AMC MCQ Recalls NOVEMBER 2023

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Amid a resurgence of COVID-19 cases in New South Wales, the state’s health authority is advising residents to adopt precautionary measures reminiscent of the pandemic’s peak to curb the virus’s spread. NSW Health reported a rise in cases in the two weeks leading up to November 4, with slightly over 11 percent of PCR tests yielding positive results. The respiratory surveillance report highlighted an escalation in COVID-19 activity across various indicators, noting an increase in emergency department visits for COVID-19 across most age groups, particularly among young children and individuals aged 65 and older. As a result of that spike in cases, NSW Health is now urging residents to once again take up “everyday habits” to keep the community safe

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 NOVEMBER 2023 compilation

Ich bleed GCS ..10
What to do next..
A Start HTN
B Intubate

Melanoma History..
Came with RUq pain .. farmer..
Ct given
A Mets
B Hydatid cyst
c Abcess

Accident high ICH
Neuro unit far
What to do
A Mannitol and hypervent
B Burr hole

Tia om aspirin already US bilateral 50 carotid stenosis
Next
A Add clopidogrel
B Enderectomy

Diabetic in hospital on metformin 1000BD
Premeals sugar control
Fasting 10 to 12
Next??
A increase bed time glargine
B add oral anti-diabetic

Pregnant Women 42 years old looking for doubts of breast cancer (not risk or age for screening) – encourage breast feeding

Post partum asking for best antic onceptive 2 dayes after – POP

19 ye old girl is having irregular periods 6 to 9 weeks.presented to GP with white breat discharge and amenorrhea for 11 weeks. What to do for establish diagnosis?
a) HCG
b) USS pelvis
c) prolactin
d) FSH and LH
e) 21 day progesterone

Lady left door open, child ran outside and died. Dx ?
Options –
1) Major depressive episode with psychosis
2) Brief psychosis
3) Acute stress syndrome
4) PTSD

27 boy asthma since childhood, used salbutamol and fluticasone, daytime symptoms 3 days/week. Management?
a/ Change his preventer to budesonide 400mcg turbuhaler twice daily.
b/ Change his preventer to a low dose combination inhaled corticosteroid

pegnant women at 20 wks had previous 2 doses of gardasil , due for 3rd dose, came to clinic ,what immunization will we offer her,
a 3 rd dose gardasil
b Pertussis
c Rubella
d Chicken pox

86 old ly, with repeated syncopal episodes è nausea n vomiting, otherwise healthy , ,5 ECGs were given in options

herpetic keratitis picture, it’s treatment asked

28 year lady came with her 4 wk old child , for regular checkup, she mentions her vit d was low in her pregnancy .rest of her checkup was normal.what will u advise her?
Vit d supple
Sun exposure
Check vit d levels
Rest were irrelevant

4 growth graphs were given, acc to me thy were showing normal growth
a) iugr
b) Short for dates
c) Long for dates
d) constitutional delay

old lady with bloody cough , she’has hx of lifelong productive cough as she was asthmatic since childhood, her x ray was given ,looks like hyperilflated lungs n her cardiac shadow wa oblong, asked for long term advice / management
a Graded exercis,
b physio,
c cardiac rehabilitation

red back spider bite , tachy 150/90, profuse sweating, excessive pain on site. what helped to lead u to confirm the diagnosis of envenomation?
A Venom kit,
B Sweating
C Pain

intern with criminal record in his own country, what shud u do?
Ask him to tellcentres legal team
Tell your centres adviser/owner

female to female sex, she has multiple female partners, but regularly gets check n otherwise healthy,what screening shud be done on regular bases( HPV IS THE MOST COMMON AMONG FEMALE REGULAR SCREENING)
Hiv ,
Chlamydia,
HPV ,
hepc
,syphilis

elderly man was brought by his wife saying behaving weird, started on levodopa/ carbidopa Parkinson’s drug 6 month back , he’s developed cogwheel rigidity, pinwheel , fine movement, tremors,his symptoms r poorly controlled , out of following which is wrong treatment for him
-Levodopa,
-Digoxin
-Some bezodiazepine was there

probability graph was given option d one asked for maximum effect

female pregnant at 14 wks , taking wine full bottle and other recreational drugs, fetal heart no, what will lead to her diagnosis
Cocaine, was not in options
actasy,
antenatal visit ,
anti ds
Alcohol

50 male, right eye blurry vision, intermittent double vision, poorly controlled type 2 diabetes, hypertension, dyslipidemia. Impaired cranial nerve?
a/ IV
b/ VI
c/ V

82-year-old female with no significant medical history, taking olandronate + calcium, suffers a fall (image by xRy) and asks about the most appropriate management.
1.full replacement
2.partial replacement
Can’t remember the other options

Video recorder of the patient by his consent and it was to be used for his records and management only.
Gp has to give presentation.
Use the video don’t tell the patient.
Delete the video after showing.
Take extra permission from the patient to show

33-year-old male with 10 years of epigastric pain who has been treated with esomeprazole without other symptoms and in good general condition, everything normal, ask for the best Ix.

  1. x-ray
  2. USD
  3. endoscopy
  4. ct

38 year old healthy female is worried because her cousin had ovarian cancer at age 53, the patient wants to know what study can be performed to know her risk of suffering from cancer

  1. Breast ca
  2. Ca 125

Pregnant lady.. exposed to rubella .. dont know status
Check serology
Give vaccine

Stemi.. teritrary unit 3hrs
Give IV tenecteplase

Mom with Charocot mary son has symptoms next to do
Nerve biopsy
Ncs
Emg

42 lady, ‘pea-sized’ lump L breast, non-tender, not related to cycle. 1cm soft mobile lump, upper outer quadrant L breast, no other changes, no lymphadenopathy. Next step?
a/ Advise her to attend BreastScreen for a screening mammogram
b/ Urgent referral to a breast surgeon

67 lady, days of fevers, lethargy, myalgia, dry cough, shortness of breath. Diagnosis: Legionella pneumophila. True statement?
a/ Patients with Legionella pneumophila may present with diarrhoea
b/ Legionella pneumophila has an incubation period of 14-21 days

woman with normal BP, no family hx of cardio v dz. Did FBS 5.9mmol/l asked what next
A. Hb1c
B. RBS in future?
C. FBS in 1 yr

23 male, painful left knee after skiing 2 wks ago. Sudden stabbing pain, swelling, dull ache, positive McMurray’s test. Likely diagnosis?
a/ Medial meniscal tear
b/ Osteochondritis dissecans

68 lady, fever, cough w/ green sputum, SOB x 2 days. Increased work of breathing. Crepitations, bronchial sounds on right. Chest x-ray given, likely diagnosis?
a/ Right upper lobe pneumonia
b/ Right middle lobe pneumonia

Patient with history of melanoma with tx pembrolizumab ( inmunosupressor) visit EM because of watery diarrhoea more than 4 time in 24 hours. Ask for treatment

Oral ciprofloxacin
Infliximab
Another oral Ab and two IV

23 girl w/ impaired hearing R ear, recurrent CSOM. Perforation to attic w/ visible white flakes, concern for cholesteatoma. Expected findings on exam/investigation?
a/ Bilateral conductive hearing loss on audiogram
b/ Sound localises to the right ear when performing Weber’s test
c/ A positive Rinne’s test in the right ear

76 old man w/ painless bloodshot R eye, lower half of sclera blood-stained. Possible underlying risk factor?
a/ Diabetes mellitus
b/ Chronic renal disease
c/ Cataracts

8wk old w/ intermittent inward eye turn. Eye exam normal. Management advice for father?
a/ advise to return if the eyes are still turning inwards after 12 months of age
b/ referral to an ophthalmologist within the next month for an eye review

4yo boy, born in Australia, Afghan parents, 3wk trip to Karachi, Pakistan, fever, abdo pain, nausea. No pre-travel consult or extra immunizations. Likely vaccine-preventable viral infection?
a/ Dengue
b/ Hepatitis B
c/ Hepatitis A

68 man, left scrotal swelling for 3 months, worse at end of day, non-painful. COPD on tiotropium bromide. Scrotal ultrasound: left hydrocoele, displaced left testis. Next step?
a/ Prescribe frusemide 40mg orally daily to reduce the swelling in his left scrotum
b/ Advise him to wear supportive underwear and re-present if the swelling increases or becomes uncomfortable.

Question on athma, about a six year old presenting with asthma symptoms plus difficulty speaking. Was administered 6 puffs of salbutamol but no response. Asked what next?
A. Repeat
B. Steroid?

2yo boy, fever, misery, not eating/drinking, ulcerative lesions on gums/tongue, mild dehydration. Diagnosis?
a/ Adverse drug reaction
b/ Herpes simplex virus infection
c/ Erythema infectiosum

72 man, worsening cough, sputum color change, SOB, rhinorrhea, myalgias, fever. Moderate COPD. Diagnosis and management?
a/ Infective exacerbation of COPD, possibly due to influenza.
b/ Viral pneumonia, possibly due to influenza.

32 female, painless lump inside lower lip for a month. Non-smoker. Recommended management?
a/ Refer her to an oral and maxillofacial surgeon for excision
b/ Reassure her that the lump will eventually self-resolve.

58 man concerned about low testosterone. DM, BMI 30, drinks 2 drinks/day. Clinical feature for androgen deficiency?
a/ Low libido
b/ Reduction in muscle bulk
c/ Reduction in testicular volume

Monogamy relationship..
Asking HPV what in history go against giving vaccine..age 27
I did she is already sexually active

Pph 750ml bloodloss
Next step
Iv line insertion

Mother came with child for vaccination.. mother not making eye contact.
What to do

16 girl wants HPV vaccine. No prior doses, eligible for catch-up. Discussed risks/benefits, assessed as having capacity. Next?
a/ Report her parents to the Department of Child Protection.
b/ Administer the Human Papilloma Vaccine to her today with her consent.

4yo kid with chest tightness, SOB, occasional wheezing. What increases asthma suspicion?
a/ History of a moist cough
b/ Symptoms recur frequently

32 man, carries Huntington’s gene, seeking health insurance. Advice?
a/ his application will be not be affected by the genetic test results.
b/ DNA test prior to applying for health insurance.

Question on a young pregnant woman who complained of poor fetal movement at 39wks, o/e she was 9cm dilated, fhr heard with Doppler, fetal decent 2/3.
A. Send her home
B. Send to maternity for further assessment
C. Admit not sure

20 lady with 3-wk frothy, odorous vaginal discharge, itching, dyspareunia. Swab: motile flagellated protozoans. Likely diagnosis?
a/ Bacterial vaginosis
b/ Trichomoniasis
c/ Chlamydia

Isotretion to start.. what test to do before you start. Female periods irregular last was 4 weeks ago..
I did beta HCG…

Patient came for vaccination you saw he has inflammed acne.. you just went seminar about new drug..
Talk about new drug
Talk according to guidelines.

Patient has PSGN..
What symptom is most imp to admit to hospital
Edema
Htn
Urine trace protein

PSGN What med to start patieng has High bp
I started ace.. but steriod was their on option as well

Psgh what test to do
U&C
C3 Levels..

Angioedema history
What test to do
C1 and c4 level

Farmer.. hand cut now came with jaundice rash.. dysuria
Cough.. confusion
I did leptospirosis

18 teenage man with 48-hr R facial droop, well prior. No fever. Likely Bell’s Palsy. Management plan?
a/ Prescribe prednisolone 75mg orally, once daily for 5 days
b/ Refer him for an urgent MRI to exclude other causes for his presentation

38 man seeks help for alcohol use. Heavy drinking for 15 yrs, 6 pack nightly + wknd binges. Correct management?
a/ Naltrexone and acamprosate have well established efficacy and are first-line treatments.
b/ The most common side effect from acamprosate is constipation.

Grandmother brought sick baby diarhea cough.. father mother 1 week ago covid
What next..
Viral PCR and covid pcr
Rapid antigen test

Female no sex for last 4 months came with recurrent tingling sensation during urination subsides itself…vaginal exam red vagina and white discharge
What to do..
Ogtt
High vaginal swab.

50 man with ED, suitable for Sildenafil. Possible side effect?
a/ Abnormal vision
b/ Bradycardia
c/ Dry mouth

45 man w 3-wk dry cough, SOB, intermittent fever, fatigue. Better in AM, worse as day progresses. No smoking. Exam: 37.9°C, diffuse fine crackles. Diagnosis?
a/ Chronic bronchitis
b/ Extrinsic allergic alveolitis

Boy isolating himself in room.. angry with parents. Found ciggs and alcohol in room
What in history to ask..
School bullying
School performance
FH of schizophrenia

Parents physically strict.. child now breaks things in school.. no remorse
What to do next..
Physical exam
Mental exam

Man on medication for schizophrenia not control now came telling i am hearing voices to kill my parents they are ploting against me and break neighbor house..
What to do..
Call police
Involuntary admission
Call family meeting

53 aldy with bad breath, husband complaints, AM noticeable. Meds: captopril, esomeprazole, azathioprine. Recently erythromycin. Smoking, daily wine. Causes of halitosis?
a/ Smoking, alcohol, obstructive sleep apnoea, sinusitis
b/ Azathioprine, smoking, sinusitis, erythromycin

13 boy vague right knee pain, swelling, AM stiffness w/ locking. Plays junior football. Right knee effusion, medial femoral condyle tenderness. Likely diagnosis?
a/ Baker’s cyst
b/ Medial meniscal injury
c/ Osteochondritis dissecans

Man alcoholic.. admitted for elective kneee replacement..4 day post op
He is confused short of breath spo2 88 on 15L..
What to ivestigate..
Alcohol level.
Ctpa.. i did CTPa

Old lady fell on ground from standing position.. hip fracture .. what to do after surgery.. no labs
Start vitamin d and ca
Or aldronate.

Man with back pain.. x ray given…
Check next..
Protein electrophoresis
Calcium level.

T3m1no prostrate cancer..
Treatment
I did ADT.

80 year old with urine incontinence.
What to do..
Pelvic excercise..
Vaiginal pessary

male presented with two day hx of melena,UGIE shows non bleeding peptic ulcer.he is on asprin 100mg for cardiac stenting (duration not given ),and also has undergone a total hip replacement 7 days ago and not on any medication for that but resolving & start to walk most appropriate mx plan

  1. Stop asprin
  2. stop asprin and start LMWH
  3. change asprin to revaroxiban
  4. continue asprin with followup UGIE in 3month

27 lady dandruff, no improvement w/ OTC shampoo, no itch, scalp lesions. Next step in management?
a/ Prescribe her mometasone furoate 0.1% ointment to be applied daily to the scalp.
b/ Advise her to wash her hair with coal tar shampoo at least twice a week

34 lady 5 wks amenorrhea, regular 27-day cycles, no med hx, BMI 32. Antenatal vitamins?
a/ Folic acid 400mcg + iodine 150mcg
b/ Folic acid 5mg + iodine 150mcg

Boy fell from 5m height. Lost conciousness, now drowsy, has a big haematoma. Closest neurosurgical unit is 4h away. What to do? Shahriar AMC
A CT
B send by ambulance
C send by chopper
D admit and observe for 6h
E let him go home

3yo boy, meets autism criteria. Upset by routine changes, picky eater, delayed speech. Referral to pediatrician. Blood test?
a/ A Guthrie test
b/ Chromosome microarray testing and DNA studies for Fragile X syndrome

41 lady w/ facial rash, gradual onset, sensitive skin. Tried OTC products, no improvement. Central facial erythema, pustules, papules. Initial treatment for mild rosacea?
a/ Mometasone ointment 0.1% once daily
b/ Metronidazole 0.75% cream or gel once to twice daily

44 lady w family history of breast cancer. Negative mammogram 5 months ago. Advice?
a/ Tamoxifen may be used for the prevention of breast cancer
b/ She could consider either tamoxifen or raloxifene treatment

50 man with perianal pain, swelling. Past haemorrhoids. BP 138/86, HR 70, temp 38°C. Next step?
a/ Prescribe flucloxacillin 500mg orally four times daily for 7 days
b/ Refer him to the emergency department for an incision and drainage of the lesion

59M, chronic snoring, wife reports apnea. Fatigued. Hx of HTN, obesity, T2DM, depression. Refer for sleep study?
a/ He must have a positive OSA screening questionnaire
b/ referred by his GP for a home-based sleep study only

25 man with dog bite, multiple puncture wounds on hand. Preferred antibiotic?
a/ Amoxycillin with clavulanic acid
b/ Cephalexin

65M, osteoarthritis, CKD stable at 50mL/min/1.73m2, eGFR drops to 34mL/min/1.73m2. New medication causing this?
a/ Prednisolone
b/ Naproxen
c/ Colchicine

Man with abdominal pain..
Bone pains and confusion..
Calcium 3.9.. rft high
Already started on IV fluids what next
a) Iv furosemide.
b) Catcitrol
c) Primdronate

58 girl mid-thoracic back pain for 1 mo, fall on coccyx during gardening, dull ache worse w/ rotation. >3 cm height loss, kyphosis, T8 vertebral crush fracture. Correct statement?
a/ trauma fracture of the hip older than 50 years of age is presumptive of osteoporosis
b/ Any patient aged > 65 years qualifies for a Medicare

30 man discolored, thickened R thumb nail. Likely onychomycosis. True statement?
a/ Topical nail preparations are first-line treatment
b/ Confirming the diagnosis with microscopy is recommended before treatment

Man heart failure.. came with nausea and vomiting.. abdominal pain.. on diagoxin 0.25.. ramipril..
All labs were normal..
Cause
Diagoxin toxcity
Viral gastroenteritis

3mo kid with large birthmark on face. Born at term, uncomplicated pregnancy. No medical conditions/meds/allergies. Advice on lesion management?
a/ Advise that the lesion will likely self-resolve over the next few years
b/ Advise referral for further investigation of possible associated neurological

16 man with post-tooth extraction difficulty opening mouth, mild facial swelling. Non-toxic, no TMJ tenderness. Management?
a/ Advise cessation of the metoclopramide
b/ Refer him urgently for maxillofacial surgical review

21lady on oral isotretinoin for cystic acne. Common side effect?
a/ Cheilitis
b/ Rectal bleeding
c/ Tinnitus

35lady lethargy, anxiety, palpitations. Abnormal TSH (0.07mIU/L). Likely cause?
a/ Graves disease
b/ Subacute thyroiditis
c/ Thyroid carcinoma

Parotid swelling.. picture same hand book
Usg done..
Next step
Fnac
Siologram

Alcoholic smoker.. came with 24hours history of left ey blurring.. picture ptosis and miosis..
Next to do
Chest xray
Ct head

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