1. You work in an office with another trainee who recently has joined the AFOEM training program. She asks you about the purpose of formative assessments.

What is the purpose of a formative assessment?

1. Its prime purpose is to build a partnership with your supervisor.
2. It appraises where you are at with a particular aspect of learning.
3. It assesses motivation to learn.
4. It formalises the making of choices in learning.

2. An obese 47-year-old woman is seen by her general practitioner for hypertension (BP 170/90 mmHg). Of note, her routine investigations show a random blood glucose of 11.3 mmol/L [3.5–5.5] and a total plasma cholesterol of 6.9 mmol/L [< 5.2], and her ECG shows changes consistent with left ventricular hypertrophy.

Which is the most appropriate single anti-hypertensive agent to prescribe?

1. Amlodipine
2. Indapamide
3. Methyldopa
4. Ramipril

3. A 28-year-old male intravenous drug user presents to the emergency department feeling unwell, with intermittent fevers and weight loss. He is found to have a raised jugular venous pressure, a pansystolic murmur at the left sternal edge that is accentuated by inspiration, a pulsatile liver and clubbing of his fingers.

What diagnosis best explains this man’s presentation?

1. Infective endocarditis
2. Rheumatic heart disease
3. Tuberculous pericarditis
4. Viral myocarditis

4. A 41-year-old woman presents to her general practitioner with a ‘multitude of symptoms’ including loin pains, constipation, muscle weakness, lethargy and an inability to concentrate. Examination is unremarkable.

Blood tests reveal:

What is the most likely cause of this woman’s symptoms?

1. Addison disease
2. Hyperparathyroidism
3. Multiple myeloma
4. Vitamin D resistance

5. A thin 54-year-old man is admitted to hospital for a routine inguinal hernia repair. On examination, his doctor is able to ballot the right kidney and orders an ultrasound scan of the renal tract. The scan confirms a normal left kidney and a normal pelvicalyceal system on the right with a large, fluid-filled area in the right upper pole that measures 10 cm × 8 cm.

What is the most likely diagnosis?

1. Hydronephrosis
2. Perinephric abscess
3. Polycystic kidney disease
4. Renal cyst

6. Following a bout of tonsillitis about a fortnight ago, an 18-year-old woman suddenly develops dozens of both round and oval-shaped red plaques topped with a silvery-white scale, 3–8 mm diameter, which are widespread on her trunk but not on her face or scalp. The plaques are not particularly itchy, and she feels well apart from mild nausea and a temperature of 37.7 oC. The long axes of the oval spots are in random directions.

What is the most likely diagnosis?

1. Guttate psoriasis
2. Lichen planus
3. Discoid eczema
4. Seborrhoeic dermatitis

7. Following a fracture of the fibula, a patient develops foot drop.

Which peripheral nerve is involved in this complication?

1. Common peroneal nerve
2. Medial plantar nerve
3. Posterior tibial nerve
4. Saphenous nerve