Australian Medical Council (AMC) MCQ Recalls OCTOBER 2024 compilation
64 lady w/ painful L foot, intermittent attacks over 6 mos, warm and swollen. Distal pulses palpable, loss of sensation, erythema on L mid-foot. cause?
a/ Charcot’s arthropathy
b/ Acute episode of gout
c/ Osteomyelitis
A pregnant woman has spontaneous rupture of membranes. The CTG results shows fetal HR 140-160/min with 2 deep late decelerations. On exam, OS is 5 cm, fully effaced, fetal head just engaged. What is the most appropriate next step ?
A. Tocolysis
B. Fetal scalp sampling
C. LSCS
D. Continue CTG monitoring
E. Instrumental delivery
A patient was diagnosed with abdominal wall cellulitis and was treated with IV flucloxacillin. Later, the patient came with persisting fever, confusion. What will be next step ?
A. Change to clindamycin
B. Add vancomycin
C. Surgical debridement
D. Ticarcillin/Clav
E. IV augmentin
10 yo girl, recent immigrant, increasing drowsiness, abdominal pain, vomiting, increased thirst/urination. Urine dipstick ++++ glucose and ++++ ketones. Key life-threatening complication?
a/ Cerebral oedema
b/ Hyperphosphataemia
c/ Acute renal failure
A 32 years old woman inform the GP that she lives in constant fear because of her husband’s aggression. But, she doesn’t want you to call the police. On exam, she has several bruises all over her body. What to do next ?
A. Inform police anyway
B. Advise her to inform police
C. Offer her phone number of a safe shelter
D. Offer counselling about domestic violence
E. Take pictures of the bruises
30 lady, 5w6d pregnant, vaginal bleeding since this morning, no pain, vitals normal. Beta hCG 1700 IU initially, 2100 IU after 48 hrs. Next step?
a/ Refer for transvaginal ultrasound to locate gestational sac
b/ Urgent review by gynaecologist at local maternity hospital
63 male w/ erectile dysfunction for 6 mos, no libido changes or mental health issues. In good health, no meds. Initial investigations?
a/ Serum testosterone, HbA1c, fasting glucose, lipid profile
b/ Full blood count, fasting lipid profile, liver function tests
72M, advanced Parkinson’s, dependent on care, no hospital transfer if unwell. Vomited this morning, ongoing nausea. Which anti-emetic?
a/ Domperidone 10mg orally
b/ Metoclopramide 10mg orally
c/ Prochlorperazine 5mg orally
40M, difficulty seeing computer screen for 1 day, no pain, normal pupils. Light reaction abnormal. Important diagnosis to consider?
a/ Optic neuritis of L eye
b/ Retinal artery occlusion of R eye
c/ Tumour in apex of R lung
A 66 years old female, recently visited south east Asia, suffered from a single episode of diarrhoea and RUQ pain, which resolved on its own. She came to GP, 3-4 weeks later, with RUQ pain, fever, malaise and jaundice. What is the diagnosis ?
A. Hydatid cyst
B. Cholecystitis
C. Cholangitis
D. Hepatitis
E. Liver abscess
A patient has history of epilepsy from 10 years age. He experienced early morning fit after sober Saturday night. He is taking carbamazepine 200 mg tds. Later, he had the same fit few days ago, otherwise he is normal. What to do now ?
A. Increase carbamazepine to 400mg bd
B. Add phenytoin 100 mg tds
C. Check anticonvulsants levels
D. Do EEG
E. Do MRI
23M plumber, back, groin, and hip pain after football camp, feverish, soft abdomen. Pain reproducible on hip flexion. Important diagnosis?
a/ Left psoas abscess
b/ Urinary tract infection
c/ Labral tear of the left hip
5M w/ 3-day fever, sore throat, +Strep pyogenes. Red, enlarged tonsils w/ exudate, tender lymph nodes. Most appropriate antibiotic?
a/ Phenoxymethylpenicillin 15mg/kg orally 12hr for 10 days
b/ Amoxicillin 15mg/kg orally 8hr for 7 days
Pediatric patient 10 months, clear rhinorrhea, fever, pharyngeal erythema, not
exudated, neck lymphadenopathy, no findings at the pulmonary level: management:
Azithromycin
Amoxicillin
Oseltamivir
25F traveling to Nigeria, needs Yellow Fever info and vaccination. What’s the best advice?
a/ Yellow Fever vaccination contraindicated for egg anaphylaxis
b/ Booster dose of Yellow Fever not required
Couple trying to conceive for 12 mos, wife has regular cycles. Interested in ovarian reserve testing. What investigations to assess?
a/ Day 2-4 FSH, E2, AMH, transvaginal ultrasound for antral follicle count
b/ Day 2-4 LH, AMH, day 21 progesterone
4yo boy, recently moved to Aus, needs immunisations. Last doses in Canada at 18m, only 1 MMR and no meningococcal/ hep B birth dose. Remaining vaccines match Aus schedule. What to administer?
a/ Requires meningococcal ACWY, diphtheria, tetanus, pertussis, poliomyelitis, and MMR booster
b/ Needs MMR booster + meningococcal ACWY vaccine
72 lady w/ 2m vulval/perianal itch, no discharge, stinging w/ urination. Tried antifungal pessaries, symptoms unchanged. Exam shows thickened skin, fissures, and ulcer. Main initial treatment?
a/ Potent topical steroids
b/ Long-term oral prednisolone
c/ Oral fluconazole
Patient have epilepsy from 10 years. Experienced early morning fit after sober
Saturday night. Taking carbamazepine 200mg tds. Had same fit few days ago.
Otherwise normal. What to do now?
Increase carbamazepine 400mg bd
Add phenytoin 100mg tds
Check anticonvulsants levels
Do EEG
Do Mri
17M presents w/ dysuria, pus at urinary meatus after unprotected sex 5d ago. Afebrile, no epididymo-orchitis. Swab for gonorrhoea taken, 1st-pass urine for NAAT. Best management option?
a/ Ceftriaxone 500mg IM in 1% Lignocaine + Azithromycin 1g orally stat
b/ Amoxicillin 3g orally stat + Probenecid 1g orally stat + Azithromycin 1g orally stat
20F has 6m of vomiting after meals, 1kg weight loss, avoids eating in front of others. Boyfriend thinks it’s bulimia. Findings likely in bulimia nervosa?
a/ Metabolic alkalosis
b/ Body mass index <18kg/m2
c/ Hypernatraemia
26F for life insurance check-up, urinalysis + for blood, normal color. Microscopy shows 12 RBCs/HPF, denies dysuria or pain. True statement about haematuria?
a/ Normal urine <10 RBCs/high power field b/ >5 squamous epithelial cells/high power field indicates contamination
57M, repeat Rx visit, hx of T2DM and HTN. Blood tests show elevated liver enzymes. Likely cause of deranged LFTs?
a/ Metabolic associated fatty liver disease
b/ Alcoholic liver disease
c/ Gilbert’s syndrome
24M had seizure, minimal sleep, witnessed by partner. Stiffness, jerking, loss of consciousness reported. No prior seizure history. Correct statement?
a/ Epilepsy diagnosed after 2 unprovoked seizures (>24hr apart)
b/ Anti-epileptic treatment usually after 3 seizures
65M has new pigmented lesion on L scapula, increasing in size over 3m. Risk factors include family hx and sunbed use. Lesion is irregular, 7mm. Initial management?
a/ Surgical excision of lesion for histopathology w/ 2mm margin
b/ Surgical excision of lesion for histopathology w/ 1mm margin
72M w/ COPD, increased breathlessness over 6m, now needs breaks every 100m. Spirometry shows FEV1 54%. Next step in COPD management?
a/ Prescribe Tiotropium bromide 18mcg inhaler once daily
b/ Prescribe fluticasone 125mcg inhaler 1 puff twice daily
35 lady presents w/ lethargy, joint pain, mouth ulcers. ANA 1:80, positive anti-dsDNA, RF positive. Likely diagnosis?
a/ Systemic Lupus Erythematosus
b/ Systemic sclerosis
61M referred for prostate cancer, biopsy benign, dx BPH. Prostate volume 50mL, has moderate urinary symptoms. Wants to discuss treatment options. Best treatment option?
a/ Tamsulosin and dutasteride
b/ Prazosin
c/ Finasteride
37F w/ painful urination, feels unwell, and has fever. Exam shows painful ulcers in vulval area and tender inguinal lymphadenopathy. Likely diagnosis?
a/ Genital herpes
b/ Behcet’s disease
c/ Candidiasis
2yo girl swallowed a possible button battery, brought in by dad, no pain/vomiting. Incident was 30m ago, honey given at home. Immediate management priority?
a/ Call Poisons Info Line; arrange neck, chest, and abdomen x-rays urgently.
b/ Call clinical toxicologist; arrange chest x-rays urgently.
3yo girl w/ 24h painful L knee, rash on buttocks, mild cramping pain. Afebrile, purpuric rash noted, trace blood in urine. Follow-up for suspected diagnosis?
a/ Weekly clinical review, BP check, urinalysis for 1 month, then fortnightly for weeks 5-12, single review at 6 and 12 months.
b/ Monthly BP checks and urinalysis for 12 months.
27M transgender male asking about PrEP for HIV prevention, motivated by friend’s recent diagnosis. Wants to know how well PrEP works. Efficacy of daily PrEP?
a/ PrEP can reduce HIV transmission risk by up to 99% from sex and 74% from IV drug use when taken daily.
b/ PrEP can reduce HIV transmission risk by up to 90% from both sex and IV drug use when taken daily.
5yo boy w/ 2h of penile pain, swollen glans after examination. Foreskin retracted, no trauma noted. Likely diagnosis?
a/ Paraphimosis
b/ Phimosis
c/ Balanitis
72F w/ hypermetropia, urgent appt for painful L eye, nausea/vomiting. Exam ongoing, seeking additional symptom for differential. Supportive symptom?
a/ Headache
b/ History of wearing contact lenses
c/ Ocular itch
69M w/ months of fatigue, low back pain after gardening. Limited forward flexion, spinal tenderness L1-L3. Bloods show normocytic anemia, leukopenia. Likely diagnosis?
a/ Multiple myeloma
b/ Osteomalacia
c/ Lymphoma
42F w/ 2w of allergic symptoms, worsening w/ blossoms, taking fexofenadine w/ little relief. No pets, good health otherwise. Next step for management?
a/ Start mometasone 50mcg, 2 sprays each nostril daily for 4 wks, then 1 spray daily, plus continue oral fexofenadine.
b/ Switch to azelastine 1mg/mL nasal spray, 1 spray each nostril twice daily.
73M concerned about new pigmented lesion on L forearm, 4mm, irregular borders. On aspirin and prasugrel after MI. Best management for skin lesion?
a/ Continue current meds; perform excision biopsy with 2mm margins under local anaesthetic.
b/ Excision biopsy under local anaesthetic with 2mm margins; stop aspirin and prasugrel day before, resume after.
28M w/ type 1 DM, planning 10-day trip to Bali in 6 wks. First-time traveler, asking about vaccines/precautions for himself and 4yo son. Correct statement about traveler’s diarrhea in kids?
a/ No chemoprophylaxis for traveler’s diarrhoea in healthy travellers, including kids.
b/ Anti-motility agents safe for kids under 12.
17M re-presents 2 wks post amoxicillin for strep throat, now has widespread rash. Exam shows non-itchy erythematous lesions on trunk/limbs. Most likely diagnosis?
a/ Guttate psoriasis.
b/ Drug-induced rash.
c/ Glandular fever.
28M w/ 2-mo hx of abdominal pain, diarrhea mixed w/ blood/mucus, and fatigue. Family hx of Ulcerative Colitis noted. Which skin condition linked to inflammatory bowel disease?
a/ Pyoderma gangrenosum.
b/ Lichen planus.
c/ Pityriasis rosea.
38F w/ new neck lump, likely thyroid nodule, TSH normal, benign FNA results. No prior thyroid issues, mother has Hashimoto’s. Advise on follow-up?
a/ Clinical monitoring w/ repeat thyroid ultrasound in 12-24 months for nodule change.
b/ No further follow-up needed.
50M collapses in waiting room, clear airway but not breathing. Ambulance called, IV access established. Most immediate treatment to start?
a/ Administer shock using defibrillator.
b/ Administer amiodarone 150mg IV.
c/ Administer adrenaline 1mg IV.
2yo boy, 34wks gestation, now has runny nose, fever, coughing, lethargy. Mild tachypnea, crackles in L lower zone, diagnosed w/ pneumonia. Likely pathogen?
a/ Respiratory syncytial virus
b/ Bordetella Pertussis
c/ Haemophilus influenzae
48F asks about 12yo daughter’s delayed period, some breast development/pubic hair present. At what age evaluate for primary amenorrhea if normal growth/sexual traits?
a/ 15 years old
b/ 10 years old
c/ 12 years old
75F w/ intermittent palpitations, fatigue, SOB, past hx of HTN/DM. ECG shows atrial fibrillation. What’s her CHA2DS2-VASc score?
a/ 4
b/ 1
c/ 2
38F, 14wks pregnant, discussing first trimester screening results. Risks for chromosomal abnormalities noted. Most appropriate advice for the couple?
a/ Offer referral to high-risk obstetrics clinic for amniocentesis.
b/ Offer referral to high-risk obstetrics clinic for chorionic villus sampling.
63M, occasional respiratory infections, smoker, alcohol smell, presents w/ ulcer on L foot. Most correct statement about his situation?
a/ Pressure reduction (offloading) is required.
b/ General practice is suitable for ulcer management.
A