The number of COVID-19 cases has exceeded 180 million worldwide and is still rising. Similar pattern has been seen in Australia as well. More Australians are in lockdown today following one COVID-19 case travelling from Sydney into the Northern Territory. Queensland prepares to strengthen its border as cases continue to climb in New South Wales, Victoria and the ACT. Therefore, we would hope that everyone would stay safe while preparing for AMC MCQ exam. A big thank you to those who had contributed in providing us with these recalls. Now let us do our part by solving these for you. You may get them from here.
Australian Medical Council (AMC) MCQ Recalls AUGUST 2021 compilation
1) Tetanus – dirty wound, vaccinated before, booster 7yrs back. Next?
A. Td and TIG
B. Not needed
2) Asthma – 3 doses of salbutamol, next?
3) No other info…Had an abd xray, after resuscitation and urine o/p 60ml/hr, next mxg regarding K+ suppl:
A. K+ needed
B. 25 mmol
C. 50 mmol
D. > 50 mmol
4) BPH Rx
5) Toxic megacolon Mxg
6) Croup – common cause
7) Pic of lesions on lip (cold sore)
A. Herpes simplex
8) In a population, the incidence of type 2 diabetes mellitus is 3 per 1k individuals a year & stable for 30 yrs. However, the prevalence of type 2 diabetes mellitus has increased progressively over the same period. Reason?
A. Decreased length of hospital stay
B. High mortality in patients with diabetes
C. Improved disease management
9) Woman complains of left-sided weakness. A 2/6 holosystolic murmur is heard at the cardiac apex. Left-sided muscle strength is 1/5 with hyperactive deep tendon reflexes, Babinski sign present. Diagnosis?
A. Antiphospholipid syndrome
B. Multiple sclerosis
10) 65-yr-old obese woman lost her grip when pouring a large pot with boiling water causing a burn on her left-hand. Has hypertension & well-controlled type 2 diabetes mellitus. There is erythema of the skin on the palmar surface of the left hand. Next step?
A. Admission for burn debridement
B. Admission for observation and IV antibiotics
C. Discharge with wound care instructions
11) 17-yr-old girl is brought with a worsening rash on her left upper arm. 3 wks ago, the rash was the size of a dime but has grown in size, developed a raised edge & become increasingly itchy. Diagnosis?
A. Dermatophyte infection
B. Erythema migrans
12) 32-yr-old woman has mild fatigue & is significant for generalized seizures controlled with chronic phenytoin therapy. Her last seizure was 6 mths ago. Has mild gingival hyperplasia & pallor. Recommended supplement?
A. Folic acid
13) PAD scenerio with ABI 0.6 and 0.8. Next Mxg
14) A scenario of PTSD. ask for dx
15) Ethics – intern noticed more complications of surgery by a surgeon, registrars on leave. Next:
A. Inform APHRA
B. Inform Head of surgery
C. At intern audit
D. Wait for registrars to come back from leave
E. Make a list of the complications occurring
16) A man with past psychiatric H/o, is presented to court. His lawyer comes to you as his GP for reports,
A. Consent of pt
B. Court order
C. Consent for family member
17) Post-op, suclavian catheter inserted. After 2 days removal(I think??), flushing, swelling of face and hand, difficult to move hand. Inv:
B. Subclavian venography
C. CT angio
18) Melanoma surgical excison done, on F/u sees 2 metaplastic nevi, next?
A. F/u surveillance
19) Hereditary spherocytosis
20) Pt with GERD On esmoprazole with mild imp, with weight loss of 2 kgs, next:
A. Increase PPI
C. Barium meal swallow
D. Change the drug
21) Type 2 DM with acidosis and high lactic acid. Mxg
22) MND scenario, inv
23) Post- MVA with severe injuries. Most imp to manage first:
A. Splenic rutpure
C. Bladder injury
D. Perforation of doudenum
26) ECG: SVT mxg
27) ECG: First degree HB (only prolonged PR) mxg
28) CT of GOO
29) Scenerio of PAD and mentioned pulses cant be felt on popliteal and dorsalis pedis on left side and ABI they mentioned is 0.6 on left and 0.8 on right, whats the most approp investigation
A. Duplex doppler
B. Ct angio
30) Patient had catheter passed in dubclavian vein and now after 2 days flushing of face unable to move hand, what inv you should do
B. Ct angio
C. Subclavian venography
D. Ct neck
31) Long standing Type 2 dM patient and on multiple drugs asking treatment of abg changes. On abgs there is metabolic acidosis. Increase lactic acid level. Treatment?
A. Sodium bicarbonate
B. Activated charcoal
C. Ca citrate
32) Pt with hemetemesis and repeated vomiting what do next
33) Patient with hx of gerd being treated with esomeprazole and mild improvement and now present with mild weight loss 1 to 2 kg and asking what to do next?
A. Increase the dose of ppi,
B. change to other drug
34) Digoxin toxicity treatment
35) One ecg with digoxin diagnosis
36) Pt after long travel and already on enoxaparin and having sudden SOB and present with tachpnea and abgs were given and asking whats next
C. Increase the dose of enoxaparin
37) One scenerio related to carboxy hemoglobinemia quite a big stem and ask what would be the initial symptom in the child
38) Prodromal schizophenia what lead to this diagnosis
A. Hx of taking drugs
B. Thought insertion
C. Low self esteem
D. Ideas of reference
39) MDD scenerio and asking what lead you to diagnosis and they have mentioned symptoms
40) Pt underwent appendectomy and had found mucinoid tumor how will you treat further
41) Toxic megacolon scenerio
42) Alcoholic Patient came back after travel to thailand, Alt alp and ggt all were rased and asking diagnosis
C. Alcoholic liver disease
D. Autoimmune hepatitis
43) 45 yr farmer with soiled lacerated wound.he had simple scratch wound 5days ago for which he received a diphtheria tetanus toxoid. He has no other history of vaccination.what is the most appropriate step after debridement?
A Tetanus immunoglobulin
B Tetanus toxoid and tetanus immunoglobulin
C no treatment is necessary
D Tetanus toxoid
44) 15 year old obese boy having sedentary life and hba1c is 7.8 , what will you advice
A. Maintain weight
B. Weight reduction and exercise
C. Check fbs , serum insulin level , serum lipase level
45) You are an intern doctor and you see one of the resident doctors using an antipsychotic drugs prescribed by himself. You speak to him and confront the situation and he tell you that he is feeling stressed and overwhelmed with the workload and uses it to help him. What is the next step you should take?
A. Do nothing
B. Tell him to see another doctor/specialist
C. Report to AHPRA
D. Report to intern co-ordinator
46) 72 years old man is brought to the ED after collapsed while walking back home from shopping. After administration of oxygen.an ECG strip is obtained emergency.he lost her wife 12months ago and is currently on Sartaline due to depression as a result of complicated grief.one week back he was prescribed azithromycin for atypical pneumonia.his other medications include aspirin for IHD, atorvastatin for hyperlipidemia and multivitamin. which one of the following is most likely to have in such presentation?
A Interaction between aspirin and azithromycin
C Azithromycin and sertaline
47) 18-yr-old man is brought with a generalized tonic-clonic seizure. Last 2 days has worsening headache & clumsy. Oriented only to person, has bilateral hyperreflexia in upper lower extremities. Diagnosis? a/ Drug-induced encephalopathy
b/ Herpes simplex virus encephalitis
48) Woman calls 911 for severe dyspnea. Bilateral crackles are heard on chest auscultation. Intubated & treated with nitrates & diuretics, left side breath sounds markedly decreased. Reason breath sounds to the left hemithorax restored?
a/ Left-sided chest tube
b/ Left-sided needle thoracostomy
c/ Repositioning the endotracheal tube
49) 54-yr-old woman underwent mastectomy & has been receiving chemotherapy. She lost interest in many things, feels down & at fault for having breast cancer because she missed 2 mammogram appointments. Next step?
a/ Aggressively manage chemotherapy side effects and monitor the patient
b/ Encourage the patient to reach out to her family for support
c/ Initiate treatment for major depressive disorder
50) 23-yr-old man comes for a physical exam prior to joining a professional soccer team. BP 114/62 & pulse 54. Myocardial infarction in his father at age 56. ECG shows sinus bradycardia with occasional dropped QRS complexes preceded by progressive lengthening of the PR interval. Next step?
a/ Exercise stress testing
c/ Reassurance with no further intervention
51) 8-yr-old boy was asleep, fell out of bed & regained consciousness after a few min. Had a blue discoloration around his lips that resolved after a few secs. He is now alert & interactive but does not remember anything about the event. Diagnosis?
a/ Breath-holding spell
b/ Cardiogenic syncope
c/ Generalized seizure
52) 72-yr-old man is brought confused, lethargic & febrile. Has type 2 diabetes, chronic kidney disease & peripheral artery disease. BP 98/54; pulse 104. He is not oriented to place, time, or situation. Both lower extremities are without palpable dorsalis pedis, posterior tibial, or popliteal pulses. Next step?
a/ Amputation of the foot
b/ Hyperbaric oxygen therapy
53) 3-yr-old girl is evaluated for hoarseness that has been getting worse over the past 2 months. Flexible laryngoscopy shows several finger-shaped lesions on both vocal cords. Cause?
a/ Anomalous airway development
b/ IgE-mediated hypersensitivity reaction
c/ Maternally transmitted viral infection
54) 53-yr-old man comes with depressed mood, low energy & poor sleep. He also has periods with a burst of energy, feels great & energetic. Mental status exam shows slow speech, a sad affect & no suicidal ideation. Diagnosis?
a/ Bipolar I disorder
b/ Bipolar II disorder
55) 29-yr-old woman complains of infertility. She was treated for gonococcal cervicitis at age 19. BMI is 31 kg/m2. Exam reveals a small uterus with a cervix that appears laterally displaced; there is pain with cervical manipulation. Cause?
a/ Endometrial polyp
56) 5-yr-old boy comes with bed-wetting problem. He tires easily. Significant for frequent urinary tract infections. Height & weight are at the 25th and 5th percentiles, respectively. Next step?
a/ Check serum creatinine level
b/ Obtain serum and urine osmolality
57) Neonat from rural area, mother hasn’t had proper follow up in her pregnancy, present with 2 weeks baby have persisting vomiting like 5-8 episode per day. baby is on breast feed. baby hasn’t gained any weight and symptoms of failure to thrive. doctor has done electrolyte which shows
Na is low
Cl is low
K is high.
What is the most likely dx ?
A. Duodenal Atresia
B. Urinary tract infection
D. Pyloric stenosis
E. Raised ICP
58) Pan question best biopsy method
Renal ,nerve ,muscle
PAN (sural nerve biopsy, renal biopsy
initial – ESR & CRP
then – NCS
Best – Renal biopsy (if renal symptoms ONLY and could cause rupture of aneurysms)
Sural Nerve Biopsy (if lateral leg symptoms)
Muscle biopsy (if muscle weakness given in Q)
Main complications – AKI and hyperkalemia
Initial Ix – ECG (to look for hyperkalemia changes)
Best initial test SPECIFIC for Rhabdomyolusis – Urine analysis (myoglobinuria)
Confirmatory – CPK level
Initial Mx – IV fluid
Initial Mx (if ECG changes) – IV calcium gluconate
60) tension pneumothorax,pneumothorax
61) peripheral arterial disease
Chronic Limb Ischemia and Acute Limb Ischemia (Ct angio, Iv ufh heparin and refer for embolectomy)
Ix – Duplex USG
Tx – If pregnant lady (RFs – prophylactic heaprin, if current dvt – therapeutic heaprin – below knee 3months, above knee – 6 months)
63) xray dislocation of 5th mcp joint
ulnar nerve damage??? , tendon injury, compartment syndrome
most common hand injury
Ix – xray
Tx – Non operative (immobilization – when pt is stable)
Operative (gross dislocation)
64) herpes zoster
vesicles on ear – ramsay hunt
Tx – antivirals + prednisolone if within 72 hours (exception is herpes zoster oph and immunocompromised – give antivirals even after 72 hours
start prednisolone within 48 hours (Bell’s palsy), after that symptomatic Tx
For neuropathic pain (amtryptiline, gabapentin, duloxitene, pregabalin) – Away Goes D Pain
65) ptsd ocd n many more questions
OCD – compulsions and obcessions (repitations)
Tx – exposure and response therapy / CBT
SSRIs (meds if needed) and longterm – fluoxetine for children
66) PTSD – stressor Hx, nightmares, hallucinations could be there, flashbacks
Tx – CBT, meds – SSRI (even if hallucination – prazosin)
67) borderline – Splitting and unstable relationships
Tx- dialectical behavioual therapy
chest pain on inspiration and relieve when person leans forward
most commonly after MI
Tx – NSAIDS
Ix – ECG initial , ECHO best
69) differentiate from dressler syndrome (autoimmune pericarditis) – 4 wks after MI
Tx – NSAIDS initial and BEST – steroids
70) 60 yr old, male, with rash on hand and joint pain for 3 week with Blood and protein in urine…dx (VASCULITIS????), REACTIVE ARTHERTITIS???
A. Renal biopsy
C. Nerve conduction
D. Full blood count
71) Pt Male 35 yr old Frontal demetia sign with Familiy history of paternal aunt and uncle who died in their 50
Dx invx ?
(Wilson’s ??, Huntingtons??)
A. genetic testing
B. Ceruloplasmin and copper (ceruloplasmin and copper, liver biopsy)
D. Nerve conduction
72) Viral pandemic (COVID-19) in 3 countries. Cummulative case Graph is given.
Country A fail to implement appropriprate measure early.
What does country B graph show?
Graph A has highest case, B in middle and then C last.
- More death rate than C
- delay in social distance
- new viral strain
- group B was not wearing masks
73) Man complaint of Allergic rhinitis which interferes with his sleep. (Pale turbinates and nasal congestiom at night)
Oral prometazine at night
Oral cetrizine in morning
Inhal Fluticasone daily
Intranasal ephedrine at night
And sth else
74) (children less than 2 years we can give cetrizine)
75) A CT was givèn
Woman after Roux En Y complaint of 3 days of abd pain. Vital normal. No abd distension given. Cause?
-Perforation (vitals shuldnot be normal)
-ileus (abdominal distension??) – but closest is this
-pancreatitis (vitals shuldnot be normal)
-loop obstruction (late complication)
(CT is sth I have never seen before)
- complications – anastomotic leak, infection
76) There was a pic of a leg( blackish discoloration with a long scar on post shin)(I think the haemosiderin deposition pic??)
He came for indigestion to GP and his leg shows the following pic. What is the most likely association with this?
-History of sx for tibia and fibula fracture
-melanoma family history (possible??)
-his of melanosis colis
-his of limb ischaemia (possible??)
77) A graph showing disease prevlance
Ca, Heart disease, DM, stroke
78) Which is correct?
Linear increase in Cancer
Non linear increase in DM
Linear decrease in stroke (etc)
79) Man MMSE 25 before trial. He live with his son(caregiver)
During trial his MMSE was 15. You think it is due to drug from trial. Who do u ask to remove him from trial?
A. His son
B. remove him yourself
C. ethic committee
D. drug company
E. pt herself
80) 18yr old athlete fell down and got fracture. You ordered 10 mg morphine for him. Nurse decide to give him only 2. After you administer the remaining dose for appropriate pain control, who do you talk?
81) The nurse herself (first raise issue with nurse to see if genuine mistake or blatant disregard of orders and then proceed accordingly)
A. nurse unit manager
B. head of nurse
C. Hosp Admin
E. incident reporting
82) You are an intern. You strated to have doubt about ur supervisor surgeon. There have been compiling list of complications after his surgery(exact words). He is now on leave. What do u do?
A. research and make a list of his complications (of the surgery)
B. intern audit
C. head of surgery
E. wait for the surgeon to come back and confront him
83) patient with stroke. First start shrinking of head then facial weakness then nystagmus then start towards left facial swelling horizontal nystagmus after then right arm and trunk weakness which of following most likely the cause
A. Right lateral medullary
B. Right medial medullary
C. Central pontine stroke
84) (should be left lateral medullary syndrome) – PICA (same sided facial weakness and contralateral body weakness)
85) 50 year old male endarterectomy done after 36 hour develops fever37.8 enlarge hematoma in neck decrease air entry on left side and scattered bilateral crackles next best step
B. Ct chest
C. Wound infection
86) 11-mth-old girl is brought with a blanching, erythematous maculopapular rash that has now spread over her entire body. Past 3 days ill with fever, cough, rhinorrhea & “pink eye.” Lives with parents & several pets. Infection preventive measure?
a/ Airborne precautions
b/ Antibiotic prophylaxis
87) 66-yr-old woman complains of watery diarrhea & abdominal cramps. Has a history of constipation requiring frequent laxative use. Takes omeprazole & metformin daily for GERD & diabetics. Cause?
a/ Chronic laxative use
b/ Chronic metformin use
c/ Gastric acid suppression
88) 4-mth-old boy is brought with fever, cough & shortness of breath. CT scan shows multifocal pneumonia with areas of cavitation. Cultures obtained via bronchoalveolar lavage grow a filamentous, gram-positive rod consistent with Nocardia infection. Immunodeficiency is suspected. Test?
a/ Flow cytometry assessment of B cell subset
b/ Flow cytometry assessment of phagocyte oxidative response
89) 10-mth-old boy is brought for a routine well-child visit. Mother discloses child is clingy, fussier & cries when picked up by others. When the physician calls the patient’s name, he turns his head away from the physician and looks at his mother. Diagnosis?
a/ Adjustment disorder
b/ Autism spectrum disorder
c/ Normal development
90) 48-yr-old woman comes with urine leakage problem. She voids frequently day & night. Sometimes has an intense urge to urinate but passes only a small amount. Next step?
b/ Midurethral sling
c/ Voiding diary
91) 4-yr-old boy is brought with vague chest discomfort. 2 mths ago, the patient was involved in a high-speed motor vehicle collision but sustained only minor injuries. Auscultation of the lungs shows decreased air entry into the left lower base. Next step?
a/ Chest tube placement
b/ CT scan of the chest and abdomen
92) 50-yr-old man comes with achy joint pain in the lower back, shoulders, hips & knees. Has excessive sweating, polyuria & erectile dysfunction. Has an enlarged tongue & hand reveals widening of the joint spaces; low testosterone & hyperglycemia. Diagnosis?
93) 15-day-old boy is brought with 2 occurrences of green vomit. Was breastfed since birth. His last stool was 2 days ago. Shows dry mucous membranes & mildly sunken anterior fontanelle. Next step?
a/ CT scan of the abdomen
b/ Upper gastrointestinal series
94) 4 yr old boy came for severe abdominal pain and bilious vomiting for 6hrs. Had no bowel movements in the past 24 hrs. Appeared ill. Temperature 37.8’C, pulse 122 bpm. Examination showed distended abdomen with rebound tenderness. Child accompanied by 14 year old brother. Surgeon recommends emergency laparotomy. Appropriate management?
a/ get consent from patient
b/ perform emergency laparotomy
c/ schedule hospital ethics consult
d/ obtain court order
e/ get consent from brother
95) 60-yr-old man complains of nausea & abdominal pain. Underwent coronary angiogram & stent placement for chest pain 5 days ago. Has hypertension, hypercholesterolemia, peripheral artery disease & type 2 diabetes mellitus. Purple mottling of the skin of both feet. Cause?
a/ Cholesterol emboli
b/ Contrast nephropathy
96) 11-yr-old girl with an unsteady wide-based gait has difficulty standing & walking. Has scoliosis. Sudden cardiac death in her father. Lower extremities have decreased vibratory & position sense & ankle jerks are absent bilaterally. Diagnosis?
a/ Acute cerebellar ataxia
b/ Benzodiazepine ingestion
c/ Friedreich ataxia
97) 15-yr-old boy comes with progressively worsening left shoulder joint pain swelling. Lifts weights & plays baseball 5 days a wk. Exam shows a tender mass at the left proximal humerus. Elevated alkaline phosphatase, erythrocyte sedimentation rate & lactate dehydrogenase. Given x-ray showed sunburst appearance. Diagnosis?
a/ Ewing sarcoma
b/ Osteoid osteoma
98) 2-day-old girl is being evaluated. Maternal blood type is B, Rh-D positive & patient’s is O, Rh-D positive. Firm fluid collection in the left parietal scalp, localized within suture lines. Liver is palpable 2 cm below the costal margin. Skin exam shows jaundice & mild scleral icterus. Hyperbilirubinemia risk? a/Discrepancy in maternal-infant blood type
b/ Enlargement of the liver
c/ Presence of scalp swelling
99) Man in a motor vehicle collision. Deformed right upper arm. Limited extension at the wrist joint & decreased sensation over the dorso-radial aspect of the right hand. Radial pulse is 1+ on the right & 2+ on the left. X-ray shows an oblique fracture of the midshaft of the right humerus. Next step?
a/ Application of a neutral wrist splint only
b/ Electromyogram of the right upper extremity
c/ Open reduction and surgical exploration
100) 32-yr-old man with history of recreational substance abuse is brought confused, not oriented to time or place & does not recall recent events. The pupils are small. Skin is mottled over the upper back, buttocks & posterior thighs. Urine toxicology screen is positive for opioids. Blood ix showed ↑ Serum K & PO4, ↓ serum Ca, ↑ AST > ALT. Greatest risk?
a/ Acute kidney injury
b/ Intracranial hemorrhage
101) patient with lump fnac shows breast cancer estrogen reuptake negative progesterone reuptake negative Brca positive what is most appropriate
A. Mastectomy with auxiliary clearance
B. 2cm wide excision
D. Sentinel node biopsy
102) 25 yr old traffic road accident femur fracture no complications mobility day 5 what is most appropriate management
(if no risk factor then compression stockings, otherwise 28 days of heparin in hip surgeries)
103) after gastro… surgery (ulcer ) pt develop sudden dyspnea after 2 days O/E Bilateral air entry scattered, crackles on base of chest on left side what is most likely diagnosis
c. Aspiration pneumonia (s/b fever and bilateral symptoms)
d. Wound hematoma
104) patient with heredita spherocytosis lethargic anemic hb 6 dec platelet what to do next?
A. Splenectomy (definitive Tx)
B. Rbc transfusuion (because hb very low)
C. Oral fe
D. IV fe
E. Folic acid
105) transfusion – hb<7 (even if asympotomatic), hb 7 to 10 (if symptomatic)
initial – cbc, peripheral smear (hemolytic anemia pic and spherocytes)
confirmatory – EOM 5
106) patient has dysphagia
B. Pharyngeal pouch
C. Barret surveillance low dysplasia
D. Eosinophilic esophagitis
106) 58 year old presents with facial swelling,tongue wasting right sided lower limb muscle wasting and ankle muscle associated with ataxia most appropriate step
A. Emg (MND – bulbar palsy)
C. Ct cervical and lumbar spine
107) pic of child look like impetigo (could it be herpes??)
A. Topical steroid
B. Topical acyclovir (if herpes presents late)
C. Oral acyclovir (if herpes presents early – within 72 hours)
E. Topical Mupirocin (if impetigo)
108) 24 hours exclusion from school after starting antibiotics and covering lesions with water tight dressing
gingivostomatitis – lignocaine
109) lantigo melanoma pic given
(same pic as in handbook – page 88 ) – usually on face
110) svt ecg asking treatment
1) cold water immersion
2) carotid massage and vagal maneouvers (not done in elderly, children less than 10 years, aortic stenosis)
3) Adenosine (C/I in asthma)
4) verapamil (if adenosine C/I)
5) sotalol (if CCB C/I)
If SVT with WPW – adenosine (initial), catheter ablation (long term)
Vt with WPW – amiodarone
AF with WPW – flecainide and procainamide
VT in children – treat as VT – give amiodarone (according to APLS) , treat as SVT (RCH??)
111) patient gambling disorder lost everything wife upset brings husband more talkative sleep whole no eye contact says I will not do gambling again.diagnosis
A. Gambling disorder (there is no such thing, only impulse control disorder – pt would only engage in that particular activity)
D. Adjustment disorder
112) best would be hypomania or mania if features given in stem.
113) patient presents with obsession he counts 20 then repeats again had trauma 2 months ago now pressured speech sleep more diagnosis
D. Adjustment disorder
E. PTSD (3 to 6 months)
114) 38-year-old nulliparous woman complains of lower abdominal discomfort and chronic constipation. Cramping with menses causing her to miss a day of work each month. Menses otherwise regular with no intermenstrual bleeding. Mother had breast cancer at age 55, maternal grandmother died of ovarian cancer at age 66. Pelvic shows enlarged uterus that is irregular and mobile with prominent posterior mass. Best next step?
a/ BRCA1 and BRCA2 genetic testing
b/ CT scan abdomen and pelvis
c/ pelvic ultrasound
115) 89-yr-old man had 2 minor accidents in the past 6 mths while reversing car. Has mild cognitive impairment, hypertension, diminished hearing, osteoarthritis & benign prostatic hyperplasia. Decreased range of motion in his neck & mild pain in his hands & knees bilaterally. Next step?
a/ Advise patient to limit his driving to familiar, local trips
b/ Recommend an on-road driving evaluation
116) 17-yr-old girl becomes increasingly irritable & sleeps poorly. Reacts negatively, always seems on edge & worries over almost everything. Feels tired & has difficulty concentrating. Diagnosis?
a/ Body dysmorphic disorder
b/ Generalized anxiety disorder
117) 78-yr-old woman is brought with sudden-onset, right-sided hemiplegia & facial droop. Significant for chronic kidney disease & hypertension. B/P 218/128. Medication nonadherence. Muscle strength is 0/5 in the right upper & lower extremities. Next step?
a/ Administration of intravenous nicardipine
b/ Observation without treatment
118) 33-yr-old man comes with wife due to marital difficulties. Suspicious of wife having an affair with her coworker. Had 2 minor car crashes while intoxicated & bought expensive cars after each one, resulting in significant debt. Multiple short-lived relationships before marriage. Diagnosis?
a/ Bipolar II disorder
b/ Borderline personality disorder
119) 72-yr-old man underwent surgical repair of an aneurysm of the infrarenal aorta. On the 1st postoperative day he complains of progressive abdominal pain & bloody diarrhea. Left lower abdomen is mildly distended & tender to palpation. Diagnosis?
a/ Pseudomembranous colitis
b/ Invasive infectious diarrhea
c/ Ischemia of the bowel
120) 34-yr-old man has a 9-yr history of asthma, for which he uses a combination inhaled corticosteroid & long-acting beta agonist inhaler. For the past 2 yrs, uses inhaler 3 times per wk. His asthma symptoms wake him from sleep approx once every wk. Seasonal allergies to ragweed. Next step?
a/ Add a long-acting muscarinic antagonist
b/ Add oral corticosteroids to current inhaler regimen
c/ Schedule his inhaler twice daily
121) 69-yr-old man underwent elective surgical repair of a descending thoracic aortic aneurysm. Has 70% stenosis of right carotid artery. After surgery, flaccid paralysis & loss of pain sensation in lower extremities & urinary retention weakness. Cause of neurologic dysfunction?
a/ Cervical spondylotic myelopathy
b/ Epidural hematoma compressing the spinal cord
c/ Spinal cord infarction
122) 62-yr-old woman involved in a motor vehicle collision complains of upper extremity weakness & numbness. Has hypertension & osteoarthritis. Weakness of hand grip bilaterally & the triceps reflex is decreased on both sides. Decreased pinprick sensation is present on the fingers. Cause?
a/ Acute stress disorder
b/ Brachial plexus injury
c/ Spinal cord injury
123) 75-yr-old man comes with periodic substernal chest pressure. Significant for hyperlipidemia. Smokes a pack of cigarettes daily. He is prescribed sublingual nitroglycerin to take as needed when anginal pain occurs & a daily medication to help prevent anginal episodes. Medication functions through?
a/ Altered myocardial calcium level
b/ Coronary artery vasodilation
c/ Decreased myocardial contractility
124) female patient with IISL WHAT is your most appropriate step
a/ Reassure no need of test
b/ Repeat test after 12 months
c/ Review 6-12 weeks
125) patient with lacerated wound last dose 7 years ago
a/ Tetanus toxoid n ig (if primary vaccination not complete)
c/ Adt (if primary vaccination complete)
126) female patient has HTN,BP,CHOLESTEROL on perindopril atorvastatin presents with diarrhea which of following is drug side effect
a/ Metformin (diarrhoea)
d/ Acarbose (diarrhoea)
127) 6 month old child fell on concrete wound not child child not vaccinated (from mplusx qbank)
c/ Tetanus toxoid
clean wound – complete vaccination
dirty wound – give immunoglobulin, toxoid and vaccination
give everything as child not vaccinated
age < 10 years – DTPa age 10 – 18 years – dTpa age > 18 years – dT
128) diabetes drug n side effects
metformin – (GI disturbance, lactic acidodis, C/I gfr <30, cardiac disease, hepatic disease)
sulphynylureas (glicazide) – (hypoglycemia, weight gain, rash)
DDP4 inhibitors (gliptins) – pancreatitis
SGL2 (glifozin) – can be given in cardiac disease, uti
Thiazilodinediones (glitazones) – cardiac disease
130) dvt post surgery
heparin (1 week) and change to warfarin (3 months below knee) and (6 months above knee)
patient long travel
moving in airplane whenever chance
compression stockings (in high risk patients)
enoxaparin (prophylactic if history of dvt)
repeat / increase dose of salbutamol in acute exacerbation (6 puffs < 6 years and 12 puffs for ages 6 – 12) after repetition give ipratropium (4 puffs if < 6 yrs and 8 puffs if >6 yrs)
IV prednisolone (vomiting)
132) In adults – ipratropium in acute exacerbation
133) 75 yr old taking shower slips fell on floor with outstretched hand radius fracture vit d 55 hb 10.5 plt 80 xray shows osteoporosis in regard to fracture stabilisation what will u add to treat
a/ Vit d
c/ Oral fe
d/ Iv iron
e/ Vit b12
134) patient with schizophrenia on risperidone came for checkup when sits on chair he’s crossing legs then relaxing then crossing what condition best explains
a/ Akathisia (motor restlessness, unable to sit, has to keep moving legs) – 1) reduce dose of antipsychotics 2) add propranolol or benzo 3) change drug to some other 4) add anticholenergics, benztropine can be added if we cant reduce dose)
b/ Dyskinesia (difficulty in moving, slowness of movements)
c/ Dystonia (increased muscle tone)
d/ Normal mvt
e/ Tardive dyskinesia (choreoathetosis movements) – no Tx but clozapine can reduce progression
135) 65 year old male otherwise healthy but many comorbids hypertension,DM,Cholesterol,CRF smokes 10 pack per day on perindopril and acarbose,atorvastatin indapamide.his heart rate 80 per minute.irregular diagnose Atrial fibrillation albulmin creatinine ratio increase gfr less than 30/min other wise well what to add in therapy
Aspirin (CHADVASC – 1)
Warfarin (CHADSVASC – 2 or more)
Metoprolol (if tachy use it)
(if DOACs present then choose that)
136) patient booked an appointment ask if possible to meet outside
a/ Say not possible
b/ Book appointment
c/ Accept his wish
d/ We can book another time
138) 8 year old comes with mother.her teacher n mother say he doesn’t obey command he is aggressive hyperactive poor school performance IQ OK LANGUAGE SLURRED most likely diagnosis
139) 65 yr old rib fracture develop red patch on chest wall she’s in pain most appropriate next step
b/ Ibuprofen (can it given before morphine????) – follow step ladder??
(should be morphine??)
140) patient with asthma shortness of breath2 time salbutamol what next
b/ Oral steroid
c/ IV adrenaline
e/ Inhaled corticosteroids (after ipratropium – because it is a preventer)
(repeat salbutamol) then ipratropium bromide
141) what is erysipelas
Bright red (fiery red, superficial, well demarcated) vs cellulitis (deeper, not well demarcated)
fever in both
142) patient with asthma on salbutamol long scenario on inhaled steroids.during exercising in school frequent night symptoms cough but otherwise normal.reason for his symptoms (these options dont match)
Increase dose of ICS or add LABA
143) copd 20 year history of smoking on inhaler and steroids which of following leads to diagnosis
Leukoplakia (whitish pathes on tongue that CANNOT be scraped off)
Ca lung (weight loss, hempotysis)
Adrenal suppression (addison’s disease)
144) your next patient 8 yrs old when you examined him you diagnosed measles patient was waiting in waiting area what is next step
a/ Check serology
b/ Give vaccine
c/ Hosp adm
d/ Cover all contagious diseases
146) 45 old syncope ct angio done carotid stenosis <30%next appropriate step of management
147) female patient tonic clinic seizure1st episode xray ct blood test normal she takes old ppl community transfer one place to another what’s your advice
a/ Can’t drive 6 months??(5years in case of commerecial purpose)
b/ Inform driving license authority
c/ You can drive
d/ Ensure this is short time u will recover
148) duchene dystrophy ..patient present with recurrent chest infection,muscle wasting proteinuria,initial investigation
a/ Ct angio
149) patient coarse tremor but not cog wheel rigidity long stem whenever grabs pen iPads them she is otherwise normal what to give
150) 55 old patient presents with facial tongue muscle wasting and lower limb ankle joint ataxia sensory system intact .what is most appropriate step
a/ Vit b12 level
c/ Nerve conduction study
d/ Ct neck of spine
151/ Pregant woman at 14 weeks preg with BMI of 41. At 10 weeks she was 105 kgs and now she weighs 109 kgs. tests were normal. What is ur advice
-no more than 50gm per week weight gain
-no more than 9kg per week weight gain.
-she needs to maintain this weight till end (i chose this because it made sense, but i dont know if it’s right)
-she needs to lose 10 kg/ week.
-no need for advice
152/ 22 yrs young girls no health problems everything was normal. She get attack of painless lip swelling and face (angioedema) everyweek and so does her mother and brother. What do you do next?
– do allergen test
– test the food for allergies
– lead poisoing or something to do with lead
– C1 esterase inhibitor assay (i made a guess and checked afterwards, it does plays a role in herediatry angioedema, plz double check yourself)
153/- question on Colposcopy
– question on PICA syndrome but the options were with “lateral medullary syndrome”, signs of Horner’s syndrome. Questions starts symptoms of Horner’s and they ask you about which artery occlusion caused it.
– got few CT scans , i was confused. Also some question were like 1 and hald line…it was difficult to figure out what they were trying to ask. Like Vic mentioned, i am also not sure about 50% of the questions. Also apart from the symptoms, some questions had other information to twist the question or to make us confuse…i really don’t know what they were thinking while making these stems……
154) A 34 yr old lady comes to your clinic with a complain of infertility for 24 months and he has a history of 6 weeks abortion of a previous pregnancy when she was 16. She also stated that she obtained her first period at the age of 11. She is a smoker and was treated for PID 1 year ago. Which one of the following risk factors do you think contributed to her infertility?
a) Her age
b) Onset of early menarche
c) History of PID
d) Her history of abortion
157) 15 yr old female patient was homeless for three years and she comes with 10 week pregnancy with her 17 yr old boyfriend and wishes to terminate the pregnancy. What should you do
a) Call her family
b) Report to child protection
c) Accept her request
d) Call her boyfriend
158) 14 yr old female patient comes with 20 week pregnancy to clinic. She was pregnated by her uncle who lives with her and her family, and wants you to keep this information a secret and also wants to keep the child. What should you do?
a) Accept her request
b) Call her mother
c) Call the police
d) Report to child protection
159) You are an intern doctor attending operation in the OR and one of the surgeon resident made a mistake that cause patient to bleed and one of the senior surgen comes to attend to patient to stop the bleeding. After the operation what action should you take as an intern doctor ?
a) Tell the patient what happened
b) Report to the hospital committee
c) Report the incident and document
d) Report to AHPRA
e) Report to intern co-ordinator
160) You are an intern doctor and you see one of the resident doctors using an antipsychotic drugs prescribed by himself. You speak to him and confront the situation and he tell you that he is feeling stressed and overwhelmed with the workload and uses it to help him. What is the next step you should take?
a) Do nothing
b) Tell him to see another doctor/specialist
c) Report to AHPRA
d) Report to intern co-ordinator
161) A 34 yr old lady comes to your clinic with a complain of infertility for 24 months and he has a history of 6 weeks abortion of a previous pregnancy when she was 16. She also stated that she obtained her first period at the age of 11. She is a smoker and was treated for PID 1 year ago. Which one of the following risk factors do you think contributed to her infertility?
a) Her age
b) Onset of early menarche
c) History of PID
d) Her history of abortion
162) 65 years old k/c of Barrett Oesophagus presents with heart burn and he is on PPI , he is otherwise normal in health you did the endoscopy it showed low grade dysplasia- most appropriate step regarding surveillance—-
A) Repeat every 2-3 years
B) Repeat every 6 months
C) Distal Esophagectomy
D) Start Chemo
163) Barrett’s esophagus high grade dysplasia…what appropriate step?
164) Dyspnea, hypotension 8/40, bilateral crepitations CT chest was given, asking diagnosis?
165) Red warm swollen n dilated leg having temp 38° pulses are non palpable, diagnosis?
166) Linear growth graph
167) Biostatistics questions, no calculations but definitions
168) Premature rupture of membrane
169) Redness, severe eye pain, decreased vision, diagnosis?
170) ECG: pericarditis asking T/M? Nsaids
171) Nurse giving dec. Dose of morphine, who to report?
172) Fellow doctor self prescribing antipsychotics.. benzodiazipine,what to do?
173) Surgeon makes a mistake, registrar out of country, what to do?
174) 18 mo old baby having febrile seizures, which vaccination should not be given:
175) Herpes zoster, after 6 days presents with nerve pain, what is treatment? (similar from mplusx qs)
a. IV acyclovir
b. Oral acyclovir
176) pt. With HSP asking complication?
177) Fever,tachycardia, muscle pain+ weakness+ joint pain,digital infarction, severe headache,diagnostic test? Dx: Polyarteritis nodusa.. Renal biopsy and other options were given
178) 10 years use of OCP causes which Carcinoma?
179) Xray- Large bowel obstruction
180) 25 yrs old man complain of low back for several months,no any comorbidites present,no history of iv drug abuse.Asking next step?
181) 8 yrs old boy with fever and cough ,RR-40.on examination chest is clear no crackles and wheeze.Asking treatment?
-iv bendy penicillin
182) 43yrs old man present with dehydration.After giving 2L 0.9% Nacl he is better now.Asking advice?
a. oral rehydration
b. Continue same treatment
c. Discharge home
183) Mva pt present with stridor and neck swelling.Asking next step?
184) Limb ischemia ABI on rt leg 0.8 and left leg 1.3 ,rt dorsalis pedis is difficult to palpate and pulse is not felt while left leg pulse is ok.Asking investigation?
-Arterial duplex usg
185) 2 yrs old child with repetitive urti,history of recurrent ear infection and nasal discharge.Asking diagnosis?
– Ciliary dysfunction
– Cystic fibrosis
– Celiac disease
186) 18m old child with nephrotic on steroids for 8m, which vaccine to avoid-
187) Young woman pain post coitus, examination normal except left cervical motion tenderness-
a/ urine routine
b/ Chlamydia pcr
c/ High vaginal swab
188) Management of kidney stone according to size
189) Ecg svt plus asthma patient
190) SVT- mgt?
191) Type of study- prevalence of diabetes in a community.
192) A RCT was conducted regarding use of Antibiotics during suturing and risk of wound infection. What is the Attributable risk?
193) Recurrent upper and lower respiratory chest infections and failure to thrive child- CF
194) Akathisia question
195) Charcott marie tooth disease
196) Graph- covid – A, B, C counties , reason for B country?
199) Post op- SBO with adhesion- which symptom present will need immediate medical attention?
a/ Vomiting with feculent material
b/ Increasing temperature
c/ Increasing pain
200)Linear increase of cancer
201) Heparin induced thrombocytopenia- on heparin developed DVT , what to do?
a/ Change to new anticoagulant
b/ Continue heparin
c/ Stop anticoagulant
202) Melanoma case excised with Breslow thickness 0.3 mm and 2 more dysplastic nevi on back. What next?
a/ Remove dysplastic nevi
b/ Wide excision
203/ Healthy Women with no family history of breast cancer but her friend recently got diagnosed with breast cancer. Worries about breast cancer and what to do next?
A Mammogram now
B mammogram screening from 50 y
C no screening needed
204/ Man with behavioural changes work as real estate agent, getting angry on others, resting tremors present and wide base gait. His uncle and aunt had same problem died at 50. What is the most appropriate investigation?
a/ Serum ceruloplasmin
205/ PTSD case under protection!
206/ Mplus- Man has hoarding problem and wife is frustrated. Which history is important?
a/ Drug abuse,
b/ sexual abuse,
c/ dementia history
207/ Man 12 hrs after surgery developed high fever. Diagnosis?
208/ Man with abdominal discomfort living in a farm. CT given with some three homogeneous hypodense lesion. Not hydatid cyst.
Amoebic liver abscess. Mgt?
c/ Needle aspiration
207/ Child with cleft palate and 16 year old mother want to give the child for adoption. What to do?
a/ Arrange for adoption
b/ Arrange for social service consultation
c/ Force her to keep baby
d/ Ask her mom to raise the baby
208/ Patient with resting tremors. Treatment?
209/ Exercise induced asthma. What to do?
a/ Inhale Salbutamol before
b/ Inhale fluticasone/falmetrol
c/ Oral steroids
d/ Oral leukotriene antagonist
210/ Acute asthma already took three SABA inhalation. What to do next?
a/ Oral steroid
b/ Inhalation ipratropium
211.Patient 20 weeks pregnant come with increasing SOB. One examination, Alec best palpated on midaxillary 5th ICS. On auscultation, systolic murmur is heard diffusely, short diastolic murmur in left 2nd ICS. S3 is heard and on echo prominent pulmonary artery and it’s branches. Hepatomegaly 3cm large palpable. Increased jugular venous. What is the diagnosis?
C Pulmonary stenosis
D Aortic stenosis
E Mitral insufficiency
212.80 yr old Patient had TIA. He had past history of hemetemesis following ibuprofen took for arthritis. It was treated with omeprazole and has gastric ulcer. What is the management?
D No treatment
213.Patient is a known case of RA on methotrexate and hydroxychloquine. Now have come for prenatal advice. She wants to conceive abs asking for advice on RA medication. What to do?
A cease both drugs and start adalimubab
B cease both and start on leflunomide
C continue methotrexate alone
D continue hydroxychloroquine
214.Angioedema hereditary case
215.PID case, next investigation?
216. Patient having primary amenorrhea. Physical examination normal. No improvement with esteogen challenge. Next investigation?
A FSH, LH
B USG Abdomen
217. Patient attained menopause having hot flush. Want to start HRT. Which is the right management?
A continuous eateogen
B continuous estrogen and progesterone
C continuous estrogen and cyclical progesterone
D high dose estrogen and progesterone
218.Patient having diarrhoea, AF and weight loss. What is the diagnosis?
B ischemic heart disease
C GI illness
219.Patient having low TSH. What is the next investigation?
B TSH and T4
C Thyroid USG
D Anti TPO
220. Patient 9 weeks pregnant have presented with MNG. Her blood tests show hyperthyroidism or hypothyroidism. What is the diagnosis of choice to confirm?
A Radionucleotide iodine uptake test
B thyroid USG
C Anti TPO ab
221/.Babinski sign positive , hypotonia , Amyotrophic lateral sclerosis case. What is the investigation of choice?
A nerve conduction study
E B12 level
222.Patient has anemia, macrocytic, thrombocytopenia, abnormal granulocytes. What is the investigation of choice to confirm?
A bone marrow biopsy
B serum B12
C serum folate
D HB electrophoresis
223.Girl collapsed and lost pulse had to do CPR to revive her. She was soon sent to hospital in ambulance. Vitals normal and she was feeling good. She wants to leave now. What is the appropriate management?
A Discharge her and do echo as out patient
B admit her under cardio care
C no management needed
224.12 year old child with history of multiple falls. On examination areflexia, loss of sensation, weakness of distal muscles.Thinking so Charcot marrie tooth disease.
225.60 year old man having difficulty in climbing upstairs and not able to comb hair. On examination difficulty in abduction. What is the diagnosis?
B Myasthenia Gravis
C Multiple sclerosis
D Motor neuron disease
226.Gross hematuria and proteinuria. Usg normal. Next investigation?
B renal biopsy
D Urine culture
227.Patient is worried about prostate cancer. His dad had it at 85 years. His neighbor has been recently diagnosed with prostate cancer. On DRE, prostate is normal. He is otherwise healthy. What to do next?
A do PSA after two weeks
C prostate Usg
228.5th metacarpal fracture and treatment?
A elevation and rest
B plate and screws
C K pin
229.Boy fell down from ladder and complain of severe headache and vomiting ever since arrived. The clinic is in rural and no CT facility available. Only USG available. What to do?
A arrange ambulance and send the boy to nearby tertiary care
B monitor and observe the patient
C Do series of skull X-ray
230.A ct given with hematoma in abdominal wall. The stem didn’t specify hematoma. Patient started to have abdominal pain. Patient is on LMWH following DVT. What is the immediate management?
A stop LMWH
B Platelet transfusion
C Surgical exploration
D start NOAC and stop LMWH
231.Patient has claudication on walking and relieved on rest. On examination, patient femoral pulses are diminished and dorsal is Pedis not felt. ABI one leg 0.8 and another 1.3. What is the most appropriate?
A CT angio
B duplex Doppler
C start on statins
232/ Pt’s taking metformin, verapramil , revostigmine , perindropil.now came with 3degree heartblock. Which drug cease
SVT ask tx
Xray COPD …
233/ Breast mass usg
224/ A school teacher 28wks pregnant. Contact Varicella chicken pox but she know develop chicken pox in childhood. Next step..
225/ Pt s/p sx on enoxiparin comes with mild chest pain and breathlessness- ctpa shows mild PE in branches.
– continue enoxiparin
– increase enoxiparin to 80mg
– switch to warfarin
227) Middle aged woman s/p sx, chest pain, pedal edema, breathlessness. O/E – left lower base dullness and diffuse fine crepts
– Postural pneumonia
229) Sx pt with long standing right subclavian central line. Now removed. Came with fever, left sided chest pain, crepts. B/L A/E normal
230) 36m old child, milestone red flag
231) 44yr aboriginal child with grean yellow discharge from both ears ×3 months, mother cannot understand child.
– organism- h infuenzae, pseuromonas, strep pneumonia, staph
232) 8m old child with nephrotic on steroids for 8m, which vaccine to avoid-
233) Young woman pain post coitus, examination normal except left cervical motion tenderness-
High vaginal swab
234) young child toxic, intermittent pain abdomen with colic, now continuous with pain and guarding and mild episode of diarrhoea-
235) Middle aged man – normal with bloody stoolscrohns
236) Child with history of urti 3 weeks ago, had painless haematuria and Protein. Now normal.
b) nephrotic syndrome
c) post viral idopathic
237) Child with purpura and multiple bruises-
c) non accidental injury
238) SAIO x ray 1st step
– NG tube
239) Young woman with right hypochondium pain and nause x3 days
Took 10tabs of pct 2days ago, now jaundice, tender hepatomegaly, lft derranged, pct level <4
a Viral hep
b Pct induced
240) K/c/o seizure disorder on ocp for 10 yrs, had one episode of seizure- Rx.-
a. Cease ocp
b. Check thrombophilia
c. Increase dose of ocp
241) Preg, tender goitre. TSH low t3, T4 normal
b. Iodine scan
242) 9yr old child comes with mother with recurrent abdominal pain and refusal to go to school and insistence that the mother stays at home with her. Mother got a new job-
b home tuition
c liaise with school about planned return
d send child to boarding school
243) Right side headache followed by severe shooting facial pain- pt has right sided weakness of face and limbs- ct brain normal-.
a) Herpetic encephalitis
b) Right parieto temp infarct
c) Right medullary infarct
d) Right pontine infact