AMC MCQ Recalls MARCH 2024

One of Australia’s prominent doctors suggests discontinuing the term “long COVID” following a study revealing similar long-term effects of COVID-19 compared to other viruses like the flu. The study conducted by Queensland Health, involving over 5000 individuals with respiratory symptoms during the Omicron variant’s prevalence, found comparable rates of functional limitations between COVID-19 and non-COVID respiratory illnesses a year after infection. The European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) presented these findings, indicating the need to reevaluate the distinctiveness of long COVID. However, some experts, including paediatric infectious diseases physician Professor Philip Britton and the director of the Australian National Phenome Center at Murdoch University Professor Jeremy Nicholson, argue against abandoning the term, citing the unique aspects and global recognition of long COVID, urging further research to understand its underlying mechanisms.

Australian Medical Council (AMC) MCQ Recalls MARCH 2024 compilation

88yo lady afib, rate 76, cardiac disease and other comorbids. eGFR 24
what should be given
a. warfarin
b. rivaroxaban
c. beta blockers

48 man never had health check before, ex-smoker, family history of diabetes, bank manager, fair complexion, red hair, overweight. BP 155/89 mmHg. Next step?
a Offer smoking cessation advice.
b Assess osteoporosis risk factors.
c Calculate height, weight, BMI, waist circumference.

as an intern, you find out that a medical student is getting information about a patient thorugh the patient’s medical records. When asked, he said the patient’s relative who lives oversea wants to know about it. what will you do?
a. counsel the medical student that this is not allowed
b. informed the medical board
c. report to the medical university

g3p0+2 pregnant 28 weeks, admits that she continues to take drugs and drinks, had 2 miscarriages before. on labs:
AB blood group, anti-Le positive, current fetus has no heart rate on doppler. what is the most important in the dx?
a. anti-D
b. 2 miscarriages
c. anti-Le antibodies
d. cocaine use
e. suboptimal antenatal visits

17 lady with Type 1 DM, abdominal pain, vomiting x4, BG 25mmol/L, ketones 1.6mmol/L. Moderately dehydrated, alert. Initial management?
a/ Administer a stat dose of dexamethasone 4mg intravenously.
b/ Start an infusion of 20% mannitol 50g over the next hour.

35 man with skin rash after Caribbean holiday, tingling, prickling sensation on R foot, itchy rash, no fevers, no significant medical history. Most appropriate management?
a/ Fluconazole 50mg orally daily for 2 weeks
b/ Ivermectin 200mcg/kg orally stat
c/ Prednisolone 50mg orally for 3 days

15 male w/ aggression, agitation, history of methamphetamine use. Foster mum suspects methamphetamine intoxication. Clinical feature supporting methamphetamine intoxication?
a/ Constricted pupils
b/ Blood pressure 90/60 mmHg
c/ Jaw clenching

67 male w/ COPD exacerbation, treated successfully. Second exacerbation in 6 months. Inhaler technique adequate. FEV1 55%. Next step in COPD management?
a/ Low dose theophylline
b/ Long-term low dose oral prednisolone
c/ Long acting muscarinic antagonist (LAMA) (e.g. tiotropium) or a long acting beta2 agonist inhaler (LABA) (e.g. salmeterol )

similar stem copd. ask for long term management.

32 yo comes with amenorrhoea for 12 months, not having sexual activity for 1 year. she is divorced. which one would be the best investigation for the diagnosis?
a. beta hcg
b. pelvic uss
c. FSH/LH

enlarged tonsils redenned, with b/L cervical LN. clear nasal discharge. most likely organism?
staphyloccoci
streptococci
adeno
ebv

OGDS 5.5cm irregular lesion at stomach, biopsy no h pylori, lymphocytosis. next mx?
a. repeat OGDS
b. prolonged omeprazole
c. urea breath test

45 male with HIV, CD4 <200 cells/μL, tenofovir disoproxil w/ emtricitabine therapy. Received DTaP booster 3 yrs ago. Immune to Hepatitis B. Which immunisation now?
a The varicella zoster immunisation
b The influenza immunisation

5boy with eczema, mainly on extensor surfaces. Managed w/ emollients, ↑ topical corticosteroids. Concerns about steroid side effects. Correct statement?
a Steroid ointments for very dry skin in children.
b Antihistamines for pruritus.

52 lady on MHT patches. Debilitating hot flushes. Last menstrual period at 50, normal cervical screening. BMI 22 kg/m2, non-smoker. Period resumed after starting patches. Next step?
a Transvaginal ultrasound for endometrial thickness.
b Reassurance about common breakthrough bleeding.

52make with thyroid lump for ≥1 yr. Worried about cancer. Ultrasound suspicious for malignancy?
a/ Spongiform nodule
b/ Solid hyperechoic nodule
c/ Solid hypoechoic nodule with microcalcifications

52lady with menopause symptoms, migraines, PCOS, no regular meds. Wants MHT. Safe condition for MHT?
a/ Ischaemic heart disease
b/ Pregnancy
c/ Treated moderate hypertension

60 yo menopause 51. started hrt –> for 8 years. vasomotor symptoms were solved in the first year. stopped 1 year back, no break through bleeding. now no vasomotor symptoms, asking for prescription for HRT. what to do?
a. combined estrogen & progresterone
b. progesterone only
c. estrogen dermal patch
d. advised to stop hrt

head injury in a rural area, suggestive of ICB, after a fall. tertiary hospital 3 hours away. what to do?
a. bur hole
b. 20% mannitol

eye injury. anterior chamber hyphema, blurred vision until seen by ophtahlmologist what to do?
a. timolol eye drop
b. bed rest
c pilocarpine eye drop

46yo alcohol/smoker. parotid swelling, coarse hair scrotal swelling cant get above lump
dx?
a. testicular seminoma
b. alcoholic liver disease

Mother concerned about child (9 month old)’s MMR vaccination before Vanuatu trip. Term baby, no significant PMH. Most appropriate advice?
a/ Child already vaccinated against measles.
b/ MMR vaccine possible before holiday, then 2 more doses needed.

7 year old boy w/ tinea capitis, hair loss, itching. Weight 30kg. Empirical treatment?
a/ Terbinafine 125mg orally daily for 4 weeks
b/ Miconazole cream 2% topically twice daily for 2 weeks
c/ Fluconazole 150mg orally stat

RFDS consult for kangaroo shooter w/ fever, headache, myalgias, cough. Suspected Q-fever. Most serious complication?
a/ Arthritis
b/ Endocarditis
c/ Empyema

19 lady with irregular periods, acne, no other symptoms. BMI 22 kg/m2. TSH 2.89 mIU/L, Prolactin 360 mIU/L, FSH 8 IU/L. Next step?
a/ Refer her to a gynaecologist for a hysteroscopy
b/ Advise her that she has a diagnosis of polycystic ovarian syndrome

5male with vesicular rash on hands x 2 days. Otherwise well. Likely pathogen?
a/ Coxsackie Virus (CV) A16
b/ Varicella zoster virus
c/ Human herpes virus-6 (HHV-6)

dermat lesion in the ear farmer
?SCC
bowens dx

lung abscess tx
?ceftriaxone + clindamycin
?vancomycin + metronidazole

endocarditis
ASOT

parenteral nutrition following cholecystecotomy

electrolyte changes in blood

wheezing 6yo given 6 puffs of saline. not responding. next?
cont saline
IPRA

32F pre-travel consult for cycling honeymoon in rural Vietnam. Concerned about Japanese Encephalitis. Advice?
1 JE vaccine recommended for >1 month in endemic regions.
2 Three different JE vaccines available in Australia.

Term baby appears jaundiced post-emergency caesarean. Well, breastfeeding normally. No antenatal care. Likely diagnosis?
a Sepsis
b Red cell haemolysis
c Biliary atresia

56 male farmer w/ sun exposure. No suspicious lesions, but actinic changes. Discussing field therapy. Absolute contraindication?
a/ Congestive Heart Failure
b/ IgA deficiency
c/ Dihydropyrimidine dehydrogenase (DPD) deficiency

80 female w urinary incontinence x 3 wks, urge to urinate. Started new medication. Suspected medication?
a, Amitriptyline
b, Benzatropine
c, Indapamide

22 male w lump under upper lip since football injury. Not sore. Likely diagnosis?
a/ Mucocele
b/ Dentigerous cyst
c/ Ranula

4boy with concerns of autism spectrum disorder. Suggestive feature?
a Deliberately annoying others
b Echolalia

after long country side hike.tender swelling on inguinal ligament, no cough impulse, non reducible. fever+
inguinal hernia
inguinal lymphadenopathy

80 yo after fracture hip day 3, planned to discharge, put on urinary catheter on admission due to incontinence, before catheter removal done urine culture and abst, o fever, abst still not available

discharge after abst report
discharge with trimethoprim
repeat ufr culture
ignore

34 year old male hits head playing sport, no LOC but slow to get up and dizzy for 30 mins. Now fully recovered. Lives alone. Most appropriate:

1. Keep playing
2. Stop playing but go hom e
3. Stop playing and 24 hours supervision
4. Medical centre or hospital for review Similar stem asking most appropriate investigation:
5. No investigation needed
6. Observe for 4 hours
7. Head

Previously well progressing 6 year old presents with painful right knee and refuse weight bear. No effusion or bony deformity but extremely tender. All other exam normal (chest, abdo, limbs given)

Hb 70
WCC 5 but neutrophilic 0.7, ?slight eosonopholia 0.3
Plts 79
ESR 65

Next Ix
Bone marrow
Blood cultures
Urinalysis
Bone scan
Xray

patient with hx of dvt… has dyspnea chest pain. Vq scan shows
no perfusion in a lung segment .Mx
A enoxapirin SC
B Thrombolysis
C warfarin

patient returned from london 2 days ago … came with flu..
suddenly started to cough and fell. Became unconcious. HR
normal BP 90/80
Dx
A PE
B cough syncope

patient with AF… pain in legs.. right leg is pallor absent
pulses… ix
A ct angiogram
B uss veins
C uss leg
D d dimer

15 yrs old by school dur to misconduct behaviour with
teachers and kids.. With hx of drugs jails school expulsion
truancy etcetc .. with multiple scars on arms… said he wants
to die…
A inform parents
B involuntry admission
C send for psychotherapy
D some medical therapy

Pt 15y.He was normal before but now school grade fall,
bunksclasses. had several offence against him. Difficult
behaviour.what in the history will lead to diagnosis?
A-family history
B-mother took amphetamine during pregnancy
C-history of pouring petrol in neighbor’s DOG
D-patients view on making those offences

Commercial driver had seizure and was adequately treated .. You told him that he souldn’t drive ..however he came back after 3 weeks telling you that his work needs made him drive yesterday and was no problems at all in that ..he thinks he is totally fit now and can drive …..Management

1. Talk to him and tell him how dangerous is that to drive now
2. Call his boss and tell him about the disease
3. Tell him that you have to report what he did for the official driving agency for safety
4. Ask him to give you his license

A 40 yr old male patient presented to ED with sudden severe chest pain radiating to his back, he had a long flight history of 18hrs. ECG done normally, what to do next ?

1. CTpulmonaryangio
2. CTchestangio.
3. Dimer
4. RepeatECG

42lady with galactorrhea post-breastfeeding. Raised prolactin. Likely cause?
a/ Clozapine
b/ Olanzapine
c/ Risperidone

28 year old man with depression, anxiety. Wants to know common mental health disorder in Australia?
a/ Anxiety disorders
b/ Bipolar affective disorder
c/ Schizophrenia

56 yo Indigenous, fallen off horse, reduced consciousness. On warfarin. Correct statement?
a/ Urgent CT brain needed.
b/ Phenytoin or levetiracetam for moderate/severe cases.

81 lady seeking advice on Advanced Care Directive. Most appropriate advice?
a/ No need for ACD with good cognitive function.
b/ Lawyer not needed for valid ACD.

7yo w distractibility, wandering in class. Happy, stable home. Feature for ADHD?
a/ Assess sensitivity to tastes/textures.
b/ Evaluate consistency of behaviour at home/school.

24M with widespread mildly itchy rash, started on hands, now arms, legs, torso. Likely diagnosis?
a/ Pityriasis versicolour
b/ Erythema multiforme
c/ Discoid eczema

Study on respiratory conditions post 2014 coalmine fire. Type of study?
a/ A cohort study
b/ A Meta-analysis

50F with AV nodal reentry tachycardia ablative therapy. Now unwell, weight loss, tremor, weakness, racing heart. Likely diagnosis?
a Anxiety
b Hyperthyroidism
c Congestive cardiac failure

72 Man, chest pain, severe, no effect from nitrates. ECG Norm. Flight 18h 2 weeks? Ago.
BP- 80/. Ps 100 Ome most apropr inv
-CT andio PA
-CT angio chest
-X-ray
-Trop?
-VQ

40 year old to ed with sudden onset severe chest pain, dyspnoea and a fever. Hr 102 Arrived from Canada to Sydney by air yesterday. Appropriate next step?

1. CXR
   2.Ecg
2. V/Q
3. D dimer
4. Ctpa

6yr old boy nausea vomiting headache. PE normal, except tanner stage 3-4/5. Dx?
A) glioblastoma
B) pinealoma
C) craniopharyngioma

Mother came with 1 yr old baby for MMR vaccination. He has hx of egg allergy with bullae and other sx. What to do?
A-Give under close observation
B-Egg allergy is not a contraindication for MMR
C-Refer for skin allergy test
D-Give test dose

Left iliac fossa pain, tenderness, no rebound, warfarin user, CT given
1.rectus sheet hematoma
2.retroperitoneal hematoma

Nurse, hep B, what next?
1.do nothing
2.tell her avoid contact percidure
3.informAPRAH

68M w/ enlarging chest lesion. Likely diagnosis?
a/ Pigmented basal cell carcinoma
b/ Seborrhoeic keratosis

51M truck driver w/ recurrent dizziness, episodes last 1-6 hrs w/ spinning sensation, ear symptoms. Likely diagnosis?
a/ Acoustic neuroma
b/ Psychogenic
c/ Anxiety

32F w/ cyclical mood symptoms, severe premenstrual distress, functional impairment. Management?
a/ Commence her on oral Sertraline 50mg daily for the 2 weeks leading up to menstruation (luteal phase)
b/ Commence her on oral Drospirenone 4mg daily

39M w/ painful, swollen right leg, mottling. Next step?
a/ Urgent duplex venous ultrasound of leg.
b/ Contact tertiary centre for expert advice/retrieval/surgery.

your friend and your colleague, want you to prescribe mirtazapine, dont want to see a GP himself,using 30 mg codein every day, what to do?
1.insist to see GP
2.inform APRAH

somalia 32 years man with cough ;hemoptysis and weight loss of 5kg since 3 months .Xray done 5 years ago for immigration purpose which was negative. Xray done this time shows opacity as R/s middle lobe of Right Lung. Send for sputum culture and microscopy. What next other test to do?
A. CT chest
B. Mantoux Test
C. MRI

A 50 years man, PSA >20 DRE, irregular, back pain and bone metastasis. Best treatment?
A. Chemotherapy
B. Androgen deprivation
C. Orchiectomy
D. Radiotherapy

Old man with recurrent falls in nursing home he is found to have many bruises in head . Ecg shows sinus tachycardia , multiple ventricular ectopies, and ventricular hypertrophy is on enalapril and thiazide. Bp lying down 150/90 hr 90mmhg. What investigation for dx
24 hr ecg
24 hr bp
Repeat bp measurements
Heat ct

52 year male , Headache , fever , weakness
No neck stiffness , h/ 0 Alcoholic and smoking , rash present over upper extremities.
Diagnosis

A.encephalitis
B.meningococoal meningitis
C. Immunosuppressive
D. septicaemia

primary malignancy of (something – can’t remember) with peritoneal carcinomatosis come with SOB and dyspnea. Patient on chemo. Next best mx?
a) peritonectomy
b) iv albumin infusion (depends on stem)
c) regular peritonecentesis
d) Furosemide

Previously well progressing 6 year old presents with painful right knee and refuse weight bear. No effusion or bony deformity but extremely tender. All other exam normal (chest, abdo, limbs given)

Hb 70
WCC 5 but neutrophilic 0.7, ?slight eosonopholia 0.3
Plts 79
ESR 65

Next Ix
Bone marrow
Blood cultures
Urinalysis
Bone scan
Xray

+ve straight leg raise and diabetes loss ankle reflex and calf pain relived with rest
Lumbar canal stenosis
Cauda equina
Disc prolapse
Diabetes neuropathy
Vascular disease

76 old man with fatigue, palpitations, shortness of breath, irregularly irregular heart rate. CHA2DS2-VA score?
a 7
b 6

65yo with stable eGFR. Recommended BP target?
a ≤130/80mmHg
b ≤150/90mmHg

Considerations for prescribing in prison?
? formal diagnosis before prescribing due to abuse potential.
? Alprazolam acceptable in prison with supervised dosing.

87 lady with Alzheimer’s, aggressive behavior, wandering. Immediate management?
a Nursing staff may use physical restraints for safety.
b Consult family/staff about prior strategies & reassess ASAP.

67 man with painless hematuria. Next step?
a Cease warfarin and await resolution
b Urine MC&S, cytology, and imaging of the renal tract

23 male teenager plumber w/ scrotal pain, fever, dysuria. Likely diagnosis?
a Left-sided epididymitis
b Torsion of the left testis

Considerations for prison medical officer role?
a Custodial facility can pose safety risks to medical staff.
b Maintain patient privacy and avoid disclosing personal information.