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GCPS Primary Exam study materials
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GCPS Primary Exam practice questions

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Question 1Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

A 24-year-old woman has a fasting plasma glucose of 6.4 mmol/L on two separate occasions and an HbA1c of 6.2%. She is asymptomatic. Which classification best fits her results?

  1. Type 2 diabetes mellitus
  2. Gestational diabetes mellitus
  3. Type 1 diabetes mellitus
  4. Impaired fasting glucose (prediabetes) Correct answer.

Explanation

A fasting plasma glucose between 6.1 and 6.9 mmol/L and an HbA1c between 5.7% and 6.4% define prediabetes (impaired fasting glucose/impaired glucose tolerance). Diabetes requires fasting glucose ≥7.0 mmol/L, HbA1c ≥6.5%, or a random glucose ≥11.1 mmol/L with symptoms. She is asymptomatic and below all diabetes thresholds.

Question 2Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

Which organism is the most common cause of community-acquired bacterial pneumonia in adults?

  1. Mycoplasma pneumoniae
  2. Legionella pneumophila
  3. Streptococcus pneumoniae Correct answer.
  4. Klebsiella pneumoniae

Explanation

Streptococcus pneumoniae remains the single most frequently isolated cause of community-acquired pneumonia in adults across all severity strata. It is a lancet-shaped gram-positive diplococcus and the target of standard pneumococcal vaccination. The other organisms cause CAP but at lower frequency.

Question 3Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

A 60-year-old man has a serum calcium of 2.85 mmol/L, a low phosphate, and an inappropriately elevated parathyroid hormone. Which diagnosis is most likely?

  1. Osteomalacia
  2. Hypoparathyroidism
  3. Secondary hyperparathyroidism from chronic kidney disease
  4. Primary hyperparathyroidism Correct answer.

Explanation

Primary hyperparathyroidism produces hypercalcaemia with inappropriately normal or high PTH and typically low phosphate, because PTH mobilises calcium from bone and increases renal phosphate excretion. Secondary hyperparathyroidism occurs with hypocalcaemia, not hypercalcaemia. The combination of high calcium with high PTH confirms primary disease.

Question 4Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

Which laboratory finding is characteristic of iron deficiency anaemia?

  1. Normal ferritin with low reticulocyte count
  2. Low ferritin with high total iron-binding capacity Correct answer.
  3. High ferritin with high transferrin saturation
  4. High ferritin with low total iron-binding capacity

Explanation

Iron deficiency reduces body iron stores, so ferritin falls, and the liver increases transferrin production, raising total iron-binding capacity while transferrin saturation drops. Ferritin is the most sensitive single indicator of depleted stores. Anaemia of chronic disease shows the opposite ferritin and TIBC pattern.

Question 5Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

A 3-year-old child presents with fever, drooling, and a muffled voice, sitting forward in a tripod position. Which diagnosis should be suspected first?

  1. Epiglottitis Correct answer.
  2. Foreign body in the oesophagus
  3. Bronchiolitis
  4. Croup

Explanation

The triad of fever, drooling, and a muffled voice with the child sitting forward suggests epiglottitis, a medical emergency requiring airway protection. Drooling indicates inability to swallow saliva, which is not typical of croup. Examination of the throat should be avoided until the airway is secured.

Question 6Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

Which vaccine is contraindicated in a child with severe combined immunodeficiency?

  1. Hepatitis B vaccine
  2. Inactivated polio vaccine
  3. Live attenuated measles-mumps-rubella vaccine Correct answer.
  4. Diphtheria-tetanus-pertussis vaccine

Explanation

Live attenuated vaccines such as MMR can cause disseminated infection in severe combined immunodeficiency and are contraindicated. Inactivated vaccines are safe because they cannot replicate. Live vaccines should be deferred until immune function is confirmed adequate.

Question 7Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

A 28-year-old woman has a 3-week history of low mood, anhedonia, poor sleep, and reduced concentration following a relationship breakdown. She denies suicidal ideation. What is the most appropriate first-line management?

  1. Structured psychological therapy such as cognitive behavioural therapy Correct answer.
  2. Long-term antipsychotic therapy
  3. Admission to an inpatient psychiatric unit
  4. Immediate electroconvulsive therapy

Explanation

Mild to moderate major depression without psychotic features or suicide risk is managed first-line with structured psychological therapy, with or without an antidepressant. ECT, antipsychotics, and inpatient admission are reserved for severe, psychotic, or high-risk presentations. The absence of suicidal ideation supports outpatient care.

Question 8Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

Which measure is the most appropriate primary prevention for reducing the incidence of cervical cancer in a young adolescent population?

  1. Colposcopy at first sexual intercourse
  2. Human papillomavirus vaccination before sexual debut Correct answer.
  3. Routine pelvic ultrasound screening
  4. Annual cervical cytology screening

Explanation

HPV vaccination before exposure to the virus prevents infection with oncogenic subtypes and reduces cervical cancer incidence, making it the primary prevention strategy. Cytology and colposcopy are secondary prevention tools that detect existing lesions. Ultrasound does not screen for cervical neoplasia.

Question 9Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

A 55-year-old smoker has a solitary pulmonary nodule measuring 12 mm on chest radiograph. Which imaging investigation is most appropriate for further characterisation?

  1. Repeat chest radiograph in 6 months
  2. Magnetic resonance imaging of the thorax
  3. Positron emission tomography as the first test
  4. Chest computed tomography with contrast Correct answer.

Explanation

Chest CT is the standard next step to characterise a solitary pulmonary nodule, assessing size, margins, and calcification, and guiding further management. MRI is less sensitive for lung parenchyma. PET is generally reserved for nodules above a size threshold or for staging suspected malignancy.

Question 10Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

Which mechanism best explains the bactericidal action of beta-lactam antibiotics?

  1. Inhibition of peptidoglycan cross-linking in the cell wall Correct answer.
  2. Inhibition of bacterial DNA gyrase
  3. Disruption of the bacterial cell membrane
  4. Binding to the 30S ribosomal subunit

Explanation

Beta-lactams bind penicillin-binding proteins and inhibit transpeptidation, preventing peptidoglycan cross-linking and causing cell lysis. DNA gyrase inhibition describes fluoroquinolones and 30S binding describes aminoglycosides or tetracyclines. Membrane disruption is the mechanism of polymyxins.

Question 11Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

A 70-year-old man with atrial fibrillation has a CHA2DS2-VASc score of 4. Which therapy is most appropriate for stroke prevention?

  1. No antithrombotic therapy
  2. Oral anticoagulation with a direct oral anticoagulant Correct answer.
  3. Clopidogrel monotherapy
  4. Aspirin monotherapy

Explanation

A CHA2DS2-VASc score of 2 or more in men indicates sufficient stroke risk to warrant oral anticoagulation, and direct oral anticoagulants are preferred over warfarin in non-valvular atrial fibrillation. Antiplatelet monotherapy is inadequate for cardioembolic stroke prevention. Anticoagulation substantially reduces stroke risk.

Question 12Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

Which finding on a peripheral blood film is most characteristic of chronic lymphocytic leukaemia?

  1. Hypersegmented neutrophils
  2. Numerous mature-appearing small lymphocytes with smudge cells Correct answer.
  3. Schistocytes and thrombocytopenia
  4. Auer rods within myeloblasts

Explanation

Chronic lymphocytic leukaemia shows a clonal proliferation of mature small lymphocytes, and fragile cells rupture during smear preparation, producing smudge cells. Auer rods indicate acute myeloid leukaemia. Hypersegmented neutrophils suggest megaloblastic anaemia, and schistocytes suggest microangiopathy.

Question 13Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

A 2-year-old child has a generalised tonic-clonic seizure lasting 4 minutes during a febrile illness. He recovers fully within 30 minutes. Which statement about simple febrile seizures is correct?

  1. They carry a high risk of subsequent epilepsy exceeding 50%
  2. They occur in children aged 6 months to 5 years with no evidence of intracranial infection Correct answer.
  3. They always require long-term anticonvulsant prophylaxis
  4. They are typically focal and last longer than 15 minutes

Explanation

Simple febrile seizures occur between 6 months and 5 years of age, are generalised, last under 15 minutes, and occur without intracranial infection. They do not require long-term prophylaxis, and the risk of later epilepsy is only slightly above baseline. Reassurance and antipyretic advice are usually sufficient.

Question 14Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

Which parameter is used to assess the sensitivity of a diagnostic test independent of disease prevalence?

  1. Post-test probability
  2. Negative predictive value
  3. Positive predictive value
  4. Sensitivity, which is the proportion of diseased persons testing positive Correct answer.

Explanation

Sensitivity is calculated as true positives divided by all persons with disease, so it is a property of the test and does not depend on prevalence. Predictive values and post-test probability change with disease prevalence. Sensitivity and specificity are therefore the prevalence-independent measures.

Question 15Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

A 45-year-old woman has a thyroid nodule. Fine-needle aspiration shows papillary architecture with nuclear grooves and psammoma bodies. Which thyroid carcinoma is most likely?

  1. Papillary thyroid carcinoma Correct answer.
  2. Medullary thyroid carcinoma
  3. Anaplastic thyroid carcinoma
  4. Follicular thyroid carcinoma

Explanation

Papillary thyroid carcinoma is characterised by nuclear grooves, Orphan Annie nuclei, and psammoma bodies, and it spreads via lymphatics. Follicular carcinoma is diagnosed by capsular or vascular invasion without these nuclear features. Medullary carcinoma arises from parafollicular C cells and secretes calcitonin.

Question 16Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

Which radiation principle states that the biological effect of fractionated radiotherapy is greater when fractions are smaller, because repair of sublethal damage is more complete?

  1. The four Rs of radiobiology, including repair of sublethal damage Correct answer.
  2. The oxygen enhancement ratio
  3. The inverse square law
  4. The linear-quadratic model of cell survival

Explanation

Fractionation exploits the four Rs of radiobiology: repair, redistribution, repopulation, and reoxygenation. Smaller fractions allow normal tissues to repair sublethal damage between treatments while tumour cells accumulate damage. This differential repair underlies conventional fractionation schedules.

Question 17Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

A 65-year-old woman is found to have a blood pressure of 168/98 mmHg on three separate visits. Which is the most appropriate initial pharmacological class in the absence of comorbidity?

  1. Loop diuretic such as furosemide
  2. Central alpha-2 agonist such as clonidine
  3. Thiazide-type diuretic, ACE inhibitor, or calcium channel blocker Correct answer.
  4. Alpha-1 blocker such as prazosin

Explanation

Guidelines recommend thiazide-type diuretics, ACE inhibitors or ARBs, and calcium channel blockers as first-line agents for uncomplicated hypertension. Alpha blockers, central agonists, and loop diuretics are reserved for specific indications such as resistant hypertension or heart failure. Choice within the first-line classes depends on comorbidities and tolerability.

Question 18Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

Which electrolyte disturbance is most likely in a patient with prolonged vomiting?

  1. Hyperkalaemia with metabolic acidosis
  2. Hypernatraemia with metabolic acidosis
  3. Hypercalcaemia with respiratory alkalosis
  4. Hypokalaemia with metabolic alkalosis Correct answer.

Explanation

Vomiting causes loss of gastric acid and chloride, producing a hypochloraemic metabolic alkalosis, while renal potassium wasting leads to hypokalaemia. The loss of hydrogen ions raises bicarbonate. Hyperkalaemia with acidosis is the pattern of renal failure or diarrhoea.

Question 19Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

A 30-year-old man has sudden severe headache described as the worst of his life. Which imaging modality should be performed first?

  1. Skull radiograph
  2. Non-contrast computed tomography of the head Correct answer.
  3. Magnetic resonance imaging of the brain
  4. Carotid Doppler ultrasound

Explanation

Sudden severe headache raises concern for subarachnoid haemorrhage, and non-contrast CT is the first-line test because hyperdense blood is detected with high sensitivity within 6 hours of onset. If CT is negative and suspicion persists, lumbar puncture for xanthochromia is performed. MRI is more time-consuming and less available acutely.

Question 20Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

Which of the following is a recognised risk factor for the development of pressure ulcers in hospitalised patients?

  1. Immobility with reduced sensory perception Correct answer.
  2. Regular two-hourly repositioning
  3. Adequate dietary protein intake
  4. Normal body mass index

Explanation

Immobility combined with reduced sensory perception increases sustained pressure over bony prominences and impairs the patient's ability to relieve it, promoting ischaemic tissue damage. Repositioning, adequate nutrition, and normal body habitus are protective rather than causative. Risk assessment tools incorporate mobility, sensory status, and nutrition.

Question 21Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

A 40-year-old woman has a positive antinuclear antibody test, malar rash, photosensitivity, and arthritis. Which additional laboratory finding would most strongly support systemic lupus erythematosus?

  1. Anti-double-stranded DNA antibodies Correct answer.
  2. Rheumatoid factor
  3. Anti-mitochondrial antibodies
  4. Anti-histone antibodies

Explanation

Anti-double-stranded DNA antibodies are highly specific for systemic lupus erythematosus and correlate with disease activity and lupus nephritis. Rheumatoid factor is nonspecific and common in many conditions. Anti-histone antibodies suggest drug-induced lupus, and anti-mitochondrial antibodies indicate primary biliary cholangitis.

Question 22Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

A 50-year-old man has a fasting glucose of 8.2 mmol/L and HbA1c of 7.8% after lifestyle measures. He has no contraindications. Which medication is the usual first-line therapy?

  1. A sulfonylurea
  2. Insulin glargine
  3. An SGLT2 inhibitor
  4. Metformin Correct answer.

Explanation

Metformin is recommended as first-line pharmacotherapy for type 2 diabetes in most patients because it is effective, weight-neutral, and inexpensive, with a low risk of hypoglycaemia. Insulin and sulfonylureas increase hypoglycaemia risk, and SGLT2 inhibitors are typically added for cardiorenal indications.

Question 23Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

Which feature in a headache history most strongly suggests a secondary cause requiring urgent evaluation?

  1. Bilateral throbbing pain relieved by rest
  2. New onset after age 50 with associated jaw claudication Correct answer.
  3. Family history of migraine
  4. Recurrent pain preceded by visual aura

Explanation

New headache after age 50 with jaw claudication suggests giant cell arteritis, which threatens vision and requires urgent corticosteroid treatment and temporal artery biopsy. Migrainous features such as bilateral throbbing, visual aura, and family history are typical of primary headache. Red flags include age over 50, thunderclap onset, fever, and focal deficits.

Question 24Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

A 68-year-old man has a haemoglobin of 92 g/L, a mean corpuscular volume of 108 fL, and a normal serum folate. Which underlying cause should be considered?

  1. Thalassaemia trait
  2. Sideroblastic anaemia
  3. Iron deficiency anaemia
  4. Vitamin B12 deficiency Correct answer.

Explanation

A macrocytic anaemia with normal folate suggests vitamin B12 deficiency, which impairs DNA synthesis and produces large oval red cells. Iron deficiency and thalassaemia cause microcytosis. Sideroblastic anaemia can be macrocytic but typically shows a dimorphic picture and ring sideroblasts.

Question 25Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

A 35-year-old woman with no prior illness has sudden tearing chest pain radiating to the back. Her blood pressure is 180/100 mmHg in the right arm and 140/85 mmHg in the left arm. Which diagnosis should be considered first?

  1. Acute myocardial infarction
  2. Pulmonary embolism
  3. Pericarditis
  4. Aortic dissection Correct answer.

Explanation

Sudden tearing chest pain radiating to the back with an inter-arm blood pressure difference suggests aortic dissection, which requires urgent imaging and blood pressure control. Myocardial infarction typically causes pressure-like pain without inter-arm discrepancy. Pericarditis is pleuritic and positional.

Question 26Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

A 24-year-old university student presents with a 2-day history of sore throat, fever and tender cervical lymphadenopathy. Examination shows exudative tonsillitis. Which laboratory finding would most strongly support a diagnosis of acute Epstein-Barr virus infection rather than streptococcal pharyngitis?

  1. Atypical lymphocytes on peripheral blood film with a positive heterophile antibody test Correct answer.
  2. A raised anti-streptolysin O titre
  3. Growth of beta-haemolytic colonies on throat culture
  4. Neutrophilia with a left shift on the full blood count

Explanation

Infectious mononucleosis classically produces reactive (atypical) lymphocytes and a positive heterophile antibody (Monospot) test, reflecting EBV-driven B-cell infection with a T-cell response. These findings distinguish it from bacterial pharyngitis, where neutrophilia and positive streptococcal cultures or serology predominate.

Question 27Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

A 58-year-old man with type 2 diabetes has an eGFR of 32 mL/min/1.73 m². Which change to his metformin therapy is most appropriate?

  1. Stop metformin because of the risk of lactic acidosis Correct answer.
  2. Add a thiazolidinedione instead and continue metformin
  3. Continue the current dose unchanged
  4. Increase the dose to improve glycaemic control

Explanation

Metformin is contraindicated when eGFR falls below 30 mL/min/1.73 m² and should be reviewed or dose-reduced between 30 and 45, because impaired renal clearance increases the risk of lactic acidosis. At an eGFR of 32 the safest action is to stop it and use an alternative agent.

Question 28Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

A 3-year-old child is brought to the emergency department with drooling, a muffled voice and high fever, sitting forward and refusing to lie down. Which diagnosis should be considered first?

  1. Croup (laryngotracheobronchitis)
  2. Foreign body in the oesophagus
  3. Infectious mononucleosis
  4. Acute epiglottitis Correct answer.

Explanation

The triad of drooling, muffled voice and the tripod (sniffing) posture in a febrile child suggests acute epiglottitis, an airway emergency. The child should not be examined with a tongue depressor; airway management takes priority.

Question 29Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

Which mechanism best explains why isoniazid is effective against Mycobacterium tuberculosis?

  1. Inhibition of the 30S ribosomal subunit
  2. Inhibition of mycolic acid synthesis in the bacterial cell wall Correct answer.
  3. Inhibition of folate synthesis
  4. Inhibition of bacterial DNA gyrase

Explanation

Isoniazid is a prodrug activated by bacterial catalase-peroxidase and inhibits InhA, blocking mycolic acid synthesis in the mycobacterial cell wall. This wall-specific action explains its selective activity against M. tuberculosis.

Question 30Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

A 62-year-old woman has a 6-month history of progressive proximal muscle weakness, a heliotrope rash and Gottron papules. Which investigation is most likely to be abnormal?

  1. Serum alpha-fetoprotein
  2. Serum thyroxine
  3. Serum calcium
  4. Serum creatine kinase Correct answer.

Explanation

Heliotrope rash, Gottron papules and proximal weakness indicate dermatomyositis, an inflammatory myopathy with muscle enzyme leakage. Creatine kinase is typically elevated and is used to monitor disease activity.

Question 31Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

In a randomised controlled trial, which feature most reduces the risk of selection bias?

  1. Use of a placebo comparator
  2. Intention-to-treat analysis
  3. Blinding of outcome assessors
  4. Concealed allocation of participants to treatment groups Correct answer.

Explanation

Selection bias arises when the groups differ systematically before treatment begins; concealed allocation prevents recruiters from anticipating assignment and enrolling selectively. Blinding, intention-to-treat analysis and placebo controls address other biases such as detection and attrition bias.

Question 32Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

A 70-year-old man with chronic kidney disease has a serum potassium of 6.8 mmol/L and peaked T waves on ECG. Which is the most appropriate immediate treatment to stabilise the myocardium?

  1. Oral sodium polystyrene sulfonate
  2. Intravenous insulin with glucose
  3. Intravenous furosemide
  4. Intravenous calcium gluconate Correct answer.

Explanation

Hyperkalaemia with ECG changes threatens cardiac conduction, and intravenous calcium antagonises the membrane effect of potassium within minutes. Insulin-dextrose, binders and diuretics lower potassium but do not immediately protect the myocardium.

Question 33Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

A 45-year-old woman has a thyroid nodule. Fine-needle aspiration shows papillary architecture with nuclear grooves and psammoma bodies. Which feature best explains the indolent behaviour of this tumour?

  1. It is associated with multiple endocrine neoplasia type 2
  2. It secretes calcitonin
  3. It arises from parafollicular C cells
  4. It usually spreads via lymphatics rather than haematogenously Correct answer.

Explanation

Papillary thyroid carcinoma typically spreads to cervical lymph nodes rather than through the bloodstream, which contributes to its favourable prognosis. Medullary carcinoma, by contrast, arises from C cells, secretes calcitonin and is linked to MEN2.

Question 34Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

A 40-year-old woman has a positive antinuclear antibody test, malar rash, photosensitivity and arthritis. Which additional finding would most strongly support systemic lupus erythematosus?

  1. Anti-histone antibodies
  2. Anti-Jo-1 antibodies
  3. Rheumatoid factor
  4. Anti-double-stranded DNA antibodies Correct answer.

Explanation

Anti-double-stranded DNA antibodies are highly specific for SLE and correlate with renal disease activity. Rheumatoid factor, anti-histone and anti-Jo-1 antibodies are associated with other conditions.

Question 35Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

A 55-year-old smoker has a solitary pulmonary nodule measuring 12 mm on chest radiograph. Which imaging investigation is most appropriate next?

  1. PET-CT
  2. MRI of the chest
  3. Repeat chest radiograph in 12 months
  4. CT of the chest Correct answer.

Explanation

A CT chest characterises the nodule's size, margins and density and guides further management, such as PET-CT or biopsy. PET-CT is usually reserved for nodules that remain indeterminate after CT.

Question 36Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

A 68-year-old man has a haemoglobin of 92 g/L, a mean corpuscular volume of 108 fL and a normal serum folate. Which underlying cause is most likely?

  1. Iron deficiency
  2. Anaemia of chronic disease
  3. Vitamin B12 deficiency Correct answer.
  4. Thalassaemia trait

Explanation

A macrocytic anaemia with normal folate suggests vitamin B12 deficiency, which may also cause neurological features. Iron deficiency and thalassaemia cause microcytosis, and anaemia of chronic disease is usually normocytic.

Question 37Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

A 25-year-old woman has a 6-month history of recurrent intrusive thoughts of contamination and repetitive handwashing that consumes two hours daily. Which class of medication is first-line pharmacological treatment?

  1. Selective serotonin reuptake inhibitors Correct answer.
  2. Antipsychotics
  3. Tricyclic antidepressants at standard doses
  4. Benzodiazepines

Explanation

Obsessive-compulsive disorder responds to SSRIs, often at higher doses and for longer than in depression. Benzodiazepines and antipsychotics are not first-line monotherapy, and clomipramine is a second-line option.

Question 38Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

Which principle of radiation biology states that the biological effect of fractionated radiotherapy is greater when fractions are smaller?

  1. The oxygen enhancement ratio
  2. The inverse square law
  3. The linear-quadratic model Correct answer.
  4. The law of Bergonié and Tribondeau

Explanation

The linear-quadratic model describes cell survival as a function of dose and explains why fractionation spares late-responding tissues with a low alpha/beta ratio. The other principles describe oxygen effect, radiosensitivity of dividing cells and dose fall-off with distance.

Question 39Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

Which measure is the most appropriate primary prevention for reducing the incidence of cervical cancer in an adolescent girl?

  1. Human papillomavirus DNA testing
  2. Prophylactic antibiotics
  3. Human papillomavirus vaccination Correct answer.
  4. Annual cervical cytology

Explanation

HPV vaccination before exposure prevents persistent infection with oncogenic subtypes and thereby reduces the incidence of cervical cancer. Cytology and HPV testing are screening tools that detect existing disease rather than preventing it.

Question 40Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

A 72-year-old man with atrial fibrillation has a CHA2DS2-VASc score of 4. Which therapy is most appropriate for stroke prevention?

  1. Clopidogrel alone
  2. An oral anticoagulant Correct answer.
  3. Aspirin alone
  4. No antithrombotic therapy

Explanation

A CHA2DS2-VASc score of 4 confers a high annual stroke risk, and oral anticoagulation substantially reduces it. Antiplatelet monotherapy is inferior for cardioembolic stroke prevention in atrial fibrillation.

Question 41Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

A 2-year-old child has a generalised tonic-clonic seizure lasting 4 minutes during a febrile illness. He recovers fully within an hour. Which statement best describes the most likely diagnosis?

  1. Epilepsy requiring long-term anticonvulsants
  2. A simple febrile seizure with a favourable prognosis Correct answer.
  3. Bacterial meningitis requiring lumbar puncture in all cases
  4. A complex febrile seizure with focal features

Explanation

A generalised seizure lasting under 15 minutes in a child aged 6 months to 5 years, with full recovery and no focal features, defines a simple febrile seizure. It carries a good prognosis and does not usually require long-term anticonvulsants.

Question 42Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

A 50-year-old man has a fasting glucose of 8.2 mmol/L and HbA1c of 7.8% after lifestyle measures. He has no contraindications. Which first-line pharmacological therapy is most appropriate?

  1. Basal insulin
  2. A sulfonylurea
  3. An SGLT2 inhibitor
  4. Metformin Correct answer.

Explanation

Metformin remains the recommended first-line agent in type 2 diabetes when tolerated and not contraindicated, because of its efficacy, safety and low cost. Insulin and other agents are added or substituted when specific indications arise.

Question 43Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

A 65-year-old woman is found to have a blood pressure of 168/98 mmHg on three separate visits. Which is the most appropriate initial management?

  1. Recommend salt restriction alone
  2. Start antihypertensive drug therapy alongside lifestyle advice Correct answer.
  3. Arrange ambulatory blood pressure monitoring before any action
  4. Reassure and review in one year

Explanation

Persistent hypertension at this level on repeated clinic readings warrants pharmacological treatment together with lifestyle modification. Ambulatory monitoring is useful when readings are borderline or discordant, not when hypertension is clearly established.

Question 44Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

A 35-year-old woman with no prior illness has sudden tearing chest pain radiating to the back. Her blood pressure is 180/100 mmHg and pulses are equal. Which investigation is most appropriate to confirm the suspected diagnosis?

  1. Transthoracic echocardiography
  2. Troponin measurement
  3. Chest radiograph
  4. CT angiography of the aorta Correct answer.

Explanation

Tearing pain radiating to the back suggests aortic dissection, and CT angiography is the definitive imaging test for diagnosis and classification. Echocardiography may show complications but is less sensitive for the whole aorta.

Question 45Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

A 30-year-old woman has a 3-week history of low mood, anhedonia, poor sleep and reduced concentration following a relationship breakdown. She denies thoughts of self-harm. Which is the most appropriate initial management?

  1. Admission to a psychiatric ward
  2. Starting a selective serotonin reuptake inhibitor immediately
  3. Offering structured psychological therapy Correct answer.
  4. Electroconvulsive therapy

Explanation

For mild to moderate depression without psychotic or suicidal features, structured psychological therapy is first-line. Antidepressants are reserved for more severe illness or where therapy is unavailable or ineffective.

Question 46Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

A 70-year-old man with chronic obstructive pulmonary disease has a resting oxygen saturation of 88% on room air. Which long-term intervention improves survival?

  1. Prophylactic antibiotics
  2. Inhaled short-acting beta-agonists alone
  3. Oral corticosteroids
  4. Long-term domiciliary oxygen therapy Correct answer.

Explanation

Long-term oxygen therapy improves survival in patients with chronic hypoxaemia from COPD when used for at least 15 hours daily. Bronchodilators relieve symptoms but do not improve survival in this context.

Question 47Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

A 24-year-old medical student asks how the kidney handles a filtered load of glucose that exceeds the transport maximum of the proximal tubule. Which statement best describes the expected finding in the urine?

  1. Glucose appears in the urine once the plasma concentration exceeds the renal threshold, because filtered load exceeds reabsorptive capacity Correct answer.
  2. Glucose is reabsorbed completely at any plasma concentration because transport is active and saturable
  3. Glucose appears in the urine only when the glomerular filtration rate falls below 60 mL/min
  4. Glucose is secreted by the distal tubule and appears in urine only when secretion is stimulated

Explanation

Proximal tubular glucose reabsorption is carrier-mediated and saturable, so once the filtered load exceeds the transport maximum the excess is excreted; the plasma level at which this begins is the renal threshold, roughly 10 mmol/L. Excretion therefore depends on the filtered load relative to transport capacity, not on a fixed GFR cut-off.

Question 48Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

A 30-year-old woman has a fasting serum calcium of 2.75 mmol/L (reference 2.15–2.55) with a low-normal phosphate and an inappropriately normal parathyroid hormone level. Which mechanism best explains these findings?

  1. Excess parathyroid hormone increases renal calcium reabsorption and bone resorption while promoting phosphate excretion Correct answer.
  2. Excess parathyroid hormone increases renal phosphate reabsorption and reduces intestinal calcium absorption
  3. Increased calcitonin secretion mobilises calcium from bone and lowers serum phosphate
  4. Reduced parathyroid hormone increases bone resorption and raises both calcium and phosphate

Explanation

Parathyroid hormone raises serum calcium by increasing renal tubular calcium reabsorption and bone resorption, and lowers phosphate by promoting renal phosphate excretion. In primary hyperparathyroidism the calcium is high with an inappropriately non-suppressed PTH.

Question 49Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

A 55-year-old man with alcohol-related cirrhosis has ascites and a serum sodium of 128 mmol/L. Which is the most appropriate first-line dietary and pharmacological approach to his ascites?

  1. Intravenous albumin infusions twice weekly as monotherapy
  2. Dietary sodium restriction plus spironolactone, with furosemide added if needed Correct answer.
  3. High-sodium diet with a loop diuretic alone
  4. Free water restriction alone without diuretics

Explanation

Ascites in cirrhosis is managed with dietary sodium restriction and a potassium-sparing diuretic such as spironolactone, reflecting secondary hyperaldosteronism; a loop diuretic is added if response is inadequate. Free water restriction addresses hyponatraemia rather than the ascites itself.

Question 50Division of Physicians - basic sciences relevant to Family Medicine, Internal Medicine, Laboratory Medicine, Oncology and Radiotherapy, Paediatrics and Child Health, Psychiatry, Public Health, Radiology

A 62-year-old woman with a 20-pack-year smoking history has a 14 mm spiculated nodule in the right upper lobe on CT. Which histological feature most strongly supports a diagnosis of adenocarcinoma rather than squamous cell carcinoma?

  1. Strong association with paraneoplastic hypercalcaemia
  2. Glandular formation with mucin production and thyroid transcription factor 1 positivity Correct answer.
  3. Peripheral location with cavitation
  4. Intercellular bridges with keratin pearls

Explanation

Adenocarcinoma shows glandular differentiation, mucin production and is usually positive for thyroid transcription factor 1, whereas squamous cell carcinoma shows keratinisation and intercellular bridges. These immunophenotypic and morphological features are the key discriminators on histology.