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
20 March 2015

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)

Imagine you had to counsel a couple on contraception, and the two options currently being
considered are the insertion of an intra-uterine contraceptive device or a vasectomy
a)
Please compare the advantages and disadvantages of the two options. Pay attention
to convenience and ease of application, effects on sexual function, contra-indications,
reliability and future reproductive options.
(12)
b)
Does the availability of the subcutaneous implant (Implanon) address some of the
issues? If it were available in your area, and the couple you counsel asks about it, how
does it compare to the two options mentioned above?
(3)
[15]

A 29-year-old male is brought to you by his father. He is known with Schizophrenia and been
receiving treatment for 3 years, but his father suspects that he has stopped using his
medication in the last few months, and has possibly been using tik (methamphetamines).
The patient is showing aggressive behaviour and appears to have paranoid delusions. The
father fears that the patient will harm himself or others
a)
Name 2 other conditions that must be excluded on assessment of patient.
(2)
b)
Name the criteria that must be fulfilled to admit this patient to a hospital as an
involuntary patient.
(3)
c)
List the forms that are required to be completed for an involuntary admission and who
completes each.
(6)
d)
Outline steps to be taken if sedation is required.
(1)
e)
Mention 3 different drug options (including route of administration) that could be used
for sedation if required in these circumstances.
(3)
[15]

A 33-year-old male consults you in a primary care centre complaining of non-specific,

intermittent chest pain over 3 years. He has been seen numerous times by other clinicians
for the same complaint and treated with a variety of analgesics and amitriptyline with no relief.
During this time he has had 2 chest x-rays, 3 ECGs including a stress ECG at secondary
level hospital where an examination by a physician was reported as normal; barium meal is
normal. Blood tests included random glucose, LFTs, U&E; all were normal
a)
Briefly state your overall approach to this patient.
(3)
PTO/Page 2 Question 3b)

2
b)
c)

Outline the details of your comprehensive approach to assessing this patient.

(9)
Describe your management using your understanding of the principles of family
medicine. Mention the key features of your approach and rationale for applying them
in your management plan.
(8)
[20]

A 62-year-old male comes to see you. He complains that he has a gradual loss of erections
for the last 3 months and is now unable to have sexual intercourse. He has heard that there
are treatments available for this condition. He is a diabetic and hypertensive. He takes
metformin 500mg twice daily, gliclazide 80mg twice daily, perindopril 4mg daily, atenolol
50mg daily and hydrochlorothiazide 12.5mg daily. You check his clinic card and his random
blood sugars for the last few months are in the range of 5 8 mol/l and his blood pressure
control is good
a)
List three possible causes for the patients loss of erections.
(3)
b)
List three lifestyle factors that may improve this condition.
(3)
c)
List two possible pharmacological treatment options for his condition.
(2)
[8]

A 78-year-old male patient is brought by his adult daughter to the emergency department
with a history of a fall when he slipped while getting out of the bath four hours ago. The
daughter is concerned that her father is unable to move his right leg and seems confused.
She informs you that he has been on treatment for hypertension for more than 20 years. On
examination, the patient seems to be in severe pain, with a GCS score of 14/15. His blood
pressure is 90/64 right arm supine, O2 saturation 90%, RR 30 per min, HR 120 per minute.
His right leg appears shortened and externally rotated. There is swelling and severe
tenderness over the right hip with no range of motion possible. The examination is otherwise
unremarkable
a)
What are the immediate management steps you would initiate for this patient?
(5)
b)
After these immediate management steps, you decide to x-ray the right hip as you
suspect a fracture. This is the x-ray of the patients right hip

Describe the abnormality(ies) in this film.

(2)
PTO/Page 3 Question 5c)

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c)
d)

List four possible reasons that could have caused this patient to fall.
(4)
You decide to refer the patient to an orthopaedic surgeon for open reduction and
internal fixation (ORIF). List 4 conditions that must be met to ensure that this patient
is legally competent to provide informed consent for surgery.
(4)
[15]

A 15-year-old female patient presents with papular/ pustular rash on her face. You diagnose
acne
a)
List four potential triggers for acne that you will enquire about.
(4)
b)
Discuss how you will determine the severity of her acne.
(4)
c)
On physical examination you find some open and closed comedones, and some
pustules on her cheeks. She also has some comedones on her back. Discuss and
explain your treatment plan.
(4)
d)
Describe the possible psychosocial impact of acne.
(3)
[15]

The HIV counsellor refers a 24-year-old woman to you. She presented with symptoms of TB
and was diagnosed HIV positive today. She is unemployed and lives with her boyfriend and
two children (2 years old and 4 years old) in a shack. The boyfriend is the only breadwinner.
Her children do not receive child support grants as their births have not been registered.
She does not have an ID document. She is scared to disclose her HIV status to her boyfriend
as he is sometimes physically abusive towards her. She appears scared and tearful. Outline
six principles of family medicine that are relevant to this consultation, and how you would use
the principles in the consultation with this patient.
(6x2=12)