AMC April 2024 Recalls – Key Exam Insights

1. Patient presents with AROU. Also had a two-day history of no bowel output. Mx?

• CT abd and pelvis
• Indwelling catheter
• Giving suppository

2. Patient presents with silvery scaly lesions around her elbows, already given hycort but no response. Next?

• Coal tar
• Methylpred
• Calcipotriol
• Acid binding resins

3. Patient is admitted to ICU for 3 weeks after sepsis. Now, generalized weakness all four limbs, sparing face. Dx?

• Polyneuropathy
• Critical illness induced neuropathy

4. Postpartum psychosis, thinking baby is evil and not breastfeed. Mx?

• ECT
• Lithium
• Quetiapine

5. Diagnosis given as IBD. What is the Tx?’

• Amitryptyline
• High fiber intake
• No option of psychotherapy or fluoxetine

6. X ray of a patient who attempted suicide by hanging. C/o breathing difficulty. What next after the initial resus?

• ET tube insertion
• Nasal PPV

7. ECG given (QRS widening), she took white tablets from her aunt’s bag for suicide. What is the drug?

• Digoxin
• Amitriptyline
• Lithium

8. Scenario of septic shock after instrumentation. What should be the next measure?

• 1 L fluid challenge
• Noradrenaline infusion
• Blood culture
• Broad-spectrum antibiotics

9. Repeat recall of twin pregnancy and on ferrous fumarate, same options

10. Child is treated with risperidone. Initial side effect?

• Gynecomastia
• Hypersomnolence
• Weight gain

11. Scenario of vomiting due to molar pregnancy, urine ketone positive, next step?

• Serum electrolytes
• Giving IV fluids
• Ondansetron wafer

12. GOO imaging was given, asking for potassium replacement. Options same as in earlier days.

13. Smoker patient, working in tunnel construction, pleural aspirate is blood stained.

• Ca lungs
• Mesothelioma
• Aspergilloma

14. BMI centile chart. Found to be 95^th Just asking if he is

• Mildly overweight
• Obese
• Normal development

15. Child with the scenario of ITP. A viral infection was given. What is the Invx?
16. Sheep farmer. Abdominal symptoms. Dx?

• Hydatid cyst
• HCC
• Liver abscess ( my choice since it looked nothing like above two)
•  

17. Patient’s fibroscan result is given as stiffening of liver. Suggestive of COL. What to look out for his best prognosis in future?

• HCC
• Hepatic encephalopathy
• Hepatorenal syndrome

18. Patient with wide-based gait and personality changes, abnormal movements, and family history two persons both died in their 50s.

• Genetic testing
• Serum Cu and ceruloplasmin
• Refer to neurosurgery

19. Repeat of “delusion of poverty” scenario.

20. Statistics are repeats

• River and children’s cancer
• Screening test and the most important factor
• E-cigarette and respiratory symptoms

21. Monochoriomic twin pregnancy with hb of 11.5 normal was 11.5 to something on ferrous fumarate what to do

Iron infusion

Increase vitamin c intake

Switch to ferrous sulphate

Transfusion

22. Hepatitis lady tarted dating new boyfriend had hepatitis test which shows hepatitis b positive and partner wants to know his risk has never been  vaccinated but does not know whether he has had hepatitis  what will you base your decision on

Her hep b dna levels

Her hep sAg

His cab

His eAg

His hep sAg

23.  6 yrs old having non itchy rash in back of neck. Fever, posterior cervical lymph nodes. Otherwise examination normal. Management? Pic given impetigo

1. a) topical mupirocin
2. b) cephelxin
3. c) prednsilone
4. d) Betamethasone

24. 5 yrs old child having rash on hand and foot. He is going to nursery thrice a week. Fever, but vitals normal. Pic given – hand foot mouth i guess Mx?

1. a) paracetamol
2. b) aciclovir
3. c) cephelxin
4. d) flucloxacillin

25. 52 years old man came to you following attempted to end his life. He and his wife successfully running a interior design company. On further quiry he is telling recently he is not interested in work, not going to golf with his friends on weekends and worried that he got delayed with new projects completion, pending works. And crying now he has lost his house and no where to go after discharge. What is the condition led him to this presentation?

1. a) ruminations of guilty
2. b) delusion of poverty
3. c) Paranoid delusion

26.  25 years old on Mirtazepine, prescribed with tramadol for back pain. And presented with anxious state Which one of the following ensure the diagnosis ( symptoms and signs of serotonin xn)

1. a) hyperreflxia
2. b) hypo mania

27. 24 years female with rheumatoid arthritis on methotrexate and hcq wants to get pregnant.

What will you do?

1. a) stop methotrexate and continue hcq
2. b) stop methotrexate & add leflonamide
3. c) stop both drugs
4. d) stop methotrexate
5. e) stop methotrexate and add adalimumab

28.  pregnant pt came to GP for 1st antenatal visit. Other than that mild nausea vomiting uneventful. Her weight today 107kg. Pre pregnancy weight 109kg. Her height 162cm. What is the goal of her weight through this pregnancy

1. a) not more than 500gm per week
2. b) not more than 9kgs weight gain through out the pregnancy
3. c) continue same weight throughout the pregnancy
4. d) maintain pre pregnancy weight
5. e) weight loss 1kg per week

29.  pt was admitted following RTA rib fracture, you prescribed sc 10mg morphine, shortly pt again complaints that pain not settled. When checking upon that you noticed nurse not given the morphine as she thinks that dose was too high for him and she gave paracetamol. What will be the next action?

1. a) complete the incident form
2. b) talk to nurse and explain the effects on patient because of her action
3. c) inform hospital director
4. d) inform APHRA
5. e) Confront her

30. your colleague was attempting intubation on a dead patient due to metastatic cancer. What will your action?

1. a) Ask him to get consent from family
2. b) its inappropriate to attempt intubation
3. c) can practice once transferred to morgue
4. d) send the relatives out of sight first
5. e) Inform APHRA

31.Question -pic of pt given and started in iv fluids and for next 24 hrs also iv fluid to continue.what to give.

1-5mmol of kcl

2-25 mmol ko kcl

3.50 mmol of kcl

4.more than 50 mmol of kcl

5.can t remember

32.  question related to knee injury -valgus twisting  and heard a pop sound n now in flexed position along with ACL tear what will be there

1PCL tear

2.lateral meniscus

3.lateral collateral ligament injury

33. scenario with pain in back during opening window and point tenderness.what to do next

1.paracetamol

2.x ray

3.mri

34. As a rule, all patients with low back pain without a red flag should be initially managed conservatively with:

1. Education and explanations
2. Simple analgesics such as paracetamol or NSAIDs for pain control
3. Encouraging maintenance of daily life and remaining physically active
4. Recommending and referral for physiotherapy for those with debilitating pain and/or severe restriction of movements
5. Review and reassessment (recommended in one and 4-6 weeks)

35. pt had schizophrenia now worse almost was on psychosis he was on olanzepine

Inc olanzepine

2, add sodium valporate

3 heliperodol

 resperidone

36. 16 years old girl with hx of traumatic ICH following RTA 2 years before come to GP to get prescribed COCP. She had 5 seizures episodes following ICH and on carbamazepine 200mg bd and fit free now. What will you do?

1. a) Stop carbamazepine and add OCP
2. b) increase carbamazepine dose and low dose OCP
3. c) Increase carbamazepine dose and high dose ocp
4. d) switch to another antiepileptic and add ocp
5. e) advice on Condoms

37. Question about a boy had history of using anti psychotics but discontinued. Stays alone in home, not interacting with anyone. Developed symptoms again, what to do?

38. 52 years old schizophrenic patient brought to ED by neighbors, saying he was agitated in day and night and suspecting others are trying to steal things from his house and shouting at times. Locking himself and cooking after switch off fire alarm. He is on olanzepine 20mg daily.

What will you do?

1. a) add risperidone
2. b) add tamazepam
3. c) add sodium valproate
4. d) switch to haloperidol
5. e) switch to aripilrazole

39. A 21 y/o known for vandalising neighbours properties, violent and has a police case. Dx?

1. ADHD
2. CD
3. Antisocial

40. pregnant of 42 weeks pw blood stained plug.FHR normal.No contraction.Temp normal.On exam cervix 0.5 cm,admits 2 fingers, head -1.what to do

a.prostaglandin

b.sweeping

c.iv oxytocin

d.lscs

41. IBS – worsening for 6 weeks

a)high fibre diet

b)amitriptyline.

42. A young female with a history of cocaine use presents with a seizure attack and is diagnosed with an intracerebral hemorrhage (ICH). What could be the likely cause of the intracerebral hemorrhage?

1. A) Hypertensive encephalopathy
2. B) Cerebral amyloid angiopathy
3. C) Arteriovenous malformation
4. D) Coagulopathy due to chronic liver disease
5. E) Ruptured aneurysm.

43. 26 years old female on etonogestrel implant for last 2 years and having 18 months of amenorrhea. Now she is on relationship with new partner for last 6 months and using condoms. Presented with 2 episodes of post coital bleeding. Her cervical screening 2 years back was normal. In addition to repeating cervical screening what should be done?

1. a) topical estrogen
2. b) Endometrial bx
3. c) replacement of implant
4. d) partner screening
5. e) USS

44. 72 y male admitted w RHC pain,USS-GB shows lobules.Admitted and started on antibiotics,pt started to deteriorate.Conscious dropping,oliguria and vitals dropping drastically.What will be next appropriate step?

a.broad spectrum antibiotics

b.ERCP

C.percutaneous cholecystectomy

d.open cholecystectomy.

e.Haemodyalysis

45. 58 y pt,who is keen gold player came with difficulty in flexion,internal rotation of shoulder jt.Further investigations reveals rupture of biceps tendon,and tear of supraspinatous indentified.next step?

a.open tendon repair

b.mri

c.physiotherapy.

d.corticosteroids

46. X-ray of hip joint. She had pain on standing when she woke up  in the morning. What to give her  that will help her .

Resperidone

Calcium

Vit d

Pcm

47. Male breast lump UL.Breast ca in mother and maternal aunt.what to do.

a.USG

b.Fnac

c.Mammography

48. 25 years old boy met with an accident 6 weeks back, after that he used to count til 20 every few hours, unless he feels something bad gonna happen. He tried to avoid this ritual yet difficult to control. He is distressed and difficult to find sleep. What is the mx?

1. a) Sertaline
2. b) benzodiazepine
3. c) olanzepine
4. d) Sertaline plus benzodiazepine
5. e) olanzepine plus Sertaline

49. pregnant pt came to GP for 1st antenatal visit. Other than that mild nausea vomiting uneventful. Her weight today 107kg. Pre pregnancy weight 109kg. Her height 162cm.
What is the goal of her weight through this pregnancy
a) not more than 500gm per week
b) not more than 9kgs weight gain through out the pregnancy
c) continue same weight throughout the pregnancy
d) maintain pre pregnancy weight
e) weight loss 1kg per week

50. 52 years old man came to you following attempted to end his life. He and his wife successfully running a interior design company. On further quiry he is telling recently he is not interested in work, not going to golf with his friends on weekends and worried that he got delayed with new projects completion, pending works. And crying now he has lost his house and no where to go after discharge. What is the condition led him to this presentation?
a) ruminations of guilty
b) delusion of poverty
c) Paranoid delusion

51. pt was admitted following RTA rib fracture, you prescribed sc 10mg morphine, shortly pt again complaints that pain not settled. When checking upon that you noticed nurse not given the morphine as she thinks that dose was too high for him and she gave paracetamol. What will be the next action?
a) complete the incident form
b) talk to nurse and explain the effects on patient because of her action
c) inform hospital director
d) inform APHRA
e) Confront her

52. 24 years female with rheumatoid arthritis on methotrexate and hcq wants to get pregnant.
What will you do?
a) stop methotrexate and continue hcq
b) stop methotrexate & add leflonamide
c) stop both drugs
d) stop methotrexate
e) stop methotrexate and add adalimumab

53. A woman with osteoporosis experiences a motor vehicle accident (MVA) but initially reports no neck pain. The following day, she develops neck pain, bilateral neck tenderness 3 cm away from the midline, and pain with neck extension. What is the reason for further investigation? shahriar amc
a. Presence of osteoporosis
b. Painful neck extension
c. Painful lateral movements
d. Bilateral neck tenderness
e. Lack of improvement with conservative measures

54. 16 years old returned from recent trip to thailand, presented with erythematous rash in body and limbs. Red eyes, fever 40°. Vitals stable
Wbc 3.1
Hb 12.1
Plt 250
Next step?

a) blood culture
b) broad specterum antibiotics
c) discharge and follow up with GP
d) c xray
e) isolation

55. 18 years old girl with BMI 20, Thin built, recurrent chest infection. FBC, LFT, SE normal. Serum globulin low, albumin lower margin. Diagnosis?

a) cystic fibrosis
b) celiac disease
c) crohn’s disease
d) anorexia nervosa

56. 78 years old female in nursing home mostly in wheel chair presented with BL ankle edema, reddish, flushed, warm. Inguinal lymphadenopathy. DM, HTN, dementia on followup. Medial sides of legs dark pigmentation. Diagnosis?
a) Lymphadema
b) cellulitis
c) chronic venous insufficiency
d) renal failure
e) malignancy

57. 12 years old girl with wide base gait, tip toe walking, loss of vibration and proprioception, and upgoing planter.
Diagnosis?
a) Charcot mary tooth disease
b) fredrich ataxia
c) vitamin B12 deficiency

58. 3 years old child having yellow teeth, he is younger one out of three children.  What is the next step?
a) refer to dentist
b) supervised brushing
c) reassure as this is deciduous teeth
d) prescribing whitening paste
e) malnutrition assessment

59.  26 years old male presented with complaint of reduced interest in sex. He went to gym and improved his muscle tone and gain some confidence compared to his puny appearance before. Now he is thinking that getting progesterone injections will improve his male appearance with masculinity and sex drive. What will ne the next step?
a) refer to sex therapy
b) prescribe testosterone
c) prescribe sildenafil
d) advice about adverse effects of testestelevel
e) check testesterone level

60.  25 years old boy met with an accident 6 weeks back, after that he used to count til 20 every few hours, unless he feels something bad gonna happen.

He tried to avoid this ritual yet difficult to control. He is distressed and difficult to find sleep.
What is the mx?
a) Sertaline
b) benzodiazepine
c) olanzepine
d) Sertaline plus benzodiazepine
e) olanzepine plus Sertaline

61.  26 years old female on etonogestrel implant for last 2 years and having 18 months of amenorrhea. Now she is on relationship with new partner for last 6 months and using condoms. Presented with 2 episodes of post coital bleeding. Her cervical screening 2 years back was normal. In addition to repeating cervical screening what should be done?
a) topical estrogen
b) Endometrial bx
c) replacement of implant
d) partner screening
e) USS

62. 16 years old girl, used to wipe thrice with serviette after each mouthful feed. Otherwise she feels something going to happen to her mother. On further inquiry she knows that this is absurb but she can’t avoid, therefore she feels frustrated and avoiding family gatherings and social events.
What is the mx?
a) Sertaline
b) benzodiazepines
c) olanzepine
d) Mirtazepine
e) sodium valproate

63.  25 years old female admitted following RTA, she was on driver seat with safety belt on. A van hitted on back of the car at 30km/hr. No LOC, vitals stable. Discharged after observation. Next day morning she had difficulty in extension and lateral flexion of neck. No issues with flexion.
What is warranting you for prompt action
a) difficulty in extension
b) difficulty in flexion
c) delayed onset pain

64.  72 years old male admitted with right hypochondrial pain, USS – gallbladder shows lobules.
Admitted and started on antibiotics, pt started to deteriorated. Consciousness dropping, oliguria and vitals dropping drastically. What will be the NEXT APPROPRIATE step?

a) broad spectrum antibiotics
b) ERCP
c) Percutaneous cholecystectomy
d) open Cholecystectomy
e) Haemodialysis

65.  58 years patient, who is a keen golf player came with difficulty in flexion, internal rotation of shoulder joint. Further investigation reveals rupture of biceps tendon, and tear of supraspinatus identified. What is the next step?
a) open tendon repair
b) MRI
c) physiotherapy
d) Corticosteroid

66. A young female with a history of cocaine use presents with a seizure attack and is diagnosed with an intracerebral hemorrhage (ICH). What could be the likely cause of the intracerebral hemorrhage?
A) Hypertensive encephalopathy
B) Cerebral amyloid angiopathy
C) Arteriovenous malformation
D) Coagulopathy due to chronic liver disease
E) Ruptured aneurysm

67. pain in back during opening window and point tenderness.what to do next
1.paracetamol
2.x ray
3.mri

68. 52 years old schizophrenic patient brought to ED by neighbors, saying he was agitated in day and night and suspecting others are trying to steal things from his house and shouting at times. Locking himself and cooking after switch off fire alarm. He is on olanzepine 20mg daily.
What will you do?
a) add risperidone
b) add tamazepam
c) add sodium valproate
d) switch to haloperidol
e) switch to aripilrazole

69. 16 years old girl with hx of traumatic ICH following RTA 2 years before come to GP to get prescribed COCP.
She had 5 seizures episodes following ICH and on carbamazepine 200mg bd and fit free now.
What will you do?
a) Stop carbamazepine and add OCP
b) increase carbamazepine dose and low dose OCP
c) Increase carbamazepine dose and high dose ocp
d) switch to another antiepileptic and add ocp
e) advice on Condoms

70. pt was admitted following RTA rib fracture, you prescribed sc 10mg morphine, shortly pt again complaints that pain not settled. When checking upon that you noticed nurse not given the morphine as she thinks that dose was too high for him and she gave paracetamol. What will be the next action?
a) complete the incident form
b) talk to nurse and explain the effects on patient because of her action
c) inform hospital director
d) inform APHRA
e) Confront her

71. your colleague was attempting intubation on a dead patient due to metastatic cancer. What will your action?
a) Ask him to get consent from family

b) its inappropriate to attempt intubation
c) can practice once transferred to morgue
d) send the relatives out of sight first
e) Inform APHRA

72. 6 yrs old having non itchy rash in back of neck. Fever, posterior cervical lymph nodes. Otherwise examination normal. Management? Pic given impetigo
a) topical mupirocin
b) cephelxin
c) prednsilone
d) Betamethasone

73. 5 yrs old child having rash on hand and foot. He is going to nursery thrice a week. Fever, but vitals normal.
Pic given – hand foot mouth i guess
Mx?
a) paracetamol
b) aciclovir
c) cephelxin
d) flucloxacillin

74. 52 years old man came to you following attempted to end his life. He and his wife successfully running a interior design company. On further quiry he is telling recently he is not interested in work, not going to golf with his friends on weekends and worried that he got delayed with new projects completion, pending works. And crying now he has lost his house and no where to go after discharge. What is the condition led him to this presentation?
a) ruminations of guilty
b) delusion of poverty
c) Paranoid delusion

75.  25 years old on Mirtazepine, prescribed with tramadol for back pain. And presented with anxious state
Which one of the following ensure the diagnosis ( symptoms and signs of serotonin xn)
a) hyperreflxia
b) hypo mania

76.  24 years female with rheumatoid arthritis on methotrexate and hcq wants to get pregnant.
What will you do?
a) stop methotrexate and continue hcq
b) stop methotrexate & add leflonamide
c) stop both drugs
d) stop methotrexate
e) stop methotrexate and add adalimumab

77. pregnant pt came to GP for 1st antenatal visit. Other than that mild nausea vomiting uneventful. Her weight today 107kg. Pre pregnancy weight 109kg. Her height 162cm.
What is the goal of her weight through this pregnancy
a) not more than 500gm per week
b) not more than 9kgs weight gain through out the pregnancy
c) continue same weight throughout the pregnancy
d) maintain pre pregnancy weight
e) weight loss 1kg per week

78. pt had schizophrenia now worse almost was on psychosis he was on olanzepine
1.Inc olanzepine
2, add sodium valporate
3 heliperodol
4 resperidone

79. 48 y Female came with a breast lump RIS. on Ex- Arm tamp (Uss -given castic lamp ¿ regular margmet) mamogram.Dense breast tissuet. Dragnosis?
1.Fibroadenoma.
2. Fat Necrosis.
3. Carcinoma.

80. 38y male with fertility, decreased libido for em, came with gynaecomastia. His Testosteron, FSH, LH – Normal what is the next Investigation.
1. prolactin
2. TSH
3. MRI brain
4 LFT.