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H Dip Fam Med(SA)


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
15 July 2016

Paper 2


(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)

While on duty at a health centre, you are called to the telephone to speak to Sister Mpho,
from the midwife obstetric unit. She has just seen Chantelle, a 21-year-old, who is 34 weeks
pregnant. She presented with two episodes of generalised tonic-clonic seizures. There is no
prior history of epilepsy. Chantelle had been quite well until earlier today. She is now fully
conscious and responsive. Her blood pressure is 160/105mmHg. She missed her last
antenatal clinic appointment, but no abnormalities were previously noted on her record
What is the most likely diagnosis?
What simple bedside investigation should be done?
Sister Mpho has just started working at the midwife obstetric unit, give her step-bystep instructions on how to manage this patient prior to referral.

Core attributes of effective primary care services have been labelled as accessibility,
continuity, co-ordination, comprehensiveness, and quality. Explain what is meant by each of
these concepts and describe one strength or weakness of your own practice with regard to
each of them.

A 34-year-old women presents with bruising on the face and lacerations on the scalp after
being assaulted by her partner. They have lived together for 5-years and have a daughter
who is 2-years-old. Describe your approach to assessing and managing this patient further.

Reflect on your practice in the last 6-months. Identify a consultation that reminded you of the
importance of one of the principles of family medicine and which made you aware of a
learning need. Define the principle and briefly describe the scenario and in what way this
illustrated the principle for you. Identify your learning need, which arose from this consultation,
and describe how you would plan to address this learning need.

You are busy consulting a couple that wants to know more about contraception. They
specifically ask about the possible insertion of an intra-uterine contraceptive device versus
parenteral hormonal use. Compare the advantages and disadvantages of the two options.[10]
PTO Page 2/Question 6


A 78-year-old male patient is brought to the emergency department of the health centre by
his adult daughter with a history of a fall after he slipped while getting out of the bath earlier
that day. The daughter is concerned that her father is unable/unwilling to move his right leg
and seems confused. She informs you that he has been on treatment for hypertension for
more than 30-years. On examination, the patient seems to be in pain, with a GCS score of
14/15. His blood pressure is 90/64 right arm, oxygen saturation 90%, respiratory rate 30 per
min, pulse 120 per minute. There is swelling and localised tenderness over the right hip with
no range of motion possible due to pain. The rest of the examination seems normal
What are the immediate management steps you would initiate for this patient?
After completing the above, you order a radiograph of the right hip. A femur neck
fracture is confirmed. Mention possible reasons that could have caused this patient to
The patient is referred to an orthopaedic surgeon. Mention the conditions that should
be met to ensure that this patient is legally competent to provide informed consent for
the surgery.

A 15-year-old female patient presents with acne

Describe four potential triggers for acne that you would like to enquire about.
Discuss how you would assess the severity of her acne.
Describe the possible psychosocial impact of her acne.


A 46-year-old man comes for his routine follow up appointment for the treatment of asthma.
In his notes you see that his diagnosis seems to alternate between asthma and chronic
obstructive pulmonary disease (COPD). He is currently prescribed salbutamol 2 puffs as
required and theophylline slow release 200mg BD
Describe how you would decide if he really has asthma or COPD.
If he has asthma how would you assess if he is controlled or not?
If he has uncontrolled asthma what issues would you look at to improve his level of
control in the management plan?

You are working in a rural clinic and the nursing staff refer a 19-month-old boy to you because
he has not gained weight over 2 visits in the last 6-months. Describe your approach to
assessing this child.