H Dip Fam Med(SA)

THE COLLEGES OF MEDICINE OF SOUTH AFRICA

Incorporated Association not for gain
Reg No 1955/000003/08

Examination for the Higher Diploma in Family Medicine of the

College of Family Physicians of South Africa
8 April 2016

Paper 2

MEQ

(3 hours)

All questions are to be answered. Each question to be answered in a separate book (or books if more than one is
required for the one answer)

Malnutrition is a common cause of significant morbidity and mortality amongst the children of
South Africa
a)
List 5 ways in which malnutrition can be prevented and detected early.
(5)
b)
Define the difference between moderate and severe malnutrition, according to the
WHO z-scores.
(6)
c)
Describe 4 challenges or opportunities faced when performing a consultation with a 6year-old child in your consulting.
(4)
[15]

You work in a district hospital in Gauteng. Mr HW a 55-year-old man had an open gastric
bypass for morbid obesity 6 months ago. He now present with acute abdominal pain with
nausea and vomiting. The patient looks acutely ill on examination. His blood pressure is
130/70mmHg, pulse 100/minute and temperature is 37.5C. He has generalised tenderness
of his abdomen
a)
List 5 late post-operative complications for this patient presenting with acute abdominal
pains.
(5)
b)
Plain abdominal radiograph and sonar are non-diagnostic in this patient. What test
should be promptly performed to get an accurate diagnosis?
(1)
c)
There is no improvement in the symptoms even after tube decompression and the CT
scan report a possible internal hernia. What is your next step in your management of
this patient?
(1)
d)
While in hospital some of the pathology tests came back abnormal. What are the main
vitamins and nutrition deficiencies in post-operative gastric bypass patients and what
diet and specific supplements will you recommend?
(5)
e)
As a family medicine doctor, mention 2 diseases that you would want to explore in this
patient with obesity and what advice would you give him?
(3)
[15]

A 35-year-old male patient comes to your OPD for a general physical examination. During
the examination you noticed that he has a thyroid nodule which is palpated in the left lower
lobe of the thyroid gland
a)
What is the primary clinical importance of the evaluation of a thyroid nodule?
(2)
PTO/Page 2 Question 3b)

b)
c)
d)

Mention 4 points for your initial evaluation in all patients with a thyroid nodule?
(4)
When will you suggest Fine Needle Aspiration biopsy based on your initial evaluation?
List five conditions.
(5)
The result came back as a benign nodule. What is your next step of management for
this patient?
(4)
[15]

A 25-year-old long distance truck driver presented you with urethral discharge and burning
urine recently
a)
List 6 history and assessment strategies for this patient. (1/2 for assessment and 1/2
for information).
(6)
b)
He was diagnosed with Male urethritis Syndrome (MUS), write down your
pharmacological management. (1/2 for generic name, 1/2 for dose, duration each and
1/2 for advice).
(7)
c)
The patient came back after 2 weeks and said that he still has discharge and burning
urine. What are your 2 possible differential diagnoses? (1/2 for each point).
(1)
d)
How will you manage them now and justify your reasons? (1/2 for generic name, 1/2
for dose and duration each).
(1)
[15]

Diabetic Ketoacidosis (DKA) is a medical emergency

a)
Write down the 4 diagnostic criteria of DKA.
(4)
b)
How would you manage DKA in the emergency room?
(6)
c)
When do you consider DKA as resolved?
(1)
d)
You see this patient after 12 months in your OPD. List four items that you would want
to do for this patient.
(4)
[15]

A 45-year-old female has come to your clinic and she informs you that she thinks that she
suffers from depression (she researched it on the internet)
a)
List 5 symptoms for you to make the diagnosis of a major depressive disorder.
(5)
b)
List 5 factors that you would consider to make an assessment of suicidal risk.
(5)
c)
Discuss the treatment options for patients with a diagnosis of major depressive
disorder.
(5)
[15]

While on duty at a level 1 hospital, you are called to the telephone to speak to Sister Anna,
from the local clinic. Sister Anna tells you that she has admitted Maria, a 15-year-old girl, who
is 34 weeks pregnant, with two episodes of generalised tonic-clonic seizures. There is no
prior history of epilepsy, and Maria had been quite well until earlier today. She has attended
regularly at the local antenatal clinic. Sister Anna tells you that Maria is now fully conscious
and comfortable, and is sitting on a chair next to her mother. Her blood pressure is
160/105mmHg
a)
What is the most likely diagnosis?
(1)
b)
What simple bedside investigation should be done?
(1)
c)
Sister Anna is uncertain about what to do next. Give step-by-step instructions on how
to manage this patient and her condition.
(8)
[10]