The Australian healthcare system is facing a crisis due to a shortage of general practitioners (GPs) and increasing pressure on both primary and secondary care services. In response, the RACGP is urging the Federal Government to provide support to international medical graduates (IMGs). The President of the College, Dr. Nicole Higgins, has emphasized that the workforce shortage is a widespread issue, affecting general practice, pharmacy, and nursing. According to Dr. Higgins, IMGs could play a critical role in addressing the issue in the short term, as many are eager to work in Australia. However, they are being discouraged by bureaucracy and a lack of support. Dr. Higgins has highlighted that rural and remote communities are particularly affected and suggested that attracting IMGs to Australia and supporting and retaining them as valuable community members could provide a simple solution to the shortage of GPs. She has urged the government to streamline the application process for doctors who want to work in areas of need by cutting red tape.
Dear IMGs, do not give up yet and take this opportunity to complete your AMC part 1 as soon as possible! Once you pass the AMC Part 1, you can start applying for medical positions. Many doctors advise doing so rather than waiting until after completing the Clinical Examination, as obtaining a position can be a lengthy and challenging process.
As a side note, we would like to extend a huge thank you to those who have provided us with these recalls. It is now our turn to do our part and help solve them for you. You can obtain them from here.
Australian Medical Council (AMC) MCQ Recalls MARCH 2023 compilation
Adult male, stabbed with a knife in the chest. Knife was still in place in his chest.. stable vitals what is the most appropriate management.
a/ Remove knife under general anesthesia
b/ Remove knife and place chest tube
c/ Remove knife and pressure dress
d/ Remove then stich.
24 yo woman comes due to dyspnea on exertion & fatigue for 2 mths. Had URTI 3 mths ago that resolved in 3-4 days. A crescendo-decrescendo systolic murmur heard along the left sternal border. Rapid upstrokes of the peripheral pulses present. Cause?
a/ Bicuspid aortic valve
b/ Decreased cardiac contractility
c/ Interventricular septal hypertrophy
34yo man is brought due to difficulty swallowing, blurred vision & mild dyspnea. Returned yesterday from a trip during which he snorkeled, ate locally cured fish & hiked in a forest. Oral mucosa is dry, speech slurred, pupils dilated & neck muscles weak. Next step?
a/ Administer antitoxin therapy
b/ Administer atropine and pralidoxime
42yo man with persistent sadness, weight gain & fatigue the past 4 mths. MDD after a divorce 3 yrs ago. History of separation anxiety disorder as a child. GAD in mother. Symptoms resolved with sertraline. Features for antidepressant therapy?
a/ Age of onset of initial depressive episode
b/ Number of prior depressive episodes
75yo man is brought due to increasing confusion over the past 3 wks. Wife died 4 wks ago & has not been sleeping well since. Has COPD & hypertension. Takes doxylamine, amlo & tiotropium. Gait is ataxic & speech dysarthric. Mild cortical atrophy. Next step?
a/ Add donepezil therapy
b/ Add selective serotonin reuptake inhibitor therapy
c/ Discontinue doxylamine
62-yr-old man with ALS is withdrawn, sleeping more than normal & having episodes of confusion. Uses a wheelchair. Percutaneous gastrostomy tube placement 6 mths ago due to dysphagia. Tongue atrophy with fasciculations & bilateral basal atelectasis. Next step?
a/ Arterial blood gas analysis
b/ Depression screening
65-yr-old man with periodic substernal chest pain. Has hypertension & diabetics. Right foot amputated. Imaging after administration of an adenosine analog reveals nonuniform radioactive isotope uptake in the myocardium, consistent with myocardial ischemia. Change observed?
a/ Augmentation of flow in non–obstructed vessels
b/ Enhancement of myocardial contractility
5yo boy is brought for evaluation of multiple new growths on the face. Patient can open & close his eyes without pain or difficulty. Next step?
a/ Biopsy the lesion
b/ Observe and provide reassurance
64-yr-old retiree comes due to 2 mths of weight loss, dry cough & progressive pain in his right arm. Treated for community-acquired pneumonia a yr ago. History of type 2 diabetes mellitus & hypertension. Used to travel internationally for work. 30-pack-yr smoking ;quit 5 yrs ago. Cause?
b/ Superior pulmonary sulcus tumor
13-yr-old girl briefly lost consciousness after a right side head injury. CT scan reveals a right frontotemporal epidural hematoma. While waiting for craniotomy, the patient becomes somnolent & develops left lower extremity weakness. Cause of worsening neurologic status?
a/ Diffuse axonal injury
b/ Subarachnoid hemorrhage
c/ Subfalcine herniation
65-yr-old woman complains of periodic headaches in the temporal region, visual disturbances & neck stiffness. Biopsy of a scalp artery confirms giant cell arteritis. Slowly progressive muscle weakness 6 mths later. Headaches resolved, but has difficulty climbing stairs & getting up from a chair. Cause?
a/ Drug-induced myopathy
b/ Inflammatory myositis
33-yr-old man with an increasing number of small lesions appearing on his hands, scalps & other locations. Spots associated with intermittent, mild itching but are otherwise asymptomatic. Uses electronic cigarettes regularly & drinks 3-5 alcoholic beverages on weekends. BMI 32. Diagnosis?
a/ Irritant contact dermatitis
b/ Lichen planus
37-yr-old woman with stabbing, unremitting abdominal pain & confusion. Worse in the upper abdomen & associated with nausea & frequent nonbloody emesis. Has type 1 diabetes mellitus & major depression. The mucous membranes are dry & capillary refill is delayed. Diagnosis?
a/ Acetaminophen overdose
b/ Acute cholangitis
23-yr-old primigravida at 32 wks gestation is brought due to a seizure that occurred 30 min ago. Patient’s head moved from side to side, eyes fluttered, jaw clenched & rhythmic, asynchronous movements of the upper & lower extremities. Episode resolves within 1 min. Next step?
a/ 24 urine
c/ video eeg
80-yr-old woman is brought due to behavioral disturbances. History of Alzheimer disease & hypertension. Medications include amlodipine & donepezil. Nightly risperidone is started & a wk later, patient is less aggressive, but her restlessness & wandering have worsened. Next step?
a/ Add memantine therapy
b/ Advise nursing home placement
c/ Discontinue risperidone
65-yr-old man with chest pain has fatigue, retrosternal heaviness & nonproductive cough. Taking diphenhydramine due to generalized pruritus. ECG reveals sinus rhythm with no ST-segment or T-wave changes. X-ray reveals a large, anterior mediastinal mass displacing the trachea. Diagnosis?
a/ Germ cell tumor
c/ Hodgkin lymphoma
27-yr-old woman comes due to intermittent headache & associated with nausea & vomiting .She is afebrile & has never had a headache like this before. Her only medication is oral contraceptive pills. BMI is 34 kg/m2. Papilledema seen on funduscopy. Left untreated?
b/ Intracranial bleeding
55-yr-old woman with worsening headaches & right-sided weakness. A retired seamstress & chronic tobacco use. Right-sided pronator drift. Partially calcified extra-axial mass compressing left frontal lobe. Mass appears dural-based & homogeneously enhances on post-gadolinium MRI. Next step?
b/ Combination antitubercular therapy
c/ Surgical resection
38yo gravida 5 para 5, with painful ambulation on postpartum day 1. Received epidural analgesia during labor & had vaginal delivery of 4.4 kg infant complicated by shoulder dystocia relieved by McRoberts maneuver & suprapubic pressure. Focal tenderness inferior to bladder. Diagnosis?
a/ Epidural abscess
b/ Femoral neuropathy
c/ Pubic symphysis diastasis
37-yr-old gravida 1 para 0, at 25 wks gestation with increasing substernal chest pain. Has twin pregnancy & admitted for inpatient monitoring for preterm labor. Receiving heparin for venous thromboembolism prophylaxis. Lower extremities 1+ pitting edema to the knees. Diagnosis?
a/ Acute fatty liver of pregnancy
b/ Heparin-induced thrombocytopenia
34-yr-old gravida 2 para 1, at 20 wks gestation on routine prenatal visit. Wks ago, had 2 days of fever & pharyngitis. Uterine fundus is below umbilicus. US shows a fetus with bilateral periventricular intracranial calcifications & an enlarged liver with multiple intrahepatic calcifications. Cause?
b/ Influenza virus
28-yr-old woman comes due to a painful leg ulcer that has been expanding over the last 2 mths. History of Crohn disease, well controlled for the past 2 yrs with azathioprine. Works as a gardener. Diagnosis?
a/ Erythema nodosum
b/ Pyoderma gangrenosum
c/ Hidradenitis suppurativa
68-yr-old woman with a 2-cm groin mass below the right inguinal ligament. History of obstructive pulmonary disease with occasional exacerbations & hypertension. 45 pack-year smoking. BMI 34. Mass is tympanitic to percussion. Next step?
a/ CT angiogram of the lower extremities
b/ Elective surgical repair
51yr-old woman comes due to progressive right arm & shoulder pain for 4 mths. History includes hypertension treated with lisinopril & hypothyroidism treated with levothyroxine. Mild atrophy of right deltoid muscle. Range of motion of right shoulder markedly reduced. Next step?
a/ Deltoid muscle biopsy
b/ Range of motion exercises
80yr old woman with increasing abdominal pain, nausea, vomiting & inability to keep food down. Has chronic paroxysmal atrial fibrillation. Abdomen distended & tympanic. Tenderness in right groin area. X-ray reveals distended bowel loops with air-fluid levels. Cause?
a/ Groin hematoma
b/ Small bowel adhesions
c/ Small bowel herniation
14-yr-old girl is brought for leg pain. Prior to this, sedentary lifestyle. Started walking routine & transitioned to plant-based diet. Feels tired most days. Weight at 90th & height at 75th percentile. Bilateral ankles, knees, elbows & wrists have mild swelling & tenderness. Medication?
29-yr-old primigravida at 36 wks gestation comes for a routine prenatal visit. She wishes to have a natural delivery without any medication that would decrease the pain. Doesn’t want cesarean delivery. Appropriate response?
a/ Giving your condition, caesarean unlikely. We’ll discuss this again only if it is absolutely needed.
b/ I would recommend a c-sec delivery only if it were absolutely necessary. Lets talk about the indication.
EXACT SAME WORD
20-yr-old college student with worsening abnormal movements, particularly at highly stressful times. Started in middle school when he would repeatedly blink & shrug his shoulders. Grades have declined & is embarrassed during class presentations. Father died age 50 from stroke. Treatment?
a/ anti- oligonuecleotide therapy
b/ ?? VMAT2 inhibitor therapy
21-yr-old woman comes with 5 mths of fatigue, excessive sweating & palpitations. Lost weight during the past 6 mths with an over-the-counter weight loss remedy. Has lid lag. Thyroid shows a small gland. Radioiodine uptake by the thyroid gland is diffusely decreased. Diagnosis?
a/ Elevated ATPA titer
b/ Elevated ESR
c/ Low serum thyroglobulin level
10-day-old boy is brought due to persistent bilious vomiting for 10 hrs. Irritable & refused to feed. His last bowel movement was 24 hrs ago. Abdomen is firm & distended with hypoactive bowel sounds & tenderness to palpation. Small amount of stool in rectal vault. Occult blood in stool. Next step?
a/ Contrast enema
b/ Exploratory laparotomy
7-yr-old girl comes due to “wetting her bed” for the past wk. Eats dinner at 6 PM, with which she has her last glass of milk or juice. Goes to bed at 8:30 PM. Her parents divorced six mths ago & she lives with her mother & older sister. Height & weight are at 40th percentile. Next step?
a/ Obtain a urinalysis
b/ Reassure that this will resolve in a few weeks
22-yr-old man being hit in the face with a basketball. Bleeding from both sides of his nose for about 10 min that stopped with pressure. Currently unable to breathe through his nose. Has allergic rhinitis treated with oral antihistamines. Soft, fluctuant swelling of septum bilaterally. Next step?
a/ Embolize the ??sphenopalatine artery
b/ Incise and drain the nasal septum
Follow-up for 6-mth-old boy after completing a course of antibiotics for a febrile urinary tract infection. US shows mild right hydronephrosis. A voiding cystourethrogram shows retrograde urine flow into right ureter & collecting system with dilation & blunting of renal calices. If untreated?
a/ Development of renal cysts
b/ Fibrosis of renal interstitial space
7-yr-old boy with bed-wetting. Never stayed dry overnight for more than 3 consecutive nights. Irritable & inattentive. Parents achieved nighttime dryness at age 5. Height & weight at 75th & 25th percentiles, respectively. BP at 90th percentile. Tonsils symmetrically enlarged. Next step?
a/ Initiate a trial of methylphenidate
b/ Obtain nocturnal polysomnography
74-yr-old man with temporal headaches, fatigue, ears ring & eyes blurry. Moderate cervical lymphadenopathy. Hepatosplenomegaly present. Dilated, segmented & tortuous retinal veins. Sensory deficits in feet. Serum protein electrophoresis reveals a sharp IgM spike. Diagnosis?
a/ Chronic lymphocytic leukemia
b/ Multiple myeloma
c/ Waldenstrom macroglobulinemia
34-yr-old gravida 2 para 1, at 34 wks gestation comes to establish prenatal care. Had cesarean delivery at 25 wks gestation due to eclampsia & fetal growth restriction. Fetus in frank breech presentation with estimated weight at 50th percentile. Wished for a vaginal delivery. Next step?
a/ Repeat US in 2 weeks to determine mode of delivery
b/ Schedule a cesarean delivery at 37 weeks gestation
55-yr-old man comes due to nausea, generalized weakness & muscle cramps. History of type 2 diabetes mellitus, hypertension & hyperlipidemia. Medication of metformin, lisinopril & rosuvastatin. Bilateral basal crackles present. Bilateral 2+ lower extremity edema. Cause?
a/ Decreased cardiac output
c/ Renal tubular injury
73-yr-old man comes due to increasing forgetfulness. Unable to concentrate & complete paperwork. Has hypertension, hypercholesterolemia, diabetes, benign prostatic hyperplasia & transient ischemic attack. Family history: hypertension, diabetes & Alzheimer disease. Cause?
a/ Alzheimer disease
45-yr-old woman comes due to diffuse abdominal pain & malaise for 24 hrs. Type 1 diabetes mellitus & end-stage renal disease 2 yrs ago. Receiving peritoneal dialysis. Aspirate from peritoneal dialysis catheter is cloudy; Gram stain of fluid shows gram-positive cocci. Cause?
a/ Contamination via bacteria from the bowel
b/ Touch contamination
34-yr-old woman comes due to excessive urination at night. Past 2 wks, has been getting up at least 3 times at night to urinate. History of hypothyroidism treated with levothyroxine & bipolar disorder treated with lithium carbonate. Decreased skin turgor & dry mucous membranes. Cause?
b/ Proximal tubule of the kidney
c/ Renal collecting ducts
62-yr-old man, 2-week history of shortness of breath and fatigue. out of breath when walking short distances and has dry nighttime cough. 25-pack-year smoking history and drinks alcohol socially. worked in construction. cause?
a/ Absence of an audible S3
b/ Lack of crackles on lung auscultation
c/ Normal BNP level (<100 pg/mL)