CLINICAL PAPER 2 4TH YR Summative 2008 Qu1) Cardiology A 61yr old man presents to GP with crushing chest pain

n which has lasted for 2 hours. He is a smoker and is slightly overweight. GP suspects he is having heart attack and calls for ambulance. 1. What management is indicated at GPs surgery while waiting for ambulance? (4)

2. Which investigations should be done in hospital? (4) .

3. What drugs may be started in hospital? (2)

Qu2) Breast disease You see a 26yr old female who is Somalian and attends with her 14 yr old son who is helping with translation. She complains of tender red raised area on left breast. 1. Describe 2 communication difficulties raised in this situation? (2)

2. What investigations are needed? (1)

She tells you through son that she has been breast feeding baby who is 2 months old.

3. What is probable diagnosis? (1)

4. What management will you advise for patient? (2)

QU 3) Infertility You see a 24yr old, who has been trying to get pregnant for past 2 years. 1. List non-invasive tests that are used in investigation of infertility (4)

2. List invasive tests that may be warranted (2)

3. List 3 causes of infertility (3)

4. List possible treatment for infertility (1)

Quip 4) Schizophernia An 18yr old boy is shouting while alone in his room, becoming increasingly isolated, thinks things are referring specifically to him, may appear suspicious and his conversation is becoming difficult to follow. He has rapid changes in mood, and is becoming preoccupied with beliefs in occult & black magic. He is also smoking cannabis etc. He has a diagnosis of schizophrenia. 1. List 3 symptoms in the history that are suggestive of psychosis.(3)

2. Give a differential, stating your reasons (2)

3. Give a common and clinically relevant side effect of olanzapine. (1)

4. Give 2 risk factors for suicide in an 18yr old male who self harms.(2)

5. He refuses admission, but you think he has a high suicide risk. Under which section of the MHA should you admit him? Explain reasoning (2)

Qu 5) Hypertension A 68yr old male is seen by his GP. He is a non-smoker who is usually fit&well. His GP makes an incidental diagnosis of hypertension (210/110 or something). His blood pressure was high 2yrs ago. Of note in his PMH, he has had 3 episodes of renal colic. 1. What is the most likely cause of his hypertension? (1)

2. What 2 blood tests would you use to estimate his 10yr CV risk? (2)

3. What 2 investigations would you do to detect end-organ damage? (2)

His bloods show raised calcium, and raised ALP with low phosphate. 4. Whats your diagnosis now? (1)

5. Give 2 surgically correctable causes of hypertension. (2)

6. List 2 drugs that aggravate/cause hypertension. (2)

QU 6) Breast cancer

QU 7) Cerebral Palsy Boy of 3 presented with delayed walking and has increased tone and pattern of upper motor neurone signs in his left arm and left leg. 1. Define cerebral palsy (2)

2. What is full name for type of cerebral palsy boy has got (2)

3. List 4 causes of cerebral palsy (4)

4. Which health care professionals may be involved in his care? (2)

QU 8) Gall stones Symptoms of gall stones Risk factors Investigation Management

QU9) Rheumatoid arthritis Give 4 symptoms of RA List 4 xray changes seen in RA What 2 DMARDs could be used to treat RA?

(QU 10) COPD