AMC MCQ Recalls MAY 2021

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The roads are empty, the crowds too small,
And no trace of life outside, none at all.
Every human is locked up in their house,
And the sunny play ground, now looks bleak.

One and a half year had passed when we first encountered COVID-19. We have been fighting the battle since then and yet the battle is not over. The virus, however has been mutated from B.1.1.7 (UK variant), to B.1.351 (South Africa variant), to P.1 (Brazil variant) and now B.1.617 (India variant). Now, a devastating second wave of COVID-19 cases is battering India, Nepal, Thailand, Malaysia and many other countries. Therefore, many of our candidates got their exam postponed to a later date. However, there are still minority of them who managed to sit for the exam. A big thank you to those who had contributed in providing us with these recalls. Now let us do our part by solving these recalls for you. You may get them from here.

Australian Medical Council (AMC) MCQ Recalls MAY 2021 compilation

1) woman, para 2, underwent an operative vaginal delivery complicated by a second-degree perineal laceration. started on ssri for postpartum depression. experience pain & dryness during intercourse. cause?
a Hypoestrogenism
b Medication side effect

2) woman comes with eye injury. industrial-strength bleach splashed into her left eye. Physical examination reveals blepharospasm & conjunctival erythema. next step?
a Application of cycloplegics for symptom relief
b Continuous irrigation with normal saline

3) 13-yr-old girl has frequent headaches. have progressively worsened in severity & now occur almost daily. mild optic disc edema. MRI of the brain would most likely show?
a Enhancing lesion in the internal auditory canal
b Parietal lesion with air-fluid levels and a hyperdense rim
forgot other option

4) 5-yr-old boy having persistent ear discharge in the right ear canal. born with a cleft palate that was repaired in infancy. retraction of the superior portion of the TM & a pearly white mass. conductive hearing loss on the right side. cause?
a Acute middle ear effusion with concurrent tympanic membrane inflammation
b Chronic foreign body impaction with external ear canal abrasion

5) man complain increasing epigastric pain that radiates to the back. has an episode of vomiting & anorexia. Breath sounds are decreased at both lung bases. Lipase 5,636
a Abdominal examination findings
b Blood urea nitrogen level

6)A woman with asthma came to ED with left lower lobe consolidation and cold sore at lip.You suspect that she has strep pneumonia and request a strep antigen test.The sensitivity of this test is 80% and the specificity 95%. The prevalence of streptococcus pharyngitis in adults with pneumonia is 40%. likelihood that patient has strep pharyngitis if antigen test is positive?
A. 95%
B. 91%
C. 88%
D. 80%
E. 5%

7) man with AIDS complains of painful swallowing. Endoscopy reveals multiple large, linear ulcers in the distal esophagus. A biopsy of the abnormal mucosa shows tissue destruction & the presence of intranuclear & intracytoplasmic inclusions. pharmacotherapy?
a/ Acyclovir
b/ Ganciclovir

8) 27-yr-old woman comes to discuss weight loss. BMI is 28 kg/m2. shows an overweight body habitus. most appropriate response?
a/ “Family stress is a common cause of weight gain. Let’s talk about how that might be affecting you.”
b/ “I can see how this is frustrating to you. Instead of dieting, I think you should try an exercise program to lose weight.”

9) woman is found unconscious in bedroom. her family suspects a drug overdose. has major depression. B/P 82/46 mm Hg, pulse 40/m respirations 12/m, blood glucose 52 mg/dL. Cause?
a/ Amitriptyline
b/ Clonidine

10) 70yo man, ischemic stroke. right-handed. Only right side face is shaved. When asked to raise his left arm, he raises right arm. areas affected by stroke?
a Left frontal cortex
b Left temporal cortex

11) 78yo woman, intermittent palpitations last 6 months. heart beating fast. average once a week, last up to an hour. occur when tired. ECG shows moderate left atrial enlargement. workup?
a Atrial fibrillation
b Atrioventricular nodal reentrant tachycardia

12) 73-yr-old man unable to pee over the past 24 hrs. urine flow weak for the past yr. has myelodysplastic syndrome, hpt & lumbar strain. catheterization of bladder produces 800 mL of urine. cause?
a. Acute inflammation of the prostate
b. Bladder outflow obstruction

13) 65-yr-old woman comes for evaluation of progressively worsening memory. has a history of hypertension & hyperlipidemia. immediately recalls all 3 of 3 items read to her, but 5 minutes later remembers none of them. gait is broad-based & shuffling. has urinary incontinence. (everything else seemed normal) cause? I think normal pressure hydrocephalus.
a. Alpha-synuclein dysfunction in dopaminergic neurons
b. Decreased csf absorption
c. Excessive amyloid peptide deposition
d. Neurocognitive effects of vit b12
Cant rmb last option

14) 43-yr-old woman complains of acute-onset, left-sided weakness. lost 6 kg. hemoglobin 10.2 g/dL & erythrocyte sedimentation rate of 60 mm/hr. multiple small, acute infarcts in the right parietal & temporal lobes & a mass in the left atrium. diagnosis?
a Infective endocarditis
b intracardiac tumor
c left atrial thrombus
d rheumatic ms

15) A 33-yr-old man complains of left flank pain. Ultrasound kidney is shown (with picture) multiple cysts seen in left kidney. The right kidney has similar findings too. Ask for most common complications associated with the condition?
Intracranial bleeding
Pancreatic cancer
PE
Restrictive Cardiomyopathy
Severe Hypercalcemia

16) man complains of episodes of nasal congestion, rhinorrhea & dry cough. examination shows a transverse nasal crease, swollen & pale nasal turbinates & a clear nasal discharge. posterior pharyngeal wall has a “cobblestone” appearance. mx?
a. Inhaled beta agonist
b. Intranasal decongestant

17) 58-yr-old woman diagnosed with mdd has had 5 lifetime episodes of major depression & a suicide attempt. After 2-week follow-up on venlafaxine, she is showing signs of improvement. Next step?
a Continue venlafaxine for 1 year, then maintain at a reduced dose
b Continue venlafaxine for 1 year, then taper gradually

18) woman complains of shortness of breath, cough & hemoptysis. Diagnosed with tuberculosis & begun on a regimen of isoniazid, rifampin, ethambutol & pyrazinamide. 1 mth later, her sputum is negative for acid-fast bacilli. Next step?
a Continue current treatment with close follow-up
b Replace current regimen with second-line anti-tuberculosis medications
Forgot other options

19) 2-day-old boy developed a diffuse rash on his torso & extremities. has been breastfeeding every 2-3 hours & voiding frequently. pulse is 132/m & respirations 42/m. pustules overlying erythematous skin on the extremities. scattered erythematous papules. next step?
a/ Empiric intravenous penicillin therapy
b/ Empiric intravenous valacyclovir therapy

20) 32-yr-old primigravida at 34 weeks gestation complains of severe right upper quadrant pain. BMI is 38 kg/m2. Leukocytes 23,000/mm3. Total bilirubin 4.8mg/dl. Diagnosis?
a/ Acute cholangitis
b/ Acute fatty liver of pregnancy

21) 34-year-old woman, gravida 2 para 1, at 14 weeks gestation comes for a routine prenatal visit. first pregnancy ended in a cesarean delivery at 30 weeks gestation due to breech presentation & preeclampsia with severe features. next step?
a/ Betamethasone
b/ High-dose (4 mg) folic acid

22) primigravida at 29 weeks gestation complains of headaches, intermittent throbbing pain in the left frontal region sometimes accompanied by a rhythmic pulsating sound. Funduscopic examination shows bilateral optic disc edema. Next step?
a/ Lumbar puncture
b/ MRI of the brain

23) woman comes with wrist pain after being pulled to the ground while walking her dog. gross deformity of the wrist with extensive swelling & bruising. developed paresthesia in the affected hand. Which is most likely?
a/ Abduction of thumb against resistance
b/ Adduction of the index and 4th digit

24) nulliparous woman starts to experience more painful contractions as she transitions into active labor. Cervical examinat appears sad. Next step?
a/ Continue risperidone and add benztropine
b/ Continue risperidone and add propranolol

25) 42-yr-old woman, para 1, comes for evaluation of insomnia following the birth of her son. has decreased appetite & no interest in seeing friends. appears restless & is tearful. diagnosis?
Adjustment disorder
Anxiety due to a general medical condition

26) man admitted for burns to 40% of body. has undergone 2 of 3 planned surgeries. under enteral feedings. developed high gastric residual volumes & progressive abdominal distension. next step?
Blood cultures and empiric antibiotic therapy
Flexible sigmoidoscopy

27) 6-day-old boy is exclusively breastfed & is gaining weight appropriately. born at 40 weeks gestation to a primigravida. medial deviation of the forefoot. next step?
Foot radiographs
Karyotype analysis
Forgot other options

28) woman, gravida 1 para 0, at 36 weeks gestation with B/P of 190/110 has elevated serum creatinine & transaminases. Nifedipine & magnesium sulfate are administered. Induction of labor is started with oxytocin. Magnesium level high. Cause of hypermagnesemia?
Drug-drug interaction
Hepatic insufficiency

29) 6-month-old child has been feeding poorly & fussier than usual. has a bulging anterior fontanelle & widely spaced sutures. scalp veins prominent. next step?
Recheck the head circumference in 1 month
Skull radiographs

30) woman complains of worsening gait disturbances. 3 years ago, had subarachnoid hemorrhage (SAH) from ruptured posterior communicating artery aneurysm, which was treated with endovascular coiling. shows flat affect & psychomotor retardation. cause?
Aqueductal stenosis
Cerebellar degeneration

31) 65-yr-old man complains of erectile dysfunction & decreased libido. has hypertension & minimal bilateral gynecomastia without galactorrhea. shows decreased testicular size. testosterone level 160 next step?
Angiography of the deep arteries of the penis
Measurement of serum prolactin level

32) woman, gravida 1 para 0, at 36 weeks gestation has a seizure with loss of urinary continence. Confused, agitated & diaphoretic. B/P 158/98, pulse 120/min. diagnosis?
Amphetamine intoxication
Eclampsia

33) 52-yr-old woman complains of intense itching & fatigue. is significant for hypothyroidism & carpal tunnel syndrome. medications include levothyroxine. Hepatomegaly is present. bilateral xanthelasma & skin excoriations evident. next step?
Check anti-mitochondrial antibodies
Check anti-smooth muscle antibodies

34) 76-yr-old man has constipation. has intermittent fecal leakage & hematochezia. prostate cancer treated 18 mths ago. Conjunctival pallor is present. Colonoscopy reveals rectal pallor with areas of mucosal hemorrhage & telangiectasias. symptoms?
Chronic inflammation of the mucosa and submucosa
Electrolyte abnormalities

35) Abroginal child came to you with greening discharge from nostrils. From ear
What is most suspected sequle
1) complete recovery
2) hearing loss
3) cholesteatoma
4) mastoditis

36) A 15 y/o boy with h/o sudden outburst of anger who is currently in a special school is now at verge of expulsion. What would be the best drug management for this case?
a) Sodium valproate
b) Risperidone
c) Olanzapine
d) Haloperidol

37) Sigmoid volvulus scenario, which will lead u to definitive diagnosis?
a. Ct
b. colonoscopy
c. rigid sigmoidoscopy
d. flexible sigmoidoscopy
e. barium enema

38) 25 year old female brought to ER by police for verbal abuse and aggression at shopping centre. She is barefoot wearing multi-coloured scarf and her speech was classic example of word salad with pressured speech . Dx?
A) schizophrenia
B) borderline personality disorder
C) illicit drugs

39) A child presents with multiple small and large bruises on abdomen and limbs with fine small petechiae as well. What will you investigate to confirm diagnosis?
A) Factor VIII
B) Von Willebrand factor
C) Liver function tests
D) Coagulation studies
E) FBC

40) 25 years woman goes to your clinic worried about last night after drinking she had sex with an unknown man. She took the morning pill and now asking advice. What is the most appropriate next step?
a. Reassure, (no test in this moment.)
b. Pregnancy test.
c. Hepatitis B serology
d. Chlamydia PCR

41) Para 6, having weight gain, lethargy and menorrhagia. Has anemia and PPH requiring transfusion 1 year ago. History missed miscarriage requiring D&C. Diagnosis?
A. Ashermann Syndrome
B. IDA
C. Hyperthyroidism
D. Sheehan syndrome
E. Hypothyroidism

42) man in preop clinic prior to an elective right knee replacement for severe osteoarthritis. uses inhaled bronchodilators, inhaled corticosteroids, and amlodipine. smoked 4 cigarettes daily. interventions?
a/ Immediate smoking cessation
b/ Long-term oxygen therapy

43) woman with progressive gait unsteadiness. frequently stumbles. has occasional electric shock–like sensation in the spine. has fibromyalgia and continues to have shoulder and neck pain. Upper extremity muscle strength is decreased. cause?
a/ Demyelinating polyneuropathy
b/ Lumbar spinal stenosis

44) man two weeks ago has motor vehicle collision. chest x-ray revealed enlarged mediastinal lymph nodes. has hypertension, takes chlorthalidone. x-ray a year ago shows mediastinal lymphadenopathy. cause?
a/ Antinuclear antibody formation
b/ BCL-2 gene overexpression

45) woman, gravida 2 para 1, at 40 weeks gestation. cesarean delivery with her first child due to breech presentation. fetal vertex at 0 station, occiput transverse. contraction strength is an average of 210 MVU every 10 minutes. aetiology?
a/ Contraction inadequacy
b/ Fetal malposition

46) man with a 30-pack-year smoking history undergoes laparoscopic cholecystectomy after an episode of biliary pancreatitis. mildly hypoxemic. respirations 22/min; po2 64; pco2 34 . cause?
a/ Aspiration of gastric secretions
b/ Bronchial wall edema and bronchospasm

47) A 20 yr old industrial worker sustains chemical burn injury to the eyes. WOF is the most appropriate immediate first aid management?
A. instillation of local anesthetic
B. referral to an ophtalmologist
C. irrigation with specific neutralising agents
D.instillation of an antibiotic

48) Predisposing factor to binge eating disorder
A)Family h/o obesity
B)Family h/o athleticsm
C)H/o substance abuse
D)Alcohol abuse
E)Childhood sexual abuse

50) A 15 yr old teenage lives with parents , she was a exellent student but recently significant drop in school performance , many hours in her room , talk rarely with her parents . Which of following obtions in history , help to reach dx ?
A. Shyness
B.erratic sleep pattern
C. Talk rarely with parents
D.loosening her associations
E.recent Anxiety

  1. 15 months old baby cries a lot at night and the mom gives her juice, to make him sleep. What is the risk in the baby?
    A. Dental caries
    B. Obesity

52) A 62-year-old male with a history of chronic lymphocytic leukemia is admitted to the hospital for chemotherapy with fludarabine after transformation into prolymphocytic leukemia. Three days later, the nurse calls you because the patient is vomiting. The patient reports he is nauseous and he feels weak. On physical exam, he is ill-appearing, and you appreciate diffuse, bilateral lymphadenopathy, symmetrical muscle weakness, and bilateral areflexia. Labs are drawn and an electrocardiogram (EKG) is obtained. In addition to cardiac stabilization, which of the following is the best next step in management?
a. albuterol
b. Iv NS
c. Furosemide
d. metoclopramide
e. insulin

53) recurrent ishiorectal abcess not resolved by antibiotics . What to do ?

54) Retinzl detachment and Vitreous hemmorhage

55) Metaanalysis forest plot

56)dysphagia scenario due to motility disorder

57)malarial prophylaxis in mental illness?

58) Anaemia with needed hb electrophoresis

59) Iga nephropathy / PSGN

60) vaginal swelling plus herpes simplex Rx for male partner

61) ECG of heart block ..VT

62) hyponatremiA/ conns syndrome/ cushings syndrome

63) 60 years diabetes and htn ..CHO increase , HDL decrease, LDL normal , which statin?

64) intermittent claudication , after rest better…what next ?

65) what is predictor of critical limb ischemia ? ABI less than 0.45.

66) pregnancy plus thenar eminence pain ..difficulty in sleeping? Rx 1) codeine 2) physiotherapy weekly 3)surgical decompression.

67) 50s yo man, acute 8h visual loss on the left eye. Malaise weight loss couple months. Right eye 6/8; left eye 6/21; fundoscopy Left eye ischemia, papillae oedema. Investigation?
A.Carotid ultrasound
B.Temporal arterial biopsy
C.CTs head ???

68) Girls comes for pregnancy termination, but doctor’s view point is that termination is only when baby has pathology, what to do?
A.Refer to a doctor who has the same view point for second opinion
B.Refer to tertiary hospital for further Mx

69) Preeclampsia, what Investigation
A. Renal function test

70) Patient with gastric tube, glycemia 19mmol/L , but no HX od DM before, Tx
A. Subcutaneous insulin
B. IV insulin
C. Metformin

71) Diabetes screening, patient with family risk factors, I dont remember details
A. OGTT
B. fasting glu
C. Random glu

72) burning pain behind sternal best investigation for Dx:
A. 24 H pH
B. Mamometry
C. Barium

73) Man cant sleep without temazepam, anxiety during day come to ask temazepam, Tx
A. Continue Temazepam
B. Change to Zopidem
C. Add SSRI

74) GBS scenario what Investigation to do next
A. Spirometry
B. Chest Xray
C. Nerve conduction

75). Tx of GBS :
A. IG
B. Methylpredisolone

76). Woman come in with firm mass on right neck, with Hx of arm melanoma and Sx of fibroadenoma, what is eatiology
A. Melanoma
B. Fibroadenoma

77). Patient 2 days Hx of abdominal pain , mild tenderness on examination, pain / DRE, temperature 38
which clinical features suggest appendicitis most?
A. Rectal pain / DRE
B. temperature
C. Increased Leukocyte

78). Haemorrhoid with red blood, puritis, on exam presents out of anal, Mx
A. Band lig
B. Sx to remove
C. Sclerosis

79) (similar scenario from mplus)
12w pregnant, no Hx of immunisation, what next?
A. Pertussis
B. Anti D

80). Infant just born 12h, jaundice, eatiology?
A. Biliary atresia
B. HBV.
C. Haemolytic incompatible blood

81) Parkinson scenario, what to counsel patient?
A. Degenerative disease with no cure
B. Death in 5 years

82) Patient committed suicide, now stable, what is the most serous in Hx
A. Give away his stuff

83) 29yo woman after Cone biopsy, develop PID with offensive discharge, what eatiology?
A. Chlamydia
B. Garnerrella
C. E coli

84) 29yo woman only have sex with other women, 1 girlfriend in the last 3 months, screening?
A. Chlamydia
B. Cervical

85) Children with ear discharge yellow green, eatiology?
A. Psuedomonas
B. Strep

86) Man come back after travel, the last 2 months psycho, bilateral neck lymphadenopathy
A. HIV
B. EBV

87) After surgery hypanatremia, and decreased in urine osmolality, Mx
A. Normal saline
B. SAline 1.8%
C. Restrict fluid intake 1,5L in the net 24h.

88) woman, para 2, underwent an operative vaginal delivery complicated by a second-degree perineal laceration. started on ssri for postpartum depression. experience pain & dryness during intercourse. cause?
a Hypoestrogenism
b Medication side effect

89) woman comes with eye injury. industrial-strength bleach splashed into her left eye. Physical examination reveals blepharospasm & conjunctival erythema. next step?
a Application of cycloplegics for symptom relief
b Continuous irrigation with normal saline

90) 13-yr-old girl has frequent headaches. have progressively worsened in severity & now occur almost daily. mild optic disc edema. MRI of the brain would most likely show?
a Enhancing lesion in the internal auditory canal
b Parietal lesion with air-fluid levels and a hyperdense rim

91) 5-yr-old boy having persistent ear discharge in the right ear canal. born with a cleft palate that was repaired in infancy. retraction of the superior portion of the TM & a pearly white mass. conductive hearing loss on the right side. cause?
a Acute middle ear effusion with concurrent tympanic membrane inflammation
b Chronic foreign body impaction with external ear canal abrasion

92) man complain increasing epigastric pain that radiates to the back. has an episode of vomiting & anorexia. Breath sounds are decreased at both lung bases. Lipase 5,636
a Abdominal examination findings
b Blood urea nitrogen level

93) 8-year-old boy is brought with a limp after a hiking trip. mild ache in upper right thigh. While supine, right hip slightly flexed, resisting extension & internal rotation. right hip shows a small intracapsular fluid collection. best pharmacotherapy?
a/ Doxycycline
b/ Ibuprofen

94) man with AIDS complains of painful swallowing. Endoscopy reveals multiple large, linear ulcers in the distal esophagus. A biopsy of the abnormal mucosa shows tissue destruction & the presence of intranuclear & intracytoplasmic inclusions. pharmacotherapy?
a/ Acyclovir
b/ Ganciclovir

95) 27-yr-old woman comes to discuss weight loss. BMI is 28 kg/m2. shows an overweight body habitus. most appropriate response?
a/ “Family stress is a common cause of weight gain. Let’s talk about how that might be affecting you.”
b/ “I can see how this is frustrating to you. Instead of dieting, I think you should try an exercise program to lose weight.”

96) woman is found unconscious in bedroom. her family suspects a drug overdose. has major depression. B/P 82/46 mm Hg, pulse 40/m respirations 12/m, blood glucose 52 mg/dL. Cause?
a/ Amitriptyline
b/ Clonidine

97) 70yo man, ischemic stroke. right-handed. Only right side face is shaved. When asked to raise his left arm, he raises right arm. areas affected by stroke?
a/ Left frontal cortex
b/ Left temporal cortex

98) 78yo woman, intermittent palpitations last 6 months. heart beating fast. average once a week, last up to an hour. occur when tired. ECG shows moderate left atrial enlargement. workup?
a/ Atrial fibrillation
b/ Atrioventricular nodal reentrant tachycardia

99) 8-year-old boy is brought with a limp after a hiking trip. mild ache in upper right thigh. While supine, right hip slightly flexed, resisting extension & internal rotation. right hip shows a small intracapsular fluid collection. best pharmacotherapy?
a/ Doxycycline
b/ Ibuprofen

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