), oestradiol of 380 pmol/L (200-400), testosterone of 2.6 nmol/L (0.5-3), LH of 3.3 U/L (2.5-10), and FSH of 3.6 U/L (2.5 -10). The next appropriate investigation is
CorrectIncorrectExplanation:
In this case the patient has features that would suggest polycystic ovary syndrome (PCOS) yet the 17OHP concentration is elevated and is compatible with non-classical congenital adrenal hyperplasia (CAH) yet just below the threshold of 33nmol/L confidently to make the diagnosis. Thus a short Synacthen test would be the most appropriate investigation with measurement of 17OHP. A rise in 17OHP above 33nmol/L suggests non classical CAH.
- Question 4 of 10
4. Question
1 pointsTwo alpha adrenergic antagonists (Drugs X and Y) decrease blood pressure by the same amount after IV administration at the following doses:
Drug X: 120 mg
Drug Y: 15 mg
This scenario implies that Drug XCorrectIncorrectExplanation:
Both drugs produce exactly the same effect, but Drug Y achieved the blood pressure response with one eighth the dosage of Drug X. This means that Drug X is 8 times less potent than Drug Y. A high therapeutic index means that the drug is relatively safe. However, the safety of a drug is not necessarily related to its potency. Differences in bioavailability between these two drugs cannot be determined because both of these drugs were administered intravenously. Bioavailability is the fraction of a (typically orally administered) drug that reaches the systemic circulation. Bioavailability is by definition (100%) when drugs are administered intravenously. The half-life is the amount of time it takes for the concentration of a drug to fall to 50% of a previous measurement. There is no information provided to determine the half-lives of these drugs.
Efficacy, which is a measurement of the drug´s maximal response, is given by the maximal height of the dose response curve. At these doses, each drug produced the same effect, but there is no information provided to determine what the maximal effect of each drug would be. In addition, potency and efficacy are not related. - Question 5 of 10
5. Question
1 pointsTypical antipsychotic drugs act by which of the following mechanism?
CorrectIncorrectExplanation:
Typical antipsychotic medications include haloperidol, chlorpromazine and thioridazine. Their mechanism of action is they block the dopamine (D2) receptors. They treat positive symptoms like hallucination or delusions.
Atypical antipsychotics include risperdione and clozapine. They work by blocking both D2 and serotonin (5-HT) receptors. They treat both positive and negative symptoms. - Question 6 of 10
6. Question
1 pointsA 25 year old woman presents with episodes of dizziness mainly on standing. Her investigation shows hyperkalaemic acidosis. She is most likely suffering from which underlying condition?
CorrectIncorrectExplanation:
Her symptoms are suggestive of postural hypotension, which together with hyperkalaemic (and hyponatraemia) acidosis would strongly indicate the presence of Addison´s disease. Cushing´s and Conn´s syndromes are associated with hypertension and hypokalaemia. Hypokalaemia is the most frequent complication of bulimia which may cause cardiac arrhythmias, fits and paraesthesia. Renal tubular acidosis (RTA) is due to inability of the renal tubules to maintain acid-base balance, causing a hyperchloraemia and a normal anion-gap. In type 1 (distal) RTA; there is hypokalaemic acidosis with low urinary ammonium production. Patients present with hyperventilation/acidosis and muscular weakness from hypokalaemia. In type 4 RTA (hyporeninaemic hypoaldosteronism), there is hyperkalaemic acidosis caused by chronic renal insufficiency from diabetes or tubulointerstitial disease.
- Question 7 of 10
7. Question
1 pointsA 32 year old man presents has complaint of inability to impregnate his wife. He wants to find out if he is infertile. He denies fatigue and states that he has a decreased libido. On exam, his testes appear normal. Lab testing would likely reveal that in addition to a low sperm count he has elevated level of which hormone?
CorrectIncorrectExplanation:
Prolactin receptors are located on Leydig cells in the testes. Under normal conditions, prolactin synergizes with LH to stimulate testosterone production by Leydig cells. In males with hyperprolactinemia secondary to a pituitary tumor, elevated prolactin levels interfere with testosterone production. Excessive prolactin reduces the number of LH receptors and/or inhibits intracellular events stimulated by LH. Hyperprolactinemia may also decrease the pulsatile nature of LH secretion, also causing a decrease in testosterone production. Testosterone production is required for spermatogenesis, so elevated prolactin decreases sperm count and frequently causes infertility. An increase in FSH, LH, and LHRH would increase testosterone production rather than decrease it. LHRH is released from the hypothalamus and acts on the anterior pituitary to stimulate LH and FSH release. LH acts on the Leydig cells of the testes to increase testosterone production which acts on the Sertoli cells to facilitate spermatogenesis. An increase in testosterone would result in an increase in spermatogenesis and would not result in infertility.
- Question 8 of 10
8. Question
1 pointsIn advising a patient diagnosed with breast carcinoma with positive nodes, which one of the following statements is correct?
CorrectIncorrectExplanation:
While recent technological advances have led to earlier detection of breast cancer, this has not led to an absolute cure and a marked increase in survival. The major advance has been in demonstrating that lumpectomy with axillary node dissection offers about the same five-year survival as mastectomy The choice between these treatments should be determined on an individual treatment basis, with the psychological implications of mastectomy weighed against the fear of recurrence if the breast is not removed.
- Question 9 of 10
9. Question
1 pointsA 62 year old man has shortness of breath. His ankles have 4+ edema and his BP is 75/50 mm Hg. Blood urea nitrogen (BUN) is 36 mg/dL and serum creatinine is 1.0 mg/ dL. CXR shows cardiac enlargement and perihilar infiltrates. What likely accounts for his BUN and creatinine levels?
CorrectIncorrectExplanation:
The patient´s ankle edema, shortness of breath, and relatively low blood pressure suggest the possibility of congestive heart failure which is confirmed by the cardiac enlargement and perihilar infiltrates seen on chest X-ray. The serum urea nitrogen is elevated while serum creatinine is normal, suggesting a prerenal cause for the azotemia.
Congestive heart failure with its resulting decreased blood pressure is a common cause of decreased renal perfusion leading to prerenal azotemia. Most disease processes that affect BUN and creatinine cause both to rise together. Exceptions are early congestive heart failure (in which the BUN can rise selectively) and processes that lead to increased urea synthesis, such as burns and prolonged high fever. Postrenal causes of azotemia are typically due to urinary tract obstruction distal to the kidney, and usually cause a rise in both urea and creatinine, with the rise in urea being larger than that in creatinine. Increased synthesis of urea is seen in severe burns and prolonged high fever. Renal glomerular disease severe enough to cause acute or chronic renal failure will cause urea and creatinine to rise together. Renal tubulointerstitial disease severe enough to cause renal failure will cause both urea and creatinine to rise. The creatinine may rise out of proportion to the urea, particularly in acute tubular necrosis. - Question 10 of 10
10. Question
1 pointsA 10 year old girl is referred by the school nurse for evaluation of scoliosis. The girl´s scoliosis was detected during a routine screening examination at the school, and it appears to be mild (curve less than 10 degrees). She is an athlete and is otherwise healthy. During the physical examination, particular attention should be given to which of the following?
CorrectIncorrectExplanation:
The treatment of scoliosis is dependent on the age of the patient and curve progression. Premenarchal females have a greater chance of curve progression then females one to two years after menarche with similar curves. Curves of less than 25 degrees are observed and reevaluated every four to six months. The stage of pubertal development is important to note because a patient who has attained menarche will only have a small amount of additional growth; therefore, scoliosis will not progress.