AMC MCQ Recalls SEPTEMBER 2024

Australian Medical Council (AMC) MCQ Recalls SEPTEMBER 2024 compilation

35y/o pcos( dx wasn’t given but hirsutism and irregular periods with weight gain history with metabolic features ) what is the most appropriate screening with regards to her management.
testosterone
LH/FSH
DHEA
FBS
lipid profile

4 boy bitten on hand by family dog. 4 contaminated puncture wounds on palm, no active bleeding, minor abrasions on dorsum. Flexor tendons intact. Mx of wound?
a Irrigate w/ sterile saline, apply antiseptic, bandage, leave open. Start oral amoxicillin/clavulanic acid, review in 2-3 days.
b Irrigate w/ povidone-iodine, suture, start oral flucloxacillin, review in 1 week.

59 guy w/ first seizure, no focal neuro findings, CT brain normal. Hx of COPD, ex-smoker, worsening cough. CXR: large central mass. Likely lab finding?
a/ Sodium 115 mmol/L
b/ Albumin 32g/L

8 year old female treated for E.coli UTI( confirmed) .Presenting after ?a week with fever,dysuria
Frequency and loin pain.What will be useful to determine the cause
A.VCUG
B.Cystoscopy
C.CT Urography
D. Uss

78lady with Type 2 DM, on max dose metformin & gliclazide. Moderate cognitive impairment, latest HbA1c 6 mo ago was 8.2%. Next HbA1c target?
a/ Less than 8.0%
b/ Less than 7.0%
c/ Less than 7.5%

12girl bitten by redback spider on R hand, pain in hand/arm. 600km from nearest hospital, oral paracetamol/ibuprofen given, pain 5/10 persists. Next step?
a/ Apply ice pack to bite site.
b/ Apply pressure immobilization to R arm

19 lady w/ swollen, red R hand after punching someone. Tender over 5th metacarpal, difficulty making fist, 2 small abrasions on knuckles. Main concern?
a/ Abrasions on 4th MCP could indicate human bite, risk of serious infection/systemic illness.
b/ Likely flexor tendon damage requiring surgical repair.

79 male dx w/ moderate Alzheimer’s. Geriatrician recommended donepezil 5mg, daughter concerned about SEs, hasn’t started. Common SEs?
a/ Urinary incontinence, vivid dreams, dyspepsia
b/ Hypotension, tachycardia, weight gain

47lady w/ heavy periods, soaked through pads every 1-2 hrs, dizzy, BP low, pale. Hb 88, β-hCG neg, IV fluids given, bleeding slowed. Next treatment?
a/ Administer IV/oral tranexamic acid.
b/ Administer IM medroxyprogesterone.

15 teenage boy w/ worsening asthma, waking nights, using salbutamol 4x/wk. Mum wants to discuss complementary therapies. Best complementary option?
a/ Physical activity
b/ Selenium
c/ Sodium restriction diet

Menopause lady with itching and redness of vulva for 3 months, no other symptom,
next
Punch biopsy
Skin scraping
Estrogen levels

56M missed 3 dialysis sessions, SOB, ECG faxed, waiting for electrolytes. Most concerning electrolyte?
a/ Potassium
b/ Sodium
c/ Chloride

68M w/ acute agitation, confused, BP 180/100, HR 115, temp 39.3°C, rest of exam normal. Hx depression, recently started citalopram, takes med for OA. Pain med likely cause?
a/ Tramadol
b/ Aspirin
c/ Diclofenac

12yo boy dx w/ OSD 6 wks ago, parents worried about no improvement. Advice on mgmt and prognosis?
a/ Avoid painful activities for at least 2 wks.
b/ Corticosteroid injections for improvement.

66 man w/ slow movement, R hand tremor. Hx L4/5 laminectomy, R shoulder arthroplasty, OA knees. Resting tremor in R hand. Feature most consistent w/ Parkinson’s?
a/ Takes multiple small steps when turning.
b/ Wide-based gait observed.

28yp man grinding teeth for wks, worried about teeth damage. Hx anxiety on escitalopram 20mg, smokes, binge drinks, uses ecstasy on weekends. Advice on teeth grinding?
a/ Encourage reduced smoking, alcohol, ecstasy; refer to psychologist for stress mgmt and habit reversal.
b/ Recommend dental splint, refer to psychologist for CBT.

42 male Melanoma patient on immunomodulatory Rx now present with watery
diarrhoea and normal except fatigue. What to do
Gancyclovir
Hydrocortisone
Azithromycin
Infliximab

35 yr female, came with complaints of severe nausea, abd pain and vomiting.
Recently Came from Thailand. She mentioned here husband and son also had same
food but they don’t have any symptoms at all. Her menstrual history is fine with 27
days cycles and bleeding for 3 days except last week when periods came a week late
and for 9 days. On physical examination he has generalised tenderness. What is the
most accurate test to make the diagnosis?

1. Hcg
2. Lipase
3. upper USG
4. STI screening

You run a GP clinic focusing on skin lesions/cosmetic procedures. 3 other GPs in the same suburb. Most appropriate advertising allowed by Medical Board?
a/ Create practice social media w/ general info on procedures, sun safety tips.
b/ Display de-identified “before”/“after” photos of cosmetic procedures on website.

43lady w/ increasing pain after tooth extraction, afebrile, no swelling, pus at site. Hx of asthma, allergic to penicillin. Likely organism?
a/ Streptococcus viridans
b/ Enterococcus faecalis
c/ Candida species

Patient on isotretinoin and on Implanon. Now Implanon no stock, but wants renew her contraception. GP away for 3 months. What is best mx?
A condoms
B mirena
C IUD
D cocp
E depo

74 lady unconscious in waiting room, abnormal breathing. ALS started, ambulance called. Reversible causes to consider during ALS?
a/ Pulmonary embolism, hypovolaemia, tamponade
b/ Pulmonary hypertension, toxins, hyperthermia

28 male w/ schizophrenia on zuclopenthixol depot, arrested for stabbing employer. You receive subpoena for his medical records. Next step?
a/ Send complete medical records to Court.
b/ Provide written statement on mental health, not full records.

62 male w/ HTN, hypercholesterolaemia, prostate ca, wants to try Sativex for pain from bony mets. Asks about SEs of THC. Possible SEs?
a/ Tachycardia, dizziness, dependence, psychosis, cognitive impairment
b/ Cognitive impairment, peripheral neuropathy, abdominal pain, vomiting

3yo boy w/ 3-wk itchy rash on trunk, hands, scalp, crusted lesions, other kids w/ similar rash. Hx recurrent otitis media. First-line tx combo?
a/ Topical permethrin 5%, leave on for 8 hrs + oral trimethoprim/sulfamethoxazole 60/300mg 12hrly for 3 days.
b/ Topical diluted benzyl benzoate 25% for 24hrs + dicloxacillin 200mg 6hrly for 7 days.

4yo boy w/ 1 BM past wk, hard, painful stool, started preschool. Abd soft, faeces in LLQ. Mgmt of constipation in kids?
a/ Encourage good toileting behavior, aim for sitting on the toilet 2-3x/day after meals.
b/ Treat constipation w/ oral docusate sodium/Senna 50/8mg daily.

67man w/ Hx of pneumothorax treated w/ pleurodesis, planning flight to NZ. CXR shows resolved pneumothorax. True statement about air travel and pneumothorax?
a/ Delay air travel for 6 wks after pneumothorax treated w/ pleurodesis.
b/ Delay air travel until pleurodesis is performed.

47 man w/ generalised itch for wks, no rash. Most likely cause of itch?
a/ Iron deficiency anaemia.
b/ Folate deficiency anaemia.
c/ Vitamin B12 deficiency.

33 lady w/ irregular spotting since IUD insertion 3mo ago. No pelvic pain/discharge, normal cervix, IUD strings visible. Next step for bleeding?
a/ Request urine beta-hCG and STI swabs before recommending further management.
b/ Urgent gynae referral for further investigation of bleeding.

23 lady w/ L ear pain and fullness for 2 wks, trouble opening mouth. No fever, normal ear exam, tender anterior to tragus. Advice for mgmt?
a/ Soft diet, warm compresses, passive stretching exercises.
b/ Start 5mg diazepam orally daily for 1 wk.

72 man w/ fatigue, SOB on stairs, 3kg weight gain, socks leave marks on ankles. Echo shows impaired LVEF <40%. Correct statement?
a/ Beta blockers may initially worsen symptoms in heart failure w/ reduced EF.
b/ Loop diuretics improve survival in heart failure w/ reduced EF.

7yo girl still bedwetting at night, dry in daytime. Mom concerned about school camp soon. No underlying issues found. Mgmt strategy for enuresis w/ best long-term efficacy?
a/ Enuresis alarm.
b/ Desmopressin.
c/ Child education about enuresis.

35yo lady w/ epilepsy on phenytoin, seeking contraception. Tried combined OCP but forgetful, interested in implant. True statement about etonogestrel implant?
a/ Implant is immediately effective if inserted during the first 5 days of the cycle.
b/ Implant has no effect on ovulation.

27yo male w/ R big toe pain spreading up leg, headache, nausea. Had been cleaning shed, suspects bite. Local sweating on toe. Likely cause?
a/ Redback spider.
b/ Brown snake.
c/ Copperhead snake.

36yo female w/ recurrent headaches interfering w/ work/life. Further history taken. Red flag for headache?
a/ Headache made worse by coughing.
b/ Headache severity maximal in the evenings.

28yo lady, 6 wks pregnant, hx of hypothyroidism on 125mcg levothyroxine. Taking iodine and folic acid. Advice on thyroid mgmt in pregnancy?
a/ Increase levothyroxine to 150mcg daily, recheck TFT in 4 wks.
b/ Increase levothyroxine to 200mcg daily, recheck TFT in 4 wks.

58yo female w/ palpitations, tremor, hot/sweaty for 2 wks, eyelid retraction, proptosis, periorbital oedema. Reflexes brisk. Likely cause of sx?
a/ Graves Disease
b/ Toxic multinodular goitre
c/ Toxic adenoma

42yo man w/ R eye lump, red w/ irritation in dry air, no vision issues. Exam: 4mm yellow fleshy lesion on sclera, normal vision. Mgmt?
a/ Advise sunglasses, hat, and lubricant eyedrops.
b/ Urgent referral for conjunctival surgery.

25yo man w/ 3mo hx of blood-stained rhinorrhoea, itchy eyes, partial relief w/ antihistamines, dx w/ chronic rhinosinusitis & polyps. Completed abx. Next mgmt step?
a/ Check for sensitivity to aspirin/NSAIDs.
b/ Cease oral antihistamines.

60yo lady w/ 24hr R facial droop, otalgia, blisters in R ear canal, paralysis on R face incl. forehead. Neuro and ENT exam otherwise normal. Mgmt?
a/ Prescribe famciclovir 500mg orally 3x/day for 7 days.
b/ Prescribe cephalexin 500mg 4x/day for 5 days.

17yo lady reports non-consensual sex after party, offender known, denies drug use, embarrassed, no police involvement. STI screen 6mo ago negative. Next step?
a/ Give Ulipristal acetate 30mg orally stat.
b/ Give Hepatitis B immunoglobulin.

62yo male w/ bright red rectal bleeding on TP for 2mo, no pain, no blood in stool, no wt loss. Exam: external haemorrhoid, no mass. Next step?
a/ Refer for colonoscopy to rule out anorectal cancer.
b/ Arrange CT colonography.

61yo female w/ AF review, no palpitations, BP 125/80, hx of OSA, obesity, hypothyroidism on thyroxine. No hx of stroke, HF, vascular disease. Mgmt of AF?
a/ Focus on risk factor control (e.g. OSA, euthyroid, weight loss).
b/ Start oral amiodarone 200mg daily.

49yo man w/ post-bronchodilator FEV1/FVC ratio of 0.64, quit smoking 3mo ago, 20 pack-year hx, physically active, no SOB. Spirometry report follow-up?
a/ Encourage lifestyle measures like smoking cessation.
b/ Start long-acting beta2-agonist inhaler.

25yo lady w/ halos around lights at night post-LASIK 3 wks ago, family hx of macular degeneration, mild dry eye using lubricants. Cause of sx?
a/ Side effect of LASIK surgery
b/ Cataract
c/ Glaucoma