AMC MCQ Recalls OCTOBER 2022

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An article from a research team has urged that up to 750,000 individuals across Australia might be in danger of exposure to Japanese Encephalitis (JEV) via mathematical modeling.

Thus far, in 2022, there are already thirty one confirmed human cases and 6 deaths. JEV is maintained in wild birds and is spread by mosquitoes between these hosts and animals such as pigs, humans and horses. The virus has spread across Australia this year, with confirmed cases in dozens of piggeries throughout the south of the country. There have additionally been confirmed cases of JEV in wild pigs within Queensland and the Northern territory. It was until last year, JEV was confined to Asia and therefore the far north of Australia.

On the side note, a huge thank you to those who had contributed in providing us with these recalls. Now let us do our part by solving these for you. You may get them from here.  

Australian Medical Council (AMC) MCQ Recalls OCTOBER 2022 compilation

73 yr old with drug eluting stent -2 mnths back ,0n clopidogrel since then, needs emergency fracture femure surgery most appropriate

a/ Do surgery nw

b/ Give platelets and do surgery

young man with tibia fracture. Patient had deep laceration over fracture site. On examination, limb is cold and pulseless. most immediate action ?

a/ Debridement

b/ Tetatus

c/ Reduction

d/ antibiotics

Nurse told you that she has relation with ex-pt in the psychiry ward. What is the appropriate action/

a/ Ask the nurse to leave the relationship immediately

b/ Take note for your future references

c/ Inform AHPRA

d/ Inform senior medical? medical board

19 G1P0 24wk, right abd pain + fever x 2/7. Increased fatigue nausea anorexia. No vomit no diarrhea. Pain unbearable. Cervix closed amniotic intact. Dx?

a/ acute appendicitis

b/ acute pyelonephritis

65 man unsteady gait. Frequent fall 2 months. Left side weak. Unable to maintain balance. Has headache & nausea. Hx hpt and t2dm. cause?

a/ brain tumour

b/ Diabetic polyneuropathy

59 yo with 1 month dysuria, urinary urgency and frequency. Dull, non-radiating suprapubic pain. Hx of obesity. T2DM. GERD. MDD. Smooth firm enlarge prostate with no tenderness, induration or asymmetry. Likely explanation?

a/ Bladder cancer

b/ Bladder infection

52 y/o man low energy, poor sleep & feeling stressed since his divorce last year. Has trouble concentrating & becoming less productive at work. No longer enjoys visiting his children. Loss of appetite. Exam shows a depressed & anxious mood with mild psychomotor agitation. Abnormality?

a/ ??enlarged lateral cerebral ventricles

b/ Increased REM sleep latency

c/ Increased serum cortisol concentration

22 yo woman is brought for right sided abd pain & vaginal bleeding. Serial hCG levels & transvaginal US confirm an ectopic pregnancy. Hx of a psychiatric diagnosis of schizophrenia. Course of action?

a/ Consent not required as emergency. Pt to be taken directly to operating room.

b/ Pt should be approached to provide consent before proceeding with the surgery.

12 yo boy is brought due to worsening bilateral eye pain. Played in snow for all day. Visual acuity is 6/12 in both eyes. Bilateral conjunctivae are erythematous with increased tearing of both eyes. Fluorescein exam reveals diffuse punctate corneal staining bilaterally. Cause?

a/ Aqueous humor obstruction

b/ UV exposure

56 yo man comes due to pain, redness & swelling in his right arm. Recently diagnosed with unresectable lung cancer. Received the 1st cycle of chemotherapy 2 wks ago through a right-sided PICC. Next step?

a/ Chest MRI

b/ Duplex ultrasonography

68 yo woman comes due to worsening shortness of breath. Smoked approx 10 cigarettes daily from age 18 to 50. Oxygen saturation 94%. Lung auscultation reveals bilateral vesicular breath sounds with occasional rhonchi that clears after cough. FEV1 is 65% & FEV1/FVC ratio 50%. Next step?

a/ Inhaled muscarinic antagonist

b/ Low dose inhaled corticosteroid

67 yo woman is evaluated prior to laparoscopic cholecystectomy for acute calculous cholecystitis. History includes hypertension & dyslipidemia. Hyperdynamic apical impulse & a grade 2/6 holosystolic murmur at the apex. S1 & S2 are diminished. Management prior to surgery?

a/ Cardiac catheterization

b/ No further intervention

55 yo woman found unconscious. En route, had a seizure. Significant for treatment-resistant MDD, hypertension & hyperlipidemia. She takes imipramine, atorvastatin & lisinopril. BP 90/50. Abdomen distended. Sodium bicarbonate therapy administered to treat?

a) Cardiac toxicity

b) Hyperkalemia

40 old man is brought due to retrosternal & epigastric pain after ingesting NaOH based drain cleaner 45 min ago. History of MDD & a prior suicide attempt. Oropharyngeal erythema & mild edema. IV normal saline infusion initiated. Next step?

a/ Activated charcoal in water

b/ Gastric decontamination with ipecac

c/ Upper gastrointestinal endoscopy

42yo woman is brought due to worsening severe bilateral headache, neck pain & an episode of vomiting. Medical history significant for HPT. Temp 38.2 C, BP 154/92 & pulse 102. Increased resistance to passive neck flexion & it also elicits pain. Next step?

a/ 100% oxygen inhalation

b/ CT scan of the brain

38yo woman with worsening clumsiness & shaking in her right arm. Takes OCP & occasionally acetaminophen. BMI 34. Right hand dysmetria & a mild right pronator drift but no muscle weakness. Several of the lesions enhance after contrast administration. Next step?

a/ gv acetazolamide

b/ gv methylprednisolone

6yo boy is brought due to progressive difficulty walking & back pain for 2 mths. Recent onset of daytime & nighttime urinary incontinence. High arches of the feet with fixed flexion of the lower extremity digits. Bilateral lower extremities have decreased strength & 1+ reflexes. Dx?

a/ Muscular dystrophy

b/ Tethered cord

26yo man comes with a 1-wk history of dysuria & increased urinary frequency. Has multiple sexual partners in the past mth & inconsistent with condom use. Mucopurulent discharge seen at the urethral meatus. Culture of discharge & urine show no growth after 48 hrs of incubation. Dx?

a/ Acute bacterial cystitis

b/ Acute pyelonephritis

c/ Chlamydial urethritis

36yo woman comes due to vaginal spotting for the past 4 days. Amenorrhoeic for the past 2 yrs. Exam shows right adnexal tenderness & a closed cervix. UPT positive. US shows a small uterus with a thin endometrium & an intrauterine device in place. Next step?

a/ Diagnostic laparoscopy

b/ Transvaginal ultrasound

72years old man comes for a health maintenance exam. Occasional pain in his knees. Significant for hypertension & osteoarthritis, for which he takes HTZ, lisinopril & as-needed acetaminophen. Inquires whether he should be screened for abdominal aortic aneurysm. Next step?

a/ Obtain a CT scan of the abdomen

b/ Obtain an abdominal ultrasound

1-hr-old boy is evaluated for feeding difficulty. Born at 40 wks gestation to a 22yo primigravida via spontaneous vaginal delivery. Apgars were 8 & 9 at 1 & 5 min, respectively. His skin continued to turn blue shortly after breast-feeding with return of normal color after crying. Next step?

a/ Draw blood cultures

b/ Measure blood ??metamoglobin level

c/ Pass a catheter through the nares

29yo flight attendant with worsening weakness & lightheadedness, causing her difficulty ambulating. Has diffuse abdominal pain & 10-kg wt loss over past 3 mths. Has hypothyroidism. BP 80/50. Orthostatic changes present. Dry & pigmented buccal mucous membranes. Cause?

a/ Autoimmune inflammation

b/ Eating disorder

19yo college student comes due to a 1-wk history of malaise, fever & a swollen, painful right knee with restricted motion. Hx of depression treated with fluoxetine. DM in his father. Need for a joint aspiration for possible septic arthritis but he refuses. Next step?

a/ Admit the patient to the hospital involuntarily as untreated septic arthritis is potentially life-threatening

b/ Allow the patient to leave, but counsel him that he can return at any time

27yo man comes due to syncope. Has 2 similar episodes last yr but did not seek medical attention. Become concerned following this 3rd episode. Has a small occipital hematoma. Next step?

a/ Ambulatory ECG monitoring

b/ CT angiography of the chest

59yr old man comes with a 3-mth history of persistent right ear pain. Works as a welder & has smoked a pack of cigarettes daily for 40 yrs & drinks a case of beer each weekend. Oral cavity exam shows poor dentition. A nontender 2-cm lymph node on the right side of his neck. Next step?

a/ Audiogram

b/ Flexible laryngopharyngoscopy

53 yr old man with 4-wk history of fatigue, dyspnea & decreased exercise tolerance. Pulse 130 & irregular. No ECG p waves. Echocardiography shows left atrial dilation, left ventricular dilation with global hypokinesis & ejection fraction of 35% & moderate central mitral regurgitation. Intervention?

a/ Coronary revascularization

b/ Rate or rhythm control

32 yr old man t2dm comes due to ED & decreased libido for the past mth. History of schizophrenia & was discharged from psychiatric hospital 3 mths ago on risperidone. Review of systems is negative except for a recent 3-kg wt gain. causes?

a/ ?drug

b/ T2dm

4 yr-old boy is brought due to behavioral difficulties at preschool. Hits other children for no clear reason. Family history includes autism spectrum disorder in his older brother. Has deep-set eyes & large ears. Highly active, does not make eye contact or answer questions directly. Establish diagnosis?

a/ autism observation score

b/ ???FRM1 DNA analysis

3 yr-old boy with fever & painful swelling in his right groin. Has 4 episodes of cutaneous abscesses & a lung abscess due to Staphylococcus aureus. Maternal uncle died in recurrent infections. Gram stain reveals organism-filled, segmented neutrophils. Cultures grow Aspergillus niger. Diagnostic test?

a/ B cell concentrations

b/ CH50 assay

c/ Dihydrorhodamine test

36 yr-old woman comes for a postoperative visit due to incisional pain & light vaginal bleeding from an abdominal hysterectomy for heavy menstrual bleeding. Incision is closed with staples & the skin edges are intact. No erythema, drainage, fluctuance, palpable masses or defects present. Next step?

a/ CT abd pelvis

b/ Observation and reassurance

88-yr-old woman with bright red postmenopausal bleeding & pelvic pain for the past wk. Lives in a nursing home, refusing to bathe or leave her room. Vulva is edematous & tender & there is a friable posterior perineal laceration. Uterus is small with a 3-mm endometrial lining. Next step?

a/ Endometrial biopsy

b/ Sexual abuse screening

28 yr old primigravid at 30 wks gestation on routine prenatal visit. Normal prenatal lab results, including a negative urine culture during the 1st trimester. Her niece recently died from neonatal group B streptococcal infection & is afraid this could happen to her baby. Appropriate response?

a/ Given your family history, I will administer prophylactic abx during your labor.

b/ Let me check for this bacterium 3-5 weeks before your expected delivery date.

48 yr old woman with right nipple discharge. Has schizophrenia, is well controlled. Plays tennis & goes to kickboxing classes regularly. Paternal aunt died from metastatic breast cancer at age 50. Scant reddish-brown fluid is expressed from the right breast. Cause?

a/ Infiltrative carcinoma of breast duct

b/ Intraductal papilloma

54 yr old man comes due to worsening shortness of breath. Frequent epigastric pain for the past 10 yrs. Significant for alcohol withdrawal seizures; consumed 7 or 8 beers a day for the past 20 yrs. Oxygen saturation 92%. X-ray reveals a large, left-sided pleural effusion. Diagnosis?

a/ Alcohol cirrhosis

b/ Esophageal perforation

c/ Pancreatic fistula

59 yr old woman is brought after falling from a standing height. Struck her left posterior chest against the nightstand. Has left-sided chest & shoulder pain, worse with deep breathing. Neck veins are flat. X-ray reveals displaced fractures of the posterior 9th & 10th ribs. Next step?

a/ CT angio chest

b/ CT abdomen

24 yr old woman on a routine physical exam before starting a new job. Has intermittent headaches, occasional abdominal bloating, seasonal allergies, fatigue & insomnia. Appears sad; feeling low. Dates but no serious relationship & believes she is unattractive. Diagnosis?

a/ Adjustment disorder with depressed mood

b/ Persistent depressive disorder (dysthymia)

58 yr-old man with nontender, hard mass on the posterior left elbow. Has hypertension, chronic kidney disease & gout. Imaging shows a 3-cm, soft tissue mass & bone erosions with overhanging edges of cortical bone at the olecranon process. Serum creatinine 150. Diagnosis?

a/ Chronic kidney disease–mineral and bone disorder

b/ Osteosarcoma

c/ Tophaceous gout

32-yr-old woman with left lower quadrant abdominal pain. History of heavy menstrual bleeding due to uterine fibroids. US reveals multiple subserosal & intramural uterine fibroids, homogenous endometrial stripe, free fluid in pelvis & left ovary with 4-cm cyst with thin walls. Next step?

a/ CT abd pelvis

b/ Laparotomy with myomectomy

c/ Observation and reassurance only

47 yr-old man is brought due to a fall down a flight of stairs. Has neck & shoulder pain afterwards. Numbness & weakness of the left upper extremity. Mild, left-sided weakness of elbow extension & wrist flexion, with decreased pain sensation of the index & middle fingers. dx?

a/ Burst fracture

b/ Facet dislocation

40 yr-old man comes due to severe headache associated with photophobia & nausea. Mild cold symptoms a wk ago. Has hpt & smoked a pack of cigarettes daily for 15 yrs. Father died of stroke at age 75. BP 170/100. Just had an episode of nonbilious vomiting. Cause?

a/ Cerebral venous thrombosis

b/ Ruptured berry aneurysm

23 yr-old woman with worsening pain in the right forefoot. Normally runs 3 times a wk & occasionally goes hiking. Right foot elicits a clicking sensation when 3rd & 4th metatarsal heads are squeezed together; this also produces a burning pain over the plantar surface of the foot. Diagnosis?

a/ Morton neuroma

b/ Plantar fasciitis

2 yr-old girl is brought due to fever, vomiting & lethargy. BP 70/36. Poorly responsive on exam. A rash present on bilateral lower extremities. Antibiotic therapy initiated & LP obtained. Gram stain of cerebrospinal fluid shows gram-negative diplococci. Additional studies?

a/ ANA

b/ Serum fibrinogen

36 yr old gravida 1 para 1, without menstrual period for 2 mths. Past 2 wks, experienced bilateral breast soreness, weight gain & increasing fatigue. Menses were all the while regular but have been irregular since taking medroxyprogesterone. Patient requests different contraception. Next step?

a/ Measure serum FSH, TSH, and prolactin levels

b/ Perform a urine pregnancy test

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