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Clinical Problem Solving
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This paper lasts 90 minutes. The questions present clinical
scenarios and require you to exercise judgement and problem
solving skills to determine appropriate diagnosis and management
of patients.
This is not a test of your knowledge, but rather your ability to apply
it appropriately. The topics will be taken from areas with which a
Pre-Registration House Officer or Foundation Programme Year 1
doctor could be expected to be familiar. There are no questions
requiring a specific knowledge of general practice.
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http://www.gprecruitment.org.uk/vacancies/stage2.htm
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Types of questions
True/false
 EMQ
 SBA
 Other question formats may be used
when appropriate e.g. Algorithms and
multiple best answers.
 Read the question
 Timing
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Clinical Problem Solving
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Cardiovascular
Dermatology / ENT / Eyes
Endocrinology / Metabolic
Gastroenterology / Nutrition
Infectious disease / Haematology /
Immunology / Allergies / Genetics
Musculoskeletal
Paediatrics
Pharmacology / Therapeutics
Psychiatry / Neurology
Reproductive (male and female)
Renal / Urology
Respiratory
www.gprecruitment.org.uk/vacancies/
stage2
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Questions may relate
to...
Disease factors
Making a diagnosis
Investigations
Management plans
Prescribing
Emergency care
True and False
1.A raised cholesterol level is associated
with increased risk of CHD.
 2. Breast feeding increases the risk of
maternal breast cancer.
 3.Young maternal age is associated with
SIDs
 4. Grief reaction is characterised by
psychosis.
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EMQ:TATT
Options:
 A Depressive illness
 B Anaemia
 C Hypothyroidism
 D Heart failure
 E Viral illness
 F Malignancy
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1. 30yr old female, post
natal, TATT and 6/12 of
increasing menorrhagia.
2. 84 yr old man, 6/52
diarrhoea and weight
loss.
3. 30yr old female
difficulty concentrating
and TATT since throat
infection 3/12 ago
EMQ: Facial Rashes
Options:
A Rosacea
B Psoriasis
C Cellulitis
D Lupus
E Impetigo
F Perioral dermatitis
G Eczema
H Contact dermatitis
1.
2.
3.
5yr old girl with erythematous
rash with a golden-crusted area
around her nose and mouth.
She is systemically well.
40yr old woman with facial
flushing. O/E erythema,
pustules and telangiectasia on
nose and cheeks.Worse in sunlight.
20yr old female with several
months of red scaly lesions
particularly around the hair line.
Similar lesions are seen on her
knees and elbows.
EMQ:Hypertension
management
Options:
A Lifestyle advise and
repeat Bp in 1/12
B Start amlodipine
C Start frusemide
D Start bendrofluazide
E Start perindopril
F Start atenolol
G Start doxazosin
F Start candesartan
1.
2.
3.
4.
A 40 yr old white male
with Bp 150/95. No
current
medications/PMH
A 60yr old DM on
perindopril. Past hx of
gout. BP 145/90
An Asian 40yr old man,
new diagnosis DM, not
on any meds. BP
140/95
A 45yr old AC woman
with Bp 165/90.
EMQ: Childhood Infections
Options:
 A Rubella
 B Measles
 C Fifth disease
 D Chicken pox
 E Roseala infantum
 F Hand foot and
mouth
1. Lesions are red macules
rapidly progressing to
papules to vesicle to
crusted lesions.
2. Illness typically causes a
malar erythema followed
by reticular rash on trunk
and extremities.
3. Rose-pink lesions
preceded by a high fever
in an otherwise well
child.
EMQ:Breathlessness
Options:
 A MI
 B Asthma
 C PE
 E Hay fever
 F Lung ca
 G COPD
 H Allergic alveolitis
1.
2.
3.
4.
49yr old female smoker,
2/12 of cough, wt loss
of 3kg. O/E chest NAD.
34yr old on coc, sudden
onset SOB and pain L
side of chest. O/E
tachypnoeic, sweating.
Bp and ECG normal.
40yr old smoker with
recurrent SOB and dry
cough. Worse at night.
50yr old smoker
productive white cough
over 3/12. Minimal SOB
EMQ:Vitamin/Dietary
Deficiencies
Options:
A Iron
 B Vitamin B12
 C Vitamin C
 D Vitamin D
 E Vitamin K
 F Folate
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1. 76yr old female, CKD,
proximal myopathy
2. 4yr old on child
protection register has
soft bleeding gums
3. 35 yr old female
epileptic patient who is
well controlled on
medication is noted to
have a macrocytic
anaemia
EMQ:Psychiatric Complaints
Options
 A Anxiety disorder
 B OCD
 C PTSD
 D Bipolar Disorder
 E Schizophrenia
 F PD
 G Drug-induced
psychosis
 H Dementia
1.
2.
3.
4.
22yr old male asks for sick cert. He
has been in prison and threatened
suicide in the past. He can be
aggressive to staff
You are asked to visit a 67yr old pt
with depression. He was found
dancing naked in the garden and
tells you he is cured.
Since starting uni a 21yr old has
become more withdrawn. He is
dishevelled in his appearance and
has had to cover all his plug
sockets in his room to keep safe.
A 25yr old has been having
increasing problems driving to/from
work for fear of a RTA. Indeed he
has to go back out, retracing his
steps to check he has not hit
anyone despite not recalling being
involved in an RTA.
EMQ: Headache
Options:
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A Tension headache
B Migraine
C Subdural
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haemorrhage
 D Meningitis
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E Subarachnoid
haemorrhage
 F Analgesic rebound
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G Cluster headache
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1. 36yr old female
secretary, recurrent
headache for few weeks.
Band-like, worse in pm.
2. 45yr old male,
recurrent headaches
around L eye, which
becomes red and watery.
Lasts a few hrs daily but
then disappears for a few
months.
3. 85yr old c/o
headaches following a
fall 2/52. Her carer says
EMQ:Elbow, Wrist and Hand
problems
Options:
 A Carpel Tunnel
 B Lateral epicondylitis
 C Medial epicondylitis
 D OA
 E Pulled Elbow
 F Ganglion
 G Tenosynovitis
 H Olecranon bursitis
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1. 58yr old office worker
has pain and swelling in
the elbow. Aspiration
reveals fluid gram stain
neg and no crystals.
2. 55yr old man with
elbow pain getting worse
over last few weeks. He
has been diagnosed with
golf’s elbow
3. 20yr old is worried
about the painless,
smooth and firm swelling
she has noticed on her
EMQ: Statistics 1
Options:
A Validity
B Selection Bias
C Publication Bias
D Information Bias
E Reliability
1.
2.
3.
4.
Occurs when studies
with positive results are
more likely to be
published.
Occurs when there are
differences between the
sample and target
populations.
Refers to the measure
of truthfulness
Refers to the measure
of repeatability
EMQ:Statistics 2
Options
A Case-controlled
study.
B Cohort study
C RCT
D Cross-sectional
survey
E Double-blind placebo
1.
2.
3.
4.
2 or more groups to which
patients are randomly allocated.
1 group is the control/nonexperimental grp.
Used to compare 2 groups
when prevalence is low.
A study in which the sample is
observed at 1 particular time. It
gives prevalence estimates.
Follow-up of 2 or more groups
with a recorded exposure to a
risk factor. Provides
comparative incidence
estimates between exposed
and non-exposed grps.
SBA: Hormonal post-coital
contraception
Choose from the following:
1. Must be given within 48hrs of UPSI
2. Involves two doses 12hrs apart
3. Contains both oestrogens and
progestogens
4. Is available OTC
SBA
Which combination of the following
diseases are notifiable?
1. Food poisoning, TB and mesothelioma
2. Mumps, Malaria and Measles
3. Anthrax, polio and anaphylaxis
SBA
Which of the following statements about
genital chlamydia is not correct?
1. It is asymptomatic in up to 70% of cases
2. Symptoms can include PCB
3. The incidence of the disease is stable
4. More common in an older population
SBA
Which of the following statements about
gout is true?
1.
2.
3.
It is always accompanied by elevated
serum uric acid levels
It is closely associated with potassiumsparing diuretics
Predominantly affect males