COLLEGE 0F PHYSICIANS & SURGEONS PAKISTAN

18th February 2020

      MCPS  
  SUBJECT: FAMILY MEDICINE PAPER: 1
ANSWERS THE ALL QUESTIONS (TOTAL QUESTIONS: 10) TIME ALLOWED
USE SEPARATE ANSWER BOOK FOR EACH QUESTION 3 HOURS

Q.1) A 40-years-old man presents to the clinic for a routine checkup. He is hydertensive and takes Tab.
Atenolol 50 mg * OD. His last checkup was 1 year ago and he has no current issues. He is adherent to his
treatment. On examination, his BP is 180/126 mmHg in both arms.

a) What other relevant examination would you also related to this issue?
b) What immediate treatment would you give?
c) What tests would you order?
d) If BP settles, what medicine would you discharge him on?

Q.2) A 17-year-old girl presents in your clinic with complains of fever, sore throat and headache for the
last two days. She is concerned since her exams are going to start after two days. On examination, temp
102oF. Pus exudates on tonsils. Cervical iymph nodes are tender and palpable.

a) What is the most likely diagnosis?

b) Enlist your management plan for this patient (pharmacological and non-pharmacological).
c) Describe the centor’s scoring criteria to justify the prescription of antibiotics in this case.

Q.3) A 30-year-old woman presents to you clinic with her 35-year-old husband. They have been
married for 2 years and they have possible fertility problems. They have no children. The Patient initially
used birth control pills for 6 months but now they have been trying to conceive. She and her husband
were counseled for focused sex around ovulation. After several months the couple wants complete
evaluation.

a) What questions in history you will ask to evaluate the couple? Give 4 important points each for
man and woman.
b) What 3 important investigations will you advise for the couple at first visit?
c) What non-pharmacological plan will you give to the couple? Give any 3 Points.
Q.4) A mother brings her 3-year-old child with the complains of inability to gain weight and height. His
weight is 10 kg and height is 90 cm. He started walking at the age of 2 years. His father is vegetable
vendor and he has six siblings.

a) What are the radiological seen on this x-Ray?

b) What is the most likely diagnosis?
c) Enlist three non-pharmacological measures you would give to her mother.
d) Enlist pharmacological management for this patient.

Q.5) A 52-year-old woman presents to you office for a well woman checkup. She informs you that her
50-year-old sister in law was diagnosed with breast cancer one month ago and that she is worried about
getting breast cancer.

a) What further questions would you like to ask?

b) List down investigations used for breast cancer screening?
c) Will you recommend her for breast cancerscreening? Why, give two justification points?
d) How would you counsel you patient regarding the benefits of breast cancer screening?

Q.6) A 32-year-old woman presents to your clinic with right sided headache for the last 2-3 years. Now
these episodes are occurring 1-2 times per week and she is unable to do her daily activities.

a) Enlist 4 relevant questions you will ask in history.

b) Enlist 4 steps of relevant examination you will perform in this patient.
c) Outline your management plain including non-pharmacological and pharmacological
management.

Q.7) A 20-year-old woman presents with 3 days history of anorexia, weakness and dark color urine. Her
LFTs are:

 Serum Bilirubin : 3.2 mg/dl (0.1-0.2 mg/dl)

 Direct bilirubin : 2.2 mg/dl
 Indirect bilirubin : 1.0 mg/dl
 ALT (SGPT) : 1200 U/l (7-55 U/L)
  ALKPO4 : 110 ( 45-15 u/L)
a) What is your diagnosis based on these laboratory results?
b) What test is of prognostic value in this condition?
c) List 3 additional test your would request in this case?

Q.8) A 45-year-old married lady presents to you with low mood, fatigue and weight gain for the last few
months. She is also complaining of menorrhagia. Her past medical history is unremarkable and she she is
not taking any medications currently.

a) Enlist any six important questions you will ask in history.

b) Enlist 2 differential diagnoses.
c) Enlist any 2 investigations you will perform in this patient.
d) Write 3 steps in management plan.

Q.9) A 52-year-old gentleman, diabetic and hypertensive for last 20 years, presents to your clinic with
complains of numbness in hands and feet. He is non complaint with medication and takes Tab.
Metformin 500 mg twice/day and glimepiride 2 mg once daily. His current labs are: Hba1c 9.2 gm%
creatinine 0.8 mg/dl. Urine DR is Positive for proteinuria. His BMI is 26 ng/m2.

a) What is the most likely diagnosis?

b) What further investigations you would like to offer to this patient?
c) Outline your management plan (Pharmacological and non-pharmacological)

Q.10) A 50-year-old woman presents to you clinic to discuss her risk of osteoporosis. She has history of
abdominal hysterectomy 10 years ago and recently her 70-year mother has been diagnosed to have
osteoporosis as a case for her hip fracture.

a) What other points in the history you will ask to evaluate her risks of osteoporosis?
b) What investigations you will advise to assess her bone status?
c) What life style advise you will give her for bone improvement.