At the time of writing this article, forty-two cases of monkeypox have now been identified in NSW residents. One case is confirmed to have acquired the infection in NSW, while two other cases acquired their infection within Australia. NSW Health Executive Director of Health Protection Dr Richard Broome said the recently diagnosed case highlights the importance of people remaining vigilant for symptoms regardless of whether they have visited high-risk environments overseas.
“Men who have sex with men who are returning from overseas should contact their GP or local sexual health clinic for a check-up when they return as symptoms of monkeypox can be mild,” Dr Broome said. “Symptoms usually begin seven to 14 days after exposure through skin-to-skin contact and can include fever, headache, body aches and a rash or lesions on the genital area. It is important that people with these symptoms avoid close contact with others, including sexual activity, as condoms are not effective at preventing the transmission of monkeypox.”
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Australian Medical Council (AMC) MCQ Recalls AUGUST 2022 compilation
48 Para3 with stage I hormone receptor–positive lobular breast carcinoma is prescribed with tamoxifen. Has hypertension & hyperlipidemia. Risk of long term tamoxifen therapy?
a/ Cervical dysplasia
b/ CAD
c/ Hot flash
Teenage boy comes due to discomfort & heaviness of his scrotum. An irregular, ropy mass is noted on both sides of the upper scrotum. Mass increases in size with Valsalva & reduces on supine positioning. Proposed surgery is to prevent?
a/ Chronic epididymitis
b/ Infertility
middle-aged man comes due to 2wk of urinary urgency, frequency, dysuria & perineal pain. Urinalysis shows pyuria, many bacteria & no red blood cells. Organisms involved?
a/ Chlamydia trachomatis
b/ Escherichia coli
40yo woman has a 4-yr history of rheumatoid arthritis & has been taking DMARD She reports significant improvement in joint pain & stiffness with treatment & can now perform daily activities without difficulty. Additional adverse effect of pharmacotherapy?
a/ Hepatotoxicity
b/ Neurotoxicity
22yold nulliparous woman sexually active a few mths ago with boyfriend; she is monogamous & uses condoms. Received all recommended vaccinations. Her mother was diagnosed with ovarian cancer at age 46. Recommended test?
a/ Cervical human papillomavirus testing
b/ STI test
c/ CA125
d/ No test needed
62man recently had episodes of sweating, headache, tremor & palpitation. T2DM, hPT, PVD & hyperlipidemia, chronic kidney disease & renal function has declined significantly over the past 2 yrs despite optimal glycemic control. Diagnosis?
a/ Angina pectoris
b/ Catecholamine-secreting tumor
c/ Insulin excess
4yr-old boy is brought due to fire ant bites. There are approx 10 small pustules on each foot that are surrounded by a large area of erythema swelling contiguous to the pustules. Patient can bear weight but cries when asked to walk. Next step?
a/ Administer intramuscular epinephrine
b/ Give oral antihistamine and topical corticosteroids
62-yr-old man from Groote island come due to 3 mths of progressive unsteadiness & difficulty walking. Never visit healthcare service provider. Episodes of transient, sharp, stabbing pain in his back & lower limbs, as well as involuntary dribbling of urine. Gait is broad based. Pupils small & irregular & constrict poorly to light. Argyl pupil? Treatment?
a/ IV benzylpenicillin
b/ Intravenous immunoglobulin therapy
25y/old woman comes due to heavy menses. An active volleyball player but unable to play recently due to increasing fatigue, diffuse myalgias & bilateral pain in her wrists. There are scattered petechiae across the body with a few large ecchymoses on the forearms. Next step?
a/ ANA screen
b/ Ascorbic acid level test
70yo woman comes for routine evaluation. History of constipation-predominant irritable bowel syndrome, hypertension & diabetes mellitus. Mild conjunctival pallor is noted. Rectal exam shows external hemorrhoids & fecal occult blood testing is positive. Next step?
a/ Anoscopy
b/ Colonoscopy
19 age waiter comes due to overwhelming “stress.” Unable to concentrate at work & is afraid will be fired because he is often late. He mentioned that he lives near at work but frequently has to make lots of stop. Everytime he drive pass a bump, he is conviced that he might run over someone and have to keep check underneath. He frequently check news if he has knock down anyone. Family history is notable for schizophrenia in a maternal uncle. What to do?
a/ Citalopram
b/ Venlafaxin
18 teenage woman is brought after a suspected drug overdose. Bottle of paroxetine 20 mg containing 30 pills was found empty & next to her. Has MDD but no prev suicidal attempt. Clothes are stained with emesis. Eyes closed, but moans & withdraws all extremities to painful stimuli. Next step?
a/ Administer activated charcoal
b/ Evaluate for coingestants
c/ Administer sodium bicarbonate
d/ administer cyproheptadine
e/ Obtain serum levels of paroxetine
11yo boy is brought due to a pruritic skin rash for 2 wks. A cousin who recently visited & shared a room with him had similar symptoms. Numerous 2- to 3-mm erythematous papules & vesicles with excoriation on his neck, hands, feet & waistline. Intervention?
a/ No intervention necessary
b/ Oral acyclovir
c/ Topical permethrin
30age woman with bipolar I disorder has been stable on valproate for the past 2 yrs. History of 2 hospitalizations at age 24 & 33 for major depressive episodes. Patient decides to stop the valproate during her pregnancy & switch to a different medication. Most appropriate option?
a/ Bupropion
b/ Carbamazepine
c/ Lamotrigine
2wk baby with eye tearing & discharge. Linear abrasions across the left cheek & lower eyelid. Fluorescein dye testing on the left eye shows equal distribution on the cornea & conjunctiva. After 5 min, a large amount of dye persists & drains over the lower eyelid & down the cheek. Diagnosis?
a/ Corneal abrasion
b/ Dacryocystitis
c/ Nasolacrimal duct obstruction
55yo man, reddish-brown urine with joint pain, fatigue, and a lower extremity rash. Diffuse palpable purpura on both lower extremities. pain with movement of the knees and elbows. diagnosis?
a/ Anti-cyclic citrullinated peptide antibody levels
b/ Serum cryoglobulin levels
24yo woman comes due to a 6-wk history of abdominal cramps, loose stool & bloating. Has 4 or 5 watery, foul-smelling stools daily. Lost 2.5 kg. Works in a day care center & has not traveled recently. The abdomen is soft with active bowel sounds & mild distention. Next step?
a/ Abdominal CT scan
b/ Stool antigen testing
58yo man comes due to yellowish discoloration of the skin, anorexia & weight loss of 6 kg over the past 3 mths. Dark urine & pale stools. History of hypertension & hyperlipidemia. Scleral icterus is present. An enlarged, nontender gallbladder is palpated. Likely finding?
a/ Cystic lesion at the tail of the pancreas
b/ Intra- and extra-hepatic biliary duct dilation
19yo teenage man is brought after a hard fall during a skateboarding trick, striking his left flank against the rail. Felt short of breath for approx a min after the impact. Has pain in the left midback. Left flank is bruised & tender to palpation. Next step?
a/ Admission for serial hematocrits
b/ CT scan of the abdomen
19 teen man with mild intellectual disability is brought by his mother for a follow-up visit. Poor work performance & a change in behavior lately. The mother says he’s somewhat sad & nervous lately, a departure from usual friendly & talkative demeanor. Avoids eye contacts. Next step?
a/ Evaluate the patient without his mother being in the room
b/ Inquire whether the patient agrees with his mother’s description of him
32yo woman comes due to “feeling anxious & down” for the past 2 wks. Cries frequently & makes mistakes in her job due to poor concentration. Tense throughout the day & difficult staying asleep most nights. Mugged 3 wks ago while walking home from work. Diagnosis?
a/ Acute stress disorder
b/ Panic disorder
32-yr-old primigravid at 18 wks gestation comes for a prenatal visit & anatomy US. Had a cousin whose child died from Tay-Sachs disease a few yrs ago. Genetic testing in the woman detects a pathogenic variant for the HEXA gene, consistent with Tay-Sachs disease. Best initial statement?
a/ “There is a chance that your son could inherit Tay-Sachs disease; we will need to test the father to better understand the risk.”
b/ “The results confirm that your son has Tay-Sachs disease; let’s talk about what that means for you and your baby.”
65y/o man complains of a 4-mth periodic back pain radiating to his buttocks & thighs. Pain is exacerbated by walking or prolonged standing. Occasional tingling & numbness in both lower extremities. Notable for benign prostatic hyperplasia, hypertension & hypercholesterolemia. Cause?
a/ Lumbar disk herniation
b/ Lumbar spinal stenosis
25yo G1P0, at 24 wks gestation comes due to decreased fetal movement. Last wk, the patient went to a picnic & the next day she had nausea, watery diarrhea & muscle aches. Heart tones absent on Doppler & a transabdominal ultrasound confirms an intrauterine fetal demise. Cause?
a/ Listeria monocytogenes
b/ Staphylococcus aureus
16yo girl comes due to not having started her menstrual period. Height at 70th percentile. Stage 4 breast development with minimal axillary & pubic hair. Vagina is 3 cm in length. No uterus, cervix, or ovaries are palpated on bimanual exam. Testosterone level of 400 ng/dL. Diagnosis?
a/ 5 alpha-reductase deficiency
b/ Androgen insensitivity syndrome
29yo woman complains of fever, chills & lower abdominal pain after undergoing dilation & curettage 2 days ago. US shows a thickened endometrial stripe. Patient is started on broad-spectrum IV antibiotics & undergoes a suction dilation & sharp curettage. Increased risk?
a/ Development of intrauterine synechiae
b/ Infarction of the pituitary gland
3yo boy is brought for evaluation of red-tinged urine. Recently treated with antibiotics for streptococcal pharyngitis. There is a firm, nontender, palpable mass in the left abdomen. Diagnosis?
a/ Nephrolithiasis
b/ Wilms tumor (nephroblastoma
34yo man with erectile dysfunction complains of pain & penile curvature during erections making vaginal penetration difficult. Has a total of 5 female sexual partners. A palpable plaque is present on the dorsal side of the penis approx half way between the glans & the pubis. Diagnosis?
a/ Genital warts
b/ Penile cancer
c/ Peyronie disease
Despite antihypertensive therapy, a 67-yr-old man has persistently HBP readings. Has type 2 diabetes mellitus, coronary artery disease & ischemic stroke. Underwent coronary artery bypass surgery 7 yrs ago & carotid endarterectomy 5 yrs ago. Upper abdominal systolic-diastolic bruit. Diagnosis?
a/ Abdominal aortic aneurysm
b/ Renal artery stenosis
46yzo man vomited blood. Notable for alcohol use disorder & chronic dyspepsia. US revealed an enlarged, hyperechoic liver & gallstones in the gallbladder & endoscopy found mild esophagitis & gastritis. Nasogastric suction returns normal stomach contents mixed with bright red blood. Cause?
a/ Hemobilia
b/ Mucosal tear at the gastroesophageal junction
5day baby boy born at 32 wks gestation has emesis with last 3 feeds; 1st two were green & 3rd coffee-ground. Mixture of breast milk & cow’s milk administered via nasogastric tube. Abdomen distended & tender. Radiograph reveals pneumatosis intestinalis. Next step?
a/ Blood cultures and antibiotics
b/ Immediate laparotomy
3day baby boy born at 37 weeks gestation to a 26-yr-old gravida 2 para 2, via spontaneous vaginal delivery. Phototherapy was initiated at 48 hrs of life due to hyperbilirubinemia. Breastfeeding every 2-3 hrs. Skin exam shows jaundice. Next step?
a/ Begin intravenous immunoglobulin therapy
b/ Start exchange transfusion therapy
3 yrs boy with rash on his face, chest, back & arms. Went on a camping trip. Has runny nose, dry cough, fever,watery & injected bilateral conjunctivae. White lesions present on buccal mucosa. The oropharynx & tonsils are erythematous. Mobile lymph nodes along the cervical chains. Diagnosis?
a/ Adenovirus
b/ Measles
21-yr-old man comes due to unsteady gait & difficulty urinating. Numbness in feet, thighs, buttocks & abdomen. Sensation to touch, temp & pinprick reduced below midthoracic region. Vibration & joint position sensation absent in both feet. Bilateral upgoing plantar reflexes. Diagnosis?
a/ Spinal epidural abscess
b/ Transverse myelitis
32 yo woman presented with 8 month hx of painless bumps at vulva. Bumps itchy and bled when pull on it. HIV negative. Photo given. Dx?
a/ Genital herpes
b/ condylomata acuminata
c/ condylomata lata
10y-old girl is brought due to right ear pain. Recent reunion at beach house; cousins visiting contracted upper respiratory infection. Had recurrent acute otitis media complicated by persistent effusion & required tympanostomy tube placement at age 2. Canal is red & swollen. Cause?
a/ Tympanostomy tube placement
b/ Water exposure
40-yo man with a wk of progressive abdominal discomfort, distension & nausea. 6 wks ago, was hospitalized for acute pancreatitis. Heavy drinker before hospitalization but abstinent since then. History of alcohol intoxication & street fights. Epigastric fullness & tenderness. Nexy step?
a/ Cholecystectomy
b/ Endoscopic drainage procedure
32y/o man is brought confused, disoriented & bleeding from the nose. History has an episode of major depression. Temp 42, BMI 40. Skin is warm & dry & his neck is supple with no stiffness. Moves all extremities but unable to speak or follow simple commands. Diagnosis?
a/ Anticholinergic toxicity
b/ Heat stroke
old man 76 comes for follow-up of hypertension. Patient is imagining things. Reports intermittent insomnia but no change in appetite. Occasionally forgets names & has word-finding difficulty. Performs household chores & handles finances. Alert, oriented & irritable. Diagnosis?
a/ Schizophrenia
b/ Delusional disorder
70-yr-old man with 10-yr Parkinson disease is brought for evaluation of dizziness. Able to walk 1 mile daily until he developed dizziness & syncope when standing. Medications include levodopa, carbidopa & a multivitamin. Neurologic exam shows mild tremor & bradykinesia. Cause of dizziness?
a/ Adrenal insufficiency
b/ Autonomic insufficiency