MD2 SAQ Recall 2013 !
1. 52-year old women found breast lump on self-examination. Has been attending breast
screening annually and was clear 12 months ago. She has 3 children, now in their 20s, each
of which was breast-fed for their first 6 months.
She has an auntie who died from breast cancer at 78, but no other relations with a history of
breast or ovarian cancers.
She recently began HRT after having some hot flushes a few months ago.
a) What examination findings would be used to determine the clinical staging of a breast
cancer? (5 marks)
The patient had a mammogram performed (CC and MLO views) [single lesion in left breast
b) Where is the lesion? Draw on diagram. (1 mark)
c) List the pathological radiology signs. (4 marks)
d) What would be the next TWO (2) investigations to help confirm diagnosis? (2 marks)
e) What are the options for this patient’s breast and axillary treatment and management? (9
2. A 45-year old woman presents for their diabetes clinic appointment. They report BSL levels
of 8-15 in the mornings, and 7-14 in the evenings. Their HbA1C level is found to be 8.0, up
from 7.0 six months ago.
She was diagnosed with type II diabetes 8 years ago after presenting with fatigue. She was
initially managed with diet and exercise, however due to worsening BSL results she was
started on metformin.
a) List FOUR (4) diabetic complications and their corresponding examination findings. (8
b) Give THREE (3) biochemical investigations to determine the presence or risk of diabetic
complications. (3 marks)
c) What is the mode of action of metformin, and what are some common side effects? (3
d) How would you manage the patient’s increasing HbA1C levels? (6 marks)
3. A 65-year old man presents to his GP with deterioration of vision. He is worried that it is
macular degeneration after hearing so much about it on the television, however his GP is
more inclined to think it is due to cataracts.
On investigation, he finds that only the right eye shows any visual impairment.
a) What would distinguish cataract from macular degeneration? Give TWO (2) history
questions and TWO (2) examination results and detail how they would be different in each
condition. (8 marks)
b) The GP believes the patient to have cataracts, but feels he is too young to be getting agerelated
cataracts. What are THREE (3) risk factors for cataract formation, other than age? (3
c) Due to the strange presentation of cataracts, the GP sends the patient to see the
ophthalmologist Dr Ahkansi Nuthn (yes, this was actually the name they used). On
examination, Dr Nuthn finds that the patient has pale optic disks and instead diagnoses the
patient with optic neuropathy.
The GP is quite embarrassed to have missed this diagnosis. What simple test will they now
never forget to do to avoid missing such a diagnosis?
(3 marks)
d) Give TWO (2) possible causes of optic neuropathy. (6 marks)
4. A 24-year old roof tiler, currently married and living with his partner and 2 young children,
presents to the ED with a co-worker after collapsing during their lunch break. The patient
states that they have no memory of the event at all. He is not taking any medications, and
has no prior diagnoses.
a) Give THREE (3) points on history and THREE (3) examination findings and explain how
they could differentiate between simple syncope and convulsive seizure. (6 marks)
b) The patient is established to have had a seizure. Give EIGHT (8) causes (not triggers) of
seizures. (4 marks)
c) Give FOUR (4) investigations that could be done in the ED to direct his immediate
management. (4 marks)
d) The patient is diagnosed as having epilepsy. On prompting, he recalls having a similar
event a few weeks prior, but attributed it to stress with his newborn son.
Detail the lifestyle impacts his new diagnosis may have. (6 marks)
5. A 72-year old mane presented to the ED with a complaint of increased shortness of breath
on exertion (down to 30m from a history of 250m before occurrence of symptoms),
orthopnoea, nocturnal dyspnoea and pitting oedema of the legs to the mid-shin.
His history is notable for:
- LV dysfunction (ejection fraction of 35%) after anterior MI four years ago.
- Diabetes type II
- Hyperlipidaemia
He is currently taking frusemide, lisinopril, metformin and aspirin.
On examination, his vital signs were:
HR 110bpm irregular
BP 110/70
RR 18
SaO2 92%
Cardiac auscultation found S1 to be quiet, and a pan-systolic murmur that radiated to the
a) Explain the pathophysiology behind the patient’s clinical presentation. (4 marks)
b) Give FOUR (4) reasons for their heart failure.
c) List SIX (6) initial investigations you would order that would influence your initial
management of this patient.
d) Explain how you would manage this patient’s heart failure.
6. An elderly gentleman in the hospital five days post-emergency surgery for small bowel
resection develops a fever of 38.6°C and is reported by the nurse to have been requesting
further pain management.
a) What is the MOST likely cause of his fever? (1 point)
What history question and examination finding would support this? (2 marks)
List THREE (3) more possible causes and a finding of each on examination (6 marks)
b) Give FIVE (5) investigations that could be performed to find the correct diagnosis of the
patient’s fever. (5 marks)
c) List THREE (3) methods of evaluating the patient’s pain and how it would establish its
severity. (3 marks)