Ageing and Endings A Examination Questions

Here are some of the past short-answer questions from the 2006 and 2007 examinations. Unfortunately, not all questions have been recorded.

2007 Examination

Question 4

A 74 year-old woman presents to her local doctor with increasing pain and stiffness in her right knee. Osteoarthritis of the knee was confirmed by X-ray.

Answer the following questions regarding this case. The times shown reflect the weighting of marks that will be given to each part of the question.

Part (i)
(17 minutes)
Give an account of the anatomy of the knee joint, including its articular surfaces, capsule, ligaments and movements.

Part (ii)
(8 minutes)
List three features that you would expect to see on this woman’s knee X-ray that would provide evidence of osteoarthritis, and briefly explain how these changes came about.

Question 5

[The question related to colorectal cancer]

Part (ii)

Part (a)
Where in the body might the cancer spread (5 marks)

Part (b)
Factors important in DETERMINING the likelihood of spread of the carcinoma (5 marks)

Question 6

Joan is a 65 year-old woman who lives alone with no family support and has metastatic breast cancer. The cancer has spread to her liver and several of her lumbar vertebrae. After an extended period of treatment, the disease appears to be resistant to chemotherapy. The decision has been made in consultation with her Medical Oncologist that she is to have no further chemotherapy. She has moderate to severe pain over the right upper quadrant of her abdomen as well as her lower back.

Part (ii) (12.5 minutes)
Imagine that you are designing a trial to compare the quality of life in hospice care with home-based palliative care.

Part (a)
Write a possible null hypothesis and the corresponding alternative hypothesis for this trial. (2.5 minutes)

Part (b)
State which trial structure you would use for the study, justifying your answer. (5 minutes)

Part (c)
List three key confounding factors that could affect the result of this trial and explain how each of these might affect the outcome results. (5 minutes)

2006 Examination

Question 1

A 56 year-old woman presents to your general practice because of pain and swelling in some of the small joints of the hands. Using a table or point form, outline the key differences between rheumatoid (RA) and osteoarthritis (OA) describing:

Part (a)
The features of the patient’s symptoms, physical findings, and investigative abnormalities that would make a correct diagnosis. (5 marks)

Part (b)
The pathological mechanisms leading to disease in both RA and OA. (5 marks)

Question 2

A 68 year old man presented to his local doctor with discomfort in his right upper quadrant that had been present for several weeks, and was gradually worsening. He also reported that he had experienced intermittent diarrhoea and constipation for the preceding 3 months, together with a sensation of incomplete evacuation following bowel motions. Recently, he had also noted bright red blood coating his stools on several occasions.

On examination, the liver was markedly enlarged, with a nodular edge palpable 10 cm below the right costal margin (liver span was 20 cm). A hard, irregular, fixed mass was palpable on per rectal examination, with blood on the examining glove.

He underwent biopsy of the lesion in the rectum via sigmoidoscopy, and microscopic examination of that tissue revealed adenocarcinoma. An abdominal CT scan revealed numerous solid space occupying lesions in the liver, consistent with multiple metastases from a primary carcinoma in the rectum.

With reference to this scenario, write short notes on each of the following questions. Each question (a-c) is of equal value.

Part (a)
Explain the symptoms that this man experienced in terms of his underlying disease process(es).

Part (b)
In broad terms, discuss the treatment options for this man. In your answer, you should describe the potential roles of surgery, chemotherapy and radiotherapy in dealing with this man’s problems. You should also discuss the role of social support strategies in managing his condition. Where applicable, highlight the benefits of these management strategies, as well as their disadvantages.

Part (c)
The man died as a result of widespread metastatic disease some 12 months later. Apart from the liver, describe possible sites of metastatic disease in this man, and outline the way that these lesions, or other specific factors, might have contributed to his death.

Question 3

A 65 year-old female patient is diagnosed with carpal tunnel syndrome.

Part (a)

What is carpal tunnel syndrome? (1 mark)

What signs and symptoms is she likely to have? (5 marks)

Part (b)

What is the carpal tunnel? Give an account of its boundaries and the structures passing through it. (8 marks)

Explain how and why carpal tunnel syndrome occurs. (4 marks)

Part (c)
What are the treatment options for this woman? (2 marks)

Question 4

In the terminal phase of his illness Andrew (Scenario 3) has developed severe abdominal and back pain resulting from widespread metastases from his colorectal carcinoma.

Part (a)
Using the knowledge that you have gained in practical classes describe how you would assess and investigate his pain.

Part (b)
Describe how you would manage Andrew’s pain. What classes of pharmaceutical and adjuvant treatments would you use and why ?