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
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. Abscess
Accident with high ICH. Neuro unit is far. What to do?
a. Mannitol and hyperventilation
b. Burr hole
TIA on aspirin already, US bilateral 50% carotid stenosis. Next?
a. Add clopidogrel
b. Endarterectomy
Diabetic in hospital on metformin 1000 BD. Pre-meal sugar control fasting 10 to 12. Next?
a. Increase bedtime glargine
b. Add oral anti-diabetic
Pregnant woman, 42 years old, looking for doubts about breast cancer (not risk or age for screening). Encourage breastfeeding.
Postpartum, asking for the best contraceptive 2 days after delivery.
a. POP
19-year-old girl with irregular periods (6 to 9 weeks) presented to GP with white breast discharge and amenorrhea for 11 weeks. What to do to establish a diagnosis?
a. HCG
b. USS pelvis
c. Prolactin
d. FSH and LH
e. 21-day progesterone
Lady left the door open, child ran outside and died. Dx?
a. Major depressive episode with psychosis
b. Brief psychosis
c. Acute stress syndrome
d. PTSD
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27-year-old boy with asthma since childhood, using salbutamol and fluticasone. Daytime symptoms 3 days/week. Management?
a. Change his preventer to budesonide 400 mcg turbuhaler twice daily
b. Change his preventer to a low-dose combination inhaled corticosteroid
Pregnant woman at 20 weeks had 2 previous doses of Gardasil, due for the 3rd dose. What immunization will we offer her?
a. 3rd dose Gardasil
b. Pertussis
c. Rubella
d. Chickenpox
86-year-old woman with repeated syncopal episodes, nausea, and vomiting, otherwise healthy. Five ECGs were given in options.
Herpetic keratitis picture, treatment asked.
28-year-old lady came with her 4-week-old child for a regular checkup. She mentions her Vitamin D was low during pregnancy. The rest of her checkup was normal. What will you advise her?
a. Vitamin D supplement
b. Sun exposure
c. Check Vitamin D levels
Four growth graphs were given. According to me, they showed normal growth.
a. IUGR
b. Short for dates
c. Long for dates
d. Constitutional delay
Old lady with bloody cough and a history of lifelong productive cough (asthmatic since childhood). X-ray shows hyperinflated lungs and oblong cardiac shadow. Asked for long-term advice/management.
a. Graded exercise
b. Physiotherapy
c. Cardiac rehabilitation
Redback spider bite, tachycardia 150/90, profuse sweating, excessive pain at the site. What helped to confirm the diagnosis of envenomation?
a. Venom kit
b. Sweating
c. Pain
Intern with a criminal record in their own country. What should you do?
a. Ask them to tell the center’s legal team
b. Tell your center’s adviser/owner
Female-to-female sex with multiple female partners, regularly gets checked, and is otherwise healthy. What screening should be done regularly?
a. HIV
b. Chlamydia
c. HPV
d. Hepatitis C
e. Syphilis
Elderly man brought by his wife for behaving weirdly. Started on Levodopa/Carbidopa for Parkinson’s 6 months ago. Developed cogwheel rigidity, pinwheel, fine movement issues, tremors. Symptoms poorly controlled. Out of the following, which is the wrong treatment?
a. Levodopa
b. Digoxin
c. Some benzodiazepine
Probability graph was given. Option D was asked for maximum effect.
Pregnant woman at 14 weeks taking a full bottle of wine and other recreational drugs. Fetal heart not present. What will lead to her diagnosis?
a. Ecstasy
b. Antenatal visit
c. Anti-ds
d. Alcohol
50-year-old male with right eye blurry vision, intermittent double vision, poorly controlled type 2 diabetes, hypertension, and dyslipidemia. Impaired cranial nerve?
a. IV
b. VI
c. V
82-year-old female with no significant medical history, taking alendronate + calcium, suffers a fall (image by X-ray) and asks about the most appropriate management.
a. Full replacement
b. Partial replacement
Video recorder of the patient by their consent, used for records and management only. GP has to give a presentation.
a. Use the video, don’t tell the patient
b. Delete the video after showing
c. Take extra permission from the patient to show
33-year-old male with 10 years of epigastric pain, treated with esomeprazole. No other symptoms and in good general condition. Everything normal. Best investigation?
a. X-ray
b. USD
c. Endoscopy
d. 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.
a. Breast CA
b. CA-125
Pregnant lady exposed to rubella, unsure of her status.
a. Check serology
b. Give vaccine
STEMI, tertiary unit 3 hours away.
a. Give IV tenecteplase
Mom with Charcot-Marie-Tooth disease, son has symptoms. Next step?
a. Nerve biopsy
b. NCS
c. EMG
42-year-old lady with a ‘pea-sized’ lump in her left breast. Non-tender, not related to the cycle. 1 cm soft mobile lump in the upper outer quadrant of the left 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-year-old lady with days of fevers, lethargy, myalgia, dry cough, and shortness of breath. Diagnosis: Legionella pneumophila. True statement?
a. Patients with Legionella pneumophila may present with diarrhea
b. Legionella pneumophila has an incubation period of 14-21 days
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Woman with normal BP, no family hx of cardiovascular disease. Did FBS 5.9 mmol/L, asked what next
a. HbA1c
b. RBS in future
c. FBS in 1 year
23-year-old male, painful left knee after skiing 2 weeks ago. Sudden stabbing pain, swelling, dull ache, positive McMurray’s test. Likely diagnosis?
a. Medial meniscal tear
b. Osteochondritis dissecans
68-year-old lady, fever, cough with green sputum, SOB for 2 days. Increased work of breathing, crepitations, bronchial sounds on the right. Chest x-ray given. Likely diagnosis?
a. Right upper lobe pneumonia
b. Right middle lobe pneumonia
Patient with history of melanoma, treated with pembrolizumab, presents with watery diarrhea more than 4 times in 24 hours. Treatment?
a. Oral ciprofloxacin
b. Infliximab
23-year-old girl with impaired hearing in the right ear, recurrent CSOM. Perforation to attic with visible white flakes, concern for cholesteatoma. Expected findings on exam/investigation?
a. Bilateral conductive hearing loss on audiogram
b. Sound localizes to the right ear when performing Weber’s test
c. A positive Rinne’s test in the right ear
76-year-old man with painless bloodshot right eye, lower half of sclera blood-stained. Possible underlying risk factor?
a. Diabetes mellitus
b. Chronic renal disease
c. Cataracts
8-week-old with 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
4-year-old boy born in Australia to Afghan parents, 3-week trip to Karachi, fever, abdominal pain, nausea. No pre-travel consult or extra immunizations. Likely vaccine-preventable viral infection?
a. Dengue
b. Hepatitis B
c. Hepatitis A
68-year-old man, left scrotal swelling for 3 months, worse at the end of the day, non-painful. COPD on tiotropium bromide. Scrotal ultrasound shows left hydrocele, displaced left testis. Next step?
a. Prescribe frusemide 40 mg orally daily to reduce the swelling
b. Advise him to wear supportive underwear and re-present if swelling increases or becomes uncomfortable
6-year-old presenting with asthma symptoms and difficulty speaking. Administered 6 puffs of salbutamol but no response. Asked what next?
a. Repeat
b. Steroid
2-year-old 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-year-old 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-year-old 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-year-old 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
Monogamous relationship, asking about HPV vaccine. What in history goes against giving the vaccine?
a. Age 27
b. She is already sexually active
PPH with 750 mL blood loss. Next step?
a. IV line insertion
Mother came with child for vaccination; mother not making eye contact. What to do?
a. Ask the mother if she needs support
b. Offer counseling or refer to appropriate support services
16-year-old girl wants the 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
4-year-old kid with chest tightness, SOB, occasional wheezing. What increases asthma suspicion?
a. History of a moist cough
b. Symptoms recur frequently
32-year-old man, carries Huntington’s gene, seeking health insurance. Advice?
a. His application will 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 39 weeks. On examination, she was 9 cm dilated, FHR heard with Doppler, fetal descent 2/3.
a. Send her home
b. Send to maternity for further assessment
c. Admit (not sure)
20-year-old lady with 3-week frothy, odorous vaginal discharge, itching, dyspareunia. Swab: motile flagellated protozoans. Likely diagnosis?
a. Bacterial vaginosis
b. Trichomoniasis
c. Chlamydia
Isotretinoin to start… what test to do before you start? Female periods irregular, last was 4 weeks ago.
a. Beta HCG
Patient came for vaccination; you saw he has inflamed acne. You just attended a seminar about a new drug…
a. Discuss the new drug based on current guidelines
Patient has PSGN (Post-Streptococcal Glomerulonephritis). What symptom is most important to admit to hospital?
a. Edema
b. Hypertension
c. Urine trace protein
PSGN, what medication to start? Patient has high BP.
a. Start ACE inhibitors
b. Steroids
PSGN, what test to do?
a. Urine & Culture (U&C)
b. C3 Levels
Angioedema history, what test to do?
a. C1 and C4 levels
Farmer, hand cut now came with jaundice, rash, dysuria, cough, confusion. I did leptospirosis.
18-year-old man with 48-hour right 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-year-old man seeks help for alcohol use. Heavy drinking for 15 years, 6-pack nightly + weekend 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 with diarrhea and cough. Father and mother had COVID 1 week ago. What next?
a. Viral PCR and COVID PCR
b. Rapid antigen test
Female, no sex for the last 4 months, came with recurrent tingling sensation during urination that subsides itself. Vaginal exam shows red vagina and white discharge. What to do?
a. Oral Glucose Tolerance Test (OGTT)
b. High vaginal swab
50-year-old man with ED, suitable for Sildenafil. Possible side effect?
a. Abnormal vision
b. Bradycardia
c. Dry mouth
45-year-old man with 3-week dry cough, SOB, intermittent fever, fatigue. Better in the AM, worse as the 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 cigarettes and alcohol in the room. What in history to ask?
a. School bullying
b. School performance
c. Family history (FH) of schizophrenia
Parents physically strict; child now breaks things in school, no remorse. What to do next?
a. Physical exam
b. Mental exam
Man on medication for schizophrenia not controlled, came telling “I am hearing voices to kill my parents, they are plotting against me, and break neighbor’s house.” What to do?
a. Call police
b. Involuntary admission
c. Call family meeting
53-year-old lady with bad breath, husband complains, AM noticeable. Meds: captopril, esomeprazole, azathioprine. Recently erythromycin. Smoking, daily wine. Causes of halitosis?
a. Smoking, alcohol, obstructive sleep apnea, sinusitis
b. Azathioprine, smoking, sinusitis, erythromycin
13-year-old boy with vague right knee pain, swelling, AM stiffness with locking. Plays junior football. Right knee effusion, medial femoral condyle tenderness. Likely diagnosis?
a. Baker’s cyst
b. Medial meniscal injury
c. Osteochondritis dissecans
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Man alcoholic, admitted for elective knee replacement. 4 days post-op. Confused, short of breath, SpO2 88 on 15L. What to investigate?
a. Alcohol level
b. CTPA (I did CTPA)
Old lady fell from standing position, hip fracture. What to do after surgery, no labs?
a. Start vitamin D and calcium
b. Start alendronate
Man with back pain, X-ray given. What to check next?
a. Protein electrophoresis
b. Calcium level
T3M1N0 prostate cancer. Treatment?
a. ADT (I did ADT)
80-year-old with urine incontinence. What to do?
a. Pelvic exercises
b. Vaginal pessary
Male presented with two-day history of melena. UGIE shows non-bleeding peptic ulcer. He is on aspirin 100mg for cardiac stenting (duration not given), also had a total hip replacement 7 days ago and is not on medication for that. Most appropriate management plan?
a. Stop aspirin
b. Stop aspirin and start LMWH
c. Change aspirin to rivaroxaban
d. Continue aspirin with follow-up UGIE in 3 months
27-year-old lady with dandruff, no improvement with OTC shampoo, no itch, scalp lesions. Next step in management?
a. Prescribe 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-year-old lady with 5 weeks of amenorrhea, regular 27-day cycles, no medical history, BMI 32. Antenatal vitamins?
a. Folic acid 400mcg + iodine 150mcg
b. Folic acid 5mg + iodine 150mcg
Boy fell from 5m height. Lost consciousness, now drowsy, has a big hematoma. Closest neurosurgical unit is 4h away. What to do?
a. CT
b. Send by ambulance
c. Send by helicopter
d. Admit and observe for 6h
e. Let him go home
3-year-old 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-year-old woman with 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-year-old woman with 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-year-old man with perianal pain, swelling. Past hemorrhoids. 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
59-year-old male, chronic snoring, wife reports apnea. Fatigued. History of hypertension, obesity, type 2 diabetes, 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-year-old man with dog bite, multiple puncture wounds on hand. Preferred antibiotic?
a. Amoxicillin with clavulanic acid
b. Cephalexin
65-year-old male, 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, renal function tests high. Already started on IV fluids, what next?
a. IV furosemide
b. Calcitriol
c. Pamidronate
58-year-old girl with mid-thoracic back pain for 1 month, fall on coccyx during gardening, dull ache worse with 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 Medicare
30-year-old man with discolored, thickened right 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 with heart failure, nausea, vomiting, abdominal pain. On digoxin 0.25 mg, ramipril. All labs were normal. Cause?
a. Digoxin toxicity
b. Viral gastroenteritis
3-month-old baby with a large birthmark on the face. Born at term, uncomplicated pregnancy. No medical conditions, meds, or 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 issues
16-year-old male 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
21-year-old female on oral isotretinoin for cystic acne. Common side effect?
a. Cheilitis
b. Rectal bleeding
c. Tinnitus
35-year-old female with lethargy, anxiety, palpitations. Abnormal TSH (0.07mIU/L). Likely cause?
a. Graves disease
b. Subacute thyroiditis
c. Thyroid carcinoma
Parotid swelling. Ultrasound done. Next step?
a. FNAC (Fine Needle Aspiration Cytology)
b. Sialogram
Alcoholic smoker with 24 hours history of left eye blurring, ptosis, and miosis. Next step?
a. Chest X-ray
b. CT head
