GAMSAT Patient Assessment and Evaluation 3 — Questions and Answers
Question 1: A nurse applies the APGAR score to a newborn at 1 minute and obtains a score of 5. Which clinical action is most appropriate?
- Initiate resuscitative measures and reassess at 5 minutes (Correct answer)
- Discharge the newborn as healthy
- Perform immediate intubation without further assessment
- Administer surfactant therapy
Correct answer: Initiate resuscitative measures and reassess at 5 minutes
An APGAR of 4–6 at 1 minute indicates moderate depression, requiring resuscitative support and close monitoring.
Question 2: When performing the Romberg test, a patient is stable with eyes open but sways markedly and nearly falls when eyes are closed. This finding primarily suggests impairment of which system?
- Proprioceptive (sensory ataxia) (Correct answer)
- Cerebellar function exclusively
- Visual acuity
- Motor cortex function
Correct answer: Proprioceptive (sensory ataxia)
A positive Romberg sign occurs when removal of visual input unmasks deficits in proprioception, indicating dorsal column disease.
Question 3: A patient presents with unilateral leg swelling, warmth, and erythema. The Wells score for DVT is calculated as 3. What is the most appropriate next step?
- Perform compression ultrasound of the affected leg (Correct answer)
- Discharge with reassurance
- Administer empirical thrombolytics immediately
- Order a chest X-ray only
Correct answer: Perform compression ultrasound of the affected leg
A Wells score ≥2 indicates high probability of DVT, and compression ultrasound is the first-line imaging investigation.
Question 4: During ophthalmoscopy, you observe papilloedema bilaterally. Which systemic condition should you urgently consider?
- Raised intracranial pressure (Correct answer)
- Diabetic retinopathy
- Central retinal artery occlusion
- Glaucoma
Correct answer: Raised intracranial pressure
Bilateral papilloedema is caused by raised ICP transmitted along the optic nerve sheath, requiring urgent investigation.
Question 5: A 45-year-old patient has a BMI of 32.5 kg/m² and a waist circumference of 98 cm (male). According to metabolic syndrome criteria, which additional finding is required to make this diagnosis?
- At least two more metabolic abnormalities from dyslipidaemia, hypertension, or elevated fasting glucose (Correct answer)
- A BMI greater than 35 kg/m² alone
- Elevated TSH level only
- Positive family history of diabetes
Correct answer: At least two more metabolic abnormalities from dyslipidaemia, hypertension, or elevated fasting glucose
Metabolic syndrome requires central obesity plus ≥2 of: raised triglycerides, low HDL, hypertension, or raised fasting glucose.
Question 6: When assessing cranial nerve XII (hypoglossal), you ask the patient to protrude their tongue. It deviates to the right. This finding indicates:
- Right-sided lower motor neuron lesion of CN XII (Correct answer)
- Left-sided upper motor neuron lesion only
- Bilateral CN XII palsy
- Normal tongue function
Correct answer: Right-sided lower motor neuron lesion of CN XII
The tongue deviates toward the side of the lesion in a lower motor neuron CN XII palsy due to weakness of ipsilateral genioglossus.
Question 7: A 30-year-old woman presents with polyuria, polydipsia, and a random plasma glucose of 13.2 mmol/L. To confirm a diagnosis of diabetes mellitus, which additional criterion must be met?
- A confirmatory fasting glucose ≥7.0 mmol/L or HbA1c ≥48 mmol/mol on a separate occasion (Correct answer)
- A urine dipstick positive for glucose
- BMI greater than 30 kg/m²
- Family history of type 2 diabetes
Correct answer: A confirmatory fasting glucose ≥7.0 mmol/L or HbA1c ≥48 mmol/mol on a separate occasion
A symptomatic patient with a random glucose ≥11.1 mmol/L meets diagnostic criteria, but if asymptomatic, a repeat test is required for confirmation.
GAMSAT Patient Assessment and Evaluation 3
A nurse applies the APGAR score to a newborn at 1 minute and obtains a score of 5.
Which clinical action is most appropriate?