One of Australia’s prominent doctors suggests discontinuing the term “long COVID” following a study revealing similar long-term effects of COVID-19 compared to other viruses like the flu. The study conducted by Queensland Health, involving over 5000 individuals with respiratory symptoms during the Omicron variant’s prevalence, found comparable rates of functional limitations between COVID-19 and non-COVID respiratory illnesses a year after infection. The European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) presented these findings, indicating the need to reevaluate the distinctiveness of long COVID. However, some experts, including paediatric infectious diseases physician Professor Philip Britton and the director of the Australian National Phenome Center at Murdoch University Professor Jeremy Nicholson, argue against abandoning the term, citing the unique aspects and global recognition of long COVID, urging further research to understand its underlying mechanisms.
88-year-old woman with AFib, rate 76, cardiac disease, and other comorbidities. eGFR 24. What should be given?
a. Warfarin
b. Rivaroxaban
c. Beta blockers
48-year-old man who has never had a health check before, ex-smoker, family history of diabetes, bank manager, fair complexion, red hair, overweight. BP 155/89 mmHg. What is the next step?
a. Offer smoking cessation advice.
b. Assess osteoporosis risk factors.
c. Calculate height, weight, BMI, waist circumference.
As an intern, you find out that a medical student is getting information about a patient through the patient’s medical records. When asked, he says the patient’s relative who lives overseas wants to know about it. What will you do?
a. Counsel the medical student that this is not allowed.
b. Inform the medical board.
c. Report to the medical university.
G3P0+2 pregnant 28 weeks, admits that she continues to take drugs and drinks, had 2 miscarriages before. On labs: AB blood group, anti-Le positive, current fetus has no heart rate on Doppler. What is the most important in the diagnosis?
a. Anti-D
b. 2 miscarriages
c. Anti-Le antibodies
d. Cocaine use
e. Suboptimal antenatal visits
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17-year-old female with Type 1 DM, abdominal pain, vomiting x4, BG 25mmol/L, ketones 1.6mmol/L. Moderately dehydrated, alert. What is the initial management?
a. Administer a stat dose of dexamethasone 4mg intravenously.
b. Start an infusion of 20% mannitol 50g over the next hour.
35-year-old man with a skin rash after a Caribbean holiday, tingling, prickling sensation on the right foot, itchy rash, no fevers, no significant medical history. What is the most appropriate management?
a. Fluconazole 50mg orally daily for 2 weeks.
b. Ivermectin 200mcg/kg orally stat.
c. Prednisolone 50mg orally for 3 days.
15-year-old male with aggression, agitation, history of methamphetamine use. Foster mother suspects methamphetamine intoxication. What clinical feature supports methamphetamine intoxication?
a. Constricted pupils.
b. Blood pressure 90/60 mmHg.
c. Jaw clenching.
67-year-old male with COPD exacerbation, treated successfully. A second exacerbation in 6 months. Inhaler technique adequate. FEV1 55%. What is the next step in COPD management for long-term care?
a. Low dose theophylline.
b. Long-term low dose oral prednisolone.
c. Long acting muscarinic antagonist (LAMA) (e.g. tiotropium) or a long-acting beta2 agonist inhaler (LABA) (e.g. salmeterol).
32-year-old female with amenorrhoea for 12 months, not having sexual activity for 1 year, recently divorced. What is the best investigation for diagnosis?
a. Beta HCG.
b. Pelvic ultrasound.
c. FSH/LH.
Enlarged tonsils, reddened, with bilateral cervical lymphadenopathy. Clear nasal discharge. What is the most likely organism?
a. Staphylococcus.
b. Streptococcus.
c. Adenovirus.
d. Epstein-Barr virus (EBV).
OGDS shows a 5.5cm irregular lesion in the stomach. Biopsy shows no H. pylori, but lymphocytosis. What is the next management step?
a. Repeat OGDS.
b. Prolonged omeprazole.
c. Urea breath test.
45-year-old male with HIV, CD4 <200 cells/μL, on tenofovir disoproxil with emtricitabine therapy. Received DTaP booster 3 years ago. Immune to Hepatitis B. Which immunisation is now needed?
a. The varicella zoster immunisation.
b. The influenza immunisation.
5-year-old boy with eczema, mainly on extensor surfaces. Managed with emollients and increased topical corticosteroids. Concerns about steroid side effects. What is the correct statement?
a. Steroid ointments for very dry skin in children.
b. Antihistamines for pruritus.
52-year-old woman on MHT patches with debilitating hot flushes. Last menstrual period at 50, normal cervical screening. BMI 22 kg/m2, non-smoker. Period resumed after starting patches. What is the next step?
a. Transvaginal ultrasound for endometrial thickness.
b. Reassurance about common breakthrough bleeding.
52-year-old male with thyroid lump for ≥1 year. Worried about cancer. Ultrasound shows a suspicious finding for malignancy. What is the most likely characteristic?
a. Spongiform nodule.
b. Solid hyperechoic nodule.
c. Solid hypoechoic nodule with microcalcifications.
52-year-old woman with menopause symptoms, migraines, and PCOS, no regular meds, wants MHT. Which condition is safe for MHT?
a. Ischaemic heart disease.
b. Pregnancy.
c. Treated moderate hypertension.
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60-year-old woman, post-menopausal since age 51, started HRT for 8 years. Vasomotor symptoms resolved in the first year. Stopped 1 year ago, no breakthrough bleeding, and now no vasomotor symptoms. Asking for a prescription for HRT. What is the next step?
a. Combined estrogen & progesterone.
b. Progesterone only.
c. Estrogen dermal patch.
d. Advised to stop HRT.
Head injury in a rural area, suggestive of intracranial bleed after a fall. Tertiary hospital 3 hours away. What should be done?
a. Burr hole.
b. 20% mannitol.
Eye injury with anterior chamber hyphema and blurred vision until seen by ophthalmologist. What should be done in the meantime?
a. Timolol eye drop.
b. Bed rest.
c. Pilocarpine eye drop.
46-year-old alcohol/smoker with parotid swelling, coarse hair, and scrotal swelling that cannot be lifted above the lump. Diagnosis?
a. Testicular seminoma.
b. Alcoholic liver disease.
Mother concerned about her 9-month-old child’s MMR vaccination before a Vanuatu trip. The child was a term baby with no significant medical history. What is the most appropriate advice?
a. Child already vaccinated against measles.
b. MMR vaccine possible before holiday, then 2 more doses needed.
7-year-old boy with tinea capitis, hair loss, and itching. Weight 30kg. What is the empirical treatment?
a. Terbinafine 125mg orally daily for 4 weeks.
b. Miconazole cream 2% topically twice daily for 2 weeks.
c. Fluconazole 150mg orally stat.
RFDS consult for kangaroo shooter with fever, headache, myalgias, and cough. Suspected Q-fever. What is the most serious complication?
a. Arthritis.
b. Endocarditis.
c. Empyema.
19-year-old woman with irregular periods, acne, and no other symptoms. BMI 22 kg/m². TSH 2.89 mIU/L, Prolactin 360 mIU/L, FSH 8 IU/L. What is the next step?
a. Refer her to a gynaecologist for a hysteroscopy.
b. Advise her that she has a diagnosis of polycystic ovarian syndrome.
5-year-old male with a vesicular rash on hands for 2 days. Otherwise well. What is the likely pathogen?
a. Coxsackie Virus (CV) A16.
b. Varicella zoster virus.
c. Human herpes virus-6 (HHV-6).
Farmer with a dermatological lesion in the ear. What is the likely diagnosis?
a. Squamous Cell Carcinoma (SCC).
b. Bowen’s disease.
Lung abscess treatment: What is the most appropriate regimen?
a. Ceftriaxone + Clindamycin.
b. Vancomycin + Metronidazole.
Endocarditis investigation: Which test is most useful?
a. ASOT (Antistreptolysin O titer).
Parenteral nutrition following cholecystectomy: What are the expected electrolyte changes in the blood?
(Answer options were not provided, but it can involve fluid and electrolyte imbalances like hypokalemia, hypophosphatemia, etc.)
6-year-old child with wheezing given 6 puffs of saline but not responding. What is the next step?
a. Continue saline.
b. Administer Ipratropium (IPRA).
32-year-old female pre-travel consult for a cycling honeymoon in rural Vietnam. Concerned about Japanese Encephalitis. What advice is correct?
a. JE vaccine recommended for >1 month in endemic regions.
b. Three different JE vaccines available in Australia.
Term baby appears jaundiced post-emergency caesarean. Well and breastfeeding normally. No antenatal care. What is the likely diagnosis?
a. Sepsis.
b. Red cell haemolysis.
c. Biliary atresia.
56-year-old male farmer with sun exposure. No suspicious lesions, but actinic changes are present. What is the absolute contraindication for field therapy?
a. Congestive Heart Failure.
b. IgA deficiency.
c. Dihydropyrimidine dehydrogenase (DPD) deficiency.
80-year-old female with urinary incontinence for 3 weeks, with an urge to urinate. She started a new medication. Which medication is most likely responsible?
a. Amitriptyline
b. Benzatropine
c. Indapamide
22-year-old male with a lump under the upper lip since a football injury. The lump is not sore. What is the likely diagnosis?
a. Mucocele
b. Dentigerous cyst
c. Ranula
4-year-old boy with concerns of autism spectrum disorder. What is a suggestive feature?
a. Deliberately annoying others
b. Echolalia
After a long countryside hike, a patient presents with a tender swelling on the inguinal ligament, no cough impulse, and non-reducible with fever. What is the likely diagnosis?
a. Inguinal hernia
b. Inguinal lymphadenopathy
80-year-old patient, 3 days post hip fracture, planned for discharge, urinary catheter inserted on admission due to incontinence. Urine culture and ABST done, but no fever, and ABST results still not available. What is the next step?
a. Discharge after ABST report
b. Discharge with trimethoprim
c. Repeat urine culture
d. Ignore
34-year-old male hits his head while playing sports, no loss of consciousness but slow to get up and felt dizzy for 30 minutes. Now fully recovered. Lives alone. What is the most appropriate management?
a. Keep playing
b. Stop playing but go home
c. Stop playing and 24 hours supervision
d. Visit a medical center or hospital for review
Previously well, a 6-year-old child presents with painful right knee and refusal to bear weight. No effusion or bony deformity, but extremely tender. All other exam findings normal (chest, abdomen, limbs). Laboratory results: Hb 70, WCC 5 (neutrophils 0.7, slight eosinophilia 0.3), platelets 79, ESR 65. What is the next investigation?
a. Bone marrow biopsy
b. Blood cultures
c. Urinalysis
d. Bone scan
e. X-ray
Patient with a history of DVT presents with dyspnea and chest pain. VQ scan shows no perfusion in a lung segment. What is the most appropriate management?
a. Enoxaparin SC
b. Thrombolysis
c. Warfarin
Patient returned from London 2 days ago with flu symptoms. Suddenly started coughing, collapsed, and became unconscious. HR normal, BP 90/80. What is the likely diagnosis?
a. Pulmonary embolism
b. Cough syncope
Patient with atrial fibrillation presents with pain in the right leg, pallor, and absent pulses. What is the next investigation?
a. CT angiogram
b. USS veins
c. USS leg
d. D-dimer
15-year-old boy with misconduct behavior at school, a history of drug use, school expulsions, truancy, and multiple scars on his arms. He says he wants to die. What is the most appropriate action?
a. Inform parents
b. Involuntary admission
c. Refer for psychotherapy
d. Prescribe medical therapy
15-year-old boy with previously normal behavior now showing a decline in school grades, skipping classes, and engaging in offenses. What aspect of his history would be most significant for diagnosis?
a. Family history
b. Mother took amphetamines during pregnancy
c. History of pouring petrol on a neighbor’s dog
d. Patient’s view on committing those offenses
Commercial driver with a history of seizure and treatment, now insists he is fit to drive despite being advised not to. He thinks he can drive without any problems. What is the best course of action?
a. Talk to him and explain the dangers of driving now
b. Call his boss and inform them about the condition
c. Report the situation to the official driving agency for safety
d. Ask him to surrender his license
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40-year-old male patient with sudden severe chest pain radiating to his back after an 18-hour flight. ECG is normal. What is the next step in management?
a. CT pulmonary angiogram
b. CT chest angiogram
c. D-dimer test
d. Repeat ECG
42-year-old woman with galactorrhea post-breastfeeding and raised prolactin levels. What is the most likely cause?
a. Clozapine
b. Olanzapine
c. Risperidone
28-year-old man with depression and anxiety wants to know the most common mental health disorder in Australia. What is the most common?
a. Anxiety disorders
b. Bipolar affective disorder
c. Schizophrenia
56-year-old Indigenous male with reduced consciousness after falling off a horse, on warfarin. What is the most appropriate course of action?
a. Urgent CT brain needed
b. Phenytoin or levetiracetam for moderate/severe cases
81-year-old woman seeking advice on Advanced Care Directive (ACD). What is the most appropriate advice?
a. No need for ACD with good cognitive function
b. Lawyer not needed for valid ACD
7-year-old child with distractibility and wandering in class. Stable, happy home. What is the key feature to assess for ADHD?
a. Assess sensitivity to tastes/textures
b. Evaluate consistency of behavior at home and school
24-year-old male with widespread mildly itchy rash starting on the hands and spreading to arms, legs, and torso. Likely diagnosis?
a. Pityriasis versicolor
b. Erythema multiforme
c. Discoid eczema
Study on respiratory conditions post-2014 coalmine fire. What type of study is this?
a. A cohort study
b. A meta-analysis
50-year-old female with AV nodal reentry tachycardia after ablative therapy, now experiencing weight loss, tremor, weakness, and racing heart. Likely diagnosis?
a. Anxiety
b. Hyperthyroidism
c. Congestive cardiac failure
72-year-old man with severe chest pain unrelieved by nitrates, normal ECG, and a history of an 18-hour flight 2 weeks ago. Next best investigation?
a. CT angiogram pulmonary artery
b. CT angiogram chest
c. Chest X-ray
d. Troponin test
e. V/Q scan
40-year-old male with sudden severe chest pain, dyspnea, and fever. He arrived from Canada to Sydney by air yesterday. What is the most appropriate next step?
a. Chest X-ray
b. ECG
c. V/Q scan
d. D-dimer
e. CT pulmonary angiogram (CTPA)
6-year-old boy with nausea, vomiting, and headache. PE is normal except for Tanner stage 3-4/5. Likely diagnosis?
a. Glioblastoma
b. Pinealoma
c. Craniopharyngioma
Mother with 1-year-old child who has egg allergy and bullae. The child is due for the MMR vaccination. What should be done?
a. Give under close observation
b. Egg allergy is not a contraindication for MMR
c. Refer for skin allergy testing
d. Give test dose
Left iliac fossa pain with tenderness, no rebound, and the patient is on warfarin. What is the likely diagnosis after CT scan?
a. Rectus sheath hematoma
b. Retroperitoneal hematoma
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Nurse exposed to Hepatitis B. What should be done next?
a. Do nothing
b. Advise avoiding contact procedures
c. Inform APRAH
68-year-old male with an enlarging chest lesion. Likely diagnosis?
a. Pigmented basal cell carcinoma
b. Seborrhoeic keratosis
51-year-old male truck driver with recurrent dizziness, episodes lasting 1-6 hours, spinning sensation, and ear symptoms. Likely diagnosis?
a. Acoustic neuroma
b. Psychogenic
c. Anxiety
32-year-old female with cyclical mood symptoms, severe premenstrual distress, and functional impairment. Management?
a. Start oral Sertraline 50mg daily for the 2 weeks leading up to menstruation (luteal phase)
b. Start oral Drospirenone 4mg daily
39-year-old male with a painful, swollen right leg and mottling. What is the next step in management?
a. Urgent duplex venous ultrasound of the leg
b. Contact a tertiary center for expert advice/retrieval/surgery
Your friend and colleague want you to prescribe mirtazapine but they don’t want to see a GP. They are using 30mg of codeine daily. What should you do?
a. Insist they see a GP
b. Inform APRAH
32-year-old Somali male with a cough, hemoptysis, and 5kg weight loss over 3 months. X-ray done 5 years ago was negative, but this time shows opacity in the right middle lobe. What is the next step?
a. CT chest
b. Mantoux test
c. MRI
50-year-old male with a PSA level >20, DRE shows irregularities, back pain, and bone metastasis. What is the best treatment option?
a. Chemotherapy
b. Androgen deprivation
c. Orchiectomy
d. Radiotherapy
Old man with recurrent falls in a nursing home, found with bruises on his head. ECG shows sinus tachycardia, multiple ventricular ectopies, and ventricular hypertrophy. He is on enalapril and thiazide. BP lying down is 150/90 mmHg, HR 90 bpm. What is the most appropriate investigation for diagnosis?
a. 24-hour ECG
b. 24-hour BP monitoring
c. Repeat BP measurements
d. Head CT
52-year-old male with headache, fever, weakness, no neck stiffness, history of alcohol use and smoking, rash on upper extremities. What is the most likely diagnosis?
a. Encephalitis
b. Meningococcal meningitis
c. Immunosuppressive
d. Septicaemia
Patient with primary malignancy and peritoneal carcinomatosis presents with SOB and dyspnea. They are on chemotherapy. What is the next best management?
a. Peritonectomy
b. IV albumin infusion (depends on stem)
c. Regular paracentesis
d. Furosemide
Previously well 6-year-old child with painful right knee, refusing to bear weight. No effusion or bony deformity, but extremely tender. Hemoglobin 70, WCC 5 with neutrophils 0.7, slight eosinophilia 0.3, platelets 79, ESR 65. What is the next investigation?
a. Bone marrow
b. Blood cultures
c. Urinalysis
d. Bone scan
e. X-ray
Positive straight leg raise, diabetes, loss of ankle reflex, and calf pain relieved with rest. What is the most likely diagnosis?
a. Lumbar canal stenosis
b. Cauda equina syndrome
c. Disc prolapse
d. Diabetic neuropathy
e. Vascular disease
76-year-old man with fatigue, palpitations, shortness of breath, and irregularly irregular heart rate. What is his CHA2DS2-VA score?
a. 7
b. 6
65-year-old with stable eGFR. What is the recommended BP target?
a. ≤130/80 mmHg
b. ≤150/90 mmHg
Considerations for prescribing in a prison setting?
a. Formal diagnosis before prescribing due to abuse potential
b. Alprazolam is acceptable in prison with supervised dosing
87-year-old woman with Alzheimer’s, aggressive behavior, and wandering. Immediate management?
a. Nursing staff may use physical restraints for safety
b. Consult family/staff about prior strategies and reassess ASAP
67-year-old man with painless hematuria. Next step?
a. Cease warfarin and await resolution
b. Urine MC&S, cytology, and imaging of the renal tract
23-year-old male plumber with scrotal pain, fever, and dysuria. Likely diagnosis?
a. Left-sided epididymitis
b. Torsion of the left testis
Considerations for the role of a prison medical officer?
a. Custodial facilities can pose safety risks to medical staff
b. Maintain patient privacy and avoid disclosing personal information
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