In Karumba, a remote Australian town, healthcare accessibility is a significant challenge due to long travel distances. Many patients endure pain and health issues without seeking medical attention because traveling for necessary procedures is too burdensome. This situation is part of a broader problem in remote areas, where healthcare outcomes are determined by postal codes. Recent data reveals higher rates of avoidable deaths and hospitalizations in remote regions compared to major cities, with fewer non-hospital medical visits per person. Urgent investment in rural healthcare, especially in primary healthcare, Medicare Benefits Schedule spending, and private hospitals, is called for by the National Rural Health Alliance to address these disparities. They stress that it’s a social and economic responsibility to improve healthcare access for rural Australians.
As Australia’s health system faces a crisis, amid a growing shortage of GPs and mounting pressure on both primary and secondary care services, the RACGP is calling on the Federal Government to support international medical graduates (IMGs).
Dear all IMGs, do not give up as Australia is still actively need more healthcare work forces!
We would like to extend a huge thank you to those who have provided us with these recalls. It is now our turn to do our part and help solve them for you. You can obtain them from here.
Australian Medical Council (AMC) MCQ Recalls SEPTEMBER 2023 compilation
63 yo lady sustained blackouts, 15-30s duration, spontaneous recovery, no meds. Normal vitals, ECG. K+ 3.3mmol/L. Bradycardia, asystole, self-reverts. Priority?
a/ Correction of hypokalaemia
b/ Arrange transfer to a Cardiology Unit
Patient drinks alcohol. Came with ascites, ankle edema, raised jvp. Liver was palpable. Hb was decreased. MCV 110.
Dx?
a/ Cirrhosis
b/ Pernicious anemia
Sensory loss over lateral border of shoulder, lateral arm, lateral forearm and thumb?
a/ C8 T1
b/ C5 C6
c/ Axillary
d/ Radial
37 yo lady sudden palpitations, dizziness, no chest pain. Had underlying asthma with frequent salbutamol use. ECG provided shows paroxysmal SVT. First-line treatment?
a/ Intravenous amiodarone 300mg stat
b/ Attempt a Valsalva manoeuvre
c/ Metoprolol 100mg orally stat
Pt with cough, hemoptysis and weight loss. Dx?
Pleural effusion
Pulm fibrosis
Bronchiectasis
67 yo man with worsening COPD, green sputum, salbutamol overuse, perindopril for HTN, penicillin allergy. He reports that he is already using his salbutamol metered dose inhaler 12 puffs every 3 – 4 hours via a spacer at home but he is struggling to cope due to breathlessness. Not requiring hospital admission. Most appropriate treatment now?
a/ Prescribe oral prednisolone 50mg for 5 days and oral amoxicillin 500mg every 8 hours for 5 days
b/ Prescribe oral prednisolone 50mg for 5 days and oral doxycycline 100mg daily for 5 days
18 months old baby, k/c of DDH…. X-ray hip joint.
18 months old, scenario of septic arthritis… Ix blood culture
52 years old lady came for annual health check. Normal mammograms and cervical screening, no significant past medical history. Elevated blood pressure 158/91 mmHg on manual sphygmomanometer. What’s correct about her blood pressure?
a/ The patient has Grade 1 (mild) hypertension
b/ The patient has Grade 2 (moderate) hypertension
A 16 year old aboriginal girl presents to a regional hospital with he complaint that her ankle has become increasingly painful over the last three days. She had fallen from play equipment at school a week earlier. Except for a recent episode of pharyngitis her previous health has been good. Her temperature is 37.9 C and her pulse rate is 95/min. On physical examination she has a mildly swollen ankle with some pain on movement, but the examination is otherwise normal.The heart sounds are normal and no murmur is heard. The lungs are clear. crp 3mg/dl Diagnosis
A/ Rheumatic fever
b/ Probable rheumatic fever
Elderly lady with atrial fibrillation, mitral stenosis, hypertension, osteoarthritis. Stable INR for 6 months, warfarin 4mg daily. eGFR 69 mL/min/1.73m2, liver function normal. INR now 3.8, nosebleed this AM, no other issues. Claimes already took warfarin as prescribed and did not change diet significantly. Next step?
a/ Advise her not to take her warfarin today and then recheck her INR tomorrow
b/ Refer her to the emergency department for urgent administration of prothrombin complex
8yo kid aboriginal from remote community, weeping rash on elbow 3 wks. Missed appointments, last Health Assessment 2 yrs ago. Up to date on immunizations. Yellow crusting on elbow (?impetigo), weight 22kg. Next step?
a/ Benzathine benzylpenicillin 1.2 million units stat via intramuscular injection
b/ Oral cefalexin 12.5mg/kg orally four times a day for five days
c/ Oral flucloxacillin 12.5mg/kg four times a day for seven days
Scenario of molar pregnancy, her D&C done and few months after her b-hcg is 900 but pregnancy test negative.. asking diagmosis..
a/ invasive mole
22 yo girl came to you today. She ?rolled left ankle during netball today, antalgic gait, mild lateral swelling, no deformity or bony tenderness, reduced ROM. You suspect she has a mild uncomplicated lateral ligament sprain and recommend rest, ice, compression and elevation. What is the best next mx?
a/ Recommend immobilisation in a backslab for two weeks
b/ Referral to her local physiotherapist for a six week rehabilitation program
34 yo lady on OCP & methotrexate for Crohn’s. Planning pregnancy, stopping OCP. Methotrexate in pregnancy advice?
a/ Methotrexate increases the risk of teeth staining in the foetus
b/ Increase folic acid to 5mg daily and reduce her dose of methotrexate
c/ Methotrexate should be ceased at least three months prior to conceiving
Young girl, Smooth, firm lump 1×1.5cm.. asking for Ix:
a/ reassurance
b/ FNAC
c/ USG
d/ mammogram
27 lady with painful menstrual periods, cyclical bloating, dyspareunia. Suspected endometriosis. Which is true statement?
a/ Endometriosis can present as primary or secondary infertility
b/ The diagnosis can be made by history and physical examination
Female with 6 weeks of amenorrhea, now came with vaginal spotting. Home pregnancy test was positive..
Next Ix?
a/ TVUS
b/ TAS
Pt with fever, neck stiffnes. LP done:
RBCs elevated
WBCs elevated
PMNs elevated
Lymphocytes elevated
Proteins and glucose normal.
a/ IV ceftriaxone
b/ IV acyclovir
c/ Symptomatic treatment
32 lady with childhood epilepsy well-controlled w/ sodium valproate. Considering pregnancy. True statement?
a/ Sodium valproate is known to increase the risk of birth defects including neural tube defects and other congenital malformations
b/ She should be advised that there is no need to consider her epilepsy management until after she has a positive pregnancy test
Indications of urgent surgery?
a/ Traumatic spleen rupture at lower pole
b/ Upper pole of kidney rupture
c/ Free fluid in the peritoneum
32 yo lady with underlying epilepsy dx during childhood. Came with GTC seizure controlled on sodium valproate 500mg orally BD. Last seizure 4 months ago and was known to local neurologist. Currently using IUD for contraception. Currently considering a family with husband. which following is true?
a) sodium valproate increase risk of birth defects (neural tube)
b) advised take 500mcg folic acid per day at least 1 month prior conceiving and up to end of first trimester
c) no need consider epilepsy treatment until positive pregnancy test
d) risk congenital malformation higher if taking carbamazepine as compared to sodium valproate
e) risk can be reduced if they stop after positive pregnancy test
Bacterial vaginosis treatment?
a/ Metronidazole
b/ clindamycin
c/ bactrim
14 yo boy presents to you alleged knocked by other player (playing rugby) and fell to ground. Denied head trauma. Since then headache (mild pressure). Witnessed by coach shoulder took impact, no loss of consciousness. No vomiting or neurological deficit. No blurry of vision. keen for him to return to sport as soon as possible due to grand final in 4 days time. Best advice?
a) Advise him that he will not be able to return to full play prior to the grand final
b) Advise him that as long as his headache resolves by the time of the grand final, he will be able to play in the match.
c) Advise him that he is able to commence non-contact drills tomorrow given he did not hit his head.
d) Advise him to take paracetamol and ibuprofen today to assist with his headache.
e) Refer him for a CT scan of his brain to rule out an intracranial haemorrhage.
A clinic treats IV drug abuser patients . Now they want to know from you as a GP what advice you can give to the hep B positive mothers
a/ Avoid Breast Feeding
b/ Check HbsAg in infant
c/ Hospital administration
23 gentleman, recent travel to Africa, concerned about schistosomiasis. Advice?
a/ Advise him that chronic infection from schistosomiasis is far more common than the acute illness
b/ Advise him that antibody tests are useful for distinguishing past and present infection in travellers
20 lady w/ lower abd pain exacerbated by exercise. ‘Bad period pain’, pain during sex. On oral contraceptive, neg urine preg test. Likely cause of pain?
a/ Irritable bowel syndrome
b/ Inguinal hernia
c/ Pelvic inflammatory disease
42 lady requests “heart check.” Family history: father, uncles, aunt – MI in late 40s-50s. No symptoms. BP: 125/85, HR: 75. Eye finding: photo shows cornea arcus. Next step in management? Answer from redbook RACGP
a/ Refer her directly to a clinical genetics service
b/ Check her history and examination findings against the Dutch Lipid Clinic Network criteria
67 yo man COPD, wife 65 yo make appointment concerning that she might have COPD too. She smokes 20 cig 40 years. SOB with sputum over 6 month. No fever night sweat weight loss. CT scan exclude lung lesion. Which of following confirms COPD dx?
a/ Hyperinflation with bronchial wall thickening on a chest xray
b/ Spirometry: FEV1 to FVC ratio < 80% and FEV1 < 70% predicted after bronchodilator
c/ Spirometry: FEV1 to FVC ratio < 70% and FEV1 < 80% predicted after bronchodilator
d/ Presence of a daily productive cough for more than 3 months in a smoker or ex-smoker
e/ Spirometry: FEV1 to FVC ratio < 70% and FEV1 < 70% predicted before bronchodilator
A 13 year old boy is admitted for acute appendicitis set to go for appendectomy after 12 hours along with 18 years old, patients not reachable, sister to whom to take consent to
a/ The patient
b/ Sister
c/ Hospital administration
14 year old Patient with drowsiness , drooling of saliva, right sided tonsillar enlargement, uvula deviated
a/ Endotracheal intubation
b/ Nasopharyngeal intubation
Pt presented with recurrent vertigo. No hearing loss. Dx?
a/ Menierre’s disease
b/ Vestibular neuronitis
c/ Otosclerosis
Patient refused blood transfusion. During surgery, shock.. what will you do?
a/ Iv dextrose
b/ Iv hemacel
c/ Iv hartmans solution
d/ Iv ringer
e/ Iv saline
Patient presented with decreased vision 6/18, which worsened recently 6/24. Poorly controlled diabetes..
Dx?
a/ Diabetic retinopathy
b/ Cataract
c/ Glaucoma
25 month baby, noticed by mum developmental concerns. Red flag?
a/ Difficulty in understanding his peer’s emotions
b/ Difficulty walking up and down stairs
c/ A vocabulary of 15 words
d/ Unable to run well
e/ Speech occasionally difficult to understand
42yo guy , health check. His father developed bowel cancer at age 55 and his mother has hypertension. You review his cardiovascular risk factors, nutrition, alcohol and physical activity. When start faecal occult blood testing?
a/ At age 50, and then every 2 years
b/ At age 45, and then every 2 years
c/ At age 55, and then every 2 years
37 man, health check, smoker, fit with regularly exercise, normal lab test, varenicline. Additional CV risk management?
a/ Recommend that he commences aspirin 100mg orally daily
b/ Advise him that medication is not indicated at this time for primary prevention of cardiovascular disease but he should return in 1-2 years’ time for review of his level of risk
48 lady, facial rash, no improvement with metronidazole. photo shows: seborrheic dermatitis What treatment?
a/ Azelaic acid 15% gel topically, twice daily until the skin returns to normal
b/ Hydrocortisone and clotrimazole (1% + 1%) cream topically, twice daily until skin is clear or for up to two weeks
26 MALE, dorsum of L hand lesion, slow growth, no discharge/pain. Work as sheep shearer. What management advice?
a/ Advise a punch biopsy to exclude a likely ulcerated basal cell carcinoma
b/ Advise that no immediate treatment is necessary, as it is probably a virus, and will heal spontaneously
c/ Recommend topical application of efuxid? cream weekly for a duration of 3 weeks and then review
d/ Recommend immediate excision and skin graft by the local surgeon
54 male, left elbow pain/swelling for 1 week post-work injury. Non-infectious diagnosis confirmed. Photo shows swelling present despite flexion and extension of elbow ?? olecranon bursitis . First-line treatment?
a/ Naproxen 500mg orally, twice daily, for seven days
b/ Surgical referral for excision and drainage
c/ Prednisolone 30mg orally, mane, for three days
d/ Resting the left elbow and wearing a compression bandage to reduce swelling
10yo girl, non-itchy white patches on face, worse in summer. Ill-defined, scaly patches around mouth/cheeks. Diagnosis?
a/ Vitiligo
b/ Pityriasis alba
c/ Atopic dermatitis
d/ Lichen simplex chronicus
42 female planning India trip in 2 months. Asks about cholera vax. Hx of hypertension, IBS. Advice?
a/ Advise that some countries require cholera vaccination as an entry requirement.
b/ Advise there is a very low risk of cholera if she follows recommendations regarding safe food, water, sanitation and handwashing.
15yo male came for wrist pain after bike fall. Swelling, tenderness in snuffbox. Next step in investigation?
a/ Arrange plain x-ray imaging of the right wrist
b/ Arrange a computed tomography scan of the right wrist
c/ Arrange a right wrist ultrasound scan
Parent wants exemption for 6-month-old child’s vaccination. Needs valid medical contraindication. What’s valid contraindication?
a/ Anaphylaxis following any component of the relevant vaccine
b/ Mother has a history of an anaphylaxis following vaccination
c/ He has a past medical history of egg allergy
50 non indigenous male wants flu vaccine. Used to free vaccine. Eligible groups for free flu vaccine?
a/ Mild asthma
b/ People aged over 65 years
c/ People aged over 55 years
Female pt at 18 weeks presented with urinary obstruction and constipation. Previous usg showed retroverted uterus. Cause?
a/ Incarcerated uterus?
Alendronate therapy pre requisiste?
a/ Dental checkup
b/ esophagoscopy?
A 72 yr old with dx of Alzheimer’s dementia has just been diagnosed with a terminal illness. His wife wishes her husband to have palliative care, but his 25 yr old son demands full treatment.
Most appropriate step in this situation?
a/ Follow wife’s wishes
b/ Follow son’s wishes
c/ Check competence of the pt
d/ Contact guardianship court
e/ Have a family meeting
PSA>20 , irregular DRE ,bone metastasis and back pain .Treatment to be given ?
a/ chemotherapy
b/ androgen deprivation
c/ orchidectomy
d/ radiotherapy
23 lady presents with depression, anger outbursts, binge eating, alcohol use, promiscuity, self-harm history. Missed appts, distrust in system. Likely diagnosis?
a/ Antisocial
b/ Avoidant
c/ Borderline
4mo boy, routine immunizations, past intussusception. NIP schedule today?
a/ Dtap Hib, pneumococcal and rotavirus
b/ Dtap, hib, hep B and pneumococcal
15yo girl, chest tightness on exertion, short of breath, can’t play netball fully. Family history: grandfathers, MI & aortic aneurysm. Likely diagnosis?
a/ Angina
b/ Asthma
c/ Costochrondritis
4mo infant, flaky scalp, yellow crusts, frontal region. (photo shows cradle cap, no redness). Diagnosis?
a/ Advise skin scrapings to confirm the diagnosis
b/ Advise application of an emollient and then removal of the scales with a soft brush/comb
54 female, dysuria, freq urination, UA: +++ leukocytes, + nitrates, ++ blood. Organism cause?
a/ Proteus mirabilis
b/ Escherichia coli
c/ Enterococcus species
10month old baby girl, sudden vomiting, diarrhea, distress. True statement about intussusception?
a/ The child is unwell between episodes of pain
b/ Lethargy may be a presenting sign
72 lady, sudden onset chest ‘fluttering’, breathless, htn, mitral valve prolapse. ECG rhythm?
a/ Atrial flutter
b/ Rapid atrial fibrillation
76 gentleman, COPD, worsening SOB, fever, colored sputum. Smoking 15 cigs/day. Treated with prednisolone, antibiotics. Still breathless on LABA/ICS. Next step to slow COPD?
a/ Inhaled long acting anticholinergic
b/ Smoking cessation
28 guy, type 1 diabetes, travel to Bali in 6 weeks. Vaccinations/precautions? Common cause of Traveler’s Diarrhea?
a/ Enterotoxigenic Escherichia coli (ETEC)
b/ Enteroinvasive Escherichia coli (EIEC)
73 old man, tender lower eyelid lump, no vision changes, prior episodes. (photo given likely meibomian abscess) Likely diagnosis?
a/ Meibomian abscess
b/ Epiphora
c/ Dacryocystitis
27yo couple planning pregnancy. Chances of conception in 1st yr with unprotected sex???????? (general knowledge qs)
a/ 70 – 75%
b/ 80 – 85%
Positive VDRL In pregnant woman.What to do next?
a/ Termination of pregnancy
b/ treat mother now
c/ treat baby post birth
Pt with frcture forearm reduction by ed consultant, history taken by intern and srgery arranged by surgical resident. Who has duty to take consent from pt??
a/ Consltant
b/ Intern
c/ Resident
Child brought to hospital by parents who moved in recently because of fracture femur. Parents say child is playful and not cautious. That he’s had many fractures before. On examination only swollen at site of fracture femur.
a/ Talk to school teacher
b/ Non accidental injury
c/ Osteogenisis imperfecta
vonwillebrand disease, pt bleed too much after dental treatment have history of bleeding from nose a/ aptt pt was normal.
Drilling of urine while coughing on examination therewassmall cystocoele treatment will be ???
Gynecomastia. 16 yo male athlete, BA controlled by salbutamol and fluticasone . Reason?
a/ Normal adolescent
b/ salbutamol
c/ fluticasone
d/ anabolic steroid use
Smoker having enlarge lymph node in inguinal area and weight loss with tender mass at the lower part where was the primary tumor
Mother brings 32 year old man with learning disability. Recently he started having aggressive outbursts with head banging plus insomnia and weight loss. Best medication for him?
a/ Escitalopram
b/ Olanzapine
c/ Diazepam
Pregnant women is an asylum seeker, lives with husband in community. Feels scared of people talking about her, frightened when husband goes to work. Irritable. (No time frame given) likely diagnosis?
a/ psychosis
b/ PTSD
c/ GAD
d/ MDD
Woman in labour meconium noticed on rom. Fetal head -1 position. Ctg reassuring. Fetal position ROP. What to do
a/ Caesarean
b/ Epidural analgesia
c/ Oxytocin
Fetus was behind the age but parts palpable.
Fundal height was 4weeks behind.
a/ Iugr
b/ Constit delay
c/ Renal agenesis
There was one woman who came with ankle disclocation in pregnancy and all her symptoms (headache proteinuria) suggested she also has preclampsia? They asked for investigations
a/ ankle xray
b/ lfts
c/ 24 hour bp monitoring
Boy from Sudan came with low vitamin D what can you give
a/ Calcitriol
b/ Cholecalciferol ********
c/ Vitamin B
d/ iron
Boy 14 years abducting there is an ray
a/ Hip bracing
b/ Pin fixation
c/ nsaid
Middle aged previously healthy man comes with a painless left side scrotal lump for one month. Recent hx of left leg infection.O/E the right side testis is normal except fr a horizontal crease.Left side testis cannot be palpated nt cord is normal Left side groin has few lymph nodes i think tender) BL gynaeconastia
Which of the following points more towards a malignancy?
a/ gynacomastia
b/ groin lymph nodes
c/ Abnormal right side testes
Ct scan chest with mass in left upper lobe what to do
a/ Sputum culture
b/ Percut biopsy
c/ Tb treatment
30 guy, painful, swollen left knee with erythema. Positive patellar tap. Recent knee trauma. MOST likely diagnosis?
a/ Cellulitis
b/ Septic arthritis
35 lady, joint pains. You consider order ANA but wonder about validity of test. Given
A= true positive test
B= false positive test
C= false negative
D= true negative
Which below is true
a/ Negative predictive value = A/(A+B) × 100
b/ Specificity = D/(D+B) × 100
c/ Positive predictive value = A/(A+C) × 100
d/ Sensitivity = A/(A+B) × 100
e/ Positive predictive value = D/(D+B) × 100
82 old man, bright red hard palate. Photo show redness over palate. Advise on management?
a/ Advise him that this condition is related to candida in the mouth and can be managed initially with oral hygiene measures
b/ Advise him that this is a sign of improperly fitted dentures and he should see the dental prosthetist again as soon as possible
74 male, fatigue, 2kg weight loss, nocturnal back pain x 6wks, pallor, multiple wedge compression fractures on thoracic spine x-ray. diagnosis?
a/ Prostate specific antigen (PSA) level
b/ Serum protein electrophoresis, immunofixation
Positive VDRL In pregnant woman.What to do next?
a/ Termination of pregnancy
b/ treat mother now
c/ treat baby post birth
Pt with frcture forearm reduction by ed consultant, history taken by intern and srgery arranged by surgical resident. Who has duty to take consent from pt??
a/ Consltant
b/ Intern
c/ Resident
Child brought to hospital by parents who moved in recently because of fracture femur. Parents say child is playful and not cautious. That he’s had many fractures before. On examination only swollen at site of fracture femur.
a/ Talk to school teacher
b/ Non accidental injury
c/ Osteogenisis imperfecta
Dribbling of urine while coughing on examination there was small cystocoele treatment will be ???
Gynecomastia. 16 yo male athlete, BA controlled by salbutamol and fluticasone . Reason?
a/ Normal adolescent
b/ salbutamol
c/ fluticasone
d/ anabolic steroid use
Smoker having enlarge lymph node in inguinal area and weight loss with tender mass at the lower part where was the primary tumor
There were two psychiatry questions which really confused me, and I haven’t seen them anywhere.
Mother brings 32 year old man with learning disability. Recently he started having aggressive outbursts with head banging plus insomnia and weight loss. Best medication for him?
a/ Escitalopram
b/ Olanzapine
c/ Diazepam
Pregnant women is an asylum seeker, lives with husband in community. Feels scared of people talking about her, frightened when husband goes to work. Irritable. (No time frame given) likely diagnosis?
a/ psychosis
b/ PTSD
c/ GAD
d/ MDD
woman in labour meconium noticed on rom. Fetal head -1 position. Ctg reassuring. Fetal position ROP. What to do
a/ Caesarean
b/ Epidural analgesia
c/ Oxytocin
Fetus was behind the age but parts palpable.
Fundal height was 4weeks behind.
a/ Iugr
b/ Constit delay
c/ Renal agenesis
There was one woman who came with ankle disclocation in pregnancy and all her symptoms (headache proteinuria) suggested she also has preclampsia? They asked for investigations
a/ ankle xray
b/ lfts
c/ 24 hour bp monitoring
Boy from Sudan came with low vitamin D what can you give
a/ Calcitriol
b/ Cholecalciferol
c/ Vitamin B
d/ Iron