The evolving perceptions of rural medicine was currently observed by UNSW Associate Dean of Rural Health, Tara Mackenzie. Initially discouraged from pursuing rural practice, Mackenzie now witnesses a cultural shift that encourages students to embrace rural training opportunities. The establishment of rural medical schools in New South Wales since 2017 has provided students with firsthand experiences of rural life during their medical education, fostering a deeper appreciation for rural healthcare.
Deniliquin, a town about three hours west of Wagga Wagga, faced limited access to general practitioners (GPs) leading to prolonged waiting times for medical care. Pam Ellerman, a passionate regional health advocate who lives in the town for almost 55 years, advocates for the concept of rurally-based medical schools, populated by students from rural backgrounds, as a means to bolster healthcare in regional Australia.
In addition to rural medical schools, universities are actively promoting rural placements for medical students, exposing them to the challenges and rewards of practicing medicine in rural settings. Sebastian Baker, a medical student from University of Adelaide, whose transformative experience in Broken Hill with the Royal Flying Doctor Service (RFDS) exemplifies the impact of rural placements in shaping career aspirations. Research indicates that students who undergo rural placements are more inclined to pursue careers in small rural or remote locations.
Nola Whyman, director of operations for a Broken Hill-based Aboriginal health service provider, stresses the significance of exposing students to rural placements in addressing the shortage of GPs. GP Madison Kane’s transition from student to practitioner at Maari Ma highlights the pivotal role of rural placements in encouraging doctors to practice in regional areas.
However, challenges persist in providing specialty training opportunities in rural areas, as highlighted by Professor Mackenzie. Limited access to specialty training programs exacerbates the ongoing doctor shortages in regional areas. Mackenzie advocates for reforms that enable doctors to complete a significant portion of their training in rural or regional settings, thereby incentivizing them to remain and practice in these areas.
There is a vivid picture of the burgeoning recognition of rural medical education and placements in tackling doctor shortages in regional Australia. Australia is currently still facing shortage of doctors especially in the rural region.
Australian Medical Council (AMC) MCQ Recalls APRIL 2024 compilation
A case of 11 year old alleged cat scratch. Asking for etiology
A Bartonella
B borrelia
C brucella
D lyme
child of 8 has dx w covid along w her parents(1 wk ago) now presented with abd pain,vomit,abd rigidity and tenderness.She is sick.What helps to make dx?
A.USG
B.COVID pcr
C.ANA
D.Xray
years old international student return from thailand, hand chest thigh erythema plus red eye , ask next step?
a blood culture??
b x ray
c CT
D isolation
Pregnant woman OGTT results abnormal. Next appropriate step?
A repeat OGTT in few weeks
Dietary advice
Initiate insulin
Refer dietician
Monitor blood glucose at home
Patient with clinical features hypothyroidism. Lab shows reduced T4 and low TSH. What is the cause?
A primary hypothyroidism
B secondary hypo
C iatrogenic hypo
D thyroid hormone resistance
E euthyroid sick syndrome
A 46 yo gentleman undergoing abdominal aortic aneurysm surveillance with 4.8cm infrarenal aneurysm. What is the appropriate management?
A semiurgent repair
B surveillance
C immediate repair
D medical management
E endovascular repair
48yo gentleman, never had health check before, ex-smoker, family history of diabetes, bank manager, fair complexion, red hair, overweight. BP 155/89 mmHg. Next step?
a Offer smoking cessation advice.
b Assess osteoporosis risk factors.
c Calculate height, weight, BMI, waist circumference.
17 lady with Type 1 DM, abdominal pain, vomiting x4, BG 25mmol/L, ketones 1.6mmol/L. Moderately dehydrated, alert. Initial management?
a Administer a stat dose of dexamethasone 4mg intravenously.
b Start an infusion of 20% mannitol 50g over the next hour.
A young lady with symptomatic anemia and hemoglobin level 8g/dL. Diagnosed with IDA. eGFR less than 25. Treated with iron supplements and 2 repeated investigations was performed.
FBC HCMC anemia observed
Serum ferritin still low
What is appropriate next step?
A serum ferritin
B EPO level
C bone marrow biopsy
D serum iron level
E GI endoscop
35 guy w/ skin rash after Caribbean holiday, tingling, prickling sensation on R foot, itchy rash, no fevers, no significant medical history. Most appropriate management?
a Fluconazole 50mg orally daily for 2 weeks
b Ivermectin 200mcg/kg orally stat
c Prednisolone 50mg orally for 3 days
15guy w/ aggression, agitation, history of methamphetamine use. Foster mum suspects methamphetamine intoxication. Clinical feature supporting methamphetamine intoxication?
a Constricted pupils
b Blood pressure 90/60 mmHg
c Jaw clenching
schizophrenic pt on quetiapine. Symptom not controlled. Next step?
A switch to clozapine
B ensure compliance
C admission to psy ward
D monitor WC count and neutrophil count
E reevaluate patient on diagnosis
67gentleman w/ COPD exacerbation, treated successfully. Second exacerbation in 6 months. Inhaler technique adequate. FEV1 55%. Next step in COPD management?
a/ Low dose theophylline
b/ Long-term low dose oral prednisolone
c/ Long acting muscarinic antagonist (LAMA) (e.g. tiotropium) or a long acting beta2 agonist inhaler (LABA) (e.g. salmeterol )
45 male w/ HIV, CD4 <200 cells/μL, tenofovir disoproxil w/ emtricitabine therapy. Received DTaP booster 3 yrs ago. Immune to Hepatitis B. Which immunisation now?
a/ The varicella zoster immunisation
b/ The influenza immunisation
5 boy w/ eczema, mainly on extensor surfaces. Managed w/ emollients, ↑ topical corticosteroids. Concerns about steroid side effects. Correct statement?
a/ Steroid ointments for very dry skin in children.
b/ Antihistamines for pruritus.
52 lady on MHT patches. Debilitating hot flushes. Last menstrual period at 50, normal cervical screening. BMI 22 kg/m2, non-smoker. Period resumed after starting patches. Next step?
a/ Transvaginal ultrasound for endometrial thickness.
b/ Reassurance about common breakthrough bleeding.
52 male w/ thyroid lump for ≥1 yr. Worried about cancer. Ultrasound suspicious for malignancy?
a/ Spongiform nodule
b/ Solid hyperechoic nodule
c/ Solid hypoechoic nodule with microcalcifications
52yo lady with menopause symptoms, migraines, PCOS, no regular meds. Wants MHT. Safe condition for MHT?
a/ Ischaemic heart disease
b/ Pregnancy
c/ Treated moderate hypertension
Mother concerned about child’s MMR vaccination before Vanuatu trip. Term baby, no significant PMH. Most appropriate advice?
a/ child already vaccinated against measles.
b/ MMR vaccine possible before holiday, then 2 more doses needed.
7boy w/ tinea capitis, hair loss, itching. Weight 30kg. Empirical treatment?
a/ Terbinafine 125mg orally daily for 4 weeks
b/ Miconazole cream 2% topically twice daily for 2 weeks
c/ Fluconazole 150mg orally stat
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
RFDS consult for kangaroo shooter w/ fever, headache, myalgias, cough. Suspected Q-fever. Most serious complication?
a/ Arthritis
b/ Endocarditis
c/ Empyema
19 lady with irregular periods, acne, no other symptoms. BMI 22 kg/m2. TSH 2.89 mIU/L, Prolactin 360 mIU/L, FSH 8 IU/L. Next step?
a/ Refer her to a gynaecologist for a hysteroscopy
b/ Advise her that she has a diagnosis of polycystic ovarian syndrome
5boy with vesicular rash on hands x 2 days. Otherwise well. Likely pathogen?
a/ Coxsackie Virus (CV) A16
b/ Varicella zoster virus
c/ Human herpes virus-6 (HHV-6)
32 lady pre-travel consult for cycling honeymoon in rural Vietnam. Concerned about Japanese Encephalitis. Advice?
a/ JE vaccine recommended for >1 month in endemic regions.
b/ Three different JE vaccines available in Australia.
Term baby appears jaundiced post-emergency caesarean. Well, breastfeeding normally. No antenatal care. Likely diagnosis?
a/ Sepsis
b/ Red cell haemolysis
c/ Biliary atresia
patient had waldenstrom macroglobulinemia in past now presenting with cough and weakness that was treated with ampicillin. On followup granulomatosis on CXR. No pic given. Asking for cause?
A sarcoidosis
B waldenstrom granulome as reactivation of prev condition
C tb
D ampicillin induced reaction
E pneumocytis
56 male farmer w/ sun exposure. No suspicious lesions, but actinic changes. Discussing field therapy. Absolute contraindication?
a/ Congestive Heart Failure
b/ IgA deficiency
c/ Dihydropyrimidine dehydrogenase (DPD) deficiency
80 old lady w/ urinary incontinence x 3 wks, urge to urinate. Started new medication. Suspected medication?
a/ Amitriptyline
b/ Benzatropine
c/ Indapamide
22 male w/ lump under upper lip since football injury. Not sore. Likely diagnosis?
a/ Mucocele
b/ Dentigerous cyst
c/ Ranula
4 yo baby with concerns of autism spectrum disorder. Suggestive feature?
a/ Deliberately annoying others
b/ Echolalia
42lady with galactorrhea post-breastfeeding. Raised prolactin. Likely cause?
a/ Clozapine
b/ Olanzapine
c/ Risperidone
nursing home patient with uti. You prescribe cephalexin. Nurse believe pt allergic to cephalexin. What to do?
A change abx
B continue cephalex
C talk to nurse that what she is doing is wrong
d. talk to nursing home manager
e. explain to nurse that it is your management and she should follow
28male with depression, anxiety. Wants to know common mental health disorder in Australia?
a/ Anxiety disorders
b/ Bipolar affective disorder
c/ Schizophrenia
56male Indigenous, fallen off horse, reduced consciousness. On warfarin. Correct statement?
a/ Urgent CT brain needed.
b/ Phenytoin or levetiracetam for moderate/severe cases.
81 lady seeking advice on Advanced Care Directive. Most appropriate advice?
a/ No need for ACD with good cognitive function.
b/ Lawyer not needed for valid ACD.
7yo with distractibility, wandering in class. Happy, stable home. Feature for ADHD?
a/ Assess sensitivity to tastes/textures.
b/ Evaluate consistency of behaviour at home/school.
24 male with widespread mildly itchy rash, started on hands, now arms, legs, torso. Likely diagnosis?
a/ Pityriasis versicolour
b/ Erythema multiforme
c/ Discoid eczema
Study on respiratory conditions post 2014 coalmine fire. Type of study?
a/ A cohort study
b/ A Meta-analysis
patient with antecedent of COPD mini mental state 28/30 with understanding of her illness decided not to have any intervention. She arrive to emergency. What to do next?
A meeting with her family
B give morphine
C evaluate her autonomy
D follow the wish of her son
Female patient with chronic disease was on 2 drugs (names cant remember -DMARD + other drug) presents with leukopenia, what is your management,
1.Reduce the dose of DMARD
2.Add Azathioprim
3.Stop DMARD
50 lady with AV nodal reentry tachycardia ablative therapy. Now unwell, weight loss, tremor, weakness, racing heart. Likely diagnosis?
a/ Anxiety
b/ Hyperthyroidism
c/ Congestive cardiac failure
68M with enlarging chest lesion. Likely diagnosis?
a/ Pigmented basal cell carcinoma
b/ Seborrhoeic keratosis
51M truck driver w/ recurrent dizziness, episodes last 1-6 hrs w/ spinning sensation, ear symptoms. Likely diagnosis?
a/ Acoustic neuroma
b/ Psychogenic
c/ Anxiety
32 lady w/ cyclical mood symptoms, severe premenstrual distress, functional impairment. Management?
a/ Commence her on oral Sertraline 50mg daily for the 2 weeks leading up to menstruation (luteal phase)
b/ Commence her on oral Drospirenone 4mg daily
39 male w/ painful, swollen right leg, mottling. Next step?
a/ Urgent duplex venous ultrasound of leg.
b/ Contact tertiary centre for expert advice/retrieval/surgery.
76M w/ fatigue, palpitations, shortness of breath, irregularly irregular heart rate. CHA2DS2-VA score?
a/ 7
b/ 6
65M w/ stable eGFR. Recommended BP target?
a/ ≤130/80mmHg
b/ ≤150/90mmHg
Considerations for prescribing in prison?
a/ Formal diagnosis before prescribing due to abuse potential.
b/ Alprazolam acceptable in prison with supervised dosing.
87 lady w/ Alzheimer’s, aggressive behavior, wandering. Immediate management?
a/ Nursing staff may use physical restraints for safety.
b/ Consult family/staff about prior strategies & reassess ASAP.
67 man w/ painless hematuria. Next step?
a/ Cease warfarin and await resolution
b/ Urine MC&S, cytology, and imaging of the renal tract
23 man plumber w/ scrotal pain, fever, dysuria. Likely diagnosis?
a/ Left-sided epididymitis
b/ Torsion of the left testis
alcohol addiction best managed by
Naltroxome opoid
Disalfirum
acomprostate
Considerations for prison medical officer role?
a/ Custodial facility can pose safety risks to medical staff.
b/ Maintain patient privacy and avoid disclosing personal information.