The evolving perceptions of rural medicine was currently observed by UNSW Associate Dean of Rural Health, Tara Mackenzie. Initially discouraged from pursuing rural practice, Mackenzie now witnesses a cultural shift that encourages students to embrace rural training opportunities. The establishment of rural medical schools in New South Wales since 2017 has provided students with firsthand experiences of rural life during their medical education, fostering a deeper appreciation for rural healthcare.

A case of 11-year-old alleged cat scratch. Asking for etiology
a. Bartonella
b. Borrelia
c. Brucella
d. Lyme

Child of 8 has dx w COVID along with her parents (1 week ago) now presented with abdominal pain, vomit, abdominal rigidity, and tenderness. She is sick. What helps to make the diagnosis?
a. USG
b. COVID PCR
c. ANA
d. X-ray

Years-old international student returned from Thailand, hand, chest, thigh erythema plus red eye, ask next step?
a. Blood culture
b. X-ray
c. CT
d. Isolation

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Pregnant woman OGTT results abnormal. Next appropriate step?
a. Repeat OGTT in a few weeks
b. Dietary advice
c. Initiate insulin
d. Refer dietician
e. Monitor blood glucose at home

Patient with clinical features of hypothyroidism. Lab shows reduced T4 and low TSH. What is the cause?
a. Primary hypothyroidism
b. Secondary hypothyroidism
c. Iatrogenic hypothyroidism
d. Thyroid hormone resistance
e. Euthyroid sick syndrome

A 46-year-old gentleman undergoing abdominal aortic aneurysm surveillance with 4.8cm infrarenal aneurysm. What is the appropriate management?
a. Semiurgent repair
b. Surveillance
c. Immediate repair
d. Medical management
e. Endovascular repair

48-year-old gentleman, never had health check before, ex-smoker, family history of diabetes, bank manager, fair complexion, red hair, overweight. BP 155/89 mmHg. Next step?
a. Offer smoking cessation advice
b. Assess osteoporosis risk factors
c. Calculate height, weight, BMI, waist circumference

17-year-old lady with Type 1 DM, abdominal pain, vomiting x4, BG 25mmol/L, ketones 1.6mmol/L. Moderately dehydrated, alert. Initial management?
a. Administer a stat dose of dexamethasone 4mg intravenously
b. Start an infusion of 20% mannitol 50g over the next hour

A young lady with symptomatic anemia and hemoglobin level 8g/dL. Diagnosed with IDA. eGFR less than 25. Treated with iron supplements and 2 repeated investigations were performed.
FBC HCMC anemia observed
Serum ferritin still low
What is the appropriate next step?
a. Serum ferritin
b. EPO level
c. Bone marrow biopsy
d. Serum iron level
e. GI endoscopy

35-year-old guy with skin rash after Caribbean holiday, tingling, prickling sensation on R foot, itchy rash, no fevers, no significant medical history. 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 guy with aggression, agitation, history of methamphetamine use. Foster mum suspects methamphetamine intoxication. Clinical feature supporting methamphetamine intoxication?
a. Constricted pupils
b. Blood pressure 90/60 mmHg
c. Jaw clenching

Schizophrenic patient on quetiapine. Symptom not controlled. Next step?
a. Switch to clozapine
b. Ensure compliance
c. Admission to psych ward
d. Monitor WC count and neutrophil count
e. Reevaluate patient on diagnosis

67-year-old gentleman with COPD exacerbation, treated successfully. Second exacerbation in 6 months. Inhaler technique adequate. FEV1 55%. Next step in COPD management?
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)

45-year-old male with HIV, CD4 <200 cells/μL, tenofovir disoproxil with emtricitabine therapy. Received DTaP booster 3 years ago. Immune to Hepatitis B. Which immunisation now?
a. The varicella zoster immunisation
b. The influenza immunisation

5-year-old boy with eczema, mainly on extensor surfaces. Managed with emollients, ↑ topical corticosteroids. Concerns about steroid side effects. Correct statement?
a. Steroid ointments for very dry skin in children
b. Antihistamines for pruritus

52-year-old lady on MHT patches. Debilitating hot flushes. Last menstrual period at 50, normal cervical screening. BMI 22 kg/m2, non-smoker. Period resumed after starting patches. 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 suspicious for malignancy?
a. Spongiform nodule
b. Solid hyperechoic nodule
c. Solid hypoechoic nodule with microcalcifications

52-year-old lady with menopause symptoms, migraines, PCOS, no regular meds. Wants MHT. Safe condition for MHT?
a. Ischaemic heart disease
b. Pregnancy
c. Treated moderate hypertension

Mother concerned about child’s MMR vaccination before Vanuatu trip. Term baby, no significant PMH. 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, itching. Weight 30kg. 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

Patient on isotretinoin and on Implanon. Now Implanon no stock, but wants to renew her contraception. GP away for 3 months. What is best management?
a. Condoms
b. Mirena
c. IUD
d. COC
e. Depo

RFDS consult for kangaroo shooter with fever, headache, myalgias, cough. Suspected Q-fever. Most serious complication?
a. Arthritis
b. Endocarditis
c. Empyema

19-year-old lady with irregular periods, acne, no other symptoms. BMI 22 kg/m2. TSH 2.89 mIU/L, Prolactin 360 mIU/L, FSH 8 IU/L. 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 boy with vesicular rash on hands x 2 days. Otherwise well. Likely pathogen?
a. Coxsackie Virus (CV) A16
b. Varicella zoster virus
c. Human herpes virus-6 (HHV-6)

32-year-old lady pre-travel consult for cycling honeymoon in rural Vietnam. Concerned about Japanese Encephalitis. Advice?
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, breastfeeding normally. No antenatal care. Likely diagnosis?
a. Sepsis
b. Red cell haemolysis
c. Biliary atresia

Patient had Waldenstrom macroglobulinemia in the past now presenting with cough and weakness that was treated with ampicillin. On follow-up granulomatosis on CXR. No pic given. Asking for cause?
a. Sarcoidosis
b. Waldenstrom granuloma as reactivation of previous condition
c. TB
d. Ampicillin-induced reaction
e. Pneumocystis

56-year-old male farmer with sun exposure. No suspicious lesions, but actinic changes. Discussing field therapy. Absolute contraindication?
a. Congestive heart failure
b. IgA deficiency
c. Dihydropyrimidine dehydrogenase (DPD) deficiency

80-year-old lady with urinary incontinence x 3 weeks, urge to urinate. Started new medication. Suspected medication?
a. Amitriptyline
b. Benzatropine
c. Indapamide

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22-year-old male with lump under upper lip since football injury. Not sore. Likely diagnosis?
a. Mucocele
b. Dentigerous cyst
c. Ranula

4-year-old baby with concerns of autism spectrum disorder. Suggestive feature?
a. Deliberately annoying others
b. Echolalia

42-year-old lady with galactorrhea post-breastfeeding. Raised prolactin. Likely cause?
a. Clozapine
b. Olanzapine
c. Risperidone

Nursing home patient with UTI. You prescribe cephalexin. Nurse believes pt allergic to cephalexin. What to do?
a. Change antibiotic
b. Continue cephalexin
c. Talk to nurse that what she is doing is wrong
d. Talk to nursing home manager
e. Explain to nurse that it is your management and she should follow

28-year-old male with depression, anxiety. Wants to know the common mental health disorder in Australia?
a. Anxiety disorders
b. Bipolar affective disorder
c. Schizophrenia

56-year-old male Indigenous, fallen off horse, reduced consciousness. On warfarin. Correct statement?
a. Urgent CT brain needed.
b. Phenytoin or levetiracetam for moderate/severe cases.

81-year-old lady seeking advice on Advanced Care Directive. Most appropriate advice?
a. No need for ACD with good cognitive function.
b. Lawyer not needed for valid ACD.

7-year-old with distractibility, wandering in class. Happy, stable home. Feature for ADHD?
a. Assess sensitivity to tastes/textures.
b. Evaluate consistency of behavior at home/school.

24-year-old male with widespread mildly itchy rash, started on hands, now arms, legs, torso. Likely diagnosis?
a. Pityriasis versicolor
b. Erythema multiforme
c. Discoid eczema

Study on respiratory conditions post-2014 coalmine fire. Type of study?
a. A cohort study
b. A Meta-analysis

Patient with antecedent of COPD, mini mental state 28/30 with understanding of her illness decided not to have any intervention. She arrives at emergency. What to do next?
a. A meeting with her family
b. Give morphine
c. Evaluate her autonomy
d. Follow the wish of her son

Female patient with chronic disease was on 2 drugs (DMARD + other drug) presents with leukopenia. What is your management?
a. Reduce the dose of DMARD
b. Add Azathioprim
c. Stop DMARD 

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50-year-old lady with AV nodal reentry tachycardia, after ablative therapy. Now unwell, weight loss, tremor, weakness, racing heart. Likely diagnosis?
a. Anxiety
b. Hyperthyroidism
c. Congestive cardiac failure

68-year-old male with enlarging chest lesion. Likely diagnosis?
a. Pigmented basal cell carcinoma
b. Seborrhoeic keratosis

51-year-old male truck driver with recurrent dizziness, episodes last 1-6 hrs with spinning sensation, ear symptoms. Likely diagnosis?
a. Acoustic neuroma
b. Psychogenic
c. Anxiety

32-year-old lady with cyclical mood symptoms, severe premenstrual distress, and functional impairment. Management?
a. Commence her on oral Sertraline 50mg daily for the 2 weeks leading up to menstruation (luteal phase)
b. Commence her on oral Drospirenone 4mg daily

39-year-old male with painful, swollen right leg, mottling. Next step?
a. Urgent duplex venous ultrasound of leg
b. Contact tertiary centre for expert advice/retrieval/surgery

76-year-old male with fatigue, palpitations, shortness of breath, irregularly irregular heart rate. CHA2DS2-VA score?
a. 7
b. 6

65-year-old male with stable eGFR. Recommended BP target?
a. ≤130/80mmHg
b. ≤150/90mmHg

Considerations for prescribing in prison?
a. Formal diagnosis before prescribing due to abuse potential
b. Alprazolam acceptable in prison with supervised dosing

87-year-old lady with Alzheimer’s, aggressive behavior, wandering. Immediate management?
a. Nursing staff may use physical restraints for safety
b. Consult family/staff about prior strategies & 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 man plumber with scrotal pain, fever, dysuria. Likely diagnosis?
a. Left-sided epididymitis
b. Torsion of the left testis

Alcohol addiction best managed by:
a. Naltrexone opioid
b. Disulfiram
c. Acamprosate

Considerations for prison medical officer role?
a. Custodial facility can pose safety risks to medical staff
b. Maintain patient privacy and avoid disclosing personal information