Guidelines to prepare for ERPM (ACT 16 Exams)

The purpose of the ERPM examination is to assess whether a candidate:
- Can approach medical practice with the appropriate intellectual skills of enquiry, clinical reasoning, critical thinking and decision making
- Possessing sufficient knowledge of the basic and clinical sciences, and an understanding of the underlying principles of scientific method
- The ability to create a differential diagnosis and rationalize a treatment plan for common clinical situations prevalent in Sri Lanka
The candidates should also be able to apply the knowledge of basic sciences to explain the aetio-pathogenesis of disease conditions.
They should demonstrate an understanding of the principles of essential procedural skills and the ability to perform such procedures.
They should be able to communicate with patients respecting their dignity, rights, fears and anxieties, taking into consideration the socio-economic, cultural, religious and educational background of the patients.

Candidates should:

have a good knowledge of the normal and abnormal structure and function of the human body and of changes occurring during the life cycle.
have knowledge of signs and symptoms of disease, be able to take a good history, conduct an examination of the patient, order the relevant investigations, arrive at a differential diagnosis and diagnosis, and know the non-pharmacological and pharmacological management of diseases.
know to manage medical emergencies.
know about disability, rehabilitation and handicap.
know the role of the family and extended family, about inter-relationships and interactions with the society, and be aware of cultural and ethnic differences about the perception and response to illnesses.
demonstrate good communication skills e.g. breaking bad news, informing relatives of results of investigations and informing them of the patient’s condition.
Understand the concepts of patient confidentiality, privileged communication and when to breach patient confidentiality; the importance of informed consent; concept of medical negligence, civil and criminal liability.
demonstrate knowledge of medical ethics, and behave in an ethical manner.
understand the concepts of evidence based medicine
know basic statistics.
understand the concepts of self learning and lifelong learning
know about the importance of record keeping.
demonstrate ability to work as part of a team
know about doctor patient relationship, patients rights and the necessity to use a chaperone when examining adults of the opposite sex.
be able to educate patients and the public with a view to health promotion and disease prevention.

Sample ERMP questions

The answers are given at the end of each question in sequential order: T = true; F = false

1. ERPM MCQ sample in IM: Characteristic features of aortic stenosis include (FFTTF)?

1. pansystolic murmur at the apex
2. loud second heart sound
3. exertional syncope
4. heaving apex beat
5. early onset of symptoms

2. ERPM MCQ sample in IM: False-negative Mantoux test is known to occur in (TTFFT)?

1. miliary tuberculosis
2. HIV infection
3. patients treated with conventional antibiotics
4. infection with multi-drug resistant tuberculosis
5. recent measles infection

3. ERPM MCQ sample in Surgery: In a patient who had a history of intermittent claudication – the following conditions need urgent surgical intervention to improve the limb circulation (TTFFF)?

1. painful ulcer at the tip of a toe
2. severe continuous pain of the affected calf requiring regular opioid analgesics
3. claudication distance of 100 yards
4. prominent varicose veins
5. recurrent attacks of transient cerebral ischaemia (TIA)

4. ERPM MCQ sample in Surgery: A 55-year old man presents with symptoms suggestive of obstructive jaundice. He has a palpable gall bladder. Following is/are likely cause/s in this patient (TFFFT)?

1. carcinoma of the head of the Pancreas
2. Gall stones
3. Cholangiocarcinoma of the common hepatic dust
4. uncomplicated choledochal cyst
5. periampullary carcinoma

5. ERPM MCQ sample in OBG: During the antenatal period (TTTFF)?

1. an intrauterine pregnancy is recognized by transvaginal ultrasound scan at six weeks of amenorrhoea
2. the uterine fundus is palpable at the symphysis pubis at 14 weeks of amenorrhoea
3. maternal perception of fetal movements first occur between 18-20 weeks
4. VDRL test is done as a diagnostic test for syphilis
5. maternal serum triple test is offered to exclude Trisomy 21

6. ERPM MCQ sample in OBG: Anaemia complicating pregnancy (TFTTF)?

1. is a risk factor for intra-uterine growth retardation (IUGR)
2. is defined if the haemoglobin is below 9 g%
3. in Sri Lanka is predominantly due to iron deficiency.
4. due to iron deficiency is treated with parenteral iron when close to term
5. is associated with preterm labour

7. ERPM MCQ sample in Pediatrics: Causes of neonatal jaundice on the fourth day of life include (TFTTF)?

1. physiological jaundice
2. breast milk jaundice
3. septicaemia
4. congenital spherocytosis
5. hyperthyroidism

7. ERPM MCQ sample in Pathology: The following are features of apoptosis (FFTTF)?

1. Hydropic swelling of the affected cell
2. Inflammatory reaction in the surrounding tissue
3. Chromatin condensation at the periphery of nucleus.
4. Formation of apoptotic bodies
5. Death of a large area of a tissue

9. ERPM MCQ sample in FM: The following are true regarding abdominal injuries (FTTFF)?

1. they are the commonest cause of death in road traffic accidents
2. subcapsular liver ruptures causes sudden collapse
3. a stab injury of the gall bladder is categorized as “fatal in the ordinary course of nature”
4. ascites is a common complication
5. effects of a blast wave are commonly seen in the liver and the kidney

Acknowledgment

Dr Nilukshi Abeysinghe – Senior Lecturer in Forensic Medicine, Faculty of Medicine, University of Colombo
Dr Deepika Attygalle – Consultant Community Physician, Family Health Bureau, Ministry of Healthcare and Nutrition
Dr A.P. de Silva, Senior Lecturer, Department of Medicine, Faculty of Medicine, University of Kelaniya.
Prof. Mohan de Silva – Professor of Surgery, Faculty of Medical Sciences, University of Sri Jayawardenepura
Prof Nilanthi de Silva, Head, Medical Education Centre, Faculty of Medicine, University of Kelaniya.
Dr Lalindra Gunaratne, Senior Lecturer in Pathology, Faculty of Medicine, University of Colombo.
Dr Nalika Gunawardene – Senior Lecturer in Community Medicine, Faculty of Medicine, University of Colombo
Dr H.M.S.S.D. Herath – Consultant Community Physician, Assistant Registrar, Sri Lanka Medical Council.
Prof. Jayantha Jayawardana – Professor of Obstetrics & Gynaecology, and Dean, Faculty of Medical Sciences, University of Sri Jayawardenepura
Prof. Lalitha Mendis – Emeritus Professor University of Colombo and President, Sri Lanka Medical Council
Dr Nihal Nonis – Consultant Physician and Registrar, Sri Lanka Medical Council
Dr Niranthi Perera – Senior Lecturer in Pathology, Faculty of Medicine, University of Colombo
Dr Gominda Ponnamperuma, Lecturer in Medical Education, Faculty of Medicine, University of Colombo
Prof. A.P. Premawardena, Head and Professor, Department of Medicine, Faculty of Medicine, University of Kelaniya.
Prof. M. P. Senanayake, Professor in Paediatrics, Faculty of Medicine, University of Colombo
Prof. A.R. Wickremasinghe, Dean and Professor of Public Health, Faculty of Medicine, University of Kelaniya.
Dr S.S. Williams, Senior Lecturer and Head, Department of Psychiatry, Faculty of Medicine, University of Kelaniya.