The Australian Government is providing $1.3 million to Beechworth Health Service to roll out and evaluate a tool that improves care planning for older Australians across what matters to them, medications, mobility and mental health. The Indigo 4Ms tool – which was co-designed with local communities and health and aged care stakeholders – will be rolled out to six rural health services across north-east Victoria, along with training to primary care clinicians on how to use it. The tool provides structure to the care of older people, ensuring that health care professionals: understand and act on a person’s values, priorities, goals and care preferences; screen for high-risk medications and prescribe medicines effectively; support patients to stay mobile and take part in physical activity that suits their ability; assess and ensure adequate hydration, nutrition and sleep ;screen, assess and manage vision, hearing, incontinence, cognitive decline and depression. This funding will translate community-led design into practice to benefit Australians living in rural and remote communities in north-east Victoria.
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Australian Medical Council (AMC) MCQ Recalls JUNE 2023 compilation
10M w/ exertional fatigue, exercise intolerance x2mo. Denies black/tarry stools, hematochezia, abd pain. diagnosis?
a/ CT angiography
b/ Fecal calprotectin
c/ Technetium 99m pertechnetate scan
What to do ?
woman in first trimester comes with Rubella IM positve
What to do if a woman first trimester IgG negatve rubella comes to you ?
22F w/ regular menses, 4-5 days. LMP 3wks ago. Mild pain in L lower abdomen x2 days. Sexually active, copper IUD. Negative pregnancy test. next?
a/ Aspiration of ovarian cyst fluid
b/ Observation and repeat examination in 6 weeks
Chest injury paradoxical breathing conscious morphine, what
Is next appropriate management? (flail chest)
A. Intubate
B.IV antibiotics
X-ray bilateral lymph node, high ca level, painful rash on legs. Next ??
A. ACE LEVEL
B. Ct chest
skin biopsy
Lung biopsy
Aggressive patient in opd. (similar question from mplus) What to give?
A IM Midazolam
B IM Haloperidol
SVT ECG shown for an 8 yo child presenting with palpitatons, pallor. Says he’s been having previous episodes. HR 220. Initial management?
A. Adenosine
B. Valsalva
C. IV hydraton
Fat obese female in her 40s presentng with sudden upper epigastric abdominal pain vomiting and nausea. Lipase highly elevated. Next thing to do?
A. IV hydraton
B. Ct scan
C. Antibiotcs
Female presentng with loin to groin pain. UA revealed clear cut UTI, urine culture done revealing E coli. Treated and feels beber but acer 4 days stll presents loin to groin pain. Next step?
A. CT
B. Change abx
C. Contnue abx
D. Urine culture
initial management of ingrown nail
Definitve managment of phlebitis
Man presence with sever rtrostoral chest pain. Took nitroghearin. 25
pack yr smoker. No ther symptoms.
Women had a travel history. Past history not significant. Has Dvt symptoms.
Started on enoxheparin. What is the long term management?
Warfarin 6 to 12 weeks.
Warfarin 6 to 12 months.
Asprin and Clopidogrel 6 to 12 weeks
Asprin and Clopidogrel 6 to 12 months
Young man with Symptoms of fever, tiredness AST, ALT, ALK Bliirubin level
deranged. FBC Normal. Long term relationship with same partner.
Atypical lymphocytes 20 %. Dx?
EBV
Cytomegalovirus
Hepatitis A
Hepatitis B
Features of primary aldosteronism. Most reliable investigation?
Aldosterone/renin ratio
78 yo female presentng with progressive dyspnea and SOB. Nyha class ili symptoms. Echo done with ischemic cardiomyopathy EF 30s. On perindopril, meformin. What is the best mgmt?
A. Digoxin
B. Spironoloactone
C. Beta blocker
Picture really resembled pyogenicc granuloma but was sheep farmer.
A. Orf
B. Pyogenic granuloma
C. SCC
Picture of dupuytren from JM. What is the mgmt?
A. Physio
B. Inject steroids
Picture of mass in old woman from HB. tender, nonfirm, slowly growing for 4 months. Best inital dx?
A. MRI head neck
B. US
C. CT sialogram
79 yr old male presents with ear pain. 40 pack yr smoker. Ear exam normal. No other sx. Most likely diagnosis
A. Acoustc neuroma
B. Otosclerosis
C. Tongue cancer
Pic of pyogenic granuloma
CT of liver hematoma. Sudden abdominal pain settled spontaneously in 6hours. Dx
Hydatid cyst
HCC
Liver hematoma
Pic with eye disease in a 6month old with yellow crust and discharge.
Exclusion period from day care?
Pic of duptyrens contracture. Treatment?
Missed contraceptive pill of D14 used to take pills at 10 pm every night. She
had intercourse during that night. Presented to GP next day morning 11am.
What will you advice?
Take the Missed pill now, and continue the other pills as same.
Take emergency contraceptive and continue same
Take the double dose and continue the same
Super long stem of old man with htn, dm. On multple meds. Picture of ECG shown. Simply asked what the ECG showed – prolonged pr (more than 5 boxes), (-) sokolow lyon, cornell, (-) delta wave
A. RBBB
B. LBBB
C. First deg AV block
D. WPW
30 y female, dairy worker with progressive headaches nausea for 3
weeks or 3 months cant recall.
LP was done revealing meningits. Cause?
A. Brucella
B. Listeria
C. Lepto
25 yo drug user (stopped 2 yrs ago) with monogamous sexual partner presentng with abdominal pain. HCV serology positve. LFTs mildly elevated Next test to do?
A. Hbsag
B. Hcv rna
Hcv genotype
Milky white painless discharge on 25 yo man. Treatment?
A. IV cro
B. IM cro
C. Oral doxy
SLE patent to be started on azathruoprine, hydrochycloro, prednisolone. Tests to ensure preventon of drug toxicity?
A. Serum crea
B. LFTs
C. TP genotype
D. Tmp phenotype
37yo, G1P0, 32wks gestation. no vaginal bleeding, contractions, or fluid leakage. wants home birth with doula and mother present. statement?
a do not recommend home births, increased risk of complications
b should come to the hospital while delivering
6hr-old boy w/ tachycardia. Born at 40 wks to 30F w/ treated Graves’ disease. Mother hypothyroid on L thyroxine during pregnancy. weight 2070g. cause?
A Ectopic thyroid tissue
B Inadequate maternal surgery
C Transplacental TSH-receptor antibody
Agitated man at mall brought by police. Shows threat and harm to other
staff at ER. What first to give?
A.IV diazepam
B. IV thiamine
C. IM droperidol
24 yo male with travel history and 3 sexual partners presenting with jaudnice generalized lymphadenopathy splenomegaly hepatomegaly. CBC reveals atypical lymphoscytes. LFTs done mildly elevated
Table given asking for specificty
Patient presented with UGIB. Endoscopy with adrenaline injection done. H pylori negative. Next best thing to do
A. Repeat endoscopy after 4 weeks
B. Triple therapy abx
C. Urea breath test
10 yr old male presenting with soiling. Is 1 yr behind high school. Most likely cause
A. Constipation
B. Sexual abuse
48M in ED w/ facial drooping, L ear discomfort. Hx of HTN, hyperlipidemia. L facial asymmetry, drooping mouth, unable to fully close L eye. pharmacotherapy?
a/ Alteplase
b/ Prednisone
4M in ED w/ increasing fatigue, persistent fever, poor appetite, weight loss, refusal to walk. Fever, pale conjunctivae. Enlarged spleen, thigh tenderness. diagnosis?
a/ Antinuclear antibody testing
b/ Bone marrow evaluation
65F w/ leg weakness, difficulty walking x6mo. Dull headache, urinary incontinence. PMH: rheumatoid arthritis on methotrexate. cause?
a/ Parasagittal meningioma
b/ Mononeuritis multiplex
Young female doing excessive exercise on low carb and high protein diet –
lose weight. Which investigation to reach diagnosis?
Serum electrolytes
Check hormones
Dental examination
Check BMI
9months of baby with features of pneumonia. Most likely causative
organism
Streptococcus pneumoniae
Hempophilus influenza B
Klebsiella
*Breast carcinoma treated years ago, lady coming with left arm swelling. 3
cm different from other arm. Red and swollen. She is obese. BMI 33.
Compression garment given. What else to do..
1 intermittent pneumatic compression
2. Warfarin
65M w/ depigmentation x6yr on face, posterior scalp, hands, genital area, feet. Skin exam: widespread depigmentation. explanation?
a/ Age-related depigmentation
b/ Destruction of melanocytes
c/ Inherited absence of melanocytes
32F w/ social withdrawal, prefers staying home, anxiety episodes x2yr, avoids friends. Difficulty sleeping, concentration problems. cause?
a/ Dependent personality disorder
b/ Panic disorder
c/ Schizoid personality disorder
38F f/u major depressive disorder. Started escitalopram + psychotherapy 2 wks ago. Stressed w/ husband away, father hospitalized for stroke. Next step?
a/ Maintain current dose of escitalopram
b/ Discontinue escitalopram and start trazodone
74M w/ persistent back pain at L1-L4. Sudden onset, constant, deep, dull pain. Difficulty falling asleep d/t increased pain. Hx: HTN, smoking (40 pack-years). next step?
a/ CT scan of the abdomen
b/ MRI of the spine
c/ Serum amylase and lipase
9M behavioral concerns. hyperactive, can’t sit still, interrupts, forgets chores. No appetite/sleep changes. scar on R leg, scabs on R knee. medication to calm down. Next step ?
a/ Obtain behavioral rating scales from the patient’s teachers
b/ Interview the parents separately
26F bizarre behavior. Hearing multiple voices, some tell her to kill herself. Admitted, started aripiprazole, improved. Treatment?
a/ Continue medication indefinitely with regular follow-up
b/ Gradually taper and discontinue medication over 1 month
37M w/ 10-day fever, cough, dyspnea on exertion. HIV+ for 10 yrs, noncompliant w/ meds. Started antibiotics, IV fluids. 2 days later, improved dyspnea but confusion. Cause?
a/ Factitious hyponatremia
b/ Inappropriate antidiuretic hormone secretion
72M w/ abd pain, vomiting. HTN, dyslipidemia. Chest pain on exertion, resolves w/ rest. Fever, hypotension, tachycardia. Diffusely tender, distended abdomen. Next step?
a/ Order coronary CT angiography
b/ Proceed to surgery without further testing
c/ Proceed with coronary angiography
42F w/ abd pain, distension. Upper abd discomfort 4 wks ago. Abd distension, dullness to percussion, tender hepatomegaly, splenomegaly. Next step?
a/ Abdominal Doppler ultrasonography
b/ Chronic hepatitis serology
Obese women with painful intercourse, no post coital bleeding. USS-retroverted uterus. No tenderness in Vaginal exam.
1. Pericerviacal fat depositin
2. UTI
3. Normal varient.
Woman had a surgery, went home and got SOB and died. Diagnosed as massive pulmonary embolism.
What to write in the death certificate.? The COD.
1. cardiac arrest
2. Pulmonary embolism
3. Surgery
skin rash, only in legs and mildly in buttocks.
1.Topical steroids
2.Topical antibiotics
3.0ral antibiotics
Woman 8 weeks pregnant, comes with spotting and abd pain. When she lies down gets shoulder tip pain. What of these is the main concern..?
1. Bleeding
2. Abd pain
3. Shoulder tip pain.
35F w/ weeklong rash in bilateral axilla. Rash not painful, doesn’t itch. Hx of right ankle fracture, ambulates w/ crutches. Prediabetes, smokes. Red papules, pustules in axillae. Likely contributor to skin condition???????
a/ Allergic contact dermatitis
b/ Mechanical irritation ??? pilo sebaceous follicles ????
60M w/ 2-wk muscle spasms in arms, startle-induced. Worsening insomnia, confusion, disorientation. Jerks, increased muscle tone, brisk reflexes, extensor plantar responses. outcome?
a/ Death within a year regardless of therapy
b/ Slow symptomatic resolution with pharmacotherapy
X ray foot fracture of tarsal? Management?
1. Orthopedic referal
2. Crape
3. Backslab
4. Complete plaster caste
CT brain con contrast
1. Cerebral hemorrage
2. Cerebral infarct
3. Cerebral tumor
Calculate number needed to treat
Calculate specificity
Study design – Need to see if there is any relationship between Alzheimer
disease progression and anti depressant use. What is the best study design?
1. Case control
2. Cohort
3. Cross sectional
17F w/ severe R shoulder pain after basketball. Shoulder dislocation, coach placed arm in sling. Limited ROM, tenderness on palpation. risk?
a/ Axillary artery thrombosis
b/ Osteomyelitis
c/ Recurrence of the condition
18moF found face down in pool, started CPR by mother. Intubated w/ uncuffed ETT, normal capnography en route. Flat line on capnography. cause?
a/ The endotracheal tube is in the esophagus
b/ The patient has bronchospasm
68M recovering from CABG surgery. Confused, reduced urine output. Hypothermic, hypotensive, tachycardic. Clear lung fields, no murmurs. Cool extremities. Next step?
a/ CT scan of the head
b/ Echocardiogram
c/ CT pulmonary angiogram
7M w/ lethargy, dark urine. No abd pain, fever, dysuria, urinary symptoms. Periorbital swelling, mild pedal edema. Low C3, normal C4. diagnosis?
a/ Minimal change disease
b/ Postinfectious glomerulonephritis
16 years old girl comes to GP with her mother before daughter is travelling to another country. You recommend vaccination against – & -. Mothers says that she doesn’t believe in vaccines and refuses. Daughter says that she is undecided. What would you do?
1. Give information on vaccination to the daughter.
2. Listen to the mother
3. Ask daughter to come without mother
Patient comes with breast lump. You want to refer to a breast surgeon. But patient says she had a sexual relationship with the surgeon previously. What is the next step?
1. Refer to another surgeon
2. Ask if the patient and doctor both comfortable about the referral
3. Counsel about the importance of referral
Male patient comes with pain at hand numbness tingling sensation at night. What is the best investigation to diagnose
1. MRI
2. Nerve conduction test
36 years Primigravida comes at 38 weeks of pregnancy. She is in active labour. Amniotomy done, fresh meconium passed. CTG FHR 150 No decelerations. What would you do next?
1. Continuous CTG
2. Fetal scalp blood sampling
3. Oxytocin
4. LSCS
Ub? Young Patient comes with trauma to the pelvis. Fracture of pelvic ramus. Blood on urethral meatus. Few hours later complains of inability to pass urine. Most appropriate next step
1.Catheterize the patient
2.Ureterescopy
Supra pubic catheter Ye Ckd patent, had gout given indomethacin, now presents with k 6 uric acid Next step
1) stop indomethacin
2 dialvsis
So One month old baby comes with purulent eye discharge. There was mild eye redness. What is the causative organism?
Chlamydia
Gonorrhea
Streptococcal
Pelvic fracture, blood in the urethral meats, unable to pass urine next step
A.urthroscope
B.utherosgraph
C. supra public catheter
D. urinary catheter
Ckd patent, had gout given indomethacin, now presents with k 6 uric acid 18. Next step
1) stop indomethacin
2)dialysis
42 Primi in active labour for 12 hours, caput + moulding + Station +1, active
pushing for 1 hour, contractions reduced. Next step
1) oxytocin
2) Assisted delivery
3) LSCS
Female palpitations and feeling of impending doom, severe headache, hypertension bp 168/100. Likely diagnosis? Pheochromoytoma, hyperthyroidism, essential hypertension
Bowens picture
Elderly with history of prostate CA st IV with multiple bone mets psa 40. Management? ERBT, Denozumab, Docitaxel, Tacrolizumab
Elderly with abdominal pain + diarrhea + vomiting. No mention of vitals. No passage of stools for 72 hrs. Presence of sigmoidal stricture seen and air distal to sigmoid. Aside from IVF next best management? Colostomy, colonoscopy, sigmoid colectomy, barium swallow
Post op patient with sudden tingling sensation around the mouth. Management? iv calgluc,
Patient complain “out of body experience”, post drowsiness Next step
1 Obtain history from witness
Post op appendectomy for ruptured appendicitis. Recovered. Was sent home. Came back after 1 week. No mention of antibiotics use. Now Fever 38.9, dre tender, chills. With previous iv site mild swelling No diarrhea mentioned. – pelvic abscess, superficial thrombophlebitis, c.diff infection
Woman came in for gyne check up. Everything normal. Sexually active. No Symptoms. Retroverted uterus on uts. Likely cause? Normal variant, PID, Chlamydia infection,
32F, G3P3, abnormal uterine bleeding. Irregular menses every 45-60 days, heavy bleeding, clots, no cramping. No period for 4 months. diagnosis?
a/ Adenomyosis
b/ Anovulation
25F w/ palpitations, fast heartbeats. Unprovoked, not related to exertion. Self-treats w/ cold-water immersion to relieve symptoms. Cold-water immersion alters what?
a/ Atrioventricular node conductivity
b/ Purkinje fiber conduction
26F w/ insomnia post vaginal delivery. Wakes at 4:00 AM despite infant sleeping. Low energy, cares for infant. Breastfeeding and supplementing. statement?
a/ try a medication that’s safe while breastfeeding
b/ any feelings of hopelessness?
65M w/ acute chest pain, substernal. Uncomfortable on exam, clear lungs, normal heart sounds. ECG shows abnormalities. Next step?
a/ Obtain CT scan of the chest without contrast
b/ Repeat the ECG in the emergency department
4mo boy, head larger than other infants. Rolls, sits, holds head, brings objects to mouth, babbles. Born at 37wks, adopted. Normal fontanelle, pupils, extraocular movements. next step?
a/ MRI of the brain
b/ Reassurance and continued observation
3yo boy w/ sore throat, mild stridor, high temp. Sitting scared on mother’s lap. Clear tympanic membranes, no erythema/exudate in posterior pharynx. diagnosis?
a/ Croup
b/ Epiglottitis
c/ Bacterial tracheitis
24M w/ worsening cough, tenacious sputum, fever, SOB x 1wk. Blood streaks in sputum. Decreased exercise tolerance, fatigue, weight loss. cause?
a/ AAT deficiency
b/ Defective chloride channels
72M w/ visual disturbances causing distress. Sees prowlers in bushes at night, disappear when he tries to look closer. Parkinson’s disease w/ carbidopa-levodopa. Next step?
a/ Add low-dose haloperidol
b/ Reduce carbidopa-levodopa
Alcoholic male, cant hold cup for 3-6mths, Dupuytren contracture phot
Ask treatment
-Physiotherapy
-steroid injection
-surgery fasciaectmy
RHC pain
Brucellosis
Leptospirosis
Listeriosis
Woman, Cholestatis, scratch
Long stem
-ursodeoxycholic acid
-choletyramin
Rural doctor – many obese children- ask screening
Screen weight and height
Woman back pain, blue finger in winter, telangectasis +
Systemic sclerosis
Another back pain with osteoporosis
Many lab given
Hb decrease
Cr increase
Other normal
-Multiple myeloma
Long stem – Albumin decrease, protein decrease
-corlisc disease
-custic fibrosis
IDA scnerio, MCV decrease
Check what
– ferratin
[UCD woman, multiple sexual partner Chlamydia + What next
– use condom
– Ask her to tell her partners
– Remove IUCD
Typical Migraine scnerio, young girl using OCO for long What next
– continue ocp
– Reduce ocp
– Cease ocp
Long stem, woman retroverted uterus, ask what cause retrovertus uterus?
– i choose normal
HCV antibody +, what to check next
– RNA/PCR
– Genotype
Patient taking many drugs, one of the drug is azathiprine. Check what
– check blood test 2-3 weekly
– Check TPMT genotype
– Check TPMT phenotype
Child 18 mth dont want to stand. Always sit. URTI last week, when flex one leg, pain in the spine.
– Transient tenosynovitis of hip
– Septic arthritis of hip
Increase lipase with upper abdominal pain
– ct abdomen ( no USS in stem)
Subclinical hyperthyroid scnerio Long stem, give lab result
Zgomatic fracture, ask cause of diplopia Jaundice coomb test +
Ca prostate spread to bone
-denosumab
-EBRT
-And another 2 drugs start with D
Child comes with jerking upper and lower limb. After seizure drowsiness 30 min.
– generalize tonic clonic
– Focal
Creamy white discharge, G negative diplococci
Ask treatment
– no azithro
– Ceftriaxone IM
Patient come wit agitation, will give IM injection
– Dz
– Droperodol
Young girl, signs of depression, ask tx
– fluoxetine
Old age live alone, comes with fall. Eyes has problem. Foot ware also has
problem.
– check eyes and foot
– Check drugs
Blood loss HR120
Ask %
-15
-30
-45
Patient, wafarin take. Has some disease and take erithromycin. INR become 7. Erythromycin already ceased. What next
-vitk
– FFP
– Stop warfarin
– Continur warfarin
Long stem. Lab result given. Platelet only 5
– i choose platelet transfusion.
80 asymptomatic routine checkup. WBC 15000.
Trimetoprim – resistence
Cephalexin – sensitive
Nitrofurintoin – sensitive
Amoxicillin – sensitive
What to give
– no treatment
– trimethoprim
– Nitrofurintoin
Compressive # ( lateral spine x rat)
– rest and anelgesic
– Mobile and anelgesic
Epilepsy 15 year with Na valporate. Want to pregnant. What next
– stop
– Reduce
– Change other anti-epilectic drugs
– refer to speech therapist
One borderline question
Female financial problem, recent husband broke arm, anxiety symptoms
and depression symptoms
Ask diagnosis
– GAD
– Depression Ethics
Girl with BMI 17, Examination normal Mother worried abt her eating
habits. She is not eating bcz of fear of chocking.
Family therapy
graded food exposure
Hypertension and headache.pt with lots of bruits. Past hx of PVD. renal
protin+, Reason for hypertenstion
1. Renal atherosclerosis
2RAAS activation
lot of GAD, depression questions were there
Borderline disorder -Splitting
Anorexia Nervosa
PID with IUCD-what to do next?
Clamydia test positive. But no symptom or discharges-what to do next?
preg mother after 2 weeks post partum coming for contraceptives
CXR-sarcoidosis, left side pneumonia
abdominal x ray-small intestional obstruction
sigmoid lesion plus caecun dilatation upto 11 cm-what to do next?
sigmoid colectomy
caecal resection
Old age live alone, comes with fall. Eyes has problem wearing glasses. Foot ware also has problem. She’s wearing uncomfortable shoes. How to make her less fall prone?
– check eyes and foot
– Check drugs
– send her to elders care home.
Protate carcinoma with bone mets. Most appropriate management
Ebrt
Degarelix like drug
Pyogrnic granuloma picture. Man works in sheep shearing area.Dx
Pyogenic granuloma
Orf was there
Scc
Bcc
14 yr old, sexually active, requesting for contraception, Not willing to
inform parents, what will you do as GP
Prescibe cocp
Advice to abstinence during ovulation
Ask about partners age
Right posterior chest stab injury, knife insitu. Bp 90/60, PR 100, iv fluids and 02 given What’s next
Cxray
Remove knife
Age 26/35yrF, on cocp and Vit d, fall during playing netball and harsh sound during the fall, lower leg distal end swollen, ankle movement preserved. Most appropriate investigation Plane xray Bone scan
Neonatal jaundice question.persistince since say 3 to 2 weeks. Mother O- child A +
SBR report was given. Total bilirubin 357. DBL 4, child feeding well, weight gain good,diagnosis
ABO incompatibility
Breast milk jaundice
Neonatal hepatitis
Mother came with a child with crohn’ s disease and a letter to get special concern for the child condition. In the letter it was clearly mentioned about the childs clinical symptosm related to crohn
What will you do
Giving the letter as written by mother
Ask from the school what are the information needed
Mitra valve replcement done, warfarin and enoxaparin started. On revies day 5INR 1.8
Whats the most appropriate(bridging therapy) – mplus question
Increase enoxa and contine warfarin same dose
Continue same dose of enoxa and increase warfarin dose
Stop enoxa and continue warfarin
PPH= 750ml after 20 hrs of labour, baby normally delivered, placenta delivered, uterus above pubic symphyis, non tender, soft.diagnosis
Uterine rupture
Uterine atony
Man with lobe pneumonia, initially came with septic shock like, started iv penicillin and azithro. On the review day 5. Fever persisting. But pt is consious. Respi symp reduced
What is next
Ceftriaxone
Continue same antibiotic
Low, loa, dry cough in the morning, bl cervical lymphadenopathy, cxray shown, not much hilar infiltration. DX?
Tb
Lymphoma
CLL
Sarcoidosis
Female, alcoholic and smoking, came wit malena and left upper quadrant pain. What is the next investigation
Gastroscopy
Colonoscopy
Uss
Positive 10……. No disease 100
Negative 20……no disease 400
Find specificity?
28 yo lady with past history of herpes. Currently presenting with painful lesions. HSV 1 positive but neg for HSV2. Currently pregnant at 8wks AOG What is the most definitive management
A. Oral acyclovir for mother
B. Treat both child and mother
C. CS at 39 weeks
AAA. From 3.2-3.4 cm in 2 yrs. What is the next best thing to do?
A. 6 monthly surveillance
B. 1 yrly surveillance
C. Biennial surveillance
D. Refer to surgeon
78 yo male presenting with sudden upper abdominal pain, hypotensive. On examination, noted tender 8cm pulsatile mass. Next best thing to do?
A. Refer to vascular sugrgeon
B. CT scan
C. Blood tests
1.5 year old wheeze, trachail tag,
Patient comes with lower limb weakness, bilateral sensory loss, urinary
intontinence,
History of UFTI
cauda equina
Guillian berry syndrome
Patient take BB, acei, and many drugs. EF<30%.
What to give next
– Digoxin
Post covid vaccine shoulder pain +, cant move above 30 degree. Local
imflammation +
– subacromi bursitis
– local imflammatory syndrome
Patient has ectopic pregnancy. What the most association
– shoulder tip pain when lying
PE and dead. Ask cause of dead
– PE
– Cardia arrest
A psammoma body in biopsy of incidental finding in a right thyroid gland treatment?
No need for treatment
Total thyroidectomy
Right thyroid aland thvroidectomv
6 year old child who has previously toilet trained and now is brought with mother because of soiling of his underwear (encoparesis). He has a history of constipation with diarrhoea for 2 months. What would be your initial management?
(mplus question)
A. laxative
B. stool exam
C. sigmoidoscopy
D. behavioural therapy
16M w/ head injury during football, helmet-to-helmet impact. Dazed,
disoriented, no loss of consciousness. Mild headache, no vision
changes. cause?
Disruption of white matter tracts
Neuronal functional disturbance
Fracture of bone at the base of the skull 188 ® 10:48 PM
58M brought to ED after suicide attempt. Lethargic, suicide note. Hx of
CAD, HTN. Bilateral wheezing, cold/clammy extremities. Next step?
Aminophylline
Glucagon
5F w/ leg pain after fall, worsens at night, refuses to walk. Mild
nonproductive cough x1mo. Pale child, palpable liver, pain on palpation
of proximal tibias. cause?
Acute lymphoblastic leukemia
Aplastic anemia
A 27-year-old woman presents with severe nausea and vomiting at 8
weeks pregnancy. She cannot take solid foods but is able to drink small
sips of liquids. She is concerned that she might have gastroenteritis,
because her partner has recently had it. Which one of the following is the
next best investigation in this situation?
A Pelvic ultrasound.
B.Urinalysis and culture.
C.Stool exam and culture.
D.Quantitative B-HCG.
E.Abdominal ultrasound.
A pregnant mother is a primi. 23yr old came at 24 weeks. Missed last
two antenatal visits. Including morphology scan. Uterus is now 30cm
SFH and hard and contracted. Cant palpate fetal parts. All antenatal
tests were normal. Her Blood group is Rh -ve.
What could the lump be?
A. Undiagnosed multiple pregnancy
B. Uterine fibroid
C. Incarcerated uterus
D. Hydrops fetalis
27F w/ joint pain for 10 days. Bilateral pain in joints, proximal
interphalangeal joints, wrists, knees, and ankles. Fatigue, loose bowel
movements. likely elevated?
Anti-streptolysin titer
Anti-narvovirus B19 laM antibodies na mw amen
28F w/ painful nodular lesions under arms, foul odor. similar lesions 4 mos ago. Smokes 1 pack/day. Axillary tender, fluctuant nodules, scar tissue bands. Risk?
a/ Poor body hygiene
b/ Tobacco use
c/ Nitrofurantoin therapy
51M w/ nausea, fatigue for wks. Occasional bilateral flank pain, nocturia for yrs. enlarged liver, mass at R flank. Mildly enlarged, nontender prostate. explanation?
a/ Bladder outlet obstruction
b/ Polycystic kidney disease
27F w/ joint pain for 10 days. Bilateral pain in joints, proximal interphalangeal joints, wrists, knees, and ankles. Fatigue, loose bowel movements. likely elevated?
a/ Anti-streptolysin titer
b/ Anti-parvovirus B19 IgM antibodies
16M w/ head injury during football, helmet-to-helmet impact. Dazed, disoriented, no loss of consciousness. Mild headache, no vision changes. cause?
a/ Disruption of white matter tracts
b/ Neuronal functional disturbance
c/ Fracture of bone at the base of the skull
42M w/ jaw pain, stiffness, difficulty eating. Symptoms for 2 days, neck stiffness today. Unable to open mouth, tense neck muscles. diagnosis?
a/ Cerebrospinal fluid analysis
b/ No additional diagnostic testing
31F, G1P0 at 8 wks gestation w/ persistent nausea, vomiting, epigastric pain, dizziness. Unable to tolerate oral intake for 1 day. Conceived through IUI w/ donor sperm. next step?
a/ Urinalysis for ketones
b/ Upper endoscopy
58M brought to ED after suicide attempt. Lethargic, suicide note. Hx of CAD, HTN. Bilateral wheezing, cold/clammy extremities. Next step?
a/ Aminophylline
b/ Glucagon
5F w/ leg pain after fall, worsens at night, refuses to walk. Mild nonproductive cough x1mo. Pale child, palpable liver, pain on palpation of proximal tibias. cause?
a/ Acute lymphoblastic leukemia
b/ Aplastic anemia
38F w/ R flank pain radiating to groin, hematuria. 6-mm calculus in distal R ureter. Symptoms improve w/ IV hydration and analgesics. pharmacotherapy?
a/ Finasteride
b/ Tamsulosin
34M roofer w/ electrical injury. No recollection of accident. Bilateral charred, leathery, insensate hands. Open wounds on soles of both feet. Risk?
a/ Cardiac tamponade
b/ Rhabdomyolysis
6 year old with abdominal pain and low mood. Has skipped school for many days due to this and father recently remarried.what’s the most appropriate management?
A. Behaviour therapy
B. Cognitive therapy
C. Fluoxetine
10 yr old soiling underwear everyday for pat 3 months. Has vague abdominal pain as well.
Not coping well in school and is one yr behind compared to peers. What’s the cause?
A. Sexual abuse
B. Constipation with overflow
C. Being bullied in school
73 yr old man with hx of Multiple myeloma has URTI 2 weeks ago and 12 hrs ago developed absence of sensation and movement of lower limbs with urinary retention. On examination
bladder palpable. Total loss of reflexes, sensation and movement of lower limbs starting from 3cm below umbilicus.what’s the cause?
A. GBS
B. Spinal cord compression
C. Cauda equina syndrome
A 20 year old man presents to ED with a 5¢cm laceration on his thigh and is in a lot of pain. Doctor instructed nurse to give codeine. When Dr reassessed patient a while later, pt complains of pain. The nurse said she didn’t think the patient needed codeine, so she gave PCM instead. What should the doctor do next?
A. Discipline the nurse for her actions
B. Complete an incident report
C. Inform APHRA
D. Bring up the incident at the next meeting
Picture of pyogenic granuloma of on finger and occupation as sheep shearer
A. Pyogenic granuloma
B. Orf
36 yr old lady complains of dyspareunia and lower abdominal pain for past 2 years. On examination, there’s retroverted uterus, tenderness on palpating of bilteral adnexa but no mass felt, and a haemorrhagic lesion seen in the posterior fornix of the vagina. What’s the diagnosis?
A. PID
B. Endometriosis
C. Gartner duct cyst
7.46 yr old lady came to gp for referral to a surgeon as she was diagnosed with cholelithiasis and needs surgery. She wants to be referred to this particular surgeon who claims to do laparoscopic cholecystectomy with smaller keyhole incisions and he can do it very fast. But the GP knows that this surgeon’s patients have a high complication rate post surgery. What should GP do?
A. Refer patient to this surgeon as per her wishes
B. Suggest referring to another surgeon
A 5 yr old child came in ED at a regional hospital brought by her father with full thickness burn to her left hand. The registrar suggests to transfer the pt to tertiary hospital for treatment. But the head surgeon at this regional hospital said the patient can be management at this hospital. What should registrar do?
A. Ask surgeon to justify his decision
B. Call the tertiary hospital’s burn unit to ask for their advice
C. Ask parents to arrange for referral to the other hospital
9. 8 weeks primigravida patient complaints of discomfort in vulva area. A year ago she had similar lesions in vulva and was treated for HSV infection. Now her HSV21 is positive and HSV2 is negative. O/E there a lesion seen on her vulva. What is the most appropriate treatment?
A. Give Antiviral now and continue for 5 days
B. Suppressive Antiviral now till delivery
C. Start antiviral a few weeks before expected delivery
60 yr old lady with a painful swelling just anterior to the Tragus of left ear. Pain increases when she’s chewing food. The swelling is soft and not fluctuant. What is the diagnosis?
A. Parotid carcinoma
B. Pleomorphic adenoma of parotid
C. Sialolithiasis
D. Sialadenitis
Man with who is an ex alcoholic (stopped drinking 2 years ago) now presents with umbilical
veins, mild ascitis, confusion and fatigue. (I think it’s hepatic encephalopathy). What
investigation will confirm your diagnosis?
A. Brain MRI
B. Serum ammonia level
C. Liver function test
8 yr old boy brought in by mother saying he doesn’t concentrate on his tasks, can’t sit and watch tv for too long. Teacher in school says he’s always running around and doesn’t concentrate during lessons. What’s the management?
Gabapentin
Neurontin
Primigravida woman currently at 28weeks gestation came for routine antenatal check up. Her blood group is O-ve. Previous visit was at 18 weeks gestation and everything was normal and estimated due date was confirmed. Now her SFH is measuring 36cm. What could be the reason?
A. Hydrops fetalis
B. Polyhydramnios
C. Foetal macrosomia
D. Wrong dates
Displaced scaphoid fracture management
A. ORIF
B. Splint
C. Hand and wrist cast
Picture of a man’s cheek and a brown- black lesion about 4cm. The lesion has been there
for the past 10 years and it didn’t bother him until 3 weeks ago when it started becoming itchy.
What’s the best next step? ( it looked like melanoma to me)
A. Punch biopsy
B. Excision all biopsy
C. Shave biopsy
73 yr old man complains of ear pain for past 1 week. On ear otoscopic examination, the
tympanic membrane appeared normal and no discharge. No rash seen on face. What’s the diagnosis?
A. Otitis media
B. Herpes zoster infection
C. Tongue carcinoma
Man underwent surgery for fracture of femur. Then he developed pulmonary embolism and
subsequently dies of cardiac arrest. What is the primary cause of death?
A. Pulmonary embolism
B. Femur fracture
C. Cardiac arrest
Lady with progressive bradykinesia, tremors on fine motor movements of fingers, blunted
facial expressions and slow speech. What is the best diagnostic investigation?
A. Ct brain
B. MRI brain
Ecg strip with no p waves and heart rate of about 60bpm
A. Atrial fibrillation
B. First degree heart block
22 yr old wants to enter football team was asked to do check up. No palpitations, chest pain
or dyspnoea. He has no complaints. Ecg shows bradycardia with delta waves in lead 2.
A. Lbbb
B. Rbbb
C. HOCM
D. Wolff Parkinson white syndrome
E. Idioventricular rhythm
38 yr old man came in complaining of bloody diarrhoea with mucus for past 6 months. Has
on and off abdominal pain. Has hx of travel to Vietnam two years ago.
A. Hydatid cyst
B. Chronic amoebic liver cyst
C. Ulcerative colitis
D. Hepatitis
71 yr old man brought by his daughter for complaint of difficulty in eating his food and
always coughs during his meals. He was previously referred to a speech pathologist who
recommended thickened foods. He tried it for a short while but hated it and preferred his
normal foods. What is the most appropriate next step?
A. Endoscopy
B. Barium swallow
14 month old boy with rhinorrhoea, fever and cough that’s associated with vomiting. On
examination, there’s intercostal recession and bilateral wheezes. He is irritable and not eating well. What’s the best treatment?
A. Penicillin
B. Dexamethasone
C. Prednisone
D. Roxithromycin
E. IV fluids
10 week old baby brought by mother because he cries when she changes his nappy for the
past few days. He has a fever and on examination, he cries when the doctor moves both his
legs. What is the diagnosis?
A. Septic arthritis of hip
B. Transient synovitis of hip
C. Septic arthritis of knees
Picture of what looked like infected ingrown toenail. Best initial management?
A. Wedge resection
B. Soak in warm water
C. Splint between toenail and skin
84 year old lady brought by her children after a recent fall saying she has been having
balance and walking problems. They also mentioned her footwear doesn’t fit properly. She
wears glasses. She has trouble with her memory since last few months. She lives alone in her
house. What’s the next best management for the patient?
A. Check her glasses and footwear
B. Put her in aged care facility
31 year old lady is in the ED with severe difficulty in breathing. Spo2 is 83%. What’s the best
oxygen delivery method for this patient?
A. Nasal prongs
B. Hudson mask 15 litres
C. Venturi mask
D. Intubation
52 yr old man brought by his wife into ED with confusion and drowsiness. He is a know
diabetic on insulin and he skipped his breakfast today to go play golf with his friend. His blood
glucose was 2.0mmol/L. What to give next?
A. 50% glucose bolus injection
B. 10% glucose infusion
C. IM glucagon
33 year old G3 P2, came for antenatal check up. Currently in 10th week of pregnancy that
was naturally conceived. The previous two children were conceived via IVF. To whom will you refer her to for continuity of antenatal care?
A. Doula
B. Midwife
C. Obstetrician specialist
D. Reproductive fertility specialist
Baby born via ventouse vacuum method and developed cephalohametoma of S5cm. On Day
3, he developed jaundice. He has been breastfeeding well and gaining weight. Now on day 12, there’s still jaundice but he appears fine except for cephalohaematoma that is now 3cm.
Bulirubin level was around 300 and conjugated was 8. What is the cause?
A. Breast milk jaundice
B. Haemolysis from cephalohaematoma
C. Biliary atresia
15 month old brought by mother with lesions on her hands and feet ( pic given that looked
like hand foot and mouth disease). Mother wants to know when can her daughter go back to
daycare?
A. When all the lesions are gone
B. When all the lesions have dried up
C. 24 hours after starting treatment
D. No exclusion required
8 yr old child says he cant go to school. When doctor asks why, he says “they t..t..t..teaze
me. I..I..I cant go to school” but does not say anything more to you or look at you. His
performance at school and studies are good.what is the Next step in management?
A. Refer to speech pathologist
B. Refer to child psychiatrist
1. (this whole question was asked about HIV testing)
Travel history, Sexually active young male present with generalized lymphadenopathy and rash. One week before the HIV antibody test was done and it was negative. He came one week back. Now what are you going to do?
1.Repeat HIV antibody test
2. Do HIV Antigen-antibody test
3.Western blot test
4.HIV P24 antigen
6 year old with abdominal pain and low mood. Has skipped school for many days due to this
and father recently remarried.what’s the most appropriate management?
A. Behaviour therapy
B. Cognitive therapy
C. Fluoxetine
10 yr old soiling underwear everyday for pat 3 months. Has vague abdominal pain as well.
Not coping well in school and is one yr behind compared to peers. What’s the cause?
A. Sexual abuse
B. Constipation with overflow
C. Being bullied in school
73 yr old man with hx of Multiple myeloma has URTI 2 weeks ago and 12 hrs ago developed
absence of sensation and movement of lower limbs with urinary retention. On examination
bladder palpable. Total loss of reflexes, sensation and movement of lower limbs starting from 3cm below umbilicus.what’s the cause?
A. GBS
B. Spinal cord compression
C. Cauda equina syndrome
A 20 year old man presents to ED with a 5¢cm laceration on his thigh and is in a lot of pain.
Doctor instructed nurse to give codeine. When Dr reassessed patient a while later, pt complains of pain. The nurse said she didn’t think the patient needed codeine, so she gave PCM instead.
What should the doctor do next?
A. Discipline the nurse for her actions
B. Complete an incident report
C. Inform APHRA
D. Bring up the incident at the next meeting
Picture of pyogenic granuloma of on finger and occupation as sheep shearer
A. Pyogenic granuloma
B. Orf
36 yr old lady complains of dyspareunia and lower abdominal pain for past 2 years. On
examination, there’s retroverted uterus, tenderness on palpating of bilteral adnexa but no mass felt, and a haemorrhagic lesion seen in the posterior fornix of the vagina. What’s the diagnosis?
A. PID
B. Endometriosis
C. Gartner duct cyst
46 yr old lady came to gp for referral to a surgeon as she was diagnosed with cholelithisis and needs surgery. She wants to be referred to this particular surgeon who claims to do laparoscopic cholecystectomy with smaller keyhole incisions and he can do it very fast. But the GP knows that this surgeon’s patients have a high complication rate post surgery. What should GP do?
A. Refer patient to this surgeon as per her wishes
B. Suggest referring to another surgeon
A 5 yr old child came in ED at a regional hospital brought by her father with full thickness burn to her left hand. The registrar suggests to transfer the pt to tertiary hospital for treatment. But the head surgeon at this regional hospital said the patient can be management at this hospital. What should registrar do?
A. Ask surgeon to justify his decision
B. Call the tertiary hospital’s burn unit to ask for their advice
C. Ask parents to arrange for referral to the other hospital
8 weeks primigravida patient complaints of discomfort in vulva area. A year ago she had
similar lesions in vulva and was treated for HSV infection. Now her HSV21 is positive and HSV2 is negative. O/E there a lesion seen on her vulva. What is the most appropriate treatment?
A. Give Antiviral now and continue for 5 days
B. Suppressive Antiviral now till delivery
C. Start antiviral a few weeks before expected delivery
60 yr old lady with a painful swelling just anterior to the Tragus of left ear. Pain increases
when she’s chewing food. The swelling is soft and not fluctuant. What is the diagnosis?
A. Parotid carcinoma
B. Pleomorphic adenoma of parotid
C. Sialolithiasis
D. Sialadenitis
Man with who is an ex alcoholic (stopped drinking 2 years ago) now presents with umbilical
veins, mild ascitis, confusion and fatigue. (I think it’s hepatic encephalopathy). What
investigation will confirm your diagnosis?
A. Brain MRI
B. Serum ammonia level
C. Liver function test
8 yr old boy brought in by mother saying he doesn’t concentrate on his tasks, can’t sit and
watch tv for too long. Teacher in school says he’s always running around and doesn’t concentrate during lessons. What’s the management?
A. Gabapentin
B. Neurontin
Primigravida woman currently at 28weeks gestation came for routine antenatal check up.
Her blood group is O-ve. Previous visit was at 18 weeks gestation and everything was normal
and estimated due date was confirmed. Now her SFH is measuring 36cm. What could be the
reason?
A. Hydrops fetalis
B. Polyhydramnios
C. Foetal macrosomia
D. Wrong dates
Displaced scaphoid fracture management
A. ORIF
B. Splint
C. Hand and wrist cast
Picture of a man’s cheek and a brown- black lesion about 4cm. The lesion has been there for the past 10 years and it didn’t bother him until 3 weeks ago when it started becoming itchy. What’s the best next step? ( it looked like melanoma to me)
A. Punch biopsy
B. Excision all biopsy
C. Shave biopsy
73 yr old man complains of ear pain for past 1 week. On ear otoscopic examination, the
tympanic membrane appeared normal and no discharge. No rash seen on face. What’s the
diagnosis?
A. Otitis media
B. Herpes zoster infection
C. Tongue carcinoma
Man underwent surgery for fracture of femur. Then he developed pulmonary embolism and
subsequently dies of cardiac arrest. What is the primary cause of death?
A. Pulmonary embolism
B. Femur fracture
C. Cardiac arrest
Lady with progressive bradykinesia, tremors on fine motor movements of fingers, blunted
facial expressions and slow speech. What is the best diagnostic investigation?
A. Ct brain
B. MRI brain
Ecg strip with no p waves and heart rate of about 60bpm
A. Atrial fibrillation
B. First degree heart block
22 yr old wants to enter football team was asked to do check up. No palpitations, chest pain
or dyspnoea. He has no complaints. Ecg shows bradycardia with delta waves in lead 2.
A. Lbbb
B. Rbbb
C. HOCM
D. Wolff Parkinson white syndrome
E. Idioventricular rhythm
38 yr old man came in complaining of bloody diarrhoea with mucus for past 6 months. Has
on and off abdominal pain. Has hx of travel to Vietnam two years ago.
A. Hydatid cyst
B. Chronic amoebic liver cyst
C. Ulcerative colitis
D. Hepatitis
71 yr old man brought by his daughter for complaint of difficulty in eating his food and
always coughs during his meals. He was previously referred to a speech pathologist who
recommended thickened foods. He tried it for a short while but hated it and preferred his
normal foods. What is the most appropriate next step?
A. Endoscopy
B. Barium swallow
14 month old boy with rhinorrhoea, fever and cough that’s associated with vomiting. On
examination, there’s intercostal recession and bilateral wheezes. He is irritable and not eating well. What’s the best treatment?
A. Penicillin
B. Dexamethasone
C. Prednisone
D. Roxithromycin
E. IV fluids
10 week old baby brought by mother because he cries when she changes his nappy for the
past few days. He has a fever and on examination, he cries when the doctor moves both his
legs. What is the diagnosis?
A. Septic arthritis of hip
B. Transient synovitis of hip
C. Septic arthritis of knees
Picture of what looked like infected ingrown toenail. Best initial management?
A. Wedge resection
B. Soak in warm water
C. Splint between toenail and skin
84 year old lady brought by her children after a recent fall saying she has been having
balance and walking problems. They also mentioned her footwear doesn’t fit properly. She
wears glasses. She has trouble with her memory since last few months. She lives alone in her
house. What’s the next best management for the patient?
A. Check her glasses and footwear
B. Put her in aged care facility
31 year old lady is in the ED with severe difficulty in breathing. Spo2 is 83%. What’s the best
oxygen delivery method for this patient?
A. Nasal prongs
B. Hudson mask 15 litres
C. Venturi mask
D. Intubation
52 yr old man brought by his wife into ED with confusion and drowsiness. He is a know
diabetic on insulin and he skipped his breakfast today to go play golf with his friend. His blood glucose was 2.0mmol/L. What to give next?
A. 50% glucose bolus injection
B. 10% glucose infusion
C. IM glucagon
33 year old G3 P2, came for antenatal check up. Currently in 10th week of pregnancy that
was naturally conceived. The previous two children were conceived via IVF. To whom will you
refer her to for continuity of antenatal care?
A. Doula
B. Midwife
C. Obstetrician specialist
D. Reproductive fertility specialist
Baby born via ventouse vacuum method and developed cephalohametoma of Scm. On Day
3, he developed jaundice. He has been breastfeeding well and gaining weight. Now on day 12, there’s still jaundice but he appears fine except for cephalohaematoma that is now 3cm.
Bulirubin level was around 300 and conjugated was 8. What is the cause?
A. Breast milk jaundice
B. Haemolysis from cephalohaematoma
C. Biliary atresia
15 month old brought by mother with lesions on her hands and feet ( pic given that looked
like hand foot and mouth disease). Mother wants to know when can her daughter go back to
daycare?
A. When all the lesions are gone
B. When all the lesions have dried up
C. 24 hours after starting treatment
D. No exclusion required
8 yr old child says he cant go to school. When doctor asks why, he says “they t..t..t..teaze
me. I..I..I cant go to school” but does not say anything more to you or look at you. His
performance at school and studies are good.what is the Next step in management?
A. Refer to speech pathologist
B. Refer to child psychiatrist